Current status of geriatric dentistry education in selected dental schools in Latin America and the Caribbean.

OBJECTIVE: Latin American and Carribean (LAC) are currently experiencing a rapid aging of their population, coupled with a significant burden of oral diseases. Despites this, there is a scarcity of evidence regarding the manner in wich geriatric dentistry is being taught in dental schools across LAC. So, the objective of this study is to investigate the current status of geriatric dentistry education at undergraduate and postgraduate levels in selected LAC dental schools. METHODS: An electronic questionnaire was developed and emailed to all 539 dental schools in 19 LAC countries. The questionnaire recorded activity levels, contents and methodology of geriatric dentistry education as part of dental degree programmes. Reminders by email and telephone calls were used to encourage non-responders to complete the questionnaire. RESULTS: In total, 317 schools from 17 countries responded to the questionnaire (response rate: 58.8%). Geriatric dentistry was taught in 54.6% of the schools at the undergraduate level and in 6.9% at the postgraduate level. Thirty two percent of the schools had a programme director trained in geriatric dentistry. Geriatric dentistry was taught as an independent course in 14.5% of the schools. Dry mouth, periodontal disease, denture-related conditions and prosthodontic management, oral mucosal disease and age-related changes of the orofacial complex were the most frequently covered topics. Clinical teaching of geriatric dentistry was reported by 26.5% of the schools, with 38.0% providing clinical training in outreach facilities. CONCLUSIONS: Geriatric dentistry education remains incipient in LAC, with only one in every four dental school offering it as a standalone course. There is an urgent need to further develop geriatric dentistry education in the continent, including further research to develop a minimum geriatric dentistry curriculum.

Association between root/coronal caries and individual factors in institutionalised elderly using ICDAS severity and activity.

BACKGROUND: Caries in the elderly has been associated with dependence, oral-health status and -care practices. This cross-sectional study aimed to investigate the association between root/coronal caries and individual factors among institutionalised elderly people in Bogotá, Colombia, using the International Caries Detection and Assessment System severity and activity criteria (ICDAS). METHODS: A total of 226 institutionalised elderly were clinically examined for root and coronal caries in 40 institutions. Caries risk was assessed with Cariogram, and demographics, oral health knowledge and practices, oral health-related quality of life and denture-use habits using a questionnaire. RESULTS: Participants (mean age: 80.1 ± 9.3 years; 63.7% female) presented a mean number of 10.8 ± 7.3 teeth and 19.4 ± 18.8 exposed root surfaces. Prevalence of Coronal-ICDAS caries experience (C-ICDAS DF) was of 100% and of 54.4% for C-ICDAS D; mean number of C-ICDAS DFS was 16.76 ± 27.36, with 50.9% of subjects having ≥ one active C-ICDAS DS. Prevalence of Root Caries Index was of 49.1% and of R-ICDAS DF of 46%; mean number of R-ICDAS DFS was 2.03 ± 2.78, with 40.3% of subjects having ≥ one active R-ICDAS DS. Most individuals had a systemic condition (94.2%) and required oral-hygiene assistance (58%). Logistic regression analyses showed significant associations (p < 0.05): for coronal active caries when having over six teeth (OR: 2.7), and for root caries, when having coronal caries (OR: 2.41), being a man (OR: 1.95), and having over 14 teeth (OR: 0.30). Those presenting with > eight exposed root surfaces were 4.04 more likely to have root caries and 2.4 times more likely to have active root caries. CONCLUSION: In the institutionalised elderly population in Bogotá significant associations were found, both for the presence as for the activity status of root and coronal caries, with individual clinical factors including coronal caries, exposed root surfaces and number of teeth.

Repensar el currículo para responder a esta y a futuras pandemias / Repensar el currículo para responder a esta y a futuras pandemias

Hace ya un año inició la circulación del SARS-Cov-2 y el listado de sus consecuencias aún sigue en aumento. La enseñanza y el ejercicio de la odontología, igual que sucedió tras la pandemia por el VIH en los años 80, no serán iguales después de la pandemia por la COVID-19. No obstante, a la hora de los balances, no tengo dudas que la profesión saldrá fortalecida. La Occupational Safety and Health Administration (OSHA) clasificó el riesgo al que los odontólogos como profesionales están expuestos en una categoría de muy alto, debido a su exposición potencial al SARS-Cov-2 cuando se realizan procedimientos que generan aerosoles (1). Si este es el caso de profesionales que teóricamente ya cuentan con la formación necesaria para realizar el manejo del riesgo, se podría esperar un riesgo mayor para los estudiantes de odontología, los cuales, además de estar aún en proceso de formación, desarrollan sus actividades académicas en ambientes que no siempre cuentan con las condiciones de infraestructura para poder hacer un adecuado control del riesgo. Pero

Predicting the outcome of initial non-surgical endodontic procedures by periapical status and quality of root canal filling: a cohort study.

To assess the previous periapical status and the quality of root canal filling as predictors of the outcome in initial non-surgical endodontic procedures. A retrospective cohort study was designed in which the presence of a previous periapical lesion was determined radiographically. The quality of the root filling was evaluated in terms of homogeneity, taper, and apical extension. The response variable was dichotomized to success and failure. Bivariate analyzes and a mixed generalized linear model interpreted the association between the explanatory variables and the outcome of the initial non-surgical endodontic procedures. A total of 349 roots were evaluated, and a failure rate of 13.18% was established. Poor filling quality was determined in 8.3% of the roots. As a main result, the presence of a preoperative periapical lesion did not determine a significant risk to the failure of the initial treatment. Unlike, a poor quality of the obturation determined association with an unfavorable outcome like this: (1) homogeneity (OR 2.32; p = 0.0181); (2) taper (OR 5.8; p = 0.0); and, (3) extension (OR 3.41; p = 0.0). Therefore, a significant association between inadequate quality of the root filling and failure of the primary non-surgical endodontic procedures was found. Short length of filling was highly associated with failure. The presence of previous periapical lesion was not found to be a significant predictor for treatment outcomes.

Vertical root fractures in endodontically-treated teeth: A retrospective analysis of possible risk factors.

AIM: The prevalence of vertical root fractures (VRF) ranges from 2% to 20%, and is associated with endodontically-treated teeth (ETT). The aim of the present study was to analyze clinically and radiographically, at different intervals of time, some of the risk factors present in ETT that developed VRF. METHODS: A classification model according to time measured the follow-up period of three groups. A match was made for times of occurrence (cases) and follow up (controls). An odds ratio (OR) test and a logistic regression model set at 95% confidence interval (CI) established the VRF probability when different clinical factors (patient, tooth, and endodontic or restorative treatment) were present. RESULTS: The sample was composed of 197 ETT (41 cases and 156 controls). A classification model set the trend, thus defining three groups: group 1 (1-4 years of follow up): endodontic retreatment (OR: 8.01, 95% CI: 1.85-37.90, P=.0014), indirect restoration (OR: .202, 95% CI: .036-.979, P=.05); group 2 (5-8 years of follow up): primary treatment (OR: .052, 95% CI: .002-.680, P=.044) and the 'single tooth' category (OR: .042, 95% CI: .002-.453, P=.02) demonstrated a significant association with VRF; and group 3 (>9 years of follow up): no association. CONCLUSION: Endodontic retreatment had the highest risk association for VRF after 1-8 years of follow up. Indirect and individual restorations were not significantly associated with VRF.

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders.

The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Oral health and mortality risk in the institutionalised elderly

Objective: Examining oral health and oral hygiene as predictors of subsequent one-year survival in the institutionalised elderly. Design: It was hypothesized that oral health would be related to mortality in an institutionalised geriatric population. A 12-month prospective study of 292 elderly residing in nine geriatric institutions in Granada, Spain, was thus carried out to evaluate the association between oral health and mortality. Independent samples, T-test, chisquare test and Cox regression analysis were used to analyse the data. Sixty-three participants died during the 12-month follow-up. Results: Mortality was increased in denture users (RR = 2.18, p= 0.007) and in people suffering severe cognitive impairment (RR = 2. 24, p= 0.003). One-year mortality was 50% in participants having both these characteristics. Conclusions: Oral hygiene was not significantly associated with mortality. Cognitive impairment and wearing dentures increased the risk of death. One-year mortality was 50% in cognitively impaired residents wearing dentures as opposed to 10% in patients without dentures and cognitive impairment (AU)

Oral health and mortality risk in the institutionalised elderly.

OBJECTIVE: Examining oral health and oral hygiene as predictors of subsequent one-year survival in the institutionalised elderly. DESIGN: It was hypothesized that oral health would be related to mortality in an institutionalised geriatric population. A 12-month prospective study of 292 elderly residing in nine geriatric institutions in Granada, Spain, was thus carried out to evaluate the association between oral health and mortality. Independent samples, T-test, chi-square test and Cox regression analysis were used to analyse the data. Sixty-three participants died during the 12-month follow-up. RESULTS: Mortality was increased in denture users (RR = 2.18, p= 0.007) and in people suffering severe cognitive impairment (RR = 2. 24, p= 0.003). One-year mortality was 50% in participants having both these characteristics. CONCLUSIONS: Oral hygiene was not significantly associated with mortality. Cognitive impairment and wearing dentures increased the risk of death. One-year mortality was 50% in cognitively impaired residents wearing dentures as opposed to 10% in patients without dentures and cognitive impairment.

Denture-related stomatitis managed with tissue conditioner and hard autopolymerising reline material.

OBJECTIVE: To compare the response of denture-related stomatitis (DS) under management with a tissue conditioner (TC) and autopolymerising hard reline material (AHRM). BACKGROUND DATA: Denture-related stomatitis affects up to 75% of denture wearers; not wearing the denture at night, using TC or prescribing topical or systemic antifungal agents could reduce its incidence. MATERIALS AND METHODS: This was a double-blind study consisting of 44 participants with DS who wear denture; they were randomly divided into two unmatched groups according to the material used for the management of DS. The TC was replaced weekly, and the AHRM was placed at the beginning of the study and was not changed for 4 weeks. A dentist performed an initial and a weekly clinical diagnosis for DS; the clinical situation was recorded by means of photographs for each week. RESULTS: Both TC and AHRM were effective in the management of DS. Significant differences were found in the DS resolution time (p < 0.001), taking longer for the TC. CONCLUSIONS: Both the tissue conditioner and AHRM are effective for the management of DS, but AHRM requires less time for recovery and as a result fewer appointments are required for the patient.

Comparación de la resolución de la estomatitis subprotesis tratada con acondicionador de tejido blando y material de rebase duro autopolimerizable / Comparison of treatment results of subdenture stomatitis treated with soft tissue conditioners and hard autopolymerizing reliners

Introducción: el uso de prótesis totales genera inflamación, inclusive subclínica, en los tejidos de soporte, la cual debe tratarse antes de su reemplazo, para esto se usan materiales blandos que deben cambiarse a menudo para conservar sus cualidades, aumentando el costo del tratamiento y afectando la prótesis existente. Se buscó determinar mediante examen clínico, si existían diferencias en la resolución de la estomatitis subprótesis (ES) luego de un mes de tratamiento con acondicionador de tejidos blandos y material de rebase duro autopolimerizable. Métodos: participaron 32 pacientes edéntulos totales superiores, con ES, de las clínicas geriátricas de la Facultad de Odontología de la Universidad Nacional de Colombia en 2005. Un patólogo oral clasificó la severidad de la ES, se tomó frotis del paladar para determinar presencia de Candida albicans. Se usaron las prótesis para dividir el paladar en dos, aplicando acondicionador de tejido en una mitad y material de rebase en la otra (coe confort y kool liner g. c.). Dos odontólogos calibrados en la clasificación de la ES, evaluaron la situación clínica durante cuatro semanas, ellos no conocían el material aplicado en cada mitad; se tomaron fotografías y se cambió semanalmente el acondicionador de tejidos. Resultados: ambos materiales readaptan las prótesis al asiento basal, resolviendo o disminuyendo la severidad de la ES, sin diferencias significativas entre ellos. Conclusiones: el material de rebase duro autopolimerizable es una alternativa para el manejo de la ES. Toda prótesis existente debería readaptarse antes de su cambio con el fin de mejorar el asiento basal.

Terceros molares incluidos: ¿cuál es la realidad dentro del contexto sistémico? / Impacted third molars: which is the truth into the systemic context?

En la práctica odontológica, los terceros molares incluidos han sido un tema de particular controversia por las implicaciones que pueden presentar, tanto a nivel local como sistémico(1,22). En este trabajo se analizó el comportamiento de éstos desde el punto de vista de la medicina bioenergética, confirmando que los individuos se comportan de manera distinta frente a un factor común. La odontología neurofocal ha postulado una teoría según la cual los dientes tienen una relación clara con cada uno de los órganos del cuerpo(28), lo que ha sido comprobado a través del método denominado electroacupuntura según Voll (EAV). El estudio de tipo exploratorio descriptivo buscó corroborar si esta relación se cumple de manera estricta teniendo en cuenta factores externos como el medio ambiente, e individuales como enfermedades sistémicas, estados de ansiedad y de estrés. Se evaluaron 15 pacientes con un rango de edad entre 18 y 33 años. El criterio de inclusión fue tener exodoncia indicada del tercer molar incluido; se realizaron mediciones del EAC, una pre y otra postquirúrgica, las cuales clasificaban el tipo de lesión tisular que pudo ser causada por la presencia del tercer molar incluido, según la clasificación propuesta por el Dr. Reinhold Voll(18). Los valores obtenidos demuestran que esta técnica sirve como marcador de funcionalidad celular de un órgano, pero no es adecuada para dar un diagnóstico orgánico. Por medio de este trabajo se da un paso para demostrar que la teoría de la relación directa entre los dientes y los distintos órganos del cuerpo no siempre se cumple, o que no siempre se afecta el trayecto directo de la relación diente órgano demostrado por Voll, evidenciando que el tercer molar incluido afecta de manera distinta a cada individuo, en el que influyen factores externos e individuales, como su propia predisposición a desarrollar enfermedades.

Perfil epidemiológico bucal de los pacientes de 55 años y más que asisten a las clínicas del geronte a la facultad de odontología de la U.N. durante el primer semestre del año 2000 y cuál es la percepción que tienen estos pacientes sobre su propio estado de salud bucal / Oral epidemiological profile of the patients aged 55 and over who assist the geriatric clinics from the school of dentistry, U.N., during the first semester of year 2000 and what is the perception they have about their own oral health status

Objetivo: determinar el perfil epidemiológico bucal y reconocer cuál es la percepción que tienen de su estado de salud bucal los pacientes de tercer edad que asisten a las clínicas del geronte de la FOUN. Metodología: este estudio combina una metodología cuantitativa y cualitativa. Para la parte cuantitativa se revisaron las historias clínicas y se hizo examen clínico a los pacientes. Para la parte cualitativa se realizaron entrevistas semiestructuradas a los pacientes seleccionados para la muestra propósito. Resultados y conclusiones: de 68 pacientes evaluados, la mayoría pertencen al grupo de 61 a 65 años de edad, la HTA es la patología más prevalente, el edentulismo parcial superior e inferior es el caso más frecuente, el N§ de dientes remanentes es de 10.7 por persona, el CPO-D es de 27 a expensas en su mayoría del componente perdido, el total de prótesis encontradas es del 63 por ciento en mal estado, ello se relaciona con la alta prevalencia de estomatitis protésica, la necesidad protésica más prevalente fue la prótesis PR inferior, seguida por la prótesis PR superior y la total superior. La gingivitis es la enfermedad periodontal que más afecta a los dientes remanentes y en general existe un 73.3 por ciento de extensión de enfermedad periodontal y 3 mm promedio de pérdida de inserción. Los pacientes consideran que su boca es de suma importancia en la estética, atribuyen la pérdida de sus dientes a la práctica indiscriminada de la exodoncia, el dolor es la experiencia que más recuerdan y la relacionan con una boca enferma. La boca está involucrada en el diario vivir (dieta) y es la idiosincracia de cada anciano

Tratamiento protésico de un caso de displasia ectodérmica hipohidrótica / Prosthetic treatment of a hypohydrotic ectodermal dysplasia case

La anodoncia es una entidad asociada con difentes sindromes. En este artículo se reporta el tratamiento con prótesis total de un caso de anodoncia de la dentición decidua y permanente, asociado a un caso de displasia ectodérmica anhidrótica, se introducen algunas variaciones a la técnica convencional para prótesis total, algunas reportadas en la literatura y otras como fruto de la investigación tanto personal como de otros autores