Oral alterations in children with cancer: literature review / Alteraciones orales en niños con cáncer: revisión del tema

For dentists, there is little information on malignant tumors and complications both because their natural evolution is secondary to treatment, despite cancer in children represents 3 percent of all cancer cases. The goal is to make a brief review of the most common neoplasm in children, to identify them and find out the oral alterations with highest incidence both as secondary to the pathology and as a side effect of treatment. This review analyses various types of malignant neoplasms which may occur in this stage of life. They are divided into haematological: leukemias, lymphomas and solid tumors. The most common leukemia is acute lymphoblastic (ALL) followed by acute myeloid and granulocytic. Lymphomas develop from the lymphatic system and are divided into Hodgkin's and non-Hodgkin's. Cancer has become a chronic disease favoring a new group of patients who achieve survival but suffer side effects due to therapies, drugs, doses and the child's characteristics. Oral complications appear in 40 percent of cases and the most frequent are mucositis, opportunistic infection, xerostomia, bleeding, periodontal disease and disorders in the development of teeth and jaw. Although cancer is located outside of the maxillofacial area, chemotherapy is aggressive for a developing organism. The side effects of radiation therapy affect the general and specific area to radiate as well as the surrounding organs and tissues. Recently, advances in diagnosis and treatment have increased survival from 20 percent to 80 percent, with long-term treatment.

Existe poca información para el odontólogo sobre tumores malignos y complicaciones por su evolución natural como secundaria al tratamiento a pesar de ser el cáncer en niños el 3 por ciento de todos los cánceres. El objetivo es hacer una revisión sucinta de las neoplasias más frecuentes en niños, identificarlas y conocer las alteraciones orales con mayor incidencia secundarias tanto a la patología como el efecto secundario del tratamiento. Realizamos una revisión analizando los diferentes tipos de neoplasias malignas que puede presentarse en esta etapa de vida, las cuales se dividen en hematológicos: leucemias y linfomas y tumores sólidos. La leucemia más frecuente es la linfoblastica aguda (LLA), después la Mieloide Aguda, y Granulocítica. Los linfomas se desarrollan del sistema linfático, se dividen en Hodgkin y no Hodgkin. El cáncer se ha convertido en una enfermedad crónica. Ello favorece un nuevo grupo de pacientes que logran supervivencia suficiente para que puedan producirse efectos secundarios por las terapias utilizadas, fármacos, dosis y las características de cada niño. Las complicaciones orales aparecen en un 40 por ciento, las más frecuentes: mucositis, infección oportunista, xerostomía, hemorragias, enfermedad periodontal, alteraciones del desarrollo de dientes y maxilar. Aunque el cáncer esté localizado fuera del área maxilofacial, la quimioterapia es agresiva en un organismo en desarrollo. Los efectos secundarios de la radioterapia son generales y específicos de la zona a irradiar, órganos y tejidos circundantes. Últimamente, los avances en diagnóstico y tratamiento aumentaron la supervivencia del 20 por ciento al 80 por ciento, con tratamientos a largo plazo.

Perinatal factors associated with developmental defects of enamel in primary teeth: a case-control study

The present study was designed to evaluate associations between developmental defects of enamel (DDE) in the primary dentition and aspects related to mothers and preschoolers in the city of Diamantina, Brazil. A case-control study was carried out involving children aged three to five years. The case group was composed of 104 children with at least one dental surface affected by DDE. The control group comprised 105 children without DDE, matched for gender and age. The diagnosis of enamel defects was performed using the Developmental Defects of Enamel Index. Information was collected through interviews investigating socio-demographic aspects, gestation, birth weight, prematurity and breastfeeding. Simple and multiple regression analyses were performed, providing unadjusted and adjusted prevalence ratios (Poisson regression). DDE were more prevalent among children who had not been breastfed (PR = 1.57; 95% CI: 1.1-2.2) and those whose mothers were under 24 years of age at the birth of the child (PR = 1.41; 95% CI: 1.1-1.9). The prevalence of DDE in the primary dentition was higher among children who had not been breastfed and those whose mothers were under 24 years of age at the birth of the child.

Alterações da articulação temporomandibular e suas repercussões orofaciais em pacientes portadores de artrite idiopática juvenil / Temporomandibular joint alterations and their orofacial complications in patients with juvenile idiopathic arthritis

Os pacientes com artrite idiopática juvenil (AIJ) podem apresentar alterações no metabolismo ósseo e no crescimento esqueletal, além de danos na articulação temporomandibular (ATM), o que pode gerar alterações extraorais e/ou intraorais, acarretando distúrbios craniofaciais. Nosso objetivo é promover uma revisão da literatura sobre as alterações orofaciais em pacientes com AIJ. Dentre os distúrbios orofaciais em pacientes com AIJ, as mudanças no crescimento mandibular, geradas por disfunções na região da ATM, parecem de grande prevalência nesses pacientes. As alterações mais encontradas são: retrognatismo, micrognatia, mordida aberta anterior, apinhamento dentário, assimetria facial e limitação de abertura de boca. Assim, o reumatologista torna-se uma peça-chave na detecção precoce dessas disfunções, ajudando no encaminhamento do paciente ao dentista. O diagnóstico, por sua vez, deve ser realizado pelo ortodontista, utilizando exames clínico e de imagem, o que possibilita tratamento precoce e prognóstico favorável. Distúrbios na ATM devem ser tratados de forma multidisciplinar, incluindo tratamento farmacológico para o controle da dor e tratamento odontológico por meio de aparelhagem funcional e/ou ortodôntica, fisioterapêutico e por vezes fonoaudiológico. Concluímos que dentre os distúrbios orofaciais em pacientes com AIJ, as mudanças no crescimento mandibular geradas por disfunções na região da ATM parecem de grande prevalência. Tais disfunções podem promover, principalmente, mordida aberta, retrusão mandibular, micrognatia, apinhamento dentário e assimetria facial. O reumatologista pode detectar tais alterações precocemente, encaminhando o paciente de imediato a uma equipe que deve ser, preferencialmente, multidisciplinar, composta por ortodontista, fisioterapeuta e fonoaudiólogo, visando reduzir futuras complicações oclusais e de crescimento mandibular.

Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications.

Estado de salud oral y nutricional en niños de una institución educativa de Cartagena, 2009 / Oral and nutritional health status in children attending a school in Cartagena, 2009

Objetivo Describir la asociación entre el estado nutricional y la salud oral de escolares de una Institución Educativa de Cartagena, Colombia. Método Estudio descriptivo de corte transversal. La muestra fue 180 niños entre 5 y 12 años, evaluándose la desnutrición por pruebas antropométricas y bioquímicas, la dieta por cuestionario y las enfermedades gingivales, alteraciones en tejidos blandos, caries dental, alteraciones del esmalte y estado de higiene oral se midieron clínicamente. Para el análisis se utilizó la estadística descriptiva a través de distribuciones de frecuencia. Para la inferencia de los resultados se estimó la ocurrencia de la enfermedad por prevalencias y para la fuerza de asociación entre variables se utilizaron razones de disparidad, "OR" con intervalos de confianza del 95 por ciento y la prueba X² para la significancia estadística. Resultados Se encontró una ocurrencia de desnutrición crónica del 2 por ciento (IC 95 por ciento; 0,0-4,4). De las patologías orales las más prevalentes fueron; caries dental con 82 por ciento (IC 95 por ciento; 77-88), enfermedad periodontal con 66 por ciento (IC 95 por ciento; 59-73), fluorosis con 30 por ciento (IC 95 por ciento; 23-37), hipocalcificación con 11 por ciento (IC 95 por ciento; 6-15) e hipoplasia con 6 por ciento (IC 95 por ciento; 3-10). Con relación a los estimadores de asociación, la desnutrición con hipoplasia y el riesgo de desnutrición con fluorosis fueron los eventos que presentaron los más altos estimadores (OR=18,5; IC 95 por ciento; 2,33-147,2; P=0,000) y (OR=2,63; IC 95 por ciento; 1,02-6,76; p=0,04), respectivamente. Conclusiones Aunque no fue posible determinar asociación directa entre la desnutrición y las patologías orales, alternaciones como fluorosis e hipoplasia pueden estar influidas por la desnutrición.

Objective Describing the association between the nutritional and oral health status of children attending a school in Cartagena, Colombia. Method This was a descriptive, cross-sectional study. The sample consisted of 180 children between aged 5 to12. Malnutrition was assessed by anthropometric and biochemical tests, a questionnaire was used for ascertaining theirdiets andgingival disease, changes in soft tissues, dental caries, enamel abnormalities and oral hygiene status were measured clinically. Descriptive statistics involved frequency distributions. Disease prevalence was estimated for inferring the results; odds ratios(OR)were used for assessing the strength of association between variables (95 percent confidence interval)and the X² test was used determining statistical significance. Results 2 percent (0.0-4.4 95 percent CI)chronic malnutrition was found. The most prevalent oral diseases were dental caries (82 percent;77-88 95 percent CI), periodontal disease (66 percent;59-73 95 percent CI), fluorosis (30 percent; 23-37 95 percent CI), hypocalcification (11 percent; 6-15 95 percent CI) and hypoplasia (6 percent;3-10 95 percent CI). Malnutrition and hypoplasia and the risk of malnutrition andfluorosis had the highest estimates of association (OR=18.5; 2.33-147.2 95 percent CI; p=0.000 and OR=2.63;1.02-6.76 95 percent CI;p=0.04, respectively). Conclusions A direct association between malnutrition and oral pathologies could not be determined;alterationssuch as fluorosis and hypoplasia could be influenced by malnutrition.

Urgencias en Estomatología / Emergencies in estomatology

Las urgencias más frecuentes en la consulta del Odontopediatria son los traumatismos dentofaciales y los problemas de dolor de origen dental, ambos y la elección del mejor tratamiento implican un reto en el manejo del paciente. En el tratamiento de los traumatismos dento-faciales el objetivo principal es la conservación de los dientes y tejidos de soporte. La literatura nos remite a la clasificación de las fracturas para identificarlas y proporcionar un buen manejo; así se tiene que existe una clasificación de las fracturas de los tejidos duros del diente, para los tejidos de soporte de los mismos y su desplazamiento. Recibiendo especial atención cada una de ellas; pero indudablemente el operador deberá basar el tratamiento en su experiencia y preparación clínica, de aquí la importancia de revisar conceptos y clasificaciones propuestas de dichas fracturas. En cuanto a los problemas de dolor de origen dental, sin lugar a dudas una de las urgencias más frecuentes en la consulta dental es el signo inequívoco de una patología pulpar crónica aguda, que a su vez representa también un reto en el manejo y tratamiento debido a la complejidad del proceso y los microorganismos involucrados