Prevalence of tooth loss, bleeding on probing and malocclusion as oral disease indicators in Costa Rican male adolescents: a cross sectional study / Prevalencia de la pérdida de piezas dentales, del sangrado al sondeo y la maloclusión como indicadores de enfermedades orales en adolescentes varones costarricenses: un estudio transversal

The evidence to characterize oral health during adolescence in Costa Rica is limited. This lack of adequate research makes it difficult to develop appropriate health policies for this subgroup of the population. This is particularly important because adolescence is the period during which good health habits must take root in order to foster good physical and cognitive development. This study aims to determine the prevalence of tooth loss, bleeding on probing and malocclusion in Costa Rican male adolescents at the ''Colegio Técnico Profesional San Agustín'' (St. Augustine's Technical High School) located in the province of Cartago. Data was collected from 428 male adolescents aged 12-22 years in a cross-sectional study during 2019. Prevalence of tooth loss was calculated as the number of individuals having lost at least one tooth. The average number of teeth lost by individuals was also recorded. The bleeding on probing was an indicator used as a proxy parameter for monitoring periodontal health where the presence of bleeding on probing and calculus was also recorded. Malocclusion was measured using the Dental Aesthetic Index (DAI). The results showed that the prevalence of tooth loss, bleeding on probing and malocclusion was of 19%, 70.0% and 98%, respectively. It was also found that 81% of the participants had all their teeth, 11% had lost 1 tooth, 8% had lost more than one tooth of which 0.5% had lost more than 5 teeth. Considering a general classification of periodontal problems based on bleeding on probing and presence of calculus, the prevalence of periodontal problems increases to 92%. Regarding the DAI, the category identifying a very severe malocclusion was the most prevalent in the sample (88%). It is alarming the high prevalence of tooth loss, bleeding on probing, and malocclusions in a sample of Costa Rican male adolescents, compared to similar studies in other countries. The overarching conclusion of this study is that oral diseases represent an important health problem that urgently need proper public health action.

La evidencia para caracterizar la salud bucal durante la adolescencia en Costa Rica es limitada. Esta falta de investigación adecuada dificulta el desarrollo de políticas de salud convenientes para este subgrupo de la población. Esto es particularmente importante porque la adolescencia es el período durante el cual se deben arraigar buenos hábitos de salud para fomentar un buen desarrollo físico y cognitivo. Este estudio tiene como objetivo determinar la prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusión en adolescentes varones costarricenses del Colegio Técnico Profesional San Agustín ubicado en la provincia de Cartago. Se recopilaron datos de 428 adolescentes varones de 12 a 22 años en un estudio transversal durante 2019. La prevalencia de pérdida de piezas dentales se calculó como el número de individuos que habían perdido al menos una pieza dental. También se registró el número promedio de dientes perdidos por individuos. El sangrado al sondeo fue un indicador utilizado como parámetro para el seguimiento de la salud periodontal donde también se registró la presencia de sangrado al sondeo y cálculo dental. La maloclusión se midió utilizando el Índice Estético Dental (DAI, por sus siglas en inglés). Los resultados mostraron que la prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusión fue del 19%, 70,0% y 98%, respectivamente. También se encontró que el 81% de los participantes tenían todos sus dientes, el 11% había perdido 1 pieza dental, el 8% había perdido más de una pieza dental, de los cuales el 0,5% había perdido más de 5 piezas dentales. Considerando una clasificación general de problemas periodontales basada en sangrado al sondeo y presencia de cálculo, la prevalencia de problemas periodontales aumenta al 92%. En cuanto al DAI, la categoría que identifica una maloclusión muy severa fue la más prevalente en la muestra (88%). Es alarmante la alta prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusiones en una muestra de adolescentes varones costarricenses, en comparación con estudios similares en otros países. La conclusión general de este estudio es que las enfermedades bucodentales representan un importante problema de salud que necesita urgentemente una acción adecuada de salud pública.

Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria.

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.

Extração dentária em pacientes com doença arterial coronariana em terapia antiplaquetária dual / Tooth extraction in patients with coronary artery disease and on dual-antiplatelet therapy

A terapia antiplaquetária dual, cada vez mais tem sido utilizada como uma forma de abordagem terapêutica em pacientes com doença arterial coronariana (DAC), e principalmente em portadores de stents farmacológicos. Drogas antiplaquetárias, quando associadas, aumentam o risco de sangramento, isto faz com que muitos profissionais recomendem a suspensão da medicação antes de qualquer procedimento cirúrgico odontológico, entretanto, a suspensão desta terapia expõe os pacientes portadores de stent coronariano à riscos adversos de eventos trombóticos. Por consequência, permanece desafiador e controverso o manejo odontológico cirúrgico de pacientes coronariopatas em uso de terapia antiplaquetária dual. Diante disso, foi realizado uma pesquisa clínica com o objetivo de avaliar quantitativamente o sangramento trans-operatório de extração dentária de pacientes em uso de terapia antiplaquetária dual (AAS + clopidogrel). Este estudo caso-controle, incluiu 38 pacientes com DAC sob terapia antiplaquetária dual com AAS e clopidogrel (grupo de estudo = GE) e 35 pacientes com doença cardiovascular sem nenhum uso de medicação antiplaquetária (grupo controle = GC), ambos com indicação de extração dentária. No dia do procedimento cirúrgico, foi realizado exame de hemograma completo, coagulograma e agregação plaquetária por turbidimetria, utilizando agonistas de adrenalina, adenosina difosfato e ácido araquidônico, no GC e pelo Verifynow no GE, e no, trans-operatório mensurada a quantidade de sangramento por meio da coleta de sangue aspirado. O GE demonstrou um sangramento mais intenso do que o GC, estatisticamente significante, com média de quantidade de sangramento 1,0 e 0,6 ml/min, respectivamente. Métodos hemostáticos locais foram suficientes para controlar o sangramento e em nenhum dos casos houve episódios de hemorragia no trans e/ou pós-operatório

A agregação plaquetária, no GC, apresentou características de hipoagregabilidade, sendo estatisticamente significante apenas o efeito da adrenalina na quantidade de sangramento ocorrido durante o procedimento cirúrgico (p-valor 0,018). No GE, a agregação plaquetária não demonstrou resultados estatísticos significantes, no entanto, foram encontrados 11 (28,94%) pacientes considerados resistentes à terapia com ácido acetilsalicílico com valores de ARU entre 550 a 700 e 12 (31,57%) pacientes considerados não respondedores ao clopidogrel, com valores de PRU acima de 230. De acordo com os nossos resultados, pacientes portadores de DAC, em uso de terapia antiplaquetária dual, AAS + clopidogrel, apresentam maior quantidade de sangramento, mas que pode ser controlado com medidas hemostáticas locais, não sendo necessária a suspensão da terapia antiplaquetária para extração de até três dentes

Dual-antiplatelet therapy has been used as a therapeutic approach for patients with coronary artery disease (CAD), mainly for those bearing pharmacological stents. The association of antiplatelet a drug increases the risk of bleeding, and for that reason many professionals withdraw the medications prior to any dental surgical procedure. Though, when this therapy is discontinued, patients with coronary stent are exposed to adverse risks of thrombotic events. As a consequence, dental surgical management of patients with CAD and on dual-antiplatelet therapy remains challenging and controversial. On this basis, a clinical research was developed with the aim to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with CAD who are either undergoing dual-antiplatelet therapy (AAS + clopidogrel). This case-control study comprised 38 patients diagnosed with CAD and on dual-antiplatelet therapy, AAS and clopidogrel (study group = SG) and 35 patients with cardiovascular disease, but not on antiplatelet therapy (control group = CG), both requiring tooth extraction. A complete blood count, blood clotting test and platelet aggregation by turbidimetry using epinephrine agonists, adenosine diphosphate and arachidonic acid were carried out on the day of the operation in the CG and using the Verifynow in the SG. The amount of bleeding was measured during the intraoperative period by means of aspirated blood collection

The statistically significant mean volumes of bleeding were 1.0 e 0.6 mL/min for both SG and CG, respectively. The SG showed a more intense bleeding compared to the CG. Local hemostatic measures showed to suffice for controlling possible bleeding problems and in none of the procedures there were intra-operative and/ or post-operative bleeding episodes. Platelet aggregation, for the CG, demonstrated platelet hypoagregability, and only the epinephrine effect was statistically significant for the amount of bleeding during the surgical procedure (p-value 0.018). In the SG, platelet aggregation has not shown statistically significant values. Nonetheless, 11 patients (28.94%) were resistant to acetylsalicylic acid demonstrating ARU values between 550 and 700, 12 patients (31.57%) have not responded to clopidogrel therapy, and the PRU values were above 230. According to the results of this study, individuals with CAD and on dual-antiplatelet therapy (AAS + Clopidogrel), demonstrated a greater amount of bleeding, which can be minimized by using local haemeostatics and not suspending the antiplatelet drug for tooth extraction

[Diagnosis and therapy of bleeding in ENT]. / Blutungen im HNO-Bereich.

Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained.

Profusely bleeding oral pyogenic granuloma in a teenage girl.

Pyogenic granuloma (PG) is a kind of inflammatory hyperplastic soft tissue lesion of the oral cavity. The lesion, however, is not related to infection and arise as a reactive growth in response to various stimuli. It has a very high vascularity because of the presence of numerous prominent capillaries. The lesion has a bleeding tendency, even after a minor traumatic episode, such as during mastication. Bleeding may be at times very severe and difficult to control. We present the case of a profusely bleeding young PG in a young teenage child.

Particle embolization of the bilateral superior and inferior alveolar arteries for life threatening dental socket hemorrhage.

Particle embolization for epistaxis and intra-oral hemorrhage are performed on an as needed basis by neurointerventionalists. A case is presented of massive oral hemorrhage associated with end stage liver disease coagulopathy after tooth extraction of bilateral maxillary and mandibular molars. A man in his fifties with end stage liver disease who presented for evaluation of a syncopal episode was determined to be in hemorrhagic shock from 2 days of persistent oral bleeding after elective tooth extractions. Conservative management with multiple blood transfusion products, packing and vasoconstrictive spray was ineffective. Microcatheter angiograms of the alveolar arteries demonstrated blood and contrast pooling within the sockets of the extracted teeth. Selection of the bilateral supplying alveolar and inferior alveolar artery branches was achieved followed by polyvinyl alcohol particle embolization (250-355 µm). Polyvinyl alcohol particle embolization of dental socket hemorrhages is technically feasible and effective.

Crohn's disease of the mouth: report of a case.

AIM: Crohn's disease is a chronic, inflammatory process, probably immunologically mediated, that may affect any segment of the gastrointestinal tract from mouth to anus, usually in a discontinuous fashion. Oral manifestations are important clinical findings in Crohn's disease. CASE REPORT: Description of a young male with oral manifestations of Crohn's disease is detailed and the current literature is briefly reviewed. Past medical history and oral clinical examination of the patient were analysed. He was treated with systemic prednisone. The case reports a significant reduction of lesion after six months of treatment.

Management of the oral manifestations of senile purpura in an edentulous patient: a case report.

Senile purpura occurs because of a weakness of the vascular supporting tissues mainly caused by aging and is most often seen on the dorsal surface of the hands and the extensor surfaces of the forearms, and has also been observed in the oral mucosa of elderly patients. These red lesions present as sharply margined subcutaneous hemorrhagic spots and are due to trauma, such as damage to the endothelium of small blood vessels, or a coagulation defect. They can also be due to reduced perivascular support, or capillary fragility and permeability, or a combination of all of these factors. Oral manifestation of senile purpura can also be induced by long periods of medication use leading to fragile areas of the mucosa. The presence of senile purpura requires continuous follow-up since drug-induced purpura may cause plaque function alterations. An accurate diagnosis in elderly complete denture wearers can minimize bleeding and prevent possible development of ulcerations under the dentures, especially during the adaptation period to the prosthesis. This case report, presents the care and 3-year follow-up of a 66-year-old woman with complete dentures who presented with the oral manifestations of senile purpura caused by the continued use of several medications.

Treatment of mandibular high-flow vascular malformations: report of 2 cases.

Two cases of high-flow vascular malformations affecting the mandible are presented. Manifesting mainly in childhood, intraosseous arteriovenous malformations are extremely rare morphologic errors of vascular morphogenesis that can lead to life-threatening hemorrhage without appropriate treatment. A dentist referred an 8-year-old girl with radiolucency in the left mandible and supraocclusion of the mandibular left first molar. During biopsy, massive bleeding occurred. Computed tomographic scan with contrast medium showed a vascular malformation. Arterial embolization was performed followed by surgical resection. Autologous bone transplantation and resorbable osteosynthesis plates were used for reconstruction. The second patient, a 15-year-old girl, had intense bleeding from the periodontal space of a highly mobile right mandibular second molar. Intraoral clinical examination showed a painless pulsatile swelling in the right buccal vestibule. Computed tomographic angiogram displayed an extensive vascular malformation involving the right mandible. After successful selective embolization, surgical resection, and reconstruction with autologous bone, transplantation was performed. Preoperative embolization is a low-risk procedure in highly vascularized lesions. It is a recommended procedure to avoid the increased risk of an emergency operation, to minimize blood loss during surgery, and to better plan reconstructive surgery.

Novel application of percutaneous cryotherapy for the treatment of recurrent oral bleeding from a noninvoluting congenital hemangioma involving the right buccal space and maxillary tuberosity.

Cryotherapy is the application of varying extremes of cold temperatures to destroy abnormal tissue. The intent of this article is to describe a novel technique using percutaneous cryotherapy for treating a noninvoluting congenital craniofacial hemangioma (NICH). An 18-year-old woman with type 1 von Willebrand's disease, as well as a qualitative platelet aggregation disorder, presented with multiple recurrent episodes of oral bleeding from a NICH involving the right buccal space and maxillary tuberosity. The patient was initially treated with a combination of endovascular particulate embolization, percutaneous sclerotherapy, tissue cauterization, and laser therapy between the ages of 4 and 8 years of age. At 18 years of age, the patient presented with recurrent episodes of oral bleeding related to the NICH. Endovascular embolization was performed using particulate and a liquid embolic agent with limited success. Due to the refractory nature of this bleeding, the patient underwent successful lesion ablation using percutaneous cryotherapy. At 9-month follow-up, the patient is asymptomatic with no episodes of recurrent bleeding.

Angina bullosa hemorrhagica: report of 4 cases.

Angina bullosa hemorrhagica is characterized by the sudden appearance of solitary or multiple hemorrhagic blisters on oral mucosa, with diameters ranging from 2 mm to 3 cm. The soft palate is most commonly affected, but angina bullosa hemorrhagica may also appear on the buccal mucosa, lips and tongue border. Clinically, the blisters have a dark red to purple appearance, and may or may not be painful. The blisters usually break, releasing bloody content and leaving an ulcer surface that heals within 7 to 10 days. In this article the authors describe four cases of angina bullosa hemorrhagica attended in Stomatology Department of Dental School, Sao Paulo State University. In case 1, a 29-year-old male presented with a sudden hemorrhagic blister on the soft palate. A drainage was performed and after seven days of follow-up the patient reported no symptoms. In case 2, a 63-year-old male presented complaining of a blister on the palate six days earlier that had spontaneously broken. General exam showed hypertension under medical control. An incisional biopsy was performed and after seven days follow-up the healing was completed. In case 3, a 61-year-old male arrived complaining of a sudden appearance of an hemorrhagic blister on the soft palate that had spontaneously broken. The patient had systemic hypertension under medical control. The ulcer healed in 10 days follow-up. In case 4, a 49-year-old woman presented complaining of pain and an ulcer on the soft palate. The patient reported the rapid onset of a blood blister during a meal that broke in few minutes. The resolution occurred after 14 days. Angina bullosa hemorrhagica seems to be more common than reported in the literature and knowledge of the condition is important to right diagnosis and approach when necessary.

Plan de salud periodontal, basado en higiene y clorhexidina, para gingivitis en adultos con síndrome de Down / Periodontal health plan, based upon hygiene and chlorhexidine, for adult gingivitis in Down syndrome patients

Objetivo: el objetivo del presente estudio fue determinar la efectividad de un programa de salud periodontal en base a técnicas de higiene y clorhexidina, para el tratamiento de gingivitis en adultos con Síndrome de Down, institucionalizados en Viña del Mar. Diseño del estudio: analítico cuasi experimental, del tipo ensayo clínico controlado. Material y método: se seleccionaron cuatro instituciones, de las cuales fueron escogidas dos como grupo experimental y dos como grupo control, obteniéndose una muestra de 43 sujetos. Se realizaron instrucciones de higiene bucal a los apoderados, personal de instituciones y sujetos síndrome de Down del grupo experimental. Los índices de biofilm de O´Leary y sangrado de Ainamo y Bay, fueron medidos pre y post-intervención, y luego comparados. Además, los índices se relacionaron entre sí y se asociaron con el tipo de institución, ingreso mensual promedio familiar y nivel de educación de los apoderados. Metodología estadística: los resultados fueron analizados mediante los test Student (t), Chi cuadrado, ANOVA y correlación de Pearson(r), considerándose estadísticamente significativo un p<0,05. Resultados: el programa de salud periodontal fue efectivo para el tratamiento de la gingivitis en adultos síndrome de Down. Los índices de biofilm de O´Leary y de sangrado gingival de Ainamo y Bay disminuyeron significativamente (p=0,0001), observándose una correlación positiva entre ambos índices. Conclusión: el programa de salud periodontal, basado en técnicas de higiene y uso de clorhexidina, fue efectivo para el tratamiento de la gingivitis en adultos síndrome de Down.