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As a relatively new tool, the use of artificial intelligence (AI) in medicine and dentistry has the potential to significantly transform the healthcare sector. AI has already demonstrated efficacy in medical diagnosis across several specialties, used successfully to detect breast, lung and skin cancer. In Oral Medicine, AI may be applied in a similar fashion, used in the detection and diagnosis of oral cancers and oral potentially malignant diseases. Despite its promise as a transformative diagnostic aid, the use of AI in healthcare presents significant safety, reliability and ethical concerns. There is no formal consensus on the safe and ethical implementation of AI systems in healthcare settings, but the literature converges on several key principles of ethical AI use including transparency, justice and fairness, non-maleficence, responsibility and privacy. This article provides a narrative review of the key ethical issues surrounding AI use in medicine, and reflects on these, providing view-points of a bioethicist and Oral Medicine clinicians from several units.
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This study aimed to evaluate the effectiveness of oral amoxicillin/clavulanate (AMX-CL) for the prevention of bacteremia following dental extractions. The study group (AMX-CLG) comprised 40 adults requiring dental extractions under general anesthesia who were administered a prophylactic regimen of 1875/125 mg of AMX-CL orally 1-2 h prior to the surgery. Venous blood samples were collected from each patient at baseline and at 30 s and 15 min after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The results for the AMX-CLG were compared with those of a control group (CG; no prophylaxis) and an amoxicillin group (AMXG; 2 g of amoxicillin orally), consisting of randomly selected patients from among those participating in two clinical trials that we have previously published. The prevalence of bacteremia in the CG, AMXG, and AMX-CLG was 97%, 50%, and 15%, respectively, at 30 s after completing the extractions, and 67%, 10%, and 4% at 15 min, respectively, after the last extraction. The prevalence of bacteremia in the AMXG and the AMX-CLG at 30 s and at 15 min after completing the extractions was significantly lower than that in the CG (p < 0.001 and p < 0.001, respectively; Fisher's exact test). The prevalence of bacteremia in the AMX-CLG at 30 s after completing the extractions was significantly lower than that in the AMXG (p < 0.001; Fisher's exact test). Based in the results of this preliminary study, oral AMX-CL could be an excellent option for preventing bacteremia secondary to dental procedures in patients at risk.
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Bacteriemia , Extração Dentária , Adulto , Humanos , Extração Dentária/efeitos adversos , Amoxicilina/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Bacteriemia/prevenção & controle , Bacteriemia/epidemiologia , Bactérias , Antibacterianos/uso terapêuticoRESUMO
Severe periodontitis is prevalent in Down syndrome (DS). This study aimed to identify genetic variations associated with periodontitis in individuals with DS. The study group was distributed into DS patients with periodontitis (n = 50) and DS patients with healthy periodontium (n = 36). All samples were genotyped with the "Axiom Spanish Biobank" array, which contains 757,836 markers. An association analysis at the individual marker level using logistic regression, as well as at the gene level applying the sequence kernel association test (SKAT) was performed. The most significant genes were included in a pathway analysis using the free DAVID software. C12orf74 (rs4315121, p = 9.85 × 10-5, OR = 8.84), LOC101930064 (rs4814890, p = 9.61 × 10-5, OR = 0.13), KBTBD12 (rs1549874, p = 8.27 × 10-5, OR = 0.08), PIWIL1 (rs11060842, p = 7.82 × 10-5, OR = 9.05) and C16orf82 (rs62030877, p = 8.92 × 10-5, OR = 0.14) showed a higher probability in the individual analysis. The analysis at the gene level highlighted PIWIL, MIR9-2, LHCGR, TPR and BCR. At the signaling pathway level, PI3K-Akt, long-term depression and FoxO achieved nominal significance (p = 1.3 × 10-2, p = 5.1 × 10-3, p = 1.2 × 10-2, respectively). In summary, various metabolic pathways are involved in the pathogenesis of periodontitis in DS, including PI3K-Akt, which regulates cell proliferation and inflammatory response.
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Síndrome de Down/complicações , Marcadores Genéticos , Predisposição Genética para Doença , Doenças Periodontais/patologia , Saliva/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/etiologia , Adulto JovemRESUMO
PURPOSE: Citation analysis is one of the most commonly used bibliometric tools for measuring the academic importance of a report in a specific area of knowledge. The objective of the present study was to identify the 100 most cited reports on medication-related osteonecrosis of the jaw (MRONJ), determine their main bibliometric characteristics, and identify the bibliometric variables that affected the citation rates. MATERIALS AND METHODS: We performed a data search in the Scopus database to determine the number of MRONJ article citations up to September 30, 2018. We next selected the 100 most referenced studies and recorded the following information: ranking according to the number of citations; citation density; number and names of authors; language and year of publication; country and institution of origin; financial support; journal name, impact factor, category, and quartile; type of research; evidence level; and area of study. RESULTS: The 100 most cited reports had a mean citation density of 21.7 ± 20.7 (range, 6.2 to 99.4) and an h-index of 96. The 100 most cited reports on MRONJ had been published in 42 scientific journals, classified into 10 separate categories of the Journal Citation Reports; 56% of the articles were in the first quartile of their category. Most of the studies had been classified with a level of evidence of 4 (n = 45) or 5 (n = 29). In the bivariate analyses, only the conflict of interest (P = .002) was associated with citation density. After adjusting for numerous variables, conflict of interest (r = 0.27; P = .020) and country of the first author (r = 0.23; P = .043) were significantly associated with citation density. CONCLUSIONS: The 100 most cited studies of MRONJ had a large number of citations and had been reported in journals with a high impact factor; however, the studies had a generally low evidence level and randomized clinical trials were lacking.
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Bibliometria , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Publicações Periódicas como Assunto , Bases de Dados Factuais , Odontologia Baseada em Evidências , HumanosRESUMO
BACKGROUND: Studies on the elderly have reported that the risk of cognitive impairment is affected by chewing difficulty. OBJECTIVE: To determine whether there is a relationship between the number of pairs of antagonist teeth that come into contact when the mouth is closed (functional masticatory units [FMUs]) and the level of cognitive impairment. METHODS: We conducted a cross-sectional observational study with 502 institutionalised White individuals older than 65 years, living in the northwest of Spain and Portugal. Through a direct visual inspection, we recorded the number of FMUs. Cognitive impairment was assessed by applying the Mini-Cognitive Examination (MCE), a test derived from the Mini-Mental State Examination. To describe the statistical relationship between the FMUs and the MCE values, a generalised linear model (GLM) was applied. We assessed the GLM predictive capacity for detecting cognitive impairment (MCE ≤23) in a new study group consisting of 156 elderly individuals. RESULTS: A large number of FMUs was significantly associated with a lower probability of cognitive impairment, regardless of the nature of the contact and its location (explained deviance, 30.1%). The model's discriminatory capacity for cognitive impairment based on the FMUs was "good" (0.820). The model's predictive capacity for cognitive impairment was "acceptable" (sensitivity, 0.786; positive predictive value, 0.900; accuracy, 0.729). CONCLUSION: In White, elderly institutionalised individuals, the absolute number of FMUs is significantly related to their MCE scores.
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Disfunção Cognitiva/fisiopatologia , Deglutição/fisiologia , Avaliação Geriátrica , Mastigação/fisiologia , Perda de Dente/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Portugal/epidemiologia , Espanha/epidemiologiaRESUMO
INTRODUCTION: Osteonecrosis of the jaw associated with bisphosphonates is currently called medication-related osteonecrosis of the jaw (MRONJ), given that in addition to bisphosphonates, jaw osteonecrosis has been related to the administration of other antiresorptive and antiangiogenic drugs, such as denosumab, sunitinib, bevacizumab and ipilimumab. CASE PRESENTATION: A 77-year-old patient with osteoporosis treated with subcutaneous injections of denosumab at an interval of 6 months is presented. The patient developed MRONJ after receiving a non-surgical periodontal therapy. Although the MRONJ was initially classified as a stage I lesion in this patient, cone beam computed tomography images confirmed the presence of a significant osteolytic lesion. Treatment consisted of the administration of chlorhexidine mouthwash and systemic doxycycline, exodontia of the involved teeth, sequestrectomy and complete surgical debridement of the necrotic bone. CONCLUSION: To our knowledge, this is the first case reported in the literature of MRONJ following non-surgical periodontal therapy in a patient with osteoporosis treated with denosumab. The risk of MRONJ development after a periodontal procedure and how to prevent this complication are still unknown.
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Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Periodontite/terapia , Idoso , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Terapia Combinada , Feminino , Humanos , Periodontite/complicações , Fatores de RiscoRESUMO
BACKGROUND: Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. OBJECTIVE: The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. METHODS: Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. RESULTS: Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01). CONCLUSIONS: The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness.
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Pessoal de Saúde/educação , Internet , Idioma , Saúde Bucal/educação , Abandono do Hábito de Fumar , Tabagismo/terapia , Benchmarking , Humanos , Internet/normas , Saúde Bucal/normas , Leitura , Ferramenta de Busca , Inquéritos e QuestionáriosRESUMO
STATEMENT OF PROBLEM: The need for tooth replacement in individuals with Down syndrome (DS) is explained by the high prevalence of dental agenesis and by the premature loss of teeth through severe periodontal disease. Dental implants may be the dental procedure of choice in some of these patients. PURPOSE: The purpose of this clinical study was to analyze dental implant survival in a series of patients with DS. MATERIAL AND METHODS: This was a multicenter, retrospective, observational study. Information on patients was gathered using a standardized questionnaire designed specifically for this study, including personal details, oral health status, information on the surgical and prosthetic phases, and follow-up visits. The questionnaire was sent to centers registered with the research network of the Spanish Society of Special Needs Dentistry (SEOENE). Patients with DS aged 18 years or older were included in the study if they had at least 1 dental implant and the corresponding prosthesis and had been followed up for at least a year. RESULTS: The study population was formed of 25 adult patients (13 men and 12 women) aged between 19 and 60 years. The interventions were performed by 5 different dental surgeons, usually under general anesthesia or deep sedation (n=17 patients). A total of 73 implants were inserted, 30 in the maxilla and 43 in the mandible, most commonly in the anterior region (n=51). The mean time to loading the implants was 4.1 ±1.3 months after surgery (range, 1 to 7 months). All patients completed prosthetic rehabilitation; the most frequent design used was the single fixed prosthesis (n=13 patients). A total of 17 (23.2%) implants failed in 8 (32%) patients; the majority (n=14 implants) failed in the postsurgical period before implant loading. The distribution by patients was 1 implant failure in 6 patients, 3 failures in 1 patient, and 8 failures in 1 patient. CONCLUSIONS: Dental implant survival is lower in individuals with DS than in the general population. The reasons for early implant failure in these patients have still not been clearly identified.
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Implantes Dentários , Falha de Restauração Dentária/estatística & dados numéricos , Síndrome de Down , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the mandibular cortical indices in osteoporotic women receiving oral bisphosphonates (oBPs). MATERIAL AND METHODS: The study group included 46 Caucasian women aged over 55 years on treatment with oBPs for postmenopausal osteoporosis. Information recorded included age, weight, height, type of oBP, duration of treatment, comorbid conditions and coadjuvant medication. Forty-six age-matched Caucasian women with no known diagnosis of osteoporosis were selected as the control group. All participants underwent cone-beam computed tomography, and the mandibular cortical width (MCW) and the height from the inferior mandibular border to the mental foramen (MBMF) were measured. RESULTS: The MBMF was similar in the participants with osteoporosis and in controls. MCW was significantly greater in the participants with osteoporosis than in the controls (p < 0.001). CONCLUSION: Mandibular cortical width should not be used to predict the risk of bisphosphonate-associated osteonecrosis of the jaws.
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Tomografia Computadorizada de Feixe Cônico , Difosfonatos/efeitos adversos , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/patologia , Administração Oral , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/tratamento farmacológicoRESUMO
BACKGROUND: A study was made to identify the most effective protocol for reducing the risk of osteonecrosis of the jaws (ONJ) following tooth extraction in patients subjected to treatment with antiresorptive or antiangiogenic drugs. MATERIAL AND METHODS: A MEDLINE and SCOPUS search (January 2003 - March 2015) was made with the purpose of conducting a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All articles contributing information on tooth extractions in patients treated with oral or intravenous antiresorptive or antiangiogenic drugs were included. RESULTS: Only 13 of the 380 selected articles were finally included in the review: 11 and 5 of them offered data on patients treated with intravenous and oral bisphosphonates, respectively. No randomized controlled trials were found - all publications corresponding to case series or cohort studies. The prevalence of ONJ in the patients treated with intravenous and oral bisphosphonates was 6,9% (range 0-34.7%) and 0.47% (range 0-2.5%), respectively. The main preventive measures comprised local and systemic infection control. CONCLUSIONS: No conclusive scientific evidence is available to date on the efficacy of ONJ prevention protocols in patients treated with antiresorptive or antiangiogenic drugs subjected to tooth extraction.
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Inibidores da Angiogênese/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/prevenção & controle , Osteonecrose/induzido quimicamente , Osteonecrose/prevenção & controle , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária , HumanosRESUMO
AIMS: This study's main objective was to analyze the discrepancy between the dental medication record (DMR) and the physician-prescribed active medications recorded in the medical medication record (MMR). METHODS: The study group consisted of 100 adults who attended the University Dental Clinic (Santiago de Compostela, Spain) requesting dental care. A dental history was created for all participants that included the DMR. The MMR were compiled from their electronic medical records. RESULTS: About 80% of the patients consumed at least one drug (94.2% of those >65 years) and 19% took more than five drugs (26.4% of those > 65 years). In total, 54% of the patients had some discrepancy between the medications recorded in the DMR and those in the MMR (48.4% for those ≤65 years and 64.7% for those >65 years). The rate of participants who omitted some drugs was higher for those >65 years. The drugs most omitted from the DMR were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives. CONCLUSIONS: It is imperative to access the MMR of patients requesting dental care because a significant number of medications are not reflected in their DMR. These discrepancies may be particularly common and relevant in elderly patients, in whom multimorbidity and polypharmacy are more frequent.
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Registros Eletrônicos de Saúde , Humanos , Idoso , Projetos Piloto , Masculino , Feminino , Espanha , Consultórios Odontológicos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Polimedicação , Registros OdontológicosRESUMO
BACKGROUND: In 1973, Saunders T. Frank described the diagonal earlobe crease (DELC) as a potential marker of cardiovascular disease. However, this anatomical finding is not routinely examined. The aim of this study was to assess the presence of this crease in the general population attending a dental setting and describe its anatomical variations to be able to categorize it as a physical sign. METHODOLOGY: A study group of 1050 white adults were selected, as participants in the framework of the "A Estrada Study of Glycation and Inflammation" (AEGIS), a cross-sectional, population-based descriptive study of a representative sample of the general adult population of the municipality of A Estrada (Pontevedra, Spain). Each participant's age, sex, and preferred head position when sleeping were recorded. Both earlobes were visually inspected and the anatomical variables of the crease were recorded (unilateral or bilateral, length, depth, and presence of secondary creases). The relationship between the study variables was analyzed using the chi-squared test, Student's t-test, the analysis of variance (ANOVA), and the nonparametric tests of Mann-Whitney and Kruskal-Wallis. RESULTS: The DELC was observed in 65.2% of the participants. In 71.5% of the cases, the sign was complete (occupying the space from the tragus to the posterior edge of the earlobe); in 56.9% of the cases, the sign was bilateral; in 45.1% of the cases it was deep; and in the 43.6% of the cases, accessory creases were identified. Neither sex nor the habitual head position when sleeping were related to the prevalence or characteristics of the DELC. The prevalence, extent and depth of Frank's sign increased significantly with age (p < .001). CONCLUSION: The prevalence of the DELC increases significantly with age, and its morphological characteristics are accentuated. This finding, therefore, gains special relevance as a marker of potential cardiovascular disease when observed in young adults.
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Orelha Externa , Humanos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Espanha , Idoso , Orelha Externa/anatomia & histologia , Estudos de Coortes , Doenças Cardiovasculares/epidemiologia , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: There is a lack of consensus regarding clinician- and patient-reported oral lichen planus (OLP) outcomes. The World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research (WONDER) Project aims to develop a core outcome set (COS) for OLP, which would inform the design of clinical trials and, importantly, facilitate meta-analysis, leading to the establishment of more robust evidence for the management of this condition and hence improved patient care. STUDY DESIGN: Ovid MEDLINE, Embase, CINAHL, CENTRAL, and Clinicaltrials.gov were searched for interventional studies (randomized controlled trials, controlled clinical trials, and case series including ≥5 participants) on OLP and oral lichenoid reactions published between January 2001 and March 2022 without language restriction. All reported primary and secondary outcomes were extracted. RESULTS: The searches yielded 9,135 records, and 291 studies were included after applying the inclusion criteria. A total of 422 outcomes were identified. These were then grouped based on semantic similarity, condensing the list to 69 outcomes. The most frequently measured outcomes were pain (51.9%), clinical grading of the lesions (29.6%), lesion size/extension/area (27.5%), and adverse events (17.5%). CONCLUSION: As a first step in developing a COS for OLP, we summarized the outcomes that have been used in interventional studies over the past 2 decades, which are numerous and heterogeneous.
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Líquen Plano Bucal , Medicina Bucal , Humanos , Líquen Plano Bucal/tratamento farmacológico , Líquen Plano Bucal/patologia , Dor , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals' skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.
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Cárie Dentária , Doenças Periodontais , Humanos , Saúde Bucal , Qualidade de Vida , Higiene Bucal , Cárie Dentária/epidemiologia , Doenças Periodontais/complicações , Doenças Periodontais/terapia , Assistência Odontológica , Transtornos da VisãoRESUMO
OBJECTIVES: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. STUDY DESIGN: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose-throat journals, using the keywords "implant," "migration," "complication," "foreign body" and "sinus." RESULTS: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. CONCLUSION: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided.
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Implantes Dentários/efeitos adversos , Migração de Corpo Estranho/etiologia , Seio Maxilar , Crânio , Implantação Dentária Endóssea , Face , HumanosRESUMO
OBJECTIVES: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. STUDY DESIGN: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). RESULTS: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). CONCLUSIONS: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications.
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Serviços de Saúde Bucal , Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Setor Privado , Setor Público , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. STUDY DESIGN: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C-telopeptide (CTX) levels were measured. RESULTS: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. CONCLUSION: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis.
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Difosfonatos/uso terapêutico , Osteoporose/tratamento farmacológico , Extração Dentária , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Difosfonatos/administração & dosagem , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. STUDY DESIGN: A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. RESULTS: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). CONCLUSION: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.
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Alendronato/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ácido Ibandrônico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , EspanhaRESUMO
BACKGROUND: The dental treatment of individuals with intellectual disability can represent a considerable professional challenge. OBJECTIVE: To develop a model for predicting the behavior of patients with intellectual disability in the dental office. METHODS: The study group comprised 250 patients with Down syndrome (DS), autism spectrum disorder (ASD), cerebral palsy (CP), idiopathic cognitive impairment or rare disorders. We collected their demographic, medical, social and behavioral information and identified potential predictors (chi-squared test). We developed stratified models (Akaike information criterion) to anticipate the patients'behavior during intraoral examinations and to discern whether the dental treatment should be performed under general anesthesia. These models were validated in a new study group consisting of 80 patients. Goodness of fit was quantified with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). We developed a mathematical algorithm for executing the models and developed software for its practical implementation (PREdictors of BEhavior in Dentistry, "PREBED"). RESULTS: For patients with DS, ASD and CP, the model predicting the need for physical restraint during examination achieved a PPV of 0.90, 0.85 and 1.00, respectively, and an NPV of 0.66, 0.76 and 1.00, respectively. The model predicting the need for performing treatment under general anesthesia achieved a PPV of 0.63, 1.00 and 1.00, respectively, and an NPV of 1.00, 1.00 and 0.73, respectively. However, when validating the stratified models, the percentage of poorly classified individuals (false negatives + false positives) ranged from 24% to 46.6%. CONCLUSIONS: The results of the PREBED tool open the door to establishing new models implementing other potentially predictive variables.