Oral health challenges in patients with chronic kidney disease: A comprehensive clinical assessment.

Loss of kidney function causes oral manifestations and multiple complications that have implications for dental treatment and patients' systemic conditions. We aimed to determine the clinical condition, epidemiological profile, and incidence of dental caries in patients with chronic kidney disease (CKD). This was an observational, cross-sectional, field study using a quantitative and epidemiological approach. The sample consisted of 45 randomly selected patients with CKD from a total of 114 patients. Data were collected through oral clinical examination, anamnesis, and medical records compiled in a clinical file specially developed for this research. Clinical evaluation was performed, including a Decayed, Missing, and Filled Teeth (DMFT) index examination. Data were analyzed using the Shapiro-Wilk test, Mann-Whitney test, and Spearman's rho coefficient. All analyses were performed using IBM SPSS Statistics software version 20.0, with a confidence interval of 95 % and significance level of 5 % (p < 0.05). The results indicated that CKD is more prevalent in the 5th decade of life, with a slight predilection for men. Oral cavity alterations were observed in 77.8 % of patients. The study population had a very high DMFT index, with a high number of missing teeth and a low number of decayed and filled teeth. Poor oral health in patients with CKD indicates a lack of care that supports the necessity of installing a preventive and therapeutic oral program and a regular follow-up aimed at this group of patients.

The practice of dentistry in intensive care units in Brazil. / A atuação da Odontologia em unidades de terapia intensiva no Brasil.

OBJECTIVE: To evaluate the practice of dentistry in intensive care units. METHODS: An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units. RESULTS: In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways. CONCLUSION: The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.

OBJETIVO: Avaliar a atuação odontológica em unidades de terapia intensiva. MÉTODOS: Estudo observacional de enquete, por meio do envio de questionários via plataforma on-line de colaboração de pesquisa em terapia intensiva no Brasil (AMIBnet). A pesquisa foi realizada de junho a outubro de 2017. Os questionários, envolvendo 26 questões fechadas sobre os hospitais e a atuação odontológica nas unidades de terapia intensiva foram enviados para 4.569 profissionais de diversas especialidades atuantes nas unidades. RESULTADOS: Obtivemos 203 questionários respondidos, resultando em uma taxa de resposta de 4,44%. A maior parte das respostas teve origem em unidades de terapia intensiva na Região Sudeste do país (46,8%). Hospitais públicos (37,9%) e privados (36,4%) tiveram participação semelhante nos resultados. Dos respondentes, 55% apontaram que um serviço de Odontologia à beira de leito estava presente, sendo prestado de maneiras diversas. CONCLUSÃO: Presença de Serviço de Odontologia e de treinamentos e protocolos de prestação de serviço em saúde bucal estiveram correlacionados. Os métodos de cuidados orais variaram sobremaneira entre as em unidades de terapia intensiva pesquisadas.

A atuação da Odontologia em unidades de terapia intensiva no Brasil / The practice of dentistry in intensive care units in Brazil

RESUMO Objetivo: Avaliar a atuação odontológica em unidades de terapia intensiva. Métodos: Estudo observacional de enquete, por meio do envio de questionários via plataforma on-line de colaboração de pesquisa em terapia intensiva no Brasil (AMIBnet). A pesquisa foi realizada de junho a outubro de 2017. Os questionários, envolvendo 26 questões fechadas sobre os hospitais e a atuação odontológica nas unidades de terapia intensiva foram enviados para 4.569 profissionais de diversas especialidades atuantes nas unidades. Resultados: Obtivemos 203 questionários respondidos, resultando em uma taxa de resposta de 4,44%. A maior parte das respostas teve origem em unidades de terapia intensiva na Região Sudeste do país (46,8%). Hospitais públicos (37,9%) e privados (36,4%) tiveram participação semelhante nos resultados. Dos respondentes, 55% apontaram que um serviço de Odontologia à beira de leito estava presente, sendo prestado de maneiras diversas. Conclusão: Presença de Serviço de Odontologia e de treinamentos e protocolos de prestação de serviço em saúde bucal estiveram correlacionados. Os métodos de cuidados orais variaram sobremaneira entre as em unidades de terapia intensiva pesquisadas.

ABSTRACT Objective: To evaluate the practice of dentistry in intensive care units. Methods: An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units. Results: In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways. Conclusion: The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.

Conhecimento de pacientes sobre o uso de benzodiazepínicos no controle da ansiedade em Odontologia / Knowledge of patients about the use of benzodiazepines for anxiety control in Dentistry

Objetivo: O objetivo desta pesquisa foi avaliar o conhecimento de pacientes sobre técnica de sedação consciente com benzodiazepínicos e sua aceitação no controle de medo e ansiedade para o tratamento odontológico. Método: Esta pesquisa baseou-se em um estudo quantitativo com abordagem descritiva através da coleta de dados realizada pelo próprio pesquisador com a finalidade de assegurar uniformidade de interpretação dos resultados através de questionários. Os pacientes antes do atendimento receberam orientação do questionário e então foram convidados a responder. Nesse momento foram prestados os devidos esclarecimentos aos responsáveis quanto à finalidade dos questionários e orientados no sentido de que os dados seriam mantidos em sigilo. Os dados foram analisados por meio de tabelas cruzando a classe socioeconômica de 150 pacientes, selecionados igualitariamente entre as classes A/B, C e D/E. A associação entre a classe social e as respostas às questões foram avaliados pelo teste exato de Fisher. Resultados: A questão 1, primeira consulta ao Cirurgião-Dentista, destaca que todos os pacientes da Classe A/B já haviam comparecido ao Cirurgião-Dentista antes, contra 86% da classe C e 94% da Classe D/E. A questão 2 aborda se o Cirurgião-Dentista afere sinais vitais na anamnese,40% dos Cirurgiões-Dentistas classe A/B afere sinais vitais e apenas 20% dos odontólogos que trabalham com uma população de classe C, D e E. As questões 3, 4 e 5 (sobre medo do cirurgião, doenças e vícios) se mostraram semelhantemente distribuída entre as classes. E as questões 6 e 7 sobre o uso de ansiolítico destaca a maior frequência na Classe A/B, o dobro da Classe C, que por sua vez também é o dobro da Classe D/E. Das sete questões avaliadas, quatro se mostraram significativamente associadas à classe social. Conclusão: Classes sociais A/B têm mais aceitação e conhecimento sobre o uso de benzodiazepínicos no controle de medo e ansiedade na Odontologia.

Objective: The aim of this search was to avaluate the knowledge of patients on technique of conscious sedation with benzodiazepines and their acceptance in the controlo the fear, pain and anxiety during dental treatment. Method: this research was based on quantitative study with descriptive approach through data gathering, conducted by the own researcher, in order to ensure uniformity in the interpretation of the results of the questionnaires. Patients were instructed about the questionnaire before treatment and then, invited to answer it. At this moment, was provided the appropriate explanations to the responsables about the purpose of the questionnaires and orientedin the sense that the data will be kept confidential. Data were analyzed by means of tables crossing the socio-economic class of 150 patients, selected equally between classes A/B, C and D/E. The association between social class and the answers to the questions were evaluated by Fisher’s exact test (Agresti, 2002; Bussab e Morettin, 2006). Results: Question 1, first visit to the dentist, highlights thatall patients Class A/B were attended by dentist before, against 86% of the class C and 94% of ClassD/E. Question 2 addresses if the dentist assesses vital signs at the anamnesis. 40% of dental surgeons class A/B assesses vital signs, against only 20% of dentists who Works with a population of class C, Dand E. Questions 3, 4 and 5 (about fear surgeon, diseases and addictions) show then selves similar lydistributed between classes. And finally, questions 6 and 7, about the use of anxiolytic highlights the most frequently in Class A/B, class C twice, which in turn is also twice the Class D/E. From 7 questions avaluated, 4 of them show thenselves significantly associated to social classes. Conclusion: Social classes A/B have more acceptence and knowledge about the use of benzodiazepines in the control of the fear and anxiety in dentistry.

Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy.

Spasticity is a motor disorder frequently present in individuals with cerebral palsy (CP). This study aimed to evaluate the effect of low-level laser therapy (LLLT) on the spasticity of the masseter and anterior temporal muscle fibers in children with CP over three weeks of intermittent laser exposures. The bite force (BF) of the masticatory muscles and the amplitude of mouth opening were evaluated before and after laser irradiation in 30 children with CP. Both sides of the masseter and temporalis muscles were irradiated with low-intensity diode laser pulses of 808-nm wavelength six times over three consecutive weeks. During the subsequent three weeks of postlaser exposures, although no laser treatment was applied, the evaluation parameters were measured and recorded. A significant improvement in the amplitude of mouth opening and a decrease in the BF were observed in the weeks following LLLT (P<0.05 ). However, by the sixth week post-LLLT, the BF and the amplitude of mouth opening reverted to values equivalent to those obtained before the first application of LLLT. Our investigation revealed low-level energy exposures from a 808-nm diode laser to be an effective short-term therapeutic tool. This method increased the amplitude of mouth opening and decreased the muscle tonus of children with spastic CP over a time course of three weeks of intermittent laser applications.

Estudo comparativo entre enzimas utilizadas no metabolismo de medicamentos em pacientes com paralisia cerebral e anestésicos odontológicos / Comparative study of the enzymes involved in drug metabolism in patients with cerebral palsy and dental anesthetics

A administração conjunta de dois ou mais fármacos é uma situação comum na prática clínica e pode criar efeitos terapêuticos indesejados. Podem surgir interações como alteração na biotransformação através de enzimas microssomais criando metabólitos tóxicos. O objetivo deste estudo foi comparar enzimas microssomais utilizadas no metabolismo de medicamentos de uso contínuo em pacientes com PC e anestésicos locais. Esta pesquisa é um estudo quantitativo com abordagem descritiva, realizado através de coleta de dados de prontuários de pacientes em tratamento no Lar Escola São Francisco (LESF) em parceria com a Universidade Cruzeiro do Sul (UNICSUL). Foram avaliados prontuários de pacientes com paralisia cerebral independente do sexo, idade e tipo de paralisia cerebral. A amostra foi constituída de 348 prontuários examinados, sendo 147 (42,2,%) do sexo feminino e 201 (57,8%) pacientes do sexo masculino. A idade variou de 5 a 16 anos (média = 9,6 DP±5,4). Do total da amostra, 79% necessitavam de tratamento odontológico, com anestesia local. Quanto ao uso de medicamentos, 170 (49%) da amostra faziam uso de medicamentos neurolépticos. Concluiu-se que o cuidado na co-administração de lidocaína, anestésico local empregado na Odontologia e drogas anticonvulsivantes, diminuirá os riscos de hepatotoxocidade, uma vez que ambos utilizam a mesma enzima microssomal. Assim, sugere-se o uso de sais anestésicos que utilizem outro citocromo como P450 CYP1A2, dentre eles a mepivacaína, articaína e bupvacaína...

Co-administration of two or more drugs is a common situation in clinical practice that can promote undesirable therapeutic effects. Interactions may occur, such as changes in biotransformation in which microsomal enzymes produce toxic metabolites. This study compared microsomal enzymes used in the metabolism of drugs in continuous use in patients with CP and local anesthetics. The research is a quantitative study with a descriptive approach conducted by collecting data from medical records of patients at the Lar Escola São Francisco (LESF) in partnership with the Cruzeiro do Sul University (UNICSUL). Records of patients with cerebral palsy were evaluated regardless of sex, age, and type of cerebral palsy. The sample consisted of 348 records, of which 201 (57.8%) were males. Patient age ranged from 5 to 16 years-old (mean = 9.6, SD ±5.4). Of the total sample, 79% required dental treatment under local anesthesia. Regarding drug use, 170 (49%) of the sample were being administered neuroleptic drugs. It was concluded that the caution in lidocaine co-administration, a local anesthetic applied in Dentistry, and anticonvulsants, will decrease the risks of hepatotoxicity, seeing that both use the same microsomal enzyme. It is suggested the use of anesthetics that utilized other cytochrome as P450 CYP1A2, among them mepivacaine, articaine, and bupivacaine...

Condição odontológica em pacientes internados em unidade de terapia intensiva / Oral conditions of patients admitted to an intensive care unit

Objetivo: Avaliar clinicamente a condição odontológica de pacientes internados em Unidade de Terapia Intensiva (UTI). Método: Foi realizado estudo exploratório, descritivo e transversal com avaliação clínica odontológica de 50 pacientes internados em UTI do Hospital São Vicente de Paula (João Pessoa/PB). Foram coletados os dados dos prontuários médicos relativos à idade, sexo, fator causal da internação e comorbidades relacionadas a problemas pulmonares. A análise da condição bucal foi qualificada em três categorias: boa (condição aceitável de higiene sem sangramento ao toque ou focos de infecção aparentes); regular (paciente apresentava pouco sangramento ao toque e/ou candidíase observada clinicamente como placas esbranquiçadas sobre mucosa inalterada ou avermelhada, removidas mecanicamente); e ruim (presença de abscessos e candidíase disseminada incluindo orofaringe). Resultados: A idade média dos examinados era de 53,8 (±18,5) sendo 23 (46%) do sexo masculino. As causas das internações de 24 (48,0%) pacientes foram neurológicas e de 26 (52%) por problemas renais, cardíacos, metabólicos, respiratórios e septicemia. Foram registrados quadros de pneumonia em 56% dos pacientes. Quanto à distribuição das condições de saúde bucal, observaram-se porcentagens significativamente maiores (p menor que 0,001) da condição de higiene ruim, comparadas às outras condições.Conclusões: A maioria dos pacientes internados em Unidade de Terapia Intensiva apresentava condição odontológica ruim, e a candidíase foi a infecção mais prevalente.

Objective: To evaluate clinically the oral conditions of the patients admitted to an Intensive Care Unit (ICU). Method: An exploratory, descriptive and transversal study was developed with clinical oral evaluation of 50 patients admitted to the ICU of the São Vicente de Paula Hospital (João Pessoa, PB, Brazil). The data were collected from the medical files concerning age, gender, cause of admission and comorbidities relative to lung problems. The oral condition was classified into three categories: good (acceptable hygiene, no gingival bleeding to touch or visible infection foci); regular (little gingival bleeding to touch and/or clinically visible candidiasis as white plaques on healthy or reddish mucosa, removed mechanically) and poor (presence of abscesses and widespread candidiasis, including the oropharynx). Results: The mean age of the patients was 53.8 (±18.5) years, 23 (46%) of them being male. Twenty-four (48%) patients were hospitalized due to neurological causes and 26 (52%) due to kidney, cardiac, metabolic or respiratory problems and septicemia. Pneumonia was present in 56% of the patients. As for the oral health conditions, there were significantly higher percentages (p less than 0.001) of poor conditions compared with the other conditions. Conclusion: Most patients admitted to the ICU presented poor oral condition and candidiasis was the prevalent infection.

High-power diode laser versus electrocautery surgery on human papillomavirus lesion treatment.

The use of high-power lasers has facilitated and improved human papillomavirus (HPV) treatment protocols and has also become very popular in recent years. This application has been more frequently used in hospitals, especially in gynecology. The present study aimed to evaluate the effects of high-power diode laser to remove oral lesions caused by HPV and the consequent effects on virus load following the wound tissue healing process compared with one of the most conventional surgical techniques involving electrocautery. Surgeries were performed on 5 patients who had 2 distinct lesions caused by HPV. All patients were submitted to both electrocautery and high-power diode laser. Following a 20-day period, when the area was healed, sample material was collected through curettage for virus load quantitative analysis.Observation verified the presence of virus in all the samples; however, surgeries performed with the laser also revealed a significant reduction in virus load per cell compared with those performed with electrocautery. The ease when handling the diode laser, because of the flexibility of its fibers and precision of its energy delivery system, provides high-accuracy surgery, which facilitates the treatment of large and/or multifocal lesions. The use of high-power diode laser is more effective in treatment protocols of lesions caused by HPV.

Percepção histórica da Bioética na pesquisa com animais: possibilidades / Historical bioethical perception on research using animals: possibilities

Este trabalho analisa os princípios da Bioética aplicados aos dilemas encontrados nas pesquisas com animais. O objetivo deste estudo foi verificar, por meio de uma revisão da literatura, o desenvolvimento histórico dos caminhos da Bioética na regulamentação dos experimentos. Como método foi utilizado uma revisão integrativa. Primeiramente foi realizada uma discussão sobre o desenvolvimento histórico dos caminhos da Bioética em ordem cronológica de pesquisa na regulamentação dos experimentos aplicados na área da saúde com animais e as leis que envolvem essas pesquisas, a fim de enfatizar dilemas e conflitos. Como resultados observou-se que as leis que envolvem o uso de animais em pesquisa são recentes. Somente em 2008 foram regulamentados os procedimentos científicos com o uso de animais, quando da publicação da lei Arouca (Lei n. 11.794/08). A utilização das práticas que envolvem os animais, para verificar os benefícios para a saúde humana, deve ser mais bem avaliada. A bioética, relacionada à condição de vida e bem-estar do animal durante todos os estágios de projetos, deve ser levada em consideração por meio da submissão destes projetos aos comitês de ética das instituições de pesquisa. Um rigoroso controle por órgãos públicos deve ser feito para proteger o interesse dos animais.(AU)

This paper analyzes bioethical principles as applied to the dilemmas found in research with animals. The aim of this study was to verify, by doing a literature survey of bioethics’ historical development regarding the regulation of experiments. We did an integrative survey, held a discussion on bioethics’ historical development by means of a chronological research about the regulation of experiments with animals in the health field and legislation in order to emphasize dilemmas and conflicts. Results showed that legislation on the use of animals in research is recent. In 2008 law Arouca (Law 11.794/08) regulated scientific procedures using animals. Practices involving animals to benefit human health must be reevaluated. Ethical precepts related to living conditions and the welfare of animals in all stages of projects must be taken into account by submitting projects to research ethics committees. A strict control by governmental institutions is imperative for warranting the interests of animals.(AU)