Cepillos interdentales, de la teoría a la práctica. Revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, con papilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica, prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have, multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixed prosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Autocuidado de las encías y salud periodontal / Autocuidado das gengivas e saúde periodontal / Self-care of the gingiva and periodontal health

Introducción: en Cuba se prioriza la atención a la salud bucal, la que está determinada por diferentes factores, entre los que prevalece la incidencia de la enfermedad periodontal que hoy se reconoce como problema de salud, pues daña el bienestar biopsicosocial del individuo. Objetivo: brindar a los estomatólogos las bases teóricas que le permitan enriquecer su preparación respecto al tema enfermedad periodontal y de esta manera mejorar su contribución a su prevención desde el nivel de atención primaria a la salud bucal. Método: se sistematizaron los referentes relacionados con la enfermedad periodontal en la Facultad de Ciencias Médicas de Guantánamo, en el período de enero a julio de 2017. Resultados: el primer estadío de la enfermedad periodontal se conoce como gingivitis. La enfermedad periodontal incide hasta en un 20 % de la población mundial. El cuidado de las encías para la prevención de la enfermedad periodontal requiere que el individuo se apropie de los saberes esenciales que le posibiliten esta finalidad, a fin de que sean capaces de percibir el riesgo de ella y contribuir con las acciones dirigidas a la protección o restauración de la salud periodontal. Conclusiones: se ofrecen bases teóricas para la comprensión de la necesidad de desarrollar en los pacientes una cultura del cuidado de las encías por una salud periodontal. Se reitera el valor de estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsables de la educación de la población en función de la promoción de salud periodontal y la prevención de las enfermedades periodontales(AU)

Introduction: in Cuba attention to oral health is prioritized, which is determined by various factors, including incidence of periodontal disease that now a day is recognized as a health problem, it damages the individual as well as biopsicosocial well-being. Objective: stomatologists provide the theoretical bases that allow them to enrich their preparation on the subject periodontal disease thus improve their contribution to prevent primary care level to oral health. Method: the references related to periodontal disease in the Faculty of Medical Sciences of Guantanamo are systematized, from January to July 2017. Results: first stage of periodontal disease is known as gingivitis. Periodontal disease affects 20% of the world population. The gingiva care to prevent periodontal disease requires the individual to appropriate the essential knowledges that will enable this purpose, so that they are able to perceive the risk of it and contribute to actions with the aim of protecting periodontal health. Conclusions: theoretical basis for understanding the need to develop in patients offer culture of gingival care by a periodontal health. The value of stomatology, family, school, community media and reiterated responsible for education as social agents of the population depending on periodontal health promotion and prevention of periodontal diseases(AU)

Introdução: Cuba atenção à saúde bucal é priorizada, que é determinada por vários fatores, incluindo a incidência de doença periodontal que prevalece é agora reconhecida como um problema de saúde, ele danifica o bem-estar biopsicossocial do indivíduo. Objetivo: fornecer aos estomatologistas as bases teóricas que lhes permitirão enriquecer seu preparo em relação à questão da doença periodontal e, assim, melhorar sua contribuição para sua prevenção, desde o nível de atenção primária até a saúde bucal. Método: os referentes à doença periodontal foram sistematizados na Faculdade de Ciências Médicas de Guantánamo, no período de janeiro a julho de 2017. Resultados: o primeiro estágio da doença periodontal é conhecido como gengivite. A doença periodontal afeta até 20% da população mundial. O cuidado das gengivas para a prevenção da doença periodontal exige que o indivíduo se aproprie dos conhecimentos essenciais que possibilitam esse propósito, para que eles sejam capazes de perceber o risco dele e contribuir com as ações voltadas à proteção ou Restauração da saúde periodontal. Conclusões: bases teóricas são oferecidas para a compreensão da necessidade de desenvolver em pacientes uma cultura de cuidado gengival para a saúde periodontal. O valor do estomatologista, da família, da escola, da mídia e da comunidade são reiterados como agentes sociais responsáveis pela educação da população em termos de promoção da saúde periodontal e prevenção de doenças periodontais(AU)

Toothbrushing procedure in schoolchildren with no previous formal instruction: variables associated to dental biofilm removal / Procedimiento de cepillado en escolares sin previo entrenamiento formal: variables asociadas al barrido del biofilm dental

The aim of this study was to establish the association betweenfeatures regarding brushing procedure performed by school-children without previous formal training and the effectivenessof biofilm removal. Out of a population of 8900 6- and 7-year-old schoolchildrenin Buenos Aires City, 600 children were selected from schoolslocated in homogeneous risk areas. Informed consent wasrequested from parents or guardians and formal assent wasobtained from children themselves. The final sample consistedof 316 subjects. The following tooth brushing variables wereanalyzed: toothbrush-gripping, orientation of active part ofbristles with respect to the tooth, type of movement applied,brushing both jaws together or separately, including all 6sextants and duration of brushing. The level of dental biofilmafter brushing was determined by O’Leary’s index, acceptablecut-off point = 20%. Four calibrated dentists performedobservations and clinical examinations. Frequency distribution,central tendency and dispersion measures were calculated.Cluster analyses were performed; proportions of variables foreach cluster were compared with Bonferroni’s correction andOR was obtained. The most frequent categories were: palm gripping (71.51%);perpendicular orientation (85.8%); horizontal movement(95.6%); separate addressing of jaws (68%) and inclusion ofall 6 sextants (50.6%). Mean duration of brushing was 48.78 ±27.36 seconds. 42.7% of the children achieved an acceptablebiofilm level. The cluster with the highest proportion of subjectswith acceptable post-brushing biofilm levels (p<0.05) differedsignificantly from the rest for the variable “inclusion of all 6 sextants in brushing procedure”. OR was 2.538 (CI 95%1.603 – 4.017). Inclusion of all six sextants could be a determinant variable forthe removal of biofilm by brushing in schoolchildren, and shouldbe systematized as a component in oral hygiene education.

El objetivo del trabajo fue establecer la asociación entre las características del procedimiento de cepillado en escolares sin previo entrenamiento formal con la efectividad para el barrido del biofilm dental. Sobre una población de 8900 escolares de Ciudad Autónoma deBuenos Aires de 6 y 7 años de edad, se seleccionaron 600 niños concurrentes a escuelas situadas en áreas de riesgo homogéneo. Sobre esta muestra se solicito consentimiento informado a losresponsables legales y el asentimiento formal, conformando una muestra final de 316 individuos. Se analizaron las siguientes variables del procedimiento de cepillado: tipo de toma del cepillo dental, orientación de la parte activa respecto del diente, tipo de movimiento aplicado, abordaje simultaneo o no de ambos maxilares, inclusión de los 6 sextantes y duración de cepillado.El nivel de biofilm dental posterior al cepillado se determinó con el índice de O’Leary-punto de corte aceptable=20 por ciento. Cuatro odontólogos calibrados realizaron las observaciones y exámenes clínicos. Se calculó: distribución de frecuencias, medidas detendencia central y su dispersión. Se realizó un análisis de clúster y comparación de proporciones de las variables de cada conglomerado con corrección de Bonferroni y OR. Las categorías más frecuentes fueron: toma palmar (71,51 por ciento); orientación perpendicular (85,8 por ciento); movimiento horizontal (95,6 por ciento); cepillado de ambos maxilares por separado (68 por ciento) einclusión de los 6 sextantes (50,6 por ciento). La media de duración delcepillado fue de 48.78 ± 27.36 segundos. El42,7 por ciento de losescolares alcanzaron un nivel de biofilm aceptable. El clúster que mostró la mayor proporción de individuos con niveles de biofilm postcepillado aceptables (p<0,05) mostró diferenciasestadísticamente significativas con los demás respecto de la variable “inclusión de 6 sextantes en el cepillado”. El OR fueigual a 2,538 (IC 95 por ciento 1,603 – 4,017)

Efficacy and acceptability of 0.074% diclofenac-containing mouthwash after periodontal surgery: A clinical study.

Background: The systemic use of non-steroidal anti-inflammatory drugs are associated with various side-effects like hepatotoxicity, blood dyscrasias, nephrotoxicity and gastric irritability. Among these, gastric irritability is the most common and the most important one, which should be taken care of. Therefore, it may be preferable to use a local formulation such as a mouthwash to treat the inflammatory conditions of the oral cavity. Aim: To determine the efficacy and acceptability of 0.074% diclofenac mouthwash in relieving pain and inflammation of post-periodontal surgery patients. Materials and Methods: The study was designed as a double-blind, placebo-controlled clinical trial. Twenty chronic periodontitis patients who were scheduled for full-mouth periodontal flap surgery were randomized to receive either diclofenac mouthwash or placebo to rinse with 15 ml of solution daily for a period of 7 days. Modified gingival index (Lobene 1986) was used to verify gingival inflammation and visual analog scale was used to assess pain. After the baseline measurements for all the parameters were recorded, spontaneous pain and burning were evaluated daily while redness and edema were recorded on the 3 rd and 7 th day from the day of treatment. Results: Data obtained were analyzed statistically using paired " t" test for intragroup comparison and unpaired " t"-test for intergroup comparison. Spontaneous pain was significantly reduced by diclofenac mouthwash. Other parameters, i.e. gingival inflammation and swelling, had not shown significant reduction in scores in either group, although the reduction was higher in the test group. Conclusion: The new 0.074% diclofenac mouthwash is an effective and tolerable medicinal product for post-surgical symptomatic relief.

Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12- to 13-year-old school children.

Background: Children with poor oral health are 12 times more likely to have restricted-activity days. Dental health education [DHE], with the objective of improving the oral hygiene of the participants, would have obvious merits. Objectives: To determine the effectiveness of school DHE, conducted at repeated and differing intervals, in improving oral health knowledge, practices, oral hygiene status, and the gingival health of schoolchildren belonging to two socioeconomic classes. Materials and Methods: This 36-week duration study assessed the effectiveness of school DHE conducted every three weeks against every six weeks on oral health knowledge, practices, oral hygiene status and gingival health of 415, 12- to 13-year-old schoolchildren belonging to social classes I and V. Of the three selected schools of each social class, one each was subjected to the intervention of either three or six weeks or was a control, respectively. Oral health knowledge and practices were evaluated using a questionnaire. Oral hygiene and gingival health were assessed using plaque and gingival indices. Statistical Analysis Used: Friedman's test was used for the longitudinal analysis of data. ANOVA and Student's t test were used for continuous data. Results: Plaque and Gingival score reductions were highly significant in intervention schools, and were not influenced by the socioeconomic status. When oral health knowledge was evaluated, highly significant changes were seen in intervention schools; more significantly in schools receiving more frequent interventions. The socioeconomic status influenced the oral hygiene aids used and the frequency of change of toothbrush. Controls showed no significant changes throughout. Conclusions: The DHE program conducted at three-week intervals was more effective than that conducted at six-week intervals in improving oral health knowledge, practices, oral hygiene status, and gingival health of schoolchildren.

O perfil dos cirurgiões-dentistas da cidade de São Paulo na prática da prevenção de cáries e doenças gengivais / The dentist surgeons profile of São Paulo city in the prevention of dental caries and gingival diseases

Introdução: Este trabalho de levantamento de dados baseou-se em questionários entregues a cirurgiõesdentistas na cidade de São Paulo, com retorno de 339 questionários válidos, visando avaliar a prevenção de cáries e doenças gengivais por eles realizada. Métodos: O questionário continha 9 questões referentes a informações demográficas e clínicas. Para fins de análise de resultados foram considerados como básicos os seguintes procedimentos preventivos: orientação de escovação, orientação de dieta, aplicação de selantes de fóssulas e fissuras, evidenciação de placa bacteriana, uso de flúor e motivação do paciente. Resultados: A grande maioria dos respondentes (97,6%) afirmou realizar prevenção, porém apenas 0,3% empregam os 6 métodos avaliados neste estudo. Verificou-se, ainda, a influência do sexo e do tempo de formado nessa prática preventiva, sendo que as mulheres realizam mais prevenção do que os homens e os dentistas recém-formados (até 5 anos) empregam menos métodos de prevenção que os formados há mais tempo. O flúor e a orientação de escovação foram os métodos mais utilizados, enquanto que a orientação de dieta foi o menos empregado. Conclusões: A prática de prevenção pelos cirurgiões-dentistas da cidade de São Paulo sofre influência do sexo e do tempo de formado, sendo os homens e recém-formados os que empregam menos métodos de prevenção de cáries e doenças gengivais, comparativamente aos demais grupos.

Introduction: This data survey study was based on questionnaires delivered to dentist surgeons of the city of São Paulo, with a total return of 339 valid questionnaires. The aim of this study was to evaluate dental surgeon practice of caries prevention and gum disease control. Methods: The questionnaire contained 9 questions referring to demographic and clinical information. For result analysis purposes, the following preventive procedures were considered as basic information: 1. tooth-brushing instructions, 2. diet instructions, 3. pit and fissure sealants , 4. dental plaque verification 5. use of fluoride, and 6. patient motivation. Results: Most of the answers (97.6%) asserted that they carry out preventive procedures, but only 0.3% utilizes all 6 methods of prevention analyzed in this study. Gender and years of graduation were also observed, women performing more preventive procedures than men, and recently-graduated dentists (5 years or less) performing fewer preventive procedures than dentists who had graduated earlier (over 5 years). Fluoride use and tooth-brushing instructions were the most common methods used, while diet instruction was the least performed preventive method. Conclusion: Preventive procedures carried out by dental surgeons of São Paulo were influenced by sex and years of graduation, recently-graduated males being the ones who least carried out caries prevention methods and gum disease control, when compared to the other groups in this study.

Efecto del control metabólico en pacientes diabéticos tipo 1 y su asociación con enfermedad periodontal / Effect of metabolic control in type I diabetes patients and its association with periodontal disease

OBJECTIVE: To compare the frequency of periodontal disease in type 1 diabetes mellitus patients with and without metabolic control, having a control group of healthy patients. MATERIAL AND METHODS: A prolective cross sectional study with simple random sampling was carried out; patients were divided in three groups: A). Forty healthy subjects, B). Twenty diabetic patients with metabolic control, and C). Twenty diabetic patients without metabolic control. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to determine the glucose control; clinical periodontal evaluations were performed for all teeth in each subject and following indexes were included: Plaque, gingival, mobility, probing depth, attachment level, bleeding on probing, and marginal bone loss. RESULTS: The imbalance of glucose of subjects with diabetes mellitus type 1 was associated with more frequency of periodontal disease (p < 0.05). CONCLUSION: The population of type 1 diabetes mellitus with imbalance of glucose showed association with periodontal disease.

Técnicas no estandaridazas de higiene oral: estudio comparativo / Non-standarized techniques of oral hygiene: comparative study

Se realizó un estudio comparativo, de diseño no experimental, con el objetivo de observar y describir las técnicas naturales o habituales de higiene oral (cepillado y uso de seda dental) y comparar su efectividad en términos de remoción de placa bacteriana con las técnicas estandarizadas (Bass modificada y de uso sistemático de seda dental). Se escogieron 75 pacientes a quienes les fueron enseñadas las técnicas estandarizadas con anterioridad a la prueba. Los resultados indican que las técnicas habituales de cepillado y sistemática de uso de la seda dental fueron más efectivas, en términos de remoción de placa bacteriana, que las técnicas de Bass modificada y habitual de seda dental (p=0,05)

Por que os dentes väo amolecendo, até se perderem, sem apresentarem problemas aparentes, como a cárie? / Why the teeth keep softening leading to their loss, without presenting apparent problems, like caries

O objetivo deste trabalho é orientar a classe médica quanto à doença que envolve o períodonto, apresentando suas características clínicas, fisiológicas e patológicas, os microrganismos que concorrem para o estabelecimento de doença, seu demais agentes etiológicos e o mecanismo de controle.

Educación para la salud dental durante el embarazo / Dental health education during pregnancy

En la educación para la salud se incluye la difusión de conocimiento y practicas sobre higiene bucal tendientes a disminuir la frecuencia de presentación de la caries y de la enfermedad parodontal. El servicio de Odontología del Instituto Nacional de Perinatología tiene una década llevando a cabo actividades educativas con los pacientes. Se instrumentó un programa educativo, y se planteó llevar a cabo una investigación que permitiera conocer el impacto del programa sobre los pacientes. Fueron formados dos grupos, uno experimental y otro control, se les impartió programa teórico, que contó con una sesión de 90 min. con apoyo didáctico impreso y un video acerca de las caries, enfermedad parodontal y técnicas higiénicas bucales. El grupo experimental contó además con eis sesiones prácticas, coincidentes con la atención curativa de la boca. Los resultados evidenciaron el aumento de conocimientos en ambos grupos. Sin embargo, al paso del tiempo en la revaloración de conocimientos se notó una disminución. En cuanto a la práctica, fué evidente la diferencia entre los que la tuvieron y los que no. La discusión se centra, igual que en el caso de otros autores, en la necesidad de continuar con el paciente en una enseñanza "permanente"

Análise biométrica da largura da gengiva inserida em pacientes com indicaçäo para tratamento ortodôntico / Biometric analysis of the width of gingiva implanted in patients with orthodontics treatment indication

O presente trabalho objetiva alertar os ortodontistas, da importância dos cuidados com o periodonto, no que se refere a uma situaçäo de ausência de gengiva inserida antes do tratamento ortodôntico. Remover acúmulos freqüentes de placa bacteriana, durante todo o tratamento é um dos cuidados obrigatórios. Neste estudo, foi realizada uma avaliaçäo da largura da gengiva inserida, na regiäo dos incisivos e caninos inferiores, em adolescentes com indicaçäo para tratamento ortodôntico com aparelho fixo. Os resultados mostraram que, dos 407 dentes estudados, em 3,4% näo havia gengiva inserida; em 7,6% existia 0.5 mm e, em 16,7% apenas 1 mm de gengiva inserida estava presente. Observa-se uma relaçäo inversa entre a largura da gengiva inserida, a quantidade de formaçäo de placa e o grau de inflamaçäo, isto é, quanto mais estreita a largura da gengiva inserida, maior era o acúmulo de placa e a inflamaçäo gengival

Problemas de salud bucal en escolares / Problems of oral health in school children

Los problemas de salud bucal constituyen motivo importante de consulta en la población. En este sentido, la patología bucal más frecuente está relacionada con caries y enfermedad gingival o periodontal. Estas alteraciones afectan, por ejemplo, al 80 y 50%, respectivamente, de la población estudiantil universitaria. La dieta consumida por la población está constituida por alimentos de alto poder cariogénico, a lo que se agrega la falta de una higiene bucal adecuada. La prevención no sólo ha de estar dirigida a tratar la enfermedad, sino a evitar que ésta se inicie o, por lo menos, reducir la patología más frecuente