Evaluation of total, soluble and ionic fluoride concentration in whitening and desensitizing toothpastes

PURPOSES

Due to the popularity and increasing launch of toothpastes with whitening and sensitivity properties on the market, this study aimed to evaluate the fluoride concentrations in these products, since the concentrations of fluoride directly interfere with the anti-caries potential.

METHODS

This is an experimental, in vitro study, where 37 samples from different batches (n = 3) purchased in different countries, were analysed in duplicate, via the ion-selective electrode technique to verify the concentration (μg/g or ppm F-) of total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF). For a comparative data analysis, ANOVA was applied followed by a Tukey's test for multiple comparisons. The level of confidence adopted was 95%.

RESULTS

In the 37 assessed toothpastes, 45.9% contained NaF and 54.1% sodium monofluorophosphate (MFP). The TF found in the formulations ranged from 902.8 to 1539.4 ppm of F (mean: 1165.2 ± 179.3); fluoride concentration in the TSF fraction ranged from 708.8 to 1306.7 ppm of F (mean: 959.5 ± 162.4); IF results ranged from 101.9 to 1162.3 ppm of F (642.2 ± 294.1). Significant differences (p < 0.05) were found in the concentrations of the 59.5% assessed toothpastes in comparisons between declared and measured total fluoride (TF) concentrations, as well as in 62.2% when total fluoride (TF) and total soluble fluoride (TSF) were compared.

CONCLUSIONS

In this study, most of the samples evaluated showed discrepancies when compared to the information declared by the manufacturers. In addition, the soluble concentrations found in half of the samples were lower than total concentrations and this may affect anti-caries effectiveness.

Monocyte immunometabolic reprogramming in human pregnancy: contribution of trophoblast cells

Immunometabolism research is uncovering the relationship between metabolic features and immune cell functions in physiological and pathological conditions. Normal pregnancy entails a fine immune and metabolic regulation of the maternal-fetal interaction to assist the energetic demands of the fetus with immune homeostasis maintenance. Here, we determined the immunometabolic status of monocytes of pregnant women compared with nonpregnant controls and its impact on monocyte anti-inflammatory functions such as efferocytosis. Monocytes from pregnant women (16-20 wk) and nonpregnant age-matched controls were studied. Single cell-based metabolic assays using freshly isolated monocytes from both groups were carried out in parallel with functional assays ex vivo to evaluate monocyte efferocytic capacity. On the other hand, various in vitro metabolic assays with human monocytes or monocyte-derived macrophages were designed to explore the effect of trophoblast cells in the profiles observed. We found that pregnancy alters monocyte metabolism and function. An increased glucose dependency and enhanced efferocytosis were detected in monocytes from pregnant women at resting states, compared with nonpregnant controls. Furthermore, monocytes display a reduced glycolytic response when stimulated with lipopolysaccharide (LPS). The metabolic profiling of monocytes at this stage of pregnancy was comparable with the immunometabolic phenotypes of human monocytes treated in vitro with human first trimester trophoblast cell conditioned media. These findings suggest that immunometabolic mechanisms are involved in the functional shaping of monocytes during pregnancy with a contribution of trophoblast cells. Results provide new clues for future hypotheses regarding pregnancies complicated by metabolic disorders.NEW & NOTEWORTHY Immunometabolism stands as a novel perspective to understand the complex regulation of the immune response and to provide small molecule-based therapies. By applying this approach to study monocytes during pregnancy, we found that these cells have a unique activation pattern. They rely more on glycolysis and show increased efferocytosis/IL-10 production, but they do not have the typical proinflammatory responses. We also present evidence that trophoblast cells can shape monocytes into this distinct immunometabolic profile.

Core curriculum in cariology for dentistry degrees in the Republic of Argentina

Aim

To prepare a consensus document of the cariology contents and competences included in the curriculum for the dentistry degree at Argentine dental faculties/schools.

Materials and Method

Planning the process in stages: Stage 1- Diagnosis of the situation (Google Form) and invitation to participate extended to the 20 academic units (AU) that offer dentistry degrees. Stage 2- Assessment process of Content (C) and Competences (I) agreements in the five domains: D1 Basic Sciences, D2 Risk and diagnosis of dental caries, D3 Decision-making for non-invasive treatments, D4 Decision-making for invasive treatment, and D5 Evidence-based cariology at community level. Stage 3- Consensus. Stages 2 and 3 were held in Workshop format in virtual mode (W).

Results

Stage 1- Of the total 20 Google forms sent to the AU, 13 responses were received: 7 from National Universities and 6 from Private Universities. All participants agreed to be part of the consensus. Stage 2- W: 20 representatives from 10 AU participated. It began with a contextualizing conference, after which the representatives were divided into 5 groups to assess the agreements of each D. Stage 3- The Cariology Curriculum document was organized into 5 Domains, and 23 C and 31 I of clinical application were defined for teaching cariology. The contents and competences for each domain were agreed upon. The final document was sent to all W participants for their approval and dissemination in each AU involved.

Conclusion

Cariology contents were defined for dentistry students at Universities in the Argentine Republic.

Fluoride in drinking groundwater and prevalence of fluorosis in children and adolescents: A systematic review

Fluorosis is a worldwide public health problem. One of the factors related to it is the type of water consumed, such as groundwater. High fluoride concentration in groundwater may be explained by contamination from local industries. Since fluoride and arsenic are the main pollutants of groundwater, some studies correlate groundwater consumption with high prevalence of fluorosis.

Aim

The aim of this study was to conduct a systematic review to determine whether children's risk of fluorosis is related to drinking groundwater.

Materials and Method

The protocol for this systematic review was registered at the National Institute of Health Research Database (CRD42021227298). A comprehensive search was conducted to identify potentially relevant studies by exploring a range of electronic databases (Medline via PubMed, Scopus, Cochrane Library, Science Direct, Web of Science Core Collection, Medline via Ovid, Lilacs, Embase, and grey literature).

Results

A total 2189 articles were found. After reading titles and abstracts, 63 were selected for screening, and the final data was extracted from 15 articles.

Conclusion

A relationship was identified between drinking fluoridated water from wells and the prevalence of fluorosis in individuals up to 18 years old. This is the first study to assess the issue systematically worldwide.

Core Cariology Curriculum Framework in Spanish for Latin American dental schools: development and consensus

The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants' agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Fluoride content in paediatric dentifrices commercialized in Brazil

OBJECTIVES

The aim of this study is to determine the total, soluble and ionic fluoride (IF) concentration in toothpastes for children since there is a lack of information about this data.

METHODS

Fifteen different brands of toothpastes were purchased in different cities in Brazil. The total fluoride (TF), total soluble fluoride (TSF) and IF of two samples of each brand were determined (μg/g F).

RESULTS

The concentration of TF found in the fluoride toothpastes ranged from 324.4 to 1466.2 μg/g F, TSF ranged from 214.6 to 1424.1 μg/g F and IF ranged from 108.3 to 1320.1 μg/g F. TSF ranged between TF and IF. Most toothpastes were formulated with sodium fluoride (NaF), and only one with monofluorophosphate (MFP). The concentrations of TF were below the reported values. TSF and IF were below the TF concentration.

CONCLUSIONS

The measured TF was less than that declared by the manufacturer in all the products. Most of the evaluated fluoride toothpastes commercialized in Brazil showed concentrations of TF below what was stated on the packaging, but with enough TSF to provide an anti-caries effect.

Fluoride concentration in dentifrices marketed In Argentina

OBJECTIVES

The objective of this study was to determine the different forms of fluoride available in dentifrices commercialized in Argentina.

METHODS

Thirty three different brands of fluoridated dentifrices were purchased in different cities of Argentina. The total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF) of two samples of each brand were analysed (μg F/ml) by ion-specific fluorine electrodes.

RESULTS

A total of 67% of dentifrices showed fluoride content that compromises anti-caries activity. A total of 54.5% was formulated with sodium fluoride (NaF), 36.3% formulated with sodium monofluorophosphate (MFP), 3% NaF associated with MFP and 9% formulated with stannous fluoride (SnF2). The TF found was less than the amount declared by the manufacturer in all the brands analysed. The concentration of TF found in the fluoride dentifrices ranged from 590.3 to 1381.4 μg/ml F, TSF ranged from 343.1 to 1258.3 μg/ml F, and IF ranged from 13.1 to 913 μg/ml F.

CONCLUSION

The concentrations of TF were below the reported values. TSF and IF were lower than the total fluoride concentration. Most of the samples studied have TSF concentration that compromises anti-caries effect. Additional studies with a larger number of samples are suggested to obtain more data.

Fluoride and silver ion concentrations and pH in silver diamine fluoride solutions from Argentina

The aim of this study was to measure the fluoride (F) and silver (Ag) ion concentration and the pH, over time, of 2 solutions of 38% silver diamine fluoride (SDF) produced in Argentina. The brand Fluorsilver® was established as Group 1 (G1) (Densell), and the brand FAgamin® (Tedequim) as Group 2 (G2), each with two different lots. The following were determined at time 0 (t0) and 30 days after opening (t30): a) fluoride concentration (w/v) by visible spectrophotometry b) Ag content (w/v) by atomic absorption spectrophotometry c) pH. Results: The data in the freshly opened bottles were for G1 lot1/lot2: a) 0.96/1, b) 8.3/7.8, c).11.5/11.3; G2 lot1/lot2: a) 11.5/9.9, b) 39/39, c) 7/6,9; and after 30 days, G1 lot1/lot2: a) 0.85/0.81, b) 7.2/8.2, c) 11.3/11.6; G2 lot1/lot2: a) 9.35/8.43, b) 38/38, c) 7.6/7.6. Conclusion In relation to the expected values (5.0-5.9% fluoride and 24.4-28.8% silver), the average concentration of fluoride and silver ions was lower for G1, but higher for G2. The pH was alkaline for G1 and neutral for G2. Over the 30 days, the content of fluoride and silver tended to decrease.

Fluoride concentration in teas derived from Camellia Sinensis produced in Argentina

To evaluate the fluoride concentration and pH of tea derived from Camellia sinensis produced and commercialized in Argentina. Forty-eight varieties of tea (black (n = 16), green (n = 21), red (n = 7), and white (n = 4)) commercialized in the form of leaves or tea bags were acquired. One bag or 2.0 ± 0.05 g of each product was infused for 5 min in 200 mL of distilled boiled water. The F^- concentration was determined using an ion-selective electrode and pH was measured using a pH meter. The found fluoride concentrations ranged from 0.1 to 9.7 µg/mL and the pH ranged from 2.7 to 5.1. A higher fluoride concentration was observed in the leaves group (2.75 ± 2.65 µg/mL) compared to tea bags (1.10 ± 0.82 µg/mL) (p < 0.05). Regarding the type of tea, green and black tea were richer in F^- than red and white tea. Fluoride and pH appeared not to be correlated (Pearson test). All the studied tea samples presented fluoride concentrations greater than the threshold recommended for drinking water. The pH proved to be low, which could be a risk for erosive tooth wear.

Gingival crevicular fluid from pregnant women impairs trophoblast cell function and trophoblast-neutrophil interaction

PROBLEM

A strong association between periodontitis and higher susceptibility to pregnancy complications like preeclampsia has been reported although the mechanisms remain elusive. Trophoblast cells modulate the recruitment and functional shaping of maternal leukocytes at early stages to sustain an antiinflammatory microenvironment and fetal growth. Neutrophil activation with reactive oxygen species (ROS) release is associated with preeclampsia. Our aim was to study the effect of the gingival crevicular fluid (GCF) from pregnant women on trophoblast cell function and trophoblast-neutrophil interaction.

METHOD OF STUDY

Pregnant women at 16-20 weeks of gestation (n = 27) and non-pregnant women (n = 8) as the control group were studied for gingivoperiodontal clinical score evaluation and GCF collection. Total bacteria and common periodontal pathogens were analyzed in GCF samples. The effect of each GCF sample was tested on first trimester trophoblast-derived cells to assess cell migration, cytokine expression and glucose uptake. Also, the effect of GCF on human peripheral neutrophil chemoattraction by trophoblast cells and ROS formation was assessed.

RESULTS

Gingival crevicular fluid from pregnant women reduced trophoblast cell migration, increased proinflammatory marker expression and glucose uptake. A significant correlation between gingivoperiodontal score and trophoblast dysfunction was observed. Upon conditioning of trophoblast cells with GCF, only the GCF from pregnant women stimulated neutrophil chemoattraction. Similarly, GCF from pregnant but not from non-pregnant controls stimulated ROS formation in neutrophils.

CONCLUSIONS

Gingival crevicular fluid from pregnant women is deleterious for first trimester trophoblast cell function. These effects could lead to placental homeostasis disruption underlying a pathogenic mechanism of pregnancy complications associated to periodontal disease.

Impact on oral health-quality of life in infants: Multicenter study in Latin American countries

To assess the impact of oral conditions on oral health-related quality of life (OHRQoL) in infants in ten Latin America countries (LAC). A cross-sectional study was conducted with 930 pairs of 1-to-3-year-old children/parents from 10 LAC, as a complementary study of the Research Observatory for Dental Caries of the Latin American Region. The scale ECOHIS, previously tested and valid in ten countries, was applied to parents/caregivers of children to measure OHRQoL. Statistical analysis included descriptive data analysis and one-way analysis of variance (ANOVA-One-Way) were performed to compare age groups with OHRQoL. Bootstrapping procedures (1000 re-samplings; 95%CI Bca) were performed. The mean scores of the ‘Child Impact’ section in the LAC was 4.0(±8.3), in the ‘Family Impact’ section was 2.0(±4.0), and in overall ECOHIS score was 6.0(±12.0). In the ‘Child Impact’ section, Argentina 10.0(+2.4) and Venezuela 17.8(±17.5) demonstrated mean scores higher than the LAC total data. In the ‘Family Impact’ section, the countries with higher mean scores were Argentina 4.9(±2.0), Ecuador 2.1(±3.1) and Venezuela 7.9(±7.8). In the overall ECOHIS score, Argentina 15.1 (±4.1) and Venezuela 25.7(±25.2) has higher mean scores than the values of LAC. There is an association between children's age and parents' report of impact on the OHRQoL (p<0.001). Three-year-olds had a higher mean when compared to one- and two-year-olds, both in the Impact on the Child and Impact on the Family (p<0.001) sections, as well as in the overall ECOHIS (p<0.001). In conclusion, there are differences in OHRQoL among Latin American countries, impacting older children more significantly.

Dental Emergency Admissions in Emergency Oral Health Care Centers during COVID-19 Pandemic in Buenos Aires, Argentina

This study aimed to describe patients’ demographic characteristics and treatment delivered in private and public dental emergency clinics and to compare them with a pre-pandemic period. A retrospective cross-sectional study was carried out on patients attending the University Dental Hospital of the University of Buenos Aires and on one private dental clinic, situated in Buenos Aires, between March and June of 2019 and 2020. The sample considered all the patients’ medical records of those requiring emergency dental treatment at these centers during that period. We systematize the treatments required and delivered by the emergency providers into categories. In 2019, 36,071 patients were treated at the university dental hospital and the private clinic. In 2020, 7485 patients received emergency treatment, showing a fivefold reduction. During a pre-pandemic period, in 2019, both oral care centers provided 44,894 treatments, around three times the treatments provided in 2020 during the same period. We have found significant differences in the age groups of people who required emergency treatment in the pandemic period compared to the pre-pandemic period. During the pandemic period, the most represented types of treatment were radiographic exams (3061) and tooth extractions (2583). Conversely, during the pre-pandemic period, the most frequent treatments were radiographic examinations (16,649) and general consultations (10,591). The percentages of all types of treatments differ significantly between the two years except for pediatric consultations and prosthetics emergencies. As the pandemic is still an ongoing sanitary problem, urgent dental care patterns should be considered.

A double-blind randomized clinical trial of Brazilian red propolis dentifrice efficacy in orthodontic patients

PURPOSE

The objective was to evaluate the efficacy of a dentifrice containing Brazilian Red Propolis (BRP) against salivary Lactobacillus spp. and plaque formation.

METHODS

This was a randomized, double-blind clinical trial. Forty-two participants were randomized into two groups according to the dentifrice employed: G1 (fluoridated BRP dentifrice) and G2 (fluoridated common dentifrice). Saliva was collected and the visible plaque index (VPI) was recorded at the baseline (D0) and 4 weeks after day 0 (D28). Microbiological analysis was performed using two dilutions. Lactobacillus spp. isolates were identified and their abundance was expressed as log (CFU/mL).

RESULTS

For the first dilution, the counts of Lactobacillus spp. in G1 was 1.15 ± 0.41 at D0 and 0.68 ± 0.15 at D28 (P < 0.05) and in G2 it was 1.33 ± 0.52 at D0 and 1.84 ± 0.39 at D28 (P < 0.05). For the second dilution, the corresponding values in G1 and G2 were 0.87 ± 0.34 and 0.64 ± 0.37, respectively (P = 0.1547), and 1.54 ± 0.47 and 1.62 ± 0.37, respectively (P = 0.9999). The corresponding VPI values for G1 and G2 were 38.10 ± 17.95 and 20.60 ± 16.44, respectively (P < 0.05), and 38.38 ± 19.65 and 27.40 ± 14.63, respectively (P = 0.03).

CONCLUSION

The dentifrice containing BRP showed antimicrobial activity against Lactobacillus spp. and decreased the VPI for up to 4 weeks.

Corrigendum to "Assesment of SARS-CoV-2 infection-in dentists and supporting staff at a university dental hospital in Argentina". Journal of Oral Biology and Craniofacial Research Volume 11, Issue 2 (2021) Pages 169-173

[This corrects the article DOI: 10.1016/j.jobcr.2021.01.006.].

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

Background

Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time.

Methods

In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate.

Discussion

The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.

Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01674-1.

Development and Innovation on Dental Products in Argentina: A Technological Prospecting Based on Patents

BACKGROUND

Argentina has progressed with industrialization in comparison to other Latin American countries and this process had a direct impact on the innovative capacity of the national economy. A constant search for market leadership, including the dentistry field and dental materials, stimulates the industries to launch new products daily. Inventions related to health researches are mostly protected by patents as intellectual property. A patent landscape analysis through searches in patent banks is a tool used to identify trends in different areas of innovations.

OBJECTIVE

This study aims to identify and evaluate the scenario of research, development and innovation of dental products in Argentina by a technological prospecting based on patents.

METHODS

A survey of patent documents was conducted by searching for deposited and granted patents of dental products. The search was carried out during January 2020 in the patent database of the National Institute of Industrial Property of Argentina (INPI-AR). The terms "dentistry", "buccal", "dental" and "oral" were used to select the titles and abstracts of patent application reports. The information extracted from patent reports was organized in tables and Figs using Fig.Pad Prism 6 software to evaluate the applications.

RESULTS

A total of 363 patents were published from 1989 to 2016, mainly by international industries, 93.3% as patent invention and 3.0% as utility model applications on dentistry. Only two patents (0.5%) were deposited by universities, as the University of Melbourne (Patent number 20060102378) and Universidad Nacional del Nordeste (Patent number 20140104149), among which only the last one is national. Among the deposits, only 6.6% were granted; mostly were in force, denied or lost. According to the specialties, most patents were related to compositions (64.7%) and personal products (21.7%), also on dentistry/cariology (6.33%) and prostheses/implants (4.68%).

CONCLUSION

In general, we find that most patent applications are related to the preventive area, personal products and compositions for formulations. Few dental patents deposits are currently available in Argentina, suggesting that the importation of products into the area remains large, which can make dental products more expensive. It is important to invest in technology-based companies to promote increased economic activity, being a consequence of an investment in knowledge creation and intellectual property to the Dentistry area.

Comprehensive clinics. A comparative study among Dental Schools in Argentina

In this study, comprehensive clinics (CC) are interpreted as a pragmatic projection of the complexity of health. The aim of the study was to analyze the characteristics of the CCs at different schools of dentistry in Argentina. Data were collected from document analysis and interviews with key respondents at 8 universities, classified according to the criteria of Bray and Thomas. Interviews were developed and analyzed according to discourse analysis. The convergences and divergences among curricula were established and analyzed statistically. Triangulation of results showed that: (a) Most curricula (7/8) included subjects called CC; (b) the permanence of CCs in the curricula was not stable, with changes recorded in different periods; and (c) in the so-called CCs, the complex clinical approach showed frequent displacements based on teacher values or competence. It was concluded that there are divergences between theory and practice, and that it would be recommendable to have more rigorous curricular design taking into account current trends regarding the complexity of health and its transfer to educational management.

Salud para Todos: Conceptualización y perspectivas

El objetivo de este documento es estimular un análisis basado en la evidencia acerca de la salud para todos. Está destinado a profesionales quienes, desde sus propias prácticas, operacionalizan y regulan frecuentemente, la atención de salud. Se describen los antecedentes acerca de las diversas conceptualizaciones desarrolladas por instituciones e investigadores sobre el tema hasta arribar a la perspectiva actual. Entender esta perspectiva implicará incorporar los desafíos propios del pensamiento complejo, ya que en ella confluyen los requisitos de equidad, interdisciplinariedad, intersectorialidad, transnacionalidad, las incertidumbres que crean las transformaciones de los contextos y las exigencias para cumplir eficazmente su cometido. Entre los actores en este escenario están las universidades quienes enfrentan la responsabilidad que les compete para dar cumplir con su misión social y cívica en la generación, difusión y aplicación de conocimientos tendientes a la salud para todos.

Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary teeth and rat molars

The aim of this study was to determine the effect of SDF on the dentin-pulp complex using two models: teeth after SDF application (ex vivo) and experimental animal molars. A descriptive study was performed using two models. In the first model, primary teeth (ex vivo) with enamel-dentin caries, without pulp involvement and previously treated with 38% SDF, were evaluated by means of two techniques: (a) Scanning Electron Microscopy (SEM) and energy-dispersive X-ray detector (EDS) to determine qualitative and quantitative composition, and (b) brightfield optical microscopy (OM) after decalcification. The second model used laboratory animal molars from 12 male Wistar rats. Standardized enamel-dentin cavities approximately 0.5 mm deep were made the distal fossa of the occlusal face of both first lower molars, to one of which a 38% SDF solution was applied, while the other was used as a control. Histological sections were prepared and dental pulp was evaluated qualitatively in both groups. SEM on ex vivo teeth showed areas of hypermineralization in the intertubular dentin and few blocked tubules, while EDS detected Ag in the center of the lesion (7.34%), its concentration declining at the edges (1.71%), with none in the areas farthest from the lesion. OM showed SDF sealing the tubules only at the site where it had been placed, with limited penetration beneath, the tubules appeared normal and the pulp tissue associated to treated caries showed chronic inflammatory infiltrate and formation of tertiary dentin, with no Ag precipitate. In the experimental animal model, pulp histology was not significantly altered in the molar cavities exposed to SDF. The observations using the different techniques on dental tissues suggest that SDF causes minimal adverse effects. The results of this study may contribute to further studies on the suitability of SDF as a cost-effective strategy for treating caries.

LAS MIGRACIONES Y LA SALUD BUCAL DESDE UNA PERSPECTIVA GLOBAL Documento de posición

<p>El presente documento de posición aborda los problemas referidos al componente bucal de la salud que se registran en la población de migrantes en Argentina y en el mundo. Se incluyen los siguientes puntos:</p><ol><li>Introducción</li></ol><ul><li>Características de los actores,  la creciente cifra y las consecuencias que acompan?an al trasplante migratorio  y,  con el mismo, los hábitos y costumbres alimentarios regidos por razones: a) climáticas, b) geológicas, c) económico-sociales, d) ambientales, e) laborales y f) de acceso a los alimentos.</li><li>Los escenarios en su complejidad donde interactúan características de ruralidad o urbanismo, el tránsito entre exclusión e inclusión social, entre equidad e inequidades, y las diferencias vinculadas con las diversas concepciones que son la expresión de los modos de vida propios de las culturas que representan, los que mantienen su vigencia luego de la migración.</li><li>La perspectiva teórica vigente en la actualidad respecto de la salud global y del papel de  los determinantes de salud.</li><li>Un análisis crítico de la metodología de algunos estudios referidos a la salud de las poblaciones migrantes</li></ul>

Dental status and dental treatment demands in preschoolers from urban and underprivileged urban areas in Mendoza city, Argentina

The aim of this study was to establish the association between dental status and demand for dental care in preschoolers at urban and underprivileged urban schools in the city of Mendoza. Dental status was diagnosed in a purposive sample of preschoolers at urban schools (Group U: n = 148) and underprivileged urban schools (Group UnU: n = 155) in Greater Mendoza city, by determining the following indicators: (a) caries-free children (%), and (b) dmft/DMFT and its discriminated components, including active non-cavitated enamel caries. The characteristics of demand for care were determined using an ad hoc structured questionnaire. The following were determined: frequency distributions and confidence intervals for categorical variables, measures of central tendency and dispersion, tests for differences in means (Student's t test), association (chi squared) and correlation among variables (Pearson's r), at a significance level p<0.05. Comparison of dental status variables between groups showed significantly higher values in group UnU for: d+D tooth (ẋ = 5.4} 3.8; t = 2.887; p = 0.004); dmft+DMFT (ẋ = 5.7}4.1; t = 0.466; p = 0.020); d+D surface (ẋ = 7.62} 6.2; t = 0.956; p = 0.014); f+F surface (ẋ = 0.12}4.5; t = 2.71; p = 0.007) and percentage of caries-free children (x2= 25.377; p= 0.018). The following trends were found in this group: higher demand on the government subsystem, fewer visits to the dentist (x2 = 7.02, p = 0.008) and greater difficulty in getting appointments (x2 = 19.91, pẋ0.001). Frequency of visits was associated to the severity of dental status (x2 = 19.412; pẋ0.001), but no correlation was found between frequency of visits during the past year and dmft+DMFT (Pearson's r coefficient = 0.091; p = 0.0426) Group U showed preferential demand for the private or "obra social" (trade union managed health insurance) systems (x2 = 78.85 p = 0.00) and there was no statistically significant association between visits to the dentist and dmft+DMFT categories (x2 = 2.781; p = 0.427), although there was direct correlation between frequency of visits during the past year and dmft+DMFT (Pearson's r coefficient = 0.486, p = 0.000). Preschoolers at UnU schools had higher caries indicators than preschoolers at U schools. For UnU the demand for care was related to the severity of dental status and situations of urgency, while U preschoolers demanded dental care in both health and disease, with a tendency to greater adherence to treatment. Actions to promote oral health in preschoolers should take into account both internal and external barriers to access to and use of oral health services.

Oral health status and oral health-related quality of life in pregnant women from socially deprived populations

The aim of the present work was to explore whether there is a relationship between oral health status and oral health-related quality of life in pregnant women from socially deprived populations in Buenos Aires City. Eighty pregnant women (age 18-39 x = 25.19 +/- 6.56) in their 1st/2nd trimester were sampled from the population of women visiting a health center located in the south of Buenos Aires City for their pregnancy check-ups. The impact of oral disease was assessed using the Spanish validated version (López, 2006) of OHIP-49 (Slade and Spencer, 1994), which includes 49 items grouped into 7 domains. Each question has five possible answers, to which values ranging from 1 to 5 were assigned. To assess oral health status, 4 calibrated researchers performed a clinical examination and recorded: Gingival Index (Löe and Silness, 1963); depth on probing, clinical attachment level, bleeding on probing and DMFT discriminating its components. Variables were analyzed in the population as a whole and in groups regarding previous dental attention (presence of fillings). Statistical analysis included: Chi Square test to establish association between variables and t-test to compare groups. 93.75% of the patients showed clinical signs of gingivitis, 2.5% showed clinical signs of periodontitis. Mean DMFT was 12.24 +/- 6.48 (D/DMFT = 6.46 +/- 4.64; M/DMFT = 4.09 +/- 4.31; F/DMFT = 2.53 +/- 3.52); 73.3% of the patients had at least one missing tooth; 92.1% presented active caries lesions; 53.7% had at least one filling. Most frequent impacts were reported in the domains: psychological discomfort (59.9% = frequent concern about dental problems) and functional limitation (51.1% = frequent perception that "a tooth did not look good"). Oral health status and oral health-related quality of life showed no significant association. Domains involving functional limitation (p < 0.04) and physical disability (p < 0.01) showed higher levels of impact in the group of patients with previous dental care (presence of fillings). Oral health-related quality of life did not reflect health status; nevertheless, it may be an intervenient variable regarding demand for dental service.

Early Childhood Oral Health Impact Scale (ECOHIS). Translation and validation in Spanish language

Health is currently recognized as lying in the individual process rooted in genes, personal habits, the social model and the understanding of the ideological standpoint from which it is viewed. The aim of this study was to validate the Early Childhood Oral Health Impact Scale (ECOHIS) for use in Latin American communities, in order to demonstrate its efficacy for determining the impact of dental condition on children under 5 years of age and their families. The ECOHIS explores two domains: impact on children (9 questions) and on families (4 questions). Validation in Spanish was done in four stages. Stage I included translation and back-translation of the questionnaire (English-Spanish-English). Stage II was a pilot test on families in Venezuela to test stability (test-retest) and make semantic adjustments. Stage III included validation of the questionnaire applied to a Venezuelan sample (n = 50) and two Argentine samples (A and B, made up of families with and without social risk, respectively; n = 95), and consisted of statistical analysis to check the questionnaire's internal consistency and discriminant capacity. In the final stage, parents were given feedback on the results and significance of each domain in the questionnaire. From the results of this study it may be concluded that the Spanish version of the ECOHIS was reliable and valid for administering to populations with homogeneous social risk, and that parents without social risk factors (AC/B) have significantly greater perception of the impact of oral health on the family's quality of life. The trends recorded suggest that (a) larger samples should be used, including variables for diagnosing social vulnerability or general risk, (b) the association with dental condition should be established by applying indicators to discriminate distinct cut-off points in the dental caries process and (c) it should be ascertained whether there are changes in perception of the impact on quality of life before and after dental treatments, including impact on general health condition.

Relationship between oral health in children and poverty related factors

The aim of this investigation was to analyze the variables related to poverty and its influence on oral health in children living in a suburban area ofBuenos Aires, Argentina. The study population consisted of 1,049 children. 579 children at social risk (Group I) were recruited from five neighborhoods with critical lacks (Katzman, 1989) and divided into 2 subgroups according to age: (A) preschool children and (B) school children. 470 preschool and school children from the same district but living in homes without critical lacks served as controls (Group II). The following variables associated with poverty were analyzed: (a) parents' instructional level, (b) employment conditions, and (c) accessibilty to regular oral health care. Group I comprised children from five neighborhoods categorized according to the incidence rate of each variable. Clinical examinations were performed under similar conditions by three calibrated investigators. DMFS, dmfs, total DMFS + dmfs, DS + ds, Care Index and Loe & Silness plaque index were recorded and analyzed using Students t test, ANOVA and Chi square test (level of significance p < 0.05). Dental indicators were significantly higher in Group I than in Group II. The dental caries indicators increased as the incidence rate of the poverty-related variables rose. The highest number of children with high cariogenic risk was observed in neighborhoods with the highest social risk (c2 = 30.48; p < 0.005). The analyzed poverty-related variables seemed to be associated with factors that play a role in the dental caries development process in school and preschool children living in the Metropolitan area of Buenos Aires.

Teachers' perception of oral health status. Design and validation of an evaluation instrument

The evaluation of health status is a complex process that requires the use of indicators that assess health both in terms of disease and of the impact the health-disease-care process has on the quality of life. The aim of the present study was to design and validate an instrument to evaluate teachers 'perceptions of oral health status. The sample comprised 78 teachers of 4 schools (province of Buenos Aires). DESIGN OF THE INSTRUMENT: (a) identification of the 5 categories that compose the instrument and can measure the object of study based on evidence; (b) creation of a questionnaire that contains 32 items by two researchers; (c) evaluation of the questionnaire by 5 professionals of 4 different professions to standardize criteria (Ventegodt et al, 2003) applying an ordinal scale. Items were reduced to 25 (Index of perception of oral health: IPOH). VALIDATION OF THE INSTRUMENT: the following parameters were evaluated: reliability employing the test-retest method at 30 days; internal consistency employing Cronbach's a coefficient (1951); content validity determined by two experts; construct validity employing the method of extreme groups (Student's t test). The established categories were knowledge on oral health, personal experience with oral health care, expectations regarding their students 'families, expectations regarding dentistry, satisfaction with his/her role as a teacher The instrument proved to be reliable as evidenced by a value of r = 0.80 in the test-retest method; a satisfactory intra-items consistency was evidenced by Cronbach's alpha coefficient value of 0.82. The differences between the results of the groups of teachers in the extreme groups were statistically significant (p = 2.2). The instrument designed to measure the teachers' perception of oral health status would be valid. It would be desirable to enlarge the sample and determine criterion validity by comparison with other instruments.

Efficiency of a schoolchildren program for oral care

The aim of this investigation was to evaluate the efficiency of an oral school program, applied during 3 years. DMFT index, the component D and CTNI of a sample of 590 children (Group I, aged 12.0 +/- 1.1 years) which received regular oral treatment during 3 consecutive years were compared with the same indicators of 586 children (Group II, aged 12.6 +/- 1.0 years) without treatment. The cost-benefit ratio of the current required treatments in both groups was calculated. Results revealed: (a) in Group I the component D of DMFT was 0.9 +/- SEM = 0.3, and in Group II, 5.5 +/- SEM = 1.5; and (b) the cost-benefit ratio of the required treatment for Group I ranged from 1.5 to 7.5 times lower than that required for cumulative pathology resolution in groups lacking preventive coverage. It seems advisable to introduce management strategies to change spontaneous demand into programmed care with a strong preventive component. The accomplishment of this regular school program appears to contribute to strengthen equity and could reduce the differences in oral health care among schoolchildren at different social risk.

Knowledge, behavior, and attitudes of adolescent university students towards HIV infection and AIDS

The aim of this study was to evaluate the knowledge, behavior, and attitudes of students entering the University of Buenos Aires (UBA) towards HIV/AIDS, as well as to determine the differences between genders and between groups with different behavior in terms of HIV/AIDS risk behavior, through the conduct of an ad hoc semi-structured questionnaire. This questionnaire was completed anonymously by 12,000 university students going in for compulsory medical check-up at the Health and Social Welfare Office of the UBA. Two thousand cases were selected by simple randomized sampling and statistically analyzed. Results revealed that: (1) 87.2% of the population under study was between 18 and 27 years old; (2) the students' knowledge of the subject was acceptable; (3) the percentage of respondents who reported having sexual intercourse with more than one person decreased as the number of sexual partners in a year increased. Less than 1.5% explicitly stated being homosexual or bisexual; (4) 53.9% of the men and 46.7% of the women claimed they always used condoms; (5) analysis of the perception of their own risk showed that 75% considered they were not at risk; (6) between 95.8% and 98% were in favor of developing educational-preventive activities and 64.2% thought compulsory AIDS screening for job applicants or candidates for educational courses was discrimination.

CONCLUSIONS

(a) Information available to admission course students is sufficient. However, there are contradictions in their responses about their own behaviors; (b) Most of the respondents are in favor of the corresponding Faculties implementing educational and preventive measures. The students would regard the University's intervention as a way of fulfilling its social role.

Relation between demographic and epidemiological characteristics and permanency under a dental health care program for HIV infected patients

The association between factors involved in health care and the health status of the people has been proven. The use of health care services, particularly in the case of patients who suffer from chronic pathologies, has been the object of many studies aimed at establishing factors which contribute to guarantee permanence in treatment and implementation of health care controls. The purpose of the present study was to identify the response of HIV infected or AIDS patients to the oral health care program and establish the association between permanence in treatment and the presence of risk factors, epidemiological or demographic conditions of the users. Ninety patients selected at random from the 300 who attended the Clinic for High Risk Patient Care, School of Dentistry, University of Buenos Aires (CLAPAR, Spanish acronym) during 1994-1995 were included in this study. The patients were assigned to one of seven groups, according to their permanence in treatment and commitment to the program during the phase of maintenance in health. Each of these categories was characterized in terms of age, sex, educational level, place of residence (CIRFS, 1990), type of job, type of health coverage and place where healthcare was received, risk behavior and date of positive serological diagnosis. The frequency of each variable was established. Contingency tables were employed to establish the statistical significance of the association between the different variables and the patient categories. The data revealed that 24.2% of the patients performed occasional or emergency consultation, 57.1% achieved discharge with or without the assistance of the social worker or are still in treatment and 18.7% abandoned the program. Significant association were found between the response to odontological treatment and the following variables: place of residence, date of positive serological diagnosis, and risk behavior. We may conclude that certain demographic, epidemiological or life-related factors would be linked to the response to odontological treatment.

Effect of self-brushing with acidulated phosphate fluoride (pH 5.6) on dental caries in children

The aim of this work was to study the effect of a preventive program on the dental plaque and on the caries incidence in school children. The program comprised weekly supervised self brushing with acidulated phosphate fluoride (APF) gel (pH 5.6; concentration: 4520 ppm of ion F-). The program involved 240 children of 1st., 3rd and 5th grade of a primary school in the City of Buenos Aires (Argentina). The population was divided in 2 groups: A (experimental) and B (control). Ninety children from both groups (45 experimental and 45 control) were submitted to baseline clinical examination (DMFT and plaque index) and microbiological analysis (total streptococci, St mutans and St. mutans and St. mutans percentage). Group A was then submitted to a preventive program which included self brushing with APF gel (4520 ppm of ion F-). The 90-children sample was monitored after 1 and 2 years of program. Results were statistically processed and they revealed the following: a--DMFT was significantly greater in the control group than in the experimental group after 1 and 2 years of program; b--an 81.43% reduction in caries increment rate at the end of the 2-years program in the experimental group as compared to the control group; c--a rise in the number of colonies of total streptococci and of St. Mutans; d--a reduction in the % of St. mutans in the total streptococci flora in the plaque of children in the experimental group; e--the presence of St. mutans colonies featuring a rough surface; f--the effectiveness of the program in the modifying the profile of the diagnosed dental pathology.

[Reaction products of indandione with ethyl alpha-cyano-beta-acrylates]

In order to obtain biologically active compounds with a probable anticoagulant activity, some new products, by Michael method from indandione and 2-phenylindandione with ethyl alpha-cyano-beta-aryl-acrylates, have been prepared. The reaction of phenylindandione with methylvinylketone has been also carried out. The products have been characterized by chemical analysis and spectral determinations. The products showed an anticoagulant activity "in vitro" in a preliminary pharmacological screening.