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1.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1535296

RESUMO

Introducción: Covid-19, una enfermedad letal que ha provocado estragos a nivel mundial causó una pandemia, afectando a casi todos los aspectos de la vida humana, por lo cual, se debe adquirir conocimientos sobre prevención, formar actitudes y comportamientos positivos para evitar más contagios y muertes. El objetivo fue determinar el nivel de conocimiento de Covid-19 entre estudiantes, docentes y personal administrativo que pertenecen a la Facultad de Odontología de la Universidad Central del Ecuador. Métodos: estudio observacional, analítico transversal, con una muestra conformada por 275 participantes entre docentes odontólogos, personal administrativo, estudiantes de pregrado y posgrado. Previo al estudio se realizó la traducción del cuestionario: Covid-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey, de inglés a español, siguiendo los debidos procesos de preparación, conciliación, retrotraducción, e informe final. Una vez establecida la fiabilidad del cuestionario (consistencia interna CCI= 0,89 y Alpha de Cronbach α= 0,63) se aplicó a la muestra total previo diseño en Google Forms y enviado a través de correo electrónico. Los datos fueron analizados en el programa estadístico SPSS v. 26 mediante la prueba de Chi-Cuadrado. Resultados: el promedio establecido del valor de la mediana mostró que los estudiantes de pregrado y los profesionales con un nivel educativo de tercer nivel tuvieron un mayor nivel de conocimientos que los otros grupos (p=0,014 y 0,012) respectivamente. Conclusiones: el grupo etario de 18 a 30 años, los estudiantes de universitarios de pregrado y los profesionales con el título de tercer nivel tuvieron un mejor nivel de conocimientos sobre Covid-19.


Introduction: Covid-19, a lethal disease that has wreaked havoc worldwide caused a pandemic, affecting almost all aspects of human life, therefore, it is necessary to acquire knowledge about prevention, form positive attitudes and behaviors to avoid more contagions and deaths. The objective was to determine the level of knowledge of Covid-19 among students, teachers and administrative personnel belonging to the Faculty of Dentistry of the Central University of Ecuador. Methods: observational, cross-sectional analytical study, with a sample of 275 participants including dental teachers, administrative personnel, undergraduate and graduate students. Prior to the study, the questionnaire Covid-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey was translated from English into Spanish, following the due processes of preparation, reconciliation, back-translation and final report. Once the reliability of the questionnaire was established (internal consistency CCI= 0,89 and Cronbach's Alpha α= 0,63), it was applied to the total sample after being designed in Google Forms and sent via e-mail. The data were analyzed in the SPSS v. 26 statistical program using the Chi-Square test. Results: the established average of the median value showed that undergraduate students and professionals with a third level education had a higher level of knowledge than the other groups (p=0,014 and 0,012) respectively. Conclusions: the age group 18-30 years, undergraduate university students and professionals with third level degree had a better level of knowledge about Covid-19.

2.
Artigo em Inglês | MEDLINE | ID: mdl-35627858

RESUMO

This study aimed to determine the general labor well-being of Latin American dentists according to sociodemographic characteristics during the COVID-19 pandemic. A cross-sectional study was conducted in a final sample of 2214 participants from 11 countries. A validated online questionnaire on general work well-being was used (data collection period from 1 June to 10 July 2021), containing two dimensions: psychosocial well-being and collateral effects. The sociodemographic characteristics of the dentists and their perception of the economic impact of the pandemic were also recorded. A multivariate linear regression analysis was performed (hierarchical regression model) to evaluate the joint effect of the explanatory variables on labor well-being and the changes in the variance between each model. A score of psychosocial well-being of 233.6 + 40.2 and collateral effects of 45 + 20.1 was found. Psychosocial well-being was associated with sex, country of origin, academic training achieved, type of dental activity, and perceived impact during the pandemic (p < 0.05). Somatization was frequently manifested through back pain (88.2%) and muscular tensions (87.2%). Women, those who worked 41 or more hours and had between 1 to 15 years of professional experience presented a greater collateral effect (p < 0.001). The impact of the COVID-19 pandemic a year and a half after it began on the labor well-being of Latin American dentists was evidenced with important interactions with social characteristics.


Assuntos
COVID-19 , COVID-19/epidemiologia , Estudos Transversais , Odontólogos , Feminino , Humanos , América Latina/epidemiologia , Pandemias
3.
Odontol. vital ; (35)dic. 2021.
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1386456

RESUMO

Resumen Objetivo. Identificar la prevalencia de fluorosis en menores de 4 a 15 años de edad, según índice de Dean y su asociación con el nivel de flúor presente en el agua de consumo en la provincia de Cotopaxi. Previa una autorización de participación por parte de sus padres y aprobación del comité de la Universidad Central del Ecuador. Métodos. Fueron examinados 115 participantes en las edades de 4 a 15 años, siguiendo protocolos de registro fotográfico validados tras verificar y cumplimiento de criterios de inclusión. A su vez, se evaluaron muestras de agua de abastecimiento que fueron recolectadas según los protocolos adecuados y examinadas según la presencia de flúor. Las fotografías obtenidas fueron analizadas por tres evaluadores certificados y entrenados en la diferenciación de los grados de fluorosis según Dean mediante índice Kappa. Resultados. Los valores emitidos por cada evaluador fueron recolectados tabulados y procesados mediante el programa SPSS, y la prueba estadística de Chi cuadrado y correlación de Spearman, evidenciando ausencia de una relación estadísticamente significativa, entre las variables analizadas. Conclusión. La presencia de fluorosis de leve a moderada en la población analizada no guarda relación con el porcentaje de flúor presente en las aguas de consumo.


Abstract Objective. Identify the prevalence of fluorosis in children between 4 and 15 years of age according to the Dean's index, and determine its association with the level of fluoride present in drinking water from Cotopaxi province. Subsequent to the authorization by their parents and approval by the committee of the Central University of Ecuador Methods. 115 participants between the ages of 4 to 15 years old were examined following validated photographic registration protocols, after verifying and fulfilling the inclusion criteria, along with the supply water samples were collected following the adequate protocols and examined for the presence of fluoride. The obtained photographs were analyzed by three certified evaluators, who were trained in the differentiation of the degrees of fluorosis according to Dean by means of the Kappa index. Results. The values emitted by each evaluator were tabulated and processed through the SPSS program, using the statistical test of Chi-square and Spearman's correlation. The absence of a statistically significant relationship between the variables was observed. Conclusion: The presence of mild to moderate fluorosis in the analyzed population is not related to the percentage of fluoride present in drinking water.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Flúor/efeitos adversos , Fluorose Dentária/etiologia , Consumo de Água (Saúde Ambiental) , Equador
4.
Caries Res ; 55(1): 55-62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33326969

RESUMO

The aim of this multicenter randomized clinical trial was to evaluate the pulp vitality and survival rate of adhesive restorations performed on posterior deciduous teeth after non-selective (NSCR) or selective (SCR) carious tissue removal over 33 months. One hundred and seven children (average age 4-8 years, SD 1.4) with at least two active moderate cavitated lesions in dentin were included. Teeth were randomized and submitted to NSCR or SCR before composite resin restoration. Restorations were clinically and radiographically assessed at baseline, 6, 12, 18, 24, and 33 months by a blinded, trained, and calibrated operator in each center. The characteristics of the restorations were recorded according to FDI criteria and were considered as restorative failures when scores 4 or 5 were presented. Pulp vitality was measured by clinical and radiographic examinations, and those teeth that presented any signs or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. Data were analyzed by a Cox regression model with shared frailty, considering two outcomes: pulp and restorative. A total of 278 restorations (137 after NSCR and 141 after SCR) were performed at baseline in four different centers and there was no loss in the follow-up period. Survival rate was 97.1 and 87.1% for pulp and for restorative outcome, respectively. The overall annual failure rate was 7%. There were no differences in the failure risk according to the treatment group, center, and all the clinical and demographic variables, regardless of outcome. Composite restorations of active moderate deep carious lesions performed on posterior primary teeth show satisfactory survival for restorative and pulp outcome after a 33-month follow-up, regardless of the technique executed for carious tissue removal.


Assuntos
Cárie Dentária , Pulpite , Criança , Pré-Escolar , Resinas Compostas , Cárie Dentária/terapia , Cimentos Dentários , Restauração Dentária Permanente , Humanos , Pulpite/terapia , Dente Decíduo
5.
Odontoestomatol ; 23(37): e301, 2021.
Artigo em Espanhol | LILACS, BNUY | ID: biblio-1250423

RESUMO

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.


Assuntos
Assistência Odontológica para Pessoas com Deficiências/estatística & dados numéricos , COVID-19 , Teleodontologia , América Latina
6.
Artigo em Espanhol, Inglês | LILACS-Express | LILACS | ID: biblio-1116694

RESUMO

La ausencia de armonía en la sonrisa de un paciente constituye una causa por la cual su autoestima y comportamiento con su entorno se ven afectados. Ecuador ha sido considerado una zona endémica de fluorosis, desencadenando alteraciones dentales estéticas y funcionales; la fluorosis se presenta como manchas opacas que siguen un patrón horizontal en su fase temprana y manchas marrones y pérdida de estructura en estado avanzado. El presente caso tiene como objetivo exponer el caso de un paciente joven, diagnosticado con fluorosis grado 3 según el índice Thylstup y Fejerskov (TF), en el cual se realizó blanqueamiento con peróxido de hidrógeno al 40%, seguido de blanqueamiento casero con peróxido de carbamida al 35%, 20 minutos diarios por 7 días. La combinación de procedimientos de blanqueamiento resultó idónea en pacientes con fluorosis grado 3 según el índice de TF, mimetizando el moteado característico de la fluorosis dental mejorando así la estética del paciente y garantizando el éxito del presente caso. La aplicación de tratamientos conservadores, es eficaz, para restablecer estética dental, función y confianza en el paciente al momento de sonreír.


The lack of harmony in a patient's smile affects their self-esteem and behavior with their environment. Ecuador has been considered an endemic zone of fluorosis, triggering aesthetic and functional dental alterations. Fluorosis appears as opaque spots that follow a horizontal pattern in its early phase and brown spots and loss of structure in an advanced stage. In this article we present the case of a young patient, diagnosed with dental fluorosis grade three of Thylstup-Fejerskov (TF) index, treated with 40% hydrogen peroxide bleaching, followed by 35% peroxide carbamide home whitening for 30 minutes daily, during 7 days. The combination of whitening procedures was ideal to mimic the mottling characteristic of dental fluorosis, thus improving the aesthetics of the patient and guaranteeing the success of the present case. The use of a conservative treatment was effective to restore dental aesthetics, function and confidence of the patient when smiling.

7.
Odontol. vital ; (32)jun. 2020.
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1386418

RESUMO

Resumen El propósito de este estudio fue determinar el impacto de la fluorosis dental (FD) en la calidad de vida (CV) de adolescentes entre 11 a 14 años del cantón Latacunga, Cotopaxi, Ecuador. Materiales y métodos: Se plantea un estudio descriptivo, en una muestra de 128 adolescentes entre 11 a 14 años y sus respectivos padres, empleando como instrumentos de recolección de información, la encuesta INEN para determinar el nivel socioeconómico, el cuestionario CPQ11-14 para precisar calidad de vida, y un registro fotográfico intraoral de cada adolescente, analizado posteriormente por tres investigadores según el índice de Thylstrup y Fejerskov (TF). Un análisis químico sobre la concentración de flúor en las fuentes de abastecimiento de agua de consumo, fue ejecutado complementariamente. Resultados: La prevalencia de FD fue de 70,3% en los grados TF 1, 2,3. El análisis químico del agua mostró una media de flúor de 1,06 mg/l. Las pruebas estadísticas revelaron una relación de la CV con FD (p = 0,000) y con el nivel socioeconómico (p = 0,001). Conclusiones: La CV se ve afectada con la presencia de FD y el nivel socioeconómico, sin relación con la edad, sexo o la presencia de flúor en el agua de consumo.


Abstract The purpose of this study was to determine the impact of dental fluorosis (DF) over the quality of life (QoL) of adolescents between 11 and 14 years old, of Latacunga, Cotopaxi, Ecuador. Materials and methods: This descriptive study had a sample of 128 adolescents between 11 to 14 years old and their respective parents. The information was collected through, the INEN survey to determine socioeconomic status and the CPQ11-14 survey to determine adolescents' QoL. In addition, intraoral photographic records were obtained for DF detection according Thylstrup and Fejerskov index (TF) and the public water company accomplished chemical analysis of fluoride concentration in water sources. Results: The prevalence of DF was 70.3% corresponding to TF 1, 2, 3 index. Chemical analyzes of water showed an average of 1.06 mg / l on Fluoride levels. Statistical analysis showed correlation between QoL and Fluorosis presence (p = 0.000) and QoL to socio-economic level (p = 0.001). Conclusions: QoL relates to DF and the socio-economic level. However, it is not to age, sex or fluoride levels in consumption water. Key words: Teenagers, dental fluorosis, oral health, life quality, water fluoridation, epidemiology, dental health survey, public health dentistry.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Qualidade de Vida , Fluorose Dentária/diagnóstico , Equador
8.
Rev. cuba. estomatol ; 57(1): e2053, ene.-mar. 2020. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126490

RESUMO

RESUMEN Introducción: El edentulismo es la pérdida total o parcial de dientes, ocasionado principalmente por la caries y la enfermedad periodontal; es un proceso gradual que está comúnmente asociado al aumento de edad. Actualmente es considerado una discapacidad debido a la limitación funcional que ocasiona en quien lo presenta. Objetivo: Exponer el tratamiento rehabilitador multidisciplinario, funcional y estético en un paciente con desarmonías oclusales. Presentación del caso: Paciente masculino de 74 años, diagnosticado con edentulismo parcial bimaxilar, mediante examen clínico y radiológico. Se sometió a terapia periodontal generalizada, cirugía preprotésica, restauración de plano oclusal de forma directa e indirecta y rehabilitación bucal con prótesis removibles total superior y parcial inferior; lo cual le permitió recuperar funcionalidad, estética y autoestima. Conclusiones: El edentulismo desencadena alteración en el estado funcional y emocional del paciente. Un diagnóstico integral y plan de tratamiento multidisciplinario y ordenado desencadenó éxito en el presente caso(AU)


ABSTRACT Introduction: Edentulism is total or partial tooth loss mainly caused by dental caries and periodontal disease. It is a gradual process often associated to aging. At present edentulism is considered to be a disability, due to the functional limitations undergone by sufferers. Objective: Describe the multidisciplinary, functional and esthetic rehabilitation treatment provided to a patient with occlusal disharmony. Case presentation: A 74-year-old male patient was diagnosed with bimaxillary partial edentulism based on clinical and radiographic examination. The patient underwent generalized periodontal therapy, pre-prosthetic surgery, direct and indirect occlusal plane restoration, and oral rehabilitation with total upper and partial lower removable prostheses, as a result of which he recovered his functionality, esthetic appearance and self-esteem. Conclusions: Edentulism triggers changes in the functional and emotional state of patients. Comprehensive diagnosis and orderly multidisciplinary treatment led to success in the case herein presented(AU)


Assuntos
Humanos , Masculino , Idoso , Doenças Periodontais/diagnóstico , Cárie Dentária/terapia , Reabilitação Bucal/métodos , Dimensão Vertical , Prótese Dentária/métodos , Estética
9.
Odontol. vital ; (31): 23-30, jul.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS, BBO - Odontologia | ID: biblio-1091424

RESUMO

Resumen Objetivo: Evaluar mediante cuantificación de halos de inhibición el efecto antibacteriano de la cáscara y pulpa del capulí (Prunus serotina capulí) y del mortiño (Vaccinium floribundum), sobre cepas de Streptococcus mutans (ATCC 35668) a las 24 y 48 horas, comparado con arándano deshidratado y gluconato de clorhexidina al 0,12%. Materiales y métodos: Estudio experimental transversal in vitro, 15 cajas petri fueron utilizadas para sembrar 20ml de cultivo de cepas de Streptococcus mutans. En cada caja fueron colocados discos de fieltro impregnados con 20 μl de las sustancias evaluadas; mortiño y capulí, en pulpa y en cáscara, arándano deshidratado y gluconato de clorhexidina al 0,12% como control, distribuidos a una distancia equidistante. El análisis del efecto antibacteriano se realizó midiendo la zona de inhibición en un tiempo de 24 y 48 horas de incubación, los datos obtenidos se analizaron estadísticamente en el programa SPSS 22 mediante las pruebas paramétricas y de Kruskal Wallis. Resultados: No existió diferencia estadística significativa entre las variables analizadas, capulí y mortiño tanto en cáscara como en pulpa y clorhexidina empleada como control, en los dos períodos evaluados (p= > 0,05). Conclusiones: Los frutos rojos analizados tienen un efecto antibacteriano a las 24 y 48 horas, lo cual guarda relación con su capacidad antioxidante.


Abstract Objective: To evaluate by quantification of halos of inhibition, the antibacterial effect of the shell and pulp of capulí, (Prunus serotina capuli) and mortiño (Vaccinium floribundum), on strains of Streptococcus mutans (ATCC 35668) at 24 and 48 hours, compared with dehydrated cranberry and chlorhexidine gluconate at 0,12%. Materials and methods: In vitro cross-sectional experimental study, 15 petri dishes were used to plant 20 ul of the evaluated substances were placed in each box, mortiño, and capuli, in pulp and in shell, dehydrated cranberry and 0,12% chlorhexidine gluconate as control, distributed at an equidistant distance. The analysis of the antibacterial effect was performed by measuring the zone of inhibition in a time of 24 and 48 hours of incubation, the dataobtained were statistically analyzed in the SPSS 22 program by parametric and Kruskal Wallis tests. Results: There was no significant statistical difference between the analyzed variables, capuli and mortiño, both in skin and pulp and chlorhexidine used as control, in the two evaluated periods of time (p=>0,05). Conclusions: The red fruits analyzed have an antibacterial effect 24 and 48 hours, which is related to its antioxidant capacity.


Assuntos
Streptococcus/efeitos dos fármacos , Clorexidina/uso terapêutico , Mirtilos Azuis (Planta)/imunologia , Cárie Dentária , Prunus avium/imunologia
10.
Odontol. vital ; (30): 79-86, ene.-jun. 2019. graf
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1091417

RESUMO

Resumen Los pacientes acuden cada vez más, al consultorio odontológico a fin de mejorar el aspecto de su sonrisa, ampliando la demanda de procedimientos estéticos, y es responsabilidad del odontólogo ofrecer distintas técnicas para que el paciente acoja un tratamiento óptimo, orientado a la conservación de los tejidos dentales en este aspecto; las carillas de cerámica sin preparación, o lentes de contacto, constituyen una opción conservadora de recubrimiento parcial, que mejora la estética del sector anterior, el siguiente caso describe una posibilidad restauradora estética mínimamente invasiva para la rehabilitación del sector anterior, con el uso de porcelana IPS e. max® Press, resaltando el proceso de planificación por medio del diseño digital en dos dimensiones.


Abstract Patients increasingly come to the dental office to improve the appearance of their smile, expanding the demand for aesthetic procedures, and it is the dentist´s responsibility to offer different techniques for the patient to receive an optimal treatment, aimed at preserving the dental tissues in this aspect, unprepared ceramic veneers, or contact lenses, are a conservative alternative, which improves the aesthetics of the front sector, the following case describes a minimally invasive aesthetic restorative alternative for the rehabilitation of the anterior sector, with the use of IPS e. max® Press porcelain, highlighting the planning process through digital design in two dimensions.


Assuntos
Humanos , Masculino , Adulto , Porcelana Dentária/uso terapêutico , Facetas Dentárias , Estética Dentária , Lentes de Contato
11.
Odontol. vital ; (30): 51-58, ene.-jun. 2019. tab
Artigo em Espanhol | LILACS, SaludCR | ID: biblio-1091413

RESUMO

Resumen Introducción: Determinar la prevalencia de fluorosis dental y los factores asociados a su presencia, en escolares de 10 a 12 años del cantón Pimampiro, provincia de Imbabura, Ecuador. Metodología: Muestra de 302 alumnos de centros educativos del cantón Pimampiro, provincia de Imbabura que cumplieron con criterios de inclusión, previo consentimiento de sus padres o representantes, y que fueron evaluados en cuanto a su alimentación y hábitos de higiene oral, acompañado de un registro fotográfico de los dientes anteriores definitivos de cada participante, las fotografías obtenidas analizadas por tres evaluadores calibrados en la detección de fluorosis mediante el índice de Thylstrup y Fejerskov. Resultados: La prevalencia de la fluorosis dental fue de 81,4 %, el grado 2 fue el más frecuente en un 32,6%. Al relacionar las variables establecidas en la encuesta y la presencia de fluorosis se encontró relación de la patología con el consumo de bebidas envasadas, con la cantidad de dentífrico usado y con su ingesta accidental (p = 0,000). Conclusión: La prevalencia de fluorosis en la población de estudio se considera alta, el grado 2 según TF fue el más frecuente, y se encontró una relación con el consumo de bebidas envasadas, la cantidad de dentífrico usado y con la ingesta accidental.


Abstract Introduction: We aimed to determine the prevalence of dental fluorosis and its associated factors, in children from 10 to 12 years old from Pimampiro, province of Imbabura, Ecuador. Methodology: 302 school children from Pimampiro, province of Imbabura who complied inclusion criteria, with the prior consent of their parents and /or representatives were evaluated in terms of their diet and oral hygiene habits, accompanied by a photographic record of the final anterior teeth of each participant, the photographs obtained were analyzed by three calibrated evaluators in the detection of fluorosis using the Thylstrup and Fejerskov index. Results: The prevalence of dental fluorosis was 81.4%, grade 2 was the most frequent with 32.6%. When relating the variables established in the survey and the presence of fluorosis, a relationship was found between the pathology and the consumption of bottled beverages, with the amount of toothpaste used and with accidental intake (p = 0.000). Discussion and Conclusion: The prevalence of fluorosis in the study population is considered high; grade 2 according to TF was the most frequent, finding a relationship with the consumption of bottled beverages, the amount of toothpaste used and with accidental intake.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Higiene Bucal/tendências , Assistência Odontológica para Crianças , Alimentos, Dieta e Nutrição , Fluorose Dentária/dietoterapia , Equador
12.
Rev. cuba. estomatol ; 56(1)ene.-mar. 2019. tab, graf
Artigo em Espanhol | CUMED | ID: cum-74130

RESUMO

Introducción: La caries dental infantil constituye un problema de salud pública en el Ecuador. Los niños de 3 a 5 años que padecen caries dental decidua, sufren complicaciones como dolor al comer y dormir, alteración del estado de ánimo, inasistencia escolar; en general, un impacto negativo en su calidad de vida. Los padres cumplen un rol clave en el cuidado de la salud bucal de sus hijos, el cual es determinado muchas veces por su nivel educativo. Objetivo: Determinar el impacto que la salud bucal tiene en la calidad de vida de preescolares, evaluado por sus padres o responsables y relacionado con su nivel de educación. Métodos: Se realizó un estudio descriptivo y transversal. Se evaluaron a 382 padres y/o representantes de preescolares niños y niñas entre 3 a 5 años pertenecientes a cuatro provincias del Ecuador seleccionadas a conveniencia del investigador; quienes previa aceptación de participación y firma de consentimiento informado respondieron la encuesta ECOHIS (Early Childhood Oral Health Impact Scale) versión en español, que valora la relación entre salud bucal y calidad de vida en preescolares. Los datos recolectados fueron tabulados en tablas de Excel y analizados mediante software libre R.V3.4.1 empleando intervalos de verosimilitud al 14,7 por ciento equivalente al 95 por ciento de confianza para proporciones, y prueba estadística de chi cuadrado. Resultados: Los valores de significancia fueron: al relacionar con el dolor referido por los niños (p=0,152), las dificultades al beber (p= 0,003), consumir alimentos (p= 0,03), al sonreír (p= 0,002), al hablar (p= 0,09) y la repercusión económica asociada a problemas de salud bucal (p= 0,003). Conclusiones: Existe asociación entre el nivel de educación de los padres y su percepción sobre la influencia que tiene la salud bucal en la calidad de vida de sus hijos(AU)


Introduction: Childhood dental caries is a public health problem in Ecuador. Children aged 3-5 years with deciduous dental caries experience unpleasant symptoms such as pain while eating or sleeping, mood changes and school absenteeism, all of which has a negative impact on their quality of life. The key role played by parents in the oral care of their children is often determined by their educational level. Objective: Determine the impact of oral health on the quality of life of preschoolers aged under 5 years as evaluated by their parents or guardians and in relation to their educational level. Methods: A descriptive cross-sectional study was conducted of 382 parents and/or guardians of preschool children aged 3-5 years from four Ecuadorian provinces selected by convenience sampling, who gave their informed consent and answered the ECOHIS (Early Childhood Oral Health Impact Scale) survey, Spanish version, which assesses the relationship between oral health and quality of life among preschoolers. The surveys were identified with codes. The data collected were transferred onto Excel tables and analyzed with the free software R.V3.4.1 using likelihood ratios at 14.7 percent equivalent to 95 percent confidence intervals for proportions, as well as the chi-square statistical test. Results: The following significance levels were obtained: for pain as reported by children (p=0.152), for difficulty when drinking (p= 0.003), eating (p= 0.03), smiling (p= 0.002), speaking (p= 0.09), and for economic impact associated to oral health problems (p= 0.003). Conclusions: An association was found between the educational level of parents and their perception of the influence of oral health upon the quality of life of their children(AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Qualidade de Vida , Inquéritos de Saúde Bucal/estatística & dados numéricos , Poder Familiar , Cárie Dentária/complicações , Epidemiologia Descritiva , Estudos Transversais
13.
Rev. cuba. estomatol ; 56(1): e1815, ene.-mar. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1003869

RESUMO

Introducción: La caries dental infantil constituye un problema de salud pública en el Ecuador. Los niños de 3 a 5 años que padecen caries dental decidua, sufren complicaciones como dolor al comer y dormir, alteración del estado de ánimo, inasistencia escolar; en general, un impacto negativo en su calidad de vida. Los padres cumplen un rol clave en el cuidado de la salud bucal de sus hijos, el cual es determinado muchas veces por su nivel educativo. Objetivo: Determinar el impacto que la salud bucal tiene en la calidad de vida de preescolares, evaluado por sus padres o responsables y relacionado con su nivel de educación. Métodos: Se realizó un estudio descriptivo y transversal. Se evaluaron a 382 padres y/o representantes de preescolares niños y niñas entre 3 a 5 años pertenecientes a cuatro provincias del Ecuador seleccionadas a conveniencia del investigador; quienes previa aceptación de participación y firma de consentimiento informado respondieron la encuesta ECOHIS (Early Childhood Oral Health Impact Scale) versión en español, que valora la relación entre salud bucal y calidad de vida en preescolares. Los datos recolectados fueron tabulados en tablas de Excel y analizados mediante software libre R.V3.4.1 empleando intervalos de verosimilitud al 14,7 por ciento equivalente al 95 por ciento de confianza para proporciones, y prueba estadística de chi cuadrado. Resultados: Los valores de significancia fueron: al relacionar con el dolor referido por los niños (p=0,152), las dificultades al beber (p= 0,003), consumir alimentos (p= 0,03), al sonreír (p= 0,002), al hablar (p= 0,09) y la repercusión económica asociada a problemas de salud bucal (p= 0,003). Conclusiones: Existe asociación entre el nivel de educación de los padres y su percepción sobre la influencia que tiene la salud bucal en la calidad de vida de sus hijos(AU)


Introduction: Childhood dental caries is a public health problem in Ecuador. Children aged 3-5 years with deciduous dental caries experience unpleasant symptoms such as pain while eating or sleeping, mood changes and school absenteeism, all of which has a negative impact on their quality of life. The key role played by parents in the oral care of their children is often determined by their educational level. Objective: Determine the impact of oral health on the quality of life of preschoolers aged under 5 years as evaluated by their parents or guardians and in relation to their educational level. Methods: A descriptive cross-sectional study was conducted of 382 parents and/or guardians of preschool children aged 3-5 years from four Ecuadorian provinces selected by convenience sampling, who gave their informed consent and answered the ECOHIS (Early Childhood Oral Health Impact Scale) survey, Spanish version, which assesses the relationship between oral health and quality of life among preschoolers. The surveys were identified with codes. The data collected were transferred onto Excel tables and analyzed with the free software R.V3.4.1 using likelihood ratios at 14.7 percent equivalent to 95 percent confidence intervals for proportions, as well as the chi-square statistical test. Results: The following significance levels were obtained: for pain as reported by children (p=0.152), for difficulty when drinking (p= 0.003), eating (p= 0.03), smiling (p= 0.002), speaking (p= 0.09), and for economic impact associated to oral health problems (p= 0.003). Conclusions: An association was found between the educational level of parents and their perception of the influence of oral health upon the quality of life of their children(AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Qualidade de Vida , Inquéritos de Saúde Bucal/estatística & dados numéricos , Poder Familiar , Cárie Dentária/complicações , Epidemiologia Descritiva , Estudos Transversais
14.
Prog Biomater ; 8(1): 23-29, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30725401

RESUMO

In vitro effect of 1% theobromine addition on the physical and chemical properties of conventional glass ionomer (GIC) cement was investigated. Conventional GIC (GIC-C) and 1% theobromine added to GIC (GIC-THEO) specimens were compared regarding the microhardness (n = 10), sorption (n = 5), solubility (n = 5), color change (n = 10), fluoride release in saliva (n = 10) and the amount of biofilm deposition (n = 20). Compared against conventional GIC, adding 1% theobromine increased microhardness (p < 0.05), while its sorption, solubility, color and fluoride release to saliva (p > 0.05) remained unchanged. On the other hand, Streptococcus mutans biofilm amount deposited on its surface decreased statistically when theobromine was added to GIC (p < 0.05). Based on the results, it could be concluded that 1% theobromine addition to GIC can be a good strategy as it keeps some of its properties and improves microhardness and biofilm deposits strengthening its role in the preventive approach of dentistry.

15.
J Clin Exp Dent ; 11(1): e42-e48, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30697393

RESUMO

BACKGROUND: To determine the prevalence of dental fluorosis in 10-12 year-old school children, in three provinces of the inter-andean Region of Ecuador: Imbabura, Pichincha and Chimborazo, as well as the relationship between certain factors, considering that the latest studies go back to the year 2009. MATERIAL AND METHODS: A cross-sectional and observational study was proposed. A sample of 599 was calculated at 95% of confidence considering population projections for children between 10 and 12 old of three zones of Ecuador. However, 608 school children, who had the acceptance and informed consent of their parents to participate, completed a survey about factors associated with dental fluorosis. Once the survey was completed, the vestibular surfaces of the upper and lower anterior teeth of the infant were photographed, following standardized distance and light procedures. Three evaluators, trained in the detection of fluorosis using the Thylstrup and Fejerskov index, analyzed the photographs. The Stata 13.0 software was used for the statistical analysis, with a level of significance of 5% and with a confidence interval of 95%. To relate the risk factor of fluorosis, a multinomial logistic model was used. RESULTS: The prevalence of dental fluorosis was of 89.96%, with a greater presence of grade 2 TF. A positive statistical relationship and statistical significance was detected between dental fluorosis and consumption of bottled beverages. Also the amount of toothpaste used and its ingestion during brushing (p = 0.000) were analyzed. CONCLUSIONS: The populations evaluated, that are related to the consumption of bottled beverages and involuntary toothpaste ingestion, and have a high prevalence of a mild level of fluorosis. Key words:Fluorosis, dental, risk factors, epidemiology.

16.
Odontol. sanmarquina (Impr.) ; 21(4)Diciembre 2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1010099

RESUMO

Objetivo: Comparar los cambios en la posición de los dientes artificiales en las prótesis totales maxilares al momento del prensado, mediante la medición en puntos de referencia pre determinados, bajo una fuerza de presión de 800, 1 000 y 1 250 kg, empleando yeso tipo III (Whip Mix, USA®) o silicona de condensación (Zhermack, Italia) como materiales de inclusión. Métodos: Fueron fabricadas 36 prótesis superiores obtenidas desde un modelo de yeso de un único paciente edéntulo total. Las réplicas fueron divididas de forma aleatoria en seis grupos, cada uno con seis repeticiones, considerando las variables involucradas, materiales y fuerza evaluada, tras el prensado y acrilizado. La diferencia entre los puntos referenciales fue establecida mediante Autocad (versión 21,2, Autodesk, España). Resultados: Se detectó una diferencia significativa entre la silicona y el yeso a 1 000 kg fuerza al 1% de nivel de significancia. Conclusiones: Existió mayor estabilidad en cuanto a movimiento cuando fue empleado como material de inclusión la silicona, con mejores resultados al emplear bajo 1 000 Kg fuerza de presión; independiente de la presión probada en todas las muestras existió movimiento en la posición original de los dientes artificiales. Palabras clave: Materiales dentales; Movilidad dentaria; Prostodoncia.


Objective: Compare the artificial teeth changes position in the maxillary total prosthesis at the time of pressing, by measuring at certain pre-determined reference points, under different types of pressure force of 800, 1 000 and 1 250 kg, using Type III gypsum (Whip Mix, USA®) and condensation silicone (Zhermack, Italy) as inclusion materials. Methods: 36 superior prostheses obtained from a plaster model of a single total edentulous patient were fabricated. The copies were randomly divided into 6 groups each with 6 repetitions, considering the involved variables, materials and evaluiated strength after press and process of being transformed in acrylic. The difference between the reference points was established by Autocad (21.2 version Autodesk, Spain). Results: significant difference was detected between silicone and gypsum at 1 000 force at 1% of significance level. Conclusions: Standing out more stability in terms of movement when used silicone as material for inclusion, with better results when using under 1 000 kg pressure force, independent of the pressure tested in all samples there was movement in the arti-ficial teeth original position. Keywords: Dental materials; Prosthodontics; Tooth mobility.

17.
Odontol. sanmarquina (Impr.) ; 21(3)Septiembre2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1010156

RESUMO

El embarazo constituye un período de la vida de la mujer donde suceden cambios tanto de su cuerpo como en su entorno. Los cambios hormonales que sufre la mujer durante el estado de gravidez pueden llegar a afectar su salud bucal desencadenándose una serie de alteraciones a nivel gingival lo cual propicia la presencia de enfermedades bucodentales. Se busca mediante esta revisión bibliográfica actualizar conocimientos acerca de las diferentes patologías bucales en la mujer gestante. Se revisaron las bases de datos Medline, SciELO y Google Scholar en busca de estudios de casos, ensayos clínicos, metanálisis, revisiones sistemáticas y revisiones de literatura publicadas en los últimos 8 años, sobre las diferentes patologías bucales que se presentan en las mujeres embarazadas, empleando como palabras clave mujeres embarazadas, enfermedades bucodentales, salud bucal y sus homólogos en inglés. Se obtuvieron 72 artículos, después de la lectura y exclusión, la selección arrojó 42 artículos considerados adecuados para cumplir con los objetivos planteados. La adopción de buenos hábitos de higiene oral y consultas periódicas al odontólogo pueden reducir los efectos adversos durante el embarazo; aunque otros investigadores afirman la ausencia de cambios durante la gestación en relación con la salud periodontal. El acompañamiento y orientación durante la gestación requiere involucrar cuidados bu-cales desde inicios de esta etapa hasta el nacimiento del bebe. Palabras clave: Enfermedades bucales; Mujeres embarazadas; Salud bucal.


Pregnancy is a period in the life of the woman where changes occur both in her body and in the environment. Due to the hormonal changes that the woman undergoes during the pregnant state, her oral health is affected, triggering a series of alterations at the gingival level, which causes the presence of oral diseases. The objective of the bibliographic review is to analyze and update knowledge about different oral pathologies in pregnant women. The Medline, SciELO and Google Scholar databases were searched for case studies, clinical trials, meta-analyzes, systematic reviews and literature reviews dealing with the different oral pathologies that occur in pregnant women in the last 8 years. The "Free Full Text" filter was used as well, searching the keywords: pregnant women, oral diseases, oral health and their English counterparts. Seventy-two articles were obtained in the initial search, however, after excluding based on the criteria, 42 articles were selected given heir relevant information. Most authors conclude that good oral hygiene habits and regular visits to the dentist can reduce adverse effects during pregnancy, although other researchers do not affirm the existence of a relationship between periodontal disease and adverse effects, but emphasize that periodontal treatment can be done during pregnancy to relieve the symptoms. Due to the changes suffered by women during the management, they require special and exclusive treatment, in addition to guiding her about oral care for both her and him after childbirth. Keywords: Mouth diseases; Oral health; Pregnant women.

18.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1010170

RESUMO

Objetivo: Evaluar el grado de microfiltración de tres cementos provisionales: IRM®, OBTUR® y CAVIT® sometidos a envejecimiento artificial. Métodos: En 60 terceros molares, libres de caries, extraídos previa indicación terapéutica, fueron realizadas ca-vidades en la superficie oclusal con una apertura a cámara pulpar de 4 mm x 4 mm, tras irrigación con NaClOal 2,5% y secado con algodón, los molares fueron divididos aleatoriamente en tres grupos (n: 20) colocando en cada uno de ellos uno de los tres cementos. Los dientes fueron sometidos a termociclado con temperaturas de -5, 37 y 55 °C; durante 900 ciclos continuos, tras lo cual fueron inmersas en azul de metileno por 24 horas, seccionados y analizados bajo estereomicroscopio para determinar el grado de microfiltración. Dos fragmentos de cada grupo fueron escogidos al azar y preparados para observación al microscopio electrónico de barrido (MEB). Resultados: El mayor grado de microfiltación fue observado en IRM. CAVIT® y OBTUR® presentaron un grado de microfiltración similar con menor microlfiltración, las observaciones realizadas al MEB corroboraron estos hallazgos. Conclusiones: El comportamiento de los cementos provi-sionales varía entre ellos, IRM®presentó un menor desempeño con mayor filtración, no existe diferencia entre CAVIT®y OBTUR®que presentaron un mejor desempeño. Palabras clave: Adaptación marginal dental; Filtración dental; Restauración dental per-manente.


Objective: Evaluate the microfiltration degree of three temporary cements: IRM®, OBTUR® and CAVIT® subjected to artificial aging. Methods: In 60 third molars, without caries, extracted because of therapeutic indication, cavities were made in the occlusal surface with pulp chamber opening of 4 mm x 4 mm, after irrigation with 2.5% NaClO and drying with cotton, the molars were randomly divided into three groups (n: 20) placing in each of them one of the three cements. The teeth were subjected to thermocycling at temperatures of -5, 37 and 55 ° C; during 900 continuous cycles, after which they were immersed in methylene blue for 24 hours, then sectioned and analyzed under a stereomicroscope to determine the microfiltration degree. Two fragments of each group were chosen randomly and prepared for scanning electron microscopy (SEM) observation. Results: The highest microfiltation degree was observed in IRM. CAVIT® and OBTUR® presented a similar degree of microfiltration with lower microfiltration, the observations made with the MEB corroborated these findings. Conclusions: The behavior of the provisional cements varies among them, IRM® presented a lower performance with higher filtration, there is no difference between CAVIT® and OBTUR® that presented better performance. Keywords: Dental leakage; Dental marginal adaptation; Dental restoration, permanent.

19.
Rev. Fac. Odontol. Univ. Antioq ; 29(2): 329-342, Jan.-June 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-977022

RESUMO

ABSTRACT. Introduction: tissue loss due to carious processes is usually resolved with restorations, requiring abundant patient collaboration in oral hygiene. The aim of the present study was to evaluate the effect of oral hygiene motivational talks addressed to parents or guardians of children aged 5 to 8 years on the duration of composite resins over 24 months. Methods: a prospective descriptive study was conducted in 31 children and their parents or guardians meeting the inclusion criteria. The parents and guardians were trained in oral hygiene techniques, and the participating children's cavitated teeth were restored with composite resin, providing dental cleaning devices every 6 months during the study period. Clinical evaluations were performed every 6 months during the study period, evaluating the deterioration of restorations and the presence of visible plaque (VPI) and gingival bleeding (GBI). The data obtained were submitted to ANOVA statistical analysis and Student t-test through the STATA software. Results: There was a close relationship between oral hygiene indexes (p = 0,2019 for VPI and p = 0,6243 for GBI) and the deterioration of restorations, especially those involving proximal sides. Survival analysis showed that failure is lower in the presence of nearby caries (42.9%), with p values of 0.0045 for the occlusal-distal surface and 0.0291 for the occlusal-mesial one. Conclusion: the oral hygiene motivational talks addressed to parents or guardians of participating children influence the durability of composite resins.


RESUMEN. Introducción: la pérdida de tejido relacionada con procesos cariosos suele ser resuelta con restauraciones, cuyo cuidado depende en gran medida de la higiene oral del paciente. El objetivo del presente estudio consistió en evaluar el efecto de la motivación en higiene bucal dirigida a padres o responsables de niños de 5 a 8 años de edad sobre la duración de resinas compuestas a lo largo de 24 meses. Métodos: se planteó un estudio descriptivo prospectivo, en el que participaron 31 niños y sus padres o responsables, que cumplieron los criterios de inclusión y exclusión previamente determinados. Los representantes fueron capacitados en técnicas de higiene bucal, y los dientes afectados por caries de los menores intervenidos fueron restaurados mediante resina compuesta, contando con acceso a dispositivos de aseo dental cada 6 meses durante el periodo del estudio. Se realizaron evaluaciones clínicas cada 6 meses durante el periodo de estudio, evaluando el deterioro de la restauración y la presencia de placa visible y de sangrado gingival. Los datos obtenidos fueron sometidos a análisis estadístico ANOVA y al test t-Student mediante el programa STATA. Resultados: se evidenció una estrecha relación entre los índices de higiene oral (p = 0,2019 para IPV y p= 0,6243 para ISG) y el deterioro de las restauraciones, en especial en aquellas que involucraban caras proximales. En la aplicación de las técnicas de supervivencia, el fracaso es menor en presencia de caries aledañas (42,9%), con valores p de 0,0045 para la superficie ocluso-distal y 0,0291 para la ocluso-mesial. Conclusión: la motivación a padres o responsables de los participantes sobre higiene bucal influyó sobre la durabilidad de las resinas compuestas.


Assuntos
Higiene Bucal , Resinas Sintéticas , Poder Familiar
20.
Rev. cuba. estomatol ; 54(4): 1-9, oct.-dic. 2017. ilus, tab
Artigo em Espanhol | CUMED | ID: cum-72131

RESUMO

Objetivo: evaluar la actividad antimicrobiana de cinamaldehído, timol, eugenol y quitosano en comparación con clorhexidina al 0,12 por ciento sobre cepas de Streptococccus mutans. Métodos: se realizaron pruebas de susceptibilidad bacteriana de cepas de Streptococccus mutans con discos embebidos en eugenol, cinamaldehído, quitosano y timol, al 0,1 y 1 por ciento con un control positivo de clorhexidina al 0,12 por ciento evaluando los halos de inhibición existentes a las 24 h y 48 h. Resultados: el cinamaldehído al 1 por ciento mostró el mejor poder de control sobre el crecimiento de Streptococccus mutans al presentar 19,91 mm y 24,44 mm de halos de inhibición a las 24 h y 48 h, respectivamente, con una diferencia significativa de p< 0,05 entre los dos intervalos. Cuando se comparó el cinamaldehído al 1 por ciento con el control positivo de clorhexidina al 0,12 por ciento, no se encontraron diferencias significativas (p> 0,05). Conclusiones: el cinamaldehído al 1 por ciento tuvo los mejores resultados seguidos por quitosano, eugenol y timol a la misma concentración en comparación con clorhexidina al 0,12 por ciento tanto a la 24 como 48 h(AU)


Objective: to evaluate the antimicrobial activity of cinnamaldehyde, thymol, eugenol and chitosan compared to chlorhexidine-0.12 percent on Streptococcus mutans strains. Methods: bacterial susceptibility tests were performed on S. mutans strains with disks embedded in eugenol, cinnamaldehyde, chitosan and thymol, at 0.1 percent and 1 percent with a positive control of 0.12 percent chlorhexidine, evaluating existing inhibition zones after 24 and 48 hours. Results: cinnamaldehyde-1 percent showed the best control power over the growth of S. mutans, presenting 19.91 mm and 24.44 mm of inhibition halos after 24 and 48 hours, respectively, with a significant difference of p< 0.05 between the two intervals. When the cinnamaldehyde-1 percent was compared with the positive control of chlorhexidine-0.12 percent, no significant differences were found (p> 0.05). Conclusions: cinnamaldehyde-1 percent had the best results followed by chitosan, eugenol and thymol in the same concentration compared to chlorhexidine-0.12 percent after both 24 and 48 hours(AU)


Assuntos
Humanos , Cárie Dentária/diagnóstico , Eugenol/uso terapêutico , Streptococcus mutans , Timol/uso terapêutico , Suscetibilidade à Cárie Dentária , Epidemiologia Descritiva , Ensaio Clínico , Estudo Observacional
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