Oral Health Literacy and Determinants among an Elderly Community in Portugal.

High average life expectancy has caused an increase in the elderly population and with it arises the need to characterize this population regarding their health and, in particular, their oral health. The purpose of this study was to assess and characterize oral health, oral rehabilitation, oral health literacy, oral health perception and quality of life in a sample of elderly participants of a physical activity program in Portugal. An observational cross-sectional study was designed with a group of 206 individuals. All the individuals were clinically assessed, DMFT, PSR and the plaque index were registered, and a questionnaire was applied in the form of a "face-to-face" interview with questions related to the quality of life related to oral health (GOHAI index and the REALD-30 scale). Of the 206 study participants, 90.3% admit brushing their teeth daily, 6.3% practice daily flossing, and 5.8% had a dental appointment in the last 12 months. Applying the REALD-30 scale, 22.7% have a low level (score 0-14), 43.7% a moderate level (score 15-22) and 33.6% a high level (score 23-29) of oral health literacy. The GOHAI scale reveals that 37.4% have a high self-perception of their oral health. A considerable proportion of the sample studied present a moderate level of oral health literacy. Therefore, educating each person about their oral health when participating in a specific health program and developing proposals for oral health promotion activities should be widely considered as a strategy towards primary prevention. Future oral health literacy sessions should be held in order to improve oral health and quality of life among the community.

Comparative Meta-Analysis of Minimally Invasive and Conventional Approaches for Caries Removal in Permanent Dentition.

Background and Objectives: Addressing deep carious lesions poses significant challenges in daily dental practice due to the inherent complexity of their treatment. Traditionally, complete removal of carious tissues has been the norm, potentially leading to pulp tissue exposure and subsequent pulpitis. In contemporary dentistry, there is a growing preference for minimally invasive techniques, such as selective removal, offering a more conservative approach with enhanced predictability and success rates. Materials and Methods: Our study commenced with a comprehensive systematic review. After that, we performed a meta-analysis focused exclusively on randomized controlled trials involving permanent dentition. Our investigation incorporated seven selected articles, which scrutinized success rates and the incidence of pulp exposure in minimally invasive techniques (MIT) versus conventional techniques (CT). Statistical analysis employed U Mann-Whitney and Wilcoxon tests to interpret the results. Results: Although the difference did not reach statistical significance, MIT demonstrated marginally superior success rates compared to CT. Furthermore, MIT exhibited a lower percentage of pulp exposure when contrasted with CT. However, due to the limited sample size, statistical significance for this difference could not be established. Conclusions: Minimally invasive techniques for caries removal emerge as a conservative and promising approach to safeguard pulp tissues in comparison to conventional techniques. The need for additional randomized controlled trials is emphasized to unequivocally establish the superior success rates of these procedures over their conventional counterparts.

Revision Strategies for Cervical Disc Arthroplasty.

STUDY DESIGN: Narrative review. OBJECTIVE: To review indications and strategies for revision of cervical disc arthroplasty (CDA). SUMMARY OF BACKGROUND DATA: No data were generated as part of this review. METHODS: A narrative review of the literature was performed. RESULTS: No results were generated as part of this review. CONCLUSIONS: CDA is a proven, motion-sparing surgical option for the treatment of myelopathy or radiculopathy secondary to cervical degenerative disc disease. As is the case with any operation, a small percentage of CDA will require revision, which can be a technically demanding endeavor. Here we review available revision strategies and associated indications, a thorough understanding of which will aid the surgeon in finely tailoring their approach to varying presentations.

Active Tactile Sensibility in Implant Prosthesis vs. Complete Dentures: A Psychophysical Study.

BACKGROUND AND OBJECTIVES: Proprioceptive information from natural dentition and adjacent oral tissues enables correct masticatory function, avoiding damage to the teeth. Periodontium is the main source of this relevant information, and when a tooth is lost, all this proprioceptive sensibility relies on receptors from muscles, the mucous membrane or the temporomandibular joint, and this sensibility gets worse. Active tactile sensibility measures this proprioceptive capability in microns by psychophysical studies consisting of introducing thin metal foils between patients' dental arches during chewing to see if they are able to notice them or not. Osseoperception is a complex phenomenon that seems to improve this sensibility in patients wearing dental implants. The objective of this investigation is to measure this sensibility in different prosthetic situations by performing a psychophysical investigation. MATERIAL AND METHODS: We divided 67 patients in three groups depending on their prosthetic situation and performed a psychophysical study by introducing aluminium foils of different thicknesses in order to establish an active tactile sensibility threshold in every group. We also measured variables such as prosthetic wearing time, age or gender to see how they may influence threshold values. We used Student's t-test and Mann-Whitney U tests to analyse these results. RESULTS: Active tactile sensibility threshold values in implants are lower than those from complete dentures but higher than values in natural dentition. However, values in implants are closer to natural dentition than complete denture values. Age, gender or prosthetic wearing time have no influence in active tactile sensibility thresholds. CONCLUSION: Active tactile sensibility threshold values depend on prosthetic rehabilitations and the mechanoreceptors involved in every situation. Implant prosthesis presents an increased active tactile sensibility thanks to osseoperception phenomenon.

Validity and reliability of the Portuguese version of the rapid estimate of adult literacy in dentistry: REALD-29 PT.

BACKGROUND: Health literacy is a main factor in health for its improvement, allowing the individuals to have a greater capacity to engage and participate in collective health promotion actions. The evaluation of functional health literacy is essential to determine the ability that each individual has to understand basic health information. The present study aimed to perform the translation and cross-cultural adaptation of the Rapid Estimate of Adult Literacy in Dentistry-30 to the Portuguese language and test the reliability and validity of this version. METHODS: After translation and cultural adaptation, the instrument was applied to a group of individuals that participate in the program Atividade Senior, developed by the municipality of Viseu, Portugal. The final sample was composed by 206 participants that accepted responding to the translated version of the instrument. Statistical validation was accomplished to complete the process and obtain the final instrument. One question was removed for the creation of the final instrument with 29 questions, therefore being named Rapid Estimate of Adult Literacy in Dentistry-29 PT. RESULTS: The Rapid Estimate of Adult Literacy in Dentistry-29 PT presented good internal reliability. Cronbach's alpha ranged from 0.89 to 0.90 when words were deleted individually. The analysis of test-retest reliability revealed excellent reproducibility. We can verify that the Rapid Estimate of Adult Literacy in Dentistry-29 PT scale for assessment of oral health literacy among older adults presents an acceptable internal consistency, with a global Cronbach´s alpha of 0.894. CONCLUSIONS: The new scale can be applied to assess oral health literacy among older Portuguese adults, presenting an acceptable internal consistency and is validated to assess oral health literacy and is crucial in epidemiological studies.

Tactile Sensibility Thresholds in Implant Prosthesis, Complete Dentures and Natural Dentition: Review about Their Value in Literature.

Background and Objectives: The periodontium has important proprioceptive receptors that prevent teeth from using excessive occlusal forces during chewing. There are other receptors from adjacent tissues that replace periodontal ones when teeth are extracted and rehabilitated with prosthesis, although they seem to be less effective. Psychophysical studies investigate tactile sensibility thresholds, which are useful to measure this masticatory efficiency in different prosthetic rehabilitations. There are two types of sensibility depending on the receptors that are activated during these studies: active and passive tactile sensibility. The purpose of this study is to obtain active and passive tactile sensibility threshold figures in natural dentition and prosthetic rehabilitations so we can compare them and understand how this sensibility works in different situations. Materials and Methods: We performed a systematic review of the available literature, following PRISMA guidelines and including articles from 2004 to 2021 in the MEDLINE database. Only 10 articles were included in this investigation as they provided concrete threshold figures. Results: The mean values of active tactile sensibility thresholds in complete dentures, implant prosthesis and natural dentition are 64 µ, 23.3 µ and 16.1 µ, respectively. The mean values of passive tactile sensibility thresholds in implant prosthesis and natural dentition are 6.7 N and 0.8 N, respectively. Conclusions: Implant prosthesis have lower thresholds, that are very close to those present in natural dentition, than complete dentures due to an increased tactile sensibility. Active tactile sensibility thresholds present fewer differences between values than passive tactile ones; as these are only influenced by receptors from periodontal or periimplant tissues.

Blood and Salivary Inflammatory Biomarkers Profile in Patients with Chronic Kidney Disease and Periodontal Disease: A Systematic Review.

Introduction: Periodontitis is the most prevalent inflammatory disease worldwide. Its inflammatory levels spread systemically, which can be associated with chronic kidney disease. Biomarkers have the potential to diagnose and correlate periodontitis and chronic kidney disease, helping to monitor systemic inflammation. Thereby, this study aimed to analyze the association between chronic kidney disease and periodontitis by conducting a biomarker analysis on blood and saliva. Material and methods: An electronic search through PubMed/MEDLINE, EMBASE, and Web of Science databases was conducted to identify clinical studies published in the last ten years, with no language restrictions. Twelve articles met all the inclusion criteria, two randomized controlled trials, one cohort study, and nine observational studies. Results: The studies included a total of 117 patients for saliva biomarkers, with a mean age of approximately 57 years old, and 56.68% of the subjects were female. After analyzing all the included studies, it was possible to verify the following biomarkers assessed: CRP, WBC, fibrinogen, IL-4 and -6, cardiac troponin T, NOx, ADMA, albumin, osteocalcin, cystatin C, PGLYRP1, cholesterol, HDL, LDL, triglycerides, and hemoglobin. Conclusion: A direct cause-effect association between periodontitis and CKD could not be established. However, it was possible to conclude that there was a correlating effect present, through the analyzed biomarkers.

Importance of Osseoperception and Tactile Sensibility during Masticatory Function in Different Prosthetic Rehabilitations: A Review.

Background and Objectives: Tactile sensibility is an important characteristic for evaluating the masticatory efficiency in different occlusal situations. When a tooth is extracted, relevant proprioceptors from the periodontal ligament get lost; and after the rehabilitation of this abscess by means of oral prosthesis, this sensibility decreases influencing masticatory function. Osseoperception is a sensitive phenomenon associated with dental implants that allows an increased tactile sensibility to those wearing implant prostheses. The purpose of this study was to determine the difference in tactile sensibility values between implant prosthesis, complete dentures, and natural teeth through a review of the available literature. Materials and Methods. In order to dissect the information, 24 articles from 2004 to 2021 were analyzed from MEDLINE, PubMed Central, and Web of Science databases. These articles were directly related to measuring tactile sensibility in different situations and demonstrating the influence of osseoperception in an improved masticatory function. Results: Tactile sensibility in implant prosthesis is slightly reduced compared with natural dentition but presents improved values with regard to complete dentures. Conclusions: Implant prosthesis are more effective during masticatory function than complete dentures, as they present an increased tactile sensibility, very similar to that present in natural dentition. This enhanced sensibility in implants is due to the osseoperception phenomenon.

Detección temprana de la escoliosis idiopática del adolescente: una estrategia en controversia / Early detection of adolescent idiopathic scoliosis: Strategy in controversy

Resumen La escoliosis idiopática del adolescente (EIA) consiste en una deformidad tridimensional de la estructura de la columna vertebral en los planos coronal, sagital y rotacional, que afecta a sujetos sanos a partir de los 10 años de edad hasta la madurez ósea o al término del crecimiento. Esta enfermedad puede comprometer el estado físico, emocional y, por lo tanto, la calidad de vida de quienes la padecen, por lo que debe ser considerada un problema de salud significativo. La EIA se puede sospechar con un examen físico de columna, mediante el cual se evalúa el nivel de los hombros, el nivel de las escápulas, el nivel de la pelvis, la prueba de Adams y el signo de Pitres. A pesar de que en México no se han establecido oficialmente programas para la detección temprana de la enfermedad, la prueba de Adams puede ser la pauta para identificar y prevenir el desarrollo de esta deformidad. La aplicación de esta prueba de tamizaje está al alcance de todos. A pesar de que se podría considerar que su detección oportuna desde etapas tempranas sería la mejor estrategia para combatirla a tiempo, existen grupos de investigación a nivel internacional que opinan distinto, lo que ha colocado a la detección temprana como un tema controversial. Por lo anterior, el objetivo de este trabajo es ofrecer al lector un panorama general y actualizado de las diferentes perspectivas del tema, esperando que sea de utilidad para la práctica profesional.

Abstract Adolescent idiopathic scoliosis (EIA), consists of a three-dimensional deformity of the structure of the spine in the coronal, sagittal and rotational planes affecting healthy subjects ranging from 10 years of age until skeletal maturity or term of growing. This disease can compromise physical and emotional state, therefore, the quality of life of those who suffer it, so the EIA must be considered as significant health problem. The EIA can be suspected by a physical examination of the spine on whichshoulders level, shoulder blades level, pelvis level, Adams Test and Pitres sign are evaluated. Even though, it hasn't been officially established a program for an early detection of the disease in Mexico, evidence through Adams Test can be a guideline to identify and prevent the development of this deformity. The application of this screening test is available to all. Although it could be considered that early detection of this deformity at young ages would be the best strategy to get on time for treatment, there are international research groups that have a different opinion, which has placed early detection of EIA as a controversy topic. Therefore, the aim of this paper is to provide a general and updated overview of the different perspectives of this issue, hoping it will be useful for the professional practice.

Fístula cutánea de origen Dental / Cutaneous fistula of dental origin

Muchas veces las fístulas cutáneas orofaciales son diagnosticadas como lesiones dermatológicas sin tener en cuenta su relación con una patología dental, prescribiéndose tratamientos erróneos e innecesarios para el paciente, que no ve resuelto su problema, y retrasando el tratamiento endodóntico que eliminará la infección dental con el consiguiente cierre y cicatrización de la fístula extraoral. Es por tanto necesario, siempre que aparezca este tipo de lesiones, buscar una causa dental y hacer un diagnóstico temprano por parte de los especialistas que están tratando al paciente para remitirlo al odontoestomatólogo y que éste realice el tratamiento de conductos radiculares (AU)

Orofacial cutaneous fistulas are often misdiagnosed as dermatological lesions without taking into account their relationship with dental disease. This leads to mistaken and unnecessary treatment for the patient., whose problem remains unresolved, and delays the endodontic therapy which will eliminate the dental infection and subsequent closure and scarring of the extraoral fistula. Accordingly, whenever this type of fistula occurs the physician should look for a dental cause and thus make an early diagnosis and refer the patient to his/her dentist so that treatment of the pulp canals can be performed (AU)

Protective effect of new nitrosothiols on the early inflammatory response to kidney ischemia/reperfusion and transplantation in rats.

Renal ischemia/reperfusion (I/R) is characterized by severe inflammatory damage. We assessed the effect of administrating recently developed nitrosothiol compounds acting as nitric oxide (NO) donors on the production of cytokines and other markers of acute inflammatory reaction in an experimental model of warm (I/R), and in a model of cold ischemia and transplant in rats. Warm ischemia was achieved by ligation of left renal pedicle for 60 min, followed by contralateral nephrectomy. NO-donors LA-803, LA-807, LA-810 were administered i.v. (1.8 micromol/kg) during 30 min before reperfusion. Cold ischemia was achieved by preservating the kidney for 24 h in Euro Collins and grafting it in consanguineous Fisher 344/Ico rats. LA-803 was administered in the preservation fluid and in the recipient rat. Reperfusion time was 4 h in warm ischemia and 3 h in cold ischemia + transplantation. Administration of LA-803, LA-807 and, in a lower proportion, LA-810 prevented from the enhanced production of tumor necrosis factor (TNF), interferon-gamma (IFN-gamma), and interleukin-1beta (IL-1beta), the decrease in interleukin-6 (IL-6) and interleukin-10 (IL-10), the increase in tissue level of superoxide anion (SOA) and superoxide dismutase (SOD), and the increase in neutrophil infiltration induced by warm I/R. Treatment with LA-803 in animals with renal transplantation after cold ischemia was also associated with reduced plasma levels of TNF, IFN-gamma, and IL-1beta, increased plasma levels of IL-6 and IL-10, reduced renal levels of SOA and SOD, and reduced neutrophil infiltration. These data demonstrate that systemic administration of new NO-donors with nitrosothiol structure diminished inflammatory responses in a kidney subjected to warm I/R or cold ischemia and transplantation.

Metabolic syndrome: prevalence, associated factors, and C-reactive protein: the MADRIC (MADrid RIesgo Cardiovascular) Study.

The metabolic syndrome (MS) is defined by the clustering of a number of cardiovascular risk factors. The aims of the present study were to estimate the prevalence of MS in Madrid (Spain) by 2 definitions and to investigate its relationship with several sociodemographic factors and C-reactive protein (CRP) levels. This was a cross-sectional population study, and participants were 1344 subjects aged 31 to 70 years. Clinical evaluation included data on sociodemographic and cardiovascular background, physical examination, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. The CRP levels were determined in a subgroup of 843 subjects. The diagnosis of MS was made according to the 2005 Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) definitions. The age- and sex-adjusted prevalence of MS was 24.6% (95% confidence interval [CI], 22.3%-26.9%) using the ATP III definition and 30.9% (95% CI, 28.4%-33.3%) using the International Diabetes Federation definition. The overall agreement rate was 91.5% (kappa = 0.80; 95% CI, 0.76-0.83). Prevalence figures by both definitions were higher in men than in women and increased with age. Male sex, older age, low educational level, and physical inactivity were all determinants of ATP III-defined MS. The presence of MS or any of its components was associated with high CRP levels. In a logistic regression analysis, low educational level and waist circumference were the best predictors for high CRP level. The prevalence of MS in the Madrid region is one of the highest in Europe and confirms the strong Spanish regional variability in this syndrome frequency. Some sociodemographic and lifestyle factors, particularly educational level, are predictors for MS and high CRP levels.

Formulation of a liquid fertilizer for sorghum (Sorghum bicolor (L.) Moench) using vermicompost leachate.

Leachate from vermicomposting contains large amounts of plant nutrients and can be used as liquid fertilizer, but normally diluted to avoid plant damage. The amount of nutrients applied is thus reduced so that an additional fertilizer is required. We investigated how dilution of vermicompost leachate combined with different concentrations of NPK triple 17 fertilizer, and polyoxyethylene tridecyl alcohol as dispersant and polyethylene nonylphenol as adherent to increase efficiency of fertilizer uptake, affected sorghum plant development. The vermicomposting leachate with pH 7.8 and electrolytic conductivity 2.6 dS m(-1), contained 834 mg K(+) l(-1), 247 mg NO(3)(-)l(-1) and 168 mg PO(4)(3-) l(-1), was free of pathogens and resulted in a 65 % germination index. Vermicompost leachate can be used as liquid fertilizer for the cultivation of sorghum without dilution and mixed with 140-170 g l(-1) of NPK triple 17 fertilizer and 2-3 ml(-1) of dispersant and 0-1 ml l(-1) adherent. It was found that vermicompost leachate stimulated plant development, but fertilization with NPK was required for maximum growth.

Anestésicos locales en odontología: valoración mediante pulsioximetría / Local anesthetics in dentistry: valuation by means of pulseoxymetry

Objetivos: Conocer la respuesta en el campo de la odontología de dos anestésicos locales que se utilizan habitualmente, como son la articaína y la lidocaína, así como los efectos adversos que se pudieran generar sobre el SNC, sobre los controles cardiocirculatorios y estructuras de la zona de infiltración. Pacientes: Se incluyeron en el estudio 264 pacientes distribuidos de forma aleatoria en dos grupos de 198 y 66 pacientes, que recibieron articaína y lidocaína respectivamente, cuyas edades estaban comprendidas entre los 19 y 56 años. Métodos: Los pacientes fueron controlados mediante un pulsioxímetro BPM 200 antes de iniciar el procedimiento, después de la anestesia, al comenzar la extracción y finalizada esta. La presión arterial se controló mediante tensiómetro digital OMRON M4-I. Los anestésicos utilizados fueron la lidocaína al 2 % con epinefrina y articaína al 4 % con epinefrina, ambos a una concentración de 1: 100.000. El análisis estadístico se realizó mediante el análisis de la varianza. Se analizó mediante el paquete estadístico SPSS versión 11 implementado para PC. El nivel de confianza fue del 80 % en la detección del riesgo relativo, con un rango de 1,84 o mayor, y de 0,54 o menor, para un nivel de significación de 0,05. Conclusión: La lidocaína como la articaína asociadas a epinefrina, pueden considerarse como anestésicos locales, adecuados y seguros en la práctica odontoestomatológica. Hay que tener singular cuidado en la utilización de estos anestésicos locales en pacientes hipertensos o con problemas cardiocirculatorios, por lo que sería conveniente el control con pulsioxímetro.

Objetives To know the answer in the field the odontolgy the two anesthetic premises that are used habitually, like are articaine and lidocaine, as well as the adverse effects that could be generated on the SNC, the cardiovascular controls and structures of the infiltration area. Patients: They were included in the study 264 distributed patients in a random way in two groups of 198 and 66 patients that received articaína and lidocaína respectively whose ages were between the 19 and 56 years. Methods: The patients were controlled by means of oximeter BPM 200 before beginning the procedure, after the anesthesia, when beginning the extraction and concluded this. The blood pressure was controlled by means of digital sphygmomanometer OMRON M4-I. The anesthetic ones used went lidocaine to the 2 % with epinephrine and articaine to 4 % with epinephrine, both to a concentration of 1: 100.000. The statistical analysis was made by means of the analysis of the variance. It was analyzed by means of the statistical package SPSS version 11 implemented for PC. The level of trust was of 80 % in the detection of the relative risk, with a range of the 1.84 or greater, one and of 0.54 or minor, for a level of significance of 0,05. Conclusión: Lidocaine like articaine associated to epinephrine, they can be considered as the local, adecuated and safe anesthetics in the dental practice. It is necessary to have singular taken care of in the use of these local anesthetics in hypertense patients or with cardiovascular problems, reason why the control with pulsioxymetry would be adecuated.

Resumo Objetivos: Para saber a resposta no campo o odontologia as duas premisoes anestésicas que são usadas habitualmente, como estão o articaine e o lidocaine, os efeitos adversos que poderiam ser gerados no SNC, os controles e as estruturas cardiovascular da área da infiltração. Pacientes: Foram incluídos nos pacientes distribuídos do estudo 264 em uma maneira aleatória em dois grupos de 198 e 66 pacientes que receberam o articaína e o lidocaína respectivamente cujas idades se realizavam entre os 19 e 56 anos. Métodos: Os pacientes eram controlados por meio do oxímetro BPM 200 antes de começar o procedimento, após o anestesia, ao começar a extração e concluído isto. A pressão de sangue era controlada por meio do sphygmomanometer digital OMRON M4-I. Anestésicos usados foram lidocaine aos 2 % com epinephrine e articaine a 4 % com epinephrine, ambos a uma concentração de 1: 100.000. A análise estatística foi feita por meio da análise da variação. Foi analisado por meio da versão estatística 11 do pacote SPSS executada para o PC. O nível da confiança era de 80 % na deteção do risco relativo, com uma escala do 1.84 ou mais grande, um e de 0.54 ou menor, para um nível de um significado de 0.05. conclusão conclusão: O lidocaine gosta do articaine associado ao epinephrine, podem ser considerados como anestésicos locais adequados e seguros na prática dental. É necessário ter cuidado tomado singular no uso destes anestésicos locais em pacientes da hipertensão ou com problemas cardiovasculares, raciocine porque o controle com pulsioximetria seria adequada.

Tratamiento de las lesiones dentales traumáticas: revisión bibliográfica actualizada / Treatment of traumatic dental injuries: an updated review of the literature

Los traumatismos dentarios son considerados como una urgencia dentro de la asistencia de la consulta dental, que deben ser tratados de inmediato. Las pautas recomendadas por la Asociación Americana de Endodoncistas, para el tratamiento de las lesiones dentales traumáticas, están pensadas para ayudar al odontoestomatólogo en el manejo y el tratamiento de lesiones dentales. La terapéutica traumatológica es una de las partes de la odontología que está en continua revisión y actualización. El objetivo al realizar este trabajo, fue dar a conocer las últimas recomendaciones publicadas por la Asociación Americana de Endodoncia respecto a las pautas de tratamiento de los traumatismos dentales

The dental traumatisms are considered as an urgency inside the attendance of the dental consultation that it should be treated immediately. The recommended guidelines of the American Association of Endodontists for the treatment of traumatic dental injuries are intended to aid the practitioner in the management and treatment of dental injuries. The traumatologic therapeutic is one of the parts of the dentistry that is in revision and upgrade continually. The objective carrying out this work, is to give to know the last recommendations came out by the American Association of Endodontists regarding the rules of treatment of the dental traumatisms.

Aspectos periodontales en mujeres menopáusicas con terapia hormonal sustitutiva / Periodontal aspects in menopausal women undergoing hormone replacement therapy

OBJETIVOS: Actualmente, gran número de mujeres, utilizan la THS para controlar sus problemas hormonales durante la menopausia. Del mismo modo, un porcentaje alto de ellas, presentan problemas en la cavidad bucal a nivel del periodonto. Es por ello que se ha marcado el siguiente objetivo para la realización del trabajo: Analizar el efecto que la menopausia, al producirse una disminución de hormonas, fundamentalmente de estrógenos, puede tener sobre la salud bucodental de la mujer y en concreto, sobre las características de la encía y el periodonto, verificando si estas características en cuanto a recesión gingival, dolor, movilidad dental y bolsas periodontales, nos permiten valorar el grado de descalcificación en la mujer menopáusica.PACIENTES: Mujeres en época menopáusica de 40 a 58 años, sometidas a terapia hormonal sustitutiva y que presentaban problemas gingivo-periodontales. La población total del estudio se constituyó con 210 pacientes. Se dividieron en dos grupos: uno que recibió THS con parches y otro que no recibió dicha terapia.MÉTODO: Se estableció para la recogida de datos, un protocolo ginecológico y otro odontoestomatológico. Se realizó una estadística descriptiva para las variables sociodemográficas, análisis de la varianza, test de MacNemar y test de Stuart-Maxwell para valorar la eficacia del tratamiento.RESULTADOS: El rango de edad de las pacientes estudiadas fue de 49 años. La THS actúa de factor de protección en el dolor dental y mejora la movilidad dental, y el sondaje de bolsas periodontales. No se encontraron resultados significativos respecto a la variable recesión gingival, tanto en las pacientes que no recibieron THS, como en las que fueron tratadas con parches.CONCLUSIONES: La respuesta de la THS con respecto a la enfermedad periodontal, está propiciada probablemente, por la presencia de los receptores estrogénicos, localizados en la encía y el ligamento periodontal

AIMS: Currently, an important number of women use HRT to control their hormonal problems during menopause. A large percentage of these have problems at periodontal level. The present study aims at examining the effects that menopause, due to a decline in the synthesis of hormones, mainly of estrogens, can cause on the oral dental health of such women; in particular on the characteristics of the gingiva and periodontium, checking whether characteristics such as gingival recession, pain, tooth mobility and periodontal pocket formation might permit physicians to evaluate the degree of bone loss in menopausal woman.PATIENTS: Menopausal women aged 40 to 58 years of age undergoing hormone replacement therapy that had gingival periodontal disturbances. The total population of the study comprised 210 patients, divided into two groups. One group received HRT administered in patches and the other group did not receive this therapy.METHOD: Gynecologic and odonto-stomatologic protocols were established for data collection. In order to assess the efficacy of the treatment a descriptive statistical study for sociodemographic variables, analysis of variance, Mc Nemar’s test and the Stuart Maxwell test were performed.RESULTS: The mean age of the patients studied was 49.6 years. HRT acts as a protective factor in dental pain and improves tooth mobility and depth of the probing of periodontal pockets. With respect to the variable gingival recession, no significant results were found either for the group not receiving HRT or for the group being treated with patches.CONCLUSIONS: The response to the HR therapy in periodontal disease is probably due to the existence of estrogen receptors localized in the gingiva and in the periodontal ligament

Periodontal aspects in menopausal women undergoing hormone replacement therapy.

AIMS: Currently, an important number of women use HRT to control their hormonal problems during menopause. A large percentage of these have problems at periodontal level. The present study aims at examining the effects that menopause, due to a decline in the synthesis of hormones, mainly of estrogens, can cause on the oral dental health of such women; in particular on the characteristics of the gingiva and periodontium, checking whether characteristics such as gingival recession, pain, tooth mobility and periodontal pocket formation might permit physicians to evaluate the degree of bone loss in menopausal woman. PATIENTS: Menopausal women aged 40 to 58 years of age undergoing hormone replacement therapy that had gingival periodontal disturbances. The total population of the study comprised 210 patients, divided into two groups. One group received HRT administered in patches and the other group did not receive this therapy. METHOD: Gynecologic and odonto-stomatologic protocols were established for data collection. In order to assess the efficacy of the treatment a descriptive statistical study for sociodemographic variables, analysis of variance, McNemar's test and the Stuart-Maxwell test were performed. RESULTS: The mean age of the patients studied was 49.6 years. HRT acts as a protective factor in dental pain and improves tooth mobility and depth of the probing of periodontal pockets. With respect to the variable gingival recession, no significant results were found either for the group not receiving HRT or for the group being treated with patches. CONCLUSIONS: The response to the HR therapy in periodontal disease is probably due to the existence of estrogen receptors localized in the gingiva and in the periodontal ligament.

Consensus statement on antimicrobial treatment of odontogenic bacterial infections.

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg/125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection.

Aetiology, classification and pathogenesis of pulp and periapical disease.

At present, the majority of the treatments that are performed in the clinic are due to disease entities involving the dental pulp and periapex. Dental pulp is a richly vascularized and innervated tissue, enclosed by surrounding tissues that are incapable of expanding, such as dentin. It has terminal blood flow and small-gauge circulatory access the periapex. All of these characteristics severely constrain the defensive capacity of the pulp tissue when faced with the different aggressions it may be subjected to. Pulp tissue can also be affected by a retrograde infection, arising from the secondary canaliculi, from the periodontal ligament or from the apex during the course of periodontitis. Due to the fact that periapical disease is almost inevitably preceded by pulp disease, we shall begin by describing the causes of pulp disease and will then proceed to a discussion of the causes of periapical disease. The course of illness and classification of these pathological entities will depend on the aetiology involved. We will analyse pulp necrosis and pulp degeneration that are capable of triggering reversible apical periodontitis or irreversible apical periodontitis.

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)