Mauricio Escoffié-Ramírez

Estudio ecológico en México (2003-2009) sobre labio y/o paladar hendido y factores sociodemográficos, socioeconómicos y de contaminación asociados

OBJECTIVE To analyze the rates of cleft lip and/or cleft palate (CLP) in Mexico between 2003 and 2009 and assess their association with variables at ecological level, sociodemographic, socioeconomic, and pollution. MATERIAL AND METHODS An ecological study was conducted with data from the 32 states of Mexico for incidence of CLP, obtained from the Ministry of Health. We included sociodemographic, socioeconomic, and pollution information, obtained from governmental agencies. CLP incidence rates were used as dependent variable; independent variables were socioeconomic, demographic and pollution indicators. Statistical analysis was performed using Spearman correlation and chi(2) tests. RESULTS During the study period 10573 new cases presented (mean 1510.43 per year). The States with the highest rate (per 1000 births) were: in 2003 the Federal District (Mexico City) (1.76), in 2004 Jalisco (2.62), in 2005 Oaxaca (1.66), in 2006 the State of Mexico (1.29), in 2007, 2008 and 2009 Jalisco (2.17, 2.92, and 1.99). For all the years men were more likely affected than women (P<.05). Variables found positively correlated to LPH rates were total population, solid waste, life expectancy, urban solid waste. The variables negatively correlated were population percentages of high alcohol users, and of alcohol abuse or addiction. CONCLUSIONS The State of Jalisco was one of the most affected locations over the years. Ecologic positive correlations existed between cleft lip and/or palate and sociodemographic, socioeconomic, and pollution factors. Incidence rate was negatively correlated with alcohol use and abuse. More detailed epidemiological studies are needed to fully characterize risk factors in Mexican populations.

Salivary Parameters (Salivary Flow, pH and Buffering Capacity) in Stimulated Saliva of Mexican Elders 60 Years Old and Older.

OBJECTIVE To compare a limited array of chewing-stimulated saliva features (salivary flow, pH and buffer capacity) in a sample of elderly Mexicans with clinical, sociodemographic and socio-economic variables. SUBJECTS AND METHODS A cross-sectional study was carried out in 139 adults, 60 years old and older, from two retirement homes and a senior day care centre in the city of Pachuca, Mexico. Sociodemographic, socio-economic and behavioural variables were collected through a questionnaire. A trained and standardized examiner obtained the oral clinical variables. Chewing-stimulated saliva (paraffin method) was collected and the salivary flow rate, pH and buffer capacity were measured. The analysis was performed using non-parametric tests in Stata 9.0. RESULTS Mean age was 79.1 ± 9.8 years. Most of the subjects included were women (69.1%). Mean chewing-stimulated salivary flow was 0.75 ± 0.80 mL/minute, and the pH and buffer capacity were 7.88 ± 0.83 and 4.20 ± 1.24, respectively. Mean chewing-stimulated salivary flow varied (p < 0.05) across type of retirement home, tooth brushing frequency, number of missing teeth and use of dental prostheses. pH varied across the type of retirement home (p < 0.05) and marginally by age (p = 0.087); buffer capacity (p < 0.05) varied across type of retirement home, tobacco consumption and the number of missing teeth. CONCLUSIONS These exploratory data add to the body of knowledge with regard to chewing-stimulated salivary features (salivary flow rate, pH and buffer capacity) and outline the variability of those features across selected sociodemographic, socio-economic and behavioural variables in a group of Mexican elders.

Retention of dental sealants placed on sound teeth and incipient caries lesions as part of a service-learning programme in rural areas in Mexico

BACKGROUND Dental sealants are an effective treatment for the prevention and management of caries. OBJECTIVE To determine the retention of sealants placed in a rural setting in Mexico as part of an international service-learning (ISL) programme and to determine associations between dental sealants retention and caries diagnosis at the time of sealant placement. METHODS Children aged 6-15 were examined for dental caries, received sealants by dental students as part of an ISL programme, and were re-examined 4, 2, or 1 years after placement to assess sealant survival. Sealants were placed on permanent sound surfaces and enamel caries lesions [International Caries Assessment and Detection System (ICDAS) criteria]. Sealant survival was explored using Cochran-Mantel-Haenszel tests and multivariate prediction models. RESULTS 219 (46%) of 478 (mean age = 10.53 SD = 5.11) children who had received sealants returned for a recall examination (mean age = 10.89 SD = 3.11). After 1-4 years, 96.4% to 60.6% of the sealants placed on sound teeth had survived, and for sealants placed on surfaces with enamel caries lesions (ICDAS 1-3), 94.2% to 55.6% had survived. Differences were not statistically significant. CONCLUSIONS Sealants had survival rates comparable to those previously reported in the literature. Sealants placed on sound and enamel caries lesions had similar survival rates.

Asociación de labio y/o paladar hendido con variables de posición socioeconómica: un estudio de casos y controles

Objectives: to investigate the association between socioeconomic position and the presence of nonsyndromic cleft lip and/or palate (CL/P). Methods: a case-control study with 110 cases with CL/P matched by age and gender with 220 controls was carried out, the cases were selected from the “Hospital Nino DIF Hidalgo” of Pachuca, Hidalgo, Mexico. A structured questionnaire which contained socioeconomic variables was used to recollect data. Applying the principal component analysis (polycoric correlation) the socioeconomic variables were combined and were builded several socioeconomic position indicators as: socioeconomic level (house characteristics), living comfort level (house supplies), parents education (school years), social security, indigenism (native language spoken by either parent). A bivariate analysis was realized using conditional logistic regression. Results: the highest frecuency found was the cleft lip and palate at the same time (90.9%) either uni or bilateral. The most common defect was left cleft lip and palate (33.6%). Cleft lip and/ or palate was associated with the living comfort level (compared with the worst quintil: 2nd OR= 0.46; p=0.030, 3rd OR=0.39; p=0.015, 4th OR= 0.30; p=0.002, 5th OR=0.27; p=0.001), socioeconomic level (compared with the worst tercil: 2nd OR=0.46; p=0.004), 3rd OR=0.18; p<0.001, fathers schooling (OR=0.86; p<0.001), and mothers schooling (OR=0.84; p<0.001).

Sociodemographic, Socio-economic, Clinical and Behavioural Factors Modifying Experience and Prevalence of Dental Caries in the Permanent Dentition.

OBJECTIVE To identify the sociodemographic, socio-economic, clinical and behavioural factors that modify the experience of decayed, missing and filled teeth (DMFT) and caries prevalence in Nicaraguan children 9-12 years old. SUBJECTS AND METHODS We conducted a cross-sectional study in 800 school children 9-12 years old in the city of León, Nicaragua. The clinical oral examinations to identify caries experience were undertaken by two trained and certified examiners. Sociodemographic, socio-economic and behavioural data were collected using questionnaires. Negative binomial regression (NBR) and binary logistic regression (BLR) models were used to model caries experience and caries prevalence, respectively. RESULTS Mean DMFT index was 0.98 ± 1.74 and caries prevalence (DMFT > 0) was 37.9%. In the NBR model, the categories that increase the expected DMFT mean were: older age, female gender, presence of plaque, and if the school children received curative and curative/preventive dental care in the last year. In the BLR model, the odds of presenting with caries in the permanent dentition were increased in older children, those from large families, mothers with a positive dental attitude, and those school children who received curative and curative/preventive dental care in the last year. CONCLUSIONS Using different models, we identified several sociodemographic, socio-economic, clinical and behavioural factors that modify the experience (NBR) and prevalence (BLR) of dental caries.

Impacted Maxillary Canine Prevalence and Its Association with Other Dental Anomalies in a Mexican Population

Objective. We quantified the prevalence of impacted maxillary canines (IMC) and their association with other dental anomalies (DAs). Materials and Methods. A retrospective study was done with 860 patients 12 to 39 years of age. The prevalence of IMC was calculated and compared by sex. The sample was divided into a control group and an impaction group, and the prevalence was calculated in both for a series of anomalies: agenesis, supernumerary teeth, shape anomalies of the upper laterals (microdontia, peg and barrel shape, and talon cusp), fusion, gemination, other impacted teeth, transposition, and amelogenesis imperfecta. The prevalence values for both groups were compared (Pearsons χ2 test, p ≤ 0.05). Results. IMC were present in 6.04% of the sample with no difference by sex (p = 0.540). Other DAs occurred in 51.92% of the IMC group and in 20.17% of the controls (p < 0.05). Significant associations (p < 0.05) were identified between IMC and four other DAs: microdontia, barrel shape, other impacted teeth, and transposition. The prevalence of all anomalies was lower in the control group. Conclusion. IMC were seen in 6.04% of patients. Patients with this condition also had a higher prevalence of other DAs. These other anomalies should be used as risk indicators for early diagnosis.

Factors Associated with Dental Pain in Mexican Schoolchildren Aged 6 to 12 Years

Objective To identify dental pain prevalence and associated factors in Mexican schoolchildren. Methods This cross-sectional study included 1,404 schoolchildren aged 6 to 12 years from public schools in the city of Pachuca de Soto, Hidalgo, Mexico. Data were collected through a questionnaire that addressed sociodemographic and socioeconomic factors, eating and dental hygiene habits, and behavior variables. The dependent variable was self-reported dental pain in the 12 months prior to the survey. Data were analyzed using nonparametric statistics and a binary logistical regression model. Results Dental pain prevalence among the studied children was 49.9%. The variables associated in the final model (p < 0.05) were younger mothers age, higher socioeconomic level, absence of an automobile in the home, fried food, fruit intake, lower tooth brushing frequency, never having used mouthwash or not knowing about it, and parents/guardians with regular to high levels of knowledge about oral health and a regular or good/very good perception of their childs oral health. Conclusions One in two children in the study had experienced dental pain in the twelve months prior to the survey. The association of socioeconomic variables with dental pain suggested inequalities among the children in terms of oral health.

Contribution of prosthetic treatment considerations for dental extractions of permanent teeth

Background. Tooth loss is an easily identifiable outcome that summarizes a complex suite of factors in an individual’s history of dental disease and its treatment by dental services over a lifetime. Assessment of overall tooth loss data is essential for epidemiologically evaluating the adequacy of dental care provided at a systems level, as well as for placing in context tooth loss for non-disease causes. For example, when derived from prosthetic treatment planning, the latter may unfortunately lead to some teeth being extracted (pulled) for the sake of better comprehensive clinical results. The objective of the present manuscript was to identify the contribution to overall tooth loss, by extraction of permanent teeth because of prosthetic treatment reasons. Material and Methods. A cross-sectional study included sex, age, total number of extractions performed by subject, sextant (anterior vs. posterior), group of teeth (incisors, canines, premolars and molars), upper or lower arch, and the main reason underlying extraction (extraction for any reason vs. prosthetic treatment), in patients 18 years of age and older seeking care at a dental school clinic in Mexico. A multivariate logistic regression model was generated. Results. A total of 749 teeth were extracted in 331 patients; 161 teeth (21.5% of total) were extracted for explicit prosthetic treatment indications. As age increased, the likelihood of having an extraction for prosthetic reasons increased 3% (OR = 1.03, p < 0.001). Women (OR = 1.57, p < 0.05) were more likely to be in this situation, and molars (OR = 2.70, p < 0.001) were most at risk. As the total number of extractions increased, the risk of having an extraction for prosthetic reasons decreased (OR = 0.94, p < 0.05). Conclusions. A significant amount (21.5%) of the extractions of permanent teeth were performed for prosthetic reasons in this dental school clinical environment; age, sex, type of tooth, and the total number of extractions moderated such pattern.

Agenesia de Terceros Molares, Prevalencia, Distribución y Asociación con otras Anomalías Dentales

La agenesia de terceros molares se ha reportado en un 24,3% en Mexico. La agenesia dental esta asociada a otras anomalias dentales debido a su origen genetico. El objetivo del presente estudio fue determinar la prevalencia y distribucion de agenesia de terceros molares asi como establecer su asociacion con otras anomalias dentales en una poblacion ortodontica. La muestra incluyo 670 pacientes ortodonticos de 9 a 20 anos de edad. Se excluyeron pacientes con tratamiento ortodontico previo y condiciones sindromicas. Se calculo la prevalencia de agenesia de terceros molares y se comparo por sexo. Posteriormente los pacientes fueron divididos en 2 grupos, con agenesia de al menos un tercer molar y un grupo control y en ambos se calculo la prevalencia de 10 anomalias dentarias. Los resultados se compararon por medio de la prueba exacta de Fisher (p<0,05). La prevalencia fue del 25,97%, no hubo diferencia estadistica entre generos (p=0,139). El 41,95% de los pacientes del grupo de agenesia presento anomalias asociadas, mientras que en el control fueron el 23,59%. Se encontro una diferencia significativa entre ambos grupos (p=0,0001). Al comparar individualmente la prevalencia de cada anomalia por grupo, se encontro que la agenesia (p=0,0001) y los dientes retenidos (p=0,015) estaban disminuidos significativamente en el grupo control. En conclusion se encontro una prevalencia del 25,97%, sin preferencia de sexo. Los pacientes con agenesia de terceros molares presentan mayor prevalencia de anomalias dentales asociadas, particularmente agenesia de otros dientes y dientes retenidos.