Lessons Learnt during the Implementation of WISN for Comprehensive Primary Health Care in India, South Africa and Peru.

INTRODUCTION: The World Health Organization introduced the workload indicators of staffing needs (WISN) in 1998 to improve country-level health workforce planning. This study presents the primary care health workforce planning experiences of India, South Africa and Peru. METHODS: A case study approach was used to explore the lessons learnt in the implementation of WISN in India and South Africa. It also describes the methods developed and implemented to estimate health workforce in Peru. We identify the barriers and facilitators faced by countries during the implementation phase through the triangulation of literature, government reports and accounts of involved health planners in the three countries. RESULTS: India implemented WISN in a referral pathway of three district health facilities, including a primary health centre, community health centre and district hospital. Implementation was impeded by limited technical support, poor stakeholder consultation and information systems challenges. South Africa implemented WISN for health workforce planning in primary care and found the skills mix and staff determinations to be unaffordable. The Peruvian Ministry of Health considered using WISN but decided to develop a context-specific tool to estimate the health workforce needed using its available resources such as the National Register of Health Personnel. The main challenge in using WISN was the insufficient information on its inputs. CONCLUSION: While India and South Africa had unique experiences with the integration of WISN in their health system, none of the countries has yet benefited from the implementation of WISN due to financial, infrastructure and technical challenges. Since the methodology developed by the Peruvian Ministry of Health is context-specific, its implementation has been promising for health workforce planning. The learnings from these countries' experiences will prove useful in bringing future changes for the health workforce.

Salivary nitrite and systemic biomarkers in obese individuals with periodontitis submitted to FMD.

The objective of this 9-month clinical study is to assess the impact of one-stage full-mouth disinfection (FMD) on salivary nitrite levels and systemic biomarkers and its correlation with total subgingival bacterial load in obese and non-obese patients with periodontitis. In total, 94 patients (55 obese and 39 non-obese) were initially evaluated, seven were lost during follow-up, resulting in 87 individuals at the end of the study. Outcomes were assessed at baseline, 3, 6, and 9 months post periodontal treatment by FMD. Salivary nitrite levels were determined using Griess reagent. Blood samples were collected to determine C-Reactive Protein (CRP), alkaline phosphatase and fasting blood glucose. Real-time PCR was used to determine the total subgingival bacterial load. FMD protocol resulted in increased salivary nitrite levels at 6- and 9-months post-treatment in the non-obese group (p<0.05). In obese individuals, FMD treatment led to an increase in salivary nitrite levels at 6 months (p<0.05); however, at 9 months, the nitrite levels returned to baseline levels. For both groups, the highest nitrite values were observed at 6 months. In addition, in both groups, FMD was associated with a decrease in biomarkers related to systemic inflammation and cardiovascular diseases, such as CRP (p<0.05) and alkaline phosphatase (p<0.05), and had no impact on the fasting blood glucose. This study demonstrates that obese patients with periodontitis present similar salivary nitrite levels when compared with non-obese individuals. FMD protocol resulted in increases in salivary nitrite levels and was associated with a positive impact on systemic biomarkers, regardless of obesity status.

Teledentistry System in Dental Health Public Services: A Mixed-Methods Intervention Study.

INTRODUCTION: Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective. OBJECTIVE: To analyze the factors that affect the implementation of a Teledentistry system in dental health public services. METHODS: The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design-sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues. RESULTS: In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers' political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry's better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists CONCLUSION: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.

[Surgical results of video-assisted thoracoscopic thymectomy for treatment of Juvenile Myasthenia Gravis]. / Resultados quirúrgicos de la timectomía por videotoracoscopía en el tratamiento de la Miastenia Gravis Juvenil.

INTRODUCTION: Juvenile myasthenia gravis (JMG) is an autoimmune disease affecting the neuromuscular junction that appears before 19 years of age with varying degrees of weakness of different muscle groups. The main treatment is pharmacological, but thymectomy has also demonstrated to improve remission rates. OBJECTIVE: To describe the clinical characteristics and postoperative course of pediatric patients with JMG who underwent video-assisted thoracoscopic (VATS) thymectomy. Clinical Serie: Six pa tients who underwent VATS thymectomy between March 2011 and June 2019. The age range at diag nosis was between 2 and 14 years and the average age at surgery was 7 years. All patients were under treatment with pyridostigmine bromide associated with immunosuppression with corticosteroids before surgery. The interval between diagnosis and thymectomy was 21.5 months on average. VATS was performed by left approach, and there was no perioperative morbidity or mortality. The average hospital stay was 2 days. Three patients remain with no symptoms and without corticotherapy. Two patients were on corticosteroids, but in smaller doses than previous to surgery. One patient presented a crisis requiring hospitalization and ventilatory support during follow-up. CONCLUSION: VATS thy mectomy is part of the treatment for JMG. In this series, it appears as a safe approach and its results were favorable.

Periodontal therapy on the oral health-related quality of life of obese and non-obese individuals.

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.

Salivary nitrite and systemic biomarkers in obese individuals with periodontitis submitted to FMD

Abstract The objective of this 9-month clinical study is to assess the impact of one-stage full-mouth disinfection (FMD) on salivary nitrite levels and systemic biomarkers and its correlation with total subgingival bacterial load in obese and non-obese patients with periodontitis. In total, 94 patients (55 obese and 39 non-obese) were initially evaluated, seven were lost during follow-up, resulting in 87 individuals at the end of the study. Outcomes were assessed at baseline, 3, 6, and 9 months post periodontal treatment by FMD. Salivary nitrite levels were determined using Griess reagent. Blood samples were collected to determine C-Reactive Protein (CRP), alkaline phosphatase and fasting blood glucose. Real-time PCR was used to determine the total subgingival bacterial load. FMD protocol resulted in increased salivary nitrite levels at 6- and 9-months post-treatment in the non-obese group (p<0.05). In obese individuals, FMD treatment led to an increase in salivary nitrite levels at 6 months (p<0.05); however, at 9 months, the nitrite levels returned to baseline levels. For both groups, the highest nitrite values were observed at 6 months. In addition, in both groups, FMD was associated with a decrease in biomarkers related to systemic inflammation and cardiovascular diseases, such as CRP (p<0.05) and alkaline phosphatase (p<0.05), and had no impact on the fasting blood glucose. This study demonstrates that obese patients with periodontitis present similar salivary nitrite levels when compared with non-obese individuals. FMD protocol resulted in increases in salivary nitrite levels and was associated with a positive impact on systemic biomarkers, regardless of obesity status.

Resumo O objetivo deste estudo clínico, é avaliar o impacto da desinfecção bucal completa (DBC) nos níveis de nitrito salivar e biomarcadores sistêmicos e sua correlação com a carga bacteriana subgengival total em pacientes obesos e não obesos com periodontite. No total, 94 pacientes (55 obesos e 39 não obesos) foram avaliados inicialmente, sete foram perdidos durante o estudo, resultando em 87 indivíduos ao final. Os resultados foram avaliados no início do estudo, 3, 6 e 9 meses após o tratamento periodontal por DBC. Os níveis de nitrito salivar foram determinados usando o reagente de Griess. Amostras de sangue foram coletadas para determinação da Proteína C Reativa (PCR), fosfatase alcalina e glicemia de jejum. A PCR em tempo real foi usada para determinar a carga bacteriana subgengival total. O protocolo de DBC resultou em níveis aumentados de nitrito salivar em 6 e 9 meses após o tratamento no grupo de não obesos (p <0,05). Em indivíduos obesos, o tratamento da DBC levou a um aumento nos níveis de nitrito salivar em 6 meses (p <0,05); no entanto, aos 9 meses, os níveis de nitrito voltaram aos níveis basais. Para ambos os grupos, os maiores valores de nitrito foram observados aos 6 meses. Além disso, em ambos os grupos, a DBC foi associada à diminuição dos biomarcadores relacionados à inflamação sistêmica e doenças cardiovasculares, como PCR (p <0,05) e fosfatase alcalina (p <0,05), e não teve impacto na glicemia de jejum. Este estudo demonstra que pacientes obesos com periodontite apresentam níveis de nitrito salivar semelhantes quando comparados a indivíduos não obesos. O protocolo de DBC resultou em aumentos nos níveis de nitrito salivar e foi associado a um impacto positivo nos biomarcadores sistêmicos, independentemente do status de obesidade.

An Approach for the Prevention, Diagnosis, and Treatment of Jaw Osteonecrosis: Report of a Case Associated with Zoledronic Acid.

BACKGROUND Osteonecrosis of the jaw is a condition manifesting as necrotic bone for 8 weeks or more, with no history of radiotherapy. It is linked to the use of antiresorptive drugs, such as bisphosphonates and denosumab. We discuss in this case report the importance of infection control during clinical procedures in patients taking antiresorptives. CASE REPORT Our case report describes a 52-year-old woman who had received zoledronic acid injections for 7 years, who presented with osteonecrosis of the jaw in the region of teeth 24, 25, and 26, with no local trauma. The report proceeds to describe the extraction of these teeth. After the dental extractions, she did not have any recurrence of the lesion, and she is currently in follow-up care. CONCLUSIONS Osteonecrosis of the jaw can be prevented through infection control and local trauma prevention. Patients who are taking antiresorptive drugs must receive special care from dental surgeons and doctors, and receive the necessary oral treatments before starting drug therapy.

Guía de recomendaciones para el manejo de pacientes pediátricos con enfermedad severa por SARS-CoV-2 / Recommendations guide for the management of pediatric patients with severe SARS-CoV-2

Resumen: La aparición del SARS-CoV-2 a partir de diciembre de 2019 y su rápida expansión en el mundo alcanzando el estatus de Pandemia, se ha convertido en un gran desafío para los equipos de salud. Aunque la evidencia de la infección en niños aún es escasa comparada a la de los adultos, se ha hecho evidente que a nivel de la población pediátrica, la mayor parte de las veces la infección es asintomática o de curso leve, sin embargo no todos los pacientes tienen esta evolución, lo que ha motivado la discusión en los equipos de Cuidados Criticos Pediátricos respecto a cómo enfrentar estos pacientes con enfermedad grave. Este consenso es fruto del trabajo de la Rama de Cuidados Intensivos Pe diátricos de la Sociedad Chilena de Pediatría, recogiendo la evidencia disponible al momento de la revisión más la opinión de expertos nacionales en Cuidados Intensivos Pediátricos. El propósito de estas recomendaciones, es ofrecer a los equipos que atienden a pacientes críticos pediátricos, una guía para el diagnóstico y tratamiento de pacientes que evolucionen con COVID 19 grave, que puedan ser aplicadas en todas las UPC Pediátricas de nuestro país, haciendo especial énfasis en aquellas medidas que han demostrado mayor efectividad a nivel de estudios diagnósticos, tratamiento y cuidados del personal de salud.

Abstract: The appearance of SARS-CoV-2 from December 2019 and its rapid expansion in the world reaching Pandemic status, has become a great challenge for health teams. Although the evidence of infection in children is still scarce compared to that of adults, it has become evident that at the pediatric po pulation level, most of the time the infection is asymptomatic or mild, but not all the patients have this evolution, which has motivated the discussion in the Pediatric Critical Care teams regarding how to face these patients with a more serious disease. This consensus is the result of the work of the Pediatric Intensive Care Branch of the Chilean Society of Pediatrics, collecting the evidence available at the time of the review plus the opinion of national experts in Pediatric Intensive Care. The purpose of these recommendations is to offer teams that care for critically ill pediatric patients a guide for the diagnosis and treatment of patients who evolve with severe COVID 19, which can be applied in all Pediatric UPCs in our country, with special emphasis in those measures that have shown greater effectiveness at the level of diagnostic studies, treatment and care of health personnel.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study.

Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review.

Background: There are inequities in the provision of oral health care, and a large proportion of the population face challenges in accessing public dental health care options. Introduction: Teledentistry (TD), a new branch of telemedicine dedicated to dentistry, is a potential approach that can be used to overcome these challenges. Therefore, the purpose of this integrative review was to collect information regarding the inclusion of the application of TD tools in the public dental health services. Methods: Five electronic databases (PubMed/Medline, Virtual Health Library, CINAHL, Scopus, and Web of Science) were searched for relevant articles if they reported on original data related to the use of TD in public dental health services. Results/Discussion: Twenty-four studies met the inclusion criteria and were, consequently, included in the review. Our key findings indicated that TD can be used for training and continuing education of professionals, for remote patient care, to exchange information among health professionals, and orientation. It increases the access to dental care and enables general practitioners to interact with specialties. The benefits include cost-effective health equity services, improve dental knowledge, and reduce consultation waiting time. However, despite the advances made with the use of this technology, there are still some obstacles to overcome, such as limited infrastructure, low levels of motivation and the lack of compliance, professional resistance, and legal and security issues. Conclusion: TD may be very a useful tool for dental public health increasing the quality of the care by improving access, professional education, and patient satisfaction.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Abstract Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Teleconsultoria no sistema único de saúde: relato de experiência inédita em Santa Catarina / Teleconsulting in Periodontics in the Unified Health System: report of unprecedented experience in Santa Catarina

The use of new technologies such as Teledentistry aims to facilitate the diagnosis and treatment of oral diseases, enabling the exchange of information between professionals at a distance. The aim of this article is to report the unprecedented experience of implementing the teleconsulting service in periodontics in the Unified Public Health System for the purpose of referral to specialized care using the Santa Catarina Telehealth Center virtual platform. The pilot project was developed in the city of Joinville, southern Brazil. Focus groups were carried out with 17 primary health care general dental practitionersand 8 specialists to know their difficulties regarding the patient's referral processes to specialized care. This data oriented the Health Department to implement the teleconsulting service in periodontics. The pilot project had also the collaboration of professors of the Federal University of Santa Catarina, coordination and technicians of Santa Catarina Telehealth Center. Since November 2018, the system has been used. By the end of May 2019, 68 teleconsultations were performed by 26 dentists. Despite some difficulties related to the integration of information systems, Teleperiodontics presents potential to improve communication among periodontists and general dental practitioners and to provide permanent health education. (AU)

A utilização de novas tecnologias como a Teleodontologia visa facilitar o diagnóstico e tratamento das doenças bucais, possibilitando a troca de informações entre profissionais à distância. O objetivo deste artigo é relatar a experiência inédita de implementação do serviço de teleconsultoria em Periodontia no Sistema Único de Saúde, para fins de encaminhamento à atenção especializada, mediante o uso da plataforma do Sistema Catarinense de Telemedicina e Telessaúde. O projeto piloto foi desenvolvido no município de Joinville, Santa Catarina. Foram realizados grupos focais com 17 cirurgiões-dentistas da atenção primária e 8 especialistas dos Centros de Especialidades Odontológicas para conhecer suas dificuldades em relação aos processos de referência e contrarreferência de pacientes. A partir dessas informações, foi estruturado o projeto piloto e implantado, pela Secretaria da Saúde de Joinville, o serviço de teleconsultoria na especialidade de Periodontia. Ainda participaram professores da Universidade Federal de Santa Catarina, coordenação e técnicos do Sistema Catarinense de Telemedicina e Telessaúde. Em novembro de 2018, o sistema iniciou as operações. Até o final de maio de 2019 foram realizadas 68 teleconsultorias por 26 dentistas. Apesar de algumas dificuldades relacionadas com a integração dos sistemas de informações vigentes, a Teleperiodontia viabilizou a comunicação com os periodontistas e favoreceu a Educação Permanente dos cirurgiões-dentistas da atenção primária à saúde. (AU)

Cyclosporine A - Induced gingival overgrowth and proliferating cell nuclear antigen expression in experimental periodontitis.

The most important microscopic characteristic of Cyclosporine A-induced gingival overgrowth is fibroepithelial hyperplasia. OBJECTIVE: The objective was to investigate the influence of previous exposure to Cyclosporine A over gingival epithelium in experimental periodontitis in rats. METHODS: Twenty Wistar rats with 12 weeks-old were divided into four groups with 5 animals each: Control Group (CG); Cyclosporine Group (CsAG); Ligature group (LG) and Cyclosporine and Ligature Group (CsALG). Daily doses of CsA (10 mg/kg) were applied to CsAG and CsALG during 60 days since the beginning of the experiment and, a ligature was placed in LG and CsALG 30 days after the beginning of the experiment. After 60 days, animals were euthanized and gingival tissue was processed to histomorphometric analysis of epithelial thickness (mm2), immunohistochemical expression of PCNA (%) and inflammatory response. Data were analyzed by Kruskal-Wallis and Mann Whitney at 0.05 significance level. RESULTS: Considering epithelial thickness, CG was thinner than all groups, CsALG was the largest and CsAG and LG were similar between each other. Regarding the PCNA expression CG (16.46 ± 9.26) was similar to CsAG (34.47 ± 19.75) and, LG (59.02 ± 10.33) was similar to CsALG (40.59 ± 18.25). Significant difference (p < 0.05) occurred only in inflammation presence comparing CG/LG and CsAG/CsALG. A weak positive correlation between the number of PCNA+ and inflammatory cells (p = 0.001; r = 0.611) was observed. CONCLUSION: Based on these results it was concluded that the enlargement of gingival epithelium observed in experimental periodontitis can be increased by previous exposition to CsA and inflammatory conditions enhanced proliferative activity of the keratinocytes.

Terapia periodontal de suporte em paciente com periodontite agressiva generalizada: acompanhamento clínico e radiográfico de 13 anos / Periodontal maintenance therapy in patient with generalized aggessive periodontitis: clinical and radiographic following by 13 years

A terapia periodontal de suporte (TPS) tem como objetivo principal a manutenção dos resultados obtidos durante o tratamento periodontal ativo, sendo a forma mais previsível de controlar a doença periodontal. Essa extensão do tratamento periodontal, pode ocorrer em intervalos de tempo que variam de acordo com a severidade da doença, condição sistêmica do indivíduo, idade, fatores de risco, entre outros. A TPS contribui para a redução da perda dentária e recorrência da doença periodontal, além de possibilitar o diagnóstico de outras doenças bucais. Durante essa etapa, é possível traçar o perfil do paciente, identificar suas dificuldades e estabelecer condutas educativas, preventivas e terapêuticas necessárias para o controle do biofilme e da doença periodontal. Assim, o periodontista deve conscientizar o paciente sobre a importância da TPS, sendo que, a adesão ao tratamento é fundamental para a manutenção da saúde dos tecidos periodontais a longo prazo. O presente relato de caso clínico, demonstra o sucesso da TPS em paciente jovem acometida por periodontite agressiva generalizada. Após a realização da terapia periodontal não cirúrgica, a paciente foi inserida em um programa de manutenção periodontal, há 13 anos atrás, no qual participa ativamente até o presente momento. (AU)

The main objective of the periodontal maintenance therapy (PMT) is to maintain the results achieved during the active periodontal therapy, being the most predictable way of controlling the periodontal disease. This extension of the periodontal treatment may occur at different times, varying according to the aggressiveness of the disease, general health condition of the subject, age and risk factors, among others. The PMT contributes to the reduction of dental loss and prevents the reoccurrence of the periodontal disease, while also allowing the diagnose of other diseases of the mouth. During this phase it is possible to trace the patient's profile, identifying the difficulties and stablishing educational, preventive and therapeutic practices to control oral biofilm and periodontal disease. Thus, the periodontist must raise the patient's awareness to the importance of the PMT, as the patient compliance to the treatment is essential for the long term preservation of the periodontal tissue health. The clinical case here described demonstrates the success of the PMT performed on a young female patient afflicted with generalized aggressive periodontitis. After having performed the non-surgical periodontal therapy, the patient entered a periodontal maintenance program 13 years ago, in which she has been actively participating until the present time.(AU)

Denosumab Related Osteonecrosis of Jaw: a Case Report.

BACKGROUND: This case report shows an affected postmenopausal patient with medicaments related osteonecrosis of the jaw injury associated with increased use of bisphosphonates and Prolia® (denosumab) for the treatment of osteoporosis. The mechanism of action of the receptor activates the denosumab of the nuclear-kB factor binding and makes nuclear-kB Factor, reducing bone volume and reabsorption in the trabecular and cortical bones and, consequently, decreasing an incidence of fractures and maintaining a bone formation. The bone physiology regulated by the hormones calcitonin, parathormone and vitamin D also undergoes interference. METHODS: The injury was located around a dental implant in region #24 and #25 and the patient complained of pain, bleeding, oedema, and halitosis for more than two months, that the dental implant had been installed five years before. According to the clinical findings, the patient presented the exposed and necrotic bone in the region of #24 and #25 and with the radiographs found, it was observed as extensive bone destruction adjacent to the dental implant. RESULTS: Patient was referred to the maxillofacial surgeon that performed the removal of bone sequestration and dental implant in the region affected. After that, the patient has been accompanied for a year. CONCLUSIONS: Patients taking medications for osteoporosis or cancer need to receive special attention from the dentist. Invasive procedures on the jaw bone of patients taking these medications may cause osteonecrosis of the jaw. When diagnosed, osteonecrosis of the jaw should be treated surgically in conjunction with antibiotic therapy and patients should be monitored.

Proteínas ósseas morfogenéticas em cirurgia de levantamento do seio maxilar / Bone morphogenetic proteins on surgery of maxillary sinus lifting

Introdução: A técnica cirúrgica de levantamento do seio maxilar é indicada nos casos de reabsorção óssea do processo alveolar da maxila na região posterior, que pode inviabilizar a instalação de implantes osseointegrados. Vários materiais de enxertia óssea podem ser associados à técnica cirúrgica com resultados previsíveis e comprovação científica de longos anos. Um dos materiais, substitutos ósseos, utilizado mais recentemente associado à técnica de levantamento do seio maxilar e que vêm apresentando resultados promissores são as proteínas ósseas morfogenéticas (BMPs). As BMPs são polipeptídeos multifuncionais que atuam na cicatrização óssea e no reparo de fraturas devido às suas propriedades osteoindutivas. O uso das BMPs associado à técnica cirúrgica de levantamento do seio maxilar constitui uma nova alternativa para os indivíduos que não querem ser submetidos à cirurgia para remoção de enxerto ósseo autógeno. Objetivo: Realizar uma revisão da literatura sobre o uso das BMPs como material de enxertia associado à técnica cirúrgica de levantamento do seio maxilar. Método: Empregando-se os termos BMP AND sinus lift ; rhBMP-2 ANDsinus lift; BMP AND maxillary sinus floor augmentation; rhBMP-2 AND maxillary sinus floor augmentation como palavras chave, foram selecionados artigos na base de dados Pubmed, publicados entre os anos de 2011 e 2016 na língua inglesa. Conclusão: O uso associado das BMPs com diferentes materiais de enxertia constitui uma alternativa eficaz nos procedimentos cirúrgicos de levantamento do seio maxilar. Todavia, novos estudos clínicos, principalmente estudos prospectivos randomizados, precisam ser realizados para avaliar a eficácia das BMPs como substituto ósseo (AU)

Introduction: The surgical technique of sinus floor elevation is indicated in the presence of severe maxillary atrophy, which can interfere with implant fixation. There are many biomaterials for the use of bone graft that can be associated with good results and scientific proof, and surgical techniques withpredictable results for many years. One of the materials, bone grafts that can be associated with the sinus floor elevation and have been introduced with high levels of success is the bone morphogenetic protein (BMPs). The BMPs are functional polypeptides that are involved in the bone healingbecause of the osteoinductive property.Theuse of the BMPs with maxillary sinus floor augmentation is a new alternative for the individuals who do not want to be submit to surgery for autogenous graft. Aims: Review and discussabout the use of BMPs,as a grafting, associated with the surgical technique for maxillary sinus floor augmentation and furthermore, to know about the indications, success rate (predictability) and the limitations. Method: Using the terms BMP AND sinus lift; rhBMP-2 AND sinus lift; BMP AND maxillary sinus floor augmentation; rhBMP-2 AND maxillary sinus floor augmentation as key words, the articles were selected in the data basePubmed, and published between the years 2011 to 2016. Conclusion: The use of BMPs with differents graft materials could be a good alternativein the maxillary sinus floor augmentation. However, it would be necessary perform more randomized clinical trials, to evaluate the efficacy of BMPs like a bone substitute.(AU)

Influência da ciclosporina a nos tecidos periodontais e na osseointegração de implantes: revisão de literatura / Influence of cyclosporine a on periodontal tissue and osseointegration of implants: review of literature

A Ciclosporina A é um potente imunossupressor utilizado no tratamento de diversas patologias mediada imunologicamente. É indicado principalmente no tratamento preventivo da rejeição de órgãos em indivíduos transplantados. Efeitos adversos relacionados com o uso do fármaco como a indução de osteopenia, desequilíbrio no processo de remodelação óssea, desenvolvimento de osteoporose e o aumento gengival são descritos na literatura. O objetivo do presente estudo foi revisar através da literatura os efeitos da ciclosporina A no metabolismo do tecido gengival, ósseo e sua influência como possível fator de risco na osseointegração de implantes. Empregando-se os termos cyclosporine AND dental implants; cyclosporine AND osseointegration; e cyclosporine AND gingival overgrowth como palavras chave, foram levantados artigos na base de dados Pubmed, publicados entre os anos de 2000 a 2016, na língua inglesa e portuguesa. Conclui-se que os efeitos adversos causados pela ciclosporina A podem interferir na saúde bucal dos indivíduos e no sucesso do tratamento odontológico. É fundamental que o cirurgião dentista conheça os mecanismos de ação do medicamento, seus efeitos adversos e interações medicamentosas, a fim de desenvolver estratégias de prevenção e tratamento para usuários do medicamento (AU)

Cyclosporine A is a potent immunosuppressive drug used in the treatment of various immunologically mediated pathologies. It is mainly indicated in the preventive treatment of organ rejection in transplant recipients. Adverse effects associated with using the drug such as the induction of osteopenia, imbalance in bone remodeling, development of osteoporosis and gingival enlargement are described in literature. The aim of this study was to review, through literature, the effects of cyclosporine A in the metabolism of gingival tissue, bone and its influence as a possible risk factor in osseointegration of implants. Using the terms cyclosporine AND dental implants; cyclosporine AND osseointegration; and cyclosporine AND gingival overgrowth as keywords, a search was conducted for articles published in the Pubmed database between the years 2000-2016, in English and Portuguese. It was concluded that the adverse effects caused by cyclosporine A may interfere in the oral health of individuals and the success of the dental treatment. It is essential that the dentist is aware of the action mechanisms of the drug, its side effects and medicinal interactions in order to develop prevention and treatment strategies for users of the drug (AU)

Avaliação da eficácia da terapia periodontal não cirúrgica em indivíduos obesos: revisão da literatura / Evaluation of the efficacy of non-surgical periodontal therapy effectiveness in obese individuals: literature review

A obesidade vem sendo considerada um dos maiores problemas de saúde pública da era moderna. A doença influencia negativamente a saúde geral do indivíduo, desencadeando ou agravando inúmeras doenças e comorbidades. Estudos sugerem que a obesidade pode influenciar a severidade e a progressão da doença periodontal, através do aumento de citocinas inflamatórias como o TNF-α, IL-6 e IL-8 secretadas pelo tecido adiposo na corrente sanguínea. Por isso, a presente revisão de literatura objetivou avaliar se a terapia não cirúrgica é eficaz no tratamento da doença periodontal em indivíduos obesos. Utilizando-se Obesity AND Periodontitis AND Periodontal Therapy como palavras chave, foram levantados artigos na base de dados Pubmed, publicados entre os anos de 2011 e 2016, na língua inglesa. A maior parte dos estudos investigou o modelo de tratamento convencional e monitorou parâmetros clínicos. Os resultados demonstraram que clinicamente os obesos respondem favoravelmente a raspagem e alisamento radicular, incluindo diminuição de profundidade de sondagem e melhora na condição gengival. Os estudos que incluíram parâmetros bioquímicos também demonstraram resultados favoráveis. Entretanto, outros parâmetros devem ser monitorados como desfechos e outras modalidades terapêuticas precisam ser testadas para que se possa avaliar melhor a real eficácia do tratamento em obesos. Considerando-se que os dados disponíveis ainda são limitados, a literatura permitiu-nos concluir que a terapia periodontal convencional é efetiva em indivíduos obesos

Obesity has been considered one of the greatest public health problems of the modern era. The disease adversely affects the overall health of the individual, triggering or worsening numerous diseases and comorbidities. Studies suggest that obesity can influence the severity and progression of periodontal disease by the increase of inflammatory cytokines such as TNF-α, IL-6 and IL-8 secreted by adipose tissue in the bloodstream. Therefore, the aim of this literature review is to assess the efficacy of non-surgical periodontal therapy in obese individuals. Using Obesity AND Periodontitis AND Periodontal Therapy as keywords, articles published between 2011 and 2016 in the English language were searched in Pubmed database. Most studies had focused on conventional treatment and monitored clinical parameters. Obese showed good clinical response to scaling and root planing, including a decrease in pocket depth and improvement in the gingival condition. Studies that included biochemical parameters also showed favorable results. However, other parameters should be monitored as outcomes and other therapeutic modalities need to be tested so that the real effectiveness of treatment in obese patients can be better evaluated. Considering the limitation of available data, the literature enabled us to conclude that periodontal therapy is effective in obese individuals

Previous exposure to Cyclosporine A and periodontal breakdown in rats.

OBJECTIVE: The aim of this study was to evaluate the influence of previous exposure to Cyclosporine A (CsA) on experimental periodontitis in rats. DESIGN: Forty rats were divided into 4 groups: Control (CON); Cyclosporine A (CsA), which received daily doses of 10mg/kg CsA; Ligature (LIG), which received an insertion of a cotton ligature around the mandibular 1st molar at day 30; and Ligature and CsA (CsAL), which were treated with CsA and the cotton ligature. At day 60 of the experiment, animals were sacrificed, and groups were compared with regards to Alkaline Phosphatase (AP) activity, gingival overgrowth, periodontal bone support (PBS), bone resorption at furcation ligament area (LA) and TRAP+ cells. Data were analyzed by ANOVA/Tukey and Kruskal-Wallis and were considered to be statistically significant at 5% level. RESULTS: CsA and LIG groups showed similar gingival area, which was higher than that in the CON and lower than in the CsAL group (p=0.001). The ratio between epithelial area and connective area for the CON group was similar to the CsA group and higher than that for the CsAL and LIG groups (p=0.0334). Mean percentage of PBS for the CON group was similar to that for the CsAL group and higher than that of the CsA and LIG groups (p=0.0007). No difference was observed regarding AP (p=0.2806) and TRAP+ cells (p=0.3995) among experimental groups. Mean values for LA of CON were similar to CsA, and both were statistically lower than the CsAL and LIG groups (p=0.0172). CONCLUSION: Based on these results, we posit that previous exposure to CsA may influence gingival overgrowth, but not bone loss, in rats with experimental periodontitis.

Bone mimetic for confection of bio inspired ceramic materials: literature review

The loss of bone mass is a very common condition that is affecting people of various ages and causing a declinein quality of life of these people. Currently there is the possibility of using bone grafts to replace this bone loss, whichcan be autogenously, halogen or heterogeneous, with autogenously those get better results, but with disadvantageof providing two surgical sites in patients. In this sense, and also for other reasons related to properties of materials,authors are seeking to mimic natural bone for the production of ceramic biocompatible materials that can retainthe structure and properties of natural bone tissue. Such material should present structure dense/porous structuresimilar to the cortical and cancellous bone. With this, these materials can have good future applications, including thereplacement of lost bone tissue, and then becoming one more option to improve the quality of life of these patients.Thus, the objective of this study was a literature review of the ceramics that mimic the bone tissue, which are thenconsidered bio inspired materials...