Clinical competency development with handmade simulator in highly realistic paediatric dentistry scenarios.

INTRODUCTION: The use of simulation is extremely useful in pregraduate students. However, there is a very small number of simulators adapted to paediatric dentistry. A paediatric simulator was created to use in simulated scenarios for paediatric dentistry using an actress in the role of mother. The objectives of the present study were three. First, to analyse the perception of clinical competencies acquired by the students. Second, to examine the realism perceived by the students. Finally, to analyse the influence on the perception of clinical competencies after the integration of a handmade simulator in the Paediatric Dentistry III course. MATERIALS AND METHODS: Eight clinical scenarios were carried out with a modified Erler Zimmer simulator for children, a professional actress in the role of the mother and two students (in the roles of dentist and assistant) on a paediatric dentistry case of pulpal pathology. The educational intervention was evaluated on 114 students by means of questionnaires with Likert-type answers applied pre- and post-simulation. RESULTS: The perception of clinical competence in the students increased an average of 0.956 points in relation with the initial clinical evaluation, finding a strong correlation between the perception of subsequent competence and all the perceived realism, with significant statistical differences in all cases. The realism of the simulated participant (professional actress) was the best rated by the students, although not significantly. The realism of the mannequin was positively and strongly correlated with the perceived realism of the cabinet. CONCLUSION: Simulation using a handmade mannequin with a professional actress in a simulated dental office increased the perception of clinical competence in 4th year dental students and raised the level of overall realism perceived by the student.

Indicadores para medir fidelidad en escenarios simulados / Indicators for measuring fidelity in simulated scenarios

INTRODUCCIÓN: La fidelidad es un elemento crucial, pero difuso, en los programas de simulación clínica. Es común que se la defina en base a preguntas de satisfacción, con enfoques subjetivos y pequeños tamaños de muestra. Se necesitan instrumentos de medición validados para una consideración más objetiva de fidelidad en escenas con participantes simulados o con maniquíes y en entornos sofisticados o no. SUJETOS Y MÉTODOS: Los indicadores se definieron mediante búsqueda bibliográfica de temas afines en artículos publicados en revistas indizadas, con las palabras clave 'fidelidad', 'realismo', 'verosimilitud' y 'alta, media y baja fidelidad', cruzadas con 'simulación clínica', en castellano e inglés. Esta es la primera fase, conceptual, de una investigación que validará formularios universales para medir la fidelidad. RESULTADOS: Se conceptualizaron tres dimensiones generales donde medir la fidelidad. A cada dimensión se le asignaron unidades específicas que se desglosaron en indicadores agrupados en tres variables de uso sistémico. La unidad mínima de medición fue el indicador. Se designaron tasadores múltiples y diferentes para cada dimensión. CONCLUSIONES: Los indicadores permiten aclarar los términos fidelidad/realismo para su uso estandarizado, definen y hacen medibles las diferentes expresiones de realismo, permiten prever y obtener el verdadero coste/beneficio de la inversión en la reproducción fiel de los entornos por parte de las instituciones, permiten describir la trazabilidad de la fidelidad ingeniera en los productos biotecnológicos y posibilitan que los activos y productos de la simulación sean validados por expertos clínicos con fundamento científico, reduciendo los sesgos por desconocimiento o indefinición

INTRODUCTION: Fidelity is a crucial, but diffuse, element in clinical simulation programs. It is commonly defined based on satisfaction questions, with subjective approaches and small sample sizes. Validated measuring instruments are needed for more objective consideration of fidelity in scenes with simulated participants and/or mannequins and in sophisticated or non-sophisticated environments. SUBJECTS AND METHODS: The indicators were defined by a bibliographic search of related topics in articles published in indexed journals with the keywords 'fidelity', 'realism', and 'high, medium and low fidelity' crossed with 'healthcare simulation', in Spanish and English. This is the first phase, conceptual, of a deeper research that will validate universal forms to measure fidelity. RESULTS: Three general dimensions were conceptualized to measure fidelity. Each dimension was assigned specific units that were broken down into indicators grouped into three systemic use variables. The minimum unit of measurement was the indicator. Multiple and different appraisers were designated for each dimension. CONCLUSIONS: The indicators make possible to clarify the terms fidelity/realism for their standardized use. They define and make measurable the different expressions of realism. They make it possible to foresee and obtain the true cost/benefit of the investment in the faithful reproduction of the environments by the institutions. They make it possible to describe the traceability of the engineering fidelity in biotechnology products. They also make possible that the assets and products of the simulation are validated by clinical experts with a scientific basis, reducing the biases due to lack of knowledge or lack of definition

Factores que influyen en la ansiedad dental del paciente infantil / Factors that influence dental anxiety in children

La ansiedad dental es un problema muy común en la actualidad, que afecta tanto a niños como a adultos. Su presencia puede desencadenar importantes conflictos a la hora de realizar el tratamiento odontológico por la aparición de conductas o comportamientos inadecuados. Diversos factores pueden contribuir a su desencadenamiento o a su acentuación, por lo que su conocimiento previo podría minimizar las posibles consecuencias adversas. El objetivo de este trabajo es dar a conocer los factores que pueden influir en la instauración de la ansiedad dental en el paciente infantil. Aunque no existen resultados concluyentes, encontramos que los factores psicológicos (influencia de padres y amigos, personalidad del paciente, sexo, experiencias anteriores...) influyen de una manera más importante en la aparición de la ansiedad dental. Los factores físicos/ ambientales (decoración de la consulta, vestuario del profesional, instrumental, nivel socioeconómico...) pueden también favorecer, en determinadas ocasiones, temores en el gabinete odontológico. Por ello, se recomienda la realización de más estudios que permitan llegar a resultados más confiables con el fin de disminuir los factores causantes de la ansiedad y miedo dental en los pacientes infantiles

Dental anxiety is a very common problem today, affecting both children and adults. The presence of this type of emotions can trigger important conflicts when performing dental treatment due to the occurrence of inappropriate behaviors. Several factors may contribute to trigger or increase anxiety, so that prior knowledge could minimize the possible adverse consequences. The objective of this review is to present the factors that may influence the dental anxiety in children. Although no conclusive results have been obtained, it was found that psychological factors (parents and friends influence, patient personality, gender, previous experiences ...) have more influence in the origin of dental anxiety. The physical/ environmental factors (decoration of the dental office, clothes or uniform, dental instrumental, socioeconomic level...) can also favor, in certain occasions, to increase fears at the dental visit. Therefore, it is recommended that more studies be carried out in order to achieve more reliable results in order to reduce the factors that cause dental anxiety and fear in young patients

Tratamiento precoz de la mordida cruzada posterior unilateral en el paciente infantil. Revisión bibliográfica / Early treatment of unilateral posterior cross bite in the child patient. Literature review

El objetivo de este trabajo es demostrar la importancia del tratamiento precoz de la mordida cruzada posterior en el paciente infantil ya que constituye una alteración que se presenta comúnmente en la práctica diaria. Es importante establecer un diagnóstico diferencial adecuado para enfocar el tratamiento según la etiología sea esquelética, dental o funcional. Para ello se ha efectuado una búsqueda bibliográfica a través de Pubmed, Medline y Google Achademic incluyendo los años 2000-2015. Las alteraciones musculares, disfunción de la ATM, aparición de bruxismo o alteraciones estéticas podrían aparecer si no se trata precozmente la mordida cruzada unilateral. La edad del paciente, la colaboración y la gravedad del problema se deben tener en consideración. Existen diferentes tratamientos como son tallado y pistas de composite, aparatología removible y aparatología fija. La mayoría de los autores coinciden en que la edad idónea de tratamiento es durante la dentición decidua o mixta primera fase para evitar que la maloclusión se agrave. La aparatología fija es la más utilizada, existiendo diversos aparatos que realizan expansión lenta o rápida del maxilar (AU)

The objective of this review is to highlight the importance of early treatment of posterior cross-bite in children because it is frequently seen in dental practice. It is important to establish an adequate diagnosis in order to opt for the correct treatment, which depends on whether the etiology is skeletal, dental, or functional. To this end it has conducted a literature search through Pubmed, Medline, and Google Scholar (2000-2015). Muscular alterations, temporomandibular joint disorders, bruxism, and/or aesthetic disorders may appear if the condition is not treated early on. The patient’s age and cooperation as well as the gravity of the condition should be considered when choosing a treatment. Various treatment options exist such as: planas direct tracks, selective oclclusal adjustment, removable plates and fixed appliances. The majority of authors agree that the ideal age for treatment is during the primary and early-mixed dentition phases. Treatment during this age range avoids any worsening of the malocclusion. Fixed appliances are the most widely used treatments, with a range of different appliances that can be used for rapid of slow maxillary expansion (AU)