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)

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)

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

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)

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))

Importância do exame radiográfico na avaliação odontológica prévia à cirurgia cardíaca / Importance of radiographic examination in dental evaluation prior to cardiac surgery

INTRODUÇÃO: A intervenção imediata em casos de focos infecciosos orais é extremamente necessária para prevenção da ocorrência de Endocardite Infecciosa (EI) nos pacientes com comprometimento valvar. Para tanto, o acompanhamento odontológico e a realização de exame radiográfico se faz indispensável na programação da cirurgia cardíaca. A radiografia panorâmica é um dos exames complementares mais requisitados em ambiente hospitalar, pois fornece qualidade de informações a respeito das condições dentárias e das estruturas de suporte associadas, sendo uma boa opção como exame de triagem e complementação diagnóstica. RELATO DE CASO: Paciente do gênero feminino, 74 anos, com diagnóstico médico de Insuficiência Cardíaca Congestiva perfil B, Estenose Aórtica sintomática, Insuficiência Tricúspide e Mitral importantes, internada em planejamento de intervenção cirúrgica cardíaca; solicitada avaliação odontológica pré-operatória, como protocolo da Instituição. Ao exame físico intra oral, paciente desdentada total superior e inferior com leve abaulamento em região ântero-posterior do rebordo maxilar. Foi requisitada radiografia panorâmica, sendo possível verificar a imagem sugestiva de raízes residuais intra ósseas na região dos dentes canino superior direito e primeiro molar superior direito. Realizada cirurgia exploratória com abertura de retalho em envelope para extração das raízes residuais, seguida de curetagem dos alvéolos, que continham grande quantidade de tecido de granulação apresentando secreção purulenta. Foi prescrita profilaxia antibiótica com 2G de amoxicilina uma hora antes do procedimento para prevenção de EI. Paciente foi, então, liberada para realização da intervenção cardíaca após remoção dos focos infecciosos orais. CONCLUSÃO: Nesse contexto, nota-se a importância do exame complementar radiográfico na avaliação odontológica para o correto diagnóstico e planejamento terapêutico do paciente, especialmente para aqueles em programação de cirurgia cardíaca.

Histoplasmosis: informe de un caso / Histoplasmosis: a case report

Objetivo: Describir el diagnóstico y el tratamiento interdisciplinario de un caso clínico de histoplasmosis. Caso clínico: Un paciente masculino de 39 años, con antecedentes de consumo de drogas, alcohol, tabaquismo crónico y VIH+ sin adherencia al tratamiento, acudió al Servicio de Odontología por una interconsulta del Servicio de Clínica Médica para la evaluación de lesiones erosivas en paladar duro y blando, reborde alveolar anterior, dorso lingual y lesión tumoral en encía anterosuperior. El diagnóstico definitivo se obtuvo por medio del análisis de muestras de biopsia transbronquial, lavado broncoalveolar y biopsia de lesión en piel. El paciente recibió tratamiento sistémico con antimicóticos (anfotericina B e itraconazol según esquema) y tratamiento local con colutorio de clorhexidina al 0,12% y 100.000 UI de nistatina en suspensión. Al momento del alta, presentaba una considerable mejoría de su estado general y de las lesiones orales, con disminución de sintomatología dolorosa. Se indicó turno para control a los 7 días de forma ambulatoria, al cual el paciente no asistió. El abordaje interdisciplinario y el análisis de los diferentes aspectos socioeconómicos, culturales, ambientales y sistémicos del paciente facilitaron el diagnóstico temprano de la enfermedad (AU)

Aim: To describe the diagnosis and interdisciplinary treatment of a clinical case of histoplasmosis. Clinical case: 39-year-old male patient with a history of drug abuse, alcohol, and chronic smoking, HIV+ without treatment compliance, attends the dental department referred by the medical department for the diagnosis of erosive lesions in the hard and soft palate, anterior alveolar ridge, lingual dorsum and tumor lesion in the anterosuperior gingiva. The definitive diagnosis was obtained by the analysis of transbronchial biopsy, bronchoalveolar lavage and skin lesion biopsy. The patient received systemic treatment with antifungals (amphotericin b, itraconazole according to protocol), and local treatment with 0.12% chlorhexidine mouthwash and 100,000 IU nystatin suspension. At the time of medical discharge, the patient presented a considerable improvement in his general condition and of the oral lesions with a reduced pain. A 7 days recall was prescribed, however the patient failed to attend. The interdisciplinary approach to the patient and the analysis of the different socio-economic, cultural, environmental and systemic aspects of the patient facilitates the early diagnosis of the disease (AU)

Manejo odontológico del paciente diabético: revisión narrativa / Dental management of the diabetic patient. Narrative review

La diabetes mellitus es una enfermedad metabólica caracterizada por altos niveles de glucosa en sangre y defectos en la producción y/o la acción de la insulina. La hiperglucemia crónica puede derivar en complicaciones metabólicas y vasculares como micro- y macroangiopatías y alteraciones en el metabolismo de lípidos y proteínas. Los pacientes diabéticos mal controlados o no controlados presentan signos y síntomas evidenciables a nivel bucal. En el mundo, alrededor del 8,8% de los adultos de entre 20 y 79 años padecen este trastorno endócrino, y se estima que para el año 2045 unos 629 millones de personas de este rango etario tendrán diabetes. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico de estos pacientes, a fin de estar preparado para brindarles un tratamiento adecuado y responder a las emergencias médicas que se presenten durante su atención. En esta revisión se emplearon resultados extraídos manualmente de artículos indexados en las bases de datos MEDLINE y EBSCO que responden a la búsqueda de los términos diabetes mellitus, dental management, oral surgery y HbA1c, con el objetivo de describir el manejo médico-odontológico del paciente diabético hasta la fecha (AU)

Diabetes Mellitus is a metabolic disease characterized by high blood glucose levels and defects in the production and/or the use of insulin. Chronic hyperglycemia can lead to metabolic and vascular complications. Vascular complications include micro and macroangiopathies. The metabolic disorders are: alterations of lipid and protein metabolism. Patients with poorly controlled or uncontrolled diabetes present symptoms that are evident in the oral cavity. Around 8.8% of adults between 20-79 years old, worldwide, have this endocrine disorder and it is estimated that by 2045, 629 million people in this age group, will have diabetes. Therefore, it is essential for dentists to be familiar with the medical management of these patients, in order to provide adequate treatment and eventual management of medical emergencies that may occur during dental treatment. The present review used data extracted manually from articles indexed in the MEDLINE and EBSCO databases, using the terms: Diabetes mellitus, Dental Management, Oral Surgery and HbA1c. The following article aims to describe the medical/dental management of the diabetic patient updated to date (AU)

Risk Factors for Post-Tooth Extraction Complications in HIV-Infected Patients: a Retrospective Study.

We aimed to assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study participants were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Blood test results, underlying diseases, surgical site, extraction method, and postoperative complication data were obtained from medical records. Potential risk factors of postoperative complications were analyzed using multivariate logistic regression. Patients were divided into two groups: 61 (26%) patients with a CD4 count < 200/µL, and 170 (74%) with a CD4 count ≥ 200/µL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n = 10; surgical site infection, n = 2). The rate of complications did not differ between the CD4 < 200/µL group (1.6%) and the CD4 ≥200/µL group (6.5%) (adjusted odds ratio [aOR]: 9.328, 95% confidence interval [CI]: 0.470, 185.229; P = 0.1431). Surgical extraction with bone excavation, but without CD4 count, was identified as a risk factor for post-extraction complications (aOR: 22.037, 95% CI: 1.519, 319.617; P = 0.0234). A low CD4 count is not a risk factor for post-extraction complications in patients with HIV infection. We conclude that tooth extraction should be performed based on dental/oral conditions, and not delayed until CD4 count improvement.

Dental Findings of Kidney and Liver Transplantation Patients from a Brazilian Oral Health Care Service

ABSTRACT Objective: To describe dental findings of kidney and liver, pre and post-transplant patients of an oral health care service from a Brazilian Southeast state. Material and Methods: A descriptive cross-sectional study was developed with a sample of patients attending the oral health care program for transplantation of Universidade Federal de Minas Gerais. Participants were divided into two groups according to the kind of transplantation-kidney or liver. Characteristics of the sample, sex (male/female), age (18-44; 45-54; 55-80), living region (Belo Horizonte, or outside), phase of transplantation (pre-Tx or post-Tx), and self-report of diabetes mellitus and hypertension were presented by frequencies. Dental caries experienced was measured by Decayed, Missing and Filled-Teeth (DMF-T) index. Results: 185 patients, kidney (46; 24.9%), and liver (139; 75.1%) were included. Mean DMFT was 18.3 (20.0). DMFT scores of males (18.7; 20.0), females (17.2; 18.0), pre-transplanted (18.3; 20.0), and post-transplanted (18.1; 20.0) were similar. The liver transplantation group (19.3; 20.0) showed higher caries experience comparing to kidney´s (15.2; 17.0). Conclusion: Dental caries experience was high in kidney and liver patients under transplantation therapy. This highlights the demand for treatment need in this population.

Fundamentos de elección terapéutica: osteonecrosis maxilar asociada a drogas antirresortivas (MRONJ) / Fundamentals of therapeutic choice: anti-resorptive drug-related maxillary osteonecrosis (MRONJ)

La acción terapéutica favorable que los antirresortivos (bifosfonatos BPs, denosumab DS) y drogas antiangiogénicas ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica cáncer o discrasias óseas incluyen hipercalcemias malignas o ­si requieren el consumo de dicha droga a baja concentración­ como ser: osteoporosis, osteopenia, enfermedad de Paget, displasia fibrosa, Osteogénesis Imperfecta. (1) La presente actualización pretende relacionar el tratamiento odontológico con prescripción crónica y drogas antirresortivas, para lo cual American Association of Oral and Maxillofacial Surgeons AAOMS: define el concepto de Osteonecrosis Maxilar Asociada a drogas Antirresortivas (MRONJ) como: «Área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. La AAOMS estableció los siguientes grupos de acuerdo con sus características clínicas en 4 estadios (0, 1 ,2 y 3) de acuerdo con el aspecto clínico y radiológico de la lesión osteonecrótica. Estadío 0: lesión osteonecrótica sin evidencia de hueso necrótico en pacientes bajo consumo de drogas antirresortivas. Estadío 1: lesión osteonecrótica con signos clínicos y ausencia de sintomatología clínica. Estadío 2: lesión osteonecrótica con signo y sintomatología clínica evidente. Estadío 3: lesión osteonecrótica con signo y sintomatología evidente que compromete a estructuras nobles: fracturas patológicas, anestesia del nervio dentario inferior, comunicación buco-nasal, comunicación buco-sinusal, fístulas cutáneas (2) (AU)

It is known the favourable action which antiresorptive (Bisphosphonates BPs, Denosumab: DS) and Antiangiogenic drugs produce in bone tissue. High concentrations are primarily used as an effective treatment in the management of cancer-related disorders, including hypercalcemia of malignant. Besides, low concentrations are used for other metabolic bone diseases including Osteoporosis, Osteopenia, Paget's Disease, Fibrous Dysplasia, Imperfect Osteogenesis. (1) The update relate relationship between dentistry and chronic treatment with antiresorptive drugs. According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), MRONJ is defined as exposed or necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in association with current or previous BPs or DS therapy and with a lack of head and neck radiotherapy. AAOMS divided the MRONJ into 4 stages (0,1, 2 and 3) according to the clinical and radiological aspect of the osteonecrotic lesion: Stage 0: osteonecrotic lesion without sign-pathognomonic evidence of osteonecrosis. Stage 1: osteonecrotic lesion with clinical signs and absence of clinical symptoms. Stage 2: osteonecrotic lesion with sign and evident clinical symptoms. Stage 3: osteonecrotic lesion with signs and evident symptoms that involve noble structures: pathological fractures, anaesthesia of the lower dental nerve, oral-nasal communication, oral-sinus communication, skin fistulas (2) (AU)

Perfil de utilização de anestésicos locais de uma cidade brasileira com ênfase em diabéticos / Profile of use of local anesthetics in a Brazilian city with emphasis on diabetics

Objetivo: avaliar o conhecimento de cirurgiões-dentistas que trabalham em consultórios particulares de Palmas, Tocantins, quanto à utilização de anestésicos locais em pacientes portadores de diabetes mellitus. Materiais e método: trata-se de um estudo descritivo qualitativo, aprovado pelo Comitê de Ética em Pesquisa da FAMERP de São José do Rio Preto, sob o protocolo 032/2007 e CAAE: 0065.0.000.140-07, respeitando-se a Resolução 466/12, do Conselho Nacional de Saúde. A coleta de dados foi realizada por meio da aplicação de um questionário, utilizando um formulário estruturado. Resultados: de 113 participantes, 47 (41,6%) eram do sexo masculino e 66 (58,4%) do sexo feminino, com idade média de 35 anos. O anestésico mais utilizado pelos cirurgiões-dentistas avaliados foi a lidocaína 2% + adrenalina 1:100.000 (53,1%), o qual também é o mais utilizado para pacientes diabéticos controlados (64,6%). Quanto à variedade de anestésicos, 47,8% dos avaliados relataram possuir somente 3 tipos de anestésicos no consultório e que 83,2% nunca presenciaram nenhum problema decorrente do uso de anestésico. Além disso, 65,5% relataram não participar de cursos para atualização de conhecimentos, sendo que 53,1% mostraram-se insatisfeitos com o ensino de anestesiologia que receberam na graduação. Conclusão: observou-se que os cirurgiões-dentistas do atendimento odontológico particular de Palmas precisam de uma reciclagem profissional, a fim de atualizarem conhecimentos adquiridos na graduação sobre indicação e utilização de anestésicos locais em tratamentos odontológicos de pacientes com necessidades especiais, com ênfase em pacientes portadores de diabetes mellitus.(AU)

Objective: to evaluate the knowledge of dentists who work in private offices in Palmas, Tocantins, regarding the use of local anesthetics in patients with diabetes mellitus. Materials and method: this research is a qualitative descriptive study, approved by the Research Ethics Committee of FAMERP from São José do Rio Preto, under protocol number 032/2007 and CAAE: 0065.0.000.140-07 in compliance with the Resolution 466/12 of the National Health Council. Data collection was performed through the application of a questionnaire, using a structured form. Results: 47 (41.6%) out of 113 participants were male and 66 (58.4%) female, with an average age of 35 years old. The anesthetic most used by the dentists evaluated was lidocaine 2% + adrenaline 1: 100,000 (53.1%) which is also the most used for controlled diabetic patients (64.6%). As for the variety of anesthetics, 47.8% of those evaluated reported having only 3 types of anesthetics in the office and that 83.2% never saw any problems resulting from the use of anesthetics. Furthermore, 65.5% reported not participating in courses to update knowledge and 53.1% were dissatisfied with the teaching of anesthesiology they received during graduation. Conclusion: it was observed that dentists who work in private dental offices in Palmas need a professional retraining in order to update knowledge acquired during graduation on the indication and use of local anesthetics in dental treatments for patients with special needs, with an emphasis on patients with diabetes mellitus.(AU)

Knowledge of Infection Prevention and Attitudes Towards HIV/AIDS Among Chinese Dental Bachelor Interns: An Appeal for Educational Intervention.

PURPOSE: The present study aimed to assess the current situation of Chinese dental bachelor interns on HIV/AIDS-related knowledge and their attitudes towards HIV/AIDS patients. MATERIALS AND METHODS: A cross-sectional, paper-based survey involving 147 dental students from three Chinese dental schools was conducted. Students were recruited to complete the questionnaire regarding their knowledge, awareness and attitudes concerning HIV/AIDS anonymously and voluntarily. RESULTS: A total of 144 students responded to the study, generating a response rate of 98.0%. Although 97.0% of the dental students believed dentists were at high risk of HIV infection, 97.2% of students expressed no prejudice towards HIV/AIDS patients and stated their willingness to provide oral healthcare service for such patients. No statistically significant differences in the responses on attitudes and some basic knowledge were found between students who had received the relevant education about infection control and the students who had not. However, regarding most questions about oral manifestations in adult and paediatric patients living with AIDS, the students who received relevant education showed more knowledge than the students who did not (p <0.05). The cognitive level about respecting HIV/AIDS patients' autonomy and privacy was generally low in all the students. CONCLUSIONS: Most of the dental students in this survey held positive attitudes towards HIV/AIDS patients and good grasp of some basic knowledge about HIV/AIDS. On the other hand, the questionnaire results reflected gaps in education, such as respecting HIV/AIDS patients' privacy.

Emergencias médicas en la atención odontológica: pacientes "de riesgo" y/o "en riesgo" / Medical emergencies in dental care: 'risk' and/or 'at risk' patients

En medicina, los pacientes de riesgo son aquellos que, al momento de la consulta, presentan antecedentes y/o pa- decimientos que implican una mayor probabilidad de sufrir complicaciones, como personas inmunodeprimidas o con en- fermedades crónicas, ya sean cardíacas, pulmonares, renales, hepáticas, sanguíneas o metabólicas (por ejemplo, diabetes). Estos pacientes se encuentran en riesgo en el caso de prác- ticas que puedan exacerbar o provocar reacciones adversas a raíz de su padecimiento. En la actualidad, el grupo poblacional vulnerable ha au- mentado a partir de nuevos tratamientos médicos que han per- mitido mejorar padecimientos sistémicos severos y prolongar la esperanza de vida. Ante pacientes "de riesgo" o "en riesgo", el odontólogo debe estar alerta y actualizado, a fin de evitar provocar alteraciones sistémicas y de reaccionar pronta y eficazmente, en caso de ser necesario, ante las urgencias médicas que se presenten (AU)

In medicine, risk patients are those who at the consulta- tion have a history and/or conditions that could cause a great- er possibility of a complication; such as immunosuppressed, chronic heart, pulmonary, kidney, liver, blood or metabolic diseases (for example, diabetes).These patients are at risk during procedures that could in- crease or cause inadequate reactions due to their conditions. Currently, the vulnerable population group has increased since newest medical treatments have emerged; allowing se- vere systemic ailments to improve and prolong life expectancy. With risk or at-risk patients, the dentist must be alert and up-to-date to avoid systemic alterations and react promptly and efficiently if necessary in any medical emergency that might take place (AU)

Sarcoma de Kaposi asociado al VIH/SIDA: importancia de su diagnóstico para un correcto manejo odontológico / HIV/AIDS associated Kaposi's sarcoma: importance of its diagnosis for a correct odontologic management

El sarcoma de Kaposi (SK) es una neoplasia vascular maligna poco frecuente, asociada al virus herpes humano tipo 8. Existen cuatro formas clínicas: clásico, endémico, asociado con inmunosupresión iatrogénica y asociado al VIH/SIDA. Este artículo presenta una revisión de la literatura sobre la epidemiología, la patogénesis, las manifestaciones clínicas y el tratamiento del sarcoma de Kaposi asociado al VIH/ SIDA (SK-VIH/SIDA) a propósito de un caso clínico manejado en la Clínica Académica de Atención Dental. La baja en la incidencia de esta neoplasia da lugar al desconocimiento de sus manifestaciones clínicas. En adición, los pacientes seropositivos suelen no mencionar su padecimiento en la anamnesis, lo cual representa un riesgo tanto para el paciente en su diagnóstico y manejo odontológico como para el odontólogo y el personal clínico con riesgo de contagio (AU)

Kaposi sarcoma (KS) is an uncommon malignant vascular neoplasm, associated with human herpes virus type 8. There are four clinical presentations: classic, endemic, associated with iatrogenic immunosuppression and associated with AIDS. This article presents a review of the literature on epidemiology, pathogenesis, clinical manifestations, treatment and HIV/AIDS-associated Kaposi sarcoma (SK-HIV/AIDS) regarding a clinical case managed at the Academic Center of Dental Care. The decrease in the incidence of this neoplasm, leads to ignorance of its clinical manifestations. In addition, seropositive patients usually don't mention their condition in the anamnesis, which represents a risk for the patients on their diagnosis and the case management as well as for the dentist and the clinical personnel from risk of infection (AU)