Mechanisms underlying the adaptive pulp and jaw bone trabecular changes in sickle cell anemia.

OBJECTIVE: Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea use with adaptive pulp and jaw bone trabecular changes in HbSS. METHODS: This cross-sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso-occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age. RESULTS: The vaso-occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso-occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02). CONCLUSION: Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.

Lesiones perirradiculares persistentes: revisión narrativa / Persistent periradicular lesions: a narrative review

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)

The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)

Evaluación del estatus del tejido pulpar postratamiento oncológico / Assessment of the status of the pulp tissue post oncological treatment

La OMS cataloga al cáncer como uno de los principales problemas en el ámbito mundial, los pacientes sometidos a terapia oncológica son más vulnerables a desarrollar complicaciones en los tejidos de la cavidad bucal entre las que tenemos: mucositis, infecciones, osteorradionecrosis. En el manejo endodóntico hay que tomar en consideración que los trata- mientos como yodoterapia, radioterapia y quimioterapia pueden generar efectos sobre el complejo dentinopulpar. El objetivo de este artículo es determinar el estatus del tejido pulpar postratamiento oncológico mediante la revisión sistemática en bases de datos de gran relevancia científica, como PubMed, Scielo, Medigraphic, Science direct. Se concluye que el sistema estomatognático es un receptor importante de estos efectos y secuelas en pacientes con terapia oncológica, el tejido pulpar no está libre de estas secuelas ya que genera daño celular, como la hipovascularidad, hipocelularidad e hipoxia la cual incrementa el riesgo de necrosis de la región (AU)

The WHO lists cancer as one of the main problems worldwide, patients undergoing oncological therapy are more vulnerable to developing complications in the tissues of the oral cavity among which we have: mucositis, infections, osteoradionecrosis. In endodontic management, it should be taken into consideration that treatments such as iodine therapy, radiotherapy, and chemotherapy can generate effects on the dentin-pulp complex. This article aims to determine the status of the pulp tissue after oncologic treatment. Through a systematic review in databases of great scientific relevance, such as PubMed, Scielo, Medigrafhic, Science direct. It is concluded that the stomatognathic system is an important receptor of these effects and sequelae in patients with oncological therapy, the pulp tissue is not free of these sequelae as it generates cellular damage because of the hypo vascularity, hypocellularity, and hypoxia which increases the risk of necrosis of the region (AU)

Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction?

Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.

Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction?

Abstract: Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.

Sickle cell anemia in Brazil: personal, medical and endodontic patterns.

Sickle cell anemia (SCA) is the most prevalent genetic disease worldwide. Recurrent vaso-occlusive infarcts predispose SCA patients to infections, which are the primary causes of morbidly and mortality. This study aimed to evaluate the relationship between SCA and endodontic diseases. Personal information, medical data (hematological indices, virologic testing, blood transfusions, medications received, splenectomy) and information on the need for endodontic treatment were obtained from SCA patients who were registered and followed up by the Fundação Hemominas, Minas Gerais, Brazil.These data were compared with the need for root canal treatment in SCA patients. One hundred eight patients comprised the studied population, and the rate of the need for endodontic therapy was 10.2%. Among the medical data, a significant difference was observed for eosinophil (p = 0.045) counts and atypical lymphocyte counts (p = 0.036) when the groups (with and without the need for endodontic treatment) were compared. Statistical relevance was observed when comparing the patients with and without the need for root canal therapy concerned eosinophil counts and atypical lymphocyte counts. The differences in statistical medical data, observed between the groups suggest that both parameters are naturally connected to the stimulation of the immune system that can occur in the presence of root canal infections and that can be harmful to SCA individuals.

Sickle cell anemia in Brazil: personal, medical and endodontic patterns

Abstract Sickle cell anemia (SCA) is the most prevalent genetic disease worldwide. Recurrent vaso-occlusive infarcts predispose SCA patients to infections, which are the primary causes of morbidly and mortality. This study aimed to evaluate the relationship between SCA and endodontic diseases. Personal information, medical data (hematological indices, virologic testing, blood transfusions, medications received, splenectomy) and information on the need for endodontic treatment were obtained from SCA patients who were registered and followed up by the Fundação Hemominas, Minas Gerais, Brazil.These data were compared with the need for root canal treatment in SCA patients. One hundred eight patients comprised the studied population, and the rate of the need for endodontic therapy was 10.2%. Among the medical data, a significant difference was observed for eosinophil (p = 0.045) counts and atypical lymphocyte counts (p = 0.036) when the groups (with and without the need for endodontic treatment) were compared. Statistical relevance was observed when comparing the patients with and without the need for root canal therapy concerned eosinophil counts and atypical lymphocyte counts. The differences in statistical medical data, observed between the groups suggest that both parameters are naturally connected to the stimulation of the immune system that can occur in the presence of root canal infections and that can be harmful to SCA individuals.

Operatoria dental y endodoncia 1: la degradación de la interfaz resina-dentina favorece la filtración bacteriana / Operative dentistry and endodontics 1: the interface resin-dentin degradation allows for the bacterial microleakage

La integridad y la estabilidad de la interfase adhesivo/dentina en las restauraciones realizadas mediante resinas compuestas se encuentra constantemente comprometida por la hidrólisis progresiva de sus componentes hidrofílicos y la degradación de la matriz colágena, producida por la reactivación de una serie de endopeptidasas denominadas metaloproteinasas (MMP) y otras enzimas colagenolíticas que se encuentran fosilizadas en la matriz de la dentina. Esto lleva a la destrucción de la capa híbrida y facilita la penetración bacteriana en la interfase, el aumento de la hipersensibilidad posoperatoria y la formación de caries recurrentes. Estos problemas inciden además en la pérdida de retención de la restauración y se constituyen en el principal factor etiológico de los procesos inflamatorios que comprometen seriamente la salud de la pulpa dental. Debido a que la integridad de la matriz colágena es esencial para preservar la durabilidad de la adhesión de las restauraciones, se han intentado algunas estrategias, con el objeto de inhibir o al menos reducir en lo posible la acción de las enzimas colagenolíticas sobre la estabilidad de la interfase. A pesar de que algunas de las estrategias ensayadas hasta el momento han demostrado ser eficaces, aún se encuentran en una etapa netamente experimental y requieren ser más profundamente investigadas

Operatoria dental y endodoncia 1: la degradación de la interfaz resina-dentina favorece la filtración bacteriana / Operative dentistry and endodontics 1: the interface resin-dentin degradation allows for the bacterial microleakage

La integridad y la estabilidad de la interfase adhesivo/dentina en las restauraciones realizadas mediante resinas compuestas se encuentra constantemente comprometida por la hidrólisis progresiva de sus componentes hidrofílicos y la degradación de la matriz colágena, producida por la reactivación de una serie de endopeptidasas denominadas metaloproteinasas (MMP) y otras enzimas colagenolíticas que se encuentran fosilizadas en la matriz de la dentina. Esto lleva a la destrucción de la capa híbrida y facilita la penetración bacteriana en la interfase, el aumento de la hipersensibilidad posoperatoria y la formación de caries recurrentes. Estos problemas inciden además en la pérdida de retención de la restauración y se constituyen en el principal factor etiológico de los procesos inflamatorios que comprometen seriamente la salud de la pulpa dental. Debido a que la integridad de la matriz colágena es esencial para preservar la durabilidad de la adhesión de las restauraciones, se han intentado algunas estrategias, con el objeto de inhibir o al menos reducir en lo posible la acción de las enzimas colagenolíticas sobre la estabilidad de la interfase. A pesar de que algunas de las estrategias ensayadas hasta el momento han demostrado ser eficaces, aún se encuentran en una etapa netamente experimental y requieren ser más profundamente investigadas (AU)

Pulp pathosis in inlayed teeth of the ancient Mayas: a microcomputed tomography study.

AIM: To evaluate three-dimensionally, using microcomputed tomography (µCT), the anatomical relationship between the cavity prepared to hold the inlay stone and the pulp chamber in the teeth of the ancient Maya. METHODOLOGY: Six well-preserved teeth from Maya corpses found in an archaeological site in Guatemala (approximately 1600 year old) were selected and scanned using a high-resolution µCT system (SkyScan 1174v2; SkyScan N.V., Kontich, Belgium). The sample comprised six maxillary teeth: two canines, one premolar, two central incisors and one lateral incisor. All teeth had one or two inlay stones on the buccal surface of the crown. Each specimen was scanned at an isotropic resolution of 22.5 µm, a rotational step of 0.70°, a rotational angle of 180° and a 3.1-s exposure time, using a 1-mm-thick aluminium filter. Images of each specimen were reconstructed from apex to the crown with dedicated software (NRecon v1.6.1.5) in approximately 450 slices. CTan v1.11 and CTVol v2.1 were used for three-dimensional visualization and qualitative analysis of the external and internal anatomy of the teeth. RESULTS: The tooth modification in all samples was classified as type E1 (one stone on the buccal surface of the crown) or E2 (two stones on the buccal surface of the crown). In the canine teeth, the cavities created to insert the inlay stone did not reach the pulp chamber. Conversely, in the maxillary incisors, the cavities clearly perforated the pulp chamber resulting in massive internal inflammatory resorption or partial calcification of the pulp cavity. In the premolar tooth, a small perforation of the pulp chamber under the buccal cusp, without morphological alteration of the intraradicular dentine, was observed. CONCLUSIONS: Microcomputed tomography analysis of teeth of the ancient Maya civilization showed that the inlay cavities cut reached the pulp chamber in the maxillary incisors and premolar teeth, with the potential to cause pulp and periapical disease.

Fuerzas ortodóncicas como agentes vulnerantes de la salud pulpar: reporte de dos casos / Orthodontic forces causing damage in pulpal condition: report of two cases

La literatura ya ha sugerido la implicancia del uso de fuerzas ortodóncicas como productoras de daño mecánico, reacción inflamatoria periodontal, lesión periapical y reabsorción radicular. Los parámetros más comúnmente explorados en investigaciones de la respuesta tisular a fuerzas ortodónticas consisten en medir los niveles de oxígeno pulpar, la vasculatura y los cambios en la circulación sanguínea. Se ha demostrado que la irrigación pulpar disminuye tempranamente cuando se realizan aplicaciones continuas de fuerzas ortodóncicas, aun si éstas son de intensidad suave, concluyendo que la magnitud de las fuerzas no necesariamente debe ser excesiva para originar daño celular, el que eventualmente podría derivar en cuadros que van desde simples cambios de color coronario hasta obliteraciones camerales o la misma necrosis pulpar. Se presentan dos casos de pacientes tratados ortodóncicamente con extravasación hemorrágica y necrosis pulpar (canino e incisivo lateral superiores izquierdos respectivamente), con ausencia informada de traumatismo previo, y se discuten protocolos diagnósticos para la evaluación de la salud pulpar.

The literature has suggested the implication of the use of orthodontic forces as producing mechanical damage, inflammatory reactions in the periodontium, periapical injury and root resorption. More commonly explored parameters in investigations of the tissue response to orthodontic forces consist of measuring the levels of pulpal oxygen and disturbances in dental pulp circulation. It has been demonstrated that the pulpal irrigation diminishes early when continuous applications of orthodontic forces are realized, even if these are of soft intensity, concluding that the magnitude of the forces must not necessarily be excessive to originate cell damage, which eventually might derive in signs such as simple crown discoloration to progressive obliteration or pulp necrosis. Two cases of orthodontically treated subjetcs with hemorrhagic extravasation and pulp necrosis (canine and lateral incisive respectively, both left upper) with absence of previous trauma are presented and the diagnostic protocols for the evaluation of the pulpal condition are discussed.

Estudo da resposta pulpar em pacientes portadores de neoplasias malignas de cabeça e pescoço submetidos à radioterapia / Evaluation of pulp response in patients undergone radiation therapy for treatment of head and neck cancer

Introdução: a radioterapia promove alterações na cavidade oral e na polpa dental que conduzem a mudanças na sensibilidade frente a estímulos em contato com a superfície dental. Torna-se necessário investigar a ocorrência dessas alterações e estabelecer o diagnóstico pulpar e perirradicular dos elementos remanescentes em áreas submetidas à irradiação ionizante, com o intuito de prevenirem-se os processos patológicos periapicais, descritos como fatores precipitadores de osteorradionecrose. Objetivo: avaliar as respostas pulpares ao teste de vitalidade com gás refrigerante tetrafluoroetano, em pacientes, submetidos à radioterapia e em um grupo de controle, em três agrupamentos dentários distintos (incisivos inferiores, incisivos superiores e caninos). Casuística e método: foram testados 91 dentes hígidos de pacientes de ambos os gêneros submetidos à radioterapia para o tratamento de neoplasias malignas de cabeça e pescoço e 103 dentes de pacientes do grupo de controle. Resultados: verificou-se que a diferença significativa (p<.05) entre os dois grupos com relação às respostas negativas apresentadas; não houve diferença entre os agrupamentos dentários avaliados. Conclusão: os pacientes submetidos à radioterapia de cabeça e pescoço apresentam amior número de elementos dentais com resposta negativa ao teste de vitalidade pulpar quando comparados com um grupo de controle

Introduction: alterations promoted by radiation therapy in the oral cavity and in dental pulp leads to sensitiveness changes in enamel surface when in contact with some external stimuli. The investigation of these changes and the establishment of the pulpal and perapicaql diagnosis of the elements remained in irradiated sites, in order to prevent pathological process that have been described as osteoradionecrosis developing factors, is mandatory. Objective: to evaluate the pulp response obtained by tetrafluoroethane in patients under gone radiation therapy and in a control group, in three dental groups (maxillary incisors, mandibular incisors and canines). Patients and methods: 91 teeth were tested in patients in both genders submitted to radiation therapy for head and neck malignances and 103 teeth in a control group. Results: the results showed sifnificant difference (p<.05) between the groups evaluated related to negative responses, despite no difference between the dental groups. Conclusion: patients undergoing radiation therapy in tghe head and neck present a greater number of teeth with negative response to the vitality test in comparison to the control group

Prevalencia del surco de desarrollo en incisivos superiores permanentes y su vinculación con problemas pulpares y periodontales / Prevalence of developmental groove in permanent upper incisors and its-

Objetivo: Establecer la prevalencia del surco de desarrollo en incisivos superiores permanentes de la población que acudió por primera vez a consulta a la Clínica Odontológica Iztacala y la Clínica de Especialización de Endoperiodontología, en un periodo de seis meses, estableciendo la dirección, profundidad y conformación de los surcos de desarrollo encontrados en dicha población, se determinó la frecuencia de problemas pulpares y periodontales relacionados con los surcos de desarrollo encontrados. Hipótesis: Si el surco de desarrollo es un factor que predispone al acúmulo de placa dentobacteriana entonces aquellos pacientes que lo presenten tendrán enfermedad periodontal, caries y/o alteración pulpar. Material y método: El diseño de la investigación fue de tipo descriptivo, prospectivo, observacional y no experimental, en relación con la evolución del fenómeno se planteó un diseño transversal y correlacional. Resultados: El promedio de las bolsas periodontales fue de 3.5 mm, lo que ayudó a establecer que la mayoría de los pacientes con esta anomalía padecen enfermedad periodontal. En cuanto a caries se observó que el 64 por ciento de los surcos la presentaban. El 51 por ciento de los pacientes presentaron pulpa sana y sólo 49 por ciento presentó una alteración pulpar, de las cuales el 36 por ciento fue pulpitis reversible, 9 por ciento pulpitis irreversible y 4 por ciento necrosis pulpar, con ello se estableció que sí existe una relación entre el surco de desarrollo y la alteración pulpar aun cuando no se tenga el mayor porcentaje, sin embargo éste es considerable. El surco de desarrollo fue más frecuente en el sexo femenino, se presenta en un porcentaje bajo del total de la población estudiada. La mayor prevalencia fue en los laterales, en su porción media. Conclusión: Esta anomalía es un factor predisponente de la caries , enfermedad periodontal y enfermedad pulpar, esta conclusión está basada en la positividad de las pruebas de correlación de Pearson...

Clinical evaluation of atraumatic restorations in primary molars: a comparison between 2 glass ionomer cements.

Dental caries continues to be a highly prevalent disease among Brazilian preschoolers, especially those with low socioeconomic status. The purpose of this randomized, controlled trial was to evaluate in vivo 245 simplified restorations in deciduous molars using glass ionomer cements (Vidrion R and Ketac-Molar). Dental restorations were evaluated at 6- and 12-month follow-ups. The teeth restored with Vidrion R (SS White) on a single tooth surface were successful in 87% of the cases evaluated at 6 months and in 63% at 12 months. The teeth restored with Ketac-Molar on one surface achieved a success rate of 95% at 6 months and 82% at 12 months. No recurrent caries or pulpal infection was evident. Logistic regression analysis demonstrated that teeth with cavities restricted to the occlusal surface on sclerotic dentin showed the best adhesion to the restorative material. The restorations with Ketac-Molar had a better clinical performance than those with Vidrion R.

Evaluation of endodontic treatments performed by students in a Brazilian Dental School.

The aims of this study were to evaluate the clinical outcomes of root canal treatments performed by final-year students in the Dental School of Piracicaba, State University of Campinas, SP, Brazil, during the year 2000 and to evaluate the success rate of these treatments at follow-ups conducted one and three years later (2001-03). All 579 endodontic treatments performed by final-year students were selected for this investigation. Detailed personal and dental history was obtained from the patient's records. Clinical and radiographic follow-up examinations were performed. For 78.8 percent of the cases, dental caries was recorded as the cause for performing endodontic treatment; for 8.8 percent, prosthetic reasons were given; and for 12.4 percent, failure of the endodontic treatment was the reason. The largest percentage (30.7 percent) of recalled patients was examined after one year; the success rate at this follow-up evaluation ranged from 83 percent to 96 percent depending on the pulp status prior to the root canal treatment. After three years, only 8 percent of treated patients returned; assessment for them revealed a 75.5 percent success rate. Dental caries is still the main reason for endodontic treatment. This level of success of the root canal treatment in a Brazilian dental school is similar to other reports in the literature.

Secuelas de los traumatismos dentarios en la dentición temporaria: caso clínico / Sequelae of tooth injuries in the primary dentition: a clinical case

Los traumatismos dentarios en la dentición primaria continúan siendo uno de los problemas dentales más comunes que ocurren en niños, afectando frecuentemente a las estructuras de sostén, produciendo numerosas secuelas tanto en la dentición primaria como permanente. Estas secuelas pueden ir desde una simple pigmentación hasta la pérdida de la pieza dentaria. Los traumatismos en la dentición primaria deben ser monitoreados tanto clínica como radiográficamente para detectar tempranamente cambios en las piezas dentarias y/o estructuras de sostén. El propósito de este artículo es mostrar el tratamiento realizado en un incisivo central superior primario traumatizado, priorizando la proximidad del germen dentario y evitando daños al sucesor permanente (AU)

Correlação entre diagnóstico do problema endodôntico e sua etiologia / Relation of diagnose status of the endodontic problem and its ethiology

Realizou-se um levantamento etiológico das doenças pulpares e periapicais dos pacientes atendidos nas disciplinas de Endodontia I e II no Estágio Supervisionado II e no Curso de Aperfeiçoamento em Endodontia da FO-UFRGS no ano de 2001. Foram catalogados 291 pacientes nos quais se registrou presença ou ausência de dor, restaurações no dente afetado, imagem radiográfica, etiologia, diagnóstico e origem da dor, além do sexo, idade e saúde geral do paciente. A partir dos dados colhidos nesse levantamento clínico constatou-se que a cárie dentária foi a patologia predominante em 70.10 por cento dos casos analisados.

Influence of the type of dental trauma on the pulp vitality and the time elapsed until treatment: a study in patients aged 0-3 years.

The purpose of the present study was to determine the influence of the type of trauma on the pulp vitality and the time elapsed until seeking dental care in children aged 0-3 years seen at the Baby Clinic of the Araçatuba Dental School, UNESP. A total of 1813 records were analyzed. Two hundred and three patients, corresponding to 302 traumatized teeth, were assessed clinically and radiographically. Hard-tissue injuries were the most frequent (52%), with a predominance of enamel crown fractures (41.4%), followed by concussions (12.6%) and intrusions (11.6%). Clinical and radiographic examination revealed that 72% of the traumatized teeth maintained pulp vitality. In the case of supporting-tissue lesions, 51.1% of the patients sought care within 1-15 days after injury, while in the case of hard-tissue injuries, 52.7% sought care only after 16 days. The results showed that supporting-tissue injuries had a significant influence on the faster seeking of dental care.

Emergencias odontológicas en la montaña / Dental emergencies in the mountain

Seis de la tarde del primer día, refugio, cansado por el acarrero delt ramo incial, me apresto a descargar la mochila apurado pr cargar agua de deshielo que corre cerca al refugio antes que se congele al caer el sol. De repente, un dolor de muelas soportable (hiperemia). Se va incrementando (pulpitis) y haciéndose imposible de soportar; no traje nada para el dolor pero el guía de montaña alivia mi angustia de psar una noche terrible o, lo que es peor, terminar mi aventura. Una bolita de algún embebida en un líquido (eugenol), la coloco en la caries, previo secado con algodón también, una pasata que lka colocamos con algún instrumento pequeño que haga las veces de espátula la mantendrá en su lugar. Situaciones como esta pueden sucederles a cualquier persona. Algunas, de fácil resolución, otras, incapacitantes, dependiendo también de la distancia (horas o días) a algún centro urbano. Si les han extraído un elemento dentario recientemente no olviden que tienen que dejar pasar al menos 48 hs antes de realizar un esfuerzo físico importante. Lo aconsejable, y aunque parezca un detalle menor sería pasar por el odontólogo que, a pesar de no ser un santo de devoción de muchos, suele darles una cierta tranquilidad al poner vuestra boca en condiciones aceptables para excursiones en la que estarán a kilómetros de distancia de su consultorio. (AU)