Influence of the radius of Monson's sphere and excursive occlusal contacts on masticatory function of dentate subjects.

OBJECTIVE: To determine the influence of the radius of Monson's sphere, the number of posterior laterotrusive, mediotrusive, and protrusive contacts, and the chewing rate on food comminution. DESIGN: Sixty healthy dentate subjects, aged 21.22 ± 2.30 years, were selected. The three-dimensional coordinates of the cusp tips of the lower canine, premolar, and molar teeth were identified from the subjects' digital models. Monson's sphere was designed using the simplex method for function minimisation by adjusting the coordinates on its surface. The contacts were verified using 12 µm metal strips in jaw excursions at 0.5, 1.0, 2.0, and 3.0 mm. The masticatory performance and efficiency, swallowing threshold, and chewing rate were assessed through particle size fractionation. Data were analysed with multiple linear regression (α = 0.05). RESULTS: The sphere's radius, laterotrusive and protrusive contacts at 0.5 mm, and chewing rate were found to be negative predictor variables for masticatory performance until 20 chewing cycles (R2 = 0.429). For 40 cycles, the radius and total contacts (0.5 mm) were also explanatory factors (R2 = 0.223). Only the radius (R2 = 0.176) and the chewing rate (R2 = 0.082) were found to be significant for 60 cycles and swallowing threshold, respectively. Masticatory efficiency was influenced by masticatory performance until 40 and 60 cycles, as well as the radius and total contacts at 2.0 and 3.0 mm (R2 = 0.958). CONCLUSION: A larger radius of Monson's sphere and a greater number of posterior excursive contacts were found to be related to better masticatory function.

Dental management in the Intensive Care Unit in the treatment of toxic epidermal necrolysis associated with phenytoin: case report / Manejo odontológico na Unidade de Terapia Intensiva no tratamento da necrólise epidérmica tóxica associada a fenitoína: relato de caso

ABSTRACT Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reactions, usually medicine-related, in which extensive and painful mucocutaneous lesions are formed. Oral lesions are characterized by the presence of erosions and ulcers. The treatment usually requires intensive care in a hospital setting, where the Dentist is essential in the multidisciplinary team, as he will act in the treatment of oral lesions. In this article, a 26-year-old female patient was reported, who presented TEN-compatible mucocutaneous lesions associated with the drug Phenytoin and required admission to a Teaching Hospital. The treatment consisted of the immediate suspension of the Phenytoin use and systemic therapy with corticosteroids and immunosuppressants. Oral lesions were monitored by the hospital dentistry team. The procedures adopted were: oral hygiene with 0.12% non-alcoholic Chlorhexidine Digluconate solution, hydration of the oral tissue with an essential fatty acid, application of frozen chamomile tea, and prescription of topical Triamcinolone Acetonide. Also, low-level laser therapy sessions (red and infrared) were performed. Oral lesions evolved with significant improvement. In this case, the importance of the Dentist in the multi-professional team is demonstrated. Although there is no protocol, the procedures used in the present case can be an alternative to therapies used in SSJ and TEN oral lesions.

RESUMO A Síndrome de Stevens Johnson (SSJ) e a Necrólise Epidérmica Tóxica (NET) são reações adversas, geralmente medicamentosas. Na pele, formam-se máculas que se tornam pápulas, vesículas e bolhas, além de eritema extenso e desprendimento da epiderme. As lesões bucais caracterizam-se pela presença de erosões e úlceras dolorosas. O tratamento geralmente é realizado em âmbito hospitalar, com necessidade de cuidados intensivos, onde o Cirurgião-dentista é fundamental na equipe multiprofissional, pois atuará na terapêutica das lesões bucais. Neste artigo foi relatado o caso de uma paciente do sexo feminino, de 26 anos, a qual apresentou lesões mucocutâneas compatíveis com NET associadas ao medicamento Fenitoína e necessitou de internamento em um Hospital Universitário. O tratamento realizado foi a suspensão imediata do fármaco desencadeador, além de terapia sistêmica com corticóide e imunossupressor. As lesões bucais foram acompanhadas pela equipe de odontologia hospitalar. As condutas adotadas foram: higiene bucal com solução de Digluconato de Clorexidina 0,12% não alcoólica, hidratação da mucosa bucal com Ácido Graxo Essencial, aplicação de raspas de chá de gelo de camomila e prescrição de Triancinolona Acetonida tópica. Além disso, foram realizadas sessões de laserterapia de baixa intensidade (vermelho e infravermelho). As lesões bucais evoluíram com melhora significativa. A paciente permaneceu internada durante 22 dias, sendo 12 em Unidade de Terapia Intensiva. Este caso demonstra a importância do Cirurgião-dentista na equipe multiprofissional. Apesar de não haver um protocolo para as lesões bucais, as condutas utilizadas no presente caso podem ser uma alternativa de terapêuticas utilizadas em lesões de SSJ e NET.