[Odontología en entorno COVID-19. Adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid.] / Dentistry in the COVID-19 environment. Adaptation of the dental health units in Madrid's public primary health centres.

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.

En el término COVID-19 se incluyen cuadros respiratorios que varían desde el resfriado común hasta cuadros de neumonía grave con síndrome de distrés respiratorio, shock séptico y fallo multiorgánico. Esta enfermedad está causada por el virus SARS-CoV-2, cuyo mecanismo de transmisión más importante en odontología es, fundamentalmente, respiratorio, mediante gotitas, probablemente aerosoles y, también, por contacto directo con mucosas (nasales, orales u oculares) a través de manos o fómites contaminados. Los profesionales de las Unidades de Salud Bucodental representan una categoría laboral con un riesgo de exposición muy alto, ya que trabajan a una distancia de trabajo reducida (menos de un metro de la cabeza del paciente) en la cavidad oral, donde se ha descrito la máxima expresión de los posibles receptores celulares de dicho virus. Además, la mayoría de los procedimientos odontológicos conllevan la generación de aerosoles. Durante la atención odontológica puede producirse infección cruzada, tanto con pacientes diagnosticados positivos por COVID-19 como con aquellos no detectados por encontrarse asintomáticos o en fase presintomática. Por estas razones, la actividad odontológica en Atención Primaria ha tenido que adaptarse a la pandemia. Dichos cambios afectan a la distribución de la agenda de citación, a la atención odontológica, e implican el establecimiento de medidas universales y específicas de protección de barrera y otras relativas a ventilación, limpieza, desinfección y esterilización, reforzadas con medidas adicionales de control de infecciones. Este artículo resume la evidencia científica disponible relativa a dicha adaptación.

Mascarillas y máscaras de protección respiratoria en entorno COVID-19 / Surgical masks and respirators in COVID-19 environment

Coronavirus Disease 2019, COVID-19, es una enfermedad respiratoria causada por un coronavirus, el SARS-CoV-2. La ruta de trasmisión es a través de gotas y salpicaduras procedentes del tracto aerodigestivo de personas infectadas, así como por el contacto con superficies contaminadas y la posterior deposición en la mucosa de los ojos, nariz o boca, siendo probable su transmisión por aerosoles. Por otra parte, el trabajo dental no permite mantener una distancia de 2 metros, ni el uso por parte del paciente de mascarilla. Por esta razón, dentro del esquema de Equipos de Protección Individual (EPI), la protección respiratoria es fundamental, junto con la ocular, y con ello la selección de la mascarilla y, sobre todo, el uso que se haga de ella. La razón del presente artículo es describir los diferentes tipos de mascarillas y el uso apropiado de cada una de ellas según el objetivo buscado. Para ello, se recomendarán las mascarillas higiénicas y las quirúrgicas en usuarios generales, con la función de disminuir la trasmisión viral por medio de la minoración de la contaminación ambiental cuando es alta la trasmisión comunitaria. Las máscaras de protección respiratoria estarán indica-das en trabajadores sanitarios y otros en contacto con pacientes potencialmente infecciosos, al menos cuando los procedimientos de trabajo impliquen un riesgo elevado para el profesional

COVID-19 is a respiratory illness caused by a new coronavirus, SARS-CoV-2. The virus spreads through droplets and spray from the respiratory tracts of infected persons, and through contact with contaminated surfaces followed by touching the eyes, nose or mouth. It is also likely that the virus can be spread through aerosols. However, dentistry does not allow for a distance of two metres to be maintained, and nor does it allow for the patient to wear a mask. As such, within the scope of Personal Protective Equipment (PPE), respiratory protection is of fundamental importance, along with eye protection and the correct usage of available masks. The purpose of this article is to describe different types of masks and the appropriate use of each one according to the required need. To this end, it is recommended that hygienic and surgical masks are used with a view to decreasing viral transmission through the reduction of environmental contamination whilst community transmission is high. Respiratory protection masks will be shown on health workers and others who are in contact with potentially infectious patients, when the work involved brings with it an increased level of risk for the worker

Odontología en entorno COVID-19. adaptación de las Unidades de Salud Bucodental en los centros de salud de la Comunidad de Madrid / Dentistry in the COVID-19 environment. Adaptation of the dental health units in Madrid's public primary health centres

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation

MULTICAGE CAD-4: Psychometric characteristics for the screening of addictive behaviors / MULTICAGE CAD-4 para la detección de adicciones conductuales: validez estructural después de la inclusión de una escala en el abuso de teléfonos inteligentes

Addictive behaviors are not limited to drugs use, but also include certain daily behaviors that can cause gratification. Their progression to more severe pathological patterns entails grave consequences for the individual, including multiple psychopathological manifestations. The early detection of this type of behavior is of concern to primary health care. Therefore, in order to detect risk at early stages, reliable and valid tools for daily practice are essential. The MULTICAGE CAD-4 questionnaire is a screening tool for simultaneously detecting addictive behaviors. This study includes a new scale for the detection of smartphone abuse. The objective is to evaluate the adequacy of its psychometric properties. A sample of 2,074 subjects that were recruited from primary care centers ofMadrid(Spain) completed the MULTICAGE CAD-4 questionnaire. A confirmatory factor analysis, using unweighted least squares method, was performed. The test showed good internal consistency both at item and scale levels. The questionnaire structure was consistent with theoretical expectations. The MULTICAGE CAD-4, including the new smartphone scale, is a robust, reliable tool with a valid structure for assessing the presence of dysfunctional or potentially addictive behaviors, and especially useful in primary health care services

Los comportamientos adictivos no se limitan al uso de drogas, sino que también incluyen ciertos comportamientos diarios que pueden causar gratificación. Su progresión a patrones patológicos más severos conlleva graves consecuencias para el individuo, incluidas múltiples manifestaciones psicopatológicas. La detección temprana de este tipo de comportamiento es de interés para la atención primaria de salud. Por lo tanto, para detectar riesgos en etapas tempranas, las herramientas confiables y válidas para la práctica diaria son esenciales. El cuestionario MULTICAGE CAD-4 es una herramienta de detección para detectar simultáneamente conductas adictivas. Este estudio incluye una nueva escala para la detección del abuso de teléfonos inteligentes. El objetivo es evaluar la adecuación de sus propiedades psicométricas. Una muestra de 2.074 sujetos reclutados en centros de atención primaria de Madrid (España) completó el cuestionario MULTICAGE CAD-4. Se realizó un análisis factorial confirmatorio, utilizando el método de mínimos cuadrados no ponderados. La prueba mostró una buena consistencia interna tanto a nivel del ítem como de las escalas. La estructura del cuestionario fue consistente con las expectativas teóricas. El MULTICAGE CAD-4, incluida la nueva escala para teléfonos inteligentes, es una herramienta robusta y confiable con una estructura válida para evaluar la presencia de comportamientos disfuncionales o potencialmente adictivos, y especialmente útil en servicios de atención primaria de salud

Hemorrhagic complications of dental extractions in 181 patients undergoing double antiplatelet therapy.

PURPOSE: There is limited information on hemorrhagic complications during invasive dental procedures in patients treated with double antiplatelet therapy. The objective of this study is to assess the frequency of hemorrhagic complications of patients taking dual antiplatelet medication undergoing dental extractions. PATIENTS AND METHODS: An observational, multicenter, prospective, cohort study was performed in 11 oral and dental care units of primary care. The study sample was derived from the population of patients aged 18 years or older who were undergoing double antiplatelet therapy and presented to the oral and dental care units requiring dental extraction. Double antiplatelet therapy is the combination of 100 mg per day of acetylsalicylic acid and a second antiplatelet agent. The predictor variables were type of extraction performed, number of extracted teeth, number of extracted roots, and presence of inflammation. The primary outcome variable was intraoperative hemorrhage, and the secondary outcome variables were hemorrhage at 24 hours and hemorrhage at 10 days. First, a univariate analysis that considered all studied variables was performed. All variables with P < .25 in the univariate analysis were included in a multivariate analysis. The association between hemorrhage severity and its relevant factors was evaluated using logistic regression analysis. RESULTS: The study included 181 patients. Light hemorrhage (<30 minutes) was observed in 165 patients (91.2%). Intraoperative hemorrhage lasted more than 30 minutes in 15 patients (8.3%) and more than 60 minutes in only 1 patient, whose hemorrhage was controlled by local hemostatic measures. The presence of inflammation and 3-root extractions increased the probability of hemorrhage persisting for more than 30 minutes by factors of 10 and 7.3, respectively. CONCLUSIONS: In 8.3% of patients treated with dual antiplatelet therapy, dental extractions cause hemorrhagic complications lasting more than 30 minutes are resolved using local hemostatic measures. The results of this study support the safety of dental extraction without withdrawal double antiplatelet therapy.

Sialolithiasis. Proposal for a new minimally invasive procedure: Piezoelectric surgery.

Sialolithiasis is the presence of stones in the ducts of the salivary glands. Most episodes are unique, and 60-80% are located exclusively in the main excretory duct. The main clinical manifestations are swelling and pain typically before, during or after meals that decreases if the obstruction is not complete. The highest prevalence of lithiasis is in the submandibular gland -87%-, whose secretion is more viscous, followed by the parotid gland -10%- and finally the sublingual gland -3%-. The most significant consequences are caused by the prolonged blockage of the duct by a stone, which can produce a persistent ductal dilatation with a swelling that does not subside, and could lead to the complete degeneration of the parenchyma, becoming a hot spot where secondary infections may occur, leading to acute bacterial sialadenitis or glandular abscesses. Treatment options range from a single probing extraction, extraction with sialographic control using the sialoendoscope, LASER intraductal lithotripsy, lithotripsy extracorporeal shock wave (ESWL), to the surgical techniques combining open duct with endoscopic or glandular removal. We propose, with regard to a case, the use of a simple piezoelectric device which, tunnelling through the glandular channel by the ostium, allows stone fragmentation, without damaging the surrounding soft tissue. Stone removal by this less invasive method reduces the need for more complex and expensive techniques. The postoperative course without retraction of the ostium, and the regaining of functionality is favourable. Key words:Calculus, lithotripsy, minimally invasive therapy, piezoelectric surgery, salivary glands, soft tissues.