Inequalities in dental services use by older adults in Chile according to eligibility for a national dental programme.

OBJECTIVES: The objectives of this study were to determine the prevalence and trends in dental service use among Chilean older adults (60+ years) between 2006 and 2017; to assess the association between socioeconomic factors and dental service use and type (public/private) in 2017 and whether these differ by eligibility to a national dental programme (GES-60). METHODS: This study involved secondary data analysis of five nationally representative cross-sectional surveys between 2006 and 2017. Trends were assessed for use of dental services and types of services used among 60-79-year-olds. Logistic regression models examined the association between use of dental services in 2017 and socioeconomic variables (income and education), accounting for covariates (age, gender, residence, ethnicity, cohabiting status, employment and disability). Estimated marginal means and odds ratios (ORs) were calculated to assess the association between socioeconomic variables and the outcomes by GES-60 eligibility. RESULTS: Across surveys, the average prevalence of use of dental services in the last 3 months was 5.0%. There was a slight increase in dental visits between 2006 and 2017. This trend was higher among GES-60 eligible individuals using public dental services. Inequalities were observed in regression analyses. Compared to the poorest quintile and those with no formal education respectively, the ORs were 2.36 (95% confidence interval (CI) 1.79-5.68) for the richest quintile and ranged from 2.91 (95% CI 1.49-5.68) to 6.43 (3.26-12.68) for each higher level of educational attainment. Inequalities were wider among GES-60 non-eligible than GES-60 eligible older adults for both outcomes. CONCLUSIONS: Socioeconomic inequalities were present among older adults regardless of GES-60 eligibility. However, these inequalities were more pronounced among non-eligible individuals. Our findings suggest a limited impact of GES-60 only among eligible older adults. Policies considering the needs of the whole older adult population are likely to have a stronger impact.

Absence of Association between Child Temperament and Early Childhood Caries: A Cross-Sectional Study.

Early childhood caries (ECC) is a worldwide public health problem. The biological and behavioural determinants that are directly involved in ECC have been well documented; however, evidence on the effects of some psychosocial factors remains conflicting. This study aimed to assess the association between child temperament and ECC in Chilean preschoolers. Prior approval of the protocol was obtained from the ethics committee of Universidad de La Frontera (Folio N° 020_17), and all of those involved in the study provided signed informed consent forms. The cross-sectional study was conducted with 172 children aged 3 to 5 years attending preschools in Temuco, Chile. Each child's temperament was assessed based on parents' responses to the Early Childhood Behaviour Questionnaire. The outcomes assessed were caries prevalence and caries experience (dmft scores). The covariates included were socioeconomic position, cariogenic diet, prolonged breastfeeding, presence of dental plaque and hypoplasia. Logistic regression models were used to predict caries prevalence and negative binomial regression for caries experience. The prevalence of ECC was 29.1%, and the most frequent child temperament was 'effortful control'. Regression model analyses, adjusting for covariates, showed no evidence of an association between any domain of children's temperament (surgency, negative affect and effortful control) with the prevalence of caries or caries experience. This cross-sectional study found no association between childhood temperament and ECC in preschool children for this population. However, due to the specificity of this population, the association cannot be entirely ruled out. Further studies are needed to help understand the association between temperament and oral health, including the influences of family environment factors and culture.

Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: A case study.

RATIONALE, AIMS AND OBJECTIVES: In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical. The guideline development process includes prioritization of the guideline topic, questions and health outcomes. This case study describes the application of a new methodology to prioritize questions and rate the importance of health outcomes for a COVID-19 dental guideline. METHODS: Panel members rated the topic and the questions' overall importance, using a 9-point scale (1 = least important; 9 = most important). In addition, they rated six criteria if multiple questions received the same overall importance rating: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. Panellists also rated the importance of each outcome, defined with health outcome descriptors, using a 9-point scale and the utility of health outcomes on a visual analogue scale. The correlation between each criterion and overall question importance was tested by Spearman correlation coefficient. RESULTS: Of seven topics, four were rated as high priority and three were rated as important, but not of high priority. Thirty-six percent of the questions (18/50) were rated as high priority to address in the guideline and 64% (32/50) were rated as an important question but not of high priority. Of the 11 outcomes, 72.7% were rated as critical for decision making. The mean utility rating was 0.57 (SD 0.32), with a minimum mean rating of 0.16 and a maximum of 0.76 (SD 0.23). CONCLUSION: This case study demonstrated that this approach provides a rigorous and transparent methodology to conduct the prioritizations of guideline topics, questions and health outcomes.

QUALITY APPRAISAL OF CLINICAL PRACTICE GUIDELINES ON PROVISION OF DENTAL SERVICES DURING THE FIRST MONTHS OF THE COVID-19 PANDEMIC.

OBJECTIVES: To evaluate the quality of clinical practice guidelines (CPGs) on dental services provision during the first months of the COVID-19 pandemic. MATERIALS AND METHODS: We systematically searched in MEDLINE, EMBASE, LILACS, Epistemonikos, Trip databases, websites of CPG developers, compilers of CPGs, scientific societies and ministries of health to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. Reviewers independently and in duplicate assessed the included CPGs using the AGREE II instrument. We calculated the standardized scores for the 6 domains and made a final recommendation about each CPG. The inter-appraiser agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS: Twenty-three CPGs published were included. Most of the CPGs were from America (n = 15) and Europe (n = 6). The overall agreement between reviewers was very good (ICC = 0.93; 95%CI 0.87-0.95). The median score for each domain was the following: Scope and purpose 67% (IQR 20%); Stakeholder involvement 33% (IQR 14%); Rigour of development 13% (IQR 13%); Clarity of presentation 64% (IQR 31%); Applicability 19% (IQR 17%) and Editorial independence 8% (IQR 8%). Twenty two guidelines were not recommended by the reviewers. Only one of the CPGs was recommended with modifications. The median overall rate was 3 (IQR 1). All CPGs were classified as low quality. CONCLUSIONS: The overall quality of CPGs on dental services provision during the first months of the COVID-19 pandemic was low, which makes its implementation difficult for clinicians and policy makers. Therefore, it is critical that developers are transparent and forthcoming about the difficulties that have arisen during the CPG development process.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic.

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

A Report of the interdisciplinary education approach within the Universidad de La Frontera Dental Curriculum

ABSTRACT: Interprofessional education has become widely recognised as fundamental to educate new generations of dentists able to successfully join the dental public and private sectors and provide appropriate dental treatment to complex patients in a complex health system. This article presents the innovated curriculum of the dentistry course at Universidad de La Frontera describing its interprofessional education components. The description of IPE in the dental curriculum was done using Institutional documents. The university vocational training policy provides the framework in which IPE is implemented in undergraduate courses. Six out of eight dental curriculum components included IPE in their educational methodologies: 'Integrated units', 'Culture, society and mankind', 'Prevention', 'Professional Projections', 'Integrated clinics', and 'Profes sional Practice'. IPE is present thorough the dental course from first to final year and it takes different forms within each componen t. IPE is one of the methodologies used to achieve the learning outcomes stated in the curriculum. Passing through all modu- les of the dental curriculum leads to the development of generic and professional skills that allow students to obtain their professional title.

RESUMEN: La educación interdisciplinaria ha sido ampliamente reconocida como fundamental en la educación de nuevas generaciones de odontólogos capaces de unirse exitosamente a los sectores público y privado de salud y de otorgar tratamiento odontológico a pacientes con condiciones complejas en un sistema de salud complejo. Este artículo presenta el curriculum innovado de la carrera de odontología de la Universidad de La Frontera, describiendo sus componentes de educación interdisciplinaria (EID). Para la de EID en el plan de estudios se usaron una serie de documentos institucionales. La política de formación profesional da un marco en el cual EID es implementado en los planes de estudio de pregrado. Seis de ocho componentes del plan de estudios de la carrera de odontología incluyen EID en sus metodologías educativas: "Unidades de integración", "Cultura, hombre y sociedad", "Prevención", "Proyecciones profesionales", "Clínicas Integrales" y "Prácticas Profesionales. EID está presente a lo largo de toda la carrera de odontología del primer al último año y toma diferentes formas de acuerdo a cada componente. EID es una de las metodologías usadas para lograr los objetivos de aprendizaje establecidos en el plan de estudios. Cumplir con todas las asignaturas del plan lleva al desarrollo de habilidades genéricas y profesionales que permiten a los estudiantes obtener su título profesional.

Geographical and socioeconomic inequalities in dental attendance among children in Peru: Findings from the Demographic and Family Health Survey 2017.

OBJECTIVE: The aim of the study was to explore the presence of inequalities in the use of dental services among <12-year-old children residing in Peru, according to their wealth quintile and natural region of residence. METHODS: This was a cross-sectional secondary data analysis of the 2017 Demographic and Family Health Survey of Peru (n = 39 881 children). Generalized Poisson regression models, adjusted for gender, age, maternal ethnicity, place of residence and health coverage, were used to study the association between wealth quintile and use of dental services followed by stratified models by the natural region (Metropolitan Lima, coast, Andes mountains and jungle) and predicted probability graphs to study the effect of the natural region on inequalities in the use of dental services. RESULTS: Inequalities in the use of dental services among children were observed according to the wealth quintile and natural region. A social gradient was present in the Andes mountains, coast and jungle regions. The greatest inequalities were observed in the coast (richest vs poorest quintile PR = 1.81 95% CI = 1.56-2.11) and jungle regions (richest vs poorest quintile PR = 1.81 95% CI = 1.53-2.14). The jungle presented the lowest proportion of children using dental services, while Metropolitan Lima had the highest proportion. No significant differences were observed between wealth quintiles among children from Metropolitan Lima. CONCLUSIONS: Differences in socioeconomic inequalities in the use of dental services among natural regions were observed. The distribution of dental centres and personnel, and the geographical and demographic characteristics of each region, may play an important role in the presence of the inequalities observed.

Prevalence of malocclusion and non-physiological oral habits in primary school children from Ercilla, Chile / Prevalencia de maloclusión y hábitos bucales no fisiológicos en niños de primaria de Ercilla, Chile

Introduction: Dentomaxillary Anomalies (DMA) affect the growth and morphology of the stomatognathic system of individuals, representing a public health problem. Few studies have described its prevalence among vulnerable populations in Chile. The aim of the study was to explore the prevalence of DMA and its association to non-physiological habits (NFH) and sociodemographic characteristics among primary school children living in Ercilla, Chile. Material and Methods: A convenience sample of 327 primary school students from six schools in Ercilla, were assessed through an intraoral and extraoral evaluation. Overjet, overbite, molar relationship, presence of DMAs, and NFHs were measured. Descriptive statistics, analysis of association between DMAs and studied factors, and logistic regression models were done and odds ratio with 95% confidence intervals presented. Results: A total of 61.5% of students presented at least one DMA. Chi-square test showed no significant association between DMA prevalence and NHFs, however, after adjusting for sociodemographic factors, children with NFH were 1.69 (95%CI 1.02-2.78) times more likely to have DMAs. Gender and area of residence were not significantly associated with DMAs. Conclusion: In children from Ercilla, DMAs were associated with NFHs, however, sociodemographic characteristics did not have a significant role in the presence of DMA, suggesting that sociodemographic factors might not strongly influence orthodontic needs among children from this geographical area.

Introducción: Las anomalías dentomaxilares (ADM) afectan el crecimiento y la morfología del sistema estomatognático de los individuos, lo que representa un problema de salud pública. Pocos estudios han descrito su prevalencia en poblaciones vulnerables en Chile. El objetivo del estudio fue explorar la prevalencia de ADM y su asociación con hábitos no fisiológicos (HNF) y características sociodemográficas en niños de escuela primaria que viven en Ercilla, Chile. Material y Métodos:Se evaluó una muestra de conveniencia de 327 estudiantes de educación básica de seis escuelas de Ercilla mediante una evaluación intraoral y extraoral. Se midieron el resalte, la sobremordida, la relación molar, la presencia de DMA y HNF. Se realizó estadística descriptiva, análisis de asociación entre ADMs y los factores estudiados, y modelos de regresión logística y se presentaron odds ratio con intervalos de confianza del 95%. Resultados: El 61,5% de los alumnos presentó al menos una ADM. La prueba de chi-cuadrado no mostróuna asociación significativa entre la prevalencia de ADM y HNF, sin embargo, después de ajustar de acuerdo a factores sociodemográficos, los niños con HNF tenían 1,69 (IC del 95%: 1,02 a 2,78) veces más probabilidades de tener ADMs. El género y el área de residencia no se asociaron significativamente con las ADMs. Conclusión: En los niños de Ercilla, las DMA se asociaron con NFH, sin embargo, las características sociodemográficas no tuvieron un papel significativo en la presencia de DMA, lo que sugiere que los factores sociodemográficos podrían no influir fuertemente en las necesidades de ortodoncia entre los niños de esta área geográfica.