L'activité odontologique hospitalière dans l'offre de soins en zone sous-dotée : exemple en Basse-Normandie.

INTRODUCTION: Demand for dental care in Basse-Normandie has been severely affected by the reduced availability of local services. One of the missions of hospital dental services is to respond to these difficulties in accessing care. PURPOSE OF THE RESEARCH: The objective of this study is to determine how hospital activity fits into the local dental care offer. To do this, we compared the activity of the dental service of the Caen hospital with that of private practices. RESULTS: The proportion of young patients, particularly those under fifteen, was greater at the university hospital than in private practice (20.9 percent vs 12.9 percent, p < 1.10 -5). The activity of private practices included a higher proportion of fixed prosthetic care and oral prophylaxis procedures, in contrast to surgical procedures, direct restorative care, and consultations, which account for a higher proportion of hospital activity (10 percent vs 22.5 percent, p < 1.10-5). CONCLUSIONS: The dental service at Caen hospital differs from private practices in Basse-Normandie in that its activity is oriented toward primary care or emergency care. This activity seems to reflect a high individual caries risk, probably associated with social vulnerability. The unit therefore seems to respond to a need for primary care.

Analysis of hospital dental care for patients with special needs in Brazil.

This analytical cross-sectional study aimed to analyze the access of patients with special needs (PSN) in Brazilian municipalities to hospital dental care of the Unified Health System (Sistema Único de Saúde - SUS), based on data from the Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do SUS- SIH/SUS - SIH), from 2010 to 2018. The Kolmogorov-Smirnov normality test was performed; the Poisson regression was used to verify factors associated with the variable total number of hospitalization authorizations with the main procedure of dental treatment for PSN ("Total de Autorizações de Internação Hospitalar" - AIH), the Spearman correlation test with a significance level of 5% was used to characterize the relationships between the Municipal Human Development Index per municipality - (Índice de Desenvolvimento Humano Municipal - HDI) and the Oral Health Coverage in the Family Health Strategy by municipality (Cobertura de saúde bucal na estratégia saúde da família por município - SBSF Coverage), and the relationship of the AIH with SBSF Coverage. A total of 127,691 procedures were performed, of which 71,517 (56%) were clinical procedures, such as restorations, endodontic treatments, supra and subgingival scaling, among others. Municipalities in the Midwest (PR=5.117) and Southeast (RP = 4.443) regions had more precedures than the others. A weak correlation was found between AIH and SBSF Coverage (r = -0.2, p < 0.001) and HDI and SBSF Coverage (r = -0.074, p < 0.001). Population size, region, health coverage, oral hygiene, and number of dentists in hospitals affected the availability of dental procedures in PSN.

Enfermedad de Caffey después del primer año de vida: caso clínico / Caffey disease after the first year of life: clinical case

Objetivo: La enfermedad de Caffey o hiperostosis cor- tical infantil es una enfermedad rara que afecta uno o más huesos en los primeros meses de vida y debido a su baja inci- dencia está subdiagnosticada, y por tanto se aplican procedi- mientos invasivos innecesarios en su estudio y tratamiento. Se presenta un caso clínico atípico de enfermedad de Caffey en una paciente mayor de 1 año de edad y su resolución. Caso clínico: El servicio de Cirugía Maxilofacial del Hospital Provincial Pediátrico Eduardo Agramonte Piña de Camagüey, Cuba, atiende a una niña de 1 año y 10 meses que se encontraba hospitalizada por presentar una inflamación alarmante en la región facial y cervical precedida de un cua- dro febril y dificultad para alimentarse. Se indicaron los estu- dios apropiados, cuyos resultados, junto a las características clínicas, permitieron diagnosticar la enfermedad de Caffey. Aunque sea una enfermedad rara, es importante estudiarla para realizar un correcto análisis de cada caso y diferenciarla de otras enfermedades que requieren de conductas terapéuti- cas agresivas (AU)

Aim: Caffey's disease or infantile cortical hyperostosis is a rare disease that affects one or more bones in the first months of life and due to its low incidence, it is underdiag- nosed, and therefore unnecessary invasive procedures are applied in its study and treatment. An atypical clinical case of Caffey's disease in a patient older than 1 year and its reso- lution is presented. Case report: The Maxillofacial Surgery service of the Eduardo Agramonte Piña Provincial Pediatric Hospital in Camagüey, Cuba, takes the case of a 1 year and 10-month-old female patient who was hospitalized for an alarming inflam- mation in the facial and cervical region, preceded by a fever and difficulty to eat. The appropriate studies were indicated, which results, together with the clinical characteristics, al- lowed the diagnosis of Caffey's disease. Although it is a rare entity, it is important to study it to carry out a correct analysis of each case and differentiate it from other diseases that re- quire aggressive therapeutic behaviors (AU)

Violencia contra niños, niñas y adolescentes: actuación del odontólogo y nivel de conocimiento para la detección y atención de casos / Violence against children and adolescents: dentist´s performance and knowledge levels for case detection and care

Objetivo: Analizar el nivel de conocimiento del pro-fesional odontólogo sobre la violencia ejercida en niños, niñas y adolescentes, poniendo énfasis en la importancia de su actuación para la detección, aten-ción y derivación de potenciales casos que posibi-liten, dentro de un contexto multidisciplinario, una intervención oportuna y efectiva. Materiales y méto-dos: Se realizó una encuesta a 132 odontólogos, 123 mujeres y 9 hombres, con experiencia profesional de 2 a 43 años, profesores universitarios especialistas en odontopediatría, cursantes de carreras de espe-cialización y posgrados afines o aquellos que desa-rrollan sus actividades laborales en 2 hospitales pú-blicos de la Ciudad Autónoma de Buenos Aires aten-diendo a menores de edad. La encuesta totalizó 15 preguntas distribuidas en 3 categorías cuyos ejes te-máticos ahondaron respecto al conocimiento sobre violencia ejercida contra menores (Categoría 1), sos-pecha de un presunto maltrato infantil en la consulta (Categoría 2) y factores que condicionan la eventual derivación del caso (Categoría 3). Cada pregunta in-cluida en las 3 categorías se direccionó conforme a si el ámbito profesional del sujeto encuestado era es-pecialista/cursante de posgrado (Grupo 1) u hospi-talario (Grupo 2). Resultados: En la primera categoría se observó una significativa carencia de formación específica en la etapa de grado con un 89% para el grupo 1 y 93,75% para el grupo 2, aunque éstos úl-timos han accedido a cursos de perfeccionamiento y actividades tendientes a incrementar destrezas y aptitudes en un 71,87%, contrastando con el 24% del otro grupo. Asimismo, el 29% del grupo 1 y un 50% del grupo 2 conocían los protocolos establecidos en sus entornos profesionales. Ambos consideraron que el odontólogo no está capacitado para detectar conductas orientativas hacia posibles casos (89%, grupo 1; 87,5%, grupo 2). Para la segunda categoría, el grupo 1 respondió positivamente en un 73%, en tanto que el grupo 2 lo hizo en un 84,38%. En la ter-cera categoría se destacó para el grupo 1 un elevado porcentaje en las preguntas relacionadas al temor por parte del odontólogo de agravar las acciones Objetivo: Analizar el nivel de conocimiento del pro-fesional odontólogo sobre la violencia ejercida en niños, niñas y adolescentes, poniendo énfasis en la importancia de su actuación para la detección, aten-ción y derivación de potenciales casos que posibi-liten, dentro de un contexto multidisciplinario, una intervención oportuna y efectiva. Materiales y méto-dos: Se realizó una encuesta a 132 odontólogos, 123 mujeres y 9 hombres, con experiencia profesional de 2 a 43 años, profesores universitarios especialistas en odontopediatría, cursantes de carreras de espe-cialización y posgrados afines o aquellos que desa-rrollan sus actividades laborales en 2 hospitales pú-blicos de la Ciudad Autónoma de Buenos Aires aten-diendo a menores de edad. La encuesta totalizó 15 preguntas distribuidas en 3 categorías cuyos ejes te-máticos ahondaron respecto al conocimiento sobre violencia ejercida contra menores (Categoría 1), sos-pecha de un presunto maltrato infantil en la consulta (Categoría 2) y factores que condicionan la eventual derivación del caso (Categoría 3). Cada pregunta in-cluida en las 3 categorías se direccionó conforme a si el ámbito profesional del sujeto encuestado era es-pecialista/cursante de posgrado (Grupo 1) u hospi-talario (Grupo 2). Resultados: En la primera categoría se observó una significativa carencia de formación específica en la etapa de grado con un 89% para el grupo 1 y 93,75% para el grupo 2, aunque éstos úl-timos han accedido a cursos de perfeccionamiento y actividades tendientes a incrementar destrezas y aptitudes en un 71,87%, contrastando con el 24% del otro grupo. Asimismo, el 29% del grupo 1 y un 50% del grupo 2 conocían los protocolos establecidos en sus entornos profesionales. Ambos consideraron que el odontólogo no está capacitado para detectar conductas orientativas hacia posibles casos (89%, grupo 1; 87,5%, grupo 2). Para la segunda categoría, el grupo 1 respondió positivamente en un 73%, en tanto que el grupo 2 lo hizo en un 84,38%. En la ter-cera categoría se destacó para el grupo 1 un elevado porcentaje en las preguntas relacionadas al temor por parte del odontólogo de agravar las acciones de violencia familiar (64%) o represalias (55%) contra el niño si efectuaran la derivación. En los mismos ítems, el grupo 2 respondió con porcentajes disímiles (28,13% y 31,25%, respectivamente). Finalmente, se diferenciaron claramente los resultados en cuanto al desconocimiento de los procedimientos a seguir si amerita derivar un caso, con un 71% para el grupo 1 y un 34,38% para el grupo 2. Conclusión: Se hace imperioso instruir y capacitar al profesional odontólogo, concientizándolo sobre la necesidad de conocer la legislación vigente y los mecanismos de detección y ulterior derivación. Si bien aquellos que desempeñan su labor a nivel hospitalario aparecen como mejor preparados para actuar, existe un evidente desconocimiento general que conlleva el riesgo de no advertir o proceder inadecuadamente en casos de violencia que atenta contra la seguridad de niños, niñas y adolescentes (AU)

Objective: To analyze the level of knowledge of the dental professional about violence committed in children and adolescents, emphasizing the importance of their actions for the detection, care and referral of potential cases that allow, within a multidisciplinary context, an intervention timely and effective. Materials and methods: A survey was carried out with 132 dentists, 123 women and 9 men, with professional experience of 2 to 43 years, university professors in the specialty of pediatric dentistry, students of specialization course and related postgraduate courses or those who carry out their work activities in 2 public hospitals in the Autonomous City of Buenos Aires that care for minors. The survey included 15 questions distributed in 3 categories whose thematic axes delved into knowledge about violence committed against minors (Category 1), suspicion of alleged child abuses in the consultation (Category 2) and factors that condition the eventual referral of the case (Category 3). Each question included in the 3 categories is addressed according to whether the professional field of the surveyed subject was a specialist/graduate student (Group 1) or a hospitalist (Group 2). Results: In the first category, a significant lack of specific training is observed in the undergraduate stage with 89% for group 1 and 93.75% for group 2, although the latter have accessed courses and improvement activities aimed at to increase skills and abilities by 71.87%, in contrast to 24% in the other group. Likewise, 29% of group 1 and 50% of group 2 knew the protocols established in their professional environments. Both considered that the dentist is not trained to detect guiding behaviors towards possible cases (89%, group 1; 87.5%, group 2). For the second category, group 1 responded positively by 73%, while group 2 did so by 84.38%. In the third category, a high percentage stood out for group 1 in the questions related to the dentist's fear of aggravating the actions of family violence (64%) or retaliation (55%) against the child if he made the referral. In the same items, group 2 responded with dissimilar percentages (28.13% and 31.25%, respectively). Finally, the results were clearly differentiated in terms of lack of knowledge of the procedures to follow if a case warrants referral, with 71% for group 1 and 34.38% for group 2. Conclusion: It is imperative to instruct and train the professional dentist, raising awareness about the need to know current legislation and the detection and subsequent referral mechanisms. Although those who carry out their work at the hospital level seem to be better prepared to act, there is an evident widespread lack of knowledge that entails the risk of not announcing or acting inappropriately in cases of violence that threaten the safety of children and adolescents (AU)

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Carcinoma de células escamosas y el rol discutido de la irritación mecánica crónica: informe de un caso / Squamous oral cell carcinoma and the discussed role of chronic mechanical irritation: report of a case

Objetivo: Describir el desarrollo de un carcinoma oral de células escamosas, en el que la irritación mecánica crónica aparenta tomar un rol protagonista en la carcinogénesis. Caso clínico: Un paciente de 41 años de edad, argen- tino, con antecedentes de fisura labio alvéolo palatina, diabe- tes mellitus, convulsiones, consumo de cocaína y marihuana, enolismo crónico y tabaquismo, acude al Servicio de Odonto- logía del Hospital Central de Mendoza para la evaluación de una úlcera dolorosa en el dorso de su lengua, de varias sema- nas de evolución, en íntima relación con un primer premolar superior derecho y una pieza supernumeraria. Se realizó una biopsia y de la anatomía patológica resultó el diagnóstico de carcinoma oral de células escamosas. Se ofreció al paciente posibles tratamientos que rechazó, por lo que se inició terapia paliativa y sintomática. Al avanzar su mal estado general, fa- lleció por complicaciones relacionadas a la deglución. Si bien no está definido el rol de la irritación mecánica crónica en la etiología de la carcinogénesis, ejerce un efecto promotor del daño causado por el tabaco y el alcohol. Si bien el paciente era fumador y bebía alcohol, se puede observar que desarrolló un carcinoma de células escamosas en evidente relación a un trauma crónico, ya que la lesión en la cara dorsal de lengua está en íntimo contacto con el factor irritante. Aun así, la evi- dencia actual disponible es limitada y discute el protagonismo del trauma crónico por lo que se necesitan más estudios para evaluar y definir la posible relación causal de la irritación me- cánica crónica en la carcinogénesis (AU)

Aim: To describe the development of an oral squamous cell carcinoma, in which chronic mechanical irritation ap- pears to play a significant role in carcinogenesis. Clinical case: A 41-year-old patient, from Argenti- na, with a history of cleft lip and palate, diabetes mellitus, seizures, cocaine and cannabis use, chronic alcoholism and smoking, comes to the Dentistry Service of the Central Hospi- tal for the evaluation of a painful ulcer on the dorsum of the tongue, which had been developing for several weeks, in close relation to an upper right first premolar and a supernumerary tooth. A biopsy was performed, and the pathological anatomy resulted in the diagnosis of oral squamous cell carcinoma. Possible treatments were offered to the patient, which he re- jected, so palliative and symptomatic therapy was initiated instead. As his poor general condition progressed, he died due to complications related to swallowing. Although the role of chronic mechanical irritation in the development of carcino- genesis is not yet fully defined, it has been shown to have a promoting effect on the damage caused by tobacco and alco- hol. Although the patient was a smoker and drank alcohol, it can be observed that he developed a squamous cell carcinoma in obvious relation to a chronic trauma, since the lesion devel- ops on the dorsal face of the tongue in close contact with the irritant factor. Still, the current evidence available is limited and discusses the role of chronic trauma, so more studies are needed to evaluate and define the possible causal relation- ship of chronic mechanical irritation in the development of carcinogenesis (AU)

Manifestaciones gingivales de sífilis secundaria: serie de casos / Gingival manifestations of secondary syphilis: case series

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sí- filis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las ca- racterísticas clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingi- vales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron le- siones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior ­tanto superior como inferior­, presentándose pla- cas rojas o blancas. Algunos casos también presentaban le- siones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis se- cundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria (AU)

Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral le- sions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present mul- tiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingi- val lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region ­both up- per and lower­, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of second- ary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be consid- ered when dealing with atypical gingivo-periodontal cases in everyday practice (AU)

Retrospective analysis of medical emergencies in an oral emergency department

Background: To retrospectively analyze the rescue of medical emergencies and critical patients in the oral emergency department in a hospital during the past 14 years; analyze the general condition of patients, their diagnosis, etiological factors, and outcomes of the disease, so as to improve the ability of oral medical staff to deal with emergencies; and optimize the emergency procedures and resource allocation in such departments. Material and Methods: Data and related information of critical patient emergency rescue from the Emergency Department of the Hospital of Stomatology, Peking University from January 2006 to December 2019, were analyzed. Results: A total of 53 critical patients were rescued in the oral emergency department in the past 14 years, which is an average of four cases per year, with an incidence rate of 0.00506%. The main type of emergency included hemorrhagic shock and active hemorrhage, with the highest incidence being in the age group of 19-40 years old. Among these cases, 67.92% (36/53) developed emergency and critical diseases before visiting the oral emergency department and 41.51% (22/53) had systemic diseases. After rescue, a total of 48 patients (90.57%) had stable vital signs and 5 (9.43%) died. Conclusions: Oral doctors and other medical staff should be able to rapidly identify medical emergencies in oral emergency departments and commence emergency treatment. The department should be equipped with relevant first-aid drugs and devices, and medical staff should be regularly trained in practical first-aid skills. Patients with oral and maxillofacial trauma, massive hemorrhage and systemic diseases should be evaluated and treated according to their conditions and systemic organ function to prevent and reduce medical emergencies. (AU)

Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

Tratamiento de comunicaciones bucosinusales y buconasales: Reporte de cinco casos de diferente etiología / Treatment of oroantral and oronasal communications: report of five cases with different etiology

Objetivo: Las comunicaciones bucosinusales y buco- nasales son condiciones patológicas que se caracterizan por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar o la cavidad nasal respectivamente. Una vez que se ha instalado una comunicación es deseable ce- rrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarse desplazando tejidos locales, regionales o injertando. El presente trabajo tiene como objetivo presentar situaciones clínicas de comunicaciones bucosinusales y buco- nasales con diferentes etiologías y sus distintos tratamientos según tamaño y ubicación del defecto. Casos clínicos: Se identificaron pacientes que asistie- ron al Servicio de Cirugía Maxilofacial del Hospital Piñero presentando cuatro comunicaciones bucosinusales agudas y crónicas y una comunicación buconasal crónica. Los casos analizados fueron tratados de manera quirúrgica utilizando di- versos colgajos según tamaño y ubicación del defecto (AU)

Aim: Oroantral and oronasal communications are patho- logical conditions characterized by the presence of a solu- tion of continuity between the oral cavity and the maxillary sinus or nasal cavity respectively. Once a communication has been installed, it is desirable to close this defect, thus avoid- ing infection of the maxillary sinus and possible difficulties in swallowing, phonation, and mastication. Different treatments have been proposed for its resolution, some non-surgical and others surgical. Surgical procedures can be performed by dis- placing local or regional tissue or by grafting. The aim of this case report is to present clinical situations of oral sinus and oral nasal communication with different etiologies and their different treatments according to the size and location of the defect. Clinical cases: A group of patients who attended the Maxillofacial Surgery Service of Piñero Hospital presenting four acute and chronic oral sinus and one oronasal communi- cations were identified. The analyzed cases were treated sur- gically using different flaps according to the size and location of the defect (AU)

Retrospective analysis of medical emergencies in an oral emergency department.

BACKGROUND: To retrospectively analyze the rescue of medical emergencies and critical patients in the oral emergency department in a hospital during the past 14 years; analyze the general condition of patients, their diagnosis, etiological factors, and outcomes of the disease, so as to improve the ability of oral medical staff to deal with emergencies; and optimize the emergency procedures and resource allocation in such departments. MATERIAL AND METHODS: Data and related information of critical patient emergency rescue from the Emergency Department of the Hospital of Stomatology, Peking University from January 2006 to December 2019, were analyzed. RESULTS: A total of 53 critical patients were rescued in the oral emergency department in the past 14 years, which is an average of four cases per year, with an incidence rate of 0.00506%. The main type of emergency included hemorrhagic shock and active hemorrhage, with the highest incidence being in the age group of 19-40 years old. Among these cases, 67.92% (36/53) developed emergency and critical diseases before visiting the oral emergency department and 41.51% (22/53) had systemic diseases. After rescue, a total of 48 patients (90.57%) had stable vital signs and 5 (9.43%) died. CONCLUSIONS: Oral doctors and other medical staff should be able to rapidly identify medical emergencies in oral emergency departments and commence emergency treatment. The department should be equipped with relevant first-aid drugs and devices, and medical staff should be regularly trained in practical first-aid skills. Patients with oral and maxillofacial trauma, massive hemorrhage and systemic diseases should be evaluated and treated according to their conditions and systemic organ function to prevent and reduce medical emergencies.

Systemic and oral health status of older adult inpatients in an intensive care unit / Avaliação da condição sistêmica e oral de idosos internados em uma unidade de terapia intensiva

Objective: To assess the systemic and oral health status of geriatric patients hospitalized in an intensive care unit (ICU). Methods: A cross-sectional descriptive study of a convenience sample of 78 older ICU inpatients. A single calibrated examiner collected demographic and clinical data by analyzing patients' records and assessing their oral cavities. Descriptive data analysis was performed to a 5.00% significance level. All patients provided informed consent and were conscious during the oral health assessment. Results: The mean age was 77.69 years and 51.28% of the sample were male. The main reasons patients were admitted to the ICU investigated were postoperative conditions (23.08%) and cardiac abnormalities (20.51%). Systemic arterial hypertension (69.23%) was the most prevalent comorbidity and patients were being treated with anticoagulants (57.69%) and antimicrobials (53.85%). Most patients did not receive oral care (64.10%), while 29.49% of them received it only once, and 57.69% were denture users. The mean decayed, missing, and filled teeth index was 23.74 (17.44 missing teeth, on average) and majorities had tongue biofilm (71.79%) and unsatisfactory oral hygiene during their time in hospital (84.62%). Conclusion: The oral status of hospitalized geriatric patients was characterized by poor hygiene and edentulism

Objetivos: Avaliar o estado de saúde sistêmica e oral de pacientes geriátricos internados em uma unidade de terapia intensiva (UTI). Metodologia: Estudo transversal descritivo, com amostra de conveniência de 78 idosos internados na UTI. Um único examinador calibrado coletou dados demográficos e clínicos, analisando os registros dos pacientes e avaliando as suas cavidades orais. A análise descritiva dos dados foi realizada com nível de significância de 5,00%. Todos os pacientes forneceram consentimento informado e estavam conscientes durante a avaliação da saúde oral. Resultados: A média de idade foi de 77,69 anos e 51,28% da amostra era do sexo masculino. Os principais motivos de internação dos pacientes na UTI investigados foram condições pósoperatórias (23,08%) e alterações cardíacas (20,51%). A hipertensão arterial sistêmica (69,23%) foi a comorbidade mais prevalente, e os pacientes estavam sendo tratados com anticoagulantes (57,69%) e antimicrobianos (53,85%). A maioria dos pacientes não recebeu cuidados orais (64,10%), enquanto 29,49% deles os receberam apenas uma vez e 57,69% eram usuários de próteses dentárias. O índice médio de dentes cariados, perdidos e obturados foi de 23,74 (17,44 dentes ausentes, em média) e a maioria apresentou biofilme lingual (71,79%) e higiene oral insatisfatória durante a internação (84,62%). Conclusão: A condição oral dos pacientes geriátricos hospitalizados foi caracterizada por má higiene e edentulismo.

Hallazgos en radiografías panorámicas de niños entre 6 y 15 años en un hospital odontológico en Argentina / Findings in panoramic radiographs of children between 6 and 15 years at a dental hospital in Argentina

Objetivo: Describir la frecuencia y localización de pato- logías y anomalías dentarias (anomalías de número, tumores, quistes y piezas retenidas) observadas en radiografías pa- norámicas de pacientes pediátricos de entre 6 y 15 años del Hospital Zonal Especializado en Odontología Infantil "Dr. A. Bollini" de la ciudad de La Plata. Materiales y métodos: Se realizó un estudio observa- cional descriptivo de 300 radiografías panorámicas, de niños (n=150) y niñas (n=150) de entre 6 y 15 años, seleccionadas aleatoriamente en el área de radiología del hospital, tomadas en el período comprendido entre marzo de 2018 y marzo de 2020. Los datos obtenidos se volcaron en planillas de cálculo y con ellos se realizó un análisis estadístico descriptivo. Se utilizaron las siguientes variables: edad, sexo, tipo de ano- malía o patología (anomalías de número, tumores, quistes y piezas retenidas), pieza dentaria y ubicación (maxilar o man- díbula). Resultados: Dentro de las anomalías registradas (n=147), se encontraron en mayor medida piezas dentarias retenidas, en un 44,22% de los casos (n=65), agenesias en un 42,18% de los casos (n=62) y supernumerarios en un 13,61% de los casos (n=20). No se hallaron quistes ni tumores. Conclusión: En un 24% de las radiografías panorámicas de niños entre 6 y 15 años se halló alguna anomalía dentaria. Las anomalías más frecuentes fueron piezas dentarias reteni- das y agenesias (AU)

Aim: To describe the frequency and location of dental pathologies and anomalies (number anomalies, tumors, cysts and retained dental pieces) observed in panoramic radio- graphs of pediatric patients between 6 and 15 years of age from the Hospital Especializado en Odontología Infantil "Dr. A. Bollini" from the city of La Plata. Materials and methods: A descriptive observational study was performed based on 300 panoramic radiographs of children (150 girls and 150 boys) between 6 and 15 years old, randomly selected in the Radiology area of the hospital, taken in the period between March 2018 and March 2020. The data obtained were entered into spreadsheets and a descriptive sta- tistical analysis was carried out. The following variables were evaluated: age, sex, type of anomaly or pathology (anomalies of number, tumor, cysts and retained dental pieces), dental piece and location (maxilla or mandible). Results: Among the registered anomalies (n=147), re- tained dental pieces were found to a greater extent, in 44.22% of the cases (n=65), agenesis in 42.18% of the cases (n=62) and supernumeraries in 13.61% of the cases (n=20). No cysts or tumors were found. Conclusion: In 24% of panoramic radiographs of chil- dren between 6 and 15 years old, some dental anomaly was found. The most frequent anomalies were retained dental pieces and agenesis (AU)

Schwannoma intraóseo mandibular: reporte de un caso clínico / Mandibular intraosseous schwannoma: a clinical case report

Objetivo: El schwannoma es un tumor neuroectodérmi- co benigno de la vaina nerviosa o vaina de mielina formada por células de Schwann. Aproximadamente entre el 25 y el 48% de los casos presentan localización en el territorio cer- vicofacial, especialmente en los tejidos blandos de esta re- gión. Se los puede clasificar como schwannomas periféricos o intraóseos, éstos últimos también denominados centrales. Los schwannomas intraóseos son poco comunes, constituyen menos del 1% de los schwannomas presentes en la región en cuestión y menos del 0,2% de todos los tumores primarios óseos. El presente trabajo tiene como objetivo reportar un caso clínico de un schwannoma intraóseo mandibular, revi- sando aspectos clínicos, radiográficos y anatomopatológicos. El schwannoma intraóseo es una entidad poco común, o al menos se encuentra en una condición de subregistro en Argen- tina, por lo que este caso constituye una rareza. Caso clínico: Se presentó a la consulta una paciente de 30 años de edad, derivada al servicio de Cirugía y Trau- matología Bucomaxilofacial del Hospital "Parmenio Piñero" de la Ciudad Autónoma de Buenos Aires por su odontólogo de cabecera, a raíz de un hallazgo radiográfico durante un control de rutina. Se planificó realizar una biopsia incisio- nal, cuyo resultado anatomopatológico fue compatible con el diagnóstico de schwannoma intraóseo. Se procedió a realizar la enucleación completa. Finalmente, la paciente evolucionó sin complicaciones (AU)

Aim: Schwannoma is a benign neuroectodermal tumor of the nerve sheath or myelin sheath formed by Schwann cells. Approximately between 25 and 48% of the cases are located in the cervicofacial territory, especially in the soft tissues of this region. They can be classified into peripheral and intraosseous schwannomas, the last one can also be reported as central. In- traosseous schwannomas are rare, constituting less than 1% of schwannomas present in the region and less than 0.2% of all primary bone tumors. This publication aims to report a clin- ical case of mandibular intraosseous schwannoma, reviewing clinical, radiographic and anatomopathological aspects. In- traosseous schwannoma is a rare entity, or at least is under a condition of underreport in Argentina, so this case is a rarity. Clinical case: A 30-year-old patient, referred to the Buccomaxillofacial Surgery and Traumatology service of the "Parmenio Piñero" Hospital of Ciudad Autónoma de Bue- nos Aires by her dentist, because of a radiographic finding during a routine check. An incisional biopsy was performed, the anatomopathological result of which was compatible with the diagnosis of intraosseous schwannoma. A complete enu- cleation was performed under local anesthesia. Finally, the patient evolved without complications (AU)

The Greater Manchester Child Friendly Dental Practice Scheme: Using a Transformational Commissioning Approach to Align Paediatric Dental Service Provision with Childhood Oral Health Needs in Greater Manchester.

In response to the impact of the COVID-19 pandemic on access to already oversubscribed specialist paediatric dental services, a pilot of an enhanced primary care paediatric dental pathway, known as the Child Friendly Dental Practice (CFDP) scheme, was commissioned by the Greater Manchester Health and Social Care Partnership. Supported by a transformational commissioning approach, the ambition of the CFDP pilot was to manage or stabilise the oral health of high-need paediatric patients who had been referred to specialist dental services within Community or Hospital Dental Service settings, through timely access to primary care clinicians who were confident and experienced in treating children. The theory of change of the CFDP pilot proposed that rapid access to enhanced primary dental care would reduce the need for onward referral to specialist paediatric dental services, whilst also stabilising the oral health of children who require more complex management in specialist services. A formative evaluation of the phase one pilot implementation of the CFDP Scheme has demonstrated the potential of the CFDP Scheme to improve access to dental services for paediatric patients referred from their General Dental Practitioner. Comparison of waiting times between the CFDP pathway and the standard paediatric dental referral pathway have revealed substantially reduced waiting times to access care along the CFDP pathway, while less than 30% of those who attended CFDPs required onward referral to specialist paediatric dental services. Encouragingly, similar attendance and treatment completion rates were noted among patients from all levels of socio-economic deprivation, reducing concerns regarding the potential for service-based interventions to increase oral health inequalities. Following successful completion of the phase one pilot implementation and evaluation, the CFDP Scheme has now been rolled out across all localities in Greater Manchester as part of a second phase pilot implementation. Public Health Competencies; Equitable healthcare provision, Partnership working, Evidence-based public health, Systems thinking, Transformational commissioning, Healthcare evaluation.

Relación entre la presión arterial y el control de la hemorragia post-exodoncia en pacientes bajo tratamiento con warfarina / Relationship between blood pressure and hemorrhage control post exodontia in patients under warfarin treatment

Objetivo: Determinar la relación entre el nivel de pre- sión arterial (PA) y la hemorragia post-exodoncia aplicando medidas de hemostasia local en pacientes bajo tratamiento con warfarina. Materiales y métodos: Este estudio se realizó sobre 30 pacientes (15 hombres y 15 mujeres) bajo tratamiento anti- coagulante oral (TACO) con warfarina. Los pacientes concu- rrían al programa de TACO del Hospital y Centro de Referen- cia de Salud El Pino (HEP y CRS). Se les realizaron una o dos extracciones dentales (n=38) sin suspensión del anticoagulan- te oral a pacientes que tuvieran un coeficiente internacional normalizado (INR) del día menor o igual a 3. Se aplicaron medidas de hemostasia local con gasa compresiva y/o sutura en 30 de las extracciones dentales. Los procedimientos quirúr- gicos fueron llevados a cabo en el Servicio Dental del CRS y HEP. Se registraron las siguientes variables: 1) PA previa a la exodoncia, 2) PA a los 30 minutos, 3) Presencia o ausencia de hemorragia a los 30 minutos post-exodoncia y 4) PA y presen- cia o ausencia de hemorragia a las 24 horas post-exodoncia. Se estudió la relación entre el nivel de PA y la hemorragia post-exodoncia. Resultados: De todos los pacientes evaluados, ninguno presentó hemorragia post-exodoncia en los distintos momen- tos de evaluación, independientemente de cuál fuera su PA. No se encontraron efectos de la variable PA ­considerando valores de PA sistólica (PAS) por debajo de 140 mmHg y de PA diastólica (PAD) menores a 90 mmHg- en relación con la hemorragia post-exodoncia. Conclusión: De acuerdo con los resultados obtenidos en este estudio, la presión arterial con PAS <140 mmHg y PAD <90 mmHg no es un factor que influya en el sangrado post-exodoncia en pacientes bajo tratamiento con warfarina con ≤3 (AU)

Aim: To establish the relationship between blood pres- sure (BP) level and post-exodontic hemorrhage by applying local hemostasis measures in patients under warfarin treat- ment. Materials and methods: This study was conducted in 30 patients (15 men and 15 women) under oral anticoagu- lant (OAC) treatment with warfarin. The patients attended the TACO program of the "Hospital y Centro de Referencia de Salud el Pino (HEP y CRS)". One or two dental extractions (n=38) were performed in the patients that had an INR low- er or equal to 3, without suspending the oral anticoagulant treatment, applying local hemostasis measures with compres- sive gauze and/or suture in 30 of the extractions. The surgical procedure was carried out in the Dental Department of the CRS and HEP. The following variables were registered: 1) BP prior to extraction, 2) BP after 30 minutes, 3) presence or absence of hemorrhage after 30 minutes post-exodontia and 4) BP and presence or absence of hemorrhage 24 hours post-exodontia. The relation between BP level and post-exo- dontic bleeding was studied. Results: Considering all the examined patients, none of them presented post-exodontic hemorrhage at any of the dif- ferent moments of evaluation, regardless of their BP level. No effect of the BP variable ­considering a range of systolic BP SBP) below 140 mmHg and a diastolic BP (DBP) under 90 mmHg- was found in relation to post-exodontic hemorrhage. Conclusion: According to the results obtained in this study, blood pressure with SBP <140 mmHg and DBP <90 mmHg is not an influential factor in post-exodontic bleeding in patients under warfarin treatment with ≤3 (AU)

Odontoma mandibular inusual y su resolución: reporte de un caso / Unusual mandibular odontoma and its resolution: report of a case

Objetivo: El odontoma es una lesión hamartomatosa benigna formada por tejido dentario (cemento, esmalte, pul­ pa). Según su grado de diferenciación podrá ser clasificado en sus dos variantes: compuesto y complejo en una relación 2:1. El objetivo de este artículo es presentar un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica. Caso clínico: Se describe el caso de un paciente mascu­ lino de 16 años de edad, portador de ortodoncia, que presenta un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica utilizando planificación 3D y confección de placa de titanio customizada (AU)

Aim: Odontoma is a benign hamartomatous lesion formed by dental tissue (cementum, enamel, pulp). According to its degree of differentiation, it can be classified in its two variants: compound and complex in a 2:1 ratio. The objective of this article is to present a large mixed odontoma of mandi­ bular location and its surgical resolution. Clinical case: A 16-year-old male patient with ortho­ dontics, who presents a large mixed odontoma with mandibu­ lar location and its surgical resolution using 3D planning and customized titanium plate fabrication (AU)

La adenopatía como clave diagnóstica para la sífilis primaria. Informe de casos / Adenopathy as diagnostic key for primary syphilis. Case reports

Objetivo: Describir tres situaciones clínicas en las que se presentan distintas manifestaciones bucales para una misma entidad patológica. En los tres casos la sospe- cha diagnóstica de sífilis primaria se basó en la presencia de una adenopatía. Los estudios de laboratorio permitieron confirmar el diagnóstico de sífilis. Por su polimorfismo y variabilidad clínica en sus diferentes etapas evolutivas, la sífilis es descripta clásicamente como "la gran simuladora". Este artículo propone que la presencia de adenomegalias características puede ser una clave para orientar el diagnós- tico de la patología, lo cual no ha sido aún reportado en la literatura. Casos clínicos: Se presentan tres casos clínicos de pa- cientes que acudieron a una consulta estomatológica privada y al Servicio de Estomatología del Hospital Alemán de Bue- nos Aires. Los tres acuden con signos y síntomas diferentes, pero compartiendo la presencia de adenopatías múltiples, en las que se destaca un elemento ganglionar más voluminoso (AU)

Aim: To describe three clinical cases that present dif- ferent oral manifestations for the same pathological entity. In all three cases, the suspected diagnosis of primary syph- ilis was based on the presence of an adenopathy. Labora- tory studies confirmed the diagnosis of syphilis. Due to its polymorphism and clinical variability in the different evo- lutionary stages, syphilis is classically described as "the great simulator". This article proposes that the presence of characteristic adenomegalies can be a key to guide the di- agnosis, which has not yet been reported in the literature. Clinical reports: Three clinical cases of patients who attended a private stomatology consultation and the Stoma- tology Service of the Hospital Alemán de Buenos Aires are presented. The three patients showed different signs and symptoms but shared the presence of multiple adenopathies with a more voluminous ganglial element (AU)

Prevalencia de mancha blanca en dentición temporaria en el Hospital de Odontología Infantil Don Benito Quinquela Martín / Prevalence of white spot in temporary dentition at Don Benito Quinquela Martin Children's Dentistry Hospital

Introducción: La caries dental es una enfermedad infecciosa y multifactorial, que co- mienza por una desmineralización del esmalte producida por la acción de ácidos generados por bacterias presentes en el biofilm dental. Estas lesiones se inician como manchas blancas (MB) y es el único estadio de la caries dental capaz de ser revertido mediante la aplicación profesional de agentes remineralizantes, por lo que es fundamental la detección y tratamiento temprano de las mismas. Objetivo: Determinar la prevalencia de manchas blancas en la dentición temporaria de los niños atendidos en el Servicio de Clínica y Orientación del Hospital de Odontología Infantil (HOI) «Don Benito Quinquela Martín¼. Materiales y métodos: Se evaluó una muestra de 94 niños con dentición temporaria, en el Servicio de Clínica y Orientación del HOI, teniendo en cuenta los ingresos y reingresos, durante el período comprendido entre septiembre de 2019 y febrero de 2020. Resultados: La prevalencia de manchas blancas de un total de 94 niños evaluados fue del 55 %. De los pacientes que presentaron MB, el 59 % fue de sexo masculino y el 41 % de sexo femenino. La media de edad fue de 4.77 años. De los pacientes atendidos, 73 concurrieron por primera vez y 21 pacientes fueron reingresos. Conclusión: La prevalencia de manchas blancas en la muestra evaluada de niños atendidos en el Servicio de Clínica y Orientación del HOI fue del 55 %. Este resultado sugiere la necesidad de continuar y potenciar la promoción de la salud bucal, no solo como herramienta estratégica para brindar conocimientos acerca de los beneficios de una correcta higiene oral y una dieta saludable, sino también como factor de prevención en cuanto a la aparición de lesiones de caries y posteriores consecuencias adversas (AU)

Introduction: Dental caries is an infectious and multifactorial disease that begins with the demineralization of the enamel produced by the action of acids generated by bacteria in the dental biofilm. These lesions start as white spots (WS), and it's the only stage of dental caries capable of being reverted by the professional application of remineralizing agents. Hence, its early detection and treatment are essential. Objective: To determine the prevalence of white spots in the temporary dentition of children treated at the Clinical and Orientation Service of "Don Benito Quinquela Martin" Children's Dentistry Hospital (CDH). Materials and methods: A sample of 94 children with temporary dentition was evaluated on admission and readmission at CDH's Clinical and Orientation Service between September 2019 and February 2020. Results: The prevalence of WS in 94 children evaluated was 55%: 59% of patients who presented WS were males, and 41% were females. The mean age was 4.77 years. Seventy-three patients seen attended for the first time, and the other 21 were readmissions. Conclusion: The prevalence of WS in children who attended CDH's Clinical and Orientation Service was relevant. This result indicates that we must continue and enhance oral health promotion as a strategy to give knowledge about good oral hygiene benefits, a healthy diet, and to prevent the appearance of caries lesions and subsequent consequences (AU)