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Critical literature review • Saude soc. 32 (Suppl 1) • 2023 • https://doi.org/10.1590/S0104-12902023220920en   copy

Occupational Dentistry: the state of the art, indicating paths for health promotion in contemporary work contexts - scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The field of Occupational Dentistry has considered theoretical-scientific ballast. This scoping review aims to reveal the state of the art on the subject in seven indexed research bases, considering almost 100 years of publications (1921-2020). Of the 337 productions initially identified, a cut was made for the last six years (2015-2021/January), applying the methodology proposed by the PRISMA extension for scope reviews (PRISMA-ScR). However, rapid review platforms used for decision making in formulating public policies or in improving health systems accounted for only 20 publications, whereas the sample of 34 productions revealed peculiarities: research favors work regimes; associates the field of study and practice with the stricto sensu model of occupational health; disregards broad and humanizing concepts in the field of Worker’s Health; tends to prioritize its own occupational dental health, and seems to reduce the concept of work accidents to illnesses. Such issues need to be overcome if the perspective is to remain at the forefront, promoting health and safety in contemporary work contexts, since, although the transversality of this field of knowledge and practices is evident, more is needed, daring to remove it from invisibility whether in private or public work organizations is necessary.

Keywords:
Occupational Dentistry; Industrial Odontology; Occupational Health; Employee Health; Policy Making

Resumo

O campo da Odontologia do Trabalho tem considerado lastro teórico-científico. Esta revisão de escopo objetiva desvelar o estado da arte acerca do tema em sete bases de pesquisas indexadas, considerando quase 100 anos de publicações (1921-2020). Das 337 produções inicialmente identificadas, realizou-se recorte para os últimos seis anos (2015-2021/janeiro), aplicando-se metodologia proposta pela extensão do Prisma para revisões de escopo (Prisma-ScR). Contudo, plataformas de revisões rápidas usadas para tomada de decisões em formulações de políticas públicas ou em aperfeiçoamentos de sistemas de saúde responderam por apenas 20 publicações, enquanto a amostra de 34 produções revelou peculiaridades: pesquisas privilegiam regimes de trabalho; associam o campo de estudo e prática ao modelo stricto sensu da saúde ocupacional; desconsideram concepções amplas e humanizantes do campo da Saúde do Trabalhador; tendem a priorizar a própria saúde ocupacional odontológica e parecem reduzir o conceito do acidente de trabalho a doenças. Tais questões precisam ser superadas se a perspectiva for manter-se em vanguarda, promovendo saúd e e segurança em contextos contemporâneos de trabalho, pois, embora seja evidente a transversalidade desse campo de saberes e práticas, é necessário mais, é preciso ousar para retirá-la da invisibilidade, seja em organizações privadas ou públicas de trabalho.

Palavras-chave:
Odontologia do Trabalho; Odontologia industrial; Saúde Ocupacional; Saúde do Trabalhador; Formulação de Políticas

Introduction

Occupational Dentistry (OD) has been dedicated to understanding how work conditions, environments and processes relate to workers’ oral health (Hiroishi; Rosetti; Naressi, 2011HIROISHI, W. K.; ROSETTI, E.; NARESSI, S. C. Odontologia do trabalho: um novo olhar sobre a saúde bucal do trabalhador. Brazilian Dental Science, São José dos Campos, v. 14, n. 3/4, p. 66-76, 2011.). Its foundation in scientific literature was structured in the seventeenth century, deriving from reports of oral diseases arising from working conditions, presented by Bernadino Ramazzini (Abhirami, 2020ABHIRAMI, An. Occupational Hazards in Dentistry. Acta Scientific Dental Sciences, Hyderabad, v. 4, n. 8, p. 128-134, 2020.; Feaver, 1988FEAVER, G. P. Occupational Dentistry: a review of 100 years of dental care in the workplace. Occupational Medicine, Oxford, v. 38, p. 41-43, 1988. DOI: 10.1093/occmed/38.1-2.41
https://doi.org/10.1093/occmed/38.1-2.41... ; Gomes, 2013GOMES, S. F. A importância e aplicabilidade da Odontologia do Trabalho na exposição ambiental ao chumbo. Revista Brasileira de Odontologia, Rio de Janeiro, v. 70, n. 1, p. 85-88, 2013.; Lima, Buarque, 2019LIMA, R. B.; BUARQUE, A. A saúde bucal no contexto da prevenção de absenteísmo e presenteísmo no trabalho. Revista Brasileira de Medicina do Trabalho, São Paulo, v. 17, n. 4, p. 594-604, 2019.).

Although discussions about the competencies of this field of knowledge and practices have advanced, consensus regarding the best nomenclature in indexed scientific productions seems far from being reached: Industrial Dentistry; Occupational Dentistry; Occupational Stomatology; Industrial Stomatology, among others.

Historically, the first cases of injury and illness arising from working environment conditions date back to the nineteenth century in a British railway company, at the same time (1887) in which there was an emblematic workplace accident involving workers’ stomatognathic system at an also British match factory (Feaver, 1988FEAVER, G. P. Occupational Dentistry: a review of 100 years of dental care in the workplace. Occupational Medicine, Oxford, v. 38, p. 41-43, 1988. DOI: 10.1093/occmed/38.1-2.41
https://doi.org/10.1093/occmed/38.1-2.41... ). This study, therefore, addresses the topic of OD in the scientific literature of rapid reviews, considering what is recommended by the World Health Organization (WHO) regarding the importance of these rapid review methodologies for making health decisions.

The guiding thread chosen for this analysis, which is not just numerical, will consider modern forms of work organizations, increasingly precarious in the world of work, masterfully revealed in the Sociology of Work (Antunes, 2009ANTUNES, R. As configurações do trabalho na sociedade capitalista. Katálysis, Florianópolis, v. 12, n. 2, p. 131-132, 2009.; 2020ANTUNES, R. (Org.). Uberização, trabalho digital e Industria 4.0. São Paulo: Boitempo, 2020.), and the expectation of finding evidence based on assumptions consistent with the historicity of the Occupational Health movement, long ago evoked to form the field of OD (Lamas, 2006LAMAS, A. E. Saúde bucal coletiva e saúde do trabalhador: repensando as práticas dos serviços públicos para um novo modelo de atenção. 2006. Dissertação (Mestrado em Odontologia) - Universidade Federal de Santa Catarina, Florianópolis, 2006.; Lamas; Blank; Calvo, 2008LAMAS, A. E.; BLANK, V. L. G.; CALVO, M. C. M. Saúde do Trabalhador e a Atenção Odontológica: entre um novo modelo de atenção e a superespecialização. Saúde e Sociedade, São Paulo, v. 17, n. 4, p. 103-110, 2008.), which maintain a certain logic to face the illness and current work dimensions.

The efforts undertaken, therefore, will be aimed at questioning whether scientific evidence in the OD field is robust and up-to-date enough for decision-making, whether in the formulation of public health policies or for advances in health systems, without losing the focus on current illness scenarios in work situations.

Methodology

To achieve its proposal, the study adopted the scoping review methodology discussed by Peters et al. (2021PETERS, M. D. et al. Scoping reviews: reinforcing and advancing the methodology and application. Systematic Review, v. 10, p. 1-6, 2021. DOI: 10.1186/s13643-021-01821-3
https://doi.org/10.1186/s13643-021-01821... ). Considered a research method with excellent results for mapping broad themes such as OD (PHAM et al., 2014PHAM, M. T. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods, New York, v. 5, n. 4, p. 371-385, 2014.), the Prisma extension for scoping reviews was used, Prisma-ScR (Tricco et al., 2018TRICCO, A. C. et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018; 169: 467-473. Disponível em: Disponível em: https://www.acpjournals.org/doi/pdf/10.7326/M18-0850 Acesso: 20 dez. 2022.
https://www.acpjournals.org/doi/pdf/10.7... ), which will respond to the following research question: is there sufficient scientific evidence on OD on rapid review platforms that support health decision-making in an agile and consistent manner?

Eligibility criteria

The research is organized into two phases: the first phase refers to 100 years of indexed publications on the topic, considering publications by M’Cord (1921)M’CORD, C. P. Industrial Dentistry. The Dental Register, Amsterdam, v. 75, n. 1, p. 30-37, 1921., Becker (1921BECKER, J. P. Industrial Dentistry. The Dental Register, Amsterdam, v. 75, n. 2, p. 76-85, 1921.), Humphrey (1923HUMPHREY, R. I. Industrial dentistry’s contribution to oral hygiene. The Dental Register, Amsterdam, v. 77, n. 10, p. 453-457, 1923.), and Millberry (1929MILLBERRY, G. Industrial Dentistry: its trend-including some observations on European practice. California and Western Medicine, Sacramento, v. 30, n. 1, p. 21-23, 1929.) up to the year 2020; and the second one refers to the last six years of publications, therefore, from 2015 to 2021.

Inclusion criteria were systematized according to Table 1, while for exclusion we considered descriptors that presented more than 1000 results on the same database, duplications and productions that were not related to the topic of OD, and publications prior to 2015 or after January/2021, in the second phase.

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Table 1
Eligibility criteria

Information sources

As for the databases, four rapid review platforms specialized in health were selected: HSE; Cochrane, CADTH, and Epistemonikos (CPDIGI-FOUSP, 2018)CPDIGI-FOUSP - Centro de Produção Digital Edmir Matson. Faculdade de Odontologia da Universidade de São Paulo. XXIV Reunião de Pesquisa da Faculdade de Odontologia da Universidade de São Paulo. Workshop Novas Bases de Dados e Métodos de “Rapid View”. Palestrante: Jorge Otávio Maia Barreto. São Paulo; 2018. Vídeo: 4:18:54 seg. Disponível em: Disponível em: https://www.youtube.com/watch?v=5W3W1z70omA&t=2341s . Acesso: 20 dez. 2022.
https://www.youtube.com/watch?v=5W3W1z70... , in addition to three indexed bases: PubMed (Medline); BVS (Bireme), and Scopus (Elsevier), accessed via Capes Portal.

Search

Extractions referring to the first phase (1921-2020) took place between November and December 2020, and each base was analyzed between January and February 2021. As for the second phase (2015-2021/January), the first extraction was used, applying criteria defined for the respective phase, and the production from January/2021 was included. Data analysis took place in March 2021.

To identify potential publications, 13 descriptors were defined that were closest to the topic of OD, considering the MeSH and DeCS platforms, as shown in Table 2.

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Table 2
Selected Descriptors

Regarding search strategies, given that the topic is a compound term, the terms defined by MeSH and DeCS were used and the Boolean operators were not applied.

On databases that presented a great deal of results, the search was limited by the use of the exact term, using quotation marks (“”) to maximize results, while on databases that presented few results, the same descriptors were used without quotation marks. The last data collection took place on February 5, 2021.

Screening and Selection

Initially, all inclusion criteria were applied and results available on rapid review platforms (HSE, Cochrane, CADTH, and Epistemonikos) were collected. Subsequently, there was exclusion of results above 1000 publications with the same descriptor and base, plus repetitions and publications that were not related to the topic. Those which remained were transferred to an Excel® spreadsheet and systematized according to author, title, country, year of publication, type of study, and database. This procedure was carried out initially, within each database searched and then considering intersections between databases, resulting in a total of 337 publications (1st phase).

For the second phase (34 results), the range of publications between 2015 and 2021 was selected in the “year of publication” column of the same Excel® spreadsheet. At this stage, domains of analysis were considered by full text readings, observing work regime, work category, type of environment/work process, occupational risks, workplace accidents, and if there was mention of worker health. The selection of evidence sources in the first and second phases followed the procedure defined in the Selection and Screening Flowchart (Figure 1).

Figure 1
Selection and Screening Flowchart

Analysis Domains

Mapping the texts (second phase), two authors (SD) and (GP) read the productions separately. A framework with six domains (Figure 2), all directly related to the broad process of worker health care, was established to guide the readings in full, and there was no disagreement between authors.

Figure 2
Analysis Domains Framework (second phase)

Summary of Results

The synthesis of publications is in Table 3 in descending order of year.

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Table 3
Syntheses of Scientific Productions on Occupational Dentistry (2015-January 2021).

Results

This scoping review originally identified 56,665 publications available on databases from the selected descriptors. The first phase covered almost a century of publications about OD, mapping 337 productions that met the criteria of this research; 20 publications were found on rapid review platforms, and a massive number of publications (317) on other indexed bases.

The dense reference extracted (first phase) required the authors to time-frame the research to allow for a more significant and qualitative corpus of publications from the six years (2015-January 2021) that preceded the study, resulting in 34 scientific productions, nine of which are available on rapid review platforms, and 25 on other indexed bases, summarized as shown in Table 3.

The analysis of the 34 publications indicated that the majority of the collection is Brazilian (19 results), followed in smaller number by English publications and publications from other nationalities. The most applied methodological design was cross-sectional studies (19), followed by integrative reviews (7), and systematic reviews (4), among other methodologies, in smaller number.

As for platforms, less than a third of the publications analyzed are on rapid review platforms (9), including Cochrane (3), and Epistemonikos (6). Considering the analytical perspective based on the developed framework, some outcomes were observed regarding the publication profile.

Work Regimes

The publication set showed a tendency to report working conditions in the private sphere (21 results) to the detriment of analyzes in public organizations (12 results). Although texts referred to both work regimes, 10 publications did not clearly indicate the work regime they were talking about.

Professional categories

As for the professional categories mentioned, publications from the last six years were organized into three groups: (1) publications that addressed different worker categories in private or public organizations (19); (2) publications that dealt exclusively with the dental professional category (14), and (3) publications that studied the Dentistry student category (4) (Figure 3).

Figura 3
Occupational Dentistry and Professional Categories

Work environment

In this domain, four publications did not define their physical locus of study; however, the other studies managed to make clear the vast possibility of environments, processes, and working conditions in which OD can act and certainly contribute to health promotion and prevention of diseases and injuries that may involve the oral and maxillofacial complex of workers (Figure 4).

Figura 4
Occupational Dentistry and Work Environments

Occupational risks

Regarding the nature of occupational risks in public and private work organizations, whose scope of publications is OD, the analyses demonstrated an emphasis on psychosocial/organizational risk such as stress, anxiety, exhaustion, and burnout syndrome, among others (10). Chemical, physical, biological, and ergonomic risks were also mentioned, but, in the dentistry field, risks such as noise, stress, musculoskeletal disorders, and chemical contamination by mercury were the most reported.

Workplace Accidents

For this domain, publications tended to discuss illnesses (29) resulting from work, with manifestations in the oral and maxillofacial complex, other publications (4) referred to the topic of workplace accidents in a more general manner, while three texts mentioned typical accidents, but always relating the event to the worker’s loss of concentration. Commuting accidents were not addressed in any publication selected in this study and five texts did not refer to workplace accidents.

Worker Health

In this context of analysis, only six texts, all Brazilian, sought to introduce discussions considering the assumptions of the Occupational Health field for OD interventions.

These publications were included on indexed databases, but not on rapid review platforms.

Discussion

Based on the results, it is inferred that there is an important base of scientific evidence that deals with the OD field throughout all continents, but the majority of these publications are available on the indexed PubMed/Medline, VHL, and Scopus databases.

The insufficient number of pieces of evidence on rapid review platforms, combined with the timid number of four systematic reviews on the topic-considering this to be the gold standard of methodologies to guide decision-making (Brazil, 2020)-defines an important gap in this field of knowledge, despite the efforts made so far.

Notably, on the platform considered the most complete in syntheses of evidence specialized in health policies and systems-HSE (CPDIGI-FOUSP, 2018)CPDIGI-FOUSP - Centro de Produção Digital Edmir Matson. Faculdade de Odontologia da Universidade de São Paulo. XXIV Reunião de Pesquisa da Faculdade de Odontologia da Universidade de São Paulo. Workshop Novas Bases de Dados e Métodos de “Rapid View”. Palestrante: Jorge Otávio Maia Barreto. São Paulo; 2018. Vídeo: 4:18:54 seg. Disponível em: Disponível em: https://www.youtube.com/watch?v=5W3W1z70omA&t=2341s . Acesso: 20 dez. 2022.
https://www.youtube.com/watch?v=5W3W1z70... -no publications on OD were found based on the descriptors defined by DeCS and MeSH.

Furthermore, by exercising the overcoming of concepts and practices that are paradoxically contrary to assumptions adopted in recent times for worker health care, as proposed by Lamas, Blank and Calvo (2008LAMAS, A. E.; BLANK, V. L. G.; CALVO, M. C. M. Saúde do Trabalhador e a Atenção Odontológica: entre um novo modelo de atenção e a superespecialização. Saúde e Sociedade, São Paulo, v. 17, n. 4, p. 103-110, 2008.), the analysis of the most recent content does not seem to differ greatly from other texts of the last 100 years, and point to exponential challenges for OD field of knowledge and practices.

Health care in the OD field needs to be expanded to work conditions beyond productive forms in private contexts. It is urgent to pay attention to contemporary management scenarios of the New Public Management (NPM) type, which produces, in an equal manner, harmful consequences for civil servants’ physical and mental health, public employees, and outsourced workers (Antunes, 2020ANTUNES, R. (Org.). Uberização, trabalho digital e Industria 4.0. São Paulo: Boitempo, 2020.; Ramos, Macêdo, 2018RAMOS, L. F.; MACÊDO, K. B. Reflexões sobre o adoecimento dos servidores técnico-administrativos em educação. Argum, Vitória, v. 10, n. 3, p. 107-122, 2018. DOI: 10.18315/argumentum.v10i3.16911
https://doi.org/10.18315/argumentum.v10i... ; TST, 2017TST - Tribunal Superior do Trabalho. Conferência Saúde Psíquica e Trabalho Judicial. Brasilia, 2017. 1 video (1:45:26 seg). Disponível em: Disponível em: https://www.youtube.com/watch?v=3IZoTYZY4SM Acesso: 20 dez. 2022.
https://www.youtube.com/watch?v=3IZoTYZY... ).

The robust centrality of scientific productions in recent years around guidelines aimed at the Dentistry professional category denotes an almost “self-absorbed” tendency in the field; therefore, future research should consider the demands of other work situations, given the OD cross-sectional nature, fundamental in the processes of health and safety at work and, therefore, in decision-making that formulates public policies and qualifies health systems.

From the point of view of workplace accidents with impacts on the oral and maxillofacial complex, the OD perspective seems to prioritize, and with some reason, occupational or work-related illnesses that impact the stomatognathic system. However, this concern should reach, with the same intensity, other types of accidents (typical and commuting), considering all as public health issues.

In this review, the absence of discussions about typical workplace accidents and commuting accidents shows a certain epidemiological incoherence, given the topographic vulnerability of the stomatognathic system in the face of numerous risk situations during working hours.

Additionally, the expansion of work in the modern world is characterized by precarious, digitally attentive labor relations, which increasingly demand more and more hours of work from the worker, therefore, a flank open to the occurrence of accidents and, however, commuting accidents were not even mentioned in the texts with an emphasis on OD.

However, a decade since the publication of the National Occupational Safety and Health Policy, Brazilian OD productions need to advance in assumptions that underlie the Occupational Health field, especially to prioritize health promotion and understand the subject in a work situation, in its historical and social perspective.

In summary, even considering the gaps, this study is encouraging as the last decades have promoted the discussion about OD especially in Latin America-with Brazil leading the publications-Europe, Central America, the Middle East and North America.

Although most research still focuses on classically recognized, tangible, and quantifiable risks (physical, chemical, biological, and ergonomic), there appears to be a movement in OD towards understanding the impacts of psychosocial and organizational risks of work on the stomatognathic system, fundamental when one intends to intervene in contemporary forms of work, intensely marked by inequities, precariousness, and collective demobilization (Antunes, 2009ANTUNES, R. As configurações do trabalho na sociedade capitalista. Katálysis, Florianópolis, v. 12, n. 2, p. 131-132, 2009., 2020ANTUNES, R. (Org.). Uberização, trabalho digital e Industria 4.0. São Paulo: Boitempo, 2020.; Rocha; Bussinguer, 2016ROCHA, S. H.; BUSSINGUER, E. C. A invisibilidade das doenças mentais ocupacionais no mundo contemporâneo do trabalho. Pensar, Fortaleza, v. 21, n. 3, p. 1104-1122, 2016. DOI: 10.5020/2317-2150.2016.v21n3p1104
https://doi.org/10.5020/2317-2150.2016.v... ), in which the stomatognathic system conditions do not go unharmed.

Study limitations

This scoping review has the following limiting aspects: searches carried out on rapid review platforms and indexed databases, therefore, unconventional literature was not considered; searches occurred based on descriptors close to the topic of OD and exclusively indicated by DeCS and MeSH; due to the significant number of repeated results, the authors agreed not to include those whose descriptor/platform intersection had more than a thousand results; and considering the inclusion criteria applied, it is possible that some production will be left out of the selection, but the authors are confident that any additional publication will not alter the results of this study.

Final considerations

The review was sufficient to answer the research question, as it identified gaps in the set of publications on OD on rapid review platforms. In this sense, although the PubMed/Medline, BVS and Scopus databases present the topic of OD on the rise across continents, the need to converge efforts to enable new research to occur in accordance with methodological guidelines and form rapid review platforms remains, as indicated by the WHO.

Furthermore, the moment is opportune as work issues, in the post-pandemic context, seem to conspire to make working and living conditions precarious, and OD has a unique chance to say what it is for, from a collective perspective of Health Promotion

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Publication Dates

  • Publication in this collection
    22 Dec 2023
  • Date of issue
    2023

History

  • Received
    22 Mar 2023
  • Reviewed
    22 Mar 2023
  • Accepted
    28 Mar 2023
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