Oral health disparities among adolescents from urban and rural communities of central Chile.

PURPOSE: Rural populations may be at increased risk for prevalent oral diseases. The aim of this study was to compare oral health status of adolescents of rural and urban areas from central Chile. METHODS: A representative sample of 552 and 486 adolescents aged 12 and 15 years, respectively, was examined using WHO methods. Adolescents were chosen from schools belonging to urban and rural districts of the region. Caries status was obtained by decayed, missing, filled teeth (DMFT) and significant caries (SiC) indexes. The gingival exam included the oral hygiene index (OHI) of Silness and Löe and the gingival index (GI) of Löe and Silness. Clinical attachment loss and community periodontal index (CPI) were restricted to 15-year-old adolescents. Statistical comparisons of medians and means were performed with the Mann-Whitney U-test. To determine the association between caries experience and oral hygiene and gingival indexes, Spearman's correlation was used at p<0.05. RESULTS: Twelve-year-old children from rural areas had caries prevalence of 67.50%, which was significantly higher (p<0.05) than children from urban areas, who had 54.04%. Caries experience of 12-year-old rural children was significantly higher (DMFT 3.36; standard deviation (SD) 2.71) than that of urban children (DMFT 2.29; SD 2.17) (p=0.0001). Rural adolescents also showed increased caries severity (SiC 6.21; SD 2.44), whereas urban children showed had a SiC of 4.71 (SD 1.74) (p=0.0001). For periodontal indexes, the average GI for 12-year-olds was 1.51 (SD 0.33), which corresponds to moderate inflammation, but rural subjects (GI 1.55; SD 0.34) had higher values (p=0.002) than their urban counterparts (GI 1.45; SD 0.29). In 15-year-old adolescents, caries prevalence was significantly higher in rural (73.58%) than in urban (64.59%) individuals (p<0.05). Although not significant, caries experience for 15-year-olds in rural areas, like in the other age group, was slightly higher than for urban 15-year-olds (DMFT 5.03; SD 3.61 and DMFT 4.65; SD 3.58, respectively) (p=0.238). The SiC in the rural subjects (9.16; SD 2.26) of this age group was significantly higher than for urban adolescents (8.51; SD 3.00). No significant differences either in the OHI (p=0.418) or in the GI (p=0.624) were observed between rural and urban participants. CONCLUSIONS: Adolescents of central Chile show clear disparities in oral health, with rural communities more affected. Gingival health seems to be less impacted by rurality than caries experience. Other social determinants of oral health may also explain these results, and further research appears necessary.

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.

Impact of rurality on the oral health status of 6-year-old children from central Chile: the EpiMaule study.

INTRODUCTION: The aim of this study was the assessment of dental caries and the gingival status of 6-year-old children living in the Maule region, Chile's most rural region, and to determine if rurality was related to a higher prevalence of oral conditions. METHODS: A representative sample of 485 children aged 6 years was examined using WHO methods. Children were chosen from schools belonging to urban and rural districts of the region. Caries status was obtained by deft (decayed, extracted, filled teeth), DMFT (decayed, missing, filled teeth) and SiC (Significant Caries) indexes. To assess gingival health status, the oral hygiene (OHI) and the gingival index (GI) were used. Urban and rural children data were compared using student's t-test at p < 0.05. RESULTS: Overall caries prevalence was 80.62%. Rural children showed higher prevalence (p < 0.0001) than urban 6-year-olds, with 88.3% and 69.9%, respectively. The deft (decayed, extracted, filled teeth) index was 4.63 for the region, with 5.74 for rural and 3.09 for urban districts (p < 0.05). The SiC index was 10.23 for rural and 7.13 for urban children (p < 0.05). Mean OHI score was 1.44, but rural children had higher OHI: 1.49 compared with 1.37 for urban 6-year-olds (p < 0.0001). The GI of the region was 1.37, but no differences were detected between rural and urban children (p < 0.05). CONCLUSIONS: Children from the Maule region in Chile have a severely deteriorated oral health, higher than Chile's mean. Rural are significantly more affected than urban children. A special focus on rural communities when designing oral health policies is strongly suggested.