Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 1 / Post-endodontic restoration and social condition as afactor of tooth preservation. part 1

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos, compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia del Círculo Odontológico de Córdoba y al servicio de la Cátedra“B” de Endodoncia de la Facultad de Odontología de la Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. Sólo asistieron a control el 48,6 por ciento de los pacientes, de los cuales se evaluaron 89 dientes. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sinrestauración, 21 con fracturas y 1 se perdió. Se observó un incremento de fracturas en control a los 18 meses. La tasa de fracturas evidenció un mayor porcentaje en pacientes con nivel de estudio alto, menor en pacientes sin trabajo, y mayor en pacientes con trabajo estable y precario. El tipo de atención no se diferenció, pero los porcentajes observados sugieren que los atendidos en asistencia pública tendrían más probabilidad de fracturas. Se observó un mayor porcentaje de restauraciones definitivas enatención privada y menor en consultorios públicos. El elevado porcentaje de inasistencia a controlesmotivó un análisis específico, del cual se pudo concluir que a mayor estabilidad laboral, de estudios yde asistencia privada, mayor fue la asistencia a controles. Estos datos revelan información importantepara establecer políticas públicas de la atención posendodoncia.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, level of study, employment status and access to dental services.To do so, we analyzed a population composed of subjects who participated in two different graduate courses at the Círculo Odontológico de Córdoba and the “Chair B” of Endodontics of the Faculty ofDentistry, National University of Córdoba. Treatments were clinically and radiographically controlled for eighteen months. The total sample included 144 patients and 174 treatments. Only 48.6% patients attended the control, 89 teeth of whom were evaluated. The study showed 37 cases with definitivecoronary restoration without fractures, 52 teeth without restoration, 21 with fractures, and 1 was lost.The fracture rate showed an increase in patients with high level of study, a decrease in unemployed patients, and an increase in both patients with stable and precarious work. The kind of attention didnot differ, but the observed percentages suggest that patients treated in public services would be morelikely to suffer from fractures. There was a higher percentage of definitive restorations in private services,and lower in public ones. The high percentage of non-attendance to controls motivated a specific analysis, from which it is possible to conclude that the more job stability, studies and private access todental services, the more the attendance to controls. These data reveal important evidence in order to establish public policies of post-endodontic services.

Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 2 / Post-endodontic restoration and social condition asa factor of tooth preservation. Part 2

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, estado periodontal, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia, del Círculo Odontológico de Córdoba, y al servicio de la Cátedra “B” de Endodoncia de la Facultad de Odontología, Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sin restauración, 21 con fracturas y 1 se perdió. De los dientes restaurados, el55,6 por ciento mostraron periodonto normal; 22,2 por ciento gingivitis, y 22 por ciento periodontitis leve. De los dientes sin restauración, el 3,9 por ciento mostraron periodonto normal; 7,8 por ciento gingivitis; 31,4 por ciento periodontitis leve; 35,3 por ciento periodontitis grave y 21,6 por ciento periodontitis complicada. De los dientes fracturados, el 16,7 por ciento mostraron periodonto normal o gingivitis; 35,3 por ciento periodontitis leve y grave, y un 72,7 por ciento periodontitis complicada. No se demostró asociación entre nivel de estudios, condición laboral y tipo de atención con fracturas de los pacientes, pero los porcentajes sugieren más probabilidad de sufrir fractura en los pacientes de la asistencia pública. El elevado porcentaje de inasistencia a control motivó un análisis específico, del cual se pudo concluir que cuanto más grave la patología periodontal, mayor el porcentaje de inasistencia. El estudio permitió observar desigualdad en el acceso a los servicios odontológicos, dientes no rehabilitados y con compromiso periodontal.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, periodontic condition, level of study, employment status and access to dental services. A population composed of patients treated in two different postgraduate courses at the Círculo Odontológico de Córdoba and Chair “B” of Endodontics, Faculty of Dentistry,National University of Córdoba were analyzed. Treatments were clinically and radiographicallycontrolled for eighteen months. The total sample included 144 patients and 174 treatments. The studyshowed 37 cases with definitive coronary restoration without fractures, 52 teeth without restoration,21 with fractures, and 1 was lost. From restored teeth, 55.6% showed normal periodontium, 22.2%gingivitis, and 22% mild periodontitis. From teeth without restoration, 3.9% showed normalperiodontitis, 7.8% gingivitis, 31.4% mild periodontitis, 35.3% severe periodontitis and 21.6%complicated periodontitis. From fractured teeth, 16.7% showed normal periodontitis or gingivitis, 35.3% had mild and severe periodontitis, and 72.7% had complicated periodontitis. There has beenno correlation between level of education, work status, and kind of service on patient with fractures,but the percentage suggest that patients in public assistance are more likely to suffer fracture. The highpercentage of non-attendance to control led to a specific analysis, from which it is possible to concludedthat the more severe the periodontal disease, the greater the percentage of non-attendance. The study showed inequality in access to dental services, un rehabilitated teeth and with periodontal compromise.

Impacto da saúde bucal na qualidade de vida do idoso / The impact of Oral Health related quality of life in elderly / Impacto de la salud bucal en la calidad de la vida de los ancianos

A preocupação com a qualidade de vida na terceira idade é relevante. Perdas dentárias podem ter efeitos significativos na saúde e na vida dos indivíduos, pois afetam a capacidade mastigatória, restringem o consumo de diversos alimentos, dificultam a fonação, além de causar danos estéticos. O objetivo desta revisão da literatura é discutir as alterações na qualidade de vida do paciente idoso, incluindo os efeitos psicológicos, a percepção dos idosos sobre saúde bucal, e o reflexo emocional.

Concern about quality of life in the elderly individuals is relevant. Dental loss cause significant effects on subjects health and life because it affects the chewing capacity, restricts some food consumption, phonation difficult and cause aesthetic damage. The aim of this literature review is discuss the changes in elderly patient quality of life, Including psychological effects, the perception of the elderly on oral health and the emotional reflex.

Una preocupación por la calidad de la vida en la tercera edad es relevante. Perdas dentarias pueden tener efectos significativos en la salud y en la vida de los individuos, para la determinación de la capacidad, la restricción o el consumo de diversos alimentos, la dificultad de fonación y el daño causado por los factores estéticos. El objetivo de la revisión de la literatura es discutir como los cambios en la calidad de la vida del paciente, incluyendo los efectos psicológicos, la percepción de los ancianos sobre salud bucal y el reflejo emocional.

Perda dentária em uma população rural e as metas estabelecidas pela Organização Mundial de Saúde / Dental loss in a rural population and the goals established for the World Health Organization

Este estudo teve como objetivo relatar a perda dentária em uma população rural, avaliando a contribuição de variáveis socioeconômicas e comportamentais e comparando os resultados com as metas da Organização Mundial da Saúde (OMS) para 2000 e 2010. Foram examinados 473 moradores, utilizando a metodologia, códigos e critérios propostos pela OMS. Os resultados foram processados no programa Epibuco e o teste qui-quadrado (p<0.05) foi utilizado para comparar o número de dentes perdidos com as variáveis estudadas. Do total de examinados, 17,8 por cento são edêntulos totais, assim como 8 por cento e 50,9 por cento dos examinados pertencentes aos grupos etários de 35 a 44 e 65 a 74 anos, respectivamente. Iniciando precocemente nesta população, a perda dentária avançou consideravelmente com a idade, estando a situação muito aquém das metas estabelecidas pela OMS para 2010. O teste qui-quadrado revelou diferenças estatisticamente significantes quanto ao número de dentes perdidos pelos entrevistados com 35 anos de idade ou mais em relação à escolaridade, tipo de moradia e autopercepção da qualidade da fala. Torna-se necessário o desenvolvimento de programas de atenção à saúde bucal, a fim de diminuir os danos causados e prevenir a continuidade da tendência à mutilação.

This study aimed to report the dental loss in a rural population, evaluating the contribution of socioeconomic and behavioral variables and comparing the results with the goals of the World Health Organization (WHO) for 2000 and 2010. A total of 473 residents had been examined using the methodology, codes and criteria according to WHO guidelines. The results were processed using the Epibuco program and the chi-square test (p<0.05) were used to compare the number of teeth lost with the variables studied. From the total of people examined, 17.8 percent were total edentulous as well as 8 percent and 50.9 percent of the examined of the age groups of 35 to 44 and 65 to 74 years-old, respectively. Initiating precociously in his population, the dental loss advanced considerably with the age, being the situation much distant of the goals established by WHO for 2010. Chi-square test revealed statistically significant differences among the number of teeth lost by the interviewed with 35 years-old or more in relation to education level, housing and self-perception of the speak quality. The development of oral health attention programs becomes necessary, in order to reduce the actual damages and to prevent the continuity of this trend of mutilation.

Tooth loss in individuals under periodontal maintenance therapy: prospective study

This prospective study aimed to evaluate the incidence, the underlying reasons, and the influence of predictors of risk for the occurrence of tooth loss (TL) in a program of Periodontal Maintenance Therapy (PMT). The sample was composed of 150 complier individuals diagnosed with chronic moderate-severe periodontitis who had finished active periodontal treatment and were incorporated in a program of PMT. Social, demographic, behavioral and biological variables were collected at quarterly recalls, over a 12-month period. The effect of predictors of risk of and confounding for the dependent variable TL was tested by univariate and multivariate analysis, as well as the underlying reasons and the types of teeth lost. During the monitoring period, there was a considerable improvement in periodontal clinical parameters, with a stability of periodontal status in the majority of individuals. Twenty-eight subjects (18.66 percent) had TL, totaling 47 lost teeth (1.4 percent). The underlying reasons for TL were: periodontal disease (n = 34, 72.3 percent), caries (n = 3, 6.4 percent), prosthetic reasons (n = 9, 19.2 percent), and endodontic reasons (n = 1, 2.1 percent). Additionally, subjects with 10 percent of sites with probing depth between 4 and 6 mm were 5 times more likely to present TL (OR = 5.13, 95 percent CI 2.04-12.09). In this study, the incidence of TL was small and limited to few individuals. Additionally, gender and severity of periodontitis were significantly associated with TL during the monitoring period.

Fatores associados à presença de dentes em adultos de São Paulo, Brasil / Factors associated with maintenance of teeth in adults in the State of São Paulo, Brazil

O objetivo deste trabalho foi verificar a associação entre ter vinte ou mais dentes e variáveis sócio-demográficas, econômicas, de uso de serviços odontológicos e de autopercepção de saúde bucal. Este trabalho foi um estudo transversal em adultos de 35 a 44 anos, em cidades representativas do Estado de São Paulo, Brasil. Além do exame, os pesquisados responderam a uma entrevista. Foram examinados 1.612 adultos. A análise dos dados se restringiu aos indivíduos dentados, divididos em dois grupos (1-19 dentes e 20 ou mais dentes). Foi usado o teste qui-quadrado e regressão logística (p < 0,05). A maioria (72,1 por cento) apresentou mais de vinte dentes. Verificou-se que a menor escolaridade apresentou forte associação com a maior falta de elementos dentários; além disso, o fato de ser mulher, ter mais idade, morar na região rural, ter cinco pessoas ou mais residindo na mesma casa, ter renda familiar baixa, buscar atendimento em rede pública e ir ao dentista motivado por dor foram diretamente relacionados com mais dentes ausentes.

This cross-sectional study investigated the association between the presence of 20 or more teeth and sociodemographic and economic variables, use of dental care, and self-perceived oral health in adults. The sample consisted of 1,612 individuals aged 35 to 44 years, representative of the State of São Paulo, Brazil. In addition to the dental examination, subjects answered a questionnaire. Analysis in this study was limited to dentate individuals, divided into two groups (1 to 19 versus 20 or more teeth). The chi-square test and logistic regression were used (p < 0.05). Most individuals (72.1 percent) had more than 20 teeth. Less schooling was heavily associated with tooth loss, as were female gender, older age, rural residence, 5 or more people in the same household, low income, seeking treatment in the public health system, and seeking care due to toothache.

The impact of restorative treatment on tooth loss prevention

A cross-sectional study was carried out to analyze tooth loss resulting from caries in relation to the number of times the extracted tooth had been restored, the type of caries diagnosed (primary or secondary), and socioeconomic indicators of patients from the city of Recife, Brazil. Ten public health centres and ten centres associated with health insurance companies were randomly selected. The size of the sample was calculated using a standard error of 2.5 percent. A confidence interval of 95 percent and a 50 percent prevalence of reasons for extractions were used for calculating the sample. The minimum size of the sample for meeting these requirements was 381 patients. Patients were randomly selected from the list of adults registered at each centre. A total of 410 patients were invited to take part in the study. The response rate was 100 percent, but 6 patients were excluded due to incompleteness of data in the questionnaire applied. An assessment was made to obtain the number of decayed, missing or filled teeth (DMFT index) and the reasons for extraction. The results showed a highly significant (p < 0.001) relationship between the number of times the tooth indicated for extraction had been restored and the reason for extraction being caries. Furthermore, the majority of teeth extracted due to caries had been restored two or more times. A highly statistically significant association was also observed between one indicator of use of dental services (F/DMFT) and extraction due to caries (p < 0.001). The findings questioned the belief that tooth loss can be prevented in the general population by merely providing restorative treatment