Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain.

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer's instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.

Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a growing health problem, and its treatment is a challenge. The purpose of the present study was to evaluate and compare the perceptions, knowledge, and clinical experiences of MIH in general dental practitioners (GDPs) and paediatric dentists (PDs) in Spain. METHODS: All dentists belonging to the College of Dentists of the Region of Murcia, in the South-East of Spain, were invited to participate in a cross-sectional survey. They were asked to complete a two-part questionnaire including sociodemographic profiles and knowledge, experience, and perceptions of MIH. Data were analysed using Pearson's chi-square test, Fisher's exact test and Cramer's V test. RESULTS: The overall response rate was 18.6% (214/1147). Most respondents were aged 31-40 years (44.86%), with more than 15 years of professional experience (39.72%). They worked mainly in the private sector (84.58%) and were licensed in dentistry (74.30%): 95.45% of PDs had detected an increase in the incidence of MIH in recent years (p <  0.001). Only 23.80% of GDPs claimed to have made a training course on MIH. With respect to the aetiology, chronic medical conditions (p = 0.029) and environmental pollutants (p = 0.008) were the only factors that showed significant between-group differences. Durability (p = 0.009) and remineralization potential (p = 0.018) were the factors where there was a between-group difference in the choice of the restoration material. In the case of post-eruptive fractures and opacities, the preferred material for both groups was resin-modified glass ionomer (RMGIC). However, in incisor lesions, composite was the material of choice for both groups, with significant differences (p = 0.032) in the use of glass ionomer. Most respondents expressed a need for continuing education on MIH. CONCLUSION: Spanish dentists perceived an increase in the incidence of MIH. The material of choice was RMGIC for non-aesthetic sectors and composite for incisors. Dentists believe it is difficult or very difficult to manage MIH, since the long-term success of restorations of MIH lesions is compromised because resin adhesion is not good. Both GDPs and PDs believe they need more training on the aetiology, diagnosis, and treatment of MIH.

Influence of a preventive program on the oral health-related quality of life (OHRQoL) of European pregnant women: a cohort study.

The aim of this study was to compare the impact of oral health on quality of life of a group of pregnant women enrolled in a program of oral health with respect to a control group of non-pregnant women. A cross-sectional study involving a sociodental indicator OHIP-14 and a dental examination was completed to assess pregnant women's knowledge of oral health, hygienic habits, periodontal and caries index. Data were collected from 113 pregnant women and 113 non-pregnant women. Sociodemographic data for both groups were homogeneous. Pregnant women have better values of general and oral health, even though they have not perceived need for dental treatment, compared with control group. A worse periodontal health was observed for the control group. Our results showed that quality of life in pregnant women has been influenced with a statistical significance (p < 0.05) by the variables age, unemployment, level of education, immigration, frequency of brushing, type of dental practice, self-reported general and oral health and perceived treatment needs. The oral quality of life of pregnant women seems to be positively influenced by the incorporation of preventive oral programs during pregnancy.

Influence of fluoride varnish on shear bond strength of a universal adhesive on intact and demineralized enamel.

The aim was to evaluate the effect of fluoride varnish on the shear bond strength (SBS) on polished and non-polished intact and demineralized enamel. Bovine incisors (half demineralized) were used. Bifluorid 12™ was applied. Bonding was made with Futurabond®M + and GrandioSO, 24 h and 7 days after varnishing. In some groups, varnish was removed by polishing before bonding. SBS was measured. Fracture type was determined by stereomicroscopy and scanning electron microscope (SEM) observations of the enamel surface were made. Between-group differences were determined by one-way ANOVA and the Tukey test. Associations between study factors and fracture modes were analysed using contingency tables and Pearson's chi-squared test. For intact enamel, SBS on varnished enamel at 24 h was significantly less than in the other groups. SBS recovered 7 days after varnishing. Varnish elimination after 24 h significantly increased the SBS. However, removal at 7 days did not modify SBS. SBS on demineralized enamel groups was significantly less than in intact enamel, except for demineralized enamel varnished and removed at 7 days. Demineralized enamel was associated with cohesive enamel fractures and intact enamel with cohesive fractures of the composite and adhesive fractures. SEM of varnish surfaces showed a homogenous layer scattered with amorphous precipitate. In conclusion, on intact enamel fluoride varnish had a negative effect on SBS at 24 h, which disappeared after 7 days. On demineralized enamel, varnish did not reduce SBS at either time. Polishing the varnished enamel surface showed a similar SBS to intact enamel after 7 days.

Federated vs Local vs Central Deep Learning of Tooth Segmentation on Panoramic Radiographs.

OBJECTIVE: Federated Learning (FL) enables collaborative training of artificial intelligence (AI) models from multiple data sources without directly sharing data. Due to the large amount of sensitive data in dentistry, FL may be particularly relevant for oral and dental research and applications. This study, for the first time, employed FL for a dental task, automated tooth segmentation on panoramic radiographs. METHODS: We employed a dataset of 4,177 panoramic radiographs collected from nine different centers (n = 143 to n = 1881 per center) across the globe and used FL to train a machine learning model for tooth segmentation. FL performance was compared against Local Learning (LL), i.e., training models on isolated data from each center (assuming data sharing not to be an option). Further, the performance gap to Central Learning (CL), i.e., training on centrally pooled data (based on data sharing agreements) was quantified. Generalizability of models was evaluated on a pooled test dataset from all centers. RESULTS: For 8 out of 9 centers, FL outperformed LL with statistical significance (p<0.05); only the center providing the largest amount of data FL did not have such an advantage. For generalizability, FL outperformed LL across all centers. CL surpassed both FL and LL for performance and generalizability. CONCLUSION: If data pooling (for CL) is not feasible, FL is shown to be a useful alternative to train performant and, more importantly, generalizable deep learning models in dentistry, where data protection barriers are high. CLINICAL SIGNIFICANCE: This study proves the validity and utility of FL in the field of dentistry, which encourages researchers to adopt this method to improve the generalizability of dental AI models and ease their transition to the clinical environment.

Orthodontic and dentofacial orthopedic treatments in patients with ectodermal dysplasia: a systematic review.

OBJECTIVE: The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to facilitate functional and aesthetic rehabilitation. METHODS: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. We systematically searched PubMed, Web of Science, Scopus, Scielo, LILACS, EBSCOhost and Embase databases up to 6 January 2022. We included articles describing patients with any type of ectodermal dysplasia who received orthodontic or dentofacial orthopedic treatment to facilitate functional and aesthetic oral rehabilitation. The search was not restricted by language or year of publication. The quality of the studies was assessed using the Joanna Briggs Institute Quality Assessment Scale of the University of Adelaide for case series and case reports. The review was registered at the University of York Centre for reviews (CRD42021288030). RESULTS: Of the initial 403 studies found, 29 met the inclusion criteria. After applying the quality scale, 23 were left for review-21 case reports and 2 case series. The initial age of patients ranged from 34 months to 24 years. Thirteen studies were on hypohidrotic and/or anhidrotic ectodermal dysplasia, of which two were X-chromosome linked. In one study, the patient had Wiktop syndrome, and in nine the type of ectodermal dysplasia was not specified. The duration of treatment was 7 weeks to 10 years. The treatments described were: fixed orthodontic appliances or simple acrylic plates designed for tooth movement, including leveling and aligning, closing of diastemata, retraction of impacted teeth in the dental arch; clear aligners; fixed and/or removable appliances for the correction of skeletal and/or dentoalveolar relationships; palatal expanders in combination with face masks for orthopedic traction of the maxilla; and orthognathic surgery. Only three studies provided cephalometric data. CONCLUSION: The level of evidence of the articles reviewed was low and most orthopedic and dentofacial orthodontic treatments described were focused on correcting dental malpositioning and jaw asymmetries and not on stimulating growth from an early age. Studies with greater scientific evidence are needed to determine the best treatment for these patients.

Spanish Paediatricians' Knowledge, Attitudes and Practices Regarding Oral Health of Children under 6 Years of Age: A Cross-Sectional Study.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic pathology, and it has a negative impact on the oral and general health of the child patient. AIM: To evaluate the knowledge, attitudes and practices of Spanish paediatricians regarding early childhood caries according to the professional's years of experience. MATERIAL AND METHODS: A cross-sectional questionnaire was conducted by Spanish paediatricians via WhatsApp and e-mails from January to April 2021. Data were analysed using Chi-squared test, Fisher's exact test and Cramer's V test. RESULTS: There were a total of 359 participants. Most respondents were women (81.3%) with up to 10 years of professional experience (31.2%) in primary health care and public health. In most cases, participants had an excellent knowledge of primary dentition (90.8%), but they ignored (56%) when the first visit to the dentist should occur. Regarding the aetiological factors of caries, oral hygiene and prevention, a lower rate of knowledge was observed. The majority of participants (80.8%) were not able to identify white spot lesions and enamel defects (76%). They considered that their knowledge in oral health was deficient, highlighting the need to increase their training. Less experienced paediatricians were found to have higher success rates. CONCLUSIONS: The level of knowledge and attitudes regarding early childhood caries of the evaluated paediatricians should be improved. Paediatricians had difficulties in identifying early caries lesions and enamel defects. Nevertheless, a higher level of knowledge and positive attitudes towards dental caries has been detected among paediatricians with fewer years of professional experience.

Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: evidence from a randomized double-blind clinical trial.

ABSTRACTBackground: In vitro studies have shown that several oral antiseptics have virucidal activity against SARS-CoV-2. Thus, mouthwashes have been proposed as an easy to implement strategy to reduce viral transmission. However, there are no data measuring SARS-CoV-2 viability after mouthwashes in vivo. METHODS: In this randomized double-blind, five-parallel-group, placebo-controlled clinical trial, SARS-CoV-2 salivary viral load (by quantitative PCR) and its infectious capacity (incubating saliva in cell cultures) have been evaluated before and after four different antiseptic mouthwashes and placebo in 54 COVID-19 patients. RESULTS: Contrary to in vitro evidence, salivary viral load was not affected by any of the four tested mouthwashes. Viral culture indicated that cetylpyridinium chloride (CPC) significantly reduced viral infectivity, but only at 1-hour post-mouthwash. CONCLUSION: These results indicate that some of the mouthwashes currently used to reduce viral infectivity are not efficient in vivo and, furthermore, that this effect is not immediate, generating a false sense of security.Trial registration: ClinicalTrials.gov identifier: NCT04707742..

[Total and soluble fluoride concentration in children´s toothpastes in Spain.] / Concentración de fluoruro total y soluble en pastas dentales de uso infantil en España.

OBJECTIVE: The use of fluoridated toothpastes is considered the most rational method in dental caries control, and it is recommended for all ages people, but for this they must be established at a minimum concentration of 1,000 ppm of total soluble fluoride, in pediatric patients. The objective of the study was to determine the concentration of total and soluble fluoride present in toothpastes marketed in Spain for pediatric use. METHODS: A descriptive and cross-sectional study was carried out throughout 2019, analyzing 11 toothpastes for pediatric use marketed in Murcia, Spain. The concentration of fluoride (ppm F=mg F/Kg) total (FT), soluble (FTS) and fluoride ion (F) and MFP (FPO32-) was analyzed using an ion-specific electrode coupled to an ion analyzer. A descriptive study was carried out to determinate mean and standard deviations for each variable analyzed. RESULTS: Among the analyzed toothpastes, 45% contained NaF (sodium fluoride), 45% MFP (sodium monofluorophosphate) and 10% both types of salts. The abrasive used was silica. 98% of the analyzed toothpastes showed total fluoride contents similar to those described by the manufacturer, only 3 toothpastes had fluoride concentrations lower than those described. The range obtained from FT oscillated between 398 -1,474.6 ppm F, and 100% of the toothpastes did not show differences between values of total fluoride and soluble fluoride. CONCLUSIONS: Most of the analyzed toothpastes contain a concentration of soluble fluoride between 1,000-1,500 ppm Fluoride, corresponding to the values described by the manufacturers However, there are still toothpastes with values lower than those recommended, minimum 1,000 ppm F, that do not allow effective anticaries activity from a public health point of view.

OBJETIVO: El uso de pastas dentales fluoradas es considerado el método más racional en el control de caries dental, y es recomendado para personas de todas las edades, pero para ello han de establecerse en una concentración mínima de 1.000 ppm de fluoruro total soluble, en pacientes pediátricos. El objetivo del estudio fué determinar la concentración de fluoruro total y soluble presente en pastas dentales comercializadas en España para uso pediátrico. METODOS: Se realizó un estudio descriptivo y transversal durante el año 2019, analizando 11 pastas dentales de uso pediátrico comercializadas en Murcia, España. Se analizó la concentración de fluoruro (ppm F=mg F/kg) total (FT), soluble (FTS) e ión de Flúor (F) y de MFP (FPO32-) mediante un electrodo ion-específico acoplado a un analizador de iones. Se llevó a cabo un estudio descriptivo determinando las medias y desviaciones estándar para cada variable. RESULTADOS: Entre las pastas dentales analizadas, el 45% contenían NaF (fluoruro sódico), 45% MFP (monofluorofosfato de sodio) y un 10 % ambos tipos de sales. El abrasivo de todas era sílice. El 98% de las pastas dentales analizadas mostraban contenidos de flúor total similares a los descritos por el fabricante, solamente 3 pastas presentaban concentraciones de flúor inferiores a las descritas por el fabricante. El rango obtenido de FT oscilaba entre 398-1.474,6 ppm F, y el 100% de las pastas dentales no mostraron diferencias entre valores de flúor total y flúor soluble. CONCLUSIONES: La mayoría de las pastas dentales analizadas contienen una concentración de flúor soluble entre 1.000-1.500 ppm F, correspondiéndose con los valores descritos por los fabricantes. Sin embargo, todavía existen pastas dentales con valores inferiores a los recomendados de mínimo de 1.000 ppm F que no permiten tener la actividad anticaries efectiva desde el punto de vista de salud pública.

Effects of Fluoride and Calcium Phosphate-Based Varnishes in Children at High Risk of Tooth Decay: A Randomized Clinical Trial.

BACKGROUND: The aim of this study was to investigate the effect of the application of two varnishes-MI Varnish (5% sodium fluoride with CPP-ACP) and Clinpro White Varnish (5% sodium fluoride with fTCP)-applied every three months in children with high caries risk for 12 months on plaque indexes, salivary pH, salivary lactic acid and chemical elements concentrations. METHODS: We included 58 children aged 4-12 years, assigned to control (placebo), Clinpro and MI groups. Baseline and three-month saliva samples were taken. We assessed changes in pH, lactic acid concentrations and chemical elements in saliva. RESULTS: At 12 months, all groups showed a nonsignificant increase in pH levels and a reduction in lactic acid, which was greatest in the placebo group. There was a significant reduction in 24Mg (p = <0.001), 31P (p = 0.033) and 66Zn (p = 0.005) levels in the placebo group (p ≤ 0.05), but not in the other elements studied: 23Na, 27Al, 39K, 44Ca, 52Cr, 55Mn, 57Fe, 59Co, 63Cu, 75As, 111Cd, 137Ba, 208Pb and 19F. CONCLUSIONS: Neither pH, lactic acid concentrations or most salivary chemical elements were useful in defining patients at high risk of caries or in monitoring the effect of MI Varnish and Clinpro White Varnish after three-month application for 12 months. However, the appearance of new cavities was stopped, and the hygiene index improved, probably due to hygienic and dietary measures and the use of fluoridated toothpaste. TRIAL REGISTRATION: ISRCTN registry, ISRCTN13681286.

Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization.

To evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.

Spanish Dentists' Awareness, Knowledge, and Practice Regarding COVID-19: A Multiple Regression Analysis.

INTRODUCTION: During the first months of the coronavirus disease 2019 (COVID-19) pandemic, Spain had the highest mortality rate and the second-highest infection rate in the world. OBJECTIVE: To analyze the occupational situation of dentists, hygienists, and dental auxiliary staff during the peak of the pandemic, after the state of alarm was declared in Spain, and when the state of alarm was declared. In addition, a possible relationship between the geographical distribution of infected people and the availability of individual protection systems was investigated. MATERIAL AND METHODS: A cross-sectional questionnaire was answered by 6470 dentists and dental staff via WhatsApp and social media. RESULTS: A total of 1 in 4 dental professionals ceased working completely. Of those that kept working, 25.28% of dentists and 19.61% of hygienist-auxiliary were equipped with filtering face piece (FFP) 2 masks (P < .05), and 61.8% complied with the official protection recommendations set by the General Council of Dentists of Spain. Nearly 59.4% of respondents had symptoms, but only 1.5% of dentists were tested, with 14% of dentists in isolation at the time of response. Overall, it is suggested that 10% of dental professionals may have been in direct contact with the coronavirus. CONCLUSIONS: Direct contact of Spanish dental health professionals with severe acute respiratory syndrome coronavirus disease 2 (SARS CoV-2) has been high during the most active phase of the pandemic. Dental professionals did not have personal protective equipment (PPE) necessary to care for patients, a situation that justified the reduction in scheduled dental care and only emergencies being treated. The Spanish geographical regions with the highest number of contagions had the least amount of individual protective resources (FFP2 and FFP3 masks).

Delivery of Health Care by Spanish Dental Hygienists in Private and Public Dental Services during the COVID-19 De-Escalation Phase (June 2020): A Cross-Sectional Study.

BACKGROUND: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists' work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. MATERIAL AND METHODS: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. RESULTS: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). CONCLUSIONS: Dental hygienists' return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors.

Clinical evaluation of antiseptic mouth rinses to reduce salivary load of SARS-CoV-2.

Most public health measures to contain the COVID-19 pandemic are based on preventing the pathogen spread, and the use of oral antiseptics has been proposed as a strategy to reduce transmission risk. The aim of this manuscript is to test the efficacy of mouthwashes to reduce salivary viral load in vivo. This is a multi-centre, blinded, parallel-group, placebo-controlled randomised clinical trial that tests the effect of four mouthwashes (cetylpyridinium chloride, chlorhexidine, povidone-iodine and hydrogen peroxide) in SARS-CoV-2 salivary load measured by qPCR at baseline and 30, 60 and 120 min after the mouthrinse. A fifth group of patients used distilled water mouthrinse as a control. Eighty-four participants were recruited and divided into 12-15 per group. There were no statistically significant changes in salivary viral load after the use of the different mouthwashes. Although oral antiseptics have shown virucidal effects in vitro, our data show that salivary viral load in COVID-19 patients was not affected by the tested treatments. This could reflect that those mouthwashes are not effective in vivo, or that viral particles are not infective but viral RNA is still detected by PCR. Viral infectivity studies after the use of mouthwashes are therefore required. ( https://clinicaltrials.gov/ct2/show/NCT04707742 ; Identifier: NCT04707742).

Influence of operator's professional experience in the postoperative course after surgical extrac-tion of the impacted lower third molar: A pilot study.

BACKGROUND: Third molars are present in 96.6% of humans, although they do not always erupt completely. Between 9.5% and 73% of them remain impacted. Surgical removal of impacted third molars is the most common practice in oral and maxillofacial surgery. This procedure results in traumatism and, consequently, the postoperative phase will involve symptomatology. It is uncommon to find studies that directly relate postoperative symptomatology and the operator's experience. The aim of this study was to determine the differences regarding postoperative symp-tomatology in patients undergoing the bilateral extraction of lower impacted third molars and according to the operator's experience. MATERIAL AND METHODS: A prospective cohort double-blind study was conducted in 50 healthy patients (100 molar extractions) to whom both lower third molars were removed by two dentists with different degree of professional experience. The extractions were randomly assigned with a split-mouth design. If an operator extracted the lower third molar on one side, the other operator extracted the contralateral one. The variables studied after four days of postoperative period were Pain (EVA scale), Inflammation and Trismus, in addition to intraoperative time and local anesthesia administered. RESULTS: Statistically significant differences were detected in the time of intervention and in trismus, since the most experienced operator always needed less time and caused higher degree of trismus. However, this does not entail more inflammation or pain in patients, so there are no relevant differences between operators with more or less experience (p>0.05). CONCLUSIONS: The postoperative period is more favorable for the most experienced operator, although the results do not vary in a relevant manner between them. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.

Recommendations by the Spanish Society of Epidemiology and Oral Public Health (SESPO) for the healthcare adaptation of public health dental clinics in Spain during the COVID-19 pandemic.

BACKGROUND: In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic and, a few days later, the Spanish Government declared a State of Emergency and the population lockdown. This crisis situation crisis forced deep changes in health care. At dental care level, it became necessary for both public health services and private consultations to plan changes to enable them to face this healthcare challenge. MATERIAL AND METHODS: SESPO and the General Council of Dentists of Spain (CGDE) appointed a Working Group to prepare a protocol for dental clinics after the lockdown stage. Continuing with this teamwork task, a series of recommendations addressed to public health managers and the dental workforce were agreed, according to the COVID-19 protection protocols, with the evidence available at the time of their preparation. RESULTS: The SESPO Working Group prepared a schedule with recommendations to be taken. The CGDE presented this document to the Ministry of Health, Consumption and Social Welfare, and SESPO emailed it to all the Health Councils of the autonomous regions. The document was also uploaded to the CGDE and SESPO websites and was emailed to all SESPO associated members. CONCLUSIONS: Keeping in mind the existing territorial variation, both at the organization level of dental public health services, and at the care level (especially in child preventive programs and care for pregnant women), this health crisis has highlighted the importance of teamwork. It is necessary to unify the standards for all dental health care units in the national territory in challenging times. Key words:COVID-19, Dental public health, dental care, dentistry, primary care, infection, SARS-CoV-2.

[Fluoride and heavy metals concentration in bottled waters: barrier measures against dental caries and fluorosis]. / Concentración de flúor y metales pesados en aguas embotelladas: medidas barrera frente a caries dental y fluorosis.

OBJECTIVE: The daily consumption of fluoridated water is one of the most beneficial measures in dental caries prevention. The objective of this paper was to analyze the content of fluorine and heavy metals in the bottled natural mineral water available in stores in Spain. METHODS: A descriptive and transversal study was done throughout 2019. Analysing a total of 20 bottled waters marketed in Spain during this year. Mainly, fluoride concentration (ppm/ml) was analyzed with an ion-specific electrode (Orion model 96-09, Orion Research, Cambridge, MA) coupled to an ion analyzer (Orion EA-940). The heavy metals were analyzed by ICP-MS (Agilent model 7900). A descriptive statistical study of the data was carried out. RESULTS: The minimum value of fluorine found was 0.05 ppm and the maximum 0.95ppm. 80% of the brands analyzed contain less than 0.6 ppm F. Only 1 brand exceeds 0.8 ppm F. Chromium and arsenic were the heavy metals present in all brands, without exceeding the maximum dose. No brand of bottled water indicated heavy metals on the label, and only 1 mark indicated the fluoride concentration on the label. CONCLUSIONS: There is a great variability in the chemical composition of bottled waters marketed in Spain. Most have a fluoride concentration lower than that recommended to prevent tooth decay, which would require an extra supply of fluoride. In the bottled waters analyzed there are heavy metals but they did not exceed the maximum doses established by legislation.

OBJETIVO: El consumo diario de agua fluorada es una de las medidas mas beneficiosas en la prevención de la caries dental. El objetivo de este estudio fue analizar el contenido de flúor y metales pesados en el agua mineral natural embotellada disponible en los comercios de España. METODOS: Se realizó un estudio descriptivo y transversal a lo largo de 2019, analizando 20 marcas de aguas embotelladas comercializadas en España en ese año. Se midió principalmente la concentración de flúor (partes por millón/mililitro) (ppm/ml), que fue analizada con un electrodo ion-específico (modelo Orión 96-09, Orion Research, Cambridge) acoplado a un analizador de iones (Orion EA-940). Los metales pesados se analizaron mediante ICP-MS (Agilent modelo 7900). Se realizó un estudio estadístico descriptivo de los datos. RESULTADOS: El valor mínimo de flúor encontrado fue de 0,05 ppm y el máximo de 0,95 ppm. El 80% de las marcas analizadas contenían menos de 0,6 ppm F. Solamente una marca superó las 0,8 ppm F. Cromo y arsénico fueron los metales pesados presentes en todas las marcas, sin superar la dosis máxima. Ninguna marca de agua embotellada indicaba los metales pesados en la etiqueta, y solo una marca indicó la concentración de flúor en la etiqueta. CONCLUSIONES: Existe una gran variabilidad en la composición química de las aguas embotelladas comercializadas en España. La mayoría tienen una concentración de fluoruro inferior a la recomendada para prevenir la caries dental, por lo que se necesitaría un aporte extra de flúor. En las aguas embotelladas analizadas existen metales pesados, pero no superan las dosis máximas establecidas por la legislación.

Structural differences in enamel and dentin in human, bovine, porcine, and ovine teeth.

BACKGROUND: The aim was to study differences between crystalline nanostructures from the enamel and dentin of human, bovine, porcine, and ovine species. METHODS: Dentine and enamel fragments extracted from sound human, bovine, porcine and ovine incisors and molars were mechanically ground up to a final particle size of <100µm. Samples were analyzed using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). RESULTS: Human enamel (HE) and dentin (HD) showed a-axis and c-axis lengths of the carbonate apatite (CAP) crystal lattice nearer to synthetic hydroxyapatite (SHA), which had the smallest size. Enamel crystal sizes were always higher than those of dentin for all species. HE and HD had the largest crystal, followed by bovine samples. Hydroxyapatites (HAs) in enamel had a higher crystallinity index (CI), CIRietveld and CIFTIR, than the corresponding dentin of the same species. HE and HD had the highest CIs, followed by ovine enamel (OE). The changes in heat capacity that were nearest to values in human teeth during the glass transition (ΔCp) were in porcine specimens. There was a significant direct correlation between the size of the a-axis and the substitution by both type A and B carbonates. The size of the nanocrystals and the crystallinity (CIRietveld y CIFTIR) were significantly and negatively correlated with the proteic phase of all the substrates. There was a strongly positive correlation between the caloric capacity, the CIs and the crystal size and a strongly negative correlation between carbonates type A and B and proteins. CONCLUSIONS: There are differences in the organic and inorganic content of human, bovine, porcine and ovine enamels and dentins which should be taken into account when interpreting the results of studies using animal substrates as substitutes for human material.

Clinical justification of dental radiology in adult patients: a review of the literature.

Although the radiological doses used by dentists are low individually, patients are often exposed to many repeat dental radiographic examinations. The "routine" use of dental radiography, such as screening of all patients using dental panoramic radiography (DPRs) or a random decision to take a dental radiograph, will inevitable lead to unnecessary patient exposure. The use of Radiographic Referral Criteria has now become a legal requirement for all practitioners following the adoption of European Legislation. All exposures to x-rays should be clinically justified and each exposure should be expected to give the patient a positive net benefit. Recently the European Commission has published guidelines on radiation protection in dental radiology. Guidelines have previously been available in a number of European countries and also within the United States. At the present time, no specific guidelines have been published within Spain. The aim of this review article is to provide the Spanish dentist with guidance as to the appropriateness of different radiographic techniques for a variety of clinical conditions and also the frequency with which they should be taken. It is hoped that this document will act as a useful work tool in daily dental practice.

Attitude towards oral biopsy among general dentists in Murcia.

OBJECTIVE: The present study explores the attitude of general dentists towards oral biopsy as a diagnostic method in application to oral lesions. MATERIAL AND METHODS: A questionnaire was administered by mail to 520 general dentists in the Autonomous Community of Murcia (Spain), addressing a number of items: sociodemographic parameters, years of professional experience, the diagnosis of mucosal lesions, the performance of oral biopsies, and their histopathological evaluation. RESULTS: The global response rate was 32.7% (55.9% for males and 43.5% for females), with a global mean age of 35.9 years. Of note is the fact that the group with least professional experience did not include oral biopsy as diagnostic procedure, with statistically significant differences versus the other groups of experience (p=0.048) CONCLUSION: The assimilation of oral biopsy as a diagnostic procedure is seen to increase with the number of years of professional experience.