Treatment under general anesthesia after dental trauma in a patient with autism spectrum disorder: a case report / Tratamento odontológico em paciente com transtorno do espectro autista, sob anestesia geral, após traumatismo dentário: relato de caso

ABSTRACT The objective of this study was to present a clinical case of a pediatric patient with ASD who had experienced dental trauma and underwent dental treatment in a hospital environment under general anesthesia. A 10-year-old male patient who was Brazilian and had leukoderma was diagnosed with ASD at three years of age, he experienced trauma to the upper teeth, with avulsion of tooth 12 and extrusive displacement of tooth 11, after being run over by a car in February 2017. He was immediately taken to the emergency room, where he was seen by a dentist and he was immediately transferred to Hospital. In the out-patient clinic of this hospital, with the aid of protective stabilization and infiltrative anesthesia, tooth 12 was reimplanted 40 minutes after trauma and restrained with composite resin. He continued treatment in another city and Endodontic and paraendodontic treatment of teeth 11 and 12 was performed under general anesthesia. Follow-ups with the patient are continuing, with the last control periapical radiograph taken in January 2020. In this case, the proposed dental treatment was successful and did not lead to any complications.

RESUMO O objetivo deste trabalho foi apresentar um caso clínico de um paciente pediátrico com TEA que sofreu traumatismo dentário e foi submetido a tratamento odontológico em ambiente hospitalar, sob anestesia geral. Paciente do sexo masculino, 10 anos, brasileiro, leucoderma, foi diagnosticado com TEA aos três anos de idade, apresentou trauma nos dentes superiores, com avulsão do dente 12 e deslocamento extrusivo do dente 11, após ser atropelado por um carro em fevereiro de 2017. Ele foi imediatamente levado para o pronto socorro, onde foi atendido por um dentista e imediatamente transferido para o Hospital. No ambulatório deste hospital, com auxílio de estabilização protetora e anestesia infiltrativa, o dente 12 foi reimplantado 40 minutos após o trauma e contido com resina composta. Ele continuou o tratamento em outra cidade, o tratamento endodôntico e paraendodôntico dos dentes 11 e 12 foi realizado sob anestesia geral. Os acompanhamentos com o paciente continuam, com a última radiografia periapical de controle realizada em janeiro de 2020. Neste caso, o tratamento odontológico proposto foi bem-sucedido e não levou a nenhuma complicação.

Dental and maxillomandibular incidental findings in panoramic radiography among individuals with mucopolysaccharidosis: a cross-sectional study

Abstract Mucopolysaccharidosis (MPS) is a group of rare and inherited metabolic disorders caused by the accumulation of macromolecule glycosaminoglycans inside lysosomes. Affected individuals may have dental and craniofacial tissue alterations, facilitating the development of several oral diseases. Objectives To assess, with panoramic radiographic images, the frequency of dental and maxillomandibular incidental findings among MPS individuals and compare them with non-MPS individuals. Methodology A cross-sectional study evaluating a sample of 14 MPS individuals and 28 non-MPS individuals aged from 5 to 26 years was carried out. They were matched for sex and age on a 2:1 proportion. Panoramic radiographs were assessed for the presence/absence of the following dental and maxillomandibular alterations: dental anomalies of number (hypodontia/dental agenesis, supernumerary teeth); anomalies of form (microdontia, macrodontia, conoid teeth, taurodontism, and root dilaceration); anomalies of position (impacted tooth, inverted tooth, tooth migration, partially bony teeth, complete bony teeth); periapical alterations (furcation lesion, circumscribed bone rarefaction); other alterations (radiolucent bone lesions, radiopaque bone lesions, radiopacity in the maxillary sinus, condylar hypoplasia). Differences between groups were tested by the Fisher's exact test and chi-square test (p<0.05). Results For intrarater agreement, Kappa values were 0.76 to 0.85. The presence of supernumerary teeth (p=0.003); conoid teeth (p=0.009); taurodontism (p<0.001); impacted teeth (p<0.001); partial bony teeth (p=0.040); complete bony teeth (p=0.013); and root dilaceration (p=0.047) were statistically more frequent in MPS individuals compared to non-MPS individuals. Bone rarefaction/furcation lesions (p=0.032), condylar hypoplasia (p<0.001), radiolucent bone lesions (p=0.001), and dentigerous cysts (p=0.002) were also more frequent in MPS individuals. Conclusion The presence of specific oral manifestations is more common in MPS individuals than non-MPS individuals.

Perfil dos pacientes com deficiências de desenvolvimento sob atendimento odontológico em um projeto de extensão intersetorial / Profile of patients with developmental disabilities under dental care in an intersectoral extension project

Objetivo: Descrever o perfil dos pacientes atendidos em uma instituição filantrópica onde funciona o projeto de extensão "Atendimento Odontológico a Pacientes com Necessidades Especiais". Métodos: A amostra foi composta por 581 prontuários de pacientes com necessidades especiais de 0 a 33 anos de idade. Foram coletadas informações sobre as prevalências de cárie nas dentições decídua e permanente, gengivite, xerostomia, bruxismo, refluxo gastroesofágico, sexo, uso de medicação de ação central, uso de chupeta, sucção digital, alimentação e higiene bucal. Os dados foram analisados por meio da estatística descritiva e teste do qui-quadrado para verificação de associação entre diagnóstico e sexo. Resultados: 51,93% dos pacientes eram meninos, 71,42% possuíam paralisia cerebral, 12,36% tinham refluxo gastroesofágico, 49,30% usavam medicação anticonvulsivante. O diagnóstico de paralisia cerebral quadriespástica esteve associado ao sexo masculino. Dentre as alterações bucais, 4,86% dos casos apresentaram xerostomia. O uso da chupeta foi encontrado em 26,93% dos indivíduos e 18,05% chupavam o dedo. Alterações gengivais foram detectadas em 15,61% das fichas. Em relação à alimentação, 56,97% dos indivíduos consumiam açúcar acima do aceitável, e com relação à higiene bucal, 14,48% foram classificados como ruim e 17,57% moderada. Em 20,57% dos prontuários havia registro de dentes decíduos cariados e em 4,29% de dentes obturados. Do total de pacientes que possuíam dentes permanentes, 13,17% tinha dentes cariados e 7,75% possuía dentes obturados. A prevalência de cárie dentária é moderada com pequena proporção de dentes restaurados. A alimentação é rica em sacarose para quase 60% destes pacientes. Conclusão: os hábitos parafuncionais apresentam um percentual preocupante de prevalência. Por isso, estes pacientes possuem um perfil de doenças bucais com gravidade moderada e que devem ter um acompanhamento odontológico sistemático para que a prevalência de doenças bucais não aumente com o passar dos anos.(AU)

Aim: The present study aimed to describe the profile of the patients who received dental care at a philanthropic institution, within the project "Dental Care for Patients with Special Needs". Methods: This study was carried out by evaluating 581 records of patients with special needs from 0 to 33 years of age. Data were collected on the prevalence of caries in deciduous and permanent dentitions, gingivitis, xerostomia, bruxism, gastroesophageal reflux, sex, use of central action medication, pacifier use, digital suction, feeding, and oral hygiene. Data were analyzed using descriptive statistics and the chi-square test to verify an association between diagnosis and sex. Results: The results showed that 51.93% were boys, 71.42% had cerebral palsy, 12.36% had gastroesophageal reflux, and 49.30% used anticonvulsant medication. The diagnosis of quadrispastic cerebral palsy was associated with males. Xerostomia was observed in 4.86% of the cases. The use of pacifiers was present in 26.93% of the individuals, while 18.05% of the patients used to suck their finger. Gingival changes were detected in 15.61% of the records. In relation to food, 56.97% of the individuals consumed sugar above the acceptable amount, and when oral hygiene was considered, 14.48% were classified as poor and 17.57% as moderate. This study also identified 20.57% of decayed and 4.29% of filled deciduos teeth. Among the patients who had permanent teeth, 13.17% had decayed teeth, while 7.75% had filled teeth. It could therefore be concluded that the prevalence of dental caries is moderate with a small proportion of treated teeth. Diet is rich in sucrose for almost 60% of these patients. Conclusion: The parafunctional habits present a worrisome percentage of prevalence. Therefore, these patients have a profile of oral diseases with moderate severity and should undergo systematic dental follow-up so that the prevalence of oral diseases does not increase over the years.(AU)

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil / Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil

O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

Full mouth rehabilitation of a patient with Sturge-Weber syndrome using a mixture of general and sedative anesthesia

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

Full mouth rehabilitation of a patient with Sturge-Weber syndrome using a mixture of general and sedative anesthesia

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.