Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy.

BACKGROUND: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. MATERIAL AND METHODS: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. STUDY DESIGN: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. RESULTS: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). CONCLUSIONS: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality.

Severity of malocclusion in patients with cerebral palsy: determinant factors.

INTRODUCTION: Our aims in this study were to compare the biopsychosocial aspects of patients with cerebral palsy and subjects in a control group, establish the severity of malocclusion, and identify determinant factors. METHODS: The group with cerebral palsy included 60 patients diagnosed with the spastic form of the disease. The control group included 60 randomly selected healthy subjects with various malocclusions. Data were collected through questionnaires, medical charts, and clinical evaluations. The criteria of the dental aesthetic index were used for the diagnosis of malocclusion. Comparisons between groups and between the independent variables and dependent variable (severity of malocclusion) were performed by using the chi-square test (P ≤ 0.05) and multivariate logistic regression (forward stepwise procedure). RESULTS: Significant differences between the groups were found for these variables: tooth loss, overjet, anterior open bite, facial type, breathing pattern, drooling, difficulty in swallowing, and lip incompetence. CONCLUSIONS: The main risk factors associated with the severity of malocclusion were cerebral palsy, mouth breathing, lip incompetence, and long face.

Intoxicação por diclorvós e cipermetrina em bovinos em Mato Grosso - Relato de caso / Dichlorvos and cypermethrin poisoning in bovine in Mato Grosso State/Brazil - Case report

Relata-se um surto de intoxicação por inseticida organofosforado e piretroide em vacas leiteiras no município de Cuiabá, Estado de Mato Grosso. Morreram onze vacas, de um total de 25 animais. Entre as principais manifestações clínicas observaram-se apatia, anorexia, sialorreia, diarreia de coloração escurecida, por vezes com estrias de sangue, tremores musculares, incoordenação e dificuldade respiratória. As lesões observadas à necropsia consistiram em edema pulmonar, enfisema subpleural e hemorragias de intensidade e formas diversas em vários órgãos. Não foram observadas alterações microscópicas significativas em nenhum dos animais. A pesquisa toxicológica em conteúdos de rúmen, retículo, omaso e abomaso resultaram negativas. Amostras de fígados e rins resultaram positivas para o grupo de inseticidas organofosforados e piretroides.(AU)

An outbreak of organophosphorus and pyrethroid insecticide poisoning in cows in the city of Cuiabá, Mato Grosso, is described. Eleven from 25 animals died. The main manifestations included diarrhea, sometimes bloody, apathy, anorexia, sialorrhea, muscular trembles, incoordenation and dyspnea. At post-mortem examinations, lung edema, sub pleural emphysema and hemorrhages disturbances of varied forms and intensity in several organs were observed. There were no significant microscopic changes in any animal. Analyses for organophosphorus and pyrethroid insecticide derivates from rumen, reticulum, omasum and abomasum contents were negative. Samples of livers and kidneys resulted positive for dichlorvos and cypermethrin.(AU)

Intoxicação por diclorvós e cipermetrina em bovinos em Mato Grosso - Relato de caso / Dichlorvos and cypermethrin poisoning in bovine in Mato Grosso State/Brazil - Case report

Relata-se um surto de intoxicação por inseticida organofosforado e piretroide em vacas leiteiras no município de Cuiabá, Estado de Mato Grosso. Morreram onze vacas, de um total de 25 animais. Entre as principais manifestações clínicas observaram-se apatia, anorexia, sialorreia, diarreia de coloração escurecida, por vezes com estrias de sangue, tremores musculares, incoordenação e dificuldade respiratória. As lesões observadas à necropsia consistiram em edema pulmonar, enfisema subpleural e hemorragias de intensidade e formas diversas em vários órgãos. Não foram observadas alterações microscópicas significativas em nenhum dos animais. A pesquisa toxicológica em conteúdos de rúmen, retículo, omaso e abomaso resultaram negativas. Amostras de fígados e rins resultaram positivas para o grupo de inseticidas organofosforados e piretroides.

An outbreak of organophosphorus and pyrethroid insecticide poisoning in cows in the city of Cuiabá, Mato Grosso, is described. Eleven from 25 animals died. The main manifestations included diarrhea, sometimes bloody, apathy, anorexia, sialorrhea, muscular trembles, incoordenation and dyspnea. At post-mortem examinations, lung edema, sub pleural emphysema and hemorrhages disturbances of varied forms and intensity in several organs were observed. There were no significant microscopic changes in any animal. Analyses for organophosphorus and pyrethroid insecticide derivates from rumen, reticulum, omasum and abomasum contents were negative. Samples of livers and kidneys resulted positive for dichlorvos and cypermethrin.

Is silent aspiration a risk factor for respiratory infection in Parkinson's disease patients?

OBJECTIVE: To assess if silent aspiration is a risk factor for respiratory infection in patients with Parkinson's disease (PD). METHOD: From February 2006 to June 2006, 19 PD patients with diurnal sialorrhea were evaluated by swallow videofluoroscopy (VF). Two patients moved away and contact with them was lost. The other patients were divided into two groups according to the presence or absence of penetration/aspiration and were followed up for 1 year. During this period, patients were assessed for airway infections, hospital admissions, weight loss, use of nasoenteral or gastric tube and to detect cases of death. RESULTS: Silent laryngeal penetration or silent aspiration (SLP/SA) was observed in four patients. During the follow up period, three of the four patients with SLP/SA developed respiratory infection, and one of the 13 patients who did not show SLP/SA had airway infection (RR=9.75, 95% CI: 1.36-69.65). Two patients with SLP/SA developed airway infection and died, and there were two deaths in the group who had not been diagnosed for SLP/SA, one due to cardiac arrest and the other related to pancreatic cancer. CONCLUSION: The results suggest that patients with Parkinson's disease with diurnal sialorrhea and SLP/SA have an increased risk of respiratory infections, which is the main cause of death in PD patients. The data support a greater emphasis on preventive interventions for silent aspirations and silent penetration to improve survival in patients with Parkinson's disease.

Silent aspiration in Parkinson's disease patients with diurnal sialorrhea.

OBJECTIVE: We studied the frequency of silent laryngeal penetration or silent aspiration (SLP/SA) in Parkinson's disease (PD) patients with diurnal sialorrhea. PATIENTS AND METHODS: In 19 consecutive PD patients with diurnal sialorrhea, swallow was evaluated using the videofluoroscopy analysis. Data were analysed to determine the frequency of aspiration and its relationship with the severity of sialorrhea. RESULTS: All patients were classified in the Hoehn and Yahr stages between 2 and 5. SLP/SA was observed in 21% of patients and the score of sialorrhea in the group with SLP/SA was 8.0+/-0.81, while in the group with no SLP/SA was 6.46+/-1.06 (p=0.02). CONCLUSION: SLP/SA is a frequent morbidity in PD patients, its risk is higher in later stages of disease and in those patients with severe sialorrhea. However, prospective and controlled studies of follow up will be necessary to determine the prognosis and management in this group of patients.

[Treatment of sialorrhoea in neurological diseases with trans-dermic injections of botulinum toxin type A in the parotid glands]. / Tratamiento de la sialorrea en enfermedades neurológicas mediante inyecciones transcutáneas de toxina botulínica A en las glándulas parótidas.

INTRODUCTION: Sialorrhoea is a disabling problem in many patients affected by neurological disorders. Anticholinergic drugs often produce side effects in these patients. Botulinum toxin A (TBA) blocks liberation of acetil-choline in motor and autonomic nerve terminals. METHODS: We report preliminary data about three patients, affected by motor neuron disease, Parkinson's disease and pons infarction respectively. All of them underwent treatment with TBA in both parotid glands to treat sialorrhoea, and were prospectively evaluated. Severity and Frequency Sialorrhoea Scale was used pre-treatment and at 6 weeks. TBA was administered in two points in each gland; a new injection was done at 2 weeks, with a dose ranging between 10 and 20 units in each point. RESULTS: Three males, with a men age of 63.6 years are reported. Sialorrhoea pre-treatment severity score was 5 while pre-treatment frequency score was 4 (continuous sialorrhoea all the days). Six weeks after TBA injection, two patients scored 2 in severity and frequency (mild sialorrhoea) and third patient had a score of 3 (moderate sialorrhoea). Side effects were observed neither after TBA injections nor at 6 week follow-up. CONCLUSIONS: Trans-dermic injection of TBA is safe and effective technique to treat sialorrhoea in neurological diseases when used by neurologists with experience, with few side effects.