Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children.

OBJECTIVES: The purpose of this study was to evaluate the cost-effectiveness of two preventive interventions aimed at increasing the proportion of caries-free preschool children of low socioeconomic status using a decision analytic model. METHODS: Two scenarios were tested, one with a school milk program (SMP) and one without (non-SMP). Fluoride varnish (FV) and a probiotic (PB) were compared to a do-nothing alternative among children in public nurseries/schools over a 4-year period. FV was applied biannually and a PB (Lactobacillus rhamnosus) added to milk powder prepared daily. A Markov decision tree model was utilized. Several sources of data were used to populate the model. Probabilistic and deterministic sensitivity analyses were performed, and a public provider perspective was used. RESULTS: In the SMP scenario, PB was more effective and less costly than FV and, compared with do-nothing, increased the proportion of caries-free children by 14.5%, with a cost of USD 12.5 per child (June 2018). PB presented an incremental cost-effectiveness ratio (ICER) or cost per extra caries-free child of USD 86.2. In the non-SMP scenario, both interventions were cost-effective. FV (compared with do-nothing) increased the percentage of caries-free children by 8.3% with an ICER of USD 338.3 and PB (compared with FV) increased the effect by 6.2% with an ICER of USD 1400.2. CONCLUSIONS: The findings showed that PB was most effective and less costly than FV in the SMP scenario only. This type of analysis and its results provide essential information for decision-makers to improve the oral health of preschool children.

Sinopsis de la Situación de Salud Oral en Chile - Parte IV: Traumatismo Dentoalveolar

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

The consumption of milk supplemented with probiotics decreases the occurrence of caries and the salivary concentration of hßD-3 in children.

OBJECTIVES: This study evaluated the effect of milk supplemented with Lactobacillus rhamnosus SP1 on the occurrence of caries and the salivary concentration of human ß-defensin-3 (hßD-3) in preschool children with high caries risk. MATERIALS AND METHODS: A sample of 42 children was randomly assigned to two groups; children in the intervention group were given 150 mL of milk supplemented with 107 CFU/mL of Lactobacillus rhamnosus SP1, while children in the control group were given standard milk, for 10 months. The occurrence of dental caries was assessed using the International Caries Detection and Assessment System (ICDAS), and the concentration of hßD-3 was measured in unstimulated saliva using an ELISA test at baseline and after the intervention. RESULTS: There was an increase in the number of teeth with carious lesions (dICDAS2-6 mft) in the control group, and this increase was statistically significant (p = 0.0489). The concentration of hßD-3 in saliva from the intervention group decreased from 597.91 to 126.29 pg/mL (p = 0.0061), unlike in the control group, where no change in hßD-3 salivary concentration was found. CONCLUSIONS: These findings showed that regular intake of probiotic-supplemented milk in preschool children with high caries risk decreased the occurrence of caries and the salivary levels of hßD-3. CLINICAL RELEVANCE: Our results suggest the need for developing and implementing probiotic supplementation, as adjuvants to the conventional treatments for caries and allow to considerate the salivary levels of hßD-3 as markers of oral tissue homeostasis.

Sinopsis de la Situación de Salud Oral en Chile - Parte III: Encuestas Nacionales de Salud / Synopsis or the Oral Health Situation in Chile - Part III: National Health Surveys

RESUMEN: Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud en Chile. Se describen sus principales características y hallazgos con el objetivo de orientar a los profesionales odontólogos en el conocimiento de material existente para el diagnóstico odontológico objetivo, así como el impacto de la salud oral en la calidad de vida, a nivel poblacional.

ABSTRACT: This article makes a brief review and synthesis of national health surveys in Chile. The article describes the main characteristics and findings in order to guide dental professionals with the knowledge of the existing material for an objective population oral health diagnosis, as well as the impact of oral health on quality of life of the population.

Sinopsis de la Situación de Salud Oral en Chile - Parte II: Diagnósticos Poblacionales de Salud Oral / Synopsis or the Oral Health Situation in Chile - Part II: Oral Health Surveys

RESUMEN: Objetivo: Sintetizar los resultados sobre los estudios epidemiológicos de caries dental, enfermedad periodontal, desdentamiento y lesiones de mucosa oral de base poblacional con representatividad nacional y regional en adultos chilenos (≥15 años). Materiales y métodos: Se realizó una revisión narrativa para identificar aquellos estudios de diagnóstico de salud bucal, a nivel nacional y/o regional, en población adulta de Chile (≥15 años), con el objetivo de establecer prevalencias para las patologías bucales de mayor relevancia nacional. Resultados: Se identificaron 6 estudios de representatividad nacional y 7 estudios de representatividad regional. Se reporta una disminución en la prevalencia de caries cavitadas y de dentición no funcional, correspondiendo a un 54.6% y 27.0%, respectivamente. La prevalencia de pérdida de inserción clínica ≥4mm., es cercana al 100%. La lesión de mucosa oral más prevalente fue la estomatitis subprotésica (22.3%). Se observaron inequidades socieconómicas y culturales en la distribución de las patologías orales en la población adulta chilena. Conclusiones: Existe una alta prevalencia de enfermedad periodontal, caries, desdentamiento y lesiones de mucosa oral en adultos y adultos mayores chilenos.

ABSTRACT Aim: To synthesize results of epidemiologic national and regional studies about dental caries, periodontal diseases, tooth loss and oral mucosa lesions in Chilean adults (≥15 years- old). Methods: A narrative revision was made in order to identify epidemiologic national or regional studies in Chilean adults (≥15 years- old). The objective was to establish the prevalence of the most common oral diseases. Results: Six national and seven regional studies were identified. The prevalence of non-treated caries and non- functional dentition was reduced to 54.6% and 27.0%, respectively. The prevalence of periodontal attachment loss ≥4mm. was almost 100%. The most frequent oral mucosa lesion was denture stomatitis (22.3%). Socioeconomic and cultural disparities were observed in the distribution of oral diseases in Chilean adults. Conclusions: The prevalence of dental caries, periodontal diseases, tooth loss and oral mucosa lesions was high in Chilean adults and elderly people.

Sinopsis de la Situación de Salud Oral en Chile - Parte I: Garantías Explícitas y Guías Clínicas / Synopsis of the Oral Health Situation in Chile - Part I: Explicit Guarantees and Clinical Guidelines

RESUMEN: El presente artículo realiza una breve revisión y síntesis sobre las Garantías Explícitas en Salud Bucal vigentes en Chile y las Guías de Práctica Clínica asociadas a su ejercicio. Se muestra una breve cronología de la reforma de salud de la cual se originan, describiendo sus principales pilares de desarrollo. Esta actualización tiene como objetivo orientar a los profesionales odontólogos de los Servicios de Salud, Sociedades Científicas, Universidades y entidades públicas y privadas que desarrollan la práctica odontológica en Chile, en el conocimiento del material existente, validado y disponible a la fecha.

ABSTRACT This article makes a brief review and synthesis of the Explicit Guarantees in Oral Health in force in Chile and the Clinical Practice Guidelines associated with their practice. It shows a brief chronology of the health reform from which they originate, describing their main pillars of development. The purpose of this update is to guide the dental professionals of the Health Services, Scientific Societies, Universities and public and private services that develop the dental practice in Chile, with the knowledge of the existing material, validated and available to date.

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.

Impacto de la hipomineralización incisivo molar en la experiencia de caries en escolares de 6-12 años en Santiago, Chile / Molar incisor hypomineralisation and its impact on caries experienced by 6-12 year-old schoolchildren from Santiago, Chile

Objetivo: El objetivo de este estudio fue determinar las consecuencias clínicas expresadas en índices COPD y ceod y su relación con la presencia de hipomineralización incisivo molar (HIM) en una población de escolares de 6 a 12 años de la provincia de Santiago. Método: Este estudio de corte transversal fue realizado en 851 escolares de 6 a 12 años de la provincia de Santiago, quienes fueron evaluados por 2 dentistas calibrados. Con consentimiento de los tutores legales, los escolares fueron examinados, y se utilizaron los criterios diagnósticos para HIM de la Academia Europea de Odontopediatría (EAPD). La historia de caries fue determinada con COPD/ceod de acuerdo a los criterios de la OMS. Los datos fueron recolectados en una ficha especialmente diseñada para esto. Los datos fueron analizados con test «t¼ para muestras individuales (considerando p < 0,05). Resultados: Los escolares afectados por HIM tuvieron una media de COPD de 0,91 (±1,21) y una media de ceod de 1,98 (±2,48), el cual fue mayor que el COPD y ceod de escolares sin HIM (0,41 [±0,95] y 1,34 [±2,15] respectivamente). La diferencia entre ambos grupos fue estadísticamente significativa para COPD (p < 0,000) y ceod (p = 0,002). Conclusiones: Escolares de la provincia de Santiago de 6 a 12 años afectados con HIM presentaron mayor COPD/ceod que escolares sin HIM.

Objective. The aim of this study was to determine the clinical consequences, expressed in DMFT and dmft, and their relationship with Molar Incisor Hypomineralisation (MIH) in a population of schoolchildren of 6 to 12 years old in the Santiago Province. Method: A cross-sectional study was conducted on 851 schoolchildren between 6-12 years old from the Santiago Province were examined by two calibrated examiners. With informed consent from their parents, the schoolchildren were examined, and the European Academy of Paediatric Dentistry (EAPD) diagnostic criteria was used for MIH detection. Caries history was assessed with the DMFT/dmft score according to WHO criteria. Data was collected with a form specially designed for this study. Data was analysed using Student's t-test for individual samples and a post-hoc Bonferroni (P < .05). Results: The mean DMFT score in the MIH-affected schoolchildren was 0.91 (±1.21), with a mean dmft score of 1.98 (±2.48), which were greater than the scores in the non-MIH affected schoolchildren (mean DMFT score 0.41 [±0.95] and mean dmft 1.34 [±2.15]). The differences between DMFT and dmft scores in the two groups were statistically significant (P < .000 and P = .002, respectively). Conclusions: Schoolchildren of Santiago Province of 6-12 year old diagnosed with MIH had higher DMFT/dmft scores compared to schoolchildren not affected with MIH.

Clinical Effects of Lactobacillus rhamnosus in Non-Surgical Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Trial With 1-Year Follow-Up.

BACKGROUND: Probiotics are living microorganisms that provide beneficial effects for the host when administered in proper quantities. The aim of this double-masked placebo-controlled parallel-arm randomized clinical trial is to evaluate the clinical effects of a Lactobacillus rhamnosus SP1-containing probiotic sachet as an adjunct to non-surgical therapy. METHODS: Twenty-eight systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically at baseline and 3, 6, 9, and 12 months after therapy. Clinical parameters measured included plaque accumulation, bleeding on probing, probing depths (PDs), and clinical attachment loss. Patients received non-surgical therapy, including scaling and root planing (SRP), and were assigned randomly to a test (SRP + probiotic, n = 14) or control (SRP + placebo, n = 14) group. The intake, once a day for 3 months, of an L. rhamnosus SP1 probiotic sachet commenced after the last session of SRP. RESULTS: Both test and control groups showed improvements in clinical parameters at all time points evaluated. However, the test group showed greater reductions in PD than the control. Also, at initial visits and after 1-year follow-up, the test group showed a statistically significant reduction in the number of participants with PD ≥6 mm, indicating a reduced need for surgery, in contrast to the placebo group. CONCLUSION: The results of this trial indicate that oral administration of L. rhamnosus SP1 resulted in similar clinical improvements compared with SRP alone.

Analgesic efficacy of lidocaine for suction-assisted lipectomy with tumescent technique under general anesthesia: a randomized, double-masked, controlled trial.

BACKGROUND: Suction-assisted lipectomy is one of the most common procedures performed in plastic surgery. To minimize blood loss and to obtain adequate analgesia, a liquid solution is infiltrated into the subcutaneous plane before suction. The objective of this study was to determine whether the use of lidocaine in the infiltration solution reduces postoperative pain. METHODS: A prospective, randomized, double-masked, clinical trial was designed. Each side of patients' body zones to be treated with suction-assisted lipectomy was randomized to receive infiltration solution with or without lidocaine. Treatment allocation was performed using computer-generated random numbers in permuted blocks of eight. Pain was assessed using the visual analogue scale and registered 1, 6, 12, 18, and 24 hours after the procedure. RESULTS: The trial was stopped after a first interim analysis. The use of lidocaine in the dilute solution reduced pain by 0.5 point on the visual analogue scale (95 percent CI, 0.3 to 0.8; p<0.001). The effect was independent of the suctioned body zone (p=0.756), and lasted until 18 hours after surgery. Its analgesic effect was lost at the 24-hour postoperative control. Pain increased an average of 0.018 point on the visual analogue scale per hour (95 percent CI, 0.001 to 0.036; p=0.043). CONCLUSIONS: The use of lidocaine in the infiltration solution is effective in postoperative pain control until 18 hours after surgery. Nevertheless, its clinical effect is limited and clinically irrelevant, and therefore it is no longer used by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Performance measures for in-hospital care of acute ischemic stroke in public hospitals in Chile.

BACKGROUND: The aim of this study were to describe acute care of ischemic stroke patients and adherence to performance measures, as well as the outcomes of these events, in a sample of patients treated in public hospitals in Chile. METHODS: We retrospectively reviewed the medical charts of patients with ischemic stroke from a sample of seven public hospitals in the Metropolitan Region of Santiago. We analyzed adherence to the following evidence-based measures: clinical evaluation at admission, use of intravenous thrombolysis, dysphagia screening and prescription of antithrombotic therapy at discharge. As outcome measures we analyzed post-stroke pneumonia and 30-day case-fatality. We used a logistic regression model by each outcome with generalized estimating equations, which accounted for clustering of patients within hospitals and included sex, age (years), clinical status at admission (reduced level of consciousness, speech disturbance, aphasia and hemiplegia), comorbidities, dysphagia screening and neurological evaluation at admission as measures of acute stroke care. RESULTS: We reviewed the charts of 677 patients, of which 52.3% were men. The mean age was 69.8 years in women and 66.3 years in men. Diagnosis of stroke was confirmed by a computed tomography scan within 4.5 hours of symptom onset in only 9.6% of the patients. Intravenous thrombolysis was administered in 1.7%. Dysphagia screening was performed in 12.1% (95% CI 9.7-15.0) and antithrombotic therapy was prescribed in 68.9% (95% CI 64.6-72.9). Pneumonia was diagnosed in 23.6% (95% CI 20.4-27.2). Thirty-day fatality was 8.7% (95% CI 6.7-11.3). The variables independently associated with 30-day case fatality were age (OR 1.08, 95% 1.06-1.10), pneumonia (OR 7.7, 95% 95% CI 4.0-14.7), aphasia (OR 2.4, 95% CI 1.1-5.6), reduced level of consciousness (OR 2.4, 95% CI 1.3-4.4), and speech disturbance (OR 1.4, 95% CI 1.0-1.9). No association was found between 30-day case fatality and dysphagia screening or neurological evaluation at admission. The factors associated with post-stroke pneumonia were female sex (OR 1.6, 95% CI 1.0-2.3), age (OR 1.04 95% CI 1.03-1.05), diagnosis of diabetes (OR 1.8, 95% CI 1.4-2.4), aphasia (OR 2.0, 95% CI 1.5-2.7), hemiplegia (OR 1.6, 95% CI 1.1-2.4), and reduced level of consciousness on admission (OR 3.4, 95% CI 2.1-5.5). No association was found between pneumonia and dysphagia screening or neurological evaluation at admission. CONCLUSIONS: Adherence to evidence-based performance measures was low. Administration of intravenous thrombolysis was particularly low and diagnostic confirmation of ischemic stroke was delayed. The occurrence of post-stroke pneumonia was frequent and should be reduced. To improve acute stroke care in Chile, organizational change in the health service is urgently needed.

Validation of the Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries".

OBJECTIVES: To translate and validate a Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" as a method of collecting information about treatment decisions on caries management in Chilean primary health care services. MATERIALS AND METHODS: The original questionnaire proposed by Espelid et al. was translated into Spanish using the forward-backward translation technique. Subsequently, validation of the Spanish version was undertaken. Data were collected from two separate samples; first, from 132 Spanish-speaking dentists recruited from primary health care services and second, from 21 individuals characterised as cariologists. Internal consistency was evaluated by the generation of Cronbach's alpha, test-retest reliability was evaluated by Cohen's kappa, convergent validity was evaluated by comparing the total scale scores to a global evaluation of treatment trends and discriminant validity was evaluated by investigating the differences in total scale scores between the Spanish-speaking dentist and cariologist samples. RESULTS: Cronbach's alpha indicated an internal consistency of 0.63 for the entire scale. Cohen's kappa correlation coefficient expressed a test-retest reliability of 0.83. Convergent validity determined a Pearson's correlation coefficient of 0.24 (p < 0.01). The comparison of proportions (chi-squared) indicated that discriminant validity was statistically significant (p < 0.01), using a one-tailed test. CONCLUSIONS: The Spanish version of the "Questionnaire on the treatment of approximal and occlusal caries" is a valid and reliable instrument for collecting information regarding treatment decisions in cariology. CLINICAL RELEVANCE: The clinical relevance of this study is to acquire a reliable instrument that allows for the determination of treatment decisions in Spanish-speaking dentists.

SMAS graft of the nasolabial area during deep plane rhytidectomy.

The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not been found. It seems that a combined approach based on summation of partially effective modalities is the best option. The authors present their experience with combined deep plane rhytidectomy, malar fat lift, and superficial musculoaponeurotic system graft in the treatment of the aging nasolabial area. Results in 70 consecutive patients are presented with this simple, nonscarring, inexpensive technique.