Dental management for a child with smithmagenis syndrome under general anesthesia: case report

Introduction: Smith-Magenis Syndrome (SMS) is a genetic disease characterized by a neuro-behavioral deficiency caused by mutations or deletions at the 17p11.2 locus comprising the retinoic acid-induced 1 (RAI1) gene. The diagnosis is made through clinical analysis looking for characteristics and to prove this suspicion, a technique called Fluorescence In Situ Hybridization (FISH) is required. Objective: The aim of this case report is to be the first to describe the planning and execution of dental treatment for a 5yearold female patient with SMS under general anesthesia. Case report: The patient was admitted to the clinic of the Universidade Federal Fluminense, with possible dental pain, in the anamnesis the need for invasive treatment was observed in many dental elements and due to the patient's behavioral pattern, treatment under general anesthesia was chosen. Results: Procedures were performed (restorations and extractions) in the hospital in the same step. The child follow-up after the intervention every six month. Conclusion: SMS is a rare syndrome that requires extensive knowledge of the dentist and a detailed anamnesis to choose the best option to solve the case.

Introdução: A síndrome de Smith-Magenis (SMS) é uma doença genética caracterizada por uma deficiência neuro-comportamental causada por mutações ou deleções no locus 17p11.2 compreendendo o gene 1 induzido por ácido retinóico (RAI1). O diagnóstico é feito por meio de análises clínicas em busca de características e para comprovar essa suspeita, é necessária a técnica denominada Hibridização In Situ por Fluorescência (FISH). Objetivo: O objetivo deste relato de caso é o primeiro a descrever o planejamento e execução do tratamento odontológico para uma paciente do sexo feminino de 5 anos de idade com SMSsob anestesia geral. Relato do caso: O paciente deu entrada no ambulatório da Universidade Federal Fluminense, com possível dor dentária, na anamnese observou-se a necessidade de tratamento invasivo em diversos elementos dentais e devido ao padrão de comportamento do paciente optou-se pelo tratamentosob anestesia geral. Resultados: Os procedimentos foram realizados (restaurações e extrações) no hospital na mesma etapa. O acompanhamento da criança após a intervenção foi a cada seis meses. Conclusão: A SMS é uma síndrome rara que requer amplo conhecimento do dentista e uma anamnese detalhada para aescolha da melhor opção para a solução do caso.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Influence of Helicobacter pylori culture supernatant on the ecological balance of a dual-species oral biofilm

Abstract Dental caries is a chronic progressive disease occurring in the tooth hard tissue due to multiple factors, in which bacteria are the initial cause. Both Streptococcus mutans and Streptococcus sanguinis are main members of oral biofilm. Helicobacter pylori may also be detected in dental plaque, playing an important role in the development of dental caries. Objective The aim of this study was to investigate the effect of H. pylori culture supernatant on S. mutans and S. sanguinis dual-species biofilm and to evaluate its potential ability on affecting dental health. Material and methods The effect of H. pylori supernatant on single-species and dual-species biofilm was measured by colony forming units counting and fluorescence in situ hybridization (FISH) assay, respectively. The effect of H. pylori supernatant on S. mutans and S. sanguinis extracellular polysaccharides (EPS) production was measured by both confocal laser scanning microscopy observation and anthrone-sulfuric acid method. The effect of H. pylori supernatant on S. mutans gene expression was measured by quantitative real-time PCR (qRT-PCR) assays. Results H. pylori supernatant could inhibit both S. mutans and S. sanguinis biofilm formation and EPS production. S. sanguinis inhibition rate was significantly higher than that of S. mutans. Finally, S. mutans bacteriocin and acidogenicity related genes expression were affected by H. pylori culture supernatant. Conclusion Our results showed that H. pylori could destroy the balance between S. mutans and S. sanguinis in oral biofilm, creating an advantageous environment for S. mutans, which became the dominant bacteria, promoting the formation and development of dental caries.

Investigação da amplificação do EGFR em carcinoma de células escamosas de boca em pacientes jovens / Investigation of polysomy and amplification of EGFR in oral squamous cell carcinoma

O carcinoma de células escamosas (CEC) de boca é uma neoplasia incomum em pacientes jovens. Na literatura de língua inglesa não há relatos de estudos que investiguem a amplificação do EGFR e a expressão desta proteína neste grupo etário. O objetivo deste estudo foi investigar a amplificação do EGFR através da técnica de hibridização por fluorescência in situ (FISH) e correlacionar os resultados obtidos através da imunomarcação da proteína EGFR com a epidemiologia e com o prognóstico dos pacientes avaliados. Ao final dos testes de FISH e imunohistoquímicos,21 amostras do grupo teste (pacientes ≤ 40 anos) e 39 amostras do grupo controle (pacientes ≥ 50 anos) foram consideradas adequadas para avaliação. As variáveis clínicas e anatomopatológicas foram comparadas pelos testes Qui-Quadrado ou exato de Fisher. A expressão do marcador EGFR e do método de FISH foi comparada entre os grupos por meio do teste não paramétrico de Mann-Whitney. As curvas de sobrevida foram calculadas utilizando o método de Kaplan-Meier e suas curvas foram comparadas através do teste de log-rank. Houve maior número de pacientes do sexo masculino, leucodermas, tabagistas e etilistas.A amplificação do EGFR foi maior no grupo teste (p = 0,018). A amplificação do EGFR associou-se estatisticamente com a variável estadiamento clínico avançado (p = 0,013), independente do grupo. A expressão da proteína EGFR correlacionou-se com tumores bem diferenciados (p = 0,011) e a presença de metástase (p = 0,035),independente da idade. A presença de amplificação foi mais frequente no grupo tese. Alguns casos de pacientes ≥40 anos de idade podem ser adequados ao emprego da terapia anti-EGFR, devido à amplificação do EGFR

Oral squamous cell carcinoma (OSCC) is uncommon neoplasia in young patients. In the English literature, there are no reports of studies that investigate the amplification of EGFR and expression of this protein in this age group. The aim of this study was to investigate the amplification ofEGFR by fluorescence in situ hybridization (FISH) and to correlate the results by immunostaining of EGFR protein with clinico pathological features and prognosis. After FISH and immunohistochemistry, 21 samples of the test group (≤ 40 years) and 39 samples of control group (≥ 50 years) were suitable for evaluating. Categorical variables were compared by the Pearson chi-square test or Fisher's exact test. Associations between protein levels and FISH results with clinicopathological characteristics of the patients were analyzed by Mann-Whitney U test. Survival rates were calculated using the Kaplan-Meier method and the curves were comparedby the log-rank test. There was predominance for male patients,leucoderma, smoking and alcohol consumption. The EGFR amplification was higher in the test group (p = 0.018) and it was associated statistically with advanced clinical stage (p = 0.013), independent of the group. Theexpression of EGFR protein was correlated to well differentiated tumors (p= 0.011) and presence of metastasis (p = 0.035), regardless of age.Presence of EGFR amplification and/or expression. Some cases of patients≥40 years old might be suitable for anti-EGFR therapy because of EGFR amplification