Manejo clínico odontológico de un paciente con mucopolisacaridosis tipo III. (Síndrome de Sanfilippo) / Dental clinical management of a patient with type III mucopolysaccharidosis (Sanfilippo syndrome)

El síndrome de Sanfilippo (mucopolisacaridosis tipo III) es un trastorno lisosomal causado por un defecto en el catabolismo del sulfato de heparano. La mucopolisacaridosis tipo III es el tipo más común de todas las mucopolisacaridosis. La base patógena de la enfermedad consiste en el almacenamiento de sustrato no degradado en el sistema nervioso central. El deterioro cognitivo progresivo que resulta en demencia y anomalías de comportamiento son las principales características clínicas del síndrome de Sanfilippo. La mucopolisacaridosis tipo III puede diagnosticarse erróneamente como otras formas de retraso del desarrollo, trastorno por déficit de atención/hiperactividad y trastornos del espectro autista, debido a la falta de síntomas somáticos y a la presencia de formas leves y atípicas de la enfermedad. Los pacientes con síndrome de Sanfilippo pueden tener niveles de glicosaminoglicanos en la orina comparativamente bajos, lo que da como resultado un ensayo urinario falso negativo. El diagnóstico definitivo se realiza mediante un ensayo enzimático en leucocitos y fibroblastos cultivados. Actualmente no existe un tratamiento eficaz de la mucopolisacaridosis tipo III, aunque las investigaciones en curso sobre el gen, la reducción de sustratos y las terapias de reemplazo de enzimas intratecales esperan obtener un método curativo para alterar el daño devastador del sistema nervioso central en un futuro próximo. El tratamiento odontológico de los pacientes con MPS-III requiere colaboración multidisciplinar, siendo de vital importancia el mantenimiento y controles periódicos, sobre todo en fases tempranas de la enfermedad. En estados avanzados se requerirá el uso de la anestesia general o la sedación profunda para dichos tratamientos, lo que supondrá un enorme reto para el profesional. (AU)

Sanfilippo syndrome (mucopolysaccharidosis type III) is a lysosomal disorder caused by a defect in the catabolism of heparan sulfate. Mucopolysaccharidosis type III is the most common type of mucopolysaccharidosis. The pathogenic basis of the disease consists of the storage of non-degraded substrate in the central nervous system. The progressive cognitive deterioration that results in dementia and behavioral abnormalities are the main clinical features of Sanfilippo syndrome. Mucopolysaccharidosis type III can be misdiagnosed as other forms of developmental delay, attention deficit/hyperactivity disorder and autistic spectrum disorders due to the lack of somatic symptoms, the presence of mild and atypical forms of the disease. Patients with Sanfilippo syndrome may have comparatively low glycosaminoglycan levels in the urine, resulting in a falsenegative urinary test. The definitive diagnosis is made by an enzymatic assay in cultured leukocytes and fibroblasts. There is currently no effective treatment for mucopolysaccharidosis type III, although ongoing research on the gene, substrate reduction and intrathecal enzyme replacement therapies hope to obtain a curative method to alter the devastating damage of the central nervous system in the future next. The dental treatment of patients with MPS-III requires multidisciplinary collaboration, being of vital importance the maintenance and periodic controls especially in early phases of the disease. In advanced stages, the use of general anesthesia or deep sedation will be required for dental procedures, which will be a huge challenge for the professional. (AU)

Bacterial cellulose adhesive composites for oral cavity applications.

Topical approaches to oral diseases require frequent dosing due to limited retention time. A mucoadhesive drug delivery platform with extended soft tissue adhesion capability of up to 7 days is proposed for on-site management of oral wound. Bacterial cellulose (BC) and photoactivated carbene-based bioadhesives (PDz) are combined to yield flexible film platform for interfacing soft tissues in dynamic, wet environments. Structure-activity relationships evaluate UV dose and hydration state with respect to adhesive strength on soft tissue mimics. The bioadhesive composite has an adhesion strength ranging from 7 to 17 kPa and duration exceeding 48 h in wet conditions under sustained shear forces, while other mucoadhesives based on hydrophilic macromolecules exhibit adhesion strength of 0.5-5 kPa and last only a few hours. The work highlights the first evaluation of BC composites for mucoadhesive treatments in the buccal cavity.

Differential expression of drug resistance genes in CD146 positive dental pulp derived stem cells and CD146 negative fibroblasts.

INTRODUCTION: The stem cell portion of the dental pulp derived cultures (DPSCs) showed a higher resistance to cytotoxic effect of restorative dental materials compared to pulpal fibroblasts (DPFs). Here, we aimed to compare the expression of some drug resistant genes between these cells. METHODS AND MATERIALS: To separate DPSCs from DPFs, we used magnetic cell sorting technique based on CD146 expression. To assess the stem cell properties, the positive and negative portions underwent colony forming assays and were induced to be differentiated into the adipocytes, osteoblasts, hepatocytes, and neural cells. Cell surface antigen panels were checked using immune fluorescence and flow-cytometry techniques. The mRNA expression of 14 ABC transporters including ABCA2, ABCB1, ABCB11, ABCC1, ABCC2, ABCC3, ABCC4, ABCC5-2, ABCC5-4,ABCC5-13, ABCC6, ABCC10, ABCC11, and ABCG2 genes was assessed, using quantitative RT-PCR technique. RESULTS: Only the CD146 positive portion could be differentiated into the desired fates, and they formed higher colonies (16.7 ± 3.32 vs. 1.7 ± 1.67, p < .001). The cell surface antigen panels were the same, except for CD146 and STRO-1 markers which were expressed only in the positive portion. Among the ABC transporter genes studied, the positive portion showed a higher expression (approximately two-fold) of ABCA2, ABCC5-13, and ABCC5-2 genes. CONCLUSION: Dental pulp stem cells which can be separated from dental pulp fibroblasts based on CD146 expression, express higher levels of some drug resistance genes which probably accounts for their features of more resistance to cytotoxic effects of some dental materials. This needs to be more validated in future.

O efeito dos inibidores seletivos da recaptação da serotonina no metabolismo ósseo e sua influência na odontologia / The effect of selective serotonin reuptake inhibitors on bone metabolism and its influence on dentistry

Objetivo: o presente trabalho teve como objetivo apresentar uma revisão do conhecimento atual do efeito dos inibidores seletivos da receptação da serotonina (ISRSs) sobre os ossos e sua influência na Odontologia, especialmente nos procedimentos dependentes da qualidade óssea, como na Implantodontia. Material e métodos: um levantamento bibliográfico foi realizado nas bases de dados Scielo e PubMed, utilizando-se as palavras-chave "antidepressivo", "inibidores seletivos da recaptação da serotonina", "osso" e "Odontologia". Foram selecionados artigos publicados de 2000 a 2018 nos idiomas inglês, português, espanhol e francês. Resultados: foram incluídos 26 artigos na presente revisão qualitativa. A maior parte dos estudos sugere que os ISRSs exercem um efeito negativo sobre a densidade óssea e aumentam o risco de fraturas, especialmente em indivíduos idosos. Na Implantodontia, os usuários de ISRSs apresentaram taxas de falha maiores que as dos não usuários, porém, sem diferença estatisticamente significante. Durante a movimentação ortodôntica, um único estudo mostrou que os ISRSs não produzem alterações, e na doença periodontal há resultados contraditórios em relação ao efeito protetor ou destruidor dos ISRSs. Conclusão: os ISRSs podem diminuir a densidade óssea corporal e prejudicar sua arquitetura. Embora não exista uma evidência sedimentada sobre a influência dos ISRSs no osso alveolar, sugere-se que maiores cuidados sejam tomados em pacientes usuários de ISRSs que serão submetidos a procedimentos dependentes da qualidade óssea, como no caso dos implantes osseointegrados. (AU)

Objetive: the objective of the present study was to present a review of the current knowledge of the effect of selective serotonin reuptake inhibitors (SSRIs) on bone and its infl uence on dentistry, especially on procedures dependent on bone quality, such as dental implants. Material and methods: a literature review was performed in the databases Scielo and PubMed, using the keywords "antidepressant", "selective serotonin reuptake inhibitors", "bone", and "dentistry". Articles published between 2000 and 2018, in English, Portuguese, Spanish and French were selected. Results: twenty-six articles were included in the present qualitative review. Most studies suggest that SSRIs exert a negative effect on bone density and increase the risk of fractures, especially in elderly. In implant dentistry, SSRI users presented higher failure rates than non-users, however, with no statistically significant difference. During orthodontic movement, a single study showed that SSRIs do not produce changes, and in periodontal disease there are contradictory results regarding the protective or destructive effect of SSRIs. Conclusion: SSRIs can decrease body bone density and impair its architecture. Although there is no settled evidence on the influence of SSRIs on the alveolar bone, it is suggested that greater care should be taken in SSRI users who will undergo bone quality-dependent procedures, such as osseointegrated implants. (AU)

Avaliação in vitro de novos produtos na diminuição da permeabilidade dentinária antes e após desafios ácidos / In vitro evaluation of new products in regarding dentin permeability reduction before and after acid challenge model

Objetivo: avaliar in vitro a efetividade de aplicações sucessivas de diferentes produtos utilizados para o tratamento da hipersensibilidade dentinária cervical na redução da permeabilidade dentinária, assim como avaliar a resistência destes produtos a desafios ácidos. Material e métodos: foram utilizados 72 terceiros molares humanos íntegros para a preparação de 72 amostras, que foram ligadas a um sistema de pressão hidráulica para mensurar a permeabilidade dentinária após os seguintes passos: 1) preparação da amostra; 2) tratamento com ácido fosfórico a 37% durante 30 segundos; 3) cinco aplicações dos produtos testados; 4) primeiro desafio ácido; 5) segundo desafio ácido; e 6) terceiro desafio ácido. As amostras foram divididas aleatoriamente em seis grupos (n=12), de acordo com os tratamentos propostos: Desensibilize Nano P, Clinpro XT, dentifrício Colgate Sensitive Pró-Alívio, dentifrício Duraphat, dentifrício Sensodyne Repair e após restauração com resina composta (grupo-controle). Conclusão: que todos os produtos testados foram capazes de promover a redução da permeabilidade dentinária significativamente, sendo que os grupos Clinpro XT, Desensibilize Nano P e controle mantiveram esses níveis reduzidos estatisticamente até o terceiro desafio ácido, enquanto que os dentifrícios Duraphat, Sensodyne Repair e Colgate Sensitive Pró-Alívio mantiveram essas reduções estatisticamente significativas até o segundo desafio ácido.

Objective: to evaluate in vitro the effectiveness of successive applications of different products used for the treatment of cervical dentinal hypersensitivity, reducing dentin permeability, as well as to evaluate the resistance of these products, acids challenges. Material and methods: 72 intact human third molars were used for the preparation of 72 samples were bound to a hydraulic pressure system to measure the dentin after the following steps: 1) sample preparation; 2) treatment with 37% phosphoric acid for 30 seconds; 3) 5 applications of the products tested; 4) first challenge acid; 5) second challenge acid; 6) third challenge acid. The samples were randomly divided into 6 groups (n=12) according to the proposed treatments: Desensibilize Nano P, Clinpro XT, toothpaste Colgate Sensitive Pro-Relief, Duraphat toothpaste, toothpaste Sensodyne Repair and after restoration with composite resin (control group). Conclusion: all products tested were able to significantly promote the reduction of dentin, and the Clinpro XT groups Desensibilize Nano P and control these reduced levels remained statistically to the third challenge acid, while toothpaste Duraphat, Sensodyne Repair and Colgate Sensitive Pro-Relief kept these statistically significant reductions to the second challenge acid.

General health and oral health status in elderly dental patients in Isparta, Turkey

The aim of this study was to describe the oral health, general health status and medication use of elderly dental patients 709 voluntary patients, aged 60 years and over, who attended Suleyman Demirel University Faculty of Dentistry for routine dental treatment between March 2008 and April 2009 in Isparta, Turkey, were interviewed for demographic data, systemic diseases, and lists of medications. The majority of the patients [84.4%] had poor oral hygiene according to the Oral Hygiene Index [OHI]. The mean level of the study population's decayed, missing, and filled teeth [DMFT] index score was 19.1 +/- 7.3. The prevalence of systemic diseases was high [90%]. Women were affected by a significantly higher incidence of systemic diseases than men [96.4% vs. 84.3%; P < 0.001]. The percentage of the elderly taking medication regularly was 72.6%. Drug adverse effects were determined in 25.5% of the study population, with more adverse effects observed in women [53.3%] than men [46.7%] [P < 0.001]. Dentists must be aware of the dental implications that may arise from systemic diseases and medications and should properly modify elderly patients' treatment accordingly

La présente étude avait pour objectif de décrire la santé bucco-dentaire de patients dentaires âgés, leur état de santé général et leur recours aux médicaments; 709 patients volontaires, âgés de 60 ans et plus, qui avaient consulté à la Faculté de Dentisterie de l'Université de Suleyman Demirel pour des soins dentaires de routine entre mars 2008 et avril 2009 à Isparta, en Turquie, ont été interrogés pour obtenir des données démographiques, ainsi qu'au sujet des maladies systémiques et des listes de médicaments qui les concernaient. La majorité des patients [84,4%] avaient une mauvaise hygiène bucco-dentaire selon l'indice d'hygiène buccale. Le niveau moyen de l'indice CAO [dent cariée, absente ou obturée] de la population étudiée était de 19,1 +/- 7,3. La prévalence des maladies systémiques était élevée [90%]. Les femmes étaient significativement plus affectées par les maladies systémiques que les hommes [96,4% contre 84,3% ; p < 0,001]. Le pourcentage de personnes âgées pregnant des médicaments sur une base régulière était de 72,6%. Les effets secondaires provoqués par les medicaments ont été déterminés pour 25,5% de la population étudiée, avec davantage d'effets secondaires observés chez les femmes [53,3%] que chez les hommes [46,7%] [p <0,001]. Les dentistes doivent avoir connaissance des implications dentaires pouvant être causées par des maladies systémiques et des traitements médicamenteux, et devraient modifier les soins apportés aux personnes âgées en conséquence

Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery.

The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias.

Adherence of preventive oral care products in the Syrian market to evidence-based international recommendations

No study has investigated the availability and adherence of preventive oral care products on the Syrian market to evidence-based international recommendations. Data were collected in 2012, and updated in 2016, in terms of availability, characteristics and adherence to evidence-based international recommendations. Few preventive products adhered to the recommendations. Despite the large decrease in the number of oral care products on the Syrian market, due to the Syrian crisis, nonadherence of some of the available products is still present. A multisectorial approach at a policy level is needed to address such important limitations. The Syrian Ministry of Health should reform regulations for fluoride products to become subject to drug monitoring systems; the Syrian Arab Committee for Measurements and Standards needs to update its standards; and the Syrian General Dental Association should distribute a preventive booklet to dental practitioners

Aucune étude n'a examiné à ce jour la disponibilité et la conformité des produits de soins dentaires préventifs sur le marché syrien avec les recommandations internationales fondées sur des données probantes. Des données ont été collectées en 2012, et mises à jour en 2016, en ce qui concerne la disponibilité, les caractéristiques et la conformité de ces produits avec les recommandations internationales fondées sur des données probantes. Peu de produits préventifs étaient conformes aux recommandations. Malgré une forte diminution du nombre de produits de soins dentaires sur le marché syrien du fait de la crise actuelle dans le pays, la non-conformité de certains produits disponibles reste d'actualité. Une approche multisectorielle au niveau politique est nécessaire pour remédier à ces lacunes importantes. Le ministère syrien de la Santé doit réformer les réglementations existantes sur les produits à base de fluor afin que ceux-ci soient soumis à des systèmes de suivi des médicaments ; le Comité arabe syrien des mesures et des normes doit mettre à jour ses normes ; et l'Association de dentisterie générale syrienne doit distribuer une plaquette de prévention à l'intention des praticiens dentaires

Emergency Drugs for the Dental Office.

Any dental office can face a variety of medical emergencies; therefore, the health care professional and the staff should always be prepared to deal with these emergencies in their office. Preparedness of the dental office staff and their prompt recognition of these emergencies will be the most important factor in dealing with the emergencies in any dental office. Health care professionals should follow the recommendations in this article to maintain a guideline for their staff and office and conduct regular emergency drills to examine the equipment and preparedness of their staff.

Pharmacologic Treatment for Temporomandibular Disorders.

Pharmacologic agents play an integral role in the overall management of temporomandibular joint disorder. The general dentist should be familiar with the different classes of drugs currently in use for dealing with this often complex medical/dental problem.

Novel anticoagulants: general overview and practical considerations for dental practitioners.

Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.

Medication-related dental erosion: a review.

Dental erosion has become a major problem that affects the long-term health of the dentition. Among the various potential causes for erosive tooth wear, the different drugs prescribed for patients may be overlooked. Several therapeutic medications can directly or indirectly be associated with dental erosion. It is the responsibility of oral health providers to make both patients and colleagues aware of drugs that may contribute to this condition. Therefore, the purpose of this discussion is to provide an overview of the various therapeutic medications that can be related to tooth erosion. The authors also include precautionary measures-summarized as The 9 Rs-to avoid or at least reduce medication-induced erosion.

Graduating dental students' views of competency statements: importance, confidence, and time trends from 2008 to 2012.

Competency documents are used in dental education as both an educational framework and an accreditation instrument. The aim of this study was to analyze the perceptions of graduating dental students at the University of British Columbia (UBC) regarding the importance of each competency statement, as well as to assess their confidence in their abilities associated with each statement. The instrument was based on the survey developed by Schönwetter et al. at the University of Manitoba using the Association of Canadian Faculties of Dentistry competency document. The current study surveyed UBC graduating students in the years 2008 through 2012. The response rates ranged from 66.7% to 95.9%, averaging 77.5% across all five years. The results showed that, overall, the students rated all the competencies as important, but they rated their confidence lower than the perceived importance. Correlation coefficients averaged a moderate correlation of 0.376 for all competency statements except the five with the greatest discrepancy between perceived importance and confidence. The competencies the students perceived as most important tended to be associated with tasks frequently performed during predoctoral dental education. The instrument used in this study can help other academic dental institutions identify patterns of students' perceived competency importance and confidence to inform allocation of teaching time and resources and adopt new methodologies to address identified areas of need.

Análise farmacológica e legal de prescrições odontológicas de antibióticos: um estudo transversal / Pharmacological and legal analysis of antitibiotic dental prescriptions: a cross-sectional study

Cirurgiões-dentistas têm a prerrogativa de prescrever medicamentos como adjuvantes ao tratamento odontológico. Em 2011, com a promulgação da Resolução de Diretoria Colegiada no 20 da Agência Nacional de Vigilância Sanitária - ANVISA, antibióticos se tornaram medicamentos sujeitos a prescrição especial. Este estudo transversal descritivo buscou conhecer o ato prescricional dos cirurgiões-dentistas quanto aos antibióticos, identificar os mais prescritos, determinar se houve erro no atendimento das determinações legais e identificar erros na prescrição profilática. Foram analisadas prescrições odontológicas de antibióticos aviadas na maior rede de drogarias de Belo Horizonte, Minas Gerais, de 1º de julho de 2011 a 30 de junho de 2012. No período da coleta de dados havia 75 lojas em funcionamento. Foi possível recuperar informações sobre as prescrições de 69 delas (Taxa de retorno=92,0%). Para o universo, 31.105 prescrições, foi realizado um sorteio da amostra, com cálculo baseado na estimativa de proporções (50% de proporção estimada de prescrição com erro, 5% de precisão e nível de confiança de 95%). Foram sorteadas 434 prescrições, pela técnica de amostragem aleatória simples. Após exclusão daquelas com repetição de prescritor e/ou de paciente, foram analisadas 366 prescrições. A precisão recalculada para este montante foi igual a 5,09%. Após dupla digitação no programa Epi-Data foi criado um banco de dados no programa SPSS. A pesquisa foi submetida e aprovada pelo Comitê de Ética em Pesquisa da UFMG. Os resultados das análises demonstraram que a maioria dos antibióticos prescritos pertence ao grupo das penicilinas (71,9%) e dos macrolídeos (17,6%). Também foram prescritos, em menor proporção, antibióticos para aplicação cutânea e vários outros, incluindo antifúngicos, além de associações: amoxicilina com ciprofloxacino e com clindamicina...

Dentists have the prerogative to prescribe drugs as adjuncts to dental treatment (BRASIL, 1966). In 2011, with the enactment of the Collegiate Board Resolution no.20 of the National Health Surveillance Agency - ANVISA, antibiotics became drugs subject to special prescription. This descriptive cross-sectional study aimed to know the limitation act of dentists as to antibiotics, identify the most prescribed, determine if there was an error in meeting the legal requirements and identify errors in prophylactic prescription. Dental antibiotic prescriptions filled in the largest drugstore chain in Belo Horizonte, Minas Gerais were analyzed from 1 July 2011 to 30 June 2012. In the period of data collection there were 75 stores in operation. It was possible to retrieve information about the prescriptions of 69 of them (return rate = 92%). For the study of 31,105 prescriptions, there was a draw of the sample, with calculation based on estimated proportions (50% of estimated proportion with prescription error, 5% precision and 95% of confidence level). 434 prescriptions were selected by the simple random sampling technique. After excluding those with repeating prescriber and / or patient, 366 prescriptions were analyzed. The accuracy recalculated for this amount was equal to 5.09%. After double entry in Epi-Date program it was created a database in the SPSS software. The research was subjected and approved by the Ethics Committee of UFMG. The results of analysis showed that most prescribed antibiotics belong to the group of penicillins (71.9%) and macrolides (17.6%). Also were prescribed, to a lesser extent, antibiotics for topical application and several others, including antifungal, in addition to associations: amoxicillin with ciprofloxacin and clindamycin. In 27.9% of the prescriptions there were errors in spelling or disobedience to the determination to follow the Brazilian Common Denomination (DCB)...

Antidiabéticos orales y odontología / Oral antidiabetic agents and dentistry

La diabetes mellitus es un conjunto de trastornos metabólicos caracterizado por la existencia de hiperglucemia. Existen varios tipos de diabetes y por tanto distintos tratamientos farmacológicos. En esta revisión, se describen las interacciones de las insulinas y antidiabéticos orales en el tratamiento de la DM tipo 2, con los principales fármacos utilizados en odontología (AU)

Diabetes Mellitus is a metabolic disorder which is characterized by hyperglycemia. There are several types of diabetes, and therefore different pharmacological treatments. In this systematic review will focus on the interactions of insulins and oral antidiabetic agents in the treatment of type 2 Diabetes Mellitus, with the main drugs used in dentistry (AU)

Actualización en Endodoncia 2013 / 2013 Update in Endodontics

Los autores revisan los artículos publicados en las revistas científicas más significativas en el ámbito de la endodoncia durante el año 2013, comparándolos entre ellos, con otros anteriores y con los conceptos clásicos de la endodoncia

The authors review the articles published in the most relevant journals concerning endodontics during the last year 2013, making a comparison between them, as well as with other older ones and with classic concepts in endodontics