[Odontología en entorno COVID-19. Adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid.] / Dentistry in the COVID-19 environment. Adaptation of the dental health units in Madrid's public primary health centres.

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.

En el término COVID-19 se incluyen cuadros respiratorios que varían desde el resfriado común hasta cuadros de neumonía grave con síndrome de distrés respiratorio, shock séptico y fallo multiorgánico. Esta enfermedad está causada por el virus SARS-CoV-2, cuyo mecanismo de transmisión más importante en odontología es, fundamentalmente, respiratorio, mediante gotitas, probablemente aerosoles y, también, por contacto directo con mucosas (nasales, orales u oculares) a través de manos o fómites contaminados. Los profesionales de las Unidades de Salud Bucodental representan una categoría laboral con un riesgo de exposición muy alto, ya que trabajan a una distancia de trabajo reducida (menos de un metro de la cabeza del paciente) en la cavidad oral, donde se ha descrito la máxima expresión de los posibles receptores celulares de dicho virus. Además, la mayoría de los procedimientos odontológicos conllevan la generación de aerosoles. Durante la atención odontológica puede producirse infección cruzada, tanto con pacientes diagnosticados positivos por COVID-19 como con aquellos no detectados por encontrarse asintomáticos o en fase presintomática. Por estas razones, la actividad odontológica en Atención Primaria ha tenido que adaptarse a la pandemia. Dichos cambios afectan a la distribución de la agenda de citación, a la atención odontológica, e implican el establecimiento de medidas universales y específicas de protección de barrera y otras relativas a ventilación, limpieza, desinfección y esterilización, reforzadas con medidas adicionales de control de infecciones. Este artículo resume la evidencia científica disponible relativa a dicha adaptación.

Hemorrhagic complications of dental extractions in 181 patients undergoing double antiplatelet therapy.

PURPOSE: There is limited information on hemorrhagic complications during invasive dental procedures in patients treated with double antiplatelet therapy. The objective of this study is to assess the frequency of hemorrhagic complications of patients taking dual antiplatelet medication undergoing dental extractions. PATIENTS AND METHODS: An observational, multicenter, prospective, cohort study was performed in 11 oral and dental care units of primary care. The study sample was derived from the population of patients aged 18 years or older who were undergoing double antiplatelet therapy and presented to the oral and dental care units requiring dental extraction. Double antiplatelet therapy is the combination of 100 mg per day of acetylsalicylic acid and a second antiplatelet agent. The predictor variables were type of extraction performed, number of extracted teeth, number of extracted roots, and presence of inflammation. The primary outcome variable was intraoperative hemorrhage, and the secondary outcome variables were hemorrhage at 24 hours and hemorrhage at 10 days. First, a univariate analysis that considered all studied variables was performed. All variables with P < .25 in the univariate analysis were included in a multivariate analysis. The association between hemorrhage severity and its relevant factors was evaluated using logistic regression analysis. RESULTS: The study included 181 patients. Light hemorrhage (<30 minutes) was observed in 165 patients (91.2%). Intraoperative hemorrhage lasted more than 30 minutes in 15 patients (8.3%) and more than 60 minutes in only 1 patient, whose hemorrhage was controlled by local hemostatic measures. The presence of inflammation and 3-root extractions increased the probability of hemorrhage persisting for more than 30 minutes by factors of 10 and 7.3, respectively. CONCLUSIONS: In 8.3% of patients treated with dual antiplatelet therapy, dental extractions cause hemorrhagic complications lasting more than 30 minutes are resolved using local hemostatic measures. The results of this study support the safety of dental extraction without withdrawal double antiplatelet therapy.

Sialolithiasis. Proposal for a new minimally invasive procedure: Piezoelectric surgery.

Sialolithiasis is the presence of stones in the ducts of the salivary glands. Most episodes are unique, and 60-80% are located exclusively in the main excretory duct. The main clinical manifestations are swelling and pain typically before, during or after meals that decreases if the obstruction is not complete. The highest prevalence of lithiasis is in the submandibular gland -87%-, whose secretion is more viscous, followed by the parotid gland -10%- and finally the sublingual gland -3%-. The most significant consequences are caused by the prolonged blockage of the duct by a stone, which can produce a persistent ductal dilatation with a swelling that does not subside, and could lead to the complete degeneration of the parenchyma, becoming a hot spot where secondary infections may occur, leading to acute bacterial sialadenitis or glandular abscesses. Treatment options range from a single probing extraction, extraction with sialographic control using the sialoendoscope, LASER intraductal lithotripsy, lithotripsy extracorporeal shock wave (ESWL), to the surgical techniques combining open duct with endoscopic or glandular removal. We propose, with regard to a case, the use of a simple piezoelectric device which, tunnelling through the glandular channel by the ostium, allows stone fragmentation, without damaging the surrounding soft tissue. Stone removal by this less invasive method reduces the need for more complex and expensive techniques. The postoperative course without retraction of the ostium, and the regaining of functionality is favourable. Key words:Calculus, lithotripsy, minimally invasive therapy, piezoelectric surgery, salivary glands, soft tissues.