Lesiones dentales por el uso de cocaína / Dental lesions due to the use of cocaine

El consumo, abuso y adicción de sustancias ilícitas, como por ejemplo la cocaína, es uno de los problemas de salud pública más preocupante en nuestro país, con diferentes índices en el conurbano. El uso de cocaína en estos medios produce daños en distintos órganos, entre los cuales podemos mencionar, corazón, cerebro, riñón y también en tejidos duros como los dientes, daños y lesiones a las que haremos referencia en este artículo. El caso presentado en este trabajo es el de un paciente de 21 años, que ingresa a la guardia por traumatismo de cráneo moderado producido por una colisión moto-autobús. Sus familiares no refieren antecedentes de enfermedades previas. Se interna en la Unidad de terapia intensiva; y llama la atención, al realizar el examen físico, las lesiones observadas en los dientes incisivos y premolares de la arcada dentaria superior.

The consumption, abuse, and addiction of illicit substances, such as cocaine, is one of the most worrying public health problems in our country, with different indices in the conurbano. The use of cocaine in these media produces damage to different organs, among which we can mention, heart, brain, kidney and also in hard tissues such as teeth, damage and injuries to which we will refer to this article. The case presented in this work is that of a 21-year-old patient, who enters the guard for moderate skull trauma produced by a motorcycle-autobus collision. His relatives do not refer to a history of previous diseases. It goes into the Intensive Therapy Unit; And it attracts attention, when performing the physical exam, the lesions observed in the incisive and premolars of the upper dental arcade

Seizure-related injuries in inadequately treated epilepsy patients: A case-control study.

PURPOSE: To compare epilepsy-related injuries in untreated or inadequately treated patients and patients on adequate treatment. METHODS: In a cross-sectional case-control study, seizure-related injuries in patients who were either on no treatment or inadequate treatment were compared with another group of patients receiving appropriate evidence-based epilepsy treatment. The inadequately treated patients or 'cases' were drawn from an outreach epilepsy clinic while the adequately treated patients or 'controls' were recruited from a tertiary care facility providing comprehensive epilepsy management. RESULTS: The odds of injury were eight times higher in inadequately treated patients or cases compared to the adequately treated patients or controls. After adjusting for gender, epilepsy duration, seizure frequency, current medication, and number of AEDs, the odds of injury were 15. 8 times higher in the cases. Major injuries such as burns, fractures, and tooth injuries were also higher in the cases. CONCLUSION: Untreated or inadequately treated epilepsy patients have a significantly higher risk of injuries. With adequate treatment, some of the risks of injury can be mitigated.

Evaluation of teeth injuries in Beagle dogs caused by autoclaved beef bones used as a chewing item to remove dental calculus.

Dental calculus (DC) is the most widespread oral problem in domestic dogs. Chewing items are used to remove DC from the tooth surface; they also favor oral health and animal welfare. Raw beef bone mastication also shortly reduces DC in adult dogs. However, it can cause oral lesions and hence is not popular. This study evaluated the impact of bone mastication on the dental roots, enamel, and gingiva of dogs. Twelve adult Beagle dogs were randomly divided into 2 treatment groups in a completely randomized block design: cortical bone (CB) or spongy bone (SB). Intraoral radiographs were obtained on days 0 and 14, and calculus assessment was performed using images captured on days 0, 3, 6, 9, 12, and 14; an integration program was used to measure the proportion between the area covered by calculus and the total area of teeth. DC was completely removed from the first and second premolars and molars from both the arcades in less than 3 days of supplementation, indicating that these teeth were frequently used for chewing (P < 0.10). Bones were highly effective for DC removal and gingival inflammation reduction. Despite the hardness of bones, no lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions-complications related to bone ingestion-were noted. However, SB showed some gingival lesions (n = 4) and bone remnants between teeth (n = 2). Gingival lesions were caused by the daily and continuous supply of new pieces of bone for 13 days. Specific pieces of bone should be used for oral home care programs because they shortly remove almost 90% of DC, allowing longer intervals between periodontal cleaning procedures. Long-term studies are required to evaluate the use of bones and evaluate their impact on teeth and periodontium after prolonged supplementation.

Evoked and spontaneous pain assessment during tooth pulp injury.

Injury of the tooth pulp is excruciatingly painful and yet the receptors and neural circuit mechanisms that transmit this form of pain remain poorly defined in both the clinic and preclinical rodent models. Easily quantifiable behavioral assessment in the mouse orofacial area remains a major bottleneck in uncovering molecular mechanisms that govern inflammatory pain in the tooth. In this study we sought to address this problem using the Mouse Grimace Scale and a novel approach to the application of mechanical Von Frey hair stimuli. We use a dental pulp injury model that exposes the pulp to the outside environment, a procedure we have previously shown produces inflammation. Using RNAscope technology, we demonstrate an upregulation of genes that contribute to the pain state in the trigeminal ganglia of injured mice. We found that mice with dental pulp injury have greater Mouse Grimace Scores than sham within 24 hours of injury, suggestive of spontaneous pain. We developed a scoring system of mouse refusal to determine thresholds for mechanical stimulation of the face with Von Frey filaments. This method revealed that mice with a unilateral dental injury develop bilateral mechanical allodynia that is delayed relative to the onset of spontaneous pain. This work demonstrates that tooth pain can be quantified in freely behaving mice using approaches common for other types of pain assessment. Harnessing these assays in the orofacial area during gene manipulation should assist in uncovering mechanisms for tooth pulp inflammatory pain and other forms of trigeminal pain.

A Mouse Model to Study Reparative Dentinogenesis.

Different animal models have been introduced recently to study the process of reparative dentinogenesis in response to injury-induced pulp exposure. Using a mouse model is advantageous over other animal models since mice can be genetically manipulated to examine specific cellular pathways and lineage trace the progeny of a single cell. However, enabling a standardized molar damage in mice is demanding due to the small size of the teeth compared to the available dental instruments. Here we describe a reproducible and reliable in vivo model that allows us to study dentinogenesis in the first maxillary mouse molar.

Dental Emergencies: Management Strategies That Improve Outcomes.

Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims - series 2.

In this the second of a series of life cycles of dental trauma victims, the short and particularly long-term responses of four survivors of either multiple luxation injuries or avulsions have been documented over periods varying up to 41 years. The development of ankylosis, either in the short or longer term post trauma, proved a common feature in the series and management strategies have been outlined. External invasive resorption was also identified as a complicating response for which the topical application of trichloracetic acid, intracanal dressing and root canal obturation proved effective in resorption management. Long-term observations indicate that some compromised teeth can be functionally and aesthetically retained for extended periods, but follow-up examinations are important so that treatment interventions can be implemented if adverse responses are diagnosed.

Management of incompletely developed teeth requiring root canal treatment.

Endodontic management of the permanent immature tooth continues to be a challenge for both clinicians and researchers. Clinical concerns are primarily related to achieving adequate levels of disinfection as 'aggressive' instrumentation is contraindicated and hence there exists a much greater reliance on endodontic irrigants and medicaments. The open apex has also presented obturation difficulties, notably in controlling length. Long-term apexification procedures with calcium hydroxide have proven to be successful in retaining many of these immature infected teeth but due to their thin dentinal walls and perceived problems associated with long-term placement of calcium hydroxide, they have been found to be prone to cervical fracture and subsequent tooth loss. In recent years there has developed an increasing interest in the possibility of 'regenerating' pulp tissue in an infected immature tooth. It is apparent that although the philosophy and hope of 'regeneration' is commendable, recent histologic studies appear to suggest that the calcified material deposited on the canal wall is bone/cementum rather than dentine, hence the absence of pulp tissue with or without an odontoblast layer.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims.

Nutritional status and physical activity level as risk factor for traumatic dental injuries occurrence: a systematic review.

AIM: To systematically review epidemiological articles assessing traumatic dental injuries (TDI) rates according to the physical activity habits and nutritional status. METHODS: A search was conducted using PubMed, ISI, Scopus, SciELO, LILACS, and gray literature in Brazilian Theses Databank. We searched for dental trauma, traumatic dental injuries, tooth injuries, tooth fractures, physical activity, motor activity, exercise, sedentary lifestyle, sports, obesity, body mass index (BMI), overweight, and fatness. Databases were searched in duplicate from their earliest records until 2012. Additional studies were identified by searching bibliographies of the articles. Two reviewers performed data extraction and analyzed study procedural quality using the Newcastle-Ottawa scale. PRISMA guidelines for reporting systematic reviews were followed. RESULTS: We found 1159 articles, of whom 14 reports involving 13 studies were selected. One article was a birth cohort, one had a case-control design, and the others were cross-sectional. The quality of evidence varied across the studies and was high (9) in 3. Eleven of the studies included assessed influence of nutritional status: five show a positive association between dental trauma and overweight and six do not show any association. Regarding physical activity level, five studies assessed its effect on trauma occurrence: two detected that physical activity acts as a protective factor and two that physical active increases the risk of dental injuries, and one showed no differences in TDI occurrence. Physical activity estimated from questionnaires and BMI were the most frequently used measures, but methodological differences prevent the comparison of results. CONCLUSION: The results suggest that no truly causal relationship exists between dental trauma and physical activity and nutritional status. Due to the relatively low level of evidence currently present, studies with more robust design, for example, prospective cohort should address this question, especially in view of the epidemic of obesity.

A retrospective study on traumatic dental and soft-tissue injuries in preschool children in Zagreb, Croatia.

The purpose of this study was to analyze data according to gender, age, cause, number of traumatized teeth, time elapsed before treatment and type of tooth from the records of traumatized children. A retrospective study was conducted in the Department of Paediatric Dentistry at the University Dental Clinic in Zagreb, Croatia using the documentation of 128 patients (61 males and 67 females) aged 1 month to 6 years with injuries of primary teeth between February 2009 and January 2013. Trauma was seen in 217 primary teeth, which implies that the number of injured primary teeth was 1.69 per child. The maxillary central incisors were the most frequently affected teeth (81.1%), they were followed by maxillary lateral incisors, while the least affected were mandibular central incisors. Traumatic dental injuries involved periodontal tissue 2.82 times more frequently than hard dental and pulp tissue. The main cause of teeth injury was fall (67.2%) and the majority of injuries occurred at home (51.6%) (p<0.05). Of 128 patients who received treatment 71 (55.5%) also had soft-tissue injuries. The distribution of soft-tissue injuries by gender (35 males, 36 females) was not statistically significant. Comparing children with soft-tissue injuries and those without them, a statistically significant difference was found in the time of arrival (p<0.01). The results of this study showed the need of informing about preventive measures against falls at home and the methods of providing first aid in dental trauma injuries.

Influence of traumatic dental injury on quality of life of Brazilian preschool children and their families.

AIM: The aim of this study was to evaluate the impact of traumatic dental injury (TDI) on the oral health-related quality of life (OHRQoL) of Brazilian preschool children and their families. MATERIAL AND METHODS: A cross-sectional study was carried out with 1632 children of both sexes aged 60-71 months in the city of Belo Horizonte, Brazil. Data on OHRQoL were collected using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), which was self-administered by parents/caregivers to record their perceptions regarding the oral health of their children. A questionnaire addressing demographic and socio-economic data was also sent to parents/caregivers. Oral examinations of the children were performed by a single, previously calibrated dentist (intraexaminer and interexaminer agreement: kappa ≥ 0.83) for the assessment of the prevalence and type of TDI using the diagnostic criteria proposed by Andreasen et al. [2007]. Bivariate and multiple Poisson regression analyses were performed, with the level of significance set at 5%. RESULTS: The prevalence of negative impact from oral conditions on quality of life was 36.8% and 31.4% for children and families, respectively. TDI was not significantly associated with OHRQoL. Tooth avulsion remained in final multiple models of child OHRQoL [PR = 1.37, 95%CI = 1.02-1.85] and family OHRQoL [PR = 1.55, 95%CI = 1.12-2.14]. Tooth discolouration remained in the final multiple models of family OHRQoL [PR = 1.23, 95%CI = 1.05-1.44]. CONCLUSIONS: The presence of TDI in Brazilian preschool children has no impact on quality of life of the children or their families. However, tooth avulsion is associated with a negative impact on OHRQoL in both groups, and tooth discolouration is associated with a negative impact on family OHRQoL.

Healing complications of traumatized permanent teeth in pediatric patients: a longitudinal study.

BACKGROUND: Traumatic dental injuries (TDI) can affect soft and hard dental tissues and supporting structures in different ways and severity. AIM: This study describes the complications associated with health in traumatized permanent teeth (TPT) over a 12-month period and assesses the relationships between TDI, involved tissues, and root development (RD). DESIGN: The study enrolled 294 patients with 548 TPT. Data were collected on the TDI, RD, and the healing complication (HC) and when they were examined (03, 06, and 12 months). Frequencies are described and analyzed using the chi-squared test, relative risk (RR), and Mantel-Haenszel analysis (P≤0.05). RESULTS: Healing complications were present in 201 (36.68%) teeth and were more frequently diagnosed 3 months (63.68%) after the TDI. Pulp necrosis was the most common HC (38.3%), and it was significantly associated with avulsion (P=0.023). Teeth with complete RD showed a tendency of developing HC over time, independent of TDI (P=0.05). HC in teeth with complete RD related to support tissue trauma (P=0.005) and avulsion (P<0.001) appeared more frequently after 3 months. CONCLUSION: Healing complications are more common in teeth that have suffered trauma in supporting tissues and avulsion, especially in teeth with complete RD. The HC occur more frequently in the first 3 months, and a necrotic pulp was the most common complication.

Pulpal response to sensibility tests after traumatic dental injuries in permanent teeth.

BACKGROUND/AIM: The assessment of pulp vitality is one of the major challenges in dental traumatology due to the temporary loss of sensibility after trauma and because of the limitations of conventional pulp tests. The aim of this study was to evaluate pulpal response to sensibility tests and to determine their accuracy after crown fractures and luxation injuries. MATERIALS AND METHODS: A total of 121 permanent anterior teeth from 78 patients treated at the Dental Trauma Clinic of the Federal University of Minas Gerais were evaluated. Responses to pulp sensibility tests were monitored for a minimum period of 24 months or until the diagnosis of pulp necrosis. RESULTS: At the first appointment, 68 teeth responded positively to sensibility tests, one tooth was necrotic and 52 teeth did not respond to sensibility tests but showed no other signs of necrosis. The initial lack of response was not associated with age (P = 0.18), but was related to the presence of luxation (P < 0.001). At the final appointment, 87 teeth were classified as vital and 31 were classified as non-vital. While a positive response shortly after trauma was a good predictor of vitality, a lack of response was not associated with subsequent necrosis. The final pulpal condition of the teeth that initially did not respond was associated with the type of injury, as displaced teeth tended to develop necrosis (P = 0.008). The accuracy of each sensibility test at the initial and final appointments was, respectively, 55.1% and 67.8% for the heat test, 55.9% and 77.9% for the cold test, and 57.6% and 89% for the electrical test. CONCLUSIONS: A temporary loss of sensibility was a frequent finding during post-traumatic pulpal healing, especially after luxation injuries. All sensibility tests presented low accuracy shortly after trauma. The electrical test provided the best support for pulpal diagnosis after long-term follow up. The clinician must be aware of additional signs of crown discoloration and radiographic changes before initiating endodontic treatment.

Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study.

BACKGROUND: Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games. METHODS: Cross-sectional study at the dental clinic within the Polyclinic in the athletes' village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted. RESULTS: 302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were 'bothered' by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year. CONCLUSIONS: The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.

Impact of traumatic dental injury on the quality-of-life of children and adolescents: a case-control study.

OBJECTIVE: To evaluate the quality-of-life of students in Nova Friburgo, Rio de Janeiro, who suffered traumatic dental injury. MATERIALS AND METHODS: A case-control study was carried out by means of structured questionnaire for traumatic dental injury evaluation, clinical oral examination and application of a quality-of-life questionnaire (CPQ11-14), validated in the Portuguese version. This study consisted of 50 children/adolescents (17 cases of traumatic dental injury and 33 controls). Psychometric properties, like internal consistency (Cronbach's Alpha) and test-re-test reliability (ICC), were evaluated. The independent variables were collected for being of interest to the study (dental trauma) or for acting as potential confounding factors (malocclusion, caries). Descriptive and univariate analyses were performed. RESULTS: The Cronbach's Alpha was 0.90 for case and 0.77 for controls. ICC was 0.99. When the groups were compared, confounding factors showed no statistical difference (p > 0.05). Among the cases CPQ11-14 mean score was 17.59 (SD = 14.01), median = 17.00, whereas among the controls it was 3.09 (SD = 4.42), median = 1.00 (p < 0.01, Mann-Whitney test). When the groups were compared, there was statistical difference frequencies between CPQ11-14 total scale and sub-scales (p < 0.05). The functional limitation and emotional well-being were the sub-scales most affected. The TDI impact was related to 'delay and difficulty in chewing', 'embarrassed or ashamed' and 'caring about what others were thinking of appearance'. CONCLUSIONS: One can observe a relationship between traumatic dental injury and its impact on quality-of-life. Children and adolescents who suffered traumatic dental injury showed negative experiences and greater functional and emotional impact.

Impact of traumatic dental injury on quality of life among Brazilian preschool children and their families.

PURPOSE: The purpose of this study was to assess the impact of traumatic dental injury (TDI) on the quality of life of preschool children and their families. METHODS: This cross-sectional study was carried out with 388 60- to 71-month-old children. Data on oral health-related quality of life (OHRQoL) were collected using the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Oral examinations of the children were performed to determine the prevalence of TDI. Data analysis involved the chi-square test and multiple Poisson regression analysis. RESULTS: The prevalence of OHRQoL of the children and their families was approximately 49% and 35%, respectively. The adjusted Poisson regression model revealed that the OHRQoL of the children and their families was significantly related to parents'/caregivers' report of the occurrence of TDI (PR =1.54, 95% confidence interval=1.22-1.93; and PR=1.63, 95% CI=1.21-2.19, respectively). The nonadjusted Poisson regression analysis, the OHRQofL of the children and their families was not related to TDI, as determined by the clinical examination (PR=1.15, 95% CI=0.92-1.42; and PR=1.28, 95% CI=0.95-1.71, respectively). CONCLUSIONS: The families and children who had traumatic dental injury, perceived by the parents/caregivers, had a greater chance of reporting an impact on quality of life.

Tooth injury increases expression of the cold sensitive TRP channel TRPA1 in trigeminal neurons.

OBJECTIVE: Transient receptor potential (TRP) channels, a family of structurally related proteins have been implicated in the sensation of pain and hyperalgesia caused by exogenous and endogenous agonists, as well as touch, pH, and temperature. The objective of this study was to determine the effects of tooth injury on the expression of the cold sensitive channel TRPA1, in the trigeminal ganglion, the primary source of sensory and nociceptive innervation of teeth. DESIGN: We analyzed TRPA1 expression in a rodent model of tooth injury, by Western blot analyses of proteins extracted from trigeminal ganglia. RESULTS: We found that TRPA1 was selectively increased in trigeminal ganglia innervating injured teeth when compared to TRPA1 expression in trigeminal ganglia innervating healthy teeth. CONCLUSIONS: Our results provide the first evidence of increased expression of a cold-sensitive TRP channel in trigeminal ganglia after pulp exposure, and are consistent with the possibility that increased expression and function of TRPA1 in trigeminal neurons contributes to hyperalgesia and allodynia following tooth injury.

Dental pulp stem cells, niches, and notch signaling in tooth injury.

Stem cells guarantee tissue repair and regeneration throughout life. The decision between cell self-renewal and differentiation is influenced by a specialized microenvironment called the 'stem cell niche'. In the tooth, stem cell niches are formed at specific anatomic locations of the dental pulp. The microenvironment of these niches regulates how dental pulp stem cell populations participate in tissue maintenance, repair, and regeneration. Signaling molecules such as Notch proteins are important regulators of stem cell function, with various capacities to induce proliferation or differentiation. Dental injuries often lead to odontoblast apoptosis, which triggers activation of dental pulp stem cells followed by their proliferation, migration, and differentiation into odontoblast-like cells, which elaborate a reparative dentin. Better knowledge of the regulation of dental pulp stem cells within their niches in pathological conditions will aid in the development of novel treatments for dental tissue repair and regeneration.

Mapping of BrdU label-retaining dental pulp cells in growing teeth and their regenerative capacity after injuries.

Recent studies have demonstrated that human dental pulp contains adult stem cells. A pulse of the thymidine analog BrdU given to young animals at the optimal time could clarify where slow-cycling long-term label-retaining cells (LRCs), putative adult stem cells, reside in the pulp tissue. This study focuses on the mapping of LRCs in growing teeth and their regenerative capacity after tooth injuries. Two to seven peritoneal injections of BrdU into pregnant Wistar rats revealed slow-cycling long-term dense LRCs in the mature tissues of born animals. Numerous dense LRCs were postnatally decreased in number and reached a plateau at 4 weeks after birth when they mainly resided in the center of the dental pulp, associating with blood vessels. Mature dental pulp cells were stained with Hoechst 33342 and sorted into (<0.76%) side population cells using FACS, which included dense LRCs. Some dense LRCs co-expressed mesenchymal stem cell markers such as STRO-1 or CD146. Tooth injuries caused degeneration of the odontoblast layer, and newly differentiated odontoblast-like cells contained LRCs. Thus, dense LRCs in mature pulp tissues were supposed to be dental pulp stem cells possessing regenerative capacity for forming newly differentiated odontoblast-like cells. The present study proposes the new hypothesis that both granular and dense LRCs are equipped in the dental pulp and that the dense LRCs with proliferative capacity play crucial roles in the pulpal healing process following exogenous stimuli in cooperation with the granular LRCs.