Evaluation of a fluorosis prevention educational program : a randomized field trial

A 2-group randomized field trial was conducted to evaluate the impact of a fluorosis educational preventive program in mother´s knowledge and practices, and on the urine fluoride concentration of their preschool children. A group of 139 mother-child pairs participated in the study. Randomly, children were assigned to an intervention group, their mothers were participants of an educational program, or a control group (CG); including 69 and 70 child-mother pairs, respectively, the follow-up period was six months. Mother´s knowledge and practices were evaluated and children´s first urine sample was used to measure fluoride concentration at the beginning of the study and at the end of the follow-up period. The mean age of the children was 4.18 (sd 0.62) years-old at baseline. Mothers in the IG improved their knowledge and practices associated with fluorosis risk factors. Adequate knowledge about the amount of toothpaste to use for brushing improved in the IG (p=0.006). In 82.1% of the children in the IG showed decrease in urine fluoride concentration was observed (p< 0.001), no significant differences were shown in the CG. Mothers participating in an education program improved their knowledge and practices, reducing the risk of dental fluorosis in their children who showed a decreased on their urine F concentration

Lesiones bucales en un grupo de pacientes con trasplante renal

Objetivo: Determinar la prevalencia de lesiones de la mucosa bucal (LB) en un grupo de pacientes con trasplante renal (TR), y analizar las posibles asociaciones de las lesiones entre sí, con el uso de fármacos y con variables clínicas y de laboratorio relevantes. Metodología. Estudio transversal, en el que se examinó a pacientes consecutivos con TR de la consulta de nefrología de un hospital General de Zona del Instituto Mexicano del Seguro Social. Se determinó la frecuencia y el tipo de lesiones bucales. Se analizaron las posibles asociaciones de las LB entre sí y con la cuenta de leucocitos totales, la función renal, el índice de higiene oral simplificado (IHO-S), los niveles de ciclosporina A (CsA) en sangre y el uso de nifedipina. Se utilizó un modelo de regresión logística para analizar la asociación entre hiperplasia gingival (HG) y la dosis de CsA y de nifedipina. Resultados. Se examinaron 50 (55.6%) hombres y 40 (44.4%) mujeres. El 60% de los pacientes presentaron al menos una lesión bucal. Se presentó candidosis bucal (CB) en 18.7%, lesiones clínicamente compatibles con leucoplasia vellosa (CLV) en 13%. Se identificó asociación entre la presencia de CB y CLV (P<0.05). Se encontró lengua saburral (LS) en 22% de los pacientes, e HG en 49%; Grado 1 en 11 (12.2%); Grado 2 en 26 (28.9%) y Grado 3 en 7 (7.8%). Los resultados de la regresión logística demostraron asociación de HG con mala higiene bucal (P<0.001), pero no con la dosis o los niveles de CsA, ni con el uso de nifedipina (P=0.075). Conclusión. El 60% de los pacientes con TR presentó al menos una lesión en la mucosa bucal. La asociación entre HG y mala higiene bucal demuestra la necesidad de supervisar la higiene bucal en el paciente trasplantado.Aim: To assess the prevalence of oral mucosa lesions (OL) in a group of kidney transplant (KT) patients, and analyze possible OL associations with one another and with drugs use and relevant clinical and laboratory variables. Methodology. Transversal study, in which consecutive KT patients from the nephrology outpatient service at a General Zonal Hospital were examined. The prevalence of several types of OL was assessed, and their possible statistical associations with one another and total leukocyte count, renal function, the simplified oral hygiene index (S-OHI), cyclosporin-A (CsA) dose and blood levels, and nifedipine use was analyzed. A logistic regression model was used to analyze the association between gingival hyperplasia (GH) and CsA dose and nifedipine use. Results. Fifty (55.6%) men and forty (44.4%) women were studied. Sixty percent of the patients had at least one OL. Oral candidiasis (OC) was found in 18.7%; 13% had lesions clinically compatible with hairy leukoplakia (CHL). An association was found between OC and CHL (P<0.05). Saburral tongue (ST) was found in 22% of the patients and gingival hyperplasia (GH) in 49%, which was distributed as follows: Grade 1 in 11 (12.2%); Grade 2 in 26 (28.9%), and Grade 3 in 7 (7.8%). Logistic regression results showed an association between GH and poor oral hygiene (P<0.001), but not to either CsA dose or blood levels, or nifedipine use (P=0.075). Conclusion. Sixty percent of the KT patients had at least one OL. The association between GH and poor oral hygiene corroborate the need for oral hygiene practices supervision in the transplant patient

Efecto del clorhidrato de pilocarpina como estimulante de la producción salival en pacientes sometidos a radioterapia de cabeza y cuello

Objetivo: Estudiar los efectos del clorhidrato de pilocarpina sobre la producción salival total en pacientes mexicanos con hiposalivación secundaria a radioterapia de la región de cabeza y cuello. Diseño del estudio: Previo consentimiento informado, 20 pacientes con hiposalivación secundaria a radioterapia de la región de cabeza y cuello (> 40 Gy) fueron evaluados mediante el Test de Saliva Global (TSG) antes, durante y al final de 10 semanas de tratamiento con clorhidrato de pilocarpina (5 mg 3 veces al día). La sintomatología relacionada a la hiposalivación fue evaluada mediante un cuestionario con escala ordinal de 0 a 10. La cantidad de saliva producida al final del tratamiento se comparó con los valores obtenidos al inicio del tratamiento en cada paciente y estos datos fueron analizados mediante la prueba de t de Student pareada. La comparación de los síntomas bucales que incluyeron sensación de humedad, malestar, dificultades para hablar y para deglutir se realizó mediante una prueba de Wilcoxon pareada. Resultados: El TSG basal indicó un promedio de 0.8 cm (d.e. 0.7) de producción salival (rango de 0 a 2.9 cm). Al cabo de las diez semanas de tratamiento el promedio de saliva producido por los pacientes fue de 2.24 cm (d.e..0.7), con un rango de 1.2 a 4.0 cm. El incremento de la producción de saliva fue del 64.5% (p<0.001). Asimismo, al final del estudio se registró mejoría en cuanto a la sensación de humedad, dificultad para hablar relacionada con la falta de saliva en la cavidad bucal, deglución y molestias bucales relacionadas a la falta de saliva en comparación con los datos iniciales (p<0.01). Los trastornos colaterales detectados fueron generalmente leves, y en ningún caso fueron causa de suspensión del tratamiento. Conclusiones: El clorhidrato de pilocarpina en dosis de 5 mg 3 veces al día produjo un incremento significativo en la producción salival y mejoría clínica en cuanto a la sintomatología bucal secundaria a hiposalivación con mínimos efectos secundarios. Asimismo, el TSG representa un método rápido, técnicamente simple y de alta confiabilidad para el registro de la producción salival en estudios prospectivos.Objective: To study the effects of pilocarpine hydrochloride on whole salivary gland production in Mexican patients affected by hyposalivation secondary to radiotherapy of the head and neck region. Study design: With previous written informed consent, 20 patients affected by hyposalivation secondary to head and neck radiation therapy (> 40Gy) were evaluated through the whole saliva test (WST) before, during and after ten weeks of treatment with pilocarpine hydrochloride (5 mg t.i.d.). Hyposalivationrelated symptomatology was assessed before and at every week by means of a questionnaire with an ordinal scale ranging from 0-10. Salivary production values recorded at the end of the study and those obtained before treatment were compared by means of Student´s t test. A paired Wilcoxon test was used to compare the differences in the oral symptoms, such as oral dryness, soreness, ability for speaking and swallowing before and after treatment. Results: Initial WST had a mean salivary production of 0.8 cm (s.d. 0.7), with a range from 0 to 2.9 cm). After ten weeks of treatment salivary production increased to a mean of 2.24 cm (s.d. 0.7), with a range from 1.2 to 4.0 cm. There was a salivary flow increase of 64.5% (p<0.001). In addition, there were significant improvements in oral dryness, mouth comfort, ability to speak and ability to swallow (p<0.01). Adverse effects were usually minimal and they did not cause withdraw from the study in any case. Conclusions: Administration of 5-mg pilocarpine hydrochloride tablets three times daily significantly improved salivary production and clinical symptomatology secondary to radiationinduced hyposalivation with minimal side-effects. In addition, this study showed that WST is a fast, technically simple and highly reliable method to study salivary production in prospective studies

Dental caries in Mexican schoolchildren : a comparison of 1988?1989 and 1998?2001 surveys

Objectives: To compare two surveys across seven states for the prevalence of dental caries among Mexican schoolchildren. Study D esign: Analysis of two cross-sectional surveys: Schoolchildren from 6 to 10 years of age were examined in the 1988?1989 survey and 6- to 10-year-old and 12-year-old students were included in the 1998?2001 survey. The baseline data of seven states were available for analysis. Representative probability samples were conducted statewide in both surveys. The World Health Organization (WHO) method was used to obtain the dental caries index (dmft, DMFT). At present, additional and more recent epidemiological data representative statewide in Mexico are unavailable. Results: The participants were 9798 schoolchildren in the 1988?1989 survey and 16882 schoolchildren in the 1998?2001 survey. The prevalence of caries in children ages 6 to 10 years was 86,6% in the first survey and 65,5% in the second survey, showing a 24,4% reduction. The primary teeth index in the first survey was dmft = 3,86 (IC95% 3,68 4,04) and in permanent teeth, it was DMFT = 1,03 (IC95% 0,95 1,11). In the second survey, the comparable values were dmft = 2,36 (IC95% 2,20 2,52) and DMFT = 0,35 (IC95% 0,29 0,40), corresponding to a reduction of 38,89% and 66,02% in the primary and permanent dentition, respectively. Treatment needs remain high: In the second survey, as 92,75% of the index DMFT was conformed as decayed teeth. Conclusion: Overall, we detected a downward trend in the dental caries indices, particularly in the permanent dentition. The increase in the availability of fluoride likely contributed to the observed decline in dental carie

Prevalence of oral lesions in patients with psoriasis

Aim: To determine the prevalence of oral lesions (OL) in patients with psoriasis, and compare these findings with the ones found in patients without this condition. Materials and methods: In the present observational and comparative study, we evaluated 207 patients, with and without psoriasis, attending the dermatological consulting service of a concentration hospital in Mexico City. The possible association between OL and psoriasis was analyzed through a logistic regression model; the Odds Ratio (OR) and its Confidence Interval (CI) was calculated to be 95%. Results: Two hundred and seven cases were examined (80 with psoriasis and 127 without psoriasis). Of these, 75 (36.2%) were men and 132 (63.7%) women. Oral lesions were found in 54 (67.5%) psoriatic patients and in 63 (49.6%) of the comparative group (p 0.05) regarding the use of tobacco. Alcohol consumption was greater (55.0%) among patients with psoriasis than among those without psoriasis (26.7%) (p 0.05). Conclusions: The high prevalence of GT and FT in patients with psoriasis suggests that these lesions should be taken into account in new studies as possible predictors or markers of the severity of this dermatosis, in order to confirm the association of these entities

Malocclusion and TMJ disorders in teenagers from private and public schools in Mexico City

Objective: To identify, among Mexican teenagers from public and private schools, the frequency, severity of maloc - clusion and orthodontic treatment needs, and their possible association with temporomandibular joint disorders. Material and Methods: Fifteen-year-old students were recruited from public and private schools. Clinical findings were registered as follows: oral hygiene status with the Oral Hygiene Index-Simplified, malocclusion using the Dental Aesthetic Index (DAI), and TMJ disorders following WHO criteria. Negative binomial and logistic regres - sion models were constructed for data analysis. Results: A total of 249 fifteen-year old students were included in the study . Conclusions: TMJ disorders and DAI scores were significantly associated. Screening/Diagnostic programs for ortho- dontic and TMJ-disorders are needed, to identify and offer treatment to teenagers with major malocclusion and TMJ/ muscle pain

Histomorphological evaluation, cell proliferation and endothelial immunostaining in oral and maxillofacial myofibroblastic lesions

Myofibroblasts (MF) are mesenchymal cells with features of both fibroblasts and smooth muscle cells. Although these are usually reactive cells, they can lead to myofibroblastic tumors that may share clinical and histomorphological characteristics but with different prognosis. The aim of this study is to perform a histomorphological evaluation as well as to compare and evaluate two different cell proliferation immunomarkers and two endothelial markers in a group of oral and maxillofacial myofibroblastic lesions (MFL). Cross-sectional and retrospective study. Demographic, clinical, histomorphological and immunohistochemical characteristics of 39 cases of MFL were analyzed. Immunohistochemical reactions were performed with the Ki67, MCM2, CD34 and CD105 antibodies. Kruskal-Wallis test and Spearman correlation analysis were used. Four cases of nodular fasciitis (NF), 18 myofibromas (My), 6 desmoplastic fibromas (DF), 7 inflammatory myofibroblastic tumors (IMT) and 4 myofibroblastic sarcomas (MFS) were studied. There were twenty women (51.2%); the median age was 13 [Q1-Q3: 8-24] years and most cases occurred in the mandible (48.7%). A statistically significant difference with MCM2 immunostaining (p=0.0221) was observed between the MFL; furthermore, a correlation between CD34 and CD105 immunostaining in NF (p <0.0001) and IMT (p=0.0408), between MCM2 and CD34 in IMT (p=0.0362) and between MCM2 and CD105 in MFS (p <0001) were found. MCM2 immunostaining could assess more clearly the cell growth fraction in MFL. The correlation between MCM2 and CD34 in IMT and between MCM2 and CD105 in MFS are indicative of the high activity of these lesions. These results emphasize the importance of the studied immunohistochemistry markers as possible tools for a better characterization of some of the MFL

Comparison of body fat percentage assessments by bioelectrical impedance analysis, anthropometrical prediction equations, and dual-energy X-ray absorptiometry in older women

Background: Individuals with high body fat have a higher risk of mortality. Numerous anthropometric-based predictive equations are available for body composition assessments; furthermore, bioelectrical impedance analysis (BIA) estimates are available. However, in older adults, the validity of body fat estimates requires further investigation. Objective: To assess the agreement between percentage body fat (BF%) estimates by BIA and five predictive equations based on anthropometric characteristics using dual X-ray absorptiometry (DXA) as reference method. A secondary objective was to identify whether excluding short-stature women improves the agreement of BF% estimates in a group of community-dwelling, older Mexican women. Methods: A concordance analysis of BF% was performed. A total of 121 older women participated in the study. Anthropometric information, BIA, and DXA body composition estimates were obtained. Five equations using anthropometric data were evaluated in order to determine body fat percentage (BF%) using DXA as reference method. Paired t-test comparisons and standard error of estimates (SEE) were obtained. The Bland-Altman plot with 95% limits of agreement and the concordance correlation coefficient (CCC) were used to evaluate the BF% prediction equations and BIA estimates. Results: The mean age of the study participants was 73.7 ( 5.8) years old. BIA and the anthropometric based equations examined showed mean significant differences when tested in the entire sample. For the taller women (height > 145 cm), no significant difference in the paired comparison was found between DXA and BIA of BF% estimates. The mean BF% was 40.3 ( 4.8) and 40.7 ( 6.2) for DXA and BIA, respectively. The concordance between methods was good (CCC 0.814), (SEE 2.62). Also, in the taller women subset, the Woolcott equation using waist-to-height ratio presented no significant difference in the paired comparison; however, the error of the estimates was high (SEE 3.37) and the concordance was moderate (CCC 0.693). Conclusion: This study found that BIA yielded good results in the estimation of BF% among women with heights over 145 cm. Also, in this group, theWoolcott predictive equation based on waist circumference and height ratio showed no significant differences compared to DXA in the paired comparison; however, the large error of estimates observed may limit its application. In older women, short stature may impact the validity of the body fat percentage estimates of anthropometric-based predictive equations

Impact of Dental Fluorosis, Socioeconomic Status and Self-Perception in Adolescents Exposed to a High Level of Fluoride in Water

Objective: To identify adolescents’ self-perception of dental fluorosis from two areas with different socioeconomic levels. Methods: A cross-sectional, descriptive study was conducted with 15-year-old youths by applying a questionnaire designed and validated to assess self-perceptions of dental fluorosis in two areas with different socioeconomic statuses (SESs). Fluorosis was clinically evaluated by applying the Thylstrup and Fejerkov (TF) index on the upper front teeth. Results: A total of 308 adolescents were included in the study. The medium-SES population, which was exposed to 2.5 ppm of fluoride in water, and the low-SES population, which was exposed to 5.1 ppm, presented the following levels of dental fluorosis: TF 2–3 (50%), TF 4–5 (45.6%) and TF 6–7 (4.4%) for medium SES and TF 2–3 (12.3%), TF 4–5 (67.1%) and TF 67 (20.6%) for low SES. A significant association was found between self-perception and dental fluorosis in those with medium and low SESs (p < 0.05). The multiple regression model found differences between TF levels and self-perception, with a 6–7 TF level for concerns about color (OR = 1.6), smile (OR = 1.2) and appearance (OR = 3.36). Conclusions: Self-perceptions of dental fluorosis affect adolescents such that adolescents with a medium SES have more negative perceptions than those with a low SES. Such perceptions increase as the TF index increases