Core curriculum in cariology for dentistry degrees in the Republic of Argentina / Contenidos Mínimos de Cariología en el Currículo de las Carreras de Odontología en la República Argentina

ABSTRACT Aim To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools Materials and Method Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W) Results Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved Conclusion Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

RESUMEN Objetivo Elaborar un documento de consenso de los contenidos y competencias de cariología en el currículo para las facultades/escuelas de odontología argentinas, a nivel del grado Materiales y Método El proceso de creación se efectuó en etapas: 1- Diagnóstico de situación (Formulario electrónico) e invitación a participar a las 20 unidades académicas (UA) donde se imparte la carrera de odontología. 2- Proceso de valoración de acuerdos de Contenidos (C) y Competencias (I) en los cinco dominios (D): D1: Ciencias Básicas; D2: Riesgo y diagnóstico de caries dental; D3: Toma de decisiones tratamientos no invasivos; D4: Toma de decisiones para el tratamiento invasivo y D5: Cariología basada en la evidencia a nivel comunitario. 3- Etapa de consenso. Las etapas 2 y 3 se efectuaron en formato de Workshop en modalidad virtual (W) Resultados Etapa 1: Del total de 20 formularios enviados a las UA se recibieron 13 respuestas (65%), 7 (53,8%) de Universidades Nacionales y 6 (46,1%) de gestión Privada. El 100% de los participantes estuvieron de acuerdo en formar parte del consenso. Etapa 2: W: Participaron 20 representantes de 10 UA. El proceso se inició con una conferencia contextualizadora, posteriormente los representantes fueron divididos en 5 grupos para la valoración de acuerdos de cada D. Etapa 3: El documento de658. 658.l Currículo en Cariología se organizó en 5 Dominios. Se definieron 23 C y 31 I de aplicación clínica para la enseñanza de la Cariología. Se consensuaron los contenidos y las competencias para cada uno de los dominios. El documento final fue enviado a todos los participantes del W para su aprobación y difusión en cada una de las UA involucradas Conclusión En base al trabajo realizado se determinó un consenso de competencias y contenidos en cariología para estudiantes de grado de Odontología, de las Universidades de la República Argentina.

¿Cómo Intervenir el Proceso de Caries en Personas Mayores? Adaptación del Consenso de ORCA/EFCD/DGZ

Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.

Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption

Abstract Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

Abstract The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Effect of liners on composite resin microleakage after selective carious lesion removal: an experimental study / Efecto de los recubrimiento en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas: un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Objetivo: Evaluar la microfiltración de resinas compuestas (RC) colocadas sobre diferentes liners cavitarios después del manejo de lesiones de caries profundas mediante la remoción selectiva de tejido cariado blando hasta dentina blanda (SRCT-S). Material y Métodos: Se recolectaron 54 dientes humanos para pruebas de microfiltración. Cada ensayo comprendía lesiones cariosas ICDAS 5 o ICDAS 6 y dientes sanos para los controles. Se prepararon dientes sanos con cavidades que reflejaban las cavidades de los dientes cariados, que se prepararon con SRCT-S. Los dientes sanos y cariados se asignaron al azar a uno de los tres grupos experimentales: Grupo A: adhesivo universal (AU) + RC, Grupo B: revestimiento de cemento de ionómero de vidrio + AU + RC, y Grupo C: hidróxido de calcio + AU+ RC. La microfiltración oclusal (MO) y la microfiltración cervical (MC) se clasificaron dentro de una de las 5 categorías de profundidad. Se calcularon las pruebas ANOVA y Chi-cuadrado (p<0,05). Resultados: La MO y MC se distribuyeron de manera similar en los subgrupos (p> 0,05). Todas las muestras del Grupo C con lesiones cariosas presentaron algún grado de microfiltración. Sin embargo, no se observaron diferencias estadísticamente significativas entre grupos y dentro de cada grupo (p>0,05). Conclusión: Los dientes restaurados con RC después de SRCT-S usando hidróxido de calcio como material de revestimiento parecen exhibir una mayor microfiltración que aquellos restaurados usando ionómero de vidrio o AU solo. Se necesita más investigación clínica para profundizar estos hallazgos. Relevancia clínica: la aplicación de hidróxido de calcio como revestimiento debajo de una resina compuesta puede reducir la longevidad de una restauración después de realizar la eliminación selectiva o parcial de los tejidos cariados. Los médicos deberían reconsiderar la necesidad de usar hidróxido de calcio para esta aplicación, aunque no haya evidencia clínica.

Sinopsis de la Situación de Salud Oral en Chile - Parte IV: Traumatismo Dentoalveolar

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

Extended biofilm formation time by Streptococcus sanguinis modifies its non-cariogenic behavior, in vitro

Abstract Although the commensal Streptococcus sanguinis [ S. sanguinis] is isolated from caries-free people, it can ferment carbohydrates producing acids. We aimed to characterize S. sanguinis cariogenic potential as a function of different enamel biofilm formation periods, in vitro. Saliva-coated enamel slabs were inoculated with S. sanguinis to form initial biofilms for 8, 12 or 16 h in presence of sucrose and followed by a period in medium with glucose for 16, 12 or 8 h, respectively, until completion of 24 h. To simulate cariogenic challenges, S. sanguinis biofilms were exposed to 10% sucrose for 5 minutes, 3x/day for 5 days. Biofilm biomass, viable cells, total proteins, intracellular and extracellular polysaccharides production, acidogenicity and enamel demineralization were determined. Biofilms of Streptococcus mutans [ S. mutans ] served as caries-positive control. Biofilms of S. sanguinis forming on enamel for 12 and 16 h showed higher demineralization than those formed during 8 h, but lower than S. mutans biofilms, regardless of the initial biofilm formation time. No differences were detected in the biofilm properties among the different biofilm formation times tested for S. sanguinis . Increased enamel initial biofilm formation time by S. sanguinis appears to induce a cariogenic potential, but lower than S. mutans .

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.

Fluoride bioavailability on demineralized enamel by commercial mouth rinses

Abstract The ability of mouth rinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouth rinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion F). Demineralized enamel slabs (n=15 per mouth rinse) were sectioned; one half was subjected to the assigned mouth rinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouth rinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations (µg F/cm2) formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouth rinses than firmly bound fluoride. Mouth rinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouth rinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouth rinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íon-específico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie.

¿Cómo Intervenir el Proceso de Caries en Adultos? Adaptación del Consenso de ORCA/EFCD/DGZ / How to Intervene the Caries Process in Adults? Adaptation of the ORCA/EFCD/DGZ Consensus

RESUMEN: El manejo terapéutico de lesiones de caries primarias y secundarias concentra gran parte del quehacer de los dentistas en el mundo. Recientes cambios en la concepción de la enfermedad de caries llevaron a un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) a analizar la evidencia y consensuar recomendaciones sobre manejo de caries en adultos. Mediante una reunión en Berlín, Alemania en 2019 y con metodología e-Delphi, los expertos analizaron la evidencia y propusieron recomendaciones clínicas. El propósito de este artículo es presentar una adaptación idiomática de las principales recomendaciones, que incluyen terapias no invasivas (higiene, uso de fluoruros y control de dieta), terapias microinvasiva (sellantes e infiltrantes), terapias necesariamente invasivas y la reparación de restauraciones. Todas las recomendaciones se basan en un enfoque mínimamente invasivo, con un adecuado manejo restaurador. Los dentistas de países hispanoparlantes podrán encontrar recomendaciones basadas en evidencia, provenientes de un consenso de expertos a nivel global, que orienten sus decisiones clínicas, apoyándose en los principios de la odontología de mínima intervención.

ABSTRACT: Therapeutic management of primary and secondary caries lesions concentrates much of the work of dentists throughout the world. Recent changes in caries disease conception and therapeutic management led a panel of experts from the European Organisation for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) to analyze the evidence and reach consensus on recommendations for caries management in adults. Through a meeting held in Berlin, Germany in 2019 and using an e-Delphi methodology, the experts analyzed the evidence and proposed clinical recommendations. The purpose of this article is to present an idiomatic adaptation to Spanish of the main recommendations, which include non-invasive therapies (hygiene, use of fluoride and diet control), microinvasive therapies (sealants and infiltrants), invasive therapies and repair of restorations. All recommendations are based on a minimally invasive dentistry approach, with a technically adequate restorative management. Spanish-speaking dentists may use these consensus recommendations to guide their clinical decisions, based on the most recent evidence and experts opinions, under the principles of minimal intervention dentistry.

Fluoride bioavailability on demineralized enamel by commercial mouthrinses

Abstract The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouthrinses than firmly bound fluoride. Mouthrinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouthrinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouthrinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Resumo Os enxaguatórios bucais comerciais fluoretados diferem na concentração e tipo de sal de fluoreto, no pH e têm alguns ingredientes que podem interferir na reatividade do fluoreto com o esmalte desmineralizado. A capacidade de enxaguatórios bucais comerciais de formar produtos de reação em esmalte desmineralizado (teste de biodisponibilidade) foi avaliada in vitro. Nove enxaguatórios bucais adquiridos no Chile foram avaliados, oito formulados com NaF (um contendo 100 µg F/mL e sete contendo 226) e um com Na2FPO3 (226 µg F/mL como íon F). Os blocos de esmalte desmineralizados (n=15 por grupo) foram seccionados, uma metade foi submetida ao tratamento com o enxaguatório designado por 10 min e a outra metade foi usada para dados baseline. Fluoreto fracamente e firmemente ligados formados no esmalte foram determinados com um eletrodo íonespecífico e os valores foram expressos em µg F /cm2. A concentração de fluoreto e o pH dos enxaguatórios foi previamente determinada. As concentrações de fluoreto tipo fluoreto fracamente ligado e fortemente ligado formadas no esmalte foram analisadas independentemente por ANOVA e teste de Tukey (α=5%). As concentrações de fluoreto fracamente ligado e fortemente ligado formados variaram de 3,2 a 36,2 e 0,4 a 1,7, respectivamente. O fluoreto fracamente ligado formado no esmalte foi significativamente mais eficaz para discriminar o efeito dos diferentes enxaguatórios bucais comerciais do que o fluoreto firmemente ligado. Enxaguatórios bucais com 226 ppm F na forma de NaF e baixo pH apresentaram significativamente maior biodisponibilidade de fluoreto no esmalte do que aqueles com maior pH ou menor concentração de NaF. O enxaguatório com Na2FPO3 apresentou reatividade muito baixa. Embora mais estudos sejam necessários, os resultados mostraram que os enxaguatórios bucais comerciais contendo fluoreto apresentam variações importantes na biodisponibilidade do fluoreto, o que poderia resultar em diferenças na eficácia anticárie

Fluoride concentration in mouth rinses marketed in Chile and Brazil, and a discussion regarding their legislations

Abstract For fluoride to be effective in controlling caries, it should be bioavailable in commercial products, so that it can be released into the mouth in the products it contains. We chemically determined the available fluoride and pH in nine mouth rinses marketed in Chile, and eleven, in Brazil, and then discussed the legislation in force in both countries, regarding the anticaries potential of these oral hygiene products. The fluoride was analyzed with an ion-selective electrode (F-ISE), using the direct technique. The determinations were made in duplicate, and the results were expressed in ppm F (μg F/mL). The total fluoride concentration found in all the mouth rinses evaluated ranged from 94.7 to 233.5 ppm F, and closely matched what was declared by the manufacturers (100.0 to 226.2 ppm F). However, some mouth rinses showed lower fluoride concentrations (90 and 180 ppm F) in both countries. A Na2FPO3-formulated mouth rinse was found only in Chile, with 216.8 ppm F as the FPO32- ion, and 4.9 ppm F as the F-. The findings show that fluoride was potentially bioavailable in all the mouth rinses evaluated. Regarding the national legislations, although the mouthwashes sold in Brazil comply with the Brazilian legislation, discrepancies were found for Chile. However, neither country had a legislation matching the best available evidence on fluoride mouthwash efficacy for caries control. Thus, some products with low fluoride concentrations (below 226 ppm F), or manufactured with a fluoride salt other than NaF (Na2FPO3) are being sold in the Brazilian and Chilean markets.

Community interventions and strategies for caries control in Latin American and Caribbean countries

Abstract Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

Sinopsis de la Situación de Salud Oral en Chile - Parte III: Encuestas Nacionales de Salud / Synopsis or the Oral Health Situation in Chile - Part III: National Health Surveys

RESUMEN: Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud en Chile. Se describen sus principales características y hallazgos con el objetivo de orientar a los profesionales odontólogos en el conocimiento de material existente para el diagnóstico odontológico objetivo, así como el impacto de la salud oral en la calidad de vida, a nivel poblacional.

ABSTRACT: This article makes a brief review and synthesis of national health surveys in Chile. The article describes the main characteristics and findings in order to guide dental professionals with the knowledge of the existing material for an objective population oral health diagnosis, as well as the impact of oral health on quality of life of the population.

Desigualdades en Salud Bucal para Personas Mayores en Tiempos del COVID-19. La Teleodontología y la Odontología de Mínima Intervención como Caminos de Solución / Oral Health Inequalities for the Elderly in Times of COVID-19. Teledentistry and Minimal Intervention Dentistry as Solution Paths

RESUMEN: Si bien la salud bucal de las personas mayores en Chile y el mundo ya era deficiente, es esperable que los estragos en materia sanitaria, producto de la COVID-19, acentúen este deterioro, particularmente en aquellos con limitaciones cognitivas o funcionales, perpetuando la desigualdad de acceso a la atención odontológica y con ello empeorando su condición de salud bucal y su calidad de vida. La emergente Odontogeriatría debe potenciarse y fortalecerse ante esta verdadera catástrofe sanitaria que se espera ocurra durante y post pandemia. Para ello, no se precisan nuevos desarrollos científicos o tecnológicos, sino la implementación de filosofías y aproximaciones ya disponibles, como son la adopción sistemática de la Teleodontología y de la Odontología de Mínima Intervención (MID). La atención domiciliaria también aparece como una estrategia necesaria ante este nuevo escenario. Este artículo analiza y discute la situación de salud bucal de las personas mayores durante estos complejos tiempos que vive Chile y la humanidad. La pandemia por COVID-19 es una oportunidad única de replantear tanto la práctica clínica como la educación en Odontología, introduciendo nuevos paradigmas, dándole un enfoque de curso de vida e implementando medidas destinadas a corregir las grandes desigualdades con que viven las personas mayores.

ABSTRACT: Although oral health of older people in Chile and the world was already poor, it is expected that the COVID-19 pandemic will increase oral deterioration, particularly in those with cognitive or functional limitations, perpetuating access inequality to dental care and worsening the oral condition and quality of life. Emerging geriatric dentistry should be strengthened in the context of this health catastrophe, expected to occur during and after the pandemic. To face this challenge, no new scientific or technological developments are required, but the implementation of already available philosophies and approaches, such as the systematic adoption of Teledentistry and Minimum Intervention Dentistry (MID). Home care also appears as a necessary strategy in this new scenario. This article analyzes and discusses the oral health situation of older people in these complex times experienced by Chile and the humanity. The COVID-19 pandemic is a unique opportunity to rethink both clinical practice and education in Dentistry, introducing new paradigms, giving it a life course approach and implementing measures aimed at correcting the outrageous inequalities for older people.

Sinopsis de la Situación de Salud Oral en Chile - Parte II: Diagnósticos Poblacionales de Salud Oral / Synopsis or the Oral Health Situation in Chile - Part II: Oral Health Surveys

RESUMEN: Objetivo: Sintetizar los resultados sobre los estudios epidemiológicos de caries dental, enfermedad periodontal, desdentamiento y lesiones de mucosa oral de base poblacional con representatividad nacional y regional en adultos chilenos (≥15 años). Materiales y métodos: Se realizó una revisión narrativa para identificar aquellos estudios de diagnóstico de salud bucal, a nivel nacional y/o regional, en población adulta de Chile (≥15 años), con el objetivo de establecer prevalencias para las patologías bucales de mayor relevancia nacional. Resultados: Se identificaron 6 estudios de representatividad nacional y 7 estudios de representatividad regional. Se reporta una disminución en la prevalencia de caries cavitadas y de dentición no funcional, correspondiendo a un 54.6% y 27.0%, respectivamente. La prevalencia de pérdida de inserción clínica ≥4mm., es cercana al 100%. La lesión de mucosa oral más prevalente fue la estomatitis subprotésica (22.3%). Se observaron inequidades socieconómicas y culturales en la distribución de las patologías orales en la población adulta chilena. Conclusiones: Existe una alta prevalencia de enfermedad periodontal, caries, desdentamiento y lesiones de mucosa oral en adultos y adultos mayores chilenos.

ABSTRACT Aim: To synthesize results of epidemiologic national and regional studies about dental caries, periodontal diseases, tooth loss and oral mucosa lesions in Chilean adults (≥15 years- old). Methods: A narrative revision was made in order to identify epidemiologic national or regional studies in Chilean adults (≥15 years- old). The objective was to establish the prevalence of the most common oral diseases. Results: Six national and seven regional studies were identified. The prevalence of non-treated caries and non- functional dentition was reduced to 54.6% and 27.0%, respectively. The prevalence of periodontal attachment loss ≥4mm. was almost 100%. The most frequent oral mucosa lesion was denture stomatitis (22.3%). Socioeconomic and cultural disparities were observed in the distribution of oral diseases in Chilean adults. Conclusions: The prevalence of dental caries, periodontal diseases, tooth loss and oral mucosa lesions was high in Chilean adults and elderly people.

Sinopsis de la Situación de Salud Oral en Chile - Parte I: Garantías Explícitas y Guías Clínicas / Synopsis of the Oral Health Situation in Chile - Part I: Explicit Guarantees and Clinical Guidelines

RESUMEN: El presente artículo realiza una breve revisión y síntesis sobre las Garantías Explícitas en Salud Bucal vigentes en Chile y las Guías de Práctica Clínica asociadas a su ejercicio. Se muestra una breve cronología de la reforma de salud de la cual se originan, describiendo sus principales pilares de desarrollo. Esta actualización tiene como objetivo orientar a los profesionales odontólogos de los Servicios de Salud, Sociedades Científicas, Universidades y entidades públicas y privadas que desarrollan la práctica odontológica en Chile, en el conocimiento del material existente, validado y disponible a la fecha.

ABSTRACT This article makes a brief review and synthesis of the Explicit Guarantees in Oral Health in force in Chile and the Clinical Practice Guidelines associated with their practice. It shows a brief chronology of the health reform from which they originate, describing their main pillars of development. The purpose of this update is to guide the dental professionals of the Health Services, Scientific Societies, Universities and public and private services that develop the dental practice in Chile, with the knowledge of the existing material, validated and available to date.

Cariology Curriculum in Chilean Universities

ABSTRACT: Aim: To describe the current state of undergraduate Cariology teaching in Chilean universities. Material and Methods: A previously content-validated questionnaire was used to conduct a cross-sectional study including all private/public universities. Statistical analysis was performed determining frecuency distributions of categorical variables with the Stata Data Analysis and Statistical Software 13.1®. Results: Cariology is a key issue in undergraduate education, and in most universities, is taught as key axis of courses, in various departments, for more than one year. Consistency was found in Cariology topics taught. The clinical threshold for surgical treatment is roughly divided into thirds (33.3% enamel microcavitation, 38.9% underlying shadow and 27.8% dentin cavity), no university indicated operative treatment for non cavitated lesions. Radiographic threshold for surgical treatment is the external dentinal third (66.7%). Conclusions: Answers revealed a mix of traditional and modern Cariology concepts. Depite some encouraging results, half of Chilean universities considered that Cariology is not appropriately implemented and no standardization exists between theoretical teaching and clinical management, nonoperative management is not properly clinically implemented, students are evaluated for tissue damage restoration and resistance to non-invasive philosophy adoption remains.