Frequency of osteonecrosis in bisphosphonate users submitted to dental procedures: A systematic review.

OBJECTIVE: To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. METHODS: This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta-analyses were pooled using the DerSimonian and Laird random effects model. RESULTS: A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9-5.2%) and proved higher for intravenous [6.9% (0.7-17.3%)] than oral [0.2% (0.9-5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed. CONCLUSIONS: Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group.

Comparison of piezosurgery and conventional rotary instruments in schneider's membrane sinus lifting: A pilot randomized trial.

BACKGROUND: The present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider's membrane sinus lifting procedure. MATERIAL AND METHODS: Twenty patients requiring bilateral maxillary bone graft augmentation in the posterior maxillary region were selected. Piezoelectric surgery was performed on one side and conventional surgery with a rotary diamond bur on the other. Postoperative pain, swelling, edema, and mouth opening were evaluated at one hour and two and seven days after the procedures. All variables were submitted to Friedman or Wilcoxon tests at a 5% significance level. RESULTS: The comparison between groups showed that postoperative pain after one hour and two days was significantly lower (p< 0.05) in the piezoelectric device group. Regarding the edema, the results of both techniques were similar at all times assessed (p> 0.05). Piezosurgery was statistically associated (p< 0.05) with greater mouth opening only at the 48-hour evaluation. CONCLUSIONS: Osteotomy with a piezoelectric device causes less pain and greater mouth opening postoperatively compared with the conventional technique. Key words:Piezosurgery, sinus lift, edema, pain, rotative instruments.

Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis.

OBJECTIVES: There is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD. DESIGN: Systematic review and meta-analysis. METHODS: We have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference -0.95, 95% CI -1.35 to -0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile. CONCLUSIONS: The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. PROTOCOL REGISTRATION: PROSPERO (CRD42016045421).

Antimicrobial resistance of bacterial strains in patients undergoing orthodontic treatment with and without fixed appliances.

OBJECTIVES: To identify microorganisms isolated from patients wearing fixed orthodontic appliances and to evaluate the resistance of isolated bacterial strains to different antimicrobials. MATERIALS AND METHODS: Seventeen healthy patients wearing a fixed orthodontic appliance (group 1) and six nonwearers (group 2, control group) were evaluated. The biofilm that formed around the orthodontic brackets was collected, and the samples were then plated in a chromogenic medium (chromIDT, bioMérieux). Colony-forming units (CFUs) were isolated and inoculated in blood-agar medium. Automated biochemical tests (VITEK 2, bioMérieux) were carried out to identify the genus and species of the microorganisms and the resistance provided by 43 drugs (37 antibacterial and 6 antifungal). RESULTS: The most prevalent microbial genera identified in group 1 were Streptococcus (24.0%), Staphylococcus (20.0%), Enterobacter (12.0%), Geobacillus (12.0%), and Candida (12.0%), and the most frequent species were Enterobacter cloacae complex (13.6%) and Staphylococcus hominis (13.6%). In group 2, the most prevalent genera were Streptococcus (57.1%), Staphylococcus (14.2%), Sphingomonas (14.2%), and Enterobacter (14.2%). With regard to antimicrobial resistance, 14 of 19 (74%) isolated bacterial strains were found to be resistant to at least 1 of the tested antimicrobials. CONCLUSIONS: The findings of the present study suggest that patients undergoing orthodontic treatment with fixed appliances have a more complex biofilm with a higher level of bacterial resistance.

Children's Perceptions of the Dentist and Dental Office Through Drawings.

Purpose: To evaluate children's perceptions of the dentist and dental office using drawings and its association with age, sex, and previous dental experience.
Methods: Participants included 144 four- to six-year-old children who were instructed to make a drawing of their perception of the dentist and dental office. Data collected included age, sex, and previous dental care experience. The data were analyzed descriptively and through multivariate logistic regression.
Results: Boys were 2.3 times more likely to have a negative perception of the dentist than girls (P =0.024). Children who had no previous dental experience were four times more likely to have a negative perception of dentists (P =0.002). Six-year-old children were three times more likely to have a negative perception of the dentist compared to four-year-old children (P =0.031).
Conclusion: Drawings can be a useful tool to evaluate children's perceptions of the dentist and dental office.

A novel dental biosafety device to control the spread of potentially contaminated dispersion particles from dental ultrasonic tips.

Strategies to return to dental practice in pandemic times is a new challenge due to the generation and spread of potentially contaminated dispersion particles (PCDP) that may contain the SARS-CoV-2, the etiological factor of the COVID-19 disease. Due to the significant dispersion of PCDP in the dental environment, the use of equipment such as ultrasonic tips have been inadvisable during the pandemic. Several clinical procedures, however, benefit from the use of such equipment. Thus, using a microbial dispersion model of PCDP, the aim of this study was to compare the dispersion caused by the dental drill (DD) an ultrasonic tip (UT) alone and the UT coupled with a Spray control (SC) device. The DD, UT (with or without the SC) were activated for one minute having had the water from the reservoir replaced with a suspension of Lactobacillus casei Shirota (1.5 x 108 CFU/mL). Petri dishes containing MRS agar were positioned at 50cm, 100cm and 150cm from the headrest of the dental chair at different angles (0 degree and 90 degrees). At 50 cm, the mean CFU (standard deviation) of L. casei Shirota was 13554.60 (4071.03) for the DD, 286.67 (73.99) for the US (97.89% reduction), and 4.5 (0.58) CFU for the UT-SC (p < 0.0001), establishing a further 98.43% reduction between UT and UT with SC. The UT with SC model proved effective in reducing dispersion from the UT, endorsing its use as an additional strategy to reduce PCDP in the dental environment in times of pandemic.

Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: a systematic review.

OBJECTIVES: It can be challenging to manage patients who are anxious during dental procedures. There is a lack of evidence regarding the effectiveness and safety of oral sedation in adults. This study evaluated the effectiveness and safety of oral sedation in patients undergoing dental procedures. DESIGN: Systematic review. METHODS: Randomised clinical trials (RCTs) compared the oral use of benzodiazepines and other medications with a placebo or other oral agents in adult patients. A search of the Cochrane (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid) and Cumulative Index to Nursing and Allied Health Literature (via Ovid) databases was conducted, without any restrictions on language or date of publication. The primary outcomes included the adverse effects and anxiety level. The secondary outcomes included sedation, satisfaction with the treatment, heart rate, respiratory rate, blood pressure and oxygen saturation. Reviewers, independently and in pairs, assessed each citation for eligibility, performed the data extraction and assessed the risk of bias. A narrative synthesis of the data was provided. RESULTS: A number of RCTs (n=327 patients) assessed the use of benzodiazepines (n=9) and herbal medicines (n=3). We found good satisfaction with treatment after the use of midazolam 7.5 mg or clonidine 150 µg and reduced anxiety with alprazolam (0.5 and 0.75 mg). Midazolam 15 mg promoted greater anxiety reduction than Passiflora incarnata L. 260 mg, while Valeriana officinalis 100 mg and Erythrina mulungu 500 mg were more effective than a placebo. More patients reported adverse effects with midazolam 15 mg. Diazepam 15 mg and V. officinalis 100 mg promoted less change in the heart rate and blood pressure than a placebo. CONCLUSIONS: Given the limitations of the findings due to the quality of the included studies and the different comparisons made between interventions, further RCTs are required to confirm the effectiveness and safety of oral sedation in dentistry. PROSPERO REGISTRATION NUMBER: CRD42017057142.

Bleeding Risk in Patients Using Oral Anticoagulants Undergoing Surgical Procedures in Dentistry: A Systematic Review and Meta-Analysis.

The management of patients who undergo dental surgical procedures and receive oral anticoagulant therapy requires particular attention due to the risk of bleeding that may occur during the procedure. Bleeding rates in these trans- or post-operative patients tend to be unpredictable. The aim of this study was to conduct a systematic review in order to assess the risk of bleeding during and after performing oral surgery in patients administered oral anticoagulants compared with a group that discontinued anticoagulant therapy. For the purposes of this review, we searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), and the Virtual Health Library (VHL) from inception of the database to December 2018. The primary outcome was defined as the occurrence of local bleeding during and after oral surgical procedures. Four reviewers, independently and in pairs, screened titles and abstracts for full-text eligibility. Data regarding participant characteristics, interventions, and design and outcomes of the included studies were extracted. The data were pooled using random-effects meta-analyses and described as risk ratios (RRs) with a 95% confidence interval (95% CI). The confidence for the pooled estimates was ascertained through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and the protocol of this review was recorded in PROSPERO (CRD42017056986). A total of 58 eligible studies were identified, of which three randomized controlled trials were included in the meta-analysis, covering a total of 323 adult participants, among whom 167 were taking anticoagulants at the time they underwent dental surgery. Of these patients, 14.2% had reported bleeding. The risk of bleeding was found to be one to almost three times greater in patients taking warfarin compared with patients who discontinued the use of anticoagulant during the trans-operative period (RR = 1.67, 95% CI = 0.97 to 2.89) and in the post-operative period (RR = 1.44, 95% CI = 0.71 to 2.92), although the quality of evidence was very low. The results indicate that there is no evidence that the use of anticoagulants eliminates the risk of bleeding during surgical dental procedures.

Comparação de estratégias para aprimoramento de graduandos de Odontologia na prescrição medicamentosa / Comparison of different teaching strategies to improve the knowledge of Dental students about prescribing standards

O objetivo deste estudo foi avaliar diferentes estratégias para o aprimoramento de graduandos de Odontologia sobre normas de prescrição medicamentosa. Foram avaliados 72 estudantes, os quais foram divididos aleatoriamente em 3 grupos (n=24): Grupo 1 ­ em cada etapa de avaliação foi apresentado um vídeo explicativo sobre normas de prescrição com duração de 15 minutos; Grupo 2 ­ o mesmo vídeo foi disponibilizado em uma plataforma virtual (com acesso ilimitado); Grupo 3 ­ controle: os estudantes não tiveram atividades adicionais sobre o tema. Foram realizadas 4 avaliações e os voluntários receberam um caso clínico diferente em cada avaliação, realizando uma prescrição para a situação clínica proposta. Para cada prescrição realizada foi atribuída uma pontuação considerando diferentes itens: identificação do profissional e do paciente, concentração, dose e quantidade do medicamento, instruções, dentre outros. Os resultados obtidos foram submetidos à análise estatística, com nível de significância de 5%. Não foram observadas diferenças significativas na avaliação basal entre os grupos (p>0,05). Após o uso das diferentes estratégias foram observados melhores resultados para G1 quando comparados a G2 e G3 (p<0,05). Concluiuse que o uso do vídeo presencial foi o que proporcionou melhores resultados em relação às normas de prescrição de medicamentos (AU).

The aim of this study was to evaluate different teaching strategies to improve the knowledge of dental students about prescribing standards. We evaluated 72 students who were randomly separated into 3 groups (n = 24): Group 1 - at each evaluation stage, an explanatory video about prescription rules was presented; Group 2 - the same video was made available on a virtual platform (with unlimited access); Group 3 - control: the students did not have additional activities on the subject. During the study period 4 evaluations were performed, and all participants received a different clinical case to carry out a prescription for the proposed clinical situation. For each prescription performed, a score was given to different items: identification of professional and patient, concentration, dosage and quantity of the medicine, instructions, among others. The results were submitted to statistical analysis and the level of significance was set at 5%. No significant differences were observed at baseline between groups (p> 0.05). However, after using the strategies better results were observed for G1 when compared with G2 and G3 (p<0.05). It could be concluded that among the strategies used, the use of video was the one that provided an improvement in knowledge of dental students in relation to prescribing standards (AU).

Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review protocol.

BACKGROUND: Rheumatoid arthritis affects 1% of the world's population and its current treatment options are costly. There are not enough studies that evaluated the efficacy and safety of anti-inflammatory drugs medications used to reduce rheumatoid arthritis's symptoms. This study will evaluate the effectiveness and the safety of steroid and nonsteroidal anti-inflammatory drugs for the treatment of patients with rheumatoid arthritis. METHODS: Randomized clinical trials eligible for our systematic review will enroll adults with rheumatoid arthritis treated with anti-inflammatory drugs compared with a control group (placebo or active control) at any dose, duration, and route of administration and double blind studies. In order to include all forms of rheumatoid arthritis and anti-inflammatory drugs, we will search the following electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid); ExcerptaMedica Database (via Ovid); Cumulative Index to Nursing and Allied Health Literature (via Ovid); Web of Science; ClinicalTrial.gov; and WHO International Clinical Trials Registry Platform. We will not impose any language restrictions or publication status. Outcomes of interest include are pain, physical function, swelling, stiffness, grip force, radiological image of the joint, quality of life, adverse events, discontinuation due to adverse events, satisfaction with the treatment, and rescue medication for pain. A team of reviewers will independently screen search results, extract data from eligible trials, and assess risk of bias. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome. Dichotomous data will be summarized as risk ratios; continuous data will be given as standard average differences with 95% confidence intervals. RESULTS: The evidence derived by this study will increase awareness of the effectiveness and safety of steroid and nonsteroidal anti-inflammatory drugs for the treatment of rheumatoid arthritis. CONCLUSION: The results could guide patients and healthcare practitioners and help facilitate evidence-based shared care decision making.

Simulação de alta fidelidade realística para o ensino de emergências médicas na prática odontológica: relato de experiência / High-fidelity simulation as a teaching method in medical emergencies in dental practice: experience report

Os cirurgiões-dentistas devem estar preparados para eventuais situações de emergências médicas que podem ocorrer durante o atendimento odontológico. Entretanto, muitos profissionais não se sentem preparados para executar estes procedimentos e têm pouca experiência em treinamentos práticos. Desta forma, o objetivo deste artigo é relatar a experiência de uma atividade de simulação em diferentes cenários de emergências médicas na prática odontológica. Esta metodologia envolve o uso de um simulador de alta fidelidade e permite a discussão na sala de debriefing sobre os principais procedimentos e treinamento prático para o manejo de emergências médicas. A simulação de alta fidelidade realística para o ensino de emergências médicas na prática odontológica representa um cenário inovador e é eficaz para o processo de ensino e aprendizagem (AU).

Dentists should be prepared to manage eventual medical emergencies that occur in the dental practice. However, many dentists are not fully prepared to manage these situations and have insufficient experience training in medical emergencies. The aim of this paper is to report the experience of educational activities using a high-fidelity simulator in different scenarios in order to prepare dental professionals for medical emergencies in the dental clinic. This methodology allows discussion in the debriefing room regarding the main techniques and procedures to be performed in clinical practice in cases of emergencies and training of dentists to meet these situations. It can be concluded that high-fidelity simulation represents an innovative learning scenario and it is an effective educational method to prepare dental professionals for medical emergencies (AU).

Clinical evaluation of two dexamethasone regimens in the extractions of impacted third molars-a randomized clinical trial.

PURPOSE: The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial. METHODS: Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8 mg of dexamethasone orally 1 h before the procedure, and in group 2, 4 mg dexamethasone orally 1 h before and 24 h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12 h; and 1, 2, 3, and 7 days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days). RESULTS: There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2 days. CONCLUSION: Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8 mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.

Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: protocol for a systematic review.

INTRODUCTION: The management of anxious patients undergoing dental procedures is still a challenge in clinical practice. Despite a wide variety of drugs for oral sedation in adult patients, there are relatively few systematic reviews that compare the effectiveness and safety of different drugs administered via this route. Thus, this study will evaluate the effectiveness and safety of oral sedation with benzodiazepines and other agents to patients undergoing dental surgical procedures. METHOD/DESIGN: We will conduct a systematic review and, if appropriate, a meta-analysis of randomised controlled clinical trials that will evaluate the use of conscious sedation administered orally to adult patients undergoing oral surgery. The search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), CINAHL (via Ovid), Lilacs (SciELO) and Capes database, without restriction of languages or date of publication. Primary outcomes include anxiety, sedation, treatment satisfaction, pain and adverse effects. Secondary outcomes include vital parameters (heart rate, respiratory rate and blood pressure) and patient cooperation during intervention. A team of reviewers will independently assess each citation for eligibility and in duplicates. For eligible studies, the same reviewers will perform data extraction, risk of bias assessment and determination of the overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation classification system. ETHICS AND DISSEMINATION: The evidence gathered from this study should provide dental surgeons with knowledge on the effectiveness and safety of oral sedation in adults requiring dental surgical procedures. This in turn should contribute towards the decision-making process in dental practice, minimising the risks of anxiety and ineffective pain control in clinical procedures, as well as possible side effects. Ethics approval is not required in protocols for systematic reviews. The systematic review will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42017057142.

Strategy to control occupational risk for Hepatitis B: impact on the vaccination and seroconversion rates in dentistry students / Estratégia para controle do risco ocupacional de Hepatite B: impacto nas taxas de vacinação e soroconversão de alunos de odontologia

ABSTRACT Objective: To describe the development of a dentistry school strategy in order to reduce the occupational risk related to hepatitis B. Methods: The academic registration documents of 242 students entering the institution between the years 2006 and 2013, were evaluated, among which were of copies of the updated vaccination cards and anti-HBs serologic testing. Demographic variables and others related to the vaccination status of hepatitis B and seroconversion were considered. Results: One hundred percent of the students were found to be vaccinated, and 87.2% had vaccination records of three doses. The results of anti-HBs tests proved seroconversion in 91.3% of the students. From 2011, the dental school was able to institutionalize the follow-up behavior of the students who had anti-HBs non-reactive. Of the twenty individuals whose serology was negative, nine students (45% of the total and all of the 2011-2013 class) were followed-up and repeated the basic vaccination and anti-HBs test; eight seroconverted and one was considered a non-responder, increasing the percentage of immune students to 95%. Eleven (55%) had other unregistered behavior or the documents analyzed showed no data on them. Conclusion: The procedure of following-up the registration in vaccination records required by the Biosafety Committee of the institution was shown to be effective in reducing the occupational risk of hepatitis B among the students.

RESUMO Objetivo: Descrever a experiência de uma Faculdade de Odontologia para redução do risco ocupacional relacionado à hepatite B. Métodos: Foram avaliados os documentos de cadastro acadêmico dos 242 alunos com ingresso na instituição entre os anos de 2006 a 2013, dos quais faziam parte cópias da carteira de vacinação atualizada e do teste sorológico anti-HBs. Variáveis demográficas e relacionadas à situação vacinal da hepatite B e de soroconversão foram consideradas. Resultados: Verificou-se que 100% dos discentes foram vacinados, sendo que para 87,2% havia registro de vacinação em três doses. Os resultados do anti-HBs comprovaram a soroconversão em 91,3% dos alunos. Dos 20 indivíduos, cuja sorologia foi negativa, 9 alunos (45% do total e todos das turmas de 2011 a 2013) foram acompanhados e repetiram o esquema básico de vacinação e o teste anti-HBs, sendo que 8 soroconverteram e 1 foi considerado não respondedor, elevando a frequência de alunos imunes para 95%. Os 11 (55%) restantes não tiveram conduta registrada ou não havia dados sobre os mesmos nos documentos analisados. Conclusão: A conduta de acompanhamento vem mostrando-se efetiva para reduzir o risco ocupacional da hepatite B entre os alunos.

Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry: a systematic review protocol.

INTRODUCTION: The management of patients undergoing oral surgical procedures using anticoagulants raises concerns regarding the risk of bleeding. Bleeding rates in those patients during or after oral surgical procedures are uncertain. The aim of this study will be to determine the bleeding rate during and after oral surgeries in patients using anticoagulants. METHODS AND ANALYSIS: A systematic review will be conducted and if appropriate, a meta-analysis of randomised clinical trials evaluating the bleeding risk during and after oral surgical procedures in patients using anticoagulants were selected. The literature search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid), Embase (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via Ovid), LILACS (SciELO) and CAPES database, without restriction of languages or date of publication. The primary outcome will be the occurrence of local bleeding rate during and after oral surgical procedures, and as secondary outcome, the following complications will be considered: implant failure, healing problems and infections. Groups of two independent reviewers will select the titles and abstracts for full-text eligibility. For eligible studies, the same reviewers will perform data extraction, bias risk assessment and determination of the overall quality of evidence for each of the outcomes using the Grading of Recommendations Assessment, Development and Evaluation classification system. Meta-analysis and subgroup analyses will be conducted, to all outcomes, if appropriate. ETHICS AND DISSEMINATION: The systematic review will be published in a peer-reviewed journal, and brief reports of the review's findings will be released directly to the intended audience. The results will help dentists in the decision-making process to minimise the risk of bleeding in patients using anticoagulants in their clinical practice. PROSPERO REGISTRATION NUMBER: CRD42017056986.

Evaluation of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries / Avaliação de dois protocolos de amoxicilina para profilaxia antibiótica em cirurgias de instalação de implantes

ABSTRACT Objective The aim of this study was to evaluate the effectiveness of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries. Methods A clinical study was performed with 66 volunteers of both genders (mean 51,9 ± 2,5 years) that met the inclusion criteria and were randomly assigned into 2 groups: Group 1 (n=35) - oral administration of amoxicillin (2g) 1 hour before the surgical procedure and Group 2 (n=31) oral administration of amoxicillin (2g) 1 hour before the surgical procedure and 500mg every 8 hours during 7 days after the surgeries. The following clinical parameters were evaluated: adverse reactions, pain and implants failure. The pain was evaluated in the surgery day (before, immediately after and at night), 24h, 48h, 72h and one week after the surgery and other clinical parameters were evaluated in daily appointments until the third postoperative day, 7 days and three months after the surgeries. Data were analyzed and statistical significance was 5%. Results Adverse reactions (headache, diarrhea, stomachache and nauseas) and implant failure occurred only in G2 (4 volunteers and 3 implants, respectively). Regarding pain, higher values for G2 on "at the night (p=0.0043), 24h (p=0.0013), 48h (p=0.0187) e 72h (p=0.0445) were observed. Conclusion The present study showed that a single dose of amoxicillin was effective in antibiotic prophylaxis in implant placement surgeries, suggesting that the use of amoxicillin in the postoperative period did not bring additional benefit.

RESUMO Objetivo Avaliar a eficácia de dois protocolos de amoxicilina em cirurgias para instalação de implantes. Métodos Foi realizado um estudo clinico com 66 voluntários de ambos os gêneros (idade média 51,9±2,5 anos) que atenderam aos critérios de inclusão e que foram distribuídos por sorteio em 2 grupos: Grupo 1 (n=35) - amoxicilina (2g) por via oral 1h antes da cirurgia e Grupo 2 (n=31) - amoxicilina (2g) por via oral 1h antes da cirurgia e 500mg a cada 8 horas durante 7 dias. Os parâmetros avaliados no pós-operatório foram ocorrência de reações adversas, dor e perda de implantes. A dor foi avaliada no dia da cirurgia (antes, imediatamente após e à noite), 24h, 48h, 72h e 1 semana após as cirurgias, e os demais parâmetros foram avaliados em consultas diárias até o terceiro dia pós-cirúrgico, 7 dias e 3 meses após as cirurgias. Os resultados foram submetidos à análise estatística com nível de significância de 5%. Resultados Reações adversas (cefaleia, diarréia, dor estomacal e náusea) e perda de implantes ocorreram apenas em G2 (4 voluntários e 3 implantes, respectivamente), e em relação à dor foram observados valores maiores para G2 nos tempos "à noite (p=0,0043), 24h (p=0,0013), 48h (p=0,0187) e 72h (p=0,0445). Conclusão Os dados sugerem que a dose única de amoxicilina (2g) foi eficaz na profilaxia antibiótica para cirurgias de implantes, e que a amoxicilina no período pós-operatório não proporcionou benefício adicional.

Rapid Tranquilization for Psychiatric Patients with Psychomotor Agitation: What is Known About it?

Rapid tranquilization is an intervention used in control of agitation or aggression in patients with mental disorders. This study synthesized the available evidence regarding efficacy and safety of drugs used for rapid tranquilization in psychiatric patients with psychomotor agitation. It is an overview study of systematic reviews and meta-analysis of randomized controlled trials (RCT) identified in the database MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library and LILACS until April 2015. A team of reviewers, in pairs and independently, identified eligible studies and assessed methodological quality using AMSTAR. Data were extracted from four studies (61 RCT, 8021 participants). The association of haloperidol with promethazine (H + P) promoted tranquilization and presented better safety profile, with moderate quality evidence. Olanzapine demonstrated benefit towards tranquilization and good safety profile, but needed additional administration to keep tranquilization. There was no benefit in the use of haloperidol alone or associated to another psychotropic to most outcomes evaluated. The evidence was of low quality to most of the interventions. H + P was considered a good option for rapid tranquilization, however, more RCT are necessary to confirm the efficacy and safety of the available interventions.

Unsatisfactory glycemic control in type 2 Diabetes mellitus patients: predictive factors and negative clinical outcomes with the use of antidiabetic drugs

ABSTRACT Many factors can interfere with glycemic control in patients with type 2 diabetes mellitus and this patient group has an increased risk of experiencing drug-related negative outcomes (DNO). The aim of this study was to identify the predictive factors of unsatisfactory glycemic control and DNO in this group of patients. A cross-sectional study was conducted collecting data from prescriptions and interviews with 100 patients of the Endocrinology Clinic of the Hospital Complex of Sorocaba, São Paulo, Brazil. Variables associated with unsatisfactory glycemic control were determined and the DNO associated with antidiabetic drugs identified. Age (<65 years) (OR=4.09), family history of diabetes (OR=3.24), use of combined therapy to treat diabetes (2-4 antidiabetic drugs) (OR=5.13) and presence of DNO (OR=5.92) were found to be predictive factors for poor patient glycemic control. DNO were observed in 49% of the patients and were caused predominantly by ineffectiveness in patients with poor glycemic control (p<0.05). There was no significant difference between groups (satisfactory and unsatisfactory glycemic control) for DNO caused by safety issues (p>0.05). Characterization of the profile of patients with uncontrolled diabetes and of aspects associated with drug treatment can contribute to the planning of interventions to improve patient care

Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors / Avaliação da glicemia de pacientes diabéticos submetidos à anestesia local com diferentes vasoconstritores

ABSTRACT Objective: In the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods: The sample consisted of 20 compensated type 2 diabetic patients (both genders) who were taking oral hypoglycemic drugs. The volunteers underwent two periodontal sessions (scaling) and one of the solutions tested was used in each visit. The cited parameters were evaluated at three different times: before the procedure (T1), 10 minutes after anesthesia (T2) and after 20 minutes (T3). Results: Regarding the blood glucose levels, no statistically significant difference was found in different times between G1 and G2 (p> 0.05). Similarly, regarding pulse oximetry and heart rate, no statistically significant differences were observed in intervals assessed between groups (p> 0.05), presenting values within normal limits. Conclusion: Considering the vasoconstrictors and the volume of anesthetic solution used, the results suggest that the evaluated vasoconstrictors do not alter significantly blood glucose, pulse oximetry and heart rate in compensated type 2 diabetic patients.

RESUMO Objetivo: Na clínica odontológica, o uso de soluções anestésicas locais contendo vasoconstritores em pacientes diabéticos ainda sucita algumas dúvidas. Desta forma, o objetivo deste ensaio clínico cruzado e randomizado foi avaliar de forma comparativa a glicemia, oximetria de pulso e frequência cardíaca de pacientes portadores de diabetes tipo II quando submetidos à anestesia local com prilocaína 3% com felipressina 0,03UI/ml (G1) e lidocaína a 2% com epinefrina 1:100.000 (G2). Métodos: Foram selecionados 20 indivíduos diabéticos do tipo II, compensados, sem distinção de gênero, que faziam uso de hipoglicemiantes orais. Os voluntários foram submetidos a duas sessões de instrumentação periodontal, sendo administrada uma das soluções testadas em cada consulta. Os parâmetros citados foram avaliados em três momentos distintos: antes do procedimento (T1), 10 minutos após a anestesia (T2) e após 20 minutos (T3). Resultados: Para os valores de glicemia não houve diferença estatisticamente significante nos diferentes tempos entre G1 e G2 (p>0,05). Da mesma forma, em relação à oximetria de pulso e frequência cardíaca, não foram observadas diferenças estatisticamente significativas nos intervalos avaliados entre os grupos (p>0,05), com valores dentro da normalidade. Conclusão: Considerando a concentração dos vasoconstritores e o volume das soluções anestésicas empregadas, os resultados sugerem que os vasoconstritores avaliados não alteram de forma significativa a glicemia, oximetria de pulso e frequência cardíca de adultos portadores de diabetes tipo II compensados.