Repercusiones en la deontología española ante el auge de las clínicas dentales low cost / Repercussions in Spanish deontology in light of the rise of low cost dental clinics / Repercussões na deontologia espanhola diante do boom das clínicas dentais de baixo custo

Resumen: El cambio en el modelo asistencial odontológico en España ha supuesto la proliferación de grandes franquicias dentales o clínicas dentales low cost. Este tipo de establecimientos suelen realizar la captación de pacientes mediante agresivas campañas de publicidad, establecen financiaciones de los presupuestos directamente con entidades bancarias y rebajan los presupuestos inicialmente marcados. En los últimos años, la Comisión de Ética y Deontología del Ilustre Colegio Oficial de Odontólogos y Estomatólogos de Aragón ha comprobado un notable aumento de las reclamaciones de pacientes procedentes de este tipo de clínicas. Uno de los casos más llamativos ha sido el cierre de la franquicia iDental, que dejó a miles de personas sin terminar sus tratamientos odontológicos. Se pretende realizar una puesta al día de las repercusiones deontológicas que estas clínicas tienen en la deontología dental de la Comunidad Autónoma de Aragón.

Abstract: The change in deontological health care model in Spain has led to the proliferation of huge dental franquises or low cost dental clinics. This type of settings generally engages customers by aggressive advertising campaigns, establishing financing with banks and reducing the agreed initial budget. In the last years, the Ethical and Deontological Commission of the Official College of Dentists and Stomatologists of Aragon has noticed a significant increase of claims by patients attending this type of clinics. One of the most striking cases has been the closing of iDental, which led thousands of patients without finishing dental treatment. This study pretends updating the deontological repercussions that these clinics have in the Autonomous Community of Aragon.

Resumo: A mudança no modelo assistencial odontológico na Espanha implicou na proliferação de grandes franquias dentais ou clínicas dentais de baixo custo. Estes tipos de estabelecimentos habitualmente realizam a captação de pacientes mediante agressivas campanhas publicitárias, estabelecem financiamento dos orçamentos diretamente com instituições bancárias e abaixam os orçamentos inicialmente apresentados. Nos últimos anos, a Comissão de Ética e Deontologia do Ilustre Colégio Oficial de Odontólogos e Estomatólogos de Aragão comprovou um notável aumento de reclamações de pacientes procedentes deste tipo de clínica. Um dos casos mais chamativos foi o encerramento da franquia iDental, que deixou milhares de pessoas sem terminar seus tratamentos odontológicos. Se pretende realizar uma atualização das repercussões deontológicas que estas clínicas têm na deontologia dental da Comunidade Autônoma de Aragão.

Prevalence of Dental Fluorosis and Its Associated Factors After Cessation of Water Fluoridation

@#Introduction: Water fluoridation (WF) was ceased in the state of Pahang, Malaysia, in July 2012. Any changes in fluoride exposure during childhood can influence the development of fluorosis. Thus, this study aimed to compare the prevalence of fluorosis between WF-ceased and WF-continued areas in Malaysia, and its associated factors among 7 and 12-year-old children. Methods: A cross-sectional study was conducted among children in WF-ceased and WF areas (n=1211). The 12-year-olds in WF-ceased areas were exposed to WF between 4.5 to 6.5 years before cessation, and it was hypothesised they would have similar fluorosis prevalence as their counterparts who lived in WF areas. The 7-year olds were born during the cessation period. Examination of fluorosis was performed by a calibrated dentist using Dean’s criteria and a parental questionnaire was utilised to collect information about demographics and exposure to fluoride. Results: Fluorosis prevalence (Dean’s≥2) was significantly lower among children in WF-ceased areas than WF areas (p< 0.001). Intra-area comparison indicated that the 12-year olds have higher prevalence of fluorosis than the 7-year-olds, except for anterior fluorosis scores among those in WF areas. The majority of fluorosis cases were very mild in both areas. Simple logistic regression indicated that duration of exposure to WF, age, mother’s income and education, age started toothbrushing with toothpaste, and frequency of toothbrushing were associated with fluorosis. Conclusions: Fluorosis prevalence decreased following water fluoridation cessation. The null hypothesis that 12-year-olds in both areas would have similar prevalence of fluorosis was rejected. Several factors were associated with fluorosis.

Relación entre factores socioeconómicos y salud bucal en estudiantes de una zona rural peruana / Socioeconomic factor in relation to oral health in students of a Peruvian rural area

ABSTRACT Introduction: The oral health of students from rural areas is a priority public health problem in Peru. Objective: To determine socioeconomic factors in relation to oral health in students from a rural Peruvian area. Methods: Descriptive cross-sectional observational study. The sample consisted of 604 students from a rural Peruvian area selected for convenience, meeting criteria of inclusion and exclusion, following ethical standards in scientific research. Socioeconomic factors were assessed using a structured questionnaire and the oral health using an epidemiological record with the indicators: DMFT index, Significant Caries Index (SiC), Simplified Oral Hygiene Index (OHI-S), Index of clinical consequences of untreated dental caries (PUFA). The evaluation was performed with natural light by calibrated observers. The data was analyzed in the program STATA 14 through frequency distribution tables and graphics. The relationship of each of the socioeconomic factors with the experience of dental caries was evaluated by the simple binary logistic regression tests. Results: The prevalence of dental caries was 85, 26 percent (DMFT = 6, 60 SiC=7, 23). The most frequent oral hygiene condition was regular, the prevalence of untreated tooth decay was 61.75 percent. Conclusions: The level of illiterate instruction, family responsibility and independent parental occupation showed a statistically significant association with their children's dental caries experience in a rural Peruvian area. (p < 0.001)(AU)

RESUMEN Introducción: La salud bucal de los estudiantes de zonas rurales es un problema prioritario de salud pública en el Perú. Objetivo: Determinar la relación entre factores socioeconómicos y salud bucal en estudiantes de una zona rural peruana. Métodos: Estudio observacional, descriptivo, de corte transversal. La muestra estuvo conformada por 604 estudiantes de una zona rural peruana, los que fueron seleccionados por conveniencia. Se evaluaron los factores socioeconómicos mediante un cuestionario estructurado y la salud bucal a través de una ficha epidemiológica con los indicadores: Índice CPOD, índice de significancia de caries dental (SIC), índice de higiene oral simplificado (IHO-S), índice de consecuencias clínicas de caries no tratadas (PUFA), la evaluación fue realizada con luz natural por observadores calibrados. Los datos se analizaron en el programa STATA v.14 mediante tablas de distribución de frecuencias y figuras. La relación de cada uno de los factores socioeconómicos con la experiencia de la caries dental se evaluó mediante pruebas de regresión logística binarias simples. Resultados: La prevalencia de caries dental fue de 85,26 por ciento (CPOD = 6,60, SIC = 7,23) y la prevalencia de caries dental no tratada fue 61,75 por ciento . La condición de higiene oral más frecuente fue regular. Conclusiones: El nivel de instrucción analfabeto, la responsabilidad familiar y la ocupación independiente de los padres mostraron asociación estadísticamente significativa con la experiencia de caries dental de sus hijos en un área rural peruana (p < 0,001)(AU)

Protocol of toothbrushing based on bioavailability of fluoride in toothpaste: a systematic review / Protocolo de cepillado basado en la biodisponibilidad del flúor en dentífricos: una revisión sistemática

The objective of the study is to propose a protocol for the appropriate use of fluorides in dentifrices (Dt), based on its bioavailability in saliva (Bs) and / or plaque (Bp) through a systematic review (SR). SR of the literature from 2005 to 2015 in PubMed, Cochrane and SciELO. Inclusion criteria: clinical studies in vivo, Spanish and English, made only with Dt that measured Bs and Bp. The results were evaluated in relation to: 1) Concentration of fluoride in Dt, 2) Brushing time with Dt, 3) Frequency of brushing, 4) Rinse post-brushing and 5) Amount of Dt on the brush. Twelve (12) studies were selected. 1) Bs increases 241 % when using a 5000 ppm of Dt compared to 1450 ppm. 2) Bs is increased by 55 % by increasing the duration of brushing 40 s to 120 s 3) Bp increases by 68 % when brushing 3 times a day compared to 2 times. 4) Not rinsing or rinsing with <10 ml for <10 s increases Bs to 270 % compared to rinses higher volume / time. 5) By increasing the amount of Dt of 0.5 g to 1.5 g, Bs increases up to 266 %. The use of 1.5 g of Dt 1450 ppm of fluoride for 120 s, 3 times a day is recommended and once brushing is complete avoiding oral rinse with water or non fluoride mouthwash.

El objetivo de este studio es proponer un protocolo para el uso adecuado de fluoruros en dentífricos (Dt), basado en su biodisponibilidad en saliva (Bs) y/o placa (Bp) mediante una revisión sistemática (RS). RS de la literatura 2005- 2015 en PubMed, Cochrane y SciELO. Criterios de inclusión: estudios clínicos in vivo, español e inglés, realizados únicamente con Dt que midieran Bs y Bp. Los resultados fueron evaluados en relación a: 1) Concentración de flúor en el Dt, 2) Tiempo de cepillado con Dt, 3) Frecuencia de cepillado, 4) Enjuague post-cepillado y 5) Cantidad de Dt en el cepillo. Fueron seleccionados 12 estudios. 1) La Bs aumenta en un 241 % al utilizar un Dt de 5000 ppm en comparación con un 1450 ppm. 2) Bs aumenta en un 55 % al aumentar la duración del cepillado de 40 s a 120 s, 3) La Bp aumenta en un 68 % al cepillarse 3 veces al día en comparación a 2 veces. 4) No enjuagarse o enjuagues de <10 ml por <10 s puede aumentar la Bs hasta en un 270 % en comparación a enjuagues con mayor volumen/tiempo. 5) Al aumentar la cantidad de Dt de 0,5 g a 1,5 g, la Bs aumenta hasta en un 266 %. Se recomienda utilizar 1,5 g de Dt 1450 ppm de flúor por 120 s, 3 veces al día, y evitar enjuague oral con agua o colutorios sin flúor una vez finalizado el cepillado.

Instrumentos validados para medir la salud bucal en los niños / Validated instruments for measuring the oral health in children

Existe un creciente interés en reconocer la salud bucal como un componente de la calidad de vida, por lo cual actualmente los esfuerzos en la investigación del sector odontológico no sólo se enfocan en rehabilitar padecimientos bucodentales, sino en explorar la relación existente entre el estado de salud bucal y la calidad de vida, para poder evaluarla, mejorarla y mantenerla. Las enfermedades bucales son las más comunes entre las enfermedades crónicas, y son un importante problema de salud pública debido a su prevalencia y al impacto que tienen sobre las personas y sobre la sociedad. Es por esto que han sido desarrollados cuestionarios dirigidos a la población infantil y a sus padres o cuidadores para medir el impacto de las afecciones bucales en la calidad de vida; estos indicadores comprenden diferentes dominios como el dolor y la incapacidad para realizar las funciones normales de la boca, trastornos del sueño, pérdida de días escolares, grado de bienestar emocional, bienestar social y el impacto que generan estas afecciones en la vida familiar. Es por esto que el objetivo de la presente revisión sistemática es mostrar un panorama actual sobre el concepto de calidad de vida relacionada con la salud bucal en los niños y los diferentes instrumentos que existen a nivel mundial para evaluarla.

There is a growing interest in recognizing oral health as a component of quality of life. The dentistry is not only focusing on research for rehabilitating oral-dental diseases, but also in exploring the relation-ship between oral health status and quality of life, in order to evaluate, improve and maintain it. Oral diseases are the most common chronic diseases and remain a major public health problem. This is be-cause of its prevalence and, the impact on individuals and society. For this reason have been developed questionnaires for children and their parents or caregivers to measure the impact of oral conditions on quality of life, with different domains including: pain and inability to perform normal functions of the mouth, sleep disturbances, loss of school days, degree of emotional, social well-being and the impact generated by these conditions in family life. Therefore, the aim of the present systematic review is to show a current overview of the concept of oral health-related quality of life in children and the different instruments that exist around the world for evaluate it.

Determinantes de la satisfacción de la atención odontológica en un grupo de pacientes atendidos en la Clínica del Adulto de la Facultad de Odontología de la Universidad de Antioquia / Determinants of dental care satisfaction in a group of patients attending the Adult Clinic of the Faculty of Dentistry, Universidad de Antioquia / Determinantes da satisfação do atendimento odontológico em um grupo de pacientes atendidos na Clínica do Adulto da Faculdade de Odontologia da Universidade de Antioquia

Problema: las instituciones formadoras de recursos humanos en salud prestan servicios a lacomunidad en condiciones diferentes a otros servicios de salud; la satisfacción al recibir dichaatención se relaciona con la aceptación que experimenta el usuario y depende de variables internasy externas. Objetivo: se exploraron los factores que influyen en la aceptación de la atenciónrecibida, en un grupo de pacientes tratados en la Facultad de Odontología de la Universidad deAntioquia. Método: estudio exploratorio cuantitativo y cualitativo mediante encuesta telefónicaa 55 pacientes y ocho entrevistas a profundidad. Resultados y discusión: el 78 % fueron mujeres,mayores de 55 años, de estratos socioeconómicos bajos. La valoración del servicio fue positivapor la atención oportuna, el trato de profesores y estudiantes, y las condiciones físicas durantela atención. Al profundizar en las entrevistas se resaltaron experiencias subjetivas propias delpaciente y factores inherentes al servicio y al talento humano...

Problem: human resource training institutions provide health services to the community underconditions different from other health services, the satisfaction receiving such care is related tothe acceptance experienced by the user and depends on internal and external variables. Objective:we explored the factors that influence the acceptance of care provided in a group of patientstreated at the Faculty of Dentistry at the University of Antioquia. Method: quantitative andqualitative exploratory study using telephone survey of 55 patients and eight depth interviews.Results and discussion: 78% were women, aged 55 years, low socioeconomic strata. The assessmentof the service was positive for timely attention, the treatment of teachers and students,and the physical conditions during the attention. The interviews highlighted the patient’s ownsubjective experiences and factors inherent to service and human resources...

Problema: as instituições formadoras de recurso humano em saúde prestam serviços à comunidadeem condições diferentes a outros serviços de saúde; a satisfação no recebimento de talatenção relaciona-se com o aceite que experimenta o utente e depende de variáveis internas eexternas. Objetivo: exploraram-se os fatores que influem na aceitação da atenção recebida, emum grupo de pacientes tratados na Faculdade de Odontologia da Universidade de Antioquia.Método: estudo exploratório quantitativo e qualitativo mediante inquérito telefônico a 55 pacientese oito entrevistas em profundidade. Resultados e discussão: o 78 % foram mulheres maioresde 55 anos, de estrato socioeconômico baixo. A avaliação do serviço foi positiva pela atençãooportuna, o trato de professores e estudantes e as condições físicas durante o atendimento. Aoaprofundar nas entrevistas exaltaram-se experiências subjetivas próprias do paciente e fatoresinerentes ao serviço e talento humano...

Qualitative research and dental public health.

The use of Qualitative Research (QR) methods are now getting common in various aspects of health and healthcare research and they can be used to interpret, explore, or obtain a deeper understanding of certain aspects of human beliefs, attitudes, or behavior through personal experiences and perspectives. The potential scope of QR in the field of dental public health is immense, but unfortunately, it has remained underutilized. However, there are a number of studies which have used this type of research to probe into some unanswered questions in the field of public health dentistry ranging from workforce issues to attitudes of patients. In recent health research, evidence gathered through QR methods provide understanding to the social, cultural, and economic factors affecting the health status and healthcare of an individual and the population as a whole. This study will provide an overview of what QR is and discuss its contributions to dental public health research.

Challenges in dental public health – An overview

Oral health diseases are common in all regions of the world and their impact on anatomical and social functioning is widely acknowledged. Their distributions are unequal between and within countries, with the greatest burden falling on disadvantaged and socially marginalized populations. The risk factors and social determinants for oral diseases have been comprehensively documented, and the evidence base for their prevention is growing. However, decisions on health care are still often made without a solid grounding in research evidence. Translation of research into policy and practice should be a priority for all. Both community and individual interventions need tailoring to achieve a more equal and person-centered preventive focus and reduce any social gradient in health. The major challenges of the future will be to translate knowledge and experiences in oral disease prevention and health promotion into action programmes. The international oral health research community needs to engage further in research capacity building and in strengthening the work so that research is recognized as the foundation of oral health policy at global level.

Valor comercial y eficacia de la cinta de politetrafluoretileno (PTFE) para la remoción de la biopelícula dental interproximal comparado con la seda dental de nylon en adolescentes y adultos jóvenes / Price and the efficacy of the polytetrafluoroethylene (PTFE) tape for the removal of the proximal dental biofilm compared to the common nylon dental floss in adolescents and young adults

Objetivo: Identificar el valor comercial y la eficacia de la cinta de politetrafluoretileno (PTFE) como método de higiene oral para la remoción de la biopelícula dental interproximal, comparado con la seda dental de nylon en adolescentes y adultos jóvenes. Métodos: Se utilizó la cinta de PTFE para remover la biopelícula dental interproximal. Por muestreo aleatorio simple el tamaño de la muestra fue de 87 (31 hombres y 56 mujeres) con un rango de edades entre 16 y 28 años. A los participantes se les suspendió toda clase de higiene oral durante un período de 12 horas, posteriormente se realizó una tinción con revelador de placa bacteriana y se llevó a cabo la remoción tanto con la cinta de PTFE como con la seda dental mediante la misma técnica y por el mismo operador. La recolección de datos se hizo con base en la división coronal (por tercios) del índice de higiene de Greene y Vermillion, pero se modificó para evaluar solamente las caras interproximales. Resultados: En el grupo de seda dental la presencia de la biopelícula dental interproximal fue 72.6% antes y 11.2% después de la remoción y en el grupo de PTFE fue 72.9% antes y 11% después; al comparar la remoción de la biopelícula con los dos métodos no hubo diferencias estadísticamente significativas (p>0.05). El valor comercial del PTFE es en promedio 2.7 veces más económico que el de la seda dental de nylon. Conclusiones: La similitud en la remoción de la bio-película interproximal de la cinta de PTFE frente a la seda dental fue significativa. Gracias a su buena bio-compatibilidad, tolerancia y bajo costo, la cinta de PTFE sirve como un método alternativo para retirar la bio-película interproximal. Los resultados de este estudio abren una puerta para investigar técnicas poco ortodoxas, pero eficaces, en el mantenimiento de la salud bucal con el único propósito de mejorar la calidad de vida en las poblaciones menos favorecidas.

Objective: To identify the price and the efficacy of the polytetrafluoroethylene PTFE tape as an oral hygiene method for the removal of the proximal dental biofilm, compared to the common nylon dental floss in adolescents and young adults. Methods: The polytetrafluoroethylene tape was used as a method for the removal of the proximal dental biofilm. By a randomized procedure the sample size was of 87 (31 men and 56 women) between 16 and 28 years old. The oral hygiene of the participants was suspended during a period of 12 hours. A suitable disclosing solution was used to paint the dental surfaces. The removal of the biofilm was made by the same operator who used the same technique with the two materials (polytetrafluoroethylene tape and nylon dental floss). The information was collected using the coronal division (in thirds) of the Greene and Vermillion Oral Hygiene Index. This index was modified to evaluate proximal surfaces only. Results: In the group of dental floss the presence of the proximal biofilm was 72.6% before and 11.2% after its removal. In the group of PTFE was 72.9% before and 11% after. After the comparison of the two methods the differences are not significant. PTFE price is 2.7 times lower than common nylon dental floss. Conclusions: The similarity in the removal of the proximal biofilm of the PTFE tape when compared to the nylon floss was significant. Thanks to its biocompatibility, tolerance and its low price, the PTFE tape is an alternative method for the removal of the biofilm in these proximal areas. Results of this study open a way for the investigation on non orthodox techniques, but effective, for the maintenance of the oral health with the only purpose of improving life quality of poor populations.