Core curriculum in cariology for dentistry degrees in the Republic of Argentina / Contenidos Mínimos de Cariología en el Currículo de las Carreras de Odontología en la República Argentina

ABSTRACT Aim To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools Materials and Method Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W) Results Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved Conclusion Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

RESUMEN Objetivo Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado Materiales y Método El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W) Resultados Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas Conclusión En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

Genetic variation in the glucosyltransferase-B gene of Streptococcus mutans and its relationship with caries experience in children from Córdoba, Argentina, and with strains from other countries.

BACKGROUND: Caries is a worldwide distributed oral disease of multifactorial nature, with Streptococcus mutans being the most commonly isolated bacterial agent. The glycosyltransferases of this bacterium would play an essential role in the aetiology and pathogenesis of caries. AIM: We explored how the glucosyltransferase-B (gtf-B) gene variability of S. mutans from children in central Argentina correlated with their caries experience and how these strains were genetically related to those of other countries. DESIGN: Dental examinations were performed on 59 children; dmft and DMFT indexes were calculated. From stimulated saliva, S. mutans was grown and counted (CFU/mL). From bacterial DNA, the gtf-B gene was amplified and sequenced. Alleles were identified and their genealogical relationships established. Clinical, microbiological, and genetic variables were correlated with caries experience. Our sequences were included in a matrix with those from 16 countries (n = 358); genealogical relationships among alleles were obtained. Population genetic analyses were performed for countries with >20 sequences. RESULTS: The mean dmft + DMFT was 6.45. Twenty-two gtf-B alleles were identified here, which showed low genetic differentiation in the network. Caries experience was correlated with CFU/mL, but not with allele variation. Low differentiation was found among the 70 alleles recovered from the 358 sequences and among the countries analyzed. CONCLUSION: In this study, caries experience in children was correlated with the number of CFU/mL of S. mutans but not with the gtf-B gene variability. Combined genetic analyses of worldwide strains support the theory that this bacterium experienced population expansions, probably associated with agriculture development and/or food industrialization.

Core curriculum in cariology for dentistry degrees in the Republic of Argentina.

Aim: To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools. Materials and Method: Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units (AU) that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W). Results: Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved. Conclusion: Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

Objetivo: Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado. Materiales y Método: El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W). Resultados: Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas. Conclusión: En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

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.

Covid-19 y la odontología latinoamericana para pacientes con necesidades especiales / Covid-19 and latin american dentistry for patients with special needs / Covid-19 and dental care for patients with special needs in Latin America

Resumen La región de América Latina se ha convertido en la más afectada del mundo por la pandemia del COVID-19. Y personas con necesidades especiales, población ya vulnerable, están sufriendo un impacto significativo de la crisis actual. Dado que estas personas no pueden dejar de ser protegidas y cuidadas, un grupo de profesores de 10 países de América Latina se reunió para analizar la situación de la odontología para pacientes con necesidades especiales en la región. En todos los países, se evidenció que el confinamiento y las restricciones de desplazamiento están interrumpiendo el acceso a bienes y servicios esenciales para ellos. En cuanto a la odontología, la disposición general es posponer los procedimientos de rutina, a menos que sean clínicamente urgentes o de emergencia; adoptar estrictas medidas de protección personal y evitar o minimizar las intervenciones que puedan producir aerosoles. La atención odontológica remota, teleodontología, se considera como una herramienta fundamental en este momento, ya que permite evaluar la necesidad de atención presencial y ofrecer soporte, información y seguridad a los pacientes y familias. La pandemia nos ha demostrado, a todos, que impulsar la Promoción de la Salud es el verdadero camino, y que no debemos esperar a que se presenten condiciones que afecten la calidad de vida.

Resumo: A região da América Latina tem se tornado a mais afetada do mundo pela pandemia do COVID-19. E as pessoas com necessidades especiais, população já vulnerável, estão sofrendo um impacto significativo da crise atual. Uma vez que essas pessoas não podem deixar de ser protegidas e cuidadas, um grupo de professores de 10 países de América Latina se reuniu para analisar a situação da odontologia para pacientes com necessidades especiais na região. Em todos os países se verificaram que o confinamento e restrições de movimento estavam interrompendo o acesso a bens e serviços essenciais para eles. Para a odontologia, a orientação geral é adiar procedimentos de rotina, a menos que seja clinicamente urgente ou emergencial; adotar medidas rígidas de proteção individual e evitar ou minimizar intervenções que possam produzir aerossóis. O atendimento odontológico à distância, teleodontología, é considerada uma ferramenta fundamental neste momento, pois permite avaliar a necessidade de atendimento presencial e oferecer suporte, informação e segurança aos pacientes e famílias. A pandemia tem demostrado, para todos, que trabalhar na Promoção da Saúde é o verdadeiro caminho, e que não devemos esperar por condições que afetem a qualidade de vida.

Abstract Latin America has become the most affected region by the COVID-19 pandemic in the world. People with special needs-an already vulnerable population-are suffering terrible consequences on account of this crisis. These people need to be protected and cared for at all times. Therefore, a group of lecturers from ten Latin American countries came together to analyze the regional situation of dental care for patients with special needs. Every country shows evidence that lockdowns and movement restrictions interrupt these people's access to essential goods and services. The general course of action regarding dental care is to postpone routine procedures unless they are clinically urgent or an emergency, implement strict personal protection measures and avoid or minimize processes that may produce aerosols. Remote dental care is considered essential these days since it allows practitioners to assess the need for face-to-face care and offer support, information, and safety to patients and families. The pandemic has shown us all that supporting health promotion is the true path and that we should not wait until conditions that affect people's quality of life appear to act.

Caries and genetic variability of streptococcus mutans / Caries y variabilidad genética de streptococcus mutans

In the last two decades, the increase in population genetics studies has contributed to elucidating important questions about the evolution of the pathogenesis of bacteria of clinical interest. The objective of this study is to revise and update the knowledge of the last fifteen years regarding the genetic variability of Streptococcus mutans and their association with dental caries. Streptococcus mutans, one of the most widely distributed bacteria in the world, are heavily associated with this condition. This research shows the results of numerous studies carried out in various countries that, using molecular and biochemical methods, revealed associations between different serotypes and caries activity. In addition, it is reported that the population genetics structure of Streptococcus mutans in Argentina is highly recombinant, which reflects the largest waves of human immigration that occurred in the 19th and 20th centuries. On the other hand, demographic analysis suggests that these bacteria experienced a population expansion that coincided with the beginning of agricultural development.

En las últimas dos décadas el incremento de los estudios de genética de poblaciones ha contribuido a dilucidar cuestiones importantes sobre la evolución de la patogénesis de bacterias de interés clínico. El objetivo de este trabajo es realizar una actualización sobre los conocimientos de los últimos quince años referidos a la variabilidad genética de Streptococcus mutans y su relación con la caries dental. Streptococcus mutans, de amplia distribución mundial, es una de las bacterias más fuertemente asociada a dicha enfermedad. En este trabajo se muestran resultados de numerosos estudios realizados en diferentes países que utilizando métodos moleculares y bioquímicos revelaron asociaciones entre diferentes serotipos y la actividad de caries. Además, se reporta que la estructura genética poblacional de Streptococcus mutans de Argentina es de alto nivel recombinante, lo que reflejaría las grandes oleadas inmigratorias humanas ocurridas en los siglos 19thy 20th. Por otra parte, los análisis demográficos sugieren que esta bacteria experimentó una expansión poblacional coincidente con el comienzo del desarrollo de la agricultura

Knowledge, attitudes, practices and oral health status in adolescents of the city of Córdoba, Argentina

Adolescence is a critical period in the appropriation of knowledge, attitudes and health practices. objective: to analyze the experience of caries in relation to the level of knowledge, to attitudes and oral health practices in adolescents. materials and methods: an analytical cross-sectional study was carried out in 52 adolescents attending the provincial dental Institute in the city of Córdoba, Argentina. the study included a clinical dental examination and a self-administered survey. all participating subjects provided an informed consent signed by their parents or guardians. the DMFT index and relative frequency of responses were calculated. Indices of "knowledge", "attitudes" and "practices" were created. Spearman's rank correlation coefficient between indices and a linear regression model with respect to the DMFT index were applied. results: mean age was 16.57±2.27 years. female subjects accounted for 57.7 percent of participants. between 92 percent and 96 percent of adolescents acknowledged that the presence of bacteria and a lack of oral hygiene could promote tooth decay. ninety-six per cent reported using toothbrush and toothpaste, 32 percent reported using fluoride toothpaste, and only 19 percent used dental floss. the DMFT index was 4.7±4.0; component C 4.4±2.9. there was a significant correlation between the indices of knowledge and attitudes about oral health (p<0.05). the linear regression analysis showed as main predictors the questions: "does brushing teeth prevent cavities?" and "how important is it for you to clean your teeth?" conclusion: although participants have information on some oral health care practices, it is necessary to design strategies that involve the participation of young people, with contents that take into account the interests and characteristics of the target population.

Estudio de la estructura genética poblacional del S Mutans en niños / Update: study of the population genetic structure of S Mutans in children

Streptococcus mutans ha sido identificado como el principal agente etiológico de la caries dental. A pesar los avances en la odontología preventiva, continúa siendo una de las enfermedades mediadas por el biofilm más prevalentes en el ser humano. Si bien en lo últimos años su prevención se ha centrado en la implementación de medidas como el control de placa o la aplicación de flúor, el estudio de las características genéticas propiedades y composición del biofilm ha hecho que aparezcan nuevos conocimientos sobre la etiología y prevención de dicha patología. Es por esto que el objetivo de este estudio es realizar una puesta al día actualizada sobre la distribución de los distintos serotipos de S. mutans y su relación con la caries dental en la población infantil (AU)

Streptococcus mutans has been identified as the main etiological agent related to dental caries. Despite the development of preventive dentistry, dental caries is still regarded as one of the most prevalent biofilm-mediated human diseases. Although its prevention has been focused on measures such as plaque control or fluoride application, research on biofilm properties, genetic characteristics and composition has caused new knowledge about etiology and prevention of this patology. The aim of this research is to develop an update about the distribution of different serotypes of S. mutans and its association with dental caries in children (AU)

The influence of the type of birth and the mother´s diet on the breastfeeding period / La influencia del tipo de nacimiento y dieta materna en el período de lactancia

The prenatal aspects may influence the duration of breastfeeding of newborns, which when reduced harm to their development brings cranio-orofacial. Correlate the type of delivery and maternal diet with breastfeeding period. This was a descriptive study based on the records of the medical records of 820 dyads of mothers and newborns participating in the University Extension Baby Clinic. The results were analyzed, considering a significance level of 5 percent. The absence of complications during pregnancy was a positive factor for the occurrence of vaginal delivery in 94 percent of the sample (p< 0.001). It was found a high percentage of cesarean delivery (43 percent). The number of caesarean sections in women with cariogenic diet was higher than in women with non-cariogenic diet. The women who have a cariogenic diet does not have a tendency to breastfeed their children for more than 6 months (p<0.01). Also there was an association between vaginal delivery and longer period of 6 months of breastfeeding (p<0.001). The collected sample mode of delivery and maternal diet influence the duration of breastfeeding.

Los aspectos prenatales pueden influir en la duración de la lactancia materna de los recién nacidos y cuando ésta se reduce puede alterar el desarrollo cráneo- orofacial. El objetivo de esta investigación fue correlacionar el tipo de parto y la dieta materna con el tiempo de duración de la lactancia materna. Se realizó un estudio descriptivo sobre la base de los registros de las historias clínicas de 820 binomios madres-recién nacidos asistentes a la Clínica del Bebé de Extensión Universitaria. Se analizaron los resultados, considerando un nivel de significación del 5 por ciento La ausencia de complicaciones durante el embarazo fue un punto positivo para la ocurrencia de parto vaginal en el 94 por ciento de la muestra (p < 0,001). Se encontró un alto porcentaje de partos por cesárea (43 por ciento). El número de cesáreas en mujeres con dieta cariogénica fue mayor que en las mujeres con la dieta no cariogénica. Las mujeres que tienen una dieta no cariogénica tenían una tendencia a amamantar a sus hijos durante más de 6 meses (p<0,01). También hubo una asociación entre el parto vaginal y mayor período de 6 meses de lactancia materna (p<0,001). En la muestra analizada el tipo de parto y la dieta materna influencian la duración de la lactancia materna.

Initial acquisition and genetic identity of Streptococcus mutans of mother-child Pairs.

PURPOSE: This study's purpose was to investigate the transmission and genetic identity of Streptococcus mutans strains in mother-child pairs from Cordoba, Argentina in order to establish whether the mother was the main source of infection of the child. METHODS: Seventeen mother-child pairs were analyzed, with samples taken of whole nonstimulated saliva and dental plaque when each child was 18 months old. The mothers gave their written, informed consent to participate in the study. The Streptococcus mutans strains were genotyped by the arbitrarily primed polymerase chain reaction (AP-PCR) technique using primers OPA-02, OPA-05, and OPA-13. Three statistical analyses were used to determine genetic identity (1) Dice similarity index, (2) principal coordinates analysis/minimum spanning tree (PCoA/MST) analysis, and (3) Neighbor-joining consensus tree. RESULTS: The AP-PCR technique showed high genetic polymorphism in the S mutans strains. According to the Dice index, 10 of the 17 pairs presented genetic identity. Results from the PCoA/MST analysis and the Neighbor-joining consensus tree showed that 7 pairs presented high similarity and the other 3 showed moderate levels of similarity CONCLUSIONS: According to the results obtained with 3 primers and with 3 different statistical methods, we could determine that the mothers are an important source of infection for the child at an early age.

Early acquisition of Streptococcus mutans for children.

Existing evidence reveals that in Early Oral Infection the main route of transmission of Streptococcus mutans is mother-child saliva contacts and that initial acquisition takes place during a specific period of time denominated "Window of Infectivity" that lapses between 6 and 30 months of the child's life, with a higher risk between 18 and 30 months of age. The aim of the present study was to analyze Early Oral Infection. The levels of Streptococcus mutans in saliva and bacterial plaque in the binomial mother-child 6 to 18 months after childbirth were evaluated. Twenty-four mother-child binomials that attended the University Hospital of Maternity and Neonatology of Córdoba participated in the study. Samples of saliva and dental plaque were taken from mother and child and seeded in selective Agar Mitis Salivarius Bacitracin medium (0.28 mg/ml) and cultured for 48 hours at 37 degrees C and in 5% CO2 to allow for the growth of Streptococcus mutans. The colonies were identified morphologically and biochemically. At 6 months after childbirth: 58.33% of the samples of the mother's saliva were positive, while the presence of the microorganism was not detected in 100% of the samples of the infants' saliva. At 18 months of after childbirth: 79.16% of the samples of saliva and 100% of the samples of the mothers' dental plaque were positive, whereas the samples of saliva and dental plaque of the infants were positive for Streptococcus mutans in 20.83% and 70.83% of the cases respectively. The initial acquisition of Streptococcus mutans would have occurred in 20.8% of the children at the age of 18 months. Eruption of primary molars occurs at this age.