Nivel de conocimientos sobre lesiones premalignas bucales en pacientes geriátricos

Fundamento: El nivel de conocimiento sobre lesiones premalignas en la población geriátrica es un factor significativo que incide en la prevención, evitando la progresión a un cáncer bucal. Objetivo: Identificar el nivel de conocimiento de los pacientes geriátricos sobre las lesiones premalignas bucales. Metodología: Entre septiembre de 2019 y junio de 2021 se realizó un estudio observacional descriptivo transversal en el Consultorio Médico de la Familia # 12 del municipio Cabaiguán, provincia Sancti Spíritus. La población estuvo constituida por 158 pacientes geriátricos y mediante un muestreo probabilístico aleatorio simple la muestra quedó conformada por 80. Se aplicaron métodos del nivel teórico, empírico, estadístico y matemático. Las variables utilizadas fueron edad, sexo, escolaridad, nivel de conocimiento sobre factores de riesgo y signos clínicos, conocimientos sobre el autoexamen bucal y la conducta a seguir. Resultados: Se constató que el nivel de conocimientos sobre factores de riesgo fue regular y sobre signos clínicos y forma y frecuencia del autoexamen bucal fue mal. La mayoría de la muestra en estudio conocía donde acudir y afirmó haber recibido información al respecto. Conclusiones: En su mayoría el nivel de conocimientos sobre lesiones premalignas se observó entre regular y mal con un descenso significativo del nivel de conocimientos en los pacientes de edades más avanzadas.

Background: The knowledge level about premalignant lesions in the geriatric population is a significant factor that influences on prevention, avoiding progression into mouth neoplasms. Objective: To diagnose the knowledge level in geriatric patients about buccal premalignant lesions. Methodology: A cross-sectional descriptive observational study was conducted between September 2019 and June 2021 at the Family Medical Office # 12 of Cabaiguán municipality, Sancti Spíritus province. The population was constituted by 158 geriatric patients and by means of a simple random probabilistic sampling, the sample was made up by 80. Theoretical, empirical, statistical and mathematical methods were applied. The used variables were age, sex, schooling, risk factors and clinical signs knowledge, knowledge of buccal self-examination and conduct to be followed. Results: The knowledge level about risk factors was found to be regular and on clinical signs and form and frequency of buccal self-examination was bad. The majority of the sample under study knew where to go and affirmed that they had received information about it. Conclusions: Mostly the knowledge level of premalignant lesions was observed to be regular to bad with a significant decrease in the knowledge level in more elderly patients.

Influencia de la salud oral en la calidad de vida de los adultos mayores: una revisión sistemática

Objetivo: analizar cómo interfieren las diversas dimensiones de la salud oral en la calidad de vida de las personas mayores. Método: se realizó una revisión sistemática en las bases bibliográficas Medline, LILACS, SciELO y EBSCO Dentistry & Oral Sciences, para ello se utilizó la estrategia de búsqueda: aged OR aging AND "oral health" OR dentistry OR "geriatric dentistry" OR "dental care" OR "dental care for aged" OR "mouth diseases" OR "tooth diseases" OR "tooth loss" OR "facial pain" OR "oral hygiene" AND "quality of life" OR "health status" OR "self concept" OR "health services needs and demand" OR "personal satisfaction" OR "attitude to health" OR "risk factors" OR "age factors" OR "health status indicators" AND "sickness impact profile" OR "health surveys" OR "need essessment" OR "surveys and questionnaires" OR "reproducibility of results". Resultados: De los 1.356 registros identificados 14 artículos fueron incluidos para el análisis. Se evidenció, mediante la evaluación bucal clínica y las encuestas de autopercepción de la salud oral, que existe una asociación entre la salud oral y la calidad de vida de las personas mayores. Conclusiones: el deterioro de la calidad de vida de las personas mayores es causado, principalmente, por la pérdida de dientes.

Objective: To analyze how the various dimensions of oral health interfere with the quality of life of older adults. Method: a systematic review was carried out in the bibliographic databases Medline, LILACS, SciELO and EBSCO Dentistry & Oral Sciences using the search strategy: aged OR aging AND "oral health" OR dentistry OR "geriatric dentistry" OR "dental care" OR "dental care for aged" OR "mouth diseases" OR "tooth diseases" OR "tooth loss" OR "facial pain" OR "oral hygiene" AND "quality of life" OR "health status" OR "self concept" OR "health services needs and demand" OR "personal satisfaction" OR "attitude to health" OR "risk factors" OR "age factors" OR "health status indicators" AND "sickness impact profile" OR "health surveys" OR "need assessment" OR "surveys and questionnaires" OR "reproducibility of results". Results: Of the 1,356 records identified, 14 articles were included for the analysis. Clinical oral evaluation and oral health self-perception surveys demonstrated the association between oral health and quality of life in older adults. Conclusions: the deterioration of the quality of life of older adults is mainly caused by the loss of teeth.

Odontogeriatría y función cognitiva I: Generalidades y conducta clínica en demencias

Introducción: Este trabajo hace una revisión de los estudios más recientes sobre la demencia, enfocándose en cómo se están abordando las necesidades de cuidado oral que presentan los pacientes afectados en las diferentes etapas de este trastorno. Se destaca la necesidad de dar a la odontología un mayor rol en las decisiones clínicas sobre pacientes con demencia. Revisión: La demencia es un deterioro progresivo de diversas facultades mentales; posee características degenerativas, no tiene tratamiento conocido y sus síntomas empeoran con el tiempo. Cada etapa del deterioro cognitivo requiere cuidados odontológicos con abordajes terapéuticos específicos, según el compromiso clínico del propio paciente. Discusión: Las personas con demencia desarrollan necesidades diferentes de cuidado oral, incluso en etapas tempranas. Los estudios han demostrado que la masticación puede considerarse como una medida que desacelera el deterioro cognitivo, siendo importante realizar acciones de prevención oral mediante tratamientos tempranos. Conclusión: Los pacientes con demencia se benefician de medidas preventivas en su cuidado oral, especialmente en las primeras etapas de este trastorno degenerativo.

Introduction: This work provides an overview of the latest progress in the study of dementia, with a focus on how dental care is being approached in patients during the various stages of this disorder. This work highlights the need for dentistry to play a greater role in clinical decisions over affected patients. Review: Dementia is a progressive deterioration of various mental faculties; it has degenerative characteristics, no known treatment and its symptoms worsen over time. Each stage of cognitive dysfunction requires specific dental care and therapeutic approaches, depending on the willingness of the patient. Discussion: People with dementia develop different needs for oral care, even during early stages. Studies have shown that preserving a patient's masticatory function is key to slowing down cognitive dysfunction, underlining the need for a proactive approach and early treatment. Conclusion: Patients with dementia benefit from preventative measures when it comes to their oral care, especially during the first stages of this degenerative disorder.

Is There Still Time to Orthodontics in Elderly Patients? / Ainda há Tempo para a Ortodontia na Melhor Idade?

Life expectancy rate has increased in the past decades and a crescent number of elderly patients are searching for dental treatment aiming for aesthetic and functional rehabilitation. Geriatric Dentistry is a dental specialty which focuses on the elderly population dental care, specially aiming at preventive and healing care of patients with diseases or systemic and chronic conditions, associated to physiological, physical or psychological deficiencies. Other specialties in Dentistry, such as Orthodontics, have become important allies in this new challenge of the Dental profession. This study aimed at analyzing characteristics involved in orthodontic treatment when associated with gerontologic needs, considering relevant factors to an adequate application based on a case report. The treatment was planned integrating Periodontics, Orthodontics, Prosthodontics and Operative Dentistry practice, allowing the reestablishment of function and aesthetics harmonically. Orthodontic treatment represents a feasible procedure in Geriatric Dentistry, as long as applying light forces and respecting both the characteristics and limitations of these areas of treatment.(AU)

Com o aumento considerável da expectativa de vida da população, um crescente número de pacientes idosos tem procurado tratamento odontológico para reabilitação estética e/ou funcional. A Odontogeriatria, é a especialidade odontológica que enfatiza o cuidado bucal da população idosa, especificamente do atendimento preventivo e curativo de pacientes com doenças ou condições de caráter sistêmico e crônico, associadas a problemas fisiológicos, físicos ou psicológicos. Diversas especialidades odontológicas, dentre elas a Ortodontia, vêm se integrando com esta área odontológica. Este trabalho objetiva abordar as características do tratamento ortodôntico associado a uma atuação odontogeriátrica, considerando os fatores relevantes para a execução do tratamento ortodôntico nesses pacientes a partir do relato de um caso clínico. Planejou-se este caso de forma integrada, envolvendo Periodontia, Ortodontia, Prótese e Dentística Restauradora, que foram capazes de devolver à paciente função e estética. O tratamento ortodôntico representa uma intervenção viável na atuação odontogeriátrica, desde que realizado com forças suaves, considerando as limitações e respeitando as características inerentes a esta atuação. (AU)

Salud bucal en ancianos del Hogar Provincial de Sancti Spíritus / Oral health in the elderly of the Provincial Home of Sancti Spíritus

RESUMEN Fundamento: Las personas de edad avanzada requieren atención estomatológica ajustada a su salud bucal. Objetivo: Describir la salud bucal de los ancianos pertenecientes al Hogar Provincial de Sancti Spíritus. Metodología: Se realizó un estudio observacional descriptivo transversal en el Hogar de ancianos provincial de Sancti Spíritus, entre diciembre de 2019 y agosto 2020. Se seleccionaron 72 ancianos, según criterios de inclusión. Se utilizaron métodos del nivel teórico, empírico y estadístico para estudiar las variables: Enfermedades bucales, factores de riesgo, higiene bucal, nivel de conocimientos sobre salud bucal y autopercepción de salud bucal. Resultados: En los ancianos predominó la enfermedad periodontal (29.4 %) y la disfunción masticatoria (28.6 %); los factores de riesgo que se observaron fueron la alimentación azucarada (12.8 %) y la diabetes mellitus (12.5 %), la higiene bucal deficiente (58.3 %), el nivel de conocimientos malo (51.4 %) y la autopercepción de salud bucal baja (54.2 %). Conclusiones: La salud bucal de los ancianos estudiados se caracterizó por presentar enfermedad periodontal y disfunción masticatoria en casi la tercera parte, con predominio de la alimentación azucarada y la diabetes mellitus como factores de riesgo y más de la mitad presentó higiene bucal deficiente, nivel de conocimientos malo y baja autopercepción de salud bucal.

ABSTRACT Background: Elderly people require dental care adjusted to their oral health. Objective: To describe the oral health of the elderly belonging to the Provincial Home of Sancti Spíritus. Methodology: A cross-sectional descriptive observational study was carried out in the Provincial Nursing Home of Sancti Spíritus, between December 2019 and August 2020. 72 elderly were selected, according to inclusion criteria. Theoretical, empirical and statistical level methods were used to study the variables: oral diseases, risk factors, oral hygiene, level of knowledge about oral health and self-perception of oral health. Results: In the elderly, periodontal disease (29.4 %) and masticatory dysfunction (28.6 %) predominated; the risk factors that were observed were sugary diet (12.8 %) and diabetes mellitus (12.5 %), poor oral hygiene (58.3%), poor level of knowledge (51.4 %) and low self-perception of oral health (54.2 %). Conclusion: The oral health of the elderly studied was characterized by presenting periodontal disease and masticatory dysfunction in almost a third of them, with a predominance of sugary diets and diabetes mellitus as risk factors, and more than half presented poor oral hygiene, level of poor knowledge and low self-perception of oral health.

Inter-examiner agreement in the application of an oral health assessment instrument in hospitalized elderly / Concordancia de interexaminadores en la aplicación de una herramienta de evaluación de la salud bucal en adultos mayores hospitalizados / Concordância interexaminadores na aplicação de instrumento de avaliação da saúde bucal em idosos hospitalizados

ABSTRACT Objectives: to analyze the correspondence between nurse and dental surgeon assessments in the application of an Oral Health Assessment in dental screening of elderly hospitalized patients. Methods: cross-sectional study with elderly patients (n = 54) admitted to University Hospital from the Federal University of São Paulo. Data were collected through the assessment of oral cavity. Descriptive statistical techniques were used to analyze them, using tables and graphs. Results: there was correlation and agreement between nurse and dental surgeon assessments referring to application of an Oral Health Assessment in dental screening of hospitalized elderly. Conclusions: oral Health Assessment in dental screening for hospitalized elderly by nurses demonstrated excellent reproducibility and may be a resource to identify buccal alteration, helping the planning and execution of nurse care associated to oral health.

RESUMEN Objetivos: analizar la concordancia entre la valoración del enfermero y del cirujano dentista respecto a la comprobación del estado de salud bucal de adultos mayores hospitalizados. Métodos: se trata de un estudio transversal realizado con adultos mayores (n=54) internados en la enfermería del Hospital Universitario de la Universidad Federal de São Paulo. Los datos se recogieron mediante la evaluación de la cavidad oral y se analizaron con técnicas estadísticas descriptivas, a partir de cuadros y gráficos. Resultados: fue posible observar correlación y concordancia entre las evaluaciones del enfermero y las del cirujano dental en la aplicación del instrumento de Evaluación de la Salud Oral para el Triaje Odontológico en adultos mayores hospitalizados. Conclusiones: la aplicación del instrumento Evaluación de la Salud Bucal para el Triaje Odontológico de parte del personal de enfermería en adulos mayores hospitalizados, demostró una excelente reproducibilidad, que puede llegar a convertirse en un recurso para examinar e identificar las alteraciones bucodentales, así como ayudar en la planificación y ejecución de los cuidados de enfermería asociados a la atención de la cavidad oral.

RESUMO Objetivos: analisar a concordância entre a avaliação do enfermeiro e a do cirurgião dentista em relação à verificação da condição da saúde bucal de idosos hospitalizados. Métodos: estudo transversal realizado com idosos (n=54) internados em enfermarias do Hospital Universitário da Universidade Federal de São Paulo. Os dados foram coletados por meio de avaliação da cavidade oral e foram analisados por técnicas de estatística descritiva, a partir de tabelas e gráficos. Resultados: houve correlação e concordância entre as avaliações do enfermeiro e as do cirurgião dentista na aplicação do instrumento Avaliação da Saúde Bucal para Triagem Odontológica em idosos hospitalizados. Conclusões: a aplicação do instrumento Avaliação da Saúde Bucal para Triagem Odontológica, em idosos internados pelo enfermeiro, demonstrou excelente reprodutibilidade, o que pode se tornar um recurso para examinar e identificar alterações bucais, bem como auxiliar no planejamento e execução da assistência de enfermagem associada aos cuidados com a cavidade oral.

Autopercepção de saúde bucal por idosos atendidos pelo sistema público de um município de Minas Gerais / Self-perception of oral health by the elderly assisted by the public system of a municipality in Minas Gerais

Objective:To analyze the self-perception of oral health by the elderly assisted by the public system of a municipality in Minas Gerais. Methods: descriptive, cross-sectional study with a quantitative approach, carried out with 100 elderly people during dental care in a public clinic and in a reference center. The data were treated using simple descriptive statistical analysis. Results: it was observed that the changes not noticeable by the elderly were: dry mouth sensation, decreased taste, decreased salivary flow and increased gingival problems. These consider it impossible to avoid tooth loss, however they reported that care for the remaining teeth and periodic consultation with the dentist are necessary. The reasons for seeking the professional were: toothache, gum pain, need for dental treatment and mouth injury. Conclusion: the elderly showed a satisfactory perception of their oral health. You are aware of oral changes resulting from aging, as well as care

Objetivo: analisar a autopercepção de idosos atendidos em uma clínica odontológica pública e em um centro de referência de um município de Minas Gerais sobre sua saúde bucal. Métodos: trata-se de um estudo descritivo, transversal, com abordagem quantitativa, realizada com 100 idosos durante atendimento odontológico em uma clínica pública e em um centro de referência. Utilizou-se um questionário semiestruturado, adaptado e validado. O tratamento dos dados se deu por meio de análise estatística descritiva simples. Resultados: observou-se prevalência de idosos do sexo feminino, casado, branco, renda de 1-2 salários, ensino médio completo e de outros municípios. As alterações não perceptíveis pelos idosos são: sensação de boca seca, diminuição do paladar, diminuição no fluxo salivar e aumento dos problemas gengivais. Os idosos consideram ser impossível evitar a perda dentária, todavia relataram que cuidados com os dentes remanescentes e consulta periódica ao cirurgião-dentista são necessários. Os motivos da procura ao dentista foram: dor de dente, dor na gengiva, necessidade de tratamento dentário e lesão na boca. Conclusão: a maior parte dos idosos apresenta uma percepção satisfatória quanto a sua condição atual de saúde bucal. Tem ciência das alterações bucais advindas do processo de envelhecimento, bem como das medidas de cuidados

Objetivo: Analizar la autopercepción de salud bucal por ancianos asistidos por el sistema público de una ciudad de Minas Gerais. Métodos: estudio descriptivo, transversal, con enfoque cuantitativo, realizado con 100 ancianos durante la atención odontológica en una clínica pública y en un centro de referencia. Los datos fueron tratados mediante análisis estadístico descriptivo simple. Resultados: se observó que los cambios que los ancianos no notaron fueron: sensación de boca seca, disminución del sabor, disminución del flujo salival y aumento de los problemas gingivales. Estos consideran imposible evitar la pérdida de dientes, pero informaron que es necesario cuidar los dientes restantes y consultar periódicamente con el dentista. Las razones para buscar al profesional fueron: dolor de muelas, dolor de encías, necesidad de tratamiento dental y lesiones en la boca. Conclusión: los ancianos mostraron una percepción satisfactoria de su salud bucal. Tiene consciencia de los cambios orales resultantes del envejecimiento, así como de la atención

Effect of dental education on knowledge and clinical behavior of turkish dentists' regarding oral-systemic health of geriatric patientsOral-systemic health of geriatric patients (Running title) / Efeito da educação odontológica no conhecimento e comportamento clínico de dentistas turcos em relação à saúde oral e sistêmica de pacientes geriátricos

Objective: The aim is to evaluate the perspectives of dentists' clinical approaches in terms of their knowledge and education regarding oral-systemic health relation of geriatric patients with a digital survey. Materials and Methods: The demographics, oral-systemic health-related lectures in participants' dentistry education, the level of awareness of the oral-systemic health relationship, and behaviors related to clinical applications were investigated on a digital platform with 49 multiple-choice questions. The results were analyzed with the SPSS 24.0 program. Results: Of a total of 410 dentists (206 women and 204 men), 23% have doctoral and/or specialty titles. While 93.1% of dentists had taken systemic health-related lectures, 21.3% of them rated these courses as "adequate" and 49.3% as weak. 72% of the participants received medical history only at the initial appointment, while 17.9% of them received it at each appointment. Dentists more often associate diabetes and cardiovascular diseases with periodontitis, compared to the development of dental caries. Dentists who think that they should work with physicians in the treatments of geriatric patients with systemic diseases refer more patients to physicians per year (p < 0.001). Conclusions: Dentists have found the lectures on the relationship between oral-systemic health of geriatric patients in dentistry education inadequate. Besides, there is a lack of information on the effects of systemic diseases on caries development, intra-oral findings, and knowledge on treatment approaches. Dentists believe that defining a curriculum that emphasizes interdisciplinary work and organizing scientific activities in partnership with medical associations will play an important role in establishing awareness of oral-systemic health. (AU)

Objetivo: O objetivo é avaliar as perspectivas das abordagens clínicas dos dentistas em relação ao seu conhecimento e educação sobre a relação da saúde oral e sistêmica de pacientes geriátricos através de um questionário digital. Material e Métodos: Os dados demográficos, as aulas relacionadas à saúde oral-sistêmica na educação odontológica dos participantes, o nível de conhecimento da relação saúde oral e sistêmica e os comportamentos relacionados às aplicações clínicas foram investigados em uma plataforma digital com 49 questões de múltipla escolha. Os resultados foram analisados com o programa SPSS 24.0. Resultados: De um total de 410 dentistas (206 mulheres e 204 homens), 23% possuem título de doutor e / ou especialidade. Enquanto 93,1% dos dentistas tiveram aulas sobre saúde sistêmica, 21,3% avaliaram esses cursos como "adequados" e 49,3% como fracos. 72% dos participantes recebem histórico médico apenas na consulta inicial, enquanto 17,9% deles recebem em cada consulta. Os dentistas associam mais frequentemente diabetes e doenças cardiovasculares à periodontite, em comparação ao desenvolvimento de cárie dentária. Os dentistas que acham que devem trabalhar em conjunto com médicos no tratamento de pacientes geriátricos com doenças sistêmicas encaminham mais pacientes ao médico por ano (p <0,001). Conclusões: Os cirurgiões-dentistas consideram inadequadas as palestras sobre a relação entre saúde oral e sistêmica de pacientes geriátricos no ensino de odontologia. Além disso, faltam informações sobre os efeitos das doenças sistêmicas no desenvolvimento de cárie, achados intraorais e conhecimento sobre as abordagens de tratamento. Os dentistas acreditam que a definição de um currículo que enfatize o trabalho interdisciplinar e a organização das atividades científicas em parceria com as associações médicas terá um papel importante no estabelecimento da consciência sobre a saúde oral e sistêmica (AU)

Survival of atraumatic restorative treatment restorations in the elderly patients: a systematic review

Abstract: This study aimed to assess the survival of glass ionomer cement (GIC) restorations performed using the atraumatic restorative treatment (ART) in elderly patients. The systematic review protocol was registered in the PROSPERO database. The records were searched until August 2020 in eight electronic bibliographic databases, and included randomized and non-randomized clinical trials and observational studies, with no restrictions on the language or year of publication. Study selection and data extraction were performed independently by two reviewers. Data were extracted, summarized, collected for qualitative analysis, and evaluated for individual risk of bias using the Joanna Briggs Institute's Critical Appraisal Tool. The literature search retrieved 5,186 records; however, only seven studies fulfilled the eligibility criteria and were included. The studies were published between 2002 and 2019. A total of 1,239 restorations were investigated at intervals of 6, 12, 24, and 60 months of follow-up. Some studies had a low risk of bias, while others had moderate and high risk of bias. In general, GIC restorations placed using ART were considered satisfactory. The 6-month, 12-month, and 24-month survival rates ranged from 81.3% to 97.2%, 72.2% to 94%, and 63% to 87%, respectively; additionally, the survival rate for the longest follow-up period (60 months) was 85%. Given the best evidence-based information regarding caries removal, we highlight the need to provide a conservative and effective technique for use in elderly patients. ART is a promising and viable alternative that guarantees the survival of restorations in elderly patients.

La odontogeriatría en la formación y superación de especialistas en Cuba / Geriatric Dentistry in the training and improvement of specialists in Cuba

Introducción: El envejecimiento de la población mundial en el nuevo milenio propicia que la atención al paciente geriátrico se mantenga como tema trascendental dentro de la literatura especializada contemporánea. Objetivo: Ofrecer una visión actual sobre el tratamiento de la odontogeriatría en los planes y programas de estudio en Cuba. Desarrollo: Se realizó una revisión bibliográfica en la literatura científica de los últimos 5 años a la fecha, en idioma español e inglés y se utilizaron preferentemente las bases de datos Ebsco, Pubmed y SciELO. Se consultaron artículos que abordaran la temática de la odontogeriatría en los currículos de estudio del pregrado en la carrera de estomatología y cómo se maneja la especialización desde el posgrado. Se hizo un análisis comparativo del tratamiento de esta disciplina en el ámbito mundial, de modo que se constató la necesidad de actualizar los planes y programas de estudio de la carrera de estomatología en Cuba, en aras de contribuir a una formación más integral del estudiante y de suplir esta carencia en los profesionales de la estomatología. Conclusiones: En Cuba resulta una necesidad, elevar la capacitación del estomatólogo, tanto en el pregrado como en el posgrado, en temas de odontogeriatría, con el fin de procurar una mayor calidad de vida de la población adulta mayor(AU)

Introduction: The aging of the world population in the new millennium favors that attention to the geriatric patient remains a transcendental subject within contemporary specialized literature. Objective: To offer a current vision on the treatment of the Geriatric Dentistry in Cuban plans and study programs. Development: A bibliographic review was carried out assuming the scientific literature of the last 5 years to date, in English and Spanish, using the databases Ebsco, Pubmed and Scielo. There were consulted articles that approached the Geriatric Dentistry thematic in the undergraduate study curricula of the Dentistry career and how the specialization is managed from the postgraduate level. A comparative analysis of the treatment of this Dentistry discipline was carried out worldwide, so the necessity to update the Dentistry study in Cuban plans and programs was confirmed, in order to contribute to a more comprehensive student training and fill this lack in Dentistry professionals. Conclusions: it is a necessity to increase dentists' training about Geriatric Dentistry in Cuban undergraduate and postgraduate studies in order to achieve a higher life quality in older population(AU)

Tratamientos prostodónticos en adultos mayores realizados en un centro dental especializado entre los años 2016 y 2018 / Prosthodontic treatments in older adults performed in a specialized dental center between 2016 and 2018

RESUMEN Los Adultos Mayores (AM) son más propensos a sufrir enfermedades y comorbilidades que afectan su estado bucal, por lo que necesitan de tratamientos prostodónticos acondicionados a su estado sistémico para devolverles la función masticatoria, estética y armonía oral. No obstante, la pobre cultura de prevención y la falta de profesionales especializados en su atención dificulta en gran medida esta labor. Objetivo: Determinar los tratamientos prostodónticos en pacientes adultos mayores realizados en el Servicio de Estomatología en Pacientes Especiales del Centro Dental Docente Cayetano Heredia desde abril de 2016 hasta diciembre de 2018. Material y métodos: Se realizó un estudio observacional, descriptivo, transversal y retrospectivo en una muestra de 144 AM con 200 tratamientos realizados. Se consideraron variables demográficas como sexo, grupo etario y procedencia. Se elaboró una base de datos, y posteriormente tablas de contenido para el análisis de sus resultados. Resultados: La PPR fue el tratamiento más realizado para ambos sexos, 39,8% (n=57) para el sexo femenino y 38,6% (n=22) para el sexo masculino. De acuerdo al grupo etario, los viejos-viejos fueron los pacientes que más PPR se realizaron con 40,19% (n=43). La mayoría de los pacientes provenientes de Lima Norte se realizaron el tratamiento de PPR con 41.96% (n=47). Conclusiones: Las prótesis removibles predominaron más que las fijas, siendo la PPR la que más se realizó. También se evidencio que el sexo femenino recibió más tratamientos prostodónticos y que el lugar de procedencia que más se registro fue el de Lima Norte, posiblemente por la cercanía al centro dental.

SUMMARY Older adults are more prone to suffer diseases and comorbidities that affect their oral condition, so they need prosthodontic treatments conditioned to their systemic state to restore their masticatory, aesthetic and oral harmony function. However, the poor culture of prevention and the lack of specialized professionals in their care greatly hinders this work. Objective: To determine the prosthodontic treatments in older adults performed in the Service of Estomatología in Pacientes Especiales of the Centro Dental Docente Cayetano Heredia from april 2016 to december 2018. Material and methods: An observational, descriptive, cross-sectional, and retrospective study was carried out in a sample of 144 older adults with 200 treatments performed. Demographic variables such as sex, age group and origin wereconsidered. A database was developed, and later tables of contents for the analysis of its results. Results: PPR was the most performed treatment for both sexes, 39.8% (n = 57) for the female sex and 38.6% (n = 22) for the male sex. According to the age group, the old-old were the patients who performed the most PPR with 40.19% (n = 43). Most of the patients from Lima Norte underwent PPR treatment with 41.96% (n = 47). Conclusions: The removable prostheses predominated more than the fixed ones, being the PPR the one that was performed the most. It was also evidenced that the female sex received more prosthodontic treatments and that the place of origin that was most recorded was Lima Norte, possibly due to its proximity to the dental center.

Questões fonoaudiológicas e odontológicas na percepção de idosos que acessam serviços do Sistema Único de Saúde / Speech therapy and oral health issues in the perception of the older adults that access the Unified Health System

RESUMO: Modelo de estudo: Estudo observacional e transversal com dados coletados a partir de questionários aplicados aos idosos em visitas domiciliares, sobre acesso a serviços de saúde. Objetivo: Analisar a percepção de idosos independentes sobre questões fonoaudiológicas e odontológicas nos serviços de Atenção Primária à Saúde do Sistema Único de Saúde. Métodos: Foram analisadas frequências absolutas das variáveis de estudo relacionadas a questões fonoaudiológicas e odontológicas através do teste do Qui-quadrado e Teste Exato-de-Fisher, ambos com nível de 0,05% de significância. Resultados: Os idosos entrevistados foram predominantemente mulheres (76,5%), cor branca (73,5%), com no mínimo ensino médio de escolaridade (64,7%). Destes idosos, 92,6% afirmaram não possuir dificuldades para se alimentar, apesar de 51,5% nunca ter feito uma avaliação fonoaudiológica. Houve maior proporção indicando que os idosos não necessitaram de consulta com fonoaudióloga (73,5%). Quanto à utilização de serviços da atenção primária, 68,7% utilizavam o sistema público e desses, 94,1% autoperceberam sua condição de saúde bucal como regular/ruim. Conclusão: Sugere-se o fortalecimento do cuidado dos idosos de forma interdisciplinar e integral, a fim de abranger as necessidades e especificidades dessa população. A baixa percepção da importância do cuidado sugere a necessidade do fortalecimento dos serviços de fonoaudiologia para a saúde da população idosa brasileira. (AU)

ABSTRACT: Study design: Cross-sectional study with data collected from questionnaires applied to older adults at domiciliary visits regarding access to health services. Objective: Analyzing the perception of independent elderly about speech-language and dental issues in the Primary Health Care Services of the Unified Health System/SUS. Methods: Absolute frequencies of the study variables related to speech-language and dental questions were analyzed using the Chi-square test and Fisher's Exact Test, both with a 0.05% significance level. Results: The elderly interviewed were predominantly women (76.5%), white (73.5%), with at least high school education (64.7%). Of these, 92.6% said they had no difficulty in eating, although 51.5% never had a speech therapist evaluation. There was also a higher proportion indicating that the elderly did not need an appointment with the speech therapist (73.5%). Regarding the use of primary care services, 68.7% used the public system, and of these, 94.1% self-perceived their oral health condition as fair/poor. Conclusion: It is suggested to strengthen the care of the elderly in an interdisciplinary and integral way to cover the needs and specificities of this population. The low perception of the importance of care suggests the need for strengthening speech therapy services for the health of the elderly Brazilian population. (AU)

COVID-19 and Geriatric Dentistry: What will be the new-normal? / COVID-19 e Odontologia Geriátrica: Qual será o novo normal?

Older adults may face many barriers when accessing oral health care. The most vulnerable groups are people living in long term care institutions and the homebound. These barriers are related but not limited to socio-economic issues, medical and oral health problems. Some socio-economic problems are lack of finances, absence of dental insurance, lack of social support networks, and being institutionalized. Some general health problems are multiple co-morbidities, polypharmacy, dementia, and reduced autonomy. Some oral health problems are having heavily restored dentitions, dry mouth, root caries, and inability to maintain adequate oral hygiene independently. In addition to these existing barriers, many new barriers have arisen which are expected to further reduce access to oral health care for older adults due to the emergence of the COVID-19 pandemic. Older adults are at greater risk of fatal outcomes from COVID-19 infection and many dental procedures have an increased risk of creating aerosols, thereby spreading COVID-19 infection. Consequently, older adults due to fear are less likely to seek or receive oral health care until a treatment or vaccine is developed for COVID-19 infections. In this article, the authors discuss the implications of the COVID-19 pandemic to the practice of geriatric dentistry, and what is expected to be the "new normal" in this field of dentistry (AU)

Os idosos geralmente enfrentam muitas barreiras para acessar os serviços de saúde bucal. Os grupos mais vulneráveis são formados por pessoas que vivem em instituições de longa permanência ou estão restritos às suas casas. Essas barreiras estão relacionadas, entre outras, a questões socioeconômicas e problemas de saúde geral e oral. Alguns problemas socioeconômicos são: problemas financeiros, falta de convênio odontológico, falta de redes de apoio social e institucionalização. Alguns problemas gerais de saúde são: múltiplas comorbidades, polifarmácia, demência e autonomia reduzida. Alguns problemas de saúde bucal são: dentição muito restaurada, boca seca, cárie radicular e incapacidade de manter uma higiene bucal adequada de forma independente. Além das barreiras já existentes, devido ao surgimento da pandemia de COVID-19 surgiram novas barreiras que deverão reduzir ainda mais o acesso aos cuidados de saúde bucal para idosos. Idosos correm maior risco de complicações fatais da COVID-19 e muitos procedimentos odontológicos têm um risco aumentado de gerar aerossóis, espalhando assim a COVID-19. Consequentemente, os idosos têm menor probabilidade de procurar ou receber cuidados de saúde bucal devido ao medo, até que um tratamento ou vacina seja desenvolvido para a COVID-19. Neste artigo, os autores discutem as implicações da pandemia de COVID-19 na prática da odontologia geriátrica e o que se espera ser o "novo normal" nesse campo da Odontologia.(AU)

Gerontología en la formación de pre grado del odontólogo del siglo XXI / Gerontology in the pre doctoral academic training at the 21th century

RESUMEN: La gerontología es la ciencia que trata de la vejez y los fenómenos que la caracterizan. Se aboca al estudio científico del proceso de envejecimiento y abarca la esfera social, psicológica y biológica. El fenómeno actual del envejecimiento de la población mundial, denominado "transición demográfica", ha puesto al quehacer de la gerontología en acuciante actualidad. Dentro de su marco conceptual, en el ámbito de la ciencia médica, surge la geriatría, especialidad que se ocupa no sólo de la prevención y asistencia de las enfermedades que presentan las personas mayores, sino también de su recuperación funcional y de su reinserción en la comunidad. En Chile, sin constituirse en una especialidad propiamente tal, la llamada "odontogeriatría" vendría a ser el equivalente de geriatría en odontología. Sin embargo, creemos que gerodontología sería más pertinente puesto que apreciamos en ésta, una visión cultural derivada de la gerontología que va allende los aspectos procedimentales propios de la odontología. Pretendemos fundamentar esta afirmación, analizando la experiencia internacional, contrastándola con la situación que se verifica en Chile, reiterando la imperiosa necesidad de comenzar desde la formación de pre grado del futuro odontólogo con la entrega de insumos gerodontológicos teóricos y clínicos, para intentar aportar de modo propositivo y no efectista, en el diseño de políticas públicas actualizadas.

SUMMARY: Gerontology is the science studying ageing and the phenomena that characterize it. It deals with the scientific approach of this process encompassing the social, psychological and biological fields. The current phenomenon of the ageing of the world population, so called "demographic transition" has put the gerontological issue in pressing today. Within its conceptual frame and in the sphere of medical sciences emerges Geriatrics, specialty covering not only prevention and care of older people diseases, but also addressing its functional recovery and reintegration into the community. In Chile, not yet a specialty, geriatric dentistry would be its equivalent regarding odontology. However, we believe that there is a conceptual difference regarding gerodontology since we appreciate its scope goes far beyond the procedural aspects of dentistry. We will make our statement, analyzing evidence from international educational experiences, as well as contrasting with the situation that occurs in Chile, altogether stressing the urgent need to start from the undergraduate curriculum of future dentists through the delivery of theoretical input and clinical gerodontologic training, in order to collaborate in a proactive way in the design of updated public policies according to the nowadays challenges.

Características de Autocuidado em Saúde Oral, Hábitos e Acesso a Serviço Odontológico por Idosos Rurais e Urbanos / Characteristics of oral health self-care, habits and access to dental service by rural and urban elderly / Características del autocuidado en salud bucal, hábitos y acceso al servicio odontológico por ancianos rurales y urbanos

O artigo buscou investigar as diferenças no estado de saúde oral entre idosos rurais e urbanos, incluindo características de autocuidado, hábitos e acesso a serviços odontológicos, através daPesquisa Nacional de Saúde de2013.Foram encontrados perfis diferentes depacientes,de acordo com a zonageográfica.Idosos urbanosmostraram melhores indicadores de saúde oral, agendamento com maior uso de tecnologiase menor busca de tratamentospor patologia oral que os idosos rurais.

We have investigated the differences related to oral health status between urban and rural elderly, including oral health self-care, habits and access to dental service characteristics. Data was obtained from Brazilian National Health Survey (2013). According to geographic area we have found different profiles. Urbans demonstrated better indicators of oral health status, more use of technology to appoint a dentistry consultation and less looking for treatment because oral pathology than rural elderly.

El artículo buscó investigar las diferencias en el estado de salud bucal entre ancianos rurales y urbanos, incluyendo características de autocuidado, hábitos y acceso a servicios dentales, a través de la Encuesta Nacional de Salud de 2013. Se encontraron diferentes perfiles de pacientes, segúnel área geográfica.Los ancianos urbanos mostraron mejores indicadores de salud bucal, programación con mayor uso de tecnologías y menor búsqueda de tratamientos para patología oral que los ancianos rurales.

Cultural adaptation and validation of the Geriatric Oral Health Assessment Index - GOHAI - Colombian version / Adaptación cultural y validación del Geriatric Oral Health Assessment Index - GOHAI - versión Colombia

Abstract Objective: This study aims to carry out the cultural adaptation and the validation of the GOHAI scale for the Colombian population. Methods: Translation process, cultural adaptation, and content and face validity were carried out with a sample of 63 participants as a pretest. The validation counted with a sample of 7,200 subjects, divided into two groups: a work sample (WS) with 3,628 subjects and a confirmatory sample (CS) with 3,572 subjects. Construct, criterion validity and internal consistency were performed for both samples. Test-retest reliability was assessed with a sub-sample of 75 participants Results: The GOHAI showed an appropriate face and content validity, the pre-test revealed an understandable questionnaire, the scale showed a unidimensional factorial structure and a Cronbach's Alpha of 0.8. Convergent validity with a self-perception on general health scale pointed to a significant correlation (p= 0.0001), while discriminant validity showed significant differences regarding groups according to age group, skin color, educational level, socio-economic level, healthcare affiliation and self-perception about need of dental prostheses. Gender groups did not show significant differences among groups within either sample. The CS showed similar results, differences existed among factorial structures of 2 and 3 factors, and for discriminant validity, the CS showed statistically significant differences for the Area variable not in the WS. Kendall's test-retest analysis's correlation is 0.85 (p= 0.0000). Conclusions: The GOHAI scale is valid and reliable enough to be used as a measure of Oral-Health-Related Quality of Life in the Colombian elderly population, also could be applied for other Latin-American populations.

Resumen Objetivo: Adaptar culturalmente y validar la escala de autopercepción de salud bucal - Geriatric Oral Health Assessment Index (GOHAI) para la población mayor colombiana. Métodos: El proceso de traducción, adaptación cultural, contenido y validez aparente se llevaron a cabo en el pre-test con una muestra de 63 participantes. La validación contó con una muestra de 7,200 sujetos, divididos en dos grupos: una muestra de trabajo (WS) con 3,628 sujetos y una muestra confirmatoria (CS) con 3,572 sujetos. Se realizó validez de constructo, criterio y consistencia interna para ambas muestras. La confiabilidad test-re-test se evaluó con una submuestra de 75 participantes. Resultados: La escala GOHAI mostró condiciones adecuadas de apariencia y contenido, El pre-test mostro un cuestionario entendible y adecuado, la escala arrojo una estructura factorial única y una consistencia interna Alfa de Cronbach de 0,8. La validez convergente con la variable autopercepción en salud general mostró diferencia significativa entre grupos (p= 0.0001), la validez discriminante mostro diferencias significativas con las variables grupo de edad, color de piel, nivel educativo, estrato socio-económico, regímenes de salud y autopercepción de necesidad de prótesis dental; la variable Área mostró diferencia significativa en la MC, no en la muestra MT. El análisis test-retest mostro una correlación de Kendall de 0.85 (p= 0.0000). Conclusión: El instrumento GOHAI es válido y confiable y puede ser usado como una medida de Calidad de Vida relacionada con Salud Bucal en personas mayores en Colombia y puede ser aplicado en otras poblaciones de habla hispana de América Latina.

Geriatric oral health concerns, a dental public health narrative

Across the world, the segment of the elderly in populations is seen to be increasing at a rapid rate. There also exists a trend in which more teeth are retained as age increases due to effective dental public health measures like fluoridation. This inevitably places an increased need for dental healthcare among the geriatric populations. Since oral health greatly affects the systemic health of aged individuals, it is imperative for dentists and physicians to work together as a team to impart treatment to the best of one’s abilities for geriatric patients. It is therefore, necessary to first assess the oral health concerns surrounding the geriatric population from the perspective of public health dentistry. Relationship of the elderly with periodontal disease, dental caries, salivary hyposalivation and xerostomia, cognitive changes, and simultaneous usage of diverse medications was discussed. This paper reviewed the literature and then examined and discussed the various problems mentioned in depth and suggested recommendations for a plan of action. Knowledge about the specific oral health concerns and issues will help to better position us in developing strategies for providing better oral healthcare to the geriatric population in addition to the existing systemic healthcare. In the future, the elderly will make up a huge portion of the demographic visiting dentist regularly for a myriad of oral health problems. Dental health professionals therefore, must have adequate training and competency to deal with the predicament of this geriatric population. Preventive and treatment services can ensure healthy aging which will improve the quality of life.

Clinical and self-perceived oral health assessment of elderly residents in urban, rural, and institutionalized communities

OBJECTIVES: This study aims to evaluate the self-perception of oral health according to the physical, psychosocial and pain/discomfort dimensions related to clinical conditions and orofacial pain of elderly people living in three different environments. METHODS: This was an observational, cross-sectional, quantitative study with a population-based approach and nonprobabilistic convenience sampling that included 81 elderly people: 27 resided in institutional homes for elderly individuals, 27 resided in an urban area and 27 resided in a rural area in the interior of Paraíba (PB) in northeastern Brazil. RESULTS: The Geriatric Oral Health Assessment Index (GOHAI) was used to assess self-perception of oral health, while the Questionnaire for Screening of Patients with Temporomandibular Disorders (QST/TMD) was used to assess the influences of orofacial pain and the biofilm indexes of teeth and prostheses. There was a statistically significant difference in the GOHAI scores among the places of residence, with the worst values associated with the rural area. According to the QST/TMD, the majority of individuals were affected by TMDs, with statistical differences for both sex and income. CONCLUSION: The biofilm analysis showed a higher incidence of clinical conditions in the rural population. The place of residence also influenced self-perception and the clinical oral health condition of elderly people; the rural population presented the worst results.

Protocol for the evaluation of chewing among older adults / Protocolo de avaliação da mastigação do idoso

Abstract Objectives : To evaluate the functional and physiological structures of the stomatognathic system of the oral cavity of older adults based on self-perception, comparing the same with a professional clinical evaluation, and investigating the difficulties encountered when chewing. Method : An analytical cross-sectional study with a quantitative approach was conducted with a sample of 53 older adults aged 60 to 90 years. A protocol consisting of three questionnaires was used: a sociodemographic evaluation, a self-perception based interview with 19 questions on the chewing of the older adults and a clinical evaluation containing 30 questions covering aspects of the oral cavity tissue. The self-perception and clinical evaluation scores were compared using the Mann-Whitney test and the proportions observed for each item were compared by the binomial test. Results : It was found that the self-perception of older adults did not correspond to the result of the clinical evaluation. While 31 (58.5%) reported satisfaction with chewing, 16 (30.2%) had high/very high impairment and 14(26.4%) moderate impairment, based on the results of the clinical evaluation found. Conclusion : It was found that the chewing analysis process cannot be exclusively based on the answers provided by the older adults, and assessment proved to be more accurate when combined with a clinical evaluation performed by a professional.

Resumo Objetivos : Avaliar as estruturas funcionais e fisiológicas do sistema estomatognático da cavidade bucal dos idosos diante da autopercepção, comparando-as com a avaliação clínica profissional e investigar as dificuldades encontradas para realizar sua mastigação. Método : Estudo transversal analítico de abordagem quantitativa, realizado com uma amostra de 53 idosos, idade entre 60 e 90 anos. Foi utilizado um protocolo constituído de três questionários: uma avaliação sociodemográfica, uma entrevista de autopercepção com 19 quesitos da mastigação do idoso e uma avaliação clínica contendo 30 quesitos abrangendo os aspectos teciduais da cavidade bucal. Os escores da autopercepção e da avaliação clínica foram comparados pelo teste de Mann-Whitney e as proporções observadas para cada item pelo teste binomial. Resultados : Constatou-se que a autopercepção relatada pelos idosos não correspondeu ao resultado da avaliação clínica. Enquanto 31 (58,5%) relataram satisfação com a mastigação, 16 (30,2%) possuíam comprometimento alto/muito alto e 14 (26,4%) comprometimento moderado. Conclusão : Evidenciou-se que o processo de análise da mastigação não pode ser realizado exclusivamente pelas respostas prestadas pelo idoso, sendo mais adequado quando se adiciona a etapa da avaliação clínica feita por um profissional.

Relación entre enfermedades periodontales y salud sistémica en la vejez / The relationship between periodontal disease and systemic health in the elderly

Se denomina Medicina Periodontal a la rama de la Odontología que busca las posibles asociaciones entre las enfermedades periodontales y enfermedades sistémicas, y su plausibilidad biológica. Esta relación se puede explicar por el paso directo de bacterias y/o mediadores inflamatorios a la sangre desde el tejido periodontal, pudiendo acceder y colonizar sitios específicos lejanos en el cuerpo, o por la propagación transtraqueal de patógenos periodontales. Si bien en la actualidad se han estudiado hasta 57 condiciones sistémicas relacionadas con las enfermedades orales y periodontales, se ha podido identificar asociaciones con Osteoporosis, Diabetes Mellitus, Enfermedad Pulmonar Obstructiva Crónica, Neumonía, Parto Prematuro y Bajo Peso al Nacer, Enfermedades Cardiovasculares, Artritis Reumatoide, Obesidad, Alteraciones Cognitivas, Cáncer, Síndrome Metabólico, Enfermedades Neurodegenerativas, Enfermedad Renal Crónica, entre otras. La presente revisión busca dar a conocer evidencia respecto a la relación entre Periodontitis Crónica y condiciones sistémicas prevalentes en los Adultos y Adultas Mayores

The branch of dentistry enquiring into possible associations between periodontal disease and systemic illness and their plausibility is Periodontal Medicine. This relationship may be explained by the direct passage of bacteria and/or inflammatory mediators from periodontal tissue to the blood, thus reaching and colonising distant sites in the body, or the transtracheal propagation of periodontal pathogens. 57 systemic conditions related to oral and periodontal disease have been studied and associations with osteoporosis, diabetes mellitus, COPD, pneumonia, prematurity and low birth weight, cardiovascular disease, rheumatoid arthritis, obesity, cognitive alterations, cancer, metabolic syndrome, neurodegenerative diseases and chronic kidney disease, amongst others have been identified. This review aims to bring to light evidence relating to the relationship between chronic periodontitis and systemic conditions prevalent in adults and the elderly.