Usefulness of health triangulation

Los inicios de la triangulación como estrategia metodológica en investigación se dan a partir de la segunda mitad del siglo XX, específicamente, en investigación cualitativa cuando fue empleada como una estrategia para corroborar los hallazgos provenientes de dos fuentes de información diferentes. Posteriormente se empezó a utilizar como una estrategia para lograr completitud del fenómeno bajo estudio. La utilidad de la triangulación radica en que esta proporciona una mayor flexibilidad en la interpretación de los datos debido a que con el empleo de diferentes fuentes se estará buscando obtener una imagen más completa del problema. La triangulación puede darse en diversos niveles, no solo en los métodos y puede emplear un amplio rango de técnicas. El proceso de triangulación es una tarea ardua debido a que se tratan de mediar las diferencias entre dos o más fuentes de información, enfoques metodológicos, diseños, perspectivas teóricas, investigadores y análisis de datos para compensar las debilidades de una sola estrategia con el fin de lograr integridad o confirmación de los hallazgos.Artículo original108-112The beginnings of triangulation as a methodological strategy in research ocurred in the second half of the 20th century, specifically, in qualitative research when it was used as a strategy to corroborate the findings from two different sources of information. Subsequently, it began to be used as a strategy to achieve completeness of the phenomenon under study. The usefulness of triangulation is that it provides greater flexibility in the interpretation of the data because with the use of different sources a more complete picture of the problem is obtained. Triangulation can occur at various levels, not only in the methods and can use a wide range of techniques. The triangulation process is an arduous task because it tries to mediate the differences between two or more sources of information, methodological approaches, designs, theoretical perspectives, researchers and data analysis to compensate the weaknesses of a single strategy to achieve integrity or confirmation of the findings

Utilidad de la triangulación en salud

Los inicios de la triangulación como estrategia metodológica en investigación se dan a partir de la segunda mitad del siglo XX, específicamente, en investigación cualitativa cuando fue empleada como una estrategia para corroborar los hallazgos provenientes de dos fuentes de información diferentes. Posteriormente se empezó a utilizar como una estrategia para lograr completitud del fenómeno bajo estudio. La utilidad de la triangulación radica en que esta proporciona una mayor flexibilidad en la interpretación de los datos debido a que con el empleo de diferentes fuentes se estará buscando obtener una imagen más completa del problema. La triangulación puede darse en diversos niveles, no solo en los métodos y puede emplear un amplio rango de técnicas. El proceso de triangulación es una tarea ardua debido a que se tratan de mediar las diferencias entre dos o más fuentes de información, enfoques metodológicos, diseños, perspectivas teóricas, investigadores y análisis de datos para compensar las debilidades de una sola estrategia con el fin de lograr integridad o confirmación de los hallazgos

Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction Relação entre a proteína C ultrarreativa, diabetes e doença periodontal em pacientes com ou sem infarto do miocárdio

ABSTRACT Objective: The purpose of this study was to evaluate the impact of diabetes and periodontal disease in us-CRP, an inflammatory marker in patients with and without acute myocardial infarction (AMI). Subjects and methods: A case-control study was conducted in 401 subjects aged between 30 and 75 years, living in Bogotá D.C. (Colombia). Patients arriving at the emergency room of the San Ignacio University Hospital with AMI were included into the case group. The control group was defined as those subjects without AMI. The following blood tests were performed: complete blood count (CBC), glycemia, total cholesterol, triglycerides, cHDL, cLDL, and us-CRP. Patients with infections or antibiotic treatment within the last three months, who had received periodontal treatment within the six months prior to the study entry, had oral ulcerations, or less than seven teeth were excluded from the study. Periodontal disease was diagnosed based on the 1999 Armitage's classification. Results: The mean us-CRP value found in diabetic patients with severe chronic periodontitis was 5.31 mg/L (SD 6.82), and 2.38 mg/L (SD 4.42) in non-diabetic patients, being statistically significant (p = 0.000). Conclusion: Diabetes had an impact in periodontal disease and us-CRP. In patients with AMI, DM and PD considerably increased the us-CRP. Arq Bras Endocrinol Metab. 2014;58(4):362-8 Keywords Diabetes mellitus; periodontal disease; cardiovascular disease; inflammation; C-reactive protein RESUMO Objetivo: O objetivo deste estudo foi avaliar o impacto do diabetes e da doença periodontal na us-CRP, um marcador inflamatório em pacientes com ou sem infarto agudo do miocárdio (IAM). Sujeitos e métodos: Um estudo caso-controle foi conduzido em 401 sujeitos com idades entre 30 e 75 anos que moravam em Bogotá D.C. (Colômbia). Os pacientes que chegavam ao pronto--socorro do hospital universitário de San Ignacio com IAM foram incluídos no grupo caso. O grupo controle foi definido por sujeitos sem IAM. Foram feitos os seguintes exames de sangue: contagem total de eritrócitos (CTE), glicemia, colesterol total, triglicérides, cHDL, cLDL e us-CRP. Os pacientes com infecções ou em tratamento com antibióticos nos últimos três meses, que receberam tratamentos periodontal nos seis meses anteriores ao estudo, tinham úlceras orais ou menos de sete dentes foram excluídos do estudo. A classificação de Armitage de 1999 foi usada para definir a doença periodontal. Resultados: O valor médio de us-CRP observados em pacientes diabéticos com periodontite crônica grave foi 5,31 mg/L (SD 6,82) e 2,38 mg/L (SD 4,42) em pacientes não diabéticos, um valor estatisticamente significativo (p = 0,000). Conclusão: O diabetes tem um impacto na doença periodontal e na us-CRP. Em pacientes com IAM, DM e DP, a us-CRP foi consideravelmente mais alta. Arq Bras Endocrinol Metab. 2014;58(4):362-8 Descritores Diabete

Relação entre a proteína C ultrarreativa, diabetes e doença periodontal em pacientes com ou sem infarto do miocárdio

Artículo original362-368Objective: The purpose of this study was to evaluate the impact of diabetes and periodontal disease in us-CRP, an inflammatory marker in patients with and without acute myocardial infarction (AMI). Subjects and methods: A case-control study was conducted in 401 subjects aged between 30 and 75 years, living in Bogotá D.C. (Colombia). Patients arriving at the emergency room of the San Ignacio University Hospital with AMI were included into the case group. The control group was defined as those subjects without AMI. The following blood tests were performed: complete blood count (CBC), glycemia, total cholesterol, triglycerides, cHDL, cLDL, and us-CRP. Patients with infections or antibiotic treatment within the last three months, who had received periodontal treatment within the six months prior to the study entry, had oral ulcerations, or less than seven teeth were excluded from the study. Periodontal disease was diagnosed based on the 1999 Armitage’s classification. Results: The mean us-CRP value found in diabetic patients with severe chronic periodontitis was 5.31 mg/L (SD 6.82), and 2.38 mg/L (SD 4.42) in non-diabetic patients, being statistically significant (p = 0.000). Conclusion: Diabetes had an impact in periodontal disease and us-CRP. In patients with AMI, DM and PD considerably increased the us-CRP

Association between periodontal disease and endothelial dysfunction in smoking patients

Q329-35Over the past two decades, there has been increasing interest in the impact of oral health on cardiovascular disease, particularly regarding the effects of chronic infections such as periodontitis on the endothelium. The aim of this study was to evaluate in healthy smokers whether there are any significant differences in the frequency of endothelial dysfunction between subjects with chronic moderate to severe periodontal disease and periodontally healthy subjects. An observational cross-sectional study was conducted. The target population was adults older than 40 years of age. Blood tests were performed to determine values of CBC, glycaemia, total cholesterol, HDL-C, and LDLC. Periodontal examinations and probing were conducted with a Florida Probe®, and standardized procedures were used to measure flow-mediated dilation. Out of 150 subjects [69 male (46%) and 81 female (54%)], 75 (50%) had chronic periodontitis. The mean value for baseline flow-mediated dilation was 4.04% and the mean value for final flow-mediated dilation was 4.66%, with a 0.62% mean difference showing a statistically significant increase (p<0.001).This study found no significant difference in the flow-mediated dilation values between periodontally healthy subjects and those with periodontitis, in contrast to the literature, which suggests a negative impact of periodontal disease on endothelial function

Comparison of Values of C-Reactive Protein in Edentulous Patients and Patients with Chronic Moderate-to-Advanced Periodontal Disease at the Pontificia Universidad Javeriana Dental School in Bogotá

Antecedentes: La enfermedad periodontal (EP) es un factor de riesgo para desarrollar enfermedadescardiovasculares. Puede influir e iniciar una reacción autoinmune, aumentandola inflamación sistémica y acelerando la progresión de placas ateroescleróticas prexistentes.Ante inflamación aumenta la concentración de proteína C-reactiva (medida por PCR-us),que está relacionada con ateroesclerosis y riesgo cardiovascular. Se ha encontrado queel valor de PCR-us es significativamente mayor en pacientes con periodontitis. Objetivo:Determinar si existen diferencias significativas en los valores de PCR-us de pacientes conEP crónica entre moderada y avanzada no tratada y pacientes edéntulos totales comomarcador de ausencia de EP. Métodos: El diseño fue de casos y controles con una muestrade 60 pacientes mayores de 30 años de edad (30 casos con periodontitis crónica moderadaa avanzada y 30 controles edéntulos totales). Se tomó una muestra de sangre a todos lospacientes (cuadro hemático, colesterol, triglicéridos, glucemia, PCR-us) y se analizaron loshallazgos. Resultados: El promedio de PCR-us en los pacientes con periodontitis fue 2,19mg/L, y en los pacientes edéntulos, de 4,12 mg/L. Existe una tendencia a hallar valoresde PCR-us más elevados en pacientes edéntulos, al considerar que se encontró mayorexposición al riesgo en los pacientes con periodontitis. Los resultados no fueron estadísticamentesignificativos. Conclusión: La PCR-us se presentó más aumentada en los pacientesedéntulos totales y los valores de PCR-us en pacientes con periodontitis no se observaroncomo un factor de riesgo elevado para enfermedad cardiovascular. Background: Periodontal disease (PD) is a risk factor for cardiovascular disease. It caninitiate an autoimmune reaction, increase systemic inflammation, and accelerate the progressionof preexisting atherosclerotic plaques. In presence of inflammation, PD increasesthe concentration of C-reactive protein (measured through hs-CRP) that is associated withatherosclerosis and cardiovascular risk. It has been found that the value of hs-CRP is significantlyhigher in patients with periodontitis. Objective: Determine if there are significantdifferences in the values of hs-CRP among patients with untreated moderate-to-advancedchronic PD and edentulous patients (marker of absence of PE). Methods: A case-controlstudy was carried out with a sample of 60 patients older than 30 years of age (30 cases withmoderate-to-advanced chronic periodontitis diagnosed and 30 edentulous controls). Bloodsamples were taken from all patients (complete blood count, cholesterol, triglycerides, glucose,hs-CRP) and the results were compared. Results: The average hs-CRP in patients withperiodontitis was 2.19 mg/L and 4.12 mg/L in edentulous patients. There is a tendency tofind values higher of hs-CRP in edentulous patients, given that there was higher exposure inpatients with periodontitis. The results were not statistically significant. Conclusion: hs-CRPwas higher in edentulous patients and hs-CRP values in patients with periodontitis were notseen as a high risk factor for cardiovascular disease.95-10

Patients with obstructive sleep apnea can favor the predisposing factors of periodontitis by the presence of P. melaninogenica and C. albicans, increasing the severity of the periodontal disease

Q2Q2Pacientes con PeriodontitisPacientes con Apnea obstructiva del sueñoObjective: The aim of this study was to analyze the cultivable oral microbiota of patients with obstructive sleep apnea (OSA) and its association with the periodontal condition. Methods: The epidemiology profile of patients and their clinical oral characteristics were determined. The microbiota was collected from saliva, subgingival plaque, and gingival sulcus of 93 patients classified into four groups according to the periodontal and clinical diagnosis: Group 1 (n = 25), healthy patients; Group 2 (n = 17), patients with periodontitis and without OSA; Group 3 (n = 19), patients with OSA and without periodontitis; and Group 4 (n = 32), patients with periodontitis and OSA. Microbiological samples were cultured, classified, characterized macroscopically and microscopically, and identified by MALDI-TOF-MS. The distribution of complexes and categories of microorganisms and correlations were established for inter- and intra-group of patients and statistically evaluated using the Spearman r test (p-value <0.5) and a multidimensional grouping analysis. Result: There was no evidence between the severity of OSA and periodontitis (p = 0.2813). However, there is a relationship between the stage of periodontitis and OSA (p = 0.0157), with stage III periodontitis being the one with the highest presence in patients with severe OSA (prevalence of 75%; p = 0.0157), with more cases in men. The greatest distribution of the complexes and categories was found in oral samples of patients with periodontitis and OSA (Group 4 P-OSA); even Candida spp. were more prevalent in these patients. Periodontitis and OSA are associated with comorbidities and oral conditions, and the microorganisms of the orange and red complexes participate in this association. The formation of the dysbiotic biofilm was mainly related to the presence of these complexes in association with Candida spp. Conclusion: Periodontopathogenic bacteria of the orange complex, such as Prevotella melaninogenica, and the yeast Candida albicans, altered the cultivable oral microbiota of patients with periodontitis and OSA in terms of diversity, possibly increasing the severity of periodontal disease. The link between yeasts and periodontopathogenic bacteria could help explain why people with severe OSA have such a high risk of stage III periodontitis. Antimicrobial approaches for treating periodontitis in individuals with OSA could be investigated in vitro using polymicrobial biofilms, according to our findings.https://orcid.org/0000-0003-0006-7822https://orcid.org/0000-0003-2528-9632https://orcid.org/0000-0002-1387-1935https://orcid.org/0000-0003-1011-4450https://orcid.org/0000-0002-4069-4719https://orcid.org/0000-0001-5576-9341https://orcid.org/0000-0002-9884-9242https://orcid.org/0000-0003-1803-9141https://orcid.org/0000-0003-1302-5429Revista Internacional - IndexadaA1N

Prevalence of dental caries in pregnant Colombian women and its associated factors

Abstract Objective To identify the prevalence of dental caries in pregnant women in the Colombian population and its association with the medical history and social determinants, based on data from the fourth National Oral Health Survey (ENSAB IV). Materials and methods A total of 1,047 pregnant women from different areas of Colombia were evaluated. A dental evaluation was performed using a flat oral mirror and blunt-tipped probe (World Health Organization, 2007). For diagnosis of the dental condition, the DMFT index was used. A negative binomial regression analysis was performed to evaluate the association between social determinants and the DMFT index. Results The results of this national study show a 59% prevalence of caries in this population. Regarding the experience of caries, 89.9% of pregnant women showed having had caries. Conclusions The results of this national study on pregnant women show a high prevalence of dental caries. The women’s level of education is an important factor associated with dental caries and filled teeth, so the role of oral health education and dental check-ups are important. Clinical relevance The findings of this study show the oral health situation of pregnant women, with a high prevalence of dental caries. This leads to the development and strengthening of oral health education strategies that empower pregnant women in their care. In addition, dental checkups during pregnancy should be implemented and reinforced to prevent and treat oral pathologies and thus prevent complications during this stage

Comportamiento epidemiológico de la caries dental en Colombia / Epidemiology of Dental Caries in Colombia

La caries se ha considerado un problema de salud pública por ser uno de los motivos de consulta más frecuente, debido a las altas prevalencias reportadas en la población colombiana. En este artículo se pretende, a partir de algunos de los datos reportados en los estudios nacionales, locales y académicos, describir la tendencia del comportamiento de la caries dental en la población colombiana, particularmente en la población escolar, pues es en ella donde se realizan la mayoría de estudios epidemiológicos. La caries dental en Colombia continúa presentándose en una gran parte de la población con una ligera disminución en los escolares afectados; pero con una menor gravedad de la enfermedad, posiblemente debido a la aplicación de medidas preventivas y al diagnóstico y tratamiento de las lesiones en etapas iniciales. Dental caries has been considered a public health problem since it is one of the most frequent reasons for dental visit because of the reported high prevalence in the Colombian population. This article analyzes some of the data reported in national, local, and academic studies in order to recognize major trends of dental caries in the Colombian population, particularly among schoolchildren because it is where most epidemiological studies have been done. Dental caries in Colombia continues to be present in a large proportion of the population with a slight decrease in schoolchildren affected, but with less severity, possibly due to the implementation of preventive measures, as well as diagnosis and treatment of initial stage lesions

Análisis con microscopía electrónica de la durabilidad de cuatro marcas comerciales de fresas de diamante al desgastar dientes naturales / Durability Analysis through Electronic Microscopy of Four Diamond Bur Brands after Preparing Natural Teeth

Background: Using elements with appropriate state and cut, is the method of choice to ensure the surface doesn’t lose the initial moisture and avoid later injuries, or pulp overheating, if a blunt or worndown tool is used. Little information is available about wear efficiency of diamond coated burs, that also relates the amount and quality of diamonds on the surface of the rotary instrument, according to the number of uses, and the deleterious effects of the diamond coated burs upon the pulp, and the influence over the dentinal sensitivity of the patient. Aim: To evaluate the durability of cut diamonds on the active surface of the high speed diamond coated burs, after making a number of wears on natural teeth, thus providing a margin of use of diamond coated burs. Methods: An ex vivo study comparing four commercial brands of rotary diamond instruments grain within the range (64 -126 microns) tapered round toe type (ISO 850) was conducted: MDT® (ISRAEL), SWISSTECH® (COLTENE-SWITZERLAND), POINTECH® (CHINA), JOTA® (SWITZERLAND), after 5 clinical applications in dental enamel. Five cuts were made in enamel tooth crown. Subsequently, rotary instruments took scanning electron microscopy to observe: a) diamond substrate adhesion in the head and body, b) state of the diamond substrate in the head and body, after 5 cuts in enamel c) final state of the diamond rotary instrument used. Results: A qualitative and quantitative analysis was performed. The four brands tested were unchanged after 5 applications made to enamel, so that both the head and body had the same wear. Although all samples showed variations in some representative was most evident, the eviction and breaking of diamonds. Conclusion: It´s necessary to change the rotary diamond instruments, after 5 uses, to have a good coated tissue and to avoid pulp damage, or restorative materials adhesion failure.Antecedentes: El método de elección para asegurar que la superficie no pierda humectación y evitar lesiones posteriores o recalentamiento pulpar es la utilización de elementos rotatorios diamantados con adecuado estado y corte. La información disponible en la literatura, no relaciona directamente la eficiencia de desgaste de las fresas de diamante, con la cantidad y calidad de diamantes en la superficie del instrumento rotatorio ni establece un número de usos que determine la vida media del instrumento. Objetivo: Evaluar la durabilidad de los diamantes de corte sobre la superficie activa de los instrumentos rotatorios de alta velocidad, tras realizar cierto número de desgastes en dientes naturales, y así proporcionar un margen de uso de las fresas de diamante. Métodos: Se realizó un estudio ex vivo que comparó 4 marcas comerciales de fresas de diamante, grano dentro del rango (64 -126 micras) tipo troncocónica, punta redonda (ISO 850): MDT® (ISRAEL), SWISSTECH® (COLTENE-SUIZA), POINTECH® (CHINA), JOTA® (SUIZA), tras 5 usos clínicos. Se realizaron 5 cortes, cada uno de 0.16 mm de la corona del diente. Posteriormente, las fresas de diamante, se llevaron a microscopía electrónica de barrido, para observar: a) adhesión de diamantes a substrato en cabeza y cuerpo, b) estado de los diamantes en el substrato en cabeza y cuerpo, tras los 5 cortes clínicos y c) estado final de las fresas de diamante utilizadas. Se realizó un análisis cualitativo y cuantitativo. Resultados: Todas las fresas, de las 4 marcas evaluadas, presentaron cambios tras los 5 usos realizados, tanto la cabeza y el cuerpo del instrumento, tuvieron el mismo desgaste. Pese a que todas las muestras presentaron variaciones, fue representativo que en algunas fue más evidente el desalojo y fractura de los diamantes. Conclusión: Es necesario que, tras 5 usos clínicos de los instrumentos, se realice un cambio de este, para garantizar un desgaste realizado por los diamantes y no por fricción, y así evitar daños en la pulpa, y en la adhesión de los materiales restaurativos.