RESUMEN
Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health-related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.
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Odontología Geriátrica , Calidad de Vida , Anciano , Odontología Geriátrica/educación , Humanos , Salud BucalRESUMEN
RESUMEN Objetivo: El objetivo fue definir los contenidos mínimos y sus indicadores de aplicación clínica en el currículo de cariología para las escuelas de odontología chilenas. Metodología: Basados en los 5 dominios curriculares internacionales, se elaboró un documento que define los contenidos e indicadores de aplicación clínica para la enseñanza de cariología en Chile. Posteriormente, profesores de cariología de 20 de 21 escuelas de odontología chilenas (95%), sesionaron para revisar, retroalimentar y elaborar el documento final, denominado "Listado de contenidos mínimos e indicadores de aplicación clínica" en cariología para estudiantes de pregrado de odontología en Chile. Resultados: Se definieron 23 contenidos y 31 indicadores de aplicación clínica para la enseñanza de la cariología. La cantidad de contenidos e indicadores separados por dominio fueron respectivamente: conocimiento de base: 5 y 7; riesgo/detección y diagnóstico: 6 y 6; toma de decisiones/manejo preventivo no operatorio: 5 y 5; decisión de tratamiento operatorio: 4 y 9 y cariología basada en la evidencia: 3 y 4. Conclusiones: Se definieron los contenidos mínimos que tributan a cada dominio y sus indicadores de aplicación clínica para la enseñanza de la cariología en Chile.
ABSTRACT: The objective: was to define the minimum contents and their indicators of clinical application in the cariology curriculum for the Chilean Dental Schools. Methodology: Based on the 5 international curricular domains, a document defining the contents and indicators of clinical application for the teaching of cariology in Chile was elaborated. Later, cariology professors from 20 out of the 21 Chilean Dentistry Schools (95%) met to review, feedback and elaborate the final document, called "List of minimum contents and indicators of clinical application" in cariology for undergraduate dentistry students in Chile. Results: Twenty-three contents and 31 indicators of clinical application for the teaching of cariology were agreed upon. The amount of contents and indicators separated by domain respectively were: basic knowledge: 5 and 7; risk/detection and diagnosis: 6 and 6; decision making/non-operative preventive management: 5 and 5; decision of operative treatment: 4 and 9 and evidence-based cariology: 3 and 4. Conclusions: The minimum contents for each domain and its clinical application indicators for the teaching of cariology in Chile were defined.
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Humanos , Facultades de Odontología , Caries Dental , Educación en Odontología , Competencia Profesional , ChileRESUMEN
The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion-related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 quasi-randomized study. Virtual interventions were mostly asynchronous via apps (n = 9), text messages (n = 9), or computer-aided learning (n = 1). The use of teledentistry as compared with conventional strategies may result in a large reduction in the plaque index (standardized mean difference, -1.18; 95% CI, -1.54 to -0.82; I2 = 92%; low certainty) and will likely result in a large reduction in the gingival index (standardized mean difference, -2.17; 95% CI, -3.15 to -1.19; I2 = 97%; moderate certainty) and in the incidence of white spot lesions (risk ratio, 0.48; 95% CI, 0.35 to 0.66; I2 = 0%; moderate certainty), with an increased effect over time. Evidence suggests that teledentistry, particularly mHealth (messages and apps), is a promising clinical tool for preventing and promoting oral health, especially under the accelerated virtualization of dentistry. Future studies should include a broader spectrum of the population, including adults and elders, to better inform policy and implementation of teledentistry (PROSPERO: CRD42020192685).
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Salud Bucal , Ensayos Clínicos Controlados Aleatorios como Asunto , Telemedicina , Adulto , Anciano , Índice de Placa Dental , HumanosRESUMEN
OBJECTIVE: This study aimed to evaluate the anti-caries effect of a fluoridated milk-based drink on a root caries model by assessing mineral loss and both biofilm microbial viability and acidogenicity under increasing concentrations of fluoride supplementation. DESIGN: Streptococcus mutans UA159 biofilms were grown on root dentin slabs for five days. The slabs were randomly assigned to following groups: milk-based drink (G1) and milk-based drink supplemented with 5-ppm NaF (G2), 10â¯ppm NaF (G3), and 20â¯ppm NaF (G4). A 10% sucrose and 0.9% NaCl solution were used as positive and negative-caries controls, respectively. Slabs/biofilms were exposed to the different treatments 3 times/day for 5â¯min. To estimate biofilm acidogenicity, the pH of the spent media was serially measured to calculate the area above the curve. Viable bacteria and dentin demineralization were assessed after the experimental phase. Results were compared using ANOVA followed by the Tukey test. RESULTS: G1 exhibited slightly lower acidogenicity than the positive caries control group (pâ¯<â¯0.05). G2, G3, and G4 induced lower acidogenicity than 10% sucrose and the non-supplemented milk-based drink. The lowest acidogenicity was found in G4 (pâ¯<â¯0.05). Fluoride-supplemented milk-based drinks (G2, G3, and G4) resulted in lower bacterial counts (pâ¯<â¯0.05) and induced lower demineralization (pâ¯<â¯0.05) than the positive caries control and non-supplemented milk-beverage (G1). There was a dose-dependent inhibition of demineralization with fluoride-supplemented milk-based drinks. CONCLUSIONS: Fluoride supplementation of a milk-based drink for older adults may reduce its cariogenicity in root dentin.
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Caries Dental , Fluoruros/administración & dosificación , Alimentos Fortificados , Leche/química , Caries Radicular , Desmineralización Dental , Animales , Biopelículas , Cariostáticos/farmacología , Caries Dental/prevención & control , Esmalte Dental , Dentina , Técnicas In Vitro , Distribución Aleatoria , Caries Radicular/prevención & control , Streptococcus mutans , Desmineralización Dental/prevención & controlRESUMEN
KNOWLEDGE TRANSFER STATEMENT: This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.
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Infecciones por Coronavirus , Salud Bucal , Pandemias , Neumonía Viral , Anciano , Anciano de 80 o más Años , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2RESUMEN
Knowledge Transfer Statement: This article provides an overview of the oral health status of older people from Latin American countries and the emergence of recent gerodontology research initiatives within the region.
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Salud Bucal , Anciano , Humanos , América LatinaRESUMEN
The traditional concept of caries as a multifactorial transmittable and infectious disease has been challenged. Novel conceptual ideas have come to add to the complexity of this highly prevalent disease worldwide. Current etiological understanding of the disease has emphasized the pivotal role of sugars in caries. In fact, current definition points toward an ecological disease caused by the commensal microbiota that under ecological imbalances, mainly due to high and or frequent sugars consumption, creates a state of dysbiosis in the dental biofilm. This modern conceptual idea, however, tends to underrate a key issue. As humans are omnivore and consume a mix diet composed by a multitude of substances, the role of the diet in caries must not be restricted only to the presence of fermentable sugars. This review explores the contribution of other food components, ubiquitous to the diet, mostly as potentially protective factors. Anticaries nutrients might determine an environmental change, affecting the ecology of the oral microbiome and partially mitigating the effect of sugars. Understanding the function of the food usually consumed by the people will contribute new knowledge on the mechanisms associated with the onset of caries, on new caries risk variables and on potential novel strategies for the prevention and treatment of the disease.
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Caries Dental/etiología , Dieta , Microbiota/efectos de los fármacos , Azúcares/efectos adversos , Animales , Biopelículas/efectos de los fármacos , Proteínas en la Dieta/farmacología , Azúcares de la Dieta/efectos adversos , Disbiosis/inducido químicamente , Ácidos Grasos/farmacología , Humanos , Leche , Boca/microbiología , Edulcorantes no Nutritivos/efectos adversos , Fenoles/farmacología , Factores Protectores , Factores de Riesgo , Almidón/efectos adversosRESUMEN
During dental caries, the dental biofilm modifies the composition of the hundreds of involved bacterial species. Changing environmental conditions influence competition. A pertinent model to exemplify the complex interplay of the microorganisms in the human dental biofilm is the competition between Streptococcus sanguinis and Streptococcus mutans. It has been reported that children and adults harbor greater numbers of S. sanguinis in the oral cavity, associated with caries-free teeth. Conversely, S. mutans is predominant in individuals with a high number of carious lesions. Competition between both microorganisms stems from the production of H2 O2 by S. sanguinis and mutacins, a type of bacteriocins, by S. mutans. There is limited evidence on how S. sanguinis survives its own H2 O2 levels, or if it has other mechanisms that might aid in the competition against S. mutans, nonetheless. We performed a genomic and metabolic pathway comparison, coupled with a comprehensive literature review, to better understand the competition between these two species. Results indicated that S. sanguinis can outcompete S. mutans by the production of an enzyme capable of metabolizing H2 O2 . S. mutans, however, lacks the enzyme and is susceptible to the peroxide from S. sanguinis. In addition, S. sanguinis can generate energy through gluconeogenesis and seems to have evolved different communication mechanisms, indicating that novel proteins may be responsible for intra-species communication.
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Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Biopelículas , Placa Dental/microbiología , Streptococcus mutans/genética , Streptococcus mutans/metabolismo , Streptococcus sanguis/genética , Streptococcus sanguis/metabolismo , Bacteriocinas/metabolismo , Simulación por Computador , Bases de Datos Genéticas , Caries Dental/microbiología , Genes Bacterianos/genética , Gluconeogénesis , Humanos , Peróxido de Hidrógeno/metabolismo , Redes y Vías Metabólicas , Boca/microbiologíaRESUMEN
AIMS: To assess the anticaries activity of an antioxidant-rich apple concentrate (ARAC) in an experimental biofilm caries model on enamel. METHODS AND RESULTS: A validated caries model with Streptococcus mutans UA159 biofilms was used. Biofilms were formed on enamel slabs during 5 days. To mimic cariogenic challenges, triplicate slabs were exposed three times per day for 5 min to 10% sucrose followed by five additional minutes of exposure to serial dilutions of ARAC in 0·9% NaCl. A triplicate slab exposed to 10% sucrose followed by 0·9% NaCl served as caries-positive control. Acidogenicity was estimated by medium pH twice per day. After the experimental phase, biofilms were recovered to determine biomass, viable bacteria and intra- and extracellular polysaccharides. Slabs were used to estimate demineralization by the percentage of surface microhardness loss (%SHL). Differences among treatments were analysed by anova and Bonferroni test (P < 0·05). Streptococcus mutans biofilms were exposed to ARAC after a cariogenic challenge with sucrose-induced lower enamel demineralization than the positive control. The highest dilution of ARAC at 1 : 100 000 (v/v) showed the most marked reduction in demineralization of about 57%. Although no differences were observed in the number of bacterial cells, the intracellular polysaccharides or in the biomass (P > 0·05), the highest dilution of the apple concentrate induced significantly lower extracellular polysaccharide formation by the biofilm. CONCLUSIONS: An apple concentrate in low concentrations appears to have a potential anticaries activity on enamel. Data suggest a metabolic rather than an antimicrobial mechanism, but further research is needed. SIGNIFICANCE AND IMPACT OF THE STUDY: Phenolic compounds contained in apple concentrates seem to have anticaries properties that may be effective even in the presence of sucrose and in very low doses. Nutritional interventions that do not require rescinding from sucrose might be derived from these findings.
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Biopelículas , Caries Dental/microbiología , Esmalte Dental/microbiología , Malus , Antioxidantes/análisis , Malus/química , Modelos Biológicos , Streptococcus mutans/fisiología , SacarosaRESUMEN
Although some studies suggest an anticaries effect of fluoridated bovine milk (F-milk) on enamel, evidence is still considered weak. Even more uncertain, the effect of F-milk on root caries remains largely unknown. This study evaluated the effect of F-milk on enamel and on root dentin demineralization using a validated Streptococcus mutans biofilm model, simulating a high cariogenic challenge. S. mutans (UA159) biofilms were formed on bovine enamel and root dentin saliva-coated slabs after measuring initial surface microhardness (SH). Biofilms were exposed to 10% sucrose 8×/day and treated 2×/day with either: (1) 0.9% NaCl (negative control), (2) bovine milk, (3) F-milk (5.0 ppm F as NaF) or (4) NaF 0.05% (anticaries-positive control). Medium pH was monitored twice/day, as a biofilm acidogenicity indicator. After 5 days for enamel and 4 days for dentin, biofilms were recovered to analyze: biomass, soluble proteins, viable microorganisms, and extra- and intracellular polysaccharides. Enamel and dentin demineralization were estimated by percentage of SH loss. Results were compared by ANOVA and Tukey's test. Neither acidogenicity nor biofilm composition differed among treatment groups in biofilms formed on enamel or dentin (p > 0.05). F-milk, however, significantly reduced enamel and dentin demineralization when compared with the negative control (p < 0.05). Also, F-milk was as efficient as 0.05% NaF to reduce enamel (p > 0.05), but not dentin demineralization (p < 0.05). These findings suggest that milk containing 5.0 ppm of fluoride is effective to control enamel caries and that it may be effective on root dentin caries prevention.
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Biopelículas , Cariostáticos/administración & dosificación , Esmalte Dental/efectos de los fármacos , Dentina/efectos de los fármacos , Fluoruros/administración & dosificación , Leche , Streptococcus mutans/fisiología , Desmineralización Dental/prevención & control , Raíz del Diente/efectos de los fármacos , Animales , Proteínas Bacterianas/análisis , Biomasa , Cariogénicos/farmacología , Bovinos , Caries Dental/microbiología , Película Dental/fisiología , Dureza , Humanos , Concentración de Iones de Hidrógeno , Viabilidad Microbiana , Polisacáridos Bacterianos/química , Saliva/fisiología , Fluoruro de Sodio/administración & dosificación , Streptococcus mutans/efectos de los fármacos , Sacarosa/farmacología , Factores de Tiempo , Desmineralización Dental/microbiologíaRESUMEN
Background: Streptococcus mutans (S. mutans) is associated with the onset of caries. Since root exposure in patients affected by periodontitis leads to higher caries rates, progressively more severe forms of periodontal disease might associate with elevated counts of S. mutans. Aim: To determine whether increasingly destructive forms of periodontal disease are associated with higher counts of S. mutans in untreated patients. Methods: 206 subjects aged 20-75 were classified into three groups according to the severity of periodontal disease: 1) gingivitis, 2) chronic slight periodontitis and 3) chronic moderate or chronic severe periodontitis. S. mutans counts (cfu/mL) were obtained by direct counting on selective agar plates from saliva samples. A cumulative proportional logistic regression model was adjusted for S. mutans counts. Results: The model failed to show differences by gender, but periodontal diagnosis had a significant effect on S. mutans counts depending on age. While in the group with moderate and severe periodontitis the probability of having high counts of S. mutans significantly increased with age, the probability remained unchanged in individuals with chronic slight periodontitis or gingivitis. Conclusion: High S. mutans levels appear directly co-associated with increased severity of periodontal disease at older ages in untreated patients.
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Humanos , Masculino , Femenino , Adulto Joven , Persona de Mediana Edad , Enfermedades Periodontales/microbiología , Streptococcus mutans/aislamiento & purificación , Recuento de Colonia Microbiana , Caries Radicular/microbiología , Gingivitis/microbiología , Periodontitis/microbiología , Análisis de Regresión , SalivaRESUMEN
Una alteración del flujo salival es clave en el desarrollo de caries, enfermedad periodontal e infecciones oportunistas. El flujo salival está determinado por diversos estímulos que actúan sobre receptores de distinta naturaleza, entre ellos mecanoreceptores articulares. Algunos estudios demuestran que las cargas articulares actúan sobre estos receptores, modificando cualitativa y cuantitativamente la secreción salival. El objetivo de este estudio fue determinar si existe una relación entre la aplicación controlada de cargas articulares y cambios en el flujo y pH salival. 30 voluntarios fueron seleccionados según criterios de inclusión establecidos. Se elaboró un dispositivo interoclusal que en relación a piezas 1.5 y 2.5, tenía botones acrílicos de 1 mm de espesor, los que al ejercer fuerzas sobre ellos provocan cargas reversibles sobre la ATM. Antes de usar el dispositivo, en cada individuo se midió flujo salival no estimulado (FSNE) el flujo salival estimulado (FSE) y el pH de ambos. Tras un periodo de adaptación diaria por una semana, cada participante usó el dispositivo durante 1 hora, ejerciendo fuerza masticatoria sostenida. Luego se midieron ambos flujos y el pH correspondiente. El procedimiento fue repetido por 7 días, bajo supervisión. No se observó una relación aparente entre la aplicación controlada de cargas articulares y cambios volumétricos de flujo salival. Las mujeres tuvieron un FSE y FSNE menor al de los hombres. La aplicación de sobrecargas articulares por un breve período de tiempo provoca una caída del pH del FSE luego de 3 días de aplicación.
Altered salivary flow is key for the onset of dental caries, periodontal disease and opportunistic infections. Salivary flow is determined by various stimuli on several receptors, including joint mechanoreceptors. Some studies show that loads on the TMJ affect these receptors causing changes on the quality and quantity of saliva secretion. The aim of this study was to determine whether a relation exists between controlled load application and changes on salivary flow and pH. Thirty volunteer subjects were recruited after excluding by inclusion criteria. A total coverage intraoral appliance was made with 1 mm acrylic buttons on tooth 1.5 and 2.5. The buttons were intentioned to direct the force vectors to apply a reversible load on the TMJ. Before using it, the Unstimulated salivary flow (USF), the Stimulated salivary flow (SSF) and the pH from each flow was obtained from each subject. After an adaptation period of a day, each volunteer used the appliance exerting steady moderate loads 1 hour/day for one week. Under the supervision of the examiner, the USF, SSF and both pH were daily registered for the entire week. There was not an apparent association between applying controlled loads on the TMJ and volumetric changes of the salivary flow. Women, however, showed lower USF and SSF than men. Load application through an oral appliance is associated with SSF pH drop from the third day.