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

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

Perception of Realism and Acquisition of Clinical Skills in Simulated Pediatric Dentistry Scenarios.

Simulation, depending on the modality and fidelity of the scenarios, is an important resource for clinical teaching and achievement of learning outcomes in dentistry. The objectives of this study were to compare the degree of realism perceived by students and teachers in a simulated scenario, and to assess the level of competence acquired by the students. METHOD: In the Pediatric Dentistry course, eight clinical scenarios were carried out, each one using a modified Erler Zimmer child simulator (handmade), a professional actress and two students (dentist and assistant) on the same pediatric dentistry case consisting of a pulp abscess in tooth 8.5. A total of 114 students in the 4th year of dentistry studies participated in the pediatric dentistry course. Questionnaires with Likert-type answers were elaborated to evaluate the educational intervention, applying them before and after the simulation. RESULTS: The realism best valued by the students was that of the simulated participant and the worst that of the manikin, the latter being strongly related to the realism of the office. It was observed that students' perception of clinical competence increased as the overall realism of the scenario increased (p-value = 0.00576). CONCLUSION: This research suggests that the creation of scenarios using handmade mannequins and simulated participants achieves a high level of realism, increasing the level of clinical competence perceived by dental students.

Técnicas alternativas del manejo de la conducta en odontopediatría / Técnicas alternativas para a gestão comportamental em odontologia pediátrica / Alternative behavioral management techniques in pediatric dentistry

Diversas técnicas convencionales han sido utilizadas con gran eficacia; sin embargo, la no aceptación de algunas de ellas por los padres, ciertos condicionamientos éticos y legales así como cambios en la educación actual y el avance en nuevas tecnologías, obligan al odontólogo a un replanteamiento de actitudes. Objetivo: El objetivo del presente trabajo es identificar qué técnicas alternativas son empleadas en la clínica dental por los profesionales para el manejo de la conducta de pacientes infantiles. Material y métodos: Se realizó un cuestionario en la plataforma de Google, remitido vía email a 190 odonto/estomatólogos que tratasen pacientes infantiles, obteniendo una participación de 132 encuestas adecuadas para el análisis de 6 técnicas alternativas de manejo de la conducta. El estudio estadístico se realizó en el programa SPSS aplicando el test de ANOVA para una significación de p= 0,05. Resultados: Un 35,1% de los encuestados utilizaban medios audiovisuales para el tratamiento dental, siendo la televisión el más frecuentemente empleado. La musicoterapia fue la técnica más utilizada (70,5% de los participantes) con mayor frecuencia del sexo femenino, aunque sin diferencias significativas, siendo la música moderna la de mayor aceptación. Un 32,8% utilizaron la ludoterapia como técnica de manejo seguida del empleo de técnicas de relajación con un 25%, ambas con mayor porcentaje femenino. Las dos técnicas menos utilizadas fueron la aromaterapia (6,8%) y la hipnosis (2,3%). Conclusiones: A pesar del incremento en la utilización de técnicas alternativas en el manejo de la conducta, todavía su empleo es escaso por los odonto/estomatólogos.

Várias técnicas convencionais têm sido usadas com grande eficácia; contudo, a não aceitação de algumas delas pelos pais, certas condições éticas e legais, assim como as mudanças na educação atual e o avanço das novas tecnologias, forçam o dentista a repensar as atitudes. Objetivo: O objetivo do presente estudo é identificar quais técnicas alternativas são utilizadas na clínica odontológica por profissionais para gerenciar o comportamento de pacientes infantis. Material e métodos: Foi realizado um questionário na plataforma Google, enviado por e-mail a 190 dentistas/stomatologistas que trataram crianças, obtendo 132 pesquisas adequadas para a análise de 6 técnicas alternativas de gestão comportamental. O estudo estatístico foi realizado no programa SPSS aplicando o teste ANOVA para uma significância de p= 0,05. Resultados: 35,1% dos inquiridos utilizaram meios audiovisuais para tratamento dentário, sendo a televisão a mais frequentemente utilizada. A musicoterapia foi a técnica mais utilizada (70,5% dos participantes) pelo sexo feminino, embora sem diferenças significativas, sendo a música moderna a mais amplamente aceita. 32,8% utilizaram a terapia lúdica como técnica de gestão seguida do uso de técnicas de relaxamento com 25%, ambas com uma percentagem maior de mulheres. As duas técnicas menos utilizadas foram a aromaterapia (6,8%) e a hipnose (2,3%). Conclusões: Apesar do aumento do uso de técnicas alternativas na gestão do comportamento, o seu uso ainda é escasso pelos odontologistas/estomatologistas.

Various conventional techniques have been used with great efficiency; nevertheless, the non-acceptance of some of them by the parents, certain ethical and legal conditions as well as changes in the current education and the advance in new technologies, force the dentist to a rethinking of attitudes. Aim: The aim of this paper is to identify what alternative techniques are used by professionals for the behavior's management of pediatric patients in the dental clinic. Material and methods: A questionnaire was carried out on the Google platform, sent via email to 190 odonto / stomatologists who treated pediatric patients, obtaining a participation of 132 appropriate surveys for the analysis of 6 alternative behavior management techniques. The statistical study was carried out in the SPSS program, applying the ANOVA test for a significance of p = 0.05. Results: 35.1% of respondents used audiovisual media for dental treatment, being television the most frequently used. Music therapy was the most applied technique (70.5% of the participants) with the highest frequency of female sex, without significant differences though, being modern music the most widely accepted. 32.8% used play therapy as a management technique followed by the use of relaxation techniques with 25%, both with a higher female percentage. The two least used techniques were aromatherapy (6.8%) and hypnosis (2.3%). Conclusions: Despite the increase in the use of alternative techniques in behavior management, their use is still scarce by dentists / stomatologists.

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

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

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

Técnicas en el manejo de la conducta del paciente odontopediátrico / Techniques in the management of the odontopediatric patient's conduct

INTRODUCCIÓN: El objetivo del presente trabajo fue evaluar las técnicas convencionales más utilizadas por el odontólogo para el manejo de la conducta del paciente infantil en la consulta dental. Diversas técnicas pueden ser aplicadas dependiendo del desarrollo físico y emocional del paciente y de la capacidad del profesional. La Academia Americana de Odontopediatría, en su guía sobre técnicas del comportamiento, las divide en: técnicas de comunicación, otras técnicas básicas y técnicas avanzadas, recomendando las pertenecientes al primer grupo. MATERIAL Y MÉTODO: Se realizó un cuestionario en la plataforma de Google, remitido vía email a 190 odonto/estomatólogos que tratasen pacientes infantiles, obteniendo un total de 115 respuestas adecuadas para el análisis de 8 técnicas convencionales de manejo de la conducta. El estudio estadístico se realizó en el programa SPSS aplicando el test de ANOVA para una significación de p= 0,05. RESULTADOS: La técnica más utilizada por los diferentes profesionales fue la técnica decir-mostrar-hacer seguida de refuerzo positivo y control de voz. Técnicas de modificación de la conducta ocuparon un segundo término: desensibilización seguida muy de cerca por imitación. La técnica menos empleada fue la anestesia general. No encontramos diferencias significativas en relación al sexo en ninguna de las técnicas analizadas excepto en el uso de premedicación (p: 0,027), siendo los varones los que más frecuentemente la utilizaban. No se encontraron diferencias significativas en relación a la especialidad ni con la edad de los profesionales. CONCLUSIONES: Las técnicas comunicativas fueron las preferidas por los odontoestomatólogos siendo las técnicas avanzadas las menos utilizadas

INTRODUCTION: The objective of this work was to evaluate the conventional techniques most used by the dentist for the management of the behavior of the child patient in the dental office. Various techniques can be applied depending on the physical and emotional development of the patient and the professional's ability. The American Academy of Pediatric Dentistry, in its guide on behavioral techniques, divides them into: communication techniques, other basic techniques and advanced techniques, recommending those belonging to the first group. MATERIAL AND METHOD: A questionnaire was carried out on the Google platform, sent via email to 190 dentists / stomatologists who treated child patients, obtaining a total of 115 appropriate responses for the analysis of 8 conventional behavior management techniques. The statistical study was carried out in the SPSS program by applying the ANOVA test for a significance of p = 0.05. RESULTS: The technique most used by different professionals was the say-show-do technique followed by positive reinforcement and voice control. Behaviour modification techniques occupied a second term: desensitization followed closely by imitation. The least used technique was general anesthesia. We found no significant differences in relation to sex in any of the techniques analyzed, except in the use of premedication (p: 0.027), with men being the most frequently used. No significant differences were found in relation to the specialty or the age of the professionals. CONCLUSIONS: The communication techniques were preferred by the professionals, with the advanced techniques being the least used

Relación entre los patrones de crecimiento facial y la maduración dental y esquelética en los pacientes en crecimiento / Relationship between facial growth patterns and dental and skeletal maturation in growing patients

El objetivo de este trabajo es realizar una revisión bibliográfica para evaluar la posible relación entre los patrones de crecimiento facial con la maduración dental y esquelética en pacientes en crecimiento. La maduración dental y esquelética son dos indicadores que nos permiten es-tablecer en qué momento del desarrollo se encuentra el paciente en crecimiento. Actualmente, para la valoración de la maduración esquelética se emplea la visualización de las vértebras cervicales en la radiografía lateral de cráneo, ya que es un método que permite disminuir la exposición radiológica del paciente que se encuentra en estudio ortodóncico, en comparación con la radiografía de muñe-ca, la cual suponía la realización de una radiografía adicional. Para el análisis de la maduración dental, la radiografía panorámica es la más empleada mediante la visualización del desarrollo de los siete dientes mandibulares izquierdos. Los pacientes que se encuentran en edad infantil presentan diversos patrones de crecimiento facial, entre los que podemos encontrar, braquifacial, mesofacial y dolicofacial. Para poder establecer el patrón de crecimiento que presenta el paciente existen diversos métodos que, a través de mediciones cefalométricas, nos clasifican al paciente en uno de los tres grupos. Existen diversos trabajos que estudian la posible relación entre los patrones de crecimiento facial y la maduración dental y esquelética. Según la literatura revisada podemos concluir que los pacientes que presentan un patrón de crecimiento vertical muestran una maduración dental y esquelética más avanzada en comparación con los pacientes que presentan un patrón de crecimiento horizontal

The objective of this paper is to present a bibliographical review to evaluate the possible relationship between facial growth patterns and dental and skeletal maturation in growing patients.Dental and skeletal maturation are two indicators that allow us to establish at what point the patient is in his growth. Currently, for the evaluation of skeletal maturation, the visualisation of the cervical vertebrae in the lateral x-ray of the skull is used, since this is a method that diminishes the radiological exposure of the patient undergoing an orthodontic study, in comparison with the x-ray of the wrist, which means taking an additional x-ray.For the analysis of dental maturation, the panoramic x-ray is the most used through visualisation of the development of the seven left jaw teeth. Children in young ages present different facial growth patterns, among which we can find brachyfacial, mesofacial and dolichofacial. In order to establish the growth pattern the patient presents, there are different methods that, through cephalometric measurements, classify the patient in one of the three groups. Different papers study the possible relationship between facial growth patterns and dental and skeletal maturation. According to the reviewed literature, we can conclude that the patients who present a vertical growth pattern show more advanced dental and skeletal maturation in comparison with the patients who present a horizontal growth pattern

¿Existen asimetrías condilares en pacientes infantiles con mordida cruzada posterior? / Are condylar asymmetries in infantile patients with posterior cross-bite?

El objetivo de este estudio fue determinar la presencia de asimetría del cóndilo mandibular en pacientes con mordida cruzada posterior unilateral que acudieron para posible tratamiento ortodóncico, comparando la altura y el ancho mandibular de ambos cóndilos. Métodos: Se midieron las anchuras y alturas condilares derechas e izquierdas en 42 ortopantomografías de pacientes infantiles de siete, ocho y nueve años, de ambos sexos, utilizando el método de Habets. Resultados: No se encontraron diferencias estadísticamente significativas, respecto al género y tipo de dentición, tanto en la altura como en la anchura condilar en la muestra compuesta por 42 pacientes. Conclusiones: No observamos la existencia de asimetría del cóndilo en el que se desarrolla la mordida cruzada posterior en relación al contralateral en los grupos de edad estudiados

The aim of this study was to determine the presence of asymmetry of the mandibular condyle in patients with a unilateral posterior crossbite who came for possible orthodontic treatment, comparing the mandibular height and width of both condyles. Methods: Right and left condyle widths and heights were measured in 42 orthopantomographies of seven, eight and nine year old children of both sexes, using the Habets method. Results: No statistically significant differences were found regarding gender and type of dentition, both in the height and in the condylar width in the sample composed of 42 patients. Conclusions: We did not observe the asymmetry of the condyle in which the posterior crossbite was developed in relation to the contralateral bite in the age groups studied

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

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

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

Oral health in children with physical (Cerebral Palsy) and intellectual (Down Syndrome) disabilities: Systematic review I.

INTRODUCTION: Traditionally, patients with physical and/or intellectual disabilities presented greater oral pathology, owing to their condition and to other external factors. Improved social and health conditions make it necessary to update knowledge on their oral and dental health. MATERIAL AND METHODS: For this purpose, a bibliographic review was done regarding the state of oral health of children with these two types of disability, in comparison with a control group. Some of the guidelines of the PRISMA statement were taken into account. The ranking of the articles found is based on the modified Newcastle-Ottawa Quality Assessment Scale. The final number of articles evaluated was 14. Parameters such as dental caries, oral hygiene, gingival health, dental traumas, malocclusion and habits were considered. RESULTS: There is no consensus among authors regarding dental caries, oral hygiene and gingival health. The different results obtained are due in part to the fact that the methodologies used were not the same. However, it has been noted that, when studying other parameters and regardless of the methodology employed, the results obtained are similar. CONCLUSIONS: Children with physical and intellectual disabilities constitute a group that needs early and regular dental care in order to prevent and limit the severity of the pathologies observed. KEY WORDS: Oral health, dental caries, malocclusion, oral habits, dental trauma, oral hygiene, disabled child, cerebral palsy and Down syndrome.

Incidence of oral health in paediatric patients with disabilities: Sensory disorders and autism spectrum disorder. Systematic review II.

INTRODUCTION: We are currently witnessing an increase in the number of disabled patients, creating the need for knowledge of each of the pathologies and of the different oral and dental conditions they present, in order to achieve efficient management and treatment. OBJECTIVES: To analyse the existing scientific literature on the oral conditions of children with autism spectrum disorder (ASD) and children with sensory deficits (SD), in comparison with the healthy child population. MATERIAL AND METHODS: The bibliographic search was carried out in Pubmed/Medline, Scopus and Cochrane Library and included articles taking a sample of children between 0 and 18 years of age diagnosed with the abovementioned disorders and including at least one of the following oral hygiene conditions - oral hygiene, dental caries, malocclusion, oral habits, dental trauma, and gingival-periodontal status - comparing them with a healthy population. RESULTS: A total of 10 articles were obtained for autism spectrum disorder and six for sensory deficits. CONCLUSIONS: Of all the variables studied, only the state of oral, gingival and/or periodontal hygiene can be considered worse in patients with ASD and SD, although we believe a larger number of research studies is needed to corroborate these results. KEY WORDS: Oral health, dental caries, malocclusion, oral habits, dental trauma, oral hygiene, disabled child, autism, autism spectrum disorder, deaf, blind.

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

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

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

Assessment of PFA-100 system for the measurement of bleeding time in oral surgery.

UNLABELLED: The common diagnostic methods to know primary hemostasis have been classified as invasive, depending on the operator, difficult to reproduce and at times not very reliable. Thus, different systems have been proposed to assess bleeding time, one of them being the PFA-100 device, which we present in this paper. OBJECTIVE: Compare specificity between the traditional Ivy method with the PFA-100 system to measure bleeding time. MATERIAL AND METHOD: We obtained a sample of 33 patients between the age of 24-80 years receiving anti-platelet treatment who needed to undergo oral surgery. Bleeding time was obtained by the Ivy method, an INR by an analysis done on the same day and a Coagucheck one hour before surgery as well as measurement of bleeding time with the PFA-100 system. RESULTS: Mean value of bleeding time through the Ivy method was 406.36 sec.. Mean bleeding time with the PFA-100 system for the collagen/epinephrine cartridge was 226.91 sec. and for the collagen/ADP cartridge was 110.27 sec.. All these values were within normality. We observed very high standard deviations with the Ivy method and more regular ones for the PFA-100 system, indicating its greater specificity. We also obtained a large correlation between collagen/epinephrine cartridge and acetylsalicylic acid. CONCLUSIONS: We found greater specificity of the analyzer of PFA-100 platelet function for the measurement of bleeding time in relationship with the traditional Ivy method.

Assessment of PFA-100 system for the measurement of bleeding time in oral surgery

Los métodos diagnósticos habituales para conocer la hemostasia primaria han sido calificados como cruentos, dependientesdel operador, de difícil reproducción y en ocasiones no muy fiables. Es por ello que se han propuesto diferentes sistemas para valorar el tiempo de hemorragia, siendo uno de ellos el dispositivo PFA-100, el cual presentamos en este trabajo.Objetivo: Comparar la especificidad entre el método tradicional Ivy con el sistema PFA-100 para la determinación del tiempo de hemorragia.Material y método: Obtuvimos una muestra de 33 pacientes de entre 24-80 años en tratamiento antiplaquetario a los cuales se debía realizar una cirugía oral. Se les realizó un tiempo de hemorragia mediante el método Ivy , un INR medianteuna analítica realizada el mismo día y un Coagucheck una hora antes de la cirugía así como la determinación del tiempo de sangrado mediante el dispositivo PFA-100. Resultados: El valor medio del tiempo de hemorragia mediante el método Ivy fue de 406.36 sg. El tiempo de hemorragia medio con el sistema PFA-100 para el cartucho de colágeno/epinefrina fue de 226.91 sg. y para el cartucho de colágeno/ADP fue de 110.27 sg. Todos estos valores se encuentran dentro de la normalidad. Observamos desviaciones típicas muy altas con el método Ivy y más regulares para el sistema PFA-100 indicando una mayor especificidad del mismo. Obtuvimos también una gran correlación entre el cartucho colágeno/epinefrina y el ácido acetil salicílico.Conclusiones: Encontramos una mayor especificidad del analizador de función plaquetaria PFA-100 para la medición del tiempo de hemorragia en relación con el método tradicional Ivy

The common diagnostic methods to know primary hemostasis have been classified as invasive, depending on the operator, difficult to reproduce and at times not very reliable. Thus, different systems have been proposed to assess bleeding time, one of them being the PFA-100 device, which we present in this paper.Objective: Compare specificity between the traditional Ivy method with the PFA-100 system to measure bleeding time.Material and method: We obtained a sample of 33 patients between the age of 24-80 years receiving anti-platelet treatment who needed to undergo oral surgery. Bleeding time was obtained by the Ivy method, an INR by an analysis done on the same day and a Coagucheck one hour before surgery as well as measurement of bleeding time with the PFA-100 system.Results: Mean value of bleeding time through the Ivy method was 406.36 sec.. Mean bleeding time with the PFA-100 system for the collagen/epinephrine cartridge was 226.91 sec. and for the collagen/ADP cartridge was 110.27 sec.. All these values were within normality. We observed very high standard deviations with the Ivy method and more regular ones for the PFA-100 system, indicating its greater specificity. We also obtained a large correlation between collagen/epinephrine cartridge and acetylsalicylic acid.Conclusions: We found greater specificity of the analyzer of PFA-100 platelet function for the measurement of bleeding time in relationship with the traditional Ivy method

Efectos del láser sobre los tejidos orales y su posible aplicación en adhesión / Effects on laser related with oral tissues and its posibilites in the search of adhesion

En este artículo se hace una revisión sobre los efectos de los láser de alta potencia, sobre los tejidos dentarios y se aportan imágenes de entrenamiento preclínico originales. Se apuntan las posibilidades de la utilización de los láser como equipamientos clínicos de primera elección cuando se trata de eliminar caries imprevistas durante la realización de tallados dentarios con instrumentos rotatorios tradicionales y se aportan imágenes clínicas originales al respecto. También se hace una valoración basada en la experiencia clínica de los autores sobre las posibilidades de algunos de estos láser en la búsqueda de adhesión de materiales a los tejidos dentarios (AU)

In this article we have realised a revision about the effects on high powered lasers related with dental tissues and we have completed this information with images of original preclinic training. We discussed the possibilities of the uses of laser as first election clinic equipments when deals with the elimination of sudden caries during the achievement of dental carved with classic rotatory instruments and we give original clinical images about this .We have also created an evaluation based in the clinical experience of others authors about the possibilities of some of this lasers in the search of the adhesion of materials to dental tissues (AU)

Efectos del láser sobre los tejidos orales y su posible aplicación en adhesión / Effects on laser related with oral tissues and its posibilites in the search of adhesion

En este artículo se hace una revisión sobre los efectos de los láser de alta potencia, sobre los tejidos dentarios y se aportan imágenes de entrenamiento preclínico originales. Se apuntan las posibilidades de la utilización de los láser como equipamientos clínicos de primera elección cuando se trata de eliminar caries imprevistas durante la realización de tallados dentarios con instrumentos rotatorios tradicionales y se aportan imágenes clínicas originales al respecto. También se hace una valoración basada en la experiencia clínica de los autores sobre las posibilidades de algunos de estos láser en la búsqueda de adhesión de materiales a los tejidos dentarios (AU)

In this article we have realised a revision about the effects on high powered lasers related with dental tissues and we have completed this information with images of original preclinic training. We discussed the possibilities of the uses of laser as first election clinic equipments when deals with the elimination of sudden caries during the achievement of dental carved with classic rotatory instruments and we give original clinical images about this .We have also created an evaluation based in the clinical experience of others authors about the possibilities of some of this lasers in the search of the adhesion of materials to dental tissues (AU)

Detection of human immunodeficiency virus type 1 RNA by in situ hybridization in oral mucosa epithelial cells from anti-HIV-1 positive patients.

Several in vitro studies have shown that HIV-1 can infect CD4 negative epithelial cells of different origin including normal human oral keratinocytes, but whether this infection of mucosal epithelial cells occurs in vivo is still unclear. In this report, the presence and cell types infected by HIV-1 in paraffin embedded oral mucosa biopsies from 17 anti-HIV-1 positive patients have been examined by in situ hybridization and immunohistochemistry. As controls, oral mucosa biopsies from eight patients without HIV-1 infection markers were also analyzed. The results showed that 8 out of the 17 anti-HIV-1 positive patients had HIV-1 RNA detectable in plasma. Positive hybridization signals were observed in the mucosa biopsies from 14 of the 17 anti-HIV-1 patients (82.3%). The mean percentage of cells showing HIV-1 RNA was 2.64% +/- 1.77% (range: 1% to 5.5%). No differences in the mean percentage of HIV-1 infected cells were found between patients with and without HIV-1 RNA in plasma (3.01% +/- 1.57% vs. 3.4% +/- 1.27% respectively), or between untreated patients and patients under antiretroviral therapy (2.83% +/- 1.63% vs. 3.42% +/- 1.29% respectively). Immunohistochemical detection of S-100 antigen, cytokeratin and CD4 showed that hybridization signals appeared in cytokeratin positive cells and CD4 positive cells but not in S-100 positive cells. In conclusion, this study has demonstrated that HIV-1 infects and replicates in oral mucosa epithelial cells in vivo and that these cells could represent a reservoir of the virus that may escape to the currently used antiretroviral therapy.

Study of the analgesic efficacy of Dexketoprofen Trometamol 25mg. vs. Ibuprofen 600mg. after their administration in patients subjected to oral surgery.

OBJECTIVES: Compare the analgesic efficacy of two nonsteroidal anti-inflammatory drugs (NSAIDs) belonging to the family of propionic acids after oral surgery in order to assess which one is most effective with the minimum side effects and lowest dose. Normally, the pain after oral surgery is considered as moderate-intense and NSAIDs are the first choice when treating post-surgical dental pain. As we know, the great problem of these drugs is found in their undesirable effects. The enantiomer-S(+) component is known to be related with analgesia and need for lower dose of these drugs. DESIGN: The patients are given questionnaires with pain assessment tables and different observations are made: postsurgical pain, pain in the first hour after administration of the analgesic, inflammation, bleeding, hematoma, etc. We assess the effect of the different drugs used in the study based on the efficacy-time coordinates as well as the anti-inflammatory effect and their side effects. RESULTS: It is verified that there is moderate pain after oral surgery and the drugs used are effective in the doses and intervals indicated. During the first hour after taking the analgesic, those patients treated with Dexketoprofen Trometamol (DKT) presented less pain compared to those who were treated with Ibuprofen (IBU). It is verified that there is inflammation in most of the interventions, the extractions of the semi-impacted third molars (SITM) present greater bleeding on the first day and the extractions of impacted third molars (ITM) present more bleeding on the third day. These last two interventions (ITM) also present hematoma. CONCLUSIONS: We demonstrate the greater analgesic efficacy of Dexketoprofen Trometamol in the first hour after the oral surgical intervention and its greater anti-inflammatory effect.

Estudio de la eficacia analgésica del Dexketoprofeno Trometamol 25 mg. vs. Ibuprofeno 600 mg. tras su administración oral en pacientes sometidos a una intervención quirúrgica oral / Study of the analgesic efficacy of Dexketoprofen Trometamol 25 mg. vs. Ibuprofen 600 mg. after their administration in patients subjected to oral surgery

Objetivos: Comparar la eficacia analgésica de dos antiinflamatorios no esteroideos (AINES), pertenecientes a la familia de los ácidos propiónicos, tras intervenciones quirúrgicas orales con el fin de valorar cual de ellos es más efectivo con el mínimo de efectos secundarios y la menor dosis. Normalmente el dolor tras una intervención quirúrgica oral está considerado como moderado-intenso, siendo los AINES los fármacos de elección para este tipo de dolor. Como sabemos, el gran problema de estos fármacos reside en los efectos indeseables. Demostramos la eficacia del enantiómero-S(+) de estos fármacos ya que de ellos depende la analgesia y nos permiten utilizar una menor dosis del fármaco. Diseño: Se entregan a los pacientes cuestionarios con tablas de valoración del dolor y se realizan distintas apreciaciones: dolor postquirúrgico, dolor en la primera hora tras la administración del analgésico, inflamación, hemorragia, hematoma, etc... Valoramos el efecto de los distintos fármacos empleados en el estudio en función de las coordenadas eficacia-tiempo, así como el efecto anti-inflamatorio y sus efectos secundarios. Resultados: Se comprueba que existe un dolor moderado tras una intervención quirúrgica oral, los fármacos empleados son eficaces en las dosis e intervalos indicados. Durante la primera hora tras la toma del analgésico, aquellos pacientes en tratamiento con DKT, presentaron menor dolor frente a los que estaban en tratamiento con Ibuprofeno (IBU). Se comprueba que existe inflamación en la mayoría de las intervenciones, las extracciones de cordales semi-incluidos (CSI) presentan mayor hemorragia el primer día y las extracciones de cordales incluidos (C1) presentan mayor hemorragia al tercer día, siendo estas intervenciones las que presentan hematoma. Conclusiones: Demostramos la mayor eficacia analgésica del Dexketoprofeno Trometamol en la primera hora tras la intervención quirúrgica oral y su mayor efecto antiinflamatorio (AU)

Bucco-dental problems in patients with Diabetes Mellitus (I) : Index of plaque and dental caries.

UNLABELLED: Diabetes mellitus is presently considered as one of the most frequent chronic disease, thus, it is important to know what its most relevant buccal disorders are. OBJECTIVES: Study the different signs and symptoms that diabetic patients present in the oral cavity. Assess the status of oral hygiene and prevalence of dental caries in a diabetic population in regards to a control population. STUDY DESIGN: We have performed the study on 70 diabetic patients (30 men and 40 women) whose ages ranged from 11 to 81 years, and a control population of 74 non-diabetic (29 men and 45 women) whose ages ranged from 11 to 75 years. Within the diabetic population, the type of diabetes, degree of control of their disease by glycosylated hemoglobin, diabetes evolution time and existence of late complications were assessed. Oral hygiene was measured with the O'Leary plaque index. The prevalence of caries was studied with the CAOD index. RESULTS: The oral hygiene status was significantly worse in the diabetic patients in regards to the controls after 56 years of age. We did not find any significant differences in the prevalence of caries or in the CAOD index, although this was slightly higher in the diabetic patients. The study of the diabetic patients showed that only the type and evolution of their disease were significant parameters in relationship to the number of caries, while no significance was found on the plaque index for any of the parameters analyzed. CONCLUSIONS: In this study, we have observed a larger number of dental absences in the diabetic population in regards to a healthy population. We have found no differences in the number of caries, absences and obturations based on metabolic control, evolution time and existence of late complications of diabetes.