Personas mayores, nutrición y salud oral en atención primaria

RESUMEN OBJETIVO: Determinar el riesgo de malnutrición y el estado de salud oral de los mayores de 65 años en atención primaria. MÉTODO: En este estudio transversal fueron obtenidos datos de 358 adultos mayores de 65 años (194 mujeres y 164 hombres) que vivían en comunidad y eran usuarios del centro de Salud Santa María de Gracia en Murcia, España. El estado de malnutrición fue analizado con un cuestionario validado, la Mini Evaluación Nutricional. Se recogieron variables antropométricas, con las que se elaboró el Índice de Masa Corporal para cada individuo, y variables socio-económicas. Se realizó una extracción sanguínea para analizar hemograma y bioquímica. La valoración odontológica incluyó una encuesta de salud oral basada en la descrita por la OMS, con exploración bucodental y la medición del Índice Periodontal Comunitario. El análisis estadístico fue realizado mediante el programa Stata. RESULTADOS: El 86.03% de ancianos que viven en comunidad tienen un estado nutricional satisfactorio. Entre las variables socioeconómicas, el ser varón, tener una mayor edad, nivel de ingresos menor de 600€ y ser soltero (todas con p<0.005) inciden negativamente en el estado nutricional. Los factores sanguíneos asociados al estado nutricional son el hierro y el hematocrito. En las variables odontológicas, la necesidad de prótesis es el principal factor determinante para el riesgo nutricional. También son variables importantes la enfermedad periodontal avanzada, la caries activa y la ausencia de más de 16 dientes, que se asociaron al déficit nutricional con p<0.005 de modo independiente del sexo, edad, pensión, escolaridad y consumo de tabaco. CONCLUSIONES: La población estudiada presenta buen estado nutricional. Los individuos con niveles normales de hierro tienen un 25% menos de probabilidad de riesgo de malnutrición, mientras que los individuos con necesidad de prótesis tienen un 13% más de probabilidad. ABSTRACT OBJECTIVE: To examine the association between nutritional deficit and oral health problems in noninstitucionalized elderly adults in Spanish community. METHODS: In this cross-sectional study, data were obtained from 358 elderly adults (194 women, 164 men) with ages between 60 and 74 years, living in community and associated to the health center Sta Maria de Gracia in Murcia, Spain. The Mini Nutritional Assessment (MNA) was used to identify nutritional deficit. Also we use anthropometric measures for developing the Body Mass Index (BMI), socioeconomic measures and blood tests. Oral evaluation was componed by an oral exam, application of oral health survey, measurement of PDI (periodontal dissease index). Multivariate analyses were adjusted by sociodemographic variables, blood tests, and oral health items. RESULTS: 86% of elderly adults noninstitucionalized presents satisfactory nutritional status. Among the socioeconomics conditions studied, being male, older, whith lower pension and single were associated with nutritional risk (p<0.005). Ferum seric and hematocrit were related with nutritional normal status. By last, the dental conditions studied of active caries, advanced periodontal illness and 16 lost teeth were associated with nutritional deficit regardless of sex, age, Pension, education and smoking. CONCLUSIONS: The study population presents a satisfactory nutricional status. Oral health impairment was associated with nutritional deficit, in a 13% for people who need oral rehabilitation. People with normal ferum seric rise 25% of protection for malnutrition

A Clinical Study on the Efficacy and Tolerability of a New Topical Gel and Toothpaste in Patients with Xerostomia: A Randomized Controlled Trial

Objective: xerostomia is a very common problem in the general population. The objective of this study was to determine the efficacy of a new gel and toothpaste in patients with xerostomia, analyze the role of salivary cytokines as biomarkers of xerostomia and assess the possible changes in salivary cytokines following treatment. Materials and methods: A randomized, controlled double-blind clinical study was carried out in 73 patients with xerostomia divided into two groups: placebo and active treatment (cymenol; tocopheryl acetate; D-panthenol; Aloe barbadensis; citrate tribasic dihydrate; fluoride) with oral gel and toothpaste three times a day for four consecutive weeks. The Thomson Xerostomia Inventory was applied, with the assessment of oral quality of life (OHIP-14) at baseline and after four weeks of application of the product. Sialometry was also performed in both groups, with analysis of the IL-1b, IL-6, IL-8 and TNFa levels in saliva. Results: In the active treatment group, the xerostomia scores decreased significantly at the end of the study versus baseline, from 33.47 to 27.93 (p p = 0.190). There were no adverse effects in either group. Regarding the saliva samples, the active treatment group showed significant differences in IL-6 concentration versus the control group (18.55 pg/mL (8–38.28) and 5.83 pg/mL (1.19–12.04), respectively; p = 0.002). No significant differences in salivary cytokines were observed in either the treatment group or the control group. Conclusions: The use of a new toothpaste and gel developed for patients with xerostomia proved effective, with greater symptom relief than in the placebo group. Further clinical studies involving longer time periods and larger samples are advisable in order to confirm the benefits of the described treatment

Photodynamic Therapy, Photobiomodulation and Acetonide Triamcinolone 0.1% in the Treatment of Oral Lichen Planus: A Randomized Clinical Trial

Objective: To evaluate the efficacy of photodynamic therapy (PDT) and photobiomodulation (PBM) in the treatment of oral lichen planus (OLP) in comparison with the use of topical corticosteroids. Material and methods: Sixty patients with OLP were randomized to three groups: group 1 photodynamic therapy applied once a week for four sessions, with orabase cream; group 2 low-power laser application with orabase cream; and group 3 inactive laser with triamcinolone acetonide 0.1%. Patient pain was evaluated, and the Thongprasom severity score, the Oral Health Impact Profile-14 (OHIP-14), and the Hamilton anxiety and depression scale at one and three months of follow-up. (ClinicalTrials.gov Identifier: NCT05127083). Results: Pain decreased significantly over time in all groups, though the symptoms relapsed over follow-up at one and three months in group 3. The OHIP-14 score improved significantly in groups 1 and 2 (p p = 0.032) and between groups 2 and 3 (p = 0.024). Conclusions: Photodynamic therapy and photobiomodulation once a week for four weeks are safe and non-invasive treatment options, with the important advantage of lacking adverse effects. Further studies are needed to confirm it