Preliminary Assessment of the Quality of Life and Daily Burden of Caregivers of Persons with Special Needs: A Questionnaire-Based, Cross-Sectional Survey.

Caregivers of persons with special needs (PSN) experience a variety of burdens and elevated levels of stress and anxiety throughout their lives, leading to a physical, psychological, emotional, social, and financial overload. This analytical study with a cross-sectional design and a quantitative approach aimed to appraise quality of life (QoL), reflecting the daily workload of informal family caregivers of PSN. METHODS: Four structured, validated questionnaires were utilised: sociodemographic, WHOQOL-bref, Zarit Burden Interview, and Functional Independence Measure Scale in 60 anonymous volunteered respondents. RESULTS: The informal caregivers were middle-aged mothers (81.7%), married (55%), stay-at-home spouses (60%) with high school degrees (51.6%), providing a care for their relatives with special needs for more than 20 years (41.8%). Most of the PSN were diagnosed with autistic spectrum disorder (ASD, 61.8%), had a wide spectrum of intellectual deficits, and required constant support for their basic needs. They were mainly adolescent males without physical limitations (83.4%) on disorder-specific medications (90%). The study revealed that those caregivers had a median perception of QoL considering four essential domains, with a highest score recorded for the physical domain (64.3 +/- 16.1 SD). A moderate burden level prevailed, revealing neither a correlation between the workload expressed by caregivers and the patient's functional capacity, nor in the performance of daily self-care tasks (Spearman correlation test p > 0.05), apart from the environmental domain (mild correlation = 0.335, p < 0.05). CONCLUSIONS: The reported average level of overload associated with QoL of informal caregivers exists, affecting a vast proportion of the respondents. The absence of a direct association between workload and the functional capacity/daily self-care tasks can be related to the significant personal dedication of family caregivers, regardless of their socioeconomic status.

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services-A Retrospective, Comparative Study.

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. OBJECTIVE: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. METHODS: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. RESULTS: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). CONCLUSIONS: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care.

Oral Langerhans Cell Histiocytosis in Two Pediatric Patients.

We report two cases of Langerhans cell histiocytosis (LCH) in the oral cavity of children. An 11-month-old girl was referred for evaluation of a nodular and sessile lesion in the alveolar ridge covering the primary left mandibular central incisor. The second patient was a seven-year-old boy with an ulcerated lesion in the gingiva covered by necrotic areas, extending to the sulcus of the vestibule. The patients underwent incisional biopsies and histopathological exams showed a proliferation of Langerhans and eosinophil cells, suggesting a diagnosis of LCH, which was confirmed by positive immunohistochemical expression of S100 and CD1.

Successful hair removal on intraoral grafts using the diode laser: Report of two cases.

AIM: The aim of this study was to describe the successful epilation of intraoral grafts using the diode laser system. METHODS AND RESULTS: Two male patients at a 12-month follow-up - who underwent radical resection of oral cancer located in the mouth floor and tongue followed by reconstruction with cutaneous flap - showed hypertrichosis in the graft region, leading to dysphagia and dysphonia. The diode (980 nm) laser was performed for both cases in order to remove the ectopic hair. Excellent aesthetic and functional outcomes with total hair removal and alteration of the tissue surface were achieved. CONCLUSIONS: There is no currently standard protocol for the laser epilation use on hairy grafts because each graft required a different number of sessions for total epilation. The diode laser system appears to be a successful therapeutic option for patients suffering from hypertrichrosis in the oral cavity.

Doença pelo Coronavírus 2019 (COVID-19): Uma abordagem preventiva para Odontologia / Coronavirus disease 2019 (COVID-19): One preventive approach to dentistry

Objetivo: a finalidade desse trabalho é, através de uma revisão de literatura recente, apresentar características clínicas da doença pelo Coronavírus (COVID-19), as vias de transmissão conhecidas, abordar como o Cirurgião-Dentista (CD) pode identificar casos suspeitos e, principalmente, apresentar medidas preventivas para controlar e minimizar a infecção no serviço odontológico. Material e Métodos: foi realizada uma pesquisa de busca bibliográfica na base de dados MEDLINE (National Library of Medicine, USA - NLM), com as palavras-chave COVID-19 and dental practice, de 12 a 16 de março de 2020, e três artigos publicados no ano corrente foram disponibilizados. Foram critérios de inclusão artigos em suas versões completas e gratuitas, na língua inglesa. Resultados: a COVID-19 apresenta como principais sintomas clínicos febre, tosse, espirros e catarro, em casos considerados leves. As principais vias de transmissão são a direta e por contato. A fim de identificar casos suspeitos o CD deve medir a temperatura corporal do paciente e aplicar um breve questionário. O profissional deve realizar com frequência a lavagem das mãos antes e após o atendimento e usar equipamentos de proteção individual. São recomendados com bochechos com Peróxido de Hidrogênio 1% e Lodopovidona a 0,2% ao tratamento, Clorexidina 0,12% não é eficaz. Conclusão: em momentos de surtos de doenças, surgem novos desafios aos quais os profissionais devem responder com cuidado ainda maior com a biossegurança, ética, zelo e treinamento atualizado e periódico

Objective: the aim of this study is to, through a recent literature review, present the clinical characteristics of COVID 19, the known transmission routes, to address how dentists can identify suspected cases and, mainly, provide preventive measures to control and minimize infection in dental practice. Material and Methods: a bibliographical research was carried out in the MEDLINE (National Library of Medicine, USA - NLM) database, with the keywords COVID 19 and dental practice, from March 12nd to 16th of 2020, and three articles published in the current year were available. The selection criteria were articles in their full and free versions, written in the english language. Results: COVID-19 has fever, cough, sneezing and phlegm as the main clinical symptoms in mild considered cases. The main transmission routes are direct and through contact. In order to identify suspected cases, dentists should measure the patient's body temperature and apply a brief questionnaire. Professionals should frequently perform hand washing before and after the service and use personal protective equipments. Mouthwash with 1.0% Hydrogen Peroxide and 0.2% povidone-iodine to treatment is recommended. 0.12% Chlorhexidine is not effective. Conclusion: in times of disease outbreaks, new challenges arise, to which professionals must respond with even greater care with biosafety, ethics, zeal and preparation.

Contribution of benzodiazepines in dental care of patients with special needs.

BACKGROUND: Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. MATERIAL AND METHODS: The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. RESULTS: Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. CONCLUSIONS: The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated. Key words:Special patients, oral sedation, benzodiazepines, midazolam, dental care.

Variable expressivity and novel PTEN mutations in Cowden syndrome.

Cowden syndrome (CS) is a phosphatase and tensin homolog gene (PTEN)-associated condition characterized by multiple mucocutaneous hamartomas and an increased risk of malignancies. We reported an isolated case and another of several individuals in one family affected by CS. The isolated case showed typical features, including fibrocystic breast disease, benign thyroid nodules, and multiple papillomatous lesions in the face and oral cavity, and the cause was a novel nonsense mutation-guanine (G) to thymine (T) transition at position 940 (c.940 G>T)-in PTEN. In the family, the proband showed erythema nodosum, duodenal ulcer, intestinal polyps, cervical lipoma, renal cysts, and glaucoma, whereas multiple members of her family were found to have intestinal polyps, and a sister had been diagnosed with breast cancer at early age. An intronic mutation-T>G transition at the +32 position of intron 8 (c.1026+32 T>G)-was found in this family, with in silico analysis revealing the creation of a new donor splice site. This study confirmed the involvement of PTEN in CS and the variable clinical expressivity of disease.

Prevalence of oral lesions caused by removable prosthetics / Chitosan/D. ambrosioides (mastruz) spheres to be applied as a biomaterial

(29%) had some type of associated injury. The lesions found included erythematous candidiasis, inflammatory fibrous hyperplasia, inflammatory papillary hyperplasia, traumatic ulcer, angular cheilitis, irritative keratosis, and denture stomatitis. Inflammatory fibrous hyperplasia was the most prevalent lesion, found in 88 patients (50%),followed by erythematous candidiasis in 75 patients (43%). Of the total number of injured patients, 141 (81%) were women and 34 (19%) were men, and 101 patients (58%) were Caucasian and 37 (21%) were black. Most lesions were located in the upper alveolar ridge and the hard palate. The most widely used type of prosthesis was full upperprosthesis with 84 users (48%). The average usage time for all prostheses was 17 years (SD ± 13). Average patient age was 62 years (SD ± 14). The prevalence of injuries caused by removable prostheses is high, and prolonged use of the device and the presence of oral lesions are strongly associated. Moreover, women represent the largest number of users of the prostheses and therefore carry the majority of the injuries.

Utilização da toxina botulínica no tratamento do bruxismo em pacientes portadores de paralisia cerebral: revisão de literatura / Use of botulinum toxin for the treatment of bruxism in patients with cerebral palsy: a literature review

A paralisia cerebral (PC) é caracterizada por lesão cerebral não progressiva, sendo a causa mais frequente de deficiência física infantil. Os problemas neuromusculares afetam a saúde bucal, sendo o bruxismo um achado frequente. Este é caracterizado pela aplicação de forças excessivas nos músculos mastigatórios, podendo causar disfunção da articulação temporomandibular, dores de cabeça e desgaste dentário. Recentemente a injeção local da toxina botulínica foi relatada como excelente opção terapêutica. O objetivo deste estudo foi realizar revisão de literatura sobre o tratamento do bruxismo com a utilização da toxina botulínica na PC.

Cerebral palsy (CP) is characterized by nonprogressive brain injury, the most common cause of child disability. Neuromuscular problems affecting oral health, being bruxism a frequent finding. This is characterized by the application of excessive forces in the masticatory muscles, may cause temporomandibular joint dysfunction, headaches and tooth wear. Recently, the local injection of botulinum toxin was reported as excellent therapeutic option. The aim of this study was to conduct a literature review on the treatment of bruxism with the use of botulinum toxin in the PC.

Sedação inalatória com óxido nitroso/oxigênio: uma opção eficaz para pacientes odontofóbicos / Nitrous oxide/oxygen inhalation sedation: an effective option for odontophobic patients

O medo é o principal obstáculo para o atendimento odontológico seguro e de sucesso. A utilização da sedação inalatória vem se mostrando eficaz para o controle de comportamento destes pacientes. Entretanto, no Brasil, ainda poucos cirurgiões-dentistas são habilitados e lançam mão desta ferramenta. O objetivo deste relato é demonstrar um caso de paciente odontofóbico atendido com sucesso através da sedação inalatória. Esta técnica é eficaz para o tratamento odontológico de pacientes odontofóbicos, permitindo a colaboração do paciente e diminuindo os riscos de emergências médicas.

The fear is the main obstacle to a safe and successful dental care. The use of inhalation sedation has proved effective for controlling behavior of these patients. However, in Brazil, yet few dentists are enabled, and lay hold of this tool. The objective of this report is to demonstrate a case of odontophobia patient treated successfully by inhalation sedation. This technique is effective for dental treatment of odontophobic patients, allowing the patient’s collaboration and decreasing the risk of medical emergencies.

Utilização de corticosteroide tópico oclusivo para o tratamento da gengivite descamativa: uma opção eficaz / Use of occlusive corticosteroid for the treatment of desquamative gingivitis: an effective option

A gengivite descamativa é uma manifestação dolorosa de algumas desordens autoimunes. O tratamento requer a utilização de corticosteroides tópicos, havendo maior eficácia se for administrado por terapia oclusiva. O objetivo deste estudo é demonstrar a eficácia da terapia oclusiva com corticosteroides no tratamento da gengivite descamativa. Foram selecionados 10 pacientes com quadro clínico de gengivite descamativa com diagnóstico prévio da condição associada. Os pacientes foram instruídos a utilizar moldeiras de silicone com corticosteroide tópico, havendo regressão total em oito pacientes após 30 dias. A terapia oclusiva com corticosteroide tópico é uma opção eficaz para o tratamento da gengivite descamativa. Entretanto, nos casos mais graves, a associação com a medicação sistêmica poderá resultar em melhor controle da doença.

The desquamative gingivitis is a painful manifestation of some autoimmune disorders. Treatment requires the use of topical corticosteroids, with greater efficacy if administered by occlusive therapy. The aim of this study is to demonstrate the efficacy of occlusive therapy with corticosteroids in the treatment of desquamative gingivitis. We selected 10 patients with clinical desquamative gingivitis with a previous diagnosis of associated condition. Patients were instructed to use silicone trays with topical steroids, with complete regression in eight patients after 30 days. The occlusive therapy with topical steroids is an effective option for the treatment of desquamative gingivitis. However, in severe cases, the association with systemic medication may result in better disease control.