Oral manifestations and rehabilitation in Fraser syndrome: A case report.

Fraser syndrome (FS) is a rare recessive autosomal genetic disorder characterized by multisystemic malformations typically comprising cryptophthalmos, syndactyly, and renal defects. We report the case of a 16-year-old patient who exhibited facial asymmetry, short roots, hypodontia, and malocclusion. Oral rehabilitation included orthodontics, exodontia, and osseointegrated dental implants to improve the patient's self-esteem and eating function. We suggest short roots and hypodontia assessment in patients with FS.

Kostmann syndrome: oral aspects and 10-year follow-up case report.

Kostmann syndrome (KS) is an autosomal recessive disorder characterized by a low neutrophil count and recurrent bacterial infections, including periodontal disease. This report describes the case of a 5-year-old female KS patient treated with regular infusions of granulocyte stimulating factor (granulokine), with primary complaint of gingival bleeding and tooth mobility, and followed up for 10 years. Conventional periodontal treatment and some extractions were performed, after neutrophil function tests using flow cytometry. The invasive procedures were carried out at an outpatient clinic under antibiotic prophylaxis due to a low neutrophil count and an impaired neutrophil function presented. During the 10-year follow-up period, despite episodes of recurrent gingivitis and periodontitis the present report describes the positive outcome of dental treatment of a patient with KS.

Oral care and nosocomial pneumonia: a systematic review / Cuidados bucais e pneumonia nosocomial: revisão sistemática

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

Apresentar revisão sistemática da literatura sobre o controle do biofilme bucal e a incidência da pneumonia nosocomial, avaliando e classificando os estudos quanto ao grau de recomendação e ao nível de evidência científica. A revisão foi realizada nas bases PubMed, LILACS e Scopus, de 1 o de janeiro de 2000 até 31 de dezembro de 2012. Foram selecionados os estudos que avaliaram os cuidados com higiene bucal relacionando-os com infecções nosocomiais em paciente internados em unidades de terapia intensiva, seguindo os critérios de inclusão. Foram incluídos artigos na íntegra publicados em inglês, espanhol ou português, que abordavam alguma técnica de higiene bucal, química ou mecânica, na prevenção de pneumonia, as intervenções executadas e os resultados. Após análise dos dados, os artigos foram classificados quanto ao nível de evidência e o grau de recomendação, de acordo com os critérios da Oxford Centre for Evidence-Based Medicine. Foram encontrados 297 resumos e, destes, 14 artigos na íntegra contemplaram nossos critérios. A maioria dos artigos incluía um grupo de estudo com uso de clorexidina e um controle com o uso de placebo para higiene bucal na prevenção de pneumonia. Quanto ao nível de evidência, todos os artigos foram classificados como B; quanto ao grau de recomendação, 12 artigos foram classificados como 2B e 2 como 2C. O controle do biofilme bucal reduz a incidência de pneumonia nosocomial, porém o nível de evidência e o grau de recomendação intermediário deixam evidente a necessidade da elaboração de estudos clínicos randomizados controlados com viés mínimo para estabelecer futuros protocolos para higiene bucal em unidades de terapia intensiva.

Oral care and nosocomial pneumonia: a systematic review.

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

A odontologia hospitalar no serviço público do Estado de São Paulo / Hospital dentistry in the public service of the State of São Paulo

O projeto Sorria mais São Paulo, recentemente lançado pelo Governo do Estado, prevê, em uma de suas vertentes, a instituição da "Odontologia Hospitalar" e, visando a integralidade da atenção à saúde, incluiu o Cirurgião-Dentista (CD) à equipe hospitalar. O objetivo deste estudo foi mapear os atuais serviços de Odontologia na Rede Hospitalar Pública do Estado de São Paulo. Para tanto, foi consultado o Cadastro Nacional de Estabelecimentos de Saúde (CNES). A rede pública conta com 199 hospitais, sendo apenas 20% dos municípios contemplados. O Departamento Regional de Saúde I apresenta a maior concentração desses estabelecimentos (37). A esfera administrativa da maioria dos hospitais é privada (87,4%) e 66,3% são de gestão municipal, sendo que 17% atendem exclusivamente ao SUS. Existem 859 CDs contratados, porém mais da metade desses profissionais possuem perfil de atuação diferente do proposto pelo programa de "Odontologia Hospitalar". Em relação à jornada de trabalho, 58% trabalham menos de 20 horas semanais e pelo menos metade do tempo desses profissionais é destinado ao atendimento ambulatorial de pacientes. 58,20% dos CDs possuem vínculo de "autônomo", e 40,39% das contratações são intermediadas por entidades filantrópicas. Ao avaliar os CDs que possuem o perfil designado no programa "Odontologia Hospitalar", verifica-se que a relação leito/CD é de 87,57:1. Com CDs com uma carga horária pequena e dividida entre o atendimento ambulatorial e hospitalar, parece apropriado tanto à estruturação de novos serviços como o aumento de contratações específicas para suprir a demanda crescente desse profissional de saúde em hospitais.

The Sao Paulo state government recently began a project known as "Sorria Mais São Paulo" ("Smile More São Paulo"). which, among other measures, instituted a Hospital Dentistry Program within the state's public healthcare system. In an attempt to be more comprehensive, the state government has added dental surgeons (DSs) to hospital staff. The goal of this study was to chart the dentistry services available in Sao Paulo's public healthcare system. To do so, Brazil's National Health Establishment Registry (CNES) was consulted. The state's public healthcare network includes 199 hospitais, though only 20% of the state's cities are covered. The largest concentration of establishments (37) are in the DRS I region. In these hospitais, the administrative sectors are often private (87.4%). 66.3% are under city management, and 17% are exclusively public hospitais. Though 859 DSs have been hired, more than half of them per- form tasks that were not proposed by the Program, 58% work fewer than 20 hours per week, and more than half of their time is spent on ambulatory care services. Of these DSs, 58.20% are considered "independent contractors." and 40.39% of their hirings are initiated by philanthropic entities. When one considers only the DSs that perform the tasks of the Program, the ratio of hospitalized patients to doctors is 87.57:1. With DSs working few hours and dividing their time between surgery and ambulatory care, it seems that the state needs to develop new servicesand increase hirings in order to meet the demand for these healthcare professionals.

Medical problems and oral care of patients with Down syndrome: a literature review.

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.

Primary Sjögren syndrome in a 2-year-old patient: role of the dentist in diagnosis and dental management with a 6-year follow-up.

BACKGROUND. Primary Sjögren syndrome is a rare autoimmune disease, especially in children, mainly affecting girls (77%), and usually diagnosed around 10 years of age. Diagnosis during childhood is difficult, especially because of the diversity of the clinical presentation and difficulty obtaining reliable history data, accounting for a higher frequency of underdiagnosed cases. Differential conditions should be considered, especially the ones that promote xerostomia, such as diabetes, ectodermal dysplasia, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, sarcoidosis, lymphoma, HIV and HTLV infection. Conditions associated with parotid enlargement should also be excluded, including juvenile recurrent parotitis (JRP), sialadenosis, sarcoidosis, lymphoma, infectious parotitis caused by streptococcal and staphylococcal infections, viral infections (paramyxovirus, Epstein-Barr virus, cytomegalovirus, and parvovirus), and diffuse infiltrative lymphocytosis syndrome (associated with HIV infection), and rare congenital conditions, such as polycystic parotid disease. CASE REPORT. A paediatric female patient was referred to our clinic for dental treatment complaining about dry mouth, oral discomfort, and dysphagia. The patient presented five of the required criteria to establish the diagnosis of pSS, including ocular symptoms, oral symptoms, evidence of keratoconjunctivitis sicca, focal sialadenitis confirmed by minor salivary gland biopsy, and evidence of major salivary gland involvement. Our patient did not have positive SS-A and SS-B autoantibodies. According to the literature, about 29% of individuals with pSS can present seronegativity for SS-A (anti-Ro) antibodies and about 33% can present seronegativity for SS-B (anti-La) antibodies. CONCLUSION. To the best of our knowledge, this is the youngest patient reported in the scientific English literature with pSS. Primary Sjögren syndrome has a wide clinical and immunologic spectrum and may progress with increased morbidity. Clinicians must be aware of the development of pSS in such an early age and exclude all possible differential findings to provide early diagnosis and treatment.

Conhecendo o HTLV e suas implicações no atendimento odontológico / Getting to know HTLV and their implications during dental care

Os vírus T Linfotrópico humano representam um grupo de retrovírus que possuem tropismo por linfócitos T e são transmitidos pelas vias parenteral, vertical e sexual. Foram identificados os tipos 1, 2, 3 e 4 sendo que o vírus T Linfotrópico humano -1 tem sido o mais associado ao desenvolvimento de doenças nos pacientes infectados. A estimativa global é de que 15 a 20 milhões de pessoas estejam infectadas pelo vírus T Linfotrópico humano -1. No Brasil o vírus é endêmico, apresentando o maior número absoluto de casos no mundo e sendo incluído na triagem hematológica realizada nos hemocentros. As principais doenças associadas ao vírus T Linfotrópico humano -1 são a leucemia/linfoma de células T do adulto e a paraparesia espástica tropical. A única manifestação bucal associada ao vírus T Linfotrópico humano é o linfoma de células T do adulto, sendo que alguns autores apontam para a possibilidade de pacientes com paraparesia espástica tropical também apresentarem a síndrome de Sjõgren relacionada à infecção pelo vírus. O fato de o vírus T Linfotrópico humano ser um vírus contagioso e com capacidade oncogênica requer a atenção do cirurgião-dentista tanto no manejo odontológico quanto no diagnóstico de possíveis doenças associadas.

The human T-lymphotropic viruses represent a group of retroviruses that possess tropism for T lymphocytes and are transmitted parenterally, vertically and sexually. Four types have been identified, 1, 2, 3 and 4. Type 1 has been most frequently associated with disease in infected individuals. It is estimated that 15 to 20 million people are affected by human T-lymphotropic virus type 1. In Brazil, the virus is endemic, presenting the greatest absolute number of cases in the world and included in blood bank screening tests. The main diseases associated with human T-lymphotropic virus type 1 are adult T-cell leukemia/lymphoma and tropical spastic paraparesis. The only oral manifestation associated with human T-lymphotropic virus is adult T-cell lymphoma. Some authors believe it is possible for some patients with tropical spastic paraparesis to also present virus-related Sjõgren?s syndrome. Since human T-lymphotropic virus is contagious and potentially oncogenic, it demands attention from the dental surgeon not only for dental management but also for diagnosing associated diseases.

Detection of the Epstein-Barr virus (EBV) by in situ hybridization as definitive diagnosis of hairy leukoplakia.

Histopathological findings in cases of hairy leukoplakia (HL) are not exclusive to this lesion. A total of 36 tissue samples from patients previously diagnosed with HL based solely on morphological aspects were used in this study. Our purpose was to confirm the presence of Epstein-Barr virus (EBV) in these tissue samples by in situ hybridization (ISH), and to compare the detection of EBV with specific histopathological findings observed in each case. Among the 36 specimens, 80.55% were EBV positive, confirming the previous clinical and histhophatological diagnosis. None of the histopathological findings analyzed correlated with the presence or absence of EBV. This shows that a definitive diagnosis of HL cannot be established based on histopathological findings alone. Because there are many important implications on the establishment of definitive diagnosis of HL, the detection of EBV by ISH is obligatory.

Identificação do vírus Epstein-Barr (EBV) e do Papiloma Vírus Humano (HPV) através da técnica de hibridização in situ em hiperplasias gengivais medicamentosas de pacientes transplantados renais / In situ hibridization for Epstein-Barr vírus (EBV) and Human Papiloma vírus in drug-induced gingival overgrowth in renal transplantation patients

A fim de prevenir a rejeição do órgão transplantado pelo hospedeiro, se faznecessário o uso de drogas imunossupressoras, como a ciclosporina, que podelevar ao aparecimento de efeitos colaterais como hipertensão arterial,nefrotoxicidade, hepatotoxicidade, e hiperplasia gengival medicamentosa (HGM),que pode ser potencializada se bloqueadores de canal de cálcio como anifedipina forem associados a fim de controlar a pressão arterial. A patogêneseda HGM ainda é incerta, entretanto fatores como a presença de cálculo e placa,concentração plasmática da droga, idade e fatores hormonais podem influenciaras características clínicas e o desenvolvimento da HGM. Recentemente, algunsvírus têm sido associados com a HGM. O HPV (Papiloma Vírus Humano) temsido associado com casos severos de HGM, enquanto que o EBV (Vírus Epstein-Barr) é associado ao aparecimento de desordens linfoproliferativas póstransplante, que se apresentam como HGM. O objetivo deste trabalho foi avaliara freqüência e o grau da HGM em pacientes transplantados renais (TR),identificar o EBV e HPV na HGM destes pacientes, e correlacionar a HGM, índicede placa, presença de cálculo e presença do EBV e HPV nos pacientes TR.Foram examinados os prontuários de 58 pacientes TR atendidos no CAPEFOUSP,e os dados com relação à medicação imunossupressora em uso e...

Secondary syphilis in an HIV positive patient.

The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso of skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.

Tensile bond strength of adhesive systems--effects of primer and thermocycling.

The objective of this study was to evaluate the effects of primer and thermocycling on the bond strength of multi-purpose adhesive systems applied to enamel, under tensile stress. The following bonding systems were applied, according to the manufacturers' instructions, on unground enamel buccal surfaces of 96 premolars, with or without the application of primer: Scotchbond MP, OptiBond FL, Amalgambond Plus and OptiBond (dual-cure). A composite resin (Z100, 3M) was applied and light-cured in a cast metal hollow cone, which was previously fixed to the enamel surfaces. Half of the sample was subjected to 3,000 thermocycles (5-37 degrees C; 37-55 degrees C, dwell time of 60 s), and the other half was stored in water at 37 degrees C for the same period. The data were treated by means of ANOVA and no significant effects were detected, which indicates that tensile bond strength was not affected by the adhesive systems, application of primer or thermocycling.

Tensile bond strength of adhesive systems - effects of primer and thermocycling / Resistência à traçäo de sistemas adesivos - efeitos do \"primer\" e dos ciclos térmicos

O objetivo desta pesquisa foi o de verificar o efeito do "primer" e dos ciclos térmicos na resistência da uniäo entre adesivos multiuso e esmalte dental, sob ensaios de traçäo. Os seguintes sistemas adesivos foram aplicados, de acordo com as instruçöes dos fabricantes, na superfície vestibular (sem desgaste) de 96 pré-molares com ou sem a aplicaçäo prévia do "primer": Scotchbond MP, OptiBond FL, Amalgambond Plus e OptiBond -"dual cure". Após a aplicaçäo do sistema adesivo, foi confeccionado um cone de resina composta (Z100, 3M), e fotoativado dentro de uma molde metálico. Metade do total de espécimes foi submetida a 3.000 ciclos térmicos (5-37ºC; 37-55ºC, 60s de imersäo); a outra metade permaneceu imersa em água a 37ºC pelo mesmo tempo dispensado no procedimento anterior. Os dados foram submetidos a uma análise de variância (p=0,05) e nenhum efeito significante foi detectado, indicando que a resistência de uniäo näo foi afetada pelo sistema adesivo, pela aplicaçäo do "primer"ou pelos ciclos térmicos