COVID-19: ¿cuál es el rol ético del odontólogo ante esta pandemia? / COVID-19: what is the ethical role of the dentist in face of this pandemic?

Introducción: Para un buen profesional de la odontología es necesaria la ética en todas las actividades que realice. La ética establece lo que es y debe ser, buscando siempre el bien y no hacer el mal o causar daño, y el odontólogo debe tener una serie de cualidades y aptitudes con el fin de llevar a cabo todo el tratamiento que amerite el paciente de manera correcta, honesta y responsable sin escatimar esfuerzos para devolverle su salud oral. La COVID-19 es una enfermedad que se ha convertido en pandemia y está afectando al mundo de manera importante. Entre los más afectados se encuentran los profesionales de la salud que arriesgan sus vidas por sanar al enfermo. Dada la situación actual, a los odontólogos se les presenta la duda si atender a sus pacientes en este periodo cumple o no con los principios éticos de la profesión. Objetivo: El objetivo del presente artículo fue realizar una revisión sistemática de la literatura con el fin de identificar el rol bioético del odontólogo ante la pandemia de COVID-19. Material y métodos: Para realizar la recolección de la literatura se compilaron artículos de diferentes bases de datos: PubMed, Cochrane, Nature y Lilacs producidos entre los años 2012 y 2020 con las palabras clave: ética, odontología, pandemia, COVID-19 y bioética en los idiomas español, inglés y portugués. Resultados: Se localizaron 70 artículos, de los cuales se escogieron finalmente 10 correspondientes a los criterios de búsqueda. Los artículos presentaron homogeneidad sobre el rol del odontólogo en la situación actual y coinciden en la búsqueda de alternativas y métodos de atención lo más seguras posibles, dando prioridad a quienes requieren atención de urgencias (AU)

Introduction: For a good dental professional, ethics is necessary in all the activities performed. Ethics stablish what is and what should be, always looking for the good and not the bad, the dentist should have a series of qualities and skills in order to perform every treatment that the patient needs in a correct, honest and responsible way without sparing efforts to give them back their oral health. COVID-19 is a disease that has converted into a pandemic affecting the world in an important manner. And, between the most affected are the health providers and professionals that risk their lives to heal the people suffering this disease. Given the current situation, dentists have been found in doubt regarding if treating their patients in this period meets or not the ethical principles of their profession. Objective: The objective of this article is to perform a systematic review of literature in order to identify the bioethics role of the dentist in face of the COVID-19 pandemic. Material and methods: To carry out the collection of literature the procedure included compiling different articles from the databases: PubMed, Cochrane, Nature, and Lilacs produced between the years of 2012 and 2020 with the key words: ethics, dentistry, pandemic, COVID-19, bioethics in the languages of Spanish, English and Portuguese. Results: 70 papers were located from which only 10 were chosen meeting the searching criteria. The papers presented homogenous results about the role of dentists in the current situation and the all agree in the search of alternatives and methods of care that are as secure as possible, giving priority to those who are in need of urgent care (AU)

Perception of 'comprehensiveness of care': a qualitative study amongst dentists in the Brazilian Health System.

Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, 'patient welcoming', 'bonding' and 'quality of care', as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through 'patient welcoming.' Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of 'bonding', they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that 'quality of care' is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

Perception of 'Comprehensiveness of Care': a qualitative study amongst dentists in the Brazilian Health System

Comprehensiveness relates both to the scope of services offered and to a holistic clinical approach. The aim of this study was to identify the perception of Brazilian dentists regarding key concepts of comprehensiveness and its importance in primary health care oral health services performed in the public sector. Focus groups were conducted to explore three main concepts, ‘patient welcoming’, ‘bonding’ and ‘quality of care’, as well as their aspects. In total, there were four focus groups comprising seven general dentists, all of whom had at least two years of experience in primary care, from municipalities of varying sizes. Discussions of approximately 60 minutes were conducted, audio-recorded and transcribed. The data were analysed by qualitative thematic analysis, in line with the framework approach. The general dentists reported that they are aware that in the Brazilian Health System, the onset of patient care by primary health care services must happen through ‘patient welcoming.’ Nevertheless, they suggested that this action is often performed poorly due to the large volume of patients. Although they knew the importance of ‘bonding’, they realised that there is a lack of education preparing professionals to address interpersonal and social issues. They were aware that ‘quality of care’ is related to multiple factors. Comprehensiveness, as an approach in dental public health practices, needs to be enhanced, and there is evidence that primary care dentists are aware of the need for such an approach.

Dental status of new caledonian children: is there a need for a new oral health promotion programme?

BACKGROUND: Before implementing a new oral health promotion program in the French overseas territory of Nouvelle Calédonie, the health authorities needed recent data about dental status of the New Caledonian child population. OBJECTIVES: This study aimed to describe the dental status of 6, 9 and 12-yr-old New Caledonian children and to investigate the environmental and behavioural risk factors related to oral health. METHODS: A randomly selected sample of 2734 children (744 6-yr-olds, 789 9-yr-olds, and 1201 12-yr-olds) was examined clinically by seven calibrated investigators and participants responded to a questionnaire. The main variables were objective criteria about dental status and subjective criteria about experience of dental care, dental fear, self-perception of oral health, cultural or ethnic identity and environmental and behavioural risk factors. RESULTS: Overall, most of the children had infectious oral diseases: more than 50% had gingivitis, and 60% of 6- and 9 yr-olds had at least one deciduous or permanent tooth with untreated caries. The mean 12-yr-old number of decayed missing and filled teeth (DMFT) was 2.09±2.82. The number of carious lesions was related to the unfavourable lifestyle, deprived social status and no preventive dental care. Kanak, Polynesians and Caledonians (respectively 27%, 18% and 45% of the study sample) were more affected by caries than metropolitan French and Asian children. Children with many untreated carious lesions had negative perceptions of their oral health; they complained of chewing difficulty and had higher scores for dental anxiety. CONCLUSION: This study highlights the need for new strategies aimed at improving oral health and at reducing inequalities in New Caledonia. An oral health promotion program would need to be developed in connection with other health programmes using the common risk factor approach within the context of the local environment.

[Long-term goals for oral health]. / Lang leve de duurzame mondzorg.

The current, optimistic prognosis is that newborns will reach an average age of 100 years. This increased life-expectancy requires a renewed vision of long-term goals for oral health. The starting-point could be a prospective end-point with minimal oral function which should be reached, for example, in the last years of one's life. The consequence is that adequate oral healthcare for the elderly starts in childhood. Choices such as the extraction of premolars for orthodontic reasons and the dental re-restoration cycle have a great negative impact on reaching this goal. The average sustainability of dental restorations or prosthetic constructions is commonly much shorter than the life-expectancy of a patient. If oral treatment is necessary, it is recommended to give priority to maintaining a minimally functional dentition up to an advanced age, instead offocusing on short- or medium-term goals.

Evaluación de calidad de la atención odontológica de los servicios de salud adscritos a la Corporación Merideña de Salud en el municipio Libertador del estado Mérida, 2005 / An evaluation of dental care quality of health services belonging to the Merida Health Corporation at the Libertador community, Merida state, 2005

En los actuales momentos el Estado venezolano viene realizando acciones tendientes a disminuir los efectos de la crisis económica y social. Para lograr verdaderos cambios en el perfil de salud, es necesario mejorar la calidad de los servicios a partir de la participación de la comunidad. La presente investigación se propone evaluar la calidad de la atención odontológica de los servicios de salud públicos. Es un estudio descriptivo, por objetivos, con un enfoque mixto y un diseño no experimental, transeccional. La muestra fue seleccionada aleatoriamente. Entre los resultados destaca que la atención odontológica se limita a los tratamientos de: cirugía dental, operatoria dental y periodoncia. No se realizan tratamientos endodónticos y los usuarios con patologías pulpares tienen como alternativa la exodoncia. La evaluación en estos servicios se encuentra limitada al reporte de las actividades realizadas sin la participación de un evaluador externo. El reporte de las actividades, resulta insuficiente para evaluar la calidad de los servicios. Los resultados reflejan una completa desvinculación entre el servicio odontológico y las organizaciones de la comunidad. La participación con la comunidad se limita a acciones puntuales, sin que exista una vinculación orgánica con las organizaciones de base. El mejoramiento de la calidad de los servicios de salud requieren de la incorporación de un modelo de gestión que permita articular las necesidades de la atención odontológica de la población con el desempeño del equipo de salud, la oferta del servicio y la evaluación continua. La evaluación permitirá medir el impacto de la prestación de los servicios odontológicos en el perfil de salud bucal de la población.

Currently, Venezuela's government is achieving some actions intending to diminish the effects of the economic and social crisis. In order to reach real changes in the health profile it is needed to improve the quality of the service starting from the participation of the community. This research intended to evaluate the quality of the service in dentistry offered by public services centers. This is a descriptive study by objectives, with a mixed approach within a non experimental, transactional design. The sample was randomly select. Among the findings it is highlighted that dental attention is limited to dental surgery, operational dentistry and periodonties. None endodontical treatment is performed and the only solutions for patients suffering from pulp pathologies is dental extraction. The assessment of the services is limited to the reports of activities without the participations of a external evaluator. Such a report is not enough to evaluate the quality of the service. The findings reveal a complete mismatch between the dental service and the organizations from the community. The participations of the people is limited to specific actions, without an organic link to the main organizations. The improvement of the quality of the health services requires the incorporations of the management model that allows to articulate the needs of the people in terms of dental attention with the performance of the personnel, the offer of the service and the continuous evaluation. That evaluation will let to measure the impact of the assistance of dental services in the profile of dental health of the population.

Outcomes two, three and four years after comprehensive care under general anaesthesia.

OBJECTIVES: The objective was to review the outcomes for three groups of children after two, three and four years following comprehensive dental treatment under general anaesthesia (GA) for 292 children aged 1.8 to 5.9 years of age. DESIGN: The study was a retrospective review of ongoing dental treatment needs following treatment under GA. METHODS: Information including the individual tooth treatments carried out, ongoing care, fluoride status, socioeconomic status and ethnicity was obtained from dental records from the School of Dentistry and the Otago District Health Board School Dental Service. The accuracy of the records was evaluated by clinically examining 10 percent of the children. RESULTS: Ninety-five percent of the treated children were followed up. Fifty-five percent had new caries recorded. For the treatments provided, amalgam had a mean success of 57.1 percent, composite 73.4 percent, compomer 85.2 percent, stainless steel crowns 92.8 percent and pulpotomies 84.6 percent. The majority of replaced restorations were because of new carious lesions. CONCLUSIONS: This study indicated that most of the restorative procedures and materials used have very successful outcomes in these high-risk children. Ongoing risk of dental caries is high despite current preventive approaches. Other preventive approaches should be investigated.