Cuidados odontológicos em pacientes diabéticos / Dental care in diabetic patients

A Diabetes Mellitus (DM) é uma doença metabólica que se particulariza pela hiperglicemia, isto é, o aumento na quantidade de glicose no sangue que pode provir da insuficiência da formação, secreção e ação da insulina produzida pelas células beta das ilhotas de Langerhans no pâncreas. Alguns dos sinais e sintomas mais encontrados em pacientes diabéticos são a poliúria, polidipsia, polifagia e perda de peso. A cavidade bucal também pode apresentar sinais e sintomas bucais muito característicos da diabetes. Abordar condutas odontológicas perante um paciente diabético, apontar aspectos relevantes de como proceder à frente ao atendimento odontológico e esclarecer informações sobre a doença por meio de uma revisão de literatura. Para realização deste trabalho foram realizadas buscas nos periódicos como a biblioteca eletrônica da Biblioteca Virtual em Saúde (BVS), SciELO, PubMed e Google Acadêmico para seleção de artigos publicados de 2003 à 2018.Se o paciente estiver com a doença controlada pode ser atendido igualmente a um paciente sistemicamente normal, e em caso de descontrole, o cirurgião dentista deve estar apto a analisar o risco benefício do tratamento odontológico e diagnosticar as situações de risco à saúde para então encaminhá-lo a um médico endocrinologista para confirmar o diagnóstico ou tratamento.

Diabetes Mellitus (DM) is a metabolic disease that is characterized by hyperglycemia, in other words, it's an increase in the amount of glucose in the blood that can result from the insufficiency of the formation, secretion, and action of the insulin produced by the beta cells of the islets of Langerhans in the pancreas. Some of the most common signs and symptoms found in diabetic patients are polyuria, polydipsia, polyphagia, and weight loss. The oral cavity may also exhibit signs and oral symptoms very characteristic of diabetes. This study aims to address dental conducts before a diabetic patient, to point out relevant aspects of how to proceed with dental care and to clarify information about the disease through a review of the literature. In order to carry out this work, we searched the electronic library of the Virtual Health Library (VHL), SciELO, PubMed and Google Scholar for the selection of articles published from 2003 to 2018That if the patient has the disease controlled, and in case of discontrol, the dental surgeon must be able to analyze the risk of benefit from dental treatment and diagnose the health risk situations and then refer him to an endocrinologist to confirm the diagnosis or treatment.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

ABSTRACT Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. Results: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. Conclusion: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.