Granuloma Periférico de Células Gigantes e Hiperparatiroidismo. Presentación de un Caso / Peripheral Giant Cell Granuloma and Hyperparathyroidism. Case Report

RESUMEN: Se presenta el caso de un paciente sexo femenino 31 años, insuficienciente renal crónica en hemodiálisis, hipertensa secundaria, consulta por aumento de volumen oral en relación a encía marginal vestibular izquierda, 6 meses de evolución. Al examen se observa aumento de volumen de 15 mm en relación a piezas. 3.6 y 3.7. Radiografía muestra compromiso periodontal pieza 3.7. Se realiza biopsia excisional y exodoncia pieza 3.7. Histopatología informa granuloma periférico de células gigantes. Se solicitan exámenes de laboratorio para estudio de hiperparatiroidismo (PTH elevada, calcemia fosfatemia normales). Evoluciona favorablemente. Sin signos de recidiva a los 3 meses. El diagnóstico histopatológico de lesión de células gigantes debe ser complementado con la clínica, exámenes de laboratorio e imagenología, el objetivo final es definir si tal diagnóstico corresponde a un tumor pardo, a un granuloma central de células gigantes o a un granuloma periférico de células gigantes. En la literatura los reportes de asociación entre granuloma periférico de células gigantes e hiperparatiroidismo son escasos. Este caso corresponde a granuloma periférico células gigantes, asociado a hipersecreción de paratohormona.

ABSTRACT: A 31-year-old female patient with chronic renal insufficiency in hemodialysis and secondary hypertension consulted due to an enlarging intraoral lesion in relation to the left marginal vestibular gingival, with 6 months of evolution. A 15mm mass in relation to mandibular left molars was noted. Radiograph showed periodontal involvement of mandibular left second molar. Excisional biopsy and tooth 3.7 extraction were performed. Histopathology reported a peripheral giant cell granuloma. Laboratory tests were requested for suspected hyperparathyroidism (aiding in the diagnosis) (high PTH, normal phosphatemia and calcemia). Evolution was favorable, without signs of reappearance after 3 months. The histopathological diagnosis of giant cell lesions should be complemented with clinical, laboratory and imaging tests. The final objective is to make the differential diagnosis between brown tumor, central giant cell granuloma and peripheral giant cell granuloma because the treatment varies considerably. There are few reports in the literature about the association between peripheral giant cell granuloma and hyperparathyroidism. This case corresponds to peripheral giant cell granuloma, possibly associated with parathormone hypersecretion.

Chilean patients' perception of oral health-related quality of life after third molar surgery.

OBJECTIVE: To describe the perception of the quality of life in oral health based on the Health-Related Quality of Life instrument in its Spanish version (HRQOL-sp) in Chilean patients with third molar extraction surgery. PATIENTS AND METHODS: A cross-sectional study. The HRQOL-sp was administered to dental patients at the Public Hospital in Rio Bueno in southern Chile treated for unilateral third molar extraction between March and June 2014. The instrument was applied by phone survey on the first, third, fifth, and seventh days after surgery. For the ordinal scale, the response was considered interference in the quality of life when patients selected the options "quite a bit of trouble" or "lots of trouble" for oral function and general activity; and selected complications-related signs and symptoms, a pain level score with a Verbal Rating Scale (range 0 to 7), and worst pain perceived. The patient's sociodemographic data, type of surgery, and the quality of life level were analyzed according to the domains of the HRQOL-sp instrument. RESULTS: A total of 106 patients were selected (age: 20.4±7.39 years; 71.7% women) and a total of 127 extracted third molars. On the first day of follow-up, most patients reported interference in their quality of life. The main problems were difficulty opening the mouth (50.94%) and swelling (83.02%). The worst symptom perceived was "bad breath" (>31%) and the worst pain felt was a mean of 4.31±1.62 on the Verbal Rating Scale. All items gradually reduced until the seventh day. CONCLUSION: The HRQOL-sp revealed substantial interference in the quality of life on the first postoperative day. It is suggested that the risk factors associated with quality of life be analyzed and the instrument in Spanish be validated.

Patrones Epidemiológicos del Trauma Dentoalveolar (PatologíaGES) en Pacientes Adultos Atendidos en un Centro de Trauma de Chile Durante 2 Períodos / Epidemiological Patterns of Traumatic Dental Injuries (GES Disease) in Adult Patients Treated at a Chilean National Trauma Center during 2 Periods

El trauma dentoalveolar (TDA) constituye un conjunto de lesiones que comprometen los dientes o a sus estructuras periodontales. En Chile, desde el año 2007, la primera consulta/tratamiento de urgencia del TDA está cubierta por la Ley N 19.966, para todas las personas afiliadas al Fondo Nacional de Salud (FONASA) y a las Instituciones de Salud Previsional Privadas (ISAPRE) a través del Programa de Garantías Explícitas en Salud (GES). Escasos estudios nacionales se han realizado en TDA de adultos y ninguno en relación al impacto del GES en estas lesiones. Se realizó un estudio retrospectivo, descriptivo y transversal de TDA con los Datos de Urgencia de todos los pacientes adultos atendidos en el Hospital de Urgencia Asistencia Pública. Se compararon las variables clínicas, etiológicas, demográficas y sociales entre 2 períodos: pre-GES (1 de Julio de 2005 al 30 de Junio de 2006) y post-GES (1 de julio de 2012 al 31 junio de 2013). En los 2 períodos se observó una mayor frecuencia de TDA en el sexo masculino del grupo de 20­29 años, producidos en la mayoría de los casos por violencia interpersonal. Sin embargo se observó en el período post-GES una mayor consulta de TDA por Accidente vehículo-motorizado, presentándose lesiones de mayor gravedad. A pesar de la implementación del GES, se observó una alta frecuencia de TDA no tratados, esto podría deberse a la gravedad del estado sistémico del paciente (postergando el tratamiento de TDA), a la falta de insumos o a la inequidad en la entrega de recursos a los servicios de salud. Es necesario realizar más estudios y vigilancia de parte de la autoridad sanitaria para mejorar las garantías del GES en el tratamiento de los TDA.

Traumatic dental injury (TDI) is a group of injuries that affect hard dental tissues and/or periodontal structures. Since 2007 the first emergency treatment/consult of TDI, for both the National Health Fund (FONASA) and profit private insurer (ISAPRE) affiliates, is guaranteed in the Regulation of Explicit Health Guarantees (GES) established by Chilean Law 19.966. Few national TDI studies in adults have been carried out, and none in relation to the impact of GES in this type of lesion. A retrospective cross sectional study of emergency charts of all adult patients attended at the Hospital de Urgencia Asistencia Pública. Etiological, clinical, demographic and social variables were compared between 2 time periods, Pre-GES period (July, 1 2005 to June, 30 June 2006) versus Post-GES period (July, 1 2012 to June, 31 2013). A high incidence of TDI caused by interpersonal violence in males between 20 and 29 years old was observed in both periods. However, an increased TDI with more severe injuries caused by automobile accident was observed during the post-GES period. In spite of GES implementation, high frequency of non-treated TDI was seen in the present study, this could be due to the severity of the patient´s systemic condition (delaying the TDI treatment), a lack of resources and/or inequity in the delivery of these healthcare resources. More studies and surveillance programs by the Government are needed to improve TDI treatment guarantees, and as well as regular assessment of GES compliance.

Metodología y visibilidad en los medios de divulgación científica de las tesis de pregrado en Odontología / Methodology and visibility in the scientific mass media for the undergraduate theses in dentistry

Objetivo: describir la aplicación de metodología científica de las tesis de pregrado realizadas en la Facultad de Odontología de la Universidad de Chile para los trienios: 2002-2003-2004 y 2007-2008-2009 y su visibilidad en medios de divulgación reconocidos por la comunidad científica odontológica. Métodos: se examinó la totalidad de las tesis desarrolladas entre los periodos 2002-2004 y 2007-2009 (n = 425) utilizando una pauta de cotejo para identificar y registrar el cumplimiento de requisitos formales para el desarrollo de una investigación científica y la difusión de sus hallazgos en medios escritos y orales. La pauta fue aplicada por miembros del mismo equipo investigador y los datos fueron analizados mediante estadísticas de resumen, junto con la descripción de los hallazgos cualitativos. Resultados: solo el 11,6 % de las tesis se publicó en alguna revista científica, sin embargo, el porcentaje se reduce a 3,3 % si se considera solo revistas ISI (Institute for Scientific Information). Por otro lado un 53,8 % fueron presentadas en eventos científicos. La dificultad en la publicación es coherente con una insuficiente calidad metodológica en distintas secciones de las tesis (análisis estadístico, procedimientos y diseño de investigación). Los hallazgos cualitativos mostraron "falta de información pertinente", "uso de conceptos metodológicos erróneos" y "falta de coherencia entre secciones". Conclusiones: el porcentaje de publicación de las tesis de pregrado en Odontología en la Universidad de Chile para el periodo 2002-2009, está bajo los estándares internacionales, aunque el número de presentaciones en congresos es adecuado. Probablemente las debilidades en la construcción de la sección de metodología se relacionan con estos insuficientes resultados.

Objective: to describe the implementation of scientific methodology of the undergraduate theses presented at the Dentistry Faculty of Universidad de Chile in the periods of 2002-2004 and 2007-2009 and their visibility in mass media acknowledged by the scientific dental community. Methods: all the four hundred and twenty five theses (425) presented in the periods of 2002-2004 and 2007-2009 were analyzed by using a comparison guideline to identify and register the compliance with the formal requirements for scientific research and dissemination of findings in written and oral media. The guideline was applied by members of the research team and the data was analyzed with summary statistics and the qualitative findings were described. Results: it was found that just 11.6 % of theses were published in some scientific journal; however, the percentage lowered to 3.3 % if we considered just ISI journals (Institute for Scientific Information). On the other hand, 53.8 % were submitted at scientific events. Difficulties in publishing these theses were related to poor methodological quality in several sections of theses (statistical analysis, procedures and research design). The qualitative results showed lack of relevant information, use of wrong methodological concepts and non-coherence among the sections. Conclusions: the percentage of publication of undergraduate theses in dentistry presented at Universidad de Chile in the period of 2002 through 2009 is low according to the international standards, but the number of submissions at congresses is adequate. It is likely that the weaknesses found in the construction of the methodology section be associated to these poor results.