Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients.

OBJECTIVE: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). MATERIAL AND METHODS: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. RESULTS: At oral physical examination, the most frequent findings were tooth loss (568-85.67%), coated tongue (422-63.65%) and oral bleeding (192-28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03-2.51) and OR = 1.69 (1.08-2.66), respectively). CONCLUSIONS: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. CLINICAL RELEVANCE: The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.

Comparação entre enxerto gengival livre e retalho reposicionado apical modificado para ganho de mucosa ceratinizada ­ relato de caso / Comparison between free gingival graft and modified apically repositioned flap to gain keratinized mucosa ­ case report

A quantidade adequada de gengiva inserida ao redor dos dentes é de extrema importância para a proteção e manutenção da saúde gengival. Na ausência de largura adequada de gengiva inserida, o enxerto gengival livre (EGL) é a técnica padrão ouro para este fim. Entretanto, o EGL necessita de duas áreas cirúrgicas, o que ocasiona maior incômodo ao paciente no pós-operatório. Uma alternativa, quando há uma faixa mínima de gengiva inserida, é o retalho reposicionado apical modificado (MARF), que apresenta apenas uma área cirúrgica e é uma técnica fácil, o que acelera o tempo transcirúrgico e diminui o desconforto pós-cirúrgico do paciente. Este artigo relata um caso clínico, no qual em um lado foi empregada a técnica de enxerto gengival livre no dente 45 e, no lado contralateral, a técnica de MARF no dente 34 a fim de aumentar a faixa de gengiva inserida. Após dez meses de controle pós-operatório, observou-se aumento satisfatório de mucosa ceratinizada em ambos os lados, 4 mm no dente 45 e 4 mm no dente 34, e aparência estética aceitável, o que favorecerá a higienização bucal e a saúde periodontal, já que são áreas adjacentes à prótese parcial removível. Concluiu-se que o MARF é uma alternativa satisfatória ao EGL, entretanto, esta técnica necessita de 1 mm de gengiva inserida e não aumenta a espessura gengival. Na ausência completa de gengiva inserida, o EGL é ainda a técnica de eleição para obter melhores resultados (AU).

Adequate amount of attached gingiva around the teeth is needed for protection and maintenance of gingival health. In the absence of suitable width of attached gingiva, gingival free graft (EGL) is the gold standard technique for such purpose. However, EGL requires two surgical areas, leading to greater postoperative discomfort to the patient. Alternatively, when there is a minimum range of attached gingiva is the flap modified apically repositioned (MARF) having only one surgical area and is an easy technique, which accelerates the cross-surgical time and reduces postoperative patient discomfort. The objective of this study is to report a case in which the free gingival graft technique was used in one side (tooth #45), and the MARF technique was used in the contralateral side (tooth #34) in order to increase the range of the attached gingiva. After ten months of postoperative control, it was observed satisfactory increase of keratinized mucosa on both sides, 4 mm on tooth #45 and 4 mm on tooth #34, and acceptable aesthetic appearance, thus promoting oral hygiene and periodontal health since they were areas adjacent to a removable partial denture. It can be concluded that the MARF is a satisfactory alternative to EGL. However, this technique requires 1 mm of attached gingiva and it does not increase gingiva thickness. In the complete absence of gingiva, EGL is still the technique of choice for best results (AU).

Evaluation of the level of microbial contamination and prevalence of gram-negative non-fermentative rods in dental unit waterlines

Introduction: The cross infection control in dental office has received great attention from professionals and one of the critical points is the bacteriological control of water used in dental unit. Objective: To perform a microbiological evaluation of the water used in dental units, the identification of Gram-negative non-fermentative rods (GNNR) and their ability to adhere to polystyrene, and the antimicrobial activity of disinfectants on the identified strains. Material and methods: The heterotrophic bacteria count and GNNR identification were performed on water samples collected from 25 dental units (air/water syringe and reservoir). The GNNR were assessed on their capability to adhere to polystyrene and on their antimicrobial activity to the following disinfectants: sodium hypochlorite (0.06%, 0.12%, 0.25%, and0.5%) and chlorhexidine (0.03%, 0.06%, and 0.12%). Results: 88% of the air/water syringe collected samples and 68% of the reservoir collected samples were out of the potability standards. The quantity of isolated bacteria from the reservoir was lower than from the air/water syringe in 88% of the dental units. Methylobacterium spp. was found in highest percentage (19.7%) during GNNR genus isolation. There was a weak adherence to polystyrene in 85.04% of the samples. Sodium hypochlorite at 0.25%, inactivated 100% of the GNNRs in 10 minutes, while the highest tested concentration of chlorhexidine (0.12%), inactivated 98.5% of the GNNRs. Conclusion: These results provide information on the contamination problem of dental unit waterlines (DUWL) and indicate a need for treatment of the water used in dental units. The disinfection of DUWL can be performed with sodium hypochlorite at 0.25% (half the concentration recommended in the literature). However, further studies are necessary regarding DUWL frequency disinfection.

Apresentação de modelo de ficha clínica periodontal / Presentation of a model of periodontal clinical record

Introdução: a ficha clínica é uma ferramenta essencial para a execução de qualquer procedimento periodontal. Sua finalidade é obter e registrar o maior número possível de informações sobre o estado de saúde geral e bucal do paciente, além de armazenar o registro de todos os procedimentos executados desde a consulta inicial até a conclusão do tratamento. Objetivo: o propósito desse trabalho é destacar a importância da ficha clínica periodontal e propor um modelo orientador a profissionais ou instituições na elaboração de suas próprias fichas clínicas. Conclusões: através da análise dos dados contidos nas fichas clínicas de diversas instituições do estudo dos principais artigos referentes ao assunto, foi criado um modelo de ficha clínica específico para a Periodontia.

Introduction: The clinic form is an essential tool for the execution of any periodontal procedure. Its finality is to obtain and record as much information as possible about the patient’s general and oral state of health, besides storing records of all executed procedures since initial appointment until the treatment conclusion. Objective: The purpose of this work is to emphasize the importance of the periodontal clinic form and propose a guidance model for professionals and institutions on the elaboration of their own clinical forms. Methods: Through the analysis of the data contained on clinical forms of several institutions and study of the main articles related to the subject it was created an specific model of clinical form for Periodontics.

Estudo comparativo entre o esfigmomanômetro e o aparelho digital de pulso na aferição da pressão arterial e da pulsação em pacientes submetidos a tratamento periodontal / Comparative study between sphygmomanometer and the wrist digital monitor in measurement of blood pressure and pulse rate in patients submitted to periodontal treatment

A aferição da pressão arterial (PA) é um importante indicador do estado de saúde atual do paciente e permite uma atuação mais consciente, segura e eficaz do clrurgião-dentista durante os procedimentos odontológicos. 0 uso dos aparelhos digitais tornaria esta medição mais prática e rápida, se comparados com o esfigmomanômetro, permitindo o monitoramento da PA e frequênoa do pulso (FP) durante a execução dos procedimentos, sem necessidade de que o operador interrompa os mesmos para tomada das medidas. 0 objetivo deste trabalho foi comprovar, através de análise estatística, a precisão das aferições realizadas com o aparelho digital de pulso, comparando-o com o esfigmomanômetro aneróide. Foram realizadas aferições em 45 pacientes da Clínica de Especialização em Periodontia da Universidade Estadual de Londrina. Os resultados demonstraram que não houve diferença estatística significativa entre as medidas obtidas e o tempo de manuseio entre os dois aparelhos. Estes dados confirmam a viabilidade do uso do aparelho digital de pulso na rotina da prática clínica periodontal.