Prevention of oral cancer through the implementation of a teledentistry platform for the elderly / Prevención del cáncer oral mediante la implementación de una plataforma de teleodontología para adultos mayores

Objective: To contribute to early diagnosis of lesions in older patients, including potentially malignant lesions or those suspected of oral cancer by support of a web-based teledentistry platform. Material and Methods:This report contains information from 27 patients with oral lesions out of a total of 135 who received mobile dental care. Specialists who participated in the study involved professionals from the disciplines of periodontics, temporomandibular disorders, oral implantology, oral radiology, oral pathology and geriatrics. Referral consultations were carried out synchronously or asynchronously. Clinical information sent to oral pathology specialists involved a medical history and a traditional description of the lesion which considered size, color, limits, symptomatology, type of surface, consistency, location, and evolution. This information was complemented with a three-dimensional representation of the lesion, simulating an extra/intra oral clinical examination including a marker tool that allows to perform the anatomical-referencing of oral lesions. Results:27 consultations from 26 patients were evaluated for oral pathology lesions. 12 lesions were diagnosed as reactive, 5 were infectious lesions, 4 of vascular etiology, 3 pigmented lesions (amalgam tattoo and smoking-related melanosis) and 3 potentially malignant lesions. The most frequent location was the tongue with 8 cases, followed by the gingiva and jugal mucosa, each with 5 cases. Four lesions required biopsy and histopathological report. Conclusion: A teledentistry platform including digital representations of oral lesions using different digital markers, also associated with a mobile system to provide dental care, constitutes an excellent tool to treat patients that present oral lesions with potential cancer risk.

Objetivo: Contribuir al diagnóstico precoz de lesiones en pacientes mayores, incluyendo lesiones potencialmente malignas o con sospecha de cáncer oral mediante el apoyo de una plataforma de teleodontología basada en la web.Material y Métodos: Este informe contiene información de 27 pacientes con lesiones orales de un total de 135 que recibieron atención odontológica móvil. Los especialistas que participaron en el estudio incluyeron profesionales de las disciplinas de periodoncia, trastornos temporomandibulares, implantología oral, radiología oral, patología oral y geriatría. Las interconsultas se realizaron de forma sincrónica o asincrónica. La información clínica enviada a los especialistas en patología oral involucró una historia clínica y una descripción tradicional de la lesión que consideró tamaño, color, límites, sintomatología, tipo de superficie, consistencia, localización y evolución. Esta información se complementó con una representación tridimensional de la lesión, simu-lando un examen clínico extra/intraoral incluyendo una herramienta marcadora que permite realizar la referenciación anatómica de las lesiones orales. Resultados: Se evaluaron 27 consultas de 26 pacientes por lesiones de patología bucal. Se diagnosticaron 12 lesiones como reactivas, 5 lesiones infecciosas, 4 de etiología vascular, 3 lesiones pigmentadas (tatuaje de amalgama y melanosis por tabaquismo) y 3 lesiones potencialmente malignas. La localización más frecuente fue lengua con 8 casos, seguida de encía y mucosa yugal con 5 casos cada una. Cuatro lesiones requirieron biopsia e informe histopatológico. Conclusión: Una plataforma de teleodontología que incluye representaciones digitales de lesiones orales utilizando diferentes marcadores digitales, también asociada a un sistema móvil para brindar atención odontológica, constituye una excelente herramienta para tratar pacientes que presentan lesiones orales con riesgo potencial de cáncer.

Desigualdades en Salud Bucal para Personas Mayores en Tiempos del COVID-19. La Teleodontología y la Odontología de Mínima Intervención como Caminos de Solución / Oral Health Inequalities for the Elderly in Times of COVID-19. Teledentistry and Minimal Intervention Dentistry as Solution Paths

RESUMEN: Si bien la salud bucal de las personas mayores en Chile y el mundo ya era deficiente, es esperable que los estragos en materia sanitaria, producto de la COVID-19, acentúen este deterioro, particularmente en aquellos con limitaciones cognitivas o funcionales, perpetuando la desigualdad de acceso a la atención odontológica y con ello empeorando su condición de salud bucal y su calidad de vida. La emergente Odontogeriatría debe potenciarse y fortalecerse ante esta verdadera catástrofe sanitaria que se espera ocurra durante y post pandemia. Para ello, no se precisan nuevos desarrollos científicos o tecnológicos, sino la implementación de filosofías y aproximaciones ya disponibles, como son la adopción sistemática de la Teleodontología y de la Odontología de Mínima Intervención (MID). La atención domiciliaria también aparece como una estrategia necesaria ante este nuevo escenario. Este artículo analiza y discute la situación de salud bucal de las personas mayores durante estos complejos tiempos que vive Chile y la humanidad. La pandemia por COVID-19 es una oportunidad única de replantear tanto la práctica clínica como la educación en Odontología, introduciendo nuevos paradigmas, dándole un enfoque de curso de vida e implementando medidas destinadas a corregir las grandes desigualdades con que viven las personas mayores.

ABSTRACT: Although oral health of older people in Chile and the world was already poor, it is expected that the COVID-19 pandemic will increase oral deterioration, particularly in those with cognitive or functional limitations, perpetuating access inequality to dental care and worsening the oral condition and quality of life. Emerging geriatric dentistry should be strengthened in the context of this health catastrophe, expected to occur during and after the pandemic. To face this challenge, no new scientific or technological developments are required, but the implementation of already available philosophies and approaches, such as the systematic adoption of Teledentistry and Minimum Intervention Dentistry (MID). Home care also appears as a necessary strategy in this new scenario. This article analyzes and discusses the oral health situation of older people in these complex times experienced by Chile and the humanity. The COVID-19 pandemic is a unique opportunity to rethink both clinical practice and education in Dentistry, introducing new paradigms, giving it a life course approach and implementing measures aimed at correcting the outrageous inequalities for older people.

The Prevention of Infections in Older Adults: Oral Health.

The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411-416, 2020.

Consideraciones actuales sobre la Estomatología Geriátrica y su importancia para una longevidad saludable / Current considerations on geriatric Dentistry and its importance for a healthy longevity

La humanidad se enfrenta al mayor envejecimiento poblacional de la historia. Los ancianos constituyen el segmento de la población con más rápido crecimiento del mundo, fenómeno que conlleva a un gran desafío. El aumento en la proporción de personas de edad avanzada constituye la transformación demográfica más importante de la sociedad cubana actual, provocando un problema en el campo de la salud y aún más dentro del estomatológico por los recursos humanos y materiales que demanda. La cavidad bucal, por su situación anatómica y por las múltiples funciones que tiene en la vida del hombre, y su exposición permanente a agentes físicos, químicos y biológicos tiene una diferente significación, por lo cual merece la atención médica más cuidadosa, tanto en la prevención como en la detección precoz de cualquier afección. El Programa Nacional de Estomatología en Cuba debe estar preparado para este reto. Se realizó una revisión bibliográfica que tuvo como propósito proporcionar a los estomatólogos información actualizada, necesaria para su desempeño, por ser el adulto mayor un grupo poblacional con características específicas. Hay que recordar que para disfrutar de un alto grado de salud general es necesaria también la salud bucal (AU).

The humanity affronts the bigger population ageing of the history. Aged people are the population segment with a faster growth in the world, a phenomenon involving a great challenge. The increase in the proportion of the advanced age persons is the most important demographic transformation of the present-days Cuban society, causing difficulties in the public health field in general, and even more in the field of Odontology owing to the demand of human and material resources. The oral cavity has an important significance because of its anatomical situation, the multiple functions it has in human life and its permanent exposition to physical, chemical and biological agents; it deserves the most careful medical attention, both in the prevention and in the precocious detection of any affection. The National Odontology Program in Cuba should be ready to affront this challenge. We did a bibliographic review having as a purpose providing dentists with updated information they need for their performance, because elder people are a population group with specific characteristics. It is necessary to remember that to enjoy a high level of general health, oral health is also required (AU).

Geriatric prosthodontic care.

The geriatric population (age 65 and older) is the fastest growing segment nationally and globally. The large population will continue to increase because of baby boomers that have recently turned 65 years old. Within this cohort, there is much diversity in health, socioeconomic levels, education, and health beliefs. There is a decline in edentulism yet still there are oral health conditions that persist with age, such as caries, tooth loss, and increased needs for prosthodontic dental treatment. Several factors should be taken into account in geriatric prosthodontic care, including quality of life and psychosocial needs.

Oral diagnostics: an integral component to geriatric health care.

Aging is inevitable, every day we live we age. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. Oral health reflects overall well being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in age. Diagnosis and proper treatment is essential for healthy aging. Timely diagnosis, appropriate treatment and regular follow-up of both oral and systemic diseases are a prerequisite for active aging. Oral diagnostics is a revolutionary development with high potential to replace other investigative modalities. Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. This paper is aimed to shed light on the growing elderly population and their ailments. It also aims to create awareness among health care providers about oral diagnostics and their application in geriatrics.

Caracterização da saúde bucal de idosos em uma instituição beneficente de longa permanência de João Pessoa-PB, Brasil / Caracterización de la salud bucal de ancianos residentes en una institución benéfica de João Pessoa-PB, Brasil / Characterization of the buccal health of elderly in an beneficent institution of the long stay of João Pessoa-PB, Brazil

Introdução: a população idosa está crescendo em números proporcionais se tornando necessário maior cuidado de sua saúde. O objetivo deste estudo foi descrever a situação epidemiológica do estado de saúde bucal dos idosos na cidade de João Pessoa - PB, Brasil. Métodos: foram analisados 55 idosos em longa permanência na instituição da cidade de João Pessoa. Os idosos foram interrogados sobre o quotidiano e hábitos pessoais e logo foram validadas as condições bucais por um especialista. A avaliação insere a condição dos dentes e a necessidade e o uso da prótese dentária. Foram coletados os dados em um formulário e analisados no SPSS(Chis quadrado ou exato do Fisher). Resultados: se verificou que 16 (29,0 porcento) das pessoas têm 60-70 anos e 39 (71,0 porcento) mais de 70 anos de idade. Estimativas do sexo evidenciaram que 43 (78,2 porcento) são mulheres e 12 (21,8 porcento) são homens. Os idosos reportaram ter marcado a última visita ao dentista ao menos um mês 2 (3,7 porcento), nos últimos 6 meses 4 (7,3 porcento) e mais de um ano 49 (89,0 porcento). A prevaência de edentulismo foi de 35 (63,6 porcento). Outros têm uma média de 6,1 dentes por indivíduo. O uso de prótese geral removível se observou em 40,0 porcento dos idosos e de prótese parcial removível em 9,1 porcento. Um total de 78 porcento dos idosos presissam de algum tipo de prótese dentária. Conclusões: os idosos tratados ficam carentes de atenção odontológica, necessitando reabilitação protética(AU)

Introducción: la población de ancianos está creciendo en números proporcionales, por lo que es necesario mayor cuidado de su salud. El objetivo de este estudio fue describir la situación epidemiológica del estado de salud oral de los ancianos en la ciudad de João Pessoa - PB, Brasil. Métodos: se analizaron un total de 55 ancianos en una larga estancia, en la institución de la ciudad de João Pessoa. Los ancianos fueron interrogados acerca de información personal, los hábitos personales y a continuación, se llevó a cabo la evaluación de condiciones bucales por un solo examinador. La evaluación incluyó la condición de los dientes y la necesidad y el uso de prótesis dental. Se recogieron los datos en un formulario y analizados en SPSS (Qui-cuadrado o exacto de Fisher). Resultados: se verificó que 16 (29,0 por ciento) de las personas tienen 60-70 años y 39 (71,0 por ciento) más de 70 años de edad. En cuanto al sexo, se encontró que 43 (78,2 por ciento) son mujeres y 12 (21,8 por ciento) son hombres. Los acianos reportaron haber realizado la última visita al dentista al menos un mes 2 (3,7 por ciento), en los últimos 6 meses 4 (7,3 por ciento) y más de un año 49 (89,0 por ciento). La prevalencia de edentulismo fue de 35 (63,6 por ciento). Los demás tienen una media de 6,1 dientes por individuo. El uso de prótesis totales removibles se observó en el 40,0 por ciento de los ancianos y de prótesis parciales removibles en 9,1 por ciento. Un total de 78 por ciento de los ancianos necesitan de algún tipo de prótesis dental. Conclusiones: los ancianos evaluados están carentes de atención odontológica, por lo que necesitan de rehabilitación protética(AU)

Introduction: The elderly population is increasing, so it is necessary to pay more attention to their health status. The objective of this study was to describe the epidemiologic situation of the oral health conditions of the older people in João Pessoa-PB, Brazil. Methods: Fifty five aged persons, who were institutionalized in a long-care center in João Pessoa, were studied. They were inquired about personal data, habits, and then the oral conditions were assessed by a single examiner. The evaluation included the tooth conditions, the requirement and the use of dentures. Data were recorded in a form and analyzed by SPSS (Fisher's Chi-square or exact value). Results: It was observed that 16 (29.0 percent) of these people were aged 60-70 years and 39 (71.0 percent) above 70 years. Regarding sex, 43 (78.2 percent) were females and 12 (21.8 percent) males. Two old people reported having gone to the dentist's at least one month ago (3.7 percent); 4 (3.7 percent), did it in the last 6 months and 49 (89.0 percent) over one year ago. Thirty five were edentulous (63.6 percent). The rest had 6.1 teeth per individual as average. The use of complete removable denture was seen in 40 percent of the elderly and of partial removable dentures in 9.1 percent. A total of 78 percent of the studied elderly needs some kind of denture. Conclusions: The evaluated elderly are lacking odontological care, so they require denture rehabilitation(AU)

Approaches to caries prevention and therapy in the elderly.

The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population. This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.

Identification and treatment of the geriatric alcoholic dental patient.

The geriatric alcoholic patient is often difficult to identify because signs of alcoholism are also signs of aging. Often, the elderly abuse alcohol for different reasons than younger individuals do, and these differences can be used for identification of geriatric alcoholics. While alcoholics may have more oral disease than nonalcoholics, most dental treatment of the alcoholic patient does not differ significantly from that for the nonalcoholic. However, the dentist must be aware of damage to the immune system and liver by alcohol, which complicates healing after surgical procedures. The dentist also must be cautious about prescribing postoperative medications to alcoholic and recovering alcoholic patients. Screening tests for alcoholism in the elderly can be used not only to identify problem drinkers, but also to make them aware of their abuse of alcohol. Referral of these patients for rehabilitation therapy is the first step to establishing a sober lifestyle, which often has social and health benefits. Thus, the alert dentist has the opportunity to improve significantly both the oral health and the lifestyle of these patients by careful analysis of the patients' social, as well as, dental needs.

Avaliação nutricional do paciente idoso como parte integrante do tratamento odontogeriátrico / Nutritional evaluation as part of the gerodontic treatment

Atualmente, a melhoria da qualidade de vida somada ao avanço da ciência, vem aumentando a expectativa de vida da população, o que tem alterado o panorama demográfico mundial. O processo de envelhecimento, porém, coincide com uma redução progressiva dos tecidos ativos do organismo e alterações na cavidade bucal ocorrem como reflexo de um desarranjo orgânico geral, muitas vezes de origem nutricional. Assim, cabe ao cirurgião dentista diagnosticar e tratar seu paciente não só do ponto de vista técnico reabilitador mas também por meio de aconselhamento nutricional. Desta maneira, realizou-se uma revisão bibliográfica com o intuito de apresentar ao cirurgião dentista as implicações e os métodos de avaliação nutricional necessários para tornar integral o atendimento odontogeriátrico.

Minimal intervention dentistry: part 1. Strategies for addressing the new caries challenge in older patients.

The aging of the population combined with increased retention of natural teeth into old age means that clinicians now face a new caries challenge in older dentate patients. An increase in the onset of dental caries is evident among patients who may not have had high levels of caries in the past and who may have undergone extensive restorative procedures during their lifetimes. Minimal intervention dentistry (MID), a modern evidence-based approach to caries management in dentate patients, uses the medical model, whereby disease is controlled by the "oral physician" and an affiliated dental team. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials and equipment; and surgical intervention only when required and only after disease has been controlled. This first in a series of 2 articles describes and illustrates oral disease management in geriatric MID, which involves the assessment and management of a diverse range of primary and modifying factors, integrated with an evaluation of the plaque-biofilm interface and the resultant dynamic oral disease process.

Minimal intervention dentistry: part 2. Strategies for addressing restorative challenges in older patients.

Minimal intervention dentistry (MID), a modern, evidence-based approach to caries management in dentate patients, uses a medical model whereby disease is controlled by the "oral physician" and an affiliated dental team. Geriatric MID helps clinicians to address the ever-increasing restorative challenges presented by older patients, including erosion, abrasion, demineralization, rampant coronal and root caries, retained roots, recurrent caries (necessitating crowns and other repairs), subgingival caries, "wet" oral environments, salivary dysfunction, disruptive behaviours, poor compliance with preventive care, high plaque levels, and financial and other restrictions on care options. The main components of a geriatric approach to MID are assessment of the risk of disease, with a focus on early detection and prevention; external and internal remineralization; use of a range of restorations, dental materials, and equipment; and surgical intervention only when required and only after disease has been controlled. This second in a series of 2 articles describes direct restorative strategies to address the challenges of geriatric caries management, including choice of material, placement of glass ionomers, sandwich technique, techniques for the management of erosion and abrasion, tunnel and slot preparations, techniques for "wet" subgingival environments, vital pulp therapy and geriatric atraumatic restorative technique.

Rational dental care: part 1. Has the concept changed in 20 years?

The concept of "rational dental care" was developed 20 years ago when it became clear that idealized treatment plans for frail and functionally dependent older adults were often inappropriate. This first in a series of 2 articles reviews the reasons for developing the concept.

Rational dental care: part 2. A case history.

Treatment planning and managing the care of an elderly, frail patient can be complicated by a variety of modifying factors. To understand the patient"s needs, one must understand the environment in which the patient functions. This second in a series of 2 articles presents a case history of a frail, older adult to illustrate some of the social, medical and community problems that are involved in caring for elderly persons.

O idoso: acessibilidade, conforto e segurança no atendimento odontogeriátrico / The aged people: the access, comfort and security in geriatric dentistry assistance

O presente trabalho verificou que com o envelhecimento da população mundial, o cirurgião-dentista deparou-se com a necessidade de conhecer as condições mais comumente associadas à terceira idade. Desta maneira, o consultório odontológico deverá ser adaptado para se adequar e eliminar todas as barreiras arquitetônicas, tendo em vista as alterações visuais, auditivas e psicomotoras que são adquiridas no decorrer da idade. Projetou-se um consultório odontológico de aproximadamente 40 m², com seis ambientes distribuídos em: sala de espera, sala de atendimento, sala de repouso, copa, banheiro adaptado para o idoso ou deficiente físico, banheiro convencional. Na sala de espera, reservou-se um espaço específico para a acomodação de cadeira de rodas, assim como se preocupou com a iluminação mais adequada e os cuidados em manter o paciente tranqüilo para se submeter ao tratamento odontológico. A disposição da sala de atendimento propicia ao paciente tanto ser atendido na cadeira odontológica como na de rodas. A sala de repouso visa à diminuição do estresse após o tratamento odontológico e também pode ser utilizada como trocador de fraldas geriátricas. Uma copa se faz necessária para a presteza e assistência nos serviços de apoio ao idoso e acompanhantes. O banheiro deverá proporcionar todos os mecanismos para evitar quedas e facilitar a sua utilização pelo paciente. Dentre estas modificações, estão: portas específicas, barras laterais, sifão elevado, área de manobra, espelho inclinado, entre outras.