RESUMEN

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

Asunto(s)

COVID-19 , Pandemias , Aerosoles , Atención Odontológica , Humanos , Pandemias/prevención & control , SARS-CoV-2

RESUMEN

Abstract The aim of this study was to compare the efficacy of the ICDAS and the DIAGNOdent Pen in the diagnosis of occlusal caries lesions without cavitation, and for basing treatment decisions on the results obtained. Eighty permanent molar teeth that were healthy and non-cavitated or that had an initial occlusal lesion were evaluated. All teeth were investigated using DIAGNOdent Pen and ICDAS by four examiners. Histological evaluation of teeth was performed using stereomicroscopy by a histologist and different experienced dentist. For evaluation of the data, weighted kappa values (kw), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR+) values of the tests were calculated. The diagnostic results obtained using the DIAGNOdent Pen were found to correlate better with the results obtained from histological sections than those obtained using ICDAS. When the treatment decisions of the observers depending on the results of ICDAS, and ICDAS and DIAGNOdent Pen combination were compared with the decisions made based on histological examinations, the decisions based on ICDAS and DIAGNOdent Pen combined (kw: 0.522) were more accurate than the ones based on ICDAS (kw: 0.415) alone. In conclution, professional experience is an effective factor in diagnosing occlusal caries lesions without cavitation with ICDAS and in making treatment decisions for them. DIAGNOdent Pen is sufficient in diagnosing occlusal caries lesions without cavitation.

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Resumen El objetivo de este estudio fue comparar la eficacia de ICDAS y de DIAGNOdent Pen en el diagnóstico de lesiones de caries oclusales no cavitadas. Ochenta molares permanentes sanos y no cavitados fueron utilizados. Todos los dientes fueron investigados usando DIAGNOdent Pen e ICDAS por cuatro examinadores. La evaluación histológica de los dientes se realizó mediante estereomicroscopía por un histólogo y por un dentista con previa experiencia. Los resultados diagnósticos obtenidos con el DIAGNOdent Pen se correlacionan mejor con los resultados obtenidos a partir de las secciones histológicas cuando comparados a los obtenidos utilizando ICDAS. Las decisiones basadas en el uso combinado de ICDAS y DIAGNOdent Pen (kw: 0.522) fueron más precisas que los basados en ICDAS (kw: 0.415). En conclusión, la experiencia profesional es un factor eficaz en diagnóstico de lesiones de caries oclusal sin cavitación con ICDAS y en la toma de decisiones de tratamiento. DIAGNOdent Pen es una herramienta confiable para diagnosticar lesiones de caries oclusales sin cavitación.

Asunto(s)

Caries Dental/diagnóstico , Caries Dental/etiología , Métodos

RESUMEN

OBJECTIVES: The aim of this study was to investigate the validity of assessment of intraoral digital photography in the evaluation of dental restorations. METHODS: Intraoral photographs of anterior and posterior restorations were classified based on FDI criteria according to the need for intervention: no intervention, repair and replacement. Evaluations were performed by an experienced expert in restorative dentistry (gold standard evaluator) and 3 trained dentists (consensus). The clinical inspection was the reference standard method. The prevalence of failures was explored. Cohen's kappa statistic was used. Validity was accessed by sensitivity, specificity, likelihood ratio and predictives values. RESULTS: Higher prevalence of failed restorations intervention was identified by the intraoral photography (17.7%) in comparison to the clinical evaluation (14.1%). Moderate agreement in the diagnosis of total failures was shown between the methods for the gold standard evaluator (kappa = 0.51) and consensus of evaluators (kappa = 0.53). Gold standard evaluator and consensus showed substantial and moderate agreement for posterior restorations (kappa = 0.61; 0.59), and fair and moderate agreement for anterior restorations (kappa = 0.36; 0.43), respectively. The accuracy was 84.8% in the assessment by intraoral photographs. Sensitivity and specificity values of 87.5% and 89.3% were found. CONCLUSIONS: Under the limits of this study, the assessment of digital photography performed by intraoral camera is an indirect diagnostic method valid for the evaluation of dental restorations, mainly in posterior teeth. This method should be employed taking into account the higher detection of defects provided by the images, which are not always clinically relevant.

Asunto(s)

Restauración Dental Permanente , Fotografía Dental/métodos , Diente/diagnóstico por imagen , Adolescente , Adulto , Brasil , Atención Odontológica , Fracaso de la Restauración Dental , Humanos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven

RESUMEN

OBJECTIVE: The present study appraises the construct validity of the Visible Occlusal Plaque Index (VOPI) along with its sub-types, convergent and discriminant validity. METHODS: 618 10-15year old Brazilian adolescents were included. The VOPI has a four-point ordinal scale ranging from no plaque to heavy plaque. VOPI scores and caries status on permanent molars were mapped and recorded at individual anatomical sites of the groove-fossa-system and at surface level. Outcomes were presence of sound site/surface and site/surface with active or inactive caries lesions (non-cavitated or cavitated). RESULTS: Construct validity was assumed based on qualitative assessment as no plaque (score 0) and thin plaque (score 1) reflected the theoretical knowledge that a regular disorganization of the dental biofilm either maintains the caries process at sub-clinical levels or inactivate it clinically. The VOPI also showed convergent validity since the likelihood that anatomical sites with no or thin plaque had inactive lesions simultaneously with sites with thick plaque (score 2) or heavy plaque (score 3) having active lesions were overall significant (RR=1.0-7.8). At surface level, discriminant validity of the VOPI was evidenced with multivariable analysis (GEE), by its ability to discriminate between the groups of adolescents with different oral hygiene status; negative association between adolescents with thick and heavy plaque and those with sound occlusal surfaces was found (OR=0.3, p<0.001). CONCLUSION: The VOPI has construct as well as convergent and discriminant validity and is therefore recommended as an additional clinical tool to estimate caries lesions activity and support treatment decisions. CLINICAL SIGNIFICANCE: The Visible Occlusal Plaque Index is an additional clinical tool to the assessment of oral hygiene and caries lesion activity. The VOPI is recommended to standardize and categorize information on the occlusal biofilm, thus being suitable for direct application in research and clinical settings.

Asunto(s)

Caries Dental/diagnóstico , Caries Dental/patología , Índice de Placa Dental , Placa Dental/patología , Adolescente , Biopelículas/crecimiento & desarrollo , Brasil/epidemiología , Niño , Caries Dental/epidemiología , Caries Dental/terapia , Esmalte Dental/patología , Placa Dental/epidemiología , Dentición Permanente , Diagnóstico Bucal , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Masculino , Diente Molar/patología , Análisis Multivariante , Higiene Bucal , Reproducibilidad de los Resultados , Factores de Riesgo , Encuestas y Cuestionarios , Erupción Dental

RESUMEN

Introducción. La posibilidad de sostener artificialmente las funciones vitales hace más difícil diferenciar al paciente en agonía terminal del paciente con posibilidades de supervivencia, lo que pone al grupo que lo rodea frente a un dilema. Por un lado, se presenta la continuación de soporte que solo prolongue un proceso irreversible, que causa daños físicos, psíquicos y a su dignidad. Por otro, la abstención o retiro de soporte vital sin la reflexión y el esfuerzo diagnóstico-terapéutico apropiado puede dejar sin esperanza y llevar a la muerte a un niño potencialmente recuperable. Además, la toma de decisiones, en estas circunstancias, enfrenta diversas barreras que dificultan lograr el mejor interés del paciente. Entre ellas, los temores legales son un factor importante. ¿En qué medida esos temores están justificados? Objetivo. Explorar la opinión del Poder Judicial de la Nación respecto al enfoque que, desde el derecho, se da a situaciones de limitación de soporte vital. Población y métodos. Profesionales activos del ámbito penal, civil y médico forense. Encuesta semiestructurada sobre tres casos hipotéticos con decisiones sobre la limitación del soporte vital. Resultados. Se repartieron 185 encuestas; se contestaron 68 (36,76%) y 51 (30,3%) fueron respondidas en forma completa. No tipificaron ningún delito en ninguno de los tres casos 28 (55%) encuestados. Trece (25%) interpretaron como delitos las decisiones de los tres casos; 6 (12%), alguno de los casos; y 4 (8%), 2 de los 3 casos. Los delitos seleccionados por los encuestados incluyeron homicidio doloso, homicidio culposo y abandono de persona. Conclusiones. El 45% de los encuestados consideraron que hubo alguna forma de delito en las decisiones tomadas.

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Introduction. The possibility of sustaining life functions makes it difficult to distinguish between a dying patient and a patient with chances of survival, raising a dilemma for everyone around them. On the one side, continuing with life support techniques that would only extend an irreversible process and result in physical and psychological damage and harm their dignity. On the other side, withholding or withdrawing life support without an adequate reflection and diagnostic-therapeutic effort which may lead to the death of a potentially recoverable child. In addition, making decisions in this context implies facing barriers that hinder the possibility of pursuing the patient's best interest. Among such barriers, the fear of litigation plays a major role. To what extent is this fear justified? Objective. To explore the opinions of the members of the National Judiciary regarding the approach to withholding or withdrawing of life support from a legal stance. Population and methods. Professionals working in the criminal, civil and forensic medicine settings. Semistructured survey on three hypothetical case histories that implied making a decision to withhold or withdraw life support. Results. One hundred and eighty-five surveys were distributed; 68 (36.76%) were partially completed and 51 (30.3%), in full. Twenty-eight (55%) survey respondents did not criminalize any of the three cases presented. Thirteen (25%) respondents considered that the decisions made in the three cases constituted a crime; 6 (12%), only in one case; and 4 (8%), in two out of the three. Crimes described by survey respondents included intentional homicide, wrongful death, and failure to render assistance. Conclusions. Forty-five percent of survey respondents considered that decisions made involved some form of crime.

Asunto(s)

Humanos , Niño , Pediatría/legislación & jurisprudencia , Actitud Frente a la Muerte , Privación de Tratamiento/legislación & jurisprudencia , Cuidados para Prolongación de la Vida/legislación & jurisprudencia , Argentina , Estudios Transversales , Encuestas de Atención de la Salud