Cuestionario de autoevaluación CAMBRA como método de cribado poblacional del riesgo de caries sin métodos exploratorios: un estudio piloto observacional transversal / Modified CAMBRA questionnaire as a method for population-based caries risk screening without exploratory methods: a cross-sectional observational pilot study

Fundamentos: Caries Management by Risk Assessment (CAMBRA) es un cuestionario de diagnóstico del riesgo global de caries dental. Este estudio tuvo como objetivo presentar un cuestionario de autoevaluación basado en CAMBRA que, a diferencia del original, es cumplimentado por padres/madres/cuidadores, sin necesidad de una exploración odontológica, permitiendo establecer un diagnóstico de presunción en menores de siete años excluidos del programa de salud oral del Sistema Nacional de Salud, con el fin de instaurar recomendaciones individualizadas al riesgo de caries y su inclusión precoz en programas preventivos del Servicio Madrileño de Salud (Madrid, España). Métodos: Se llevó a cabo un estudio observacional transversal basado en las recomendaciones STROBE, empleando por primera vez un cuestionario de autoevaluación basado en CAMBRA en niños/as de tres a seis años de una escuela infantil de Madrid (España). Los resultados se analizaron mediante una estadística descriptiva y para el estudio de la relación entre variables cualitativas se utilizó el estadístico exacto de Fisher. Resultados: El cuestionario fue respondido por padres de 120 niños, de los cuales, el 40,8% presentó, a priori, un riesgo de caries bajo, el 42,5% un riesgo moderado y el 16,7% un riesgo alto de caries. Conclusiones: El presente estudio permite la identificación de pacientes en riesgo de presentar y/o desarrollar caries. No obstante, futuros estudios han de evaluar su sensibilidad y especificidad mediante su comparativa frente a un diagnóstico de confirmación tras una exploración odontológica. Pese a ello, el cuestionarioCAMBRA modificado podría ser una herramienta útil para el cribado poblacional, facilitandoel acceso de la población en riesgo de caries y en riesgo de exclusión a planes preventivos y comunitarios.(AU)

Background:Caries Management by Risk Assessment (CAMBRA) is a questionnaire used to diagnose the patient’s overall caries risk. This study aimed to present a self-assessment questionnaire based on CAMBRA which, unlike the original, is completed by parents/caregivers, without the need for a dental examination, allowing a presumptive diagnosis to be established in children under seven years of age excluded from the oral health programme of the National Health System to establish individualised recommendations for caries risk and their early inclusion in preventive programmes of the Madrid Health Service (Madrid, Spain). Methods: A cross-sectional observational study was carried out following STROBE guidelines using for the first time a self-assessment questionnaire based on CAMBRA in a population of children aged from three to six years from a nursery school in Madrid (Spain). The results were analysed using descriptive statistics and Fisher’s exact statistic was used to study the relationship between qualitative variables. Results: The questionnaire was answered by the parents of 120 children (response rate=53.1%), of whom 40.8% presented a low a priori caries risk, 42.5% a moderate risk and 16.7% a high caries risk. Conclusion: The present study allow the identification of patients at risk of presenting and/or developing caries. However, future studies should evaluate its sensitivity and specificity by comparing it with a confirmatory diagnosis after a dental examination. Nevertheless, the modified CAMBRA questionnaire could be a useful tool for population screening, facilitating the access of the population at risk of caries and risk of exclusion to preventive and community plans.(AU)

[Modified CAMBRA questionnaire as a method for population-based caries risk screening without exploratory methods: a cross-sectional observational pilot study]. / Cuestionario de autoevaluación CAMBRA como método de cribado poblacional del riesgo de caries sin métodos exploratorios: un estudio piloto observacional transversal.

OBJECTIVE: Caries Management by Risk Assessment (CAMBRA) is a questionnaire used to diagnose the patient's overall caries risk. This study aimed to present a self-assessment questionnaire based on CAMBRA which, unlike the original, is completed by parents/caregivers, without the need for a dental examination, allowing a presumptive diagnosis to be established in children under seven years of age excluded from the oral health programme of the National Health System to establish individualised recommendations for caries risk and their early inclusion in preventive programmes of the Madrid Health Service (Madrid, Spain). METHODS: A cross-sectional observational study was carried out following STROBE guidelines using for the first time a self-assessment questionnaire based on CAMBRA in a population of children aged from three to six years from a nursery school in Madrid (Spain). The results were analysed using descriptive statistics and Fisher's exact statistic was used to study the relationship between qualitative variables. RESULTS: The questionnaire was answered by the parents of 120 children (response rate=53.1%), of whom 40.8% presented a low a priori caries risk, 42.5% a moderate risk and 16.7% a high caries risk. CONCLUSIONS: The present study allow the identification of patients at risk of presenting and/or developing caries. However, future studies should evaluate its sensitivity and specificity by comparing it with a confirmatory diagnosis after a dental examination. Nevertheless, the modified CAMBRA questionnaire could be a useful tool for population screening, facilitating the access of the population at risk of caries and risk of exclusion to preventive and community plans.

OBJETIVO: Caries Management by Risk Assessment (CAMBRA) es un cuestionario de diagnóstico del riesgo global de caries dental. Este estudio tuvo como objetivo presentar un cuestionario de autoevaluación basado en CAMBRA que, a diferencia del original, es cumplimentado por padres/madres/cuidadores, sin necesidad de una exploración odontológica, permitiendo establecer un diagnóstico de presunción en menores de siete años excluidos del programa de salud oral del Sistema Nacional de Salud, con el fin de instaurar recomendaciones individualizadas al riesgo de caries y su inclusión precoz en programas preventivos del Servicio Madrileño de Salud (Madrid, España). METODOS: Se llevó a cabo un estudio observacional transversal basado en las recomendaciones STROBE, empleando por primera vez un cuestionario de autoevaluación basado en CAMBRA en niños/as de tres a seis años de una escuela infantil de Madrid (España). Los resultados se analizaron mediante una estadística descriptiva y para el estudio de la relación entre variables cualitativas se utilizó el estadístico exacto de Fisher. RESULTADOS: El cuestionario fue respondido por padres de 120 niños, de los cuales, el 40,8% presentó, a priori, un riesgo de caries bajo, el 42,5% un riesgo moderado y el 16,7% un riesgo alto de caries. CONCLUSIONES: El presente estudio permite la identificación de pacientes en riesgo de presentar y/o desarrollar caries. No obstante, futuros estudios han de evaluar su sensibilidad y especificidad mediante su comparativa frente a un diagnóstico de confirmación tras una exploración odontológica. Pese a ello, el cuestionario CAMBRA modificado podría ser una herramienta útil para el cribado poblacional, facilitando el acceso de la población en riesgo de caries y en riesgo de exclusión a planes preventivos y comunitarios.

Comparison of the effectiveness of two manual toothbrushes: Conventional design versus double-sided toothbrush design. A pilot study.

OBJECTIVES: Dental hygiene is the most effective method in the prevention of oral diseases. However, most patients do not use the recommended teeth brushing techniques and/or time brushing is insufficient. With this objective, modifications in conventional toothbrushes have been developed to deal with these findings. The aim of this study was to compare plaque removal effectiveness of a manual toothbrush with a modified head (MTMH) with a wrap-around design versus a conventional manual toothbrush. METHODS: This pilot prospective clinical study was designed according to STROBE guidelines. The patients suspended oral hygiene habits for 24 h (baseline). Subsequently, the teeth were brushed for 60 s. Both toothbrushes followed the same study procedure, separated by 1 month. Plaque-removing effectiveness was measured before and after tooth brushing using the modified O'Leary Plaque Index (PI). RESULTS: Seven patients were included in this pilot study. The mean age was 37.66 ± 10.68 years. PI mean differences between baseline and after brushing were 51.99% ± 16.43 for MTMH and 27.93 ± 6.85, for conventional toothbrush (p = 0.0013). After brushing, mean PI values were 18.36% ± 6.95%, and 37.61% ± 10.57% respectively (p < 0.001). CONCLUSION: Within the limitations of the present study, it can be concluded that the effectiveness of plaque removal by using MTMH is significantly higher than the conventional manual toothbrush.

In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study.

Current data on the efficacy of antiseptic mouthwashes to reduce viral load are contradictory. Firstly, in vitro data indicate very strong virucidal effects that are not replicated in clinical studies. Secondly, most clinical studies identify a limited effect, do not include a control/placebo group, or do not evaluate viral viability in an infection model. In the current manuscript, we perform a double-blind, randomized clinical trial where salivary viral load was measured before and after the mouthwash, and where saliva samples were also cultured in an in vitro infection model of SARS-CoV-2 to evaluate the effect of mouthwashes on viral viability. Our data show a 90-99% reduction in SARS-CoV-2 salivary copies with one of the tested mouthwashes, although we show that the remaining viruses are mostly viable. In addition, our data suggest that the active ingredient concentration and the overall excipients' formulation can play an important role; and most importantly, they indicate that the effect is not immediate, being significant at 15 min and having maximum effectiveness after 1 h. Thus, we show that some oral mouthwashes can be useful in reducing viral transmission, although their efficacy must be improved through refined formulations or revised protocols.

Prevalence of aphthous stomatitis in patients with inflammatory bowel disease after the treatment with monoclonal antibodies: a systematic review and meta-analysis

Background: Currently, the most frequently employed therapies in the treatment of inflammatory bowel diseases (IBD), i.e., Crohn's Disease (CD), Ulcerative Colitis (UC) or unclassified IBD (IBD-U) are monoclonal anti-TNFs and anti-integrin therapies, such as vedolizumab (VDZ). Forty-seven per cent of these patients present extra-intestinal manifestations, the second most prevalent being aphthous stomatitis (AS). The present study aims to investigate which of the two therapies is associated with a lower prevalence of AS after treatment. Material and methods: An electronic search of the MEDLINE (via PubMed), Web of Science, SCOPUS, LILACS and OpenGrey databases was carried out. The criteria used were those described by the PRISMA Statement. The search was not temporarily restricted and was updated to January 2022. The quality assessment was analyzed using the JBI Prevalence Critical Appraisal Tool. Results: After searching, 7 studies were included that met the established criteria. Of these, 6 analysed the prevalence of AS in CD patients and 4 in UC. A total of 1,744 patients were analysed (CD=1,477 patients; 84.69%; UC=267; 15.31%). The greatest reduction in AS prevalence was observed after anti-TNF therapy. The effect of these therapies on the prevalence of AS in patients with IBD-U could not be determined. Conclusions: Both biologic therapies achieve a reduction in the prevalence of AS in IBD patients (CD and UC). However, the best results were obtained in patients treated with anti-TNFs, possibly because VDZ is often used in patients who do not respond adequately to previous treatment with anti-TNFs and because of its intestinal specificity. (AU)

Effect of oral antiseptics in reducing SARS-CoV-2 infectivity: evidence from a randomized double-blind clinical trial.

ABSTRACTBackground: In vitro studies have shown that several oral antiseptics have virucidal activity against SARS-CoV-2. Thus, mouthwashes have been proposed as an easy to implement strategy to reduce viral transmission. However, there are no data measuring SARS-CoV-2 viability after mouthwashes in vivo. METHODS: In this randomized double-blind, five-parallel-group, placebo-controlled clinical trial, SARS-CoV-2 salivary viral load (by quantitative PCR) and its infectious capacity (incubating saliva in cell cultures) have been evaluated before and after four different antiseptic mouthwashes and placebo in 54 COVID-19 patients. RESULTS: Contrary to in vitro evidence, salivary viral load was not affected by any of the four tested mouthwashes. Viral culture indicated that cetylpyridinium chloride (CPC) significantly reduced viral infectivity, but only at 1-hour post-mouthwash. CONCLUSION: These results indicate that some of the mouthwashes currently used to reduce viral infectivity are not efficient in vivo and, furthermore, that this effect is not immediate, generating a false sense of security.Trial registration: ClinicalTrials.gov identifier: NCT04707742..

Treatment of oroantral communication with Platelet-Rich Fibrin: A systematic review.

BACKGROUND: Oroantral communication (OAC) is the opening between the maxillary sinus and the oral cavity, which constitutes a gate for the mucosal infection in the maxillary sinus. On the other hand, an OAF develops when the OAC does not close spontaneously, remains manifest and is epithelialized. Several methods have been proposed to solve these situations, however, they are associated with increased postoperative morbidity and/or higher associated costs and require some experience of the surgeon to perform them. To overcome these disadvantages, the use of Platelet-Rich Fibrin (PRF) is proposed. The present study aims to perform a systematic review of the literature, collecting cases in which PRF was used in the treatment of OACs/OAFs. MATERIALS AND METHODS: An electronic search of the MEDLINE database (via PubMed) and Web of Science was performed using the following MeSH terms (Medical Subjects Headings): (oroantral communication OR oroantral fistula OR buccosinusal communication) AND (platelet-rich fibrin OR prf OR fibrin mesh). The criteria used were those described by the PRISMA® Statement. The search was not time-restricted and was updated to April 2021. RESULTS: After searching, 11 articles were included that met the established criteria. In these, PRF was used alone or in combination with bi- or trilaminar techniques achieving complete resolution in 100% of cases (n = 116). CONCLUSIONS: With the limitations of this study, it can be established that PRF can be used alone for the treatment of OACs/OAFs up to 5 mm and, in larger defects, it is advisable to combine it with bi- or trilaminar techniques. PRF is an effective therapeutic option, with minimal associated postoperative morbidity compared to other techniques and allows the position of the mucogingival junction to be preserved. Its combination with bone grafting improves the starting point before the replacement of the missing tooth with a dental implant.

Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review.

As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs.

Preventive antibiotic therapy in bone augmentation procedures in oral implantology: A systematic review.

INTRODUCTION: Since the beginning of Oral Implantology, preventive antibiotic therapy has been routinely prescribed. However, at present, due to the growing appearance of antimicrobial resistance, its use has been questioned, generating a great debate and an emerging controversy. The present systematic review aims to analyze the scientific literature to determine whether the preventive prescription of antibiotics in augmentation procedures with the insertion of implants in one or two phases decreases the incidence of postoperative infections and/or the survival rate of the implants. MATERIAL AND METHODS: The MEDLINE database was searched (via PubMed) with the following keywords: (bone grafting OR alveolar ridge augmentation OR bone graft augmentation OR guided bone regeneration OR bone block) AND (dental implants OR dental implant OR oral implantology) AND (antibiotic prophylaxis OR antibiotics). The criteria used were those described by the PRISMA® Statement. The search was limited to randomised clinical trials, systematic reviews and meta-analyses published in the last 15 years (2005-2020). RESULTS: After reading the titles and abstracts of the resulting articles, only one systematic review meeting the described criteria and 4 randomised clinical trials were included. CONCLUSIONS: Prescription of 2 or 3 g of amoxicillin one hour before surgery is recommended to reduce the early failure rate of one-stage implants and to decrease the bacterial load of grafted bone particles in bone augmentation procedures with one or two-stage implants.

Delivery of Health Care by Spanish Dental Hygienists in Private and Public Dental Services during the COVID-19 De-Escalation Phase (June 2020): A Cross-Sectional Study.

BACKGROUND: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists' work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. MATERIAL AND METHODS: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. RESULTS: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). CONCLUSIONS: Dental hygienists' return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors.

Preventive Antibiotic Prescribing Habits among Professionals Dedicated to Oral Implantology: An Observational Study.

The prescription of preventive antibiotics (PA) in oral implantology is a controversial issue. The study aimed to determine the prescribing habits of PA in professionals dedicated to oral implantology in various treatments in healthy and at-risk patients. This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of 4 blocks of questions was sent to members of the Spanish Society of Implants. The data were analyzed using descriptive analysis. A total of 303 participants (20.8%) responded to the questionnaire. One percent never prescribed PA, 55.4% prescribed them always, and 43.6% prescribed them sometimes. Ninety-six percent administered them preoperatively, while 92.4% administered them postoperatively. The most commonly used antibiotic is amoxicillin followed by amoxicillin with clavulanic acid (875/125 mg). Clindamycin is the most commonly administered antibiotic in patients with allergies. Professionals dedicated to oral implantology frequently prescribe PA in both healthy and at-risk patients, especially perioperatively. Immediate implant placement, sinus lifts, bone regeneration, and multiple implant placement are the treatments in which PA are most commonly prescribed, as well as in patients with heart valve prostheses or a history of bacterial endocarditis and immunodeficiency.

Pautas de prescripción de antibióticos preventivos en Implantología Oral. Análisis de encuestas entre dentistas de la Unión Europea / Prescription guidelines for preventive antibiotics in Oral Implantology. Analysis of surveys among dentists in the European Union

Introducción: La prescripción de antibióticos con el fin de prevenir fracasos tempranos de implantes dentales e infecciones postoperatorias supone en la actualidad un tema controvertido. El objetivo del presente estudio es el de analizar las pautas de prescripción preventiva de antibióticos en tratamientos de implantología oral entre dentistas de la Unión Europea (UE) con el fin de conocer si existe un consenso y si las recomendaciones basadas en la evidencia se están llevando a cabo. Métodos: Se realizó una búsqueda en la base de datos de MEDLINE (vía Pubmed) con los términos MeSH siguientes: “antibiotic prophylaxis survey OR antibiotic prophylaxis prescribing habits” AND “dental implant OR oral implant surgery”, de los últimos 10 años (23/02/2010 al 23/02/2020), de artículos publicados en inglés y español. Resultados: Se incluyeron 7 estudios, dirigidos a un total de 1.271 encuestados, con unas ratios respuesta de 40.51% ± 23.23. La posología más descrita es la pre y postoperatoria (40.89%). El antibiótico más empleado en cualquiera de las pautas es la amoxicilina, seguido de amoxicilina/ ácido clavulánico. Conclusiones: A pesar de las limitaciones de este estudio es plausible pensar que las recomendaciones basadas en la evidencia científica más actual no se están llevando a cabo. Por tanto, son necesarios protocolos que definan las indicaciones de la prescripción preventiva de antibióticos en la inserción de implantes dentales con el fin de prevenir complicaciones y/o fracasos tempranos y evitar los riesgos inherentes al uso de estos fármacos. (AU)

Introduction: Taking antibiotics to prevent early dental implant failures and postoperative infections is currently a controversial issue. The objective of this study is to analyse the guidelines for the preventive prescription of antibiotics in oral implantology treatments among dentists in the European Union (EU) to find out if there is consensus and if the evidence-based recommendations are being carried out. Methods: A search was carried out in the MEDLINE database (via Pubmed) with the following MeSH terms: “antibiotic prophylaxis survey” OR “antibiotic prophylaxis prescribing habits” AND “dental implant OR oral implant surgery” over the last 10 years (23/02/2010 to 23/2/2020) for articles published in English or Spanish. Results: 7 studies were included, targeting a total of 1,271 respondents, with response ratios of 40.51% ± 23.23. The dosage most described was pre- and post-operative (40.89%). The most widely used antibiotic in any of the regimens was amoxicillin, followed by amoxicillin/clavulanic acid. Conclusions: Despite the limitations of this study, it is reasonable to consider that recommendations based on the most current scientific evidence are not being carried out. Therefore, protocols are required to establish preventive prescription indications for antibiotics for the insertion of dental implants to prevent complications and/or early failures, as well as to minimise the risks inherent in the use of these drugs. (AU)

New Rules for Teaching in Dental Schools in the COVID-19 Era

ABSTRACT: The crisis caused by COVID-19 has led to the development of strategies for adapting the undergraduate and postgraduate teaching of dentistry to the new situation, as well as guaranteeing the safety of all staff, students, patient s and persons accompanying them.We reviewed a total of 36 documents, including articles and guidelines or recommendations issued by dental schools, scientific societies and other institutions, in order to take stock of the current evidence available about the impact of the COVID-19 pandemic on dental schools. Additional training is required in the management of infectious diseases and the prevention of their transmission. Dental schools must be prepared and implement the necessary measures according to the level of infection risk during face-to-face activities, especially in clinics, while guaranteeing quality teaching and allo wing research to be carried out. Adapting teaching to new technologies is essential for the development of non-classroom training, a s is conducting questionnaires that collect information on crisis management and assessing the stress level of students, faculty and other staff. The incorporation of new technologies in both training and assessment reduces the chances of contagion and enhances student autonomy. Distance learning competencies must be clear to students and be included in the description of the academic programme. We must not forget that the primary objective of teaching is for students to acquire the necessary skills f or their profession. More than ever, the international cooperation of universities in the elaboration of protocols is essential. T hese protocols must ensure the health of everyone in this pandemic and in possible future scenarios. We must transform this crisis into an opportunity that will revolutionize dental education.

RESUMEN: La crisis originada por la COVID-19 ha obligado a desarrollar estrategias para adaptar la enseñanza pre y postgrado en odontología a la nueva situación, así como para garantizar la seguridad de todo el personal de la facultad, estudiantes, pacientes y acompañantes. Revisamos un total de 36 documentos, incluyendo artículos y guías o recomendaciones facilitadas por facultades de odontología, sociedades científicas y otras instituciones, con el fin de obtener la evidencia científica disponible sobre el impacto de la pandemia de la COVID-19 en las facultades de odontología. Las facultades de odontología deben estar preparadas e implementar las medidas necesarias según el nivel de riesgo de infección de SARS-CoV-2 durante las actividades presenciales, especialmente en clínica, además de garantizar una enseñanza de calidad y permitir el desarrollo de investigación. Es fundamental la adaptación de la docencia a las nuevas tecnologías para el desarrollo de formación no presencial, así como la realización de cuestionarios que recaben información sobre la gestión de la crisis y analicen el estrés de estudiantes, profesores y personal. La incorporación de las nuevas tecnologías tanto en la formación como en la evaluación reduce las posibilidades de contagio y potencia la autonomía del alumno. Las competencias de la educación a distancia deben quedar claras para los estudiantes, e incluirse en la descripción del curso académico siendo objetivo primordial de la docencia la adquisición de las mismas. La cooperación internacional de universidades es esencial en la elaboración de protocolos que garanticen la salud de todos en esta pandemia y en posibles futuros escenarios. Esta crisis supone una oportunidad para revolucionar la educación en odontología.

COVID-19 Safety Protocols in Dental Clinical Education in the Second Wave

ABSTRACT: This second wave of the COVID-19 pandemic has led to the development of strategies for guaranteeing clinical teaching in dental schools and adapt it to this new epidemiological situation protecting the health of all staff, stud ents, patients and persons accompanying them. We reviewed a total of 51 documents, including articles and guidelines or recommendations issued by dental schools, scientific societies and other institutions, in order to take stock of the current evidence available about the impact of the COVID-19 pandemic on dental schools. We describe a series of measures to implement in semi-critical and critical areas of dental schools to guarantee the safety of all and the continuity of the clinic al training of students. These include: mobility circuits, appropriate distancing, patient scheduling, telephone triage, personal protective equipments, measures to reduce viral transmission by air ventilation and several other actions specific to low or high aerosol generating by treatments. Dental schools must be prepared and implement the necessary measures according to the level of infection risk during face-to-face activities, especially in clinics, which provide essential formation and imp ossible to acquire online. Dental schools should focus on prioritizing preventive and minimally invasive dentistry minimizing aerosol generating procedures whenever possible. More than ever, the international cooperation among universities for the elaboration of protocols is essential. These protocols must ensure the health of everyone in this new second wave of the pandemic and in possible future epidemiological scenarios.

RESUMEN: Esta segunda oleada de la pandemia COVID-19 ha llevado al desarrollo de estrategias para garantizar la docencia clínica en las facultades de odontología y adaptarla a esta nueva situación epidemiológica protegiendo la salud de todo el personal, estudiantes, pacientes y acompañantes. Revisamos un total de 51 documentos, incluidos artículos y guías o recomendaciones emitidas por escuelas de odontología, sociedades científicas y otras instituciones, con el fin de hacer un balance de la evidencia actual disponible sobre el impacto de la pandemia de COVID-19 en las escuelas de odontología. Describimos una serie de medidas a implementar en áreas semicríticas y críticas de las facultades de odontología para garantizar la seguridad de todos y la continuidad de la formación clínica de los estudiantes. Estos incluyen: circuitos de movilidad, distanciamiento apropiado, programación de pacientes, triaje telefónico, equipos de protección personal, medidas para reducir la transmisión viral por ventilación de aire y varias otras acciones específicas para la generación baja o alta de aerosoles por los tratamientos. Las escuelas de odontología deben estar preparadas e implementar las medidas necesarias de acuerdo al nivel de riesgo de infección durante las actividades presenciales, especialmente en las clínicas, que brindan formación imprescindible e imposible de adquirir en línea. Las escuelas de odontología deben centrarse en priorizar la odontología preventiva y mínimamente invasive minimizando los procedimientos que generan aerosoles siempre que sea posible. Más que nunca, la cooperación internacional entre universidades para la elaboración de protocolos es fundamental. Estos protocolos deben garantizar la salud de todos en esta nueva segunda ola de la pandemia y en posibles escenarios epidemiológicos futuros.

Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review.

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2-3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted.

[Odontología en entorno COVID-19. Adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid.] / Dentistry in the COVID-19 environment. Adaptation of the dental health units in Madrid's public primary health centres.

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.

En el término COVID-19 se incluyen cuadros respiratorios que varían desde el resfriado común hasta cuadros de neumonía grave con síndrome de distrés respiratorio, shock séptico y fallo multiorgánico. Esta enfermedad está causada por el virus SARS-CoV-2, cuyo mecanismo de transmisión más importante en odontología es, fundamentalmente, respiratorio, mediante gotitas, probablemente aerosoles y, también, por contacto directo con mucosas (nasales, orales u oculares) a través de manos o fómites contaminados. Los profesionales de las Unidades de Salud Bucodental representan una categoría laboral con un riesgo de exposición muy alto, ya que trabajan a una distancia de trabajo reducida (menos de un metro de la cabeza del paciente) en la cavidad oral, donde se ha descrito la máxima expresión de los posibles receptores celulares de dicho virus. Además, la mayoría de los procedimientos odontológicos conllevan la generación de aerosoles. Durante la atención odontológica puede producirse infección cruzada, tanto con pacientes diagnosticados positivos por COVID-19 como con aquellos no detectados por encontrarse asintomáticos o en fase presintomática. Por estas razones, la actividad odontológica en Atención Primaria ha tenido que adaptarse a la pandemia. Dichos cambios afectan a la distribución de la agenda de citación, a la atención odontológica, e implican el establecimiento de medidas universales y específicas de protección de barrera y otras relativas a ventilación, limpieza, desinfección y esterilización, reforzadas con medidas adicionales de control de infecciones. Este artículo resume la evidencia científica disponible relativa a dicha adaptación.

Odontología en entorno COVID-19. adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid / Dentistry in the COVID-19 environment. Adaptation of the dental health units in Madrid's public primary health centres

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation