Atendimento odontológico de pacientes com necessidades especiais na atenção secundária em um estado do nordeste do Brasil / Dental care of special needs patients in secondary care in a northeastern state of Brazil / Atención odontológica a pacientes con necesidades especiales en la atención secundaria en un estado del nordeste de Brasil

O objetivo desse estudo foi descrever a produção dos atendimentos oferecidos aos pacientes com necessidades especiais nos Centros de Especialidades Odontológicas (CEO) da Paraíba (Brasil) e sua relação com o cumprimento das metas de produtividade, entre o período de 2019 e 2022. Trata-se de um estudo descritivo e ecológico em que foram coletados dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), através da captação da produção ambulatorial individualizada (BPA-I), por meio da ferramenta TabWin, dos 98 CEO operantes na Paraíba. Realizou-se análise descritiva e analítica, por meio dos testes Qui-Quadrado de Pearson e Exato de Fisher entre a variável dependente "alcance da meta" e a variável independente "adesão à Rede de Cuidados à Pessoa com Deficiência (RCPD)". Em todos os anos, a porcentagem de CEO cumpridores da meta (15,3% em 2019; 1% em 2020; 12,2% em 2021; e 11,2% em 2022) foi substancialmente menor que os números expressados por aqueles que não alcançaram a produção mínima. Os resultados também apontaram maior realização de procedimentos restauradores (29,6% em 2019; 28,6% em 2020; 32,7% em 2021; e 37,8% em 2022) em detrimento aos periodontais, cirúrgicos e preventivos. No que concerne a estar aderido à RCPD, no ano de 2022, 90,9% dos CEO que alcançaram a meta estavam aderidos à Rede (p<0,05). Concluiu-se que uma baixa frequência de CEO alcançou o cumprimento da meta de produtividade da especialidade de Odontologia para Pacientes com Necessidades Especiais nos CEO. No entanto, a adesão à RCPD manifestou-se como elemento influenciador para aqueles que cumpriram suas metas mensais e anuais.

The objective of this study was to describe the production of care provided to special needs patients in the Dental Specialties Centers (CEO) of Paraíba (Brazil) and its relationship with the achievement of productivity goals, between the period 2019 and 2022. This is a descriptive and ecological study in which secondary data were collected from the SUS Outpatient Information System (SIA/SUS), by capturing the individualized outpatient production (BPA-I), through the TabWin tool, of the 98 operating CEOs in Paraíba. We carried out descriptive and analytical analysis, using Pearson's Chi-square and Fisher's Exact tests between the dependent variable "goal attainment" and the independent variable "adherence to the Care Network for People with Disabilities (RCPD)". In all years, the percentage of CEOs meeting the goal (15.3% in 2019; 1% in 2020; 12.2% in 2021; and 11.2% in 2022) was substantially lower than the numbers expressed by those who did not meet the minimum output. The results also indicated greater performance of restorative procedures (29.6% in 2019; 28.6% in 2020; 32.7% in 2021; and 37.8% in 2022) to the detriment of periodontal, surgical, and preventive procedures. Regarding being adhered to the RCPD, in the year 2022, 90.9% of the CEOs who reached the goal were adhered to the Network (p<0.05). It was concluded that a low frequency of CEOs achieved compliance with the productivity target of the specialty of Dentistry for Special Needs Patients in CEOs. However, adherence to the RCPD manifested itself as an influential element for those who met their monthly and annual goals.

El objetivo de este estudio fue describir la producción de la atención prestada a pacientes con necesidades especiales en los Centros de Especialidades Odontológicas (CEO) de Paraíba (Brasil) y su relación con el alcance de las metas de productividad, entre el período de 2019 y 2022. Se trata de un estudio descriptivo y ecológico en el que se recogieron datos secundarios del Sistema de Información Ambulatoria del SUS (SIA/SUS), mediante la captura de la producción ambulatoria individualizada (BPA-I), a través de la herramienta TabWin, de los 98 CEOs en funcionamiento en Paraíba. Se realizaron análisis descriptivos y analíticos, utilizando las pruebas Chi-cuadrado de Pearson y Exacta de Fisher entre la variable dependiente "cumplimiento de metas" y la variable independiente "adhesión a la Red de Atención a Personas con Discapacidad (RCPD)". En todos los años, el porcentaje de directores generales que cumplieron el objetivo (15,3% en 2019; 1% en 2020; 12,2% en 2021; y 11,2% en 2022) fue sustancialmente inferior a las cifras expresadas por los que no alcanzaron el rendimiento mínimo. Los resultados también indicaron una mayor realización de procedimientos restauradores (29,6% en 2019; 28,6% en 2020; 32,7% en 2021; y 37,8% en 2022) en detrimento de los procedimientos periodontales, quirúrgicos y preventivos. Respecto a estar adherido a la RCPD, en el año 2022, el 90,9% de los CEOs que alcanzaron el objetivo estaban adheridos a la Red (p<0,05). Se concluyó que una baja frecuencia de CEOs alcanzó el cumplimiento de la meta de productividad de la especialidad de Odontología para Pacientes con Necesidades Especiales en CEOs. Sin embargo, la adhesión al RCPD se manifestó como un elemento influyente para aquellos que cumplieron sus objetivos mensuales y anuales.

La Comunicación como Herramienta de Coordinación en las Organizaciones de Formación Clínica Odontológica / Communication as a Coordination Tool in Dental Clinical Training Organizations

El caso de los espacios clínicos odontológicos en Chile, en una primera instancia, deben ser observados como organizaciones altamente complejas y multidimensionales -debido a que dentro de ellas operan y funcionan tres lógicas de funcionamiento, por un lado, la educación formativa de pregrado y posgrado en odontología, la perspectiva de salud producto de las prestaciones que realiza y oferta para el desarrollo de prácticas, aprendizajes y procedimientos odontológicos, por tanto, no tan solo serán espacios organizacionales tradicionales universitarios, sino que más bien serán campos sociales complejo de analizar.

The case of dental clinical spaces in Chile, in the first instance, should be observed as highly complex and multidimensional organizations - because within them operate and function three logics of operation, on the one hand, undergraduate and postgraduate training education in dentistry, the health perspective resulting from the services provided and the offer for the development of dental practices, learning and procedures, therefore, they will not only be traditional university organizational spaces, but rather complex social fields to analyze.

Cumplimiento de las metas de salud bucal para 2015 en un consultorio del médico de la familia / Fulfilment of the oral health goals for 2015 in a Family Physician's Office

RESUMEN Introducción: la epidemiología en salud bucal es fundamental para comprender el impacto de la enfermedad y contribuir con la organización de los servicios de salud. Objetivo: determinar el grado de cumplimiento de las metas de salud bucal propuestas para 2015, en el Consultorio del Médico de la Familia no. 3. Materiales y métodos: se realizó un estudio observacional descriptivo transversal en el Consultorio del Médico de la Familia no. 3, del área Centro del municipio Sancti Spíritus, entre septiembre y noviembre de 2019. El universo estuvo constituido por toda la población del consultorio, y la muestra -150 pacientes- por un muestreo aleatorio simple. Se estudiaron las variables: edad, prevalencia de caries dental, enfermedad periodontal y maloclusiones. Se emplearon métodos empíricos y estadísticos. Resultados: el grupo más afectado resultó el de 60 a 74 años, con un índice CPO-D de 14,12 a expensas de los dientes perdidos. El 71,3 % de la muestra no estuvo enfermo periodontalmente; de los afectados, el grupo de 60 a 74 años mostró una prevalencia del 68 %. El 27 % de la población menor de 19 años presentó algún tipo de anomalía oclusiva, predominando el grupo de 18 años. Solo se incumplió con el porcentaje de población sin afección periodontal (63 % enfermos) respecto a las proyecciones propuestas para el año 2015. Conclusiones: se incumplió con el propósito relacionado con el porcentaje de población sin afección periodontal; el resto de los propósitos fueron cumplidos, incluso superando lo obtenido en la provincia y el país en el año 2015.

ABSTRACT Introduction: epidemiology in oral health is essential to understand the impact of the disease and contribute to the organization of health services. Objective: to determine the degree of fulfilment of the proposed health goals for 2015, in the Family Physician's Office Nr. 3. Materials and methods: a cross-sectional descriptive observational study was conducted in the Family Physician's Office Nr. 3, ot the area Centro of the municipality of Sancti Spiritus, between September and November 2019. The universe was formed by the entire population of the physician's office, and the sample -150 patients- by a simple random sampling. The variables studied were: age, prevalence of dental caries, periodontal disease and malocclusions. Empiric and statistical methods were used. Results: the most affected group was the 60 to 74-year-old age group, with a COP-D index of 14.12 at the expense of the lost teeth. 71.3 % of the sample did not have periodontal disease. Of those affected, the age group aged 60 to 74 years showed a prevalence of 68 %. 27 % of the population under 19 years had some kind of occlusive anomaly, predominating the 18-year-old age group. Only the percentage of population with without periodontal disease (63 % sick) was not accomplished with respect to the projections for 2015. Conclusions: it was no accomplished the purpose related to the percentage of population without periodontal disease; the rest of the purposes were achieved, even surpassing the achievements in the province and the country in 2015.

Laser dentistry in daily practice during the COVID-19 pandemic: Benefits, risks and recommendations for safe treatments.

The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue­matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.

Repercussões da epidemia de COVID-19 nos atendimentos odontológicos de urgência do Sistema Único de Saúde em Piracicaba, 2020 / Repercusiones de la epidemia de COVID-19 en la atención odontológica de emergencia del Sistema Único de Salud en Piracicaba, Brasil, 2020 / Repercussions of the COVID-19 epidemic on Brazilian National Health System urgent dental care in Piracicaba, Brazil, 2020

Objetivo: Avaliar as repercussões da pandemia de COVID-19 nos procedimentos realizados por um serviço público odontológico de urgência (SPOU). Métodos: Estudo transversal, utilizando-se dados do SPOU de Piracicaba, SP, Brasil, relativos a dois períodos, anterior (fevereiro e março de 2020) e durante a pandemia (março e abril de 2020). Diferenças no perfil de atendimentos, entre os períodos pré-COVID-19 e COVID-19 selecionados, de acordo com sexo, idade e procedimentos odontológicos, foram analisadas pelo teste qui-quadrado de Pearson. Também foi calculado o tamanho do efeito Cramer's V. Resultados: Houve redução de 51% no número de atendimentos, entre o período anterior (n=824) e o período da pandemia de COVID-19 observado (n=404). O percentual de exodontias reduziu-se, de 14,7 para 8,9%, enquanto o de selamento provisório de cavidades aumentou de 22,9 para 33,2%, entre ambos períodos. Conclusão: A pandemia de COVID-19 repercutiu na quantidade e no padrão de procedimentos realizados pelo serviço odontológico de urgência do município.

Objetivo: Evaluar el impacto de la pandemia COVID-19 en los procedimientos realizados por un servicio de odontología pública de emergencia (SOPE). Métodos: Estudio transversal, utilizando datos del SOPE de Piracicaba, SP, Brasil, para los períodos anteriores (febrero y marzo 2020) y durante la pandemia (marzo y abril 2020). Las diferencias en el perfil de atención entre los períodos Pre-COVID-19 y COVID-19, según sexo, edad y procedimientos dentales, se analizaron mediante la prueba Chi-cuadrado de Pearson. También se calculó el tamaño del efecto de Cramer V. Resultados: Hubo una reducción del 51% en el número de visitas entre el período anterior (n=824) y el período de la pandemia de COVID-19 (n=404). El porcentaje de extracciones se redujo del 14,7% al 8,9%, mientras que el porcentaje de sellado provisional de cavidades aumentó del 22,9% al 33,2%, entre estos períodos. Conclusión: La pandemia de COVID-19 afectó la cantidad y patrón de procedimientos realizados en el servicio de odontología de emergencia de la ciudad.

Objective: To evaluate the repercussions of the COVID-19 pandemic on procedures performed by a public urgent dental care service (PUDS). Methods: This was a cross-sectional study, using data from the PUDS in Piracicaba, SP, Brazil, prior to the pandemic (February-March 2020) and during the pandemic (March-April 2020). Differences in the care profile between the pre-COVID-19 period and the COVID-19 period, according to sex, age and dental procedures were analyzed using Pearson's Chi-square test. Effect size was also measured using Cramer's V. Results: There was a 51% reduction in the number of visits between the pre-COVID-19 period (n=824) and the COVID-19 period (n=404). The percentage of extractions reduced from 14.7% to 8.9%, while the percentage of temporary cavity fillings increased from 22.9% to 33.2%, between the two periods. Conclusion: The COVID-19 pandemic had repercussions on the amount and pattern of procedures performed at the city's urgent dental care service.

Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model.

OBJECTIVES: Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS: We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS: Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION: Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.

[Oral care and the Coronavirus COVID-19 epidemic]. / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

[Oral care and the Coronavirus COVID-19 epidemic] / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

Setting up and maximising the usage of an Urgent Dental Care Centre in Blackpool. Sharing our experiences.

An integrated Urgent Dental Care Centre with Tier 2 Oral Surgery support was set up in Blackpool starting 24th March 2020. This was in reaction to the COVID-19 pandemic. In the first month 1433 patients had telephone consultations and 713 extractions were performed. The challenges surrounding set up and continuity of care are discussed.

Health Care for Refugee and Immigrant Adolescents.

This article describes the current scope of immigration to the United States, defines the different categories of immigrants, and describes the Centers for Disease Control and Prevention-mandated overseas and postarrival medical assessment of adolescent refugees. Guidelines for primary care physicians who care for refugee youth are provided, including diagnosis and treatment of common medical and mental health conditions. Special considerations in caring for this vulnerable population include acknowledging prior traumas, acculturation and challenges to education such as bullying, and adjustment to a new health care system that emphasizes preventive care in addition to curative medical care.

Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England.

BACKGROUND: To help promote a flexible and sustainable workforce in dentistry, it is necessary to access accurate and timely data about the structure and nature of the evolving dental team. This paper considers the results and learning from a region-wide dental workforce survey conducted in one area of Health Education England and how the team has changed since the last survey a decade earlier. METHODS: A mixed-methods approach comprised two phases. In Phase 1 a customised workforce questionnaire was sent to all dental practices registered with the Care Quality Commission in the North East of England and North Cumbria in March 2016. Findings then informed Phase 2, a regional symposium held in October 2016, where interactive workshops generated qualitative data that elaborated on factors influencing workforce development. RESULTS: Of 431 primary dental care practices identified, 228 questionnaires were returned - a 53% response rate. The largest professional groups were dental nurses (n = 1269, 53% by headcount; 50% of fte) and dentists (34% by headcount; 42% by fte), though there had been increases in numbers of all staff groups over the decade, which was most marked for dental therapists (from 1 per 39 dentists to 1 per 8 dentists). The dental team predominantly fell into 'younger' age groups (< 46 years age), with evidence of a significant increase in the number of dentists reporting part-time working in a practice since the last survey. Around one third of dental practices reported employing dental nurses with additional skills (n = 74, 32.5%) or dental therapists (n = 73, 32%), and nearly half employed a dental hygienist (n = 104, 46%). However, there was considerable variability in whether these staff actually carried out the range of skills within their scope of practice. Factors shaping workforce development were identified as, the national context, loss of expertise, patients' health needs and expectations, surgery premises and financial constraints. CONCLUSIONS: The composition and work patterns of the primary care dental workforce have changed markedly over the last decade, though utilisation of skill-mix continues to be constrained. Consideration of factors determining career progression of dentists and dental care professionals is needed to optimise a sustainable future workforce.

Determinación de la simbología más utilizada en expedientes odontológicos en Costa Rica en el año 2019 con fines de identificación de seres humanos / Determination of the most common symbology used in dental records in Costa Rica in 2019 for identification of human beings

Resumen Introducción: El objetivo de la investigación fue establecer cuál es la simbología utilizada por los profesionales en odontología para documentar los hallazgos odontológicos más comunes en sus expedientes; con la finalidad de incluirla en un formato único odontológico estandarizado con fines de identificación en Costa Rica. Materiales y métodos: Mediante un cuestionario se identificó y comparó la simbología utilizada por profesionales en odontología generales y especialistas para registrar los hallazgos odontológicos en sus expedientes. Se realizó una fase piloto con 8 cuestionarios y posterior a las correcciones se aplicó a una muestra de 49 odontólogos que incluyó a profesionales en odontología generales y de todas las especialidades. Las técnicas estadísticas utilizadas para el análisis de la información recolectada en las encuestas son las distribuciones de frecuencia, cruce de variables, comparación de medias con base en el análisis de variancia. El nivel mínimo de confianza para las comparaciones fue del 95%. El procesamiento estadístico de los datos se diseñó una base de datos creada en EPI-INFO 6.4, el procesamiento estadístico de los datos se realizó en SPSS versión 13.0 y en Excel. Resultados: De los 49 participantes, 56% fueron hombres y 44% mujeres. La edad varía entre 25 y 65 años; la edad promedio fue de 44,5 años (IC 95%: 41,7 - 47,3) y una edad mediana [1] de 43 años, la cual no tuvo diferencia estadísticamente significativa (p = 0,552) entre la edad promedio entre los hombres y mujeres. El 70% de los odontólogos usan expediente físico, mientras que sólo un 17% usan expediente digital, y el 13% usan ambos; en el expediente digital es en el que se presenta la mayoría de problemas con un 62,5 %, en comparación al físico que tiene una prevalencia de 36,4% donde el principal problema es que no se comprendió la letra en un 86,7%. Conclusiones: El examen clínico odontológico es de extrema utilidad para colaborar en el proceso de identificación de víctimas mortales, sin embargo, se logró identificar, que no todos los profesionales en odontología en Costa Rica realizan una adecuada documentación en sus expedientes clínicos. Se propone una simbología estandararizada para dicha documentación.

Abstract Introduction: The objective of the research was to establish what is the symbology used by dentistry professionals to document the most common dental findings in their records; with the purpose of including it in a single standardized dental format for identification purposes in Costa Rica. Materials and methods: Through a questionnaire the symbology used by general dentists and specialists was identified and compared to record the dental findings in their files. A pilot phase with 8 questionnaires was carried out and after the corrections, it was applied to a sample of 49 dentists that included general and all specialties dentists. The statistical techniques used for the analysis of the information collected in the surveys are frequency distributions, crossing of variables, comparison of means based on the analysis of variance. The minimum level of confidence for the comparisons was 95%. The statistical processing of the data was designed a database created in EPI-INFO 6.4, the statistical processing of the data was performed in SPSS version 13.0 and in Excel. Results: The sample was conformed by 49 participants, 56% were men and 44% women. The age varies between 25 and 65 years; the average age was 44.5 years (95% CI: 41.7 - 47.3) and a median age [1] of 43 years, which had no statistically significant difference (p = 0.552) between the average age between men and women. A 70% of dentists use physical records, while only 17% use digital records, and 13% use both; digital files present the majority of problems with 62.5%, compared to the written format who has a prevalence of 36.4% where the main problem is that the letter was not understood in an 86.7 %. Conclusions: Dental records are extremely useful to collaborate in the process of human identification in fatalities; however, it was possible to identify that not all dental professionals in Costa Rica make adequate documentation in their clinical records. A standardized symbology is proposed for such documentation.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial.

BACKGROUND: This study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient's mouth). METHODS: A multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models. RESULTS: A total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up. CONCLUSIONS: Although a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy. TRIAL REGISTRATION: ISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.

COVID-19: Perspectives for the management of dental care and education

Abstract The rapid and abrupt transmission pattern of the SARS-CoV-2 unleashed the current COVID-19 pandemic, as recognized by the World Health Organization in March 2020. Considering the high risk of transmission of the virus in dental environments and the specificities in clinical practice, COVID-19 posed immediate challenges for dental care and education. Due to the need to establish infection prevention and control guidance in dental health settings to enable a safe clinical practice, this review aims to list the challenges and perspectives in managing dental care in services and schools. This review employed materials collected from PubMed and the main guidelines and studies on the novel coronavirus to provide an overview of the clinical procedures and decisions made by health care personnel in dental offices and dental schools. We expect the COVID-19 scenario to promote significant changes in clinical practice and dental education; dentists should seek specific and particular regulations for dental practice established by their state or country. Biosafety checklists are strongly recommended for appointments at dental services and face-to-face activities in dental schools.

COVID-19 y el nuevo rol del odontólogo en el equipo de salud / COVID-19 and the dentist's new role in the health team

El COVID-19 es un tipo de coronavirus que ha provocado la emergencia sanitaria más grande de los últimos años. Mayoritariamente genera cuadros leves, cuyos signos y síntomas son fiebre, tos y disnea, pero también produce cuadros severos, que conllevan a neumonía y la muerte del paciente. Debido a su alta tasa de contagiosidad, ha colapsado los sistemas de salud en países como Estados Unidos, España e Italia, lo que finalmente se traduce en mayor cantidad de muertes. Las condiciones propias de la atención dental elevan exponencialmente el riesgo de contagio y expansión de la enfermedad, por lo que se ha recomendado suspender las atenciones odontológicas electivas, dejando al odontólogo al margen de la situación sanitaria. El odontólogo tiene en su formación, una base médica que le permitiría, en situaciones de urgencia, ser capacitado y redistribuido según sus competencias y experiencia, a distintos roles dentro del equipo de salud, permitiendo maximizar el rendimiento y efectividad del sistema de salud, ayudando a descongestionarlo y permitiendo salvar vidas.

COVID-19 is a type of coronavirus that has generated the largest health emergency in recent years. It generates mainly mild symptoms, such as fever, cough, and dyspnea. Nevertheless, it also produces severe results, which could lead to pneumonia and finally, death. Due to its high contagiousness rate, it has collapsed different health systems in developed countries such as the United States, Spain and Italy, which translates into more deaths. The conditions of dental care exponentially increase the risk of contagion and expansion of the disease, which is why it has been recommended to suspend elective dental care, leaving the dentist outside the health situation. Dentists have a medical training that allows them to be trained and redistributed, according to their competences and experiences, to different roles within the health team. Consequently, it would allow to maximize the performance and effectiveness of the health system, by helping to decongest it and as a result, to save lives.

Desafíos de la Odontología Frente a la Pandemia del COVID-19 / Challenges of Dentistry in the Face of the Covid-19 Pandemic

RESUMEN: La emergencia sanitaria mundial, originada debido a la Pandemia del Covid -19, ha modificado nuestras costumbres y ha desnudado las carencias de un fragmentado sistema de salud en latinoamérica. Es crucial en estos momentos, para preservar la odontología y el bienestar de los pacientes, que a través de los ministerios de salud y colegios profesionales se tomen medidas de emergencia para ayudar al odontólogo con los altos costos de mantener la seguridad del personal y la de los pacientes en su práctica profesional.

ABSTRACT: The worlwide sanitary emergency caused by the Covid-19 Pandemy, has modified our costums and has showed big deficiencies in the latinoamerican health system. At present time, is crucial for the dentistry field and patients, that through the goverment Health Ministeries and Professionals organisms, emergency meausures be taken to help the dentist with the high cost of keeping the security of his personnel and patients in the dental practice during this pandemy.