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Revisión sistemática de los eventos adversos neurológicos derivados de la atención odontoestomatológica

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2018
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Introducción: Desde que, en 2004, la OMS creó la Alianza Mundial para la Seguridad del Paciente, no han dejado de sucederse las iniciativas para mejorar la seguridad de los pacientes en el ámbito médico. Sin embargo, en el campo odontoestomatológico, no es hasta 2011 cuando surgen las primeras iniciativas concretas, con la propuesta del primer "Plan de Gestión de Riesgos Sanitarios en Odontología" y la creación del Observatorio Español de Seguridad para el Paciente en Odontología (OESPO) por el Consejo General de Dentistas.En el presente Trabajo de Investigación de Fin de Máster, y dada la ausencia de estudios sobre eventos adversos neurológicos en Odontoestomatología se proponen los siguientes objetivos. Objetivos: Realizar una revisión sistemática de los eventos adversos neurológicos en la práctica Odontoestomatológica. Estudiar y analizar la tipología de los eventos adversos más frecuentes en la práctica Odontoestomatológica. Material y métodos: Para abordar los objetivos planteados, se realiza una revisión sistemática de la literatura y un análisis de las bases de datos específicas de eventos adversos neurológicos, mediante el formato PICO y los criterios de la Guía PRISMA para revisiones sistemáticas. Posteriormente se estudian y analizan los eventos adversos en las áreas con mayor frecuencia de eventos adversos reportados: Endodoncia, Cirugía Bucal, Implantología Oral, y Cirugía Ortognática. Resultados: La búsqueda inicialmente se desarrolló mediante un criterio general, en el universo de artículos y estudios, de todo lo referido a eventos adversos neurológicos ocurridos en la atención odontoestomatológica, incluyendo todo tipo de estudio, reporte, ensayo o trabajo de investigación, sin considerar el área odontológica. Esta búsqueda inicial dio como resultado 4.778 artículos, que cumplían los criterios de la búsqueda. Según los criterios de la Guía PRISMA para revisiones sistemáticas y los criterios de inclusión y exclusión propuestos, y tras la revisión de las referencias cruzadas, se obtuvo un total de 76 artículos válidos para la realización del presente trabajo, que incluían 161 estudios. Se registraron un total de 22.767 participantes, de los cuales 6.068 manifestaron eventos adversos neurológicos, con un total de 8.242 eventos adversos. Discusión: Se estudiaron como casos de eventos adversos neurológicos, los casos de anestesias, parestesias, disestesias, hiperestesias, y neuralgias. Todos los eventos adversos se produjeron durante maniobras y tratamientos odontológicos, tanto quirúrgicos como conservadores o rehabilitadores. Las áreas clínicas estudiadas fueron, por su frecuencia, la Endodoncia, la Cirugía Bucal, la Implantología Oral, la Cirugía Maxilofacial y el resto de tratamientos. Conclusiones: Según los resultados obtenidos, se observan cuatro áreas de la Odontoestomatología donde se acumula la mayor frecuencia de eventos adversos: Cirugía Bucal (especialmente en cirugía del tercer molar), con un 52,38% de los EA registrados; Cirugía Maxilofacial (especialmente en osteotomía sagital bilateral), con un 30,50% de los EA registrados; Implantología Oral (especialmente en implantes mandibulares), con un 2,36% de los EA registrados; y Endodoncia (especialmente en endodoncia de premolares y molares mandibulares), con un 1,43% de los EA registrados.
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