Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia.

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.

Early diagnosis of lip cancer preceded by a persistent actinic lesion in a kidney transplant patient: a case report.

Lip cancer is 65 times more likely to occur in kidney transplant patients than in members of the general population. Immunosuppression drugs taken by the transplant patients have been associated with this increased occurrence. This case report shows the progression from actinic cheilosis to squamous cell carcinoma (SCC) in the lower lip of a 58-year-old man receiving immunosuppressive therapy 9 years after undergoing a kidney transplant. Earlier incisional biopsies had resulted in a histological diagnosis of actinic cheilosis. However, the last incisional biopsy showed histological results compatible with SCC, and oncological surgery was performed. Eight months post-surgery, the patient was free of cancer and metastasis. Frequent dental follow-up visits allowed for the early diagnosis, proper treatment, and an improved prognosis for this patient.

Oral cancer from a health promotion perspective: experience of a diagnosis network in Ceará.

The aim of this study is to share the experience of implementing a network for the diagnosis of oral cancer by integrating primary, secondary, and tertiary oral health care centers and identifying the possible weaknesses of the process. The study also investigated the risks of exposure to the main risk factors for oral and lip cancer and their most common potentially malignant lesions (PML). A quantitative cross-sectional study was conducted in two different regions, with patients seen at a primary health care facility from August 2010 to July 2011. Patients with oral lesions were referred to dental specialty centers for biopsy. Patients with PML were treated in dental specialty centers, and patients with squamous cell carcinoma (SCC) were referred to tertiary health care facilities. The dentists' knowledge of PML and SCC was assessed by an objective questionnaire. A total of 3,965 individuals were examined, 296 lesions were found, and 73 biopsies were performed, of which 13.7% were diagnosed as PML and 9.6% as SCC. Tobacco use and sunlight exposure were associated with SCC (85.7%) and PML (80%), respectively. In total, 55 dentists were assessed. The lesions most commonly recognized as PML were leukoplakia (74%), erythroplakia (57%), and actinic cheilosis (56%). Most dentists (74%) felt incapable of performing biopsies, most likely because of an anxiety towards oral cancer, and 57% had never performed one. The integration of primary and secondary health care enables the diagnosis of PML and SCC and establishes a diagnosis network. However, the inability of most primary care dentists to identify PML and perform biopsies is a weakness of the diagnostic process.

Clinical aspects and conservative dental management of a patient with fibrodysplasia ossificans progressiva.

AIM: T o present the clinical findings of a patient with fibrodysplasia ossificans progressiva (FOP), highlighting peculiarities of dental treatment in patients with this condition. BACKGROUND: FOP is a rare genetic disease characterized by skeletal malformations and ectopic ossifications in skeletal muscles, tendons, ligaments and aponeurosis. Exacerbation of these ossifications can be caused by dental treatment, resulting in disease progression. CASE DESCRIPTION: A 26-year-old male patient with a diagnosis of FOP was referred to our service for dental treatment. The patient presented decreased mobility in peripheral joints (knees and elbows), postural disability (ankylosis of the vertebral column), lateral deviation and shortness of the hallux, as well as heterotopic ossifications on the hands and back. The implementation of conservative dental procedures, such as oral hygiene instructions and recurrent topical fluoride applications, were performed in addition to endodontic and restorative treatments. Brief dental appointments were conducted without using regional anesthesia or dental dam clamps. The dental chair was positioned at 45° to provide more comfort and to avoid exacerbating the disease. The patient has now completed 6 months of follow-up and is free of heterotopic ossifications resulting from dental treatment. CONCLUSION: The dental treatment modifications implemented for the present case were sufficient to establish good oral health and to prevent the formation of heterotopic ossifications in the maxillofacial region. CLINICAL SIGNIFICANCE: FOP is a rare disease dentists must familiarize themselves with to provide adequate, personalized treatment, which minimizes traumas that may exacerbate the disease.

Molecular analysis of oral bacteria in dental biofilm and atherosclerotic plaques of patients with vascular disease.

BACKGROUND: Oral bacteria have been detected in atherosclerotic plaques at a variable frequency; however, the connection between oral health and vascular and oral bacterial profiles of patients with vascular disease is not clearly established. The aim of this study was to evaluate the presence of oral bacterial DNA in the mouth and atherosclerotic plaques, in addition to assessing the patients' caries and periodontal disease history. METHODS: Thirty samples of supragingival and subgingival plaque, saliva and atherosclerotic plaques of 13 patients with carotid stenosis or aortic aneurysm were evaluated, through real-time polymerase chain reaction, for the presence of Streptococcus mutans (SM), Prevotella intermedia (PI), Porphyromonas gingivalis (PG) and Treponema denticola (TD). All patients were submitted to oral examination using the DMFT (decayed, missing and filled teeth) and PSR (Periodontal Screening and Recording) indexes. Histopathological analysis of the atherosclerotic plaques was performed. RESULTS: Most of the patients were edentulous (76.9%). SM, PI, PG and TD were detected in 100.0%, 92.0%, 15.3% and 30.7% of the oral samples, respectively. SM was the most prevalent targeted bacteria in atherosclerotic plaques, detected in 100% of the samples, followed by PI (7.1%). The vascular samples were negative for PG and TD. There was a statistically significant difference (p<0.05) between the presence of PG and TD in the oral cavity and vascular samples. CONCLUSION: SM was found at a high frequency in oral and vascular samples, even in edentulous patients, and its presence in atherosclerotic plaques suggests the possible involvement of this bacterium in the disease progression.

Clinic-pathological study and comparative analysis of orofacial lesions in a brazilian population of children and adolescents

Objective:To describe the sample of Maxillofacial Complex (MFC) Lesions observed in a Brazilian service diagnostic reference for such lesions, and comparatively analyse observed data across the national and international literature. Material and Methods:Aliterature review of survey of MFC Lesions in Children and Adolescentes was performed. The keywords used were “Oral, Pathology” and “Child”, and 18 articles were selected. Then, we surveyed the biopsy archives of the Department of Pathology and Legal Medicine and the Oral Pathology Laboratory of the Federal University of Ceará recorded from 1994 to 2010. The inclusion criterion was patients whose age fell within the range of 0-16 years old. Results:From a total of 4,775 histological results, 499 (10.4%) were selected.Most lesions were diagnosed in female patients, and the prevalence increased with age. Benign lesions represented 90.4% of those reported; some patients had mucocele and inflammatory lesions, and malignant lesions accounted for 1.8% of all lesions reported. These data, compared to the selected articles, showed little similarity between populations at the international level. Conclusion:the evaluated population had significant differences compared to the articles reviewed. The international level of distribution has little influence on this prevalence, which indicates the necessity for performing more local surveys to establish reliable epidemiological profiles

Dentists' protective measures against occupational and sexual exposure to hepatitis B virus / Perfil de proteção de cirurgiões-dentistas frente à transmissão ocupacional e sexual do vírus da Hepatite B

Objective: This study investigated the sexual and occupational exposure of dentists to hepatitis B virus. Methods: The study used a self-administered, structured, and anonymous questionnaire to collect data from 318 dentists who attended the International Congress of Dentistry held in 2009. The findings were tabulated and associations between variables were determined by the chi-square and Fisher-Freeman-Halton tests. Results: Most (84.9%) dentists used all the personal protective equipment. Roughly 68.0% had experienced percutaneous injuries but only 36.4% sought specialized care. An unimpressive 75.8% of the sample received the three doses of the hepatitis B vaccine, and a meager 27.0% was tested for hepatitis B surface antibodies (anti-HBs). Only 20.1% of the study dentists used condoms and those with more years of practice were less likely to use them (p=0.006). Conclusion: The results show that the study sample is at sexual and occupational risk of hepatitis B infection.

Objetivo: Comparar os riscos de transmissão sexual do Vírus da Hepatite B e o perfil de proteção profissional de cirurgiões-dentistas. Métodos: Questionário auto-aplicável, estruturado e anônimo foi respondido por 318 profissionais participantes de Congresso Internacional de Odontologia, em 2009. Os achados foram agrupados em tabelas, e a associação de variáveis foi feita por meio do teste qui-quadrado e teste de Fisher-Freeman-Halton. Resultados: Foi observado que 84,9% dos profissionais relataram utilizar todos os Equipamentos de Proteção Individual.Aproximadamente 68,0% já se feriram com instrumento pérfuro-cortante, mas apenas 36,4% procuraram serviço especializado. A prevalência de vacinação completa contra hepatite B foi 75,8%, todavia somente 27,0% realizaram o teste de conversão sorológica(anti-HBs). Quanto ao uso de preservativo, apenas 20,1% afirmaram ter utilizado esse insumo e o tempo de formado foi estatisticamente significante quando associado à menor frequência na utilização (p = 0,006).Conclusão: Os resultados revelaram possível vulnerabilidade dos dentistas para hepatite B nos âmbitos sexual e profissional.

Expression of S-100, EMA, CD34 and presence of mast cells in eight oral neurofibromas, and a review of 127 cases of the literature / Expressão de S-100, EMA, CD34 e presença de mastócitos em oito neurofibromas orais e revisão de 127 casos da literatura

INTRODUCTION: The rarity of oral neurofibromas (ONs) generates problems regarding their epidemiological and immunohistochemical characterization. OBJECTIVES: The aim of this study was to evaluate the expression of different markers in ONs and review epidemiologic data reported in the literature. MATERIAL AND METHODS: Clinicopathologic, immunohistochemical (markers S-100, epithelial membrane antigen [EMA], CD34) and histochemical (modified-Ziehl-Neelsen-method) studies were performed in eight cases of ON diagnosed in the Department of Pathology and Legal Medicine (DPML), Universidade Federal do Ceará (UFC), Ceará, Brazil, between 1994 and 2010. RESULTS: Oral neurofibromas represented 0.2% of the oral lesions diagnosed by our service in 16 years, and the buccal mucosa was the most frequent oral site (71.4%). Seven (87.5%) and 8 (100.0%) cases were positive for S-100 and CD34, respectively, and none for EMA. Mast cells were identified in seven cases (87.5%). The literature search indicated that solitary ONs are more common and occur preferentially in females, affecting patients between 30 and 40 years old. The alveolar ridge is the most commonly involved site. CONCLUSION: S-100- and CD34 markers proved to be of great value as a diagnostic tool, unlike EMA staining. Identification of mast cells in most cases suggests their involvement in this tumor pathogenesis. The clinicopathologic data retrieved from the literature enabled the establishment of a more consistent epidemiological profile.

INTRODUÇÃO: A rara ocorrência de neurofibromas orais (NO) gera problemas com relação à caracterização epidemiológica e imuno-histoquímica dessas lesões. OBJETIVOS: Avaliar a expressão celular de diferentes marcadores em NO e revisar dados epidemiológicos reportados na literatura. MATERIAL E MÉTODOS: Estudos clinicopatológico, imuno-histoquímico (marcadores S-100, epithelial membrane antigen [EMA] e CD-34) e histoquímico (método Ziehl-Neelsen modificado) foram realizados em oito casos de NO diagnosticados no Departamento de Patologia e Medicina Legal (DPML) da Universidade Federal do Ceará (UFC), Ceará, Brasil, entre 1994 e 2010. RESULTADOS: Os NO representaram 0,2% das lesões bucais diagnosticadas pelo serviço em 16 anos; mucosa jugal foi a localização mais frequente (71,4%); sete (87,5%) e oito (100%) casos apresentaram positividade para S-100 e CD-34, respectivamente, e nenhum para EMA. Adicionalmente, mastócitos foram identificados em sete casos (87,5%). A revisão de literatura indicou que NO solitários são mais comuns e ocorrem preferencialmente em mulheres, afetando pacientes entre 30 e 40 anos. O rebordo alveolar é a localização intraoral mais comum. CONCLUSÃO: Os marcadores S-100 e CD34 provaram ser de grande valor como ferramentas diagnósticas, diferente da coloração EMA. A identificação de mastócitos na maioria dos casos sugere seu envolvimento na patogênese desse tumor. Os dados clinicopatológicos da revisão de literatura ajudaram no estabelecimento de um perfil epidemiológico mais consistente.

Evaluation of oral diseases in a population of special needs patients / Avaliação das doenças orais em uma população de pacientes com necessidades especiais

Objective: To evaluate the oral health status of a population of patients with special needs cared for in the specialization course of the Brazilian Association of Dentistry, Ceará Branch. Methods: In this cross-sectional, descriptive study the indexes DMFT and CPI were used to evaluate dental caries and periodontal disease, respectively, from August 2009 through March 2010. The need for dental treatment and other soft tissue lesions were also investigated. Results: 88 patients selected by convenience sampling were examined intraorally, and the mean age was 43.8 ± 16. Most of the patients fell within the group of systemic diseases (68.1%), especially cardiovascular diseases (15.9%). The mean DMFT index was 17.54 ± 7.13, and 87.5% of patients presented active dental caries. According to the highest degree of periodontal condition observed in the individual, the dental tartar (index 2) was present in a greater number of patients (50.9%). Regarding the need for dental treatment, 68.1% of patients needed restorative treatment, 43.1% of patients needed surgery (extractions) and 21.5% of patients needed endodontic treatment. There were no soft-tissue abnormalities in most patients (89.7%). Conclusion: The examined patients showed a high prevalence of oral diseases such as dental caries and gingivitis/periodontitis, and therefore a great need for dental treatment. Given the results, it becomes important to stimulate dental care and preventive practices focused on this segment of the population.

Objetivo: Avaliar a condição de saúde bucal de uma população de pacientes com necessidades especiais atendida no curso de especialização da Associação Brasileira de Odontologia, Seção Ceará.Métodos: Nesse estudo de natureza descritiva e transversal utilizou-se os índices CPO-D e IPC para avaliação das doenças cárie e periodontal, respectivamente, entre os meses de Agosto de 2009 e Março de 2010. Necessidades de tratamento dentário e outras lesões em tecidos moles orais também foram investigadas. Resultados: Realizaram-se exames bucais em 88 pacientes selecionados por conveniência, sendo a média de idade correspondente a 43,8 ± 16 anos. A maioria se enquadrava no grupo de doenças sistêmicas (68,1%), destacando-se as diseases cardiovasculares (15,9%). O índice CPO-D médio foi 17,54 ± 7,13, com 87,5% dos pacientes apresentando cárie ativa. Segundo o maior grau de condição periodontal observado no indivíduo, o cálculo dental (índice 2) foi o que esteve presente em um maior número de pacientes (50,9%). Quanto às necessidades de tratamento dental, 68,1% deles necessitaram de tratamento restaurador, 43,1% de tratamento cirúrgico (exodontias) e 21,5% de tratamento endodôntico. Não foram encontradas anormalidades em tecido mole na maioria dos pacientes (89,7%). Conclusão: Os pacientes examinados possuíam alta prevalência de doenças orais, como cárie e gengivite/periodontite e, conseqüentemente, grande necessidade de tratamento odontológico. Diante dos resultados, torna-se importante motivar a atenção odontológica e as práticas preventivas voltadas para essa parcela da população.

Clinical, histological, and immunohistochemical features of a mandibular metastasis from a primary cardiac angiosarcoma.

Primary cardiac angiosarcoma is an extremely rare malignant tumor. Distant metastases are common at the time of diagnosis but have never been reported in the jaw. A 45-year-old female patient with primary cardiac angiosarcoma was referred for dental care due to pain in the mandibular alveolar ridge. Oral examination revealed a red-violet lesion that was soft on palpation and had been present for 3 months. Histological analysis confirmed the diagnosis of metastatic cardiac angiosarcoma. The patient died of multiple metastases.

Odontologia e doenças sexualmente transmissíveis: qual o maior risco de infecção entre cirurgiões dentistas, sexo ou acidente ocupacional? / Dentistry and sexually transmitted diseases: what is the greatest risk of infection among dentists, sex or occupational accident?

Objetivo - Avaliar atitudes e práticas de cirurgiões-dentistas frente às infecções HIV/Aids eHepatite B, estabelecendo uma correlação entre riscos de transmissão ocupacional e sexual dedoenças infecciosas. Métodos - 318 cirurgiões-dentistas (CDs) responderam a questionáriosautoaplicáveis e anônimos, abordando atitudes frente ao risco ocupacional e práticas sexuais,durante o III Congresso Internacional de Odontologia, realizado em 2009. Análise estatísticadescritiva simples foi realizada. Resultados - Respectivamente, 32,0% e 26,8% relataram nãose sentir seguros em atender pacientes vivendo com HIV/Aids e o VHB (Vírus da HepatiteB), o que atribuíram ao medo de infecção ocupacional. Aproximadamente 69% dos CDs jáse feriram com instrumentos perfurocortantes, no entanto apenas 24,8% procuraram algumserviço especializado. Em se tratando de atitudes frente às práticas sexuais, 20,1% utilizarampreservativo em todas as relações sexuais e 60,3% nunca utilizaram ou utilizaram apenas algumasvezes. Conclusões - 0O0 alto índice de acidentes ocupacionais reportados e a insegurançafrente ao atendimento de pacientes vivendo com HIV/Aids e VHB, quando relacionados como baixo percentual de utilização de preservativos em todas as relações sexuais revelaram umcontexto de vulnerabilidade desfavorável para os CDs pesquisados

Objective - To evaluate attitudes and practices by dentists toward patients with HIV/AIDS andhepatitis B, establishing a correlation between risks of occupational and sexual transmission ofdiseases. Methods - 318 dentists answered to self-administered and anonymous questionnairesabout attitudes toward occupational risks and sexual practices, in the III International Congressof Odontology, held in 2009. Descriptive statistical analyses were held. Results - Respectively,32,0% and 26,8% reported feeling insecure to treat patients living with HIV/AIDS and theHBV (Hepatitis B Virus), which was attributed to fear of acquiring occupational infection.Approximately 69% of the dentists suffered percutaneous injury, however only 24,8% soughtspecialized services for treatment. In regards the attitudes toward sexual practices, 20,1% usedcondoms in all sexual relations and 60,3% never used or used only a few times. Conclusions- The high index of percutaneous injury reported and the insecurity toward treating patientsliving with HIV/AIDS and HBV, when related with the low percentage of use of condoms inall sexual relations, reveled a context of unfavorable vulnerability of the dentists researched