Endodontic treatment as a Reduction in the Risk of infective Endocarditis in a Male Patient with Eisenmenger Syndrome

This case report aimed to describe the importance of endodontic treatment in reducing infectious foci in patients with Eisenmenger syndrome (ES) and describe the characteristics of ES, so that the endodontist can safely treat these patients. A 57-year-old male with ES sought dental care complaining of dental pain. Irreversible pulpitis was diagnosed in tooth 37 and pulp necrosis in teeth 36, 34 and 31. Tests of prothrombin time (PT), activated partial thromboblastin time (APTT) and international normalized ratio (INR) were prescribed to evaluate the profile of coagulation using Marevan and antibiotic prophylaxis with amoxicillin. The endodontic treatments were performed. At the end, the patient reported no pain or discomfort in the teeth and improved masticatory function. The removal of oral infectious foci in patients with ES is important to reduce the risk of IE, which could seriously compromise the health and overall prognosis of the patient.

Este reporte de caso tuvo como objetivo describir la importancia del tratamiento endodóntico en la reducción de focos infecciosos en pacientes con síndrome de Eisenmenger (SE) y describir las características del SE, para que el endodoncista pueda tratar con seguridad a estos pacientes. Un hombre de 57 años con ES buscó atención dental quejándose de dolor dental. Se diagnosticó pulpitis irreversible en el diente 37 y necrosis pulpar en los dientes 36, 34 y 31. Se solicitaron pruebas de tiempo de protrombina (PT), tiempo de tromboblastina parcial activada (TTPA) y índice internacional normalizado (INR) para evaluar el perfil de coagulación utilizando Marevan y profilaxis antibiótica con amoxicilina. Se realizaron los tratamientos de endodoncia. Al final, el paciente no refirió dolor ni molestias en los dientes y mejoró la función masticatoria. La eliminación de focos infecciosos orales en pacientes con ES es importante para reducir el riesgo de EI, que podría comprometer gravemente la salud y el pronóstico general del paciente.

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Desafios da abordagem interdisciplinar de indivíduo cardiopata grave com abcesso odontogênico agudo / Challenges of the interdisciplinary approach in an individual with severe heart disease and acute dental abcess

Os indivíduos sistemicamente comprometidos e com múltiplas comorbidades são um desafio para a abordagem cirúrgica. Pacientes com flutter atrial fazem uso de anticoagulantes para diminuir o risco de eventos tromboembólicos, porém há maior risco de hemorragia durante procedimentos cirúrgicos. As infecções de origem odontogênica podem ter disseminação hematogênica e agravar ainda mais o quadro clínico geral do indivíduo. A abordagem cirúrgica deve sempre visar à segurança e à qualidade de vida do paciente, levando em consideração os riscos e benefícios do procedimento e o preparo do profissional frente a possíveis acidentes e complicações, haja vista o risco de mortalidade perioperatória. O presente caso relata o desafio de estabelecer plano de tratamento e conduta diante de infecção odontogênica em indivíduo cardiopata grave polimedicado ASA IV com histórico de doença renal crônica sob hemodiálise, hipertensão arterial sistêmica, diabetes mellitus, anemia, insuficiência coronariana, flutter atrial, aterosclerose e pé diabético. Para o procedimento sob anestesia geral, foi instituída a terapia de ponte prévia, utilização de medidas hemostáticas locais e antibioticoterapia pré e pós-operatória. A atuação interdisciplinar mostrou-se essencial para estabelecer critérios de segurança e decidir o melhor momento para a atuação cirúrgica

Systemically compromised individuals with multiple comorbidities represent a challenge in terms of the surgical approach. Patients with atrial flutter take anticoagulants to reduce the risk of thromboembolic events, but there is a greater risk of hemorrhaging during surgical procedures. Infections of odontogenic origin may involve hematogenous dissemination and further aggravate the patient's overall clinical condition. The surgical approach should always target the patient's safety and quality of life, considering the risks and benefits of the procedure and the professional's preparedness to cope with possible accidents and complications, given the risk of perioperative mortality. This is a case report of the challenge of establishing a treatment plan and course of action for dental infection in an ASA IV polymedicated patient with a history of chronic kidney disease undergoing hemodialysis, systemic arterial hypertension, diabetes mellitus, anemia, coronary insufficiency, atrial flutter, atherosclerosis and diabetic foot. Prior bridge therapy, use of local hemostatic measures, and pre- and postoperative antibiotic therapy were instituted for the procedure to be carried out under general anesthesia. Interdisciplinary action has proved to be essential for establishing safety criteria and deciding on the best time for surgical intervention

Case-control study of oral disease indexes in individuals with head and neck cancer after antineoplastic therapy / Estudo caso-controle de índices de doenças bucais em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

ABSTRACT Objective To evaluate the oral health of patients with head and neck cancer after antineoplastic treatment, and to compare them with patients with no history of cancer. Methods A total of 75 patients, divided into Study Group, composed of individuals after antineoplastic treatment (n=30), and Control Group, with individuals with no history of cancer (n=45), aged 37 to 79 years. The oral health status was evaluated through the index of decayed, missing or filled permanent teeth (DMFT), community periodontal index and evaluation of the use and need of prosthesis. All of these items were evaluated according to the criteria recommended by the World Health Organization. The statistical analysis was descriptive and used the Pearson's χ2 test. Results The community periodontal index was higher in the Study Group when compared to the Control Group (p<0.0001). The need for an upper (p<0.001) and lower (p<0.0001) prostheses was higher in the Study Group. Also, the use of upper prosthesis was higher in the Study Group (p<0.002). The missing or filled permanent teeth index between the two groups (p>0.0506) and the use of lower prosthesis (p>0.214) did not present a relevant statistical difference. Conclusion Periodontal disease and edentulism are the most significant changes in individuals who received antineoplastic therapy for head and neck cancer as well as greater need for oral rehabilitation.

RESUMO Objetivo Avaliar a saúde bucal de pacientes com câncer de cabeça e pescoço após tratamento antineoplásico, e compará-los com pacientes sem histórico de câncer. Métodos Foram avaliados 75 pacientes, divididos em Grupo de Estudo de indivíduos após tratamento antineoplásico (n=30) e Grupo de Controle de indivíduos sem histórico de câncer (n=45), com faixa etária de 35 a 79 anos. A condição de saúde oral foi avaliada pelo índice de dentes permanentes cariados, perdidos e obturados (CPOD), pelo índice periodontal comunitário e por uma avaliação de uso e necessidade de prótese, conforme critérios preconizados pela Organização Mundial da Saúde. A análise estatística foi descritiva e realizada por meio do teste do χ2 de Pearson. Resultados O índice periodontal comunitário foi maior no Grupo de Estudo quando comparado ao controle (p<0,0001). A necessidade de prótese superior (p<0,001) e inferior (p<0,0001) foi maior no Grupo de Estudo. O uso de prótese superior foi maior no Grupo de Estudo (p<0,002). O índice de dentes permanentes cariados, perdidos e obturados entre os dois grupos (p>0,0506) e o uso de prótese inferior (p>0,214) não apresentaram diferença estatística relevante. Conclusão A doença periodontal e o edentulismo são as alterações mais significativas em indivíduos que receberam terapia antineoplásica de câncer de cabeça e pescoço, assim como maior necessidade de reabilitação oral.