Evaluating conceptual model measurement and psychometric properties of Oral health-related quality of life instruments available for older adults: a systematic review.

BACKGROUND: Older adults present a variety of oral diseases and conditions, in addition to co-morbidities and limited access to dental care, which significantly impact their oral health-related quality of life (OHRQoL). There are many instruments published to measure OHRQoL. However, it is challenging for clinicians and researchers to choose the best instrument for a given purpose. PURPOSE: To identify OHRQoL instruments available for older adults and summarize the evidence on the conceptual and measurement model, psychometric properties, interpretability, and administration issues of OHRQoL instruments available for older adults through a systematic review. METHODS: A systematic search was conducted in MEDLINE, EMBASE, LILACS, and CENTRAL up to February 2023. Articles reporting information on the concept model measurement, psychometric properties, and administration issues of an instrument measuring OHRQoL in older adults were included. Two researchers independently evaluated each instrument using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The overall score and seven attribute-specific scores were calculated (range 0-100): Conceptual and measurement model, Reliability, Validity, Responsiveness, Interpretability, Burden, and Alternative forms. RESULTS: We identified 14 instruments evaluated in 97 articles. The overall score varied between 73.7 and 8.9, with only six questionnaires over the threshold score 50.0. EORTC QLQ OH-15 (cancer-specific questionnaire) achieved the highest score (73.7), followed by OHIP (generic OHRQoL questionnaire) (66.9), GOHAI (generic OHRQoL questionnaire) (65.5), and OHIDL (generic OHRQoL questionnaire) (65.2). Overall, the Conceptual and measurement model and Validity showed the best performance, while Responsiveness and Interpretability showed the worst. Insufficient information was presented for an overall evaluation of DSQ and OHAI. CONCLUSION: The evidence supports using EORTC QLQ-OH15 as a specific instrument to assess OHRQoL in cancer patients and the OHIP-49, GOHAI, or OHIDL as generic instruments to assess OHRQoL either for cross-sectional or longitudinal studies in older adults.

Intercultural sensitivity in Chilean healthcare profession students.

Each culture has unique health care related values, habits, perceptions, expectations, norms, etc., that makes cultural competence an important attribute to be developed by healthcare professionals, to ensure they provide effective treatment. Intercultural sensitivity (IS) is the affective dimension of cultural competence. The objective of this study is to explore the self-perceived level of IS in first and last year students of three health sciences professions (i.e., Dentistry, Medicine, and Nursing) at the Universidad de la Frontera, Temuco, Chile. This study adopted a cross-sectional design and a group comparison (e.g., year of study). 312 students completed the Intercultural Sensitivity Scale (ISS). Findings showed that overall ISS scores ranged from 1.83 to 4.94, with a mean score of 4.11 (s.d. 0.43). Group comparison between first and final year students showed statistically significant differences (4.18 vs. 4.00; p < 0.001). Medical and nursing students had a significantly higher overall mean IS score compared to dental students (4.21 and 4.16, respectively vs. 4.02; p < 0.01). There were also significant differences between three factors (interaction engagement; interaction confidence; and interaction enjoyment) by healthcare profession. These findings allow for discussion of the need for explicit incorporation and development of cultural competence in on health care professional curricula. Longitudinal research is needed to explore how IS changes over time, along with generating qualitative data from the student populations IS experiences and exposure.

Emergency and sequalae management of traumatic dental injuries: a systematic survey of clinical practice guidelines.

BACKGROUND: The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI clinical practice guidelines (CPGs) assist clinicians in determining a diagnosis and guide them to the most appropriate therapy. The aim of this systematic survey was to identify and evaluate the quality of CPGs for the diagnosis, emergency management, and follow-up of TDIs. MATERIALS AND METHODS: A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. ANOVA or Student's t-tests were used to determine the attributes of CPGs associated with the total score in AGREE II. RESULTS: Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n = 6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores (the higher the score, the better the domain assessment) per domain were as follows: Scope and purpose 78.0 ± 18.9%; stakeholder involvement 46.9 ± 29.6%; rigour of development 41.8 ± 26.7%; clarity of presentation 75.8 ± 17.6%; applicability 15.3 ± 18.8%; and editorial independence 41.7 ± 41.7%. The overall mean rate was 4 ± 1.3 out of a maximum score of 7. Two guidelines were recommended by the reviewers for use in practice and rated as high quality. CPGs developed by government organizations showed a significantly higher overall score. CONCLUSIONS: The overall quality of CPGs on TDI was suboptimal. CPG developers should synthesize the evidence and formulate recommendations using high-quality methodologies and standards in a structured, transparent, and explicit way.

Cultural Competence in the nursing, dentistry, and medicine professional curricula: a qualitative review.

BACKGROUND: Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs. METHOD: A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula. RESULTS: Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses. Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline. CONCLUSION: Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching-learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients' cultural characteristics and needs.

Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis.

OBJECTIVES: The aim of this study was to conduct a systematic review in order to assess the impact of early childhood caries (ECC) and its severity on Oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: An electronic search was conducted in MEDLINE, EMBASE, Cochrane, SciELO and Lilacs databases. The study eligibility criteria were primary studies published in English, Spanish or Portuguese that assessed OHRQoL in preschool children with dental caries using validated instruments. Two researchers independently performed the selection process and data extraction. The Effective Public Health Practice Project's Quality Assessment Tool was used for the quality assessment. Random effects models were used to estimate the pooled effect for continuous and categorical data. RESULTS: Of 2,037 identified articles, thirty-five studies (37 articles) met the inclusion criteria. The methodological quality was judged mainly as moderate. Children with ECC were more likely to report any impact on OHRQoL than children without caries (OR: 1.99; 95% CI: 1.51-2.62; 6 studies). Severe ECC (dmft > 5) presented a higher effect (OR: 5.00; 95% CI: 3.70-6.74; 8 studies). Sensitivity analysis including only population studies showed uncertain results on the impact of ECC on OHRQoL (OR: 1.67; 95% CI: 0.99-2.82; I2  = 95%). The symptom and psychological domains were the most affected (SMD: 0.60, 95% CI: 0.38-0.81 and SMD: 0.61, 95% CI: 0.37-0.85 respectively). CONCLUSIONS: ECC has a negative impact on the OHRQoL of both preschoolers and their families. However, its impact on OHRQoL is diluted when it is evaluated at population level.

QUALITY APPRAISAL OF CLINICAL PRACTICE GUIDELINES ON PROVISION OF DENTAL SERVICES DURING THE FIRST MONTHS OF THE COVID-19 PANDEMIC.

OBJECTIVES: To evaluate the quality of clinical practice guidelines (CPGs) on dental services provision during the first months of the COVID-19 pandemic. MATERIALS AND METHODS: We systematically searched in MEDLINE, EMBASE, LILACS, Epistemonikos, Trip databases, websites of CPG developers, compilers of CPGs, scientific societies and ministries of health to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. Reviewers independently and in duplicate assessed the included CPGs using the AGREE II instrument. We calculated the standardized scores for the 6 domains and made a final recommendation about each CPG. The inter-appraiser agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS: Twenty-three CPGs published were included. Most of the CPGs were from America (n = 15) and Europe (n = 6). The overall agreement between reviewers was very good (ICC = 0.93; 95%CI 0.87-0.95). The median score for each domain was the following: Scope and purpose 67% (IQR 20%); Stakeholder involvement 33% (IQR 14%); Rigour of development 13% (IQR 13%); Clarity of presentation 64% (IQR 31%); Applicability 19% (IQR 17%) and Editorial independence 8% (IQR 8%). Twenty two guidelines were not recommended by the reviewers. Only one of the CPGs was recommended with modifications. The median overall rate was 3 (IQR 1). All CPGs were classified as low quality. CONCLUSIONS: The overall quality of CPGs on dental services provision during the first months of the COVID-19 pandemic was low, which makes its implementation difficult for clinicians and policy makers. Therefore, it is critical that developers are transparent and forthcoming about the difficulties that have arisen during the CPG development process.

Adaptation and validation of the PEDSQL™ oral health scale for toddlers in Chilean population.

BACKGROUND: The Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale was developed to measure oral health-related quality of life (OHRQoL). The aim of this study was to cross-culturally adapt the parent-reported version for toddlers of PedsQL™ Oral Health Scale into Spanish and to assess the acceptability, reliability and validity of this version in Chilean preschool population. METHODS: The PedsQL™ Oral Health Scale for toddlers was cross-culturally adapted for the Spanish language using the recommended standards. To assess metric properties, a cross-sectional study was carried out with 301 children aged 2 to 5 years in Carahue, Chile. Chilean versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, and Early Childhood Oral Health Impact Scale (ECOHIS) were completed by the children's parents. Dental caries, malocclusion and dental trauma were examined by trained dentists. The PedsQL™ Oral Health Scale was administrated a second time 14-21 days after. The reliability of the scale was verified by analysis of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). The validity of the construct was assessed by confirmatory factor analysis and known groups method. The convergent validity was assessed by calculating the Spearman's correlation with the ECOHIS questionnaire. RESULTS: The PedsQL™ Oral Health Scale demonstrated good reliability, with Cronbach's alpha coefficient of 0.79 and ICC of 0.85. A moderate-to-strong correlation was found between the PedsQL™ Oral Health Scale and the ECOHIS questionnaire (- 0.64); the PedsQL™ Oral Health Scale score was lower in children with poor than those with excellent/very good oral health (median 100 vs 85, p < 0.001); it also was lower in children with caries than in those caries-free (median 100 vs 90, p < 0.001). No statistically significant differences were found among groups according to malocclusion and traumatic dental injuries. CONCLUSIONS: The PedsQL™ Oral Health Scale for toddlers in Spanish showed to be equivalent to the original version, and its psychometric properties were satisfactory for application in a Chilean pre-school population.

Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments.

OBJECTIVES: To obtain a systematic and standardized evaluation of the current evidence on development process, metric properties, and administration issues of oral health-related quality of life instruments available for children and adolescents. MATERIALS AND METHODS: A systematic search until October 2016 was conducted in PubMed, Embase, Lilacs, SciELO, and Cochrane databases. Articles with information regarding the development process, metric properties, and administration issues of pediatric instruments measuring oral health-related quality of life were eligible for inclusion. Two researchers independently evaluated each instrument applying the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0-100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden, and alternative forms. RESULTS: We identified 18 instruments evaluated in 132 articles. From five instruments designed for preschoolers, the Early Childhood Oral Health Impact Scale (ECOHIS) obtained the highest overall EMPRO score (82.2). Of nine identified for schoolchildren and adolescents, the best rated instrument was the Child Perceptions Questionnaire 11-14 (82.1). Among the four instruments developed for any age, the Family Impact Scale (FIS) obtained the highest scores (80.3). CONCLUSION: The evidence supports the use of the ECOHIS for preschoolers, while the age is a key factor when choosing among the four recommended instruments for schoolchildren and adolescents. Instruments for specific conditions, symptoms, or treatments need further research on metric properties. CLINICAL RELEVANCE: Our results facilitate decision-making on the correct oral health-related quality of life instrument selection for any certain study purpose and population during the childhood and adolescence life cycle.

Validation and usability of a mobile phone application for epidemiological surveillance of traumatic dental injuries.

BACKGROUND/AIM: Traumatic dental injuries (TDI) are a public health problem, given their prevalence and consequences. However, their epidemiology is uncertain due to a general lack of quality data capture. The aim of this study was to evaluate the validity and usability of a mobile phone-based application for community-based surveillance of traumatic dental injuries. MATERIALS AND METHODS: A mobile phone-based application, Dental Trauma Tracker (DTT), was developed. This system involves a mobile application for general users to report TDIs and a Web application for researchers to generate epidemiological data. The DTT evaluation used mixed methods and was conducted in three phases: (a) validation of a trauma identification system using preselected TDI images; (b) design evaluation by experts; and (c) usability evaluation measured by the reporting of three fictitious TDI cases and using the System Usability Scale (SUS). RESULTS: In the first phase, 182 participants participated. Most images showed over 95% accuracy, indicating that they adequately represented the type of dentoalveolar trauma being evaluated (κ = 0.75). The design evaluation identified nine usability problems-four of them with a "High priority" to be fixed, four with "Low priority," and one "No fix necessary." A total of 29 volunteers participated in the usability evaluation. The mean time for users to complete all of the reports was 7.8 ± 3.0 minutes. Mean SUS score was 67.4 ± 21.9 (Range: 0-100; worst to best). The global agreement between cases registered with the gold standard was also "Substantial" (κ = 0.71). CONCLUSIONS: This preliminary evaluation confirmed the App's usability, using a sample of potential users, as well as reporting on the results of an expert panel review of the DTT. These are the minimum requirements necessary before further expansion and widespread implementation occurs to confirm these results.

The cost-utility of school-based first permanent molar sealants programs: a Markov model.

BACKGROUND: Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention. METHODS: A cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer's perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out. RESULTS: After a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The "seal all" strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the "seal all" strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR. CONCLUSIONS: A school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.

Cross-cultural adaptation and psychometric evaluation of the early childhood oral health impact scale (ECOHIS) in chilean population.

BACKGROUND: The Early Childhood Oral Health Impact Scale (ECOHIS) measures the impact of dental diseases on Oral Health-Related Quality of Life both in children and their families. The aim of this study was to develop a Chilean Spanish version of the ECOHIS that is conceptually equivalent to the original and to assess its acceptability, reliability and validity in the preschool population of Chile. METHODS: The Chilean version of the ECOHIS was obtained through a process including forward and back-translation, expert panel, and cognitive debriefing interviews. To assess metric properties, a cross-sectional study was carried out in Carahue, Southern Chile (April-October 2016). Children younger than six years old without systemic diseases, disabilities or chronic medication from eleven public preschools were included. Parents were invited to complete the Chilean version of the ECOHIS, PedsQL™4.0 Generic Core and PedsQL Oral Health scales, and to answer global questions about their children's general and oral health. A subsample was administrated ECOHIS a second time 14-21 days after. A clinical examination was performed to assess dental caries, malocclusion, and traumatic dental injuries. Reliability was evaluated using measures of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). Construct validity was assessed by testing hypotheses based on available evidence about known groups and relationships between different instruments. RESULTS: The content comparison of the back-translation with the original ECOHIS showed that all items except one were conceptually and linguistically equivalent. The cognitive debriefing showed a suitable understanding of the Chilean version by the parents. In the total sample (n = 302), the ECOHIS total score median was 1 (IQR 6), floor effect was 41.6%, and ceiling effect 0%. Cronbach's alpha was 0.89 and the ICC was 0.84. The correlation between ECOHIS and PedsQL™4.0 Generic Core was weak (r = 0.21), while it was strong-moderate (r = 0.64) with the PedsQL Oral Health scale. In the known groups comparison, the ECOHIS total score was statistically higher in children with poor than excellent/very good oral health (median 11.6 vs 0, p < 0.01), and in the high severity than in the caries-free group (median 8 vs 0.5, p < 0.01). No differences were found according to malocclusion and traumatic dental injuries groups. CONCLUSIONS: These results supported the feasibility, reliability and validity of the Chilean version of ECOHIS questionnaire for preschool children through proxy.

Effectiveness of Nasoalveolar Molding in the Unilateral Cleft Lip and Cleft Palate.

BACKGROUND: Cleft lip and palate develops during embryogenesis due to an alteration in the fusion of the tissues which will form the upper lip and palate. The rate of occurrence in Chile is 1.6 per 1000 live births. The object of the present study was to determine the effectiveness of the Grayson nasoalveolar molding appliance in reducing the gap between the alveolar segments in cases of unilateral cleft lip and palate by sex, age at start of treatment, initial gap between the alveolar segments, and number of checkups. METHODS: The study design was quasi-experimental, with measurements taken before and after surgery and no control group. The authors studied the medical records and models of a sample of 52 patients with complete unilateral cleft lip and palate who were discharged after treatment using Grayson nasoalveolar molding appliance. Treatment was considered effective when the final gap was 3 mm or less. Then the percentage of cases in which treatment was effective, applying statistical tests, including log regression, to assess the influence of other variables was calculated. RESULTS: The authors observed that the Grayson nasoalveolar molding appliance was effective in 69.23% of patients. Of the variables studied, the initial gap presented statistically significant differences (initial gap of 8-12 mm, effectiveness 82.61%); in the log regression, the same variable presented a statistically significant difference in the adjusted odds of effectiveness. CONCLUSION: Grayson nasoalveolar molding appliance presents good effectiveness in reducing the gap between the alveolar segments in patients with unilateral cleft lip and palate, especially in cases with a gap of 8 to 12 mm.

An update on methods for detection of prognostic and predictive biomarkers in melanoma.

The approval of immunotherapy for stage II-IV melanoma has underscored the need for improved immune-based predictive and prognostic biomarkers. For resectable stage II-III patients, adjuvant immunotherapy has proven clinical benefit, yet many patients experience significant adverse events and may not require therapy. In the metastatic setting, single agent immunotherapy cures many patients but, in some cases, more intensive combination therapies against specific molecular targets are required. Therefore, the establishment of additional biomarkers to determine a patient's disease outcome (i.e., prognostic) or response to treatment (i.e., predictive) is of utmost importance. Multiple methods ranging from gene expression profiling of bulk tissue, to spatial transcriptomics of single cells and artificial intelligence-based image analysis have been utilized to better characterize the immune microenvironment in melanoma to provide novel predictive and prognostic biomarkers. In this review, we will highlight the different techniques currently under investigation for the detection of prognostic and predictive immune biomarkers in melanoma.

Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: A case study.

RATIONALE, AIMS AND OBJECTIVES: In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical. The guideline development process includes prioritization of the guideline topic, questions and health outcomes. This case study describes the application of a new methodology to prioritize questions and rate the importance of health outcomes for a COVID-19 dental guideline. METHODS: Panel members rated the topic and the questions' overall importance, using a 9-point scale (1 = least important; 9 = most important). In addition, they rated six criteria if multiple questions received the same overall importance rating: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. Panellists also rated the importance of each outcome, defined with health outcome descriptors, using a 9-point scale and the utility of health outcomes on a visual analogue scale. The correlation between each criterion and overall question importance was tested by Spearman correlation coefficient. RESULTS: Of seven topics, four were rated as high priority and three were rated as important, but not of high priority. Thirty-six percent of the questions (18/50) were rated as high priority to address in the guideline and 64% (32/50) were rated as an important question but not of high priority. Of the 11 outcomes, 72.7% were rated as critical for decision making. The mean utility rating was 0.57 (SD 0.32), with a minimum mean rating of 0.16 and a maximum of 0.76 (SD 0.23). CONCLUSION: This case study demonstrated that this approach provides a rigorous and transparent methodology to conduct the prioritizations of guideline topics, questions and health outcomes.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic.

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

Angle class II correction: stepwise mandibular advancement or bite jumping? : A systematic review and meta-analysis of skeletal, dental and condylar effects.

INTRODUCTION: There is no consensus regarding which mode of activation or mandibular advancement (stepwise [SW] or maximum bite-jumping [BJ]) of fixed or removable functional appliances (FFA; RFA) for correction of Angle class II malocclusion is advantageous to produce dental, skeletal or condylar effects and has the lowest rate of undesired dental or technical side-effects. METHODS: A systematic search was conducted up to Oct. 20, 2019 in the MEDLINE, EMBASE, Scopus, Central Cochrane Library, and BBO databases. Included were preadolescent, adolescent, and adult humans with initial (pretreatment) Angle class II malocclusion, without further restriction. The intervention group was composed of subjects treated with FFA or RFA in SW mandibular advancement; the control group received BJ advancement. Search terms included prospective randomized and nonrandomized trials in English, German, Spanish, and Portuguese with the primary outcomes of skeletal and dental class II correction, effects on condylar growth, lower incisor proclination, overjet and overbite reduction. The risk of bias (ROB) was assessed using the Cochrane Collaboration's ROB2 tool. Mean differences were calculated and pooled by a meta-analysis using a random effects model. RESULTS: Data from five randomized controlled trials (RCT) with 401 participants (mean age 13.84 years; SD 1.53) were included; 331 derived from four studies were included in the meta-analysis. The ROB in the selected articles was high. We detected a slightly increased reduction of the ANB (mean difference [MD] -0.95°, 95% confidence interval [CI] -1.80 to -0.10°; I2 = 72%) that may be attributed to a slightly more pronounced increase of the SNB angle in SW-advanced mandibles (MD 0.27°; 95% CI -0.47 to 1.00°; I2 = 38%). SW advancement tended to reduce the undesired side effect of lower incisor proclination (MD = -1.59°; 95% CI -3.98 to 0.8°; I2 = 0%), indicating more pronounced mandibular incisor changes with bite-jumping advancement. CONCLUSION: There is weak evidence indicating a slightly increased reduction of the ANB and less lower incisor proclination with SW advancement compared to BJ, but the clinical relevance is debatable due to the small overall magnitude and small number of high-quality papers. REGISTRATION: Prospero #CRD42017075469 (www.crd.york.ac.uk/prospero).

Cost-effectiveness of adding fluoride varnish to a preventive protocol for early childhood caries in rural children with no access to fluoridated drinking water.

OBJECTIVES: Evidence of the cost-effectiveness of fluoride varnish in the prevention of caries is not yet fully conclusive. The aim of this study was to assess the incremental cost-effectiveness ratio (ICER) of the community-wide application of fluoride varnish in the prevention of early childhood caries (ECC) in non-fluoridated areas. MATERIALS AND METHODS: A cost-effectiveness analysis was carried out based on a clinical decision tree from the payer's perspective. The effectiveness and cost of the varnish were determined from a two-year follow-up triple-blind randomized control trial in 275 two- to three-year-old children. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) valued in July, 2019 (exchange rate USD = CLP686.06). A univariate deterministic sensitivity analysis was carried out. RESULTS: Incidence of ECC was 45 % for the varnish group and 55.6 % for the placebo group with a two-year follow-up. The weighted cost to intervene and treat the consequences of ECC was CLP 67,757 (USD98.76) for the fluoride varnish and CLP 67,739 (USD98.74) for the control group. The ICER was CLP 173 (USD0.25) for each extra healthy child in favor of fluoride varnish. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICER. CONCLUSIONS: The protocol that included fluoride varnish is more effective and less costly in the prevention of ECC in non-fluoridated areas, compared with a placebo. CLINICAL SIGNIFICANCE: Findings support the application of fluoride varnish as a cost-effective community strategy to prevent ECC in non-fluoridated areas.

Response to SARS-CoV-2 Pandemic in a Non-COVID-19 Designated Latin-American Neurosurgery Department.

Background: Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. Methods: An organized response regarding personnel, surgical case selection, operating room behavior, and facility reorganization were designed to prevent an internal coronavirus outbreak in the neurosurgery department at the Fray Antonio Alcalde Civil Hospital of Guadalajara. Results: Distancing actions by the staff and residents, including ward case discussions, neurosurgery rounds, and classes, will be carried out virtually. We classified neurosurgical patients into 4 groups depending on whether their condition demands care in 0-6 hours, 6-48 hours, 48 hours to 14 days, and >14 days. Subsequently, a questionnaire with epidemiologic, radiologic, clinical, and serologic criteria will be applied to determine the risk of COVID-19 infection to define to which area they are going to be transferred according to the different risk zones in our facility. Conclusions: Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.

Efectividad de bioceramicos en el mantenimiento de la vitalidad pulpar en recubrimiento pulpar directo en denticion primaria y permanente: revisión sistemática con metaanálisis

Introducción: Se han desarrollado materiales bioactivos para el recubrimiento pulpar directo con el objetivo de preservar la pulpa dentaria y mantener el diente por mayor tiempo en la cavidad oral. Objetivo: El objetivo de esta revisión fue evaluar la efectividad del uso de bioceramicos como material de recubrimiento directo pulpar para mantener la vitalidad pulpar en dientes primarios y permanentes con pulpitis reversible. Metodología: Se realizó una revisión sistemática con meta análisis. Se estudió el éxito en el tratamiento del mantenimiento de la vitalidad, el dolor postoperatorio y la decoloración. Se realizó una búsqueda Electrónica en las bases de datos: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Se extrajeron los datos y se analizaron con Rev Man. Resultados: Se incluyeron ensayos clínicos aleatorizados en la cual se realizaron recubrimiento pulpar directo con silicatos tricalcicos comparado con otros materiales de recubrimiento. Comparando tres biocerámicos no se encontraron diferencias significativas en el mantenimiento de la vitalidad pulpar. En cuanto a la decoloración se observaron diferencias estadísticamente significativas a favor de Biodentine (p <0,001). Discusión: la relevancia clínica de estos hallazgos es discutible debido a su pequeña magnitud general y al alto riesgo de sesgo de los estudios incluidos.

Introduction: Bioactive materials have been developed for direct pulp capping in order to preserve the dental pulp and keep the tooth longer in the oral cavity. Objective: The objective of this review was to evaluate the effectiveness of the use of bioceramics as direct pulp capping material to maintain pulp vitality in primary and permanent teeth with reversible pulpitis. Methods: A systematic review with meta-analysis was performed. Success in treating vitality maintenance, postoperative pain, and discoloration was studied. An electronic search was carried out in the databases: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Data were extracted and analyzed with Rev Man. Results: Randomized clinical trials in which direct pulp capping with tricalcium silicates was performed compared with other capping materials were included. Comparing three bioceramics, no significant differences were found in the maintenance of pulp vitality. Regarding discoloration, statistically significant differences were observed in favor of Biodentine (p <0.001). Discussion: the clinical relevance of these findings is debatable due to their small overall magnitude and the high risk of bias of the included studies.

Asociación entre utilización de Guía de Referencia Clínica a Ortodoncia y derivación pertinente / Association between the use of the Clinical Reference Guide to Orthodontics and pertinent referral

Objetivo Los Servicios de Salud en Chile tienen una demanda insatisfecha en ortodoncia y muchas de las interconsultas no son pertinentes. Buscando una solución, el Servicio de Salud Metropolitano Norte (SSMN) implementó la "Guía de Referencia Clínica Ortodoncia (GRCO) para Servicios Públicos de Salud". El objetivo de este estudio fue evaluar si existe asociación entre utilizar GRCO y pertinencia en derivaciones a Ortodoncia realizadas por odontólogos de Atención Primaria. Materiales y Métodos Se realizó un estudio observacional analítico en 167 pacientes derivados por odontólogos que utilizaron la GRCO y 167 pacientes derivados por odontólogos que no la utilizaron. Una especialista en ortodoncia evaluó pertinencia en la derivación. Los datos se analizaron mediante la prueba de chi-cuadrado, y la prueba t-test. Resultados De los odontólogos que usaron la guía solo un 3% de sus derivaciones fueron no pertinentes, mientras que aquellos que no la usaron, tuvieron un 54% de derivaciones no pertinentes (p <0,001). Odontólogos que no usan la GRCO presentan 38 veces más probabilidad de realizar una derivación no pertinente. (OR 38,8; IC 14,9 - 125,9). Conclusión El uso de Guía de Referencia Clínica a Ortodoncia se asocia fuertemente con la pertinencia en la derivación de pacientes a la especialidad ortodoncia.

Objective. Health Services in Chile have an unsatisfied demand in orthodontics and the largest waiting list for dental specialties, with many of the referrals being irrelevant. Seeking a solution, the North Metropolitan Health Service (SSMN) implemented the "Orthodontic Clinical Referral Guideline (GRCO) for Public Health Services", to define the appropriateness of referrals. The objective of this study was to assess whether there is an association between the GRCO and the appropriateness of orthodontic referrals made by Primary Health Care dentists of the SSMN. Materials and methods. An analytical observational study was carried out in 167 patients referred by dentists who used the GRCO and 167 patients referred by dentists who did not use it. A calibrated orthodontic specialist assessed the relevance of the referral. The data was analyzed using the chi-square test, and the t-test. Results. Only 3% of the referrals made by dentists who used the GRCO were inappropriate, compared to 54% of those who did not use it. Dentists who do not use the GRCO are 38 times more likely to make an inappropriate referral than those who adhere to the GRCO (OR 38.8; CI 14.9 - 125.9) Conclusion. The use of the Orthodontic Clinical Referral Guideline is strongly associated with appropriateness in referring patients to the orthodontic specialty.