Oral metastasis intraosseous mimicking periapical lesion: a case report / Metástase oral intraóssea mimetizando lesão periapical: um relato de caso

ABSTRACT Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient's medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.

RESUMO As metástases mandibulares podem ser confundidas com doenças inflamatórias ou infecciosas. Sendo assim, elas devem ser consideradas no diagnóstico diferencial de lesões desconhecidas na mandíbula. Esse relato de caso envolveu metástase de câncer de mama na mandíbula de uma mulher de 45 anos. O diagnóstico diferencial mais importante foi uma lesão reacional, em uma localização periapical incomum, associada a um dente não vital. No entanto, dado o histórico médico da paciente e uma vez que parestesia e dor foram observadas alguns dias após a realização da pulpectomia, a metástase de câncer de mama não foi descartada. Quando a cintilografia óssea sugeriu a metástase de um tumor ósseo maligno, uma biópsia incisional foi realizada. O exame histopatológico e a reação imunohistoquímica confirmaram o diagnóstico de metástase do câncer de mama, e a quimioterapia foi então realizada. Infelizmente, a paciente morreu 2 anos após o diagnóstico. Portanto, dentistas e médicos generalistas devem considerar a presença demetástases oral em casos que envolvam sintomas atípicos, principalmente em pacientes com doença maligna conhecida.

Avaliação da taxa de infecção no pós-operatório de cirurgias odontológicas em uma instituição pública / Evaluation of postoperative infection rate of dental surgery in a public institution

Objetivo: Avaliar a taxa de infecção e eventos adversos no pós-operatório de cirurgias orais menores, em uma instituição pública de atenção odontológica, entre 2017 e 2018. Métodos: Após realização dos procedimentos cirúrgicos, um formulário foi preenchido com dados relacionados ao paciente e à cirurgia. Trinta dias após, os egressos cirúrgicos foram contactados, via telefone e questionados quanto à ocorrência de eventos adversos (dor, secreção, sangramento e deiscência de sutura) e sobre uso de antibióticos. Realizou-se a análise descritiva dos dados (distribuição de frequências e percentuais) e cálculo da taxa de infecção global. Resultados:Foram incluídos 3.745 procedimentos cirúrgicos. A média de idade dos pacientes da amostra foi de 42,7 anos, com ligeiro predomínio do sexo masculino (51,3%). A clínica de cirurgia teve a maior concentração de procedimentos cirúrgicos realizados (53,8%), a prevalência média anual de eventos adversos no pós-operatório foi de 1,7% e a dor foi o evento adverso mais informado (4,0%). A maioria dos pacientes (64,2%) não recebeu nenhum tipo de prescrição antibiótica (profilático, terapêutico ou ambos) e a taxa de infecção no pós-operatório apresentou prevalência média total de 1,1%. Conclusão: As taxas de eventos adversos e a de infecção das feridas cirúrgicas encontradas foram baixas, demonstrando que o serviço atua de forma comprometida com os padrões de biossegurança, zelando pelos cuidados com o paciente.

Aim: To evaluate the rate of infection and adverse events in the postoperative stage of dental surgeries in a public dental care institution between 2017 and 2018. Methods: After performing the surgical procedures, a form was filled with data related to the patient and the surgery. Thirty days later, the patients were contacted via telephone, inquiring about the occurrence of adverse events (pain, discharge, bleeding, suture dehiscence) and antibiotic use. Descriptive data analysis (frequency and percentage distribution) and global infection rate were calculated. Results: This study included 3,745 surgical procedures. The mean age of the patients was 42.7 years, with a slight predominance of males. The surgery clinic presented the highest concentration of executed surgical procedures (53.8%); the average annual incidence of postoperative adverse events was 1.7%; and pain was the most commonly reported adverse event (4.0%). Most patients (64.2%) received no type of antibiotic prescription (prophylactic, therapeutic, or both) and the postoperative infection rate presented a total average incidence of 1.1%. Conclusion: The rates of adverse events and the infection of surgical sites were low, demonstrating that the service acts in a manner committed to the standards of biosafety, thus ensuring patient care.

Patients' Perceptions of Endodontic Treatment as Part of Public Health Services: A Qualitative Study.

Evaluations by patients constitute an important part of the process of improving health services. This study examined patients' perceptions of secondary dental care in three cities in Minas Gerais, Brazil based on the endodontic treatment received. Data were collected using semi-structured interviews (addressing access, treatment and results) and a field diary (direct observations and report of professionals). The interviews were audiotaped, fully transcribed, and analyzed using content analysis. Two principal themes were identified: access to service and quality of service. The difficulties in accessing service were associated with the insufficient number of professionals to meet the high demand for endodontic treatment, problems in referring from primary to secondary care and geographic barriers. Service quality was related to the presence/absence of pain and anxiety that patients experienced, the time and number of sessions required to complete treatment, how patients were treated by dentists, and whether those patients would recommend the service to other patients. Access to endodontic treatment was a problem emphasized by users, and satisfaction with the quality of the service was more related to how patients were treated than to the technical competence of the dentist.