Prevalence of erosive tooth wear and associated risk factors in Colombian adolescents.

Accurate determination of the prevalence of erosive tooth wear (ETW) and associated risk factors in adolescents can inform clinical management guidelines. The aim of this analytical cross-sectional study was to estimate the prevalence, severity, and risk factors of ETW in adolescents aged 12-15 years in the municipality of Usaquén in Bogotá, Colombia. Two calibrated examiners clinically assessed ETW using Basic Erosive Wear Examination (BEWE) Index (range: 0-3). All tooth surfaces (excluding proximal) were scored to allow estimation of the Highest (0-3) and Total BEWE (sum of Highest BEWE score per sextant: 0-18) scores per patient. Sociodemographic characteristics, ETW risk factors, and caries severity (ICDAS-epi-merged) were evaluated, and their association with the presence of ETW (indicated by a Highest BEWE score of 2-3) was examined using preliminary analyses and logistic regression models. The study sample included 454 adolescents (mean age: 13.5±1.1 years; female: 61.7%), and the prevalence of ETW was 71.6%. The majority of participants exhibited a Highest BEWE score of 3 (58.0%) and a Total BEWE score ≤8 (84.3%). The preliminary analysis showed an association between the presence of ETW and age, caries, and brushing teeth before eating (p-value < 0.05). Risk factors for ETW included always brushing teeth before eating [adjusted Prevalence Ratio (PRa) 1.31, p-value=0.014], presence of extensive carious lesions (PRa 1.23, p-value = 0.024), male gender (PRa 1.14, p-value = 0.028), and age > 14 years (PRa 1.17, p-value = 0.009). Although ETW was highly prevalent, most Colombian adolescents exhibited low Total BEWE scores. ETW was associated with frequent fruit intake, age, toothbrushing habits, caries lesions, and sex.

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.

Seroprevalence, infection, and personal protective equipment use among Colombian healthcare workers during the COVID-19 pandemic.

Introduction: Healthcare workers (HCWs) are at the forefront of the COVID-19 response and frequently come into close contact with patients and their virus-contaminated body fluids. Recent studies have identified differential risks of infection and the use of personal protective equipment (PPE) among HCWs. However, available data might be interpreted with caution because of differences in the national health systems, local implementation issues, and adherence limitations to guidelines. A comprehensive description of infection, exposure at work, and biosafety habits during the COVID-19 pandemic has not been conducted among the HCW groups in Latin American populations. Objective: To describe SARS-CoV-2 seroprevalence, infections, and extent of PPE use during the COVID-19 pandemic among HCWs at three different times, including dental practitioners (DP), nursing assistants (NA), physicians (P), and respiratory therapists (RT), from Bogotá, Colombia. Methods: After IRB approval, this cross-sectional study included 307 HCWs. Participants provided nasopharyngeal swabs and blood samples to detect viral RNA (RT-qPCR) and IgM/IgG anti-SARS-CoV-2 (ELFA-ELISA) at baseline (BL) and two follow-ups. Infection prevalence was defined as the number of positive-tested participants (RT-qPCR and/or IgM). Data on clinical status and biosafety habits were collected each time. Results: Differential infection prevalence was found among HCWs through the study timeline (BL: RT-qPCR = 2.6%, IgM = 1.6%; follow-up 1 (45 days after BL): RT-qPCR = 4.5%, IgM = 3.9%; follow-up 2 (60 days after BL): RT-qPCR = 3.58%, IgM = 1.3%. Dental practitioners showed a higher infection frequency in BL and follow-up 1. IgG-positive tested HCWs percentage progressively increased from BL to follow-ups among the whole sample while index values decreased. Limitations in N95 availability and a high perception of occupational risk were reported. Conclusion: A low prevalence of active SARS-CoV-2 infections among HCWs groups was found. Over time, there was an increase in participants showing IgG antibodies, although the levels of these antibodies in the blood decreased. Additionally, HCWs reported limitations in the availability of PPE as well as a variation in their safety practices.

Tracing ΦX174 bacteriophage spreading during aerosol-generating procedures in a dental clinic.

OBJECTIVE: The aim of this study was to test the plausibility of using the ΦX174 bacteriophage as a tracer of viral aerosols spreading in a dental aerosol-generating procedure (AGP) model. METHODS: ΦX174 bacteriophage (~ 108 plaque-forming units (PFU)/mL) was added into instrument irrigation reservoirs and aerosolized during class-IV cavity preparations followed by composite fillings on natural upper-anterior teeth (n = 3) in a phantom head. Droplets/aerosols were sampled through a passive approach that consisted of Escherichia coli strain C600 cultures immersed in a LB top agar layer in Petri dishes (PDs) in a double-layer technique. In addition, an active approach consisted of E coli C600 on PDs sets mounted in a six-stage cascade Andersen impactor (AI) (simulating human inhalation). The AI was located at 30 cm from the mannequin during AGP and afterwards at 1.5 m. After collection PDs were incubated overnight (18 h at 37 °C) and bacterial lysis was quantified. RESULTS: The passive approach disclosed PFUs mainly concentrated over the dental practitioner, on the mannequin's chest and shoulder and up to 90 cm apart, facing the opposite side of the AGP's source (around the spittoon). The maximum aerosol spreading distance was 1.5 m in front of the mannequin's mouth. The active approach disclosed collection of PFUs corresponding to stages (and aerodynamic diameters) 5 (1.1-2.1 µm) and 6 (0.65-1.1 µm), mimicking access to the lower respiratory airways. CONCLUSION: The ΦX174 bacteriophage can be used as a traceable viral surrogate in simulated studies contributing to understand dental bioaerosol's behavior, its spreading, and its potential threat for upper and lower respiratory tract. CLINICAL RELEVANCE: The probability to find infectious virus during AGPs is high. This suggests the need to continue characterizing the spreading viral agents in different clinical settings through combination of passive and active approaches. In addition, subsequent identification and implementation of virus-related mitigation strategies is relevant to avoid occupational virus infections.

How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM-B analysis.

OBJECTIVE: The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. METHODS: A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed. RESULTS: All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. CONCLUSION: Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

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.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe.

Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Validation of an erosive tooth wear risk factors questionnaire for adolescents.

OBJECTIVE: To validate a questionnaire for the identification of factors associated with erosive tooth wear (ETW) in adolescents. MATERIALS AND METHODS: Based on previous questionnaires, a 73-question instrument was designed (four domains: socio-demographics, general/oral health history, diet and oral care habits). Content validity was assessed by five external experts, and the questions' understandability was evaluated in a pilot study (10 adolescents). Three internal experts agreed on modifications. Construct validity was assessed after the resulting questionnaire was applied to 454 12- to 15-year olds from Bogotá (Colombia). Statistical analyses included exploratory factor analysis (EFA), internal consistency, and confirmatory factor analysis (CFA). RESULTS: After the content validation, 52% of the questions were excluded and remaining 38 questions were adjusted. Construct validation: The EFA resulted in the regrouping of questions into the three remaining domains (KMO = 0.68; Bartlett's test: p < 0.001). Internal consistency was good (general questionnaire Cronbach's α = 0.67; individual factors' Cronbach's α = 0.30-0.69; ICC = 0.39-0.62; p < 0.001), and the model showed satisfactory fit. CFA showed good convergent and discriminatory validity suggesting the elimination of 14 additional questions (χ2 = 238.518; p > 0.086; CFI = 0.96; TLI = 0.95; RMSEA = 0.017; PRATIO = 0.76). The final validated questionnaire comprised 24 questions (general/oral health history: n = 5; dietary habits: n = 15; oral care habits: n = 4). CONCLUSION: The validation of the ETW questionnaire for adolescents was satisfactory and resulted in a short applicable questionnaire version. CLINICAL RELEVANCE: This study achieved a satisfactorily validated, short, and applicable questionnaire for assessing erosive tooth wear risk factors in adolescents, recommended for the clinical practice, research, and epidemiology.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe

Abstract Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Patrón de distribución de severidad de fluorosis: ¿qué nos dice sobre exposición local a fluoruros? / Padrão de distribuição de severidade da fluorose: Que nos diz sobre exposição local ao fluoretos? / Distribution pattern of enamel fluorosis severity: What is it telling us about local fluoride exposure?

Resumen Introducción y objetivo: la severidad de la fluorosis dental refleja exposición a fluoruros durante el desarrollo del esmalte. Recientemente se han reportado asociaciones entre la exposición prenatal y postnatal a fluoruros y efectos negativos en el neurodesarrollo. El objetivo de este estudio fue describir y comparar la severidad y el patrón de distribución de la fluorosis en las denticiones primaria y permanente, como base para discutir la temporalidad de la exposición en niños viviendo en áreas endémicas en el departamento del Huila. Materiales y métodos: odontólogos entrenados diagnosticaron fluorosis en 840 niños (preescolares y escolares) de cuatro municipios usando el índice de Thylstrup & Fejerskov. Para estimar la prevalencia de las diferentes severidades, cada niño se clasifico de acuerdo con la severidad más alta en boca. La distribución de la prevalencia de severidades por grupo etario y tipo de dentición se reportan como tasas de prevalencia (%). Resultados: la prevalencia en preescolares y escolares fue de 97.2% y 99.9%, respectivamente y la fluorosis moderada la más prevalente (75.6% y 63.5%, respectivamente). En ambas denticiones, la fluorosis leve fue más prevalente en los dientes anteriores que en posteriores. Las severidades moderada y severa tuvieron mayor prevalencia en dientes posteriores que en anteriores. Conclusiones: el patrón de distribución de la severidad de la fluorosis sugiere exposición prenatal y postnatal a fluoruros, por encima de los niveles recomendados. Este estudio resalta la importancia de la alidación de la fluorosis del dental como un potencial biomarcador histórico de exposición a luoruros en momentos críticos para el neurodesarrollo.

Resumo Introdução e objetivo: a severidade da fluorose dentária reflete a exposição a fluoretos durante o desenvolvimento do esmalte. Recentemente, associações entre a exposição pré-natal e pós-natal ao fluoretos e efeitos negativos no desenvolvimento neurológico foram relatadas. O objetivo deste estudo é descrever e comparar o padrão de severidade e distribuição da fluorose na dentição decídua e permanente, como intuito para a discussão sobre a temporalidade da exposição em crianças moradoras em áreas endêmicas de fluorose no departamento de Huila, Colômbia. Materiais e métodos: Cirurgiões-dentistas treinados diagnosticaram fluorose em 840 crianças (pré-escolares e escolares) de quatro municípios, utilizando o índice de Thylstrup & Fejerskov. Para estimar a prevalência dos diferentes estágios de severidade, cada criança foi classificada de acordo com o escore mais severo da boca. A distribuição da prevalência de fluorose nos diferentes estágios de severidade por faixa etária e tipo de dentição é apresentada como taxa de prevalência (%). Resultados: a prevalência de fluorose em pré-escolares foi de 97,2% e em escolares de 99,9%. Fluorose moderada foi a mais prevalente (75,6% e 63,5%, respectivamente). Em ambas as dentições, a fluorose leve foi mais prevalente nos dentes anteriores do que nos posteriores. Porém, tanto fluorose moderada como severa foram mais prevalentes nos dentes posteriores do que nos anteriores. Conclusões: o padrão de distribuição da severidade da fluorose sugere uma exposição pré- e pós-natal a fluoretos acima de níveis recomendados. Este estudo salienta a importância da validação da fluorose dentária como um potencial biomarcador histórico da exposição ao fluoretos durante momentos críticos para o neurodesenvolvimento.

Abstract Introduction and objective: dental fluorosis severity reflects fluoride exposure during dental enamel development. Recently, prenatal and postnatal exposure to fluoride has been associated with negative neurodevelopmental outcomes. The aim of this study was to describe and compare the severity and distribution pattern of dental fluorosis in the primary and permanent dentition, as a basis to discuss the timing and extent of fluoride exposure of children living in endemic areas of fluorosis in the department of Huila. Materials and methods: 840 children (preschoolers and schoolchildren) from four municipalities of the Huila Department were examined by trained dentists for dental fluorosis using the Thylstrup & Fejerskov Index. To estimate the prevalence of severities of fluorosis, each child was classified according to the most severe score. The distribution of the prevalence of enamel fluorosis severity by age-group and type of dentition were reported as prevalence rates (%). Results: Prevalence of dental fluorosis in preschoolers was of 97.2% and in schoolers of 99.9%. For both preschoolers and schoolers moderate fluorosis was the most prevalent (75.6% and 63.5%, respectively). For both primary and permanent teeth, mild fluorosis was more prevalent in anterior teeth than in posterior teeth. Moderate and severe fluorosis were more prevalent in posterior teeth than in anterior teeth. Conclusions: the distribution pattern of the severity of dental fluorosis suggests both prenatal and postnatal exposure to fluoride above recommended levels. This study raises the importance of the validation of dental fluorosis as a potential historical biomarker of fluoride exposure at moments that are critical for neurodevelopment.

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol.

BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.

Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent.

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup & Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician.

Understanding dentists' caries management: The COM-B ICCMS™ questionnaire.

OBJECTIVE: To design and validate a questionnaire to measure caries management based on the Capability, Opportunity, and Motivation Behavior model (COM-B) and the International Caries Classification and Management System (ICCMS™). METHODS: A combination of Cariology and Psychology experts developed a 79-item pool that measured the COM-B components according to the ICCMS™ caries management recommended behaviours. After face and content validation and a pilot study, two samples of Colombian dentists participated: clinicians (n = 277) and clinical-practice educators (n = 212). RESULTS: Using parallel analysis and exploratory structural equation modelling (ESEM), the questionnaire was reduced to a 47-item 5-factor instrument that demonstrated good internal consistency and validity properties, including a robust factor structure, measurement invariance across samples and high predictive validity of ICCMS™ recommended behaviours. Scales' mean scores showed that dentists were conducting recommended behaviours "most-of-the-time" (Behavior), showed high confidence in their ability to conduct these behaviours (Capability) and considered recommendations as highly relevant (Opportunity-Relevance), while their appraisals of the available resources (Opportunity-Resources) and remuneration (Motivation) were notably lower. CONCLUSION: Overall, the findings highlight the practical utility of the COM-B ICCMS™ Questionnaire in understanding the potential antecedent variables that may explain dentists' behaviours related to caries diagnosis and management and in suggesting avenues for achieving a positive change in their behaviour.

Description of respiratory syncytial virus genotypes circulating in Colombia.

INTRODUCTION: Respiratory syncytial virus (RSV) is the most common cause of acute respiratory infections in children younger than two years but also produces infection in older children and even reinfection in people of any age, a characteristic related to the existence of different infecting subtypes and genotypes. Although Colombia has established the surveillance of classical respiratory viruses, there is no information about the RSV genotypes circulating in Colombian patients. METHODOLOGY: A subgroup of 227 previously RSV positive respiratory secretion samples were taken from a nationwide surveillance study, amplified and sequenced to define the circulation pattern of RSV subtypes and genotypes during 2000-2009 period in Colombia. RESULTS: RSV exhibited seasonal behavior with an A subtype more prevalent. Both RSV subtypes had low nucleotide variability. During the study period, the GA2 and GA5 genotypes from RSV subtype A and the BA genotype from RSV subtype B were found. CONCLUSION: In this report, for the first time RSV genotypes circulating in Colombia were described, this information adds valuable information about virus epidemiology helping to understand the RSV epidemic and prepare our country for the introduction of new vaccines.

Geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples, and its possible relationship with the prevalence of enamel fluorosis in children in four municipalities of the department of Huila (Colombia).

Fluoride is an element that affects teeth and bone formation in animals and humans. Though the use of systemic fluoride is an evidence-based caries preventive measure, excessive ingestion can impair tooth development, mainly the mineralization of tooth enamel, leading to a condition known as enamel fluorosis. In this study, we investigated the geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples in four endemic enamel fluorosis sentinel municipalities of the department of Huila, Colombia (Pitalito, Altamira, El Agrado and Rivera), and its possible relationship with the prevalence of enamel fluorosis in children. The concentration of fluoride in drinking water, table salt, active sediment, rock, and soil was evaluated by means of an ion selective electrode and the geochemical analyses were performed using X-ray fluorescence. Geochemical analysis revealed fluoride concentrations under 15 mg/kg in active sediment, rock and soil samples, not indicative of a significant delivery to the watersheds studied. The concentration of fluoride in table salt was found to be under the inferior limit (less than 180 µg/g) established by the Colombian regulations. Likewise, exposure doses for fluoride water intake did not exceed the recommended total dose for all ages from 6 months. Although the evidence does not point out at rocks, soils, fluoride-bearing minerals, fluoridated salt and water, the hypothesis of these elements as responsible of the current prevalence of enamel fluorosis cannot be discarded since, aqueducts might have undergone significant changes overtime.