Manejo odontológico de una paciente con síndrome de Apert / Dental management of a patient with Apert syndrome

El síndrome de Apert, marcado por la acrocéfalo-sindactilia, es una condición genética que genera deformidades dentofaciales incluyendo craneosinostosis, alteraciones faciales y malformaciones en extremidades. La mutación en el gen FGFR2, ya sea heredada o resultante de mutaciones esporádicas, desencadena esta compleja condición. La relevancia de abordar el síndrome de Apert se manifiesta no sólo en las implicaciones estéticas, sino también en su impacto en la salud oral. Romper con los paradigmas odontológicos actuales implica reconocer las particularidades de estos pacientes y proporcionar una atención especializada. La necesidad de una capacitación específica para los profesionales de la salud oral es evidente, permitiendo un enfoque integral que aborde la prevención y el tratamiento de las malformaciones craneofaciales asociadas. Superar los desafíos tradicionales implica adoptar una perspectiva inclusiva y personalizada en la atención odontológica. Esto no sólo mejora la calidad de vida de los pacientes con síndrome de Apert, sino que también destaca la importancia de una atención adaptada que trascienda los límites convencionales, ofreciendo soluciones innovadoras para las complejidades bucodentales asociadas a esta condición genética (AU)

Apert syndrome, marked by acrocephalosyndactyly, is a genetic condition that generates dentofacial deformities, including craniosynostosis, facial alterations and limb malformations. Mutation in the FGFR2 gene, whether inherited or resulting from sporadic mutations, triggers this complex condition. The relevance of addressing Apert syndrome is manifested not only in the aesthetic implications, but also in its impact on oral health. Breaking with current dental paradigms involves recognizing the particularities of these patients and providing specialized care. The need for specific training for dental health professionals is evident, allowing a comprehensive approach that addresses the prevention and treatment of associated craniofacial malformations. Overcoming traditional challenges means taking an inclusive and personalized perspective on dental care. This not only improves the quality of life of patients with Apert syndrome, but also highlights the importance of tailored care that transcends conventional boundaries, offering innovative solutions for the oral complexities associated with this genetic conditio (AU)

Oral findings and comprehensive dental management of Moebius syndrome: a systematic review.

BACKGROUND: Moebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management. METHODS: A digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate. RESULTS: Twenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%). CONCLUSIONS: This systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.

Manejo odontológico de pacientes com hemofilia: revisão de literatura narrativa / Dental management of patients with hemophilia: narrative literature review

Objetivo: Apresentar aos profissionais de Odontologia, através de uma revisão de literatura narrativa, o manejo odontológico dos pacientes com hemofilia. Materiais e métodos: Foi realizada uma busca por artigos científicos em português e inglês, publicados nas bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (Pubmed) e ScienceDirect, datado entre os anos de 2007 a 2023. Para a busca, foram utilizados os descritores contidos na lista dos Descritores em Ciência da Saúde (DeCS), no idioma português: Transtornos da Coagulação Sanguínea, Transtornos Herdados da Coagulação Sanguínea e Hemofilia; e no idioma inglês: Blood Coagulation Disorders, Inherited Blood Coagulation Disorders e Hemophilia. Resultados: Nessa revisão, apresentamos o manejo odontológico dos pacientes hemofílicos, bem como as condutas adequadas nos principais procedimentos em que esses pacientes são submetidos. Conclusão: Os pacientes hemofílicos podem ser submetidos a qualquer procedimento odontológico, desde que o profissional tenha conhecimento necessário sobre a patologia e as condutas a serem tomadas. Para maior segurança e conforto do paciente e da equipe profissional, o tratamento deve ser bem-planejado pelo cirurgião-dentista e com apoio do médico hematologista.

Objective: To present to dental professionals, through a narrative literature review, the dental management of patients with hemophilia. Materials and methods: A search was carried out for scientific articles in Portuguese and English, published in the Scientific Electronic Library Online (SciELO), US National Library of Medicine (Pubmed) and ScienceDirect databases, dated between 2007 and 2023. the search used the descriptors contained in the list of Health Science Descriptors (DeCS), in Portuguese: Blood Coagulation Disorders, Inherited Blood Coagulation Disorders and Hemophilia; and in the English language: Blood Coagulation Disorders, Inherited Blood Coagulation Disorders and Hemophilia. Results: In this review, we present the dental management of hemophiliac patients, as well as the appropriate conducts in the main procedures in which these patients are submitted. Conclusion: Hemophiliac patients can undergo any dental procedure, as long as the professional has the necessary knowledge about the pathology and the actions to be taken. For greater safety and comfort of the patient and the professional team, the treatment must be well-planned by the dentist and with the support of the hematologist.

Brazilian dental consensus on dental management in hematopoietic stem cell transplantation− Part I− pre-HSCT

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

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)

Manejo odontológico de pacientes con el síndrome de Ehlers-Danlos. Revisión narrativa / Dental management in patients with Ehlers-Danlos syndrome. Narrative review

Resumen El síndrome de Ehlers-Danlos es una enfermedad hereditaria, 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 enzimas encargadas de la estructura y síntesis de colágeno. En vista de los 20 tipos de colágeno que existen, este síndrome es extremadamente heterogéneo tanto en su presentación clínica como en su progresión y evolución. Dentro de los signos y síntomas habituales encontramos la hiperlaxitud articular, hiperelasticidad de la piel e hiperequimosis de los vasos sanguíneos. Con relación a las complicaciones que pueden presentar estos pacientes, encontramos dislocaciones articulares, fragilidad en la piel, dolor articular, ruptura de grandes vasos sanguíneos, dificultad en la cicatrización y, en consecuencia, mayor incidencia de procesos infecciosos y de cicatrices poco estéticas. Presenta una incidencia de 1 caso cada 2.500-5.000 nacidos 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 tratamiento adecuado y responder ante las posibles complicaciones que se pueden presentar. En esta revisión se emplearon resultados extraídos manualmente 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.

Abstract 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 synthesis 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 present, 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 respond to possible complications that may arise. In this review, results were manually extracted from articles, 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-Danlos syndrome to date.

Brazilian dental consensus on dental management in hematopoietic stem cell transplantation - Part I - pre-HSCT.

The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

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)

Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Protocolo de profilaxis antibiótica para pacientes dentales en riesgo de infección / Antibiotic prophylaxis protocol for dental patients at risk of infection

La profilaxis antibiótica involucra el uso de fármacos en una etapa preoperatoria de atención odontológica, con la finalidad específica de contribuir a la prevención de infecciones sistémicas como la endocarditis infecciosa (EI) asociada a bacteriemias transitorias por procedimientos odontológicos que implican sangrado en pacientes con alto riesgo de complicación por su condición sistémica cardiaca o no cardiaca. Esta complicación potencial inflama el revestimiento interno de las válvulas cardiacas, por proliferación de microorganismos específicos, y aunque es infrecuente es responsable de una elevada tasa de morbilidad y mortalidad. En el año 2007, la Asociación Estadounidense del Corazón (AHA), publica la última actualización vigente en la literatura sobre las recomendaciones y directrices aplicadas para el uso de profilaxis antibiótica. El objetivo de esta revisión pretende desarrollar una síntesis de evidencia existente seguida de un balance honesto de los riesgos y beneficios de forma individual sobre el uso de este protocolo. Se realizó una búsqueda digital integral en idioma español e inglés sobre los protocolos de profilaxis antibiótica en pacientes con riesgo de infección. Se incluyeron bases de datos como: MEDLINE, PUBMED y SciELO, adicionalmente se tomaron como referentes de partida las recomendaciones de la AHA. Se concluye con gran énfasis y soporte de la literatura actual, que los beneficios del uso de profilaxis antibiótica en un momento preoperatorio superan los posibles riesgos de resistencia bacteriana y anafilaxia, por lo que son totalmente justificables y requeridos para los pacientes adultos y niños inmunológicamente comprometidos.

Antibiotic prophylaxis involves the use of drugs at a preoperative stage of dental care, with a specific aim of contributing to the prevention of systemic infections such as infectious endocarditis (IE) associated with transient bacteremia due to dental procedures that involve bleeding in patients at high risk of complication due to their non-cardiac or cardiac systemic condition. This potential complication inflames the inner lining of the heart valves, due to the proliferation of specific microorganisms, and although it is uncommon, it is responsible for a high rate of morbidity and mortality. In 2007, the American Heart Association (AHA) published the last current update in the literature on the recommendations and guidelines applied for the use of antibiotic prophylaxis. The aim of this review is to develop a synthesis of existing evidence followed by an honest assessment of the risks and benefits individually on the use of this protocol. A comprehensive digital search was conducted in both Spanish and English on antibiotic prophylaxis protocols in patients at risk of infection. Databases such as MEDLINE, PUBMED, and SciELO were included, in addition the AHA recommendations were taken as baseline references. It is concluded with great emphasis and support from the current literature, that the benefits of the use of antibiotic prophylaxis in a preoperative moment overcome the possible risks of bacterial resistance and anaphylaxis, so they are fully justifiable and required for immunologically compromised adult and children patients.

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)

Manejo e integración estomatológica del paciente pediátrico con trastorno de Asperger / Management and dental integration of the pediatric patient with Asperger disorder

Trastorno neurológico enmarcado dentro de los trastornos de espectro autista (TEA) cuyas manifestaciones se reflejan en los ámbitos de la comunicación, interacción e imaginación social. Se clasifica en el manual diagnóstico y estadístico de trastornos mentales (DSM IV), se caracteriza por un mayor o menor grado de deterioro en las habilidades de lenguaje y comunicación, así como patrones repetitivos o restrictivos de pensamiento y comportamiento. El síntoma más distintivo es el interés obsesivo en un solo objeto o tema y la exclusión de cualquier otro pero siempre conservando habilidades de lenguaje. El pronóstico es bueno, debido a la compensación cognitiva, el enfoque repetitivo y restrictivo a actividades humanas productivas o generadoras de deferencias particulares, aunque no hay tratamiento específico, sino más bien interdisciplinario e individualizado, éste consiste en manejar los síntomas conductuales y la comorbilidad de forma independiente ya sea farmacológica o intervencionista. Paciente masculino de cinco años de edad, con un peso de 26 kg, cuadro de inmunizaciones completas, previamente diagnosticado con trastorno de Asperger (2015); caries dental de diversos grados, manejo estomatológico para su rehabilitación. El objetivo de este reporte es dar a conocer los cuidados para el tratamiento dental en pacientes con este trastorno (AU)

Neurological disorder known as autism spectrum disorders (ASD) whose main manifestations are reflected in the areas of communication, interaction and social imagination. It was first classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM lV), characterized by a greater or lesser degree of deterioration in language and communication skills, as well as repetitive patterns or restrictive of thought and behavior. The most distinctive symptom is obsessive interest in a single object or topic and the exclusion of any other, but always retaining language skills. The prognosis is good in most of the cases, due to the cognitive compensation, the repetitive and restrictive approach to productive or deferential human activities, although there is no specific treatment, but rather interdisciplinary and individualized, this consists of managing behavioral symptoms and comorbidity independently either pharmacologically or interventionally. Male patient with five years old and weight of 26 kg, complete immunization chart, previously diagnosed with Asperger's disorder (2015); with dental caries of various degrees implementing dental management. The objective of this report is to make aware of the care and behavior management for dental treatment in patients with this Disorder (AU)

Evaluation of Dental Practices Changes During the COVID-19 Pandemic in Brazil.

Dentists are healthcare professionals who are at high risk of infection and transmission of the coronavirus disease-19 (COVID-19). The primary objective of the present study was to evaluate the changes in clinical practice made by Brazilian dentists during the COVID-19 pandemic. From June 22 to July 13, 2020, an online questionnaire was sent to dentists using Google Forms. After providing consent, 1,178 dentists answered questions regarding their knowledge and clinical experiences related to COVID-19. Data were analyzed using Chi-square, Fisher's exact, or Kruskal-Wallis tests, with a significance level of 5%. Brazilian dentists significantly changed their routine dental practices. Biosafety measures were added in their offices by 98% of the dentists, increasing operating costs for 88.3% of dentists. Greater discomfort due to the increase in personal protection equipment (PPE) worn during the pandemic was reported by 58.6%. Furthermore, 84.2% reduced heir hours of service. It was found that the dentists decreased their workload, used additional PPE, and took additional biosafety measures.

Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report / Manejo de un niño con trastorno de apego reactivo en el entorno clínico dental: Reporte de un caso

ABSTRACT Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child's developing brain. This disorder can significantly affect the pediatric patient's behavior in the dental setting. An uncooperative 9-year- old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist's guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient's oral health and general welfare.

RESUMEN: El trastorno de apego reactivo (RAD, por sus siglas en inglés) es una enfermedad de salud mental en la primera infancia caracterizada por interacciones sociales y capacidades de comunicación deterioradas y por déficits neurológicos en el cerebro en desarrollo del niño. Este trastorno puede afectar significativamente el comportamiento del paciente pediátrico en el entorno dental. Una niña mexicana de 9 años de edad, poco cooperadora, que residía en un hogar temporal, fue remitida a la Clínica de Odontología Pediátrica con su cuidadora, solicitando un examen y tratamiento dental. La paciente presentó un diagnóstico previo de RAD con discapacidad intelectual/ social. Con la orientación del Psiquiatra, se llevó a cabo una profilaxis oral exhaustiva en las citas iniciales, seguidas de diversos tratamientos de restauración bajo la aplicación continua de técnicas de manejo del comportamiento. Estos procedimientos de restauración incluyeron restauraciones de resina y selladores de fosas y fisuras, bajo anestesia local y aislamiento con dique de goma, en los primeros cuatro molares permanentes. Todo el tratamiento se completó en seis semanas. La paciente y su cuidadora recibieron estrategias educativas y motivacionales detalladas para mejorar la higiene oral y también recibieron asesoría nutricional. Para las revisiones de control y refuerzo de los hábitos preventivos, las citas posteriores se programaron cuidadosamente. Una colaboración pediátrica interdisciplinaria entre el dentista, la enfermera y el psiquiatra fue fundamental para mejorar la salud oral y el bienestar general del paciente.

El paciente hemofílico: consideraciones clínicas y moleculares de importancia para el odontólogo / Hemophilic patients: clinical and molecular considerations of interest to dentists

RESUMEN Introducción: La hemofilia es una enfermedad genética poco frecuente en la consulta odontológica. En algunas situaciones se presenta como una urgencia odonto-estomatológica, en la que el profesional debe relacionar las manifestaciones clínicas generales de la enfermedad, con una correcta semiología, paraclínicos y análisis genético-molecular, para diagnosticar y aplicar pertinentes terapéuticas dirigidas a resolver el motivo de consulta del paciente así como el manejo y control de sus complicaciones. Objetivo: Describir los principales aspectos fisiopatológicos generales y de importancia odontológica de la hemofilia, así como las herramientas diagnósticas desde el punto de vista clínico, paraclínico y genético-molecular. Métodos: Búsqueda bibliográfica en las bases de datos Pubmed, Proquest, Scielo y Elsevier, en idioma inglés y español, en las que se seleccionaron artículos publicados en un periodo de 13 años para un total de 50 (2005-2018), empleando los descriptores "hemophilia A, hemophilia B, diagnostic criteria, genetic, molecular, oral health, clinical diagnosis". Análisis e integración de la información: Los estudios han demostrado que la hemofilia, una condición genética y sistémica, tiene repercusiones bucales en el contexto de sus manifestaciones y complicaciones, lo que la hace importante para el odontólogo, debido a que debe ser diagnosticada desde el punto de vista genético-molecular y manejada interdisciplinariamente. Conclusiones: La implicación del diagnóstico genético-molecular por parte del genetista soporta la integración del hematólogo y el odontólogo para el manejo y control de la interconsulta cuando se trata de pautar procedimientos en pacientes con hemofilia(AU)

ABSTRACT Introduction: Hemophilia is a genetic disease scarcely found in dental practice. On occasion it presents as a dental emergency in face of which the professional should relate the general clinical manifestations of the disease to an appropriate semiological, paraclinical and genetic-molecular analysis to diagnose the condition and apply relevant therapies aimed at solving the patient's main concern as well as managing and controlling its complications. Objective: Describe the main general pathophysiological features and aspects of dental interest of hemophilia, as well as the diagnostic tools related to the condition from a clinical, paraclinical and genetic-molecular perspective. Methods: A bibliographic search was conducted in the databases Pubmed, Proquest, Scielo and Elsevier of papers published in English and Spanish in a period of 13 years (2005-2018), using the search terms "hemophilia A", "hemophilia B", "diagnostic criteria", "genetic", "molecular", "oral health", "clinical diagnosis". A total 50 papers were selected. Data analysis and integration: Studies have shown that hemophilia, a genetic systemic condition, may have oral manifestations and complications. This makes it important to dentists, since the disease should be diagnosed from a genetic-molecular point of view and managed in an interdisciplinary manner. Conclusions: Genetic-molecular diagnosis by geneticists implies involvement of hematologists and dentists in the management and control of the condition via interconsultation, when it comes to deciding on procedures for hemophilic patients(AU)

Supernumerary teeth in a patient with Turner syndrome: An unusual finding.

AIMS: Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X-chromosome, occurring in about 1 in 2000 to 1 in 3000 live-born girls. We present a case of a 14-year-old girl with TS, who was referred to our outpatient clinic in 2016 because of an ectopic eruption. METHODS AND RESULTS: Dental clinical examination and radiographic investigation revealed eight supernumerary teeth, short roots, enamel hypoplasia, increased overjet, rotation and displacement of teeth, moderate gingivitis and morphological alteration of the upper right central incisor. Dental treatment included extraction of erupted supernumerary teeth, composite resin restoration, supragingival scaling and oral hygiene for plaque control. CONCLUSIONS: The unpublished finding of supernumerary teeth in our patient has led us to suggest the investigation of this dental developmental anomaly in other patients with Turner syndrome.

Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case.

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Una mirada al manejo odontológico del paciente geriátrico con demencia / A review of dental management for geriatric patients with dementia

Resumen El envejecimiento poblacional, es una realidad que enfrentan la mayoría de países desarrollados y un reto que empiezan a plantearse los países en desarrollo. Tener una vida más larga, es un logro de la humanidad, pero es también una constante preocupación por las repercusiones demográficas, económicas, laborales, sanitarias y éticas que se plantean. Con los cambios asociados a la edad, la prevalencia de enfermedades crónicas, la polimedicación y la pérdida de autonomía, el objetivo es ahora procurar una vida en condiciones de calidad y bienestar. Dentro de las enfermedades comunes y asociadas a dependencia, en las poblaciones mayores están las demencias. Con las consecuencias que tiene, por el impacto físico, psicológico, social y económico, sobre la calidad de vida de los pacientes, familias y sus cuidadores. El odontólogo tiene un papel fundamental, dentro del equipo multidisciplinario que debe estar a cargo del cuidado y soporte de calidad de vida de éstos pacientes. Fue esa la motivación para realizar éste artículo, que tuvo como objetivo revisar las consideraciones de manejo y terapéutica odontológica, indicadas para cada etapa en la que evoluciona la demencia. Concluyendo que, involucrar al paciente en medidas preventivas tempranas es fundamental para facilitar el manejo y disminuir las complicaciones a medida que progresa la demencia; el adecuado manejo de la salud del paciente con demencia debe involucrar al círculo de cuidadores del paciente y la valoración de las intervenciones terapéuticas odontológicas deberán ser desde una mirada real, más que ideal, ajustada a cada caso individual.

Abstract Population aging is a reality faced by most developed countries and a challenge that developing countries are beginning to face. To have a longer life is an achievement of humanity, but it is also a constant concern for the demographic, economic, labor, health and ethical repercussions that arise. With the changes associated with age, prevalence of chronic diseases, polymedication and loss of autonomy, the aim is now to seek a life in conditions of quality and well-being. Within the common diseases and associated to dependence, in the populations majors are dementias. With the consequences it has, the physical, psychological, social and economic impact on the quality of life of patients, families and their caregivers. The dentist has a fundamental role, within the multidisciplinary team that must be in charge of the care and support of quality of life of these patients. This was the motivation to perform this article, which aimed to review the management and dental treatment considerations, indicated for each stage in which dementia evolves. Concluding that involving the patient in early preventive measures is essential to facilitate management and decrease complications as dementia progresses; The proper management of the health of the patient with dementia should involve the circle of caregivers of the patient and the assessment of therapeutic dental interventions should be from a real, rather than an ideal look adjusted to each individual case.

Carcinoma escamocelular de labio superior en paciente con síndrome nevoide basocelular. Reporte de caso clínico / Upper-Lip Squamous Cell Carcinoma in Patients with Nevoid Basal Cell Carcinoma Syndrome. A Clinical Case Report

Antecedentes: El síndrome de Gorlin-Goltz, o síndrome nevoide de células básales (SNCB), es un trastorno autosómico dominante de baja incidencia. Su etiología se relaciona con una mutación en el gen PTCH y afecta los sistemas esquelético, oftalmológico y neurológico. Su prevalencia es de 1:60.000 y las mutaciones de novo se presentan aproximadamente en un 20 % a 30 % de los casos. Objetivo: Describir el proceso diagnóstico y manejo de un caso de esporádica presentación de una paciente con SNCB con carcinoma escamocelular (CEC) en labio superior. Descripción del caso: Se trató de una mujer de 58 años, quien asistió a consulta odontológica por motivos estéticos y funcionales. Se encontró un CEC (confirmado por inmunohistoquímica) asintomático delimitado en el lado izquierdo del labio superior, con erosiones de color rojizo y costra. No se encontraron linfoadenopatías asociadas. También evidenció fisuras palmoplantares y múltiples carcinomas basocelulares en la espalda y el dorso de la mano izquierda (con antecedentes familiares similares). Radiográficamente, no se observaron queratoquistes mandibulares que usualmente se asocian con el síndrome de Gorlin-Goltz. Conclusiones: Se diagnosticó SNCB en la paciente, pues presentaba dos criterios mayores (dos o más CBC y piqueteado palmoplantar) y dos menores (calcificación laminar de la hoz del cerebro y antecedente de fibromas ováricos). El tratamiento odontológico se planeó y se remitió a la paciente a la institución pertinente para manejar su condición sistémica.

Background: Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder with low incidence. The etiology' is associated with a PTCH gene mutation and affects the skeletal, ophthalmic and neurological systems. The prevalence is 1:60,000 and de novo mutations occur approximately in 20% to 30% of the cases. Objective: To describe the diagnosis and management process for a rare case of a NBCCS patient who developed squamous cell carcinoma (SCC) in the upper lip. Case Description: The patient is a 58 year-old woman who attended to the dental office for aesthetic and functional reasons. An asymptomatic SCC was found (confirmed after immunohistochemical evidence) with defined limits to the left of the upper lip. It showed reddish erosions and some scab. No associated lymphadenopathies were found. The patient had some plantar foot fissures and multiple carcinoma basal cells in the back and in the left hand dorsum (with similar family previous cases). No maxillary keratocyst were observed in the radiographs, notwithstanding they are always associated with the Gorlin-Goltz syndrome. Conclusions: The patient was diagnosed with NBCCS based on two main criteria (two or more SCC lesions and plantar foot fissures) and two mild criteria (laminar calcification in the cerebral falx and family background of ovarian fibromas). A dental treatment was designed, and the patient was referred to another institution for a systemic treatment of her disease.

Manejo odontológico del paciente con parálisis cerebral infantil por medio de los sonidos binaurales

El objetivo más importante de la investigación fue demostrar la eficacia de los sonidos binaurales en la consulta dental como técnica actual para disminuir la ansiedad de los pacientes con parálisis cerebral infantil, así como comprobar que el entorno odontológico genera temor en los pacientes pediátricos. Por medio de un oxímetro de pulso, un aparato reproductor mp3 y auriculares, se logró cuantificar las pulsaciones cardíacas durante tres momentos a lo largo de la investigación. Se valoraron las historias médicas de cada uno de los niños del Hogar Divina Misericordia, así como los medicamentos que consumen diariamente y las enfermedades asociadas a la parálisis cerebral. Se observaron diversos tipos de reacciones al utilizar cada uno de los sonidos, desde el llanto y enojo hasta conseguir la tranquilidad y alegría en los pacientes. Finalmente los resultados revelan los beneficios y la veracidad de los sonidos binaurales mientras que, por el contrario, se expone a los sonidos del ambiente odontológico como un método distractor y desfavorable durante las visitas dentales.

The most important objective of the research was to demonstrate the efficiency of binaural beats in the dental consultant as a current technique to reduce anxiety in child patients with cerebral palsy, also prove that the dental environment generates fear in pediatric patients. To achieve quantify the heartbeats of the children during three different moments throughout the investigation, we used fingertip pulse oximeter, a mp3 player and headphones. We evaluate the medical histories of each children from Hogar Divina Misericordia, as well the medicines they consume daily and diseases related with cerebral palsy. We observed different types of reactions when using each of the sounds, some cried and got anger until they get relax and happy. Finally the results in this research show the benefits and the veracity of the binaural beats while on the contrary are expose to the sounds of the dental environment as a distracting and unfavorable method during dental visits.