Is dental caries associated with liver transplantation? A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the experience of dental caries in individuals pre- or postliver transplant. MATERIALS AND METHODS: Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases' inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta-analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. RESULTS: The search retrieved 1990 references. Twenty-four cross-sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre-liver transplant and healthy individuals (mean difference = 1.65, confidence interval = -0.87 to 4.17). The prevalence of dental caries among pre-liver transplant individuals was 73.82% and in the post-transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. CONCLUSIONS: Dental caries may be a relevant issue in pre- and postliver transplant individuals. Oral health counseling should be included in the care of pre- and/or postliver transplant individuals.

Cárie dentária em pacientes de transplante de células tronco hematopoiéticas, fígado e rim: aspectos clínicos, epidemiológicos e salivares / Dental caries in patients of hematopoietic stem cell, liver and kidney transplants: clinical, epidemiological and salivary aspects

Este estudo objetivou avaliar a experiência de cárie dentária e fatores associados, em indivíduos de transplante de células tronco hematopoiéticas, fígado e rim. Avaliou-se também o impacto da saúde bucal na qualidade de vida desses indivíduos e sua associação com a experiência de cárie e fluxo salivar. Um estudo transversal analítico controlado, com 40 indivíduos de transplante e 40 controles não indicados ao transplante, pareados por idade e sexo, atendidos na Faculdade de Odontologia da UFMG (Brasil) foi conduzido. Dados sociodemográficos e econômicos, medicações em uso e tempo de pós-transplante foram coletados. Avaliou-se a experiência de cárie pelos índices CPOS e COR (superfície). O impacto da saúde bucal na qualidade de vida foi mensurado pelo instrumento Oral Health Impact Profile (OHIP-14). Coletou-se saliva para obtenção do fluxo, pH, composição química e capacidade tampão. Avaliou-se a ingestão de açúcares livres pelo recordatório de 24 horas. A análise de regressão mostrou que o aumento de um indivíduo morador na casa do paciente aumenta as chances de ter alta experiência de cárie (OR = 1,35; IC95% 1,02-1,79). O aumento de um ponto do fluxo salivar diminuiu as chances de alta experiência de cárie dentária (OR = 0,14; IC95% 0,03-0,72). Quanto ao impacto da saúde bucal na qualidade de vida, os indivíduos em condição de transplante de fígado apresentaram valores significativamente maiores de medianas (4,0 [0-7,0]) comparados aos de transplante de rim (0,5 [0-5]) (p=0,043), para o domínio desconforto psicológico. As medianas do número de superfícies perdidas foram significativamente maiores nos indivíduos de transplante de fígado (45,0 [0-81,0]), comparados aos de rim (12,0 [0-65,0]) (p=0,045). Os indivíduos de transplante de rim (32,5 [1,0-58,0]) apresentaram número de superfícies restauradas significativamente maiores, comparados aos de fígado (13,0 [0-32,0]) (p=0,049). A faixa etária entre 56 e 61 anos (13,0 [7,0-25,0]) apresentou maiores valores do OHIP- 14, comparada à faixa de 25 a 40 anos (4,5 [0-29,0]) (p=0,013). Os valores de OHIP-14 apresentaram correlação positiva moderada significativa, com o número de superfícies dentárias perdidas (ρ=0,433; p=0,005). Não houve correlação entre o valor de OHIP-14 e o fluxo salivar. Concluiu-se que o aumento do fluxo salivar diminuiu as chances de o indivíduo apresentar uma alta experiência de cárie. O aumento do número de indivíduos moradores da casa aumentou as chances de ocorrência de alta experiência de cárie. Indivíduos de transplante de fígado apresentaram maior desconforto psicológico e um maior número de superfícies dentárias perdidas, comparados aos de transplante renal. A maior perda dentária foi correlacionada com um pior impacto da saúde bucal na qualidade de vida dos indivíduos de transplante. Indivíduos a partir de 56 anos de idade demonstraram um maior impacto na qualidade de vida relacionada à saúde bucal.

The aim of this study was evaluate the experience of tooth decay and associated factors in hematopoietic stem cell, liver and kidney transplant patients. The impact of oral health on the quality of life of these individuals and its association with the experience of caries and salivary flow were also evaluated. A controlled analytical cross-sectional study with 40 transplant individuals and 40 controls not indicated for transplantation, matched for age and sex, attended at the UFMG School of Dentistry (Brazil) was conducted. Sociodemographic and economic data, medications in use and post-transplant time were collected. The caries experience was evaluated using the CPOS and COR (surface) indexes. The impact of oral health on quality of life was measured using the Oral Health Impact Profile (OHIP-14). Saliva was collected to obtain flow, pH, chemical composition and buffering capacity. The intake of free sugars was evaluated by the 24-hour recall. The regression analysis showed that the increase of an individual living in the patient's home increases the chances of having a high caries experience (OR =1.35; 95% CI 1.02-1.79). The increase of one point in the salivary flow decreased the chances of high experience of dental caries (OR=0.14; 95% CI 0.03-0.72). As for the impact of oral health on quality of life, individuals in conditions of liver transplantation had significantly higher median values (4.0 [0-7.0]) compared to those of kidney transplantation (0.5 [0- 5]) (p = 0.043), for the psychological discomfort domain. The medians of the number of surfaces lost were significantly higher in the liver transplant subjects (45.0 [0-81.0]), compared to the kidney (12.0 [0-65.0]) (p = 0.045). The kidney transplant individuals (32.5 [1.0-58.0]) had significantly higher number of restored surfaces, compared to the liver (13.0 [0-32.0]) (p = 0.049). The age group between 56 and 61 years old (13.0 [7.0-25.0]) presented higher OHIP-14 values, compared to the age group from 25 to 40 years old (4.5 [0-29.0]) (p=0.013). The OHIP-14 values showed a significant moderate positive correlation, with the number of missing dental surfaces (ρ = 0.433; p = 0.005). There was no correlation between the OHIP-14 value and the salivary flow. It was concluded that the increase in salivary flow decreased the chances of the individual having a high experience of caries. The increase in the number of individuals living in the home increased the chances of high caries experience. Individuals with liver transplantation had greater psychological discomfort and a greater number of missing dental surfaces, compared to those of kidney transplantation. The greater tooth loss was correlated with a worse impact of oral health on the quality of life of transplant individuals. Individuals over 56 years of age demonstrated a greater impact on quality of life related to oral health.

Anxiety in patients attending dental university clinics / Ansiedade em pacientes atendidos em clínicas odontológicas universitárias

This study aimed to investigate anxiety in patients attended at a university dental clinic. The present cross-sectional study included 49 patients recruited at the undergraduate dental clinics, Federal University of Juiz de Fora, Governador Valadares campus, Minas Gerais, Brazil, from September 2016 to August 2017. Information regarding gender, age, family income, educational level, frequency of dental consultations and dental procedure causing discomfort were collected using a questionnaire. The level of anxiety was evaluated by the Dental Anxiety Scale. A mild level of anxiety (median=6) was observed, with a minimum level of 4 (not anxious) and a maximum level of 19 (extremely anxious). Women had higher anxiety than men (p=0.047). Individuals with 9-11 years of schooling presented a lower level of dental anxiety than those with 0-8 years of schooling (p=0.025). Participants who attributed a greater discomfort to surgeries and the use of high-speed burs had a greater anxiety (p=0.002). Light anxiety is present in patients undergoing dental treatment in university clinics, and women are more anxious than men. Patients with higher education were less anxious than lower education level. The report of a greater discomfort with surgeries and procedures with high-speed burs were associated with a greater anxiety (AU).

Este estudo objetivou investigar a ansiedade em pacientes atendidos em clínicas odontológicas universitárias. O presente estudo transversal incluiu 49 pacientes recrutados nas clínicas odontológicas da Universidade Federal de Juiz de Fora, campus Governador Valadares, Minas Gerais, Brasil, de setembro de 2016 a agosto de 2017. Informações sobre sexo, idade, renda familiar, escolaridade, frequência de consultas odontológicas e procedimentos odontológicos causadores de desconforto foram coletadas por meio de questionário. O nível de ansiedade foi avaliado pela Dental Anxiety Scale. Observou-se um nível de ansiedade leve (mediana = 6), com mínimo de 4 (não ansioso) e máximo de 19 (extremamente ansioso). As mulheres apresentaram maior ansiedade que os homens (p = 0,047). Indivíduos com 9 a 11 anos de escolaridade apresentaram menor nível de ansiedade odontológica do que aqueles com 0 a 8 anos de estudo (p = 0,025). Os participantes que atribuíram maior desconforto às cirurgias e ao uso de alta rotação apresentaram maior ansiedade (p = 0,002). Conclui-se que a ansiedade leve está presente em pacientes submetidos a tratamento odontológico em clínicas universitárias, sendo as mulheres mais ansiosas do que os homens. Pacientes com maior grau de instrução foram menos ansiosos. O relato de maior desconforto com cirurgias e procedimentos alta rotação pode estar associado a uma maior ansiedade (AU).

Tratamento cir£rgico de seio frontal atrav‚s da cranializa‡Æo e utiliza‡Æo do acesso bicoronal – relato de caso / Surgical treatment of frontal sinus through cranialization using bicoronal access – case report

O trauma maxilofacial ‚ um dos grandes desafios para os servi‡os de sa£de e representa um dos problemas mais importantes devido … elevada taxa de incidˆncia e alto custo financeiro. A frequente associa‡Æo entre trauma craniofacial e maxilofacial exige abordagens e tratamento multiprofissional e sÆo cada vez mais complexos, com tempo de interna‡Æo mais longo e altos custos para o sistema p£blico de sa£de. Este estudo apresenta um relato de caso cl¡nico de um paciente admitido no servi‡o de emergˆncia do Hospital Municipal Salgado Filho (HMSF) – RJ, v¡tima de agressÆo f¡sica por pedra no ter‡o superior de face e submetido ao tratamento cir£rgico por equipe multiprofissinal (neurocirurgiÆo e cirurgiÆo bucomaxilofacial), com cranializa‡Æo do seio frontal e reparo do defeito ¢sseo com tela de titƒnio de reconstru‡Æo. Conclui-se neste trabalho que a proposta cir£rgica, que consistiu na cranializa‡Æo do seio frontal pelo acesso bicoronal, como tratamento proposto para o paciente, apresentou- -se satisfat¢ria, segundo as referˆncias liter rias consultadas. Sugere-se acompanhamento p¢s-operat¢rio cl¡nico e radiogr fico do paciente, uma vez que neste relato foi mencionado apenas o tratamento cir£rgico do caso.

TMaxillofacial trauma is a major challenge for health services and represents a serious problem due to its high incidence and high costs. The frequent association between craniofacial and maxillofacial trauma requires multidisciplinary approaches and treatment, and it i salso very complex, with longer hospitalization time and high costs to the public health system. This study presents a case report of a patient assisted in the emergency department of the Salgado Filho Municipal Hospital (HMSF) – RJ, victim of physical assault by stone in the upper third of the face, who underwent surgery conducted by multiprofissinal team (neurosurgeons and maxillofacial surgeon) with cranialization of the frontal sinus and repair of bone defect reconstruction with titanium screen. It was concluded that the surgical approach, which consisted of the frontal sinus cranialization using bicoronal access was satisfactory as treatment according to the researched literature. It is suggested post-operative clinical and radiographic follow-up of the patient since in this report only the surgical treatment of the case was approached.