Dental Trauma Tracker: A Mobile Phone Application for the Epidemiologic Surveillance of Dental and Maxillofacial Trauma

In the broad field of injury and traumatology, injuries affecting the maxillo-facial region have an important role: dental trauma (DT) makes up 35% of facial injuries, and 31-39% of dental emergencies are consequences of DT. Dental trauma is injury to the soft tissue as well as the teeth. Although in the majority of cases dental trauma is not fatal, it still may cause some long-lasting psychological or physical damage to the victims. Consequently, DT is recognised as a major dental public health problem worldwide. However, lack of data reduces the timeliness and effectiveness of dental trauma research. Thus the ‘Dental Trauma Tracker’ project was established to promote the development of research in dental trauma. The aim of this project was to implement a mobile phone-based application for the epidemiologic surveillance of dental and maxillo-facial trauma. The Dental Trauma Tracker application takes advantage of mobile phone data capture capabilities (text, photo, video, and audio) for epidemiologic surveillance of dental trauma. The initial work to activate larger scale, longer-term studies in the future is described. The goal in the initial stage is to present the development of a working prototype system collecting dental trauma data to provide an overview of the nature and extent of DT, letting researchers view and summarise the collected data, and make greater use of the data for improvements at a local level (e.g., educating on the best first aid, identifying high-risk locations and activities).

Dermatofitos en reclutas y en áreas de riesgo en regimientos de la ciudad de Valdivia (Chile)

El estudio de muestras de piel interdigital plantar y uñas de soldados en Valdivia, Chile, mostró que en el 29,3% de estos habla dermatofitos, aislandose, con excepción de T. rubrum, solo T. mentagrophytes. No se encontraron hongos en piel inguinal. En el 6, 4% de las muestras de pisos, baños, duchas y alfombras de dormitorios, se aisló únicamente T. mentagrophytes. Para cada situación se sugieren medidas preventivas para evitar adquirir una micosis o ser vehículo de dermatofito

Which physical therapy intervention is most effective in reducing secondary lymphoedema associated with breast cancer? Protocol for a systematic review and network meta-analysis

Lymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain. MEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results. This protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications. CDR42022323541

Current State of Teledentistry in Chile

Chile is a country where the geography and territorial distribution of the population make healthcare a constant challenge. Despite a reported improvement on oral health indicators, some levels of inequality are still noted in terms of access to healthcare services. In this context, teledentistry has been considered an effective tool to respond to the population’s healthcare needs. The aim of this paper is to present the current state of teledentistry in Chile. This paper describes the initiatives and programmes of teledentistry developed in Chile, the ethical and legal aspects, financing sources and pending challenges for its consolidation. It is expected that teledentistry will contribute toward an increase in coverage and access to specialists, improve the appropriateness of referrals and reduce costs of specialist care

Prevalence of early childhood caries in non-fluoridated rural areas of Chile.

Introduction: Early Childhood Caries (ECC) constitutes a serious public health issue worldwide, especially in communities without water fluoridation. Objectives: To assess the prevalence of ECC in children 2 and 3 years old from rural preeschools without access to water fluoridation. Methods: A cross-sectional study to community level was performed during 2012. The eligible population was children 2 and 3 years old from rural preschools in non-fluoridated areas located in the Regions of the Araucanía, Los Ríos and Los Lagos. Four calibrated researchers (ICC= 0.83) determined the prevalence of dental caries on the criteria proposed by the WHO. The data was analyzed using the statisticals, chi-square test, t-test and logistic regression models. Results: The sample was constituted by 587 children of whom 53.32% had 2 years old and 52.47 were girls. The prevalence of ECC was 51.62% with a dmft index average of 2.53. The Region with the most prevalence was Araucania with a 52.79%. The variables that showed association were age, IHO-S and prevision (p<0.05). Conclusion: The prevalence of ECC in non-fluoridated areas is high

Sealants for preventing dental caries in primary teeth

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of sealants in preventing pit and fissure caries in primary molars.</p

Adaptation and validation of the PEDSQL™ oral health scale for toddlers in Chilean population

The Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale was developed to measure oral health-related quality of life (OHRQoL). The aim of this study was to cross-culturally adapt the parent-reported version for toddlers of PedsQL™ Oral Health Scale into Spanish and to assess the acceptability, reliability and validity of this version in Chilean preschool population. The PedsQL™ Oral Health Scale for toddlers was cross-culturally adapted for the Spanish language using the recommended standards. To assess metric properties, a cross-sectional study was carried out with 301 children aged 2 to 5 years in Carahue, Chile. Chilean versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, and Early Childhood Oral Health Impact Scale (ECOHIS) were completed by the children's parents. Dental caries, malocclusion and dental trauma were examined by trained dentists. The PedsQL™ Oral Health Scale was administrated a second time 14-21 days after. The reliability of the scale was verified by analysis of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). The validity of the construct was assessed by confirmatory factor analysis and known groups method. The convergent validity was assessed by calculating the Spearman's correlation with the ECOHIS questionnaire. The PedsQL™ Oral Health Scale demonstrated good reliability, with Cronbach's alpha coefficient of 0.79 and ICC of 0.85. A moderate-to-strong correlation was found between the PedsQL™ Oral Health Scale and the ECOHIS questionnaire (- 0.64); the PedsQL™ Oral Health Scale score was lower in children with poor than those with excellent/very good oral health (median 100 vs 85, p < 0.001); it also was lower in children with caries than in those caries-free (median 100 vs 90, p < 0.001). No statistically significant differences were found among groups according to malocclusion and traumatic dental injuries. The PedsQL™ Oral Health Scale for toddlers in Spanish showed to be equivalent to the original version, and its psychometric properties were satisfactory for application in a Chilean pre-school population

Cross-cultural adaptation and psychometric evaluation of the early childhood oral health impact scale (ECOHIS) in chilean population

The Early Childhood Oral Health Impact Scale (ECOHIS) measures the impact of dental diseases on Oral Health-Related Quality of Life both in children and their families. The aim of this study was to develop a Chilean Spanish version of the ECOHIS that is conceptually equivalent to the original and to assess its acceptability, reliability and validity in the preschool population of Chile. The Chilean version of the ECOHIS was obtained through a process including forward and back-translation, expert panel, and cognitive debriefing interviews. To assess metric properties, a cross-sectional study was carried out in Carahue, Southern Chile (April-October 2016). Children younger than six years old without systemic diseases, disabilities or chronic medication from eleven public preschools were included. Parents were invited to complete the Chilean version of the ECOHIS, PedsQL™4.0 Generic Core and PedsQL Oral Health scales, and to answer global questions about their children's general and oral health. A subsample was administrated ECOHIS a second time 14-21 days after. A clinical examination was performed to assess dental caries, malocclusion, and traumatic dental injuries. Reliability was evaluated using measures of internal consistency (Cronbach's alpha) and reproducibility (Intraclass correlation coefficient - ICC). Construct validity was assessed by testing hypotheses based on available evidence about known groups and relationships between different instruments. The content comparison of the back-translation with the original ECOHIS showed that all items except one were conceptually and linguistically equivalent. The cognitive debriefing showed a suitable understanding of the Chilean version by the parents. In the total sample (n = 302), the ECOHIS total score median was 1 (IQR 6), floor effect was 41.6%, and ceiling effect 0%. Cronbach's alpha was 0.89 and the ICC was 0.84. The correlation between ECOHIS and PedsQL™4.0 Generic Core was weak (r = 0.21), while it was strong-moderate (r = 0.64) with the PedsQL Oral Health scale. In the known groups comparison, the ECOHIS total score was statistically higher in children with poor than excellent/very good oral health (median 11.6 vs 0, p < 0.01), and in the high severity than in the caries-free group (median 8 vs 0.5, p < 0.01). No differences were found according to malocclusion and traumatic dental injuries groups. These results supported the feasibility, reliability and validity of the Chilean version of ECOHIS questionnaire for preschool children through proxy

Calidad de vida relacionada con la salud oral en niños y adolescentes

Las enfermedades orales son altamente prevalentes a nivel mundial a pesar de la mejora en los índices de salud oral en las últimas décadas del siglo XX. Es bien sabido que sus consecuencias en los niños son graves y pueden afectar la calidad de vida relacionada con la salud oral. El objetivo general de esta tesis doctoral fue estimar el impacto de las patologías orales más prevalentes y de sus tratamientos en la calidad de vida relacionada con la salud oral de la población pediátrica. Se realizaron cuatro trabajos de investigación, tres de ellos fueron revisiones sistemáticas cuyos objetivos específicos fueron: 1) Obtener una evaluación sistemática y estandarizada de la evidencia actual sobre el proceso de desarrollo, las propiedades métricas y los problemas de administración de los instrumentos de calidad de vida relacionada con la salud oral disponibles para niños y adolescentes; 2) Evaluar el impacto de los traumatismos dentoalveolares en la calidad de vida relacionada con la salud oral de preescolares y escolares; y 3) Evaluar los efectos del tratamiento restaurador atraumático en comparación con el tratamiento convencional para el tratamiento de las lesiones de caries dentales en dientes primarios y permanentes de niños y adultos. Finalmente se realizó la adaptación transcultural de la Early Childhood Oral Health Impact Scale (ECOHIS) para obtener la versión en español para Chile, y un estudio transversal para evaluar su aceptabilidad, fiabilidad y validez en población preescolar. La revisión sistemática sobre los instrumentos de calidad de vida relacionada con la salud oral, identificó 18 instrumentos, siendo la edad un factor clave al momento de elegir entre los instrumentos genéricos de calidad de vida relacionada con la salud oral: el ECOHIS fue el más recomendable para preescolares, el Child Perceptions Questionnaire el más recomendable para escolares y el Child Oral Impact on Daily Performance para adolescentes. Entre los instrumentos genéricos desarrollados para cualquier edad, la Family Impact Scale (FIS) fue el mejor evaluado. La síntesis de la evidencia disponible mostró que los niños que presentan traumatismos dentoalveolares tienen una probabilidad significativamente mayor de afectación de la calidad de vida relacionada con la salud oral en comparación con los controles tanto en edad preescolar como escolar. Sin embargo, se requieren estudios de cohortes prospectivos para confirmar estos resultados y describir su evolución temporal. Los estudios de niños con caries en su dentición primaria que son tratados con el método restaurador atraumático usando cemento de ionómero de vidrio de alta viscosidad mostraron mayor riesgo de fracaso que los que reciben un tratamiento convencional con el mismo material. En futuros ensayos clínicos se debería aportar datos sobre resultados reportados por los pacientes como dolor, incomodidad o calidad de vida relacionada con la salud oral a través de cuestionarios validados, dado que hasta el presente no se dispone de suficiente información. La versión Chilena de la ECOHIS mostró resultados de fiabilidad y validez similares a los de la versión original desarrollada en Estados Unidos. Estos resultados sugieren que la versión Chilena es equivalente a la original, y puede ser utilizada para medir la calidad de vida relacionada con la salud oral de los preescolares en Chile, tanto en la práctica clínica como para la investigación.Despite a significant improvement in oral health rates during the last decades of the twentieth century, oral diseases continue to be highly prevalent worldwide. It is an undeniable fact that its consequences in children are serious, and can affect their oral health-related quality of life. The general objective of this doctoral thesis was to estimate the impact of the most prevalent oral diseases and their treatments, regarding to the oral health-related quality of life in the pediatric population. Four research studies were carried out, three of which were systematic reviews with the following specific objectives: 1) To obtain a systematic and standardized evaluation of the current evidence on development process, metric properties, and administration issues of oral health-related quality of life instruments available for children and adolescents; 2) To assess the impact of traumatic dental injuries on the oral health-related quality of life of preschoolers and schoolchildren; and 3) To assess the effects of atraumatic restorative treatment compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. Finally, the cross-cultural adaptation of the Early Childhood Oral Health Impact Scale (ECOHIS) was performed to obtain the Spanish version for Chile, and a cross-sectional study was carried out to evaluate its acceptability, reliability and validity in the preschool population. The systematic review on oral health-related quality of life instruments identified 18 instruments, with age considered as a key factor when choosing among the generic oral health-related quality of life instruments: ECOHIS was the most recommended for preschool children, the Child Perceptions Questionnaire the most recommended for schoolchildren and the Child Oral Impact on Daily Performance, for adolescents. Among the generic instruments developed for any age, the Family Impact Scale (FIS) was the best rated. Synthesis of the available evidence showed that children who present traumatic dental injuries have a significantly higher chance of reporting any impact on oral health-related quality of life, compared to controls in pre-school age and schoolchildren. However, prospective cohort studies are required to confirm these results and describe their evolution along time. Studies on children with caries in their primary dentition who are treated with the atraumatic restorative method, using high viscosity glass ionomer cement, showed a higher risk of failure than those who received conventional treatment with the same material. Future clinical trials should provide detailed data on patient-reported outcomes, such as pain, discomfort or oral health-related quality of life through validated questionnaires, since to date there is not enough information available. The Chilean version of ECOHIS showed similar reliability and validity results to the original version developed in the United States. These results suggest that the Chilean version is equivalent to the original version, and can be used to measure the oral health-related quality of life of preschool children in Chile, in clinical practice as well as in research