Asociación entre el acceso a los servicios odontológicos y la altitud de la residencia de niños peruanos

Introducción: El acceso a servicios odontológicos es importante para garantizar una adecuada salud bucal. Por ello, es importante evaluar las barreras geográficas que pueden repercutir en el acceso, como la altitud. Objetivo: Determinar la asociación entre el acceso a los servicios odontológicos y la altitud de residencia de los niños menores de 12 años en Perú, 2019. Métodos: El estudio fue de tipo transversal con una muestra de 42 350 registros de niños menores de 12 años. Las variables fueron acceso a la atención odontológica, tiempo de la atención odontológica, lugar de la atención odontológica, altitud, región, área de residencia, lugar de residencia, región natural, seguro de salud, índice de riqueza, sexo y edad. Se realizó un análisis descriptivo y bivariado con la prueba de chi cuadrado. Los resultados pasaron por un análisis multivariado mediante la regresión de Poisson para obtener las razones de prevalencia y razones de prevalencia ajustadas. Se contó con un nivel de confianza de 95 por ciento y un p < 0,05. Resultados: Se encontró que la altitud estuvo vinculada con el acceso a la atención odontológica (RP = 1,15; IC95 por ciento:1,12 - 1,18; p < 0,001), también cuando se consideran las variables área de residencia, lugar de residencia, región natural, seguro de salud, índice de riqueza, sexo y edad (RPa = 1,10; IC95 por ciento: ºº1,04 - 1,16; p < 0,001). Conclusiones: En 2019, los niños peruanos menores de 12 años, que viven a más de 2500 msnm, tuvieron mayor probabilidad de recibir una atención odontológica en los últimos 2 años(AU)

Introduction: Access to dental services is important to guarantee adequate oral health. Therefore, it is important to assess the geographical barriers that may affect access, such as altitude. Objective: To determine the association between access to dental services and the altitude of residence of children under 12 years of age in Peru, 2019. Methods: The study was a cross-sectional with a sample of 42,350 records of children under 12 years of age. The variables were access to dental care, time of dental care, place of dental care, altitude, region, area of residence, place of residence, natural region, health insurance, wealth index, sex and age. A descriptive and bivariate analysis was performed with the chi square test. The results underwent multivariate analysis using Poisson regression to obtain prevalence ratios and adjusted prevalence ratios. There was a confidence level of 95 percent and p < 0.05. Results: It was found that altitude was linked to access to dental care (PR = 1.15; 95 percent CI: 1.12 - 1.18; p < 0.001), it was also found when considering the variables area of residence, place of residence, natural region, health insurance, wealth index, sex and age (RPa = 1.10; 95 percent CI: ºº1.04 - 1.16; p < 0.001). Conclusions: In 2019, Peruvian children under 12 years, living at more than 2500 masl, were more likely to receive dental care in the last 2 years(AU)

The role of primary dental care practitioners in the long-term management of patients treated for head and neck cancer.

Patients treated for head and neck cancer may be susceptible to a higher incidence of dental disease due to long-term sequelae of treatment for head and neck cancer. Most patients with head and neck cancer are discharged from a hospital environment and responsibility for long-term dental care is transferred back from the restorative dentistry team to the dentist and dental care professionals in primary care. Treatment of these patients should be undertaken in a supportive environment, taking into account the physical and psychological repercussions of previous treatment. With the exception of some surgical procedures, routine dental care is not contraindicated in patients after head and neck cancer treatment and it is expected that the dentist and dental care professionals will be responsible for long-term routine dental treatment. Primary dental care practitioners should be aware of the process to refer patients back to the head and neck cancer multidisciplinary team if they note a suspicious change during their routine clinical examinations. Referral to a restorative dentistry consultant for planning and carrying out complex items of care may sometimes be necessary, but patients should always remain under the long-term care of their primary dental care practitioner.

Tego: a new concept of teledentistry for the elderly through a web platform and mobile app in the context of the covid-19 pandemic / Tego: un nuevo concepto de teleodontología para adultos mayores a través de una plataforma web y aplicación móvil en el contexto de la pandemia del covid-19

Objective: To develop a new concept of teledentistry for the elderly through a web platform and associated mobile application in the context of the COVID-19 pandemic. Material and Methods: A new concept for attention via teledentistry of the elderly supported by the web platform/app TEGO (Acronym for Tele-platform of Geriatric and Dental Specialties in Spanish) was developed. Priority and urgent dental care for elderly patients in the context of the COVID-19 pandemic was provided onboard a mobile dental clinic equipped with all the necessary conventional dental care facilities as well as state-of-the-art digital technology. Dental care was carried out in five cities of Chile. For the study, 135 elderly patients were treated. The tele-dental care model includes visit-appointment and remote interconsultation with a staff of specialists. To evaluate patient satisfaction aspects, regarding the service / care provided, a user satisfaction survey was applied. Results: A total of 68 questionnaires were completed by patients. The results showed high levels of patients' satisfaction after the priority or urgent dental care, which reached above 75% in all dimensions of the questionnaire (Access to dental care, user treatment, platform, recommendation). Conclusion: The generation of a technological ecosystem for teledentistry can provide a series of important advantages in the attention of elderly patients, by optimizing the dental care coverage by different specialists who can provide attention to a population that has limited or no access to them.

Objetivo: Desarrollar un nuevo concepto de teleodon-tología para adultos mayores a través de una plataforma web y aplicación móvil asociada en el contexto de la pandemia de COVID-19. Material y Métodos: Se desarrolló un nuevo concepto de atención vía teleodontología del adulto mayor apoyado en la plataforma/app web TEGO (Teleplataforma de Especialidades Geriatricas y Odontológicas). La atención dental prioritaria y urgente para pacientes de edad avanzada en el contexto de la pandemia de COVID-19 se brindó a bordo de una clínica dental móvil equipada con todas las instalaciones de atención dental convencional necesarias, así como con tecnología digital de última generación. La atención odontológica se realizó en cinco ciudades de Chile. Para el estudio, 135 pacientes de edad avanzada fueron atendidos. El modelo de atención teledental incluye visita-cita e inter-consulta remota con un staff de especialistas. Para evaluar los aspectos de satisfacción del paciente, respecto al servicio/atención brindada, se aplicó una encuesta de satisfacción del usuario. Resultados: Los pacientes completaron un total de 68 cuestionarios. Los resultados mostraron altos niveles de satisfacción de los pacientes tras la atención odontológica prioritaria o urgente, que superó el 75% en todas las dimensiones del cuestionario (Acceso a la atención odontológica, trato al usuario, plataforma, recomendación). Conclusión: La generación de un ecosistema tecnológico para la teleodontología puede brindar una serie de ventajas importantes en la atención de pacientes adultos mayores, al optimizar la cobertura de atención odontológica por parte de diferentes especialistas que pueden brindar atención a una población que tiene acceso limitado o nulo.

Analysis of clinical indicators of teledentistry management for the elderly population during the covid-19 pandemic in Chile / Análisis de indicadores clínicos del manejo de la teleodontología para la población adulta mayor durante la pandemia del covid-19 en Chile

Objective: To analyze clinical indicators of teledentistry management for the elderly population during the COVID-19 pandemic in Chile. Material and Methods:A pilot teledentistry project was developed for dental care of the elderly in 5 regions of Chile. The data obtained were recorded on the TEGO Platform to be subsequently selected and analyzed by the researchers in terms of clinical management indicators: degree of installed occupancy, degree of available occupation, degree of real occupation, interconsultation indicator per patient attended, urgencies according to reason for consultations, unpostponable prosthetic treatment according to reason for consultations, prevention in relation to granted benefits, prevention in relation to the patients cared for, and project absenteeism indicator. Results: The clinical management indicators obtained were as follows: The average degree of installed occupancy was 67%. The average degree of available occupancy was 78%, which accounts for the clinical time in which there are dental chairs and dentists willing to work. The average real occupancy degree was 86%. The average interconsultation indicator per patient observed was 25%. The indicator of urgencies according to the reason for the consultation was 95%, which indicates that the purpose of the study was fulfilled. The average unpostponable prosthetic treatment according to the reason for consultations was 5%. The prevention in relation to granted benefits reached 39%. Finally, the average indicator of absenteeism was 17%. Conclusion: The measurement of clinical management indicators contributes to meet the Chilean Ministry of Health Explicit Health Guarantees (GES), which are: Access, Timely Attention, Quality and Financial Protection.

Objetivo: Analizar indicadores clínicos del manejo de la teleodontología para la población de adultos mayores durante la pandemia de COVID-19 en Chile. Material y Métodos: Se desarrolló un proyecto piloto de teleodontología para la atención odontológica del adulto mayor en cinco regiones de Chile. Los datos obtenidos fueron registrados en la plataforma TEGO para ser posteriormente seleccionados y analizados por los investigadores en cuanto a indicadores de gestión clínica: grado de ocupación instalada, grado de ocupación disponible, grado de ocupación real, indicador de interconsulta por paciente atendido, urgencias según motivo por consultas, tratamiento protésico improrrogable según motivo de consultas, prevención en relación a las prestaciones otorgadas, prevención en relación a los pacientes atendidos e indicador de ausentismo del proyecto. Resultados: Los indicadores de gestión clínica obtenidos fueron los siguientes: El grado medio de ocupación instalada fue del 67%. El grado medio de ocupación disponible fue del 78%, lo que da cuenta del tiempo clínico en el que hay sillones dentales y odontólogos dispuestos a trabajar. El grado de ocupación real promedio fue del 86%. El indicador medio de interconsultas por paciente observado fue del 25%. El indicador de urgencias según el motivo de la consulta fue del 95%, lo que indica que se cumplió con el propósito del estudio. El promedio de tratamientos protésicos impostergables según el motivo de consulta fue del 5%. La prevención en relación a las prestaciones otorgadas alcanzó el 39%. Finalmente, el indicador promedio de ausentismo fue de 17%. Conclusión: La medición de indicadores de gestión clínica contribuye a cumplir con las Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile, que son: Acceso, Oportunidad, Calidad y Protección Financiera.

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.

Oral health in Brazil: What were the dental procedures performed in Primary Health Care?

This cross-sectional study aims to describe the primary dental care procedures performed by Oral Health Teams (OHTs), adhering to the third cycle of the "National Program for Improving Access and Quality of Primary Care" (PMAQ-AB) in Brazil. A descriptive analysis was performed through 26 dental procedures, including spontaneous, preventive, restorative/prosthetic and surgical procedures, and actions of cancer monitoring. Each conducted procedure assigned a score to the OHT, the final score being the sum of the number of procedures performed by the OHTs. These scores were then compared among the geographic regions of the country. Most OHTs perform basic dental procedures, such as supragingival scaling, root planning and coronal polishing (98.1%), composite filling (99.0%), and permanent tooth extraction (98.6%). The frequency related to dental prosthesis and monitoring of oral cancer decreased. Only 12.9% of the OHTs carries out biopsies, 30.9% monitor patients undergoing biopsy, 15.1% carry out impression for prostheses, and 13.6% carry out prostheses' installation. The scores reveal that OHT's performed, on average, 19.45 (±3.16) dental procedures. The OHTs in the South, Southeast, and Northeast had a higher number of primary dental procedures, while the teams in the North and Midwest performed, on average, fewer procedures. The Brazilian regions with the highest dental need have the lowest number of dental procedures. It is necessary to increase the range of procedures offered by OHT and reduce regional inequalities, adapting to the needs of the population in order to achieve comprehensive oral health.

Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Urgência e emergência clínico-cirúrgica odontológica na atenção primária / Urgency and clinical-surgical dental emergency in primary care

Atenção Primária em Saúde Bucal é um assunto abrangente que aborda desde a atuação da equipe de saúde bucal, passando por medidas de prevenção e controle em tempos de pandemia, atenção à gestante e pré-natal, à saúde da pessoa idosa, a doenças crônicas, pacientes com HIV/AIDS e hepáticas virais, pessoas com deficiência e câncer de boca, emergências e urgências odontológicas. Cada profissional da equipe de saúde bucal tem suas próprias competências e atribuições, e a equipe como um todo tem um amplo campo de atuação na atenção primária à saúde bucal. As medidas preventivas e de controle incluem cuidados com pacientes e profissionais, higiene das mãos, limpeza e desinfecção de superfícies e materiais odontológicos. A atenção à gestante e ao pré-natal inclui acompanhamento dos cuidados com a cavidade oral durante a gestação e prevenção de doenças como gengivite gravídica e granuloma gravídico. A atenção à saúde da pessoa idosa destaca a importância da saúde bucal para a qualidade de vida deste grupo. A atenção especial às doenças crônicas inclui hipertensão arterial e diabetes, e a atenção a pacientes com HIV/AIDS e hepáticas virais destaca a importância do acompanhamento bucal nestes casos. As emergências e urgências odontológicas são definidas pela American Dental Association e incluem alterações na consciência e respiração.

Oral Health Primary Care is a comprehensive subject that covers the performance of the oral health team, including measures for prevention and control during pandemics, care for pregnant and prenatal women, elderly health, chronic diseases, patients with HIV/AIDS and viral hepatitis, people with disabilities, and oral cancer, as well as dental emergencies and urgencies. Each member of the oral health team has their own competencies and responsibilities, and the team as a whole has a broad field of action in oral health primary care. Preventive and control measures include patient and professional care, hand hygiene, cleaning and disinfection of surfaces and dental materials. Care for pregnant and prenatal women includes monitoring oral cavity care during pregnancy and prevention of diseases such as pregnancy gingivitis and pregnancy granuloma. Attention to elderly health highlights the importance of oral health for the quality of life of this group. Special attention to chronic diseases includes hypertension and diabetes, and attention to patients with HIV/AIDS and viral hepatitis emphasizes the importance of oral health follow-up in these cases. Dental emergencies and urgencies are defined by the American Dental Association and include changes in consciousness and breathing.

La Atención Primaria en Salud Bucal es un tema amplio que abarca desde la actuación del equipo de salud bucal, pasando por medidas de prevención y control en tiempos de pandemia, atención a la gestante y pre-natal, la salud de la persona mayor, las enfermedades crónicas, pacientes con VIH / SIDA y hepatitis víricas, personas con discapacidad y cáncer de boca, emergencias y urgencias odontológicas. Cada profesional del equipo de salud bucal tiene sus propias competencias y responsabilidades, y el equipo en su conjunto tiene un amplio campo de actuación en la atención primaria a la salud bucal. Las medidas preventivas y de control incluyen cuidados con pacientes y profesionales, higiene de manos, limpieza y desinfección de superficies y materiales odontológicos. La atención a la gestante y el pre-natal incluye el seguimiento de los cuidados con la cavidad oral durante el embarazo y prevención de enfermedades como la gingivitis gravídica y el granuloma gravídico. La atención a la salud de la persona mayor destaca la importancia de la salud bucal para la calidad de vida de este grupo. La atención especial a las enfermedades crónicas incluye hipertensión arterial y diabetes, y la atención a pacientes con VIH / SIDA y hepatitis víricas destaca la importancia del seguimiento bucal en estos casos. Las emergencias y urgencias odontológicas se definen por la Asociación Dental Americana e incluyen cambios en la conciencia y la respiración.

Comparación del desempeño técnico-asistencial en programas escolares con diferentes modalidades de implementación / Comparison of technical-assisstance performance in school programs with different implementation modalities

Se comparó el desempeño técnico-asistencial de 2 programas de atención odontológica con iguales protocolos de atención y diferente modalidad de implementación. Ambos programas se caracterizaron por un perfil preventivo-promocional; uso de protocolos validados según riesgo biológico, atención odontológica adaptada a sedes no convencionales, recursos asignados por método de necesidades; ejecución por recurso humano pre-profesional supervisado y modulación por altas. La modalidad de implementación difirió en la densidad/concentración de las actividades realizadas: en el Programa Extensivo (PE) las acciones se implementaron con frecuencia semanal; en el Programa Intensivo (PI) las acciones se concentraron en una semana en el año. Cobertura anual: PE = 120 escolares de 6 a 9 años de edad; PI = 180 escolares y preescolares de 3 a 12 años de edad. Se midió la cantidad de prestaciones, sesiones y tiempo -en minutos- hasta alcanzar el Alta Básica Operativa (ABO). Para comparar grupos (PI y PE) se utilizaron los tests: U de Mann Whitney, t de Student para mues-tras independientes, chi cuadrado y comparación de proporciones. La razón de prestaciones/sesión fue significativamente mayor (p=0,000) en el programa intensivo. El número de prestaciones hasta el alta (ABO) y la razón tiempo/sesión no mostraron diferencias entre programas (p=0,8 p=0,087), mientras que se evidenció una mayor razón tiempo/prestación y tiempo en alcanzar el alta (ABO) en la modalidad extensiva (p=0,000). La modalidad intensiva mostró mayor eficiencia en el desempeño técnico asistencial que la extensiva (AU)

Aim: To compare technical-care performance of 2 dental care programs with the same care protocols and different implementation modalities. Both programs shared the following features: preventive-promotional profile; use of validated clinical protocols according to biological risk, dental care adapted to non-conventional settings, allocation of resources by needs method; supervised pre-professional human resource and modulation by discharges. The implementation mode differed in the density/concentration of the activities: in the extensive program (EP) the actions were implemented on a weekly basis along the year; in the intensive program (IP) the actions were concentrated in one week in the year. Annual coverage of the programs: 180 schoolchildren and preschoolers (3 -12 years old); EP = 120 schoolchildren (6 - 9 years old). We measured the following variables: the number of dental services performed, the number of sessions and the time, in minutes, to reach the basic operating discharge (BOD). We used the following tests to compare groups (IP and EP): Mann Whitney U; Student's t for independent samples, chi square and comparison of proportions test. The action per session ratio was significantly higher (p=0.000) in the intensive program. The number of actions performed until discharge (BOD) and the time per session ratio did not show differences between programs (p=0.8 p=0.087). In the extensive mode, compared to intensive mode, it took longer to reach discharge (BOD) (p=0.000) The program implemented with intensive modality (PI) showed greater efficiency regarding technical-care performance when compared to the extensive mode (AU)

Evaluación de la calidad del servicio de Prótesis Estomatológica, centrada en el liderazgo / Assessment of dental prosthesis quality service focused on leadership

RESUMEN Fundamento: Para lograr la calidad en los servicios estomatológicos se realizan investigaciones sobre su evaluación. Las definiciones entre los autores son variadas en dependencia de la importancia otorgada a diferentes dimensiones. Hasta el momento no se ha encontrado una propuesta que favorezca el protagonismo de los líderes. Objetivo: Diseñar una metodología para la evaluación de la calidad del servicio de Prótesis Estomatológica centrada en el liderazgo en clínicas estomatológicas municipales. Metodología: Se emplearon métodos teóricos y empíricos. Con el análisis de los documentos que rigen el proceso de evaluación de la calidad se identificaron las dimensiones priorizadas y los aspectos que se deben considerar en la elaboración de la propuesta. Resultados: La metodología se estructuró a partir de las siguientes etapas: planificación y organización, recolección de la información y ejecución y control del proceso y para cada una de ellas se establecieron los procedimientos que se deben seguir para realizar una evaluación sistemática y alcanzar la calidad del servicio. Conclusiones: Se diseñó una metodología para la evaluación de la calidad de los servicios de Prótesis Estomatológica centrada en el liderazgo y estructurada en tres etapas.

ABSTRACT Background: In order to achieve dental quality service, some researches on its evaluation is conducted. Definitions among authors are diverse depending on the importance given to unlike scopes. So far, no proposal has been found that favors the leaders´ protagonism. Objective: To design a methodology for the assessment of dental Prosthesis quality service focused on leadership in municipal dental clinics. Methodology: Theoretical and empirical methods were used. Though the documents´ enquiry that rule the quality evaluation process, highlighted dimensions and aspects to be considered in the proposal production were identified. Results: The methodology was structured on the basis of the following stages: planning and organization, information gathering, execution and process control, also the procedures to be followed to conduct a systematic assessment and achieve quality service were established. Conclusions: A methodology for the evaluation of dental prosthesis quality services focused on leadership and structured in three stages was designed.

Toxicity Assessment of Long-Term Exposure to Non-Thermal Plasma Activated Water in Mice.

Non-thermal plasma activated water (PAW) has recently emerged as a powerful antimicrobial agent. Despite numerous potential bio-medical applications, studies concerning toxicity in live animals, especially after long-term exposure, are scarce. Our study aimed to assess the effects of long-term watering with PAW on the health of CD1 mice. PAW was prepared from distilled water with a GlidArc reactor according to a previously published protocol. The pH was 2.78. The mice received PAW (experimental group) or tap water (control group) daily for 90 days as the sole water source. After 90 days, the following investigations were performed on the euthanatized animals: gross necropsy, teeth mineral composition, histopathology, immunohistochemistry, hematology, blood biochemistry, methemoglobin level and cytokine profile. Mice tolerated PAW very well and no adverse effects were observed during the entire period of the experiment. Histopathological examination of the organs and tissues did not reveal any structural changes. Moreover, the expression of proliferation markers PCNA and Ki67 has not been identified in the epithelium of the upper digestive tract, indicating the absence of any pre- or neoplastic transformations. The results of our study demonstrated that long-term exposure to PAW caused no toxic effects and could be used as oral antiseptic solution in dental medicine.

Cleidocranial dysostosis: a case report with clinical illustration.

Cleidocranial Dysostosis or Dysplasia (CCD) is an infrequent clinical condition, with an autosomal dominant hereditary mode of inheritance. Triad lesions: multiple supernumerary teeth, partial or complete absence of the clavicles and open sagittal sutures and fontanelles. Nine-year-old female patient comes to our service for outpatient consultation with the main complaint of upper limbs mobility restriction with shoulders hypermotility. The chest X-ray showed partial absence of the clavicles and a cone-shaped thorax. The diagnosis of CCD was performed. Treatment of these patients requires a multidisciplinary approach which includes orthopaedic and dental corrections. The premature diagnosis allows a proper orientation for the treatment, offering a better life quality for the patient.

Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study.

OBJECTIVES: Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. METHODS: This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). RESULTS: The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. CONCLUSIONS AND CLINICAL RELEVANCE: Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

Microfiltración marginal de resinas de relleno masivo y nanohíbrida en molares deciduos / Marginal microleakage of bulk fill and nanohybrid resins in deciduous teeth

Introducción: En la atención odontológica a niños es crucial seleccionar materiales restaurativos con buen rendimiento clínico y corto tiempo de aplicación, especialmente en pacientes con capacidad de atención limitada. Las resinas compuestas, con el mejoramiento de sus propiedades físicas y mecánicas, constituyen hoy uno de los materiales de mayor elección por el odontopediatra. Las resinas de relleno masivo son una alternativa atractiva para las restauraciones en el sector posterior. Objetivo: Comparar el grado de microfiltración marginal de resinas de relleno masivo y nanohíbrida en molares deciduos. Métodos: Estudio experimental, in vitro, en cuarenta molares deciduos; exodonciados por motivos terapéuticos, divididos en dos grupos. Grupo I: resina nanohíbrida con técnica incremental (Tetric® N Ceram - Ivoclar Vivadent) y Grupo II: resina de relleno masivo con técnica monoincremental (Tetric® N Ceram bulk fill - Ivoclar Vivadent). Se realizó un proceso de termociclado manual de 500 ciclos, entre 5 ºC ± 2 ºC y 55 ºC ± 2 ºC. Las muestras fueron sumergidas en azul de metileno al 0,5 por ciento durante 24 horas a 37 ºC. Se analizaron con el microscopio estereoscópico de luz a 40X. Resultados: Todas las muestras presentaron microfiltración. Con el uso de resina nanohíbrida, el 25 presentó microfiltración leve; el 30 por ciento, moderada; y el 45 por ciento, severa. En el grupo de la resina de relleno masivo, el 30 por ciento presentó microfiltración leve; el 35 por ciento, moderada; y el 35 por ciento, severa. No se encontró diferencia significativa entre ambos grupos (p = 0,55). Conclusiones: Ambas resinas, de relleno masivo y nanohíbrida, presentaron similar microfiltración marginal in vitro, en molares deciduos; por lo que la técnica de relleno masivo, por su fácil y rápida aplicación en un solo tiempo, es una buena alternativa en la rehabilitación dental odontopediátrica(AU)

Introduction: In children's dental care it is crucial to select restorative materials of proven clinical quality and a short application period, particularly with patients of limited attention capacity. Due to their improved physical and mechanical properties, composite resins are currently one of the materials of choice for children's dental care. Bulk fill resins are an attractive alternative for posterior restorations. Objective: Compare the degree of marginal microleakage of bulk fill and nanohybrid resins in deciduous teeth. Methods: An experimental in vitro study was conducted of 40 deciduous teeth extracted for therapeutic reasons, which were divided into two groups. Group I: nanohybrid resin by incremental technique (Tetric® N Ceram - Ivoclar Vivadent) and Group II: bulk fill resin by monoincremental technique (Tetric® N Ceram bulk fill - Ivoclar Vivadent). A manual 500-cycle thermocycling procedure was performed at 5ºC ± 2ºC to 55ºC ± 2ºC. The samples were soaked in 0.5 percent methylene blue at 37ºC for 24 hours and analyzed under a light stereo microscope at 40X. Results: Microleakage was present in all the samples. In the nanohybrid resin group, microleakage was mild in 25 percent, moderate in 30 percent and severe in 45 percent. In the bulk fill resin group, microleakage was mild in 30 percent, moderate in 35 percent and severe in 35 percent. No significant difference was found between the groups (p = 0.55). Conclusions: Both resins, bulk fill and nanohybrid, presented similar in vitro marginal microleakage in deciduous molars. The bulk fill technique is therefore a good alternative for children's dental rehabilitation, due to its easy and fast application in a single session(AU)

Urgencias médicas durante la experiencia profesional de estomatólogos en La Habana / Medical emergencies in the professional practice of Havana dentists

Introducción: Las urgencias médicas durante la atención estomatológica son eventos que pueden poner en peligro la salud de los pacientes. Objetivo: Caracterizar las urgencias médicas que se les han presentado a los estomatólogos durante su práctica profesional. Métodos: Se realizó un estudio descriptivo y transversal, de enero a marzo de 2019. El universo estuvo constituido por los estomatólogos de 12 de las 20 clínicas estomatológicas de subordinación docente a la Facultad de Estomatología de La Habana "Raúl González Sánchez". Variables utilizadas fueron: presencia de urgencias, tipo de especialidades, frecuencia de las urgencias médicas, tipo de urgencia médica, procederes estomatológicos y cantidad de urgencias. Resultados: El 61,2 por ciento de los encuestados refirió que eran eventos poco frecuentes, el 50,8 por ciento presentó dos urgencias médicas. Las urgencias más frecuentes fueron las lipotimias (29,9 por ciento) y los síncopes vaso vágales (25,2 por ciento). Conclusiones: Las urgencias médicas son eventos que pueden producirse durante la atención estomatológica. El presente estudio aborda un área del conocimiento poco estudiada en Estomatología en Cuba. Los profesionales, durante los procederes estomatológicos, juegan un papel protagónico en la prevención de las urgencias médicas y en su tratamiento inicial. Los datos epidemiológicos y clínicos de estos eventos, aportados por esta investigación, pueden servir de referencia a otros estudios(AU)

Introduction: Medical emergencies occurring during dental care may pose a risk to the health of patients. Objective: Characterize medical emergencies experienced by dentists in their professional practice. Methods: A descriptive cross-sectional study was conducted from January to March 2019. The study universe was the dentists of 12 of the 20 university dental clinics attached to the Dental School of Havana. The variables analyzed were occurrence of emergencies, specialty, frequency of medical emergencies, type of medical emergency, dental procedures and number of emergencies. Results: 61.2 percent of the respondents stated that medical emergencies were not frequent, and 50.8 percent reported two medical emergencies. The most common emergencies were loss of consciousness (29.9 percent) and vasovagal syncope (25.2 percent). Conclusions: Medical emergencies may occur during dental care. The study addresses an area of dental practice not much dealt with in Cuba. During the performance of dental procedures, professionals play a leading role in the prevention of medical emergencies and their initial treatment. The epidemiological and clinical data about these events contributed by this research may serve as reference for other studies(AU)

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.

Effects of preoperative dental examination and oral hygiene instruction on surgical site infection after hepatectomy: a retrospective study.

PURPOSE: This study retrospectively investigated relationships among risk factors and post-hepatectomy surgical site infection (SSI) and other complications in patients who underwent hepatectomy for hepatocellular carcinoma (HCC). METHODS: We included 334 patients who underwent hepatectomies for liver cancers between January 2011 and December 2015 in this study. We evaluated risk factors for SSI and other post-hepatectomy complication, including demographic factors, preoperative factors, and preoperative intervention including oral management, perioperative factors, and length of hospital stay, with univariate and multivariate analyses. The oral management intervention included self-care instructions, extraction of infected teeth, removal of dental plaques and calculus (scaling), professional mechanical teeth cleaning, removal of tongue coating, and cleaning of dentures. SSI was defined in accordance with the guideline issued by the Centers for Disease Control and Prevention; it included purulent discharge from any incision or organ space within 30 days postoperatively, with or without microbiological evidence. Complications of grade II or greater, according to the Clavien-Dindo classification, were regarded as postoperative complications. RESULTS: We found bacterial infection of ascites (Odds ratio (OR) = 13.72), lack of preoperative oral management intervention (OR = 10.17), and severe liver fibrosis (OR = 2.76) to be associated with SSI and severe liver fibrosis (OR = 2.28), hypoalbuminemia (OR = 2.02), blood transfusion (OR = 1.86), and longer operation time (OR = 1.80) to be associated with postoperative complications. CONCLUSIONS: Preoperative oral management may reduce the risk of SSI in patients with HCC who undergo hepatectomy.