Efficacy of Roncolab mobile application for diagnosing the primary sign of sleep-disordered breathing (snoring) in children / Eficacia de la aplicación móvil Roncolab para el diagnóstico de signo primario de trastorno respiratorio del sueño (ronquido) en niños

ABSTRACT Sleep-disordered breathing (SDB) is a group of disorders associated with breathing anomalies during sleep. Easily detectable by sound, snoring is one of the most common manifestations and the main sign of SDB. Snoring is characteristic of breathing sound during sleep, without apnea, hypoventilation, or interrupted sleep. It may reduce the percentage of sleep and increase microarousals due to breathing effort or gas exchange. A range of questionnaires have been validated and adapted to the pediatric population to screen for patients who require laboratory testing. The Pediatric Sleep Questionnaire (PSQ) screens for SDB and identifies primary signs such as snoring. RoncoLab is a mobile application that records and measures snoring intensity and frequency Aim To compare the RoncoLab app and the PSQ regarding how efficiently they diagnose snoring Materials and Method This was an observational, analytical study of 31 children aged 7 to 11 years who visited the pediatric dental clinic at Benemérita Universidad Autónoma de Puebla, Mexico (BUAP). The PSQ was applied to diagnose SDB. Guardians were then instructed on how to download and use the mobile application to record data while the child was sleeping at home. Agreement between RoncoLab and the PSQ was analyzed statistically by Cohen's Kappa index at 95% confidence level Results The Kappa index for identification of primary snoring was 0.743 (p<0.05). App sensitivity was 0.92, and specificity 0.82 Conclusion There is good agreement between PSQ and RoncoLab for diagnosing primary snoring, with acceptable sensitivity and specificity.

RESUMEN Los trastornos respiratorios del sueño (TRS) son un grupo de padecimientos asociados con anormalidades respiratorias del sueño. Una de las manifestaciones más comunes es el ronquido; signo fácil de detectar por el ruido que emite y se considera como el signo principal. Este trastorno es característico del ruido respiratorio durante el sueño, sin apneas, hipoventilación, ni interrupciones del sueño. Este puede ocasionar disminución del porcentaje del sueño y aumentar los microdespertares, esto debido al esfuerzo respiratorio o al intercambio de gases. En la actualidad existen cuestionarios validados y adaptados para la población pediátrica útiles como herramienta clínica para el tamizaje y selección de pacientes que requieran pruebas de laboratorio. El Pediatric Sleep Questionnaire (PSQ) permite el cribado de TRS e identificación de signos primarios como el ronquido. RoncoLab es una aplicación móvil que registra y mide la intensidad y frecuencia del ronquido. Objetivo Comparar la eficacia del diagnóstico del ronquido por medio del RoncoLab contrastado con el PSQ Materiales y Método Estudio observacional, analítico, en el cual se incluyeron 31 niños de 7 a 11 años, que acudieron a la clínica de odontopediatría de la Benemérita Universidad Autónoma de Puebla, México (BUAP) Se aplicó el PSQ a los 31 niños para el diagnóstico de TRS, después se le instruyó al tutor como descargar y utilizar la aplicación móvil para registrar los datos obtenidos en las horas de sueño en casa. El análisis estadístico de concordancia entre los instrumentos diagnósticos se realizó con el Índice Kappa de Cohen a un nivel de confianza del 95% Resultados El Índice de Kappa para la identificación de los ronquidos primarios fue de 0.743 (p<0.05). La sensibilidad de la aplicación fue de 0.92, mientras la especificidad fue de 0.82 Conclusión Existe buena concordancia entre el PSQ y el RoncoLab en el diagnóstico de ronquido primario, con sensibilidad y especificidad aceptable.

Percepción de Miedo al COVID-19 en Estomatólogos Generales y Especialistas / Perception of Fear of COVID-19 in General and Specialist Stomatologists

Durante la pandemia por COVID-19, se incrementaron las preocupaciones, la ansiedad y el miedo, especialmente al brindar atención estomatológica. El objetivo de esta investigación fue analizar la percepción del miedo al COVID-19 en estomatólogos generales y especialistas durante la pandemia. Se diseñó un estudio observacional, analítico, unicéntrico y homodémico. Se incluyeron estomatólogos generales y especialistas de cualquier sexo de diversas disciplinas estomatológicas como ortodoncia, endodoncia, cirugía maxilofacial, etc. La muestra estuvo constituida por 72 estomatólogos, 42 de práctica general (58,3 %) y 32 especialistas (41,6 %). Los datos se recolectaron durante marzo a septiembre del 2021. Participaron 72 estomatólogos (M= 39 años, D.E. 10,82). El 69,4 % de la muestra (n =50) fueron mujeres. De acuerdo con el análisis de medias de la escala total, se encontró que los hombres se perciben ligeramente con más miedo al Covid-19 (M=3,09) que las mujeres durante su práctica estomatológica (M=2,78) sin diferencias significativas. La edad impactó en las respuestas, ya que los mayores de 40 años percibieron más miedo M= 3.23 (IC 95%: 2,65-3,81) que el grupo de 20 a 40 años M=2,73 (IC 95%: 2,37-3,09). Los especialistas, también percibieron mayor miedo al COVID-19 contrastados con los estomatólogos de práctica general (M=2,63) vs (M=3,06). Los resultados denotaron que el 36,1 % de los estomatólogos tuvieron miedo al COVID-19. La investigación anterior mostró resultados similares al estudio de Monterrosa-Castro et al. (2020) en médicos generales colombianos en el que el 37,1 % presentó síntomas de miedo al COVID-19 (FCV-19S). El contexto de pandemia, además de la incertidumbre del comportamiento del COVID-19 y la falta de vacunación masiva al momento de levantar los datos, jugaron un papel muy importante en la percepción del miedo al COVID-19. Los especialistas observaron mayor miedo al COVID-19 al igual que el grupo de mayor edad.

During the COVID-19 pandemic, worries, anxiety and fear increased, especially when providing dental care. The objective of this research was to analyze the perception of fear of COVID-19 in general dentists and specialists during the pandemic. An observational, analytical, single center and homodemic study was designed. General stomatologists and specialists of any sex from various dental disciplines such as orthodontics, endodontics, maxillofacial surgery, etc., were included. The sample consisted of 72 dentists, 42 general practice (58.3 %) and 32 specialists (41.6 %). Data was collected from March to September 2021. 72 dentists participated (M= 39 years, S.D. 10.82). 69.4 % of the sample (n = 50) were women. According to the analysis of means of the total scale, it was found that men perceive themselves to be slightly more afraid of Covid-19 (M=3.09) than women during their dental practice (M=2.78) without significant differences. Age had an impact on the responses, since those over 40 years of age perceived more fear M= 3.23 (95% CI: 2.65-3.81) than the group from 20 to 40 years M=2.73 (95% CI: 2.37- 3.09). Specialists also perceived greater fear of COVID-19 compared to general practice dentists (M=2.63) vs (M=3.06). The results denoted that 36.1 % of the dentists were afraid of COVID-19. Previous research showed similar results to the study by Monterrosa-Castro et al. (2020) in Colombian general practitioners in which 37.1 % presented symptoms of fear of COVID-19 (FCV-19S). The pandemic context, in addition to the uncertainty of the behavior of COVID-19 and the lack of mass vaccination at the time of collecting the data, played a very important role in the perception of fear of COVID-19. The specialists observed greater fear of COVID-19 as well as the older group.

Trastornos temporomandibulares en niños y su relación con la lactancia artificial con uso del biberón / Temporomandibular disorders in children and its relation to artificial lactation with bottle-feeding

Objetivo. Establecer la relación de los trastornos temporomandibulares (TTM) de niños de 8 a 10 años, con lactancia artificial exclusiva con uso del biberón. Métodos. Estudio de casos y controles, (pareados por edad y sexo). Se incluyeron 38 niños, sin alteraciones del crecimiento ni parafunciones bucales severas, previo consentimiento (madres) y asentimiento (niños) informado. Los participantes fueron diagnosticados con TTM (19 casos) o sin diagnóstico de TTM (19 controles) utilizando los criterios diagnósticos para los TTM (CD/TTM), previa estandarización de la investigadora; kappa inter 0,98 e intraobservador 0,73. Los antecedentes de lactancia fueron registrados con cuestionario ex profeso: tipo y tiempo de administración y datos generales del niño y la madre. Se calculó estadística descriptiva e inferencial; Ji cuadrada para identificar la asociación entre TTM y lactancia artificial exclusiva con uso del biberón, y razón de posibilidades (OR), con valor significativo ≤0,05. Resultados. Edad 8,95±0,84 años, 57,9% sexo masculino, sin diferencias por grupos en la edad y escolaridad de las madres (p>0,05). El tipo de TTM más común fue dolor muscular (57,9%), seguido de luxación del disco con reducción y su combinación (21,1%). La media de apertura bucal, sitios musculares y articulares doloridos fue estadísticamente diferente entre los casos y controles (p<0,05). El porcentaje de alimentación con lactancia artificial exclusiva con uso del biberón fue igual en ambos grupos (57,9% p=1,00), el OR calculado fue de 1 con IC95% de 0,27-3,60. Conclusión. No se encontró relación entre la lactancia artificial con el uso del biberón y los TTM. El tipo de TTM más frecuente fue dolor muscular. Palabras clave: Niños; Conducta en la lactancia; Asimetría facial; Trastornos de la articulación temporomandibular; Odontología pediátrica (fuente DeCS BIREME).

Objective. To establish the relationship of temporomandibular disorders (TMD) in children aged 8 to 10 years, with exclusive artificial feeding. Methods. Case-control study (matched by age and sex). 38 children were included, without growth disturbances or severe oral parafunctions, with prior informed consent (mothers) and assent (children). Participants were diagnosed with TMD (19 cases) or without TMD diagnosis (19 controls) using the Diagnostic Criteria for TMD (CD / TMD), after standardization by the researcher; kappa inter 0.98 and intraobserver 0.73. The history of breastfeeding was recorded with an express questionnaire: type and time of administration, and general data of the child and the mother. Descriptive and inferential statistics were calculated; Chi square analysis was performed to identify the association between TMD and exclusive artificial feeding, and odds ratio (OR), with a significant value of ≤0.05. Results. Age 8.95 ± 0.84 years, 57.9% male, with no differences in age or education of the mother between groups (p> 0,05). The most common type of TMD was muscle pain (57.9%), followed by disc luxation with reduction and combination (21.1%). The mean mouth opening, muscle and joint pain sites were statistically different between cases and controls (p <0.05). The percentage of exclusive artificial feeding was the same in both groups (57.9% p = 1.00), the calculated OR was 1 with a 95% CI of 0.27-3.60. Conclusions. Artificial feeding with the use of a bottle was not related to TMD. The most common type of TMD was muscle pain.

Evaluación de la susceptibilidad y autoeficacia ante VIH/sida en profesionales de Estomatología / Avaliação da suscetibilidade e autoeficácia contra o HIV/AIDS em profissionais de Estomatología / Evaluation of susceptibility and self-efficacy against HIV/AIDS in stomatology professionals

Introducción: el VIH/sida es una de las enfermedades que mayor repercusión social ha tenido y afecta a millones de personas. Objetivo: identificar la susceptibilidad y la autoeficacia de los profesionales de la salud de la Facultad de Estomatología de la Benemérita Universidad Autónoma de Puebla (FEBUAP) frente al virus VIH/sida. Método: se trató de un estudio observacional descriptivo. Se incluyeron 250 alumnos y 50 docentes de la FEBUAP, con previa aceptación voluntaria y firma de consentimiento informado, seleccionados mediante una muestra por conveniencia. Se aplicó la Escala VIH/SIDA-65, instrumento con validez y confiabilidad demostrada para la evaluación de las subescalas del instrumento (alfa de Cronbach 0,79), propuesta por Paniagua en 1998 y adaptada al español por Bermúdez, Buela-Casal &Uribe en 2005. Resultados: con respecto a la autoeficacia, los alumnos demostraron superioridad. En la susceptibilidad, la creencia de la posibilidad de contraer el virus fue mayor en docentes (64 por ciento vs. 48 por ciento). La creencia de que solo homosexuales debieran preocuparse por el contagio fue mayor en docentes (92 por ciento). Se encontró una autoeficacia mayor en alumnos y una mejor susceptibilidad en docentes. Conclusiones: es necesario fortalecer estrategias que refuercen conceptos y comportamientos frente al VIH/sida(AU)

Introduction: HIV/AIDS is one of the diseases that has had the greatest social impact and affects millions of people. Objective: to identify the susceptibility and self-efficacy of the health professionals of the Faculty of Stomatology of the Benemérita Autonomous University of Puebla (FEBUAP) against the HIV / AIDS virus. Method: it was a descriptive observational study. 250 students and 50 FEBUAP teachers were included, with prior voluntary acceptance and signed informed consent, selected by means of a convenience sample. The HIV/AIDS-65 scale was applied, an instrument with proven validity and reliability for the evaluation of the subscales of the instrument (Cronbach alpha 0.79), proposed by Paniagua in 1998 and adapted to Spanish by Bermúdez, Buela-Casal & Uribe in 2005. Results: with respect to self-efficacy, the students demonstrated superiority. In the susceptibility, the belief of the possibility of contracting the virus was higher in teachers (64 percent vs. 48 percent). The belief that only homosexuals should worry about contagion was higher in teachers (92percent). We found a higher self-efficacy in students and a better susceptibility in teachers. Conclusions: it is necessary to strengthen strategies that reinforce concepts and behaviors against HIV / AIDS(AU)

Introdução: O HIV/AIDS é uma das doenças que mais impactou socialmente e afeta milhões de pessoas. Objetivo: identificar a suscetibilidade e autoeficácia dos profissionais de saúde da Faculdade de Estomatologia da Universidade Autônoma de Benemérita de Puebla (FEBUAP) contra o vírus HIV/AIDS. Método: foi um estudo observacional descritivo. Foram incluídos 250 alunos e 50 professores da FEBUAP, com prévia aceitação voluntária e termo de consentimento livre e esclarecido, selecionados por meio de amostra de conveniência. escala VIH/SIDA-65 foi aplicado, e instrumento válido para avaliar a fiabilidade comprovada das subescalas do instrumento (alfa Cronbach 0,79), proposto pela Paniagua em 1998 e adaptadas para o español por Bermudez, Buela-Casal & Uribe em 2005. Resultados: com relação à autoeficácia, os estudantes demonstraram superioridade. Na suscetibilidade, a crença na possibilidade de contrair o vírus foi maior nos professores (64 por cento vs. 48 por cento). A crença de que apenas os homossexuais deveriam se preocupar com o contágio era maior nos professores (92%). Encontramos uma maior autoeficácia nos alunos e uma melhor susceptibilidade nos professores. Conclusões: é necessário fortalecer estratégias que reforcem conceitos e comportamentos contra o HIV/AIDS(AU)

Calidad de vida en adultos mayores con trastornos temporomandibulares / Qualidade de vida dos idosos com disfunçao temporomandibular / Quality of life of older adults with temporomandibular disorders

Introducción: los trastornos temporomandibulares (TTM) son una condición músculo esquelética dolorosa que afecta los músculos de la masticación, la articulación temporomandibular (ATM) y varias estructuras anatómicas del sistema estomatognático. Objetivo: comparar la calidad de vida; determinada con el instrumento OHIP 49-Mx, de adultos mayores con trastornos temporomandibulares (TTM) vs. libres de TTM. Método: se realizó un estudio observacional analítico en la población de adultos mayores en una Unidad Gerontológica de Puebla, México. Se estableció el diagnóstico de TTM en las instalaciones; con los criterios diagnósticos para TTM propuesto por Dworkin y mejorados por Schiffman en el 2014 por investigadora previamente capacitada. Adicionalmente, se evaluó la calidad de vida (OHIP 49-Mx) por la misma investigadora. El manejo estadístico fue realizado con U de MannWhitney (contraste de medianas) con valor significativo ≤0.05, en el programa SPSS v.21. Resultados: se evaluaron 192 adultos mayores; 131 (68,2 por ciento) con TTM; 84 por ciento mujeres. Los pacientes con TTM, presentaron medianas superiores en la mayoría de las dimensiones del instrumento OHIP 49 Mx: limitación funcional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Conclusiones: los adultos mayores con TTM, denotaron una menor calidad de vida relacionada con la salud bucal; específicamente en las dimensiones de limitación funcional, inhabilidad física, psicológica y dolor(AU)

Introduction: temporomandibular disorders (TMD) are a painful skeletal muscle condition that affects the muscles of the mastication, the temporomandibular joint (TMJ) and various anatomical structures of the stomatognathic system. Objective: to compare the quality of life; determined with the OHIP instrument 49-Mx, of older adults with temporomandibular disorders (TMD) vs. free of TTM. Method: an analytical observational study was conducted in the elderly population in a Gerontological Unit of Puebla, Mexico. The diagnosis of TMD was established in the facilities; with the diagnostic criteria for TTM proposed by Dworkin and improved by Schiffman in 2014 by a previously trained researcher. Additionally, the quality of life (OHIP 49-Mx) was evaluated by the same researcher. The statistical management was performed with Mann-Whitney U (medium contrast) with significant value ≤0.05, in the SPSSv.21 program. Results: 192 older adults were evaluated; 131 (68.2 per cent) with TTM; (84 per cent) women Patients with TMD had higher medians in most dimensions of the OHIP instrument 49 Mx: limitación functional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Md=16 vs. 13, p=0.06; pain Md=8.0 vs. 4.0, p=0.02; psychological discomfort Md=3 vs. 3, p=0.31; physical disability Md=11 vs. 3, p≤0.00; psychological disability Md=1 vs. one, p=0.03; social disability Md=0 vs. 0, p=0.90 and disability Md=1 vs. 1, p=0.03. Conclusions: the elderly with TMD, showed a lower quality of life related to oral health; specifically in the dimensions of functional limitation, physical, psychological and pain disability(AU)

Introdução: as disfunções temporomandibulares (DTM) são uma condição dolorosa do músculo esquelético que afeta os músculos da mastigação, a articulação temporomandibular (ATM) e diversas estruturas anatômicas do sistema estomatognático. Objetivo: comparar a qualidade de vida; determinado com o instrumento OHIP 49-Mx, de idosos com disfunção temporomandibular (DTM) vs. livre de TTM. Método: estudo observacional analítico foi realizado na população idosa em uma Unidade Gerontológica de Puebla, México. O diagnóstico de DTM foi estabelecido nas instalações; com os critérios diagnósticos para TTM propostos por Dworkin e aprimorados por Schiffman em 2014 por um pesquisador previamente treinado. Além disso, a qualidade de vida (OHIP 49-Mx) foi avaliada pelo mesmo pesquisador. O tratamento estatístico foi realizado com o teste Mann-Whitney U (meio de contraste) com valor significativo ≤0,05, no programa SPSS v.21. Resultados: 192 idosos foram avaliados; 131 (68,2 por cento) com TTM; 84por cento mulheres Pacientes com DTM apresentaram medianas mais altas na maioria das dimensões do instrumento OHIP 49 Mx: limitação funcional Md = 16 vs. 13, p = 0,06; dor Md = 8.0 vs. 4,0 p = 0,02; desconforto psicológico Md = 3 vs. 3, p = 0,31; deficiência física Md = 11 vs. 3, p <0,00; incapacidade psicológica Md = 1 vs. 1; p = 0,03; deficiência social, Md = 0 vs. 0; p = 0,90 e incapacidade Md = 1 vs. 1, p = 0,03. Conclusões: os idosos com DTM apresentaram menor qualidade de vida relacionada à saúde bucal; especificamente nas dimensões de limitação funcional, física, psicológica e incapacidade de dor(AU)

Alteraciones posturales frecuentes en pacientes con diferentes tipos de trastornos temporomandibulares / Frequent postural alterations in patients with different types of temporomandibular disorders

RESUMEN Objetivo Describir las alteraciones posturales más frecuentes, de acuerdo al tipo de trastorno temporomandibular (TTM). Metodología Se analizaron 30 pacientes con edad media de 27,4 años; 80% mujeres, con diagnóstico de TTM confirmado con los Criterios Diagnósticos (CD/TTM) por investigador capacitado en la clínica de la Facultad de Estomatología de la BUAP. Posteriormente se realizó el análisis postural (tres vistas) con ayuda de una cuadrícula de acetato en las instalaciones de la Licenciatura de Fisioterapia de la BUAP. Se analizaron los resultados con estadística descriptiva en el programa SPSS v20. Resultados El 16,7% de los pacientes presentó TTM de origen muscular, el 36,7% articular y el resto combinado. Las alteraciones posturales más frecuentes fueron: hombro elevado: 93,3%, basculación pélvica: 86,7% y posición de cabeza adelantada: 83,3%. El mayor porcentaje de pacientes presentó cinco alteraciones posturales. El 100% presentó alteraciones en la vista lateral y el 50% de los pacientes con TTM de origen combinado presentaron alteraciones en las tres vistas, mientras en los de origen articular; el 45,5% y en los de origen muscular; el 60%. Conclusiones Los pacientes con TTM presentan alteraciones posturales; principalmente posición de cabeza adelantada, basculación pélvica y hombro elevado, con especial compromiso en los de diagnóstico muscular y combinado.(AU)

ABSTRACT Objective To describe postural alterations according to the type of temporomandibular disorder (TMD). Methods Prior informed consent, 30 patients were included in the study, with a mean age of 27.4 years; 80% women, diagnosed with TMD based on Diagnostic Criteria (DC/ TTM) by a trained researcher in the clinic of the Faculty of Stomatology of the BUAP. Subsequently, a postural analysis (three views) was carried out at the facilities of the School of Physiotherapy of the BUAP using an acetate grid. The results were analyzed with descriptive statistics in the SPSS v20 program. Results 16.7% of the patients presented muscular TMD, 36.7% joint TMD, and the rest combined TMD. The most common postural alterations were: high shoulder: 93.3%, pelvic tilt: 86.7%, and forward head posture: 83.3%. On average, the patients had between 4 and 5 postural changes. 100% of the patients ha alterations in the side view, while 50% of the patients with TMD of combined origin had alterations in the three views, as well as 45.5% of the patients with TMD of joint origin, and 60% of the patients with TMD of muscular origin. Conclusions TMD patients present postural changes, mainly forward head posture, pelvic tilt and high shoulder, with special involvement related to muscle and combined diagnosis.(AU)

Prevalencia de trastornos temporomandibulares en niños mexicanos con dentición mixta / Prevalence of temporomandibular disorders in Mexican children with mixed dentition

Objetivo Determinar y contrastar con la bibliografía reportada, la prevalencia de trastornos temporomandibulares con un instrumento validado en dentición mixta de niños mexicanos. Métodos Se incluyeron 150 niños de 8 a 12 años de edad, de cualquier sexo que asistieron a la clínica de estomatología pediátrica de la BUAP, evaluados con los criterios diagnósticos para la Investigación de los TTM (CDI/TTM) por investigador previamente estandarizado (kappa=0,93). Los resultados se contrastaron con lo reportado en la bibliografía. Resultados La prevalencia de TTM fue del 20,7%, predominantemente de tipo muscular (77,4%), el 33,3% presentó alteración del patrón de apertura bucal, el 34% presentó ruidos articulares (chasquido), la función mandibular más comprometida fue el masticar (6%). Estos resultados contrastan con lo reportado en la bibliografía, específicamente en los sitios musculares doloridos y las cefaleas, probablemente explicado por los diferentes instrumentos utilizados. Conclusión La prevalencia de TTM es contrastante entre diversos estudios, es necesario enfatizar la necesidad de evaluar éstos durante la niñez y la juventud con instrumentos validados.(AU)

Objective To determine and compare with reports in the bibliography, the prevalence of temporomandibular disorders with an instrument validated for Mexican children with mixed dentition. Methods 150 children, from 8 to 12 years of age and of any sex who attended the pediatric stomatology clinic of the BUAP (Meritorious Autonomous University of Puebla) were included and evaluated with the diagnostic criteria for research on TTM (CDI/TTM) by a researcher who had been previously standardized (kappa=0.93). The results contrasted with reports in the bibliography. Results The prevalence of TTM was 20.7%. It was predominantly muscular (77.4%), though 33.3% showed alteration of the mouth-opening pattern, 34% showed joint noises (clicks). The most compromised mandibular function was chewing (6%). These results contrast with reports in the bibliography, specifically in terms of muscle pain sites and headaches, probably explained by different instruments used. Conclusion The prevalence of TTM is in contrast among different studies. It is necessary to place emphasis on the need to evaluate these factors during the childhood and adolescence with validated instruments.(AU)

Asociación entre hábitos parafuncionales de la cavidad bucal y los transtornos temporomandibulares en adolescentes / Parafunctional habits of oral cavity and adolescents temporomandibular disordes

La musculatura del sistema masticatorio y la articulación temporomandibular (ATM) están protegidos por reflejos nerviosos básicos y sistema neuromuscular a través de la coordinación de fuerzas musculares, todo lo que produce sobrecarga muscular repetitiva como los hábitos parafuncionales (HPF) pueden ocasionar trastornos temporomandibulares (TTM) Los HPF se caracterizan por movimientos anormales a la función mandibular normal sin objetivo funcional, al estar alterados constituyen una fuente productora de fuerzas traumáticas caracterizadas por dirección anormal, intensidad excesiva y repetición frecuente y duradera (Rolando Castillo Hernández, 2001). El objetivo del estudio fue identificar la asociación entre la presencia de hábitos parafuncionales de la cavidad bucal y los TTM en adolescentes de la ciudad de Puebla. Estudio observacional descriptivo. Se incluyeron 258 adolescentes, 132 (51.2%) mujeres y 126 (48.8%) hombres, con una edad promedio de 12.5±.73 y quienes fueron diagnosticados con los CDI/TTM y los HPF fueron auto-reportados por los pacientes. Se encontró una prevalencia de los TTM del 39.9% y una prevalencia de HPF del 86%. Los HPF más frecuentemente reportados fueron la succión labial y la onicofagia. Se encontró una asociación significativa (x2=7.31, p=0.007) entre los hábitos parafuncionales y los TTM en adolescentes.

The muscles of the masticatory system and temporomandibular joint (TMJ) are protected by basic nerve reflex and neuromuscular system through the coordination of muscle forces, all that repetitive muscle overload occurs as habit parafunctional (HPF) can cause temporomandibular disorder TMD) The characteristics of HPF are abnormal jaw movements without a functional objective. Being the jaw movements altered, they constitute a source of traumatic forces with an abnormal direction, excessive intensity and long-lasting and frequent duration. (Rolando Hernandez Castillo 2001). Objective: was to identify the association between the presences of parafunctional habits of the oral cavity and TMD in adolescents in the Puebla city in Mexico. Material and methods: Is a observational study, we included 258 adolescents 132 (51%) females and 126 (48.8%) were men, mean age 12.5±.73 and who were diagnosed with CDI/TTM and HPF were self- reported by patients. Results: The prevalence of TMD was 39.9% and a prevalence of 86% HPF. The most frequently reported HPF were lip sucking and nail biting. We found a significant association (x2= 7.31, p = 0,007) between HPF and TMD in adolescents.

Prevalence of signs and symptoms of temporomandibular disorders in children in the state of Puebla, Mexico, evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD)

The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa.90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31+1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.

El objetivo del presente trabajo fue describir la prevalencia de signos y sintomas de los trastornos temporomandibulares (TTM) en ninos del estado de Puebla, Mexico. Se realizo un estudio observacional descriptivo. Previo calculo de tamano de muestra, se incluyeron ninos que cumplieron con criterios previos de seleccion: inscriptos en escuela primaria oficial, de cualquier sexo, en edades de 8 a 12 anos, que aceptaron participar en el estudio y cuyos padres firmaron el consentimiento informado. Se utilizaron los Criterios de Investigacion Diagnostica para los TTM, aplicados por investigador estandarizado (Kappa .90) bajo las mismas condiciones. Se calculo estadistica descriptiva con el programa SPSS v15. Se incluyeron 235 ninos, 129 (54.9%) mujeres y 106 (45.1%) varones con promedio de edad de 9.31}1.2 anos. La prevalencia de signos y sintomas de TTM fue del 33.2% predominantemente musculares (82%), 48.1% presentaron dolor muscular y 19.1% articular. El 63.4% presento alteraciones en el patron de apertura bucal, 39.1% presento ruidos articulares en apertura o cierre y 20.4% a las excursiones mandibulares. Las altas prevalencias de los signos y sintomas relacionadas con los Trastornos Temporomandibulares, particularmente en ninos con denticion mixta, demuestran la importancia de la evaluacion de los TTM durante este periodo, donde prevalecen los cambios morfologicos asociados al crecimiento y al desarrollo craneofacial.

Necesidades de tratamiento periodontal en adultos de la región rural Mixteca del Estado de Puebla, México / Periodontal treatment needs in adults from Mixteca rural area in Puebla State, Mexico

Objetivo Determinar las necesidades de tratamiento periodontal (NTP) utilizando el índice Comunitario de Necesidades de Tratamiento Periodontal (ICNTP) en una muestra de habitantes de la región Mixteca del estado de Puebla. Material y Métodos Se realizó un estudio transversal en el que se incluyeron 50 pacientes de la clínica rural de Nativitas Cautempan, Puebla., México. Para determinar el estado de salud periodontal se utilizaron el índice Gingival y el índice Comunitario de Necesidades de Tratamiento Periodontal propuesto por la Organización Mundial de la Salud y la Federación Dental Internacional, aplicados por el mismo investigador previamente capacitado y estandarizado. En el análisis, se calculó media y desviación estándar para las variables cuantitativas y frecuencias y proporciones para las variables categóricas. Resultados La edad promedio fue 37,6± 13,6 años. El 60,0 por ciento fueron mujeres, cuya principal ocupación fue amas de casa (46,0 por ciento). El 14 por ciento fueron campesinos. El índice gingival reportó 50,0 por ciento, 32,0 por ciento y 14,0 por ciento para gingivitis leve, moderada y severa, respectivamente. Los sextantes posteriores superiores presentaron mas comúnmente bolsas de 4 a 5 mm, los sextantes anteriores, cálculo y los posteriores inferiores cálculo y hemorragia. El 94,0 por ciento de los pacientes requiere tratamiento periodontal en un promedio de 3,6 sextantes por paciente. Conclusiones Las necesidades de tratamiento periodontal fueron altas en este estudio, nueve de cada diez pacientes de la región Mixteca del Estado de Puebla lo requieren. Es necesario encaminar esfuerzos con el fin de mejorar la salud bucal en las comunidades indígenas.

Objective This study was aimed at determining periodontal treatment needs, as determined by the Community Periodontal Index of Treatment Need (CPITN), in a sample of adults from the Mixteca region of the State of Puebla, in Mexico. Materials and Methods This was a descriptive, cross-sectional, single-centre study. Previous informed consent was obtained; 60.0 percent of the sample were women whose main activity was housework (46 percent), 14.0 percent were farmers. Average age was 37.6 ± 13.6. Gingival and Community Periodontal Index of Treatment Need proposed by the World Health Organisation and the International Dental Federation were used; they were implemented by the same, previously-standardised researcher. Means, standard deviations and confidence intervals were calculated for dimensional variables and percentages for categorical ones. Results The gingival index gave 50.0 percent light gingivitis, 32.0 percent moderate and 14.0 percent severe gingivitis. The rear superior sextants commonly showed more 4 to 5 mm pockets, the front sextants calculus and the rear inferior sextants showed calculus and bleeding. 94.0 percent of the patients required periodontal treatment (3.6 sextants per patient average). Conclusions Periodontal treatment needs were high in this study; nine out of ten patients in the Mixteca region of the State of Puebla required periodontal treatment. Efforts must thus be guided towards improving oral health in indigenous communities.

Confiabilidad y validez de la SCL-90 en la evaluación de psicopatología en mujeres

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Abstract: Women are especially vulnerable to anxiety and depressive disorders, as shown in the international literature and, in our country, in the National Survey of Psychiatric Epidemiology. However, it is important not only to identify the disorders as such, but also to identify the symptoms, that though not becoming a disorder generate illnesses in women and can respond to psychopharmacological or psychotherapeutic interventions. The Symptom Check List (SCL 90) is a widely used instrument. In this study, three groups of women were assessed: one group of the community (as reference group), a second one, of women diagnosed as depressed in a third level psychiatric institution, and another group of women with a temporomandibular disorder (TMD). The main objective of this study was to identify the psychometric characteristics of the SCL-90. The alpha of Cronbach was determined (internal consistency) by each one of the 9 subscales. The validity was determined through the following criteria: Validity of the SCL-90 as a method to detect depressed women. A ROC curve was made, comparing the depressed women and the women of the community. Validity of the SCL-90 as a measurement of depression. We hypothesized a high correlation with Beck's depression scale and Hamilton's depression scale. Sensitivity to change: effect size. We hypothesized that the greater effect would be in the depression subscale. For construct validity we compare the psychopathological profiles of the three groups of women. We hypothesized the existence of a gradient: the highest ratings in depressed women, the lowest in women of the community, and intermediate ratings in women with TMD. A factorial analysis was also carried out. Women older than 18 years of age were included, who were literate and accepted to participate in this study. They had no cognitive deficit (mental retardation, dementia, psychosis, states of confusion) or any other problem that would impede that they answer the surveys. The three groups were made up as follows: Women with TMD: Women with clinical diagnosis of Temporomandibular Disorder who went to an ambulatory service of Maxilofacial Surgery of the ISSSTEP (Social Security Hospi tal for State Government Employees), who had not had treatment for TMD during the past six months and who did not have degenerative arthritic illness. No previous psychiatric diagnosis. Depressed women: Women attending to the National Psychiatric Institute who were diagnosed with Major Depressive Disorder and were prescribed anti-depressive treatment. Women of the community: Mothers of the students at the secondary school Pablo Cassals, a field of work of the Community Psychiatric Service of the Psychiatric Hospital Fray Bernardino Alvarez Results: The interview was carried out with 289 women, 131 were depressed women, 96, women of the community, and 62, women with TMD. The mean (standard deviation) age was simi lar in the three groups: 36 (10), 37.7 (5.5), 37.6 (11.9) respectively Of the women with depression, 64% had a stable partner, 100% of the women in the community, and 61% of the women with TMD. 69% of the women with depression were dedicated to keeping house, 34% of the women with TMD, and 74% of the women of the community. Internal consistency was determined through Cronbach's alfa. The results of this analysis show us a high consistency of the instrument's nine subscales. Except for the subscale of paranoid symptoms in the women of the community, the alpha coefficients of all subscales in the 3 groups were higher than 0.7. Another form of establishing the validity of the instrument is through the determination of the cut-off point for patient identification. Through the ROC curve, 1.5 points in the subscale of depression was taken, as the best score to minimize the number of false positive and false negative results. As a measurement of depression, it was observed that the correlations of the subscales with Hamilton's depression scale and Beck's depression inventory had the highest correlations with the subscale of depression. The correlations with Beck's Inventory are higher than with Hamilton's scale of depression. This information supports the convergent validity of the subscale of depression with conventional instruments for its assessment. Another way of determining the validity of an instrument is to establish sensitivity to change. The size of the effect was calculated dividing the average of the difference (before-after) over the basal standard deviation of depressed women who participated in the longitudinal study. The size of the effect was higher in Hamilton's scale of depression and second in the subscale of depression, which indicates that there is a specific answer to a specific anti-depressive intervention. According to what has been hypothesized (construct validity), the highest ratings corresponded to the depressed women; the lowest to the women of the community, and the intermediate to the women with TMD. The differences between groups were statistically significant in each of the nine subscales and in the total indexes. The group of the community was significantly different from those of the depressed women and the women with TMD. The difference between these last two groups was also significant. In an exploratory factorial analysis of the 90 reactives, 87 had factorial loads higher than .40 in a first factor that explained 46.77% of the total variance of the SCL 90. Although 13 more factors with Eigen values higher than 1 were identified, the variance explained by each of them was lower than 5%; according to this technique, only one general factor is the best explanation for the checklist. The two reactives with small factorial loads were: "Do you believe that others should be blamed for your problems?", "Do you hear voices that others don't hear?" and "Excesive eating". Although the checklist was developed for the assessment of a psychopathological profile, some authors have proposed that it should be used as a measurement of general psychopathology. In this study, the checklist was evaluated as a method of assessing a psychopathological profile as originally proposed by Derogatis, as a method of assessing general psychopathology (with the three total indicators), and as a specific method of assessing depression. The information that most solidly supports the validity of the List's subscales is the differences in the profile that were observed among the three groups. The points in all the subscales were higher for women with TMD than those for the women of the community, but lower than in depressed patients; this shows that the psychological state of women with TMD tends to be similar to that of women with psychiatric diagnosis of depression. In this regard, the advantage of using the List to measure a profile is evident, and not only to assess general psychopathology The Symptom Checklist proved to have the psychometric characteristics appropriate to be used as an instrument to assess a psychopathological profile, to identify patients with depression, and to measure the intensity of depression. As an instrument to measure change, it is sensitive to psychopharmacological interventions. Although the size of the effect observed in the depression subscale is lower than that observed with the Hamilton scale, it is notably higher than the one observed with Beck's Depression Inventory. With these psychometric characteristics, it is possible to use the List in any type of research, including those that assess anti-depressive interventions.