The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study.

OBJECTIVES: The purpose of this study is to investigate the effect of the comprehensive oral care program on oral health status and symptoms in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS: This was a quasi-experimental study using a non-equivalent control group in non-synchronized design. All participants including control and experimental group were asked for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 (EORTC QLQ-H&N35) and given an oral health education 4 times at baseline, immediate postradiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy. In each visit except for final, the experimental group was given fluoride varnish application and fluoride mouth rinsing solution for daily use. Oral health examination for dental caries, plaque score (PS), bleeding on probing (BOP), and salivary flow rate was performed in baseline and 6 months after radiotherapy. Statistical analyses were done by paired t-tests and mixed ANCOVA repeated-measures analysis. RESULTS: From November 1, 2013 to October 31, 2015, a total 61 patients undergoing radiotherapy for HNC cancer were enrolled (30 in control and 31 in experimental groups). Decrease in salivary flow rate was comparable between 2 groups. Dental caries increased in control group (P = .006); PS and BOP were decreased in experimental group (P < .001 and .004, respectively). Experimental group showed lower swallowing, speech problems, and less sexuality scores in EORTC QLQ-H&N35 than control group. CONCLUSION: We found improvement in oral health and the quality of life in HNC patients with comprehensive oral care intervention by dental professionals. Communicating and cooperating between the healthcare and dental professionals is needed to raise the quality of health care services for HNC patients receiving radiotherapy.

Atención odontológica a personas con discapacidad intelectual: una cuestión de derecho / Dental care for people with intellectual disabilities: a matter of law

En el planeta hay 100 millones de personas con alguna discapacidad yen México es el 6.2 por ciento de la población total. Estas personas son altamente vulnerables porque el entorno donde se desenvuelven no ofrece las condiciones para favorecer su integración y participación social, como el acceso a servicios médicos. De acuerdo con la Organización Mundialde la Salud, las personas con discapacidad son las menos atendidas en los Servicios Odontológicos, principalmente por inexperiencia del profesionista sobre el trato a estas personas, o bien por desconocimiento de los familiares-cuidadores de la importancia de mantener una boca sana. Las personas con discapacidad intelectual (PDI) constituyen un retopara el odontólogo, quien tiene que capacitarse para diseñar estrategiaspara su atención, ya que los tratamientos para este tipo de pacientes son específicos y poco convencionales. Adicionalmente conviene tomar precauciones en su atención dental, debido a que los PDI consumen diversos medicamentos, por lo que el odontólogo debe asegurarsecon otros especialistas para su manejo. Un punto medular sobre las características de la atención odontológica es que ésta tiene que generar confianza y enfrentar con paciencia y destreza a un PDI que cumpla con las expectativas del usuario, trato digno, calidez y confianza centrada en la prevención como principal criterio en la intervención odontológica, sobre todo en la supervisión de la higiene por parte de los familiares. Actualmente se habla de la relación médico-paciente participativa donde se define lo que corresponde a cada persona involucrada en el cuidado de la PDI, sin olvidar que esta atención conviene que sea en equipo. Así, ante este contexto, los odontólogos tendrían que formarseen el cuidado de la salud de las PDI quienes son sujetos de derecho,por tanto tienen que ser atendidos, respetados y tratados con dignidad.

On the planet, there are 100 million people with some disability andin Mexico; it is 6.2% of the total population. These people are highly vulnerable because the environment where they operate does not offer the conditions to favor their integration and social participation, such as access to medical services. According to the World Health Organization, people with disabilities are the least attended in the dental services, mainly because of the inexperience of the professional about the treatment of these people, or because the family/caregivers do notknow about the importance of maintaining a healthy mouth. People with intellectual disabilities (PIDs) are a challenge for the dentist,who has to be trained to design strategies for their care since the treatments for these types of patients are specific and unconventional.In addition, precautions should be taken in dental care, because PIDsconsume different medications, so the dentist must be sure with other specialists to handle them. A central point about the characteristicsof dental care is that it has to generate trust and face with patience and dexterity a PDIs that meets user expectations, dignified treatment, warmth, and confidence focused on prevention as the main criterion inthe intervention dental care, especially in the supervision of the hygieneby the relatives. At the moment we are talking about the participative doctor-patient relationship where it is defined that corresponds to eachperson involved in the care of the PDIs, without forgetting that this careshould be in a team. Thus in this context dentists should be trained inthe health care of the IDPs who are subjects of law, therefore have tobe attended, respected and treated with dignity.

Current methods of sedation in dental patients - a systematic review of the literature

OBJECTIVE: The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study DESIGN: A systematic literature review of the PubMed MEDLINE database was carried out using the key words "conscious sedation", "drugs", and "dentistry". A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. RESULTS: A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2 O) are also effective sedative drugs. CONCLUSIONS: Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective

Design and Outcomes of a Comprehensive Care Experience Level System to Evaluate and Monitor Dental Students' Clinical Progress.

A Comprehensive Care Experience Level (CCEL) system that is aligned with Commission on Dental Accreditation (CODA) standards, promotes comprehensive care and prevention, and addresses flaws observed in previous Relative Value Units (RVU)-based programs has been implemented at the School of Dental Medicine, Case Western Reserve University since 2011. The purpose of this article is to report on the design, implementation, and preliminary outcomes of this novel clinical evaluation system. With the development of the CCEL concept, it was decided not to award points for procedures performed on competency exams. The reason behind this decision was that exams are not learning opportunities and are evaluated with summative tools. To determine reasonable alternative requirements, production data from previous classes were gathered and translated into CCEL points. These RVU points had been granted selectively only for restorative procedures completed after the initial preparation stage of the treatment plan, and achievement of the required levels was checked at multiple points during the clinical curriculum. Results of the CCEL system showed that low performing students increased their productivity, overall production at graduation increased significantly, and fluoride utilization to prevent caries rose by an order of magnitude over the RVU system. The CCEL program also allowed early identification and remediation of students having difficulty in the clinic. This successful implementation suggests that the CCEL concept has the potential for widespread adoption by dental schools. This method also can be used as a behavior modification tool to achieve specific patient care or clinical educational goals as illustrated by the way caries prevention was promoted through the program.

La odontología restauradora integral y la estética / Comprehensive restorative dentistry and esthetics

La planificación es una de las etapas más importantes del tratamiento y también una de las más difíciles. Si lo hacemos de manera específica, parcial y no integral, no vamos a avanzar ni a terminarlo correctamente. Además, es preciso cumplir con las expectativas de los pacientes, quienes buscan restauraciones permanentes que duren toda la vida. Si tenemos en cuenta los estudios clínicos de cualquier tipo de tratamiento, veremos que la tasa de supervivencia a largo plazo nunca es del 100 por ciento. El plan de tratamiento es la base del éxito de la rehabilitación. Después de haber almacenado los datos necesarios de forma integral, el profesional tiene la capacidad de ejecutar un plan de trabajo en detalle, lo cual puede facilitar el desarrollo de las actuaciones y dar lugar a un tratamiento exitoso.

Comprehensive Oral Health Care to Reduce the Incidence of Severe Early Childhood Caries (s-ECC) in Urban China.

OBJECTIVE: To explore the effectiveness of comprehensive oral health care to reduce the caries incidence for children with severe early childhood caries (s-ECC) in an urban area in China. METHODS: A total of 357 children aged 3 to 4 years old and diagnosed with s-ECC were recruited in this randomised controlled, single-blinded clinical trial for 1 year. Children of two different kindergarten classes were enrolled in this study and randomly divided into a test group (205 children) and a control group (152 children). The test group received comprehensive oral health care, which included: oral health examination, oral health education, topical fluoride application and dental treatment, and the children in the control group only received the oral health examination. The evaluation of the oral health questionnaire for parents was also performed. An evaluation was carried out at the time of recruitment and 1 year later to explore the effectiveness of the comprehensive oral health care model. RESULTS: The differences in decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), filled tooth surfaces (fs) and the ratio of ft /(dt + ft) between the two groups were statistically significant (P < 0.001) at 1 year. The incidence of caries in the control group was higher than that of the test group (P = 0.02). The rate of awareness of oral health knowledge (P = 0.01) and the practice of good diet habits (P = 0.02) by parents in the test group were significantly higher than those in the control group. CONCLUSION: The present study demonstrated that the comprehensive oral health care program reduces and prevents caries amongst children with s-ECC.

Tratamiento interdisciplinario en la resolución de un caso clínico / Interdisciplinary treatment for the resolution of a clinical case

La resolución del caso clínico presentado, demuestra la importancia de la prevención como objetivo de toda acción odontológica. Los datos obtenidos a través de la anamnesis de la paciente tratada (hábito de succión del pulgar, antecedentes familiares, tabaquismo) no dejan lugar a dudas de cómo las anomalías que motivaron la consulta fueron consecuencias directas de este hábito que trajo aparejado, además, severos problemas periodontales, estéticos y funcionales asociados entre sí. La resolución obtenida debe ser considerada como bastante buena en relación al complejo problema que presentaba el caso clínico. El trabajo realizado fue muy valorado por el paciente y trajo como consecuencia una mejoría no solamente en su salud bucal, sino también en su bienestar personal y anímico. El enfoque multidisciplinario, por otra parte, permite la integración de varias ramas de nuestra profesión y los avances logrados en rehabilitación con el trabajo mancomunado de la ortodoncia, cirugía y la prótesis, brindan la posibilidad de resolver casos complejos, lo que hasta hace un tiempo era impensado. Queremos resaltar que la atención precoz de los pacientes, ya sea desde el punto de vista ortopédico-ortodóncico como desde el punto de vista periodontal, tendría que ser un objetivo primordial en nuestra salud. Este caso resume varios problemas odontológicos que podrían haberse resuelto solamente con prevención y atención precoz...

Descriptive study of the patients treated at the clinic 'Integrated Dentistry for patients with Special Needs' at Complutense University of Madrid (2003-2012)

OBJECTIVES: To study clinical and epidemiological characteristics of the patients treated at the clinic 'Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)' at Complutense University of Madrid (UCM),as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. Study DESIGN: Medical records review of all the patients referred to the clinic of 'Integrated Dentistry for Patients with Special Needs', performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). RESULTS: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%)and intellectual disability (8,85%). 70'18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%

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Manejo clínico odontológico integral del paciente con síndrome de Sjögren: Una propuesta / Integral dental clinical management of patients with Sjögren's syndrome: A proposal

El síndrome de Sjögren (SS) es una enfermedad autoinmune, crónica e inflamatoria caracterizada por infiltración de células plasmáticas y linfocitos en las glándulas exocrinas, particularmente en las salivales y oculares. La patogénesis del SS está relacionada con factores inmunológicos, neurológicos, genéticos, virales y hormonales. La deficiente calidad y cantidad de saliva trae consecuencias devastadoras para la salud dental y bucal, alteraciones del esmalte, caries en las superficies dentarias expuestas, principalmente cervicales, fallas en la adhesión de los materiales obturadores, queratosis en las mucosas, síndrome de boca urente y disconfort en el uso de prótesis dentarias, a pesar de un manejo exhaustivo del medio bucal. Un diagnóstico tardío del SS conlleva a graves consecuencias físicas, sicológicas y económicas en estos pacientes. Su diagnóstico y tratamiento son de gran interés para el odontólogo. La experiencia clínica señala que aquellas piezas dentarias restauradas con prótesis fijas tienen mayor sobrevida y la rehabilitación con prótesis implantosoportadas brindaría un mayor confort para los pacientes. La clínica odontológica debe tener un enfoque integral del daño y la forma de tratamiento debe considerarlos como pacientes de muy alto riesgo de caries basados en CAMBRA (Caries management by risk assesement). El manejo eficaz de la salud oral en estos pacientes comprende la mejora de la producción salival, preservación de mucosas orales y la evaluación periódica del estado bucal. Se propone un protocolo de atención odontológica integral que consta de tres fases: 1) Fase inicial, paliativa y preventiva; 2) Fase restauradora y rehabilitadora, y 3) Fase de mantenimiento (AU)

Sjögren's syndrome (SS) is an autoimmune, chronic and inflammatory disease characterized by infiltration of plasma cells and lymphocytes in the exocrine glands. The pathogenesis of SS is related to immune, neurological, genetic, viral and hormonal factors. Complications are related to glandular destruction and mucosal dryness. The poor quality and quantity of saliva brings devastating consequences to dental and oral health. Alterations in the enamel structure, constant presence of caries in tooth surfaces exposed, mainly cervical, failures in the adhesion of filling materials, keratoses on the mucous membranes, burning mouth syndrome and discomfort in the use of dentures, despite the exhaustive management of the oral environment, are described. A late diagnosis of SS leads to serious physical, psychological and economic consequences in these patients. Its diagnosis and treatment are of great interest to the dentist. Clinical experience indicates that those teeth restored with fixed prostheses have an improved survival and rehabilitation with implant-supported prostheses would provide greater comfort for patients. The dental clinic must have a comprehensive approach to injury and the form of treatment should be considered as patients at high risk of caries based on CAMBRA (Caries management by risk assesement). Effective management of oral health in these patients includes improving the production of saliva, oral mucosal preservation and regular assessment of oral status. A comprehensive dental care protocol consisting of three phases, is proposed: 1) Initial, palliative and preventive phase, 2) Restorative and rehabilitation phase, and 3) Maintenance phase (AU)

Cuidados orales en el paciente oncológico / Oral care in the oncological patient

El odontólogo tiene un papel muy importante no solo en la detección precoz del cáncer oral, sino en el cuidado del paciente oncológico. Los tratamientos de quimioterapia y radioterapia producen efectos adversos en la cavidad oral, y el mantenimiento de la salud a ese nivel es esencial para prevenir y minimizar dichos efectos. Las complicaciones orales más comunes en pacientes con tratamiento oncológico son la mucositis, la hiposialia, las alteraciones del gusto, la osteonecrosis, el sangrado de la mucosa oral y las infecciones por inmunodepresión. El manejo de estas complicaciones comprende la identificación de la población de riesgo, el inicio de las intervenciones antes del tratamiento oncológico y el manejo oportuno de las lesiones provocadas por el mismo. Es imprescindible llevar a cabo una evaluación de la cavidad oral antes del tratamiento oncológico, realizando los tratamientos odontológicos que estén indicadas para así reducir las complicaciones durante y después del tratamiento antineo-plásico (AU)

The dentist has a very important role not only in the early detection of oral cancer, but also in the care of the oncological patient. Chemotherapy and radiotherapy treatments produce adverse effects in the oral cavity, and the maintenance of health at this level is essential to prevent and minimise these effects. The most common oral complications in patients with oncological treatment are mucositis, hyposalivation, taste alterations, osteonecrosis, bleeding of the oral mucosa and infections due to immuno-suppression. The management of these complications includes the identification of the population at risk, the commencement of interventions before the oncological treatment and the timely management of the lesions caused by it. It is essential to carry out an evaluation of the oral cavity before the oncological treatment, performing dental treatments that are indicated in order to reduce the complications during and after the antineoplastic treatment (AU)