Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study.

OBJECTIVE: This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS: Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS: Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION: It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.

Therapeutic alternatives in the management of osteoradionecrosis of the jaws. Systematic review / Alternativas terapéuticas en el manejo de osteorradionecrosis de los maxilares. Revisión sistemática

Background: to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) amongthe therapeutic alternatives: surgical, pharmacological and combined.Material and Methods: The review was organized according to the PRISMA protocol with regards to the fol-lowing PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention);between all therapies (C=Comparison); healing of lesions (O=outcome).Results: Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclu-sively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effectiveoption, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p=0.002). Only 1 case (0.9%) cor-responded to low level laser therapy.Conclusions: It seems clear that early intervention with conservative surgical combined with pharmacologicalmethods improves the prognosis of ORN.(AU)

Manejo clínico ambulatorial do paciente portador de hepatite viral / Clinical management of patients with viral hepatitis

O fígado pode ser afetado por agentes químicos, físicos ou biológicos. Atualmente, aceita-se a existência de 9 vírus hepatotrópicos capazes de causar hepatites virais. Independentemente do tipo de hepatite viral, as alterações hepáticas podem estar presentes no paciente e representar distúrbios funcionais importantes. O cirurgião-dentista deve estar apto a tratar o paciente hepatopata, sendo capaz de avaliar as alterações sistêmicas relacionadas ao mau funcionamento do órgão.