Accuracy of working length measurement: electronic apex locator versus cone-beam computed tomography.

AIM: To compare the accuracy of working length (WL) determination using the Raypex 6(®) electronic apex locator and cone-beam computed tomography (CBCT). METHODOLOGY: A total of 150 extracted human teeth were decoronated and randomly assigned to five groups (n = 30). WL was measured with the Raypex 6(®) at both the 'constriction' and the 'apex' marks under dry conditions (group 1) or with 2.5% NaOCl, distilled water or Ultracain(®) (groups 2-4). The radiological WL (group 5) was calculated from bucco-lingual and mesio-distal CBCT sections. Differences between electronic, CBCT measurements and actual length (AL) were calculated. Positive and negative values, respectively, indicate measurements falling short or long of AL. Two-way anova and the Bonferroni and Welch tests were used to compare mean differences amongst groups. The chi-squared and Fisher's exact tests were used to compare percentages of precise, ±0.5 and ±1.0 mm of the AL measurements amongst the experimental groups. Statistical analysis was performed at α = 0.05. RESULTS: Mean differences with respect to AL ranged from 0.26 to -0.36 mm and from 0.05 to 0.18 mm, respectively, for the electronic measurements at the 'constriction' mark and 'apex' mark. CBCT measurements were an average of 0.59 mm shorter than AL. Percentages of electronic measurements falling within ±0.5 mm of the corresponding AL referred to the 'apex' mark were greater than at the 'constriction' mark, but the differences were only significant in group 4 (with Ultracain(®) ). Percentages of CBCT measurements falling within ±0.5 mm of AL (46.7%) were significantly lower than electronic measurements, regardless of the condition of the root canal. In 30-38.5% of the measurements taken at the 'apex' mark and in 3.4-13.3% of those at the 'constriction' mark, the file tip extended beyond the foramen. CONCLUSIONS: Electronic measurements were more reliable than CBCT scans for WL determination. The Raypex 6(®) was more accurate in locating the major foramen than the apical constriction under the experimental set-up.

Fuentes de información bibliográfica (XIX). Pediatría basada en la evidencia y revistas secundarias / Sources of bibliographic information (XIX). Evidencebased paediatrics and secondary journals

El objetivo de las publicaciones secundarias es informar a los clínicos acerca de los avances más importantes alcanzados en medicina, cuyos resultados tengan la máxima probabilidad de ser verdaderos y útiles. Para ello, se seleccionan artículos publicados en revistas médicas primarias y se presentan en un formato de resumen estructurado, seguido de un comentario crítico realizado por expertos en la materia. Las revistas secundarias de interés en Pediatría son AAP GrandRounds, The PedsCCM Evidence-Based Journal, la sección «Current Best Evidence» de Journal of Pediatrics, la sección «Archimedes» de Archives of Disease in Childhood, y la sección «Atención Primaria Basada en la Evidencia» de Formación Médica Continuada, Revista Evidencia Actualización en la Práctica Ambulatoria y Evidencias en Pediatría. Analizamos con cierto detalle Evidencias en Pediatría, una revista secundaria pediátrica y en español, órgano oficial de la Asociación Española de Pediatría (AEP), y también avalada por la Asociación Latinoamericana de Pediatría (ALAPE)(AU)

The purpose of secondary publications is to alert clinicians to important advances in medicine whose results are most likely to be both true and useful. For this goal, they select from the biomedical literature the original and review artcles that are summarised in abstracts and commented by clinical experts. The most important secondary publications in pediatrics are AAP GrandRounds, PedsCCM Evidencie-Based Journal, the section of «Current Best Evidence» from the Journal of Pediatrics, the section of «Archimedes» from Archives Disease in Childhood, the section of «Atención Primaria Basada en la Evidencia» from Formación Médica Continuada, Revista Evidencia Actualización en la Práctica Ambulatoria y Evidencias en Pediatría. We review in detail Evidencias en Pediatría, a seconday publication in spanish from the Asociación Española de Pediatría (Spanish Association of Pediatrics) (AEP) and endorsed by the Asociación Latinoamericana de Pediatría (Latin American Association of Pediatrics) (ALAPE)(AU)

En niños alérgicos con asma o rinitis, ¿es útil la inmunoterapia? / In allergic children with asthma or rhinitis, is immunotherapy useful?

Conclusiones de los autores del estudio: en niños y adolescentes con rinoconjuntivitis alérgica, la inmunoterapia no ha mostrado beneficio para disminuir los síntomas o la utilización de medicación. En el asma alérgica la inmunoterapia subcutánea parece reducir los síntomas y el uso de medicación, pero la evidencia es limitada en cuanto a la magnitud del efecto. Además, no está exenta de efectos secundarios. La inmunoterapia sublingual en dosis altas produce mejoría sintomática y disminuye el uso de medicación en niños con asma y alergia a polen de gramíneas. Comentario de los revisores: la prevalencia de las enfermedades alérgicas está aumentando, generando importante morbilidad. El tratamiento con inmunoterapia no ha demostrado su eficacia, ya que produce mejorías estadísticamente significativas pero clínicamente poco importantes y con riesgo de efectos secundarios. Por ello no debe generalizarse su uso, reservándolo solo para casos concretos evaluados detenidamente (AU)

Authors’ conclusions: There is at present insufficient evidence that immunotherapy in any administration form has a positive effect on symptoms and/or medication use in children and adolescents with allergic rhino conjunctivitis. In allergic asthma, the subcutaneous immunotherapy appears to reduce symptoms and use of medication but the evidence is limited concerning the size of benefit. It is not free of side effects. High dose sublingual immunotherapy produces symptomatic improvement and decreases the medication use in children with asthma and allergies to grass pollen. Reviewers’ commentary: The prevalence of allergic diseases is increasing, and its burden is substantial. The efficacy of the treatment with allergen-specific immunotherapy has not been demonstrated; although the improvement has statistical significance, the clinical relevance is poor, with an increased risk of adverse reactions. Due to that, the use of immunotherapy should not be generalised, reserving it for cases thoroughly evaluated (AU)

Dissolving efficacy of eucalyptus and orange oil, xylol and chloroform solvents on different root canal sealers.

AIM: To evaluate the solubility of five root canal sealers in orange oil, eucalyptol, xylol and chloroform solvents. METHODOLOGY: The solubility of RoekoSeal, Sealer 26, Epiphany, Endomethasone and EZ-Fill sealers was assessed in orange oil, eucalyptol, xylol, chloroform and distilled water. Seventy-five samples of root canal sealers were prepared and then divided into five groups for immersion in solvent for 2, 5 or 10 min. The means of loss weight were determined for each material in each solvent at all immersion periods, and the values were compared by factorial analysis of variance (anova) and SNK multiple comparisons. RESULTS: In the orange and eucalyptus oil groups, there was no significant difference among RoekoSeal, Sealer26, Epiphany and EZ-Fill at the three immersion periods (P > 0.05). With xylol, no significant differences were found at 5 and 10 min (P > 0.05) for each root sealer. Orange and eucalyptus oil solvents were as effective as chloroform at 2 min in dissolving all the root sealers. CONCLUSIONS: Xylol was the most effective solvent followed by the chloroform and the essential oils (eucalyptol and orange oil). Orange oil behaved in a similar way to eucalyptus oil.

Topographical evaluation of the major apical foramen in permanent human teeth.

AIM: To determine the distance from the anatomical root apex to the major apical foramen and the position of the major foramen on the root apex. METHODOLOGY: Crowns of 926 human teeth were sectioned at the cementum-enamel junction. Specimens were mounted on microscope slides for measurement parallel to the long axis of the teeth. The major foramen was identified as the largest-diameter opening at the root apex. A total of 1331 root specimens were evaluated using an optical stereomicroscope to an accuracy of 0.01 mm at 40 x (+/-10) magnification. The distance from the anatomical apex to the most apical point of the major foramen was measured, and its location (central, buccal, lingual, mesial and distal) was recorded. RESULTS: The mean distance between the major foramen and the anatomical root apex was 0.69 mm; the mean distance was larger in posterior teeth (0.82 mm) and smaller in anterior teeth (0.39 mm). A wide range of anatomical apex to major foramen distances were observed in all tooth groups: the greatest distance was in maxillary molars (0.95 mm) followed by mandibular pre-molars (0.87 mm) and mandibular molars (0.80 mm). The major foramen was at the tip of the root in 40% of teeth. The most frequent deviations of the foramen were to the buccal (20%) and distal (14%). CONCLUSION: In this sample of teeth without apical resorption the distance between the major foramen and the anatomical root apex was always <1 mm. Deviation of the major foramen from the anatomic apex varied widely amongst tooth groups.

¿Hay que tratar a los niños con talla baja idiopática con hormona de crecimiento? / Children with idiopathic short stature, have to be treated with growth hormone?

La talla baja idiopática (TBI), o talla baja sin causa definida es un diagnóstico de exclusión. Implica una respuesta normal a las pruebas de estimulación de la hormona del crecimiento (HC). En el año 2003, la FDA aprobó el uso de HC para el tratamiento de los niños con talla baja idiopática con una talla inferior a -2,25 desviaciones estándar y pronóstico de talla por debajo del rango normal. Existe un importante debate sobre los beneficios de tratar a niños bajitos, por otra parte sanos. En estudios realizados la ganancia de talla parece estar entre 3 y 7 cm, con una duración media del tratamiento (que implica inyecciones diarias) de 6 años. Además no se ha demostrado que los niños con TBI tengan problemas psicosociales, ni que el tratamiento con HC mejore la calidad de vida relacionada con la salud. Existe preocupación acerca de posibles efectos a largo plazo por la administración de dosis suprafisiologías de HC durante años, además del elevado coste. El fondo de la cuestión es si la TBI es una enfermedad o una variante de la normalidad y si el tratamiento con HC es una intervención médica o estética (AU)

Idiopathic short stature, or short stature of undefined cause, is a diagnosis of exclusion. Implicit in the diagnosis is a normal growth hormone responses to stimulation testing- In 2003, the FDA approved the use of recombinant growth hormone (GH) for treatment of idiopathic short stature, defined by height SDs < 2.25 and adult height prognosis bellow the normal range. Considerable debate exits about the benefits of therapy in otherwise healthy short children. Studies suggest that growth hormone therapy increases adult height between 3 and 6 cm, with a mean duration of therapy (regimen of daily injections) of about 6 years. In addition, the studies have failed to prove that children with short stature have psychosocial problems; moreover growth hormone therapy has not showed to improve quality of life. Concern exists about potentially long-term adverse effects with administration of supraphysiologic GH doses apart from its high cost. At the core of controversy is the question about whether short stature is a disease or a normal variant development and therefore whether growth hormone therapy is a therapeutic or a cosmetic intervention (AU)

[Poland syndrome: description of two patients in the same family]. / Síndrome de Poland: descripción de dos casos familiares.

Poland syndrome is a congenital condition that consists of the unilateral absence of the large pectoral muscle, ipsilateral sympbrachydactyly, and is occasionally associated with other malformations of the anterior chest wall and breast. The aetiology of Poland's syndrome is unknown, although it is believed to be caused by an interruption or reduction in the embryonic circulation during pregnancy, and the majority of reported cases are sporadic. Only in a few instances there is a familial incidence. We describe the occurrence of Poland's syndrome in two cousins and the malformation is mainly in the large pectoral muscle.

Síndrome de Poland: descripción de dos casos familiares / Poland syndrome: description of two patients in the same family

El síndrome de Poland es una alteración congénita consistente en la ausencia total o parcial del músculo pectoral mayor y anomalías de la mano homolateral. Se puede asociar con otras malformaciones pectorales, cervicales, intratorácicas e incluso braquiales. Se desconoce su causa exacta, pero parece corresponder a una alteración en la circulación embrionaria durante la gestación. La mayoría de los casos descritos son esporádicos. Sólo de forma excepcional se han comunicado casos familiares. Se presentan dos casos cuya peculiaridad es que son casos familiares (primos) y que su malformación afecta principalmente a los músculos pectorals (AU)

Poland syndrome is a congenital condition that consists of the unilateral absence of the large pectoral muscle, ipsilateral sympbrachydactyly, and is occasionally associated with other malformations of the anterior chest wall and breast. The aetiology of Poland's syndrome is unknown, although it is believed to be caused by an interruption or reduction in the embryonic circulation during pregnancy, and the majority of reported cases are sporadic. Only in a few instances there is a familial incidence. We describe the occurrence of Poland's syndrome in two cousins and the malformation is mainly in the large pectoral muscle (AU)

Decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine.

AIM: To evaluate and compare ex vivo the decalcifying effect of 15% EDTA, 15% citric acid, 5% phosphoric acid and 2.5% sodium hypochlorite on root canal dentine. METHODOLOGY: Two 2-mm-thick slices were cut from the coronal third of the root of 10 human incisors. Each slice was sectioned into two equal parts. Specimens were assigned to one of four groups (n = 10) for immersion in 20 mL of either 15% EDTA, or 15% citric acid, 5% phosphoric acid or 2.5% NaOCl, for three time periods (5, 10 and 15 min). The concentration of Ca(2+) extracted from the dentine was measured by atomic absorption spectrophometry. The amount of calcium extracted was analysed using the Kruskal-Wallis test for global comparisons and the Mann-Whitney U-test for pairwise comparisons. RESULTS: In the three time periods, 15% EDTA and 15% citric acid extracted the largest amount of calcium, with no significant differences between them. The 2.5% NaOCl solution extracted insignificant amounts of calcium, whereas 15% EDTA extracted 86.72% of the calcium in the first 5 min, and 15% citric acid and 5% phosphoric acid had a similar pattern of calcium removal (77.03% and 67.08% in first 5 min, respectively). CONCLUSIONS: Solutions of 15% EDTA, 15% citric acid and 5% phosphoric acid decalcify root dentine, with most calcium extracted during the first 5 min of action. The efficacy of 15% citric acid and 15% EDTA solutions was significantly greater than that of 5% phosphoric acid solution at each time period (5, 10 and 15 min).

Reacción urticarial generalizada tras la utilización de toallitas limpiadoras / Generalized urticarial reaction after the use of baby wipes

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Los adolescentes que consumen comida rápida y no desayunan tienen más riesgo de ser obesos en la vida adulta / No disponible

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Diagnósticos y actividades preventivas en la población adolescente de un centro de salud / No disponible

Objetivo: describir las actividades realizadas con la población adolescente en un centrode salud.Pacientes y métodos: estudio descriptivo retrospectivo de la actividad realizada con lapoblación adolescente en un centro de salud durante dos años. Se seleccionaron a 434 pacientescon edades comprendidas entre 11 y 18 años. Se registraron los datos sociodemográficos,el número de visitas, los diagnósticos, los exámenes de salud, consejos acerca del consumode alcohol, tabaco, drogas, advertencias sobre sexualidad, nutrición y accidentes,petición de pruebas complementarias, consultas a otras especialidades, estado vacunal, rendimientoescolar, relaciones familiares e ingresos hospitalarios.Resultados: durante el período de estudio acudieron al menos una vez a la consulta 353adolescentes (el 81% del total de la muestra). El número medio de visitas fue 3,97 + 4,6 (IC95% = 3,53-4,41) y el número medio de exámenes de salud fue 0,57 + 0,64 (IC 95% =0,51-0,63). Los diagnósticos más frecuentes fueron infecciones respiratorias de las vías altas,seguidas de enfermedades de la piel, osteoarticulares y ginecológicas. En 212 adolescentes(49%) se realizó al menos un examen de salud durante ese período; la proporciónmayor tuvo lugar en el grupo de menores de 16 años.El 69% de los pacientes recibió consejo de prevención de riesgos (alcohol, tabaco, drogas,educación sexual, nutrición y accidentes). En un 98% de los pacientes las recomendacionesfueron realizadas en las consultas de pediatría.Conclusiones: la eliminación de barreras favorece la asistencia de los adolescentes alcentro de salud y su inclusión en actividades preventivas

Purpose: to examine the adolescents’ (age 11-18) utilization of ambulatory care.Methods: prospective study of the activity in a Primary Care Health Centre over twoyears. 434 adolescents were included (age 11-18). Visit characteristics consisted of gender,age, country, number of visits, morbidity, health supervision visits, counselling on six selectedtopics: alcohol consumption, tobacco, and other illicit drugs, diet and exercise, injuryprevention, sex advice, other explorations and specialty consultation, immunization status,family relationship and school performance, hospital admissions.Results: 353 adolescents (81%) attended at least once the physicianoffice during this period. The mean number of visits was 3.97 + 4.6 (CI 95% = 3.53-4.41)and the mean number of check-ups was 0.57 + 0.64 (CI 95% = 0.51-0.63). The leading reasonsfor both male and female visits were respiratory, dermatological and musculoskeletalconditions. 212 adolescents (49%) had at least one check-up during this period, most of themamong the group younger than 16. 69% of the adolescents received behavioural counsellingregarding drinking, drugs, tobacco use, sexual education and nutrition. 98% of counsellingwas in the pediatric office.Conclusions: decreasing barriers to accessing Primary Care increases adolescent visitsand their inclusion in preventive activities (AU)

No hay evidencia suficiente para afirmar que la introducción precoz de sólidos en la dieta del lactante se relaciona con un mayor riesgo de enfermedades alérgicas, aunque parece aumentar el riesgo de eccema / There is not enough evidence to claim that early introduction of solid foods in infants is related to an increased risk of allergic disease, although it sems to raise the risk of eczema

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¿Qué hacer ante el hallazgo de un soplo cardíaco en un niño asintomático? / No disponible

El hallazgo de un soplo cardíaco al auscultar a un niño es frecuente en la práctica pediá- trica y es la primera causa de consulta con el cardiólogo infantil. La disyuntiva que se plantea es la de decidir si se trata de un soplo funcional o de si es necesaria la realización de estudios complementarios. El 50% de los niños puede tener un soplo cardíaco; se trata en la mayoría de los casos de un soplo “inocente” o funcional, aunque esto varía con las edades y es más probable que se trate de un soplo funcional en los niños mayores y que haya una anomalía en neonatos y lactantes. Su detección conlleva con frecuencia la realización de una serie de exámenes complementarios que incluyen electrocardiograma y radiografía de tórax. Sin embargo, su realización de forma rutinaria podría no estar justificada. En los estudios analizados su realización no ofrece ventajas para distinguir un soplo inocente de uno que no lo es; en algún estudio se ha encontrado que incluso podría actuar como factor de confusión. Dentro de las estrategias más rentables para valorar un soplo en un niño estarían la derivación selectiva de pacientes al cardiólogo y la derivación de todos los niños con soplo, bien al cardiólogo o a realizar un ecocardiograma. Estas dos últimas estrategias incrementan el coste de forma considerable. Así pues, la mejor manera de clasificar un soplo, incluso en una época de gran desarrollo tecnológico como la actual, continúa siendo la realización de una cuidadosa evaluación clínica de los niños con un soplo cardíaco. Si se sospecha que el soplo es patológico se debe derivar al cardiólogo infantil para su valoración (AU)

The detection of a heart murmur is an important problem faced by paediatricians in theirpractice and it is the most frequent reason for patient referral to cardiologists. The dilemma faced at such a time is to decide which child requires further evaluation and which child has an “innocent” murmur. Up to 50% of children are detected to have a cardiac murmur. Some murmurs in neonates, many in infants and most in childhood are “innocent”. Its detection implies to obtain further studies as a chest X ray (CXR) and electrocardiogram (ECG). However in several studies, ECG and CXR examination did no help in the diagnosis and in those cases where it was thought helpful it was often misleading. Overall, it appears that ECG and CXR examination add little to the clinical evaluation of the child with an asymptomatic heart murmur. The most cost-effective strategies for the diagnosis of heart murmurs in children could be: the paediatrician selectively refers those with suspected pathologic murmurs to a cardiologist, he refers all patients with murmurs to a cardiologist, or he refers all patients with murmurs for an echocardiogram (ECHO). These strategies could imply a high cost of health care. Even in today’s hi-tech world, the best way to correctly classify a murmur as “innocent” or “pathological” is by clinical evaluation with special emphasis on a careful auscultation. Concerns about a pathological cause after clinical examination should prompt a referral to a paediatric cardiologist for further assessment (AU)

Disminución del dolor durante la toma de muestras en niños / Diminishing pain during venipunctures in children

Las punciones venosas y del talón para la extracción de muestras son procedimientosfrecuentes en la consulta pediátrica y pueden ser un motivo de dolor, molestia y nerviosismopara los niños, los padres y los profesionales sanitarios.Hay estudios que encuentran que el dolor experimentado durante el período neonatalpuede tener efectos a largo plazo.Para controlar el dolor durante la realización de estas técnicas se han propuesto algunostratamientos. Los anestésicos tópicos pueden disminuir el dolor en las extracciones venosas.Las soluciones edulcoradas con sacarosa pueden disminuir el dolor en las punciones venosasy del talón de los neonatos.Aunque en el ámbito de la Atención Primaria los niños no son sometidos a muchas técnicasque produzcan dolor, el personal sanitario debería identificar a aquellos niños que tienenmás riesgo de efectos secundarios por éste. Sobre todo los niños con historia de reacciónvasovagal por el dolor, los que han tenido experiencias dolorosas previas y los que recibenmás punciones venosas

Venipunctures and heel lancing are common procedures in Paediatric Care and may bea source of pain, discomfort, and distress for children, parents and health professionals. Preliminarystudies suggest that pain experienced by infants in the neonate period may havelong-lasting effects on future infant behaviour.To control the pain associated with minor procedures as venipuncture and heel lancingthere are some treatments. Topical anesthetics can be placed proactively to control the painassociated with venipuncture.Recent studies have suggested methods by which neonatal distress during painful procedurescan be minimized. Sucrose has been found to decrease the response to noxious stimulisuch as heel sticks and injections in neonates.Although children don’t get many painful procedures in Primary Care, health care providersshould identify patients at risk of increased pain and its side-effects. In particular children with a history of vasovagal reaction to needles and those who require repeated venipuncturesand who had painful procedures before

An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space.

STATEMENT OF PROBLEM: Coronal leakage can produce contamination of periapical tissues, resulting in endodontic failure. PURPOSE: The purpose of this in vitro study was to evaluate the ability of 2 sealers to prevent coronal leakage in canals filled with gutta-percha and prepared for cast dowels but without coronal sealing. MATERIAL AND METHODS: The crowns of 60 extracted single-rooted teeth were amputated. The root canals were prepared corono-apically and filled with gutta-percha cones and 1 of 2 different endodontic sealers: a resin-based sealer (AH Plus) and a calcium hydroxide-based sealer (Sealapex). Specimens were then stored in water for 7 days to allow the sealers to set. The specimens were prepared in 1 of 2 ways: no preparation for cast dowel or preparation of cast-dowel space (n=15). External surfaces of the roots were sealed with cyanoacrylate cement. The teeth were thermal cycled at 5 degrees and 55 degrees C in water baths (dwell time=30 seconds) for 500 cycles. Specimens were then submerged in 2% methylene blue colorant for 24 hours. Microleakage was measured according to the percentage of area stained with the colorant. Effects of each factor (cast-dowel preparation and type of sealant) on microleakage were analyzed by the Student t test (alpha=.05). RESULTS: The AH Plus and Sealapex sealers with cast-dowel preparation resulted in significantly (P<.001) more leakage compared to sealers with no dowel preparation. CONCLUSION: Cast dowel-space preparation had a negative influence on the sealing ability of the remnant root-canal filling material.

Decalcification of root canal dentine by citric acid, EDTA and sodium citrate.

AIM: To measure the demineralization capability of 1 and 10% citric acid, 10% sodium citrate and 17% EDTA during immersions of 5, 10 and 15 min on root canal dentine. METHODOLOGY: Crowns were sectioned from eight maxillary canines. The cementum was removed from the cervical third of the roots to expose the dentine. Canals were prepared using a handpiece-mounted Largo Peeso reamer. A 3-mm thick cross-sectional slice was obtained from the cervical third of each root. Each slice was sectioned into four equal parts. These specimens were assigned to one of four groups (n = 8) for the application of 1% citric acid, 10% citric acid, 10% sodium citrate or 17% EDTA. Each specimen underwent three successive 5-min immersions in each solution at room temperature. The solutions were not renewed between immersions. Two millimetres of solution were collected from the extracts and lanthanum oxide was added for the calcium reading by spectrophotometry. To compare the amounts of calcium removed by each solution, the Friedman test was used for the global comparison and the Wilcoxon test for paired comparisons. Differences between groups were evaluated using the Kruskal-Wallis test for the global comparison and Mann-Whitney test for paired comparisons. RESULTS: Overall, 1 and 10% citric acid were more effective than EDTA or sodium citrate at the three immersion times (P < 0.001); 10% citric acid was more effective than 1% citric acid (P < 0.001). EDTA and 1 and 10% citric acid showed decreasing effectiveness with time, and the decrease was significant for citric acid at both concentrations (P < 0.001). Although sodium citrate removed little calcium during the three time periods, the small increase recorded was significant (P < 0.01). CONCLUSIONS: Citric acid at 10% was the most effective decalcifying agent, followed by 1% citric acid, 17% EDTA and 10% sodium citrate.

[Dental fillings in school-children from the Alcalá la Real-Martos Health District (Jaén)]. / Restauraciones dentales en escolares del Distrito Sanitario Alcalá la Real-Martos (Jaén).

OBJECTIVE: To evaluate 4-6 years later the state of dental fillings in 6-8 year old school-children treated at a health centre. DESIGN: Monitoring of a cohort with intervention. SETTING: Alcalá la Real Health Centre (Jaén). PATIENTS: In the school years 94-95 and 95-96 a total de 88 second-year EPO (compulsory primary education) students received at least one occlusal silver amalgam filling in their first permanent molars. 4-6 years later, 78 students, who had had 157 fillings, were examined. INTERVENTIONS: Silver amalgam fillings in first permanent molars. MAIN MEASUREMENTS AND RESULTS: The success or failure of the fillings was measured. The failure rate was 11.5% (95% CI, 6.0-17.0), with authentic failures (marginal infiltration, recurrent caries, broken filling and broken tooth) (58.8%) predominating over false failures (caries elsewhere) (41.2%). Neither sex, age when the filling was inserted, dental arch (upper or lower), nor the index of temporary caries at the start were statistically linked to the failure of fillings. CONCLUSIONS: In clinical terms, the health centre has an adequate level of efficacy 4-6 years after inserting simple silver amalgam fillings in 6-8 year old school-children.

Restauraciones dentales en escolares del Distrito Sanitario Alcalá la Real-Martos (Jaén) / Dental fillings in school-children from the Alcalá La Real-Martos health district (Jaén)

Objetivo. Evaluar a 4-6 años de seguimiento el estado de las restauraciones dentales realizadas en escolares de 6-8 años de edad en un centro de salud. Diseño. Seguimiento de una cohorte intervenida. Emplazamiento. Centro de Salud de Alcalá la Real ( Jaén ). Pacientes. Durante los cursos 1994-1995 y 1995-1996 un total de 88 escolares de segundo de EPO (enseñanza primaria obligatoria) recibió al menos una restauración oclusal de amalgama de plata en primeros molares permanentes. Transcurridos 4-6 años se ha explorado a 78 escolares a los que se les habían realizado 157 restauraciones. Intervenciones. Restauraciones de amalgama de plata en primeros molares permanentes. Mediciones y resultados principales. Se mide el éxito/fracaso de las restauraciones. El porcentaje de fracaso fue del 11,5 per cent (intervalo de confianza [IC] del 95 per cent,6,017,0); predominando los fracasos verdaderos (filtración marginal, caries recurrente, fractura de la restauración y fractura del diente) (58,8 per cent) sobre los falsos (caries en otra localización) (41,2 per cent). Ni el sexo, ni la edad de colocación de la restauración, ni la arcada dentaria (superior o inferior), ni el índice de caries temporal al inicio se asociaron estadísticamente al fracaso de las restauraciones. Conclusiones. Desde una perspectiva clínica el centro de salud permite realizar restauraciones simples de amalgama de plata con un nivel adecuado de eficacia a 4-6 años en escolares de 6 a 8 años de edad. (AU)