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

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

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

COVID-19 pandemic accelerated virtual transformation in dental education: a multicenter review of remote teaching and teledentistry / Transformação virtual acelerada pela pandemia de COVID-19 na educação odontológica: uma revisão multicêntrica do ensino à distância e da teleodontologia

ABSTRACT Although prior to the pandemic there was some resistance to the virtualization of dental education, the COVID-19 pandemic is providing us a unique opportunity to overcome several barriers that previously blocked the adoption of remote teaching and teledentistry. Thanks to the extended availability of telecommunications, digital technologies, and platforms, remote education and teledentistry appear to be the preferred choice to maintain dental education and patient care active under this pandemic, without contamination risks. In this paper, we review valid remote education strategies and possible alternatives useful in virtual transformation in dental education. Furthermore, the role of teledentistry and its advantages and challenges are also revised. Under the current pandemic context, as dental educators, we are called to be creative and flexible. Every dental school should adapt and use remote education as much as possible until clinical attention can be readopted. The evidence presented in this review supports our position that under this pandemic, remote education and telemedicine/teledentistry may be "the virtual convenient solution", to adapt and improve the hitherto classic way of teaching dentistry through tele-education.

RESUMO Embora antes da pandemia houvesse alguma resistência à virtualização da educação odontológica, a pandemia COVID-19 está nos fornecendo uma oportunidade única de superar várias barreiras que anteriormente bloqueavam a adoção do ensino à distância e teledontologia. Graças à ampla disponibilidade de telecomunicações, tecnologias digitais e plataformas, a educação à distância e a teledontologia parecem ser a escolha preferida para manter a educação odontológica e o atendimento ativo aos pacientes durante a pandemia, sem riscos de contaminação. Neste artigo, revisamos estratégias válidas de educação a distância e possíveis alternativas úteis na transformação virtual na educação odontológica. Além disso, o papel do teleodontologia e suas vantagens, assim como também os desafios. No atual contexto pandêmico, como educadores odontológicos, somos chamados a ser criativos e flexíveis. Cada escola de odontologia deve se adaptar e usar a educação à distância, tanto quanto possível, até que a atenção clínica possa ser readotada. As evidências apresentadas nesta revisão corroboram nossa posição de que, sob esta pandemia, a educação a distância e a telemedicina / teleodontologia podem ser "a solução virtual conveniente", para adaptar e aprimorar a forma até então clássica de ensino de odontologia, agora por meio da teleducação.

Strategies and operational procedures in oral radiology to mitigate potential SARS-CoV-2 transmission / Estrategias y procedimientos operacionales en Radiología Oral para mitigar transmisión de SARS-CoV-2

SUMMARY Coronavirus disease (COVID-19) is highly transmissible through respiratory droplets, saliva, and aerosol particles. Infection can lead to severe acute respiratory syndrome and trigger multi-organ failure and death. Most clinical dental procedures involve contact with saliva or the generation of aerosols with saliva and blood. These airborne particles increase the risk of transmission by COVID-19 between dentists and patients. Thus, dentistry must adopt procedures to reduce transmission during dental procedures. Although these strategies may not be directly applicable to all institutions due to cultural, social, geographical, and economic differences, the underlying principles and implemented strategies remain relevant and can be adopted or modified by the institutions dealing with the current COVID-19 outbreak. The purpose of this article is to discuss one of the principal sources of COVID-19 transmission: saliva, the biofluid most frequently handled in a radiology environment. The authors also recommend strategies and operational procedures to decrease the spread of COVID-19 in a radiological routine.

RESUMEN La enfermedad por coronavirus (COVID-19) se transmite fácilmente a través de gotitas respiratorias, saliva y partículas de aerosol. La infección puede desencadenar un síndrome respiratorio agudo severo, insuficiencia multiorgánica y, en algunos casos, la muerte. Los procedimientos clínicos dentales determinan el contacto con saliva o la generación de aerosoles con saliva y sangre, lo que implica un alto riesgo de transmisión por COVID-19 entre odontólogos y pacientes. Por ello, la práctica odontologica debe adoptar medidas para detener la propagación durante los procedimientos dentales. En este artículo se revisan las estrategias para mitigar el riesgo de transmisión de COVID-19. Si bien estas estrategias pueden no ser directamente aplicables a todas las instituciones debido a diferencias culturales, sociales, geográficas y económicas inherentes, los principios subyacentes y las estrategias implementadas siguen siendo relevantes y pueden ser adoptados o modificados por las instituciones que se ocupan del brote actual de COVID-19. El propósito de este artículo es discutir una de las principales fuentes de transmisión de COVID-19: la saliva, el biofluido que se maneja con mayor frecuencia en un entorno radiológico. Los autores también recomiendan estrategias y procedimientos operativos para disminuir la propagación de COVID-19 en una rutina radiológica.

Concentración de fluoruro en aguas embotelladas comercializadas en Chile: importancia en caries y fluorosis dental / Fluoride concentration in bottled waters sold in Chile

Background: Bottled water consumption has currently increased and their fluoride (F) concentration may not be ideal in terms of caries benefit or risk of fluorosis. While low concentrations would have little anticaries effect, high F concentration would increase the risk of dental fluorosis. Aim: To measure F concentration in bottled waters sold in Chile. Material and Methods: Thirty bottles of water were purchased (15 sold as mineral water, six sold as purified water and nine as favored water). Samples were analyzed in duplicate with a previously calibrated ion-specific electrode. Mean F concentration of each product was calculated and expressed as ppm F (mg F/L). Results: A mean (± SD) concentration of 0.39 ± 0.42, 0.02 ± 0.006 and 0.11 ± 0.18 ppm F for mineral, purified and favored waters respectively, was found. Three samples were within the optimal F concentration recommended for drinking water in Chile, which ranges from 0.6 to 1.0 ppm F. Two were above such concentration and the others below. Only two waters displayed F concentration information in the label, which was corroborated by the analysis. Conclusions: Only 10% of the bottled waters commercialized in Chile have potential to prevent caries. The F concentration in most of them does not represent an increased risk of fluorosis.

Fermentable carbohydrate dietary consumption measured by a cariogenicity scoring system and caries experience in youth and adults / Consumo de carbohidratos fermentables en la dieta medido mediante un sistema de puntaje para la cariogenicidad y experiencia de caries en jóvenes y adultos

Aim: To evaluate if dietary fermentable carbohydrate consumption associates with caries experience of youths and adults when assessed by a scoring system of putative cariogenicity of the foods. Methods: Two hundred and seventy five subjects (12 to 67 years-old) were examined to assess caries experience by the DMFT Index (decay missing and filled teeth) and radiographs. Subjects filled a weekly diet diary registering the type, frequency and time of consumption of foods. An arbitrary scoring system was used to determine cariogenic potential of the diet based on food consistency frequency and occasion of consumption. Results: DMFT index significantly increased with age (p<0.001). Females showed higher cariogenic potential than males (p=0.04). When subjects were divided into four DMFT categories, no differences were detected in cariogenic potential of the diet in any caries group. No correlation between caries experience and cariogenic potential of the diet could be found. Conclusions: Arbitrarily assigned cariogenicity of dietary fermentable carbohydrates does not seem to associate with caries experience, when information was obtained through a cariogenicity scoring system.

Objetivo: Evaluar si el consumo de carbohidratos fermentables se asocia con la experiencia de caries en jóvenes y adultos, cuando es medido por un sistema de asignación de puntajes a los alimentos según su presunta cariogenicidad. Metodología: 275 sujetos (12 a 67 anos) fueron examinados para determinar su experiencia de caries mediante el índice COPD (dientes cariados, obturados y perdidos) y radiografías. Los sujetos llenaron un diario dietético semanal. Se utilizó un sistema arbitrario para asignar puntajes y determinar el potencial cariogénico de la dieta basado en la consistencia, frecuencia y ocasión de consumo. Resultados: Las mujeres mostraron mayor potencial cariogénico que los hombres (p=0,04). Cuando los sujetos fueron divididos en 4 categorías de COPD, no se detectaron diferencias en su potencial cario-génico en ningún grupo de caries. No se observó correlación entre la experiencia de caries y el potencial cariogénico de la dieta (p>0,05). Conclusiones: La cariogenicidad arbitrariamente asignada a los carbohidratos fermentables de la dieta no parece asociarse con la experiencia de caries en adultos.