Abstract 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.

Abstract Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe’s design influences this examiner’s assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners’ roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners’ reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner’s agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Resumen Antecedentes: La exposición dietética al mercurio en mujeres en edad fértil podría provocar efectos neurológicos en el feto. En Bogotá, Colombia no se han realizado evaluaciones de riesgo por la exposición al mercurio total debido a la ingesta de productos de la pesca en este grupo de la población. Por otro lado, ha sido sugerido que el contenido de selenio en los productos de la pesca podría tener un efecto protector frente a la toxicidad por mercurio, sin embargo, el contenido de selenio en las especies de peces comercializadas en Bogotá, Colombia no ha sido determinado. Objetivo: Evaluar el riesgo de exposición al mercurio total y el contenido de selenio en los productos de la pesca consumidos por las mujeres en edad fértil de Bogotá, Colombia. Métodos: Se determinaron las concentraciones de mercurio total y selenio en distintos productos de la pesca disponibles en pescaderías y supermercados. El riesgo de exposición a mercurio total se estimó considerando la ingesta de estos productos por parte de un grupo de mujeres en edad fértil. Resultados: Las concentraciones más altas de mercurio total fueron de 0.8166 mg/kg en mota (Calophysus macropterus) y 0.6275 mg/kg en bagre (Pseudoplatystoma tigrinum). Por otro lado, la concentración más alta de selenio fue de 0.6471 mg/kg en nicuro (Pimelodus blochii). Finalmente, se estableció que el riesgo de exposición a mercurio total, debido a la ingesta de mota, excedió en 8.56 veces la dosis de referencia en el grupo de mujeres en edad fértil. Conclusiones: La ingesta de mota aumenta el riesgo de exposición a mercurio total en las mujeres en edad fértil de Bogotá, Colombia. Por otro lado, los niveles de selenio identificados en los productos evaluados, excepto en bagre y mota, teóricamente sugieren un posible efecto protector del selenio contra la toxicidad por mercurio. Considerando lo indicado, es necesario realizar un monitoreo continuo de las concentraciones de mercurio total en los productos de la pesca, con el fin de proteger la salud de las mujeres en edad fértil y de la población general de Bogotá, Colombia.

Abstract Background: Dietary exposure to mercury on in women of childbearing age could result in neurological effects on the fetus. A health risk assessment to of total mercury by fishery products intake have been nothas not been conducted in this population group in Bogota, Colombia. On the other hand, it has been suggested that selenium content on fishery products may have a protective effect against mercury toxicity. Nevertheless, selenium content on fish species marketed in Bogotá has not been determined. Objective: Exposure risk to total mercury and selenium content on fishery products, consumed by women of childbearing age from Bogota, Colombia, were assessed. Methods: Total mercury and selenium concentrations for products available at fish stores and supermarkets were determined. The exposure risk to total mercury was estimated considering the intake of these products by women of a childbearing age population group. Results: Total mercury highest concentrations were 0.8166 mg/kg in mota (Calophysus macropterus), and 0.6275 mg/kg in catfish (Pseudoplatystoma tigrinum). On the other hand, the highest selenium concentration was 0.6471 mg/kg in nicuro (Pimelodus blochii). Finally, it was established that for women of the childbearing age population group, exposure the risk to of total mercury due to mota intake exceeded by 8.56-fold the reference dose. Conclusions: Mota intake considerably increases exposure risk to total mercury on women of childbearing age from Bogota, Colombia. The selenium levels established in the fishery products assessed, except for catfish and mota, are theoretically suggestive to of a protective effect of selenium against mercury toxicity. Consequently, continuous total mercury concentrations monitoring is required to protect health of the women of childbearing age and the general population from Bogota, Colombia.

RESUMEN Objetivo: identificar determinantes sociales de salud, en el ámbito familiar, en preescolares de Anapoima, Cundinamarca, y su relación con la prevalencia de experiencia de caries. Métodos: en el marco de la Alianza por un Futuro Libre de Caries-Capítulo Colombia (AFLC-CC), se valoró la prevalencia de experiencia de caries en niños preescolares de Anapoima, Cundinamarca, usando el Sistema Internacional de Detección y Valoración de Caries (ICDAS) y el índice ceod (cariados, extraídos y obturados, por diente), y se caracterizaron sus familias y viviendas. Se hizo análisis descriptivo y usando 2 se exploraron asociaciones entre ceod e ICDAS y condiciones socioeconómicas, de infraestructura y prácticas de salud en las familias. Resultados: se valoraron 120 niños de jardines infantiles del municipio de Anapoima y se visitaron sus hogares. La prevalencia de experiencia de caries (ceod) fue de 33,3% (promedio: 1,3 ± 2,5); al incluir lesiones iniciales, fue de 46,7% (4,3 ± 7,0). Se encontró relación entre presencia de caries y tipo de problemas de salud bucal referidos por los padres, relación filial con el cuidador, asistencia al servicio de salud bucal y disponibilidad de un espacio para el cepillo (p < 0,05). Conclusiones: los niños valorados presentaron baja experiencia de caries, en comparación con referentes nacionales, lo cual se explica por los determinantes intermedios identificados en su ámbito familiar, en los que se evidencian condiciones económicas, de infraestructura y de conformación familiar favorables para las prácticas de salud. Es necesario profundizar en la comprensión de la relación entre determinantes sociales y salud bucal desde la esfera estructural y fortalecer las estrategias en salud, con miras a lograr poblaciones libres de caries.

ABSTRACT. Objective: identify social determinants of health in families of preschoolers from Anapoima, Cundinamarca, and their relationship with prevalence of caries experience. Methods: in the framework of the Alliance for a Caries-Free Future - Colombia Chapter (Alianza por un Futuro Libre de Caries-Capítulo Colombia, AFLC-CC), the prevalence of caries experience in preschool children from Anapoima, Cundinamarca, was assessed using the International Caries Detection and Assessment System (ICDAS) and the dmft (decayed, missing, filled teeth) index, characterizing their families and homes. Descriptive analysis was done, using X2 to explore associations between dmft and ICDAS with socioeconomic and infrastructure conditions, as well as health practices in families. Results: 120 kindergarten children from the municipality of Anapoima were assessed and their homes were visited. The prevalence of caries experience (dmft) was 33.3% (average: 1.3 ± 2.5); when initial lesions were included, the prevalence reached 46.7% (4.3 ± 7.0). There was a relationship between the presence of caries and type of oral health problems referred to by parents, kin relationship with caregiver, visits to the oral health service, and availability of a space for the toothbrush (p < 0.05). Conclusions: the assessed children showed low caries experience compared to national benchmarks, which can be explained by the intermediate determinants identified in their family environments, with economic, infrastructure and family structure conditions favorable to health practices. It is necessary to better understand the relationship between social determinants and oral health from a structural point of view and to strengthen health strategies, in order to achieve caries-free populations.

Resumo Um estudo epidemiológico de cárie usando o sistema ICDAS foi realizado em crianças pequenas colombianas. O objetivo deste estudo foi associar o tempo necessário para o exame clínico da cárie e o risco de cárie em crianças de 1 a 5 anos de acordo com a idade e o risco de cárie e avaliar a autopercepção do comportamento e da dor na criança durante o exame, de acordo com a idade. Após a aprovação do comitê de ética e do consentimento informado dos pais/responsáveis, sete examinadores treinados avaliaram crianças de 1 a 5 anos em creches em condições locais de campo. A experiência de cárie do ICDAS (depiMEmf) foi avaliada da seguinte forma: Epi-depi inicial (ICDAS 1/2 sem secagem ao ar); Moderado-dM (ICDAS 3,4); lesões extensas de dE (ICDAS 5,6); restaurações devido a cárie -f e superfícies/dentes ausentes-m. O risco de cárie foi avaliado com Cariogram®. O comportamento de crianças (Frankl-Behavior-Rating-Scale) e a autopercepção de dor (Escala Visual-Analógica-de-Rostos) durante o exame foram avaliados. O tempo de exame clínico foi registrado com um cronômetro. 592 crianças participaram (1 ano: n = 31; 2 anos: n = 96; 3 anos: n = 155; 4 anos: n = 209, 5 anos: n = 101 ). A prevalência do depiMEmfs foi de 79,9% e a média de 8,4 ± 10,4. A maioria era de crianças com alto risco de cárie (68,9%). A maioria (58,9%) apresentou ≥ comportamento positivo e ≤ autopercepção de dor leve (88,4%). O tempo médio de exame clínico foi em torno de 3,5 min (216,9 ± 133,9 s). Para crianças de 5 anos, correspondeu a 4 min (240,4 ± 145,0 s) vs. 2 min (122,8 ± 80,1 s) para crianças de 1 ano de idade (Kruskal-Wallis; p = 0,00). Para crianças com alto e baixo risco de cárie, foi em torno de 4,3 min (255,7 ± 118,5 s) e 3,3 min (201,3 ± 129,4 s), respectivamente (ANOVA; p = 0,01). Este estudo demonstra que a utilização do sistema ICDAS em crianças pequenas é viável, levando menos de 4 min para o exame clínico sem problemas de autopercepção de comportamento/ dor em crianças.

Abstract A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers’ informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child’s behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.

The aim of this study was to assess whether caries risk, nutritional status, access to dental care and socio-behavioral factors are associated to two caries experience outcome variables using the Epidemiologic International Caries Detection and Assessment System (ICDASepi), which includes initial enamel caries lesions: 1- The presence of ICDAS-epi caries experience (dmf-ICDASepi ≥ 1), and 2- Having an ICDAS-epi caries experience (dmft-ICDASepi) higher than national figures for the same age. The sample included 316 eight- to 71-month-old children from the municipality of Anapoima, Colombia. Assessments included: prevalence and mean of caries experience using the ICDASepi system without compressed air-drying of teeth surfaces (dmf-ICDASepi), caries risk and nutritional status. Caregivers completed an elevenitem questionnaire assessing oral health-related social determinants, practices and quality of life (OHRQoL), and children's access to dental care. Data were analysed using the Wilcoxon-rank-sum test, the test, the Fisher-exact test, and bivariate-linear and non-conditioned logistic-multivariate regression models. Prevalence and mean number of teeth with dmft-ICDASepi were 65. 2% and 3. 5±4. 13, respectively. Nutritional status outside the normal status, lower educational level of caregivers and age were significantly associated with dmf-ICDASepi≥ 1. OHRQoL, access barriers to miss and to attend dental care, operative-treatment or emergency being the reason to attend dental care, high caries risk, and age were significantly associated with a higher-than-national dmft-ICDASepi. The significant associations found between early childhood caries experience and other variables represent oral-health inequalities in early childhood in Anapoima, Colombia.

El objetivo de este estudio fue evaluar en la primera infancia la asociación entre el riesgo de caries, el estado nutricional, el acceso a la consulta odontológica y los factores socio-comportamentales y dos variables de desenlace de experiencia de caries usando el Sistema epidemiológico Internacional de Detección y Valoración de Caries (ICDASepi), que incluye lesiones de caries en el esmalte: 1-La presencia de experiencia de caries ICDAS-epi (ceod-ICDASepi ≥ 1) y, 2- Tener una experiencia de caries ICDASepi (ceod-ICDASepi) mayor que los datos nacionales correspondientes para la misma edad. La muestra fue de 316 niños del municipio de Anapoima, Colombia, de 8 a 71 meses de edad. Las valoraciones incluyeron: prevalencia y promedio de experiencia de caries usando el sistema ICDASepi sin secado de las superficies de los dientes con aire comprimido (dmf-ICDASepi); riesgo de caries y estado nutricional. Los cuidadores respondieron un cuestionario de once ítems que valoraba en relación con salud oral, determinantes sociales, prácticas y calidad de vida y, el acceso de los niños a la consulta odontológica. Los datos fueron analizados con la prueba de suma de rangos de Wilcoxon, la prueba de χ², la prueba exacta de Fisher y, modelos de regresión logística multivariada tipos bivariantelineal y no condicionada. La prevalencia de experiencia de caries (ceod-ICDASepi) fue de 65. 18% y el promedio de dientes con ceod-ICDASepi de 3. 5 ± 4. 13. El estado nutricional por fuera de rangos de normalidad, el bajo nivel educativo de los cuidadores y la edad se asociaron significativamente con ceo-ICDASepi ≥ 1. Se encontró asociación estadísticamente significativa entre tener un ceod-ICDASepi mayor que el promedio nacional y, calidad de vida relacionada con salud oral, barreras de acceso para perder y asistir a consulta odontológica, tratamiento operatorio o urgencia como motivo de consulta odontológica, alto riesgo de caries y edad. Las asociaciones estadísticamente significativas encontradas en este estudio entre la experiencia de caries de infancia temprana y demás variables representan inequidades en salud oral en la primera infancia en Anapoima, Colombia.