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

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

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

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED / Study and management of thyroid nodes by non specialist physicians: SOCHED consensus

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

Impacto de las prótesis removibles en la posición lingual, patrón de deglución y calibre sagital de la vía aérea orofaríngea / The impact of removable prosthesis on the position of the tongue during resting and swallowing states, and on the sagittal size of the oropharyngeal airway

Introducción: las prótesis dentales removibles y su influencia en las praxis linguales, no han sido analizadas clínica y radiográficamente. El objetivo fue determinar si las prótesis removibles causan modificaciones clínicas en la posición lingual y en el patrón de deglución; y cambios radiográficos en el calibre sagital de la vía aérea orofaríngea en pacientes con pérdida de mesa molar. Métodos: mediante un diseño preexperimental preprueba posprueba en un solo grupo, se evaluaron 15 pacientes en tres tiempos distintos: pretratamiento (T1), inmediatamente al insertar las prótesis (T2) y a los 6 meses posteriores (T3). La posición lingual se evaluó según Kotsiomiti. El patrón de deglución se evaluó según Bossart. Se hizo el análisis cefalométrico basado en Delaire y Argandoña para medir la vía área orofaríngea. Los datos clínicos fueron analizados estadísticamente con la prueba de Friedman, para la cefalometría se usó el análisis de varianza (ANOVA) y la prueba de Duncan. (p > 0,05) Resultados: se encontraron diferencias altamente significativas en la posición lingual, variando desde la posición anormal superior a la normal inferior. En el patrón de deglución se encontraron diferencias significativas, variando del linguo-mandibular al linguo-dentario. El calibre sagital de la vía aérea orofaríngea disminuyó significativamente entre T1 y T2. Conclusiones: línicamente ocurren cambios positivos en la posición lingual en reposo y en el patrón de deglución. Los cambios negativos que ocurren en la vía aérea orofaríngea al insertar las prótesis tienden a revertirse a los 6 meses de uso, producto de la acomodación estructural y funcional del macizo lingual.

Introduction: removable dentures and their influence on lingual position have not been clinically and radiographically tested. The objective of this study was to determine whether dentures cause clinical changes in tongue position and swallowing patterns, as well as radiographic changes in the sagittal caliber of the oropharyngeal airway in patients with molar table loss. Methods: by means of a pretest-posttest preexperimental design in a single group, 15 patients were evaluated at three different times: pretreatment (T1), immediately after inserting the prosthesis (T2) and 6 months afterwards (T3). Lingual position was evaluated according to Kotsiomiti. Swallowing patterns were assessed according to Bossart. The cephalometric analysis by Delaire and Argandoña was conducted in order to measure the oropharyngeal airway. The clinical data were statistically analyzed by using the Friedman test, and for cephalometry both the variance analysis test (ANOVA) and Duncan test were used (p > 0.05). Results: highly significant differences were found in tongue position, ranging from upper abnormal position to lower normal position. In terms of swallowing pattern, significant differences were found, ranging from lingual-mandibular to lingual-dental. The sagittal caliber of oropharyngeal airway significantly decreased between T1 and T2. Conclusions: clinically, positive changes occur in tongue position at rest and in swallowing pattern. Negative changes in the oropharyngeal airway after inserting dentures tend to revert within 6 months of use as a consequence of the structural and functional accommodation of the tongue mass.