Manifestaciones orales y manejo estomatológico de paciente pediátrico con secuelas por COVID-19 / Manifestações orais e gestão estomatológica do paciente pediátrico com sequelas devido ao COVID-19 / Oral manifestations and stomatological management of pediatric patients with sequelae due to COVID-19

Introducción: Desde diciembre de 2019, la nueva cepa del coronavirus 2, causante del síndrome respiratorio agudo severo (SARS-CoV-2), ha provocado una pandemia mundial. Los niños y los adolescentes infectados generalmente son asintomáticos y solo experimentan síntomas respiratorios leves. Sin embargo, se ha reportado, una nueva tendencia alarmante en las infecciones pediátricas por COVID-19, en las cuales los pacientes han llegado a presentar manifestaciones agravantes que han requerido de hospitalización, dejando secuelas importantes. Objetivo: Dar a conocer las manifestaciones orales asociadas al caso clínico de un paciente pediátrico contagiado por SARS-CoV-2, así como la rehabilitación estomatológica de mínima invasión. Presentación de caso clínico: Paciente masculino de 5 años, con antecedente de COVID-19, quien, en su estancia hospitalaria en el Instituto Nacional de Pediatría de México, presentó choque séptico refractario secundario SARS-COV-2 y falla orgánica múltiple. Se observaron lesiones en dorso lingual secundarias a la infección por COVID-19 las cuales eran asintomáticas. El paciente presentaba caries, y fue rehabilitado exitosamente cumpliendo medidas de bioseguridad, con materiales bioactivos y convencionales, estableciendo un excelenterapport. Conclusiones: El odontólogo pediatra debe diagnosticar las manifestaciones bucales del COVID-19, estableciendo protocolos adecuados de atención. El presente caso fue tratado exitosamente con una estrategia de rehabilitación oral efectiva y parámetros de prevención. Es importante reportar las manifestaciones orales por lo que se sugiere realizar seguimiento de estos hallazgos.

Introdução: Desde dezembro de 2019, a nova cepa do Coronavírus 2, que causa a síndrome respiratória aguda grave (SARS-CoV-2), causou uma pandemia global. Crianças e adolescentes infectados são geralmente assintomáticos ou apresentam apenas sintomas respiratórios leves. Entretanto, uma nova tendência de alarme tem sido relatada nas infecções pediátricas por COVID-19, nas quais os pacientes passaram a apresentar manifestações agravantes que precisaram de hospitalização, deixando sequelas significativas. Objetivos: Apresentar as manifestações orais associadas ao caso clínico de um paciente pediátrico infectado pela SRA-CoV-2, bem como a reabilitação estomatológica minimamente invasiva. Apresentação do caso clínico: Paciente do sexo masculino com 5 anos, com história de COVID-19, que durante sua internação hospitalar no Instituto Nacional de Pediatria do México, apresentou choque séptico refratário secundário ao SARS-COV2 e falha orgânica múltipla. Foram observadas lesões no dorso da língua secundárias à infecção por COVID-19, assintomáticas. Foi reabilitado com materiais bioativos e convencionais, estabelecendo um excelente relacionamento com o paciente. Conclusões: O estomatologista pediátrica deve diagnosticar as manifestações orais da COVID-19, estabelecendo protocolos de cuidados apropriados. O presente caso foi tratado com sucesso com uma estratégia eficaz de reabilitação oral e parâmetros de prevenção. É relevante mencionar as manifestações orais, por isso sugere-se o acompanhamento desses achados.

Introduction: Since December 2019, the new strain of coronavirus 2, which causes severe acute respiratory syndrome (SARS-CoV-2), has caused a global pandemic. Infected children and adolescents are generally asymptomatic and experience only mild respiratory symptoms. However, an alarming new trend has been reported in pediatric COVID-19 infections, in which patients have even presented aggravating manifestations that have required hospitalization, leaving significant sequelae. Objectives: To present the various oral manifestations associated with this case of a pediatric patient infected by SARS-CoV-2, as well as minimally invasive stomatological rehabilitation. Case presentation: A 5-year-old male patient, with a history of COVID-19, who during his hospital stay at the National Institute of Pediatrics of Mexico, presented refractory septic shock secondary to SARS-COV-2 and multiple organ failure. Lesions on the dorsum of the tongue were observed secondary to COVID-19 infection, which were asymptomatic. The patient presented caries, and was rehabilitated following biosafety measures, with bioactive and conventional materials, establishing an excellent rapport. Conclusions: The pediatric stomatologist's should diagnose the oral manifestations of COVID-19, establishing adequate care protocols. The present case was successfully treated with an effective oral rehabilitation strategy and prevention parameters. It is important to report oral manifestations, so it is suggested to follow up on these findings.

Síndrome de niño maltratado con repercusión estomatológica. Reporte de un caso / Battered child sindrome with stomatological repercussions. Case report

Introducción: El síndrome de niño maltratado se define como toda forma de violencia, perjuicio o abuso físico o mental, descuido o trato negligente, mientras el niño se encuentra bajo el cuidado de sus padres, de un tutor o de cualquier otra persona en función de su superioridad física y/o intelectual. En más del 50% de los casos las lesiones se presentan en cabeza, cara y cuello. Es por eso que el odontólogo y especialmente el odontopediatra deben estar preparados para reconocer alguna forma de maltrato o negligencia con base en una historia clínica adecuada y una exploración intencionada ante la sospecha de síndrome de niño maltratado. Objetivo: Conocer los indicadores intraorales y extraorales que le permitan al odontopediatra reconocer los signos y contribuir en el diagnóstico como parte de un equipo multidisciplinario encargado de la atención de estos pacientes. Caso clínico: Paciente masculino de dos años cinco meses quien acude al Servicio de Urgencias del Instituto Nacional de Pediatría por presentar edema periorbitario, múltiples fracturas en extremidades e indicadores orofaciales que permitieron diagnosticar síndrome de niño maltratado. Conclusión: Considerando la frecuencia con que las estructuras orofaciales se ven involucradas en el síndrome de niño maltratado, existe un compromiso médico, ético y legal para que todos los dentistas y específicamente los odontopediatras intervengan en la prevención, detección, diagnóstico y tratamiento de este problema médico social.

Introduction: Battered child syndrome is defined as all forms of violence, prejudice or physical and mental abuse, carelessness or neglect inflicted on the child while under the care of his parents, tutors or any other person exerting physical and/or intellectual superiority. In over 50% of all cases lesions are found in the head and neck area. For that reason, dentists, especially pediatric dentists, must be aware to recognize all sorts of battering or neglect based on a suitably-taken clinical history, and focused exploration when suspicion of battered child syndrome is established. Objective: To be knowledgeable with BCS intra- and extra-oral indicators which might allow the pediatric dentist to recognize signs and contribute in the diagnosis as part of a multi-disciplinary team in charge of providing care to this type of patients. Clinical case: A two year, five month old male patient was brought to the National Pediatrics Institute afflicted with peri-orbital edema, multiple limb fractures and oral-facial indicators which suggested battered child syndrome diagnosis. Conclusion: Taking into consideration the frequency with which oral and facial structures are involved in battered child syndrome cases there is a medical, ethical and legal commitment for all dentists and specifically pediatric dentists, to intervene in prevention, detection, diagnosis and treatment of this medical and social problem.

Características dentales del raquitismo hipofosfatémico: Reporte de un caso / Dental characteristics of hypophosphatemic rickets: Case report

El raquitismo hipofosfatémico resistente a la vitamina D está caracterizado por una hipofosfatemia persistente e hiperfosfaturia. Este disturbio metabólico causa una calcificación deficiente de las estructuras mineralizadas tales como en los huesos y dientes. Una de las alteraciones bucales más importantes de esta enfermedad es la recurrente formación de abscesos ''espontáneos'' afectando a múltiples dientes primarios, así como permanentes sin caries o trauma, relacionado con una mineralización deficiente de la dentina. Nosotros reportamos un caso de raquitismo hipofosfatémico resistente a la vitamina D en un paciente que reportó múltiples abscesos dentales y requirió tratamiento con pulpectomías, pulpotomías y coronas de acero cromo en molares y resinas en dientes anteriores. El objetivo del presente artículo es dar a conocer las características de este trastorno, el tratamiento y las consideraciones dentales.

Hypophosphatemic vitamin-D resistant rickets is characterized by persistent hypophosphatemia and hyperphosphaturia. This metabolic disorder causes deficient calcification of mineralized structures such as bones and teeth. One of the most important oral alterations elicited by this condition is the recurrent formation of ''spontaneous'' abscesses. These affect multiple caries or trauma to free primary o permanent teeth and are related to a deficient dentin mineralization. We report a case of hypophosphatemic vitamin-D resistant rickets in a patient who reported multiple dental abscesses and who required treatment consisting in pulpectomies, pulpotomies and chrome-steel crowns in molars and composite resin in anterior teeth. The aim of the present article was to raise awareness on the characteristics of this disorder, as well as its treatment and dental considerations.

Osteogenic distraction and orthognathic surgery to correct sequelae of ankylosis of the temporomandibular joint: a case report.

A 17-year-old female patient presented with sequelae to ankylosis of the temporomandibular joint, which included vertical maxillary protrusion, anterior open bite, labial incompetence, micrognathia, undefined neck angle, facial asymmetry, Class II molar relationship, and Class III canine relationship. She presented with the following cephalometric and soft tissue data: SNA angle = 78 degrees, SNB angle = 70 degrees, incisor-nasion-point A = 11 degrees, incisor-nasion-point B = 33 degrees, Frankfort-mandibular plane angle = 43 degrees, occlusal plane = 25 degrees, subnasale-stomion = 20 mm, stomion superius-stomion inferius = 9 mm, stomion inferius-soft tissue menton = 30 mm, neck angle = 144 degrees, and chin projection = 10 mm. Orthognathic surgery and mandibular osteogenic distraction were employed, specifically Le Fort I osteotomy to decrease a vertical excess of 12 mm, augmentation genioplasty of 17 mm, and bilateral extraoral distractors of bidirectional vector for a 14-mm augmentation of the mandible. The result was satisfactory with minimal adverse complications.