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El objetivo de la odontología preventiva es reducir al máximo el riesgo de desarrollar enfermedades bucodentales; para lograrlo, existen múltiples métodos como la aplicación de flúor, así como la colocación de selladores de fosas y fisuras. Los selladores son materiales resinosos capaces de cubrir y eliminar las retenciones de las fosas y fisuras características de la anatomía oclusal. Si bien los selladores son ampliamente utilizados en pacientes pediátricos, erróneamente se cree que su colocación está contraindicada en adultos. Los selladores son métodos preventivos capaces de beneficiar a cualquier paciente que los necesite, independientemente de su edad. El objetivo de este artículo es analizar y esclarecer las indicaciones y contraindicaciones de los selladores de fosas y fisuras en pacientes adultos (AU)

The objective of preventive dentistry is to minimize the risk of developing oral diseases and to achieve this there are multiple methods such as the application of fluoride, as well as the placement of pit and fissure sealants. Sealants are resinous materials capable of covering and eliminating retentions in pits and fissures characteristic of occlusal anatomy. Although sealants are widely used in pediatric patients, it is erroneously believed that their placement is contraindicated in adult patients. Sealants are preventive methods capable to benefiting any patient who needs them regardless of age. The aim of this article is to analyze and clarify the indications and contraindications of pit and fissure sealants in adult patients (AU)

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ABSTRACT Objective: This study evaluated the effectiveness of preventive strategies on caries risk reduction in patients undergoing orthodontic treatment, using the Cariogram program. Methods: In this quasi-experimental study, samples were selected using a convenience quota sampling technique, in a public dental school. At first, caries risk profile was determined for each subject using the Cariogram before brackets bonding. The sample size consisted of 36 patients. The intervention group (n = 18) received preventive programs, and the control group (n = 18) was trained based on the routine oral health education by means of pamphlets. Then, Cariogram parameters were calculated for patients in both groups after six months. Results: The age range of participants was from 12 to 29 years. The mean percentage of the "Actual chance of avoiding new cavities" section in the intervention group increased from 45.72 ± 21.64 to 62.50 ± 17.64. However, the mean percentage of other parameters - such as "Diet", "Bacteria" and "Susceptibility" - decreased after six months (p< 0.001). Besides, the differences in the mean percentage between intervention and control group at the end of the study period (T1) related to the Cariogram parameters were statistically significant (p< 0.001). Accordingly, the mean percentage of 'Actual chance of avoiding new cavities'' parameter in the intervention group (62.50) was statistically higher than in the control group (42.44) (p< 0.001). Conclusion: Implementing different preventive approaches is able to reduce the caries risk in patients undergoing fixed orthodontic treatment, which can be clearly demonstrated using Cariogram program.

RESUMO Objetivo: O presente estudo usou o software Cariogram para avaliar a eficácia de estratégias preventivas para redução do risco de cáries em pacientes sob tratamento ortodôntico. Métodos: Nesse estudo quase-experimental, as amostras foram selecionadas por meio de uma técnica de amostragem por cota de conveniência, em uma faculdade pública de Odontologia. Inicialmente, o perfil de risco de cárie foi determinado para cada indivíduo usando o Cariogram antes da colagem dos braquetes. A amostra consistiu de 36 pacientes: o grupo experimental (n = 18) recebeu programas preventivos, e o grupo controle (n = 18) recebeu orientações sobre a saúde bucal por meio de folhetos. Após seis meses, os parâmetros obtidos por meio do Cariogram foram calculados novamente para os pacientes de ambos os grupos. Resultados: A faixa etária dos participantes foi de 12 a 29 anos. A porcentagem média da seção "Probabilidade real de prevenir novas cáries" no grupo experimental aumentou de 45,72 ± 21,64 para 62,50 ± 17,64. Por outro lado, a porcentagem média de outros parâmetros - como "Dieta", "Bactérias" e "Suscetibilidade" - diminuiu após seis meses (p< 0,001). Além disso, as diferenças nas porcentagens médias entre o grupo experimental e o grupo controle ao fim do estudo (T1), relacionadas aos parâmetros do Cariogram, foram estatisticamente significativas (p< 0,001). Assim, a porcentagem média do parâmetro "Probabilidade real de prevenir novas cáries" no grupo experimental (62,50) foi estatisticamente maior do que no grupo controle (42,44) (p< 0,001). Conclusão: A implementação de diferentes abordagens preventivas pode reduzir o risco de cárie em pacientes sob tratamento ortodôntico com aparelhos fixos, o que pode ser observado claramente por meio do software Cariogram.

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BACKGROUND: Sickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD. TYPES OF STUDIES REVIEWED: Using a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations. RESULTS: Systemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care. PRACTICAL IMPLICATIONS: In SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.

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OBJECTIVES: We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children. MATERIALS AND METHODS: The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05). RESULTS: A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%). CONCLUSIONS: Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time. CLINICAL RELEVANCE: Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

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This study aimed to evaluate the association between the fissure depth (tooth morphology) of permanent molars and dental caries incidence with a five-year follow-up period. In total, 110 Mexican schoolchildren aged seven years were recruited at baseline, of which 88 children completed the follow-up assessments. The fissure depths of the first permanent lower molars were recorded, and dental caries [decayed, missing, and filled deciduous surfaces (dmfs) and decayed, missing, and filled permanent surfaces (DMFS)] was evaluated annually. A generalized estimating equation model was constructed for evaluating the association between dental caries and fissure depth. The initial and final DMFS scores were 0.02 (±0.2) and 1.55 (±2.49), respectively. The generalized estimating equation model showed that children with deep molar fissures were more likely to develop caries lesions, (Odds Ratio OR = 3.15, p = 0.028) compared to children with shallow fissures. Moreover, dental caries in primary teeth (OR = 1.07, p = 0.005) was associated with the development of carious lesions in the permanent dentition. Fissure depth was a useful predictor of dental caries, according to this five-year follow-up study. The detection of deep occlusal fissures in the lower first permanent molars could contribute to the identification of children at high risk of dental caries. Tooth morphology may be used to identify children at a higher caries risk, particularly in settings with limited resources.

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AIM: To compare (a) enamel carious (EC) and dentin carious (DC) lesions and (b) caries risk, between normal-weight (NW) and overweight/obese (OW) children/adolescents. DESIGN: In this cross-sectional study, 91 participants aged 6-12 years were classified according to the body mass index (BMI): NW (n = 50) and OW (n = 41). Caries experience was evaluated using the International Caries Detection and Assessment System (ICDAS) with two thresholds: "EC/DC" (ICDAS 1-3/4-6) and "DC" (ICDAS 4-6). Caries risk was determined by the Caries Management by Risk Assessment (CAMBRA) system. A logistic regression analysis was performed to determine the association among OW, caries thresholds, and caries risk. RESULTS: Caries experience was similar for both groups at the "EC/DC" threshold (P = .477) and higher for the NW group at the "DC" threshold (P = .009). For CAMBRA, caries risk classification was similar for both groups (P = .082). The logistic regression showed the OW group was less likely to exhibit radiographically visible proximal carious lesions (odds ratio [OR] of 0.330, P = .019), thick biofilm visible on the tooth surface (OR = 0.360, P = .019), high caries risk (OR = 0.367, P = .039), and moderate-to-high caries levels (OR = 0.190, P = .022). CONCLUSION: OW children/adolescents had lower caries experience, at both ICDAS thresholds, and lower caries risk, compared to NW children/adolescents.

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This study reports on the full-day workshop "The Shape of The Future of Dental Education for Dental Caries-and how we get there" held immediately prior to the May 2017 ADEE/ADEA/King's College London meeting "Shaping the Future of Dental Education." A standardised, evidence-led Core Curriculum in Cariology (CCC) was developed jointly and systematically by ORCA and ADEE, starting in 2010. At the same time, the ICDAS Foundation was developing a comprehensive caries management system, ICCMS™. The workshop reported on what has been achieved on a global basis by many building on these initiatives. The CCC has been, or is currently being, localised in a number of places around the world and has, in some countries, been successfully implemented. There are also other areas which are struggling more with the logistics of introducing it. The workshop presented geographical perspectives and experiences on implementing the CCC from Colombia, the United States and Europe, as well as professional perspectives from hygienists, students and policymakers. The workshop then considered the future of the CCC and the roles of Interprofessional Education, Technology, Global Networking and Assessment in a Global Context in 4 breakout groups. Having had reports back and plenary discussion, it was concluded that the caries world has made good progress towards a "futuristic" curriculum with parallel development of a comprehensive, preventive and tooth-preserving caries management system-ICCMS™. The implementation challenge is now to share even more effectively in order to have these developments more widely accepted and adopted worldwide.

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OBJECTIVE: The objective of this study was to compare the ICDAS-II caries status and caries-related factors among children from rural and urban schools in Pasto, Colombia. MATERIALS AND METHODS: The study included 120 children (4 - 6 year- old children) from rural (privileged) and urban (unprivileged) schools. Caries was evaluated using the ICDAS-II criteria. A survey about the factors related to the presence of caries was applied. Chi-square and Fisher's tests were used to assess the differences in each study variable between the two groups. A Mann-Whitney U test was used to compare the number of teeth, per ICDAS-II category, between the groups. Negative binomial regression was used to estimate the percentage change in the mean number of teeth, per ICDAS-II category, among the rural and urban students. RESULTS: Significant differences were found between the rural and urban students for the ICDAS-II 0 and 3-6 categories (p<0.001). The mean number of teeth with moderate-to-severe caries status increased 233% in children from the rural school compared to those attending the urban school (p=0.0). Toothbrushing frequency (p=0.006), cariogenic diet, time elapsed from last dental visit, socioeconomic status, and type of health regime (p<0.001) were among the significant factors related to the rural and urban schools. CONCLUSIONS: This was the first study to compare ICDAS-II caries status between rural and urban students in Colombia. A worse caries status was found in rural students. This study identified the socioeconomic and clinical factors to guide specific interventions for rural children by modifying the available oral health promotion and disease prevention programs.

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OBJECTIVE: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. METHODS: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. RESULTS: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). CONCLUSIONS: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

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OBJECTIVES: The aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1 year and to estimate the risk of caries incidence and progression on these surfaces. METHODS: This prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1 year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function. RESULTS: Twenty-two children (11 %) presented "caries progression" (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6 %) or with inactive enamel lesion (3.9 %) at the baseline examination (χ (2) test, p = 0.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (OR = 0.98, 95 % CI = 0.40-2.38). CONCLUSION: Within the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions. CLINICAL RELEVANCE: Occlusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period.

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O objetivo do presente estudo foi avaliar a eficácia da técnica de selamento realizada sobre dentina cariada em molares decíduos. Para isto, um ensaio clínico controlado e randomizado foi desenvolvido. Previamente ao ensaio clínico, um estudo para avaliação de método foi realizado. Buscou-se comparar o risco à cárie em crianças (n=28) de 3 a 9 anos de idade, através dos seguintes instrumentos preditores: Cariogram® com análise microbiológica (níveis salivares de Streptococcus mutans - SM) incluída no modelo; Cariogram® sem SM incluído no modelo; e um formulário baseado no Cariogram® também sem a variável SM. Os resultados demonstraram que não houve diferença entre os métodos de avaliação (p>0,05) e que os níveis salivares de SM não foram necessários para avaliação do risco da criança a desenvolver cárie. Diante desses resultados, os sujeitos foram aleatoriamente alocados em dois grupos: principal (STC) e controle (RPTC), levando-se em conta a classificação de risco (baixo, moderado ou alto) à doença. Assim, uma homogeinização dos grupos, quanto à saúde bucal das crianças, foi alcançada. Buscando-se comparar STC com RPTC, os principais desfechos do ensaio foram o sucesso clínico dos selamentos e das restaurações (através do critério USPHS); bem como a presença ou não de progressão de cárie (análise pareada de radiografias interproximais), avaliados por examinadores externos e cegos, ao longo de 1 ano de acompanhamento. A ansiedade das crianças antes e após cada tratamento e o tempo despendido em cada uma das intervenções representaram desfechos secundários. Os níveis salivares de S. mutans, Lactobacillus spp. Candida spp. e Bifidobacterium spp. das crianças, também foram observados e comparados entre os grupos antes e após os tratamentos. Após 1 ano de acompanhamento, 22 crianças foram avaliadas, totalizando 44 dentes com lesões oclusais (1,5mm de diâmetro) até o 1/3 externo de dentina. Clinicamente não houve diferença entre os grupos em relação às restaurações. Apenas um elemento do STC apresentou progressão da lesão após 1 ano, contudo não houve diferença estatística entre os tratamentos (p=0,529). O nível de ansiedade não sofreu alterações significativas antes e após as duas intervenções (p=0,650). A média de tempo de tratamento do STC (9,03 ± 1,91 min) foi estatisticamente menor (p=0,002) que a média do RPTC (17,13 ± 5,26). Em acréscimo, os níveis salivares de todos os microrganismos avaliados não foram diferentes, entre as crianças dos dois grupos, em cada momento de avaliação. Os resultados demonstraram que a técnica de selamento de cárie até 1/3 externo da dentina pode ser indicada em Odontologia, uma vez que não alterou a ansiedade das crianças, reduziu o tempo de cadeira e apresentou uma taxa de sucesso clínico e radiográfico sem diferença estatística em relação à remoção parcial de tecido cariado seguida da restauração (AU)

The aim of this study was to evaluate the efficacy of the sealing technique performed on carious dentin in primary molars. For this, a controlled, randomized clinical trial was developed. Prior to the trial, a study method was executed. Thus, the risk of caries in children (n = 28) aged 3-9 years old was compared by the using of the following predictors instruments: Cariogram® with microbiological analysis (salivary levels of Streptococcus mutans - SM) included in the model; Cariogram® without SM included in the model; and a form based on Cariogram® also without SM variable. The results showed no difference between the assessment methods (p> 0.05) and the salivary levels of SM were not essential to assess the caries risk of children. Taking these results into account, the subjects were randomly divided into two groups: main (SCT) and control (PRCT), considering the risk classification (low, moderate or high) to the disease. Thus a homogenization of the groups was achieved, regarding the caries risk status of children. Seeking to compare SCT with PRCT, the main outcomes of the trial were the clinical success of sealings and restorations (by USPHS criteria); as well as the presence or absence of caries progression (paired analysis of bitewing radiographs), evaluated by blind independent examiners over 1-year follow-up. The anxiety of children before and after each treatment and the time required for each intervention comprised the secondary outcomes. Salivary levels of S. mutans, Lactobacillus spp., Candida spp. and Bifidobacterium spp. were also observed and compared between the groups before and after the treatments. After 1 year of follow up, 22 patients were evaluated, thus 44 teeth with occlusal lesions (1.5 mm diameter) in the outer half of dentin were analysed. Clinically, there was no difference between the groups regarding restorations. Only one molar from SCT showed lesion progression after 1 year, but there was no statistical difference between the treatments (p = 0.529). The anxiety level did not change significantly after the two interventions (p = 0.650). The average treatment time SCT (9.03 ± 1.91 min) was statistically lower (p = 0.002) than the mean of the PRCT (17.13 ± 5.26). In addition, the salivary levels of all target microorganisms were not different between children included in both groups at each assessment point. The results demonstrated that caries sealing technique performed on the outer half of carious dentin may be used in dentistry since it did not alter the children anxiety, reduced chair time and demosntrated clinical success rate and no radiographic statistical difference in relation to the partial caries removal followed by restoration. (AU)

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The aim of this study was to evaluate the commercial chair-side assays Saliva-Check Mutans and ClinproTM Cario L-PopTM in high microbiological caries-risk dental students compared with conventional semi-quantitative colony counting culture-based technique as the reference method. Saliva samples from 93 subjects of both sexes aged 18-26 years were seeded (Köhler and Bratthall method) on plates containing SB-20M culture medium method and 12 subjects with high caries risk were selected. These 12 individuals were subjected to determination of caries risk using two commercial rapid detection chair-side assays (Saliva-Check Mutans and ClinproTM Cario L-PopTM) according to the manufacturers' instructions. The results were analyzed by the Kappa correlation test using SAS statistical software. There was a perfect agreement (Kappa=1) among the three caries risk evaluation methods - chair-side assays and semi-quantitative CFU count (control) - in all subjects. The results suggest that the commercial chair-side assays evaluated in this study may be practical and useful to identify high microbiological caries-risk subjects.

Resumo O objetivo do estudo foi avaliar os testes comerciais de consultório Saliva-Check Mutans e ClinproTM Cario L-PopTM, em estudantes de Odontologia de alto risco à cárie, comparado à técnica convencional semi-quantitativa baseada em contagem de colônias, como método de referência. Amostras de saliva de 93 estudantes de ambos os sexos, entre 18 e 26 anos de idade, foram semeadas em placas contendo meio de cultura SB-20M e 12 pacientes de alto risco à cárie foram selecionados. Estes 12 indivíduos foram submetidos à determinação de risco à cárie por dois testes comerciais de rápida detecção (Saliva-Check Mutans e ClinproTM Cario L-PopTM), seguindo as instruções dos fabricantes. Os resultados foram analisados pelo teste de correlação Kappa, por meio do software estatístico SAS. Houve uma concordância perfeita (Kappa=1) entre os três métodos de avaliação de risco á cárie - testes comerciais e contagem semi-quantitativa de UFC (controle) - em todos os pacientes. O resultado sugere que os testes comerciais de consultório avaliados neste estudo podem ser práticos e úteis para identificar indivíduos de alto risco microbiológico à cárie.

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Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904; p<0.00001), showing that the most significant factors influencing caries risk were caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources. Conclusion: The use of the form based on the Cariogram® software enabled classification of the schoolchildren at low, moderate and high caries risk. Caries experience, oral hygiene, frequency of food consumption, sugar consumption and fluoride sources are the variables that were shown to be highly correlated with caries risk. .

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Cuando se considera a la caries como una enfermedad, no como una lesión, y se identifican los factores de riesgo implicados en su etiología, se poseen las herramientas para prevenir la aparición de nuevas lesiones y la progresión de las existentes. Esto implica un cambio de conducta en los profesionales de la salud bucal, tanto a nivel académico en las escuelas de odontología, como en los servicios públicos y privados. Es por ello, que se hace necesario el diseño, evaluación, implementación y divulgación de mecanismos e instrumentos que faciliten el diagnóstico del riesgo a caries. Asignar al paciente en un nivel de riesgo es el primer paso para el manejo y tratamiento de la enfermedad caries. Esta evaluación se realiza en dos fases: en la primera se identifican factores patológicos específicos o indicadores de la enfermedad, factores biológicos predisponentes y factores protectores de cada paciente. En la segunda fase se determina el nivel de riesgo de acuerdo al análisis de todos los factores involucrados, y posteriormente se planifica, desarrolla y ejecuta estrategias personalizadas dirigidas a controlar la enfermedad.

When considering caries as a disease, not a lesion, and identifying the risk factors involved in their causes, you have the tools to prevent the appearance of new lesions and progression of existing ones. This implies a change in behavior in oral health professionals, both academic dental schools, and in public and private services. This is why it is necessary to do the design, evaluation, implementation and dissemination of mechanisms and tools to facilitate the diagnosis of caries risk. Assign the patient to a level of risk is the first step in the management and treatment of caries disease. This evaluation is performed in two phases: in the first phase are identified pathological factors specific or indicators of the disease, biological factors predisposing and protective factors of each patient. The second phase determines the level of risk according to the analysis of all the factors involved, and then plans, develops and implements customized strategies aimed at controlling the disease.

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Objetivo: Dada la limitada información epidemiológica en Chile sobre las patologías orales más prevalentes y el efecto de los programas de salud instaurados, el objetivo de este estudio fue evaluar los cambios en la prevalencia de caries y gingivitis en una población de 6 y 12 años de la VI Región, entre los años 2000 y 2010. Sujetos y Métodos: 143 sujetos de 6 y 12 años atendidos en el CESFAM de Peralillo fueron examinados clínicamente para detectar caries y diagnosticar gingivitis. Las fichas clínicas de 134 niños de las mismas edades y procedencia atendidos el año 2000 fueron analizadas para comparar los indicadores. Se obtuvo el índice de caries mediante el COPD y el ceod, además del diagnóstico gingival mediante parámetros clínicos. Los resultados de ambos años fueron comparados estadísticamente y las diferencias consideradas significativas si p<0.05. Resultados: La prevalencia de caries a los 6 años disminuyó de 89 por ciento a 65 por ciento, pero sólo el COPD mostró una reducción estadísticamente significativa de 0.93 a 0.086. A los 12 años, ni la prevalencia de caries ni el índice COPD mostraron un cambio significativo. La prevalencia de gingivitis disminuyó significativamente en ambos segmentos de edad en los 10 años de evaluación. Conclusiones: Pese a verificarse una leve disminución, la prevalencia de caries en Peralillo continua siendo muy alta y no ha variado sustancialmente en 10 años. Se sugieren más estudios similares para evaluar la eficacia de los programas en curso.

Aim: Given the limited epidemiological information in Chile on the most common oral diseases and the effectiveness of the existent programs, the aim of this study was to evaluate the changes in caries and gingivitis prevalence in a 6 and 12 year-old children from the VI Region, between the years 2000 and 2010. Subjects and Methods: 143 6 and 12 year-old children treated at the CESFAM of Peralillo were clinically examined to detect and diagnose caries and gingivitis. Clinical records of 134 same ages children treated at the same service in the year 2000 were analyzed to compare the indexes. Caries index was obtained by DMFT and dmft and gingivitis was assessed by clinical parameters. Results obtained both years were compared and considered significant if p<0.05. Results: Caries prevalence decreased in the group of 6 year-olds from 89 percent to 65 percent, but only DMFT showed a significant reduction from 0.93 to 0.086. In the 12 year-old children, neither caries prevalence nor DMFT showed significant changes within the 10-year period. Conclusions: In spite of a slight decrease, caries prevalence in Peralillo continues to be very high and it has not substantially changed in 10 years. Further similar studies are suggested to assess the efficacy of the current programs in use.

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O conhecimento do risco de cárie na gravidez é essencial para um correto plano de tratamento com ações educativas e preventivas às mães para que possam cuidar adequadamente de sua saúde bucal e de seus filhos. Este estudo retrospectivo teve como objetivo identificar o risco de cárie de gestantes (15-44 anos; média= 25 anos) que frequentaram a clínica de odontologia preventiva da Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista de 1999 a 2007. Um total de 166 prontuários, preenchidos por alunos do 3º ano do Curso de Graduação, seguindo orientações pré-estabelecidas, foram utilizados. Coletou-se informação sobre: classificação do diagnóstico de risco de cárie, trimestre gestacional, consumo de carboidratos (entre ou durante as refeições), placa corada (registro de controle de placa de O'Leary), número e grupo de dentes com experiência de cárie. Para análise estatística foram utilizados o teste de qui-quadrado e ANOVA. A maioria das gestantes (92,1 por cento) apresentou 25 por cento ou mais das superfícies dentárias com placa dental. A média (desvio-padrão) de dentes obturados e cariados foi 7,9 (5,1) e 4,0 (3,4), respectiva emente. Os dentes posteriores foram os mais acometidos por cárie/restaurações. Quanto ao diagnóstico de risco à cárie, a classificação alta foi observada em 38,5 por cento das gestantes, moderada em 47,6 por cento e baixa em 13,9 por cento. Houve associação estatisticamente significativa (p= 0,001) entre o consumo de carboidratos e o diagnóstico de risco de cárie. O índice de placa foi semelhante nos diferentes trimestres gestacionais (f= 0,223; p= 0,803). Portanto pode-se concluir que o risco de cárie da grande maioria das gestantes foi alto ou moderado e esteve estatisticamente associado ao consumo de carboidratos(AU)

The knowledge of risk of carried during pregnant is essential for an appropriate treatment using educational and preventives actions to mother for a good care of their oral health and that of children. The main objective of present retrospective study was to identify the risk of caries of pregnants (aged 15-44, mean= 25 years) came to clinic of Preventive Odontology of Araraquara-UNSEP from 1999 to 2007, using 166 medical records obtained by the third pregraduate year students, following the pre-established guidelines. The information collected includes: classification of caries risk diagnosis, pregnancy trimester, carbohydrates ingestion (between or during foods), dental plaques (O'Leary's plaque control registry) and the number of teeth with caries. The statistical analysis used the Chi² and ANOVA tests. Most of patients showed a 25 percent or more of teeth surfaces with dental plaques (92.1 percent) and carbohydrates consumption among foods (89.2 percent). The mean (SD) of carried and restores teeth was of 7.9 (5.1) and 4.0 (3.4), respectively and the posterior teeth were the more involved by caries/restorations. As regards the diagnosis of caries risk, classification of high risk was observed in the 38.5 percent of pregnants, moderate in the 47.6 percent) and low in the 13.9 percent. There was a statistically significant association (p= 0.001) between the carbohydrates consumption and the diagnosis of caries risk. The plaque's rate was similar in the different trimesters of pregnancy (f= 0.223; p= 0.803). The caries risk of most pregnant women was high or moderate and it was associated with the consumption of carbohydrates(AU)

El conocimiento del riesgo de padecer de caries dental durante el periodo de embarazo es esencial para un correcto plan de tratamiento con las acciones educativas y preventivas necesarias para que las madres puedan cuidar adecuadamente de su salud bucal y la de sus hijos. Este estudio retrospectivo tuvo como objetivo identificar el riesgo de caries dental en las mujeres en periodo de gestación con edades comprendidas entre 15 y 44 años, con una media de 25 años, que acudieron a la clínica de odontología preventiva de la Facultad de Odontología de Araraquara, Universidad Estadual Paulista, del año 1999 al 2007. Se utilizaron 166 historias clínicas hechas por los estudiantes de tercer año de pregrado, según las directrices preestablecidas. La información recogida fue: clasificación del diagnóstico de riesgo de caries, trimestre de embarazo, la ingesta de hidratos de carbono entre o durante las comidas, placa dental (registro de control de placa de O'Leary) y el número de grupo de dientes con caries. El análisis estadístico utilizó el Chi cuadrado y ANOVA. La mayoría de los pacientes mostraron el 25 por ciento o más de las superficies de los dientes con la placa dental con un valor de 92,1 por ciento e hidratos de carbono consumidos entre comidas con un valor de 89,2 por ciento. La media (desviación estándar) de los dientes cariados y restaurados fue de 7,9 (5,1) y 4,0 (3,4) respectivamente; los dientes posteriores se vieron más afectados por la caries o restauraciones. En cuanto al diagnóstico de riesgo de caries, la clasificación de alto riesgo se observó en 38,5 por ciento de las mujeres embarazadas, moderado en 47,6 por ciento y bajo en 13,9 por ciento. Existió una asociación estadísticamente significativa (p= 0,001) entre el consumo de hidratos de carbono y el riesgo de caries. El índice de placa fue similar en los diferentes trimestres del embarazo (f= 0,223 y p= 0,803). El riesgo de padecer caries dental en la gran mayoría de las mujeres embarazadas fue alto o moderado y se asoció significativamente con el consumo de hidratos de carbono(AU)

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Introducción. La experiencia previa de caries (EPC) es el más accesible de los métodos de predicción de este padecimiento. El objetivo de este trabajo es analizar aspectos metodológicos de los estudios de predicción de riesgo para mostrar la ventaja de la utilización de la EPC en la predicción de riesgo de caries. Métodos. En un estudio longitudinal de 3 años, realizado en 1 814 escolares de 6 a 8 años de edad, en el que se evaluó la capacidad predictiva de la EPC en la predicción de riesgo, se analizaron: a) la clasificación dicotómica de la población en alto y bajo riesgo; b) el empleo de los valores de sensibilidad y especificidad para la evaluación de la capacidad predictiva de la EPC, y c) el empleo de criterios cuantitativos en el registro de la EPC y la variable respuesta. Resultados. El uso de criterios cualitativos mostró mejor las diferencias en la severidad de caries entre los grupos de riesgo; la razón de riesgo (RR) de presentar lesiones cariosas graves en dientes permanentes fue 10 veces mayor (RR =10.25, intervalo de confianza de 95% [IC95%]=3.74-28.05) para el grupo de alto riesgo (RIV) con respecto al grupo de bajo riesgo (RI), mientras que utilizando el número de dientes afectados, ésta fue sólo 3 veces mayor (RR=3.20, IC95%=2.49-4.10). Los valores para los grupos de riesgo intermedios (RII y RIII) mostraron que es inadecuado dividir a la población en alto y bajo riesgo, resultando no adecuado el empleo de los valores de sensibilidad y especificidad para la evaluación de la capacidad predictiva de la EPC. Conclusión. Si se emplean métodos adecuados en el diseño de estudios de predicción, la EPC resulta una poderosa herramienta para determinar el riesgo de caries en escolares.

Introduction. Because of the reported values of sensitivity and specificity, it has been concluded that previous caries experience (PCE) is not a suitable method in caries risk prediction. However, PCE is the most accessible of the methods in caries prediction. The aim of this study is to analyze methodological issues used in prediction studies and to show the advantage of PCE for risk prediction. Methods. This is a 3-year-follow-up study in which the ability of PCE was studied as a predictive risk factor in 1 841 schoolchildren. The following parameters: classification of the population in high at low risk groups, use of sensitivity and specificity values, and use of quantitative criteria were analyzed. Results. Important differences in caries severity among risk groups were identified by means of the qualitative criteria; the risk ratio (RR) to present extender carious lesions was 10 times higher (RR =10.25, 95%CI =3.74-28.05) for the high risk group (RIV), respect to low risk group (RI), while it was only 3-fold higher (RR =3.20, 95%CI =2.49-4.10) using the number of affected teeth. The values of RR in the middle risk groups showed that the division of the population in high and low risk is inadequate and therefore neither is the use values of sensitivity and specificity in assessing the predictive ability of the PCE. Conclusion. PCE is a powerful tool to determine the risk of caries in schoolchildren when methodological suitable designs are applied.

RESUMO

O objetivo deste trabalho é propor um protocolo de procedimentos práticos no modelo de promoção de saúde com base na revisão da literatura. O atendimento do paciente é dividido em quatro fases: exame diagnóstico e plano de tratamento; tratamento dos pacientes em atividade de doenças cárie e periodontal; tratamento restaurador e manutenção periódica. Esse protocolo permite a realização de um tratamento mais efetivo, uma vez que possibilita detectar precocemente a atividade das doenças cárie e periodontal intervindo com medidas mais simples e efetivas, ao mesmo tempo que envolve o paciente no processo de manutenção de sua saúde.

The goal of this Project is to propose a protocol of clinical procedures used to promote health care, based in the specific literature. The patient treatment is divided in four steps: diagnostics and a treatment plane; treatment of the caries and periodontal diseases; restoration and maintenance. This protocol allows a more effective treatment, because it detects early caries and periodontal diseases so simpler and less invasive measures can be used; at the same time that it educates and involves the patient on how care for his own health.

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Resumen Introducción. El objetivo de este reporte es presentar las asociaciones iniciales de los factores de riesgo inmutable (género y edad) y los factores de riesgo biológico en la línea basal de un modelo diagnóstico de predicción de riesgo a caries. Material y métodos. Se registró en 110 niños entre 6 y 7 años que asisten a 2 escuelas públicas de la Ciudad de México, los siguientes indicadores: clínicos o dentales (morfología, índices de caries y lesiones activas); salivales (flujo salival estimulado y prueba de Snyder); y bacteriológicos (cuentas de Lactobacillus y Streptococcus mutans en saliva y placa dentobacteriana). Resultados. La experiencia de caries se asoció con los siguientes indicadores: morfología, prueba de Snyder y 3 de los indicadores bacteriológicos (ANOVA). Los puntos de corte de riesgo más altos en esta muestra fueron: conteo de S. mutans en saliva (0.96), prueba de Snyder (0.61) y experiencia de caries (0.58). Se usaron 3 modelos de ANOVA con y sin ponderación de los factores de riesgo inmutables, identificando que los indicadores: morfología, lesiones de caries activa y conteo de Lactobacillus salivales son los factores que se asocian de manera significativa con la experiencia de caries en los 3 modelos. Conclusión. El modelo que mejor explica la caries es el que pondera el género R² 62%.

Introduction. The objective of this report is to present the initial associations between age and gender and the biological risk factors at the baseline of a diagnostic model to predict the risk for caries. Material and methods. The following indicators were registered in 110 elementary school children between 6-7 years of age, who attended to 2 public schools in Mexico City: dental (morphology, caries indexes and active caries lesions); salivary (stimulated flow rate and Snyder test); and bacteriological (Streptococcus mutans and Lactobacillus counts in plaque and saliva). Results. Caries experience was associated with dental morphology, Snyder test and with 3 of the bacterial indicators (ANOVA). When the biological risk factors were analyzed by the cut off point for risk, the following variables were identified: salivary S. mutans counts (0.96), Snyder test (0.61) and history of caries (0.58) as highest. Three models of ANOVA were used with/without weighted immutable risk factors, identifying that the indicators: morphology, active lesions and salivary Lactobacillus counts as the factors significantly associated with the caries experience in the 3 models. Conclusion. The model that best explains the risk for caries is the 1 that weighted for gender R² 62%.