Pedro Christian Aravena

Oral Health-Related Quality of Life in Children in Chile Treated for Cleft Lip and Palate: A Case-Control Approach

Objective To compare the oral health–related quality of life of patients treated for cleft lip and/or cleft palate (CL/P) versus unaffected children between 8 and 15 years of age using a Spanish-language version of the Child Oral Health Impact Profile (COHIP-Sp) administered to a Chilean population. Design A cross-sectional study with a matched case-control design was used. Methods Participants were 48 children (mean age 11.3 years) with a history of CL/P from three cities in Chile and one group of 96 children (mean age 11.2 years) unaffected by CL/P. The COHIP-Sp was applied to both groups. Quality of life was compared according to the overall score and the average score of items and domains on the COHIP-Sp scale between the two groups (Mann-Whitney U test; P < .05). Results The COHIP-Sp score was 94.1 ± 19.3 in children with CL/P and 97.1 ± 15.6 for the control group (P = .31). A significantly lower score was observed in the group with CL/P in the domains “functional well-being” (P = .001) and “school environment” (P = .001); the only average in favor of the quality of life in children with CL/P was in “self-image” (P = .0002). Conclusion The oral health–related quality of life of children with a history of CL/P was similar to that of the control group. Nevertheless, a lower quality of life was observed concerning items associated with speech and being understood by other people. Further study into the risk factors associated with surgery and rehabilitative treatment is recommended.

Proximal Femoral Epiphysis Anatomy in Chilean Population: Orthopedic and Forensic Aspects

Desde un punto de vista biomecanico, la geometria y la densidad osea son factores correlacionados con la resistencia del hueso del femur al apoyar el peso corporal, con los parametros geometricos, como el diametro de la cabeza femoral y el cuello, la longitud del cuello del femur, y el angulo del cuello femoral factores determinantes en la incidencia de fracturas de cadera, que aumentan en frecuencia y gravedad en los pacientes con osteoporosis. En Chile, no existen datos morfometricos que relacionen la anatomia de la epifisis proximal del femur como un factor asociado a las fracturas de cadera ni indices antropometricos que pueden contribuir a las ciencias forenses. El proposito de este estudio es establecer las medidas promedio de la epifisis proximal de femur en poblacion adulta chilena. Estudio Descriptivo. Se analizaron la epifisis proximal de 81 femures adultos secos (44 derechos y 37 izquierdos), midiendo los siguientes parametros: longitud del cuello femoral (LC) , angulo cervico-diafisiario femoral (ACD), circunferencia de la cabeza femoral (CCa) y circunferencia del cuello femoral (CCu). Se analizo la relacion estadistica de las medidas con el lado de cada muestra (test Chi cuadrado p:0,05) Las longitudes promedios fueron LC: 3,59 cm (±0,43 cm); ACD: 124,17 (±6,37 cm); CCa: 14,34 cm (±1,27 cm) y CCu: 9,7 cm (±0,87 cm). No se encontraron diferencias significativas entre el lado derecho e izquierdo. Los resultados proponen la necesidad de realizar estudios anatomo-clinicos y epidemiologicos actualizados en poblacion chilena donde la geometria de la epifisis proximal del femur se incluya dentro del analisis.

Validez y Confiabilidad en Investigación Odontológica

El proceso de medicion consiste en asignar valores numericos a caracteristicas del paciente, un nivel de dano, certeza diagnostica de la enfermedad, entre otros. Sin embargo, existen fenomenos complejos que incluyen conceptos mas amplios que requieren de la creacion y validacion de instrumentos psicometricos para su registro. El objetivo de esta revision es presentar los conceptos de validez y confiabilidad de instrumentos de medicion aplicados en Odontologia. Se expone la definicion en salud de variables directas e indirectas, la importancia del uso de instrumentos psicometricos, la definicion de Validez y Confiabilidad de un instrumento y sus distintas clasificaciones (validez de contenido, de criterio y de constructo; confiabilidad del instrumento y del observador). Ademas, se presenta algunos ejemplos del proceso de validacion de instrumentos, su metodologia y forma de analisis de los resultados. De esta forma, presentamos los topicos necesarios para comprender el proceso de medicion usado en nuestro quehacer clinico o en investigacion odontologica, con el fin de identificar los instrumentos adecuados (validos y confiables) para nuestras necesidades.

Relationship between mandibular nerve block anesthesia and body mass index in children

El objetivo de este trabajo fue observar la relacion entre el bloqueo anestesico efectivo (BAE) del nervio mandibular, inyectando 1,8 ml de lidocaina al 2% con epinefrina 1:100.000, en ninos y su indice de masa corporal (IMC). Fue disenado un estudio de cohorte prospectivo. Se selecciono una muestra de 93 ninos que se atienden en el Modulo Dental de JUNAEB de Frutillar entre abril y julio de 2011. Se registro edad, sexo, motivo de la exodoncia y tipo de diente (permanente o deciduo). Se calculo el IMC para cada nino, que fue categorizado en 2 cohortes de acuerdo al criterio de la OMS: “bajo peso - normal” (BPN) para aquellos con un IMC p85. Despues de aplicar la tecnica anestesica, a los 10 minutos se evaluo su efectividad registrando el BAE. Se analizo la relacion estadistica entre IMC y BAE mediante Test exacto de Fisher (p<0,05). Se logro el BAE en 84 ninos (90,3%), con un 89,36% en el grupo BPN y 91,30% en el grupo SPO. No se hallo una asociacion estadisticamente significativa entre BAE e IMC (p=1,00). No existe relacion entre la efectividad del bloqueo anestesico del nervio mandibular y el indice de masa corporal en ninos.

Prevalencia de Historia de Caries en Escolares de 10 Años, Frutillar, 2007-2010

En Chile, la prevalencia de historia de caries dental en ninos de 6 y 12 anos es de 70,3% y 62,5%, respectivamente. Por ello, el Programa de Salud Bucal de la Junta Nacional de Auxilio Escolar y Becas (JUNAEB) desarrolla promocion, prevencion y tratamiento dental con el fin de disminuir esta tasa en poblaciones mas vulnerables, como en la ciudad de Frutillar. El objetivo de esta investigacion fue determinar la prevalencia caries por medio de los indices ceod y COPD en ninos de 10 anos atendidos en el Modulo Dental JUNAEB de la ciudad de Frutillar entre el ano 2007 a 2010. Estudio descriptivo. Se recolectaron los formularios de pacientes de 10 anos atendidos en el Modulo dental JUNAEB entre el 1 de enero de 2007 al 31 de diciembre de 2010. Por cada ano, se registro el numero de pacientes, el genero y los indices COPD y ceod. Se evaluo la asociacion de los datos demograficos con la historia de caries usando la prueba chi-cuadrado, t de student y ANOVA (p<0.05). Se registraron 389 pacientes. El 83,03% presento historia de caries. El indice promedio COPD y ceod fue de 1,56 (D.E. ± 1,8) y 1,65 (D.E. ± 1,94) respectivamente. Se observo una reduccion significativa en la historia de caries (p=0,04) y en el indice COPD (p=0,001) en el ultimo ano. No se observo una asociacion de historia caries con el genero ni en el numero de pacientes (p=0,57). La prevalencia de historia caries en ninos de 10 anos disminuyo significativamente entre el ano 2007 al 2010. Se promueve realizar estudios de cohorte con el fin de evaluar el efecto real del programa en ninos de entre 6 y 12 anos de edad.

Skin and mucosal ischemia as a complication after inferior alveolar nerve block

The anesthetic block of the inferior alveolar nerve (IAN) is one of the most common techniques used in dental practice. The local complications are due to the failures on the anesthetic block or to anatomic variations in the tap site such as intravascular injection, skin ischemia and ocular problems. The aim of this article is to present a case and discuss the causes of itching and burning sensation, blanching, pain and face ischemia in the oral cavity during the IAN block.

Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial

Background The purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect. Patients and methods A double-blind, split-mouth randomized clinical trial was designed. Seventy-two volunteer students (22.1±2.45 years old; 51 men) from the School of Dentistry at the Universidad Austral de Chile (Valdivia, Chile) participated. They were each administered 0.9 mL of lidocaine HCl 2% with epinephrine 1:100,000 (Alphacaine®) using two injections in the buccal vestibule at the level of the upper lateral incisor teeth. Anesthesia was administered in a hemiarch at 42°C (107.6°F) and after 1 week, anesthesia was administered by randomized sequence on the contralateral side at room temperature (21°C–69.8°F) at a standardized speed. The intensity of pain perceived during the injection was compared using a 100 mm visual analog scale (VAS; Wilcoxon test p<0.05). Results The use of anesthesia at room temperature produced an average VAS for pain of 35.3±16.71 mm and anesthesia at 42°C produced VAS for pain of 15±14.67 mm (p<0.001). Conclusion The use of anesthesia at 42°C significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections. The physiological mechanism of the temperature on pain reduction could be due to a synergic action on the permeabilization of the Transient Receptor Potential Vanilloid-1 channels, allowing the passage of anesthetic inside the nociceptors.

Single-Dose Bioavailability for Prophylactic Coverage in Patients Undergoing Dental Implant Surgery

PURPOSE The use of antibiotic prophylaxis in dental implant surgery is a routine dental practice to prevent implant failure. Current systematic reviews have yet to confirm the effectiveness of antibiotic treatment at reducing postoperative infection rates in implant procedures. The aim of this study was to quantify amoxicillin plasma levels at the peripheral venous blood and at the surgical implant site in patients undergoing dental treatment. MATERIALS AND METHODS A prospective study was conducted. Patients undergoing dental implant surgery were selected, and preoperative doses of 1 g of amoxicillin, in the form of an oral tablet, were administered 1 hour prior to implant surgery. The blood samples (1.5 mL) were collected from both the venous and implant sites. Data on the antibiotics were measured using high-pressure liquid chromatography. The quantification method was validated for linearity, selectivity, and detection limits. Statistical analysis of plasma antibiotic was performed, comparing both samples and the age, height, weight, and body mass index (BMI) (Wilcoxon test, P < .05; STATA v.10.0). RESULTS Thirty-two patients (mean age: 56.28 ± 12.2 years; range: 31 to 79 years; 20 men) were selected. Both blood samples were taken at a mean 1.16 ± 0.37 hours after antibiotic intake. The mean amoxicillin concentration at the implant site reached 5 ± 2.63 μg/mL (range: 2.04 to 11.18 μg/mL), while the venous blood level was 4.21 ± 2.12 μg/mL (range: 1.6 to 9.98 μg/mL) (P = .33). No correlations were observed between age, height, weight, and BMI with antibiotic plasma levels. CONCLUSION These findings demonstrate that plasma concentrations of a prophylactic dose of amoxicillin are higher than the minimum inhibitory concentration needed to prevent the common dental bacteria involved in peri-implantitis and periodontal diseases.

Relación entre distancia intercantal y ancho de dientes anterosuperiores en jóvenes chilenos

objective: Intercanthal distance (ICD) is a parameter used to select the upper anterior teeth and the most stable measurement overtime. However, it is variable between race and populations, particularly in South America. The aim of this study was to establish the correlation between ICD and the width of maxillary anterior teeth in young adult population from southern of Chile. Materials and Methods: A Cross-sectional study was designed. One Hundred eleven volunteers students (average age 22.4 years; 65.7% men) from Valdivia city (southern of Chile) were included. ICD and mesiodistal width of maxillary central incisor, linear distance of the four upper incisors and linear distance of the six upper front teeth in plaster study models weremeasured. The mean of difference measurement between sex (ttest; p<0.05) and the linear correlation between DIC and the width of the upper anterior were analyzed (r=0.8; p<0.05; STATA v.10.0). results: All measurement were significantly higher in male than female (p<0.05). A statistically significant correlation between ICD and distance of the four upper incisors (p=0.04) and the six upper front teeth (p=0.03) were observed. A 1:0.94 and 1:1.28 ratios between ICD with the linear distance of the upper incisors and the six maxillary anterior were obtained respectively. conclusion: ICD presented a linear and proportional correlation with maxillary anterior teeth. With these results it is possible to estimate the linear width of the upper front teeth in young adult population from southern of Chile.

Chilean patients’ perception of oral health-related quality of life after third molar surgery

Objective To describe the perception of the quality of life in oral health based on the Health-Related Quality of Life instrument in its Spanish version (HRQOL-sp) in Chilean patients with third molar extraction surgery. Patients and methods A cross-sectional study. The HRQOL-sp was administered to dental patients at the Public Hospital in Rio Bueno in southern Chile treated for unilateral third molar extraction between March and June 2014. The instrument was applied by phone survey on the first, third, fifth, and seventh days after surgery. For the ordinal scale, the response was considered interference in the quality of life when patients selected the options “quite a bit of trouble” or “lots of trouble” for oral function and general activity; and selected complications-related signs and symptoms, a pain level score with a Verbal Rating Scale (range 0 to 7), and worst pain perceived. The patient’s sociodemographic data, type of surgery, and the quality of life level were analyzed according to the domains of the HRQOL-sp instrument. Results A total of 106 patients were selected (age: 20.4±7.39 years; 71.7% women) and a total of 127 extracted third molars. On the first day of follow-up, most patients reported interference in their quality of life. The main problems were difficulty opening the mouth (50.94%) and swelling (83.02%). The worst symptom perceived was “bad breath” (>31%) and the worst pain felt was a mean of 4.31±1.62 on the Verbal Rating Scale. All items gradually reduced until the seventh day. Conclusion The HRQOL-sp revealed substantial interference in the quality of life on the first postoperative day. It is suggested that the risk factors associated with quality of life be analyzed and the instrument in Spanish be validated.