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Impact of oral conditions on the quality of life of adolescents in a rural area of Brazil. 口腔状况对巴西农村地区青少年生活质量的影响。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/081
Tatiany V Roque, Isabela Q Magnani, Saul M Paiva, Lucas G Abreu

The aim of this study was to assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of early adolescents aged 11 to 14 years in the rural population of a Brazilian municipality. Adolescents attending public schools in the municipality participated in the study. OHRQoL was measured using the short Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) with four domains: oral symptoms, functional limitations, emotional wellbeing and social wellbeing. A higher score indicates a more negative perception of the adolescent regarding his/her OHRQoL. Oral conditions such as dental caries, malocclusion and dental trauma were evaluated using DMTF index, Dental Aesthetics Index (DAI) and Andreasen criteria, respectively. The variables sex and age, number of siblings, parents' schooling, family monthly income, number of times of tooth-brushing/day and visits to the dentist/year were also evaluated. Descriptive analysis and regression models were performed. Of the 202 participants, 94 (46.5%) were female and 108 (53.5%) were male. Adolescents from low-income families (p=0.042) and with more severe malocclusion (p=0.037) scored higher in the CPQ11-14. Those with severe malocclusion scored higher in the emotional wellbeing domain (p=0.009). Females scored higher than males in the oral symptoms domain (p=0.002). Adolescents from low-income families scored higher in the social wellbeing domain (p=0.006). Malocclusion negatively affected the OHRQoL of adolescents from a Brazilian rural area, mainly regarding emotional wellbeing. Negative repercussions were also observed among females and adolescents whose families had lower income.

本研究的目的是评估口腔状况对巴西一个城市农村人口中11至14岁早期青少年口腔健康相关生活质量(OHRQoL)的影响。该市公立学校的青少年参与了这项研究。OHRQoL使用巴西版儿童感知问卷(CPQ11-14)进行测量,分为四个领域:口腔症状、功能限制、情绪健康和社会健康。得分越高,表明青少年对自己的OHRQoL的看法越消极。分别采用DMTF指数、牙科美学指数(DAI)和Andreasen标准评价龋病、错牙合和牙外伤等口腔状况。性别和年龄、兄弟姐妹人数、父母受教育程度、家庭月收入、每天刷牙次数和每年看牙医次数等变量也进行了评估。进行描述性分析和回归模型。在202名参与者中,94名(46.5%)是女性,108名(53.5%)是男性。低收入家庭的青少年(p=0.042)和错牙合越严重的青少年(p=0.037)在CPQ11-14中的得分越高。严重错颌患者在情绪健康方面得分较高(p=0.009)。女性在口腔症状领域的得分高于男性(p=0.002)。来自低收入家庭的青少年在社会福利领域得分更高(p=0.006)。错牙合对巴西农村青少年的OHRQoL产生负面影响,主要表现在情绪健康方面。在家庭收入较低的女性和青少年中也观察到负面影响。
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引用次数: 2
Epithelial rests of Malassez in experimental animals at different ages. 不同年龄实验动物马拉色氏菌的上皮休止。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/003
Gisela E Pulitano-Manisagian, Patricia M Mandalunis

Epithelial rests of Malassez (ERMs) are fragments of Hertwig's sheath in the periodontal ligament. There is extensive knowledge of their role in the etiology ofpathological processes and current evidence links them to maintenance of periodontal homeostasis. The aim of this study was to assess the behavior of ERMs with relation to the changes in periodontal tissues during growth in an experimental model with Wistar rats. Mesiodistal sections were made of the first lower molars from Wistar rats aged 1 month (n=7), 3 months (n=7) and 5 months (n=6). Sections were stained with H&E to evaluate number of ERMs/ mm, size/area of ERMs (pm2), height of periodontal ligament (PL.h) (pm), area of cement in the furcation zone (C.Ar) (pm2) and bone area related to the ERM zone (BAr/TAr)(%). Posthoc Bonferroni and ANOVA were applied for statistical analysis of results. Number of ERMs/mm declined significantly with age (1m: 4.34±1.51, 3m: 1.48±0.89, 5m: 0.27± 0.50, p<0.05), and there was great variability in size. There was significant increase in C.Ar (1m: 3418.96 ± 905.88, 3m: 19365.76 ± 5500.52, 5m: 32182.76 ± 7114.51, p< 0.05) and interradicular (BAr/TAr) (1m: 25.26 ± 2.37, 3m: 44.70 ± 3.95, 5m: 46.81 ± 7.80, p< 0.05: 1 vs 3, 1 vs 5). There was significant decline in PLh at 5 months (1m: 141.42 ± 29.25, 3m: 162.06 ± 28.21, 5m: 124.72 ± 18.67, p< 0.05: 1 vs. 3, 3 vs. 5). The decline in number of ERMs as animal age increases may be related to the significant increase in C.Ar and reduction in PL.h. It remains to ascertain its relationship with the increase observed in BAr/ TAr. Further studies are needed to learn more about the role of ERMs and their relationship with periodontal tissues when confronted with different normal and pathological stimuli.

马拉塞氏上皮残余(ERMs)是牙周韧带中Hertwig氏鞘的碎片。它们在病理过程的病因学中的作用已经有了广泛的了解,目前的证据表明它们与牙周稳态的维持有关。本研究的目的是在Wistar大鼠实验模型中评估erm的行为与牙周组织变化的关系。采用1月龄Wistar大鼠(n=7)、3月龄Wistar大鼠(n=7)、5月龄Wistar大鼠(n=6)的第一下磨牙进行中远端切面。切片采用H&E染色,评估ERM数/ mm、ERM大小/面积(pm2)、牙周韧带高度(PL.h) (pm)、分节区骨水泥面积(c.r ar)(pm2)和ERM区相关骨面积(BAr/TAr)(%)。采用Posthoc Bonferroni和ANOVA对结果进行统计分析。随着年龄的增长,erm /mm数量明显下降(1m: 4.34±1.51,3m: 1.48±0.89,5m: 0.27±0.50,p
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引用次数: 0
Vertical Dimension of Occlusion: A comparative study between Anthropometric and Knebelman's craniometric methods. 咬合的垂直尺寸:人体测量法与Knebelman颅骨测量法的比较研究。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/043
Francisco Avila-Vásquez, Paúl Vergara-Sarmiento, Cristina Crespo-Crespo

The masticatory system changes as time passes. The vertical dimension of occlusion (VDO) undergoes alterations due to temporomandibular joint disorders which in turn may be caused by related muscle modifications or pathological tooth wear. There are many methods to measure VDO. Among these, the anthropometric method and Knebelman's craniometric method have been shown to be the most closely related to facial biotype. The aim of this study was to compare data recorded with those two methods. A descriptive cross-sectional study was performed with a total 200 patients. A vernier caliper was used to measure facial landmarks. Results were analyzed using paired t-test, setting the level of significance at p<0.05. There was no significant difference between the two methods but Knebelman's method had less variability. Results suggest that Knebelman's method should provide more reliability for determining VDO in all the facial biotypes studied.

咀嚼系统随着时间的推移而变化。由于颞下颌关节紊乱,牙合的垂直尺寸发生改变,而颞下颌关节紊乱又可能由相关的肌肉改变或病理性牙齿磨损引起。测量VDO的方法有很多。其中,人体测量法和Knebelman's颅测量法已被证明与面部生物型关系最密切。本研究的目的是比较这两种方法记录的数据。对200例患者进行了描述性横断面研究。使用游标卡尺测量面部标志。结果采用配对t检验进行分析,显著性水平为p
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引用次数: 0
Cross-cultural adaptation of a quality of life questionnaire for individuals with oral potentially malignant disorders in the Brazilian context. 巴西口腔潜在恶性疾病患者生活质量问卷的跨文化适应。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/071
Igor Fb de Almeida, Kátia S Freitas, Deybson B de Almeida, Aminne O da S Bastos, Mariane Td Farias, Márcio C Oliveira

The aim of this article is to describe the cross-cultural adaptation of a quality of life (QoL) questionnaire for individuals with potentially malignant oral diseases (OPMD) in the Brazilian context. This methodological study consisted of the following stages of content validation process: (1) Conceptual and item equivalence: stage during which a comprehensive literature review on the construct was performed; (2) Semantic equivalence. The extensive literature review showed that the questionnaire enables evaluation of QoL, and that domains and items are also considered and relevant to the Brazilian context. Semantic equivalence was evaluated as satisfactory by a committee of judges. The scope of the domains was analyzed according to the agreement rate and presented results equal to or greater than 84%. The general Content Validity Calculation (CVC) was 0.84 for clarity and 0.92 for representativeness. Of the 20 items, 18 presented CVC values above 0.8. The indicators for content validation, pre-test and operational equivalence indicate that the Brazilian version of the OPMD QoL questionnaire is a promising instrument and a tool that seems valid to evaluate the quality of life of people with oral potentially malignant disorders. As a next step, it is important to measure equivalences to evaluate the psychometric properties of this instrument.

这篇文章的目的是描述生活质量(QoL)问卷在巴西背景下对潜在恶性口腔疾病(OPMD)患者的跨文化适应性。本方法学研究包括以下几个阶段的内容验证过程:(1)概念和项目等效:在这一阶段,对概念和项目进行全面的文献回顾;(2)语义等价。广泛的文献回顾表明,问卷可以评估生活质量,并且也考虑了与巴西背景相关的领域和项目。语义等价被一个评审委员会评价为满意。根据一致性率分析域的范围,结果等于或大于84%。一般内容效度计算(CVC)的清晰度为0.84,代表性为0.92。20个项目中,CVC值在0.8以上的项目有18个。内容验证、预测试和操作等效性指标表明,巴西版OPMD生活质量问卷是一种很有前途的工具,似乎是评估口腔潜在恶性疾病患者生活质量的有效工具。下一步,重要的是测量当量来评估该工具的心理测量特性。
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引用次数: 1
Structural resistance of orthodontic mini-screws inserted for extra-alveolar anchorage. 牙槽外支抗置入微型螺钉的结构阻力。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/027
Carlos Am Vieira, Francyelle Pires, Wallisen T Hattori, Cleudmar A de Araújo, Marcelo A Garcia-Junior, Darceny Zanetta-Barbosa

The risk of fracture or strain in mini-screws is higher if diameter, length, type of alloy or insertion angle is selected inappropriately. The aims of this study were to test the structural resistance of two types of orthodontic mini-screws -one made of stainless steel and another of titanium- from an international brand and to evaluate the efficacy of two other titanium miniscrews of Brazilian origin, during an extra-alveolar anchorage procedure. The mini-screws analyzed were: Bomei stainless steel and Bomei titanium / Taiwan, Morelli titanium and Neodent titanium/ Brazil. Experiments were conducted on pig mandibles to simulate the process of extra-alveolar anchorage. Two insertion processes were used: Direct at 30º, and Indirect, starting at 60º and ending at 30º with gradual continuous movement. Strain was evaluated using Optical and Scanning Electron Microscopy. Data were evaluated using Kruskal-Wallis non-parametric statistical analysis and post hoc Tamhane test. Significant statistical differences in strain were observed among the mini-screws used in the extra-alveolar insertions, both for the direct and indirect procedures. In the indirect insertion tests, both stainless steel and titanium mini-screws suffered deformation, showing that angling can be an important factor in mini-screw failure rates. The change in angle during the insertion movement increased deformation rates independently of alloy type, increasing the risk of failure. These results could help orthodontists in choosing mini-screws for extra-alveolar anchorage, which can be performed with direct or indirect insertion. In vivo studies should be conducted to confirm the findings of this study.

如果直径、长度、合金类型或插入角度选择不当,微型螺钉发生断裂或应变的风险较大。本研究的目的是测试来自国际品牌的两种类型的正畸微型螺钉(一种由不锈钢制成,另一种由钛制成)的结构阻力,并评估另外两种来自巴西的钛微型螺钉在牙槽外锚固过程中的疗效。所分析的微型螺钉有:台湾Bomei不锈钢和Bomei钛,巴西Morelli钛和Neodent钛。以猪下颌骨为实验对象,模拟牙槽外支抗的过程。采用两种插入过程:直接插入30º和间接插入,从60º开始,在30º结束,逐渐连续移动。用光学显微镜和扫描电镜对应变进行评估。采用Kruskal-Wallis非参数统计分析和事后Tamhane检验对数据进行评价。在直接和间接的牙槽外插入中,微型螺钉的应变有显著的统计学差异。在间接插入试验中,不锈钢和钛微型螺钉均出现变形,表明角度是微型螺钉故效率的重要因素。插入运动过程中角度的变化增加了变形率,与合金类型无关,增加了失效的风险。这些结果可以帮助正畸医师选择直接插入或间接插入的微型螺钉进行牙槽外支抗。应该进行体内研究来证实本研究的发现。
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引用次数: 1
Effect of treatment time on performance of nano-encapsulated fluoride dentifrices for remineralization of initial carious lesions: an in vitro study. 治疗时间对纳米氟化物胶囊治疗初始龋齿再矿化性能的影响:体外研究
Andressa Fb Oliveira, Elizabeth Bg Sousa, Nayanna Ls Fernandes, Ingrid A Meira, Juliane R Lavôr, Ana Mbp Chaves, Fábio C Sampaio

The aim of this in vitro study was to evaluate the influence of treatment time on the remineralization performance of nanoencapsulated fluoride dentifrices on initial carious lesions. Ninety-six human enamel samples were allocated to eight groups (n = 12): 50% NanoF + 50% free NaF, 100% NanoF, 100% NaF (positive control), and placebo (negative control), using two different treatment times (one and five minutes) for each dentifrice tested. After the carious lesion induction, the specimens were submitted to a pH remineralizing cycling model for seven days. Surface microhardness was measured before and after carious lesion induction and after treatment. The percentage of surface remineralization was calculated for each study time. Data were analyzed using two-way ANOVA and ANOVA repeated-measures tests followed by the Bonferroni correction (p < 0.05). Remineralization differences were observed in the dentifrices analyzed according to the treatment time used. NanoF formulations with 50% (one-min treatment) and 100% (five-min treatment) promoted significant remineralization of enamel after the caries challenge when compared to the placebo dentifrice (p < 0.05). Thus, time was considered an important factor for the fluoride release system. Nanotechnology can be a promising system for caries remineralization as it makes fluoride available on the dental surface for a longer time.

本实验的目的是评估治疗时间对纳米氟化物胶囊对初始龋齿损伤再矿化性能的影响。96份人类牙釉质样本被分为8组(n = 12): 50% NanoF + 50%游离NaF, 100% NanoF, 100% NaF(阳性对照)和安慰剂(阴性对照),每种牙膏使用两种不同的处理时间(1分钟和5分钟)。龋齿诱导后,进行pH再矿化循环模型,持续7天。在龋齿诱发前后及治疗后分别测定表面显微硬度。计算每个研究时间的表面再矿化百分比。数据分析采用双因素方差分析和方差分析重复测量检验,并进行Bonferroni校正(p < 0.05)。根据治疗时间的不同,观察牙釉质再矿化的差异。与安慰剂牙膏相比,50%(治疗1分钟)和100%(治疗5分钟)的NanoF配方在龋齿攻击后显著促进牙釉质再矿化(p < 0.05)。因此,时间被认为是氟化物释放系统的一个重要因素。纳米技术是一种很有前途的龋齿再矿化系统,因为它可以使牙齿表面的氟化物在更长的时间内有效。
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引用次数: 0
Centric relation registration with intraoral central bearing on curved vs. flat plates with rim trays in edentulous patients. 无牙患者弯曲钢板与边缘托盘的口内中心定位的中心关系定位。
Pub Date : 2021-04-01 DOI: 10.54589/aol.34/1/035
Jorge E Aredes, Norberto A Fassina, Ricardo L Macchi

The aim of this study was to compare jaw relation record in the completely edentulous patient using acrylic rim trays with curved or flat registration plates or using the manual guidance technique. The study included 17 patients - 11 female and 6 male, average age 70 years. Three jaw relation records were taken during one session, in the same vertical dimension, using acrylic rim trays: (1) with manual guidance (IM), (2) with self-guided recording system with acrylic rim tray and central support using a curved plate (BYC) and (3) with self-guided recording system with acrylic rim tray and central support using a flat plate (BYR). The models were mounted on a Whip Mix 2240 articulator to which a condyle position device (Orthodent) was added to register, at the level of the condyle box and incisal table, the differences among the positions recorded with the different setups (IM, BYC and BYR). The distances were measured on millimeter paper provided by the recording system manufacturer. For statistical analysis, confidence intervals (95%) were calculated for the mean differences and Student's t-test for paired data (significance level: alpha<0.05). On both the mesiodistal plane and the vertical plane at the level of each condyle box and the incisal table, there were statistically significant differences among the three systems (p<0.001). At the level of incisal table, BYC and BYR provided more retrusive records than IM [arithmetic means (standard deviations) in millimeters: 3.82 (2.10) and 4.53 (2.18), respectively). The records obtained with BYR were significantly more retrusive with BYC [arithmetic mean (standard deviation) in millimeters: 1.41 (1.00)]. We reject the null hypothesis that proposes that all three registration systems described are clinically equivalent for establishing a jaw relation record in completely edentulous patients.

本研究的目的是比较完全无牙患者使用弯曲或平坦配位板的丙烯酸环托盘或使用手动引导技术的下颌关系记录。本研究纳入17例患者,其中女性11例,男性6例,平均年龄70岁。在同一次治疗中,使用亚克力托盘在相同的垂直尺寸下记录三个颌骨关系:(1)人工引导(IM),(2)使用弯曲板(BYC)使用亚克力托盘和中心支撑的自导向记录系统(BYR)使用平板(BYR)使用亚克力托盘和中心支撑的自导向记录系统。这些模型安装在Whip Mix 2240关节器上,在该关节器上添加了一个髁突位置装置(Orthodent),以在髁突盒和切表的水平上记录不同设置(IM, BYC和BYR)下记录的位置差异。距离是在记录系统制造商提供的毫米纸上测量的。对于统计分析,计算均值差异的置信区间(95%),并对配对数据进行学生t检验(显著性水平:alpha)
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引用次数: 0
Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial. 两支软毛牙刷去除牙菌斑的效果。一项随机对照试验。
Gerson Pj Langa, Francisco Wm Gomes Muniz, Harry J Rivera Oballe, Juliano Cavagni, Stephanie Anagnostopoulos Friedrich, Zilson Malheiros, Bernal Stewart, Cassiano K Rösing

The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, using Mann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gumline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77 vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

本研究的目的是比较两种软毛牙刷在牙菌斑清除方面的疗效。70名志愿者被随机分配到A组(锥形牙刷组)和B组(圆锥形牙刷组)。在基线预约(第0天),志愿者使用改进的斑块识别指数进行斑块检查。在监督下,他们用指定的牙刷刷牙1分钟,并重复检查牙菌斑。志愿者继续进行口腔卫生方案(分配牙刷和研究人员提供的常规牙膏)7天。重复第0天的实验步骤。采用Mann-Whitney检验,分别对两次全口、近端间和牙龈线菌斑减少的平均百分比进行统计分析,p0.05)。综上所述,在第0天,从全口、龈线和近端间菌斑评分来看,A组在龈上菌斑清除方面的疗效高于B组。
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引用次数: 0
Association between demarcated enamel hypomineralization on second primary molars and dental caries in childhood. 儿童第二磨牙牙釉质低矿化与龋病的关系。
Pub Date : 2020-12-01 DOI: 10.54589/aol.33/3/181
C. M. Costa-Silva, G. M. Ambrosano, F. Mialhe
Hypomineralized Second Primary Molars (HSPM) is the name used to describe the presence of demarcated enamel hypomineralization in second primary molars. HSPM has been compared with Molar Incisor Hypomineralization (MIH) as regards its clinical appearance and consequences. The aim of this study was to investigate associations between HSPM and dental caries in childhood. It was a cross-sectional populationbased study that included 216 children aged 4-6 years from public schools in Botelhos, Brazil. Children with all second primary molars erupted were eligible for participation. Clinical examination was performed by one calibrated examiner. HSPM was recorded according to modified European Academy of Paediatric Dentistry criteria. The main outcome was dental caries experience as indicated by the dmft index (%dmft>0) according to WHO criteria. Chi-square test and Logistic Regression Model were used to adjust the results for effects of covariates Among the 216 children examined, 22.2% presented HSPM. After adjustment for logistic regression, children with HSPM were found to have a 2.28 times greater chance of presenting dental caries. Our results reinforce the importance of HSPM in caries development in children, which should be considered by public health dentists in the process of planning actions aimed at this population.
第二初级磨牙低矿化(HSPM)是指第二初级磨牙牙釉质低矿化现象。HSPM与磨牙切牙低矿化(MIH)的临床表现和后果进行了比较。本研究的目的是调查儿童HSPM与龋齿之间的关系。这是一项以人口为基础的横断面研究,包括216名来自巴西博特勒霍斯公立学校的4-6岁儿童。所有第二初磨牙均萌出的儿童均符合参与条件。临床检查由一名校准的检查员进行。HSPM根据修改后的欧洲儿科牙科学会标准进行记录。根据世卫组织标准,主要结果是龋病指数(%dmft>0)所表示的龋病经历。采用卡方检验和Logistic回归模型对协变量的影响进行校正。216名儿童中,有22.2%的儿童存在HSPM。经logistic回归校正后,发现HSPM儿童出现龋齿的几率是其他儿童的2.28倍。我们的研究结果加强了HSPM在儿童龋齿发展中的重要性,公共卫生牙医在针对这一人群的计划行动过程中应考虑到这一点。
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引用次数: 0
Comprehensive clinics. A comparative study among Dental Schools in Argentina. 综合诊所。阿根廷牙科学校的比较研究。
Noemí Bordoni, Angela Argentieri, Aldo Squassi

In this study, comprehensive clinics (CC) are interpreted as a pragmatic projection of the complexity of health. The aim of the study was to analyze the characteristics of the CCs at different schools of dentistry in Argentina. Data were collected from document analysis and interviews with key respondents at 8 universities, classified according to the criteria of Bray and Thomas. Interviews were developed and analyzed according to discourse analysis. The convergences and divergences among curricula were established and analyzed statistically. Triangulation of results showed that: (a) Most curricula (7/8) included subjects called CC; (b) the permanence of CCs in the curricula was not stable, with changes recorded in different periods; and (c) in the so-called CCs, the complex clinical approach showed frequent displacements based on teacher values or competence. It was concluded that there are divergences between theory and practice, and that it would be recommendable to have more rigorous curricular design taking into account current trends regarding the complexity of health and its transfer to educational management.

在本研究中,综合诊所(CC)被解释为健康复杂性的实用主义预测。本研究的目的是分析阿根廷不同牙科学校的cc的特点。数据收集自8所大学的文献分析和对主要受访者的访谈,根据布雷和托马斯的标准进行分类。访谈根据话语分析进行开发和分析。建立了课程间的趋同与差异,并进行了统计分析。三角测量结果显示:(a)大多数课程(7/8)包括称为CC的科目;(b)课程中CCs的持续时间并不稳定,在不同时期有所变化;(c)在所谓的cc中,复杂的临床方法显示出基于教师价值观或能力的频繁位移。结论是,理论与实践之间存在分歧,建议在考虑到保健的复杂性及其向教育管理转移的当前趋势的情况下,进行更严格的课程设计。
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引用次数: 0
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