Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology

Abstract The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

Sensopercepción olfatoria: una revisión / Olfactory sensory perception

The five senses have had a fundamental importance for survival and socialization of human beings. From an evolutionary point of view the sense of smell is the oldest. This sense has a strong representation within the genome, allowing the existence of many types of receptors that allow us to capture multiple volatile odor producing molecules, sending electrical signals to higher centers to report the outside world. Several cortical areas are activated in the brain, which are interconnected to form an extensive and complex neural network, linking for example, areas involved with memory and emotions, thus giving this sense of perceptual richness. While the concept of fl avor is largely related to the sense of taste, smell provides the necessary integration with the rest of the senses and higher functions. Fully understanding the sense of smell is relevant to health professionals. Knowing the characteristics of the receptors, the transduction processes and convergence of information in the higher centers involved, we can properly detect olfactory disorders in our patients.

Sensopercepción gustativa: una revisión / Gustatory sensory perception: a review

Los órganos de los sentidos confieren a los seres humanos la capacidad de percibir y responder a una gran gama de estímulos que provienen del entorno, lo cual nos brinda la facultad de elaborar respuestas con el fin de adaptarnos a los cambios medioambientales, cubrir nuestras necesidades básicas y sobrevivir. Para nutrirnos, el sentido del gusto posee un rol primordial que nos permite seleccionar dentro de una amplia variedad de alimentos, las sustancias que son necesarias para nuestro metabolismo, protegiéndonos a su vez de compuestos potencialmente nocivos, debido a su toxicidad o grado de descomposición. Este sentido también es capaz de brindarnos la capacidad de seleccionar y discriminar alimentos que nos permitan sentir agrado y placer. Para los dentistas es fundamental comprender adecuadamente los complejos procesos del sentido del Gusto, identificar las estructuras involucradas tanto a nivel periférico (papilas, receptores y vías nerviosas) como a nivel central (núcleos y cortezas cerebrales); además de conocer las modalidades básicas del gusto y sus respectivos mecanismos de transducción. Este conocimiento aportará los elementos necesarios para enfrentar de manera correcta una situación en la cual un paciente presente una alteración gustativa, siendo capaz de identificar las posibles causas y adoptar medidas adecuadas para resolverla y/o tolerarla en el caso de ser provocada en forma transitoria por un procedimiento que forme parte o no de nuestro tratamiento.

The sense organs give to humans the ability to perceive and respond to a wide range of stimuli from the environment. This allows us the power to shape responses in order to adapt to environmental changes, control our basic needs and survive. The sense of taste has a key role in nurture. Enable us to select from a wide variety of foods, elements that are necessary for metabolism and also protecting from potentially harmful compounds, as of its toxicity or degree of decomposition. This sense of taste is also capable of giving us the ability to select and discriminate food that allow us to feel enjoy and pleasure. For dentists is critical to understand adequately the complex processes of taste, identify the structures involved peripheral (papillae, nerve pathways and receptors) and central (nuclei and cerebral cortices), besides knowing the basic modalities of taste and their respective transduction mechanisms. This knowledge will provide the basis to address properly a situation in which a patient has an altered taste, being able to identify possible causes and take appropriate action to resolve it and / or tolerate if temporary caused by a procedure that may be part of our dental treatment.