Prevalence and severity of periodontal disease among Spanish military personnel.

INTRODUCTION: Periodontal disease ranges from simple gums inflammation to major damage to the periodontal tissues, even losing teeth. Severe periodontitis has a world overall prevalence of 11.2%. These are evaluated with periodontal probes and oral epidemiological indices. Our aim is to estimate the prevalence and severity of periodontal disease of a Spanish military population according to the 2013 WHO criteria. METHODS: Observational study of prevalence carried out in a representative random sample of 221 military staff from the Spanish Army base 'Conde de Gazola'. Prevalence was estimated by calculating the Community Periodontal Index modified, loss of attachment, Plaque Index and Gingival Bleeding Index measured with a third-generation electronic 'Pa-on' periodontal probe. RESULTS: Averages of probing depth, recession and clinical attachment level were 2.17, 0.19 and 2.36 mm. Plaque and gingival bleeding indices were 71% and 40.3%. All subjects bled in some tooth after probing. 3.6% of subjects had no periodontal pockets, 58.8% mild periodontal pockets and 37.1% severe periodontal pockets. All had some loss of attachment, 52% mild loss of attachment and 47.5% severe loss of attachment. Teeth present with and without bleeding were 24.4 (86.5%) and 3.6 (13.1%). 28% of teeth had periodontal pockets and 40.4% loss of attachment. Sextant averages with periodontal pockets and loss of attachment were 2.79 and 3.56. CONCLUSIONS: Our plaque and gingival bleeding indices were high and we found a higher prevalence and severity of periodontal disease than other Spanish and foreign military populations. This could be related to differences in context, life habits and insufficient dental hygiene.

Epidemiological methods used in the periodontal health research in military personnel: a systematic review.

INTRODUCTION: Periodontal disease is a prevalent pathology in military personnel worldwide. The objective is to analyse the methodological features of periodontal health research performed in military personnel in their home countries. METHODS: A PRISMA systematic review of literature was carried out in PubMed, EMBASE and Web of Science databases on military periodontal health studies. Study design type, language, publication date, year, country, size and sample selection, age, sex, military, diagnostic procedure, examiners, periodontal, gingival and oral hygiene index were extracted. RESULTS: Eighty-eight out of 5355 studies found were selected, published between 1921 and 2020, with samples ranging from 52 to 16 869 individuals, generally not randomised, and consisting mainly of men with a mean age of 25 years. Predominant studies were cross-sectional descriptive studies, carried out in the Army, on American military personnel, and in the English language. Most of the studies used the WHO periodontal probe handled by two or more examiners. The Löe and Silness gingival index and the Silness and Löe plaque index were the most used indexes to assess gingival condition and oral hygiene, respectively. Community Periodontal Index of Treatment Needs was the most widely used periodontal index. CONCLUSIONS: Research on periodontal health carried out in military populations from the 1920s to the present has been performed from an almost exclusively descriptive approach. Issues such as the characteristics and representativeness of the samples, the epidemiological design and the different gingival-periodontal indexes used may limit the comparability of the study results.

El distalizer@: Ventajas e inconvenientes / No disponible

El tratamiento de la clase II ha sido objeto de numerosas publicaciones. Las pautas actuales se dirigen a la distalización de los molares superiores mediante sistemas que no requieren la cooperación por parte del paciente. En el 2004 Carriére incorporó al armamentario clínico un sistema de distalamiento capaz de desplazar todo el sector posterosuperior (Distallizer@). Este aparato permite corregir la relación sagital de molares, premolares y caninos en un único tiempo. Esta ventaja permite reducir el tiempo de tratamiento y la dificultad del mismo. Sin embargo, es necesaria la colocación de elásticos intermaxilares de clase II para la activación del sistema, dependiendo por tanto de la colaboración del paciente (AU)

Class II treatment has been largely studied and documented. Nowadays distalization of the upper molars is one of the first choices of treatment, by non patient cooperation systems. In 2004 Carriére L, developed a distalization system able to move the posterior segment (Distalizer@). This device allows correcting the sagital relationship between molars, bicuspid and canines all at the same time. The advantage stands on the shorter period of time of the treatment and its difficulty. However, it is necessary the use of class II elastics so that the system works, and this is where the patient collaboration is required (AU)

[Orthodontics and the upper airway]. / Orthodontie et voies aérifères supérieures.

One of the general aims of orthodontic treatment and of the combination of orthodontics and orthognathic surgery is to achieve good occlusion and aesthetic improvement, especially in cases of severe dentoskeletal deformities. However, on many occasions, the parameters of the upper airways are not taken into account when the aims of conventional treatment are fulfilled. Patients with obstructive alterations during sleep represent for the orthodontist a type of patient who differs from the normal; for them, treatment should include the objective of improving oxygen saturation. Here, functional considerations should outweigh purely aesthetic ones. It is important, when making an orthodontic, surgical or combined diagnosis for a patient, to bear in mind the impact that treatment may have on the upper airways. Good aesthetics should never be achieved for some of our patients at the expense of diminishing the capacity of their upper airways.

[Chronic snoring and obstructive sleep apnea-hypopnea syndrome in children]. / Ronchopathie chronique et syndrome de l'apnée-hypopnée obstructive du sommeil chez l'enfant.

The problems children have in sleeping are manifold; the gamut of disorders that have been described ranges from simple, occasional snoring with no accompanying complications, through the syndrome of increased blockage of the upper airways to the obstructive sleep apnea-hypopnea syndrome (OSAHS) where respiratory difficulties accompanied by hypoxemia, hypercapnia and structural sleep difficulties. Mouth breathing and chronic snoring occur frequently in children, with the incidence of snoring, identical for both sexes, varying between 3.2 and 27%. Difficulties in sleeping begin between the ages of the 3 and 9, peaking between 3 and 6. These results demonstrate, in a general way, the disparity between growth of the adenoids and tonsils, and upper airway growth. A differential diagnosis between the various pathological possibilities is based on the observed clinical signs and symptoms, analysis of cephalometric radiographs, polysomnography, a nocturnal cardio-respiratory polygraph and a video film taken during sleep. Snoring is the most characteristic sign of OSAHS in children. We do not yet have available any synthetic study that would sum up results of studies of sleep disorders in children. Nevertheless, we can define obstructive sleep apnea in children as the partial or total cessation of nose and mouth breathing for a period double that of the normal respiratory cycle. Classical treatment of children who suffer from severe respiratory difficulties during sleep, after identification of the etiology of the problem, consists of surgical removal of the adenoids or tonsils and, in certain, continuous positive pressure to assist breathing. The authors of this article have worked with 137 patients between the ages of 6 and 9, 77 of whom were chronic snorers with an average age of 7 years 6 months. The average age of the control group of 60 children was 7 years 2 months. We collected clinical data, medical histories, and distributed a questionnaire to determine individual sleep and vigilance behavior of each child in the sample. To complete our evaluation, we made a cephalometric analysis of facial type, antero-postero skeletal pattern, upper airways, and hyoid bone position. The symptom that we encountered most frequently in young chronic snorers was agitated and uneasy sleep, sometimes accompanied by bed-wetting and cervical hyperextension. We often found daytime symptoms of hyperactivity and personality or behavioral problems. Hypertrophy of the adenoids, the adenoidal fascia, and the tonsils were also frequent clinical signs. The cephalometric analyses often showed the patients to be of the dolichocephalic facial type, often with the mandible rotated posteriorly. The children were as likely to be classified as Class II owing to retrognathic mandibles as to be Class III owing to maxillary deficiencies or mandibular excess. At the level of the upper airways, it appears that the development of snoring can be explained by a reduction in the dimensions of the upper pharynges accompanied by an increase in the dimensions of the middle and lower pharynges.

Cambios en la posición del incisivo inferiorasociados con el pendulum / Lower incisor position changes associated with the pendulum appliance

El uso del péndulo en los pacientes que presentan una maloclusión de Clase II, división 2.ª, de Angle en dentición mixta permite distalar el primer molar superior permanente apoyándonos como anclaje en los primeros y segundos molares deciduos o en los premolares. Aunque la acción terapéutica principal tiene lugar en el maxilar superior, el objetivo de este estudio se ha centrado en la mandíbula, donde el hallazgo fundamental ha sido la vestibuloversión espontánea de los incisivos inferiores sin la utilización de aparatología complementaria inferior (AU)

Protocolo de toma de muestras en la autopsia forense mínimamente invasiva / Protocol for postmortem sampling technique in minimally invasive medico-legal autopsy

Partiendo de la especificidad de la autopsia forense, es posible definir un muestreo de referencia a través de técnicas mínimamente invasivas que cumplan de forma simultánea tanto su máxima utilidad eventual en la investigación forense, como un mínimo de dificultad en su obtención y necesidad de medios de conservación y almacenamiento. Se describen los métodos autópsicos mínimamente invasivos para la obtención de distintas muestras orgánicas. Se aborda la conveniencia de formularios normalizados de almacenamiento de muestras con valor forense que aseguren su valor probatorio dentro de un eventual procedimiento judicial. Se aporta un anexo con un formulario simple susceptible de ser tratado a través de un procesador de texto convencional y su inclusión en una eventual base de datos (AU)

Elección del tipo de autopsia forense I. Autopsia mínimamente invasiva (AMI) / Choosing the type of Medicolegal Autopsy in Practice I. Minimally Invasive Necropsy (MIN)

La autopsia en la investigación forense sigue una línea de decisión diferente a la de la autopsia clínica en algunos aspectos que le son específicos, encontrándose regida por una normativa propia que se recoge en nuestra Ley de Enjuiciamiento Criminal.En base a esta especificidad, en Medicina Forense es posible establecer un árbol de decisión autópsica basado en el estudio de las siguientes categorías: grado de contenido forense, nivel de conocimiento previo del sujeto, interés clínico o social de la autopsia, riesgo de aquella para los médicos y técnicos forenses e impacto emocional para la familia, que permitan diferentes opciones respecto al abordaje necrópsico. Estas opciones incluyen, desde la decisión de llevar a cabo una autopsia reglada y completa, hasta la de no practicar aquella (aspecto éste que se encuentra regulado en España por el art. 785,8° f de la Ley E. Cr.), pasando por la aplicación de una autopsia parcial, utilizando técnicas necrópsicas mínimamente invasivas como una alternativa a la aplicación de otras técnicas destructivas cadavéricas (AU)

[Cephalometric indices in patients with sleep apnea syndrome]. / Indices cefalométricos en pacientes con síndrome de apnea del sueño.

The cephalometric indexes of 16 patients with obstructive sleep apnea syndrome (OSAS) were compared with those of 12 controls in order to determine if fundamental anatomical changes were present in the patients and to identify a pattern of facial features that might be characteristic of individuals with OSAS. Our results point to micrognathia of the upper maxilla in OSAS patients (indicated by significantly lower indexes for convexity, Mx 1, and the angles SNA and ANB). We also found a longer soft palate and a functionally shallower pharynx. Together theses features reduce the permeability of the posterior pharyngeal air space. Additionally, we observed a dolichocephalic facial pattern in OSAS patients, along with a tendency to morbid anterior opening. We analyze the limitations of conventional cephalometry. While recognizing its usefulness in establishing baseline indexes before treatment and in postsurgical assessment, we nevertheless point out that it cannot be relied upon as the only test for evaluating surgical correction in OSAS patients.

[Suicides in Zaragoza (1988-1991). Epidemiology and outline of suicides]. / El suicidio consumado en Zaragoza (1988-1991). Aspectos epidemiológicos y perfiles suicidas.

We review 312 suicide cases autopsied in the Forensic Institute of Zaragoza (Spain) during 1988-1991. Suicide rate was notabily higher than official statistics (15.01/100,000 habs. in Zaragoza vs. 4.3/100,000 Habs. from the National Statistic Institute). Reasons for this discrepancy are discussed emphasizing the role of suicide underrecording in the official statistics. Forensic Institute data are considered as a precise source for suicide epidemiologic study in Spain. Profiles for each different suicide type are described according to the results of our study concerning to age, sex, seasonal and month distribution, and other epidemiological data. A National Forensic Suicide Data Bank is proposed to approach properly the problematic of suicide epidemiology, based in the desirable informatic support to the Forensic Institutes. A modification in the Death Certificates is essential to include medico-legal etiology (suicide, accidental or criminal) which is essential in Forensic Reports but is not included, at the present, in the usual Death Certificates.

[Post-radiotherapy xerostomia in patients with oral cancer. Changes in salivary inorganic components and immunoglobulins]. / Xerostomía post-radioterapia en pacientes con cáncer oral. Modificaciones de los componentes inorgánicos e inmunoglobulinas de la saliva.

Following therapeutic doses of irradiation to the salivary glands the glandular tissues suffer an early degeneration of the serous cells and focal necrosis of the parenchyma. Xerostomia is present and persist for a time, depending upon the dose of irradiation.

[Bone loss in an urban juvenile population in Oviedo]. / Pérdida ósea en la población juvenil urbana de Oviedo.

Periodontal bone loss in 126 individuals between 9 and 20 years of age was screened radiographically by means of 2 standarized interproximal bite-wings radiographs. This group was selected from a population of 1253 young people according to the criteria of "having one or more probing pocket depths equal or higher than 4 mm". "Bone loss" was measured when the distance from the CEJ to the alveolar crest was greater than 2 mm per cent of this sample had bone loss, being more prevalent in females (34.3%) than in men (18.75%). Vertical defects predominated in the mesial aspect of mandibular first molars. Only one individual had radiographic features typical of localized juvenile periodontitis, representing 0.7% of the selected sample and 0.007% of the population studied.

[Early diagnosis of periodontal disease]. / Diagnostico precoz de la enfermedad periodontal.

Early diagnosis is necessary if the prevalence of periodontal disease is to be brought under control. For periodontal screening in dental practice we propose to employ the C.P.I.T.N. system, combined with examination of two or four dental bite-wing radiographs. Both of these procedures can be accurately applied in general dental practice conditions. The screening is not time consuming and can yield very important diagnostic data.