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    Ethical principles in dental research of behavioral and social factors
    (2024) Ramírez Chan, Karol Gabriela
    Given the importance of conducting research ethically when studying humans, this article involves considerations on basic ethical principles in dental research of behavioral and social factors. Research in these fields contribute to understand social interactions, attitudes, individual and group dynamics. As well, research in these areas not only delve into scientific knowledge of human nature, but also support evidence-based decision-making of health policies and interventions. The four main ethical principles apply to studies on behavioral and social factors. First, respect for persons dictates researchers must protect participants’ autonomy, which is the basis for informed consent. Moreover, the principle of beneficence refers to act in such a way that participants benefit from taking part of a research study. Also, beneficence promotes participants’ safety and well-being. Non-maleficence requires that researchers avoid or minimize harm to others. Justice implies fair treatment. Additional aspects of justice involve respecting participants’ privacy and confidentiality. Ethical principles require interpretation. Therefore, some examples are provided, aiming that researchers overview and apply these norms. Ethical judgement and appropriate decision making are of great importance at any stage of research with human beings.
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    Importance of assessing the impact of combined lifestyle factors related to periodontitis in Costa Ricans
    (2024) Rodríguez Callaci, María Fernanda; Ramírez Chan, Karol Gabriela
    Periodontal disease is an infectious and inflammatory disease, which is characterized by the destruction of tooth supporting tissues: root cementum, periodontal ligament and alveolar bone. Dental biofilm or plaque is the etiological risk factor for gum disease. There are a variety of risk factors that may contribute the onset and progression of periodontitis. Modifiable risk factors are habituated risk factors that can be changed by adjusting behavioral attitudes. These adjustments minimize the possibility of chronic disease occurrence. Thus, it becomes important, to identify individual modifiable factors such as lifestyle factors, which could influence the severity and higher risk of progression of periodontitis. Diet, physical activity, stress levels, sleep quality, smoking, and alcohol consumption, in relation to periodontal disease have been studied individually. Little is known about the combined effect of these health-related lifestyle patterns related to health and periodontal status. Studying the combination of lifestyle factors is recommended to establish an adequate management and treatment plan of patients with periodontitis. Costa Ricans present a unique pattern of sociodemographic, ethnic, cultural diversity, and lifestyle factors. Assessing these variables in different populations are a priority, to prevent and treat chronic diseases, such as periodontitis.
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    Evolution of regulatory governance for human research in Costa Rica
    (2024) Ramírez Chan, Karol Gabriela
    Regulatory governance of human research derives from historical abuses of people participating in health related and non-health relates studies. Costa Rica was no exception and nowadays counts with a Regulatory Law of Biomedical Research (Law 9234) that guarantees the protection of research participants’ human rights. The aim of this narrative review is to overview the gradual development and state of the art of protections and oversight of research with humans in Costa Rica. A recapitulation of why regulatory governance for biomedical human research was enacted in 2014 will be discussed. Even so, there is no legal requirement in Costa Rica, as in other developing nations, for non-health related protocols with human participants, to undergo the scrutiny of research boards. Nonetheless, even before Law 9234 was passed, the University of Costa Rica made efforts to compel compliance with research ethics when studying humans. Therefore, another objective is to review the current ethical guidelines dictated by the University of Costa Rica and Scientifical Ethics Committee of the University of Costa Rica to conduct responsible human research. The University of Costa Rica’s institutional regulatory framework on human research, can serve as a model to other national and international institutions from developing nations, where ethical assessment of sociocultural research is relatively neglected, compared to the review of biomedical and clinical studies.
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    The relationship between dental anxiety and oral health-related quality of life in patients with periodontitis
    (2024) Padilla Fonseca, Nicole; Araya Castillo, Agatha; Arias Campos, María Paula; Solís Rivera, Ana Paula; Jiménez Matarrita, Jeniffer; Ramírez Chan, Karol Gabriela
    Abstract: Objectives: This study aimed to (1) investigate whether dental anxiety (DA) and oral health-related quality of life (OHRQoL) differed between patients diagnosed with periodontitis and individuals with periodontal health, (2) examine associations and correlations between these pa-tient-reported measures, and (3) analyze demographic and clinical parameters. Methods: Nine-ty-six patients diagnosed with periodontitis and age- and sex-matched periodontally healthy con-trols were included. Participants’ demographic characteristics, smoking status, current dental pain, dental pain during the last month, the Modified Corah’s Scale (MDAS), and the Oral Health Impact Profile (OHIP-14) were determined. Results: The mean age of participants was 48.51 years ± 11.41. Patients with periodontitis experienced higher pain in the last month compared to controls (p = 0.003). Patients with periodontitis exhibited significantly higher MDAS total and sub-scores (p < 0.001). Compared to controls, the periodontitis group indicated extreme DA (1.04% vs. 7.79%, p = 0.034). Patients with periodontitis feared having a foreign object in the mouth compared to controls (p = 0.004). The periodontitis group exhibited worse OHIP-14 global and sub-scores (all Ps < 0.001). Positive associations and correlations of MDAS total and sub-scores with OHIP-14 global and domain scores were found for the periodontitis group, but not for controls. Patients with periodontitis who reported “moderate and extreme anxiety” had poorer OHRQoL compared to controls (p = 0.001). The minimal importance difference for this finding indicates a large effect size and a moderate standardized response mean between groups. Conclusions: Patients with per-iodontitis had higher levels of DA and worse OHRQoL compared to controls. Our study highlights the importance of providing a comprehensive approach, including psychosocial well-being, when diagnosing and treating periodontal disease.
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    Efecto del post curado en las propiedades físicas y mecánicas de resinas dentales de impresión 3D para restauraciones definitivas.
    (2024) Umaña Alfaro, Glenda; Lafuente Marín, José David
    En odontología restaurativa, se observó un crecimiento exponencial en el uso de tecnologías digitales, lo cual genera la necesidad de aumentar la investigación científica en esta área. Objetivo: evaluar el efecto de protocolos de poscurado y almacenamiento en propiedades físicas y ópticas de resina de impresión 3D para restauraciones definitivas. Materiales y métodos: se utilizaron tres marcas de resina para impresión 3D de restauraciones (2 para definitivas y 1 control para provisionales): VSS ( Varseo Smilecrown), SCT (Saremco Crowntec), ADT (Denta Tooth ASIGA). Para medir la estabilidad de color se imprimieron (Asiga Max UV) 84 discos de 10x2 mm de los materiales mencionados sometidos a dos tiempos de postcurado (90 s y 180 s), divididos luego en partes iguales para envejecer por 40 días en agua destilada y café, totalizando 12 grupos con una n= 7. A cada muestra se le realizó una medida de las coordenadas de color (L*a*b*H*C*) con un espectrofotómetro de uso dental (Easy Shade, Vita) antes y después del envejecimiento. Se calculó su ΔE (CIEDE 2000) y los datos se analizaron con la prueba de Anova de tres vías (material*poscurado*envejecimiento*) y Tukey (α=0.05). Para medir la resistencia a la flexión y el módulo de elasticidad se imprimieron 60 barras de 25x2x2 mm (ISO 10477) de cada material, divididas posteriormente en partes iguales para someterlas a dos ciclos de poscurado (90 y 180 s, n = 15), la mitad de las muestras se quebraron al inicio y las demás se almacenaron en agua destilada durante 3 meses para envejecer. Se sometieron a la prueba de flexión de tres puntos (ISO 10477), utilizando una máquina de pruebas universal electromecánica (Electropuls E3000, Instron) operando a 1 mm/min y los cálculos de las variables se generaron con el software asociado (Bluehill Universal). Los resultados se registraron en MPa para la flexión y en GPa para el módulo de elasticidad. Los datos de flexión se analizaron estadísticamente con las pruebas Anova de tres vías y Tukey, los datos de módulo se analizaron mediante la prueba de la mediana de Mood, todas las pruebas a un nivel de significancia de 0.05. Resultados: el Anova de tres vías para estabilidad de color reveló que los tres factores resultaron estadísticamente significativos (p < 0.05), también resultaron significativas las interacciones “Material vs. Envejecimiento” (p < 0.0001) y “Fotocurado vs. Envejecimiento” y la triple interacción “Material vs. Fotocurado vs. Envejecimiento” (p < 0.008). Para resistencia a la flexión se reveló que los tres factores resultaron estadísticamente significativos (p < 0.0001), también resultaron significativas las interacciones “Material vs. Envejecimiento” (p < 0.0001) y “Fotocurado vs. Envejecimiento” (p < 0.011). Para el módulo de elasticidad, la mediana de Mood reveló que los factores “Material” (p < 0.0001) y “Fotocurado” (p = 0.016) resultaron estadísticamente significativos. Conclusiones: un tiempo de poscurado de 180 segundos produce mayor resistencia a la flexión, módulo de elasticidad y estabilidad de color en las resinas de impresión 3D que se estudian. La resina de impresión 3D de uso provisional Asiga Dental Tooth posee una resistencia a la flexión y un módulo de elasticidad similar a la resina de indicación definitiva Saremco Crowntec, pero tiene un mal comportamiento en estabilidad de color. Las resinas de impresión 3D con indicación de uso definitivo Saremco Crowntec y Varseo Smile Crown poseen una buena estabilidad de color, al estar en contacto con café a lo largo de 40 días, tanto para un poscurado de 90 s como de 180 s. La resina Varseo Smile Crown tiene los valores más bajos de resistencia a la flexión y módulo de elasticidad al ser comparada con las otras dos resinas. En esta investigación, la resina Saremco Crowntec cuenta con las mejores características físicas y mecánicas.
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    Association of the severity and progression rate of periodontitis with systemic medication intake
    (2024) Batista Cárdenas, Daniela; Araya Castillo, Agatha; Arias Campos, María Paula; Solís Rivera, Ana Paula; Jiménez Matarrita, Jeniffer; Piedra Hernández, Lucía; Madriz Montero, Luis Alonso; Ramírez Chan, Karol Gabriela
    Background/Purpose: Information on the systemic medication profiles of patients with periodontitis is limited. Therefore, this retrospective cross-sectional study aimed to analyze the relationship between the severity and rate of progression of periodontitis and systemic medication intake using a database of patients who attended the Clinic of Periodontics of the Faculty of Dentistry of the University of Costa Rica. Methods: Electronic health records of patients diagnosed with periodontitis based on the Classification of Periodontal and Peri-Implant Diseases and Conditions (2017) were evaluated. Individuals were further categorized based on the severity (stage) and rate of progression (grade). Data extracted from the patient records included age, sex, and self-reported medication intake. Results: In total, 930 records were included. Most of the studied population was middle-aged (36–64 years old); 43.01% were male, and 56.99% were female. Four hundred and fifty-seven patients (49.14%) reported taking at least one systemic medication for a chronic condition. Regarding the periodontal treatment phase, 62.37% underwent steps 1-3, and 37.63% underwent step 4. The most common systemic medications taken were for cardiovascular diseases (42.28%), followed by medications for diabetes (14.46%) and neurologic disorders (14.46%). Most patients (59.35 %) were diagnosed with Stage III periodontitis. Grade B (48.28%) was the most prevalent. Calcium channel blockers demonstrated a disease severity-dependent association with the periodontal stage (p=0.021). In addition, systemic medications for diabetes mellitus were associated with periodontal disease severity and rate of progression (all Ps <0.05). Conclusions: This study provides indirect evidence of the association between systemic diseases and periodontitis. The positive association between medications used to treat diabetes and the severity and rate of progression of periodontitis may be due to the underlying disease rather than the medications per se.
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    Crystallographic and Topographic Analysis of Ultra-Translucent Zirconia After Various Surface Treatments
    (2024-03-07) Vargas Koudriavtsev, Tatiana; Santamaría Villalobos, Jorge Andrés
    The aim of the present study was to analyze the effects of 4 different surface treatments, on the crystallographic characteristics of Ultra-Translucent Zirconia. Fully sintered zirconia specimens of highly translucent yttria partially stabilized zirconia (Y-PSZ) (KATANA UTML) were divided into four experimental groups and a control group (n=10). Each group received one of the following surface treatments: sandblasting with 50μm alumina particles (Al₂O₃), sandblasting with 110μm alumina particles, and grinding with a rotary high-speed turbine with and without water irrigation. For each sample, x-ray diffraction was carried out to analyze peak intensity, calculate the crystallite size, and detect the presence of compressive and tensile stress. Surface roughness was measured on all specimens using a standard scanning profilometer. Additionally, scanning electron microscopy (SEM) was performed to qualitatively analyze the surfaces of the specimens. Statistical analysis included repeated measures analysis of variance and post hoc Tukey test (p≤0.05). The control group exhibited the highest crystallite size (323nm). All surface treatments led to a reduction in the crystallite size, with the most significant reduction observed in the groups subjected to sandblasting with 110μm alumina particles and high-speed grinding with irrigation. Sandblasting with 50μm alumina particles resulted in less transformation of the crystallite size. A general tendency of the diffraction peaks to shift to a lower angle can be observed in the experimental groups, indicating the presence of compressive stress on the samples. Profilometry revealed higher roughness in the ground samples (6,14μm and 6,57μm) compared to the sandblasted groups (2,93μm and 2,02μm). The crystal domain size showed a tendency to decrease after the surface treatments. Sandblasted samples, as well as ground samples without irrigation, exhibited compressive stress. Sandblasted samples had lower surface roughness compared to the ground samples. Sandblasting with 50μm alumina particles caused the least decrease in crystallite size.
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    Perception of oral health-related quality of life before the first step and after the second Step of periodontal therapy
    (2023) Fernández Gudiño, Andrés; Cruz Morera, María Amalia; Vega Cruz, Mariana; Quesada Romero, Sofía María; Alvarado Echeverría, Juan Ignacio; Vargas Godínez, María Mercedes; Piedra Hernández, Lucía; Gómez Fernández, Adrián; Ramírez Chan, Karol Gabriela
    Background: Periodontal research has focused on clinical outcomes of periodontitis and in a lesser extent on patient-reported outcomes. Objective: The objectives of this study were to 1) determine oral health-related quality of life (OHRQoL) before the first step and after the second step of periodontitis therapy and 2) compare sociodemographic and clinical characteristics with changes in OHRQoL. Methods: Patients with periodontitis that had never been treated with subgingival plaque instrumentation were recruited. Clinical parameters were recorded. A questionnaire was applied to collect sociodemographic data, smoking status, and pain. The Oral Health Impact Profile-14 (OHIP-14) was used to evaluate OHRQoL before the first step and after the second step of periodontitis therapy. Results: Fifty-one participants completed the study, mean age 46.88 years ± 11.16. OHIP-14 total score decreased from 16.98 ± 11.48 to 8.41 ± 9.06 after treatment. Improvements in physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap accounted for the changes. The most frequent periodontal staging was stage III. As for grading, Grade A was diagnosed in 16 (31.37 %) participants, Grade B in 16 (31.37 %), and Grade C in 17 (33.33 %). Mean plaque index was 61.4 % ± 17.6 before the first step of periodontitis therapy and 22.8 % ± 10.6 after. Pain in the last month decreased after periodontal care. No differences in OHRQoL changes were detected when comparing age categories, gender, and educational level. Better scores were reported from non-smokers, before and after therapy (p = 0.003). Conclusion: Periodontal therapy had a positive impact on self-perceived quality of life of patients.
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    Dental anxiety before the first step and after the second step of periodontitis therapy
    (2023) Sanabria Bogantes, Daniela; Redondo Gómez, Katherine Andrea; Artavia Segura, Johnny; Torres Venegas, José Andrés; Cubillo Vargas, Antonio; Solórzano Duarte, Dylan Arturo; Piedra Hernández, Lucía; Gómez Fernández, Adrián; Ramírez Chan, Karol Gabriela
    Introduction: individuals that experience Dental Anxiety (DA) may avoid dental appointments and even postpone treatments, including periodontal treatment. The aim of this study was to 1) determine DA in patients with periodontitis before the first step and after the se cond step of periodontitis therapy (non surgical periodontal treatment), and 2) collect sociodemographic and clinical characteristics of the studied population. Methods: patients with periodontitis that had never received subgingival instrumentation and attended the Clinic of Periodontics of the Facultad de Odontología, Universidad de Costa Rica, were invited to participate. From the electronic dental record, the following information was obta ined: periodontal staging, Plaque Index (PI) and Gingival Bleeding Index (GBI). A questionnaire was applied before the first step and after the second step of periodontitis therapy. Data collected included: sociodemographic factors, smoking habits, ex smoker status, pain, and the Modified Corah Dental Anxiety Scale (MDAS). Results: fifty one patients completed the study, 19 men and 32 women, mean age 46 ±11.16 years. Most of the participants reported having com pleted high school. Regarding smoking habits, 46% were non smokers. Of the non smokers, 7.8% were former smokers. Patient’s maxim al pain in the last month decreased after the completion periodontitis therapy. The most prevalent periodontal diagnosis was Stage III followed by Stage II. The average PI was 61.4% and the average GBI was 39.5%. Fear to the sound of rotatory instruments/u ltrasonic scalers ameliorated after completion of therapy. Total MDAS score and sub scores decreased from baseline. Conclusion: self perceptions of DA improved over the course of periodontal treatment in our clinical setting.
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    Evaluación de la liberación de iones Ca2+, pH y resistencia a la flexión de cuatro cementos selladores endodónticos bioactivos
    (2023-12-12) Suárez Quesada, Luis Carlos; Infante Amore, Fiorella; Ramírez Hidalgo, Eladio; Benavides, Marianella
    El objetivo de este estudio fue evaluar la liberación de iones de calcio, la resistencia a la flexión y el pH de los cementos endodónticos bioactivos ProRoot MTA Ⓡ, BIODENTINE Ⓡ y Bio C Repair Ⓡ y NeoPutty Ⓡ. Para evaluar la liberación de calcio se utilizaron 34 discos de 2 mm de dentina radicular estandarizados en el conducto con Gates Glidden número 6, obturados y sumergidos en una solución de 10 ml de PBS, se realizaron mediciones con pHímetro y espectrometría atómica al día 1, 3, 5, 10 y 15. En cuanto a la prueba de resistencia a la flexión, se confeccionaron moldes de 10 barras de 7 mm x 2 mm x 2 mm de cada material, almacenados en recipientes herméticos con humedad durante 48 horas, estos especímenes se sometieron a la prueba mini-flex. Resultados: Los discos de dentina obturados con el Biodentine obtuvieron una menor liberación de calcio y presentaron una diferencia estadísticamente significativa (p=< 0.01) con respecto a los otros cementos; en la prueba de resistencia a la flexión el ProRoot MTA, se presentó mayor fuerza flexural; sin embargo, no hubo diferencia estadísticamente significativa (p=>0.05) entre los cementos. Se concluye que el NeoPutty es el material con mayor liberación de iones de calcio a lo largo de los 15 días y ProRoot MTA obtuvo mayor resistencia a la flexión.
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    Neurofibroma solitario en paladar duro: Reporte de caso y revisión de literatura
    (2023-12-23) Suárez Quesada, Luis Carlos; Boza Oreamuno, Yadira Vanessa
    Introducción: Los neurofibromas son tumores benignos que se derivan de la vaina de nervios periféricos. Se caracterizan por la proliferación de células de Schwann, células perineurales y fibroblastos endoneurales. Pueden ser solitarios o estar asociados a síndromes como la neurofibromatosis tipo I y tipo II. Su aparición en cavidad oral es poco frecuente, siendo lengua la localización más común. Clínicamente se presentan como lesiones papulares, nodulares y tumorales de base sésil o pedunculada que varían de tamaño,deconsistencia fibrosa y de color similar alos tejidoscircundantes. Reporte de caso:mujer de 72 años con antecedente de meningioma, se presenta a consulta para cambiar prótesis totales removibles, se observaen launión delpaladar duro y blando al lado derecho de la línea media,una lesión papular cercana a la línea de vibración coincidiendo con el límite posterior de la prótesis superior, tamaño 10 x 8 mm de color similar a los tejidos circundantes, superficie lisa, blanda a la palpación y tiempo de evolución desconocido,paciente asintomática. Se realizóbiopsia excisionaly el estudiohistopatológico más inmunohistoquímica paraS100 confirmóque se trataba de un neurofibroma solitario. La evolución del paciente fue buena, sin recidivas. Conclusiones: se resalta la importancia deconsiderar alneurofibromacomo posible diagnóstico de lesiones papulares y tumorales en paladar, además, como en este caso una completa anamnesis, una correcta intervención quirúrgica y el estudio anatomopatológicopermitieronun diagnóstico definitivo de la lesión.
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    Fístula extraoral asociada a sialolitiasis en el conducto de Wharton. Reporte de un caso
    (2015-11-15) Obando Solano, Danny; Fernández Chaves, José Manuel
    La sialolitiasis es una de las patologías que afectan con mayor frecuencia las glándulas salivales, y es en la glándula submandibular donde se presenta más comúnmente debido a sus características anatómicas. Existen muchas teorías que explican su etiología, pero aún no está completamente determinada. La sintomatología más común es la presencia de dolor, especialmente a la hora de comer debido a la estimulación salival producida por los alimentos. También se presenta inflamación del piso de la boca e infección, asociadas a procesos de sialadenitis crónica, la formación de fístulas cutáneas es muy poco frecuente. Se reporta el caso de un paciente masculino de 31 años quien presenta una fístula extraoral en lado izquierdo su cuello, a nivel de subzona Ib (submandibular) con una sialadenitis crónica asociada a sialolitiasis en el conducto de Wharton izquierdo con una evolución de cuatro años. Se realiza la descripción del manejo quirúrgico y se hace una revisión de la literatura.
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    Protocolo de control de infecciones 2014
    (2014) Rodríguez Villalobos, Patricia; Esquivel Umaña, Mónica; Fernández Chaves, José Manuel
    Como Centro docente y de atención clínica en Odontología, tenemos la obligación ética, moral y pedagógica de garantizar que, tanto el paciente como el personal odontológico (estudiantes, profesores, asistentes dentales), administrativos, personal de limpieza y otros, no estarán expuestos a enfermedades infectocontagiosas durante su atención, su trabajo y/o aprendizaje. Para evitar la propagación de enfermedades infectocontagiosas, es necesario interrumpir el proceso de transmisión de las mismas. Antes bien, se debe reconocer que además de la sangre todos los fluidos corporales son considerados infecciosos, y que todo paciente es potencialmente infeccioso. Lograr actitudes y conductas que atenúen el riesgo de los y las estudiantes, de los docentes, técnicos (as) dentales y demás personal que trabaja en la Clínica Docente de la Facultad de Odontología de la Universidad de Costa Rica. Con el fin de reducir los riesgos de infecciones o enfermedades asociadas a cuidados de la salud oral se deben seguir las recomendaciones que el Protocolo de Control de Infecciones de la Facultad de Odontología pronuncia a continuación.
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    Age estimation through the development of third molars in a case of multiple dismemberment
    (2023-09) Fernández Chaves, José Manuel
    Organized crime has become an international scourge made up of outlaw groups that carry out all kinds of activities ranging from human trafficking, kidnapping, extortion, drug trafficking and many more. As a result of this phenomenon, the disappearance and execution of people is becoming more frequent every day, in many cases the bodies are burned or dismembered to prevent or make identification more difficult. Forensic odontology has become a transcendental discipline in the identification of corpses and skeletal remains, in addition to having multiple methods to estimate the approximate age of a person. The case of a multiple dismemberment of three male individuals is presented, where it was essential to identify a person under 18 years of age.
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    Perception of the usefulness of dental records as a method of human identification in high-risk professions: the case of the Costa Rican Red Cross workers
    (2023-09) Fernández Chaves, José Manuel
    Introduction: Those who provide care in emergency situations are exposed to a high risk of injury or death during rescue work, whether in traffic accidents, natural disasters, terrorist attacks, or humanitarian crises generated by armed conflicts. This research was carried out among Costa Rican Red Cross (CRC) workers to establish the perception of the usefulness of dental records as a method of identification and to develop a single format for antemortem dental information. Materials and methods: A pilot questionnaire was designed and applied to 10 persons to be calibrated and validated. Subsequently, a final electronic questionnaire was generated in the Google Forms platform and sent via institutional e-mail to 175 workers, of whom 92 responded during the period from November 20, 2022, to January 20, 2023. The results were analyzed by means of frequency distributions, crossing of variables, and comparison of means based on the analysis of variance. The minimum confidence level for comparisons was 95%. Results: The questionnaire was completed by 92 people, 75% men and 25% women. The age range between 36 and 40 years was the most frequent (23.9%). A total of 60.9% worked in the province of San José, 58% indicated that they had visited the dentist a year ago or less and 38.6% said that they had never had a panoramic X-ray taken, 81.8% said they had dental treatments such as crowns, bridges or implants; and 75% considered dental records to be very useful as a method of identification, and placed it in second place in terms of knowledge (89.8%) when compared with DNA (97.7%) and dactyloscopy (86.4%). Conclusions: Costa Rican Red Cross workers consider dental records to be useful in the identification of human beings and have useful antemortem information for this purpose.
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    Professional liability in the practice of dentistry in Costa Rica: Part I
    (2023-03) Fallas Morales, Lucía; Fernández Chaves, José Manuel
    The number of complaints related to professional liability in health sciences has increased worldwide, it is essential for dental professionals to be aware of the implications of their labor, as well as to comply with bioethical and legal principles to ensure a healthy dentist-patient relationship. It is important to understand that the practice of dentistry in Costa Rica is regulated by norms, codes, and laws like any other human activity in a State governed by the rule of law.
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    Understanding of informed consent by patients at the Faculty of Dentistry of the University of Costa Rica
    (2022-03) Fernández Chaves, José Manuel
    Introduction: Informed consent is the result of the evolution of the relationship between health professionals and their patients or users where the principle of autonomy is above anything else. There are many articles on informed consent but none of the studies found assessed whether patients really understand it. The objective of this research was to determine the level of understanding of informed consent by the patients of the Clinic of Oral Surgery of the Faculty of Dentistry of the University of Costa Rica, in the period August to September 2022, by means of a questionnaire that would allow correlating the understanding with the level of schooling. Materials and methods: A questionnaire was administered to 100 people divided into two parts, one on sociodemographic data and the other to establish the understanding of informed consent and to determine whether the level of schooling was related to the understanding of the same. Results: The group between 20 and 30 years of age was the largest, of these 51% had university studies, and although the majority (98%) referred to knowing the concept of informed consent, only 33% obtained the correct answers to the clinical questions asked. Conclusions: Even though patients refer to knowing what informed consent is the results suggest an unclear understanding of important concepts such as complications or immediate or late adverse reactions produced by the effect of dental treatments or surgical procedures
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    Difficulties in the identification of corpses and skeletal remains by Forensic Odontology in Costa Rica: Analysis of 165 autopsies
    (2022-09) Fernández Chaves, José Manuel
    Introduction: In Costa Rica the elaboration of dental records or clinical files is not performed routinely in all patients as it is required by law in many countries. The completion of the dental record is only regulated by the Code of Ethics of the Colegio de Cirujanos Dentistas de Costa Rica (Board of Dental Surgeons of Costa Rica), which means that failure to do so is considered an ethical-disciplinary offense with few consequences for the professional; however, it has serious consequences in the efforts to identify a person. This study aims to describe the impact of the absence or poor quality of antemortem data in identification cases performed by the Forensic Odontology Unit of the Department of Legal Medicine over a period of almost eight years (2015-2022). Materials and Methods: A detailed review was performed in the database of the Forensic Medicine System (SIMEL) of the Legal Medicine Department of the Judicial Investigation Organism of the totality of interconsultation requests of the Forensic Pathology Section from January 2015 to August 2022. The information collected was tabulated in Excel and included both the results of the expert analysis and the characteristics of the available antemortem information. Results: The analysis of the data made it possible to determine that in a period of almost 8 years 165 assessments were carried out for identification purposes, of which 51 individuals were identified, 9 cases presented insufficient information and 105 had no dental files. Conclusions: A complete dental record is indispensable for a positive identification; an incomplete or non-existent record nullifies the possibility of identifying a human being.
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    Accidental ingestion of a three-way (air-water-spray) syringe tip during dental procedure recovered by gastroscopy: case report
    (2021-09) Fernández Chaves, José Manuel
    The ingestion or aspiration of dental material or instruments is one of the most feared complications in clinical dental practice, it can occur in both children and adults. The mouth is a moist, dark, small area; where the involuntary movements of the patient during the procedures and the small dimensions of the materials and instruments turn dental care into a challenge. A swallowed or aspirated foreign body during dental treatment can result in serious complications and even death, these depend largely on the shape, size and anatomical pathway through which it passes. This article describes an uncommon complication of which there is only one report in the literature worldwide, the ingestion of the tip of a triple syringe during a routine dental procedure that was recovered by esophagogastroduodenoscopy. It also highlights the importance of knowing the protocols for handling aspirated or swallowed foreign bodies where a fast and adequate approach during the first minutes can make the difference between life and death.
  • Ítem
    Dental malpractice lawsuits in Costa Rica: analysis of 124 cases in the period 2015-2020
    (2021-09) Fernández Chaves, José Manuel
    Introduction: In Costa Rica, dental malpractice lawsuits (professional liability) are classified under the crime of culpable injuries according to the Criminal Code of Costa Rica. The purpose of this study is to describe the characteristics of all the claims analyzed by the Forensic Dentistry Unit of the Department of Legal Medicine in a period of six years (2015-2020). Materials and methods: A detailed review was carried out in the database of the Legal Medicine System (SIMEL) of the Legal Medicine Department of the Organismo de Investigación Judicial (Judicial Investigation Agency) of all the complaints of dental "malpractice" filed since January 1, 2015 to December 31, 2020. The information collected was tabulated in Excel and classified by year, related dental discipline, sex of the complainant and the result of the expert analysis. Results: The data analysis determined a total of 124 complaints, the disciplines with the highest percentages were oral and maxillofacial surgery (39.52%), dental implants (16.94%) and orthodontics (12.9%). More than two thirds (66.12%) of the complaints correspond to women and within the results of the forensic report 10% of the cases were positive, 32% negative and 58% inconclusive. Conclusions: the complete dental record is essential to be able to determine a causal link between the investigated facts and the results of a treatment; in this study more than 50% of the files where incomplete, invasive procedures such as oral surgery generate a greater possibility of lawsuits that could be avoided through proper management of risks and complications, adequate patient-caregiver communication, and management of treatment expectations.