Manejo odontológico del paciente con anemia falciforme: revisión integrativa / Dental management of the patient with falciform anemia: integrative review / Manejo odontológico do paciente com anemia falciforme: revisão integrativa

La anemia falciforme (AF) es un trastorno genético autosómico recesivo que afecta la hemoglobina y los glóbulos rojos adquieren una forma de hoz. Este evento provoca episodios de vaso-oclusión y hemólisis y, en consecuencia, una amplia gama de manifestaciones clínicas. Objetivo: realizar una revisión bibliográfica integrativa sobre el cuidado dental para pacientes con anemia falciforme. Materiales y Métodos: Se realizó una búsqueda en las bases de datos de PubMed y SciELO, utilizando como estrategia una asociación de tér-minos relacionados ("Anemia de Células Falciformes" y " Atención Odontológica"). Resultados: Se incluyeron los artículos publicados a partir de 1990 y se excluyeron revisiones de literatura, lo que resultó en dieciocho artículos para análisis. La evidencia científica demostró que la atención odontológica preventiva es esencial para los pacientes con anemia falciforme, ya que puede reducir el número de ingresos hospitalarios. Las me-didas previas, durante y posteriores al tratamiento pueden incluir profilaxis antibiótica, uso de sedación, buen control de los niveles de oxígeno, hidratación del paciente y mantenimiento de una perfusión tisular adecuada. Sin embargo, persisten algunas dudas, sobre la seguridad del uso de anestésicos locales con vasoconstric-tores y la oseointegración de implantes dentales. Conclusión: El conocimiento de la enfermedad es esencial para el tratamiento dental de pacientes con anemia falciforme; durante la atención, se debe tener en cuenta ciertos cuidados para reducir los factores que promueven crisis agudas como acidosis, hipotensión, hipoxia, infección, vasoconstricción y estrés.

Sickle cell anemia (SCA) is an autosomal recessive genetic disorder that affects the hemoglobin molecule of red blood cells in sickle-shaped cells formation. This event causes vaso­occlusive crises and hemolysis, and consequently, a wide range of clinical manifestations. Objective: This study aimed to present an integrative review of the literature on dental care of patients with SCA. Material and Methods: A search was conducted in Pubmed and Scielo databases using as a search strategy an association of terms related to disease and dentistry ("Sickle Cell Anemia", "Dental Care"). Results: Studies published since 1990 were included while literature reviews were excluded, resulting in eighteen articles for analysis. The literature has shown that pre-ventive dental care is essential for patients with sickle cell anemia and is able to reduce the number of hospi-talizations. Pre, trans and post-treatment measures may include antibiotic prophylaxis, use of sedation, good control of oxygen levels, patient hydration, and maintenance of adequate tissue perfusion. Still, more studies are needed to clarify some dental uncertainties during the care given to patients with AF, such as the safety of local anesthetics with vasoconstrictors and the use of osseointegrated implants. Conclusion: The knowledge of the disease is essential for dental management. Certain precautions should be taken to reduce factors that promote acute crises, such as acidosis, hypotension, hypoxia, infection, vasoconstriction and stress.

A anemia falciforme (AF) é uma alteração genética autossômica recessiva que afeta a molécula de hemoglo-bina das hemácias, resultando na formação de células em forma de foice. Esse evento provoca episódios de vaso-oclusão e hemólise, e consequentemente, uma ampla gama de manifestações clínicas. Objetivo: Este trabalho teve como objetivo apresentar uma revisão integrativa de literatura sobre os cuidados odontológicos ao paciente com anemia falciforme. Materiais e Métodos: Foi conduzida uma busca nas bases de dados Pubmed e Scielo, utilizando-se como estratégia uma associação de termos relacionados à doença e à odon-tologia ("Anemia Falciforme" e "Assistência Odontológica"). Resultados: Foram incluídos artigos publicados a partir de 1990 e excluídas revisões de literatura, resultando em dezoito artigos para análise. A literatura mostrou que o atendimento odontológico preventivo é essencial para o paciente com anemia falciforme, sendo capaz de diminuir a quantidade de internações hospitalares. As medidas pré, trans e pós-tratamento podem incluir a profilaxia antibiótica, o uso de sedação, um bom controle dos níveis de oxigênio, a hidratação do paciente e a manutenção da perfusão tecidual adequada. No entanto, algumas dúvidas persistem como a segurança dos anestésicos locais com vasoconstritor e a instalação de implantes osseointegrados. Con-clusão: O conhecimento da doença é primordial para o manejo odontológico desses pacientes e, durante o atendimento, certos cuidados devem ser tomados para diminuir os fatores que promovem as crises agudas como a acidose, hipotensão, hipóxia, infecção, vasoconstrição e estresse.

Assessment and management of oral health in liver transplant candidates.

UNLABELLED: Liver transplantation has become a standard treatment for end-stage liver disease and the number of recipients has grown rapidly in the last few years. Dental care during pre-transplant workup is important to reduce potential sources of infection in the drug-induced immunosuppression phase of liver transplantation. OBJECTIVES: The objectives of this study were to document the prevalence of oral abnormalities in patients on a liver transplant waiting list presenting to an urban dental school clinic, discuss the appropriate dental treatment according their systemic conditions and compare their oral manifestations with those of healthy individuals. MATERIAL AND METHODS: A pilot study was conducted involving 16 end-stage liver disease individuals (study group- SG) attending the Special Care Dentistry Center of the University of São Paulo and 16 control individuals (control group--CG) with no liver diseases, receiving dental care at the Dental School of the University of São Paulo. These individuals were assessed for their dental status (presence of oral disease or abnormalities), coagulation status, and dental treatment indications. RESULTS: The patients from SG exhibited a greater incidence of oral manifestations compared with CG (p=0.0327) and were diagnosed with at least one oral disease or condition that required treatment. Coagulation abnormalities reflecting an increased risk of bleeding were found in 93.75% of the patients. However, no bleeding complications occurred after dental treatment. CONCLUSIONS: The patients with chronic liver diseases evaluated in this study exhibited a higher incidence of oral manifestations compared with the control group and had at least one oral disease or abnormality which required dental treatment prior to liver transplantation. Careful oral examination and evaluation of the patient, including laboratory tests, will ensure correct oral preparation and control of oral disease prior to liver transplantation.

Granulocytic sarcoma of the oral cavity in a chronic myeloid leukemia patient: An unusual presentation

Intraoral granulocytic sarcoma is an unusual manifestation of chronic or acute leukemia. The oral manifestationsoften involve enlargements of the gingival and mucosal tissue from direct leukemic cell infiltration. Only 38 caseshave been reported in scientific literature to date. We present the case of a 47 year-old female who was diagnosedwith chronic myeloid leukemia (CML) in December 2006. She was referred to a dentist for further evaluation,revealing generalized gingival overgrowth as well as periodontal, apical disease, and bleeding of the gums. Anoral biopsy was performed and histological features revealed immature blast-like cells (AU)

Multiple brown tumours of tertiary hyperparathyroidism in a renaltransplant recipient: A case report

Tertiary Hyperparathyroidism (HPT) is an uncommon condition that affects patients with secondary HPT aftera successful kidney transplant. Bone alterations are the main consequences of this endocrine condition, includingthe development of an osteolytic lesion called brown tumour. This paper reports an unusual case of multiplebrown tumours located in the maxilla and mandible in a 58-year-old renal transplant recipient, with tertiary HPT.Incisional biopsies were performed and, in both samples, the histopathological diagnoses were giant cell lesions.Due to these diagnoses, the medical history of chronic renal failure, and high levels of serum calcium and PTH,lesions were diagnosed as multiple brown tumours of tertiary HPT. The lesions showed regression within the twomonths following a total parathyroidectomy. Minimal local interventions were established to make an early diagnosisand to treat these lesions. The diagnosis of primary oral lesions was very important in order to demonstratethe relevance of interdisciplinary activity and the inclusion of dentists as part of organ transplant units (AU)

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