Condiciones de salud bucodental en personas adultas mayores con enfermedad de Alzheimer: Scoping Review

Introducción: El aumento de la longevidad de las personas ha generado en la última etapa de vida la aparición de enfermedades de tipo multifactorial y relacionadas con el estilo de vida, aumentando la prevalencia de patologías mentales y enfermedades orales. Objetivo: Identificar las condiciones de salud oral en personas adultas mayores con enfermedad de Alzheimer. Métodos: Se planteó una revisión de la literatura tipo Scoping Review, determinando una estrategia de búsqueda para tres bases de datos (Pubmed, EbscoHost y LILACS). Fueron incluidos artículos con diseño de corte transversal, cohorte y casos y controles en idioma español, inglés y portugués entre 2011 y 2021. Se realizó la extracción y evaluación del riesgo de sesgo teniendo en cuenta los criterios de elegibilidad. Resultados: Se seleccionaron 32 artículos para revisión de texto completo y síntesis cualitativa de la información. Alemania y Estados Unidos presentan mayor cantidad de publicaciones, el sexo femenino predominó como población de estudio. Se observó menor frecuencia de cepillado, mayor cantidad de ausencias dentales en pacientes con demencia por Alzheimer y consecuentemente un mayor uso de prótesis en dicha población. Conclusiones: Es importante fortalecer la relación sistémico-oral de los adultos mayores mediante un manejo interdisciplinario entre el geriatra y el odontólogo.

Introduction. The increase in the longevity of individuals has led to the emergence of multifactorial diseases related to lifestyle during the later stages of life, thereby increasing the prevalence of mental disorders and oral diseases. Objective: To identify oral health conditions in older adults with Alzheimer's disease. Methods: A Scoping Review literature review was conducted, outlining a search strategy for three databases (Pubmed, EbscoHost, and LILACS). Articles with a cross-sectional, cohort, or case-control design published in Spanish, English, or Portuguese between 2011 and 2021 were included. Extraction and bias risk assessments were performed based on eligibility criteria. Results: Thirty-two articles were selected for full-text review and qualitative synthesis of information. Germany and the United States had the highest number of publications, with females predominating as the study population. A lower frequency of brushing, a higher number of missing teeth in Alzheimer's patients, and consequently higher use of prosthetics were observed in this population. Conclusions: It is essential to strengthening the systemic-oral relationship in older adults through interdisciplinary management involving geriatricians and dentists.

Introdução: O aumento da longevidade das pessoas tem gerado na última fase da vida o aparecimento de doenças multifatoriais e relacionadas ao estilo de vida, aumentando a prevalência de patologias mentais e doenças bucais. Objetivo: identificar as condições de saúde bucal em idosos com doença de Alzheimer. Métodos: foi realizada uma revisão de escopo da literatura, determinando uma estratégia de busca em três bancos de dados (Pubmed, EbscoHost e LILACS). Foram incluídos artigos com desenho transversal, de coorte e de caso-controle em espanhol, inglês e português entre 2011 e 2021. A extração e a avaliação do risco de viés foram realizadas levando-se em conta os critérios de elegibilidade. Resultados: Trinta e dois artigos foram selecionados para revisão do texto completo e síntese qualitativa das informações. A Alemanha e os Estados Unidos tiveram o maior número de publicações, e a população do estudo era predominantemente feminina. Observou-se menor frequência de escovação, maior número de ausencias odontológicas em pacientes com demência de Alzheimer e, consequentemente, maior uso de dentaduras nessa população. Conclusões: É importante fortalecer a relação sistêmico-oral dos idosos por meio do gerenciamento interdisciplinar entre o geriatra e o dentista.

Describing the Oral Health of Warfarin Users. A Short Report

Aim: To describe the burden of oral diseases and of self-reported periodontal disease of patients under Oral Anticoagulation Therapy (OAT) with warfarin. Methods: A cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease and demographic variables. After calibration (Kappa > 0.80), an examiner evaluated dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Results: The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The average DMFT (Decayed, Missing, and Filled Teeth) index was 22.9 (SD = 7.6), with the missing component being the highest (Mean = 16.23). The use of maxillary prosthesis (53.2%) was higher than mandibular (32.3%). The need for mandibular prosthesis reached 66.5%. The percentage of participants that referred gum disease, tooth migration, and tooth mobility was 29.6%, 37.4%, and 30.4%, respectively. Conclusions: The burden of oral diseases among individuals undergoing OAT is worrisome.

Objetivo: Describir la carga de enfermedades bucales y la enfermedad periodontal autorreportada de pacientes en tratamiento con anticoagulación oral con warfarina. Métodos: Se realizó un estudio transversal. Los cuestionarios validados evaluaron la enfermedad periodontal autoinformada y las variables demográficas. Después de la calibración (Kappa> 0.80), un examinador evaluó la caries dental y la necesidad de prótesis dentales. El análisis estadístico involucró proporciones y medidas de tendencia central. Resultados: La muestra estuvo formada por 158 individuos, con una edad media de 58.8 años (DE = 12.1), de los cuales el 62.7% de los participantes eran mujeres. El índice CPOD promedio fue de 22.9 (DE = 7.6), siendo el componente perdido el que más contribuyó al índice (Media = 16.23). El uso de prótesis maxilar (53.2%) fue mayor que el de prótesis mandibular (32.3%). La necesidad de prótesis mandibular alcanzó el 66.5%. El porcentaje de participantes que informaron enfermedad de las encías, migración de los dientes y movilidad de los dientes fue del 29.6%, 37.4% y 30.4%, respectivamente. Conclusiones: Las enfermedades bucales y la necesidad de rehabilitación oral entre los individuos sometidos a anticoagulación oral con warfarina fue motivo de preocupación.

Association between Stress at Work and Temporomandibular Disorders: A Systematic Review.

Temporomandibular disorders (TMD) have been traditionally associated with psychosocial factors; however, occupational stress as a factor related to TMD has not been adequately assessed in the literature. The aim was to investigate the association between stress at work and TMD on adult paid workers. An electronic search included PubMed, Scopus, Web of Science, Embase, and LILACS databases. Manual searches in the included articles' reference and gray literature were performed. There were no restrictions regarding language or publication period. The inclusion criteria comprised observational studies with paid workers of any category, of both sexes, above 18 years old, assessing occupational stress/stress or distress and TMD as diagnosis or isolated signs and symptoms. Methodological quality was evaluated using Joanna Briggs tools. We narratively assessed the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. We collected 12 studies. 50% reported a positive association between stress and TMD diagnostic across various job categories. On the other hand, TMJ sounds (a TMD sign) and work stress were associated only in a musicians' population. However, the shortage of eligible articles and the methodological limitations provided a very low certainty of the evidence; only 4 of the studies used validated tools for both stress and TMD (2 reporting positive association). The association between stress and TMD is inconclusive by the available data. In the future, we expect more robust epidemiologic studies addressing these relevant aspects.

Effectiveness of local hemostatic to prevent bleeding in dental patients on anticoagulation: A systematic review and network meta-analysis.

This study aimed to determine the effectiveness of hemostatic protocols to prevent bleeding in dental procedures among individuals undergoing oral anticoagulation therapy. A systematic review and network meta-analysis were accomplished. Searches of literature and grey literature were performed in different electronic databases. Clinical trials were considered as part of the inclusion criteria. Data extraction and assessment of the risk of bias of the included articles were performed. Assessment of the certainty of evidence was also performed. As results we find that the N-butyl-2-cyanoacrylate [RR -35.00 (95% CI - 107.12, -5.78)], calcium sulfate (CaSO4) [RR -5.62 (95% CI -11.41, -1.03)], and tranexamic acid (TXA) [RR -3.46 (95% CI -7.63, -0.77)] showed beneficial effects compared to placebo. However, only TXA presented beneficial effects with moderate certainty evidence. N-butyl-2-cyanoacrylate and CaSO4 presented very low certainty evidence. In the comparisons between the hemostatic agents, no differences were observed. For the mean bleeding time, no significant difference in the comparisons was observed as well. Concluding, bleeding events in individuals on oral anticoagulation decreased with the use of TXA compared to placebo. N-butyl-2-cyanoacrylate and CaSO4 were also superior to placebo, but the certainty of evidence was low. For the mean bleeding time, no significant difference in hemostatic agents was observed.

Oral Health-Related Quality of Life in Anticoagulated Patients with Warfarin Treatment: A Cross-Sectional Study.

To evaluate factors associated with oral health-related quality of life (OHRQoL) in patients under oral anticoagulant therapy with warfarin, a cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL using the short version of the Oral Health Impact Profile (OHIP-14) instrument. After calibration (Kappa > 0.60), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (worse OHRQoL) was associated with ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Demographic and clinical factors can negatively influence the perception of anticoagulated patients on OHRQoL.

Effectiveness of hemostatic protocols for the prevention of bleeding during oral procedures among individuals receiving anticoagulation therapy: a systematic review protocol.

OBJECTIVE: The objective of this review is to determine the effectiveness of hemostatic protocols for the prevention of bleeding during dental procedures among individuals receiving oral anticoagulation therapy. INTRODUCTION: Dental procedures may increase the chance of bleeding in individuals receiving oral anticoagulation therapy. The literature suggests different hemostatic protocols for the prevention of bleeding in these individuals but offers no consensus regarding their effectiveness. INCLUSION CRITERIA: Randomized controlled clinical trials comparing the effectiveness of different hemostatic protocols for the prevention of bleeding during oral procedures among individuals 18 years or older receiving oral anticoagulation therapy will be included. METHODS: Computerized searches will be conducted in seven electronic databases. Gray literature and searches in the reference lists of the included articles will also be screened. Two independent reviewers will assess titles/abstracts for potential inclusion against the eligibility criteria. References that meet the eligibility criteria will be included without restriction on the language or date of publication. Assessment of the methodological quality of the included articles and data extraction will be performed. Statistical heterogeneity of meta-analysis will be assessed. In the event of high statistical heterogeneity, sensitivity analysis will be performed. Subgroup analysis will be planned. The certainty of the evidence will be evaluated with the Grading of Recommendations, Assessment, Development and Evaluation. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019136744.

Dental Caries Remains a Significant Public Health Problem for South American Indigenous People.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Dental caries in South American Indigenous people: A systematic review. Soares GH, Pereira NF, Gabriela M, Biazevic H, Braga MM, Michel-Crosato E. Community Dent Oral Epidemiol 2019;47(2):142-52. SOURCE OF FUNDING: Brazilian National Council for Scientific and Technological Development (CNPq). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Saúde bucal em pacientes em terapia anticoagulante e efetividade das terapias hemostáticas para a prevenção do sangramento / Oral health in patients under anticoagulant therapy and effectiveness of hemostatic therapies for bleeding prevention

O objetivo deste trabalho foi determinar a efetividade das terapias hemostáticas em indivíduos sob terapia anticoagulante a fim de evitar o sangramento por procedimentos odontológicos e descrever os fatores associados à qualidade de vida e saúde bucal entre pacientes em terapia anticoagulante oral com varfarina. Inicialmente foi desenvolvida uma revisão sistemática e meta-analise em rede que revisou os ensaios clínicos em diferentes bases de dados para determinar a efetividade das terapias hemostáticas. A extração de dados, a avaliação do risco de viés dos artigos incluídos (ferramentas de JBI e Cochrane) e a avaliação da certeza das evidências (GRADE) foram realizadas. Como resultados, foi verificado que o N-butil-2-cianoacrilato [RR -35,00 (95% CI - 107,12, -5,78)], sulfato de cálcio (CaSO4) [RR -5,62 (95% CI -11,41, -1,03)], e Ácido tranexâmico (TXA) [RR -3,46 (95% CI -7,63, -0,77)] mostraram efeitos benéficos em comparação com o placebo. No entanto, apenas o TXA apresentou efeitos benéficos com evidência de certeza moderada. N-butil-2-cianoacrilato e CaSO4 apresentaram evidência de certeza muito baixa. Não foram observadas diferenças entre agentes hemostáticos na prevenção de eventos de sangramento. Concluindo, os eventos de sangramento em indivíduos em anticoagulação oral diminuíram com o uso de TXA em comparação com o placebo. O N-butil-2-cianoacrilato e o CaSO4 também foram superiores ao placebo, mas a certeza das evidências era baixa. Para o tempo médio de sangramento, não foi observada diferença significativa nos agentes hemostáticos. Por outro lado, foi desenvolvido um estudo transversal, questionários validados avaliaram doença periodontal auto-relatada, variáveis demográficas e qualidade de vida relacionada à saúde bucal (QVRSB), usando a versão curta do instrumento Oral Health Impact Profile (OHIP-14), em pacientes anticoagulados de um Hospital de Belo Horizonte, Brasil. Após a calibração intra-examinador (Kappa = 0,95), um examinador avaliou a experiência dos pacientes com cárie dentária e a necessidade de próteses dentárias. A análise estatística envolveu proporções e medidas de tendência central. Modelos de regressão binomial negativos foram usados para estimar as razões de taxas (RR) e os intervalos de confiança de 95% (IC) correspondentes. A média do OHIP-14 foi de 10,62 (DP = 10,92). Um escore total do OHIP-14 mais alto (baixa QVRSB) foi associado ao grupo étnico, idade, auto-relato de doença periodontal, cárie dentária e auto-relato de saúde bucal. Concluindo, as doenças bucais entre indivíduos submetidos a terapia anticoagulante oral com varfarina é preocupante. Os fatores demográficos e clínicos têm uma influência na percepção de pacientes anticoagulados na QVRSB.

This study aimed to determine the effectiveness of hemostatic protocols in anticoagulated patients to prevent bleeding in dental procedures and describe the factors associated with quality of life and oral health-related to patients undergoing oral anticoagulant therapy with warfarin. In the first instance, in the systematic review and network meta-analysis, a search of the literature was conducted in different databases where clinical trials were evaluated to determine the effectiveness of hemostatic protocols. Data extraction and assessment of the risk of bias (JBI and Cochrane tools) of the included articles were performed. Assessment of the certainty of the evidence (GRADE) was also performed. As results we find that the N-butyl-2-cyanoacrylate [RR -35.00 (95% CI - 107.12, -5.78)], calcium sulfate (CaSO4) [RR -5.62 (95% CI -11.41, -1.03)], and tranexamic acid (TXA) [RR -3.46 (95% CI -7.63, -0.77)] showed beneficial effects compared to placebo. However, only TXA presented beneficial effects with moderate certainty evidence. N-butyl-2-cyanoacrylate and CaSO4 presented very low certainty evidence. No differences were observed between hemostatic agents in preventing bleeding events. Concluding, the bleeding events in individuals on oral anticoagulation decreased with the use of TXA compared to placebo. N-butyl-2-cyanoacrylate and CaSO4 were also superior to placebo, but the certainty of the evidence was low. For the mean bleeding time, no significant difference in hemostatic agents was observed. On the other hand, a the cross-sectional study was performed, validated questionnaires assessed self-reported periodontal disease, demographic variables, and OHRQoL, using the short version of the Oral Health Impact Profile (OHIP-14) instrument in anticoagulated patients at a Belo Horizonte, Brazil. After calibration (Kappa = 0,95), an examiner evaluated patients' experience with dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Negative binomial regression models were used to estimate the rate ratios (RR) and the corresponding 95% confidence interval (CI). The OHIP-14 mean was 10.62 (SD = 10.92). A higher OHIP-14 total score (low OHRQoL) was associated with an ethnic group, age, periodontal disease self-report, dental caries, and oral health self-report. Concluding, the burden of oral diseases among individuals undergoing OAT is worrisome. Additionally, demographic and clinical factors have an influence on the perception of anticoagulated patients on OHRQoL.

Effectiveness of Antimicrobial Prophylaxis in Preventing the Spread of Infection as a Result of Oral Procedures: A Systematic Review and Meta-Analysis.

PURPOSE: To determine the effectiveness of prophylactic antibiotics for preventing localized infections of the oral cavity, neck, and thoracic cavity in patients undergoing oral procedures. MATERIALS AND METHODS: A systematic review and meta-analysis was performed. A search strategy was applied to the Medline database through Ovid, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, and OpenGrey. Clinical trials were included, and studies in which patients underwent procedures outside the oral cavity were excluded. Statistical analysis was performed using Stata 13 and RevMan 5.3. A risk of bias assessment was performed according to Cochrane recommendations. RESULTS: For the primary results of oral cavity infection with antibiotic intervention versus placebo, 6 studies with a risk difference (RD) of -0.025 were included (95% confidence interval [CI], -0.043 to -0.007). For bacteremia with antibiotic intervention versus placebo, 7 studies with an RD of -0.278 were included (95% CI, -0.380 to -0.176); when an analysis of antibiotic versus antibiotic was performed, 6 studies with an RD -0.072 were included (95% CI, -0.255 to -0.112), favoring antibiotic prophylaxis. There was no evidence of neck and thoracic cavity infection. For type of treatment, implant surgery with placebo showed an RD of -0.021 (95% CI, -0.043 to 0.001), whereas an RD -0.245 was observed when performing tooth extraction (95% CI, -0.337 to -0.154). CONCLUSION: The incidence of infections in the oral cavity decreased with the use of antibiotic prophylaxis in patients undergoing tooth extraction. However, for implant surgery and endodontic surgery, prophylactic antibiotic showed no differences compared with placebo. No infections in the neck or thoracic cavity were reported. It is necessary to evaluate antibiotic prophylaxis in high-risk patients.

Uso de inmunoglobulinas intravenosas en una paciente obstétrica con choque séptico: reporte de caso y revisión de la literatura / Use of intravenous immunoglobulins in an obstetric patient with septic shock: Case report and review of the literature

Objetivo: Reportar el caso de una paciente obstétrica que desarrolló un shock séptico secundario a una infección gastrointestinal y el uso de inmunoglobulina endovenosa (IVIG) como terapia coadyuvante y hacer una revisión de la literatura publicada del uso de inmunoglobulinas en shock séptico con énfasis en su uso en el embarazo. Materiales y métodos: Se presenta el caso de una paciente con embarazo de 36 semanas, quien presentó un choque séptico secundario a una infección gastrointestinal y progresó con falla orgánica multisistémica. En vista de la pobre respuesta al tratamiento instaurado se inició terapia coadyuvante con inmunoglobulina enriquecida en IgM con una buena respuesta. Se realizó una búsqueda de la literatura en la bases de datos de Medline vía PubMed, Direct Sciencie, Biblioteca Cochrane y SciELO utilizando las palabras clave de los Descriptores en Ciencias de la Salud (DeCS) como inmunoglobulina endovenosa y sepsis en embarazo. Resultados: Se encontraron 6 artículos relacionados directamente con el uso de IVIG en sepsis en el embarazo, 1 revisión de tema, 2 reportes de caso y 3 guías diagnósticas y de manejo. Las inmunoglobulinas intravenosas se han utilizado con mayor frecuencia en pacientes no obstétricas en shock séptico como terapia coadyuvante especialmente en infección por estreptococos y estafilococos. Conclusión: Las inmunoglobulinas intravenosas podrían ser una alternativa como coadyuvante en manejo de shock séptico en gestantes con pobre respuesta al tratamiento convencional. Se necesitan estudios analíticos que incluyan gestantes para confirmar estos hallazgos.

Objective: To report the case of an obstetric patient who developed septic shock secondary to a gastrointestinal infection, and the use of intravenous immunoglobulin (IVIG) as an adjunct, and to conduct a review of the published literature on the use of immunoglobulins in septic shock with emphasis on its use during pregnancy. Materials and methods: Case report of a patient with 36 weeks of gestation who presented with septic shock secondary to a gastrointestinal infection resulting in multiple organ failure. In view of poor response to treatment, adjunctive therapy with IgM-enriched immunoglobulin therapy was initiated, achieving good response. A search of the literature was conducted in the Medline, Direct Science, Cochrane Library and SciELO databases using Health Science Descriptors (DeCS) such as intravenous immunoglobulin and sepsis in pregnancy. Results: Six articles directly related to the use of IVIG in sepsis during pregnancy were found, including 1 review, 2 case reports and 3 diagnosis and management guidelines. Intravenous immunoglobulins have been used with greater frequency in non-obstetric patients in septic shock as an adjunct especially in streptococcal and staphylococcal in fections. Conclusion: Intravenous immunoglobulins could be an alternative as adjunct therapy in the management of septic shock in pregnant women who respond poorly to conventional treatment. Analytical studies including pregnant women are needed in order to confirm these findings.