Time to revisit the purported link of leprosy reactions with infective triggers: An unnecessary economic burden for patients.

Existing literature on factors triggering leprosy reactions is based only on case reports and case series, and thus probably gives a biased view. We undertook a case-control study to investigate such purported trigger factors in 42 leprosy reaction patients and 40 non-reactional controls, and the cost of investigations required for the same. Detailed history, clinical evaluation and investigations for triggers were carried out. Infections (typhoid, dental caries) were the most common triggers found, followed by pregnancy. Trigger factors were commoner in the type 2 reaction (T2R) group compared to type 1 (T1R) reaction group. There was however no statistical difference between the two groups. The average estimated cost of investigations was higher in the reactional group and this difference was statistically significant. Hence, except for essential investigations required for initiating steroids, an extensive battery of investigations is unjustified unless the medical history suggests a definitive infective trigger.

Current updates on dental perspectives of leprosy - Revisited.

The present review summarizes the current updates on dental perspectives on leprosy and the affording factors that are responsible for the prevalence of caries and periodontal diseases in leprosy. It also highlights immunopathological phenomena and reactional episodes of leprosy that occur due to daedal interactions between the perio-odontopathic bacteria and M. leprae. In addition, a brief introduction, historiography, classification and clinicopathological aspects are also been covered.

Salud Dental en pacientes con Lepra / No disponible

La lepra conlleva una serie de efectos secundarios indeseables que condicionan la tolerancia y la calidad de vida del paciente. Así, dentro de la esfera orofacial, la boca puede ser asiento de lesiones que, pese a su accesibilidad, pueden por ignorancia pasar desapercibidas y dificultar el adecuado tratamiento de un proceso que hasta ese momento había producido pocas lesiones corporales. Para ello, realizamos una revisión bibliográfica para estudiar el daño dental que esta grave enfermedad puede llegar a causar en la cavidad oral, comparando distintas poblaciones hansenianas

Leprosy involves a series of undesirable side effects, which determine the patient’s tolerance and quality of life. The mouth can be the seat of injuries, which despite their accessibility, can be unnoticed and impede the suitable treatment of a process, which up to that moment, had produced few skin injuries. We performed a bibliographic review to study the dental damage that this serious disease can cause in the oral cavity, comparing different Hansenian populations

Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon.

Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population.

Dental caries and risk indicators for patients with leprosy in China.

BACKGROUND: In leprosy, oral health is often neglected and poorly understood. This study aimed to evaluate the prevalence and risk indicators of dental caries in patients with leprosy in China. METHODS: This cross-sectional, multicentre study included 613 patients with leprosy and 602 control subjects. Based on the established standards of the World Health Organization, we investigated dental caries in cluster samplings from six so-called 'leprosy villages' in three Chinese provinces. Clinical oral examinations were performed and data were reported as decayed (D), missing (M) and filled (F) teeth (DMFT scores). RESULTS: The average DMFT scores were 10.39 in patients with leprosy (D = 4.43; M = 5.94; and F = 0.02) and 4.39 in control individuals (D = 2.29; M = 2.02; F = 0.08). The DMFT scores were statistically significantly different in patients with different ages, educational backgrounds and daily brushing frequency (P < 0.05). High DMFT scores were related to age, low educational levels and poor toothbrushing habits. CONCLUSIONS: The results indicate that patients with leprosy have a high prevalence of severe dental caries. Effective therapy and oral health education should be enhanced for this group of patients.

Fluoretação das águas de abastecimento público no Brasil: o olhar de lideranças de saúde / Public water supply fluoridation in Brazil according to health sector leaders / Fluorización de las aguas de abastecimiento público en Brasil: el punto de vista de los líderes en salud

Desde sua implantação, a fluoretação das águas tem enfrentado oposição de alguns grupos, enquanto outros, baseados em evidência científica, apoiam a medida. Neste artigo, descrevem-se as percepções dos delegados à 13ª Conferência Nacional de Saúde sobre a obrigatoriedade da fluoretação das águas de abastecimento público no Brasil. Como técnica de processamento de depoimentos, utilizou-se o Discurso do Sujeito Coletivo. Constata-se que, mais do que dúvidas, persiste certo grau de desinformação sobre aspectos básicos da fluoretação das águas, frequentemente confundida com a cloração. Torna-se evidente também a necessidade de permanente divulgação à sociedade de dados sobre a fluoretação da água e o desejo de que medidas que afetam a saúde pública não sejam tomadas pelo Congresso Nacional sem que se ouçam os setores interessados. Conforme a percepção majoritária dos participantes deste estudo, a revogação da obrigatoriedade de fluoretar as águas ou deficiências no controle sanitário de sua aplicação poderiam, no contexto brasileiro, piorar os índices populacionais de cárie dentária.

Various groups have opposed water supply fluoridation in Brazil, while others have supported the measure based on scientific evidence. This article describes the perceptions of delegates to the 13th National Health Conference on mandatory fluoridation of the country’s public water supply. Interviews were processed using collective subject discourse analysis. A certain degree of misinformation persists regarding basic characteristics of water fluoridation, which is frequently confused with chlorination. The delegates’ discourses showed a continuing need for public awareness-raising regarding fluoridation and the delegates’ desire that the National Congress not take measures impacting public health without consulting society’s stakeholders. However, most of the interviewees agreed that to repeal mandatory water fluoridation or loosen the control of its implementation could increase the incidence of tooth decay in the population.

Desde su implantación, la fluorización del agua se ha encontrado con la oposición de diversos grupos, mientras que otros, basándose en evidencias científicas, sí apoyan la medida. En el presente artículo se describen las opiniones de los participantes en la 13ª Conferencia Nacional de Salud sobre la obligatoriedad de la fluorización de las aguas de abastecimiento público en Brasil. El método utilizado de procesamiento de testimonios ha sido el Discurso del Sujeto Colectivo. Parece que, más que dudas, lo que persiste en la actualidad es cierto grado de desinformación sobre los aspectos básicos de fluorización del agua. Resulta evidente la necesidad de la divulgación pública permanente de los datos sobre la fluorización del agua, así como el deseo de que el Congreso Nacional se abstenga de tomar medidas que afectan a la salud pública, sin antes escuchar a los sectores afectados. De acuerdo con la percepción mayoritaria de los participantes, la revocación de la obligatoriedad de fluorizar las aguas o las deficiencias en el control podrían aumentar los índices de caries dentales.

Orofacial and dental condition in leprosy

AIM: To verify the orofacial and dental complex in individuals affected by leprosy concerning lesions, prevalence of dental caries and biofilm storage. METHODS: This study was performed on 56 patients with leprosy: 28 under treatment and 28 treated for the disease. A clinical form was prepared to include demographic and leprosy data. The prevalence of caries was analyzed using the decayed, missing, filled teeth (DMFT) index and oral hygiene was evaluated using the Plaque Control Record. The statistical significance was measured by chi-square and Student's t-test. RESULTS: The mean age was 56.4 years, and there was predominance of males. The treatment group had more women (Pearson ÷2=12.47, p=0.0004) and younger patients (Pearson ÷2=9.688, p=0.0079) than the healed group. As much as 30.4% of patients had orofacial complaints related to the disease. The most often observed variations of normality as racial melanin pigmentation (67.8%) and lingual varices (32.1%), and lesions such as atrophy of the anterior nasal spine (25%), inflammatory papillary hyperplasia (17.8%), and collapse of the nasal bridge (14.3%). There were no specific oral lesions among leprosy patients. The mean DMFT was 20.8 and the Plaque Control Record was 70.2%. The treated group had higher DMFT than the treatment group (Student's t p=0.003). CONCLUSIONS: The oral health status of individuals with leprosy is poor, with high levels of plaque and DMFT. No oral lesions associated with the disease were seen.

Oral health status and alveolar bone loss in treated leprosy patients of central India.

A descriptive cross sectional study was carried out, in a group of 160 leprosy patients treated with multi drug therapy. The patients with age group of 25 to 60 year were considered. Out of 160 patients 50 patients were selected by simple random sampling technique for radiological assessments. Intra-oral periapical radiographs (6 for each patient) were taken. The paralleling long cone technique was used and radiographs were attached with grids so as to enable measuring the bone height. The grid was spaced in 1 mm marking and placed directly over the film. Clinical examination revealed that Prevalence of dental caries was 76.25% and periodontal disease was 78.75%. Mean DMFT score was 2.26. Mean OHI-S score was 3.50. Score for Gingival index was 1.60 and average loss of gingival attachment was 1.2 mm. Radiographic findings showed mean alveolar bone loss in maxillary anterior region to be 5.05 mm and in maxillary posterior region it was 4.92 mm. Alveolar bone loss in mandibular anterior region was 4.35 mm and in mandibular posterior region was 5.14 mm. Overall Dental Health Status of the leprosy patients was poor and needed more attention for dental care. There was also an increase in the alveolar bone loss, which was generalized. This bone loss could be due to advance stage of the disease or late approach to rehabilitation center, these patients also had peripheral neuropathy leading to hand and feet deformity in the form of claw hand or ulcer on hand, making maintenance of oral hygiene difficult.

Caries dental en pacientes con enfermedad de Hansen

Las caries dental es una enfermedad de evolución lenta, siendo necesario meses, e incluso años, para que se produzca una cavitación. Las caries dental no afecta a todos los dientes y superficies dentarias por igual. Se desarrolla preferentemente en las zonas donde hay mayores acúmulo de placas y en donde los macanismos de autolimpeza y control son menos efectivos. Los factores que influyen en la placa bacteriana careógena son: la proliferación de una determinada flora, presencia de azúcares facilmente permeables y aparición de un PH ácido. En los enfermos de Hansen, estos factores se ven favorecidos para la instalación de las caries, pues a las limitaciones que tiene la higiene oral debido a las diversas mutilaciones en manos, hay que añadir la multiterapia que toman, que disminuye considerablemente el PH salival. Así pues, encontramos en estos pacientes fundamentalmente tres tipos de caries: 1ª Caries de superficie proximales, que se forman en los puntos de contacto o más frecuentemente por debajo de ellos. 2ª Caries radiculares, se localizan en la unión amelocementaria cuando los cuellos dentarios quedan expuestos al medio ambiente oral. 3ª Caries de superficies libres, que aunque sean menos frecuentes también la padecen. Teniendo en cuenta estos tres tipos de lesión, es fundamental el diagnóstico precoz, así como en el caso de lesion restaurar todo el tijido enfermos antes de una complicación mayor que puede llevar a la pérdida del diente.

Cárie dentária no Brasil: alguns aspectos sociais, políticos e econômicos / Dental caries in Brazil: economics, politics and social aspects

Os autores abordam alguns aspectos sociais, políticos e econômicos da cárie dentária confrontando os avanços da VIII Conferência Nacional de Saúde e da Constituiçäo Federal de 1988 com a realidade da saude bucal no particular aspecto da cárie dentária

Caries dental en pacientes con enfermedad de Hansen

La caries dental es una enfermedad de evolución lenta, siendo necesario meses, e incluso años, para que se produzca una cavilación. La caries dental no afecta a todos los dientes y superficies dentarias por igual. Se desarrolla preferentemente en las zonas donde hay mayores acúmulos de placas y en donde los mecanismos de autolimpieza y control son menos efectivos. Los factores que influyen en la placa bacteriana careógena son: la proliferación de una determinada flora, presencia de azúcares fácilmente permeables y aparición de un PH ácido. En los enfermos de Hansen, estos factores se ven favorecidos para la instalación de las caries, pues a las limitaciones que tiene la higiene oral debido a las diversas mutilaciones en manos, hay que añadir la multiterapia que toman, que disminuye considerablemente el PH salival. Así pues, encontramos en estos pacientes fundamentalmente tres tipos de caries: 1.ª Caries de superficies proximales, que se forman en los puntos de contacto o más frecuentemente por debajo de ellos.2.ª Caries radiculares, se localiza en la unión amelocementaria cuando los cuellos dentarios quedan expuestos al medio ambiente oral.3.ª Caries de superficies libres, que aunque sean menos frecuente también la padecen. Teniendo en cuenta estos tres tipos de lesión, es fundamental el diagnóstico precoz, así como en el caso de lesión restaurar todo el tejido enfermo antes de una complicación mayor que puede llevar a la pérdida del diente (AU)

Epidemiological Bulletin, v. 3, n.2, Apr. 1982  

IN THIS ISSUE: Argentine Hemorrhagic Fever | Diseases subject to the International Health Regulations | Tuberculosis in the United States and Canada, 1980 | Drug resistance in the treatment of leprosy | Surveillance and control of Aedes aegypti in Bolivia | Prevalence of dental caries in the United States | Diarrheal diseases | Reports of meetings and seminars | Courses | Publications

Boletín Epidemiológico, v. 3, n. 2, Abr. 1982

EN ESTE NUMERO: Fiebre hemorrágica argentina | Enfermedades sujetas al Reglamento Sanitario Internacional | Tuberculosis en los Estados Unidos y Canadá, 1980 | Resistencia a los quimioterápicos en el tratamiento de la lepra | Vigilancia y control del Aedes aegypti en Bolivia | Prevalencia de la carie dental en los Estados Unidos | Enfermedades diarreicas | Informes de reuniones y seminarios | Cursos | Publicaciones