A randomized controlled trial assessing denture adhesive efficacy on denture retention across 13 hours.

PURPOSE: To compare the effects of two denture adhesive formulations on the bite force required to dislodge a maxillary denture in adult participants during a 13-h test period. MATERIALS AND METHODS: Twenty-two participants with a fair-to-poor fitting maxillary denture opposed by natural dentition or a stable mandibular denture were enrolled in this single-center, randomized, double-blind, two-treatment, 4-period crossover study. Participants were randomly assigned a product usage sequence so that each participant used each product twice during the 4-day test period. The test product was a denture cream adhesive formulated with an optimized calcium/zinc partial salt of polyvinyl methyl ether/maleic acid (Fixodent Ultra technology); the control product was a cream adhesive formulated with a calcium/zinc partial salt of polyvinyl methyl ether/maleic acid (Fixodent Original technology). On each study day, bite force at dislodgement was measured with a gnathodynamometer at baseline, representing the "no adhesive" score. Then, after standardized product application to the participant's existing maxillary denture by site staff, bite force measurements were retaken at 1, 3, 5, 7, 9, 11, and 13 h. The change from baseline and the 13-h area under the bite-force-change-from-baseline curve were analyzed via an analysis of variance. RESULTS: Twenty-one participants completed all test periods; one additional participant completed three test periods so 22 participants were included in the analysis. There were 15 females and 7 males with a mean age of 70 years. The mean 13-h area under the bite-force-change-from-baseline curve was 8% greater (p = 0.010) for the test adhesive (114.3 lb) than for the control adhesive (105.9 lb). Both adhesives showed a statistically significant increase in bite force (p < 0.001) at each time point compared to no adhesive. CONCLUSIONS: The optimized calcium/zinc partial salt of polyvinyl methyl ether/maleic acid test adhesive provided superior maxillary denture retention relative to that of the control adhesive across 13 h. Both adhesives increased bite force at dislodgement compared to no adhesive.

Exploratory Analysis of Objective Outcome Measures for the Clinical Assessment of Erosive Tooth Wear.

This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p < 0.001), BEWE scores, Sa, and Str increased (p < 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p < 0.001) and moderately with BEWELingual (r = 0.42, p < 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = -0.15-0.16, p < 0.001) and did not correlate with Δenamel thickness (r = 0.02-0.09, p > 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness.

Prevalencia de síndrome de intestino irritable en América Latina / Irritable bowel syndrome prevalence in Latin America

El síndrome de intestino irritable es una enfermedad funcional intestinal frecuente a nivel mundial, pero con pocos estudios de prevalencia. Su diagnóstico es clínico y se basa en criterios acordados internacionalmente que han cambiado con el tiempo, actualmente regidos por el Consenso de Roma IV. Objetivo: Recabar y actualizar datos disponibles de prevalencia de América Latina para entender mejor el comportamiento regional de SII. Materiales y métodos: Se realizó una búsqueda de trabajos originales, autodefinidos de prevalencia, en las bases de datos Pubmed y Lilacs así como presentaciones en congresos de trabajos originales. Resultados: Se encontraron 27 estudios según los criterios de búsqueda establecidos. De ellos, 16 eran en población general. Dos trabajos incluyeron el estudio de prevalencia de más de una población constituyendo finalmente 22 referencias desarrolladas en 9 países. La prevalencia promedio total para América Latina fue 15,4%. La prevalencia promedio encontrada por criterios de Roma II fue 23,5%; por Roma III 11,8% y por Roma IV 6,98%. Conclusión: Esta es la primera revisión en reunir datos de prevalencia de síndrome de intestino irritable en población general de nueve países de América Latina. La prevalenci d fue amplia y los criterios diagnósticos utilizados hicieron la mayor diferencia.

Although irritable bowel syndrome is a common functional bowel disease worldwide, few prevalence studies have been published. Diagnosis is clinical and based on internationally agreed criteria that have changed over time. Currently the Rome IV Consensus is used as the international reference. Objective: collect and update available prevalence data from Latin America to better understand the regional behavior of irritable bowel syndrome. Materials and methods: a search was carried out for original works, self-defined on prevalence, in the Pubmed and Lilacs databases. Presentations or posters at congresses of original works were also considered. Results: according to the established search criteria, 27 studies were found. Of these, 16 were in the general population. Two studies included the study of the prevalence of more than one population, for which reason 22 prevalence data were obtained from 9 countries. The total average prevalence for Latin America was 15.4%. The average prevalence found by the Rome II criteria was 23.5%; by Rome III 11.8% and by Rome IV 6.98%. Conclusion: this is the first review to collect data on the prevalence of irritable bowel syndrome in the general population from nine Latin American countries. The average prevalence found was 15%. The variability was wide and the diagnostic criteria used made the biggest difference.

Anemia y patología digestiva / Anemia and digestive diseases / Anemia e patologia digestiva

Cada vez más los pacientes diagnosticados con anemia son referidos al gastroenterólogo para su evaluación. La necesidad de realizar un adecuado planteo clínico y una correcta interpretación de las pruebas de diagnóstico ha motivado la revisión de este tema. Varios trastornos gastroenterológicos, con frecuencia, conducen a anemia como resultado de pérdidas sanguíneas, inflamación, malabsorción o a consecuencia de las terapias farmacológicas. En algunas patologías como la cirrosis, EII o neoplasias las causas son a menudo multifactoriales. Esta revisión, pretende proporcionar un enfoque útil para la práctica clínica. Para ello se ha revisado la información actualizada acerca de la patogénesis, diagnóstico y tratamiento de la anemia vinculada a patologías digestivas y se han confeccionados cuadros y algoritmos para facilitar su comprensión.

More and more patients diagnosed with anemia are referred to the gastroenterologist for evaluation. The need to carry out an adequate clinical approach and a correct interpretation of diagnostic tests has motivated this review. Several digestive diseases frequently lead to anemia because of blood loss, inflammation, malabsorption, or drug therapies. In some of them such as cirrhosis, IBD or neoplasms, the etiology is multifactorial. This review is intended to provide a useful approach to clinical practice. To this aim, updated information on the pathogenesis, diagnosis, and treatment of anemia related to digestive diseases has been reviewed, and tables and algorithms have been built to favor its understanding.

Cada vez mais pacientes diagnosticados com anemia são encaminhados ao gastroenterologista para avaliação. A necessidade de realizar uma abordagem clínica adequada e uma interpretação correta dos testes de diagnóstico motivou a revisão deste tema. Vários distúrbios gastroenterológicos freqüentemente levam à anemia como resultado de perda de sangue, inflamação, má absorção ou pelas próprias terapias farmacológicas. Em algumas patologias como cirrose, DII ou neoplasias, as causas costumam ser multifatoriais. Esta revisão visa fornecer uma abordagem útil à prática clínica. Para esse fim, foram revisadas informações atualizadas sobre a patogênese, o diagnóstico e o tratamento da anemia associada à patologia digestiva e foram elaboradas tabelas e algoritmos para facilitar seu entendimento.

Antibiofilm effect of ozonized physiological saline solution on peri-implant-related biofilm.

BACKGROUND: Removal of dental plaque and local application of local chemical adjuncts, such as chlorhexidine (CHX), have been used to control and treat peri-implant disease. However, these methods can damage the surface properties of the implants or promote bacterial resistance. The application of ozone as an adjunctive treatment represents a new approach in the management of peri-implantitis. Thus, the purpose of this study was to evaluate the antimicrobial effect of ozonized physiological saline solution in different concentrations against oral biofilms developed on titanium surface. METHODS: Single and multi-species biofilms of Porphyromonas gingivalis, Fusobacterium nucleatum, and Streptococcus oralis were formed on titanium specimens for 5 days in anaerobic conditions. Biofilms were treated with ozonized saline solution at different concentrations (25, 50, and 80 µg/NmL), for 30 seconds and 1 minute. CHX (0.12%) and saline solution (0.89% NaCl) were used as positive and negative controls, respectively. Bacterial viability was quantified by colony forming units (CFU mL-1 ), and biofilm images were acquired by confocal laser scanning microscopy (CLSM). Data were analyzed by parametric test (ANOVA) with Tukey post-hoc test (P < 0.05). RESULTS: Ozonized saline solution showed antibiofilm activity at a concentration of 80 µg/NmL for 30 seconds and 1 minute, reducing, mainly, Porphyromonas gingivalis viability, with 2.78 and 1.7 log10 CFU mL-1 of reduction in both single and multi-species biofilms, respectively, when compared to the control (saline), whereas CHX reduced 1.4 and 1.2 log10 CFU mL-1 . CONCLUSION: Ozonized saline solution has antibiofilm activity, with better effect when applied for 1 minute at 80 µg/NmL, being a promising candidate therapy for the treatment of peri-implant diseases.

Chapter 6: Vitamins and Oral Health.

Vitamins are essential organic compounds that catalyze metabolic reactions. They also function as electron donors, antioxidants or transcription effectors. They can be extracted from food and supplements, or in some cases, synthesized by our body or gut microbiome. Severe vitamin deficiencies result in systemic complications, including the development of scurvy, rickets, pellagra, and beriberi. Some moderate and severe deficiencies also result in oral conditions. A lower intake of vitamin A has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia and periodontitis. Vitamin D deficiency during tooth development may result in non-syndromic amelogenesis and dentinogenesis imperfecta, enamel and dentin hypoplasia, and dysplasia. Clinical studies have demonstrated an association between vitamin D's endocrine effects and periodontitis. On the other hand, no significant association has been found between cariogenic activity and vitamin D deficiency. Vitamin C deficiency results in changes in the gingivae and bone, as well as xerostomia; while vitamin B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, cheilosis, cheilitis, halitosis, gingivitis, glossitis, atrophy of the lingual papillae, stomatitis, rashes around the nose, dysphagia, and pallor. The effects of vitamins E and K on oral health are not as clear as those of other vitamins. However, vitamin K has a systemic effect (increasing the risk of haemorrhage), which may affect individuals undergoing oral surgery or suffering an oral injury. Health care professionals need to be aware of the effects of vitamins on oral health to provide the best available care for their patients.

A randomised bite force study assessing two currently marketed denture adhesive products compared with no-adhesive control.

Unlike other oral care products, there are limited technologies in the denture adhesive category with the majority based on polymethyl vinyl ether/maleic anhydride (PVM/MA) polymer. Carbomer-based denture adhesives are less well studied, and there are few clinical studies directly comparing performance of denture adhesives based on different technologies. This single-centre, randomised, three-treatment, three-period, examiner-blind, crossover study compared a carbomer-based denture adhesive (Test adhesive) with a PVM/MA-based adhesive (Reference adhesive) and no adhesive using incisal bite force measurements (area over baseline over 12 hr; AOB0-12) in participants with a well-made and at least moderately well-fitting complete maxillary denture. Eligible participants were randomised to a treatment sequence and bit on a force transducer with increasing force until their maxillary denture dislodged. This procedure was performed prior to treatment application (baseline) and at 0.5, 1, 3, 6, 9, and 12 hr following application. Forty-four participants were included in the modified intent-to-treat population. AOB0-12 favoured both Test adhesive to No adhesive (difference: 2.12 lbs; 95% CI [1.25, 3.00]; p < 0.0001) and Reference adhesive to No adhesive (difference: 2.76 lbs; 95% CI [1.89, 3.63]; p < 0.0001). There was a numerical difference in AOB0-12 for Test versus Reference adhesive (-0.63 lbs; [-1.51, 0.25]); however, this was not statistically significant (p = 0.1555). Treatments were generally well tolerated. Both PVM/MA and carbomer-based denture adhesives demonstrated statistically significantly superior denture retention compared with no adhesive over 12 hr, with no statistically significant difference between adhesives.

A Randomized Proof-of-Principle Bite Force Study of Two Experimental Denture Adhesives and a Commercially Available Adhesive.

PURPOSE: To assess the efficacy of two experimental denture adhesive gels (adhesives 1 and 2) compared to a commercially available denture adhesive cream (positive control) and no adhesive (negative control). MATERIALS AND METHODS: This was a single-center, randomized, four-treatment, examiner-blind, crossover study in participants with well-made and at least moderately well-fitting maxillary complete dentures. Incisal bite force until denture dislodgment was measured before application (baseline) and over the following 12 hours for each of the treatments. Between-treatment differences in the area over baseline (AOB) for the bite force at each time point were analyzed using an analysis of covariance model. RESULTS: The efficacy and safety analyses were based on results from 48 participants. Compared to the negative control, adhesive 1 showed a statistically significantly higher bite force AOB over 12 hours (AOB0-12h; primary endpoint), as well as for AOB0-6h and AOB0-9h (all P < .05), but not for AOB0-1h or AOB0-3h. Adhesive 2 was not significantly different from the negative control or from adhesive 1 for any measure of AOB. The positive control was associated with a significantly higher bite force AOB than either of the experimental adhesives for all time points (P < .05). Although the positive control was well tolerated, both experimental adhesives were associated with a larger number of oral adverse events. CONCLUSION: Only adhesive 1 was significantly better than the negative control, and its performance did not match that of the positive control. Adhesives 1 and 2 showed the largest number of oral adverse events.

Screening en cáncer colorrectal. Primer estudio de población asintomática en Uruguay / Screening in colorrectal cancer. First study in an non symptomatic population in Uruguay

Se presenta el primer screening realizado en nuestro país dirigido a la detección precoz de cáncer colorrectal y lesiones preneoplásicas. El cáncer colorrectal es la segunda causa de muerte por cáncer en nuestro país y la primera por cáncer de origen digestivo. El screening es eficaz para la detección precoz de estas lesiones malignas y premalignas y debe ser utilizado en aquellas enfermedades que por su frecuencia signifiquen un riesgo sanitario para la población. Hemos empleado como herramienta de screening la detección de sangrado oculto en las materias fecales realizando la detección con fecatest inmunológico, anticuerpo antihemoglobina humana que presenta una especificidad y sensibilidad mayor de 90 por ciento. Entre el 3 de julio y el 16 de octubre de 1996 se incluyeron en forma prospectiva 1.000 pacientes que concurrieron a tramitar el carné de salud en las clínicas preventivas del Ministerio de Salud Pública. Se incluyeron solamente pacientes sin sintomatología digestiva y que fueran mayores de 50 años. 80,5 por ciento de los participantes (805) completaron el estudio y de ellos 14,6 por ciento (117) fueron positivos, por lo que se les indicó la realización de una colonoscopía, la que se realizó en 70 pacientes. Se encontraron 75 lesiones recto-colónicas en 48 pacientes, correspondiendo más de la mitad a pólipos, 28 de ellos adenomatosos

El territorio como espacio para la enseñanza-aprendizaje de la medicina / The territory as a space for the teaching-learning of medicine

INTRODUCCIÓN: El desarrollo del espacio territorial como soporte de los procesos de enseñanza-aprendizaje de la medicina ha sido objetivo central de la Unidad Docente Asistencial (UDA) Canelones al Este desde su instalación en el año 2010. El territorio se asume desde la dimensión compleja que define el geógrafo brasileño Milton Santos: la población es parte del territorio que la contiene, y ambos, población y territorio, se construyen mutuamente. El equipo de salud del primer nivel de atención se hace parte de este proceso. Esto ofrece un escenario privilegiado para la comprensión de los procesos de salud-enfermedad y para la enseñanza-aprendizaje de los principios de la atención primaria de la salud. OBJETIVOS: a) sistematizar algunos aspectos de la práctica docente a partir de la experiencia de trabajo en territorio de la UDA; b) identificar barreras y dificultades para el desarrollo teorizado; c) identificar oportunidades de la práctica docente en el territorio; d) delinear recomendaciones para la estandarización de los procesos de enseñanza-aprendizaje em territorio. METODOLOGÍA: Sistematización en matriz FODA de informes, evaluaciones y reflexiones del equipo docente en los ámbitos regulares de trabajo de la UDA Canelones al Este: Plenarios Del equipo UDA, Coordinación docente, coordinación interinstitucional, coordinación UDA- ASSE, Reuniones de equipo de policlínicas. RESULTADOS y CONCLUSIONES: El territorio ofrece oportunidades, pero también dificultades. La aproximación adecuada se ve favorecida por la existencia de un vínculo previo del equipo de salud local con La institución o grupo comunitario de referencia. La formación a nivel comunitario resulta más efectiva si los equipos y grupos estudiantiles se involucran en procesos propios de La comunidad que ya están en marcha, con o sin participación previa del equipo de salud local. Cuando las propuestas para el trabajo de salud comunitario no está orientado a lãs necesidades de la población, no se logra un proceso efectivo, la comunidad no se involucra y falla el diálogo e intercambio que da soporte a al aprendizaje. El desarrollo de la enseñanza en el ámbito comunitario requiere una doble matriz de trabajo: a) el relacionamiento de base comunitaria, al cual da sustento el equipo de salud local en su vínculo longitudinal con población e instituciones, en el cual los grupos de estudiantes deben integrarse respetuosamente, y b) la reflexión desde el equipo docente- asistencial con participación de los estudiantes. Entre las debilidades están: la variabilidad o carencia de referentes técnicos ocomunitarios estables en algunos procesos. La estigmatización negativa de la Universidad en algunos ámbitos territoriales, así como la estigmatización negativa de la cultura popular por algunos universitarios son ameazas latentes. La permanencia del equipo del primer nivel de atención en el territorio es un elemento clave que genera confianza en la gente, pero también en las instituciones y los equipos de territorio. La presencia de estudiantes de pre y postrado de diferentes disciplinas exige superación permanente en los docentes como referentes territoriales lo que mejora La calidad de la asistencia y el aporte de la Universidad a las comunidades.