ABSTRACT
Abstract The COVID-19 pandemic has highlighted the economic, social, and oral care health inequities in societies, especially in the developing world. Severe restrictions have been imposed on dental practices, limiting prophylactic and routine oral care health, allowing treatment only for emergencies. Since dental care includes procedures that generate aerosols, the risk of infection for dental personnel has increased significantly. In this review, a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the impacts it is having on oral health care is presented. The ongoing repercussions in dental practice and in dental education, including the opportunities for practice innovation that are evolving, are also indicated. Also, a discussion of the psychosocial factors that affect health and the quality of life of an individual, such as stress, depression, and anxiety, is provided. This pandemic may be an opportunity to promote the inclusion of well-established prevention measures, together with the use of teledentistry in academic dental curricula, encourage the implementation of new perspectives for the effective instruction and interactions with students, and foster the transition toward e-learning strategies in dental education.
Resumo A pandemia COVID-19 destacou as desigualdades econômicas, sociais e de saúde bucal, especialmente no mundo em desenvolvimento. Severas restrições têm sido impostas para a prática odontológica, limitando a rotina de saúde bucal, permitindo o tratamento apenas em emergências. Como o atendimento odontológico inclui procedimentos que geram aerossóis, o risco de infecção para a equipe odontológica aumentou significativamente. Nesta revisão, é abordada uma fonte abrangente e atualizada de informações sobre o SARS-CoV-2/COVID-19 e os impactos que têm nos cuidados de saúde bucal. As repercussões contínuas na profissão odontológica e na educação odontológica, incluindo as oportunidades de inovação da prática. Além disso, é fornecido o efeito de fatores psicossociais que afetam a saúde e a qualidade de vida, como estresse, depressão e ansiedade. Esta pandemia pode ser uma oportunidade para promover a inclusão de medidas de prevenção bem estabelecidas, juntamente com o uso da teledontologia nos currículos acadêmicos de odontologia, trazendo novas perspectivas sobre a forma de ensinar e interagir com os alunos, com a transição para estratégias de e-learning na educação odontológica.
ABSTRACT
Objetivo. Evaluar tres técnicas para el manejo de conducta: Desensibilización Sistemática (DS), Método Treament and Education of Autistic and related Communication Handi-capped Children (TEACCH) y la técnica Decir, Mostrar, Hacer (DMH), durante la atención dental a personas con trastorno del espectro autista (TEA). Métodos. Participaron 18 personas del Noreste de México con diagnóstico de TEA, con un rango de 13 a 15 años divididos en tres grupos según la técnica TEACCH, DS y DMH con seis personas por grupo. A los participantes se les realizó una profilaxis dental empleando la técnica de manejo de conducta y comunicación según el grupo, la conducta se evaluó usando las escalas Frankl Ìs Behavior Rating Scale (FBRS) y Comfort Behavior Scale (CBS). Se usaron las pruebas Chi cuadrado, ANOVA y t de Student para comparar los resultados. Resultados. La conducta evaluada con la escala de Frankl, fue definitivamente positiva en los grupos TEACCH (33,3%) y DS (16,7%). Conducta positiva semejante en los tres grupos (66,7%). Conducta negativa semejante en DS y DMH (16,7%). Conducta definitivamente negativa solo en el grupo DMH (16,7%). En la escala CBS, solo el grupo DMH presentó aumento del tono muscular (p= 0,013) y tensión facial no sostenida (p= 0,001), al compararlo con TEACCH y DS. Conclusiones. Las tres tecnicas utilizadas son efectivas para el manejo de conducta de las personas con TEA durante el tratamiento dental, sin embargo en la técnica DMH se observó conducta definitivamente negativa y respuesta corporal-conductual que refleja tensión emocional.
Objective. Evaluate three behavior management techniques: Systematic Desensitization (SD), the Treament and Education of Autistic and related Communication Handicapped Children (TEACCH) and Tell, Show, Do (TSD) Method, during dental care for people with Autism Spectrum Disorder (ASD). Methods. Eighteen people from Northeast Mexico diagnosed with autism spectrum disorder participated, with a range of 13 to 15 years, divided in to three groups, according to the TEACCH, SD and TSD technique with six participants per group. A dental prophylaxis was performed on the participants, using the behavior management and communication technique according to the group, the behavior was evaluated using the Frankl's behavior rating scale (FBRS) and Comfort Behavior Scale (CBS). Chi square, ANOVA and Student's t tests were used to compare the results. Results. Behavior evaluated with Frankl scale was definitely positive in TE-ACCH (33.3%) and DS (16.7%) groups. Similar positive behavior in the three groups (66,7%). Similar negative behavior in DS and DMH (16.7%). Definitively negative behavior only in the DMH group (16.7%). With CBS scale, only the DMH group presented increased muscle tone (p= 0.013) and evident not sustained tension in some facial muscles (p= 0.001), when compared with TEACCH and DS by ANOVA analysis. Conclusions. The three techniques evaluated are effective for managing behavior of people with ASD during dental treatment, however, in DMH technique, definitely negative behavior and a corporal-behavioral response were observed, reflecting emotional stress.
ABSTRACT
Resumen El diagnóstico adecuado del bruxismo incluye el análisis y la correlación de signos y síntomas con diferentes métodos de diagnóstico, siendo esencial la interpretación y evaluación de los síntomas que reporta el paciente. El presente es un trabajo inicial sobre las propiedades psicométricas del cuestionario de bruxismo autoinformado (CBA). Participaron 100 personas (34 hombres y 66 mujeres) del noreste de México, la muestra se dividió en dos grupos, uno con diagnóstico clínico y autoinforme de bruxismo (N = 50) y otro sin bruxismo. Se evaluó la confiablidad por consistencia interna, la estructura factorial y la validez convergente entre la escala de estrés percibido PSS-14 y el CBA. Los resultados muestran consistencia interna entre los 11 ítems (α = .88). El análisis factorial confirmatorio para un solo factor presentó índices estadísticos de bondad de ajuste adecuados (χ2/gl = 1.461; GFI = .916; AGFI = .857, CFI = .967, RMSEA = .068). La correlación entre las escalas PSS-14 y CBA fue positiva (r = .27; p = .001), y entre la escala de estrés percibido y las subescalas bruxismo de sueño r = .20 (p = .039) y bruxismo de vigilia r = .29 (p = .002), La correlación entre las subescalas BS y BV fue r = .71 (p = .001), Los resultados del CBA muestran alta confiabilidad, consistencia interna y correlación inter-ítems apropiada, y respaldan la validez convergente del cuestionario. Asimismo, contribuyen a mejorar los estándares de calidad al evaluar los datos subjetivos aportados por personas con bruxismo y se considera de interés continuar con el análisis del CBA, evaluando su comportamiento en otras poblaciones.
Abstract Bruxism is defined as a repetitive jaw-muscle activity, characterized by grinding or clenching the teeth, and /or by bracing or thrusting of the mandible, which has different circadian manifestations, either during sleep (sleep bruxism) or when wakefulness (awake bruxism). For an appropriate clinical diagnosis of bruxism different techniques have been proposed; the most common technique is the usage of a self-reported questionnaire combined with a professional evaluation. While the first is a questionnaire in which the patient expresses their symptoms, the second depends on the presence of observed signs associated according to an evaluator, including tooth wear as well as identify symptoms associated to this jaw-muscle activity, to confirm a clinical diagnosis, there must be a correlation between the self-report questionnaire and clinical diagnosis. Therefore, there is no quantifiable measure that may help to evaluate, from a patient's perspective, the signs and symptoms that belongs to his/her muscle and mandibular activity while assessing both its proportion and measure. To strengthen the self-report technique as a reliable procedure for assessing the information expressed by patient with bruxism, this initial study reports the reliability and validity proprieties of the self-report bruxism questionnaire (CBA). The present study was conducted in Mexico and includes one hundred participants. Fifty percent of them presented a clinical diagnosis of bruxism (n = 50), the other half (control group) do not. In both groups the perceived stress scale (PSS) and the self-reported bruxism questionnaires (CBA) were equally completed on a self-administered way. Both a high internal consistency (α = .884) was found on the eleven items and a corrected item-total correlation ranged from .43 to .78, reflects an adequate reliability. The exploratory factor analysis was used to group the CBA variables; the extraction was made using a main component with Varimax rotation method. The sample adequacy coefficients, the Kaiser Meyer-Olkin (KMO = .826) and Bartlett's Sphericity test (χ2 = 579.866, p = .000) were assessed and expressed an appropriate intercorrelation between items. The factor analysis showed a bifactorial: the latent variables explained one factor of 47.8 % (eigenvalue = 5.26) variance and another of 11.5 % (eigenvalue = 1.27), thus its cumulative variance of this model was 59.36 %. Due to amount of explained variance and the difference between the eigenvalues of this initial solution we considered to prove a unidimensional model. A one solution factor scale was feasible, with factor weights greater than .52 on all items. This single-factor structure was verified in a confirmatory factor analysis, which presented significant values and suitable goodness of fit indexes (χ2/df = 1.461; GFI = .916; AGFI = .857, CFI = .967, RMSEA = .068). Also, a convergent analysis was performed proving a positive (r = .27; p = .001) correlation between the PSS-14 and CBA scales, the correlation with the subscales of self-reported awake bruxism, SAB was positive (r = .299, p = .002). Regarding self-reported sleep bruxism, SAB the correlation was also positive (r = .207, p = .039). The correlation between the subscales was both positive and strong (r = .713, p = .001). Based on the results obtained, we can conclude that, there are a positive, significant, and adequate correlation between PSS-14 scale and the scale of self-reported bruxism, as though as in the sub-scales SAB and SSB. These results suggested that the one factor solution of the CBA has high reliability, internal consistency, and an appropriate inter-item correlation; also, it supports the convergent validity of the questionnaire. Due to the possible contributions of the CBA to the improvement of the quality standards of the evaluation of subjective data provided by people with bruxism, it is suggested to continue with the analysis of the scale in future studies with other populations.
ABSTRACT
Despite being a commonly studied topic, it is difficult to find studies which explain the problem of dental erosion. For this article, literature was analyzed to find information on the agents which trigger dental erosion, the main diagnosis methods, the most common treatments used nowadays and the interrelationship with dental materials. The etiology of dental erosion is multifactorial, including acids, eating disorders and gastro-esophageal reflux. However, biological factors such as saliva or habits also play a part in the establishment of this condition. In order to establish a reliable diagnosis, clinical appearance becomes decisive. The Basic Index Erosive Wear Exami¬nation (BEWE), created in 2008, is an auxiliary diagnosis tool for assessing the status and progress of the erosion. Treatment should be linked to the eradication of the causative agent and it can range from simple observational monitoring of slightly affected teeth to the placement of total crowns in the most severe cases, but this will depend entirely on the extent, severity, symptoms and type of dentition. Regarding dental materials used in the treatment of eroded parts, there are glass ionomer and composite; the latter presents the greatest resistance to biodegradation when interacting with acids. Glass ionomers are the most vulnerable material while resin is seen as the most resistant. In conclusion, dental erosion has become an issue of great importance in the dental practice because of its serious impact on dental structures. Consequently, it is ranked among the most important dental disorders in the present day.
A pesar de ser un tópico altamente examinado, es difícil encontrar estudios que esclarezcan la problemática de la erosión dental. En este trabajo se analizó en la literatura los agentes que desencadenan la erosión dental, los principales métodos de diagnosis, los tratamientos más empleados en la actualidad y la interrelación con los materiales dentales. La etiología de la erosión es multifactorial incluyendo elementos ácidos, desórdenes alimenticios y reflujo gastroesofágico. Sin embargo, los factores biológicos como la saliva o los hábitos también intervienen en el establecimiento de la afección. Para establecer un diagnóstico fiable, la apariencia clínica se vuelve decisiva. Un auxiliar diagnóstico para evaluar el estado y progreso de la erosión es el índice Basic Erosive Wear Examination (BEWE) establecido en el 2008. La terapéutica deberá estar ligada a la erradicación del agente causal y consistirá desde simple observación hasta coronas totales en los casos más severos, pero esta dependerá totalmente de la extensión, severidad, sintomatología y tipo de dentición presente. Dentro de los materiales dentales empleados en el tratamiento de piezas erosionadas, se encuentran el ionómero de vidrio y el composite; siendo este último quien presenta mayor resistencia a la biodegradación al interactuar con elementos ácidos. El ionómero de vidrio constituye el material más vulnerable mientras que la resina se posiciona como la más resisten¬te. La erosión dental se ha vuelto una cuestión de gran importancia en el ámbito odontológico por las graves re¬percusiones que se producen en las estructuras dentales, posicionándola como uno de los desordenes dentales con mayor trascendencia en la actualidad.
Subject(s)
Humans , Tooth Erosion/diagnosis , Tooth Erosion/etiology , Tooth Erosion/therapyABSTRACT
It comes to consulting the Faculty of Dentistry at the University of Nuevo León pediatric male patient of 9 years 10 months, who was admitted with a presumptive diagnosis of hemophilia due to a subsequent persistent bleeding to treatment with steel crowns made in an earlier appointment. Interconsultation is performed with the hematologist who by laboratory examinations notice decreased coagulation factor VIII confirming the diagnosis of hemophilia A. It plans and conducts comprehensive treatment dental team with the hematologist who said that patients in hospitals with the replacement of missing clotting factor is prepared by cryo precipitates or with concentrated factor VIII intravenously before and after his dental intervention. The aim of the article is to highlight that hemophilia can be a disease detected during dental surgery in some patients and for it to be successfully treated with multidisciplinary management protocol is required between hematologists and dentists.
Se presenta a consulta en la Facultad de Odontología de la Universidad Autónoma de Nuevo León paciente masculino pediátrico de 9 años 10 meses, el cual ingresa con un diagnóstico de presunción de hemofilia debido a un sangrado persistente posterior al tratamiento con coronas de acero realizadas en una cita anterior. Se efectúa interconsulta con el hematólogo quien mediante exámenes de laboratorio observa una disminución del factor VIII de coagulación lo que confirma el diagnóstico de hemofilia tipo A. Se planea y realiza el tratamiento integral odontológico en equipo con el hematólogo quien indica que se prepare al paciente a nivel hospitalario con la reposición del factor de coagulación faltante a través de crio precipitados o mediante concentrado del factor VIII por vía intravenosa previo y posterior a su intervención dental. El objetivo del artículo es destacar que la hemofilia puede ser una enfermedad detectada durante la consulta dental en algunos pacientes y que para que éstos sean tratados con éxito se requiere un protocolo del manejo multidisciplinario entre hematólogos y odontólogos.