Estudio epidemiológico sobre las necesidades de tratamiento de ortodoncia en la población escolar de la Comunidad Valenciana

Introducción: La OMS recomienda la realización periódica de estudios epidemiológicos mediante encuestas de salud bucal, proporcionando una base para evaluar el estado actual de salud bucal de la población y permitiendo planificar estrategias de actuación en el tratamiento de las diferentes patologías. Dado que la última Encuesta de necesidad de tratamiento ortodóncico en escolares de la Comunidad Valenciana se publicó en el año 2010, el presente trabajo se desarrolla con la finalidad de realizar una nueva evaluación y actualización de resultados. Objetivos: El objetivo del presente estudio consiste en evaluar la necesidad de tratamiento ortodóncico en adolescentes de 12 y 15 años de la Comunidad Valenciana, así como el impacto psicosocial producido por la maloclusión y la posible relación de ésta con la presencia de caries u obesidad. Metodología: Enmarcado en la Encuesta de Salud Oral de la Comunidad Valenciana, realizada en 2018 y aprobada por el Comité de Ética de la Universitat de València, se realizó un estudio transversal sobre una muestra de 539 escolares de 12 años y 460 de 15, seleccionada por conglomerados y representativa de la población escolar de la Comunidad Valenciana, empleando los índices IOTN-DHC, IOTN-AC y DAI. Las exploraciones se desarrollaron siguiendo la metodología sugerida por la OMS en su Guía para la realización de este tipo de encuestas, examinando a los adolescentes en el mismo centro escolar. Se empleó un espejo plano y una sonda PCP 11.5b para registrar los rasgos de maloclusión necesarios para determinar los índices. Dichas exploraciones fueron realizadas por 3 examinadores calibrados previamente frente a un gold standard y acompañados de tres anotadores. Para la evaluación del IOTN-AC se empleó una ficha con 10 fotografías de vista anterior de los diferentes tipos de oclusión dental, tal y como propusieron los desarrolladores de índice. Cada escolar debía identificarse con una de las imágenes, anotándolo en la hoja de exploración. Para comparar la percepción del adolescente frente a la de un profesional de la salud oral, el examinador también realizó dicha identificación. El impacto psicosocial de la maloclusión se evaluó empleando el cuestionario autocumplimentado PIDAQ, validado para la población adolescente. Todos los datos se registraron en una hoja de cálculo de Microsoft® Excel® para, posteriormente, realizar en análisis estadístico mediante el programa IBM® SPSS® v.24. Se realizó una estadística descriptiva de la muestra para cada una de las variables. Las diferencias entre proporciones se analizaron empleando el test Chi-cuadrado, mientras que para las medias se empleó el test ANOVA, con la prueba Post Hoc de Bonferroni o el test T de Student. Para analizar la concordancia entre variables se empleó el porcentaje de acuerdo y el test Kappa, interpretando el resultado mediante la escala de Landis-Koch. Se realizó también una validación confirmatoria del cuestionario PIDAQ, así como un análisis de regresión lineal para evaluar cuáles son las variables afectan al impacto psicosocial. Resultados y discusión: La necesidad de tratamiento determinada según el IOTN-DHC fue del 12,6% a los 12 años y del 7% a los 15. Para los índices IOTN-AC y DAI, las necesidades fueron del 4,3 y 0,9% y del 30,1 y 20,9% respectivamente. La concordancia entre IOTN-DHC y DAI ha sido de 0,52 a los 12 años y 0,48 a los 15, empleando el estadístico kappa cuadrático. Estos resultados fueron similares a los obtenidos en el estudio anterior realizado sobre la misma población diana. No se observó una asociación significativa entre la necesidad de tratamiento y el sexo o la clase social. Por otra parte, se ha observado una relación lineal entre los valores del PIDAQ y los diferentes índices de medición de la maloclusión, encontrando que el impacto psicosocial es mayor a medida que aumenta la necesidad de tratamiento. La validación confirmatoria del PIDAQ arrojó los mismos cuatro dominios que el cuestionario original. En el análisis de regresión lineal se encontró que las variables “Sexo femenino”, “Portador de ortodoncia en el pasado”, “Necesidad de tratamiento IOTN” y “Necesidad de tratamiento DAI” mostraban significación estadística en su asociación con el impacto psicosocial. No se encontró relación entre la necesidad de tratamiento ortodóncico y la presencia de caries u obesidad. Conclusiones: La necesidad de tratamiento ortodóncico presenta unos valores similares a los obtenidos en 2010. Existe una concordancia baja-moderada en el diagnóstico de necesidad de tratamiento entre IOTN y DAI. El impacto psicológico de la estética dental muestra una asociación lineal positiva con la necesidad de tratamiento ortodóncico

Caries prevalence in children from Valencia (Spain) using ICDAS II criteria, 2010

Objectives: To assess the oral health status of the child population and its evolution over the 2004-2010 period. Study Design: A descriptive cross-sectional study of the entire schoolchild population of the Valencia region of Spain was conducted using cluster sampling. Seventy schools were selected. The sample size was 1373 pupils, aged 6, 12 and 15 years. The children were examined in November and December 2010, at their schools, by 6 examiners calibrated in the ICDAS II method. The descriptive statistics, comparison of means and comparison of proportions ( p <0.05) were recorded. Results: The caries prevalence (ICDAS 4-6>0) was 30% in primary dentition at 6 years and 37.7% and 43.6% in permanent dentition at 12 and 15 years respectively. At 6, 12 and 15 years, the df.t/DMF. TICDASII 4-6 scores were 0.98, 0.83 and 1.08, the df.s/DMF.SICDASII 4-6 scores were 1.43, 1.27 and 1.64 and the care index results were 14.3%, 59% and 71.3% respectively. Conclusions: Both the caries indices (df.t at 6 years and DMF.T at 12 and 15) and caries prevalence have improved, as the values obtained were lower than in 2004. Using the comparison at 95% CI, between both years, the improvement was only noticeable in the 15 year-old group. The care index continued to be low at 6 years of age but higher values than in 2004 were found at 12 and 15 years. Social class continued to influence the child caries indicators

Need for Orthodontic Treatment in Pupils Aged between 12 and 15 in the Valencian Region (Spain)

The World Health Organization recommends carrying out periodic epidemiological studies in order to provide a basis for the evaluation of the state of health of the population at any given time; in doing so, action strategies can be established for the treatment of different pathologies. The objective of this study is to evaluate the need for orthodontic treatment in adolescents at school aged between 12 and 15 in the Spanish autonomous region known as Comunidad Valenciana (hereafter: Valencian Region). A cross-sectional study was carried out on a sample of 539 12-year-old schoolchildren and 460 15-year-olds, respectively, selected by cluster sampling and representative of the school-aged population of the Valencian Region, using the IOTN-DHC, IOTN-AC, and DAI indices. The need for specific orthodontic treatment according to the IOTN-DHC was 12.6% at 12 years and 7% at 15. For the IOTN-AC and DAI indices, the treatment needs were 4.3% and 0.9% at 12 years and 30.1% and 20.9% at the age of 15. These results were similar to those obtained in the previous study carried out on the same target population. There was no significant association between the need for treatment and gender or social class. We conclude that the need for orthodontic treatment presents values similar to those obtained in 2010

Knowledge and perception regarding molar incisor hypomineralisation among dental students and dental hygienist students in Spain: a cross-sectional study

Abstract Background Molar incisor hypomineralisation (MIH) has a high prevalence in the Spanish pediatric population and is a precursor of carious lesions in teeth in which it is present. Although this pathology is included in the curricula of the Degree in Dentistry and the Training Cycle in Oral Hygiene in our country, the contents currently taught seem to be insufficient in relation to the level of knowledge that we have today about this condition. Methods A digital questionnaire of 18 questions was sent to a sample of 448 students attending the 4th and 5th year of the Degree in Dentistry and 2nd year of the Training Cycle in Oral Hygiene from different universities and vocational training centers in the Valencian Community. Descriptive and multivariate statistical analysis of the data was subsequently performed. Results Of the 290 questionnaires that were obtained, 53.8% were from students attending the 2nd year of a training course in oral hygiene and 46.2% were from students pursuing a degree in dentistry. Most of the respondents had heard about MIH (75.2%), mainly through master classes. However, most students had difficulties distinguishing MIH lesions from other lesions (58.3%). The degree of knowledge about MIH was greater among dental students in all the aspects evaluated: prevalence, diagnosis, prevention, and treatment. Of all the students, 83.8% were interested in increasing their training on MIH, especially in the areas of diagnosis and treatment. Conclusion The results of the present study justify the need to expand the content on MIH, both theoretical and practical, in the educational curricula of the Degree in Dentistry and Integrated Vocational Training Centers in Spain

Meta-Analysis of the Use of 8-OHdG in Saliva as a Marker of Periodontal Disease

The objective was to collect the available evidence on oxidative stress marker measurements in periodontal patients, focusing specifically on 8-hydroxy-2′-deoxyguanosine (8-OHdG) as a salivary marker of periodontal disease, and to perform meta-analyses to calculate differences in concentration compared to healthy persons. A systematic search in PubMed, Cochrane Library, Embase, and Scopus identified 81 articles. Of these, 38 were duplicates. After reading the abstracts of the remaining 43, 42 were selected for full-text assessment. Finally, 17 articles were included in the qualitative synthesis. Those excluded were of low quality, did not answer the research question, or did not meet the inclusion and exclusion criteria. Of the 17 in the qualitative synthesis, 9 were included in the meta-analysis. The 9 studies in the meta-analysis were combined in a random effects model. Their heterogeneity was high (Q=3982.02, p<0.001, I2=99.8%). The difference in mean 8-OHdG concentration in saliva between periodontal and healthy subjects was estimated at 2.11 ng/ml (95% CI 1.23–2.98). The different saliva collection methods (stimulated/unstimulated) did not explain the heterogeneity. The 8-OHdG levels in saliva of periodontal patients were almost double to those of healthy patients: 8-OHdG is clearly a powerful periodontal disease marker

Association between passive tobacco exposure and caries in children and adolescents. A systematic review and meta-analysis.

To examine the available evidence on the association between exposure to tobacco use in the womb and in infancy and the presence of caries in primary and permanent dentition in children and adolescents. A systematic review was conducted through searches in 4 data bases (Pubmed, Scopus, Embase and Web of Science), complemented by hand-searching. Of the 559 articles identified, 400 were duplicates. Finally, 28 articles were included in the qualitative review and 21 in the meta-analysis. Their quality was assessed using the Newcastle-Ottawa scale. The quality was medium in 44% of the articles included and high in 56%. The overall meta-analysis gave a significant odds ratio (OR = 1.53, 95% confidence interval 1.39-1.68, Z test p-value = 0.000) and high heterogeneity (Q = 200.3, p = 0.000; I2 = 86.52%). Separate meta-analyses were also performed for three subgroups: exposure in the womb (prenatal) and caries in primary dentition, which resulted in a significant OR = 1.46 with a 95% CI of 1.41-1.52 (Z test p = 0.000), without heterogeneity (Q = 0.91, p = 0.824; I2 = 0%); exposure in infancy (postnatal) and caries in primary dentition, with OR = 1.72 (95% CI 1.45-2.05) and high heterogeneity (Q = 76.59, p = 0.00; I2 = 83.01%); and postnatal exposure and caries in permanent dentition, with OR = 1.30 (95% CI 1.25-1.34) and no heterogeneity (Q = 4.48, p = 0.880; I2 = 0%). In children and adolescents, a significant though moderate association was found between passive tobacco exposure and caries

Diagnostic Validity of Digital Imaging Fiber-Optic Transillumination (DIFOTI) and Near-Infrared Light Transillumination (NILT) for Caries in Dentine

The objective of the study is to analyse the available evidence for the validity of the transillumination method in the diagnosis of interproximal caries. Bibliographic searches were carried out in three data bases (PubMed, Embase, Scopus) with the key words &ldquo;Transillumination AND caries&rdquo;. A total of 11 studies were selected for the qualitative analysis and meta-analysis. In the qualitative analysis, both in vivo and in vitro studies were included. The gold standards were tomography, digital radiography, and clinical visual diagnosis. The meta-analysis determined the sensitivity, specificity, and area below the ROC curve relative to the transillumination method in the diagnosis of caries in dentine. Meta-analysis results obtained for transillumination gave a sensitivity value of 0.69 (confidence interval: 0.54&ndash;0.81), a specificity value of 0.89 (confidence interval: 0.61&ndash;0.98), while giving an AUC value of 0.79 (confidence interval: 0.67&ndash;0.87). Transillumination is a method offering moderate validity in the diagnosis of carious lesions in dentine, there is no strong evidence that may enable us to affirm that transillumination may fully substitute X-rays in the complementary diagnosis of carious lesion

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821–0.933) and inter-examiner (0.817–0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686–1.000) and inter-examiner (0.809–0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis

Factors related to the psychological impact of malocclusion in adolescents

Abstract To study the association between orthodontic treatment need and the psychosocial impact of dental aesthetics in a sample of adolescents, as well as other associated factors. A transversal study was conducted on 1,158 adolescents (12–16 years old) examined at the schools selected for the 2018 epidemiological study on oral health in the Comunidad Valenciana (Spain). The need for orthodontic treatment was determined by DAI and IOTN. The psychosocial impact was established by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Other variables considered were sex, social class, DMFT index and Body-Mass Index, and having previously worn or presently wearing an orthodontic device. A lineal regression statistical technique was applied to study the significant associations with the scoring obtained in PIDAQ. The PIDAQ scores revealed a significant and positive lineal relationship with regard to need for orthodontic treatment: DAI (ẞ = 0.20) and IOTN-DHC (ẞ = 4.87), in women (ẞ = 2.66) and a negative one for having previously worn an orthodontic device (ẞ = − 5.74). The rest of the variables had no statistical significance (p > 0.05). The psychosocial impact of dental aesthetics in adolescents is associated with the presence of malocclusion and the female sex, while the condition of having previously worn an orthodontic device reduces the psychosocial impact

Relationship between Periodontal Condition of the Pregnant Woman with Preterm Birth and Low Birth Weight

The aim of this study was to determine the association between the mother’s periodontal condition and perinatal complications, such as preterm birth (PTB) and/or low birth weight (LBW), in a cohort of women in Valencia, Spain. Other related factors, such as tobacco, were also analysed. A prospective cohort study was carried out in a sample of 102 women with a single foetus and ages ranging between 18 and 42 years. Sociodemographic and obstetric variables, caries status, percentage of bleeding, clinical attachment loss (CAL), and probing pocket depth (PPD) data have been collected and analysed. The mean age was 32.4 years, and the BMI was normal. The average weight of new-borns (NB) was 3034 g. A total of 9.8% of the women smoked during their pregnancy. Bleeding percentage was 16.43% (SD 14.81%) and PPDs > 3 mm 8.8 (SD 11.08). The mean of CAL > 0 mm was 1.14 (SD 2.83). The frequency of PTB and LBW was 26%. No statistically significant differences were found between probing depth > 3 mm or CAL > 1 mm, with PTB and/or LBW. Periodontal disease in the mother was not statistically significantly related to either PTB or LBW. Tobacco use during pregnancy showed a statistical significance linked to LBW, but not with PTB