Experience, prevalence, need for treatment and cost of care for caries: A multicenter study in a developing country.

OBJECTIVE: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. BASIC RESEARCH DESIGN: Cross-sectional clinical study. SETTING: Elementary public schools. PARTICIPANTS: 500 schoolchildren aged 6 to 12 years. METHOD: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. MAIN OUTCOME MEASURES: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. RESULTS: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. CONCLUSIONS: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's.

Association of added sugar intake and caries-related experiences among individuals of Mexican origin.

OBJECTIVE: Determine the association between key dental outcomes and added sugar intake using a survey instrument to assess added sugars, which was specifically tailored to immigrant and US-born adults of Mexican origin. METHODS: Hispanic adults of Mexican origin (n = 326; 36.2 ± 12.1 years) completed a self-administered survey to gather acculturation, self-reported dental experiences and self-care practices (eg brushing, flossing, pain, bleeding gums), and socio-demographic information. The survey included a culturally tailored 22-item Added Sugar Intake Estimate (ASIE) that assessed added sugar intake from processed foods and sugar-sweetened beverages in a semiquantitative food frequency questionnaire format. Linear regression, 2-sample t test, and ANOVA were used to evaluate associations of demographic and dental outcomes with daily added sugar intake. RESULTS: Of the mean total daily added sugar intake (99.6 ± 94.6 g), 36.5 ± 44.4 g was derived from sugar-containing foods and snacks, and 63.1 ± 68.2 g from beverages. Participants who reported greater added sugar intake were more likely to have reported the presence of a toothache in the preceding 12 months, having been prescribed antibiotics for dental reasons, being less likely to floss daily, have reported eating or drinking within 1 hour before bed and have lower psychological acculturation (P < .05 for all). Results were comparable when assessing intake from sugar-containing foods/snacks and sugar-sweetened beverages. CONCLUSIONS: This study confirmed the association between added sugar intake and self-reported dental outcomes among adults of Mexican origin and points to an urgent need to improve dietary behaviours in this population.

Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services.

OBJECTIVES: We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. METHODS: Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees' (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. RESULTS: A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. CONCLUSIONS: This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos' orientation toward dental care.

Identification of barriers and beliefs influencing engagement by adult and teen Mexican-Americans in oral health behaviors.

OBJECTIVE: To identify barriers and beliefs influencing oral health and dental care-seeking among Mexican-Americans. RESEARCH DESIGN: Interviews and Likert-scale survey questions were utilized to explore urgent and preventive dental care-seeking, oral hygiene habits and lifestyle practices. Thirty-three interviews were conducted with 16 adults (ages 33-52), and 17 adolescents (ages 14-19). RESULTS: Teens identified the same main barriers to accessing dental care as adults: high cost, financial limitations and lack of insurance. Most Mexican-Americans agreed with the belief that everyone will need urgent dental treatment and the majority believed that going to a dentist in private practice instead of the Emergency Room was important. Although adults recognized the importance of preventive dental care, half reported being unlikely to seek such care while half of teens reported that they were likely to do so. Adults reported relying equally on themselves and on peers to make dental care decisions, while teens mostly depended on others to make decisions about urgent and preventive care. Virtually all respondents believed regular brushing to be important and many flossing too. A major barrier to flossing was being unsure of the proper technique. Another barrier to better oral health was not having seen messages encouraging changes in lifestyle. CONCLUSIONS: This study found that Mexican-American teens and adults may experience oral health similarly. Teens do not have more positive oral health beliefs and encounter mostly the same barriers to care as adults.

Dental problems and Familismo: social network discussion of oral health issues among adults of Mexican origin living in the Midwest United States.

OBJECTIVE: To examine the influence of collectivist orientation (often called familismo when applied to the Latino sub-group in the United States) in oral health discussion networks. BASIC RESEARCH DESIGN: Through respondent-driven sampling and face-to-face interviews, we identified respondents' (egos) personal social network members (alters). Egos stated whom they talked with about oral health, and how often they discussed dental problems in the preceding 12 months. PARTICIPANTS: An urban community of adult Mexican-American immigrants in the Midwest United States. We interviewed 332 egos (90% born in Mexico); egos named an average of 3.9 alters in their networks, 1,299 in total. METHOD: We applied egocentric network methods to examine the ego, alter, and network variables that characterize health discussion networks. RESULTS: Kin were most often leveraged when dental problems arose; egos relied on individuals whom they perceive to have better knowledge about dental matters. However, reliance on knowledgeable alters decreased among egos with greater behavioral acculturation. CONCLUSIONS: This paper developed a network-based conceptualization of familismo. We describe the structure of oral health networks, including kin, fictive kin, peers, and health professionals, and examine how networks and acculturation help shape oral health among these Mexican-Americans.

Reasons why erupted third molars are extracted in a public university in Mexico.

PURPOSE: The aim of this study was to determine the reasons for which erupted third molars (3M) are extracted in a sample of Mexican patients. SUBJECTS AND METHODS: A retrospective cross-sectional study was performed on a sample of 83 patients attending exodontia (minor oral surgery) clinics of a public university in Mexico (Autonomous University of Hidalgo State). The outcome variable was the reason for extractions using Kay and Blinkhorn's classification. The independent variables were age, gender, arch and tooth number according to the World Health Organization (WHO). For statistical analysis, we used the Chi-squared test in Stata 9.0. RESULTS: Eighty-three patients underwent 150 3M extractions. Mean age was 38.67 ± 13.96 years, and 71.1% were female. The four reasons for 3M extraction were prosthetic (44.0%), followed by orthodontic (24.7%), dental caries (20.0%) and periodontal disease (11.3%). Differences were observed in the reasons for 3M extractions across age groups (p < 0.05). No significant differences existed between men and women (p > 0.05), or the WHO tooth number (p > 0.05). CONCLUSION: Women and patients 18 to 34 years of age had erupted 3M extracted more frequently, primarily for prosthetic reasons. The age profile indicated a trend in demand for services that differ from those of overall tooth extractions, but not for the trend across gender.

Salivary Parameters (Salivary Flow, pH and Buffering Capacity) in Stimulated Saliva of Mexican Elders 60 Years Old and Older.

OBJECTIVE: To compare a limited array of chewing-stimulated saliva features (salivary flow, pH and buffer capacity) in a sample of elderly Mexicans with clinical, sociodemographic and socio-economic variables. SUBJECTS AND METHODS: A cross-sectional study was carried out in 139 adults, 60 years old and older, from two retirement homes and a senior day care centre in the city of Pachuca, Mexico. Sociodemographic, socio-economic and behavioural variables were collected through a questionnaire. A trained and standardized examiner obtained the oral clinical variables. Chewing-stimulated saliva (paraffin method) was collected and the salivary flow rate, pH and buffer capacity were measured. The analysis was performed using non-parametric tests in Stata 9.0. RESULTS: Mean age was 79.1 ± 9.8 years. Most of the subjects included were women (69.1%). Mean chewing-stimulated salivary flow was 0.75 ± 0.80 mL/minute, and the pH and buffer capacity were 7.88 ± 0.83 and 4.20 ± 1.24, respectively. Mean chewing-stimulated salivary flow varied (p < 0.05) across type of retirement home, tooth brushing frequency, number of missing teeth and use of dental prostheses. pH varied across the type of retirement home (p < 0.05) and marginally by age (p = 0.087); buffer capacity (p < 0.05) varied across type of retirement home, tobacco consumption and the number of missing teeth. CONCLUSIONS: These exploratory data add to the body of knowledge with regard to chewing-stimulated salivary features (salivary flow rate, pH and buffer capacity) and outline the variability of those features across selected sociodemographic, socio-economic and behavioural variables in a group of Mexican elders.

Frequency of tooth brushing and associated factors in Mexican schoolchildren six to nine years of age.

OBJECTIVE: To determine the prevalence of daily tooth brushing and evaluate some variables associated. SUBJECTS AND METHODS: A cross-sectional study was carried out in 320 schoolchildren six to nine years old in Campeche, Mexico. Information on sociodemographic and socio-economic variables, oral hygiene practices and attitudes were collected through a questionnaire. The frequency of tooth brushing was categorized as "0" = fewer than seven times/week, "1" = at least once a day. In the analysis, nonparametric tests were used. RESULTS: Mean age was 6.99 +/- 1.00 years, 52.5% were boys. The prevalence of daily tooth brushing was 81.6%. In bivariate analysis, the prevalence of tooth brushing was higher (p < 0.05) among the children of mothers with higher schooling (9.80 years vs 8.47 years, p < 0.05), and in younger children (84.6% in 6-7-year olds vs 71.2% in 8-9-year olds, p < 0.05). A slight, non-significant association (p < 0.10) was noted between the current frequency of tooth brushing and an earlier age when the child first started brushing with toothpaste. There were no statistically significant differences (p > 0.05) in the frequency of tooth brushing by gender or by the mother's attitude toward the oral health of her child. CONCLUSIONS: The prevalence of daily tooth brushing was high compared to other studies. Mother's maximum level of schooling (as an indicator of socio-economic position) was associated with higher frequency of tooth brushing. Maternal characteristics are associated with the oral health behaviour of their children.

Treatment needs for Dental Caries, Restorative Care Index, and Index of Extractions in adolescents 12 and 15 years old / Necesidades de tratamiento para Caries Dental, Indice de Cuidados Restauradores, e Índice de Extracciones en adolescentes de 12 y 15 años de edad

OBJECTIVE: To determine the Treatment Needs Index (TNI) for dental caries, the restorative Care Index (CI), and to introduce a Tooth Extractions Index (TEI) to estimate past and current treatment needs among Mexican adolescents. SUBJECT AND METHODS: A descriptive cross-sectional study was carried out on 1538 adolescents aged 12 and 15 years in the state of Hidalgo, Mexico, to collect decayed, missing, filled teeth (DMFT) data to describe TNI, CI and TEI indices. RESULTS: Higher TNI was identified in younger male teenagers who had always lived in the same community, without dental visits in the last year, and who had poorer socio-economic markers. Higher CI was found in older, female subjects who had moved in their lifetimes to a new community in the area, with dental visits in the last year and who had better socio-economic markers. Higher TEI was found in older, female teenagers who had moved in their lifetimes to a new community in the area, without dental visits in the last year, and who had worse socio-economic markers. CONCLUSIONS: We observed high rates of treatment needs for dental caries and little experience of restorative treatment. While dental extractions due to advanced caries should ideally be zero, relatively few adolescents had this treatment experience. Despite the fact that the overall background of these adolescents is rather homogeneous, it was still possible to find that treatment needs'indices (past and present needs) appeared to be modified by sociodemographic and socio-economic variables.

OBJETIVO: Determinar las necesidades de tratamiento para caries dental (INT), el índice de cuidados restauradores (IC) así como proponer un índice que haga referencia a las extracciones dentales (IE), para estimar necesidades de tratamiento actual y pasada en adolescentes mexicanos. MATERIAL Y MÉTODOS: Se realizó un estudio transversal descriptivo en 1538 adolescentes de 12 y 15 años en el Estado de Hidalgo, México. Empleando el índice CPOD se calcularon los índices TNI e IC; asimismo se propone un IE a las que ha estado expuesta la población. RESULTADOS: El INT fue mayor en los de 12 años, hombres, los que vivieron siempre en la misma comunidad, que no tuvieron visita al dentista en el último año, y con marcado nivel socioeconómico bajo. El IC fue mayor en los sujetos de 15 años, las mujeres, con migración interna, que si tuvieron visita al dentista en el último año, y con mejor nivel socioeconómico. El IE fue mayor en los de 15 años, mujeres, con migración interna, que no tuvieron visita al dentista en el último año, y con peores condiciones socioeconómicas. CONCLUSIONES: Se observaron altas necesidades insatisfechas de tratamiento para caries dental y poca experiencia de tratamiento restaurador. Las extracciones se observaron en pocos adolescentes, considerando cero como ideal. A pesar de que los antecedentes de estos adolescentes es bastante homogéneo, fue posible encontrar que los índices de necesidades de tratamiento (necesidades presentes y pasadas) parecen ser modificados por variables socio-demográficas y socioeconómicas.

Frequency of tooth brushing and associated factors in mexican schoolchildren six to nine years of age / Frecuencia del cepillado dental y factores asociados en escolares mexicanos de seis a nueve años de edad

OBJECTIVE: To determine the prevalence of daily tooth brushing and evaluate some variables associated. SUBJECTS AND METHODS: A cross-sectional study was carried out in 320 schoolchildren six to nine years old in Campeche, Mexico. Information on sociodemographic and socio-economic variables, oral hygiene practices and attitudes were collected through a questionnaire. The frequency of tooth brushing was categorized as "0" = fewer than seven times/week, "1" = at least once a day. In the analysis, nonparametric tests were used. RESULTS: Mean age was 6.99 ± 1.00 years, 52.5% were boys. The prevalence of daily tooth brushing was 81.6%. In bivariate analysis, the prevalence of tooth brushing was higher (p < 0.05) among the children of mothers with higher schooling (9.80 years vs 8.47 years, p < 0.05), and in younger children (84.6% in 6-7-year olds vs 71.2% in 8-9-year olds, p < 0.05). A slight, non-significant association (p < 0.10) was noted between the current frequency of tooth brushing and an earlier age when the child first started brushing with toothpaste. There were no statistically significant differences (p > 0.05) in the frequency of tooth brushing by gender or by the mother's attitude toward the oral health of her child. CONCLUSIONS: The prevalence of daily tooth brushing was high compared to other studies. Mother's maximum level of schooling (as an indicator of socio-economic position) was associated with higher frequency of tooth brushing. Maternal characteristics are associated with the oral health behaviour of their children.

OBJETIVO: Determinar la prevalencia del cepillado dental diario y evaluar algunas de las variables asociadas. SUJETOS Y MÉTODOS: Se llevó a cabo un estudio transversal en 320 escolares de seis a nueve años de edad en Campeche, México. La información sobre las variables sociodemográficas y socio-económicas, las prácticas higiénicas orales y las actitudes, fue recopilada mediante un cuestionario. La frecuencia de cepillado dental fue clasificada con las siguientes categorías: "0" = menos de siete veces por semana, "1" = por lo menos una vez al día. En el análisis, se usaron pruebas no paramétricas. RESULTADOS: La edad promedio fue 6.99 ± 1.00 años, 52.5% fueron varones. La prevalencia del cepillado dental diario fue 81.6%. En el análisis bivariante, la prevalencia del cepillado dental fue más alta (p < 0.05) entre los niños de madres con mayor escolaridad (9.80 años frente a 8.47 años, p < 0.05), y en los niños de menor edad (84.6% en los de 6 a 7 años frente a 71.2% en los de 8 a 9 años, p < 0.05). Una ligera asociación no significativa (p < 0.10) fue observada entre la frecuencia actual del cepillado dental, y la existente en una edad más temprana, cuando el niño comenzara por primera vez a cepillarse con crema dental. No hubo ninguna diferencia estadísticamente significativa (p > 0.05) en la frecuencia del cepillado dental por género o por la actitud de la madre hacia la salud oral de su niño. CONCLUSIONES: La prevalencia del cepillado dental diario fue alta en comparación con la de otros estudios. El máximo nivel escolar de las madres predominio (como indicador de posición socio-económica) estuvo asociado con una mayor frecuencia del cepillado dental. Las características maternas se encuentran asociadas con la conducta en la relación con la salud oral de sus hijos.

Treatment needs for dental caries, restorative care index and index of extractions in adolescents 12 and 15 years old.

OBJECTIVE: To determine the Treatment Needs Index (TNI) for dental caries, the restorative Care Index (CI), and to introduce a Tooth Extractions Index (TEI) to estimate past and current treatment needs among Mexican adolescents. SUBJECTS AND METHODS: A descriptive cross-sectional study was carried out on 1538 adolescents aged 12 and 15 years in the state of Hidalgo, Mexico, to collect decayed, missing, filled teeth (DMFT) data to describe TNI, CI and TEI indices. RESULTS: Higher TNI was identified in younger male teenagers who had always lived in the same community, without dental visits in the last year, and who had poorer socio-economic markers. Higher CI was found in older, female subjects who had moved in their lifetimes to a new community in the area, with dental visits in the last year and who had better socio-economic markers. Higher TEI was found in older, female teenagers who had moved in their lifetimes to a new community in the area, without dental visits in the last year, and who had worse socio-economic markers. CONCLUSIONS: We observed high rates of treatment needs for dental caries and little experience of restorative treatment. While dental extractions due to advanced caries should ideally be zero, relatively few adolescents had this treatment experience. Despite the fact that the overall background of these adolescents is rather homogeneous, it was still possible to find that treatment needs' indices (past and present needs) appeared to be modified by sociodemographic and socio-economic variables.

Maternal characteristics and treatment needs as predictors of dental health services utilisation among Mexican school children.

AIM: To determine whether maternal characteristics and treatment needs are associated with dental health services utilization (DHSU) in school children. MATERIALS AND METHODS: A cross-sectional study in 1373 school children aged 6- 12 years in elementary schools in Campeche, Mexico collected family and sociodemographic characteristics; an oral examination was conducted. The dependent variable was DHSU in the year preceding the study. RESULTS: DHSU prevalence was 65.5%. The variables associated (p<0.05) with DHSU in the final multivariate model were age (OR=1.27), maternal schooling (OR=1.07), mother's attitude toward oral health (OR=1.39), frequency of tooth brushing (OR=1.83), enamel defects (OR=1.55), and unmet oral health needs (moderate: OR=1.42 and high: OR=2.30). CONCLUSION: Specific sociodemographic and maternal variables were associated with DHSU. Strategies are needed to increase appropriate and timely use of services to improve health status.

Efficacy of chlorhexidine varnish for the prevention of adult caries: a randomized trial.

The Prevention of Adult Caries Study, an NIDCR-funded multicenter, double-blind, randomized clinical trial, enrolled 983 adults (aged 18-80 yrs) at high risk for developing caries (20 or more intact teeth and 2 or more lesions at screening) to test the efficacy of a chlorhexidine diacetate 10% weight per volume (w/v) dental coating (CHX). We excluded participants for whom the study treatment was contraindicated or whose health might affect outcomes or ability to complete the study. Participants were randomly assigned to receive either the CHX coating (n = 490) or a placebo control (n = 493). Coatings were applied weekly for 4 weeks and a fifth time 6 months later. The primary outcome (total net D(1-2)FS increment) was the sum of weighted counts of changes in tooth surface status over 13 months. We observed no significant difference between the two treatment arms in either the intention-to-treat or per-protocol analyses. Analysis of 3 protocol-specified secondary outcomes produced similar findings. This trial failed to find that 10% (w/v) chlorhexidine diacetate coating was superior to placebo coating for the prevention of new caries (Clinicaltrials.gov registration number NCT00357877).

Letter from America: UK and US state-funded dental provision.

OBJECTIVES: Current UK and US economic conditions have re-focussed attention on the need to deliver dental care with limited finance and resources. This raises hard questions determining which services will be offered and what they should achieve to satisfy public demands and needs. We consider impending dental health reforms in the US and UK within the context of contemporary experiences to identify issues and delivery goals for the two nations. BACKGROUND: The paper provides a brief history and background of the development of social dental care models in the UK and US, highlighting some differences in state-funded delivery of dental care. SHIFTING DEMAND: From the 1950s, demand for dental treatment has increased and acquired a more complex composition growing from predominantly surgical and restorative treatment to encompass preventive care and cosmetic services. PRIORITISING CARE ACCORDING TO NEED: Despite improvements in general health and technology, inequalities in access and utilisation of dental care are still experienced, primarily by groups with low socio-economic status. DELIVERY: BALANCING RESOURCES, DEMAND AND NEED: In developing and delivering reform agendas, much can be learned from previous policy interventions. Pressures of cost, coverage, and capacity, besides demand versus need must be carefully considered and balanced to deliver quality service and value for users and taxpayers. CONCLUSIONS: Ethical and moral consideration should be given to making services needs-driven to address high treatment requirements rather than the high care demands of the worried well. This challenge brings the additional political pressure of convincing many of the voters (and subsequent complainers) that their demands may be less important than the needs of others.

Association between developmental enamel defects in the primary and permanent dentitions.

AIM: To determine if the presence of developmental enamel defects (DED) in the primary dentition is a risk indicator for the presence of DED in the permanent dentition in children with mixed dentition, as well as others factors. MATERIALS AND METHODS: A cross-sectional study was undertaken in 1296 school children ages six to 72 years. The DED [FDI; 1982] in both dentitions were identified by means of an oral exam scoring enamel opacities [classified as demarcated or diffused], and enamel hypoplasia. Sociodemographic and socioeconomic variables were collected through a questionnaire. Socioeconomic status (SES) was determined based on the occupation and maximum level of education of parents. Statistical analysis included logistic regression. RESULTS: Mean age of participants was 8.40 +/- 1.68; 51.6% were boys. DED prevalence was 7.5% in the permanent dentition and 10.0% in the primary dentition. The logistic regression model, adjusting for sociodemographic and socioeconomic variables, showed that for each primary tooth with DED, the odds of observing DED in the permanent dentition increased 7.38 times [95% CI = 1.17-1.64; p < 0.001]. CONCLUSION: An association between DED presence in both permanent and primary dentitions was observed. Further studies are necessary to fully characterise such relationship.

Estudio ecológico en México (2003-2009) sobre labio y/o paladar hendido y factores sociodemográficos, socioeconómicos y de contaminación asociados / Ecologic study in Mexico (2003-2009) on cleft lip and/or palate and associated sociodemographic, socioeconomic and pollution factors

Objetivo: Analizar de 2003 a 2009 las tasas de labio y/o paladar hendido (LPH) en México y determinar su asociación a nivel ecológico con variables sociodemográficas, socioeconómicas y de contaminación. Material y métodos: Se realizó un estudio ecológico utilizando datos de la incidencia de LPH. También se incluyó información en cuanto a aspectos sociodemográficos, socioeconómicos y de contaminación, obtenida de instituciones públicas gubernamentales. Se utilizó como variable dependiente la tasa de incidencia del LPH, y como variables independientes los indicadores socioeconómicos, sociodemográficos y de contaminación. En el análisis se utilizaron las pruebas de correlación de Spearman y de la chi cuadrado. Resultados: Durante el período estudiado se presentaron 10.573 nuevos casos de LPH (promedio de 1.510,43 por año). Los estados con mayor tasa de LPH (x 1.000 nacidos) fueron: en 2003 Distrito Federal (1,76), en 2004 Jalisco (2,62), en 2005 Oaxaca (1,66), en 2006 Estado de México (1,29), en 2007, 2008 y 2009 Jalisco (2,17, 2,92 y 1,99, respectivamente). Los varones fueron los más afectados (p < 0,05). Las variables correlacionadas positivamente a las tasas de LPH fueron: población total, residuos sólidos, esperanza de vida, sólidos urbanos; y negativamente: porcentaje de consumidores altos de alcohol y abuso o dependencia de alcohol. Conclusiones: Jalisco fue el estado más afectado cada año. Se encontraron correlaciones ecológicas entre las tasas de LPH con factores sociodemográficos, socioeconómicos y de contaminación, aunque de forma inversa con el consumo de alcohol. Es necesario realizar estudios epidemiológicos más detallados sobre el tema para caracterizar adecuadamente los factores de riesgo en poblaciones mexicanas (AU)

Objective: To analyze the rates of cleft lip and/or cleft palate (CLP) in Mexico between 2003and 2009 and assess their association with variables at ecological level, sociodemographic, socioeconomic, and pollution. Material and methods: An ecological study was conducted with data from the 32 states of Mexico for incidence of CLP, obtained from the Ministry of Health. We included sociodemographic, socioeconomic, and pollution information, obtained from governmental agencies. CLP incidence rates were used as dependent variable; independent variables were socioeconomic, demographic and pollution indicators. Statistical analysis was performed using Spearman correlation and chi2 tests .Results: During the study period 10573 new cases presented (mean 1510.43 per year). The States with the highest rate (per 1000 births) were: in 2003 the Federal District (Mexico City)(1.76), in 2004 Jalisco (2.62), in 2005 Oaxaca (1.66), in 2006 the State of Mexico (1.29), in 2007, 2008 and 2009 Jalisco (2.17, 2.92, and 1.99). For all the years men were more likely affected than women (P < 0.05). Variables found positively correlated to LPH rates were total population, solid waste, life expectancy, urban solid waste. The variables negatively correlated were population percentages of high alcohol users, and of alcohol abuse or addiction. Conclusions: The State of Jalisco was one of the most affected locations over the years. Ecologic positive correlations existed between cleft lip and/or palate and sociodemographic, socioeconomic, and pollution factors. Incidence rate was negatively correlated with alcohol use and abuse. More detailed epidemiological studies are needed to fully characterize risk factors in Mexican populations (AU)

[Ecologic study in Mexico (2003-2009) on cleft lip and/or palate and associated sociodemographic, socioeconomic and pollution factors]. / Estudio ecológico en México (2003-2009) sobre labio y/o paladar hendido y factores sociodemográficos, socioeconómicos y de contaminación asociados.

OBJECTIVE: To analyze the rates of cleft lip and/or cleft palate (CLP) in Mexico between 2003 and 2009 and assess their association with variables at ecological level, sociodemographic, socioeconomic, and pollution. MATERIAL AND METHODS: An ecological study was conducted with data from the 32 states of Mexico for incidence of CLP, obtained from the Ministry of Health. We included sociodemographic, socioeconomic, and pollution information, obtained from governmental agencies. CLP incidence rates were used as dependent variable; independent variables were socioeconomic, demographic and pollution indicators. Statistical analysis was performed using Spearman correlation and chi(2) tests. RESULTS: During the study period 10573 new cases presented (mean 1510.43 per year). The States with the highest rate (per 1000 births) were: in 2003 the Federal District (Mexico City) (1.76), in 2004 Jalisco (2.62), in 2005 Oaxaca (1.66), in 2006 the State of Mexico (1.29), in 2007, 2008 and 2009 Jalisco (2.17, 2.92, and 1.99). For all the years men were more likely affected than women (P<.05). Variables found positively correlated to LPH rates were total population, solid waste, life expectancy, urban solid waste. The variables negatively correlated were population percentages of high alcohol users, and of alcohol abuse or addiction. CONCLUSIONS: The State of Jalisco was one of the most affected locations over the years. Ecologic positive correlations existed between cleft lip and/or palate and sociodemographic, socioeconomic, and pollution factors. Incidence rate was negatively correlated with alcohol use and abuse. More detailed epidemiological studies are needed to fully characterize risk factors in Mexican populations.

Edentulism risk indicators among Mexican elders 60-year-old and older.

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0±9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p<0.05) with edentulism were living with a spouse (odds ratio=OR=0.31), and lacking health insurance (OR=0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR=1.61), having received radiation therapy (OR=4.49), being a smoker (OR=4.82), and having diabetes (OR=2.94) or other chronic illnesses (OR=1.82) (with hypertension approaching significance, p=0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population.

Infection control attitudes and perceptions among dental students in Latin America: implications for dental education.

UNLABELLED: Latin American dental schools are at diverse stages in the continuum of implementation of infection control (IC) programmes that comply with evidence-based recommendations. Poor IC training may result in low compliance and negative attitudes against patients infected with blood borne pathogens (BBP). OBJECTIVE: To evaluate students' knowledge on IC and attitudes toward occupational BBP risks, in six dental schools in Latin America. METHODS: This survey was administered to convenience samples of dental students at one school in Costa Rica; four schools in Mexico, and one in Venezuela. The questionnaire included Likert-type scale evaluations of agreement with statements. Study variables included knowledge about and confidence in recommended IC procedures, degree of concern about HIV and HBV transmission in dental settings, and attitudes toward patients infected with BBP. Possible associations between variables were analysed using Pearson's Chi square and Kruskal Wallis tests. RESULTS: Substantial numbers of students had incomplete knowledge and often lacked confidence on IC and procedures; believed that HIV and HBV could be transmitted during clinical procedures; felt worried about occupational exposure to BBP, and held prejudices towards HIV and HBV infected individuals. CONCLUSIONS: Educational efforts are needed to enhance IC teaching and compliance. Diverse educational resources and international networks for research collaboration are available from organisations specialised in IC, hopefully paving the way to harmonising regional standards.

Systemic antibiotics and tooth loss in periodontal disease.

Systemic antibiotics have been recommended for the treatment of destructive periodontal disease. Our goal was to relate antibiotic use for medical or dental reasons to subsequent tooth loss in a cohort of 12,631 persons with destructive periodontal disease. After adjustment for age, smoking, and other confounders, the dispensing of antibiotics for 1-13 days, 14-20 days, or 21 or more days was not associated with reduced tooth loss [Adjusted rate ratio (RR) = 1.0; 95% Confidence Interval (CI) = 0.8-1.1; RR = 1.2; 95% CI = 0.9-1.4, and RR =1.2, 95% CI =1.0-1.3, respectively]. Numerous subgroup analyses were consistent with these overall null findings, with two exceptions: Longer courses of tetracyclines were associated with reduced tooth loss among persons receiving periodontal care, and penicillin was associated with reduced tooth loss among persons with more severe disease. Long-term, larger randomized trials are needed to provide evidence that antibiotics reduce tooth loss when used in the management of destructive periodontal disease.