Determinantes sociais de saúde de crianças em consulta de puericultura: das condições socioeconômicas aos aspectos relacionados à saúde bucal / Social determinants of health of children in child care consultation: from socioeconomic conditions to aspects related to oral health / Determinantes sociales de la salud de los niños en la consulta infantil: de las condiciones socioeconómicas a los aspectos relacionados con la salud bucal

A imaturidade do sistema imunológico, associado a Determinantes Sociais de Saúde (DSS), promove doenças na infância. Especificamente, na cavidade oral, os DSS, representados pelo consumo elevado de açúcar, limitado acesso aos serviços de saúde e deficiência na higiene bucal, favorecem transtornos locais e sistêmicos. Assim, o estudo objetivou associar os DSS, no contexto das condições socioeconômicas, do acompanhamento pelo serviço de saúde e dos aspectos relacionados à saúde bucal de crianças atendidas em Unidades Básicas de Saúde (UBS) de um município cearense. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães em Acarape - CE. Após consentimento, essas preencheram um questionário. Os dados foram analisados. Das 70 mães, 87,14% e 90,00% tinham idade inferior ou igual a 30 anos e renda de até um salário mínimo, respectivamente. Das 70 crianças, 87,14% tinham seus dentes/gengiva higienizados por seus pais ou responsável. Do total, 94,29% nunca se submeteram a atendimento odontológico. Observou-se associação significativa entre a mãe ter escolaridade superior ao ensino fundamental incompleto e higienizar os dentes/gengiva do filho com escova dental e dentifrício. Constatou-se associação significativa entre a criança ingerir bolacha doce/recheada, não consumir refrigerante e usar escova dental e dentifrício na higienização oral. Conclui-se que as crianças eram acompanhadas nas UBS regularmente; no entanto, esse serviço não esteve relacionado ao atendimento odontológico. Apesar da ausência desse tipo de acompanhamento e do consumo de alimentos cariogênicos, as mães se preocupavam com a saúde bucal das crianças, higienizando a cavidade oral diariamente, com meios adequados.

The immaturity of the immune system, associated with Social Determi- nants of Health (SDH), promotes diseases in childhood. Specifically, in the oral cavity, SDH, represented by high sugar consumption, limited access to health services, and poor oral hygiene, favors local and systemic disorders. Thus, the study aimed to associate the SDH, in the context of socioeconomic conditions, monitoring by the health service and aspects related to children's oral health assisted in Basic Health Units (BHU) of a muni- cipality in Ceará. This is an observational, analytical, cross-sectional study with a quan- titative approach conducted with children and their mothers in Acarape - CE. After con- sent, they filled out a questionnaire. Data were analyzed. Of the 70 mothers, 87.14% and 90.00% were aged less than or equal to 30 years and had income up to one minimum wage, respectively. Of the 70 children, 87.14% had their teeth/gums cleaned by their pa- rents or guardian. Of the total, 94.29% never underwent dental care. There was a signifi- cant association between the mother having higher education than incomplete elementary school and cleaning the child's teeth/gums with a toothbrush and toothpaste. A significant association was found between the child eating sweet/stuffed biscuits, not consuming soft drink, and using a toothbrush and dentifrice for oral hygiene. It is concluded that the chil- dren were regularly monitored at the BHU; however, this service was not related to dental care. Despite the absence of this type of follow-up and the consumption of cariogenic foods, the mothers were concerned about their children's oral health, cleaning the oral cavity daily with adequate means.

La inmadurez del sistema inmunológico, asociada a los Determinantes So- ciales de la Salud (DSS), promueve enfermedades en la infancia. Específicamente, en la cavidad bucal, los DSS, representados por el alto consumo de azúcar, el acceso limitado a los servicios de salud y la mala higiene bucal, favorecen los trastornos locales y sisté- micos. Así, el estudio tuvo como objetivo asociar el DSS, en el contexto de las condicio- nes socioeconómicas, el seguimiento por el servicio de salud y los aspectos relacionados con la salud bucal de los niños atendidos en las Unidades Básicas de Salud (UBS) de un municipio de Ceará. Se trata de un estudio observacional, analítico, transversal con enfo- que cuantitativo, realizado con niños y sus madres en Acarape ­ CE. Después del consen- timiento, completaron un cuestionario. Los datos fueron analizados. De las 70 madres, 87,14% y 90,00% tenían edad menor o igual a 30 años e ingresos hasta un salario mínimo, respectivamente. De los 70 niños, al 87,14% se les limpió los dientes/encías por sus pa- dres o tutores. Del total, el 94,29% nunca realizó atención odontológica. Hubo una aso- ciación significativa entre la madre con educación superior a la primaria incompleta y la limpieza de los dientes/encías del niño con cepillo y pasta dental. Se encontró una asoci- ación significativa entre el niño que come galletas dulces/rellenas, no consume gaseosas y usa cepillo de dientes y dentífrico para la higiene bucal. Se concluyó que los niños eran monitoreados periódicamente en la UBS; sin embargo, este servicio no estaba relacionado con el cuidado dental. A pesar de la ausencia de este tipo de seguimiento y del consumo de alimentos cariogénicos, las madres se preocupan por la salud bucal de sus hijos, reali- zando la limpieza de la cavidad bucal diariamente, con medios adecuados.

Saúde bucal e gravidez: desafios e fragilidades no cuidado sob a perspectiva dos resultados do Previne Brasil / Oral Health And Pregnancy: Challenges And Fragilities On Care Under The Perspective Of The Results Of Previne Brasil / Salud Bucal Y Embarazo: Retos Y Debilidades En La Atención Bajo La Perspectiva De Los Resultados De Previne Brasil

Introdução: Por muitos anos a saúde bucal esteve à margem das políticas públicas de saúde no Brasil. Em 2004, com a criação da Política Nacional de Saúde Bucal, houve uma proposta de reorganização do cuidado em todos os níveis de atenção no âmbito do Sistema Único de Saúde. Quando avalia-se a qualidade da atenção em populações específicas, a análise dos indicadores torna-se cada vez mais escassa, o que impacta diretamente no financiamento das equipes da atenção básica, já que com a ascensão do novo modelo de financiamento, o Previne Brasil (Portaria n° 2.979/2019), alteram-se algumas formas de repasse para os municípios. Objetivo:Investigar o cuidado odontológico durante a gravidez sob a ótica dos resultados do Previne Brasil, com recorte temporal dos três últimos quadrimestres do ano de 2020, no município de Belém, no Pará. Metodologia:Estudo de natureza descritiva baseado nos dados disponíveis para domínio público provenientes do Sistema de Informação da Atenção Básica. Estes dados foram tabulados no software Microsoft Excel®. A análise dos dados se deu com base no referencial teórico disponível na Scientific Electronic Library Onlinee de documentos oficiais do Ministério da Saúde. Resultados:Belém possui 23,94% de cobertura de saúde bucal, com uma população que ultrapassou um milhão de habitantes. Quando se analisa a proporção de gestantes com atendimento odontológico realizado, Belém apresentou 4%, 3% e 5% respectivamente, em cada quadrimestre de 2020. Conclusões:Os dados revelam que para alcançar um nível satisfatório no acesso e oferta de serviços odontológicos no município amazônico, deve haver um fortalecimento e expansão das políticas públicas de saúde bucal, não excluindo a atenção às linhas de cuidado presentes na Política Nacional de Saúde Bucal, como as gestantes (AU).

Introduction:For several years, oral health had been on the fringe of public policies in Brazil. In 2004, with the establishment of the National Policy for Oral Health, there had been a proposal for reorganization of care in every assistance level in the scope of the Brazilian National Health System. When the quality of assistance to specific populations is availed, the analysis of the indexes becomes increasingly scarce, what directly affects the funding of primary care teams, as with the ascension of the new model of funding, the Previne Brasil (Directive nº 2.979/2019), some forms of transfer to municipalities are changed.Objective:Investigate the dental care during pregnancy under the perspective of the results of Previne Brasil, using the time frame of the three latter four-month periods of 2020, in the city of Belém, in Pará. Methodology: Descriptive study based on the data available for public domain from the Basic Care Information System. These data were tabulated on the Microsoft Excel® software. The data analysis had been done based on the theoretical framework available at the Scientific Electronic Library Online and on official documents from the Ministry of Health. Results: Belém has 23,94% of oral health coverage, with a population that has surpassed 1 million inhabitants. When the proportion of pregnant women with dental assistance is analyzed, Belém presented 4%, 3%, and 5% respectively, in each four-month period of 2020. Conclusions:The data revealed that to reach a satisfactory level of access and supply of dental health services in the Amazonian city, there must be strengthening and expansion of oral health public policies, without excluding the attention to the care lines contained on the National Policy for Oral Health, such as the pregnant women (AU).

Introducción:Durante muchos años, la salud bucal estuvo al margen de las políticas de salud pública en Brasil. En 2004, con la creación de la Política Nacional de Salud Bucal, se propuso reorganizar el cuidado en todos los niveles de atención dentro del Sistema Único de Salud. Al evaluar la calidad de la atención en poblaciones específicas, el análisis de indicadores se vuelve cada vez más escaso, lo que impacta directamente en el financiamiento de los equipos de atención primaria, ya que con el surgimiento del nuevo modelo de financiamiento, Previne Brasil (Ordenanza No. 2979/2019), algunos Se modifican las formas de transferencia a los municipios.Objetivo:Investigar la atención odontológica duranteel embarazo desde la perspectiva de los resultados de Previne Brasil, con un marco temporal de los últimos tres trimestres del año 2020, en la ciudad de Belém, en el estado de Pará. Metodología:Estudio descriptivo basado en datos disponibles para el dominio público del Sistema de Información de Atención Primaria. Estos datos se tabularon en el software Microsoft Excel®. El análisis de los datos se basó en el marco teórico disponible en la Biblioteca Científica Electrónica en Línea y documentos oficiales del Ministerio de Salud. Resultados:Belém posee el 23,94% de cobertura de salud bucodental, con una población que supera un millón de habitantes. Al analizar la proporción de embarazadas con atención odontológica, Belém presentó 4%, 3% y 5%, respectivamente, en cada cuatrimestre de 2020. Conclusiones:Los datos muestran que para alcanzar un nivel satisfactorio de acceso y oferta de servicios odontológicos en el municipio amazónico, se debe fortalecer y ampliar las políticas públicas de salud bucal, sin excluir la atención a las líneas de cuidado presentes en la Política Nacional de Salud Bucal, como las mujeres embarazadas (AU).

A Description of Infection Control Structure in Primary Dental Health Care, Brazil.

OBJECTIVE: This study is aimed at describing a score to assess infection control structures in Oral Health Teams (OHT) in Primary Health Care (PHC) in Brazil. METHODS: Secondary data from a national external evaluation of PHC conducted in 2017 and 2018 were analyzed. The construction of the score used 14 variables, divided into the following: structural characteristics of the PHC, infection control equipment under conditions of use, and biosafety supplies in sufficient quantity. The questions were mostly dichotomous (yes/no). Descriptive analyses were carried out to characterize the OHT and factor analyses to reduce the number of observed variables to a specific number of factors. RESULTS: Among 20,301 health units with OHT, 4,510 (22.2%) units did not have washable floors, ceilings, and walls; 8,406 (41.4%) did not have a sealer; 16,780 (82.7%) did not have taps with noncontact activation, and 4,663 (23.0%) units did not have rubber gloves. Regarding personal protective equipment (PPE), 1,618 (8.0%) units did not have a sufficient quantity of basic PPE. Three factors were defined to explain the 14 evaluated variables. The South region had the best score of infection control, while the North had the worst. CONCLUSIONS: Regional inequalities in the failures in infection control structures identified in PHC with OHT were related to the physical structure, equipment, and supplies used for infection control and the absence of PPE for OHT.

Clinical and Molecular Disorders Caused by COVID-19 During Pregnancy as a Potential Risk for Enamel Defects

ABSTRACT This paper discusses the potential risk that COVID-19 generates for the development of enamel defects. This hypothesis was built based on the etiopathogenesis of enamel defects and the relationship with the symptom's characteristic of COVID-19. Pregnancy is a critical period for the child's development; exposure to pathological agents can cause systemic imbalances and risks of adverse perinatal and prenatal outcomes. The main clinical symptoms of this disease and its association with that dental outcome were considered. Fever, breathing, cardiovascular disorders, and diarrhea were related as potential etiological factors of ameloblast metabolism imbalance, which can interfere qualitatively and quantitatively in the development, maturation and mineralization of the tooth enamel. Molecular disorders derived from COVID-19, as well as their clinical symptoms, can be considered potential risk factors for the development of enamel defects. Individuals with enamel defects experienced high stress levels during pregnancy or early childhood. The approach adopted may help build new research to ensure understanding of the etiology of the development of dental enamel defects and its relationship with COVID-19. However, longitudinal studies need to be conducted to confirm the association between COVID-19 and adverse events during pregnancy.

Manejo Multidisciplinario de la Cavidad Oral en Pacientes COVID-19 bajo Ventilación Mecánica Invasiva. Rol del Equipo Odontológico / Multidisciplinary Management of the Oral Cavity in COVID-19 Patients under Invasive Mechanical Ventilation. Role of the Dental Team

RESUMEN: El objetivo de este artículo es presentar algunas consideraciones odontológicas y un protocolo de mantención para el manejo y cuidado de cavidad oral en pacientes en ventilación mecánica invasiva (VMI) en unidades de cuidados intensivos hospitalarios. Además, presentar recomendaciones para la implementación de estas. Desde el desarrollo del COVID-19 en el mundo, los casos de VMI prolongada han aumentado y junto con ellos, se ha visibilizado las complicaciones propias de este tipo de terapia, dentro de las cuales encontramos aquellas que afectan la cavidad oral. Los centros hospitalarios normalmente cuentan con servicios dentales conformados por distintas especialidades, las cuales en un trabajo mancomunado pueden entregar herramientas y educar al personal encargado para el cuidado de la cavidad oral en estos pacientes si es que son requeridos, siendo el odontólogo el encargado de evaluar las distintas situaciones clínicas y entregar directrices para la prevención y tratamiento de patología de la cavidad oral. En este trabajo se describen los pasos a seguir para realizar una correcta higiene oral de estos pacientes y el manejo de las distintas complicaciones posibles de observar, junto con la experiencia local de cómo solucionarlos de la mejor manera. Consideramos importante que las unidades de cuidados intensivos (UCI) conozcan el rol del odontólogo y las acciones que este equipo puede aportar en el cuidado de los pacientes hospitalizados para disminuir los riesgos asociados a ventilación prolongada, basados principalmente en el manejo de la higiene oral y lesiones asociadas.

ABSTRACT: The aim of this sutudy dental considerations and an oral cavity maintenance and care protocol in patients on invasive mechanical ventilation (IMV) in hospital intensive care units. Since the development of COVID-19 in the world, cases of prolonged IMV have increased and together with them, the complications of this type of therapy have been made visible, among which we find those that affect the oral cavity. Hospital centers normally have dental services made up of different specialties, which in a joint effort can provide tools and educate the personnel in charge of the care of the oral cavity in these patients if they are required, being the dentist the one in charge of evaluating and deliver guidelines for the prevention and treatment of pathology of the oral cavity. This work describes the steps to be followed to carry out correct oral hygiene in these patients and the management of the different complications that may be observed, along with local experience on how to best solve them. We consider important that the intensive care units (ICU) get to know the role of the dentist in the hospital environment and that they become part of the care of hospitalized patients to reduce the risks associated with prolonged ventilation, based mainly on oral hygiene management and associated injuries.

Dental care and personal protective measures for dentists and non-dental health care workers.

As a pathogen spread primarily by the respiratory route COVID-19 infection not only poses significant risks to health care workers, but to dentists and dental health care workers, owing to the potential prolonged exposure and proximity to patients. This holds true for non-dentist health care workers who often in the setting of emergency departments and urgent care centers are tasked with addressing oral symptoms including abscesses, damaged teeth, jaw injuries and other dental urgencies. Infection control practice guidelines were evaluated for COVID-19 infection prevention in a dental setting. In this brief review, protective measures to reduce the risk of COVID-19 infection for dentists and non-dentist health care providers will be introduced. This includes patient evaluation, personal and patient protective equipment use, sterilization and disinfection protocols.

Willingness of Adults in the United States to Receive HIV Testing in Dental Care Settings: Cross-Sectional Web-Based Study.

BACKGROUND: The Centers for Disease Control and Prevention estimates that 1.1 million people in the United States are living with HIV and 1 in 8 are estimated to be unaware of their serostatus. Little is known about whether individuals would consider being tested for HIV in nontraditional health care settings such as a dentist's office. Studies in selected US cities have indicated high acceptability of receiving an HIV test among people attending dental clinics. However, we are not aware of studies that have assessed willingness to receive HIV testing in dental care settings at a national level. OBJECTIVE: Using a web-based sample of adult residents of the United States, we sought to assess the self-reported willingness to receive any type of HIV testing (ie, oral fluid rapid testing, finger-stick blood rapid testing, or venipuncture blood testing) in a dental care setting and evaluate independent associations of willingness with the extent to which dental care providers were perceived as knowledgeable about HIV and how comfortable participants felt discussing HIV with their dental care providers. METHODS: Participants were recruited using banner advertisements featured on social networking platforms (Facebook and Instagram) from December 2018 to February 2019. Demographic and behavioral data including information on sexual behaviors in the past 6 months, HIV testing history, and dental/health care-seeking history were collected using an anonymous web-based survey. Willingness to receive any type of HIV testing in a dental care setting was assessed on 4-point scale from very willing to very unwilling. Factors independently associated with participants' willingness were identified using a multivariable logistic regression model. RESULTS: Of the 421 participants in our study aged 18 to 73 years, 271 (64.4%) reported having oral sex, 197 (46.8%) reported having vaginal sex, and 136 (32.3%) reported having anal sex in the past 6 months. Approximately one-third had never been tested for HIV (137/421, 32.5%), and the same proportion had not been tested in the past year (137/421, 32.5%). Most participants had dental insurance coverage (356/421, 84.6%), and more than three-fourths reported being very or somewhat willing (326/421, 77.4%) to receive any type of HIV testing in a dental care setting. Higher levels of willingness were associated with being 18 to 24 years versus ≥35 years (aOR 3.22, 95% CI 1.48-6.98), 25 to 34 years versus ≥35 years (aOR 5.26, 95% CI 2.52-10.98), believing that one's dental care provider is knowledgeable about HIV (aOR 2.04, 95% CI 1.06-3.92), and feeling comfortable discussing HIV with one's dental care provider (aOR 9.84, 95% CI 3.99-24.27). CONCLUSIONS: Our data indicate high acceptability of receiving HIV testing in a dental care setting, especially among those who report having a positive patient-provider relationship. Future research should focus on assessing dental care providers' attitudes, self-efficacy, and beliefs about whether HIV testing fits into the scope of dentistry.

Plano de Contingência de Arapoema frente a pandemia do Coronavírus COVID-19 / Arapoema Contingency Plan against the COVID-19 Coronavirus pandemic

Orienta na campanha para ações de combate ao Coronavírus (Covid-19) no município de Arapoema no Tocantins.

He guides in the campaign for actions to combat the Coronavirus (Covid-19) in the municipality of Arapoema in Tocantins.

Orienta en la campaña de acciones de combate al Coronavirus (Covid-19) en el municipio de Arapoema en Tocantins.

Il guide dans la campagne d'actions de lutte contre le Coronavirus (Covid-19) dans la commune d'Arapoema à Tocantins.

Prosthetic treatment in the adult French population: Prevalence and relation with demographic, socioeconomic and medical characteristics.

BACKGROUND: The aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France. METHODS: The data were obtained from the 2002-2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics. RESULTS: The prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR=0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR=0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR=1.29; 95% CI: [1.17; 1.43]) than those without chronic disease. CONCLUSION: This study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.

Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: A systematic review and MTC meta-analysis.

BACKGROUND: Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective. AIM: To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes. DESIGN: Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated. RESULTS: An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS: Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.

Prevalence of Different Types of Apical Root Canal Morphology and their Treatment Recommendations in an Institute.

INTRODUCTION: Canals can be of different shapes in cross section including round canals, oval canals, long oval canals or ribbon shaped canals. Recesses of nonround canals may not be included in the round preparation created by rotary instruments and thus they remain unprepared. The aim of this study included determination of shape and taper of the apical root canal based on diameter at different levels. Measurement of the diameter of the root canal at one, two and three mm cross sections from the apex of the tooth were done such that apical instrumentation in root canal treatment could be modified based on the results obtained. METHODS: This was a cross sectional study which used convenient sampling technique to determine the sample size. Seventy extracted teeth were sectioned horizontally at one, two and three millimeter from the apex using the diamond disc which was observed under trinocular research microscope for the determination of diameter of root canal under 10x magnification. Digital images of the sections were taken by a camera attached to the research microscope and analysis done using DigiPro 4.0 software. RESULTS: The most common canal configuration was oval. The taper of the canals was 25% in mesial root and 20% in distal in bucco-lingual orientation and 14% in mesial root and 15% in distal in mesio-distal orientation. CONCLUSIONS: The most prevalent canal configuration in this study was non round, however, most of the rotary instruments tend to prepare root canals into round shape making their use questionable. The taper of the root canals was found to be higher in our study than what most of the shaping instruments have to offer. So it would be advisable to consider this fact while selecting instruments and preparing these non-round canals as far as the Nepalese subpopulation is considered.

Anesthetic management of a patient with 15q tetrasomy for dental treatment / Manejo anestésico de paciente com tetrassomia 15q para tratamento odontológico

Abstract Background and objectives 15q tetrasomy is a chromosomal abnormality that is a part of the heterogeneous group of extra structurally abnormal chromosomes. This syndrome is characterized by epilepsy, central hypotonia, developmental delay and intellectual disability, and autistic behavior. This is the first report of the anesthetic management of a patient with this syndrome. Case report We administered general anesthesia for dental treatment in a patient with 15q tetrasomy. Conclusions Appropriate planning for the prevention of complications such as seizures and hypotonia, and for delayed emergence from anesthesia, is required. Specifically, choosing short-acting drugs that do not induce seizures, together with suitable monitoring, resulted in successful anesthetic management of the patient with 15q tetrasomy.

Resumo Justificativa e objetivos Tetrassomia 15q é uma anomalia cromossômica que faz parte do grupo heterogêneo de cromossomos extras, estruturalmente anormais. Essa síndrome é caracterizada por epilepsia, hipotonia central, atraso no desenvolvimento e deficiência intelectual e comportamento autista. Este é o primeiro relato do manejo anestésico de um paciente com essa síndrome. Relato de caso Administramos anestesia geral para tratamento odontológico em um paciente com tetrassomia 15q. Conclusões Um planejamento adequado para prevenir complicações como convulsões e hipotonia e para emergência tardia da anestesia é necessário. O manejo anestésico bem-sucedido do paciente com tetrassomia 15q foi o resultado específico da escolha de fármacos de curta duração que não induzem convulsões e monitoração adequada.

Dental Treatment Effect on Deep Brain Stimulation System in Parkinson's Disease.

Parkinson's disease (PD) is a highly prevalent, long-term neurodegenerative disorder that is sometimes treated by deep brain stimulation (DBS), which significantly reduces the need for dopaminergic drug therapy and improves quality of life. Such patients are cautioned, however, that dental instruments such as a dental turbine or ultrasonic scaler may adversely affect the functioning of such a system. Here, we report dental treatment for right maxillary tooth pain in a 65-year-old woman undergoing DBS for PD. The diagnosis was occlusal trauma. After verification with occluding paper each time, treatment comprised milling of the high contact points of tooth #17, followed by scaling with an ultrasonic scaler. This treatment was spread out over 3 visits, and its course was uneventful. To our knowledge, there are no previous reports on the interaction between dental instruments and DBS systems. Although no interference with the DBS system was observed here, we believe that the dentist should be aware of the potential for such, especially with the use of devices used to measure root canal length, dental lasers, and electrical scalpels.

Asistencia odontológica a bordo del Buque de Asalto Anfibio «Galicia» durante la operación de mantenimiento de la paz Atalanta 2015. Incidencias en la primera rotación / Dental aid on board the Amphibious Assault Ship «Galicia» during Atalanta peace keeping operation 2015. Incidence rate in first rotation

OBJETIVOS: Analizar y cuantificar las diferentes emergencias odontológicas que tuvieron lugar durante la primera rotación de la Operación de Mantenimiento de la Paz (OMP) ATALANTA 2015 a bordo del Buque de Asalto Anfibio (BAA) «Galicia». MATERIAL Y MÉTODO: Se realizó un estudio descriptivo longitudinal de incidencias acumuladas de las patologías y tratamiento realizados entre el 20 de abril de 2015 a 1 de julio del mismo año (73 días). RESULTADOS: La patología que mostraron más incidencias fue la caries con un 40% y la gingivitis 31,3% del total. Las restauraciones/obturaciones y las tartrectomías fueron los tratamientos más realizados con un 44% y 28% respectivamente. La patología se acumuló en un cuarto de la población (25,6%). Los pacientes que mostraron más incedencia (95,3%) fueron los destinados en el BAA «Galicia». CONCLUSIONES: Los resultados obtenidos vienen a confirmar que las emergencias bucodentales presentan una alta incidencia. La patología y la necesidad de asistencia se acumulan en un grupo poblacional que sería conveniente su identificación para diagnóstico y tratamiento en fases previas al despliegue. Se observó como la mejora en la oferta o el fácil acceso de los servicios odontológicos incrementó la demanda de asistencia. La caries y las enfermedades gingivales, son sin duda, las lesiones que requirieron más necesidad de asistencia. Estos resultados de confirmarse en próximos estudios, pueden ayudar a dirigir a que las políticas de «salud oral» y el «perfil del Oficial Odontólogo» se adapten mejor a las necesidades asistenciales de la población diana

OBJECTIVE: Analyze and quantify odontological emergencies onboard during first rotation in Peace Keeping Operation ATALANTA 2015 in the Amphibious Assault Ship «Galicia». MATERIAL AND METHOD: A longitudinal descriptive research of incidences and their treatments was carried out, from 20th April to 1st July 2015 (73 days). RESULTS: The most common pathology was caries with 40% and gingivitis 31,3% of the total. Restorations/Fillings and tartar removal were the most frequently carried out treatments during the study period with 44% and 28% respectively. A quarter of the population were affected by some ondontological pathology (25,6%). 95,3% of the patients were crew of the Amphibious Assault Ship «Galicia». CONCLUSIONS: Results confirm that odontological emergencies show a high incidence. The pathology and the need for assistance accumulate in a population group, that would be convenient identify them for diagnosis and treatment in previous deployment phases. It was observed that easy access to odontological services increased the demand of it. Caries and gingivitis disease, are undoubtedly, the injuries which required most of the need for assistance. If the data is confirmed the «oral health» policies and the profile of the Dental Officer must be adapted to improve the care of the target population

Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces.

BACKGROUND: The accurate detection of approximal caries is generally difficult. The aim of this study was to assess the ability of the pen-type laser fluorescence device (LF pen) to detect approximal carious lesions in comparison to bitewing radiographs (BW). METHODS: Three hundred forty-one tooth surfaces were diagnosed in 20 patients with an average age of 26.70 (±2.82) years. Each test tooth was sequentially assessed by a single calibrated examiner using visual inspection, BW, and the LF pen. Radiographs were used as the gold standard to calculate an appropriate cut-off. RESULTS: Sensitivity, specificity and accuracy values for cut-off limits of 15, measured by the LF pen were compared using the chi2 test (McNemar test). For approximal caries at D3 level, the highest values of specificity and sensitivity were observed for the LF pen at a cut-off value of 15 (96.8 and 83.0 %) and for visual inspection (99.3 and 4.3 %). CONCLUSION: Within the limitations of this study, dentin caries on approximal surfaces could be detected equally well by the LF pen as by the bitewing radiographs. Therefore, the LF pen can be recommended as an alternative to radiographs for the detection of approximal caries in a regular dental practice setting. TRIAL REGISTRATION: DRKS00004817 on DRKS on 12th March 2013.

Tools and Equipment for Managing Special Care Patients Anywhere.

This article describes many of the tools and equipment used by dental professionals to successfully treat special care patients in a variety of settings. Such equipment can be used in the dental office, operating room, hospital, surgical center, nursing home, private home, institution, hospice, and even in the field without electricity. Equipment discussed includes seating, laughing gas and sedation systems, body wraps and mouth props, lighting, radiographic exposure and imaging systems, dental isolation devices, and other tools the authors use.

Utilizing a Diabetes Risk Test and A1c Point-of-Care Instrument to Identify Increased Risk for Diabetes In an Educational Dental Hygiene Setting.

PURPOSE: The objective of this pilot study was to demonstrate the number of patients at increased risk for type 2 diabetes development using a validated survey; and to assess the rate of compliance for A1c screening in an educational dental hygiene setting. METHODS: This was a descriptive study using a purposive sample of patients in an academic dental hygiene clinic, who were 18 years or older, not diagnosed with prediabetes or type 2 diabetes. Utilizing the American Diabetes Association adopted diabetes risk survey, patients determined to be at increased risk for type 2 diabetes were offered the opportunity for further assessment by having their A1c tested using a point of care instrument. Patients demonstrating an increased risk for prediabetes or type 2 diabetes, with either the survey or the point of care instrument, were referred to their primary physician for further evaluation. RESULTS: A total 179 of the 422 solicited patients agreed to participate in the American Diabetes Association adopted diabetes risk survey. According to the survey guidelines, 77 participants were considered increased risk for type 2 diabetes for an at-risk prevalence of 48% (95% Confidence Interval (CI): 40 to 56%). The at-risk participants were then asked to have an A1c test of which 45 agreed (compliance rate 58%, 95% CI: 47 to 70%). Using American Diabetes Association A1c parameters, 60.98% (n=25) indicated a prediabetes (5.7 to 6.4%) range, and 4.88% (n=2) indicated a diabetes (≥6.5%) range. CONCLUSION: Utilizing the American Diabetes Association adopted diabetes risk survey in any dental setting could provide patients with invaluable health information, and potentially improve overall health outcomes.

[An overview on rubber dam application in dental treatments].

Rubber dam technique is the a method used in dentistry to isolate the operation field from the rest of mouth with rubber sheet. Rubber dam can protect both patients and dental workers effectively and provide patients with more professional, safe and comfortable experience. In recent years, this technique has gradually gained more and more recognition by dentists. However, the prevalence of using rubber dam technique in our country is still relatively low compared with those in developed countries. This condition involves many factors and need to be paid enough attention. This review summarized the current situation of rubber dam usage in various countries, the technique's application field, the effect analysis, the influencing factors and the modified products.

Full 3-dimensional digital workflow for multicomponent dental appliances: A proof of concept.

BACKGROUND: The authors used a 3-dimensional (3D) printer and a bending robot to produce a multicomponent dental appliance to assess whether 3D digital models of the dentition are applicable for a full digital workflow. METHODS: The authors scanned a volunteer's dentition with an intraoral scanner (Lava Chairside Oral Scanner C.O.S., 3M). A digital impression was used to design 2 multicomponent orthodontic appliances. Biocompatible acrylic baseplates were produced with the aid of a 3D printer. The metal springs and clasps were produced by a bending robot. The fit of the 2 appliances was assessed by 2 experienced orthodontists. RESULTS: The authors assessed both orthodontic appliances with the volunteer's dentition and found the fit to be excellent. CONCLUSIONS: Clinicians can fully produce a multicomponent dental appliance consisting of both an acrylic baseplate and other parts, such as clasps, springs, or screws, using a digital workflow process without the need for a physical model of the patient's dentition. PRACTICAL IMPLICATIONS: Plaster models can be superfluous for orthodontic treatment as digital models can be used in all phases of a full digital workflow in orthodontics. The arduous task of making a multicomponent dental appliance that involves bending wires can possibly be replaced by a computer, design software, a 3D printer, and a bending robot.

Human amygdala activation by the sound produced during dental treatment: A fMRI study.

During dental treatments, patients may experience negative emotions associated with the procedure. This study was conducted with the aim of using functional magnetic resonance imaging (fMRI) to visualize cerebral cortical stimulation among dental patients in response to auditory stimuli produced by ultrasonic scaling and power suction equipment. Subjects (n = 7) aged 23-35 years were recruited for this study. All were right-handed and underwent clinical pure-tone audiometry testing to reveal a normal hearing threshold below 20 dB hearing level (HL). As part of the study, subjects initially underwent a dental calculus removal treatment. During the treatment, subjects were exposed to ultrasonic auditory stimuli originating from the scaling handpiece and salivary suction instruments. After dental treatment, subjects were imaged with fMRI while being exposed to recordings of the noise from the same dental instrument so that cerebral cortical stimulation in response to aversive auditory stimulation could be observed. The independent sample confirmatory t-test was used. Subjects also showed stimulation in the amygdala and prefrontal cortex, indicating that the ultrasonic auditory stimuli elicited an unpleasant response in the subjects. Patients experienced unpleasant sensations caused by contact stimuli in the treatment procedure. In addition, this study has demonstrated that aversive auditory stimuli such as sounds from the ultrasonic scaling handpiece also cause aversive emotions. This study was indicated by observed stimulation of the auditory cortex as well as the amygdala, indicating that noise from the ultrasonic scaling handpiece was perceived as an aversive auditory stimulus by the subjects. Subjects can experience unpleasant sensations caused by the sounds from the ultrasonic scaling handpiece based on their auditory stimuli.