Resumen El artículo revisa políticas públicas sobre el envejecimiento en Chile desde 1990 hasta 2022, basándose en los cuatro ejes de la Política Integral de Envejecimiento Positivo: saludable, seguro, institucional y participativo. Para ello, se analizaron, según cada eje, diferentes ámbitos de intervención, tales como alimentación, establecimientos de larga estadía, reforma de pensiones, ley de envejecimiento activo, sexualidad, transporte público y ciudades amigables. Los resultados indican que los ámbitos de intervención presentan inconvenientes en su implementación, cobertura, efectividad y/o consenso social, lo que limita el impacto de las políticas públicas en la calidad de vida de las personas mayores. Las conclusiones señalan que se requiere un trabajo coordinado e integrado de todos los niveles del Estado y las instituciones para abordar los problemas de las personas mayores de forma integral y participativa, así como identificar y caracterizar los aportes y limitaciones de las intervenciones existentes y visibilizar potenciales líneas de investigación en el campo.

ABSTRACT: The challenges of population aging and the accumulation of oral damage force us to develop valid and reliable diagnostic tools to characterize the population, evaluate their therapeutic needs, plan significant interventions, and monitor their condition post treatment. We carried out a systematic review of the relevant literature to establish a sequential method for the validation of the Preventive Dental Examination of the Elderly diagnostic tool. We selected 48 relevant articles, whose heterogeneity prevented us from performing a meta-analysis. However, the selected articles were subjected to an analytical quantitative synthesis, which allowed us to identify the relevant domains and strategies for validation and then propose a protocol of five sequential phases that we present in detail in this article.

RESUMEN: Los desafíos del envejecimiento de la población y la acumulación de daño oral nos obligan a desarrollar herramientas diagnosticas validas y confiables que nos permitan caracterizar a la población, evaluar sus necesidades terapéuticas, planificar intervenciones significativas y realizar seguimiento de su condición. Con este propósito realizamos una revisión sistemática de la literatura relevante para establecer una metódica secuencial para la validación de la herramienta diagnostica Examen Dental Preventivo del Adulto Mayor. Seleccionamos 48 artículos relevantes, cuya heterogeneidad impidió la realización de un metaanálisis. Sin embargo, los artículos seleccionados fueron sometidos a una síntesis cuantitativa analítica, que nos permitió identificar los dominios y estrategias relevantes para la validación y proponer un protocolo de cinco fases secuenciales que presentamos en extenso en el presente artículo.

Abstract Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. Methodology Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. Results In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. Conclusions We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related “common risk factors”. noncommunicable non communicable uncertain (MDI selfreported self webbased web based questionnaires Crosssectional Cross sectional 1860 18 60 (18-6 old lowcost low cost timesaving time saving methodology platform crude (crude determinants smoking 17 OR 95% 95 [95 intervals estimated total 35 year goodgood good 118 1 1.1 1.041.34, 104134 1.04 1.34 , 04 34 1.04-1.34] p=0.013, p0013 p p=0.013 0 013 p=0.013) 112 12 1.011.25, 101125 1.01 1.25 01 25 1.01-1.25] p=0.035, p0035 p=0.035 035 p=0.035) 124 24 1.2 1.101.40, 110140 1.10 1.40 10 40 1.10-1.40] p<0.001, p0001 p<0.001 001 p<0.001) age sex level environment Nevertheless common factors. factors . factors” 186 6 (18- 9 [9 3 11 1. 041 1.041.34 10413 104 1.0 134 1.3 1.04-1.34 p001 p=0.01 011 1.011.25 10112 101 125 2 1.01-1.25 p003 p=0.03 03 1.101.40 11014 110 140 1.4 4 1.10-1.40 p000 p<0.00 00 (18 [ 1.041.3 1041 13 1.04-1.3 p00 p=0.0 1.011.2 1011 1.01-1.2 1.101.4 1101 14 1.10-1.4 p<0.0 (1 1.041. 1.04-1. p0 p=0. 1.011. 1.01-1. 1.101. 1.10-1. p<0. ( 1.041 1.04-1 p=0 1.011 1.01-1 1.101 1.10-1 p<0 1.04- p= 1.01- 1.10- p<

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

Abstract The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

ABSTRACT: Non-communicable diseases constitute the greatest burden of disease in Chile and the world. The close preventive and therapeutic relationship between oral diseases and systemic diseases in the context of non-communicable diseases, highlights the urgent need to design health policies that allow the incorporation of oral health in the control of these diseases. Despite the implementation of programs in Chile for the treatment of the main oral diseases in prioritized groups, through explicit guarantees in health and other dental programs, these benefits are not aimed at people with cardiovascular diseases, diabetes or other non-communicable diseases with high impact on the population. The available evidence and the recommendations of international scientific organizations support the incorporation of oral health in general health plans and programs. Unfortunately, a more integrated medical-dental approach in the control and management of non-communicable diseases remains a pending challenge in Chile.

RESUMEN: Las enfermedades no transmisibles constituyen la mayor carga de enfermedad en Chile y el mundo. La estrecha interrelación preventiva y terapéutica entre las enfermedades orales y las enfermedades sistémicas en el contexto de las enfermedades no transmisibles, pone de manifiesto la urgente necesidad de diseñar políticas públicas que permitan incorporar la salud oral en el control de estas enfermedades. A pesar de que en Chile se han implementado programas para el tratamiento de las principales enfermedades orales en grupos priorizados, a través de garantías explicitas en salud y de otros programas odontológicos, estas prestaciones no están dirigidas a personas con enfermedades cardiovasculares, diabetes u otras enfermedades no transmisibles de alto impacto en la población. Aunque, la evidencia disponible y las recomendaciones de las organizaciones científicas internacionales, fundamentan la incorporación de la salud oral en los planes y programas de salud general, lamentablemente un enfoque médico-odontológico más integrado en el control y manejo de las enfermedades no transmisibles sigue siendo un desafío pendiente en Chile.

ABSTRACT: This article makes a brief review and synthesis of national health surveys in Chile. The article describes the main characteristics and findings in order to guide dental professionals with the knowledge of the existing material for an objective population oral health diagnosis, as well as the impact of oral health on quality of life of the population.

RESUMEN: Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud en Chile. Se describen sus principales características y hallazgos con el objetivo de orientar a los profesionales odontólogos en el conocimiento de material existente para el diagnóstico odontológico objetivo, así como el impacto de la salud oral en la calidad de vida, a nivel poblacional.

ABSTRACT Aim: To synthesize results of epidemiologic national and regional studies about dental caries, periodontal diseases, tooth loss and oral mucosa lesions in Chilean adults (≥15 years- old). Methods: A narrative revision was made in order to identify epidemiologic national or regional studies in Chilean adults (≥15 years- old). The objective was to establish the prevalence of the most common oral diseases. Results: Six national and seven regional studies were identified. The prevalence of non-treated caries and non- functional dentition was reduced to 54.6% and 27.0%, respectively. The prevalence of periodontal attachment loss ≥4mm. was almost 100%. The most frequent oral mucosa lesion was denture stomatitis (22.3%). Socioeconomic and cultural disparities were observed in the distribution of oral diseases in Chilean adults. Conclusions: The prevalence of dental caries, periodontal diseases, tooth loss and oral mucosa lesions was high in Chilean adults and elderly people.

RESUMEN: Objetivo: Sintetizar los resultados sobre los estudios epidemiológicos de caries dental, enfermedad periodontal, desdentamiento y lesiones de mucosa oral de base poblacional con representatividad nacional y regional en adultos chilenos (≥15 años). Materiales y métodos: Se realizó una revisión narrativa para identificar aquellos estudios de diagnóstico de salud bucal, a nivel nacional y/o regional, en población adulta de Chile (≥15 años), con el objetivo de establecer prevalencias para las patologías bucales de mayor relevancia nacional. Resultados: Se identificaron 6 estudios de representatividad nacional y 7 estudios de representatividad regional. Se reporta una disminución en la prevalencia de caries cavitadas y de dentición no funcional, correspondiendo a un 54.6% y 27.0%, respectivamente. La prevalencia de pérdida de inserción clínica ≥4mm., es cercana al 100%. La lesión de mucosa oral más prevalente fue la estomatitis subprotésica (22.3%). Se observaron inequidades socieconómicas y culturales en la distribución de las patologías orales en la población adulta chilena. Conclusiones: Existe una alta prevalencia de enfermedad periodontal, caries, desdentamiento y lesiones de mucosa oral en adultos y adultos mayores chilenos.

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Abstract: A high level of general and oral health are invaluable assets, a factor not always considered a basic human right for their better life quality. The mouth is a critical point of contact with the external environment, which is established when we talk, chew, swallow and when food digestion begins. From a perspective of the human condition, the mouth is crucial for the integration of sound, social appearance of the individual, and is one of the fundamental components of overall health. Therefore, not having an adequate level of oral health affects self-esteem, quality of life and people's general well-being.

Abstract: Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.