Erosive Tooth Wear and Associated Risk Indicators in Schoolchildren from Rural and Urban Areas of the State of Mexico: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Limited access to health services and low educational levels are factors in the rural population that are associated with the development of oral pathologies. However, the specific risk indicators contributing to erosive tooth wear (ETW) in these populations remain unclear. The objective of this study was to identify risk indicators associated with the prevalence of erosive tooth wear (ETW) in schoolchildren aged 8-12 years from rural and urban areas in the State of Mexico. METHODS: A cross-sectional study was carried out in public schools in rural and urban areas. The prevalence of ETW was evaluated using the Basic Erosive Wear Examination (BEWE). The risk indicators studied were gastroesophageal reflux, vomiting, vitamin C, food, beverages, dental hygiene, bruxism, and hyposalivation. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of ETW was higher in the rural area (77.3%) compared to the urban area (51.2%) (p = 0.001). The odds of presenting ETW were more than twice in schoolchildren from rural areas compared to those from urban areas (OR: 2.25, 95% CI: 1.11-3.98). Risk indicators varied between rural and urban populations, with different factors such as the consumption of fresh tomato sauce, orange, tangerine, atole (artisanal corn-based drink), and teeth grinding in the rural area, and lemon, soft drink, fruit juice consumption, and the simplified oral hygiene index in the urban area (p < 0.05). CONCLUSIONS: To prevent ETW, strategies offering tailored dietary and hygiene advice should be proposed, considering the specific conditions of each geographic area.

Risk indicators for the severity of erosive wear in deciduous dentition of Mexican schoolchildren aged 5 to 7 years.

The objective of this work was to estimate the prevalence and severity of erosive tooth wear (ETW), and to identify risk indicators of deciduous dentition of a group of schoolchildren from public schools in Tlalnepantla de Baz, State of Mexico. A cross-sectional study was carried out in 352 schoolchildren from 5 to 7 years old. The severity of the ETW was evaluated using the Basic Erosive Wear Examination (BEWE). Risk indicators were evaluated through a survey which included food and beverage consumption, consumption habits, vitamin C consumption, gastroesophageal reflux, heartburn, belching, xerostomia, vomiting and teeth grinding. Multinomial logistic regression models were fitted. The prevalence of ETW was 99.7% (n = 351). Regarding severity, 46.6% were at a null/mild level, 27.3% moderate, and 26.1% severe. Males were more likely to present severe ETW (odds ratio (OR) = 2.23, 95% confidence interval (CI), 1.27-3.93; p = 0.005). The risk indicators for the severity of ETW were the frequent consumption of citrus fruits (OR = 2.09, 95% CI, 1.12-3.89; p = 0.021), fruit juice (OR = 1.99, 95% CI, 1.06-3.75; p = 0.033), processed beverages (OR = 2.15, 95% CI, 1.23-3.78; p = 0.008) and hot sauce (OR = 1.82, 95% CI, 1.03-3.20; p = 0.036). The prevalence of ETW in the deciduous dentition was very high (99.7%) and ~1/3 for severe ETW. The dietary factors associated with severe ETW are part of the regular consumption of Mexican school-age children, which impact their oral health condition. It is important to establish intervention strategies from the infant stage, focused on both children and their caregivers.

Germline mutations in pediatric cancer cohort with mixed-ancestry Mexicans.

BACKGROUND: Childhood cancer is one of the primary causes of disease-related death in 5- to 14-year-old children and currently no prevention strategies exist to reduce the incidence of this disease. Childhood cancer has a larger hereditary component compared with cancer in adults. Few genetic studies have been conducted on children with cancer. Additionally, Latin American populations are underrepresented in genomic studies compared with other populations. Therefore, the aim of this study is to analyze germline mutations in a group of mixed-ancestry Mexican pediatric patients with solid and hematological cancers. METHODS: We analyzed genetic variants from 40 Mexican childhood cancer patients and their relatives. DNA from saliva or blood samples was used for whole-exome sequencing. All variants were identified following GATK best practices. RESULTS: We found that six patients (15%) were carriers of germline mutations in CDKN2A, CHEK2, DICER1, FANCA, MSH6, MUTYH, NF1, and SBDS cancer predisposition genes, and additional new variants predicted to be deleterious by in silico algorithms. A population genetics analysis detected five components consistent with the demographic models assumed for modern mixed-ancestry Mexicans. CONCLUSIONS: This report identifies potential genetic risk factors and provides a better understanding of the underlying mechanisms of childhood cancer in this population.

Prevalence, and Risk Indicators of Coronal and Root Caries in Mexican Older Adults in Nursing Homes.

Background: Several factors are associated with coronal and root caries in older persons. The purpose of this study was to determine the experience, prevalence, and risk indicators (socioeconomic, sociodemographic, and dental variables) of coronal and root caries in older persons residing in nursing homes in Mexico. Methods: A cross-sectional study was carried out in 227 dentate participants with natural teeth. Convenience sample, where all dentate residents were invited to participate. The dependent variables were coronal caries and root caries, which were determined through an oral clinical examination. The independent variables were sociodemographic factors, location, type of center, surfaces free of dental biofilm and calculus, surfaces with recession, retainers in contact with surfaces with recession, xerostomia, smoking, and the previous use of dental services. The binary logistic regression model was used in the analysis. Results: The mean age of the participants in this study was 77.7±8.8 years, and 69.2% were women. Moreover, 71.8% live in long-term care facilities, and 48.0% live in Mexico City. The prevalence of coronal and root caries was found to be 67.8% and 50.7%, respectively. Being male and living in Mexico City were risk indicators for coronal caries, and with a 1% increase in surfaces with no biofilm, the risk decreased by 2%. Being widowed, having government or no social security, denture retainers, and coronal caries were risk indicators for root caries, while the utilization of dental services indicated lower risk. Conclusion: Several variables that differ in nature were found to be risk indicators for coronal and root caries. Coronal caries increases the risk of root caries. Prevention should be aimed at identifying persons at higher risk, and dental care should be improved for persons living in long-term care institutions.

Using the Expanded Andersen Model to Determine Factors Associated with Mexican Adolescents' Utilization of Dental Services.

Many factors contribute as facilitators of or barriers to adolescents' use of dental services. Guided by the expanded Andersen model for dental service utilization, the aim of this study was to identify factors associated with the use of dental services among adolescents ages 12-16 in south Mexico City (n = 247). Adolescents answered a questionnaire on predisposing factors (age and gender), enabling factors (socioeconomic status, oral health support, parental years of education, and previous dental treatments), and psychosocial and behavioral factors (attitudes towards oral health; knowledge of gingivitis; alcohol, drug, and tobacco use; and depressive symptoms), and they underwent a visual clinical exam to determine their need factors (caries and gingivitis). The adolescents reported whether or not they had attended a dental visit in the last year for any reason. Multiple logistic regression was used to evaluate these factors. Having oral health support increased the odds of a dental visit by 2.69 (95% CI = 1.24-5.84). Previous dental treatment increased the odds of a dental visit by 2.25 (95% CI = 1.12-4.52). The presence of depressive symptoms reduced the odds of a dental visit by 4% (OR = 0.96, 95% CI = 0.94-0.99). Enabling and psychosocial factors of oral health support and previous dental treatment were positively associated with the utilization of dental services, while depressive symptoms were negatively associated.

Diseño y validación de una escala de soporte social para adolescentes / Design and validation of a social support scale for adolescents

Introducción: el soporte social es de gran importancia en la adolescencia; aquellos adolescentes con mayor soporte tienen mejores estrategias de salud. Existen pocos instrumentos para evaluar el soporte social en todas sus dimensiones y las fuentes de éste, ninguno ha sido validado en español. El objetivo de este estudio es evaluar la validez y confiabilidad de un nuevo instrumento para identificar el soporte social y la fuente de este soporte en adolescentes. Material y métodos: la escala de soporte social para adolescentes (ESSA) consiste en un cuestionario de autoaplicación de 22 ítems, con cinco opciones de respuesta tipo Likert que van de nunca a siempre, con seis subescalas: familia, mejor amigo, compañeros de clase, profesores, otras relaciones, y salud general y oral. Los datos de la ESSA se recogieron de estudiantes de secundaria (N = 191; edad media 16.1 ± 1.2 años). Los análisis psicométricos incluyeron análisis factorial de ejes principales, consistencia interna (alfa de Cronbach) y correlaciones de la escala con la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Depresión 20 del Centro de Estudios Epidemiológicos (CESD20) (correlaciones de Spearman, p). Resultados: el análisis factorial de ejes principales mostró que la escala explica el 72.23% de la variabilidad. La escala completa mostró una consistencia interna adecuada, con un alfa de Cronbach = 0.92 [0.90-0.93]. En cuanto a la validez discriminativa, la correlación con las puntuaciones de la escala CES-D20 fue ρ = -0.32, la escala mostró una fuerte correlación con las puntuaciones MSPSS (p = 0.81). Los resultados fueron estables en la repetibilidad (ICC = 0.93). Conclusiones: la ESSA es válida y confiable. Este instrumento podría ser adecuado para una amplia gama de aplicaciones de investigación entre la población adolescente (AU)

Introduction: social support is of great importance in adolescence; those who have more support have better health strategies. There are few instruments to evaluate social support in all its dimensions and the sources of this support, and none has been validated in Spanish. The aim of this study is to evaluate the validity and reliability of a new instrument to identify social support and the source of this support for adolescents. Material and methods: the adolescent social support scale (ADSSS) consists of a 22-item self-report questionnaire with 5 Likert-type responses ranging from never to always and six different subscales: family, best friend, classmates, teachers, other relationships, and general and oral health. ADSSS data were collected from high school students (N = 191; mean age 16.1 years [standard deviation = 1.2]). Psychometric analyses included main axis factor analysis, internal consistency (Cronbach's alpha), and scale correlations with the multidimensional scale of perceived social support (MSPSS) and the Center for Epidemiologic Studies Depression Scale-20 (CES-D20) (Spearman correlations, p). Results: main axis factor analysis showed that the scale explained 72.23% of the variability. The entire scale showed adequate internal consistency, with Cronbach's alpha = 0.92 [0.90-0.93]. For discriminative validity, the correlation with CES-D20 scores was p = -0.32, and the scale showed a strong correlation with MSPSS scores (p = 0.81). The results were stable across repeated measurements (ICC = 0.93). Conclusions: the ADSSS has good reliability and validity. This instrument could be suitable for a broad range of research applications among adolescents (AU)

Relationship between the Social Development Index and Self-Reported Periodontal Conditions.

Inequalities in oral health are influenced by the social strata of the population. Few studies have focused on the multitude of factors related to social development as indicators of living conditions and periodontal health status. The aim of this study is to evaluate the association between self-reported periodontal conditions and the Social Development Index (SDI). A cross-sectional validated questionnaire was carried out among 1294 Mexican adults. Descriptive statistics and multivariate logistic regression models were used to identify the best predictors of self-reported periodontal conditions. Bone loss reporting was used as a proxy for the presence of periodontal disease. We found that higher global scores on the SDI and quality and available space in the home (QASH) increase the probability of having bone loss. Global SDI (OR = 7.27) and higher QASH (OR = 3.66) were indeed the leading societal factors related to periodontal disease. These results have pointed out how SDI and its indicators, in particular QASH, can be used to further explore inequities related to privileged access to dental care in the context of periodontal diseases.

Oral health condition and development of frailty over a 12-month period in community-dwelling older adults.

BACKGROUND: To determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults. METHODS: Population-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t0), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t1) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services. RESULTS: 663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t0, a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t1, 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health. CONCLUSION: Older adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period.

Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy-by early public health interventions or epidemiological surveillance approaches-and for the population empowerment-via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health-will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.

Prevalence, Incidence, and Progression of Erosive Tooth Wear and Their Respective Risk Factors Among Schoolchildren in Mexico City.

Purpose: To evaluate the cumulative incidence and progression of erosive tooth wear (ETW) and identify risk factors over 18 months in a cohort of 11- to 14-year-old schoolchildren in Mexico. Methods: The study was conducted in public schools located in northern Mexico City. Permanent teeth of 424 schoolchildren were examined using the basic erosive wear examination. The possible risk factors were included in the logistic models: the consumption of acidic food and beverages; habits related to the consumption of beverages; medication; gastroesophageal reflux; frequent vomiting; and characteristics of the saliva. Results: The prevalence of ETW was 62.5 percent (265 out of 424). The cumulative incidence was 35.2 percent (56 out of 159) and the progression was 72.8 percent (193 out of 265). The consumption of acidic beverages increased the relative risk (RR) of both the cumulative incidence (RR equals 1.09; 95 percent confidence interval [95% CI] 1.02 to 1.18; P=0.005) and the progression (RR equals 1.16; 95% CI 1.01 to 1.34; P=0.003). Conclusions: This population has a high risk of the development and progression of ETW, found in approximately one-third and approximately two-thirds of the schoolchildren, respectively. The most important risk factor was the consumption of acidic beverages.

Out-Of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting.

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.

Indicators of oral health in older adults with and without the presence of multimorbidity: a cross-sectional study.

PURPOSE: The aim of this study was to determine whether there are differences in the distribution of various indicators of oral health among elderly people with and without multimorbidity (ie, two or more chronic diseases). SUBJECTS AND METHODS: A cross-sectional, comparative study was conducted using a sample of Mexican elderly individuals aged ≥60 years. The average age of the cohort was 79.06±9.78 years, and 69.1% were women. The variables indicating oral health were as follows: functional dentition, edentulism, hyposalivation, xerostomia, root caries and periodontitis. The multimorbidity variable was operationally categorized as follows: 0= subjects with no chronic disease or one chronic disease and 1= subjects with two or more chronic diseases. Questionnaires were used to collect information on various variables regarding general health. Likewise, the participants underwent a clinical oral examination. The analysis was performed using Stata 11.0. RESULTS: The overall prevalence of multimorbidity was 27.3%. The prevalences of various oral health indicators were as follows: without functional dentition 89.9%; hyposalivation 59.7%; edentulism 38.9% and self-reported xerostomia 25.2%. Dental caries were observed in 95.3% of the subjects, and the prevalence of severe periodontitis was 80%. We found a significant difference only in edentulism; its prevalence was higher among subjects with multimorbidity (55.3% vs 32.7%, P=0.015) than among those without multimorbidity. CONCLUSION: The presence of edentulism in this sample of Mexican older adults was higher in subjects with multimorbidity. Multimorbidity and oral diseases constitute a true challenge in elderly people, because they affect quality of life and are associated with high health care costs.

Relationship between erosive tooth wear and beverage consumption among a group of schoolchildren in Mexico City.

OBJECTIVE: To assess the association between erosive tooth wear (ETW) and consumption of different kinds of beverages in a group of schoolchildren 11-14 years old in Mexico City. METHODS: Cross-sectional study in a sample of students (n = 512) in Mexico City. The Basic Erosive Wear Examination (BEWE) was used to quantify ETW. Beverage consumption (BC) was determined using a frequency questionnaire; beverages included pure water, natural fruit juices, milk, hot beverages, and soft drinks. Ordinal logistic regression model was used to evaluate the association between the presence of ETW and BC. RESULTS: In total, 45.7% of the schoolchildren showed an initial loss of surface texture (BEWE = 1) and 18.2% a distinct defect involving loss of dental tissue (BEWE ≥ 2) in at least one tooth. For each glass (350 ml) of milk/week, the odds of not having erosive wear (BEWE = 0) versus having an initial loss of surface texture (BEWE = 1) or of having an initial loss of surface texture versus the presence of a defect involving the loss of dental tissue (BEWE ≥ 2) decreased 4% (OR = 0.96, 95% CI 0.93-0.99, p = 0.008); for each portion of sweet carbonated beverage consumed (350 ml), the odds increased 3% (OR = 1.03, 95% CI 1.001-1.07, p = 0.046). CONCLUSION: The intake of milk and milk-based products could be a dietary means of helping prevent ETW, especially if their consumption could replace sweet carbonated drink consumption. CLINICAL RELEVANCE: Knowing the impact of beverage consumption on ETW helps to provide suitable recommendations for the prevention and control of ETW in order to promote tooth longevity.

Evaluation of a fluorosis prevention educational program: A randomized field trial.

BACKGROUND: A 2-group randomized field trial was conducted to evaluate the impact of a fluorosis educational preventive program in mother´s knowledge and practices, and on the urine fluoride concentration of their preschool children. MATERIAL AND METHODS: A group of 139 mother-child pairs participated in the study. Randomly, children were assigned to an intervention group, their mothers were participants of an educational program, or a control group (CG); including 69 and 70 child-mother pairs, respectively, the follow-up period was six months. Mother´s knowledge and practices were evaluated and children´s first urine sample was used to measure fluoride concentration at the beginning of the study and at the end of the follow-up period. RESULTS: The mean age of the children was 4.18 (sd 0.62) years-old at baseline. Mothers in the IG improved their knowledge and practices associated with fluorosis risk factors. Adequate knowledge about the amount of toothpaste to use for brushing improved in the IG (p=0.006). In 82.1% of the children in the IG showed decrease in urine fluoride concentration was observed (p< 0.001), no significant differences were shown in the CG. CONCLUSIONS: Mothers participating in an education program improved their knowledge and practices, reducing the risk of dental fluorosis in their children who showed a decreased on their urine F concentration. Key words:Knowledge, practices, urinary fluoride, water fluoride, preschool children, mothers.

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Risk factors associated with actinic prurigo: a case control study.

BACKGROUND: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. OBJECTIVE: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. METHODS: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. RESULTS: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). STUDY LIMITATIONS: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. CONCLUSIONS: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Adaptación Transcultural y Validación del Early Childhood Oral Health Impact Scale en preescolares ecuatorianos / Adaptação Transcultural e Validação do Early Childhood Oral Health Impact Scale em pré-escolares ecuatorianos / Cross-Cultural Adaptation and Validation of Early Childhood Oral Health Impact Scale in ecuadorian preschool children

Objetivo: Traducir, adaptar y validar el ECOHIS, para evaluar la calidad de vida relacionada con la salud bucal de pre-escolares ecuatorianos. Materiales y métodos: 50 padres y/o cuidadores de niños de 3 a 5 años de edad participaron en dos pruebas piloto para obtener la traducción y adaptación transcultural del ECOHIS. La validación del mismo se obtuvo mediante entrevista "face to face" realizada en 212 padres y/o cuidadores con sus niños de 3 a 5 años de edad, que fueron examinados clínicamente para diagnosticar caries dental, maloclusiones y traumatismos dentales. La consistencia interna se evaluó con Alfa de Cronbach, la estabilidad del instrumento fue determinada mediante el Coeficiente de Correlación Intraclase (CCI), la validez de constructo y discriminante se evaluaron al relacionar las variables clínicas con las puntua-ciones obtenidas en el Ec-ECOHIS. Resultados: Se obtuvo unaConsistencia Interna de 0744; la estabilidad fue confir-mada por Coeficiente de Correlación Intraclase (CCI= 0,919); Validez de Constructo se demostró con las asociaciones estadísticamente significativas entre la puntuación total del Ec-ECOHIS, y de sus secciones EIN y EIF con el ceod y sus componentes, la validez discriminante fue ratificada al encontrar diferencias significativas entre los grupos con presencia o ausencia de caries dentales, maloclusión y trauma dental (p = 0,009; p = 0,028; p = 0,001 respectivamente). Conclusión: El Ec-ECOHIS, es un instrumento válido y fiable para evaluar la calidad de vida relacionada con la salud bucal de los preescolares ecuatorianos.

Objective: To translate, to adapt and to validate ECOHIS, in order to evaluate the quality of life related to the oral health of Ecuadorian preschoolers. Equipment and methods: Fifty three-to-five-year-old-child parents and/or caregivers parti-cipated in two experimental tests for getting the translation and cross-cultural adaptation of ECOHIS. Its validation was obtained through face-to-face interviews applied on 212 parents and/or caregivers with their respective children, who were clinically examined in order to detect dental cavities, malocclusions, or any other trauma. The internal consistency of the questionnaire was evaluated using Cronbach's alfa, the stability of the instrument was determined with the intra-class correlation coefficient (CCI). The validity of the construct and discriminant was evaluated after correlating the clinical variables with the scores obtained from the Ec-ECOHIS. Results: The internal consistency obtained was 0744. Its stability was confirmed by the intra-class correlation coefficient (CCI=0,919). The validity of the construct was proved by with the statistically significant relations between the total score from Ec-ECOHIS, and sections EIN and EIF, with the CEOD and its components. The validity of the discriminant was confirmed after finding important differences between the groups that presented and that did not present dental cavities, malocclusions, or other trauma (p = 0,009; p = 0,028; p = 0,001, respec-tively) Conclusion: Ec-ECOHIS is a valid and reliable instrument for evaluating the quality of life related to oral health of Ecuadorian preschoolers.

Objetivo: Traduzir, adaptar e validar o ECOHIS para avaliar a qualidade de vida relacionada à saúde bucal dos pré-escola-res equatorianos. Materiais e Métodos: 50 pais e / ou cuidadores infantil com idade entre 3 a 5 anos de idade participaram de dois testes-piloto para a tradução e adaptação cultural do ECOHIS. A validação foi obtida pela entrevista "face a face" feito com 212 pais e / ou cuidadores infantis de 3 a 5 anos de idade que foram examinados clinicamente para diagnosticar a cárie dentária, maloclusões e trauma dental. A consistência interna foi avaliada com Cronbach alfa, a estabilidade do instrumento foi determinada pelo coeficiente de correlação intra-classe (ICC), a validade de constructo e discriminante foi avaliada pela relação entre as variáveis clínicas com as pontuações no Ec-ECOHIS. Resultados: Foi obtida uma Cron-bach alfa de 0,744. A estabilidade foi confirmada pelo coeficiente de correlação intra-classe (ICC = 0,919); a validade de construto foi demostrada pelas associações estatisticamente significativas entre a pontuação total do Ec-ECOHIS, e as suas secções EIN e EIF com ceod e seus componentes, a validade discriminante foi confirmada por haver diferenças significa-tivas entre os grupos com a presença ou ausência de cárie dentária, maloclusãos e trauma dentário (p = 0,009; p = 0,028; p = 0,001, respectivamente). Conclusão: Ec-ECOHIS, é um instrumento válido e confiável para avaliar a qualidade de vida relacionada à saúde bucal dos pré-escolares equatorianos.

Self-report of gingival problems and periodontitis in indigenous and non-indigenous populations in Chiapas, Mexico.

OBJECTIVE: To estimate the prevalence of self-reported gingival and periodontal conditions and their association with smoking, oral hygiene, indigenous origin, diabetes and location (urban or rural) in indigenous and non-indigenous adults in Chiapas, Mexico. METHODS: A cross-sectional study of 1,749 persons, ≥20 years of age, living in four rural and four urban marginal localities in Comitán (Chiapas, México). The variables investigated were: age; sex; indigenous origin; oral hygiene; halitosis; chewing ability; gingival conditions; periodontitis; smoking; alcoholism; diabetes; and location. Bivariate analysis and a logistic regression model were used to identify the association of periodontitis with the independent variables. RESULTS: In total, 762 (43.6%) indigenous and 987 (56.4%) non-indigenous persons were interviewed. Their mean age was 41 ± 14 years, 66.7% were women and 43.8% lived in rural locations. Gingival problems were reported by 68.5% and periodontitis by 8.7%. In total, 17.9% had used dental services during the previous year, 28.7% wore a removable partial or a complete dental prosthesis, 63.7% had lost at least one tooth, the prevalence of diabetes was 9.2% and the prevalence of smoking was 12.2%. The logistic regression model showed that age, diabetes and the interaction between rural location and indigenous origin were associated with the presence of periodontitis. CONCLUSIONS: Indigenous people living in rural areas are more likely to have periodontitis. It is necessary to promote oral health practices in indigenous and marginalised populations with a focus on community-oriented primary care.

Prevalence of erosive tooth wear and associated factors in a group of Mexican adolescents.

BACKGROUND: Erosive tooth wear is the irreversible loss of dental hard tissue as a result of chemical processes. When the surface of a tooth is attacked by acids, the resulting loss of structural integrity leaves a softened layer on the tooth's surface, which renders it vulnerable to abrasive forces. The authors' objective was to estimate the prevalence of erosive tooth wear and to identify associated factors in a sample of 14- to 19-year-old adolescents in Mexico. METHODS: The authors performed a cross-sectional study on a convenience sample (N = 417) of adolescents in a school in Mexico City, Mexico. The authors used a questionnaire and an oral examination performed according to the Lussi index. RESULTS: The prevalence of erosive tooth wear was 31.7% (10.8% with exposed dentin). The final logistic regression model included age (P < .01; odds ratio [OR], 1.64; 95% confidence interval [CI], 1.26-2.13), high intake of sweet carbonated drinks (P = .03; OR, 1.81; 95% CI, 1.06-3.07), and xerostomia (P = .04; OR, 2.31; 95% CI, 1.05-5.09). CONCLUSIONS: Erosive tooth wear, mainly on the mandibular first molars, was associated with age, high intake of sweet carbonated drinks, and xerostomia. PRACTICAL IMPLICATIONS: Knowledge regarding erosive tooth wear in adolescents with relatively few years of exposure to causal factors will increase the focus on effective preventive measures, the identification of people at high risk, and early treatment.

Comparación clínica del uso del colgajo de avance coronal e injerto de tejido conectivo subepitelial con o sin proteínas derivadas de la matriz del esmalte para la cobertura de recesiones gingivales. Caso clínico / Clinical comparison of coronary displaced flap and sub-epithelial connective tissue graft with or without enamel matrix protein derivative for gingival recession coverage. Clinical case presentation

Se presenta un caso clínico donde se evaluó si la agregación del derivado de la matriz del esmalte (DME) al procedimiento del colgajo de avance coronal con injerto de tejido conectivo subepitelial (CDC + ITCS) mejoraría la cantidad de cobertura radicular en recesiones gingivales clase I y II de Miller comparados con el mismo procedimiento solo, en un paciente con recesiones gingivales múltiples a seis meses. Se incluyeron 12 recesiones gingivales, seis tratadas con (CAC + ITCSE + DME) y seis con (CAC + ITCSE) en diferentes cuadrantes. Al inicio y a los seis meses se midieron los parámetros clínicos tales como profundidad de la recesión gingival (PR), profundidad al sondeo (PS), nivel de inserción clínica (NIC), y ancho de tejido queratinizado en dirección apico-coronal (TQ). Un valor p < 0.05 se consideró significativo. Los resultados mostraron que a los seis meses ambos procedimientos, CAC + ITCSE + DME y CAC + ITCSE produjeron una significativa cobertura radicular en promedio 2.83 ± 1.16 mm (p = 0.001) y 2.50 ± 0.83 mm (p = .002), respectivamente. Todas las recesiones gingivales tratadas con el DME tuvieron el 100% de cobertura radicular y sólo el 65.3% de cobertura para los sitios tratados con CAC + ITCSE. Al comparar ambos procedimientos a los seis meses, se observaron mejores resultados con CAC + ITCSE + DME en cuanto al nivel de inserción clínica (p = .02) y la cobertura radicular (p = .06); sin embargo, ni la diferencia del nivel de inserción clínico ni la ganancia en la cobertura radicular mostraron ser significativos. Por otro lado, no se observaron diferencias significativas en la PS y TQ. Conclusión: El presente caso clínico no mostró beneficio adicional cuando se agregó el DME al procedimiento de CAC + ITCSE para la cobertura de recesiones gingivales múltiples clase I y II de Miller.

The present article described a clinical case where it was assessed whether aggregation of enamel matrix derivative (EMD) to the procedure of coronary-advanced flap with sub-epithelial connective tissue graft (CAF + SCTG) would improve the amount of root coverage in Miller's class I and II gingival recessions when compared to the same isolated procedure in a patient suffering multiple gingival recessions, in a 6 month time-span. Twelve gingival recessions were included in the study: six treated with (CAF + SCTG + EMD) and six treated with (CAF + SCTG) in different quadrants. At beginning of procedure as well as six months later, the following clinical parameters were measured: gingival recession depth (RD), depth to probing (PD), clinical insertion level (CIL) and width of keratinized tissue (KT) in apex-coronary direction. A p < 0.05 was considered statistically significant. Results established that after a six month procedure CAF + SCTG + EMD and CAF + SCTG produced significant root coverage, respective averages were 2.83 ± 1.16 mm (p = 0.001) and 2.50 ± 0.83 mm (p = .002). All gingival recessions treated with EMD experienced 100% root coverage, sites treated with CAF + SCTG + EMD exhibited coverage of only 65.3%. When comparing results at six months, better results were observed with CAF + SCTG + EMD with respect to clinical insertion level (p = .02) and root coverage (p = .06). Nevertheless, neither the difference of clinical level insertion nor the gain in root coverage resulted significant. Additionally, no significant differences were observed between PD and KT. Conclusion: The present clinical case did not show additional benefits when EMD were aggregated to the CAF + SCTG in the coverage of multiple Miller's class I and class II gingival recessions.