Percepción Intraoperatoria del Paciente sobre la Preparación de la Cavidad de Acceso Endodóntico / Patient Intraoperatory Perception About Endodontic Access Cavity Preparation

RESUMEN: La creencia de que el tratamiento de endodoncia es el tratamiento dental más doloroso es algo habitual. A pesar de ello, la percepción intraoperatoria durante el tratamiento de endodoncia ha sido poco estudiada. Por ello, el objetivo de esta investigación fue describir la percepción de dolor y la experiencia intraoperatoria del paciente tratado en endodoncia, durante la etapa de acceso endodóntico. Se analizaron las valoraciones sobre dolor intraoperatorio realizadas por 20 pacientes, tratados en la clínica de especialidad de una universidad tradicional chilena, durante la etapa de acceso endodóntico en molares. Para ello se utilizaron escalas cuantitativas de valoración de la intensidad del dolor y el análisis de contenido cualitativo de una entrevista semi-estructurada. Se observó que los participantes de sexo femenino, los tratamientos en molares mandibulares y en dientes con diagnóstico de pulpitis irreversible sintomática obtuvieron medias mayores en cuanto a la valoración de la intensidad del dolor. Sin embargo, en la mayoría de los casos el dolor fue descrito como leve. En el análisis cualitativo lo descrito por los participantes se agrupó en 10 categorías. Se observó un mayor porcentaje de referencias a la categoría "Ansiedad ante el tratamiento" (16 %) seguido de "Percepción de la atención profesional" (14 %). Sin embargo, también destacaron las referencias al dolor en su totalidad (25 %) ya sea a "Ausencia de dolor" (13 %) o a "Presencia de dolor en algún grado" (12 %). Se concluyó que entre los participantes de esta investigación existió percepción de dolor intraoperatorio durante la etapa de acceso endodóntico, sin embargo, este fue de carácter leve en la mayoría de los casos.

ABSTRACT: There is a common belief that endodontic treatment is the most painful dental treatment of all. Despite this idea, intraoperative perception during endodontic treatment has not been fully studied. Therefore, the aim of this research was to describe the perception of pain and the intraoperative experience of endodontic treated patients, during the endodontic access cavity preparation. We analyzed the valuations on intraoperative pain completed by 20 patients, treated at the endodontic clinic of a traditional Chilean university, during the endodontic access cavity preparation in molars. For this purpose, quantitative scales of pain intensity assessment and qualitative content analysis of a semi-structured interview were employed. Female participants, treatments in mandibular molars and in teeth diagnosed with symptomatic irreversible pulpitis obtained higher means in terms of assessment of pain intensity. However, in most cases the pain was described as mild. In the qualitative analysis the participant's descriptions were grouped into 11 categories. There was a higher percentage of references to the category "Anxiety before treatment" (16 %) followed by "Perception of professional care" (14 %). However, references to pain in its totality (25 %) either to "Absence of pain" (13 %) or to "Presence of pain to some degree" (12 %) also stood out. It was concluded that among the participants of this investigation there was perception of intraoperative pain during the endodontic access stage, however, this was mild in most cases.

Permeabilización del Canal Radicular y Transporte Apical: Comparación de Tres Sistemas / Root Canal Glide Path and Apical Transportation: Three System Comparison

La mantención de la anatomía original del canal radicular incide directamente en el éxito del tratamiento endodóntico. Para ello, los sistemas rotatorios de instrumentación requieren de canales radiculares permeables. Existen distintas limas y sistemas para la permeabilización o glide path como las limas tipo K manuales de acero inoxidable y los sistemas de NiTi rotatorios PathFile y ProGlider (Dentsply, Maillefer). Así, el objetivo de esta investigación fue comparar la capacidad de distintos sistemas de permeabilización para mantener la anatomía radicular sin producir transporte apical en canales mesiales de molares inferiores humanos extraídos. Se realizó un estudio cuantitativo experimental cuya muestra estuvo conformada por 36 canales mesiales de molares mandibulares humanos extraídos. Las muestras fueron divididas aleatoriamente en tres grupos conformados por 12 canales, cada uno de los cuales fueron sometidos a distintos sistemas de permeabilización (Lima K, PathFile y ProGlider). Las muestras fueron fotografiadas antes y después de la permeabilización utilizando un microscopio con magnificación 30X. Se cuantificó el desplazamiento del canal radicular en sentido mesio - distal y buco - lingual posterior a la permeabilización. Para el análisis de los datos se utilizó el paquete estadístico InfoStat/L y se aplicó la prueba de ANOVA / Tukey. Se observó que el sistema PathFile produce mayor transporte del canal radicular en su tercio apical en la dirección mesio-distal (p=0,77) y el sistema ProGlider en la dirección buco-lingual (p=0,57). Sin embargo, estas diferencias no fueron significativas. En conclusión, los sistemas de permeabilización analizados no presentaron diferencias en cuanto a su capacidad para mantener la anatomía sin producir transporte apical.

Preservation of the original root canal anatomy has a direct influence on the success of an endodontic treatment. In order to achieve this, rotary instrumentation systems require permeable root canals. Different files and systems are used for the establishment of a glide path such as manual stainless steel K files and NiTi rotatory systems like PathFile and ProGlider (Dentsply, Maillefer). Thus, the objective of this research was to compare the ability of different systems to create a glide path and maintain root canal anatomy without producing apical transportation in mesial root canals of extracted human lower molars. A quantitative experimental study was performed with a sample of 36 mesial root canals of extracted human mandibular molars. The samples were randomly divided into three groups consisting of 12 root canals each, which were subjected to different glide path systems (K-Files, PathFile and ProGlider). Samples were photographed before and after creating glide path using a microscope with 30X magnification. The displacement of the root canal in a mesio - distal and bucco - lingual direction was quantified after creating glide path. Data was analyzed using the statistical package InfoStat / L and the ANOVA / Tukey test was applied. The PathFile system produced greater transport of the root canal in its apical third in the mesio-distal direction (p = 0.77) and the ProGlider system in the bucco-lingual direction (p = 0.57). However, these differences were not significant. In conclusion, the glide path systems analyzed do not present any differences in their ability to maintain the anatomy without producing apical transportation.

Antimicrobial evaluation of copper sulfate (II) on strains of Enterococcus faecalis: in vitro study / Evaluación antimicrobiana del sulfato de cobre (II) sobre cepas de Enterococcus faecalis: estudio in vitro

Introduction: Controlling Enterococcus faecalis is of vital importance in endodontics, as this pathogen is associated with endodontic failure. Experimental evidence has shown that copper has antibacterial activity against other pathogens with similar characteristics. The objective of this study was to determine the antimicrobial activity of copper (II) or cupric (SC-II) sulfate on strains of Enterococcus faecalis and to compare it with the most commonly used antimicrobials. Methodology: We used 33 strains of Enterococcus faecalis isolated from different clinical pictures in different Chilean hospitals. The minimum inhibitory concentration (MIC) of SC-II, chlorhexidine and calcium hydroxide was determined by the broth microdilution technique, following the recommendations given by the Clinical and Laboratory Standards Institute. Results: The MIC for CHX varied in the range of 5-10 ug/ml; SC-II from 1.5 to 12 ug/ml, and HC was >32 mg/ml. The geometric mean of SCII was 6 ug/ml, lower than that of CHX, which was 7.29 ug/ml. Conclusions: SCII showed antimicrobial activity at lower concentrations than CHX. HC (which could have been affected by the buffer effect of the broth microdilution technique) showed high values, not comparable to other compounds. We suggest carrying out further studies on the properties of SC-II, such assessing its biocompatibility and reaction with other materials to be used clinically in endodontic therapy.

Introducción: El control de Enterococcus faecalis es de vital importancia en endodoncia, ya que este patógeno está asociado al fracaso endodóntico. Evidencias experimentales que han demostrado que el cobre presenta actividad antibacteriana en otros patógenos de similares características. El objetivo de este estudio es determinarla actividad antimicrobiana del sulfato de cobre (II) o cúprico (SC-II) sobre cepas de Enterococcus faecalis y compararla con los antimicrobianos más usados en la actualidad. Metodología: Estudio in vitro. Se utilizó la técnica de microdilución en caldo según lineamientos del Clinical and Laboratory Standards Institute, incluyendo 33 cepas de Enterococcus faecalis obtenidas desde hospitales chilenos, para cada una de las cuales se determinó las concentraciones mínimas inhibitorias (CMI) de: SC-II, Clorhexidina (CHX) e Hidróxido de calcio (HC). Resultados: La CMI para CHX tuvo un rango de 5-10 ug/ml, el SC-II de 1,5-12 mM y el HC fue >32 mg/ml. Estas diferencias fueron estadísticamente significativas entre los 3 antimicrobianos utilizados (p<0,001).Conclusiones: El SC-II mostró actividad antimicrobiana a bajas concentraciones, superiores a CHX, pero menores a HC (que pudo ser afectado por el efecto tampón de la técnica de microdilución en caldo). Se sugiere seguir con los estudios de las propiedades del SC-II, como evaluación de biocompatibilidad y reacción con otros materiales para ser utilizados clínicamente en la terapia endodóntica.

The effect of visual prompts as a behavioral strategy in the promotion of on the job physical activity among government employees in a corporate setting

OBJECTIVES: To determine the effectiveness of visual cues/prompts to promote On-the-job physical activities. DESIGN: Cross-over experimental design, using On-the-Job Physical Activity Questionnaire. SETTING: A four-storey building of a government corporation. PATIENTS: Responses of 289 randomly selected government employees who hold office in the fourth floor were deemed evaluable out of 561 (52 percent, response rate). INTERVENTIONS: The control and experimental groups baseline on-the-job physical activity were measured and compared to their post-intervention physical activity. For Phase 1, after a one-week waiting period, a "walk" sign and a "stair" sign visual prompt were placed in the corridors and elevator entrances of the employees in their building for two weeks for the intervention group whereas the control had none. A one-week wash-out period was made. Then, phase 2 commenced with the visual prompts now placed in the building of the previous control group, and the previous experimental group now had no prompts (the cross-over). MAIN OUTCOME MEASURES: Comparison of the baseline physical activity with the post-interventional activity using the Chi-square goodness of Fit Test. RESULTS: The post-intervention group showed improved walking and use of stairs in their time on-the-job spent. CONCLUSION: Visual prompts promote the use of walking and climbing stairs among government workers in their office in a corporate setting.

Dementia screening: Assessment and correlation of cognitive and functional impairments among the elderly in the ambulatory clinics of a tertiary hospital

DESIGN: Descriptive-cross-sectional with correlational analysis using ANOVA. SETTING: Outpatient Department (OPD) of Santo Tomas University Hospital (STUH) Clinical Division. PARTICIPANTS: One hundred one out of 105 patients 60 years old and above consulting at the OPD using total enumeration by using computed sample size with the Epi Info 6 Program. MAIN OUTCOME MEASURES: Demographic and Medical Profile of respondents, results of the Mini-Mental State Exam (MMSE) for cognitive dysfunction, and Daily Activities and Social Independence Test (DAST) for functional dependence and correlation between MMSE and DAST and test of association between the two and the demographic profile by ANOVA. RESULTS: A total of 47 out of 101 (46.5 percent) scored 23 and below suggesting possible dementia. With scores adjusted to educational attainment, the prevalence of dementia was estimated to be 21.7 percent. The MMSE score had a strong indirect correlation with the total score of Daily Activities and Social Independence test (4=0.79, p0.05). These scores were likewise correlated with the educational attainment and age but no associations noted with regards to sex and civil status. CONCLUSIONS: The Occurrence of dementia was noted as age advanced, and was inversely related to the level of educational attainment. There is also an expected impairment among those who scored positive for dementia screening.