A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture.

BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.

Na antissepsia peri-bucal pré-operatória de exodontias deve-se utilizar clorexidina ou pvp-i? / Should chlorhexidine or pvp-i be used in preoperative peri-oral antisepsis of extractions?

A odontologia contemporânea tem se preocupado de grande maneira com o aumento de transmissão de doenças infecto-contagiosas e contaminação cruzada no sítio cirúrgico. Este estudo objetivou avaliar a eficácia da antissepsia em efeito imediato de dois antissépticos na redução bacteriana da região peri-bucal, previamente aos procedimentos cirúrgicos em exodontia. A pesquisa foi realizada nas clínicas odontológicas do Centro de Ensino Superior dos Campos Gerais (CESCAGE), localizado na cidade de Ponta Grossa-PR. Para realização do experimento foram coletadas amostras de 38 pacientes. Em cada paciente foram colhidas 3 amostras, divididas essas em 3 grupos: Grupo A: Material Controle, Grupo B: Digluconato de Clorexidina a 2% e Grupo C: PVP-I (polivinilpirrolidona-iodo). Em 12 pacientes foram enriquecidas as placas com o caldo de BHI (Infusão Cérebro Coração). Nos demais 26 pacientes as amostras foram coletadas sem o uso do caldo de BHI. Nos resultados com a utilização do caldo de BHI, as amostras sofreram alterações, pois esse enriqueceu as colônias de bactérias, promovendo o seu crescimento desproporcional e exacerbado e inativando o efeito dos antissépticos, não tendo um resultado confiável. Em relação aos 26 pacientes sem uso do caldo de BHI, compreende-se que o digluconato de clorexidina a 2% das 26 amostras coletadas, em 2 mostrou-se não eficaz, em 13 razoável e em 11 eficaz. Já no Grupo PVP-I, 11 mostraram- -se não eficazes, sendo 10 amostras razoáveis e 5 eficazes. Portanto, pode-se concluir que a clorexidina apresentou resultados melhores, mostrando-se excelente, com maior redução da carga microbiana do que o PVP-I (AU).

The contemporary dentistry has been really concerned with the increased transmission of infectious diseases and cross contamination at the surgical site. This study aimed to evaluate the efficacy of antisepsis into immediate effect of two antiseptics in bacterial reduction of peri-oral region prior to surgical procedures for extraction. The research was conducted in dental clinics of the Centro de Ensino Superior dos Campos Gerais (CESCAGE), located in the city of Ponta Grossa-PR. To perform the experiment samples of 38 patients were collected. Three samples of each patient were collected and they were divided into 3 groups: Group A: Control Material, Group B: Chlorhexidine Digluconate 2% and Group C: PVP-I (polyvinylpyrrolidone-iodine). In 12 patients plates were enriched with BHI broth (Brain Heart Infusion). In the remaining 26 patients samples were collected without the use of BHI broth. In the results with the use of BHI broth, samples have suffered alterations, as this enriched bacteria colonies promoting their disproportionate overgrowth and inactivating the effect of antiseptics, not having a reliable result. In relation to 26 patients without the use of BHI broth, it is understood that the chlorhexidine digluconate 2% of the 26 samples collected showed in two of them to be not effective, in 13 reasonable and in 11 effective. In the PVP-I Group, 11 proved to be not effective, 10 samples reasonable and 5 effective. Therefore, it can be concluded that chlorhexidine presented best results, showing to be excellent, with greater reduction of microbial load than PVP-I (AU).

Analysis of blood pressure during tooth extraction

Introduction: Surgical procedures have a history of dental pain, apprehension and fear reported by patients. Because of these reasons, they trigger a series of modifications that lead to changes in blood pressure and stress occurrences. Objective: This study aimed to monitor changes in blood pressure pre-, trans-, and postoperatively and assess whether the differences would be significant. Material and methods: One hundred and ninety-four patients, both genders, aged between 14 and 65 who were undergoing surgery for tooth extraction were selected. They had their systolic and diastolic blood pressures measured at four different times: preoperative (M1), post-anesthesia (M2), post-extraction (M3) and at the end, after the suture (M4), with the aid of a digital tensiometer. Results: There were statistically significant differences between systolic blood pressure changes among all times, except between M1 and M4. Concerning the diastolic blood pressure measurement, there were statistical differences among all times except between M1xM4 and M2xM3. Conclusion: There were changes in blood pressure between different moments of extractions.

Hemangioma lingual: relato de caso / Lingual hemangioma: case report

Hemangioma é um termo clínico que designa uma neoplasia vascular benigna ou má- -formação vascular de origem endotelial. Quando sua localização é bucal, as áreas mais afetadas são lábios, língua e mucosa jugal. O tratamento é indicado em condições de deformações que resultem em uma alteração estética, presença de sangramento constante e de massa palpável. Dentre as opções de tratamento, a escleroterapia vem sendo utilizada com resultados satisfatórios clínicos e estéticos em lesões pequenas, sem a necessidade de intervenção cirúrgica, tornando-se uma opção viável e de baixo custo para os casos de hemangioma da cavidade bucal. A patologia citada resulta em danos físicos e psicológicos ao paciente, dessa forma, torna-se necessária a realização de um atendimento diferenciado. Objetivou-se nesse estudo descrever a resposta ao tratamento de hemangioma lingual com a utilização de soluções esclerosantes, relatar a técnica do tratamento e identificar os benefícios do tratamento. No presente estudo foi possível promover a involução da lesão utilizando o agente esclerosante Ethamolin®. Após observações realizadas no caso clínico exposto e na revisão de literatura, concluímos que as soluções esclerosantes levam à involução da lesão de modo rápido e seguro, através de método não cirúrgico, favorecendo a recuperação estética e, principalmente, a melhora no aspecto psicológico do paciente

Hemangioma is a clinical term that designates a benign vascular neoplasm or vascular malformation of endothelial origin. When is located on the mouth, the most affected areas are the lips, tongue and buccal mucosa. Treatment is indicated in cases of deformation resulting on aesthetic alteration, the presence of constant bleeding and palpable mass. Among treatment options, sclerotherapy has been used with satisfactory clinical and aesthetic results in minor injuries, without requiring surgery, what makes it a viable and cost-effective alternative for cases of oral cavity hemangioma. The referred pathology results in physical and psychological harm to the patient requiring differential treatment. The objective of this study was to describe the response to treatment of lingual hemangioma using sclerosing solutions, and report the treatment technique and its benefits. In the present study it was possible to promote involution of the lesion using the sclerosing agent Ethamolin ®. After the clinical case and literature review, it was concluded that sclerosing agents lead to involution of the injury quickly and safely through non-surgical method, favoring aesthetic recovery, and specially the improvement of psychological aspects of the patient

Granuloma central de células gigantes: relato de um caso clínico / Giant cells central granuloma: a case report

Este trabalho apresenta um caso clínico de granuloma central de células gigantes em uma paciente do sexo feminino de 25 anos de idade com uma lesäo expansiva na abóbada palatina direita e com mobilidade dentária na hemi-arcada ipsilateral. Após a avaliaçäo radiográfica e biópsia incisional da lesäo foi realizada a curetagem e a remoçäo dos dentes envolvidos sob anestesia geral, resultando em uma ampla comunicaçäo buconasal, a qual foi selada com uma prótese parcial removível com obturador nasal