Las consecuencias de la pandemia por SARS-CoV-2 en la salud oral de las personas: un desafío para la Odontología

La pandemia por COVID-19 tiene consecuencias en la salud bucal, directas e indirectas. A través de una revisión de la literatura se encontró evidencia del impacto negativo de la pandemia en la carga acumulada de enfermedades orales. En el territorio maxilofacial se han observado manifestaciones tales como ageusia y anosmia, además de otros tipos de lesiones como xerostomía y lesiones vesiculobulosas. En general estos efectos directos se consideran discretos y transitorios. Por otro lado, dado el rol de los determinantes sociales de salud en las enfermedades bucales crónicas no transmisibles, las medidas tomadas para la mitigación y control de la pandemia podrían acentuar inequidades en la distribución y frecuencia de estas en las poblaciones. Al mismo tiempo, COVID-19 ha producido una reingeniería de la atención en cuanto a ventilación, uso de elementos de protección personal y espacios físicos con implicancias para los equipos clínicos y las comunidades. La teleodontología ha aparecido como una oportunidad, pero al mismo tiempo requiere mayores alcances y regulación. En conclusión, la pandemia ha generado un desafío a corto, mediano y largo plazo en Odontología. Este evento sin precedentes podría ser una iluminación para el rol de la profesión en la provisión de salud oral.

The COVID-19 pandemic has direct and indirect oral health consequences. Our literature review found evidence of the negative impact of the pandemic on the cumulative burden of oral diseases. In the maxillofacial territory, manifestations such as ageusia and anosmia have been observed, in addition to other types of lesions such as xerostomía and vesiculobullous lesions. In general, these direct effects are considered to be discrete and transitory. On the other hand, given the role of social determinants of health in chronic noncommunicable oral diseases, the measures taken for the mitigation and control of the pandemic could accentuate inequities in the populations. At the same time, COVID-19 has produced a reengineering of care in terms of ventilation, use of personal protective equipment and physical spaces with implications for clinical workers and communities. Teledentistry has appeared as an opportunity, but at the same time, it requires greater scope and regulation. In conclusion, the pandemic has created a short-, medium- and long-term challenge for dentistry. This unprecedented situation could be an illumination for the role of the profession in the provision of oral health.

Prevalencia de caries en adolescentes atendidos en la red de salud del Valle del Cauca: alternativas de medición y factores asociados / Caries prevalence in adolescents treated in the Valle del Cauca health network: alternative measurement and factors associated

Introdución: La caries dental es un problema de salud pública y la forma como se ha medido su prevalencia no ha tenido en cuenta las lesiones cariosas sin cavidad. Objetivo: Describir la prevalencia de caries y la relación con factores sociales en adolescentes atendidos en hospitales públicos en el Valle del Cauca. Materiales y métodos: Se realizó un estudio transversal analítico en 305 adolescentes; se registró el índice COP clásico y COP modificado según instrumento clínico suministrado por el Ministerio de Protección Social de Colombia. Los adolescentes auto diligenciaron una encuesta estructurada que incluían variables sociodemográficas y prácticas en salud bucodental. Los estimadores fueron calculados teniendo en cuenta el diseño, utilizando el programa estadístico SPSS® versión 17 y Epi Info 3.5.1. Resultados: Se encontró una prevalencia de caries de 82,3% (caries con o sin cavitación) y una prevalencia de 62,6% (caries con cavitación); con una media de dientes cariados sin cavitación de 1,7 (IC95% 1,4-2,0) y una media de 2,9 (IC95% 2,5-3,3) de dientes cariados con cavitación. La prevalencia más baja se presentó a los 12 y 13 años de edad. Se encontró un COP clásico de 4,6±4,5; el COP modificado fue de 6,3±4,8. En análisis de regresión simple, el tipo de seguridad social y la edad se correlacionaron con el de COP y la historia de caries. Conclusiones: La prevalencia de caries fue mayor a la encontrada en el ENSAB III y IV. Tanto la historia de caries como la prevalencia de caries resultaron asociadas a la edad, la seguridad social, la pertenencia a un grupo poblacional vulnerable.

Introduction: Tooth decay is a public health problem and how has measured its prevalence has not taken account of carious lesions without cavity. Objetive: This study aims to describe the prevalence of tooth de Valle del Cauca. Materials and methods: A cross-sectional study was conducted in 305 adolescents; classic-modified DMF index and caries experience as clinical instrument provided by the Ministry of Social Protection of Colombia was recorded. The auto teens fill out an application structured questionnaire that included demographic variables and practices in oral health. The estimates were calculated taking into account the design, using the statistical program SPSS version 17 and Epi Info 3.5.1. Results: Prevalence 82.3% caries (caries with or without cavitation) and 62.6% prevalence (caries cavitation) was found; with an average of decayed teeth without cavitation of 1.7 (95%CI 1.4-2.0) and a mean of 2.9 (95%CI 2.5-3.3) of decayed teeth with cavitation. The lowest prevalence was presented at 12 and 13 years old. a classic DMF of 4.6±4.5 was found; the modified DFM was 6.3±4.8. In simple regression analysis, the type of social security and age were correlated with DFM and history of caries. Conclusion: The prevalence of caries was higher than that found in the ENSAB III and IV ENSAB. Both the history of caries and caries prevalence were associated with age, social security, membership in a vulnerable population group.

Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes.

OBJECTIVES: To determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU. PATIENTS AND METHODS: We included 50 patients who underwent redo BMGU between February 2009 and September 2014. Patients' charts and non-validated questionnaires were reviewed. The primary endpoint was success rate, defined as stricture-free survival. Stricture recurrence was defined as any postoperative claims of catheterization, dilatation, urethrotomy or repeat urethroplasty, or a maximum urinary flow rate <15 mL/s, and a stricture was consecutively verified in a combined cysto-urethrogram or cystoscopy at annual follow-up visit. The secondary endpoint was oral morbidity. Additional endpoints were erectile function, urinary continence and patients' satisfaction. RESULTS: Redo BMGU was performed for bulbar (71.4%) or penile (28.6%) recurrent strictures. The mean (median; range) follow-up was 25.6 (15.5; 3-70) months. Stricture recurrence occurred in 18.0% of patients within a mean (median; range) of 13.8 (9.0; 3-36) months. Stricture-free survival at 12, 24 and 36 months was 91.2, 86.2 and 80.8%, respectively. The majority of the patients (97.0%) reported no or only mildly changed salivation or problems in opening of the mouth. Severe or very severe oral numbness occurred in 13.5% of patients. Oral problems in daily life were a moderate or severe burden to 13.6 and 2.7% of the patients, respectively, while 75.0% of the patients reported improved quality of life compared with preoperative status. CONCLUSIONS: The success rate and oral morbidity of redo BMGU are almost the same as outcomes of primary BMGU. Oral numbness was the most frequently reported oral disorder.

Using morbidity and income data to forecast the variation of growth and employment in the oral healthcare sector.

The perception of the health sector from an economic policy point of view is changing. In the past, health expenditure was mostly seen as a "cost" item, probably because many medical treatments are covered by public health insurance. However, policymakers are increasingly realizing that a growing health sector may be quite beneficial for an economy. It creates employment opportunities and it is relatively resistant to the fluctuations of the business cycle. Input-output analysis could be a useful tool to study the structural change resulting from the growth of the health sector. This paper quantifies for the first time the economic significance of the oral healthcare sector as a component of the German healthcare sector as a whole. The current data for the healthcare sector comes from Health Satellite Accounts, which while comprehensive do fail to answer important questions due to not incorporating certain sectors such as the oral healthcare sector. Therefore on the basis of the Health Satellite Account a specific Satellite Account for the oral healthcare sector is created by using billing data as well as epidemiological data, provided by several dental associations and the Institute of German Dentists. Based on this added information, gross value added data and the number of employees in the oral healthcare sector are computed. Gross value added in 2010 amounted to €13.4 billion, with around €4 billion being attributable to the secondary oral healthcare market; the market for solely out-of-pocket payments. In a second step the paper develops a model to forecast oral healthcare sector growth based on various explanatory variables such as demographic change, take-up behaviour, medical-technical progress, oral morbidity, aggregated supply (collective dental treatment times) as well as income levels and distribution, where the latter two are considered to be of particular importance. According to this model, by 2030 gross value added in the oral healthcare sector will amount to €15.9 million, which corresponds to a 19.2 % increase. The secondary oral healthcare market will be the key to this increase since the model predicts a disproportionately high growth of 60.3 % bringing the total to €6.3 million gross value added in 2030.