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2.
Spec Care Dentist ; 40(3): 308-314, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32357263

RESUMO

BACKGROUND: Factor X deficiency (known as; Stuart-Prower factor deficiency or F10 deficiency) is a rare inherited bleeding disorder. It affects one per 1 million individuals worldwide. Patients with inherited bleeding disorder reported difficulty in accessing primary dental care either due to their medical diseases or their related barriers. AIM: This article aims to identify barriers to oral health as perceived by the patient with factor X deficiency who had been refused treatment by three dentists. A further aim is to provide dentists with the knowledge required to manage patients diagnosed with factor X deficiency. METHODS AND CASE REPORT: A 30-year-old male with the inherited, severe factor X deficiency (<1%) was asked to complete a survey which includes 22 semistructured, validated questions to assess his perceived barriers to dental services. Dental examination revealed that the patient required having nonsurgical periodontal therapy under local anesthesia. The treatment plan was discussed with the patient and his hematologist. The patient's hematologist advised performing dental treatment shortly (ie, 1-2 h) after hematological cover with a prothrombin complex concentrate (1000 U; Octoplex® ) via intravenous infusion. The hematologist also prescribed tranexamic acid mouthwash (250 mg in 5 mL) and the patient was instructed to rinse his mouth for 3-5 min with 500 µg (10 mL) in case of bleeding following treatment. FINDINGS: The patient reported several barriers to dental services such as high anxiety levels regarding oral bleeding, difficulty in finding a suitable dental clinic, high cost of dental treatment, and the need for hematological cover prior to dental treatment. CONCLUSIONS: The proper communication between dentist and hematologist was a vital step to render safe and effective dental care and to reduce the patient's anxiety toward the dentist.


Assuntos
Odontólogos , Saúde Bucal , Adulto , Assistência Odontológica , Humanos , Masculino , Hemorragia Bucal , Assistência ao Paciente
3.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 30(2 Suppl. B): 296-296, abr-jun., 2020.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1117803

RESUMO

INTRODUÇÃO: A anticoagulação é utilizada na prevenção de eventos tromboembólicos e indicada a diversos pacientes, inclusive valvopatas com prótese metálica, porém seu uso aumenta o risco de sangramento em procedimentos cirúrgicos. RELATO de CASO: paciente gênero masculino, 40 anos, valvopata aórtico-mitral por etiologia reumática com três cirurgias prévias, flutter atrial, miocardiopatia valvar, lesão hepática aguda com prótese metálica mitral internado na enfermaria de um hospital terciário para cirúrgica de retroca valvar e em uso de anticoagulante enoxaparina 70mg 2 vezes ao dia. Foi solicitada avaliação odontológica prévia a cirurgia cardíaca. No exame físico extraoral, paciente contactuante e deambulante e no exame físico intraoral (EFIO), dentado parcial superior e inferior, com presença de cárie e cálculo dentário. Na radiografia panorâmica e periapical, imagem radiolúcida sugestiva de lesão periapical em primeiro molar superior direito com tratamento endodôntico insatisfatório. Optado por remoção do foco infeccioso bucal para posterior liberação para cirurgia cardíaca. A exodontia foi realizada e evoluiu sem intercorrências. Entretanto, no terceiro dia de pós-operatório, paciente retorna com hemorragia bucal. Em EFIO, presença de coágulo mal formado e sangramento ativo na região da exodontia. A conduta realizada foi anestesia local, remoção de coágulo mal formado, curetagem periapical, nova sutura oclusiva da região e curativo local com antifibrinolitico. Novos episódios de sangramento ocorreram no pós operatório, totalizando cinco reabordagens cirúrgicas com o uso de hemostáticos locais e suturas oclusivas, mas sem sucesso. Foi discutido com equipe médica e optado por suspensão do anticoagulante para controle da hemorragia bucal por 48 horas. RESULTADO: Após intervenção odontológica associada a suspensão de medicação, paciente evoluiu sem outros episódios hemorrágicos e com cicatrização da região. Considerações finais: O caso enfatiza a importância da interação entre cirurgião dentista e equipe médica no controle de hemorragia bucal intensa após exodontia em paciente cardiopata grave em uso de anticoagulação de forma eficiente.


Assuntos
Cirurgia Bucal , Hemorragia Bucal , Anestesia Local , Anticoagulantes
4.
Emerg Med J ; 37(1): 14-18, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31767676

RESUMO

OBJECTIVE: The aim of this study was to compare the incidence of airway haemorrhage between participants who received manual cardiopulmonary resuscitation (CPR) and those who had received mechanical CPR using the LUCAS device. METHODS: A retrospective cohort study was conducted by means of a medical chart review. All non-traumatic cardiac arrest patients that presented to the ED, from May 2014 to February 2018, were recruited. The groups were stratified according to those who had the majority of CPR performed using the LUCAS and those who had the majority of CPR performed manually. The primary outcome was the proportion of participants with airway haemorrhage, defined as blood observed in the endotracheal tube, pharynx, trachea or mouth, and documented in the doctor or nursing notes. Logistic regression analysis was performed to adjust for confounders. RESULTS: 12 of 54 (22%) participants in the majority LUCAS CPR group had airway haemorrhage, compared with 20 of 215 (9%) participants in the majority manual CPR group, a difference of 13% (95% CI 3% to 26%, p=0.02). The unadjusted odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.8 (95% CI 1.3 to 6.1). After adjusting for confounders, the odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.5 (95% CI 1.1 to 5.7). CONCLUSIONS: The LUCAS mechanical CPR device is associated with a higher incidence of airway haemorrhage compared with manual CPR. Limitations in the study design mean this conclusion is not robust.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Reanimação Cardiopulmonar/instrumentação , Hemorragia Bucal/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Obstrução das Vias Respiratórias/mortalidade , Obstrução das Vias Respiratórias/fisiopatologia , Austrália , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Desenho de Equipamento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Bucal/mortalidade , Hemorragia Bucal/fisiopatologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
5.
Int J Oral Maxillofac Surg ; 49(10): 1355-1359, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371154

RESUMO

The purpose of this study was to determine whether tooth extraction for patients with ventricular assist devices (VADs) could be performed without interruption of anticoagulant and/or antiplatelet therapy and whether treatment with von Willebrand factor concentrates and desmopressin is required. The study consisted of three groups of patients undergoing oral surgery. The two experimental groups comprised patients with VADs, while the third group included cardiovascular patients without VADs who served as controls. All patients were treated intraoperatively with topical haemostatic agents (oxidized cellulose or collagen). The first group was additionally treated with fibrin glue. All 75 oral surgical procedures were performed under local anaesthesia without sedation. Three of 40 patients in the experimental groups and two of 20 patients in the control group suffered a haemorrhage, with no significant difference in the incidence of haemorrhage between the groups. The findings suggest that dental extraction can be performed without modification of oral anticoagulation or antiplatelet treatments, providing that INR is less than 3.5 on the day of the operation. It can further be hypothesized that an acquired coagulopathy in VAD patients does not influence the bleeding risk in dental extractions, and so the administration of desmopressin and/or von Willebrand factor concentrates is not required.


Assuntos
Coração Auxiliar , Hemorragia , Hemostasia , Humanos , Hemorragia Bucal , Extração Dentária
7.
Infect Immun ; 88(3)2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-31871101

RESUMO

Severe malaria is mostly caused by Plasmodium falciparum, resulting in considerable, systemic inflammation and pronounced endothelial activation. The endothelium forms an interface between blood and tissue, and vasculopathy has previously been linked with malaria severity. We studied the extent to which the endothelial glycocalyx that normally maintains endothelial function is involved in falciparum malaria pathogenesis by using incident dark-field imaging in the buccal mucosa. This enabled calculation of the perfused boundary region, which indicates to what extent erythrocytes can permeate the endothelial glycocalyx. The perfused boundary region was significantly increased in severe malaria patients and mirrored by an increase of soluble glycocalyx components in plasma. This is suggestive of a substantial endothelial glycocalyx loss. Patients with severe malaria had significantly higher plasma levels of sulfated glycosaminoglycans than patients with uncomplicated malaria, whereas other measured glycocalyx markers were raised to a comparable extent in both groups. In severe malaria, the plasma level of the glycosaminoglycan hyaluronic acid was positively correlated with the perfused boundary region in the buccal cavity. Plasma hyaluronic acid and heparan sulfate were particularly high in severe malaria patients with a low Blantyre coma score, suggesting involvement in its pathogenesis. In vivo imaging also detected perivascular hemorrhages and sequestering late-stage parasites. In line with this, plasma angiopoietin-1 was decreased while angiopoietin-2 was increased, suggesting vascular instability. The density of hemorrhages correlated negatively with plasma levels of angiopoietin-1. Our findings indicate that as with experimental malaria, the loss of endothelial glycocalyx is associated with vascular dysfunction in human malaria and is related to severity.


Assuntos
Endotélio Vascular/patologia , Glicocálix/patologia , Malária Falciparum/patologia , Mucosa Bucal/patologia , Hemorragia Bucal/patologia , Angiopoietina-1/sangue , Angiopoietina-2/sangue , Biomarcadores/sangue , Criança , Pré-Escolar , Endotélio Vascular/fisiopatologia , Feminino , Glicosaminoglicanos/sangue , Humanos , Lactente , Malária Falciparum/sangue , Malária Falciparum/diagnóstico por imagem , Malária Falciparum/fisiopatologia , Masculino , Mucosa Bucal/irrigação sanguínea , Mucosa Bucal/diagnóstico por imagem , Mucosa Bucal/fisiopatologia , Hemorragia Bucal/sangue , Hemorragia Bucal/diagnóstico por imagem , Hemorragia Bucal/fisiopatologia
8.
Ned Tijdschr Geneeskd ; 1632019 11 21.
Artigo em Holandês | MEDLINE | ID: mdl-31769631

RESUMO

A 35-year-old woman developed acute swallowing problems caused by a big oral blood blister after eating nuts. The blister ruptured 32 hours later and healed without scarring. 'Angina bullosa haemorrhagica' was diagnosed after ruling out bleeding disorders.


Assuntos
Vesícula/etiologia , Hemorragia Gastrointestinal/etiologia , Doenças da Boca/diagnóstico , Doenças da Boca/etiologia , Hemorragia Bucal/etiologia , Adulto , Vesícula/diagnóstico , Edema/etiologia , Face , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Mucosa Bucal/patologia
9.
J Clin Exp Hematop ; 59(3): 119-123, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31391403

RESUMO

Gamma-heavy chain disease (γ-HCD) is a rare B-cell tumor producing truncated IgG lacking the light chain. The clinical features of γ-HCD are heterogeneous, similar to lymphoplasmacytic lymphoma, and most patients have generalized and progressive disease. In some γ-HCD patients, autoimmune diseases are associated. Thus, γ-HCD as a restricted or indolent disease is exceptional. A 66-year-old male was referred to our hospital because of subungual hemorrhage at the bilateral halluces. Physical and laboratory examination results were nonspecific, and the hemorrhage was revealed to be traumatic. However, serum electrophoresis demonstrated a small M-peak, which was monoclonal IgG-Fc without the corresponding light chain on immunofixation and immunoelectrophoresis. Bone marrow aspirate demonstrated a small number of lymphoplasmacytic cells that were positive for CD19, CD38, CD138, and cyIgG, but negative for cyκ- and -λ light chains on flow cytometry. A diagnosis of γ-HCD was made. Chest and abdominal CT demonstrated neither hepatosplenomegaly, lymphadenopathy, nor bone lytic lesions. The serum concentrations of IgG and M-peak configuration have remained relatively unchanged for nearly 3 years. Therefore, this γ-HCD may correspond to a rare form of monoclonal gammopathy with undetermined significance.


Assuntos
Antígenos CD/sangue , Imunoglobulina G/sangue , Gamopatia Monoclonal de Significância Indeterminada , Tomografia Computadorizada por Raios X , Idoso , Humanos , Masculino , Gamopatia Monoclonal de Significância Indeterminada/sangue , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico por imagem , Hemorragia Bucal/sangue , Hemorragia Bucal/diagnóstico por imagem
11.
Saudi Med J ; 40(5): 490-498, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31056627

RESUMO

OBJECTIVES: To compare the effects of diode and erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers in second-stage implant surgery applications. METHODS: This is a cross-sectional study that was carried out on patients who received implant treatment at the Departments of Oral and Maxillofacial Surgery and Periodontology, Van Yuzuncu Yil University, Van, Turkey between January 2017 and January 2018. Implants of the patients in the first group (n=20) were exposed with 940 nm Ga-Al-As diode laser while the implants of the second group (n=20) were uncovered with 2780 nm Er,Cr:YSGG laser in the second-stage surgery. Visual analogue scale (VAS) values during day 0 and following the operation on days 1, 2, 3 intraoperative bleeding grades, number of analgesics used in the postoperative period, operation time per implant, and postoperative complications were recorded. RESULTS: When gender, smoking, the presence of systemic disease, toothbrushing frequency, analgesic use, bleeding and complications observed at the control session were analyzed, no statistically significant relationship was found between the 2 groups. It was observed that males had statistically significant higher VAS values than females (p less than 0.05). CONCLUSION: Since diode lasers are more economical, smaller, and can meet the clinical needs of clinicians, it is likely that these lasers may be the preferred choice of the clinicians in surgical procedures.


Assuntos
Cromo , Implantação Dentária/métodos , Implantes Dentários , Érbio , Lasers Semicondutores , Lasers de Estado Sólido , Cirurgia Bucal/métodos , Escala Visual Analógica , Adulto , Idoso , Analgésicos/administração & dosagem , Estudos Transversais , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Hemorragia Bucal , Complicações Pós-Operatórias , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
12.
Cochrane Database Syst Rev ; 4: CD011385, 2019 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-31002742

RESUMO

BACKGROUND: Minor oral surgery or dental extractions (oral or dental procedures) are widely performed and can be complicated by hazardous oral bleeding, especially in people with an inherited bleeding disorder such as haemophilia or Von Willebrand disease (VWD). The amount and severity of singular bleedings depend on disease-related factors, such as the severity of the haemophilia, both local and systemic patient factors (such as periodontal inflammation, vasculopathy or platelet dysfunction) and intervention-related factors (such as the type and number of teeth extracted or the dimension of the wound surface). Similar to local haemostatic measures and suturing, antifibrinolytic therapy is a cheap, safe and potentially effective treatment to prevent bleeding complications in individuals with bleeding disorders undergoing oral or dental procedures. However, a systematic review of trials reporting outcomes after oral surgery or a dental procedure in people with an inherited bleeding disorder, with or without, the use of antifibrinolytic agents has not been performed to date. This is an update of a previously published Cochrane Review. OBJECTIVES: Primarily, we aim to assess the efficacy of antifibrinolytic agents to prevent bleeding complications in people with haemophilia or VWD undergoing oral or dental procedures.Secondary objectives are to assess if antifibrinolytic agents can replace or reduce the need for clotting factor concentrate therapy in people with haemophilia or VWD and to establish the effects of these agents on bleeding in oral or dental procedures for each of these patient populations. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches of the Cochrane Central Register of Controlled Trials (CENTRAL), of MEDLINE and from handsearching of journals and conference abstract books. We additionally searched the reference lists of relevant articles and reviews. We searched PubMed, Embase, Cinahl and the Cochrane Library. Additional searches were performed in ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP).Date of last search of the Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register: 01 March 2019. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials in people with haemophilia or VWD undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid or epsilon aminocaproic acid (EACA)) to prevent perioperative bleeding compared to no intervention or usual care with or without placebo. DATA COLLECTION AND ANALYSIS: Two authors independently screened the titles and abstracts of all identified articles. Full texts were obtained for potentially relevant abstracts and two authors independently assessed these for inclusion based on the selection criteria. A third author verified trial eligibility. Two authors independently performed data extraction and risk of bias assessments using standardised forms. MAIN RESULTS: While there were no eligible trials in people with VWD identified, two randomised, double-blind, placebo-controlled trials (total of 59 participants) in people with haemophilia undergoing dental extraction were included. One trial of tranexamic acid published in 1972 included 28 participants with mild, moderate or severe haemophilia A and B and one of EACA published in 1971 included 31 people with haemophilia with factor VIII or factor IX levels less than 15%. Overall, the two included trials showed a beneficial effect of tranexamic acid and EACA, administered systemically, in reducing the number of bleedings, the amount of blood loss and the need for therapeutic clotting factor concentrates. Regarding postoperative bleeding, the tranexamic acid trial showed a risk difference (RD) of -0.64 (95% confidence interval (CI) -0.93 to - 0.36) and the EACA trial a RD of -0.50 (95% CI 0.77 to -0.22). The combined RD of both trials was -0.57 (95% CI -0.76 to -0.37), with the quality of the evidence (GRADE) for this outcome is rated as moderate. Side effects occurred once and required stopping EACA (combined RD of -0.03 (95% CI -0.08 to 0.13). There was heterogeneity between the two trials regarding the proportion of people with severe haemophilia included, the concomitant standard therapy and fibrinolytic agent treatment regimens used. We cannot exclude that a selection bias has occurred in the EACA trial, but overall the risk of bias appeared to be low for both trials. AUTHORS' CONCLUSIONS: Despite the discovery of a beneficial effect of systemically administered tranexamic acid and EACA in preventing postoperative bleeding in people with haemophilia undergoing dental extraction, the limited number of randomised controlled trials identified, in combination with the small sample sizes and heterogeneity regarding standard therapy and treatment regimens between the two trials, do not allow us to conclude definite efficacy of antifibrinolytic therapy in oral or dental procedures in people with haemophilia. No trials were identified in people with VWD.


Assuntos
Antifibrinolíticos/uso terapêutico , Hemofilia A/complicações , Hemorragia Bucal/prevenção & controle , Doenças de von Willebrand/complicações , Hemofilia A/tratamento farmacológico , Humanos , Procedimentos Cirúrgicos Menores/efeitos adversos , Hemorragia Pós-Operatória/prevenção & controle , Cirurgia Bucal , Extração Dentária/efeitos adversos
13.
Spec Care Dentist ; 39(2): 173-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30773677

RESUMO

INTRODUCTION: Optimal delivery of dental care for adults with congenital bleeding disorders (CBD) requires close collaboration between hemophilia treaters and dentists. AIM: To explore U.K. hemophilia treaters' knowledge of dental procedures and associated hemostatic management in adults with CBD. METHOD: Staff (N = 180) from N = 60 hemophilia facilities in the United Kingdom were invited to participate in a questionnaire-based study using a web-based tool. The questionnaire assessed participants' knowledge, adherence and appropriateness of application of U.K. guidance on hemostatic management of common dental procedures. RESULTS: The response rate was 23% of treaters (n = 41) from 62% (n = 32) hemophilia facilities. Individual participants (87%; n = 34) reported they adhered to guidelines, though knowledge of guidance was poor with only 36% (n = 15) applying guidance appropriately in 3 common dental scenarios. There was a tendency for participants to assign the use of systemic hemostatic measures independent of the agreed bleeding risk associated with the proposed dental procedure. CONCLUSION AND RECOMMENDATIONS: While hemophilia treaters were aware of current guidelines, their knowledge of the guidelines and ability to risk assess dental procedures was poor. There was a tendency to overprescribe systemic hemostatic measures for dental procedures. Education initiatives to aid decision making are needed.


Assuntos
Assistência Odontológica para Doentes Crônicos/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Hemofilia A/complicações , Hemorragia Bucal/etiologia , Hemorragia Bucal/prevenção & controle , Médicos , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Hemostasia , Humanos , Masculino , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Reino Unido
16.
Int J Oral Maxillofac Surg ; 48(1): 28-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30032974

RESUMO

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.


Assuntos
Vesícula , Hemorragia Bucal , Biópsia , Vesícula/diagnóstico , Vesícula/epidemiologia , Vesícula/etiologia , Vesícula/terapia , Diagnóstico Diferencial , Humanos , Hemorragia Bucal/diagnóstico , Hemorragia Bucal/epidemiologia , Hemorragia Bucal/etiologia , Hemorragia Bucal/terapia , Recidiva , Fatores de Risco
18.
Emerg Med Clin North Am ; 37(1): 109-119, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454773

RESUMO

Tracheostomy is a common procedure for long-term airway management. Although the overall complication rate is greater than 50%, the incidence of serious complications is low. These serious complications can, however, lead to significant morbidity and mortality and it is incumbent on the emergency provider to be prepared to deal with such tracheostomy-related emergencies. The greatest life threats to the tracheostomy patient are decannulation, obstruction, and hemorrhage. Other important but lower-acuity complications include tracheoesophageal fistula formation, tracheal stenosis, infection, and tracheocutaneous fistula formation.


Assuntos
Emergências , Traqueostomia , Humanos , Hemorragia Bucal/etiologia , Hemorragia Bucal/terapia , Traqueostomia/efeitos adversos , Traqueostomia/métodos
19.
Emerg Med Clin North Am ; 37(1): 81-93, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454782

RESUMO

Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures.


Assuntos
Doenças Estomatognáticas/diagnóstico , Emergências , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/terapia , Humanos , Boca/lesões , Hemorragia Bucal/etiologia , Dor/etiologia , Doenças Estomatognáticas/patologia , Doenças Estomatognáticas/terapia , Avulsão Dentária/diagnóstico , Avulsão Dentária/terapia , Traumatismos Dentários/diagnóstico , Traumatismos Dentários/terapia
20.
Australas J Dermatol ; 60(2): e105-e108, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30215869

RESUMO

BACKGROUND/OBJECTIVES: The aim of this study was to describe a previously unreported association of oral pemphigus vulgaris with short-lived blood-filled painless blisters resembling angina bullosa haemorrhagica (ABH). METHODS: A cross-sectional study of consecutive patients with Pemphigus vulgaris. All patients were examined for the presence of ABH-like lesions, and demographic, clinical and histopathological data were collected. Histopathological examination was performed when feasible. RESULTS: A total of 318 with pemphigus vulgaris were included (63.5% female, mean age: 46 years). ABH-like lesions were present in 82 (25.8%) patients, commonly observed in the buccal mucosa (47, 57.3%) followed by the palate (15, 18.3%). All patients had normal platelet counts with no evidence of bleeding diathesis. Biopsies of the ABH-like lesions showed suprabasal clefts in four of six samples. ABH-like lesions were significantly associated with partial remission of pemphigus vulgaris (47.5%, P = 0.002) and the use of intraoral steroids (P = 0.001, odds ratio: 5.9 [95% confidence interval: 2.5-13.6]). CONCLUSION: ABH-like lesions may represent a transient or abortive form of oral pemphigus vulgaris and tend to have a benign and self-limiting nature.


Assuntos
Vesícula/patologia , Doenças da Boca/patologia , Hemorragia Bucal/patologia , Pênfigo/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/tratamento farmacológico , Mucosa Bucal/patologia , Hemorragia Bucal/tratamento farmacológico , Pênfigo/tratamento farmacológico , Prednisolona/uso terapêutico , Adulto Jovem
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