Randomized double-blind clinical trial comparing clobetasol and dexamethasone for the topical treatment of symptomatic oral chronic graft-versus-host disease.

Patients who undergo allogeneic stem cell transplantation frequently develop an immunologic disease caused by the reactivation of the graft to the host tissues. This disease is called graft-versus-host disease (GVHD) and it is usually a systemic disorder. In a large proportion of cases, oral disorders that are related to a chronic phase of GVHD (cGVHD) occur, and their treatment involves the use of topical immunosuppressive drugs. Several medications have been studied for this purpose, but only a small number of clinical trials have been published. The present study is a randomized, double-blind clinical trial that compares topical clobetasol and dexamethasone for the treatment of symptomatic oral cGVHD. Patients were randomly assigned to treatment with clobetasol propionate .05% or dexamethasone .1 mg/mL for 28 days. In both arms, nystatin 100,000 IU/mL was administered with the corticosteroid. Oral lesions were evaluated by the modified oral mucositis rating scale (mOMRS) and symptoms were registered using a visual analogue scale. Thirty-five patients were recruited, and 32 patients were randomized into the study groups: 18 patients (56.3%) to the dexamethasone group and 14 patients (43.8%) to the clobetasol group. The use of clobetasol resulted in a significant reduction in mOMRS total score (P = .04) and in the score for ulcers (P = .03). In both groups, there was significant symptomatic improvement but the response was significantly greater in the clobetasol group (P = .02). In conclusion, clobetasol was significantly more effective than dexamethasone for the amelioration of symptoms and clinical aspects of oral lesions in cGVHD.

Relação entre ansiedade e dor em anestesia local e procedimentos periodontais / Anxiety and pain associated with local anesthesia and periodontal therapy

O objetivo deste estudo cruzado foi avaliar 21 voluntários, submetidos a tratamento periodontal, quanto ao grau de ansiedade e sensação dolorosa, em duas sessões: 1) anestesia local (AL1) e raspagem periodontal (RP); 2) anestesia local (AL2) e raspagem periodontal associada a cirurgia periodontal (CP). A ansiedade foi avaliada pela Escala de Ansiedade Dental de Corah (EADC), aplicada antes das sessões, e a sensibilidade dolorosa através da Escala Analógica Visual (EAV), após o término das sessões. Os dados foram submetidos aos testes de Wilcoxon pareado e correlação de Spearman, com nível de significância de 5%. A maioria dos voluntários foi considerada "levemente ansiosa" nas duas sessões de atendimento. Não houve diferença significativa entre as sessões com relação à sensibilidade dolorosa à anestesia local e aos procedimentos periodontais, porém, quanto à sensibilidade dolorosa, houve diferença significativa entre anestesia local e procedimentos periodontais em cada sessão (EAV-AL1 e EAV-RP: p = 0,009;EAV-AL2 e EAV-CP: p = 0,008), sem correlação entre grau de ansiedade e sensibilidade dolorosa, exceto para EADC2-EAV-AL2 (r = 0,47; p = 0,03). Concluiu-se que o grau de ansiedade manteve-se constante independente do procedimento e que a sensibilidade dolorosa à anestesia local foi superior à do procedimento periodontal, sugerindo que, controlada a dor do paciente por meio da anestesia local, os procedimentos subseqüentes tornam-se menos estressantes aos pacientes

This crossover study evaluated the level of anxiety and painful sensibility due to local anesthesia and periodontal therapy of 21 volunteers submitted to periodontal treatment, in two sessions: 1) Local anesthesia (LA1) and root scaling (RS); 2) Local anesthesia (LA2) and root scaling associated to periodontal surgery (PS). The anxiety was assessed by Corah Dental Anxiety Scale (CDAS) applied at the beginning of the sessions; pain sensibility was assessed by Visual Analogue Scale (VAS) in the end of the sessions. The data were analyzed by Spearman and Wilcoxon tests (α = 0.05). The majority of the volunteers was considered as "slightly anxious" in both sessions (p = 0.80). No statistically significant difference was observed between sessions in relation to pain sensibility to local anesthesia and periodontal treatment, however there was statistically significant difference in pain sensibility between local anesthesia and periodontal treatment in each session (VAS-LA1 and VAS-RS: p = 0.009; VAS-LA2 and VAS-PS: p = 0.008), with no correlation between anxiety and pain sensibility, except for CDAS2-VAS-LA2 (r = 0.47;p = 0.03). It can be concluded that the level of anxiety remained unchanged in the sessions with no correlation to the procedure and that pain sensibility to local anesthesia was higher than that associated to periodontal treatment, which suggests that, once the once the pain is controlled by local anesthesia, the treatment becomes less stressful to the patient

Atendimento odontológico de pacientes com doença de Alzheimer / Dental treatment of patients with Alzheimer’s disease

Com o aumento da expectativa de vida e dos cuidados com a saúde bucal, o número de pacientes odontológicos com mais de 65 anos tem aumentado consideravelmente. Esse grupo de pacientes apresenta, invariavelmente, doenças sistêmicas que exigem cuidados especiais por parte do cirurgião-dentista. Dentre essas, destaca-se a doença de Alzheimer, pelo aumento de sua incidência. Os autores apresentam uma revisão sobre as principais características clínicas da doença e as implicações no atendimento odontológico desses pacientes