An Approach for the Prevention, Diagnosis, and Treatment of Jaw Osteonecrosis: Report of a Case Associated with Zoledronic Acid.

BACKGROUND Osteonecrosis of the jaw is a condition manifesting as necrotic bone for 8 weeks or more, with no history of radiotherapy. It is linked to the use of antiresorptive drugs, such as bisphosphonates and denosumab. We discuss in this case report the importance of infection control during clinical procedures in patients taking antiresorptives. CASE REPORT Our case report describes a 52-year-old woman who had received zoledronic acid injections for 7 years, who presented with osteonecrosis of the jaw in the region of teeth 24, 25, and 26, with no local trauma. The report proceeds to describe the extraction of these teeth. After the dental extractions, she did not have any recurrence of the lesion, and she is currently in follow-up care. CONCLUSIONS Osteonecrosis of the jaw can be prevented through infection control and local trauma prevention. Patients who are taking antiresorptive drugs must receive special care from dental surgeons and doctors, and receive the necessary oral treatments before starting drug therapy.

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study.

Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review.

Background: There are inequities in the provision of oral health care, and a large proportion of the population face challenges in accessing public dental health care options. Introduction: Teledentistry (TD), a new branch of telemedicine dedicated to dentistry, is a potential approach that can be used to overcome these challenges. Therefore, the purpose of this integrative review was to collect information regarding the inclusion of the application of TD tools in the public dental health services. Methods: Five electronic databases (PubMed/Medline, Virtual Health Library, CINAHL, Scopus, and Web of Science) were searched for relevant articles if they reported on original data related to the use of TD in public dental health services. Results/Discussion: Twenty-four studies met the inclusion criteria and were, consequently, included in the review. Our key findings indicated that TD can be used for training and continuing education of professionals, for remote patient care, to exchange information among health professionals, and orientation. It increases the access to dental care and enables general practitioners to interact with specialties. The benefits include cost-effective health equity services, improve dental knowledge, and reduce consultation waiting time. However, despite the advances made with the use of this technology, there are still some obstacles to overcome, such as limited infrastructure, low levels of motivation and the lack of compliance, professional resistance, and legal and security issues. Conclusion: TD may be very a useful tool for dental public health increasing the quality of the care by improving access, professional education, and patient satisfaction.

Teleconsultoria no sistema único de saúde: relato de experiência inédita em Santa Catarina / Teleconsulting in Periodontics in the Unified Health System: report of unprecedented experience in Santa Catarina

The use of new technologies such as Teledentistry aims to facilitate the diagnosis and treatment of oral diseases, enabling the exchange of information between professionals at a distance. The aim of this article is to report the unprecedented experience of implementing the teleconsulting service in periodontics in the Unified Public Health System for the purpose of referral to specialized care using the Santa Catarina Telehealth Center virtual platform. The pilot project was developed in the city of Joinville, southern Brazil. Focus groups were carried out with 17 primary health care general dental practitionersand 8 specialists to know their difficulties regarding the patient's referral processes to specialized care. This data oriented the Health Department to implement the teleconsulting service in periodontics. The pilot project had also the collaboration of professors of the Federal University of Santa Catarina, coordination and technicians of Santa Catarina Telehealth Center. Since November 2018, the system has been used. By the end of May 2019, 68 teleconsultations were performed by 26 dentists. Despite some difficulties related to the integration of information systems, Teleperiodontics presents potential to improve communication among periodontists and general dental practitioners and to provide permanent health education. (AU)

A utilização de novas tecnologias como a Teleodontologia visa facilitar o diagnóstico e tratamento das doenças bucais, possibilitando a troca de informações entre profissionais à distância. O objetivo deste artigo é relatar a experiência inédita de implementação do serviço de teleconsultoria em Periodontia no Sistema Único de Saúde, para fins de encaminhamento à atenção especializada, mediante o uso da plataforma do Sistema Catarinense de Telemedicina e Telessaúde. O projeto piloto foi desenvolvido no município de Joinville, Santa Catarina. Foram realizados grupos focais com 17 cirurgiões-dentistas da atenção primária e 8 especialistas dos Centros de Especialidades Odontológicas para conhecer suas dificuldades em relação aos processos de referência e contrarreferência de pacientes. A partir dessas informações, foi estruturado o projeto piloto e implantado, pela Secretaria da Saúde de Joinville, o serviço de teleconsultoria na especialidade de Periodontia. Ainda participaram professores da Universidade Federal de Santa Catarina, coordenação e técnicos do Sistema Catarinense de Telemedicina e Telessaúde. Em novembro de 2018, o sistema iniciou as operações. Até o final de maio de 2019 foram realizadas 68 teleconsultorias por 26 dentistas. Apesar de algumas dificuldades relacionadas com a integração dos sistemas de informações vigentes, a Teleperiodontia viabilizou a comunicação com os periodontistas e favoreceu a Educação Permanente dos cirurgiões-dentistas da atenção primária à saúde. (AU)

Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Abstract Objective Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

Terapia periodontal de suporte em paciente com periodontite agressiva generalizada: acompanhamento clínico e radiográfico de 13 anos / Periodontal maintenance therapy in patient with generalized aggessive periodontitis: clinical and radiographic following by 13 years

A terapia periodontal de suporte (TPS) tem como objetivo principal a manutenção dos resultados obtidos durante o tratamento periodontal ativo, sendo a forma mais previsível de controlar a doença periodontal. Essa extensão do tratamento periodontal, pode ocorrer em intervalos de tempo que variam de acordo com a severidade da doença, condição sistêmica do indivíduo, idade, fatores de risco, entre outros. A TPS contribui para a redução da perda dentária e recorrência da doença periodontal, além de possibilitar o diagnóstico de outras doenças bucais. Durante essa etapa, é possível traçar o perfil do paciente, identificar suas dificuldades e estabelecer condutas educativas, preventivas e terapêuticas necessárias para o controle do biofilme e da doença periodontal. Assim, o periodontista deve conscientizar o paciente sobre a importância da TPS, sendo que, a adesão ao tratamento é fundamental para a manutenção da saúde dos tecidos periodontais a longo prazo. O presente relato de caso clínico, demonstra o sucesso da TPS em paciente jovem acometida por periodontite agressiva generalizada. Após a realização da terapia periodontal não cirúrgica, a paciente foi inserida em um programa de manutenção periodontal, há 13 anos atrás, no qual participa ativamente até o presente momento. (AU)

The main objective of the periodontal maintenance therapy (PMT) is to maintain the results achieved during the active periodontal therapy, being the most predictable way of controlling the periodontal disease. This extension of the periodontal treatment may occur at different times, varying according to the aggressiveness of the disease, general health condition of the subject, age and risk factors, among others. The PMT contributes to the reduction of dental loss and prevents the reoccurrence of the periodontal disease, while also allowing the diagnose of other diseases of the mouth. During this phase it is possible to trace the patient's profile, identifying the difficulties and stablishing educational, preventive and therapeutic practices to control oral biofilm and periodontal disease. Thus, the periodontist must raise the patient's awareness to the importance of the PMT, as the patient compliance to the treatment is essential for the long term preservation of the periodontal tissue health. The clinical case here described demonstrates the success of the PMT performed on a young female patient afflicted with generalized aggressive periodontitis. After having performed the non-surgical periodontal therapy, the patient entered a periodontal maintenance program 13 years ago, in which she has been actively participating until the present time.(AU)

Influência da ciclosporina a nos tecidos periodontais e na osseointegração de implantes: revisão de literatura / Influence of cyclosporine a on periodontal tissue and osseointegration of implants: review of literature

A Ciclosporina A é um potente imunossupressor utilizado no tratamento de diversas patologias mediada imunologicamente. É indicado principalmente no tratamento preventivo da rejeição de órgãos em indivíduos transplantados. Efeitos adversos relacionados com o uso do fármaco como a indução de osteopenia, desequilíbrio no processo de remodelação óssea, desenvolvimento de osteoporose e o aumento gengival são descritos na literatura. O objetivo do presente estudo foi revisar através da literatura os efeitos da ciclosporina A no metabolismo do tecido gengival, ósseo e sua influência como possível fator de risco na osseointegração de implantes. Empregando-se os termos cyclosporine AND dental implants; cyclosporine AND osseointegration; e cyclosporine AND gingival overgrowth como palavras chave, foram levantados artigos na base de dados Pubmed, publicados entre os anos de 2000 a 2016, na língua inglesa e portuguesa. Conclui-se que os efeitos adversos causados pela ciclosporina A podem interferir na saúde bucal dos indivíduos e no sucesso do tratamento odontológico. É fundamental que o cirurgião dentista conheça os mecanismos de ação do medicamento, seus efeitos adversos e interações medicamentosas, a fim de desenvolver estratégias de prevenção e tratamento para usuários do medicamento (AU)

Cyclosporine A is a potent immunosuppressive drug used in the treatment of various immunologically mediated pathologies. It is mainly indicated in the preventive treatment of organ rejection in transplant recipients. Adverse effects associated with using the drug such as the induction of osteopenia, imbalance in bone remodeling, development of osteoporosis and gingival enlargement are described in literature. The aim of this study was to review, through literature, the effects of cyclosporine A in the metabolism of gingival tissue, bone and its influence as a possible risk factor in osseointegration of implants. Using the terms cyclosporine AND dental implants; cyclosporine AND osseointegration; and cyclosporine AND gingival overgrowth as keywords, a search was conducted for articles published in the Pubmed database between the years 2000-2016, in English and Portuguese. It was concluded that the adverse effects caused by cyclosporine A may interfere in the oral health of individuals and the success of the dental treatment. It is essential that the dentist is aware of the action mechanisms of the drug, its side effects and medicinal interactions in order to develop prevention and treatment strategies for users of the drug (AU)

Bone mimetic for confection of bio inspired ceramic materials: literature review

The loss of bone mass is a very common condition that is affecting people of various ages and causing a declinein quality of life of these people. Currently there is the possibility of using bone grafts to replace this bone loss, whichcan be autogenously, halogen or heterogeneous, with autogenously those get better results, but with disadvantageof providing two surgical sites in patients. In this sense, and also for other reasons related to properties of materials,authors are seeking to mimic natural bone for the production of ceramic biocompatible materials that can retainthe structure and properties of natural bone tissue. Such material should present structure dense/porous structuresimilar to the cortical and cancellous bone. With this, these materials can have good future applications, including thereplacement of lost bone tissue, and then becoming one more option to improve the quality of life of these patients.Thus, the objective of this study was a literature review of the ceramics that mimic the bone tissue, which are thenconsidered bio inspired materials...

Avaliação in vitro da influência de lactobacillus casei na aderência de enterobacter cloacae em células epiteliais da mucosa jugal / In vitro evaluation of the influence of Lactobacillus casei in the adherence of Enterobacter cloacae in the oral epithelial cells of oral mucosa

Probióticos são bactérias que apresentam efeitos benéficos à saúde do hospedeiro, devido à capacidade de modular a resposta imune e melhorar as propriedades da microbiota intestinal. A maior eficácia dos probióticos tem sido relacionada à capacidade de adesão à superfície da mucosa e células epiteliais prevenindo a instalação de patógenos. O presente trabalho teve por objetivo verificar, in vitro, a aderência de Enterobacter cloacae, Lactobacillus casei e sua associação em células epiteliais da mucosa jugal. Em um pool de células epiteliais da mucosa jugal (105 céls/mL) previamente preparadas foram adicionadas suspensões (1,5 x 108 céls/mL) de L. casei, E. cloacae e de ambos. Após incubação, células e microrganismos foram filtrados e a partir da membrana filtrante, foram obtidas células com microrganismos aderidos, das quais foram confeccionados esfregaços corados pelo método de Gram. Foram avaliadas cem células realizando-se contagem do número de bactérias aderidas às mesmas. Os resultados obtidos foram analisados pelo teste t de Student. A aderência de L. casei às células epiteliais da mucosa jugal foi superior a de E. cloacae quando incubadas isoladamente (p= 0,0175) ou quando associadas (p= 0,0000). A associação entre L. casei e E. cloacae reduziu (p= 0,0000) a aderência de E. cloacae, portanto, L. casei apresentou, in vitro, aderência favorável às células da mucosa e interferiu negativamente na aderência de E. cloacae...

Probiotics are beneficial bacteria that have effects on the health of the host due to the ability to modulate the immune response and improve the properties of the intestinal microbiota. The greater efficacy of probiotics has been related to their capacity to adhere to the mucosal surface epithelial cells and preventing the onset of pathogens. The aim of this work was to verify, in vitro, the adherence of Enterobacter cloacae and Lactobacillus casei, alone or associated, to the epithelial cells of the human oral mucosa. Suspensions of L. casei and/or E. cloacae were incubated with a suspension of epithelial cells, filtered through a membrane and the retained material was transferred to glass sheets and stained by the Gram method. One hundred epithelial cells were analyzed for counting of the adhered bacteria. The results were compared and analyzed using Student t test. It was observed that the adherence of L. casei to the epithelial cells was higher than the adherence of E. cloacae, when incubated alone (p = 0.0175) or associated (p = 0.0000). L. casei was also able to reduce significantly the adherence of E. cloacae to oral epithelial cells. In conclusion, L. casei has more ability to adhere to epithelial cells, in vitro, suggesting that this microorganism could compete and probably avoid the colonization of E. cloacae on oral mucosa...