Evaluation of plaque index, gingival index and oral health-related quality of life in obese patients / Evaluación del índice de placa, índice gingival y calidad de vida relacionada con la salud bucal en pacientes obesos

Obesity is a chronic disease that may be related to caries, periodontitis, xerostomia, and dental erosion, as well as increasing morbidity and mortality. The aim of this study was to evaluate the plaque index (Silness & Löe, 1964), the gingival index (Löe & Silness, 1963), and the oral health-related quality of life (OHRQoL) in obese patients. The study included 45 extremely obese, 45 obese, and 45 normal-weight individuals between the ages of 18 and 58. The plaque index and gingival index of the individuals were determined by clinical examination by probing. In addition, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was used for the OHRQoL. The IBM SPSS Statistic 22.0 software program was used for the statistical evaluation of the study data. The plaque index and gingival index values were statistically higher in obese compared to normal weight individuals (p0.05). There was no statistically significant difference between the OHIP-14 total scores of the groups (p>0.05). Increased apparent plaque index and gingival index values in obese patients may adversely affect periodontal health.

La obesidad es una enfermedad crónica que puede estar relacionada con caries, periodontitis, xerostomía y erosión dental, además de aumentar la morbimortalidad. El objetivo de este estudio fue evaluar el índice de placa, el índice gingival y la calidad de vida relacionada con la salud bucal (CVSB) en pacientes obesos. El estudio incluyó a 45 individuos extremadamente obesos, 45 obesos y 45 de peso normal entre las edades de 18 y 58 años. El índice de placa y el índice gingival de los individuos se determinaron mediante examen clínico y sondaje periodontal. Además, se utilizó el cuestionario Oral Health Impact Profile-14 (OHIP-14) para la evaluación CVSB. Se utilizó el programa informático IBM SPSS Statistic 22.0 para la evaluación estadística. Los valores del índice de placa y del índice gingival fueron estadísticamente más altos en obesos en comparación con los individuos de peso normal (p0,05). No hubo diferencia estadísticamente significativa entre las puntuaciones totales de OHIP-14 de los grupos (p>0,05). El aumento del índice de placa aparente y los valores del índice gingival en pacientes obesos pueden afectar negativamente la salud periodontal.

Comparison of Oncostatin M in Patients with Chronic Periodontitis with and without Diabetes

Abstract Objective: To compare the Oncostatin M (OSM) concentrations in tissues of patients with chronic periodontitis with and without diabetes. Material and Methods: Sixty-four subjects visiting the dental outpatient department were categorized as "healthy" (Group 1), "periodontitis" (Group 2), and "diabetes with periodontitis" (Group 3) groups. The clinical oral examination included assessment of plaque, gingivitis, probing depth, clinical attachment level. Blood glucose was assessed for group 3 patients. OSM concentration in the tissues was assessed using ELISA in all groups. Results: The mean OSM was 0.02 ± 0.04 pg/mg in the healthy group, 0.12 ± 0.09 pg/mg in the chronic periodontitis group and 0.13 ± 0.10 pg/mg in the diabetes-periodontitis group. A significantly higher mean OSM was seen in Group 2 and Group 3 than Group 1. The amount of OSM positively correlated with probing depth and clinical attachment level. Conclusion: Periodontal disease causes a rise in Oncostatin M, independent of the diabetic status. Expression of OSM in the gingival tissues can serve as an inflammatory marker.

Evaluation of Antimicrobial Photodynamic Therapy as an Adjuvant in Periodontal Treatment in Individual with Down Syndrome

Abstract Objective: To evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT), associated with scaling and root planing in the non-surgical periodontal treatment of individuals with Down Syndrome. Material and Methods: A controlled, randomized, split-mouth study was conducted. A total of 8 participants diagnosed with Down Syndrome aged 17-38 years of both sexes with clinical periodontitis were included in the study. Participants were treated at least three times: at the baseline, Plaque Index (PI), Bleeding on Probing (BOP), and Probing Pocket Depth (PPD) were obtained. After one week, conventional scaling and root planing were performed, and two quadrants were randomly selected for aPDT application. The reassessment was obtained one month after the aPDT application. The significance level was set at 5%. Analyses were performed considering a 95% confidence interval. Results: In the intergroup evaluation, no statistically significant differences were observed (p>0.05). In the intragroup evaluation, no statistically significant variations were observed in relation to the PI (p>0.05) and PPD (p>0.05); however, a statistically significant reduction in the BOP was observed between the test group (p=0.013) and control group (p=0.015). Conclusion: The use of aPDT as adjuvant therapy did not promote additional benefits in decreasing PI and PPD after 1 month of treatment. However, a significant reduction in the BOP was observed in the intragroup evaluation.

Efectividad del cepillo dental eléctrico versus manual para la remoción de biofilm en pacientes con síndrome de Down / Effectiveness of electric versus manual toothbrush for biofilm removal in patients with Down syndrome

Introducción: La salud oral en pacientes con síndrome de Down (SD) es un reto, ya que las alteraciones en la motricidad ocasionadas por la discapacidad intelectual (DI) hacen que tareas como la remoción del biofilm oral o placa dentobacteriana (PDB) con el cepillado sea deficiente. La efectividad de los cepillos eléctricos (CE) comparada con los manuales (CM) en afectados con SD sigue siendo un tema debatible ya que no se ha encontrado una homogeneidad de resultados. Es conveniente mayor investigación sobre el tema, debido a que el SD es considerada la alteración cromosómica más frecuente y la causa principal de DI en el mundo. Objetivo: Conocer la efectividad del CE en comparación con el CM para la remoción de PDB en pacientes mexicanos con SD de entre seis y 14 años. Material y métodos: Estudio transversal experimental, con emparejamiento de sujetos con SD de ambos géneros según la edad (seis a 14 años), asignando el cepillo a utilizar (grupo 1 CM o grupo 2 CE). Se realizó educación dental y método de cepillado con la técnica de Fones, así como control de PDB antes y después el efectuado por medio del índice de O'Leary durante tres días. Se analizaron los resultados utilizando estadística descriptiva e inferencial (prueba de normalidad Lilliefors, prueba t para variables independientes y dependientes). Se aceptó un análisis de significancia p < 0.05. Resultados: La utilización de la t para muestras independientes presentó una mejoría en incremento de dicho marcador de O'Leary en el conjunto total en los tres días de seguimiento respectivamente (t = 6.9, p < 0.00002; t = 8.4, p < 0.00000; y t = 9.5, p < 0.00000). Al comparar por prueba t aplicada a muestras dependientes el índice de O'Leary basal versus cada una de las evaluaciones de seguimiento también se observaron diferencias significativas en los dos conjuntos (grupo 1: p = 0.003, p = 0.0006 y p = 0.0017; grupo 2: p = 0.007, p = 0.0006 y p = 0.0002). Conclusión: La instrucción dental y motivación del paciente fueron determinantes hacia el buen desempeño del cepillado de los dientes y remoción de placa en el par de colectivos, es decir, la reafirmación de la técnica de Fones incrementa gradualmente la mejoría de la forma de uso del cepillo en niños con SD. Ambos métodos con CM y con CE fueron efectivos a fin de remover significativamente la placa, observándose una mayor mejoría en el grupo con CE, sugiriendo que éste disminuye la dificultad de la higiene bucal en personas con SD. Esta línea de investigación es importante en el beneficio de la condición oral de esta población (AU)

Introduction: Oral health in patients having Down syndrome (DS) is a challenge since the changes in motor skills caused by intellectual disability (ID) deteriorate tasks such as the removal of biofilm or dental plaque (DP) with brushing. The effectiveness of electric toothbrushes (ET) compared to manual toothbrushes (MT) in DS patients remains debatable since no homogeneity of results has been found. Further research on the subject is advisable as DS is considered the most frequent chromosomal alteration and the leading cause of ID in the world. Objective: To know the effectiveness of the ET in contrast to the MT for the removal of DP in Mexican DS patients between six and 14 years old. Material and methods: Experimental cross-sectional study, with the pairing of DS subjects of both genders according to age (six to 14 years), assigning the brush to be used (group 1 MT or group 2 ET). Dental education and brushing were performed employing the Fones technique and DP control before and after brushing employing the O'Leary index for three days. The results were analyzed using descriptive and inferential statistics (Lilliefors normality test, t-test for independent and dependent variables). A significance test p < 0.05 was accepted. Results: The t-test for independent samples showed an improvement in the increase of the O'Leary index in the complete group in the three days of follow-up respectively (t = 6.9, p < 0.00002; t = 8.4, p < 0.00000; and t = 9.5, p < 0.00000). When comparing by t-test for dependent samples the baseline O'Leary index versus each of the follow-up evaluations, significant differences were also observed in both groups (group 1: p = 0.003, p = 0.0006 and p = 0.0017; group 2: p = 0.007, p = 0.0006 and p = 0.0002). Conclusion: The dental education and motivation of the patient were decisive for the good performance of tooth brushing and removal of the plaque in both groups. The reaffirmation of the Fones technique gradually increases the improvement of the brushing technique in DS children. Both brushings using MT and ET were effective in removing the biofilm significantly. However, a greater improvement was observed in the group with ET, suggesting that it reduces their difficulty with tooth brushing. This line of research is important to benefit the oral condition of this population (AU)

Brush up: an innovative technological aid for parents to keep a check of their childrens oral hygiene behaviour / Brush up: uma ajuda tecnológica inovadora para os pais controlarem o comportamento de higiene bucal de seus filhos

ABSTRACT Objective: To investigate the impact of "Brush Up" - a mobile application, on oral hygiene behaviours of 4-6-year-old children in Bangalore city. Methods: In this experimental study, 247 children aged 4-6, were randomly divided into three groups. Considering "Brush Up" is a mobile application, parents of the children in Group 1 (n=82) downloaded the application on their smartphones. Children in Group 2 (n=83) and Group 3 (n=82) received tooth brushing instructions by an educative video and manual demonstration, respectively. Effectiveness of tooth brushing was assessed with plaque scores, which were recorded for all the groups at baseline and one month using Visible Biofilm Index. Results: Wilcoxon signed rank test showed a significant improvement in the tooth brushing behaviour for the Brush Up group, which was indicated by a lower plaque score after a follow-up of one month. Kruskal-Wallis test followed by post-hoc test showed that the mean ranks of plaque scores of Brush Up group are consistently lower than those of video demonstration group and manual demonstration group. Conclusions: The lower plaque score in subsequent follow-up in Brush Up group suggests that using a smart system can enhance learning a correct tooth brushing method in young children and can also help in implementing the required reinforcement and motivation to brush and aid in better plaque control.

RESUMO Objetivo: Investigar o impacto do "Brush Up", um aplicativo móvel, sobre comportamentos de higiene bucal de crianças de 4 a 6 anos na cidade de Bangalore, na Índia. Métodos: Neste estudo experimental, 247 crianças de 4 a 6 anos foram divididas aleatoriamente em 3 grupos. Como "Brush Up" é um aplicativo móvel, os pais das crianças do Grupo 1 (n=82) baixaram o aplicativo em seus smartphones. As crianças do grupo 2 (n=83) e do grupo 3 (n=82) receberam instruções sobre escovação por meio de vídeo educativo e demonstração manual, respectivamente. A efetividade da escovação foi avaliada por meio de escores de placa bacteriana, registrados para todos os grupos antes da intervenção e um mês depois. Resultados: O teste de Wilcoxon sinalizou uma melhora significativa na escovação para o grupo "Brush Up", com uma pontuação mais baixa na placa bacteriana após um mês de acompanhamento. O teste de Kruskal-Wallis, seguido do teste post hoc, mostrou que as classificações médias das pontuações do grupo "Brush Up" foram consistentemente mais baixas do que as do grupo com demonstração em vídeo e demonstração manual. Conclusões: Os resultados obtidos no grupo "Brush Up" sugerem que o uso de um sistema inteligente pode melhorar o aprendizado de um método correto de escovação em crianças pequenas e ajudar na implementação do reforço e motivação necessários para escovar e controlar melhor a placa bacteriana.

Dental Status of Firefighters of Rio de Janeiro State and Comparison with Brazilian Oral Health Surveys

ABSTRACT Objective: This cross-sectional study aimed to assess clinical dental status in military firefighters of Rio de Janeiro State and compare data with Brazilian National and Regional oral health surveys. Material and Methods: A sample of 926 military firefighters was examined using the visible biofilm index, the DMFT index and the Community Periodontal Index (CPI). Clinical exams were performed by 15 trained dentists. The Kruskal-Wallis test and Mann-Whitney test with Bonferroni correction were used. Results: Higher biofilm accumulation was associated with increased age. The mean DMFT index for the whole sample of this study was 12.74 (±7.03), and the 'filled' component was the most prevalent (69.9%), whereas the 'decayed' and 'missing' components were, respectively, 8.4% and 21.7%. There was a higher prevalence of periodontal diseases with increasing age, ranging from 57.1% in firefighters of 34 years or less to 70.5% in the ones between 35 and 44 years old and 75.4% in participants at age 45 years or older. Clinical dental status of the military firefighters who belonged to the age group 35-44 was better than the one observed for the Brazilian population at the same age range. However, pathological conditions that can be solved with health promotion strategies associated with dental procedures of low complexity still persist. Conclusion: These results suggest that the availability of dental health care services itself does not represent the most effective approach to the oral health problems found in the studied population.

Periodontal Comparison on Systemic Lupus Erythematosus Patients and Healthy Subjects: A Cross-Sectional Study

ABSTRACT Objective: To analyze periodontal comparison between Systemic Lupus Erythematosus (SLE) subject and healthy control. Material and Methods: This descriptive cross-sectional study included 122 subjects, 61 SLE patients and 61 healthy subjects who visited the Rheumatology Department, Dr. Saiful Anwar General Hospital, Malang, during 2017-2018. Clinical examination of SLE was using Mexican SLE Disease Activity Index and oral cavity conditions were assessed using the periodontal index, gingival index, calculus index, bleeding on probing, clinical attachment loss and mobility teeth. Results: The age of SLE patients ranged from 18-55 years old with the mean age of 29.50 ± 9.57 years old. Periodontitis was higher in SLE patients (88.5%) than healthy subjects (22.95%). In addition, periodontitis occurrence in SLE (2.66 ± 1.02) was significantly different (p<0.001) compared to healthy subjects (0.51 ± 0.81). Conclusion: This study found higher rates of periodontitis, gingivitis, bleeding on probing, clinical attachment loss, and mobility tooth among SLE patients compared to healthy subjects. Periodontitis was also found to be higher along with more severe SLE group.

Desfechos periodontais e qualidade de vida relacionada à saúde bucal em indivíduos de transplante de células tronco hematopoiéticas, fígado e rim: um estudo transversal comparativo / Periodontal outcomes and quality of life related to oral health in hematopoietic stem, liver and kidney transplant individuals: a comparative cross-sectional study

Esse estudo observacional transversal comparativo teve como objetivos avaliar os parâmetros clínicos periodontais, índice gengival modificado (IGM), índice de placa visível (IPV), crescimento gengival induzido por drogas (CGID), mensurar volume e fluxo do fluido crevicular gengival (FCG), perda dentária bem como o impacto da saúde bucal auto-relatada na qualidade de vida, em pacientes pré e pós-transplante de células tronco hematopoiéticas (TCTH), fígado (TX-fígado), rim (Tx-rim), comparados a indivíduos sem doença sistêmica diagnosticada. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (UFMG) (CAAE-18019619.1.0000.5149). A amostra foi recrutada dentre usuários da Faculdade de Odontologia da UFMG, de março a dezembro de 2019. Foram registrados: IGM, IPV, profundidade à sondagem (PS), sangramento à sondagem (SS), nível de inserção clínico (NIC), recessão gengival (RG), CGID, fluxo e volume do FCG e número de dentes presentes. O instrumento Oral Health Impact Profile (OHIP-14) foi aplicado para avaliar a Qualidade de Vida Relacionada à Saúde Bucal (QVRSB). O grupo controle incluiu pacientes sem doença sistêmica diagnosticada, pareados por sexo e idade. Os dados foram analisados pelo programa SPSS versão 25. Análises descritivas e comparativas foram realizadas usando os testes de Wilcoxon, Mann Whitney e Kruskal-Wallis seguido de Dunn-Bonferroni. Modelos de regressão logística binária condicional estimaram a Odds-Ratio, considerando como desfechos presença de periodontite e prevalência de alto impacto na QVRSB. Em todos os testes, o nível de significância de 5% foi adotado. As frequências de periodontite foram maiores em indivíduos em condição de transplante que no grupo controle, na fase pré-transplante e nos pacientes Tx-fígado. O diagnóstico mais frequentemente encontrado foi a periodontite estágio I localizada. As medianas de IPV, PS, NIC, volume e fluxo do FCG foram maiores em pacientes de transplante comparados aos controles (p<0,05). Comparados aos respectivos controles, os grupos Tx-fígado e Tx-rim apresentaram medianas de IPV e PS significativamente maiores. O número de dentes presentes foi menor no grupo Tx fígado que no Tx rim (p=0,027). No modelo ajustado final, nenhuma variável mostrou associação com a presença de periodontite (p>0,05). Pacientes de transplante tiveram pior percepção do impacto na QVRSB que os indivíduos controle (p=0,015). Os grupos TCTH (p=0,008) e Tx-fígado (p=0,033) foram mais impactados que seus controles. Na regressão logística, a variável transplante não afetou a frequência de alto impacto na QVRSB. No modelo final ajustado, a escolaridade e o número de dentes presentes permaneceram como fatores preditores do impacto da saúde bucal na qualidade de vida auto-relatada. Indivíduos com menor escolaridade (OR = 3,590; 1,021-12,622) e com menor número de dentes (OR = 4,991; IC95% 1,386-17,970) tiveram maior impacto na QVRSB. Concluiu-se, que as frequências de periodontite foram maiores em indivíduos em condição de transplante, na fase pré e em pacientes Tx-fígado. A periodontite estágio I localizada foi o diagnóstico mais frequente. A condição de transplante não afetou a presença de periodontite. O número de dentes presentes e a escolaridade tiveram impacto na QVRSB dos indivíduos em condição transplante, e estes demonstram uma pior percepção que os controles.

This cross-sectional observational study aimed to assess periodontal clinical parameters, modified gingival index (MGI), visible plaque index (VPI), drug-induced gingival overgrowth (DIGO), measuring gingival crevicular fluid (GCF) volume and flow , tooth loss as well as the impact of self-reported oral health on quality of life, in patients before and after hematopoietic stem cell (HSCT), liver (Tx-liver), kidney (Tx-kidney) transplantation compared to individuals without diagnosed systemic disease. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) (CAAE-18019619.1.0000.5149). The sample was recruited from users of the Faculty of Dentistry at UFMG, from March to December 2019. The outcomes MGI, VPI, probing depth (PD), bleeding on probing (BoP), clinical attachment level (CAL), gingival recession (GR), DIGO, flow and volume of GCF and number of teeth present were recorded. The Oral Health Impact Profile instrument (OHIP-14) was applied to assess the Oral Health Related Quality of Life (HRQoL). The control group included patients without diagnosed systemic disease, matched for sex and age. The data were analyzed using the SPSS software version 25. Descriptive and comparative analyzes were performed using the Wilcoxon, Mann-Whitney and KruskalWallis followed by Dunn-Bonferroni tests. To estimate the Odds-Ratio, conditional binary logistic regression models were used, considering as outcomes presence of periodontites and prevalence of hight impact on OHRQoL. In all tests, the significance level of 5% was adopted. The frequency of periodontitis was higher in individuals undergoing transplantation than in the control group, in the pre-transplant phase and in Tx-liver patients. The most frequently found diagnosis was localized stage I periodontitis. The medians of VPI, PD, CAL, GCF volume and flow were higher in transplant patients compared to controls (p <0.05). The Tx-liver and Tx-kidney groups had significantly higher VPI and PD medians than their respectives controls. Comparing the transplant groups, the number of teeth present was lower in Tx-liver than in Tx-kidney (p = 0.027). In the final adjusted model, no variable was associated with the presence of periodontitis (p> 0.05). Transplant patients had a worse perception of the impact on OHRQoL than control subjects (p = 0.015). The groups HSCT (p = 0.008) and Tx-liver (p = 0.033) were more impacted than their controls. In logistic regression, the transplant variable did not affect the frequency of high impact on OHRQoL. In the final adjusted model, schooling and the number of teeth present remained as predictors of the impact of oral health on self-reported quality of life. Individuals with less education (OR = 3.590; 1.021-12.622) and with fewer teeth (OR = 4.991; 95% CI 1.386-17.970) had a greater impact on HRQoL. It was concluded that the frequencies of periodontitis were higher in individuals in a transplant condition, in the pre-transplantation phase and in Tx-liver patients. Localized stage I periodontitis was the most frequent diagnosis. The transplant condition did not affect the presence of periodontitis. The number of teeth present and education had an impact on the HRQoL of transplantation individuals, and these demonstrate a worse perception than the controls.

Effectiveness of three different types of educational methods on implementation of proper oral hygiene behaviour prior to orthodontic treatment

ABSTRACT Objective: The aim of this study was to compare three teaching methods' time and personnel requirements, and their effects on plaque and gingival indices. Methods: This study was a single-blind randomized controlled trial on fixed orthodontic appliance candidates (n = 90), assigned into a control group (n = 30) and two different study groups (n = 30 each). The control group received standard printed educational material and was assisted with verbal information. The study groups either received video-assisted or hands-on training about fixed orthodontic appliance and oral hygiene. The time requirements for all three educational interventions was recorded during the initial visit. The adequacy of oral hygiene was documented through plaque and gingival indices during the initial visit and eighth week of the treatment. The continuous variables were analyzed using 1-way ANOVA. Tukey HSD and Student t-tests were used for post-hoc comparisons (α?#8197;= 0.05). Also, a chi-square test was used for the analysis of categorical variables. Results: Standard education failed to maintain the plaque and gingival indices at the eighth week of the treatment. Although both video-assisted and hands-on training took a considerable amount of time, they served well in preserving both of the indices at the eighth week. The longer the educational intervention was, the better the preservation of the plaque and gingival indices. Conclusion: Educational intervention, either with video-assisted or hands-on programs, provided better results in oral hygiene depending on the time and personnel constraints of the orthodontist.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a duração e os pré-requisitos de equipe de três métodos de orientação ao paciente, e seus efeitos sobre os índices de placa e de sangramento gengival. Métodos: Esse foi um estudo controlado aleatório cego em candidatos (n=90) a tratamento ortodôntico fixo, que foram divididos em um grupo controle (n=30) e dois grupos de estudo (n= 30 cada). O grupo controle recebeu material educacional impresso e foi orientado com informações verbais. Os grupos de estudo receberam treinamento em formato de vídeo ou treinamento hands-on sobre o tratamento com Ortodontia fixa e higiene bucal. O tempo necessário para cada um dos três tipos de treinamento foi registrado durante a visita inicial. A qualidade da higiene bucal foi avaliada por meio dos índices de placa e de sangramento gengival durante a visita inicial e na oitava semana de tratamento. As variáveis contínuas foram analisadas utilizando-se one-way ANOVA. Os testes HSD de Tukey e t de Student foram utilizados para comparações post-hoc (α?#8197;= 0,05), e o teste qui-quadrado foi utilizado para análise das variáveis categóricas. Resultados: O método de ensino convencional fracassou em manter os índices de placa e de sangramento gengival até a oitava semana de tratamento. Apesar de tanto o método de treinamento com vídeos e de treinamento hands-on demandarem um tempo considerável, eles conseguiram manter ambos os índices até a oitava semana. Quanto mais longa a orientação realizada, melhor foi a manutenção dos índices de placa e de sangramento gengival. Conclusão: Tanto o método de treinamento com vídeo quanto no formato hands-on obtiveram melhores resultados de higiene bucal, mas dependem do tempo e das limitações de equipe de cada ortodontista.

Association between fixed orthodontic treatment and dental caries: a 1-year longitudinal study

Abstract: This longitudinal study aimed to assess the association between the use of fixed orthodontic appliances and the incidence/increment of active caries lesions in adolescents and young adults over a one-year period. A total of 135 10-30-year-old individuals were divided into two groups: Group G0 was composed of individuals who required orthodontic treatment, but who did not undergo fixed orthodontic therapy over the study period (n=70); Group G1 was composed of individuals who used a fixed orthodontic appliance for 1 year (n=65). Data collection included a questionnaire and clinical oral examinations (plaque index, gingival index, and dental caries index), performed at baseline and after 1 year. Caries examination was performed by a single calibrated examiner, after tooth cleaning and drying, and included the recording of non-cavitated and cavitated, inactive and active lesions of all tooth surfaces. Poisson regression models were used to assess the association between the group and the following study outcomes: incidence (binary variable) and increment (counting variable). The incidence of active caries lesions was 4.8% in G0 and 39.6% in G1. The mean increment of active caries lesions was 0.14 in G0 and 0.61 in G1. G1 showed a greater risk of developing active caries lesions than G0 (incidence analysis, adjusted IRR=9.48, 95%CI=2.62-34.30; increment analysis, adjusted IRR=4.13; 95%CI=1.94-8.79). In conclusion, this study showed that individuals undergoing fixed orthodontic therapy for 1 year had a significantly higher incidence and increment of active caries lesions than those without a fixed appliance.

Clinical study of periodontal endoscope-assisted subgingival scaling in the treatment of residual pocket / 华西口腔医学杂志

OBJECTIVES@#To compare the treatment effects of periodontal endoscope-assisted and traditional subgingival scaling on residual pockets.@*METHODS@#A total of 13 patients with periodontitis from Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University were recruited. After 4-6 weeks of initial treatment, the residual pockets with a probing depth (PD) of ≥4 mm and attachment loss (AL) of ≥4 mm and bleeding on probing were examined with traditional (control group) and periodontal endoscope-assisted subgingival scaling (endoscopy group) in a randomly controlled split-mouth design. At baseline and 6 weeks and 3 months after treatment, plaque index (PLI), PD, AL, and bleeding index (BI) were measured. Differences in these clinical parameters within and between groups and patient-reported outcomes were compared.@*RESULTS@#A total of the 694 sites of 251 teeth were included in this trial. Both groups showed significant improvement in each periodontal parameters 6 weeks and 3 months after treatment (@*CONCLUSIONS@#Periodontal endoscope-assisted subgingival scaling resulted in better effects than traditional subgingival scaling when the residual pockets were in a single-rooted tooth, with a PD of ≥5 mm but without vertical alveolar bone resorption and furcation involvement.

The effect of dental plaque level and self-performed oral hygiene on periodontal status: a cross-sectional study in Brazilian Indigenous / O efeito do nível da placa dentária e da higiene bucal autorrealizada no estado periodontal: um estudo transversal em indígenas brasileiros

Objective: This study evaluated the associations of periodontal status with dental plaque index and frequency of toothbrushing and flossing in Kiriri Brazilian Indigenous people. Methods: Gingival bleeding, periodontal clinical attachment level, and dental plaque index were clinically evaluated in 204 adult Brazilian indigenous. They were categorized as healthy, gingivitis, or periodontitis. Sociodemographic data and oral hygiene habits were registered. Bivariate and logistic regression analyses were performed (p≤0.05). Results: Gingivitis [odds ratio (OR): 2.83; 95% confidence interval (CI), 1.52­5.25; p=0.001] and periodontitis (OR: 6.88; 95%CI, 1.44­32.78; p=0.02) were associated with plaque index level, but not with toothbrushing or flossing frequency (p ≥0.55). Conclusion: Gingivitis and periodontitis were associated with higher plaque index, but not with the frequency of toothbrushing and flossing. To enhance this population's periodontal health, a prevention program focused on improving the quality of self-performed oral hygiene should be planned and implemented.

Objetivo: avaliar as associações do estado periodontal com o índice de placa dentária, a frequência de escovação e o uso do fio dental em Indígenas Brasileiros Kiriri. Métodos: sangramento gengival, nível de inserção clínica periodontal e índice de placa dentária foram avaliados, clinicamente, em 204 indígenas brasileiros adultos. Eles foram classificados como saudáveis, com gengivite ou periodontite. Dados sociodemográficos e hábitos de higiene bucal foram registrados. Foram realizadas análises bivariadas e de regressão logística (p≤0,05). Resultados: gengivite [Odds Ratio (OR): 2,83; Intervalo de confiança de 95% (IC), 1,52-5,25; p = 0,001] e periodontite (OR: 6,88; IC 95%, 1,44­32,78; p = 0,02) foram associados ao nível de índice de placa, mas não à frequência de escovação ou uso do fio dental (p ≥0,55). Conclusão: gengivite e periodontite foram associados a maior índice de placa, mas não com frequência de escovação e uso do fio dental. Para melhorar a saúde periodontal dessa população, um programa de prevenção com foco na melhoria da qualidade da higiene bucal autorrealizada deve ser planejado e implantado.

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial / Eficácia de duas escovas de cerdas macias na remoção de Placa. Um ensaio clínico randomizado

ABSTRACT The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, usingMann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gymline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

RESUMO O objetivo desse ensaio clínico, examinador-cego, randomizado e controle foi de comparadas a eficácia de duas escovas de cerdas macias em relagäo ao controle de placa. Setenta vo-luntários foram randomicamente alocados para Grupo A (es-cova com ponta cónica) ou Grupo B (escova com ponta arredondada). Na consulta inicial (dia 0), voluntarios receberam exame de placa utilizando o Índice de identificagäo de placa melhorado. Sob supervisäo, eles escovaram seus dentes por 1 minuto com as escovas designadas e o exame de placa foi repetido. Voluntarios continuaram seu regime de higiene oral (escova dental alocada e dentifrício comum fornecidos pelos pesquisadores) durante 7 dias. Os procedimentos da consulta inicial foram novamente repetidos. Análises estatísticas distintas foram realizadas para percentual de redugäo média de placa para os escores de boca toda, interproximal e linha gengi-val em ambos os momentos, utilizando teste de Mann-Whitney, p<0,05. Após único uso da escova, no dia 0, o percentual de redugäo média de placa foi significativamente reduzido em ambos os grupos (p<0,05), com reduções significativas para boca toda (21,39±12,44 vs. 11,40±11,17), linha gengival (6,32±7,37 vs. 2,89±4,57) e interproximal (10,82±10,49 vs. 5,21±7,68) no Grupo A quando comparada com o Grupo B. Entretanto, no dia 7, nenhuma diferenga significativa foi observada entre os grupos para boca toda (29,94±20,91 vs. 26,58±18,64), linha gengival (14,04±18,82 vs. 13,78±17,63) e interproximal (26,41±22,77 vs. 23,12±20,98) (p>0,05). Em conclusäo, no dia 0, a escova do Grupo A apresentou eficácia superior na remo-gäo de placa suprageng ival quando comparada com a escova do Grupo B, como demonstrado nos escores de placa de boca toda, linha gengival e interproximal.

Expansion treatment using Invisalign®: Periodontal health status and maxillary buccal bone changes. A clinical and tomographic evaluation / Tratamiento de expansión con Invisalign®: estado de salud periodontal y cambios óseos maxilares. Evaluación clínica y tomográfica

ABSTRACT The aim of this study was to evaluate changes in periodontal status and maxillary buccal bone by considering clinical and tomographic parameters during the first year of orthodontic expansion with Invisalign® aligners. Upper first (1PM) and upper second (2PM) premolars of 19 patients with orthodontic expansion requirement treated with Invisalign® aligners were evaluated. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and cone beam tomographic (CBCT) records were collected at 76 sites before starting treatment (T0) and at 12 months (T1). Bone height was measured from cementoenamel junction (CEJ) to the crest cortical bone (CC). Bone thickness was measured at two levels: 4 mm (CEJ+4) and 6 mm (CEJ+6) apical to the CEJ. A descriptive analysis was made of the variations of bone thickness and height in a series of cases. The average expansion was 1.93 mm for 1PM and 167 mm for 2PM. Arithmetic mean of distance CEJ-CC in 1PM was 3.05 mm at T0, and remained at 3.05 mm at T1. Arithmetic mean of distance CEJ-CC in 2PM was 2.06 mm at T0 and 2.31 at T1. Post-expansion, most of the analyzed sites (86%) exhibited a bone thickness of ≥0.5 mm. The greatest variations between T0 and T1 were observed at the level of 1PM CEJ+ 4 and 2PM CEJ+ 6. The minimal changes in the clinical records (GI, PI, PPD and CAL) between T0 and T1 were compatible with the maintenance of gingivalperiodontal health. Invisalign® for expansion movements did not produce substantial changes in the evaluated periodontal clinical parameters or in the bone measurements. Removable appliances reduce plaque retentive factors and favor adequate oral hygiene.

RESUMEN El objetivo de este estudio fue evaluar los cambios en el estado periodontal y hueso facial maxilar a través de parámetros clínicos y tomográficos durante la expansión ortodóncica con alineadores Invisalign® en el primer año de tratamiento. Se evaluaron los primeros (1PM) y segundos (2PM) premolares superiores pertenecientes a 19 pacientes con requerimiento de expansión ortodóncica tratados con alineadores Invisalign®. Se registraron los índices de placa (IP), índice gingival (IG), profundidad al sondaje (PS) y nivel de inserción (NI) y registros tomográficos de haz cónico (CBCT) en 76 sitios antes de comenzar el tratamiento (T0) y a los 12 meses (T1). Se midió la altura ósea desde el límite amelocementario (LAC) hasta la cortical de la cresta (CC) y el espesor en dos niveles; a 4 mm (LAC+4) y a 6 mm (LAC+6) hacia apical del LAC. Se realizó un análisis descriptivo de las variaciones de la altura y espesor óseo en una serie de casos. La expansión promedio para 1PM fue de 1,93 mm y para 2PM fue de 1,67 mm. La media aritmética de LAC-CC en primeros premolares fue de 3,05 mm en T0 y se mantuvo el valor de 3,05 mm en T1. La media aritmética de LAC-CC en segundos premolares fue de 2,06 mm en T0 y 2,31 en T1. Post expansión, la mayoría de los sitios (86%) analizados exhibieron un espesor óseo ≥0,5 mm. Las mayores variaciones entre T0 y T1 se observaron a nivel de 1PM CEJ+4 y 2PM CEJ+6. Los registros clínicos (PI, GI, PPD y CAL) evidenciaron mínimos cambios entre T0 y T1, compatibles con el mantenimiento de la salud gíngivo-periodontal. El uso de Invisalign ® para movimientos de expansión no produjo cambios sustanciales en los parámetros clínicos periodontales evaluados ni en las mediciones óseas. La aparatología removible reduce los factores retentivos de placa bacteriana y facilita una adecuada higiene oral.

Effectiveness of Dental Health Education Intervention Using the 16-Surface Tooth Brushing Program Among 7-9-Year-Old Schoolchildren in Indonesia

Abstract Objective: To determine the effect of dental health education for teachers and parents on children aged 7-9 years old. Material and Methods: This was a quasi-experimental study with a nonrandomized control group and a pretest-posttest design. The intervention group comprised 20 teachers and 66 mothers, whereas the control group consisted of 10 teachers and 54 mothers. Data on the knowledge and behavior of teachers and mothers were retrieved by pretest and posttest questionnaires. The 66 children in the intervention group underwent a 16-surface tooth brushing program, whereas the 54 children in the control group were only provided theoretical education by their teachers and mothers. The evaluation was conducted after one month to measure the children's dental plaque index. Results: An increase in teachers' oral health knowledge (16.7%), teachers' oral health behavior (20%), mothers' oral health knowledge (16.7%), and mothers' oral health behavior (20%) was noted; the children's plaque index was decreased (47%). Conclusion: The dental health education of teachers and parents (mothers) supported by the 16-surface teeth brushing program resulted in a significant reduction in the dental plaque index in children aged 7-9 years old.

Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial

Abstract Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR). Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS). Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively. Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Abstract Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Clinical and microbiological evaluation of surgical and nonsurgical treatment of aggressive periodontitis

Abstract The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment. ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.

Resumo O presente estudo teve como objetivo avaliar os efeitos clínicos e microbiológicos de terapia periodontal cirúrgica e não cirúrgica no tratamento da periodontite agressiva generalizada (PAgG). Dezesseis pacientes portadores de PAgG foram incluídos neste estudo clínico, prospectivo, randomizado, de boca dividida. Os quadrantes superiores de cada paciente foram alocados em dois grupos: um grupo de terapia não-cirúrgica (NST) e um grupo de terapia cirúrgica (ST). Os parâmetros clínicos avaliados foram: índice de placa (PI), sangramento à sondagem índice (BoP), profundidade de sondagem (PD), nível clínico de inserção (CAL) e posição da margem gengival (GMP). Também foram determinadas as concentrações de Porphyromonas gingivalis (Pg) e Aggregatibacter actinomycetemcomitans (Aa) no biofilme subgengival. Os parâmetros clínicos e microbiológicos foram avaliados no início, 3, 6 e 12 meses após o tratamento. A terapia cirúrgica foi capaz de promover maior redução de PD em comparação com NST em bolsas profundas aos 12 meses (p<0,05) e em dentes posteriores aos 6 meses (p<0,05). Além disso, houve maior recessão gengival nos dentes posteriores do grupo ST no 6° mês (p<0,05). Entretanto, ST não promoveu ganho adicionais de inserção (CAL) em nenhum período do avaliação. A avaliação microbiológica não mostrou diferença estatística nos níveis de Aa e Pg, para ambos os grupos, em todos os períodos de acompanhamento. O tratamento cirúrgico promoveu benefícios clínicos similares ao tratamento não cirúrgico em pacientes com PAgG. Além disso, ambas as terapias não conseguiram reduzir os níveis Aa e Pg após terapia.

Periodontal parameters of two types of 3 x 3 orthodontic retainer: a longitudinal study

ABSTRACT Introduction: bonded fixed retainers are often used to stabilize the results obtained with the orthodontic treatment. It is important that they do not prejudice dental health, as they will be used for a long period. Objective: The purpose of the present study was to compare periodontal indexes between two types of bonded fixed retainers, conventional 3 x 3 plain retainer (0.8-mm orthodontic wire, bonded to the canines only) and a manufactured braided retainer (0.2 x 0.7-mm stainless steel wire, bonded to all anterior teeth) after use. Methods: a test group of 15 volunteers (aged from 18 to 25 years) used both the conventional retainer and braided retainer for six months. A randomized longitudinal study design, with a two week washout interval, was applied. The dental plaque index, gingival index and dental calculus index were evaluated. Furthermore, the calculus accumulated along the retainer wire was measured and all patients answered a questionnaire about the use, acceptance and comfort of both types of retainers. Results: the scores for plaque and gingival indexes were higher for the braided retainer (p< 0.05) on the lingual and proximal surfaces. The same occurred with the calculus index on the lingual surfaces (p< 0.05). The calculus index along wire was higher for the braided retainer (p< 0.05). All patients preferred the conventional retainer, and said that it was also more comfortable to use. Conclusion: it was concluded that the conventional retainer showed better periodontal indexes than the braided type.

RESUMO Introdução: as contenções ortodônticas fixas são amplamente utilizadas após o tratamento ortodôntico, sendo fundamental que esses dispositivos não se tornem prejudiciais à saúde dentária, já que serão usados por um longo período. Objetivo: o presente estudo teve como objetivo a avaliação periodontal da região da arcada inferior, comparando as condições de acúmulo de placa e cálculo ao longo do fio e na margem gengival, em decorrência do uso da contenção convencional (fio 0,8 mm de aço inoxidável colado apenas nos caninos) ou de uma contenção pré-fabricada com fio trançado (0,2 x 0,7 mm colado em todos os dentes anteroinferiores) após exposição ao meio bucal. Métodos: participaram do estudo 15 voluntários adultos jovens (idades entre 18 e 25 anos) que utilizaram dois tipos de contenções, por seis meses cada. Foi utilizado um modelo de estudo longitudinal, randomizado, com washout de 15 dias. Os parâmetros periodontais utilizados foram: índice gengival, índice de placa e índice de cálculo. O cálculo acumulado ao longo da contenção foi avaliado e todos os pacientes responderam a um questionário sobre o uso, aceitação e conforto de ambos os tipos de contenção. Resultados: observou-se que o índice de placa foi maior para a contenção com fio trançado (p<0,05), assim como o índice gengival (p<0,05). O mesmo ocorreu para o índice de cálculo nas faces proximais e lingual (p<0,05). O índice de cálculo ao longo do fio também foi significativamente maior para a contenção com fio trançado (p<0,05). Em relação ao questionário aplicado, 60% dos voluntários consideraram que a contenção com fio trançado foi mais desconfortável, e todos eles preferiram a contenção convencional. Conclusão: concluiu-se que a contenção convencional apresentou melhores resultados periodontais, quando comparada à contenção pré-fabricada com fio trançado.

A peer-led dental education program for modifying oral self-care in Mexican children / Un programa de educación para la salud guiado por pares dirigido al autocuidado bucal en niños mexicanos

Abstract: Objective: To compare peer-led dental education (PLDE) versus conventional dental instruction (CDI) in modifying children's oral self-care. Materials and methods: The intervention group (two schools) received PLDE and the control group (two schools) received CDI. The quality of oral self-care practice (OSC-P) and oral self-care skills (OSC-S) were indicated by dental plaque levels (%) and compared before and after dental education. Results: There were no baseline OSC-P differences between the control (55.8 ± 12.8%) and intervention (55.5 ± 14.6%) groups or OSC-S differences between the intervention (38.5 ± 13.2%) and control (38.1 ± 12.5%) groups. At the three-month follow-up we observed OSC-P deterioration in the control group (63.2 ± 15.0%) and OSC-P improvement in the intervention group (52.2 ± 15.6%). The OSC-P/OSC-S regression models found these predictors: baseline oral self-care, group affiliation, and mother's education (p<0.05). Conclusion: The hypothesis was confirmed and significant predictors were baseline oral self-care levels, group affiliation, and mother's education.

Resumen: Objetivo: Comparar un programa educativo guiado por pares (PEGP) versus un programa basado en educación convencional (EC) dirigido al autocuidado bucal en niños. Material y métodos: El grupo de intervención recibió un PEGP y el grupo control recibió EC. La calidad de prácticas de autocuidado (OSC-P) y habilidades de autocuidado (OSC-S) fueron indicadas por los niveles de placa dental (5) y comparadas antes y después de la intervención. Resultados: No se observaron diferencias en los datos de línea base del OSC-P entre el grupo control (55.8 ± 12.8%) y el de intervención (55.5 ± 14.6%) o en el OSC-S entre el grupo de intervención (38.5± 13.2%) y el control (38.1 ± 12.5%). En el seguimiento a tres meses, se observó un deterioro en las OSC-P en el grupo control (63.2 ± 15.0%) y un mejoramiento en las OSC-P en el grupo de intervención (52.2 ± 15.6%). Los modelos de regresión lineal para las OSC-P/OSC-S encontraron como significativos los siguientes predictores: autocuidado bucal de línea base, el grupo de afiliación y la educación materna (p<0.05). Conclusión: La hipótesis fue confirmada y los predictores significativos fueron los niveles de autocuidado bucal de línea base, el grupo de afiliación y la educación materna.