Detection of Cavitated Proximal Carious Lesions in Permanent Teeth: A Visual and Radiographic Assessment.

Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

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.

An assessment of three contemporary dental caries epidemiological instruments: a critical review.

Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly.

PURPOSE: Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices. METHODS: To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months. RESULTS: An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006). CONCLUSIONS: Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.

Oral health disparities among adolescents from urban and rural communities of central Chile.

PURPOSE: Rural populations may be at increased risk for prevalent oral diseases. The aim of this study was to compare oral health status of adolescents of rural and urban areas from central Chile. METHODS: A representative sample of 552 and 486 adolescents aged 12 and 15 years, respectively, was examined using WHO methods. Adolescents were chosen from schools belonging to urban and rural districts of the region. Caries status was obtained by decayed, missing, filled teeth (DMFT) and significant caries (SiC) indexes. The gingival exam included the oral hygiene index (OHI) of Silness and Löe and the gingival index (GI) of Löe and Silness. Clinical attachment loss and community periodontal index (CPI) were restricted to 15-year-old adolescents. Statistical comparisons of medians and means were performed with the Mann-Whitney U-test. To determine the association between caries experience and oral hygiene and gingival indexes, Spearman's correlation was used at p<0.05. RESULTS: Twelve-year-old children from rural areas had caries prevalence of 67.50%, which was significantly higher (p<0.05) than children from urban areas, who had 54.04%. Caries experience of 12-year-old rural children was significantly higher (DMFT 3.36; standard deviation (SD) 2.71) than that of urban children (DMFT 2.29; SD 2.17) (p=0.0001). Rural adolescents also showed increased caries severity (SiC 6.21; SD 2.44), whereas urban children showed had a SiC of 4.71 (SD 1.74) (p=0.0001). For periodontal indexes, the average GI for 12-year-olds was 1.51 (SD 0.33), which corresponds to moderate inflammation, but rural subjects (GI 1.55; SD 0.34) had higher values (p=0.002) than their urban counterparts (GI 1.45; SD 0.29). In 15-year-old adolescents, caries prevalence was significantly higher in rural (73.58%) than in urban (64.59%) individuals (p<0.05). Although not significant, caries experience for 15-year-olds in rural areas, like in the other age group, was slightly higher than for urban 15-year-olds (DMFT 5.03; SD 3.61 and DMFT 4.65; SD 3.58, respectively) (p=0.238). The SiC in the rural subjects (9.16; SD 2.26) of this age group was significantly higher than for urban adolescents (8.51; SD 3.00). No significant differences either in the OHI (p=0.418) or in the GI (p=0.624) were observed between rural and urban participants. CONCLUSIONS: Adolescents of central Chile show clear disparities in oral health, with rural communities more affected. Gingival health seems to be less impacted by rurality than caries experience. Other social determinants of oral health may also explain these results, and further research appears necessary.

Negative ageing stereotypes in students and faculty members from three health science schools.

OBJECTIVE: To explore the ageing stereotypes held by health students and faculty members in three health science schools in Chile. METHODS: This cross-sectional study surveyed 284 students and faculty members from the dental, physical therapy and speech therapy schools of the University of Talca, Chile. A validated 15-question questionnaire about negative stereotypes was used (CENVE). The questions were divided into three categories: (i) health, (ii) social factors and motivation and (iii) character and personality. The scores for each category were grouped into the following categories: (i) positive, (ii) neutral and (iii) negative. Negative stereotypes were compared across genders, socio-economic status levels, classes, positions (student or faculty member) and schools. RESULTS: The majority of the participants held neutral stereotypes towards ageing, followed by positive perceptions. No differences were detected between the genders, schools or classes. While most of the students had neutral perceptions about ageing, the faculty's perceptions were rather positive (p = 0.0182). In addition, people of lower-middle socio-economic status held more positive stereotypes about ageing than the participants of high and middle status (p = 0.0496). CONCLUSION: Stereotypes about ageing held by health-related students and faculty members appear to be rather neutral. The stereotypes seem to be better among students with some clinical experience, students of lower socio-economic status and faculty members.

Factors related to unmet oral health needs in older adults living in Chile.

To assess the oral health status and treatment needs of an ambulant population of older adults, living in the Maule Region, Chile, and provide descriptive information on its distribution by selected socio-demographic characteristics. The source of primary data was the Regional Oral Health Survey. A stratified random sample of 438 older adults, aged 65-74 years, living independently in the community was orally examined, and underwent an oral health interview. The sample was largely a dentate one (74.9%); with a mean DMFT score of 25.7 (s.d. 6.5) and an average number of missing teeth of 22.4 (s.d. 5.8). Dentate participants had 41% of their restorative care needs unmet, and 68.4% needed oral hygiene instruction plus removal of calculus on their teeth. Almost 30.1% required complex periodontal therapy. 21% of those fully edentulous were in need of full dentures. Comparing these findings with existing data on the oral health of older adults in Chile, participants in this study appear to have lower missing teeth scores and less need for complex periodontal treatment. Inequities were apparent in the proportion of unmet restorative and prosthetics needs. Community-based preventive care programs specifically tailored to older adults are needed to address this challenge.