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y aunque la p&#233;rdida completa de dientes ha disminuido sigue siendo una condici&#243;n prevalente en las personas mayores<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a>&#46; En Chile&#44; un estudio con una muestra representativa nacional de 1553 personas adultas inform&#243; un 11&#44;4&#37; de edentulismo en la poblaci&#243;n de 65-74 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46; Los datos de la Encuesta Nacional de Salud &#40;ENS&#41; chilena de 2016-2017 indican que el 81&#44;7&#37; de las personas mayores de 65 a&#241;os tienen menos de 20 dientes&#44; y el uso de pr&#243;tesis dental en este grupo alcanza el 65&#44;8&#37;&#44; significativamente superior al total del pa&#237;s &#40;22&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diversos estudios han asociado la mala salud oral con diversas condiciones de salud&#44; como problemas cardiovasculares&#44; hipertensi&#243;n arterial&#44; diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a> y depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#46; Menos explorada es su asociaci&#243;n con las enfermedades neurodegenerativas&#44; un grupo de trastornos caracterizados por un deterioro progresivo de las funciones motoras o cognitivas&#44; entre ellas las demencias&#44; siendo la enfermedad de Alzheimer la m&#225;s prevalente en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46; Un estado que precede a las demencias es el deterioro cognitivo&#44; condici&#243;n en la cual las personas presentan un deterioro en una o m&#225;s funciones cognitivas&#44; mayor que el esperado para su edad&#44; sin o con m&#237;nima afectaci&#243;n en las actividades de la vida diaria instrumentales y sin presencia de demencia<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Actualmente no existe un tratamiento efectivo para el deterioro cognitivo&#59; sin embargo&#44; la identificaci&#243;n de sus factores de riesgo ha sido de gran relevancia para generar intervenciones oportunas que ayuden a su prevenci&#243;n o a evitar su progresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Existe evidencia internacional que vincula el deterioro cognitivo con la salud oral en poblaci&#243;n adulta mayor de amplia heterogeneidad cultural<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#46; Sin embargo&#44; hasta nuestro conocimiento&#44; no existen investigaciones recientes que analicen esta asociaci&#243;n en poblaci&#243;n chilena&#46; Dado lo anterior&#44; este estudio tuvo como objetivo identificar la asociaci&#243;n entre salud oral y sospecha de deterioro cognitivo en personas chilenas de 60 y m&#225;s a&#241;os de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">En este estudio observacional&#44; de corte transversal&#44; utilizamos datos disponibles de la ENS de 2016-2017<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; una encuesta poblacional realizada en una muestra nacional&#44; probabil&#237;stica&#44; estratificada y multiet&#225;pica de 6233 personas de 15 y m&#225;s a&#241;os de edad&#44; con representatividad nacional&#44; regional y por &#225;rea urbana&#47;rural&#44; de la que se excluyeron mujeres embarazadas y personas con antecedentes de conductas violentas&#46; En este estudio se utilizaron los datos de una submuestra conformada por 1826 personas mayores de 60 a&#241;os &#40;el 51&#44;6&#37; eran mujeres&#41; que contaban con datos completos en las variables de inter&#233;s&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo de estudio fue aprobado por el Comit&#233; de &#201;tica de la Escuela de Medicina de la Pontificia Universidad Cat&#243;lica de Chile&#46; Todas las personas participantes firmaron un consentimiento informado &#40;ENS 2016-2017&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Variables e instrumentos</span><p id="par0215" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#41;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Salud oral</p></li></ul></p><p id="par0214" class="elsevierStylePara elsevierViewall">Las medidas de salud oral fueron recogidas mediante un examen cl&#237;nico&#44; realizado por enfermeras entrenadas&#44; que consider&#243;&#58; a&#41; conteo de n&#250;mero de dientes&#44; b&#41; presencia de caries y c&#41; uso de pr&#243;tesis dental&#46; Se incluy&#243; el autorreporte a trav&#233;s de preguntas cerradas sobre salud oral y presencia de dolor o molestias en la cavidad oral<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El n&#250;mero de dientes fue categorizado como variable continua&#44; correspondiente al n&#250;mero de dientes &#40;0 a 32&#41;&#44; ausencia total de dientes &#40;edentulismo&#41; y tertiles &#40;0 a 9 dientes&#44; 10 a 20 dientes y<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20 dientes&#41;&#46; La presencia de caries y el uso de pr&#243;tesis dental fueron categorizados en s&#237; &#40;presencia&#41; o no &#40;ausencia&#41;&#46; La salud oral autorreportada fue medida con la pregunta &#171;En general&#44; &#191;c&#243;mo dir&#237;a usted que es su salud oral&#63;&#187;&#44; y las respuestas fueron categorizadas en muy buena o buena&#44; mala&#44; o muy mala&#46; La presencia de dolor o molestias en la cavidad oral fue medida con la pregunta &#171;&#191;Son mis dientes o boca una causa de dolor o molestia&#63;&#187;&#44; y las respuestas fueron codificadas dicot&#243;micamente &#40;s&#237; o no&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Sospecha de deterioro cognitivo</p></li></ul></p><p id="par0221" class="elsevierStylePara elsevierViewall">Para la evaluaci&#243;n de sospecha de deterioro cognitivo se utiliz&#243; el <span class="elsevierStyleItalic">Mini-Mental State Examination</span> &#40;MMSE&#41;&#44; instrumento de cribado de deterioro cognitivo en su versi&#243;n abreviada de seis preguntas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#44; con una puntuaci&#243;n m&#225;xima de 19 puntos y una puntuaci&#243;n de corte &#8804;13 puntos correspondiente a MMSE alterado&#44; indicativo de sospecha de deterioro cognitivo&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#41;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Covariables</p></li></ul></p><p id="par0226" class="elsevierStylePara elsevierViewall">Las variables sociodemogr&#225;ficas edad&#44; sexo &#40;hombre&#47;mujer&#41;&#44; a&#241;os de educaci&#243;n &#40;&#8804;8 a&#241;os&#44; 9-12 a&#241;os o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os&#41;&#44; zona de residencia &#40;urbana o rural&#41; y estilo de vida se obtuvieron mediante autorreporte con cuestionarios de la ENS 2016-2017<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46; Incluyeron h&#225;bito tab&#225;quico &#40;nunca ha fumado&#44; exfumador o fumador&#41;&#44; consumo de alcohol <span class="elsevierStyleItalic">&#40;AUDIT score&#41;</span><a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> categorizado en baja ingesta &#40;&#62;8 puntos&#41; o alta ingesta &#40;&#8804;8 puntos&#41;&#44; e &#237;ndice de calidad de la dieta basado en el cumplimiento de las gu&#237;as alimentarias nacionales con puntuaciones de 0 a 12 distribuidas en tres categor&#237;as seg&#250;n la adherencia a una dieta saludable &#40;&#8805;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>adherencia&#44; 5-8<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>adherencia moderada y &#8804;4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no adherencia&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; El nivel de actividad f&#237;sica&#44; el tiempo destinado a las actividades de transporte activo y las actividades de intensidad moderada o vigorosa fueron determinados con el <span class="elsevierStyleItalic">Global Physical Activity Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#44; y las personas se clasificaron como activas o inactivas seg&#250;n su gasto energ&#233;tico &#40;punto de corte&#58; 600 MET&#47;min&#47;semana&#41;&#46; La condici&#243;n de bajo peso se determin&#243; seg&#250;n el &#237;ndice de masa corporal utilizando los puntos de corte de valoraci&#243;n espec&#237;fica para personas adultas mayores<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> &#40;bajo peso<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; Adicionalmente se utilizaron medidas de presi&#243;n arterial para el diagn&#243;stico de hipertensi&#243;n arterial y glucemia en ayuno para el de diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2&#46; La depresi&#243;n fue evaluada con la versi&#243;n corta del <span class="elsevierStyleItalic">Composite International Diagnostic Interview</span> &#40;CIDI-SF&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a>&#44; un instrumento de cribado que identifica s&#237;ntomas de depresi&#243;n en los &#250;ltimos 12 meses&#46; Adicionalmente&#44; se solicitaron el reporte de dolor cr&#243;nico&#44; el diagn&#243;stico de asma&#44; el diagn&#243;stico de artritis reumatoide&#44; problemas auditivos y presencia de problemas para dormir&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#41;</span><p id="par0235" class="elsevierStylePara elsevierViewall">An&#225;lisis estad&#237;stico</p></li></ul></p><p id="par0231" class="elsevierStylePara elsevierViewall">Los datos de caracterizaci&#243;n de la poblaci&#243;n&#44; salud oral y deterioro cognitivo se analizaron como promedios e intervalos de confianza para variables continuas&#44; y como porcentajes con sus respectivos intervalos de confianza del 95&#37; &#40;IC95&#37;&#41; para las categ&#243;ricas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para determinar la asociaci&#243;n entre la sospecha de deterioro cognitivo y las distintas condiciones de salud oral se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica en tres modelos&#58; modelo 1&#44; sin ajustar&#59; modelo 2&#44; ajustado por edad&#44; sexo&#44; nivel de educaci&#243;n y zona de residencia&#44; y modelo 3&#44; ajustado por las variables del modelo 2 m&#225;s h&#225;bito tab&#225;quico&#44; ingesta de alcohol&#44; calidad de la dieta&#44; actividad f&#237;sica&#44; hipertensi&#243;n&#44; diabetes&#44; bajo peso &#40;s&#237;&#47;no&#41; y depresi&#243;n&#46; Los resultados se presentan como <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y sus respectivos IC95&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tambi&#233;n se realiz&#243; un an&#225;lisis de regresi&#243;n lineal para establecer la asociaci&#243;n entre el deterioro cognitivo &#40;esta vez usado como variable continua&#58; puntuaci&#243;n en el MME&#41; y el n&#250;mero de dientes &#40;tambi&#233;n como variable continua&#41;&#46; Se analizaron tres modelos usando las mismas variables de ajuste antes mencionadas&#46; Los resultados se presentan como coeficientes &#946; y sus respectivos IC95&#37;&#46; Se consider&#243; estad&#237;sticamente significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis fueron ajustados por el factor de expansi&#243;n&#44; resultando en una muestra expandida de 3&#46;066&#46;214 individuos correspondientes a la extrapolaci&#243;n a la poblaci&#243;n nacional utilizando los factores de expansi&#243;n sugeridos por la ENS 2016-2017&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con STATA V17 &#40;2021 StataCorp&#59; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La caracterizaci&#243;n de la muestra se detalla en la <a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#46; En comparaci&#243;n con personas sin deterioro cognitivo&#44; aquellas con sospecha de deterioro cognitivo presentaron un mayor promedio de edad &#40;73&#44;4 vs&#46; 68&#44;9 a&#241;os&#41;&#44; un menor nivel educativo y una mayor proporci&#243;n de mala calidad de la dieta y alta ingesta de alcohol &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La caracterizaci&#243;n de la muestra seg&#250;n sexo indica que la edad promedio de las mujeres con sospecha de deterioro cognitivo fue mayor que la de los hombres con la misma condici&#243;n &#40;75&#44;2 vs&#46; 73&#44;9 a&#241;os&#41;&#44; y para ambos grupos esta edad fue mayor que la del grupo sin sospecha de deterioro cognitivo&#46; Los hombres con sospecha de deterioro cognitivo tuvieron una mayor proporci&#243;n de &#8804;8 a&#241;os de escolaridad&#44; alta ingesta de alcohol y sospecha de depresi&#243;n que las mujeres en igual condici&#243;n&#46; Por otra parte&#44; las mujeres con sospecha de deterioro cognitivo mostraron mayor proporci&#243;n de estado nutricional de bajo peso&#44; problemas auditivos y problemas para dormir que los hombres en igual condici&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Al comparar las condiciones orales de la muestra total seg&#250;n el deterioro cognitivo&#44; las personas con sospecha de deterioro presentaron en promedio cinco dientes menos &#40;13&#44;4 vs&#46; 8&#44;5 dientes&#41;&#46; Una mayor proporci&#243;n de personas con sospecha de deterioro cognitivo informaron mala calidad de salud oral&#44; en comparaci&#243;n con las personas sin sospecha de deterioro cognitivo &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El an&#225;lisis comparativo seg&#250;n el sexo &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41; mostr&#243; que las mujeres con sospecha de deterioro cognitivo presentaron casi siete dientes menos que aquellas sin sospecha&#44; diferencia muy superior a la encontrada en los hombres&#44; en quienes el n&#250;mero de dientes se mantuvo casi similar en aquellos con y sin deterioro cognitivo&#46; Del mismo modo&#44; la presencia de edentulismo fue mayor en las mujeres con deterioro cognitivo &#40;26&#44;8&#37;&#41; que en los hombres con igual condici&#243;n &#40;17&#44;6&#37;&#41;&#44; y lo mismo para el uso de pr&#243;tesis &#40;16&#44;9&#37; vs&#46; 12&#44;7&#37;&#41;&#46; La presencia de caries fue mayor en los hombres con sospecha de deterioro cognitivo que en las mujeres &#40;14&#44;1&#37; vs&#46; 12&#44;3&#37;&#41;&#44; lo mismo que la presencia de dolor oral &#40;25&#44;4&#37; vs&#46; 24&#44;8&#37;&#41; y de muy mala o mala salud reportada &#40;22&#44;6&#37; vs&#46; 19&#44;5&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Las asociaciones entre las variables de salud oral y sospecha de deterioro cognitivo se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; En el modelo sin ajustar&#44; la presencia de edentulismo se asoci&#243; con mayor probabilidad de sospecha de deterioro cognitivo &#40;OR&#58; 2&#44;08&#59; IC95&#37;&#58; 1&#44;29-3&#44;35&#41;&#46; Consistentemente&#44; tener 10-20 dientes &#40;OR&#58; 0&#44;48&#59; IC95&#37;&#58; 0&#44;31-0&#44;78&#41; o m&#225;s de 20 dientes &#40;OR&#58; 0&#44;35&#59; IC95&#37;&#58; 0&#44;17-0&#44;72&#41; se asoci&#243; a menor probabilidad de deterioro cognitivo&#44; en comparaci&#243;n con las personas que ten&#237;an 0-9 dientes&#46; Una mala o muy mala salud oral autorreportada se asoci&#243; con mayor probabilidad de sospecha de deterioro cognitivo&#44; en comparaci&#243;n con quienes reportaron buena o muy buena salud oral &#40;OR&#58; 1&#44;64&#59; IC95&#37;&#58; 1&#44;03-2&#44;60&#41;&#46; Tras ajustar por las variables de confusi&#243;n en los modelos 2 y 3&#44; las asociaciones previamente identificadas fueron atenuadas&#44; permaneciendo estad&#237;sticamente significativas solo para dolor oral&#44; cuya presencia se asoci&#243; a 1&#44;99 &#40;IC95&#37;&#58; 1&#44;09-3&#44;63&#41; veces m&#225;s probabilidad de presentar sospecha de deterioro cognitivo en comparaci&#243;n con quienes no refer&#237;an dolor oral &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">En los modelos de regresi&#243;n lineal &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; por cada diente adicional se observ&#243; un aumento del 2&#37; en la puntuaci&#243;n del MMSE&#46; La relaci&#243;n se mantuvo significativa aun despu&#233;s de ajustar por todas las variables de confusi&#243;n&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los hallazgos de este estudio evidencian una asociaci&#243;n entre la salud oral y la sospecha de deterioro cognitivo en las personas mayores chilenas&#46; Los participantes con sospecha de deterioro cognitivo tuvieron menor n&#250;mero de dientes y mayor presencia de dolor oral&#46; Por otra parte&#44; la probabilidad de sospecha de deterioro cognitivo fue mayor en caso de dolor oral y en personas con p&#233;rdida total de dientes o menor n&#250;mero de dientes&#44; aunque estas asociaciones pierden significaci&#243;n en los modelos ajustados&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La p&#233;rdida de dientes fue una condici&#243;n prevalente en la muestra estudiada&#44; con independencia de la presencia de deterioro cognitivo&#44; lo que confirma los hallazgos previos en muestras representativas de personas mayores chilenas&#44; que indican que el 11&#44;4&#37; padecen edentulismo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre deterioro cognitivo y p&#233;rdida de dientes ha sido previamente confirmada<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46; Un estudio de cohorte prospectivo de 4 a&#241;os realizado en Jap&#243;n determin&#243; que las personas con 0-9 dientes ten&#237;an mayor probabilidad de desarrollar deterioro cognitivo que aquellas con &#8805;10 dientes &#40;OR&#58; 3&#44;31&#59; IC95&#37;&#58; 1&#46;07-10&#46;2&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#44; y una revisi&#243;n sistem&#225;tica y metaan&#225;lisis de 14 estudios encontr&#243; que los sujetos con mayor p&#233;rdida de dientes ten&#237;an 1&#44;48 veces m&#225;s riesgo de desarrollar deterioro cognitivo &#40;IC95&#37;&#58; 1&#44;18-1&#44;87&#41; y 1&#44;28 veces m&#225;s riesgo de ser diagnosticados de demencia &#40;IC95&#37;&#58; 1&#44;09-1&#44;49&#41;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&#46; Otro estudio con personas mayores de 60 a&#241;os&#44; con y sin demencia evaluados con el MMSE&#44; inform&#243; que a medida que aumentaba la disfunci&#243;n cognitiva tambi&#233;n aumentaba la p&#233;rdida de dientes<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se postula que la asociaci&#243;n de deterioro cognitivo y salud oral est&#225; m&#225;s relacionada con la capacidad masticatoria que con el n&#250;mero de dientes<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a>&#46; Las personas con dificultades masticatorias deben realizar cambios en las texturas de los alimentos que ingieren&#44; evitando s&#243;lidos y priorizando los alimentos tipo pudding<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a>&#44; lo cual&#44; adicionado a las deficiencias de micro- y macronutrientes&#44; propicia la disminuci&#243;n del rendimiento masticatorio&#46; Esta condici&#243;n contribuir&#237;a al deterioro cognitivo&#44; debido a que la masticaci&#243;n estimula la actividad del hipocampo&#44; estructura considerada clave en la funci&#243;n cognitiva y la memoria&#46; Tambi&#233;n contribuir&#237;a a aumentar el flujo sangu&#237;neo cerebral&#44; aportando mayor cantidad de ox&#237;geno hacia otras regiones cerebrales&#44; como corteza motora primaria&#44; suplementaria&#44; sensorial&#44; &#237;nsula&#44; t&#225;lamo y cerebelo<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Otro mecanismo que podr&#237;a explicar la asociaci&#243;n positiva entre la p&#233;rdida de dientes y el deterioro cognitivo es que las personas con p&#233;rdida de dientes parcial o total&#44; y problemas masticatorios asociados&#44; presentan mayor riesgo de desnutrici&#243;n&#44; lo cual se ha asociado con deterioro cognitivo y enfermedad de Alzheimer<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Tambi&#233;n se asocian a la p&#233;rdida de dientes los malos h&#225;bitos de higiene dental&#44; planteando que el funcionamiento cognitivo alterado induce a inadecuadas rutinas de higiene&#44; pero tambi&#233;n es posible que no cumplir con una rutina de higiene sea un s&#237;ntoma inicial de alteraci&#243;n en el funcionamiento cognitivo<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a>&#46; Vinculado a lo anterior&#44; las personas mayores con alteraciones cognitivas informan menor uso de los servicios dentales<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#44; lo que puede exacerbar el problema&#46; Lo anterior puede sugerir bidireccionalidad en la relaci&#243;n entre salud oral y funcionamiento cognitivo&#44; en tanto que una mala salud oral induce alteraciones cognitivas y&#44; a su vez&#44; estas inciden en la salud oral&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La enfermedad periodontal es considerada una de las principales causas de p&#233;rdida de piezas dentarias en las personas mayores de 45 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; As&#237;&#44; otro mecanismo explicativo de la asociaci&#243;n entre salud&#44; dolor oral y deterioro cognitivo radica en la infecci&#243;n bacteriana y el proceso inflamatorio cr&#243;nico productor de citocinas proinflamatorias &#40;interleucina 1<span class="elsevierStyleHsp" style=""></span>B&#44; interleucina 6 y factor de necrosis tumoral&#41;&#44; que en etapas avanzadas pueden provocar una inflamaci&#243;n sist&#233;mica general y promover procesos neuroinflamatorios que incluyen amiloidosis&#44; muerte neuronal&#44; adelgazamiento cortical y reducci&#243;n del volumen cerebral&#44; todos ellos eventos relacionados con la enfermedad cerebrovascular y la neurodegeneraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Adicionalmente&#44; la exposici&#243;n a diversos agentes pat&#243;genos o bacterias genera una respuesta inflamatoria que desencadena una cascada de reacciones que inducir&#237;an la destrucci&#243;n del tejido cerebral<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; El da&#241;o neuronal en la&#160;patog&#233;nesis de la enfermedad de Alzheimer estar&#237;a causado por la infecci&#243;n por <span class="elsevierStyleItalic">Porphyromonas gingivalis</span> a trav&#233;s de la secreci&#243;n de gingipa&#237;nas<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#46; Igualmente&#44; se ha descrito el papel de la neuroinflamaci&#243;n en la patog&#233;nesis del deterioro cognitivo y las demencias<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#44; lo que provocar&#237;a una serie de eventos que comienzan con la estimulaci&#243;n de las c&#233;lulas gliales para la generaci&#243;n de citocinas proinflamatorias y terminan con el da&#241;o de las c&#233;lulas nerviosas<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Otro hallazgo de este estudio es la mayor probabilidad de deterioro cognitivo en presencia de dolor de la cavidad oral&#46; Las revisiones del tema confirman esta asociaci&#243;n&#44; pero enfatizan la escasez de estudios al respecto y la complejidad de la evaluaci&#243;n de la salud oral en las personas mayores<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a>&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fortalezas y limitaciones del estudio</span><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudio se desarroll&#243; en una muestra representativa de personas mayores chilenas e incorpor&#243; un examen cl&#237;nico para determinar la salud oral&#44; lo que otorga solidez a los hallazgos&#46; Entre sus limitaciones se encuentra el uso de una medida global de funcionamiento cognitivo&#44; el MMSE&#44; que solo es indicativo de sospecha de deterioro&#46; De igual forma&#44; algunas medidas de salud oral fueron evaluadas mediante autorreporte&#44; aun cuando estudios longitudinales han mostrado su correlaci&#243;n con indicadores objetivos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a>&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los problemas de salud oral son altamente prevalentes en la poblaci&#243;n adulta mayor chilena&#44; en particular en grupos de bajo nivel educativo y bajo nivel de ingresos&#46; Los hallazgos de este estudio confirman la asociaci&#243;n entre mala salud oral&#44; particularmente p&#233;rdida de dientes&#44; dolor oral y sospecha de deterioro cognitivo&#46; Lo anterior aporta en la identificaci&#243;n temprana de los factores de riesgo de deterioro cognitivo y en la promoci&#243;n de la salud y la prevenci&#243;n de las enfermedades neurodegenerativas&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Disponibilidad de bases de datos y material para r&#233;plica</span><p id="par0165" class="elsevierStylePara elsevierViewall">Estos datos fueron obtenidos de los siguientes recursos disponibles en el dominio p&#250;blico&#58; sitio web del Departamento de Epidemiolog&#237;a del Ministerio de Salud de Chile&#58; http&#47;&#47;epi&#46;minsal&#46;cl&#47;encuesta-ens&#47; &#40;accedido el 1 de octubre de 2022&#41;&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Editora responsable del art&#237;culo</span><p id="par0185" class="elsevierStylePara elsevierViewall">Leila P&#46; Garc&#237;a&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Declaraci&#243;n de transparencia</span><p id="par0190" class="elsevierStylePara elsevierViewall">La autora principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Contribuciones de autor&#237;a</span><p id="par0200" class="elsevierStylePara elsevierViewall">Contribuci&#243;n sustancial a la concepci&#243;n y el dise&#241;o&#58; F&#46; D&#237;az-Toro&#44; G&#46; Nazar y F&#46; Petermann-Rocha&#46; An&#225;lisis e interpretaci&#243;n de los datos&#58; F&#46; D&#237;az-Toro&#44; G&#46; Nazar y F&#46; Petermann-Rocha&#46; Redacci&#243;n del art&#237;culo&#58; G&#46; Nazar&#44; P&#46; Roa&#44; F&#46; D&#237;az-Toro&#44; F&#46; Petermann-Rocha&#44; C&#46; Troncoso-Pantoja y A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#46; Revisi&#243;n cr&#237;tica&#58; C&#46; Troncoso-Pantoja&#44; A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#44; I&#46; Cigarroa y C&#46; Celis-Morales&#46; Aprobaci&#243;n de la versi&#243;n final&#58; G&#46; Nazar&#44; F&#46; D&#237;az-Toro&#44; P&#46; Roa&#44; F&#46; Petermann-Rocha&#44; C&#46; Troncoso-Pantoja&#44; A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#44; I&#46; Cigarroa y C&#46; Celis-Morales&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Agradecimientos</span><p id="par0240" class="elsevierStylePara elsevierViewall">Se agradece a los participantes de la ENS 2016-2017&#44; as&#237; como tambi&#233;n al MINSAL y la Pontificia Universidad Cat&#243;lica de Chile que lideraron la ENS 2016-2017&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflictos de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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    "fechaRecibido" => "2022-10-24"
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            0 => "Oral health"
            1 => "Cognitive impairment"
            2 => "Tooth loss"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar la asociaci&#243;n entre salud oral y sospecha de deterioro cognitivo en personas mayores chilenas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal con 1826 participantes &#8805;60 a&#241;os de la Encuesta Nacional de Salud de Chile&#44; 2016-2017&#46; La salud oral fue evaluada por el n&#250;mero de dientes&#44; la presencia de caries&#44; el uso de pr&#243;tesis dental y el autorreporte de salud oral y dolor en la cavidad oral&#46; La sospecha de deterioro cognitivo fue evaluada mediante el <span class="elsevierStyleItalic">Mini-Mental State Examination</span> &#40;MMSE&#41;&#46; Se emple&#243; regresi&#243;n log&#237;stica y lineal&#44; ajustada por variables sociodemogr&#225;ficas y de estilos de vida&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En comparaci&#243;n con personas sin sospecha de deterioro cognitivo&#44; aquellas con sospecha de deterioro cognitivo presentaron cinco dientes menos &#40;13&#44;4 vs&#46; 8&#44;5 dientes&#41;&#44; diferencia muy superior en mujeres que en hombres&#44; y mayor frecuencia de dolor oral&#46; El edentulismo y el menor n&#250;mero de dientes se asociaron a mayor probabilidad de sospecha de deterioro cognitivo&#44; asociaciones que no se mantuvieron en modelos ajustados&#46; El dolor oral se asoci&#243; a mayor probabilidad de sospecha de deterioro cognitivo &#40;<span class="elsevierStyleItalic">odds ratio&#58;</span> 1&#44;99&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 1&#44;09-3&#44;63&#41;&#46; Por cada diente adicional se observ&#243; un aumento del 2&#37; &#40;IC95&#37;&#58; 0&#44;01-0&#44;05&#41; en la puntuaci&#243;n del MMSE&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mala salud oral&#44; en particular la p&#233;rdida de dientes y la presencia de dolor&#44; se asociaron con deterioro cognitivo en personas mayores chilenas&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To identify the association between oral health and suspected cognitive impairment in older adults in Chile&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study including 1826 people &#8805;60 years who participated in the National Health Survey of Chile&#44; 2016-2017&#46; Oral health was evaluated by the number of teeth&#44; presence of caries&#44; use of dental prostheses&#44; self-reported oral health&#44; and pain and&#47;or discomfort in the oral cavity&#46; Cognitive impairment was assessed using the Mini-Mental State Examination &#40;MMSE&#41;&#46; The association was evaluated by logistic and linear regression&#44; adjusted for sociodemographic and lifestyle variables&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compared with people without suspicion of cognitive impairment&#44; people with suspected impairment had five fewer teeth &#40;13&#46;4 vs&#46; 8&#46;5 teeth&#41;&#44; a much higher difference in women than in men&#44; and a higher frequency of oral pain&#46; Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment&#44; associations that were not maintained in adjusted models&#46; Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model &#40;odds ratio&#58; 1&#46;99&#59; 95&#37; confidence interval &#91;95&#37;<span class="elsevierStyleSmallCaps">C</span>I&#93;&#58; 1&#46;09-3&#46;63&#41;&#46; In linear models&#44; an increase of 2&#37; &#40;95&#37;CI&#58; 0&#46;01-0&#46;05&#41; in the MMSE score was observed for each additional tooth&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Poor oral health&#44; particularly tooth loss and the presence of pain&#44; was associated with cognitive impairment in older adults in Chile&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Con sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">n total</span><span class="elsevierStyleItalic">N expandida</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1501N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;591&#46;897&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>325N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>474&#46;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>956N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;337&#46;966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>208N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>249&#46;884&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>545N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;253&#46;931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>224&#46;432&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Porcentaje &#40;IC95&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;5 &#40;81&#44;6-87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4 &#40;12&#44;9-18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;3 &#40;80&#44;7-87&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;47 &#40;12&#44;7-19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;8 &#40;79&#44;9-88&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;1 &#40;11&#44;3-20&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;9 &#40;68&#44;1-69&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;4 &#40;71&#44;7-75&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;3 &#40;69&#44;9-71&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;2 &#40;74&#44;5-79&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;9 &#40;68&#44;2-71&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;9 &#40;71&#44;8-75&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;1 &#40;72&#44;8-80&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&#44;9 &#40;19&#44;2-27&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;4 &#40;72&#44;2-81&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&#44;6&#40;18&#44;1-27&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&#44;5 &#40;69&#44;4-82&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&#44;5 &#40;17&#44;6-30&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>9-12 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#44;4 &#40;78&#44;3-97&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">94&#44;7 &#40;90&#44;5-97&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;3 &#40;2&#44;9-9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95&#44;4 &#40;90&#44;7-97&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;6 &#40;2&#44;1-9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#44;9 &#40;3&#44;1-7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#44;1 &#40;94&#44;7-99&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9 &#40;0&#44;7-5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Residencia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca ha fumado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Actual fumador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;4 &#40;4&#44;2-15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Actividad f&#237;sica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Problemas auditivos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sospecha de depresi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Salud oral autorreportada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy buena o buena&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;2 &#40;11&#44;2-17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala o muy mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46;&#176; dientes&#44; promedio &#40;IC&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edentulismo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;7 &#40;67&#44;5-82&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73&#44;2 &#40;63&#44;8-80&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46;&#176; dientes &#40;tertiles&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;08 &#40;1&#44;29-3&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;0&#44;81-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;36 &#40;0&#44;82-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46;&#176; dientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10-20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48 &#40;0&#44;31-0&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62 &#40;0&#44;37-1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;61 &#40;0&#44;35-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35 &#40;0&#44;17-0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51 &#40;0&#44;26-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54 &#40;0&#44;28-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Salud oral autorreportada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy buena o buena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala o muy mala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;64 &#40;1&#44;03-2&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;52 &#40;0&#44;94-2&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;41 &#40;0&#44;89-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Uso de pr&#243;tesis dental</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">IC95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Modelo 1&#58; sin ajustar<span class="elsevierStyleBold">&#46;</span> Modelo 2&#58; ajustado por edad&#44; sexo&#44; nivel de educaci&#243;n y &#225;rea geogr&#225;fica de residencia&#46; Modelo 3&#58; adicionalmente ajustado por h&#225;bito tab&#225;quico&#44; ingesta de alcohol&#44; calidad de la dieta&#44; actividad f&#237;sica&#44; hipertensi&#243;n&#44; diabetes&#44; bajo peso y sospecha de depresi&#243;n&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Coeficientes &#946; para la asociaci&#243;n de n&#250;mero de dientes y sospecha de deterioro cognitivo</p>"
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Asociación entre salud oral y deterioro cognitivo en personas mayores chilenas
Association between oral health and cognitive decline in older Chileans
Gabriela Nazara, Felipe Díaz-Torob,c,
Autor para correspondencia
fd2433@cumc.columbia.edu

Autor para correspondencia.
, Pablo Road,e, Fanny Petermann-Rochaf, Claudia Troncoso-Pantojag, Ana María Leiva-Ordóñezh, Igor Cigarroai, Carlos Celis-Moralesj,k, en representación del Consorcio de Investigación ELHOC-Chile
a Departamento de Psicología, Facultad de Ciencias Sociales y Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
b Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
c Facultad de Enfermería, Escuela de Enfermería, Universidad Andrés Bello, Santiago, Chile
d Departamento de Fonoaudiología, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
e Doctorado Salud Mental, Departamento de Psiquiatría, Universidad de Concepción, Concepción, Chile
f Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
g Centro de Investigación en Educación y Desarrollo (CIEDE-UCSC), Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
h Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
i Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles, Chile
j BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
k Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile
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y aunque la p&#233;rdida completa de dientes ha disminuido sigue siendo una condici&#243;n prevalente en las personas mayores<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a>&#46; En Chile&#44; un estudio con una muestra representativa nacional de 1553 personas adultas inform&#243; un 11&#44;4&#37; de edentulismo en la poblaci&#243;n de 65-74 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46; Los datos de la Encuesta Nacional de Salud &#40;ENS&#41; chilena de 2016-2017 indican que el 81&#44;7&#37; de las personas mayores de 65 a&#241;os tienen menos de 20 dientes&#44; y el uso de pr&#243;tesis dental en este grupo alcanza el 65&#44;8&#37;&#44; significativamente superior al total del pa&#237;s &#40;22&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diversos estudios han asociado la mala salud oral con diversas condiciones de salud&#44; como problemas cardiovasculares&#44; hipertensi&#243;n arterial&#44; diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#44;10</span></a> y depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#46; Menos explorada es su asociaci&#243;n con las enfermedades neurodegenerativas&#44; un grupo de trastornos caracterizados por un deterioro progresivo de las funciones motoras o cognitivas&#44; entre ellas las demencias&#44; siendo la enfermedad de Alzheimer la m&#225;s prevalente en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46; Un estado que precede a las demencias es el deterioro cognitivo&#44; condici&#243;n en la cual las personas presentan un deterioro en una o m&#225;s funciones cognitivas&#44; mayor que el esperado para su edad&#44; sin o con m&#237;nima afectaci&#243;n en las actividades de la vida diaria instrumentales y sin presencia de demencia<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Actualmente no existe un tratamiento efectivo para el deterioro cognitivo&#59; sin embargo&#44; la identificaci&#243;n de sus factores de riesgo ha sido de gran relevancia para generar intervenciones oportunas que ayuden a su prevenci&#243;n o a evitar su progresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Existe evidencia internacional que vincula el deterioro cognitivo con la salud oral en poblaci&#243;n adulta mayor de amplia heterogeneidad cultural<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#46; Sin embargo&#44; hasta nuestro conocimiento&#44; no existen investigaciones recientes que analicen esta asociaci&#243;n en poblaci&#243;n chilena&#46; Dado lo anterior&#44; este estudio tuvo como objetivo identificar la asociaci&#243;n entre salud oral y sospecha de deterioro cognitivo en personas chilenas de 60 y m&#225;s a&#241;os de edad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">En este estudio observacional&#44; de corte transversal&#44; utilizamos datos disponibles de la ENS de 2016-2017<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; una encuesta poblacional realizada en una muestra nacional&#44; probabil&#237;stica&#44; estratificada y multiet&#225;pica de 6233 personas de 15 y m&#225;s a&#241;os de edad&#44; con representatividad nacional&#44; regional y por &#225;rea urbana&#47;rural&#44; de la que se excluyeron mujeres embarazadas y personas con antecedentes de conductas violentas&#46; En este estudio se utilizaron los datos de una submuestra conformada por 1826 personas mayores de 60 a&#241;os &#40;el 51&#44;6&#37; eran mujeres&#41; que contaban con datos completos en las variables de inter&#233;s&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo de estudio fue aprobado por el Comit&#233; de &#201;tica de la Escuela de Medicina de la Pontificia Universidad Cat&#243;lica de Chile&#46; Todas las personas participantes firmaron un consentimiento informado &#40;ENS 2016-2017&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Variables e instrumentos</span><p id="par0215" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#41;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Salud oral</p></li></ul></p><p id="par0214" class="elsevierStylePara elsevierViewall">Las medidas de salud oral fueron recogidas mediante un examen cl&#237;nico&#44; realizado por enfermeras entrenadas&#44; que consider&#243;&#58; a&#41; conteo de n&#250;mero de dientes&#44; b&#41; presencia de caries y c&#41; uso de pr&#243;tesis dental&#46; Se incluy&#243; el autorreporte a trav&#233;s de preguntas cerradas sobre salud oral y presencia de dolor o molestias en la cavidad oral<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El n&#250;mero de dientes fue categorizado como variable continua&#44; correspondiente al n&#250;mero de dientes &#40;0 a 32&#41;&#44; ausencia total de dientes &#40;edentulismo&#41; y tertiles &#40;0 a 9 dientes&#44; 10 a 20 dientes y<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20 dientes&#41;&#46; La presencia de caries y el uso de pr&#243;tesis dental fueron categorizados en s&#237; &#40;presencia&#41; o no &#40;ausencia&#41;&#46; La salud oral autorreportada fue medida con la pregunta &#171;En general&#44; &#191;c&#243;mo dir&#237;a usted que es su salud oral&#63;&#187;&#44; y las respuestas fueron categorizadas en muy buena o buena&#44; mala&#44; o muy mala&#46; La presencia de dolor o molestias en la cavidad oral fue medida con la pregunta &#171;&#191;Son mis dientes o boca una causa de dolor o molestia&#63;&#187;&#44; y las respuestas fueron codificadas dicot&#243;micamente &#40;s&#237; o no&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Sospecha de deterioro cognitivo</p></li></ul></p><p id="par0221" class="elsevierStylePara elsevierViewall">Para la evaluaci&#243;n de sospecha de deterioro cognitivo se utiliz&#243; el <span class="elsevierStyleItalic">Mini-Mental State Examination</span> &#40;MMSE&#41;&#44; instrumento de cribado de deterioro cognitivo en su versi&#243;n abreviada de seis preguntas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#44; con una puntuaci&#243;n m&#225;xima de 19 puntos y una puntuaci&#243;n de corte &#8804;13 puntos correspondiente a MMSE alterado&#44; indicativo de sospecha de deterioro cognitivo&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#41;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Covariables</p></li></ul></p><p id="par0226" class="elsevierStylePara elsevierViewall">Las variables sociodemogr&#225;ficas edad&#44; sexo &#40;hombre&#47;mujer&#41;&#44; a&#241;os de educaci&#243;n &#40;&#8804;8 a&#241;os&#44; 9-12 a&#241;os o<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os&#41;&#44; zona de residencia &#40;urbana o rural&#41; y estilo de vida se obtuvieron mediante autorreporte con cuestionarios de la ENS 2016-2017<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#46; Incluyeron h&#225;bito tab&#225;quico &#40;nunca ha fumado&#44; exfumador o fumador&#41;&#44; consumo de alcohol <span class="elsevierStyleItalic">&#40;AUDIT score&#41;</span><a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> categorizado en baja ingesta &#40;&#62;8 puntos&#41; o alta ingesta &#40;&#8804;8 puntos&#41;&#44; e &#237;ndice de calidad de la dieta basado en el cumplimiento de las gu&#237;as alimentarias nacionales con puntuaciones de 0 a 12 distribuidas en tres categor&#237;as seg&#250;n la adherencia a una dieta saludable &#40;&#8805;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>adherencia&#44; 5-8<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>adherencia moderada y &#8804;4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no adherencia&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; El nivel de actividad f&#237;sica&#44; el tiempo destinado a las actividades de transporte activo y las actividades de intensidad moderada o vigorosa fueron determinados con el <span class="elsevierStyleItalic">Global Physical Activity Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#44; y las personas se clasificaron como activas o inactivas seg&#250;n su gasto energ&#233;tico &#40;punto de corte&#58; 600 MET&#47;min&#47;semana&#41;&#46; La condici&#243;n de bajo peso se determin&#243; seg&#250;n el &#237;ndice de masa corporal utilizando los puntos de corte de valoraci&#243;n espec&#237;fica para personas adultas mayores<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> &#40;bajo peso<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>23<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; Adicionalmente se utilizaron medidas de presi&#243;n arterial para el diagn&#243;stico de hipertensi&#243;n arterial y glucemia en ayuno para el de diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2&#46; La depresi&#243;n fue evaluada con la versi&#243;n corta del <span class="elsevierStyleItalic">Composite International Diagnostic Interview</span> &#40;CIDI-SF&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a>&#44; un instrumento de cribado que identifica s&#237;ntomas de depresi&#243;n en los &#250;ltimos 12 meses&#46; Adicionalmente&#44; se solicitaron el reporte de dolor cr&#243;nico&#44; el diagn&#243;stico de asma&#44; el diagn&#243;stico de artritis reumatoide&#44; problemas auditivos y presencia de problemas para dormir&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#41;</span><p id="par0235" class="elsevierStylePara elsevierViewall">An&#225;lisis estad&#237;stico</p></li></ul></p><p id="par0231" class="elsevierStylePara elsevierViewall">Los datos de caracterizaci&#243;n de la poblaci&#243;n&#44; salud oral y deterioro cognitivo se analizaron como promedios e intervalos de confianza para variables continuas&#44; y como porcentajes con sus respectivos intervalos de confianza del 95&#37; &#40;IC95&#37;&#41; para las categ&#243;ricas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para determinar la asociaci&#243;n entre la sospecha de deterioro cognitivo y las distintas condiciones de salud oral se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica en tres modelos&#58; modelo 1&#44; sin ajustar&#59; modelo 2&#44; ajustado por edad&#44; sexo&#44; nivel de educaci&#243;n y zona de residencia&#44; y modelo 3&#44; ajustado por las variables del modelo 2 m&#225;s h&#225;bito tab&#225;quico&#44; ingesta de alcohol&#44; calidad de la dieta&#44; actividad f&#237;sica&#44; hipertensi&#243;n&#44; diabetes&#44; bajo peso &#40;s&#237;&#47;no&#41; y depresi&#243;n&#46; Los resultados se presentan como <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y sus respectivos IC95&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tambi&#233;n se realiz&#243; un an&#225;lisis de regresi&#243;n lineal para establecer la asociaci&#243;n entre el deterioro cognitivo &#40;esta vez usado como variable continua&#58; puntuaci&#243;n en el MME&#41; y el n&#250;mero de dientes &#40;tambi&#233;n como variable continua&#41;&#46; Se analizaron tres modelos usando las mismas variables de ajuste antes mencionadas&#46; Los resultados se presentan como coeficientes &#946; y sus respectivos IC95&#37;&#46; Se consider&#243; estad&#237;sticamente significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis fueron ajustados por el factor de expansi&#243;n&#44; resultando en una muestra expandida de 3&#46;066&#46;214 individuos correspondientes a la extrapolaci&#243;n a la poblaci&#243;n nacional utilizando los factores de expansi&#243;n sugeridos por la ENS 2016-2017&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con STATA V17 &#40;2021 StataCorp&#59; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La caracterizaci&#243;n de la muestra se detalla en la <a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#46; En comparaci&#243;n con personas sin deterioro cognitivo&#44; aquellas con sospecha de deterioro cognitivo presentaron un mayor promedio de edad &#40;73&#44;4 vs&#46; 68&#44;9 a&#241;os&#41;&#44; un menor nivel educativo y una mayor proporci&#243;n de mala calidad de la dieta y alta ingesta de alcohol &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La caracterizaci&#243;n de la muestra seg&#250;n sexo indica que la edad promedio de las mujeres con sospecha de deterioro cognitivo fue mayor que la de los hombres con la misma condici&#243;n &#40;75&#44;2 vs&#46; 73&#44;9 a&#241;os&#41;&#44; y para ambos grupos esta edad fue mayor que la del grupo sin sospecha de deterioro cognitivo&#46; Los hombres con sospecha de deterioro cognitivo tuvieron una mayor proporci&#243;n de &#8804;8 a&#241;os de escolaridad&#44; alta ingesta de alcohol y sospecha de depresi&#243;n que las mujeres en igual condici&#243;n&#46; Por otra parte&#44; las mujeres con sospecha de deterioro cognitivo mostraron mayor proporci&#243;n de estado nutricional de bajo peso&#44; problemas auditivos y problemas para dormir que los hombres en igual condici&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Al comparar las condiciones orales de la muestra total seg&#250;n el deterioro cognitivo&#44; las personas con sospecha de deterioro presentaron en promedio cinco dientes menos &#40;13&#44;4 vs&#46; 8&#44;5 dientes&#41;&#46; Una mayor proporci&#243;n de personas con sospecha de deterioro cognitivo informaron mala calidad de salud oral&#44; en comparaci&#243;n con las personas sin sospecha de deterioro cognitivo &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El an&#225;lisis comparativo seg&#250;n el sexo &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41; mostr&#243; que las mujeres con sospecha de deterioro cognitivo presentaron casi siete dientes menos que aquellas sin sospecha&#44; diferencia muy superior a la encontrada en los hombres&#44; en quienes el n&#250;mero de dientes se mantuvo casi similar en aquellos con y sin deterioro cognitivo&#46; Del mismo modo&#44; la presencia de edentulismo fue mayor en las mujeres con deterioro cognitivo &#40;26&#44;8&#37;&#41; que en los hombres con igual condici&#243;n &#40;17&#44;6&#37;&#41;&#44; y lo mismo para el uso de pr&#243;tesis &#40;16&#44;9&#37; vs&#46; 12&#44;7&#37;&#41;&#46; La presencia de caries fue mayor en los hombres con sospecha de deterioro cognitivo que en las mujeres &#40;14&#44;1&#37; vs&#46; 12&#44;3&#37;&#41;&#44; lo mismo que la presencia de dolor oral &#40;25&#44;4&#37; vs&#46; 24&#44;8&#37;&#41; y de muy mala o mala salud reportada &#40;22&#44;6&#37; vs&#46; 19&#44;5&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Las asociaciones entre las variables de salud oral y sospecha de deterioro cognitivo se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; En el modelo sin ajustar&#44; la presencia de edentulismo se asoci&#243; con mayor probabilidad de sospecha de deterioro cognitivo &#40;OR&#58; 2&#44;08&#59; IC95&#37;&#58; 1&#44;29-3&#44;35&#41;&#46; Consistentemente&#44; tener 10-20 dientes &#40;OR&#58; 0&#44;48&#59; IC95&#37;&#58; 0&#44;31-0&#44;78&#41; o m&#225;s de 20 dientes &#40;OR&#58; 0&#44;35&#59; IC95&#37;&#58; 0&#44;17-0&#44;72&#41; se asoci&#243; a menor probabilidad de deterioro cognitivo&#44; en comparaci&#243;n con las personas que ten&#237;an 0-9 dientes&#46; Una mala o muy mala salud oral autorreportada se asoci&#243; con mayor probabilidad de sospecha de deterioro cognitivo&#44; en comparaci&#243;n con quienes reportaron buena o muy buena salud oral &#40;OR&#58; 1&#44;64&#59; IC95&#37;&#58; 1&#44;03-2&#44;60&#41;&#46; Tras ajustar por las variables de confusi&#243;n en los modelos 2 y 3&#44; las asociaciones previamente identificadas fueron atenuadas&#44; permaneciendo estad&#237;sticamente significativas solo para dolor oral&#44; cuya presencia se asoci&#243; a 1&#44;99 &#40;IC95&#37;&#58; 1&#44;09-3&#44;63&#41; veces m&#225;s probabilidad de presentar sospecha de deterioro cognitivo en comparaci&#243;n con quienes no refer&#237;an dolor oral &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">En los modelos de regresi&#243;n lineal &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; por cada diente adicional se observ&#243; un aumento del 2&#37; en la puntuaci&#243;n del MMSE&#46; La relaci&#243;n se mantuvo significativa aun despu&#233;s de ajustar por todas las variables de confusi&#243;n&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los hallazgos de este estudio evidencian una asociaci&#243;n entre la salud oral y la sospecha de deterioro cognitivo en las personas mayores chilenas&#46; Los participantes con sospecha de deterioro cognitivo tuvieron menor n&#250;mero de dientes y mayor presencia de dolor oral&#46; Por otra parte&#44; la probabilidad de sospecha de deterioro cognitivo fue mayor en caso de dolor oral y en personas con p&#233;rdida total de dientes o menor n&#250;mero de dientes&#44; aunque estas asociaciones pierden significaci&#243;n en los modelos ajustados&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La p&#233;rdida de dientes fue una condici&#243;n prevalente en la muestra estudiada&#44; con independencia de la presencia de deterioro cognitivo&#44; lo que confirma los hallazgos previos en muestras representativas de personas mayores chilenas&#44; que indican que el 11&#44;4&#37; padecen edentulismo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre deterioro cognitivo y p&#233;rdida de dientes ha sido previamente confirmada<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46; Un estudio de cohorte prospectivo de 4 a&#241;os realizado en Jap&#243;n determin&#243; que las personas con 0-9 dientes ten&#237;an mayor probabilidad de desarrollar deterioro cognitivo que aquellas con &#8805;10 dientes &#40;OR&#58; 3&#44;31&#59; IC95&#37;&#58; 1&#46;07-10&#46;2&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#44; y una revisi&#243;n sistem&#225;tica y metaan&#225;lisis de 14 estudios encontr&#243; que los sujetos con mayor p&#233;rdida de dientes ten&#237;an 1&#44;48 veces m&#225;s riesgo de desarrollar deterioro cognitivo &#40;IC95&#37;&#58; 1&#44;18-1&#44;87&#41; y 1&#44;28 veces m&#225;s riesgo de ser diagnosticados de demencia &#40;IC95&#37;&#58; 1&#44;09-1&#44;49&#41;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&#46; Otro estudio con personas mayores de 60 a&#241;os&#44; con y sin demencia evaluados con el MMSE&#44; inform&#243; que a medida que aumentaba la disfunci&#243;n cognitiva tambi&#233;n aumentaba la p&#233;rdida de dientes<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se postula que la asociaci&#243;n de deterioro cognitivo y salud oral est&#225; m&#225;s relacionada con la capacidad masticatoria que con el n&#250;mero de dientes<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a>&#46; Las personas con dificultades masticatorias deben realizar cambios en las texturas de los alimentos que ingieren&#44; evitando s&#243;lidos y priorizando los alimentos tipo pudding<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a>&#44; lo cual&#44; adicionado a las deficiencias de micro- y macronutrientes&#44; propicia la disminuci&#243;n del rendimiento masticatorio&#46; Esta condici&#243;n contribuir&#237;a al deterioro cognitivo&#44; debido a que la masticaci&#243;n estimula la actividad del hipocampo&#44; estructura considerada clave en la funci&#243;n cognitiva y la memoria&#46; Tambi&#233;n contribuir&#237;a a aumentar el flujo sangu&#237;neo cerebral&#44; aportando mayor cantidad de ox&#237;geno hacia otras regiones cerebrales&#44; como corteza motora primaria&#44; suplementaria&#44; sensorial&#44; &#237;nsula&#44; t&#225;lamo y cerebelo<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Otro mecanismo que podr&#237;a explicar la asociaci&#243;n positiva entre la p&#233;rdida de dientes y el deterioro cognitivo es que las personas con p&#233;rdida de dientes parcial o total&#44; y problemas masticatorios asociados&#44; presentan mayor riesgo de desnutrici&#243;n&#44; lo cual se ha asociado con deterioro cognitivo y enfermedad de Alzheimer<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Tambi&#233;n se asocian a la p&#233;rdida de dientes los malos h&#225;bitos de higiene dental&#44; planteando que el funcionamiento cognitivo alterado induce a inadecuadas rutinas de higiene&#44; pero tambi&#233;n es posible que no cumplir con una rutina de higiene sea un s&#237;ntoma inicial de alteraci&#243;n en el funcionamiento cognitivo<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a>&#46; Vinculado a lo anterior&#44; las personas mayores con alteraciones cognitivas informan menor uso de los servicios dentales<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a>&#44; lo que puede exacerbar el problema&#46; Lo anterior puede sugerir bidireccionalidad en la relaci&#243;n entre salud oral y funcionamiento cognitivo&#44; en tanto que una mala salud oral induce alteraciones cognitivas y&#44; a su vez&#44; estas inciden en la salud oral&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La enfermedad periodontal es considerada una de las principales causas de p&#233;rdida de piezas dentarias en las personas mayores de 45 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; As&#237;&#44; otro mecanismo explicativo de la asociaci&#243;n entre salud&#44; dolor oral y deterioro cognitivo radica en la infecci&#243;n bacteriana y el proceso inflamatorio cr&#243;nico productor de citocinas proinflamatorias &#40;interleucina 1<span class="elsevierStyleHsp" style=""></span>B&#44; interleucina 6 y factor de necrosis tumoral&#41;&#44; que en etapas avanzadas pueden provocar una inflamaci&#243;n sist&#233;mica general y promover procesos neuroinflamatorios que incluyen amiloidosis&#44; muerte neuronal&#44; adelgazamiento cortical y reducci&#243;n del volumen cerebral&#44; todos ellos eventos relacionados con la enfermedad cerebrovascular y la neurodegeneraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Adicionalmente&#44; la exposici&#243;n a diversos agentes pat&#243;genos o bacterias genera una respuesta inflamatoria que desencadena una cascada de reacciones que inducir&#237;an la destrucci&#243;n del tejido cerebral<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; El da&#241;o neuronal en la&#160;patog&#233;nesis de la enfermedad de Alzheimer estar&#237;a causado por la infecci&#243;n por <span class="elsevierStyleItalic">Porphyromonas gingivalis</span> a trav&#233;s de la secreci&#243;n de gingipa&#237;nas<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#46; Igualmente&#44; se ha descrito el papel de la neuroinflamaci&#243;n en la patog&#233;nesis del deterioro cognitivo y las demencias<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#44; lo que provocar&#237;a una serie de eventos que comienzan con la estimulaci&#243;n de las c&#233;lulas gliales para la generaci&#243;n de citocinas proinflamatorias y terminan con el da&#241;o de las c&#233;lulas nerviosas<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Otro hallazgo de este estudio es la mayor probabilidad de deterioro cognitivo en presencia de dolor de la cavidad oral&#46; Las revisiones del tema confirman esta asociaci&#243;n&#44; pero enfatizan la escasez de estudios al respecto y la complejidad de la evaluaci&#243;n de la salud oral en las personas mayores<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a>&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fortalezas y limitaciones del estudio</span><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudio se desarroll&#243; en una muestra representativa de personas mayores chilenas e incorpor&#243; un examen cl&#237;nico para determinar la salud oral&#44; lo que otorga solidez a los hallazgos&#46; Entre sus limitaciones se encuentra el uso de una medida global de funcionamiento cognitivo&#44; el MMSE&#44; que solo es indicativo de sospecha de deterioro&#46; De igual forma&#44; algunas medidas de salud oral fueron evaluadas mediante autorreporte&#44; aun cuando estudios longitudinales han mostrado su correlaci&#243;n con indicadores objetivos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a>&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los problemas de salud oral son altamente prevalentes en la poblaci&#243;n adulta mayor chilena&#44; en particular en grupos de bajo nivel educativo y bajo nivel de ingresos&#46; Los hallazgos de este estudio confirman la asociaci&#243;n entre mala salud oral&#44; particularmente p&#233;rdida de dientes&#44; dolor oral y sospecha de deterioro cognitivo&#46; Lo anterior aporta en la identificaci&#243;n temprana de los factores de riesgo de deterioro cognitivo y en la promoci&#243;n de la salud y la prevenci&#243;n de las enfermedades neurodegenerativas&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Disponibilidad de bases de datos y material para r&#233;plica</span><p id="par0165" class="elsevierStylePara elsevierViewall">Estos datos fueron obtenidos de los siguientes recursos disponibles en el dominio p&#250;blico&#58; sitio web del Departamento de Epidemiolog&#237;a del Ministerio de Salud de Chile&#58; http&#47;&#47;epi&#46;minsal&#46;cl&#47;encuesta-ens&#47; &#40;accedido el 1 de octubre de 2022&#41;&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Editora responsable del art&#237;culo</span><p id="par0185" class="elsevierStylePara elsevierViewall">Leila P&#46; Garc&#237;a&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Declaraci&#243;n de transparencia</span><p id="par0190" class="elsevierStylePara elsevierViewall">La autora principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Contribuciones de autor&#237;a</span><p id="par0200" class="elsevierStylePara elsevierViewall">Contribuci&#243;n sustancial a la concepci&#243;n y el dise&#241;o&#58; F&#46; D&#237;az-Toro&#44; G&#46; Nazar y F&#46; Petermann-Rocha&#46; An&#225;lisis e interpretaci&#243;n de los datos&#58; F&#46; D&#237;az-Toro&#44; G&#46; Nazar y F&#46; Petermann-Rocha&#46; Redacci&#243;n del art&#237;culo&#58; G&#46; Nazar&#44; P&#46; Roa&#44; F&#46; D&#237;az-Toro&#44; F&#46; Petermann-Rocha&#44; C&#46; Troncoso-Pantoja y A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#46; Revisi&#243;n cr&#237;tica&#58; C&#46; Troncoso-Pantoja&#44; A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#44; I&#46; Cigarroa y C&#46; Celis-Morales&#46; Aprobaci&#243;n de la versi&#243;n final&#58; G&#46; Nazar&#44; F&#46; D&#237;az-Toro&#44; P&#46; Roa&#44; F&#46; Petermann-Rocha&#44; C&#46; Troncoso-Pantoja&#44; A&#46;M&#46; Leiva-Ord&#243;&#241;ez&#44; I&#46; Cigarroa y C&#46; Celis-Morales&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Agradecimientos</span><p id="par0240" class="elsevierStylePara elsevierViewall">Se agradece a los participantes de la ENS 2016-2017&#44; as&#237; como tambi&#233;n al MINSAL y la Pontificia Universidad Cat&#243;lica de Chile que lideraron la ENS 2016-2017&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflictos de intereses</span><p id="par0210" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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            0 => "Oral health"
            1 => "Cognitive impairment"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar la asociaci&#243;n entre salud oral y sospecha de deterioro cognitivo en personas mayores chilenas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal con 1826 participantes &#8805;60 a&#241;os de la Encuesta Nacional de Salud de Chile&#44; 2016-2017&#46; La salud oral fue evaluada por el n&#250;mero de dientes&#44; la presencia de caries&#44; el uso de pr&#243;tesis dental y el autorreporte de salud oral y dolor en la cavidad oral&#46; La sospecha de deterioro cognitivo fue evaluada mediante el <span class="elsevierStyleItalic">Mini-Mental State Examination</span> &#40;MMSE&#41;&#46; Se emple&#243; regresi&#243;n log&#237;stica y lineal&#44; ajustada por variables sociodemogr&#225;ficas y de estilos de vida&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En comparaci&#243;n con personas sin sospecha de deterioro cognitivo&#44; aquellas con sospecha de deterioro cognitivo presentaron cinco dientes menos &#40;13&#44;4 vs&#46; 8&#44;5 dientes&#41;&#44; diferencia muy superior en mujeres que en hombres&#44; y mayor frecuencia de dolor oral&#46; El edentulismo y el menor n&#250;mero de dientes se asociaron a mayor probabilidad de sospecha de deterioro cognitivo&#44; asociaciones que no se mantuvieron en modelos ajustados&#46; El dolor oral se asoci&#243; a mayor probabilidad de sospecha de deterioro cognitivo &#40;<span class="elsevierStyleItalic">odds ratio&#58;</span> 1&#44;99&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 1&#44;09-3&#44;63&#41;&#46; Por cada diente adicional se observ&#243; un aumento del 2&#37; &#40;IC95&#37;&#58; 0&#44;01-0&#44;05&#41; en la puntuaci&#243;n del MMSE&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mala salud oral&#44; en particular la p&#233;rdida de dientes y la presencia de dolor&#44; se asociaron con deterioro cognitivo en personas mayores chilenas&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To identify the association between oral health and suspected cognitive impairment in older adults in Chile&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study including 1826 people &#8805;60 years who participated in the National Health Survey of Chile&#44; 2016-2017&#46; Oral health was evaluated by the number of teeth&#44; presence of caries&#44; use of dental prostheses&#44; self-reported oral health&#44; and pain and&#47;or discomfort in the oral cavity&#46; Cognitive impairment was assessed using the Mini-Mental State Examination &#40;MMSE&#41;&#46; The association was evaluated by logistic and linear regression&#44; adjusted for sociodemographic and lifestyle variables&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compared with people without suspicion of cognitive impairment&#44; people with suspected impairment had five fewer teeth &#40;13&#46;4 vs&#46; 8&#46;5 teeth&#41;&#44; a much higher difference in women than in men&#44; and a higher frequency of oral pain&#46; Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment&#44; associations that were not maintained in adjusted models&#46; Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model &#40;odds ratio&#58; 1&#46;99&#59; 95&#37; confidence interval &#91;95&#37;<span class="elsevierStyleSmallCaps">C</span>I&#93;&#58; 1&#46;09-3&#46;63&#41;&#46; In linear models&#44; an increase of 2&#37; &#40;95&#37;CI&#58; 0&#46;01-0&#46;05&#41; in the MMSE score was observed for each additional tooth&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Poor oral health&#44; particularly tooth loss and the presence of pain&#44; was associated with cognitive impairment in older adults in Chile&#46;</p></span>"
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Femeninon<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1164N exp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;587&#46;850</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Masculinon<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>662N exp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;478&#46;364</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Con sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Con sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Con sospecha de deterioro cognitivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">n total</span><span class="elsevierStyleItalic">N expandida</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1501N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;591&#46;897&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>325N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>474&#46;317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>956N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;337&#46;966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>208N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>249&#46;884&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>545N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;253&#46;931&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>224&#46;432&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Porcentaje &#40;IC95&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;5 &#40;81&#44;6-87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4 &#40;12&#44;9-18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;3 &#40;80&#44;7-87&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;47 &#40;12&#44;7-19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;8 &#40;79&#44;9-88&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;1 &#40;11&#44;3-20&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad&#44; promedio &#40;IC95&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;9 &#40;68&#44;1-69&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;4 &#40;71&#44;7-75&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;3 &#40;69&#44;9-71&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;2 &#40;74&#44;5-79&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;9 &#40;68&#44;2-71&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;9 &#40;71&#44;8-75&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;os educaci&#243;n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;8 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;1 &#40;72&#44;8-80&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;9 &#40;19&#44;2-27&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;4 &#40;72&#44;2-81&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&#40;18&#44;1-27&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#44;5 &#40;69&#44;4-82&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;5 &#40;17&#44;6-30&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>9-12 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;4 &#40;78&#44;3-97&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;6 &#40;2&#44;4-21&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#44;7 &#40;90&#44;5-97&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;3 &#40;2&#44;9-9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;4 &#40;90&#44;7-97&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6 &#40;2&#44;1-9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;1 &#40;92&#44;1-96&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9 &#40;3&#44;1-7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;1 &#40;94&#44;7-99&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;0&#44;7-5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#44;3 &#40;68&#44;6-96&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;6 &#40;3&#44;1-31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Residencia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">H&#225;bito tab&#225;quico &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nunca ha fumado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Actual fumador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Calidad de la dieta &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Regular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC bajo peso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Problemas auditivos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sospecha de depresi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor cr&#243;nico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Salud oral autorreportada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy buena o buena&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;2 &#40;11&#44;2-17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala o muy mala&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">80&#44;4 &#40;70&#44;9-87&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46;&#176; dientes&#44; promedio &#40;IC&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#44;4 &#40;12&#44;5-14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;5 &#40;6&#44;7-10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;2 &#40;11&#44;5-16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#44;6 &#40;5&#44;7-8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo 2</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo 3</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edentulismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;08 &#40;1&#44;29-3&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;0&#44;81-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;36 &#40;0&#44;82-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#46;&#176; dientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10-20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48 &#40;0&#44;31-0&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62 &#40;0&#44;37-1&#44;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;61 &#40;0&#44;35-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35 &#40;0&#44;17-0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51 &#40;0&#44;26-0&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54 &#40;0&#44;28-1&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Salud oral autorreportada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muy buena o buena&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mala o muy mala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;64 &#40;1&#44;03-2&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;52 &#40;0&#44;94-2&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;41 &#40;0&#44;89-2&#44;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Uso de pr&#243;tesis dental</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;61-1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;897&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83 &#40;0&#44;54-1&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83 &#40;0&#44;53-1&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de caries</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73 &#40;0&#44;48-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;89 &#40;0&#44;58-1&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;602&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;89 &#40;0&#44;57-1&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;614&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor oral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;Ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;92 &#40;1&#44;08-3&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;92 &#40;1&#44;06-3&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;99 &#40;1&#44;09-3&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3631098.png"
              ]
            ]
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                      "titulo" => "Is depression associated with oral health outcomes in adults and elders&#63;&#46; A systematic review and meta-analysis"
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                      "titulo" => "Theories of aging and the prevalence of Alzheimer&#39;s disease"
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ISSN: 02139111
Idioma original: Español
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