ABSTRACT
OBJECTIVE: The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system. METHODS: A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed. RESULTS: All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours. CONCLUSION: Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.
Subject(s)
Dental Caries , Dentists , Humans , Dental Caries Susceptibility , Professional Role , Dental Caries/diagnosis , Dental Caries/epidemiology , Dental Caries/prevention & control , StudentsABSTRACT
BACKGROUND: Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this "Caries OUT" study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. METHODS: In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children's oral-health behaviour change, parents' and dentists' process acceptability, and costs exploration. A sample size of 258 3-5 and 6-8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments' time. A trained examiner per centre will conduct examinations at baseline, at 5-5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child's CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents' and dentists' process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. DISCUSSION: The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. TRIAL REGISTRATION: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h . Protocol-version 2: 27/01/2021.
Subject(s)
COVID-19 , Dental Caries , Adolescent , Adult , Aged , Child , Child, Preschool , Dental Caries/epidemiology , Dental Caries/prevention & control , Dental Caries Susceptibility , Dentists , Humans , Middle Aged , Multicenter Studies as Topic , Pandemics/prevention & control , Professional Role , Retrospective Studies , SARS-CoV-2 , Young AdultABSTRACT
Introducción y objetivo: El cuidado y el autocuidado de la salud bucal de niños y jóvenes con Síndrome de Down están asociados especialmente con los imaginarios sociales de padres, cuidadores y niños, en torno al cuidado de su salud. Comprender los sentidos del autocuidado general y bucal e interpretar las percepciones que tienen los niños, los jóvenes y los adultos significativos responsables de su cuidado sobre el tema. Materiales y métodos: Estudio de corte cualitativo con enfoque hermenéutico. Participaron 34 niños y jóvenes, y los adultos significativos de una Institución especializada en Antioquia-Colombia. La recolección de la información se realizó mediante la utilización de metodologías participativas y lúdicas. El proceso de análisis de la información consistió en la condensación de los datos a partir del ejercicio de codificación abierta y axial. Resultados: Dos categorías emergieron: los sentidos de autocuidado bucal, concepción ligada a la realización de prácticas para evitar la enfermedad y a la boca con una connotación relacionada con lo afectivo. La segunda categoría, las percepciones acerca del cuidado, muestran la carencia de autonomía en niños y jóvenes para realizar prácticas de autocuidado, y en los padres, representación social acerca de la incapacidad de los niños y jóvenes para asumir su propio cuidado. Conclusión: Es necesario desarrollar procesos educativos conducentes a la transformación de imaginarios que inhabilitan a los niños y jóvenes con síndrome de Down como actores de su cuidado. Igualmente, trabajar por el reconocimiento de la diversidad, para que este grupo poblacional desarrolle habilidades para una vida autónoma, digna y saludable.
Introduction and objective: The care and self-care in the oral health of children and young people with Down syndrome are associated especially with the social imaginary of parents, caregivers and children about the care of your senses salud. Understand the meanings of self-care and oral and interpret the perceptions of children, youth and significant adults responsible for their care about it. Materials and methods: Qualitative study with a hermeneutic approach. Involved 34 children and young people and significant adults in a specialized institution Antioquia - Colombia. The data collection was performed by the use of participatory methodologies and playful. The process of data analysis consisted of the condensation of the data from the exercise of open and axial coding. Results: Two categories emerged: the senses of oral self-care concept linked to the implementation of practices to prevent disease and mouth with a connotation related to the affective. The second category, perceptions of care, show the lack of autonomy in children and young people to make self-care practices, and parents, social representations about the inability of children and young people to take their own care. Conclusions: It is necessary to develop leading to the transformation of imaginary disqualifying children and young people with Down syndrome as actors in their care educational processes. Also work for the recognition of diversity, that this population develop skills for independent, dignified and healthy life.
ABSTRACT
La mesa de trabajo por la salud bucal del proyecto interinstitucional de cooperación "Gestión de Políticas Públicas y Salud", tiene como propósito promover la reflexión que conduzca a la formulación de propuestas de política pública que afecten positivamente la salud general y su componente bucal. Existen en el ámbito mundial y nacional antecedentes de dicha política que han sido desconocidos por la reforma al sistema de seguridad social en salud, lo que ha provocado en el caso específico de Medellín, el desmonte de porgramas de salud pública que en otros tiempos mostraron ser eficientes. Se exponen algunos ejemplos que ilustran esta afirmación y se proponen algunos enunciados básicos que deben hacer parte de una política pública con impacto en el componente bucal de la salud. Se concluye que los cambios políticos, económicos y demográficos que el país ha experimentado en los ùltimos años han dado lugar a un determinado perfil de salud enfermedad que debe ser atendido mediante la gestión organizada de la sociedad; el componente bucal de la salud también se ha visto afecado y la práctica odontológica convocada a responder a las necesidades nuevas o antiguas que en este campo tiene la población
