Oral management of pemphigus vulgaris in the intensive care unit.

Pemphigus vulgaris (PV) is a rare and potentially lethal autoimmune disease that affects the skin and mucous membranes. Injuries caused by the disease cause pain, risk of infection, and other complications that result in a high mortality rate. Frequently, management of the PV requires intensive care and a multidisciplinary approach. Oral lesions of PV are usually the first clinical signs of the disease and the last lesions to heal, requiring treatment by a specialized dental team. The aim of this study was to report two clinical cases of PV with involvement of the oral mucosa. The patients were admitted to an intensive care unit, and underwent multidisciplinary management of their condition along with low-level laser therapy. Both cases demonstrated the importance of specialized dental care in improving the quality of life of patients with PV.

Tooth abnormalities in pediatric patients submitted to antineoplastic treatment for central nervous system neoplasms / Anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central

Objective: The aim of this study was to evaluate the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms. Material and methods: This crosssectional study assessed thirty-one patients, median age 14.2 years (range 5 - 25), who were off therapy for at least one year, comparatively with a control group of thirty-one healthy patients matched for age with the study group. Tooth abnormalities were evaluated by panoramic radiographs. Results: There was no statistical significant evidence that patients of the study group (age range 5 - 25 years) have more frequency of tooth abnormalities comparatively with controls. However, in children who were diagnosed before five years of age, microdontia was the most common abnormality with statistically significant difference (P = 0.037). Root shortening grade III was observed in patients over 10 years of age at the time of radiographic examination, also with statistical significance (P = 0.046). Conclusions: There was no difference in the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms, comparatively with the control group. However, the findings of this study highlight the importance of giving parents and patients orientation about maintenance of good oral hygiene and proper treatment.

Objetivo: O objetivo deste estudo foi avaliar a frequência de anormalidades dentárias em pacientes pediátricos tratados para neoplasias do sistema nervoso central. Material e Métodos: Este estudo transversal avaliou trinta e um pacientes, com média de idade de 14,2 anos (entre 5 – 25 anos), que estavam fora de terapia há pelo menos um ano, comparativamente com um grupo controle composto por 31 pacientes saudáveis pareados por idade com o grupo de estudo. As anormalidades dentárias foram avaliadas por meio de radiografias panorâmicas. Resultados: Não houve evidência estatisticamente significante de que pacientes do grupo de estudo (entre 5 – 25 anos) apresentam maior frequência de anormalidades dentárias quando comparados aos pacientes do grupo controle. No entanto, em crianças diagnosticadas antes dos cinco anos de idade, microdontia foi a anormalidade mais comumente encontrada, com diferença estatisticamente significante (P=0.037). Encurtamento radicular grau III foi observado em pacientes com mais de 10 anos de idade ao exame radiográfico, também com significância estatística (P=0.046). Conclusão: Não houve diferença na frequência de anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central, comparativamente ao grupo controle. No entanto, os achados deste estudo ressaltam a importância de reconhecer os efeitos dentários tardios do tratamento antineoplásico em crianças com câncer e deste modo orientar pacientes e responsáveis sobre cuidados de higiene bucal e sobre opções de tratamento apropriado.

Dental anomalies in children submitted to antineoplastic therapy.

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Dental anomalies in children submitted to antineoplastic therapy

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Necessidade de cuidados paliativos odontológicos em crianças com doenças crônicas (PAP)

O cuidado paliativo em crianças é uma abordagem multidisciplinar que tem como objetivo melhorar a qualidade de vida de crianças com doenças que limitam a vida e seus familiares, por meio do controle sintomático, cuidado psicossocial, espiritual e suporte durante o luto. A cavidade oral é frequentemente acometida nos pacientes em cuidados paliativos e diversas alterações bucais podem aparecer, podendo ser decorrentes da própria doença, pela terapêutica indicada ou por um transtorno concorrente. Podem aparecer durante todo o curso da doença, porém são mais prevalentes durantes as terapias e em sua fase terminal. Em geral, os problemas bucais que afetam a população pediátrica também estão presentes em crianças e adolescentes em cuidados paliativos, no entanto, podem se manifestar de maneira mais intensa e freqüente pelo comprometimento do estado de saúde geral do paciente, tipo de dieta, medicações, hospitalização prolongada, higiene deficiente e outros. Os problemas bucais se não tratados podem resultar em dor, desconforto e comprometimento nutricional, com impacto na evolução e prognóstico da doença. O dentista contribui para o alívio e controle dos sintomas, minimizando a dor e o sofrimento das crianças e seus familiares, com cuidados de suporte e simples intervenções a fim de assegurar uma boca limpa, livre de dor e infecções. Assim, o objetivo deste trabalho é apresentar um projeto de pesquisa para avaliar as necessidades de cuidados paliativos em crianças com doenças crônicas e caracterizar a amostra.