Estado de salud oral de pacientes hospitalizados con trastornos mentales: Revisión sistemática de la literatura / Oral Health Status of Hospitalized Patients with Mental Disorders: Systematic Review of the Literature

RESUMEN De acuerdo a la literatura, los pacientes hospitalizados con trastornos mentales (TM), tienen mayor riesgo a desarrollar caries y enfermedad periodontal que la población general, asociado a la dificultad motora para hacerse una adecuada higiene oral, a los efectos adversos que ocasionan los medicamentos para el control de los síntomas psiquiátricos y a la falta de cuidado oral y atención clínica. El objetivo era realizar una revisión sistemática de la literatura sobre el estado de salud oral de pacientes hospitalizados con TM. Se hizo una búsqueda sistemática de la literatura en PubMed, de acuerdo con la metodología de la declaración PRISMA, a través de los descriptores en salud MeSh "Dental Caries" y "Mental Disorders" a febrero de 2017. De acuerdo a los diferentes filtros que fueron aplicados, se obtuvieron 14 artículos que describieron el estado de salud oral -mediante el índice COP-D (dientes con caries, dientes con restauraciones, dientes perdidos y dientes con extracción mandatoria)- de pacientes hospitalizados con TM. Se debe promover el reconocimiento de la importancia de la salud oral por parte de los profesionales de la salud, cuidadores y familiares; se debe explorar la cavidad oral para determinar el estado de salud además de instruir a los pacientes y personal de apoyo en higiene oral; las instituciones de salud mental deben establecer un programa de intervención para eliminar focos infecciosos orales y luego implementar un programa preventivo multidisciplinario para mantener la salud oral de acuerdo al diagnóstico del TM.

ABSTRACT According to the literature, hospitalized patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalized patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalized patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Oral health status of hospitalised patients with mental disorders: Systematic review of the literature.

According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained-through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)-of hospitalised patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Oral Health Status of Hospitalised Patients with Mental Disorders: Systematic Review of the Literature. / Estado de salud oral de pacientes hospitalizados con trastornos mentales: Revisión sistemática de la literatura.

BACKGROUND: According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. AIM: To carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). MATERIALS AND METHODS: A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017 RESULTS: According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalised patients with MD. CONCLUSIONS: The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Afectación por caries dentales de los pacientes con ataxia espinocerebelosa tipo 2. Posibles factores etiológicos / Tooth Decay Affectation in Type II Spinocerebellar Ataxia Patients. Possible Etiological Factors

Introducción: la caries dental es la enfermedad más frecuente que afecta al ser humano y se relaciona con varios factores etiológicos. Objetivo: determinar el grado de afectación por caries y relacionar los posibles factores etiológicos. Método: se realizó un estudio descriptivo, transversal en 26 enfermos de ataxia espinocerebelosa tipo 2 (SCA2), seleccionados mediante muestreo deliberado, ingresados en el Hospital de Medicina Natural y Tradicional en el periodo desde enero-marzo de 2011. Previo consentimiento informado, se realizó interrogatorio y examen clínico y bucal, en condiciones óptimas de ambientación e iluminación. Se precisaron datos generales y particulares de cada enfermo. Se aplicó escala para la estimación y cuantificación de ataxia (SARA) y se determinó índice COP-D y de higiene bucal de Love. Resultados: el índice COP-D de los enfermos de SCA2 resultó elevado, predominaron los dientes extraídos. El 80,76% de los pacientes tenían higiene bucal deficiente y el número de repeticiones de CAG correlacionó significativamente con la puntuación de la escala SARA (r=0,56; p=0,05) y esta a su vez con el estadio clínico de la enfermedad. Se observó una correlación lineal negativa, estadísticamente significativa (r=-0,23, p=0,00) entre los índices COP-D y de higiene bucal de Love. Conclusiones: en los pacientes atáxicos existe una higiene bucal deficiente, con gran afectación por caries dental, las que experimentan un incremento progresivo a medida que evoluciona la enfermedad, debido a un mayor deterioro motor, optando más por las extracciones dentarias, fueron indispensables acciones de prevención y promoción encaminadas a incrementar su salud bucal.

Introduction: tooth decay is the most common disease that affects humans and it is related to several etiological factors. Objective: to determining the degree of affectation by tooth decay as well as to establish some of the possible etiologic factors Methods: a descriptive study was carried out, in 26 illness patients of Spinocerebellar Ataxia type 2 (SCA2) intentionally selected, entered in the Natural and Traditional Medical hospital from January to March of 2011. There were carried out, previous informed consent, oral and clinical exam. COP-D and oral Hygiene of Love index were determined, and the relationships between clinical and molecular variables were established. Results: COP-D index of SCA2 patients was high, with a predominance of extracted teeth. 80.76% of the patients had faulty oral hygiene, and existed a significantly association between the number of CAG repetitions (r=0.56; p=0.05) with the score of SARA scale that also correlated with de clinical stage of the disease. A negative, lineal correlation between COP-D and Buccal Hygiene of Love index were found with statistically significant results (r=-0.23; p=0.00). Conclusions: ataxic patient had deficient oral hygiene, with high affectation of tooth decay, causing a progressive increase of them as the disease progresses, for that reason; the patients prefer the dental extraction. Promotional and prevention activities were necessary to propose to improve the oral health.

Afectación por caries dentales de los pacientes con ataxia espinocerebelosa tipo 2. Posibles factores etiológicos / Tooth Decay Affectation in Type II Spinocerebellar Ataxia Patients. Possible Etiological Factors

Introducción: la caries dental es la enfermedad más frecuente que afecta al ser humano y se relaciona con varios factores etiológicos.Objetivo: determinar el grado de afectación por caries y relacionar los posibles factores etiológicos.Método: se realizó un estudio descriptivo, transversal en 26 enfermos de ataxia espinocerebelosa tipo 2 (SCA2), seleccionados mediante muestreo deliberado, ingresados en el Hospital de Medicina Natural y Tradicional en el periodo desde enero-marzo de 2011. Previo consentimiento informado, se realizó interrogatorio y examen clínico y bucal, en condiciones óptimas de ambientación e iluminación. Se precisaron datos generales y particulares de cada enfermo. Se aplicó escala para la estimación y cuantificación de ataxia (SARA) y se determinó índice COP-D y de higiene bucal de Love.Resultados: el índice COP-D de los enfermos de SCA2 resultó elevado, predominaron los dientes extraídos. El 80,76 por ciento de los pacientes tenían higiene bucal deficiente y el número de repeticiones de CAG correlacionó significativamente con la puntuación de la escala SARA (r=0,56; p=0,05) y esta a su vez con el estadio clínico de la enfermedad. Se observó una correlación lineal negativa, estadísticamente significativa (r=-0,23, p=0,00) entre los índices COP-D y de higiene bucal de Love.Conclusiones: en los pacientes atáxicos existe una higiene bucal deficiente, con gran afectación por caries dental, las que experimentan un incremento progresivo a medida que evoluciona la enfermedad, debido a un mayor deterioro motor, optando más por las extracciones dentarias, fueron indispensables acciones de prevención y promoción encaminadas a incrementar su salud bucal(AU)

Prevalencia de Caries y Nivel de Higiene Oral en Niños de 6 años Atendidos Bajo la Norma GES y el Modelo JUNAEB / Prevalence of Dental Caries and Oral Hygiene Level in Children Aged 6 Years Attended Under GES and JUNAEB Models

El objetivo del estudio fue conocer la prevalencia de caries e índice de higiene oral en escolares de la comuna de Temuco, y comparar las diferencias del impacto entre dos modelos de atención de salud oral vigentes, bajo norma GES y JUNAEB entre los años 2007­2008. Se realizó un estudio descriptivo observacional en un consultorio del Servicio de Salud, bajo norma GES y un módulo dental JUNAEB. Se seleccionaron mediante muestreo no probabilístico por conveniencia 113 escolares de 6 años. Mediante examen de diagnóstico oral se consignó el índice COP-D, ceo-d e IHO-S al inicio del tratamiento y al control posterior del alta integral. Para los cálculos y estimaciones estadísticas se utilizó el programa Stata 9.0. El total de los estudiantes presentó una alta prevalencia de caries (COP-D 0,88 y ceo-d 3,86) e higiene oral deficiente (IHO-S 1,45). Al comparar el impacto, el modelo JUNAEB mostró mayor disminución de nuevas caries y mejores niveles de higiene oral (-0,70, p=0,0000). Considerando la alta prevalencia de caries, bajo IHO y la necesidad de controles periódicos, la aplicación del modelo JUNAEB generó menor recurrencia de lesiones cariosas y mejor IHO, gracias a su enfoque preventivo, curativo y educativo.

The aim of this work was to study the prevalence of caries and oral hygiene index among schoolchildren in Temuco, and compare the impact differences between two models of oral health care existing, under standard GES and JUNAEB model between the years 2007-2008. A descriptive observational study in an consulting health service, under standard GES and dental JUNAEB module. We selected by non-probability sampling 113 schoolchildren aged 6 years. The COP-D, ceo-d e OHI-S indexes were recorded at oral examination at the initiation of treatment and aftercare in the final integral treatment. Calculations and statistical estimates used Stata 9.0. The total number of students showed a high prevalence of caries (COP-D ceo-d 0.88 and 3.86) and poor oral hygiene (OHI-S 1.45). When comparing the impact, the JUNAEB model showed greater reduction of new dental caries and better oral hygiene levels (-0.70, p=0.0000). In conclusion, considering the high prevalence of dental caries, poor OHI and the need for periodic controls, application of the JUNAEB model generated a lower recurrence of dental caries and better OHI using a preventive, healing and educational approach.

Epidemiología de la caries dental en la población venezolana menor de 19 años / Epidemiology of dental caries in the Venezuelan population under age 19

Introducción: la caries dental es una enfermedad crónica, infecciosa, multifactorial y transmisible, muy prevalente durante la infancia; por su magnitud y trascendencia constituye un problema de salud pública.Objetivo: describir la epidemiología de la caries dental en la población venezolana menor de 19 años.Métodos: se realizó un estudio observacional, descriptivo, transversal a 370 niños menores de 19 años, que acudieron al consultorio popular de Barrio Adentro durante el año 2010; se seleccionó una muestra de 111 niños por el método de muestreo aleatorio simple, a los que se les realizó interrogatorio y examen clínico bucal con luz artificial en la consulta estomatológica, auxiliados de espejos bucales planos y el explorador. Como prueba estadística se utilizó el Ji cuadrado y los resultados se presentaron en tablas con frecuencias absolutas y relativas.Resultados: la afectación por caries dental fue de un 86,0 por ciento. El índice ceo-d reportó cifras de 3,37 y el índice COP-D de 2,74. Los molares resultaron más afectados, para un 78,49 por ciento. La lesión cariosa tipo 2 fue la más frecuente con el 43,94 por ciento.Conclusiones: la prevalencia de caries dental fue alta, afectándose más la dentición temporal que la permanente, y los dientes molares, no existiendo diferencia entre las arcadas dentarias. Las lesiones con severidad tipo 2, fueron las predominantes, lo que demuestra la poca cultura de atención estomatológica oportuna, para detectar y tratar precozmente estas lesiones (AU)

Introduction: dental caries is a chronic, infectious, multifactorial and communicable, highly prevalent disease during childhood; because of its magnitude and significance it is a public health problem.Objective: to describe the epidemiology of dental caries in the Venezuelan children under 19 years.Methods: an observational, descriptive, cross-sectional study of 370 children under age 19 who attended the popular clinic of Barrio Adentro Mission Inside the Neighborhood in 2010; a sample of 111 children was selected by the simple random sampling method, which were interrogated and to which it was performed clinical buccal examination with artificial light in the stomatological consultation, aided by buccal plane mirrors and explorer. As statistical test it was used chi-square and results were presented in tables with absolute and relative frequencies.Results: involvement of dental caries was 86,0 per cent. The CEOD index reported figures of 3,37 and CPOD index 2,74. The molars were the most affected, for a 78,49 per cent. The carious lesion type 2 was the most frequent with 43,94 per cent.Conclusions: the prevalence of dental caries was high, affecting more the temporal dentition than the permanent one, and the molar teeth, with no difference between the dental arches. The lesions with severity type 2 were predominant, thus demonstrating the low culture of timely dental care to detect and treat precociously these lesions (AU)

Age-related hip proprioception declines: effects on postural sway and dynamic balance.

OBJECTIVE: To evaluate the effects of age on hip proprioception, and determine whether age-related hip proprioception declines disrupt balance. DESIGN: Survey of proprioception and balance differences between 3 age groups. SETTING: University balance laboratory. PARTICIPANTS: Volunteer sample of independent community-dwelling adults (N=102) without sensory or other neurologic impairments in 3 age groups: younger (mean age, 24.6y; range, 19-37y), mid-aged (mean age, 53.3y; range, 40-64y), and older adults (mean age, 76.3y; range, 65-94y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Hip joint position sense (JPS) and kinesthesia were measured using a custom-built device. JPS error was determined by the magnitude of matching errors during vision and no-vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision. Postural sway was assessed during static stance and measured using root mean square of center of pressure (COP) displacement and velocity of COP displacement. Clinical balance and fear of falling were assessed with the mini-Balance Evaluation Systems Test (mini-BESTest) and Activities-specific Balance Confidence Scale, respectively. RESULTS: Both older and mid-aged adults had significantly increased JPS error compared with younger adults (P<.05). Kinesthesia accuracy was significantly decreased in older adults compared with mid-aged and younger adults (P≤.01). Both measures of proprioception error correlated with age (P≤.001). There were no relationships between hip proprioception error and postural sway during static stance. However, older adults with lower proprioceptive error had significantly higher mini-BESTest scores of dynamic balance abilities (P=.005). CONCLUSIONS: These results provide evidence of significant hip proprioception declines with age. Although these declines are not related to increases in postural sway, participants with hip proprioception declines demonstrated disrupted dynamic balance, as indicated by decreased mini-BESTest scores.

Prevalencia de fluorosis y experiencia de caries dental en un grupo de escolares en el área urbana del Municipio de Yondó (Antioquia, Colombia), 2010 / Prevalence of fluorosis and dental caries experience in a school age group in the urban area of the Municipality of Yondó (Antioquia, Colombia), 2010

Introducción y Objetivo: La caries dental y la fluorosis dental son problemas de Salud Pública que requieren sistemas de vigilancia y control en edades tempranas. El objetivo fue determinar la prevalencia de fluorosis dental en escolares de 12 años, y la historia de caries en escolares de 5 y 12 años en la Institución Educativa Luis Eduardo Díaz del área urbana del Municipio de Yondó (Antioquia) durante el año 2010. Materiales y Métodos: Estudio transversal en una población de 62 escolares de 5 años y 145 de 12 años. Se realizó examen clínico y se estableció la experiencia de caries dental (índices ceo-d; 5 años, COP-D; 12 años) y la prevalencia de fluorosis dental (Índice de Dean). Se calcularon frecuencias, medianas y promedios por sexo en el caso de caries dental y prevalencia de fluorosis global y por grados de severidad. Cálculo de razones de prevalencia de fluorosis por sexo con sus intervalos de confianza al 95% (RP, IC95%). Se analizaron las principales fuentes de agua del área de estudio. Resultados: El promedio ceo-d a los 5 años fue de 2,37 ±3,39, con experiencia de caries del 61%. A los 12 años se encontró un promedio COP-D de 0,73 ±1,28, y una experiencia de caries del 33,1%. No se encontraron diferencias estadísticamente significativas por sexo. La prevalencia global de fluorosis fue de 97,9%, con mayor prevalencia en hombres, aunque sin diferencias significativas (RP 1,05, IC95% 0,98- 1,12). El análisis fisicoquímico no mostró niveles altos de concentración de flúor en agua. Conclusión: Se encontraron niveles altos de experiencia de caries dental a los 5 años y alta prevalencia de Fluorosis a los 12 años que exigen acciones de mejoramiento y estrategias en salud pública para esta población.

Introduction and Objetive: Dental caries and dental Fluorosis are public health problems, which require surveillance and control systems in primary ages. We aim to determine the prevalence of dental Fluorosis in school children age 12 and the caries experience of school children between 5 and 12 years old at the Institution “Luis Eduardo Diaz”, located in the urban area of the Municipality of Yondó (Antioquia, Colombia), during 2010. Materials and Methods: A cross-sectional study was conducted in 62 scholars of 5 years and 145 scholars of 12 years. Clinical examinations were carried out and the caries dental experience was established (DMFT and dmf indexes) and the prevalence of dental Fluorosis (Dean’s index). Prevalence, mean and median and for sex were estimated in case of dental caries and the global prevalence of Fluorosis and taking into account severity groups and sex. We calculate the prevalence ratio for sex and the 95% confidence intervals (PR, 95% CI). The main water sources of the study area were analyzed. Results: Mean dmf for 5 years was 2,37(±3,39) and the dental experience was 61%. At 12 years a DMTF mean was 0,73 (±1,28) and the dental experience was 33,1%. No statistical significance was found for sex. The global prevalence of Fluorosis was of 97,9%, the frequency was higher in males but the differences do not have statistical significance (RP 1z5, 95%CI 0,98- 1,12). The physicochemical analysis did not show high levels of fluoride concentrations in water. Conclusion: Higher levels of dental caries in case of scholars of 5 years dental Fluorosis for scholars of 12 years were found. Improvement actions and public health strategies are required for these populations.