Teledentistry System in Dental Health Public Services: A Mixed-Methods Intervention Study.

INTRODUCTION: Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective. OBJECTIVE: To analyze the factors that affect the implementation of a Teledentistry system in dental health public services. METHODS: The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design-sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues. RESULTS: In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers' political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry's better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists CONCLUSION: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.

Cyclosporine A - Induced gingival overgrowth and proliferating cell nuclear antigen expression in experimental periodontitis.

The most important microscopic characteristic of Cyclosporine A-induced gingival overgrowth is fibroepithelial hyperplasia. OBJECTIVE: The objective was to investigate the influence of previous exposure to Cyclosporine A over gingival epithelium in experimental periodontitis in rats. METHODS: Twenty Wistar rats with 12 weeks-old were divided into four groups with 5 animals each: Control Group (CG); Cyclosporine Group (CsAG); Ligature group (LG) and Cyclosporine and Ligature Group (CsALG). Daily doses of CsA (10 mg/kg) were applied to CsAG and CsALG during 60 days since the beginning of the experiment and, a ligature was placed in LG and CsALG 30 days after the beginning of the experiment. After 60 days, animals were euthanized and gingival tissue was processed to histomorphometric analysis of epithelial thickness (mm2), immunohistochemical expression of PCNA (%) and inflammatory response. Data were analyzed by Kruskal-Wallis and Mann Whitney at 0.05 significance level. RESULTS: Considering epithelial thickness, CG was thinner than all groups, CsALG was the largest and CsAG and LG were similar between each other. Regarding the PCNA expression CG (16.46 ± 9.26) was similar to CsAG (34.47 ± 19.75) and, LG (59.02 ± 10.33) was similar to CsALG (40.59 ± 18.25). Significant difference (p < 0.05) occurred only in inflammation presence comparing CG/LG and CsAG/CsALG. A weak positive correlation between the number of PCNA+ and inflammatory cells (p = 0.001; r = 0.611) was observed. CONCLUSION: Based on these results it was concluded that the enlargement of gingival epithelium observed in experimental periodontitis can be increased by previous exposition to CsA and inflammatory conditions enhanced proliferative activity of the keratinocytes.

Denosumab Related Osteonecrosis of Jaw: a Case Report.

BACKGROUND: This case report shows an affected postmenopausal patient with medicaments related osteonecrosis of the jaw injury associated with increased use of bisphosphonates and Prolia® (denosumab) for the treatment of osteoporosis. The mechanism of action of the receptor activates the denosumab of the nuclear-kB factor binding and makes nuclear-kB Factor, reducing bone volume and reabsorption in the trabecular and cortical bones and, consequently, decreasing an incidence of fractures and maintaining a bone formation. The bone physiology regulated by the hormones calcitonin, parathormone and vitamin D also undergoes interference. METHODS: The injury was located around a dental implant in region #24 and #25 and the patient complained of pain, bleeding, oedema, and halitosis for more than two months, that the dental implant had been installed five years before. According to the clinical findings, the patient presented the exposed and necrotic bone in the region of #24 and #25 and with the radiographs found, it was observed as extensive bone destruction adjacent to the dental implant. RESULTS: Patient was referred to the maxillofacial surgeon that performed the removal of bone sequestration and dental implant in the region affected. After that, the patient has been accompanied for a year. CONCLUSIONS: Patients taking medications for osteoporosis or cancer need to receive special attention from the dentist. Invasive procedures on the jaw bone of patients taking these medications may cause osteonecrosis of the jaw. When diagnosed, osteonecrosis of the jaw should be treated surgically in conjunction with antibiotic therapy and patients should be monitored.

Previous exposure to Cyclosporine A and periodontal breakdown in rats.

OBJECTIVE: The aim of this study was to evaluate the influence of previous exposure to Cyclosporine A (CsA) on experimental periodontitis in rats. DESIGN: Forty rats were divided into 4 groups: Control (CON); Cyclosporine A (CsA), which received daily doses of 10mg/kg CsA; Ligature (LIG), which received an insertion of a cotton ligature around the mandibular 1st molar at day 30; and Ligature and CsA (CsAL), which were treated with CsA and the cotton ligature. At day 60 of the experiment, animals were sacrificed, and groups were compared with regards to Alkaline Phosphatase (AP) activity, gingival overgrowth, periodontal bone support (PBS), bone resorption at furcation ligament area (LA) and TRAP+ cells. Data were analyzed by ANOVA/Tukey and Kruskal-Wallis and were considered to be statistically significant at 5% level. RESULTS: CsA and LIG groups showed similar gingival area, which was higher than that in the CON and lower than in the CsAL group (p=0.001). The ratio between epithelial area and connective area for the CON group was similar to the CsA group and higher than that for the CsAL and LIG groups (p=0.0334). Mean percentage of PBS for the CON group was similar to that for the CsAL group and higher than that of the CsA and LIG groups (p=0.0007). No difference was observed regarding AP (p=0.2806) and TRAP+ cells (p=0.3995) among experimental groups. Mean values for LA of CON were similar to CsA, and both were statistically lower than the CsAL and LIG groups (p=0.0172). CONCLUSION: Based on these results, we posit that previous exposure to CsA may influence gingival overgrowth, but not bone loss, in rats with experimental periodontitis.