Reduced mastication is a risk factor for Rome IV postprandial distress syndrome in patients investigated with upper endoscopy.

BACKGROUND AND AIMS: Reduced mastication could force the stomach to do extra work on crushing food and contribute to dyspeptic symptoms. This study aimed to assess the relationship between mastication and dyspepsia. METHODS: This cross-sectional study involved 209 consecutive patients referred for elective upper endoscopy. Before endoscopy, an expert dentist performed an oral examination and scored chewing function in three levels (normal, regular, and reduced), and applied questionnaires for assessment of dyspepsia (Rome IV), xerostomia, and mastication (normal, regular, and reduced). A reduced masticatory function was defined when an oral examination or mastication questionnaire rated the chewing as poor. Associations between mastication, confounders, and dyspepsia were estimated by prevalence ratio [PR (95% Confidence Interval)] using Poisson regression. RESULTS: Thirty-four patients showed relevant organic conditions in the upper gastrointestinal tract (moderate to severe reflux oesophagitis, peptic ulcer, neoplasia, and surgical modification) and were excluded. Among 175 patients with non-organic diseases (aging 51.3 ± 15.7 years; 61.7% women), 50 (28.6%) had reduced mastication, and 125 (71.4%) had normal/regular mastication. After adjusting for age and xerostomia, reduced mastication was associated with postprandial distress syndrome [PR = 1.93 (95%CI 1.27 - 2.91)] but not with epigastric pain syndrome [PR = 1.09 (95%CI 0.75 - 1.60)]. CONCLUSIONS: In patients referred for upper digestive endoscopy, reduced mastication was associated with postprandial distress syndrome but not with epigastric pain syndrome. An interdisciplinary approach with dentists and physicians might benefit dyspeptic patients with postprandial distress syndrome.

Laser cirúrgico no tratamento de hiperplasia fibrosa / Surgical laser on fibrous hyperplasia treatment

Objetivo: demonstrar, por meio de relato de caso clínico, a exérese de uma hiperplasia fibrosa inflamatória (HFI) com o uso de laser cirúrgico de diodo. Relato de caso: paciente leucoderma, gênero masculino, 48 anos, compareceu ao Ambulatório de Especialidades do SUS do Hospital São Vicente de Paulo, Passo Fundo/ RS, apresentando ausência do elemento dentário 46 e lesão nodular exofítica, pediculada, coloração rósea, superfície lisa em mucosa jugal medindo aproximadamente 2 cm, ocupando o espaço do elemento ausente, com histórico de 6 anos, sem queixa álgica no local. O tratamento proposto foi a remoção cirúrgica com laser de diodo, seguindo protocolo sugerido pelo fabricante. Sob anestesia infiltrativa local, realizou-se a excisão da lesão com incisão uniforme pela base. A peça cirúrgica foi fixada em formol 10% e encaminhada para exame anatomopatológico. O exame histopatológico apresentou como diagnóstico fibroma de irritação. Considerações finais: o uso de laser cirúrgico de diodo é um método seguro e eficaz, além de apresentar inúmeras vantagens quando comparado com a técnica convencional para excisões cirúrgicas de lesões de tecidos moles na cavidade oral. A remoção cirúrgica da HFI com pequena margem de segurança e remoção do fator etiológico constitui uma terapêutica satisfatória; a amostra deve sempre ser enviada para análise anatomopatológica, para confirmar o diagnóstico. O cirurgião-dentista deve ter conhecimento específico para operação e indicação do uso do laser cirúrgico.

Objective: to demonstrate through a clinical case report the excision of an inflammatory fibrous hyperplasia (IFH) with the use of surgical diode laser. Case report: male leucoderma patient, 48 years old, sought assistance on the Specialty Outpatient Clinic of SUS (Unified Health System) of the Hospital São Vicente de Paulo, in the city of Passo Fundo / RS - Brazil, lacking tooth 46 and with nodular exophytic lesion, pedunculated, with a pinkish color and smooth surface, on the buccal mucosa measuring approximately 2 cm and occupying the space of the missing element. The patient had a history of 6 years without pain complaint on site. The proposed treatment was surgical removal with diode laser, following manufacturer's suggested protocol. Under local infiltrative anesthesia, an excision of the lesion with uniform incision at the base was made. The surgical specimen was fixed in 10% formaldehyde and sent for pathological examination. Histopathological examination presented fibroma irritation as diagnosis. Final considerations: the use of surgical diode laser is a safe and effective method, and presents numerous advantages compared to the conventional technique for surgical excisions of soft tissue lesions in the oral cavity. Surgical removal of IFH with small safety margin, and removal of the etiologic factor is a satisfactory therapy. The sample should always be sent for pathological examination to confirm the diagnosis. The dentist must have specific knowledge to operate and recommend the use of surgical laser.