Medications Affecting Treatment Outcomes in Dentistry: Part 2.

Today, it is common for medically complex patients who are receiving multiple medications, to seek routine and emergent dental care. It is essential for the practitioner to recognize and comprehend the impact of such medications on the patient's ability to tolerate the planned dental treatment and on dental treatment outcomes. An active appraisal of current literature is essential to stay abreast of emerging findings and understand their treatment implications. This article outlines the process of such active critical appraisal, illustrating key paradigms of the models that describe the impact of medications on treatment outcomes.

Systemic Lupus Erythematosus: Clinical Manifestations, Medical Management, and Dental Treatment Modifications.

Systemic lupus erythematosus (SLE) is an autoimmune disorder that varies in clinical presentation and disease course. SLE has a strong female predilection and is more common in certain racial groups than others. There is no single set of universally accepted diagnostic criteria for SLE, which can make the disease challenging to diagnose. The disorder has the potential to affect nearly every organ system in the body, including the oral cavity. A complete understanding of the etiology and pathophysiology of SLE continues to evade the medical profession; however, advances in this area of research have drastically improved the quality of life of SLE patients. There currently is no cure for this condition, so present-day therapies aim to control patient symptoms and reduce SLE flare-ups. This article discusses the pathophysiology, diagnosis, oral and systemic manifestations, therapeutic interventions, and dental management of SLE patients.

The heart of it: dental care and cardiothoracic surgery.

Both dental and cardiovascular disease are prevalent in the general population, have common risk factors and may be closely associated.Following cardiothoracic surgery, patients may be higher risk for developing infective endocarditis (IE) than the general population. Before cardiothoracic interventions, it is common practice for a dental assessment to be carried out and any necessary dental treatment provided. This aims to reduce the risk of IE arising from dental sources and avoid dental pain or infection during the peri- and post-operative period. There is little guidance on which treatments should be performed and when.Many patients with cardiac disease may have dental treatment provided safely in primary care. However, there is often a need to consider additional factors, including bleeding risk, condition stability or medication interactions. Dental teams must have an awareness of the implications of cardiac disease and provide reasonable adjustments to care provision where necessary, ensuring patient safety.This article proposes a protocol for dental management of patients awaiting cardiothoracic surgery and explores important considerations for dental care in this patient group.

[Haemophilia and dental procedures; a complex combination]. / Hemofilie en tandheelkundige behandelingen; een complexe combinatie.

A 28-year-old patient with severe haemophilia A presented to the emergency department with significant and painful swelling of the left cheek, an extensive haematoma extending from the left ear to the anterior thoracic region, an intraoral haematoma over the soft palate with deviation of the uvula to the right, and complaints of shortness of breath when lying down. Three days prior, his dentist had performed a restoration of the 36 molar under local anaesthesia. Due to pain, the general practitioner had administered an intramuscular injection of a non-steroidal anti-inflammatory drug (NSAID) two days post-procedure. The patient was admitted for treatment with coagulation factors and pain management. Dental procedures and local anaesthesia in patients with a severe coagulation disorder require specific preparatory measures, such as administration of coagulation factors. Collaboration and consultation with a patient's haematologist or haemophilia treatment centre are essential requirements for safe dental care.

Expert consensus on endodontic therapy for patients with systemic conditions.

The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

Expanding the phenotype in Pitt-Hopkins syndrome; description of new oral finding and dental management considerations.

BACKGROUND: Pitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder with physical, cognitive, and behavioral characteristics that is caused by heterozygous mutations in the TCF4 gene. Patients with PTHS might present a unique challenge for oral healthcare professionals because of the associated comorbidities. CASE REPORT: Here we describe a new case of PTHS in a 13-year-old girl with particular emphasis on oro-dental findings and oral healthcare management. Observed oro-dental findings in our case included shallow palate, absence of lingual frenum, gingival enlargement, thick lips and relative microdontia. The patient was unable to tolerate dental care under local anesthesia. Therefore, comprehensive dental treatment was performed under general anesthesia after a careful pre-anesthetic cardio-respiratory, neurological, and hematological evaluation. The patient was closely monitored intra-operatively for breathing rhythm, O2 saturation, and signs of respiratory distress. The patient was observed for 24 h post-op for respiratory distress and was discharged then uneventfully. CONCLUSION: Dental treatment under general anesthesia in these patients might be complicated by the abnormal breathing rhythm, and close monitoring and follow up for signs of respiratory distress after general anesthesia is necessary. Recognition of oral and dental findings might help to expand the phenotype and better characterize rare syndromes.

Odontopediatría en el paciente con enfermedad sistémica / Pediatric dentistry in patients with systematic disease

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)

This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)

Dental implant considerations in patients with systemic diseases: An updated comprehensive review.

BACKGROUND: Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM: The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS: The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS: In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION: In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Manejo odontológico de pacientes con el síndrome de Ehlers-Danlos: revisión narrativa / Dental management in patients with Ehlers-Danlos syndrome: a narrative review

El síndrome de Ehlers-Danlos es una enfermedad heredita- ria, producida por mutaciones cromosómicas que pueden llegar a tener un comportamiento autosómico dominante, recesivo o ligado al cromosoma X. Se caracteriza por defectos en las enzi- mas encargadas de la estructura y síntesis de colágeno. En vista de los 20 tipos de colágeno que existen, este síndrome es extre- madamente heterogéneo tanto en su presentación clínica como en su progresión y evolución. Dentro de los signos y síntomas habituales encontramos la hiperlaxitud articular, hiperelastici- dad de la piel e hiperequimosis de los vasos sanguíneos. Con relación a las complicaciones que pueden presentar es- tos pacientes, encontramos dislocaciones articulares, fragilidad en la piel, dolor articular, ruptura de grandes vasos sanguíneos, dificultad en la cicatrización y, en consecuencia, mayor inci- dencia de procesos infecciosos y de cicatrices poco estéticas. Presenta una incidencia de 1 caso cada 2.500-5.000 na- cidos vivos. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico-dental de estos pacientes, a fin de estar preparado para brindarles un trata- miento adecuado y responder ante las posibles complicacio- nes que se pueden presentar. En esta revisión se emplearon resultados extraídos manual- mente de artículos, indexados en las bases de datos PUBMED y EBSCO, que respondían a la búsqueda de los términos Ehlers-Danlos syndrome, dental management y oral surgery. El objetivo fue describir el manejo médico-odontológico del paciente con síndrome de Ehlers-Danlos hasta la fecha (AU)

Ehlers-Danlos syndrome is a hereditary disease, produced by chromosomal mutations that can have an autosomal behavior, which can be dominant, recessive or X-linked. It is characterized by defects in the enzymes responsible for the structure and syn- thesis of collagen. In view of the 20 existent types of collagen, this syndrome is extremely heterogeneous in its clinical presentation, as well as in its progression and evolution. Within the usual signs and symptoms, we find joint hyperlaxity, skin hyperelasticity and hyper-ecchymosis of the blood vessels. Regarding the complications that these patients can pres- ent, we find joint dislocations, skin fragility, joint pain, rupture of large blood vessels, difficulty in healing and, consequently, a higher incidence of infectious processes and unsightly scars. It presents an incidence of 1 case every 2.500-5.000 live births. Therefore, it is essential that the dentist is familiar with the medical-dental management of these patients, in order to be prepared to provide them with adequate treatment and re- spond to possible complications that may arise. In this review, results were manually extracted from ar- ticles, indexed in the PUBMED and EBSCO databases, that respond to the search for the terms Ehlers-Danlos syndrome, dental management and oral surgery. The aim was describing the medical-dental management of patients with Ehlers-Dan- los syndrome to date (AU)

Lesiones de la ATM en pacientes con artritis reumatoidea / TMJ lesions in patients with rheumatoid arthritis

En el siguiente trabajo se desarrollan, luego de una extensa búsqueda bibliográfica, los hallazgos clíni- cos y radiográficos existentes en lesiones de la ATM en pacientes con artritis reumatoidea, para luego proponer una metodología de abordaje odontoló- gico que logre un buen tratamiento para devolverle al paciente un mejor funcionamiento de la ATM, aliviando el dolor y la inflamación, pero sobre todo mejorando su calidad de vida. Ello, siempre desde los estadios tempranos de la enfermedad, ya que facilita el tratamiento y previene secuelas. De ser necesario, se realiza una rehabilitación protética y evalúan los riesgos de procedimientos odontológicos conside- rando la medicación habitual de estos pacientes, como los aines y corticoides (AU)

In the following work, after an extensive bibliographical search, the existing clinical and radiographic findings in Temporo Mandibular Joint (TMJ) lesions in patients with rheumatoid arthritis are developed in order to later propose a dental approach methodology achieving a good treatment to restore better TMJ function to that patient relieving pain and inflammation but above all improving the quatity of life , always from the early stages of the disease to facilitate treatment and prevent sequelae, perform prosthetic rehabilitation if necessary and assess the risks of dental procedures considering the usual medication of these patients such as NSAIDs and corticosteroids (AU)

Nivel de conocimiento de los estudiantes del tercer curso en Odontología de la UNAN-León, sobre trastornos de presión arterial y manejo odontológico / Level of knowledge third year dentistry students UNAN-León about blood pressure disorders and dental management

Las patologías cardiovasculares constituyen la causa más frecuente de muerte en el mundo, las más comunes son hipertensión e hipotensión. En la consulta odontológica, los pacientes con trastornos de presión arterial requieren diferentes protocolos de atención. En el tercer curso de odontología se tiene el primer contacto con pacientes, al haber estudiado y aprobado la parte teórica del manejo odontológico. Según los antecedentes encontrados, no existen investigaciones que abarquen ambos trastornos de la presión arterial, por lo que se realizó un estudio descriptivo de corte transversal para determinar el nivel de conocimiento en estudiantes del tercer curso Odontología UNAN-León, sobre trastornos de la presión arterial y su manejo odontológico en el segundo semestre del año 2021, por una encuesta tipo examen a estudiantes inscritos en cirugía bucal I, 55 estudiantes fueron encuestados. Se determinó que 50.9% tienen un nivel de conocimiento regular, seguido por 27.3% con nivel bueno, 12.7% deficiente y 9.1% obtuvo nivel de conocimiento excelente sobre los trastornos de presión arterial. Según investigaciones previas en odontología, la mayoría de los estudiantes presentaba un nivel de conocimiento deficiente sobre hipertensión arterial. Por lo que es importante evaluar periódicamente los niveles de conocimiento sobre éstos y otros trastornos que pueden presentarse en la consulta dental (AU)

Cardiovascular diseases are the most common cause of death world, hypertension and hypotension are very common nowadays. In the dental office, patients with blood pressure disorders require different care protocols. Students of the third year of dentistry have their first contact with patients, having studied and approved the theoretical part of dental management. According to antecedents researched, there are no investigations that cover both blood pressure disorders. So a descriptive cross-sectional study was made to determine the knowledge of third-year dentistry students UNAN-León, about blood pressure disorders and their dental management in the second semester of the year 2021, by an exam-type survey of students registered in oral surgery I, with 55 students surveyed. It determined that 50.9% have a regular level of knowledge, followed by 27.3% with a good level, 12.7% poor and 9.1% has an excellent level of knowledge about blood pressure disorders. According to previous research in dentistry faculty, the majority of students have a poor level of knowledge about high blood pressure. Therefore, it's important to evaluate periodically the levels of knowledge about these and other disorders that may occur in the dental office (AU)

Avaliação do conhecimento de dentistas de um município de Minas Gerais sobre o atendimento de pacientes com doença renal crônica / Evaluation of the knowledge of dentists in a municipality of Minas Gerais for the care of patients with chronic kidney disease

Introdução: Pacientes com doença renal crônica (DRC) apresentam uma maior suscetibilidade a infecções e sangramentos e podem manifestar variadas alterações bucais. Por isso, é essencial que o cirurgião-dentista possua os conhecimentos necessários para adequar suas condutas às particularidades apresentadas por esses pacientes. Objetivo: Avaliar, por meio da aplicação de um questionário, os conhecimentos e as condutas dos cirurgiões-dentistas atuantes no município de Juiz de Fora, Minas Gerais, ao prestarem atendimento a pacientes com DRC em hemodiálise. Material e Métodos: Estudo com abordagem quantitativa, de caráter observacional, transversal e analítico, realizado com 100 cirurgiões-dentistas atuantes no município de Juiz de Fora no período de abril a setembro de 2022. Resultados: 100 dentistas compuseram a amostra. Destes, 37% não se sentiriam confortáveis para realizarem procedimentos odontológicos invasivos em pacientes renais crônicos (PRC) em hemodiálise e 87% solicitariam algum exame laboratorial complementar previamente à realização desses procedimentos; 83% consideram importante o contato com o nefrologista do paciente para a obtenção de informações detalhadas acerca de sua condição sistêmica e aplicam isso em sua rotina clínica; 56% identificaram de forma correta as alterações bucais mais comumente encontradas em indivíduos com DRC em hemodiálise; 77% prescreveriam profilaxia antibiótica para PRC em hemodiálise diante de procedimentos invasivos, enquanto 22% prescreveriam para procedimentos não invasivos. Conclusão: A maioria dos cirurgiões-dentistas prescreve erroneamente a profilaxia antibiótica para PRC, o que demonstra desconhecimento do protocolo atual de emprego dessa terapia. Além disso, uma parcela dos profissionais se sente insegura ao atender esses pacientes. Portanto, evidencia-se a defasagem existente no conhecimento dos cirurgiões-dentistas quanto ao atendimento de pacientes com DRC, destacando-se a necessidade de dar maior enfoque a esse tema nas universidades e programas de pós-graduação, a fim de formar profissionais melhor capacitados para o atendimento dessa parcela da população.

Introduction: Patients with chronic kidney disease (CKD) are more susceptible to infections and bleeding and may manifest various oral alterations. Therefore, it is essential that the dental surgeon has the necessary knowledge to adapt his conduct to the particularities presented by these patients. Objective: To evaluate, through the application of a questionnaire, the knowledge and behavior of dentists working in the city of Juiz de Fora, Minas Gerais, when providing care to patients with CKD on hemodialysis.Material and methods: Study with a quantitative, observational, cross-sectional and analytical approach, carried out with 100 dentists working in the city of Juiz de Fora, Minas Gerais, from April to September 2022. Results: 100 dentists composed the sample. Of these, 37% would not feel comfortable performing invasive dental procedures in chronic kidney patients (CKP) on hemodialysis and 87% would request some complementary laboratory test prior to performing these procedures; 83% consider it important to contact the patient's nephrologist to obtain detailed information about their systemic condition and apply this in their clinical routine; 56% correctly identified the oral alterations most commonly found in individuals with CKD undergoing hemodialysis; 77% would prescribe antibiotic prophylaxis for CKP in hemodialysis in the face of invasive procedures, while 22% would prescribe it for non-invasive procedures. Conclusion: Most dentists incorrectly prescribes antibiotic prophylaxis for chronic kidney patients, which demonstrates unfamiliarity of the actual protocol for using this therapy. In addition, a number of dentists feel insecure when assisting them and are unaware of the oral alterations most commonly found in CKP. Therefore, the existing gap in the knowledge of dentists regarding the care of patients with CKD is evident, highlighting the need to give greater focus to this theme in universities and postgraduate programs, in order to train better qualified professionals to serve this portion of the population.

Osteonecrosis maxilar asociada con altas dosis de antirresortivos en paciente oncolólgico adulto mayor: resolución interdisciplinaria de caso clínico / Osteonecrosis of the jaw associated with high doses of antiresorptive in an elderly cancer patient: interdisciplinary resolution of a clinical case

La osteonecrosis maxilar relacionada con medicamentos (ONMM) es una patología de características clínicas objetivas con signo-sintomatología patogno-mónica. El criterio clínico aceptado es la presencia de hueso necrótico expuesto y visible sobre el reborde óseo maxilar que no ha cicatrizado luego de 8 sema-nas, en pacientes con antecedentes de tratamiento antirresortivo. La denominación relacionada con medicamentos se utiliza por el creciente número de casos asociados con otros fármacos antirresortivos como denosumab y con terapias antiangiogénicas, más allá de la conocida relación con bifosfonatos. Si bien la incidencia de ONMM en pacientes tratados por osteopatías metabólicas es muy baja, la situa-ción se torna más compleja en pacientes oncológicos con altas dosis de antirresortivos para tratamiento de metástasis ósea. Varios informes de casos des-criben cuadros de ONMM en pacientes con cáncer que reciben terapias dirigidas, específicamente TKI (inhibidores de tirosina kinasa) y anticuerpos mo-noclonales-VEGF (anticuerpos dirigidos al factor de crecimiento del endotelio vascular). La ONMM afecta negativamente la calidad de vida del paciente onco-lógico y produce comorbilidad significativa. Resulta imperioso identificar los pacientes en riesgo y dise-ñar un protocolo de atención odontológica específico para estos casos. En este artículo, se presenta un caso de ONMM asociado con altas dosis de Deno-sumab y administración simultánea de anticuerpos monoclonales específicos. El caso sorprende por la magnitud de la necrosis y su cuadro insidioso. El pro-tocolo de tratamiento descripto permitió controlar el cuadro inicial, limitar el avance de la lesión, asegurar el control del dolor y la infección, y finalmente, la cu-ración total de la lesión (AU)

Medication-related osteonecrosis of the jaws (MRONJ) is a pathology with objective clinical characteristics with pathognomonic signs and symp-toms. The accepted clinical criterion is the presence of exposed and visible necrotic bone on the maxillofacial region that has not healed after 8 weeks, in patients with history of antiresorptive treatment. The name medication-related is justified by the growing number of cases associated with other antiresorptive drugs such as denosumab and antiangiogenic therapies, beyond the known relationship with bisphosphonates. Although the incidence of MRONJ in patients treated for metabolic osteopathies is very low, the situation becomes more complex in cancer patients who re-ceive high doses of antiresorptives for the treatment of skeletal metastases. Several case reports describe the presence of MRONJ in cancer patients receiving targeted therapies, specifically TKI (tyrosine kinase inhibitors) and monoclonal antibodies-targeting VEGF (vascular endothelial growth factor). MRONJ nega-tively affects the quality of life in cancer patients and produces significant comorbidity. It is imperative to identify patients at risk and design a specific den-tal care strategy for these cases. In this article, we present a case of MRONJ associated with high doses of Denosumab and simultaneous administration of specific monoclonal antibodies. The case is surpris-ing due to magnitude of the necrosis. The described treatment strategies made it possible to control the initial symptoms, limit the lesion progression, ensure pain and infection control, and finally, the total heal-ing of the lesion (AU)

Perfil Epidemiológico de Pacientes Oncológicos Atendidos em um Serviço Odontológico de Referência do Estado do Ceará: Estudo Retrospectivo / Epidemiological Profile of Oncology Patients Followed Up at a Reference Dental Service in the State of Ceará: a Retrospective Study / Perfil Epidemiológico de Pacientes Oncológicos Atendidos en un Servicio de Odontología de Referencia en el Estado de Ceará: Estudio Retrospectivo

Introdução: Pacientes com câncer necessitam de atendimento odontológico personalizado em virtude das terapias antineoplásicas para minimizar a ocorrência ou a gravidade dos efeitos adversos causados por essas terapias nos tecidos bucais. Objetivo: Traçar o perfil epidemiológico e odontológico de pacientes oncológicos acompanhados em um serviço de referência em odontologia do Estado do Ceará. Método: Estudo retrospectivo observacional transversal, baseado em prontuários de pacientes com necessidades especiais atendidos ambulatorialmente entre 2017 e 2021. Tais variáveis foram analisadas utilizando os testes exato de Fisher ou qui-quadrado de Pearson, adotando um nível de confiança de 95% com o software SPSS versão 20.0 para Windows. Resultados: A maioria dos pacientes avaliados era do sexo masculino (55,8%), com idade entre 51 e 60 anos (39,0%), sendo o câncer de cabeça e pescoço o mais prevalente (37,7%). Os principais motivos de procura por atendimento odontológico foram adequação bucal pré-tratamento de câncer (36,4%), tratamento pós-câncer (22,05%) e dor (15,6%), a maioria em fase pós-quimioterapia (42,9%) e pós-radioterapia (39,0%). Os procedimentos odontológicos mais realizados entre os pacientes foram dentística (64,9%), periodontia (59,7%) e cirurgia (48,1%). Em relação à higiene bucal, 49,2% escovavam os dentes uma vez ao dia e 54,5% não utilizavam fio dental; 47,8% desses pacientes apresentaram índice CPO-D (dentes permanentes cariados, perdidos e obturados) superior a 20. Conclusão: Aproximadamente metade dos pacientes procurou atendimento odontológico para adequação pré-tratamento oncológico, entretanto, a maior parte deles buscou atendimento após o fim da quimioterapia e radioterapia, o que pode estar associado ao elevado índice de CPO-D

Introduction: Cancer patients need personalized dental care due to antineoplastic therapies to minimize the occurrence or severity of adverse effects caused on oral tissues. Objective: Design the epidemiological and dental profile of cancer patients followed up at a reference dentistry service in the State of Ceará. Method: Cross-sectional observational retrospective study, based on medical records of patients with special needs followed up at an outpatient clinic from 2017 to 2021. The variables were tabulated using Fisher's or Pearson's chi-square tests, with a confidence level of 95% with the software SPSS version 20.0 for Windows. Results: The majority of patients evaluated were males (55.8%), aged between 51 and 60 years (39.0%) with head and neck cancer as the most prevalent (37.7%). The main reasons for seeking dental care were oral adequacy pre-cancer treatment (36.4%), post-cancer treatment (22.05%) and pain (15.6%), with the majority in post-chemotherapy phase (42.9%) and after radiotherapy (39.0%). Restorative dentistry (64.9%), periodontics (59.7%) and surgery (48.1%) were the dental procedures most performed. Regarding oral hygiene, 49.2% brushed their teeth once a day and 54.5% did not use dental floss, 47.8% of these patients had a DMFT Index (decayed, missing, filled teeth) greater than 20. Conclusion: Approximately half of the patients sought dental care for pre-oncological treatment adjustment, however, the majority sought care post-chemotherapy and radiotherapy, which may be associated with high DMFT index

Introducción: Los pacientes oncológicos necesitan una atención odontológica personalizada debido a las terapias antineoplásicas, con el objetivo de minimizar la aparición o severidad de los efectos adversos que estas terapias provocan en los tejidos orales. Objetivo: Trazar el perfil epidemiológico y odontológico de pacientes oncológicos seguidos en un servicio de referencia en odontología en el estado de Ceará. Método: Estudio retrospectivo observacional transversal, basado en historias clínicas de pacientes atendidos ambulatoriamente para pacientes con necesidades especiales de 2017 a 2021. Dichas variables se tabularon mediante las pruebas de Fisher o ji-cuadrada de Pearson, adoptando un nivel de confianza del 95% en el software SPSS v20.0 para Windows. Resultados: La mayoría de los pacientes evaluados fueron del sexo masculino (55,8 %), con edad entre 51 y 60 años (39,0 %), siendo el cáncer más prevalente entre ellos, los de cabeza y cuello (37,7%). Los principales motivos de búsqueda de atención odontológica fueron tratamiento precanceroso de adecuación oral (36,4%), tratamiento poscanceroso (22,05%) y dolor (15,6%), siendo la mayoría en fase posquimioterapia (42,9%) y después radioterapia (39,0%). Los procedimientos odontológicos más realizados entre los pacientes fueron odontología restauradora (64,9%), periodoncia (59,7%) y cirugía (48,1%). En cuanto a la higiene bucal, el 49,2% se cepillaba los dientes una vez al día y el 54,5% no utilizaba hilo dental, donde el 47,8% de estos pacientes presentaba un índice de CPOD (dientes permanentes, con caries, perdidos y curados) superior a 20. Conclusión: Aproximadamente la mitad de los pacientes buscó atención odontológica para ajustar el tratamiento preoncológico, sin embargo, la mayoría de los pacientes buscó atención después del final de la quimioterapia y radioterapia, lo que puede estar asociado con la alta tasa de CPOD

Mucormicosis asociada a COVID-19: revisión de la literatura para odontólogos / COVID-19 associated mucormycosis: a literature review for dentists

La mucormicosis es una infección fúngica rara, con alta morbilidad y mortalidad. Se presenta principalmente en pa- cientes con diabetes mellitus no controlada, inmunocompro- metidos, con tratamiento crónicos con esteroides, entre otros. Actualmente, se cree que la pandemia de COVID-19 y los tratamientos con corticosteroides podrían estar implicados en el aumento de casos de esta micosis. Este hongo invade el sistema vascular, ocluyendo el flujo sanguíneo arterial y generando una rápida trombosis e isque- mia, lo que provoca la necrosis de los tejidos duros y blandos, con invasión rápida a los tejidos circundantes. Hay varias formas clínicas. En la cavidad bucal se presenta la variante rino-orbito-cerebral, que afecta el paladar en forma de lesión eritematosa o grisácea que puede progresar hacia la formación de una masa necrótica o ulceración con muy escaso sangrado de mucosa. Se manifiesta con síntomas típicos de una rinosinusitis con fiebre y dolor en las piezas dentarias superiores. El tratamiento consta de tres pilares fundamentales: el diagnóstico, un manejo adecuado de las comorbilidades y la combinación de las terapias antifúngica y quirúrgica. Desde el año 2020, la mucormicosis asociada a COVID-19 pasó a ser un evento de notificación obligatoria inmediata al Sistema Nacional de Vigilancia de la Salud (SNVS2.0) me- diante el Sistema Integrado de Información Sanitaria Argen- tina (SISA). Es importante destacar que se han reportado casos de mu- cormicosis luego de extracciones dentales; lo que impulsa a afianzar los conocimientos sobre esta enfermedad, extremar las medidas preventivas e incentivar el diagnóstico precoz en la atención odontológica, debido a la rapidez en la evolución de la patología (AU))

Mucormycosis is a rare fungal infection, with high mor- bidity and mortality. It occurs mainly in patients with uncon- trolled diabetes mellitus, immunocompromised, on chronic treatment with steroids, among others. Currently, it is believed that the COVID-19 pandemic and the corticosteroid treatments could be one of the causes of increased cases. This fungus invades the vascular system, occluding arteri- al blood flow and generating rapid thrombosis and ischemia, which causes necrosis of hard and soft tissues, with rapid in- vasion to the surrounding tissues. There are several clinical forms. In the oral cavity, the rhino-orbito-cerebral variant presents itself affecting the pal- ate in the form of an erythematous or grayish lesion that can progress towards the formation of a necrotic mass or ulcera- tion with very little mucosal bleeding. It manifests itself with typical symptoms of rhinosinusitis, with fever and pain in the upper teeth. The treatment consists of three fundamental pillars: diag- nosis, proper management of comorbidities and the combina- tion of antifungal and surgical therapies. Since 2020, COVID-19 associated mucormycosis became an event of mandatory immediate notification to the National Health Surveillance System (SNVS2.0,) through the Argentina Integrated Health Information System (SISA). It is important to emphasize that mucormycosis cases had been reported following tooth extractions, which drives to strengthen knowledge about this disease, extreme preventive measures and encourage early diagnosis in dental care, due to the speed of the evolution of the pathology (AU))

Cardiopatía isquémica. Consideraciones para la atención odontológica / Ischemic heart disease. Considerations for dental treatment

La cardiopatía isquémica es un padecimiento que se caracteriza por la falta de oxígeno del músculo cardiaco y es la principal causa de infarto de miocardio. Existen múltiples factores que predisponen al desarrollo de ésta como la obesidad, la hiperlipidemia, el sedenta- rismo, tabaquismo, diabetes e hipertensión. Dadas las características que configuran la fisiopatología de la cardiopatía isquémica, existen diversas consideraciones que deben ser tomadas en cuenta toda vez que el estomatólogo brinde atención a un paciente con este padecimiento. El objetivo del presente artículo es conocer todo lo relacionado con la fisiopatología de la cardiopatía isquémica, sus manifestaciones clínicas, su tratamiento médico y lo más importante, las consideraciones que deben tomarse en el consultorio dental cuando se atienda a un paciente que padezca esta condición (AU)

Ischemic heart disease is a condition characterized by a lack of oxygen in the heart muscle and is the main cause of myocardial infarction. There are multiple factors that predispose to the development of this, such as obesity, hiyperlipidemia, sedentary lifestyle, smoking, diabetes and hypertension. Given the characteristics that make up the pathophysiology of ischemic heart disease, there are various considerations that must be taken into account whenever the stomatologist provides care to a patient with this condition. The objective of this article is to know everything related to the pathophysiology of ischemic heart disease, its clinical manifestation, its medical treatment and most importantly, the considerations that must be taken in the dental office when caring for a patient with this condition (AU)

Osteonecrosis de los maxilares: reacción medicamentosa / Osteonecrosis of the jaws: drug reaction

La osteonecrosis de los maxilares (ONM) secundaria al consumo de medicamentos antirresortivos y antiangiogénicos es una patología oral que afecta el funcionamiento del organismo de los seres humanos no sólo a nivel bucal, sino que disminuye su calidad de vida y aumenta su morbilidad. La ONM se define como la presencia de hueso necrótico expuesto que puede ser explorado mediante una fístula en el territorio maxilofacial, que se mantiene durante un periodo mínimo de ocho se- manas. Los fármacos antirresortivos y antiangiogénicos son indicados a pacientes que presentan patologías osteometabólicas, cáncer, entre otras, de ahí la importancia de mantener una estrecha relación entre médico tratante-odontólogo-paciente. El propósito de este artículo es establecer un protocolo de cuidado oral básico y definir las funciones del médico tratante, cirujano dentista y cirujano maxilofacial mediante una revisión bibliográfica con el fin de crear una propuesta preventiva para el tratamiento de estos pacientes (AU)

Medication-related osteonecrosis of the jaw (MRONJ), secondary to the consumption of antiresorptive and antiangiogenic drugs is an oral pathology that affects the functioning of the human body, not only at the oral level, but also decreasing their quality of life and increasing their morbidity. MRONJ is defined as the presence of exposed necrotic bone that can be explored through a fistula in the maxillofacial territory, which is maintained for a minimum period of eight weeks. Antiresorptive and antiangiogenic drugs are indicated for patients with osteometabolic pathologies, cancer, among others. For the same reasons, the importance of maintaining a close relationship between the treating physician, dentist and patient. The purpose of this article is to establish a clinical guide for basic oral care and define the functions of the treating physician, dental surgeon and maxillofacial surgeon through a bibliographic review; in order to create a preventive proposal for the treatment of these patients (AU)