Object
To identify the perception of barriers to the comprehensive management of cleft lip and palate (CLP) by parents/caregivers of Colombian children with this condition.
Setting and Sample ...Population
Fifty parents/caregivers of children with CLP under 12 years attending a center specialized in the management of craniofacial congenital conditions in Bogota, Colombia.
Materials and Methods
This study consisted of 2 phases: a quantitative phase (descriptive cross-sectional) and a qualitative phase (focus group FG). Chi-square and Fisher exact tests were used to analyze the association variables. The barriers and alternative ways to overcome barriers were analyzed in the FG.
Results
Comprehensive management was mostly defined as access to multiple treatments (54%), and this concept was expanded in the FG toward understanding CLP at all levels. Monoparental families spend their income on treatments (29%) than nuclear families (0%) (P = .001). All parents with high education levels were familiar with healthcare centers specialized in CLP as opposed to 66.7% of parents with basic primary education (P < .05). Regarding the timeliness of appointments, 12.2% of parents earning between 1 and 2 minimum wages reported some kind of difficulty, whereas those earning less than one minimum wage reported difficulties in 66.7% of cases (P = .046).
Conclusions
All participants reported barriers, which increased or decreased depending on their socioeconomic status. The FG allowed the discussion of alternatives to overcome barriers, such as structural, solidarity, and self-management actions.
Introduction:
Craniofacial growth is a dynamic and unpredictable process influenced by genetic and environmental factors, presenting phenotypic and gender differences.
Objective:
Evaluate the ...differences in craniofacial growth and development in a group of Colombian individuals with complete unilateral and bilateral cleft lip and palate (CLP) and without CLP, classified by gender and age.
Setting and Sample Population:
Five hundred forty-one profile radiographs of 126 patients with unilateral CLP, 126 with bilateral CLP, and 289 without CLP. All patients of affected groups had a history of CLP correction surgery without nasoalveolar molding with orthopedic and orthodontic treatments.
Materials and Methods:
This cross-sectional study was performed comparing 8 cephalometric measurements on radiographs, 5 linear/3 angular. Analysis was performed by median and interquartile range for all cephalometric measurements. Comparison between the groups was performed using Kruskal-Wallis and Mann-Whitney U, with a 95% confidence.
Results:
Significant differences between the groups of patients with and without CLP, between types of clefts and genders. The skeletal structures of patients with CLP were smaller than those of control but improved with growth. Patients with unilateral CLP presented flat profiles and predominant class III malocclusions, while patients with bilateral CLP, at early ages, were class II and in the prepubertal stage, the values were progressively negative until the end of the growth period, suggesting class III. Patients with CLP presented posteroinferior rotation of the mandible, vertical measurements increased, and deflection of the cranial base.
Conclusion:
Given their growth alterations, patients with CLP benefit from orthopedic and orthodontic treatment.
Resumen Introducción y objetivo: la severidad de la fluorosis dental refleja exposición a fluoruros durante el desarrollo del esmalte. Recientemente se han reportado asociaciones entre la exposición ...prenatal y postnatal a fluoruros y efectos negativos en el neurodesarrollo. El objetivo de este estudio fue describir y comparar la severidad y el patrón de distribución de la fluorosis en las denticiones primaria y permanente, como base para discutir la temporalidad de la exposición en niños viviendo en áreas endémicas en el departamento del Huila. Materiales y métodos: odontólogos entrenados diagnosticaron fluorosis en 840 niños (preescolares y escolares) de cuatro municipios usando el índice de Thylstrup & Fejerskov. Para estimar la prevalencia de las diferentes severidades, cada niño se clasifico de acuerdo con la severidad más alta en boca. La distribución de la prevalencia de severidades por grupo etario y tipo de dentición se reportan como tasas de prevalencia (%). Resultados: la prevalencia en preescolares y escolares fue de 97.2% y 99.9%, respectivamente y la fluorosis moderada la más prevalente (75.6% y 63.5%, respectivamente). En ambas denticiones, la fluorosis leve fue más prevalente en los dientes anteriores que en posteriores. Las severidades moderada y severa tuvieron mayor prevalencia en dientes posteriores que en anteriores. Conclusiones: el patrón de distribución de la severidad de la fluorosis sugiere exposición prenatal y postnatal a fluoruros, por encima de los niveles recomendados. Este estudio resalta la importancia de la alidación de la fluorosis del dental como un potencial biomarcador histórico de exposición a luoruros en momentos críticos para el neurodesarrollo.
Fluoride is an element that affects teeth and bone formation in animals and humans. Though the use of systemic fluoride is an evidence-based caries preventive measure, excessive ingestion can impair ...tooth development, mainly the mineralization of tooth enamel, leading to a condition known as enamel fluorosis. In this study, we investigated the geochemical characterization of fluoride in water, table salt, active sediment, rock and soil samples in four endemic enamel fluorosis sentinel municipalities of the department of Huila, Colombia (Pitalito, Altamira, El Agrado and Rivera), and its possible relationship with the prevalence of enamel fluorosis in children. The concentration of fluoride in drinking water, table salt, active sediment, rock, and soil was evaluated by means of an ion selective electrode and the geochemical analyses were performed using X-ray fluorescence. Geochemical analysis revealed fluoride concentrations under 15 mg/kg in active sediment, rock and soil samples, not indicative of a significant delivery to the watersheds studied. The concentration of fluoride in table salt was found to be under the inferior limit (less than 180 μg/g) established by the Colombian regulations. Likewise, exposure doses for fluoride water intake did not exceed the recommended total dose for all ages from 6 months. Although the evidence does not point out at rocks, soils, fluoride-bearing minerals, fluoridated salt and water, the hypothesis of these elements as responsible of the current prevalence of enamel fluorosis cannot be discarded since, aqueducts might have undergone significant changes overtime.
Introduction and objective: dental fluorosis severity reflects fluoride exposure during dental enamel development. Recently, prenatal and postnatal exposure to fluoride has been associated with ...negative neurodevelopmental outcomes. The aim of this study was to describe and compare the severity and distribution pattern of dental fluorosis in the primary and permanent dentition, as a basis to discuss the timing and extent of fluoride exposure of children living in endemic areas of fluorosis in the department of Huila. Materials and methods: 840 children (preschoolers and schoolchildren) from four municipalities of the Huila Department were examined by trained dentists for dental fluorosis using the Thylstrup & Fejerskov Index. To estimate the prevalence of severities of fluorosis, each child was classified according to the most severe score. The distribution of the prevalence of enamel fluorosis severity by age-group and type of dentition were reported as prevalence rates (%). Results: Prevalence of dental fluorosis in preschoolers was of 97.2% and in schoolers of 99.9%. For both preschoolers and schoolers moderate fluorosis was the most prevalent (75.6% and 63.5%, respectively). For both primary and permanent teeth, mild fluorosis was more prevalent in anterior teeth than in posterior teeth. Moderate and severe fluorosis were more prevalent in posterior teeth than in anterior teeth. Conclusions: the distribution pattern of the severity of dental fluorosis suggests both prenatal and postnatal exposure to fluoride above recommended levels. This study raises the importance of the validation of dental fluorosis as a potential historical biomarker of fluoride exposure at moments that are critical for neurodevelopment.
Antecedentes: Diferentes estudios describen el tratamiento ortopedico en pacientes con labio y paladar fisurado o hendido (LPH) con diagnostico de maloclusion clase III; sin embargo, no existe una ...estandarizacion en la tecnica de tratamiento ortopedico en estos pacientes. Objetivo: Determinar la efectividad del tratamiento con mascara facial y un aparato fijo intraoral en pacientes con LPH y maloclusion clase III, que fundamente su implementacion dentro de una guia de manejo integral. Metodos: Se realizo una busqueda en multiples bases de datos electronicas y busqueda manual. Se encontraron 199 articulos a los que se aplicaron como criterios de inclusion: ensayos clinicos aleatorizados o abiertos, en ingles y espanol, pacientes con LPH, edades entre 5 y 12 anos, maloclusion clase III y/o mascara facial y/o protraccion maxilar, evaluados mediante radiografias de perfil, analisis cefalometricosy observacion clinica. Resultados: Se seleccionaron ocho articulos a los que se les hizo analisis de calidad. Los resultados indican que el tratamiento con mascara facial y aparato intraoral fue efectivo en los pacientes con labio y paladar hendido para lograr protraccion maxilar, entre los que la mascara facial con el aparato Hyrax mostro mejores resultados esqueleticos. Conclusion: La mascara facial, junto con el aparato intraoral Hyrax, entre los 8 y los 10 anos, con fuerzas de 450-500 g y una direccion de 10grados-30grados, bajo el plano oclusal utilizado por 12 horas/dia durante minimo 9,2 meses de tratamiento, mostro los mayores cambios esqueleticos en la zona maxilar y mandibular en pacientes con labiopaladar hendido y maloclusion clase III. PALABRAS CLAVE maloclusion clase III; labio y paladar hendido; anomalias craneofaciales; expansion maxilar; mascara facial; protraccion maxilar; Hyrax AREAS TEMATICAS diagnostico; tratamiento; anomalias craneofaciales; ortodoncia. Background: Several studies describe the orthopedic treatment of patients with cleft lip and palate, diagnosed with class III malocclusion; however, there is no standardization in the orthopedic treatment planning in these patients. Objective: To determine the effectiveness of treatment with facemask and a fixed intra-oral appliance for patients with cleft lip and palate and Class III malocclusion. Methods: A literature search conducted in several databases and print journals produced 199 articles. Inclusion criteria were: randomized clinical or open trials, English and Spanish language, patients with cleft lip and palate, 5-12 years of age, Class III malocclusion and/or facemask and/or maxillary protraction, assessment with lateral radiographs, cephalometric analysis, and clinical observation. Results: The sample consisted of eight articles that underwent quality analysis. Results indicate that treatment with facemask and intraoral appliance was effective in patients with cleft lip and palate to achieve maxillary protraction, of which a combination of facemask and Hyrax showed better skeletal results. Conclusion: Treatment with facemask with the intraoral appliance Hyrax, at 8-10 years of age, with 450-500 g forces and a 10degrees-30degrees inclination below the occlusal plane, used at least 12 hours/day for 9.2 months in patients with cleft lip and palate cleft and class III malocclusion, showed major skeletal changes in the maxilla and mandible. KEYWORDS malocclusion angle class III; cleft lip and palate; craniofacial anomalies; maxillary expansion; facemask; maxillary protraction; hyrax THEMATIC FIELDS diagnosis; treatment; craniofacial abnormalities; orthodontics
Antecedentes: El examen clinico es el metodo mas utilizado para valorar los patrones oclusales. Tiene la limitante de ser realizado en vigilia: cuando una persona controla la expresion real de los ...contactos en sueno como consecuencia del bruxismo. El BruxcheckerR es un dispositivo novedoso que permite, por medio de inspeccion visual, analizar los contactos durante la dinamica mandibular en sueno sin alterar la actividad muscular y oclusal. De acuerdo con diferentes caracteristicas clinicas: es de esperarse que la relacion intermaxilar genere diferentes contactos y, en consecuencia: patrones oclusales individualizados. Por lo tanto, es necesario identificar los patrones de desgaste oclusal durante la dinamica del sueno para establecer su funcionalidad. Proposito: esta serie de casos describe et BruxcheckerR como una herramienta de facil uso y eficaz en el diagnostico del patron oclusal en odontologia. PALABRAS CLAVE abrasion dental: BruxcheckerR: bruxismo deL sueno: desgaste dental: facetas de desgaste: patron oclusal AREAS TEMATICAS Bruxismo; oclusion dental; procesos dentales fisiologicos Background: Clinica: examination is the most used method for the evaluation of occlusa: patterns, However, that evaluation is usually carried out during wakefulness when a person can hide the real expression of occlusal contacts that occur during sleep as a consequence of bruxism: BruxcheckerR is a new device that allows, by visual inspection, analyzing contacts of mandibular dynamics during sleep without altering the muscular and occlusal activity: Based on clinical characteristics, it could be expected that the intermaxillary relation generates different contacts and, as a result individualized occlusal patterns. Therefor it is necessary to identify the wear occlusal patterns during sleep dynamics to establish their functionality. Purpose: This case series report describes the BruxcheckerR as a simple-touse tool that is effective to diagnose occlusal patterns in dentistry. KEYWORDS Bruxchecker; occlusal pattern; sleep bruxism; tooth abrasion; tooth wear; tooth wear pattern THEMATIC FIELDS Bruxism; dental physiologica: processes: denta: occlusion
Metodos: Se evaluo caries dental en 85 sujetos con labio y paladar hendido entre 2 y 25 anos de edad, usando criterios del ICDAS y registrando adicionalmente superficies obturadas o perdidas por ...caries. Resultados: Todos los participantes presentaron mayor que o igual a 1 lesiones de caries (ICDAS) en denticion primaria y mayor que o igual a 5 en mixta y permanente. La media de ceo-s/ COP en los tres grupos siguio patrones similares, aun cuando aumento sustancialmente al adicionar lesiones no cavitadas. Los dientes mas afectados fueron: en denticion primaria, el segundo molar temporal inferior izquierdo; en denticion mixta, el primer molar permanente inferior izquierdo, y en denticion permanente, el segundo molar inferior izquierdo. Los dientes anterosuperiores mas afectados fueron: en denticion primaria, el incisivo lateral superior derecho (cuarto lugar); en mixta, el incisivo superior izquierdo (tercer lugar), y en permanente, el canino superior derecho (cuarto lugar). Conclusiones: Los resultados muestran una alta experiencia de caries en esta poblacion. A diferencia de lo esperado, los dientes anterosuperiores no fueron los mas afectados y la distribucion de la caries siguio un patron natural. PALABRAS CLAVE Caries dental, criterios ICDAS, labio y paladar hendido. AREAS TEMATICAS Caries dental, cariologia, deteccion temprana de enfermedad, labio hendido, paladar hendido. Methods: Caries status was assessed in 85 2-to-25-year-old subjects with cleft lip palate using ICDAS-visual criteria and scoring filled/missing due-to-caries surfaces. Results: All participants had greater than or equal to 1 caries lesions (ICDAS-criteria) in the primary dentition and greater than or equal to 5 in the mixed and permanent dentition. The mean dmf-s/DMF-S was very similar in the three groups with significantly higher values when non cavitated lesions were added. The most affected teeth with caries lesions were, in primary dentition, the second lower-left- primary molar; the first lower left permanent molar in mixed dentition; and the second lower left permanent molar in permanent dentition. Regarding the anterior upper teeth, in the primary dentition group, the lateral right upper incisor was the fourth most affected; in the mixed dentition group the left central upper incisor was the third; and in the permanent dentition group the right upper canine was the fourth most affected. Conclusions: The results showed a high caries experience, with an apparently natural teeth distribution, not being the anterior upper teeth the most affected, as one could expect. KEY WORDS Dental caries, ICDAS visual-criteria, cleft lip and palate. THEMATIC FIELDS Dental caries, cariology, dental caries diagnosis, disease early detection, cleft lip, cleft palate.
Proposito: Comparar el estado de maduracion osea en radiografias de perfil en una poblacion colombiana con y sin labio y paladar fisurado por medio del analisis de maduracion de vertebras cervicales ...(MVC). Metodos: Un examinador previamente calibrado (kappa = 0,76) evaluo el estado de MVC en 145 radiografias de perfil de individuos con y sin labio y paladar fisurado, con edades entre 7 y 18 anos. De ellos 73 tenian labio y paladar fisurado y 72 no tenian fisura. Se realizo un analisis estadistico descriptivo e inferencialcon la prueba de chi cuadrado (alfa = 0,05). Resultados: A los 7-9 anos de edad, el mayor porcentaje de las vertebras cervicales se encontro en estadio CS1 y ninguna en CS5 y CS6. A los 10-12 anos, la mayor frecuencia se encontro en CS4 y ninguno en CS6. A los 13-15 anos, la mayor proporcion estaba en CS4. A los 16-18 anos, el mayor porcentaje se observo en CS5 y ninguno en CS1, CS2 o CS3. Al comparar el desarrollo de las vertebras cervicales entre los dos grupos, no se encontraron diferencias estadisticamente significativas (p = 0,8). Conclusion: El estado de maduracion osea en la poblacion estudiada de individuos colombianos con y sin labio y paladar fisurado, por medio del analisis de MVC en radiografias de perfil, mostro resultados similares en los dos grupos. El pico maximo de crecimiento se presento en el grupo de 10-15 anos (CS3 y CS4). PALABRAS CLAVE labio y paladar fisurado; maduracion de vertebras cervicales; crecimiento y desarrollo AREAS TEMATICAS diagnostico; anomalias craneofaciales; ortodoncia Purpose: To compare the state of bone maturation in a Colombian population with and without cleft lip palate (CLP), using cervical vertebral maturation (CVM) analysis. Methods: A previously calibrated examiner (kappa = 0.76) evaluated the CVM of 145 7-to-18-year-old individuals with and without CLP through lateral radiographs. 73 patients had CLP and 72 did not have the condition. Descriptive and inferential (chi2) statistical analyses were performed to the data (alpha = 0.05). Results: The 7-to-9-year-old group had the highest percentage of cervical vertebras in stage CS1 and none in stages CS5 and CS6. Patients in the group of 10-12 years of age showed the highest frequency in stage CS4 and none in CS6. The 13-15 year olds had the highest proportion in CS4. Among the 16-to-18-year-old patients, the highest percentage was found in stage CS5. When comparing the cervical vertebral development between the two groups, there were no significant differences (p = 0.8). Conclusion: The state of bone maturation in individuals with and without CLP showed similar results when analyzed regarding CVM in lateral radiographies. There was no evidence of earlier maturation in the 7-to-9-year-old patients. The highest level of growth was shown at ages 10-15 (CS3, CS4). KEY WORDS cleft lip and palate; cervical vertebral maturation; growth and development THEMATIC FIELDS diagnosis; craniofacial abnormalities; orthodontics
Antecedentes: La presencia de dos o mas anomalias craneofaciales puede estar asociada con sindromes y defectos congenitos. La identificacion de anomalias menores y mayores facilita la deteccion ...temprana, la remision y el diagnostico de malformaciones que se pueden relacionar con condiciones congenitas. Proposito: Disenar, probar y validar un instrumento para detectar clinicamente anomalias menores y mayores que puedan estar asociadas con malformaciones congenitas de la region craneofacial. Metodos: Se realizo un estudio descriptivo piloto en una muestra aleatoria de 34 escolares (21 ninas y 13 ninos), entre 5 y 17 anos de edad. Se tomaron fotografias y medidas antropometricas de variables que se analizaron descriptivamente. Resultados: Un escolar presentaba una malformacion mayor (labio y paladar hendido). Otros hallazgos fueron mesocefalia (47%), macrocefalia (35%), microcefalia (17%), mesoprosopo (8,82%), euriprosopo (5,88%), leptoprosopo (85,29%), anomalias de pelo (67%), asimetrias faciales (76%), frente angosta (44%), depresion metopica (un escolar), anomalias en ojos como pliegues epicantales (26%), anomalias en nariz (11%), anomalias en orejas (64%), apendice preauricular (un escolar), anomalias en boca (35%) y anomalias dentales (58%). Conclusion: El formato se diseno para ser aplicado de forma masiva en las poblaciones y se debe complementar con el estudio del genotipo para corroborar diagnosticos en los casos en que se presentan dos o mas anomalias menores o en los casos con hallazgos relevantes. PALABRAS CLAVE anomalias craneofaciales; antropometria; medidas; sistemico; condiciones; congenito AREAS TEMATICAS diagnostico; anomalias craneofaciales; ortodoncia Background: The presence of two or more craniofacial abnormalities may be associated with developmental syndromes and/or genetic defects. Identifying minor and major anomalies helps early detection, referrals to a specialist, and diagnosis of malformations of congenital origin. Purpose:To design, test, and validate an instrument to detect minor and major clinical craniofacial anomalies that may be associated with congenital conditions. Methods: A descriptive pilot study was carried out with a sample of 34 5-to-17-year-old schoolchildren (21 girls and 13 boys). Photographs and craniofacial anthropometric measurements were taken and variables were analyzed descriptively. Results: Findings showed one schoolchild with major abnormality (cleft lip and palate) macrocephaly (35%), microcephaly (17%), mesoprosopic (8.82%), euryprosopic (5.88%), leptoprosopic (85.29%), hair distribution abnormalities (67%), facial asymmetries (76%), narrow forehead (44%), metopic depression (one child), eye abnormalities such as epicanthal folds (26%), nose abnormalities (11%), ear abnormalities (64%), preauricular appendix (one child), mo and data analysisfrequency anduth abnormalities (35%), and tooth anomalies (58%). Conclusion: The instrument of this study was designed for massive application in communities and should be complemented with genotype analysis in cases with two or more minor abnormalities or other relevant findings. KEYWORDS craniofacial anomalies; anthropometric; measurements; systemic; conditions; congenital THEMATIC FIELDS diagnostics; craniofacial abnormalities; orthodontics
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