Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis.

INTRODUCTION: The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). METHODOLOGY: A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. RESULTS: IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). CONCLUSION: None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.

Comprendiendo y combatiendo el fracaso anestésico en odontología / Understanding and combatting anesthetic failures in dentistry

El fracaso anestésico en odontología es un tema de constante investigación, ya que se presenta con frecuencia a la hora de realizar bloqueos del nervio alveolar inferior (BNAI) y en pacientes con pulpitis irreversible o procesos infecciosos. Son múltiples las causas que se han asociado al fracaso, entre las que destacan: factores anatómicos, bioquímicos, fisiológicos, patológicos, psicológicos, operatorios y aquellos relacionados con la solución anestésica per se. Una buena anestesia es un punto crítico a lograr en cualquier tratamiento dental y por eso se han propuesto diversas estrategias clínicas y farmacológicas como uso de técnicas suplementarias, utilización de dispositivos y coadyuvantes anestésicos, empleo de soluciones anestésicas distintas, modifi cación de los anestésicos, utilización de premedicación analgésica e incluso la aplicación local de analgésicos y otro tipo de fármacos; todo con el fin de compensar y tratar de disminuir el fracaso anestésico

Failures in anesthesia in dental practice are a topic of ongoing research due to the fact that these occur frequently when performing an inferior alveolar nerve block (IANB) in patients with irreversible pulpitis or infectious processes. Multiple causes have been associated with this problem, including anatomical, biochemical and physiological, patho-logical, psychological, and operative factors, as well as issues related to the anesthetic solution itself. Good anesthesia is critical in any dental treatment that involves pain, which is why various clinical and pharmacological strategies have been proposed in order to decrease the likelihood of anesthetic failure (such as the use of supplementary techniques, devices and aids, alternative anesthetic solutions, changing anesthetics, analgesic premedication, and even the local application of analgesics and other drugs).

[The changing age distribution of the Brazilian population in the first half of the 21st century]. / A transição da estrutura etária da população brasileira na primeira metade do século XXI.

Brazil is currently in an advanced stage of both the mortality and fertility transitions, which allows one to confidently forecast the age distribution and population size over the next four decades. Whereas the elderly population (> or=65 years) will increase at high rates (2-4% per year), the young population will decline. According to United Nations projections, the elderly population will increase from 3.1% of the population in 1970 to 19% in 2050. Meanwhile, within the young and adult populations, growth rates will vary among different age groups, ranging from negative to positive values. The changing age distribution of the Brazilian population brings opportunities and challenges that could lead to serious social and economic issues if not dealt with properly in the coming decades.

A transição da estrutura etária da população brasileira na primeira metade do século XXI / The changing age distribution of the Brazilian population in the first half of the 21st century

A trajetória da população brasileira, na primeira metade deste século, tanto em termos de seu volume, quanto de sua estrutura etária, já está praticamente definida, pois, tanto a transição de mortalidade quanto a da fecundidade já se encontram muito avançadas. Enquanto a população idosa (65 e mais anos de idade) aumentará a taxas altas (entre 2 por cento e 4 por cento ao ano), a população jovem tenderá a decrescer. Segundo projeções das Nações Unidas, de 3,1 por cento da população total, em 1970, a população idosa brasileira deverá passar a aproximadamente 19 por cento, em 2050. Paralelamente, conviverão dentro das populações jovem e adulta subgrupos etários com crescimento negativo e positivo. A transição etária brasileira gera oportunidades e desafios que, se não aproveitados e enfrentados, no momento devido, levará o país a seriíssimos problemas, nas próximas décadas.

Brazil is currently in an advanced stage of both the mortality and fertility transitions, which allows one to confidently forecast the age distribution and population size over the next four decades. Whereas the elderly population (> 65 years) will increase at high rates (2-4 percent per year), the young population will decline. According to United Nations projections, the elderly population will increase from 3.1 percent of the population in 1970 to 19 percent in 2050. Meanwhile, within the young and adult populations, growth rates will vary among different age groups, ranging from negative to positive values. The changing age distribution of the Brazilian population brings opportunities and challenges that could lead to serious social and economic issues if not dealt with properly in the coming decades.

The prevalence of diagnosed diabetes among the elderly of seven cities in Latin America and the Caribbean: The Health Wellbeing and Aging (SABE) Project.

OBJECTIVE: To examine the relation of diagnosed diabetes mellitus (DM) to the level of education and body mass index (BMI) among the elderly of seven cities using data from SABE. METHODS: The SABE survey was based on a probabilistic sample of the elderly population. RESULTS: Results: The prevalence of diagnosed diabetes among the elderly was 15.7% (95% CI 14.7-16.8), with the highest prevalence reported in Bridgetown and the lowest in Buenos Aires. DISCUSSION: There was a high prevalence of diagnosed DM among the elderly of the seven cities. The prevalence of diagnosed DM was strongly associated with BMI and low education. The inclusion of these factors in policies and programs aiming to reduce the prevalence of diabetes among the elderly is recommended.