Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus.

The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

Abstract The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Relationship between intrinsic and extrinsic factors with Erosive Tooth Wear in adults: a cross-sectional study.

The objective of this study was to explore the relationship between intrinsic and extrinsic factors and a high cumulative score of the Basic Erosive Wear Examination (BEWE) in a Chilean adult group. A cross-sectional study was performed with the Ethics Committee's approval from the Universidad de los Andes. A consecutive adult (18 to 46 years old) sampling (n = 553) from the Health Center in San Bernardo-Chile, was selected from September 2016 to January 2017. Dental exams were performed by two trained and calibrated examiners, according to the BEWE index. In order to search for potentially related factors, a hetero-applied questionnaire previously developed and evaluated was applied. Our interest was individuals with severe erosion tooth wear (BEWE ≥ 14). Logistic regression models reporting crude odds ratio (OR) and adjusted OR by age, 95% confidence interval (95%CI), and p-values were estimated. Variables, odds ratios and 95% CI related with BEWE ≥ 14 were: age (OR 1.1 [1.07-1.14]); currently drinking alcohol (OR 1.59 [1.06-2.39]); esophagitis (OR 8.22 [1.60-42.22]); difficulty to swallow (OR 2.45 [1.10-5.44]); chest pain (OR 2.07 [1.18-3.64]); anorexia (OR 3.82 [1.07-13.68]); vitamin C intake (OR 1.92 [1.08-3.43]). Age, alcohol consumption, self-reported esophagitis, history of gastric symptoms, anorexia, and vitamin C intake were related as risk factors to high BEWE scores in this sample of Chilean adults in San Bernardo, Chile.

Associated risk factors with quantitative erosive tooth wear progression.

OBJECTIVES: The aim of this study was to determine predictors of erosive tooth wear (ETW) progression, using novel primary-care quantitative analysis techniques. METHODS: In a single-centre, prospective, observational cohort longitudinal study, adolescents, aged 11-18 years, underwent a baseline BEWE examination, validated risk factors questionnaire and baseline intraoral scan (IOS, TRIOS 3.0, 3Shape, Copenhagen, Denmark). One year later a repeat scan was taken. Quantitative analysis of wear progression (volume loss) on first permanent molars and upper central incisors was performed using previously published protocols. Multilevel linear regression was used to investigate the associations between baseline predictors and volume loss per mm2. RESULTS: A total of 295 dental surfaces (131 incisors and 164 molars) in 70 patients were analysed for this study. The mean age of participants at baseline was 15.0 years (SD: 0.79), and the average time between scans was 11.8 months (1.61 SD; range 10-13). The mean volume loss per mm2 of dental surfaces was -0.013 mm3 (SD: 0.009). Greater volume loss was observed amongst adolescents with higher baseline BEWE scores and those whose parents had lower education as well as on molar than incisor surfaces. No associations were found with dietary acid intake and intrinsic acid exposure when baseline levels of tooth wear, parental education and other factors were controlled for. CONCLUSIONS: The findings help to characterise groups at greater risk of ETW and would indicate that improved screening and upstream preventative measures should form the basis of a preventative program. CLINICAL SIGNIFICANCE: Intra-orals scans and registration software might improve the ability to diagnose, monitor and prevent the early loss of dental hard tissue.

Relationship between intrinsic and extrinsic factors with Erosive Tooth Wear in adults: a cross-sectional study

Abstract The objective of this study was to explore the relationship between intrinsic and extrinsic factors and a high cumulative score of the Basic Erosive Wear Examination (BEWE) in a Chilean adult group. A cross-sectional study was performed with the Ethics Committee's approval from the Universidad de los Andes. A consecutive adult (18 to 46 years old) sampling (n = 553) from the Health Center in San Bernardo-Chile, was selected from September 2016 to January 2017. Dental exams were performed by two trained and calibrated examiners, according to the BEWE index. In order to search for potentially related factors, a hetero-applied questionnaire previously developed and evaluated was applied. Our interest was individuals with severe erosion tooth wear (BEWE ≥ 14). Logistic regression models reporting crude odds ratio (OR) and adjusted OR by age, 95% confidence interval (95%CI), and p-values were estimated. Variables, odds ratios and 95% CI related with BEWE ≥ 14 were: age (OR 1.1 [1.07-1.14]); currently drinking alcohol (OR 1.59 [1.06-2.39]); esophagitis (OR 8.22 [1.60-42.22]); difficulty to swallow (OR 2.45 [1.10-5.44]); chest pain (OR 2.07 [1.18-3.64]); anorexia (OR 3.82 [1.07-13.68]); vitamin C intake (OR 1.92 [1.08-3.43]). Age, alcohol consumption, self-reported esophagitis, history of gastric symptoms, anorexia, and vitamin C intake were related as risk factors to high BEWE scores in this sample of Chilean adults in San Bernardo, Chile.

Risk factors for dental caries in Latin American and Caribbean countries.

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Risk factors for dental caries in Latin American and Caribbean countries

Abstract Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Recommendations and guidelines for dentists using the basic erosive wear examination index (BEWE).

This paper explains how to screen tooth wear in general practice using the Basic Erosive Wear Examination (BEWE) index. It explains how stakeholders in the UK acknowledged the convenience of the BEWE and that it could be recorded at the same time as the Basic Periodontal Examination (BPE). The article contains examples of anterior and posterior tooth wear for each BEWE score to help dentists in their evaluation.

Prevalence of erosive tooth wear in Chilean adults, 2016: A cross-sectional study.

OBJECTIVES: To determine the prevalence, severity and distribution of erosive tooth wear lesions in adult patients at the Universidad de los Andes Health Center in the San Bernardo Metropolitan Region, Chile, during a period of 4 months in 2016. METHODS: A cross-sectional study was conducted. A consecutive sample of patients from 18 to 46 years old who were receiving care at the Universidad de los Andes Health Center during a period from September 2016 to January 2017 was analysed. Basic erosive wear examinations (BEWEs) were performed by two calibrated examiners. RESULTS: A total of 535 adults were included in this study. An erosive tooth wear prevalence of 97.9% was found in which at least one surface had a BEWE score of 2 or 3 as the highest score (98.56% for females and 95.8% for males). In the sample, 75.70% and 74.77% of individuals had at least one surface with a BEWE score of 3 at the second and fifth sextant, respectively. The median of cumulative BEWE scores was 12. The median by individual of the affected percentage of tooth surfaces with BEWE scores 2 or 3 was 19.70%. CONCLUSIONS: We found a high prevalence of erosive tooth wear, mainly in the anterior group of teeth. No differences were found between the sexes, but a positive correlation with age was found. The percentage of surfaces affected was low or moderate.

Uso de dentífricos y colutorios para el control de la hipersensibilidad dentinaria en adultos: una revisión narrativa / Use of toothpastes and mouthwashes for the control of dentin hypersensitivity in adults: a narrative review

RESUMEN: Objetivo: Describir la efectividad del uso de los distintos agentes desensibilizantes contenidos en dentífricos y colutorios para el control de la hipersensibilidad dentinaria en adultos. Método: Se realizó una búsqueda electrónica de la evidencia científica en las bases de datos PubMed, Epistemónikos, EBSCO, BEIC y Cochrane Library; utilizando una estrategia de búsqueda que incluye las palabras clave. Para cada artículo encontrado se analizó el nivel y calidad de evidencia, riesgo de sesgo y ética. Resultados: En total 36 artículos fueron incluidos, 29 ensayos clínicos controlados aleatorizados y 7 revisiones sistemáticas. De los ensayos clínicos encontrados, cinco probaron la eficacia de colutorios, dos realizaron una comparación con dentífricos y colutorios y 22 evaluaron sólo el uso de dentífricos. Los agentes desensibilizantes testeados principalmente encontrados fueron sales de potasio, arginina, nano-hidroxiapatita, fosfosilicato de calcio y sodio (CSFS) y sales de estroncio. Sólo los primeros dos agentes fueron evaluados en presentación dentífrico y colutorio. Todos los ensayos clínicos demostraron reducir la hipersensibilidad dentinaria con alguno de los agentes utilizados en comparación a la medición inicial. Conclusión: Se podría recomendar el uso de nitrato y citrato de potasio, arginina, fosfosilicato de calcio y sodio y nano-hidroxiapatita en dentífricos para el tratamiento de la hipersensibilidad.

ABSTRACT: Objectives: Describe the effectiveness of the use of different desensitizing agents contained in dentifrices and mouthwashes for the control of dentin hypersensitivity in adults. Method: An electronic search of the scientific evidence available was made in PubMed, Epistemónikos, EBSCO, BEIC and Cochrane Library; using a search strategy that included the key words. For each article found the level and quality of evidence, risk of bias and ethics were analyzed. Results: A total of 36 articles were included, 29 randomized controlled clinical trials and 7 systematic reviews. Of the clinical trials, five tested the efficacy of mouthwashes, two made a comparison using dentifrices and mouthwashes and 22 tested only the use of dentifrices. The desensitizing agents mainly found were potassium salts, arginine, nano-hydroxiapatite, calcium sodium phosphosilicate (CSPS) and strontium salts. Only the first two were tested in both presentations. All the clinical trials demonstrated a reduction in dentin hypersensitivity with the use of an agent in comparison to the initial measurement. Conclusions: The use of nitrate and citrate potassium, arginine, calcium sodium phosphosilicate and nano-hydroxyapatite in dentifrices for the treatment of hypersensitivity may be recommended.

Creación de un Currículo de Competencias en Cariología para Estudiantes de Pregrado de Odontología en Chile / Development of a Competency-based Curriculum in Cariology for Undergraduate Dental Students in Chile

RESUMEN: Objetivo: Creación de un currículo de competencias mínimas en Cariología, para la formación de los Cirujano-Dentistas egresados de las escuelas de Odontología de Chile. Metodologías: A partir de una reunión de académicos de las Universidades de Talca y de Chile (año 2011), se elaboró una propuesta de currículo inicial, basado en los dominios propuestos por la Unión Europea (Schulte AG y cols). Durante el año 2016, dicha propuesta fue analizada mediante diálogos digitales y grupos de trabajo, con la participación del 96% de las Escuelas de Odontología existentes en el país, que concluyeron en un documento intermedio. Este documento fue analizado, discutido y perfeccionado durante el Taller para el Desarrollo de un Currículo de Competencias Mínimas en Cariología para las Escuelas de Odontología Chilenas (22/Mayo/2017, Talca, organizado por la Universidad de Talca y la Universidad de Chile) con la asistencia de representantes del 96% de las escuelas dentales chilenas, Ministerio de Salud de Chile, Colegio de Cirujano-Dentistas de Chile y con la asesoría de los profesores de Cariología Dres. Margherita Fontana y Carlos González-Cabezas (Universidad de Michigan, Ann Arbor, EEUU). Cada grupo de trabajo revisó el documento y envió nuevos comentarios, los que fueron incorporados en el documento final por una comisión asesora. Resultados: El documento del Currículo en Cariología se organizó en 5 Dominios: 1. Conocimientos base; 2. Determinación de Riesgo, diagnóstico de caries y detección de lesiones de caries; 3. Toma de decisiones y manejo preventivo no operatorio; 4. Toma de decisiones y manejo operatorio y 5. Cariología basada en la evidencia, en la práctica clínica y de salud pública. Se consensuaron las definiciones operacionales, las competencias principales y las sub-competencias para cada uno de los dominios. Las sub-competencias fueron clasificadas en tres niveles: A: Ser competente en; B: Tener conocimientos sobre y C: Estar familiarizado con. El documento final fue enviado a todos los participantes del taller para su aprobación y difusión en cada una de las instituciones involucradas. Conclusiones: Se logró, por medio de consenso, la construcción del Currículo de Competencias mínimas en Cariología para estudiantes de pregrado de Odontología en las universidades chilenas.

ABSTRACT: Objective: Development of a minimum set of competencies in Cariology that every dentist graduated from a Dental School in Chile must have. Methodology: Starting from a meeting of scholars from the Universities of Talca and Chile (year 2011), an initial proposal for a curriculum was developed, based on the domains proposed by the European Cariology Curriculum (Schulte, et al, 2011). During 2016, this proposal was discussed through online dialogues and working groups, with the participation of 95.2% of the Chilean dental schools, which resulted in an intermediate document. This document was analyzed, discussed and refined during the Workshop for the Development of a Curriculum of Minimum Competencies in Cariology for Chilean Dental Schools (May 22, 2017, Talca, organized by the Universities of Talca and Chile) with the attendance of representatives from 95.2% of the Chilean dental schools, the Chilean Ministry of Health, Chilean College od Dentists and with the assistance of the professors of Cariology Margherita Fontana and Carlos González-Cabezas (University of Michigan, Ann Arbor, USA). Each working group revised the document and provided feedback, which was incorporated in the final document by an advisory committee, elected on the day of the workshop, including the authors of the present article. Results: The Cariology Curriculum was organized in 5 Domains: 1. Basic knowledge; 2. Risk assessment, caries diagnosis and caries lesion detection; 3. Decision-making and non-operative preventive treatment; 4. Decision making and operative treatment; and 5. Evidence-based, clinical and public health practice. Operational definitions, main competencies and sub-competencies for each domain were agreed. Sub-competencies were classified into three levels: A: Be competent in; B: Have knowledge about, and C: Be familiar with. The final document was sent to all the participants of the workshop for dissemination in each of the institutions involved. Conclusions: The development of the Competency-based Curriculum in Cariology for undergraduate dental students at Chilean universities was achieved through consensus.