Zirconia crowns--an esthetic and resistant restorative alternative for ECC affected primary teeth.

The present report discusses briefly the problem of ECC in very young children and the recommended approaches for prevention and treatment. The esthetic restoration of the maxillary incisors with Zirconia Nu Smile crowns is described. It is also stressed that the luxation injury two months after placement did not damage the appearance nor the stability of the crowns.

Oral health status of a population with multiple sclerosis.

OBJECTIVE: To determine the oral treatment needs of a sample of patients diagnosed with multiple sclerosis in the Community of Madrid (Spain). PATIENTS AND METHODS: A cross-sectional epidemiological study was carried out with a sample of 64 patients who were aged 25 to 77 years. They were distributed into homogeneous age groups: < 46 years, 46-54 years and > 54 years. In order to evaluate the oral health status and treatment requirements, the parameters and guidelines of the WHO were used. RESULTS: The prevalence of caries was 100%, or very close in all three groups. As age increased, the morbidity rate decreased, but the mortality rate increased considerably. On analyzing gingival health, 65% of patients had calculus, 5% bleeding and 30% were healthy. CONCLUSIONS: The DMFT index found provided data that was, in general, very similar to that of the general population in Spain. However, the gingival health status found demonstrated that the population of multiple sclerosis patients requires specific assistance.

Ethics of medical care for body packers (drug smugglers): untangling a web of fears and conflicts of interest.

Body packing by drug smugglers--the transport of illicit drugs in packets swallowed or inserted into body cavities--is a global phenomenon and is becoming more prevalent. The medical care of these patients raises difficult medical and ethical problems. While the medical aspects of treating body packers have been systematically analysed, the ethical issues have received little attention in the literature. The patient may be under police custody or being sought by their criminal patron which may result in imposed interrogations and risky medical procedures. Obtaining informed valid consent for procedures from the patient-detainee may thus be compromised. In addition, physicians may be intimidated by the patient's criminal contacts. This article analyses the conflicts of interest that doctors may face when treating body packers, and proposes some principles to promote institutional guidelines for the treatment of these patients.

Characteristics of dental arches and occlusion in children born prematurely. A case-control study.

AIM: To determine if there are differences between the dental arch dimensions and occlusal characteristics of children born prematurely and admitted into a Neonatal Intensive Care Unit (NICU) (study group) and children born at term (control group). The study group was analysed at the same time in order to find out if the parameters of the dental arches are related to specific perinatal variables. MATERIALS: Study design: Out of a total of 504 children born between 2011 and 2014 in high-risk conditions at the clinic of the University Hospital "San Cecilio" in Granada (Spain), 78 children were selected. Of these 42 had been born prematurely and admitted to the NICU (study group) and 36 had been born at term (control group). The age of the sample was 5 to 8 years. The parameters of the dental arches, together with the occlusal characteristics, were examined using dental casts. Both the upper and lower arches were measured for a total of 156 dental casts with a FINO digital caliper. CONCLUSION: The data confirm the smaller size of the dental arch dimensions of children born prematurely and admitted to a NICU compared with children born at term. This fact should be taken into consideration with regard to future orthodontic and paediatric dentistry treatments.

The internist as clinical ethics consultant: An antidote to "the barbarism of specialisation" in hospital practice. / El internista como consultor de ética clínica: un antídoto contra «la barbarie del especialismo¼ en la práctica hospitalaria.

The development of hospital clinical ethics in Spain depends almost exclusively on the healthcare ethics committees, which have been criticized for a lack of proximity to the patient's bedside in day-to-day ethical conflicts and for their scarce practical operation, reflected in the low number of consultations they receive. In this study, we reflect on the need to change the current healthcare model in clinical ethics so as to reactivate it and call attention to the essential role of internists as the engine for this change. To this end, we propose a model in which the healthcare ethics committees incorporate ethics consultants, who are better positioned to discuss cases at the patient's bedside. We then analyse the characteristics that these consultants should have.

[Evaluation and improvement of the management of informed consent in the emergency department]. / Evaluación y mejora del manejo del consentimiento informado en urgencias.

OBJECTIVE: To assess the preoperative management in our emergency surgical service and to improve the quality of the care provided to patients. MATERIAL AND METHODS: In order to find the causes of non-compliance, the Ishikawa Fishbone diagram was used and eight assessment criteria were chosen. The first assessment includes 120 patients operated on from January to April 2007. Corrective measures were implemented, which consisted of meetings and conferences with doctors and nurses, insisting on the importance of the informed consent as a legal document which must be signed by patients, and the obligation of giving a copy to patients or relatives. The second assessment includes the period from July to October 2007 (n=120). RESULTS: We observed a high non-compliance of C1 signing of surgical consent (CRITERION 1: all patients or relatives have to sign the surgical informed consent for the operation to be performed [27.5%]) and C2 giving a copy of the surgical consent (CRITERION 2: all patients or relatives must have received a copy of the surgical informed consent for the Surgery to be performed [72.5%]) and C4 anaesthetic consent copy (CRITERION 4: all patients or relatives must have received a copy of the Anaesthesia informed consent corresponding to the operation performed [90%]). After implementing corrective measures a significant improvement was observed in the compliance of C2 and C4. In C1 there was an improvement without statistical significance. CONCLUSIONS: The carrying out of an improvement cycle enabled the main objective of this paper to be achieved: to improve the management of informed consent and the quality of the care and information provided to our patients.

El internista como consultor de ética clínica: un antídoto contra "la barbarie delespecialismo" en la práctica hospitalaria / The internist as clinical ethics consultant: An antidote to "the barbarism of specialization" in hospital practice

El desarrollo de la ética clínica hospitalaria en España depende casi exclusivamente de los comités de ética asistencial. Estos han sido criticados por su falta de cercanía a la cabecera del paciente en los conflictos éticos cotidianos y por su escasa operatividad práctica, que se refleja en el escaso número de consultas que reciben. En el presente trabajo reflexionamos sobre la necesidad de modificar el modelo actual de atención en ética clínica para reactivarlo y llamar la atención sobre el papel primordial del internista como motor de dicho cambio. Para ello proponemos un modelo en que los comités de ética asistencial incorporen consultores de ética, mejor posicionados para la discusión de casos a la cabecera del enfermo. Seguidamente analizamos las características que dichos consultores deberían poseer

The development of hospital clinical ethics in Spain depends almost exclusively on the healthcare ethics committees, which have been criticized for a lack of proximity to the patient's bedside in day-to-day ethical conflicts and for their scarce practical operation, reflected in the low number of consultations they receive. In this study, we reflect on the need to change the current healthcare model in clinical ethics so as to reactivate it and call attention to the essential role of internists as the engine for this change. To this end, we propose a model in which the healthcare ethics committees incorporate ethics consultants, who are better positioned to discuss cases at the patient's bedside. We then analyse the characteristics that these consultants should have

Paying donors and the ethics of blood supply.

Countries may be erring in the current trend towards relying entirely on volunteers to fulfil blood and plasma needs. Complementing uncompensated blood with compensated blood is vitally necessary not only effectively to meet the blood and plasma needs of most countries, but it is also ethically sound.

[When to start orthodontic treatment]. / Cuándo comenzar un tratamiento de ortodoncia.

We are frequently ashed by patient and dentist what the best age is to begin orthodontic treatment. In this article we will try to classify what the best age to begin treatment is, according to the type of malocclusion.

[The pedodontist and dentinogenesis imperfecta]. / El odontopediatra ante la dentinogénesis imperfecta.

The purpose of this article is to present a treatment of dentinogenesis imperfecta in a 3 years old child. We reviewed some of the aspects to consider in the treatments of this alteration in primary dentition.

IgG antibody response to ES or somatic antigens of Dicrocoelium dendriticum (Trematoda) in experimentally infected sheep.

The ELISA technique was used to study the kinetics of IgG antibodies against excretory-secretory (ES) and somatic (So) antigens of Dicrocoelium dendriticum in the sera of 32 lambs: 12 experimentally infected with 1,000 metacercariae, 12 with 3,000 and 8 controls. Both antigen types were used at a 2 microg/ml concentration. Dilutions of sera and the anti-sheep IgG peroxidase conjugate were: 1:200 and 1:6,000, respectively. Optical density values for each type of antigen in the two infected groups were higher than the cut-off point from day 30 post infection (p.i.), showing positive infection. Maximum antibody levels were observed 60 days p.i. and remained high until the experiment ended 180 days p.i. This pattern was similar for both ES and So antigens, although with slightly lower figures in the latter. Antibody kinetics were very similar for each of the two doses, except on day 30 p.i. No correlation between the antibody level and parasite burden could be established.

Segundo cáncer en pacientes pediátricos / Second cancer in pediatric patients

Se revisa la casuística de un servicio de oncología pediátrica desde 1968 a 1987. En este período se atendieron 1.580 pacientes, 7 de los cuales sufrieron un segundo cáncer (SC). Se incluye un octavo caso, cuyo primer cáncer fue atendido en otro hospital. Los diagnósticos iniciales fueron: meduloblastoma, neuroblastoma,tumor de Wilms, retinoblastoma, sarcoma de Ewing, enfermedad de Hodgkin y dos leucemias linfoblásticas agudas. El tratamiento fue cirugía en 5/8, quimioterapia en 7/8 y radioterapia en todos. La latencia entre el primero y el segundo cáncer fue de 3,5 a 12 años (mediana 8,5 años). Los SC fueron osteosarcoma en 5 casos, rabdomiorsacoma en uno, linfoma no Hodgkin en uno y astrocitoma en otro paciente. En 6/8 casos se ubicaron en la zona irradiada. Os otros dos SC fueron un osteosarcoma de extremidades, después de un retinoblastoma bilateral y un linfoma diagnosticado 9 años después de una leucemia en remisión. Solo 3/8 pacientes con SC aún sobreviven, cumpliendo entre 14 y 34 meses de observación. Los beneficios de las terapias de los pacientes oncológicos sobrepasan en gran medida al riesgo de un segundo cáncer

Las anomalías del esmalte dentario y su relación con enfermedades generales / Dental anomalies and its relationship with systemic diseases

El esmalte dentario es uno de los tejidos más duros del organismo, sin embargo las células formadoras del esmalte, los ameloblastos, son muy sensibles a los cambios que ocurren durante el periodo de formación del diente. Son muchas las patologías que pueden alterar el funcionamiento del ameloblasto provocando lesiones de hipoplasia o hipomineralización, y a diferencia de lo que ocurre en otros tejidos, el esmalte dentario carece de mecanismos de reparación. En este artículo, revisamos las principales causas genéticas y ambientales que pueden ser responsables de las anomalías en esmalte dentario, así como el aspecto clínico que pueden presentar estas anomalías

Dental enamel is one of the hardest tissues in thehuman body. However, ameloblast cels wich compraisthe enamel, are extremely sensitive to the changes occurring during dental development. There are many pathologys that can alter the normal function in ameloblast cels and cause hypoplasia orhypomineralization. In contrast to other tissue enamel tissue does not have its own repair mechanisms. In this article we review the principal genetic andenvirolmental causes that may contribute to dental anomalies as well as the clinical aspect of these anomalies

La alergia al látex en la consulta dental / Latex allergy in the dentist office

Las reacciones alérgicas al látex se han incrementado en las dos últimas décadas y este problema afecta tanto a los pacientes como al personal sanitario. Por un lado, la profesión dental se incluye dentro de los grupos de riesgo para desarrollar la alergia al látex y por otro lado, el paciente alérgico puede acudir a la consulta para tratamiento dental.1,2Entre los factores que han contribuido al aumento de esta patología está el incremento en la utilización de los productos fabricados con látex, sobre todo desde la aparición de enfermedades como el SIDA (a mayor exposición hay mayor riesgo de desarrollar una alergia); Por otro lado, este aumento de la demanda ha provocado un incremento en la producción de látex y en la elaboración de productos derivados, con un deterioro en la calidad. Otro factor que probablemente haya contribuido al aumento de la frecuencia es un mejor diagnóstico de los casos. El objetivo de este artículo es revisar los aspectos más relevantes de la alergia al látex y sugerir un protocolo para el tratamiento de los pacientes alérgicos (AU)

Allergic reactions to latex have been increasing in the two last decades and this problem affects patients as well as sanitary personnel. On the one hand, the dental profession is one of the risk groups subjected to develop allergy to latex and on the other hand, patients allergic to latex visit the dentist office for treatment.1,2Included in the causes that have contributed to the augment of this pathology is the increase in the use of products made with latex, specially since the emergence of diseases as AIDS (with greater expose there is greater risk of developing allergy); On the other hand, this increase of the demand has caused an increase in the production of latex and of products of low quality that derived from latex. Another factor that probably has contributed to the increase in the numbers of allergy cases is a better diagnosis of this pathology. The objective of this article is to review the most important aspects about latex allergy and suggest a procedure for the treatment of the allergic patients (AU)