Brazilian dental consensus on dental management in hematopoietic stem cell transplantation−Part I−pre-HSCT

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

Manejo odontológico de pacientes con el síndrome de Ehlers-Danlos: revisión narrativa / Dental management in patients with Ehlers-Danlos syndrome: a narrative review

El síndrome de Ehlers-Danlos es una enfermedad heredita- ria, producida por mutaciones cromosómicas que pueden llegar a tener un comportamiento autosómico dominante, recesivo o ligado al cromosoma X. Se caracteriza por defectos en las enzi- mas encargadas de la estructura y síntesis de colágeno. En vista de los 20 tipos de colágeno que existen, este síndrome es extre- madamente heterogéneo tanto en su presentación clínica como en su progresión y evolución. Dentro de los signos y síntomas habituales encontramos la hiperlaxitud articular, hiperelastici- dad de la piel e hiperequimosis de los vasos sanguíneos. Con relación a las complicaciones que pueden presentar es- tos pacientes, encontramos dislocaciones articulares, fragilidad en la piel, dolor articular, ruptura de grandes vasos sanguíneos, dificultad en la cicatrización y, en consecuencia, mayor inci- dencia de procesos infecciosos y de cicatrices poco estéticas. Presenta una incidencia de 1 caso cada 2.500-5.000 na- cidos vivos. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico-dental de estos pacientes, a fin de estar preparado para brindarles un trata- miento adecuado y responder ante las posibles complicacio- nes que se pueden presentar. En esta revisión se emplearon resultados extraídos manual- mente de artículos, indexados en las bases de datos PUBMED y EBSCO, que respondían a la búsqueda de los términos Ehlers-Danlos syndrome, dental management y oral surgery. El objetivo fue describir el manejo médico-odontológico del paciente con síndrome de Ehlers-Danlos hasta la fecha (AU)

Ehlers-Danlos syndrome is a hereditary disease, produced by chromosomal mutations that can have an autosomal behavior, which can be dominant, recessive or X-linked. It is characterized by defects in the enzymes responsible for the structure and syn- thesis of collagen. In view of the 20 existent types of collagen, this syndrome is extremely heterogeneous in its clinical presentation, as well as in its progression and evolution. Within the usual signs and symptoms, we find joint hyperlaxity, skin hyperelasticity and hyper-ecchymosis of the blood vessels. Regarding the complications that these patients can pres- ent, we find joint dislocations, skin fragility, joint pain, rupture of large blood vessels, difficulty in healing and, consequently, a higher incidence of infectious processes and unsightly scars. It presents an incidence of 1 case every 2.500-5.000 live births. Therefore, it is essential that the dentist is familiar with the medical-dental management of these patients, in order to be prepared to provide them with adequate treatment and re- spond to possible complications that may arise. In this review, results were manually extracted from ar- ticles, indexed in the PUBMED and EBSCO databases, that respond to the search for the terms Ehlers-Danlos syndrome, dental management and oral surgery. The aim was describing the medical-dental management of patients with Ehlers-Dan- los syndrome to date (AU)

Manejo odontológico de pacientes con el síndrome de Ehlers-Danlos. Revisión narrativa / Dental management in patients with Ehlers-Danlos syndrome. Narrative review

Resumen El síndrome de Ehlers-Danlos es una enfermedad hereditaria, producida por mutaciones cromosómicas que pueden llegar a tener un comportamiento autosómico dominante, recesivo o ligado al cromosoma X. Se caracteriza por defectos en las enzimas encargadas de la estructura y síntesis de colágeno. En vista de los 20 tipos de colágeno que existen, este síndrome es extremadamente heterogéneo tanto en su presentación clínica como en su progresión y evolución. Dentro de los signos y síntomas habituales encontramos la hiperlaxitud articular, hiperelasticidad de la piel e hiperequimosis de los vasos sanguíneos. Con relación a las complicaciones que pueden presentar estos pacientes, encontramos dislocaciones articulares, fragilidad en la piel, dolor articular, ruptura de grandes vasos sanguíneos, dificultad en la cicatrización y, en consecuencia, mayor incidencia de procesos infecciosos y de cicatrices poco estéticas. Presenta una incidencia de 1 caso cada 2.500-5.000 nacidos vivos. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico-dental de estos pacientes, a fin de estar preparado para brindarles un tratamiento adecuado y responder ante las posibles complicaciones que se pueden presentar. En esta revisión se emplearon resultados extraídos manualmente de artículos, indexados en las bases de datos PUBMED y EBSCO, que respondían a la búsqueda de los términos Ehlers-Danlos syndrome, dental management y oral surgery. El objetivo fue describir el manejo médico-odontológico del paciente con síndrome de Ehlers-Danlos hasta la fecha.

Abstract Ehlers-Danlos syndrome is a hereditary disease, produced by chromosomal mutations that can have an autosomal behavior, which can be dominant, recessive or X-linked. It is characterized by defects in the enzymes responsible for the structure and synthesis of collagen. In view of the 20 existent types of collagen, this syndrome is extremely heterogeneous in its clinical presentation, as well as in its progression and evolution. Within the usual signs and symptoms, we find joint hyperlaxity, skin hyperelasticity and hyper-ecchymosis of the blood vessels. Regarding the complications that these patients can present, we find joint dislocations, skin fragility, joint pain, rupture of large blood vessels, difficulty in healing and, consequently, a higher incidence of infectious processes and unsightly scars. It presents an incidence of 1 case every 2.500-5.000 live births. Therefore, it is essential that the dentist is familiar with the medical-dental management of these patients, in order to be prepared to provide them with adequate treatment and respond to possible complications that may arise. In this review, results were manually extracted from articles, indexed in the PUBMED and EBSCO databases, that respond to the search for the terms Ehlers-Danlos syndrome, dental management and oral surgery. The aim was describing the medical-dental management of patients with Ehlers-Danlos syndrome to date.

Nivel de conocimiento de los estudiantes del tercer curso en Odontología de la UNAN-León, sobre trastornos de presión arterial y manejo odontológico / Level of knowledge third year dentistry students UNAN-León about blood pressure disorders and dental management

Las patologías cardiovasculares constituyen la causa más frecuente de muerte en el mundo, las más comunes son hipertensión e hipotensión. En la consulta odontológica, los pacientes con trastornos de presión arterial requieren diferentes protocolos de atención. En el tercer curso de odontología se tiene el primer contacto con pacientes, al haber estudiado y aprobado la parte teórica del manejo odontológico. Según los antecedentes encontrados, no existen investigaciones que abarquen ambos trastornos de la presión arterial, por lo que se realizó un estudio descriptivo de corte transversal para determinar el nivel de conocimiento en estudiantes del tercer curso Odontología UNAN-León, sobre trastornos de la presión arterial y su manejo odontológico en el segundo semestre del año 2021, por una encuesta tipo examen a estudiantes inscritos en cirugía bucal I, 55 estudiantes fueron encuestados. Se determinó que 50.9% tienen un nivel de conocimiento regular, seguido por 27.3% con nivel bueno, 12.7% deficiente y 9.1% obtuvo nivel de conocimiento excelente sobre los trastornos de presión arterial. Según investigaciones previas en odontología, la mayoría de los estudiantes presentaba un nivel de conocimiento deficiente sobre hipertensión arterial. Por lo que es importante evaluar periódicamente los niveles de conocimiento sobre éstos y otros trastornos que pueden presentarse en la consulta dental (AU)

Cardiovascular diseases are the most common cause of death world, hypertension and hypotension are very common nowadays. In the dental office, patients with blood pressure disorders require different care protocols. Students of the third year of dentistry have their first contact with patients, having studied and approved the theoretical part of dental management. According to antecedents researched, there are no investigations that cover both blood pressure disorders. So a descriptive cross-sectional study was made to determine the knowledge of third-year dentistry students UNAN-León, about blood pressure disorders and their dental management in the second semester of the year 2021, by an exam-type survey of students registered in oral surgery I, with 55 students surveyed. It determined that 50.9% have a regular level of knowledge, followed by 27.3% with a good level, 12.7% poor and 9.1% has an excellent level of knowledge about blood pressure disorders. According to previous research in dentistry faculty, the majority of students have a poor level of knowledge about high blood pressure. Therefore, it's important to evaluate periodically the levels of knowledge about these and other disorders that may occur in the dental office (AU)

Dental Considerations of Hereditary Bleeding Disorders in Children: An Overview

Introduction: Hereditary bleeding disorders are the diverse group of disorders that happen due to the inherent abnormalities in the blood vasculature preventing the blood clotting process and leading to delayed bleeding. Objectives: To review this heterogenous group of disorders and update the clinicians about their oral manifestations and dental management to prevent the onset of any complications in dental settings. Materials and Methods: Review papers, original studies, case reports published in PubMed/MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar, as well as numerous publications, were used to compile the data by four reviewers. Result and Conclusion: This review article explains the existing paradigm. Children with various hereditary bleeding disorders are a significant challenge for clinicians. Many authors have emphasized that patients with bleeding disorders can be managed safely in a dental setting if specific recommendations are followed.

Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Protocolo de profilaxis antibiótica para pacientes dentales en riesgo de infección / Antibiotic prophylaxis protocol for dental patients at risk of infection

La profilaxis antibiótica involucra el uso de fármacos en una etapa preoperatoria de atención odontológica, con la finalidad específica de contribuir a la prevención de infecciones sistémicas como la endocarditis infecciosa (EI) asociada a bacteriemias transitorias por procedimientos odontológicos que implican sangrado en pacientes con alto riesgo de complicación por su condición sistémica cardiaca o no cardiaca. Esta complicación potencial inflama el revestimiento interno de las válvulas cardiacas, por proliferación de microorganismos específicos, y aunque es infrecuente es responsable de una elevada tasa de morbilidad y mortalidad. En el año 2007, la Asociación Estadounidense del Corazón (AHA), publica la última actualización vigente en la literatura sobre las recomendaciones y directrices aplicadas para el uso de profilaxis antibiótica. El objetivo de esta revisión pretende desarrollar una síntesis de evidencia existente seguida de un balance honesto de los riesgos y beneficios de forma individual sobre el uso de este protocolo. Se realizó una búsqueda digital integral en idioma español e inglés sobre los protocolos de profilaxis antibiótica en pacientes con riesgo de infección. Se incluyeron bases de datos como: MEDLINE, PUBMED y SciELO, adicionalmente se tomaron como referentes de partida las recomendaciones de la AHA. Se concluye con gran énfasis y soporte de la literatura actual, que los beneficios del uso de profilaxis antibiótica en un momento preoperatorio superan los posibles riesgos de resistencia bacteriana y anafilaxia, por lo que son totalmente justificables y requeridos para los pacientes adultos y niños inmunológicamente comprometidos.

Antibiotic prophylaxis involves the use of drugs at a preoperative stage of dental care, with a specific aim of contributing to the prevention of systemic infections such as infectious endocarditis (IE) associated with transient bacteremia due to dental procedures that involve bleeding in patients at high risk of complication due to their non-cardiac or cardiac systemic condition. This potential complication inflames the inner lining of the heart valves, due to the proliferation of specific microorganisms, and although it is uncommon, it is responsible for a high rate of morbidity and mortality. In 2007, the American Heart Association (AHA) published the last current update in the literature on the recommendations and guidelines applied for the use of antibiotic prophylaxis. The aim of this review is to develop a synthesis of existing evidence followed by an honest assessment of the risks and benefits individually on the use of this protocol. A comprehensive digital search was conducted in both Spanish and English on antibiotic prophylaxis protocols in patients at risk of infection. Databases such as MEDLINE, PUBMED, and SciELO were included, in addition the AHA recommendations were taken as baseline references. It is concluded with great emphasis and support from the current literature, that the benefits of the use of antibiotic prophylaxis in a preoperative moment overcome the possible risks of bacterial resistance and anaphylaxis, so they are fully justifiable and required for immunologically compromised adult and children patients.

Manejo odontológico del paciente diabético: revisión narrativa / Dental management of the diabetic patient. Narrative review

La diabetes mellitus es una enfermedad metabólica caracterizada por altos niveles de glucosa en sangre y defectos en la producción y/o la acción de la insulina. La hiperglucemia crónica puede derivar en complicaciones metabólicas y vasculares como micro- y macroangiopatías y alteraciones en el metabolismo de lípidos y proteínas. Los pacientes diabéticos mal controlados o no controlados presentan signos y síntomas evidenciables a nivel bucal. En el mundo, alrededor del 8,8% de los adultos de entre 20 y 79 años padecen este trastorno endócrino, y se estima que para el año 2045 unos 629 millones de personas de este rango etario tendrán diabetes. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico de estos pacientes, a fin de estar preparado para brindarles un tratamiento adecuado y responder a las emergencias médicas que se presenten durante su atención. En esta revisión se emplearon resultados extraídos manualmente de artículos indexados en las bases de datos MEDLINE y EBSCO que responden a la búsqueda de los términos diabetes mellitus, dental management, oral surgery y HbA1c, con el objetivo de describir el manejo médico-odontológico del paciente diabético hasta la fecha (AU)

Diabetes Mellitus is a metabolic disease characterized by high blood glucose levels and defects in the production and/or the use of insulin. Chronic hyperglycemia can lead to metabolic and vascular complications. Vascular complications include micro and macroangiopathies. The metabolic disorders are: alterations of lipid and protein metabolism. Patients with poorly controlled or uncontrolled diabetes present symptoms that are evident in the oral cavity. Around 8.8% of adults between 20-79 years old, worldwide, have this endocrine disorder and it is estimated that by 2045, 629 million people in this age group, will have diabetes. Therefore, it is essential for dentists to be familiar with the medical management of these patients, in order to provide adequate treatment and eventual management of medical emergencies that may occur during dental treatment. The present review used data extracted manually from articles indexed in the MEDLINE and EBSCO databases, using the terms: Diabetes mellitus, Dental Management, Oral Surgery and HbA1c. The following article aims to describe the medical/dental management of the diabetic patient updated to date (AU)

Manejo e integración estomatológica del paciente pediátrico con trastorno de Asperger / Management and dental integration of the pediatric patient with Asperger disorder

Trastorno neurológico enmarcado dentro de los trastornos de espectro autista (TEA) cuyas manifestaciones se reflejan en los ámbitos de la comunicación, interacción e imaginación social. Se clasifica en el manual diagnóstico y estadístico de trastornos mentales (DSM IV), se caracteriza por un mayor o menor grado de deterioro en las habilidades de lenguaje y comunicación, así como patrones repetitivos o restrictivos de pensamiento y comportamiento. El síntoma más distintivo es el interés obsesivo en un solo objeto o tema y la exclusión de cualquier otro pero siempre conservando habilidades de lenguaje. El pronóstico es bueno, debido a la compensación cognitiva, el enfoque repetitivo y restrictivo a actividades humanas productivas o generadoras de deferencias particulares, aunque no hay tratamiento específico, sino más bien interdisciplinario e individualizado, éste consiste en manejar los síntomas conductuales y la comorbilidad de forma independiente ya sea farmacológica o intervencionista. Paciente masculino de cinco años de edad, con un peso de 26 kg, cuadro de inmunizaciones completas, previamente diagnosticado con trastorno de Asperger (2015); caries dental de diversos grados, manejo estomatológico para su rehabilitación. El objetivo de este reporte es dar a conocer los cuidados para el tratamiento dental en pacientes con este trastorno (AU)

Neurological disorder known as autism spectrum disorders (ASD) whose main manifestations are reflected in the areas of communication, interaction and social imagination. It was first classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM lV), characterized by a greater or lesser degree of deterioration in language and communication skills, as well as repetitive patterns or restrictive of thought and behavior. The most distinctive symptom is obsessive interest in a single object or topic and the exclusion of any other, but always retaining language skills. The prognosis is good in most of the cases, due to the cognitive compensation, the repetitive and restrictive approach to productive or deferential human activities, although there is no specific treatment, but rather interdisciplinary and individualized, this consists of managing behavioral symptoms and comorbidity independently either pharmacologically or interventionally. Male patient with five years old and weight of 26 kg, complete immunization chart, previously diagnosed with Asperger's disorder (2015); with dental caries of various degrees implementing dental management. The objective of this report is to make aware of the care and behavior management for dental treatment in patients with this Disorder (AU)

Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report / Manejo de un niño con trastorno de apego reactivo en el entorno clínico dental: Reporte de un caso

ABSTRACT Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child's developing brain. This disorder can significantly affect the pediatric patient's behavior in the dental setting. An uncooperative 9-year- old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist's guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient's oral health and general welfare.

RESUMEN: El trastorno de apego reactivo (RAD, por sus siglas en inglés) es una enfermedad de salud mental en la primera infancia caracterizada por interacciones sociales y capacidades de comunicación deterioradas y por déficits neurológicos en el cerebro en desarrollo del niño. Este trastorno puede afectar significativamente el comportamiento del paciente pediátrico en el entorno dental. Una niña mexicana de 9 años de edad, poco cooperadora, que residía en un hogar temporal, fue remitida a la Clínica de Odontología Pediátrica con su cuidadora, solicitando un examen y tratamiento dental. La paciente presentó un diagnóstico previo de RAD con discapacidad intelectual/ social. Con la orientación del Psiquiatra, se llevó a cabo una profilaxis oral exhaustiva en las citas iniciales, seguidas de diversos tratamientos de restauración bajo la aplicación continua de técnicas de manejo del comportamiento. Estos procedimientos de restauración incluyeron restauraciones de resina y selladores de fosas y fisuras, bajo anestesia local y aislamiento con dique de goma, en los primeros cuatro molares permanentes. Todo el tratamiento se completó en seis semanas. La paciente y su cuidadora recibieron estrategias educativas y motivacionales detalladas para mejorar la higiene oral y también recibieron asesoría nutricional. Para las revisiones de control y refuerzo de los hábitos preventivos, las citas posteriores se programaron cuidadosamente. Una colaboración pediátrica interdisciplinaria entre el dentista, la enfermera y el psiquiatra fue fundamental para mejorar la salud oral y el bienestar general del paciente.

El paciente hemofílico: consideraciones clínicas y moleculares de importancia para el odontólogo / Hemophilic patients: clinical and molecular considerations of interest to dentists

RESUMEN Introducción: La hemofilia es una enfermedad genética poco frecuente en la consulta odontológica. En algunas situaciones se presenta como una urgencia odonto-estomatológica, en la que el profesional debe relacionar las manifestaciones clínicas generales de la enfermedad, con una correcta semiología, paraclínicos y análisis genético-molecular, para diagnosticar y aplicar pertinentes terapéuticas dirigidas a resolver el motivo de consulta del paciente así como el manejo y control de sus complicaciones. Objetivo: Describir los principales aspectos fisiopatológicos generales y de importancia odontológica de la hemofilia, así como las herramientas diagnósticas desde el punto de vista clínico, paraclínico y genético-molecular. Métodos: Búsqueda bibliográfica en las bases de datos Pubmed, Proquest, Scielo y Elsevier, en idioma inglés y español, en las que se seleccionaron artículos publicados en un periodo de 13 años para un total de 50 (2005-2018), empleando los descriptores "hemophilia A, hemophilia B, diagnostic criteria, genetic, molecular, oral health, clinical diagnosis". Análisis e integración de la información: Los estudios han demostrado que la hemofilia, una condición genética y sistémica, tiene repercusiones bucales en el contexto de sus manifestaciones y complicaciones, lo que la hace importante para el odontólogo, debido a que debe ser diagnosticada desde el punto de vista genético-molecular y manejada interdisciplinariamente. Conclusiones: La implicación del diagnóstico genético-molecular por parte del genetista soporta la integración del hematólogo y el odontólogo para el manejo y control de la interconsulta cuando se trata de pautar procedimientos en pacientes con hemofilia(AU)

ABSTRACT Introduction: Hemophilia is a genetic disease scarcely found in dental practice. On occasion it presents as a dental emergency in face of which the professional should relate the general clinical manifestations of the disease to an appropriate semiological, paraclinical and genetic-molecular analysis to diagnose the condition and apply relevant therapies aimed at solving the patient's main concern as well as managing and controlling its complications. Objective: Describe the main general pathophysiological features and aspects of dental interest of hemophilia, as well as the diagnostic tools related to the condition from a clinical, paraclinical and genetic-molecular perspective. Methods: A bibliographic search was conducted in the databases Pubmed, Proquest, Scielo and Elsevier of papers published in English and Spanish in a period of 13 years (2005-2018), using the search terms "hemophilia A", "hemophilia B", "diagnostic criteria", "genetic", "molecular", "oral health", "clinical diagnosis". A total 50 papers were selected. Data analysis and integration: Studies have shown that hemophilia, a genetic systemic condition, may have oral manifestations and complications. This makes it important to dentists, since the disease should be diagnosed from a genetic-molecular point of view and managed in an interdisciplinary manner. Conclusions: Genetic-molecular diagnosis by geneticists implies involvement of hematologists and dentists in the management and control of the condition via interconsultation, when it comes to deciding on procedures for hemophilic patients(AU)

Oral surgery management in Asperger Syndrome: A case report

@#Asperger syndrome is a developmental disorder characterized by difficulties in social interaction and communication. Dental treatment of patients with Asperger syndrome could be challenging due to lack of communication and compliance. This case report described the dental treatment of a patient with Asperger syndrome. A surgeon should be aware of the problems associated with patients with Asperger syndrome and how these can interfere in the surgical treatment. Communication is the key to successful dental treatment in a patient with Asperger syndrome.

Dental Management in a Patient with Infantile Osteopetrosis : A Case Report with a 7-Year follow-up / 대한소아치과학회지

Osteopetrosis is characterized by impaired osteoclast function and increased bone density. Infantile osteopetrosis is a severe form of the disease and has characteristics such as diffusely sclerotic skeleton, pancytopenia, cranial nerve entrapment, infection susceptibility, and abnormal craniofacial appearance. Patients with infantile osteopetrosis often experience developmental delay, and may have a short life span.A 14-month-old girl with osteopetrosis presented to the department of pediatric dentistry. Incipient caries on deciduous incisors were observed. The patient revisited 4 years of age. Besides medical problems, oral complications such as growth retardation, narrow upper arch, crowding, dental caries, and abnormal tooth development were observed. After consultation with her pediatrician, dental treatments were performed on the deciduous molars under sedation after a prophylactic antibiotic injection. At a periodic follow-up, multiple deciduous teeth were treated and extracted, and oral-rehabilitation with a removable partial denture was initiated.Patient with osteopetrosis are highly susceptible to infection because of their compromised immune system and problems associated with wound healing that lead to osteomyelitis or sepsis development.Active participation in dental care for sugar intake management and proper oral hygiene are obligatory.

Una mirada al manejo odontológico del paciente geriátrico con demencia / A review of dental management for geriatric patients with dementia

Resumen El envejecimiento poblacional, es una realidad que enfrentan la mayoría de países desarrollados y un reto que empiezan a plantearse los países en desarrollo. Tener una vida más larga, es un logro de la humanidad, pero es también una constante preocupación por las repercusiones demográficas, económicas, laborales, sanitarias y éticas que se plantean. Con los cambios asociados a la edad, la prevalencia de enfermedades crónicas, la polimedicación y la pérdida de autonomía, el objetivo es ahora procurar una vida en condiciones de calidad y bienestar. Dentro de las enfermedades comunes y asociadas a dependencia, en las poblaciones mayores están las demencias. Con las consecuencias que tiene, por el impacto físico, psicológico, social y económico, sobre la calidad de vida de los pacientes, familias y sus cuidadores. El odontólogo tiene un papel fundamental, dentro del equipo multidisciplinario que debe estar a cargo del cuidado y soporte de calidad de vida de éstos pacientes. Fue esa la motivación para realizar éste artículo, que tuvo como objetivo revisar las consideraciones de manejo y terapéutica odontológica, indicadas para cada etapa en la que evoluciona la demencia. Concluyendo que, involucrar al paciente en medidas preventivas tempranas es fundamental para facilitar el manejo y disminuir las complicaciones a medida que progresa la demencia; el adecuado manejo de la salud del paciente con demencia debe involucrar al círculo de cuidadores del paciente y la valoración de las intervenciones terapéuticas odontológicas deberán ser desde una mirada real, más que ideal, ajustada a cada caso individual.

Abstract Population aging is a reality faced by most developed countries and a challenge that developing countries are beginning to face. To have a longer life is an achievement of humanity, but it is also a constant concern for the demographic, economic, labor, health and ethical repercussions that arise. With the changes associated with age, prevalence of chronic diseases, polymedication and loss of autonomy, the aim is now to seek a life in conditions of quality and well-being. Within the common diseases and associated to dependence, in the populations majors are dementias. With the consequences it has, the physical, psychological, social and economic impact on the quality of life of patients, families and their caregivers. The dentist has a fundamental role, within the multidisciplinary team that must be in charge of the care and support of quality of life of these patients. This was the motivation to perform this article, which aimed to review the management and dental treatment considerations, indicated for each stage in which dementia evolves. Concluding that involving the patient in early preventive measures is essential to facilitate management and decrease complications as dementia progresses; The proper management of the health of the patient with dementia should involve the circle of caregivers of the patient and the assessment of therapeutic dental interventions should be from a real, rather than an ideal look adjusted to each individual case.

Carcinoma escamocelular de labio superior en paciente con síndrome nevoide basocelular. Reporte de caso clínico / Upper-Lip Squamous Cell Carcinoma in Patients with Nevoid Basal Cell Carcinoma Syndrome. A Clinical Case Report

Antecedentes: El síndrome de Gorlin-Goltz, o síndrome nevoide de células básales (SNCB), es un trastorno autosómico dominante de baja incidencia. Su etiología se relaciona con una mutación en el gen PTCH y afecta los sistemas esquelético, oftalmológico y neurológico. Su prevalencia es de 1:60.000 y las mutaciones de novo se presentan aproximadamente en un 20 % a 30 % de los casos. Objetivo: Describir el proceso diagnóstico y manejo de un caso de esporádica presentación de una paciente con SNCB con carcinoma escamocelular (CEC) en labio superior. Descripción del caso: Se trató de una mujer de 58 años, quien asistió a consulta odontológica por motivos estéticos y funcionales. Se encontró un CEC (confirmado por inmunohistoquímica) asintomático delimitado en el lado izquierdo del labio superior, con erosiones de color rojizo y costra. No se encontraron linfoadenopatías asociadas. También evidenció fisuras palmoplantares y múltiples carcinomas basocelulares en la espalda y el dorso de la mano izquierda (con antecedentes familiares similares). Radiográficamente, no se observaron queratoquistes mandibulares que usualmente se asocian con el síndrome de Gorlin-Goltz. Conclusiones: Se diagnosticó SNCB en la paciente, pues presentaba dos criterios mayores (dos o más CBC y piqueteado palmoplantar) y dos menores (calcificación laminar de la hoz del cerebro y antecedente de fibromas ováricos). El tratamiento odontológico se planeó y se remitió a la paciente a la institución pertinente para manejar su condición sistémica.

Background: Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder with low incidence. The etiology' is associated with a PTCH gene mutation and affects the skeletal, ophthalmic and neurological systems. The prevalence is 1:60,000 and de novo mutations occur approximately in 20% to 30% of the cases. Objective: To describe the diagnosis and management process for a rare case of a NBCCS patient who developed squamous cell carcinoma (SCC) in the upper lip. Case Description: The patient is a 58 year-old woman who attended to the dental office for aesthetic and functional reasons. An asymptomatic SCC was found (confirmed after immunohistochemical evidence) with defined limits to the left of the upper lip. It showed reddish erosions and some scab. No associated lymphadenopathies were found. The patient had some plantar foot fissures and multiple carcinoma basal cells in the back and in the left hand dorsum (with similar family previous cases). No maxillary keratocyst were observed in the radiographs, notwithstanding they are always associated with the Gorlin-Goltz syndrome. Conclusions: The patient was diagnosed with NBCCS based on two main criteria (two or more SCC lesions and plantar foot fissures) and two mild criteria (laminar calcification in the cerebral falx and family background of ovarian fibromas). A dental treatment was designed, and the patient was referred to another institution for a systemic treatment of her disease.

Dental management of patients with X-linked hypophosphatemia

X-linked hypophosphatemia (XLH) is a hereditary metabolic disease caused by the loss of phosphate through the renal tubules into the urine, and an associated decrease in serum calcium and potassium phosphate. Its dental features include spontaneous dental abscesses that occur in the absence of trauma or dental caries. The aim of this case report was to describe the dental problems of XLH patients and to evaluate limitations in their treatment. A 14 year old male and a 38 year old female with XLH were referred to the Department of Conservative Dentistry for endodontic treatment. The dental findings were periapical abscesses without obvious trauma or caries. Conservative endodontic treatment was performed in teeth with pulp necrosis and abscess. In case 1, the treated teeth showed improvements in bone healing, without clinical symptoms. However, in case 2, the implants and the treated tooth showed hypermobility, and the final restoration was therefore postponed. Early diagnosis, periodic examinations, and communication with the patient's pediatrician are important in the dental management of patients with XLH.

Manejo odontológico del paciente con parálisis cerebral infantil por medio de los sonidos binaurales

El objetivo más importante de la investigación fue demostrar la eficacia de los sonidos binaurales en la consulta dental como técnica actual para disminuir la ansiedad de los pacientes con parálisis cerebral infantil, así como comprobar que el entorno odontológico genera temor en los pacientes pediátricos. Por medio de un oxímetro de pulso, un aparato reproductor mp3 y auriculares, se logró cuantificar las pulsaciones cardíacas durante tres momentos a lo largo de la investigación. Se valoraron las historias médicas de cada uno de los niños del Hogar Divina Misericordia, así como los medicamentos que consumen diariamente y las enfermedades asociadas a la parálisis cerebral. Se observaron diversos tipos de reacciones al utilizar cada uno de los sonidos, desde el llanto y enojo hasta conseguir la tranquilidad y alegría en los pacientes. Finalmente los resultados revelan los beneficios y la veracidad de los sonidos binaurales mientras que, por el contrario, se expone a los sonidos del ambiente odontológico como un método distractor y desfavorable durante las visitas dentales.

The most important objective of the research was to demonstrate the efficiency of binaural beats in the dental consultant as a current technique to reduce anxiety in child patients with cerebral palsy, also prove that the dental environment generates fear in pediatric patients. To achieve quantify the heartbeats of the children during three different moments throughout the investigation, we used fingertip pulse oximeter, a mp3 player and headphones. We evaluate the medical histories of each children from Hogar Divina Misericordia, as well the medicines they consume daily and diseases related with cerebral palsy. We observed different types of reactions when using each of the sounds, some cried and got anger until they get relax and happy. Finally the results in this research show the benefits and the veracity of the binaural beats while on the contrary are expose to the sounds of the dental environment as a distracting and unfavorable method during dental visits.

Dental perspective on Sjõgren’s syndrome: literature review / Perspectiva odontológica del síndrome de Sjõgren: revisión de literatura

The human body releases around 500-600mL of saliva daily, however when values of unstimulated whole saliva range from 0.1 to 0.2mL/ min, there is a condition called Hyposalivation or hyposialia. Hyposalia is characterized by a large number of systemic conditions, including Sjõgren’s syndrome, a chronic autoimmune disease that affects between 0.1 and 3 percent of the world population and is characterized by exocrinopathy of the salivary glands leading to glandular hypofunction and thus decreasing the normal salivary flow. Saliva is part of innate immunity, when there is a decrease in protein secretion, numerous oral manifestations occur such as dental caries, candidiasis, gingival disease, angular cheilitis, lymphomas of the salivary glands, dysphagia, erythematous and fissured tongue, among others. Currently there is no defined dental treatment, however there are alternative treatments by sialogogues and salivary substitutes, plus non-pharmacological therapies, which seek to maintain the ecology and oral conditions stable, in addition to preventive and restorative dental treatment for lesions already established as a consequence of the disease. The aim of this study is to conduct a literature review on the characteristics, classification, oral manifestations and dental management of Sjõgren’s syndrome...

El ser humano secreta alrededor de 500 a 600 mL de saliva diariamente, sin embargo, al encontrarse valoresde 0.1 - 0.2 mL/min de saliva en reposo se presenta una condición llamada hiposalivación o hiposialia, la cual puedeser manifestada por una numerosa cantidad de condiciones sistémicas, entre ellas el síndrome de Sjõgren, la cual es una enfermedad autoinmune crónica presente en entre el 0.1 y3% de la población mundial, y es caracterizada por exocrinopatíade las glándulas salivales conllevando a la hipofunción glandular y disminuyendo así el flujo salival normal.Debido a que la saliva forma parte de la inmunidad innata, al presentarse una disminución en su secreción proteica sedesencadenan numerosas manifestaciones orales, tales comocaries dental, candidiasis, enfermedad gingival, queilitis angular, linfomas de las glándulas salivales, disfagia, lenguaeritematosa y fisurada, entre otras. Actualmente no existe un tratamiento odontológico definido, sin embargo se tienen alternativas de tratamiento mediante fármacos sialogogos ysustitutos salivales, además de terapias no farmacológicas, las cuales intentan mantener la ecología y las condiciones orales estables, además de los tratamientos odontológicos preventivosy restaurativos para lesiones ya establecidas por consecuenciade la enfermedad. El objetivo del presente estudio es realizar una revisión de literatura sobre las características, criterios de clasificación, manifestaciones orales y el manejoodontológico del Síndrome de Sjõgren...

Cornelia De- Lange Syndrome: A Case Report.

Cornelia de Lange syndrome (CDLS) is a congenital disorder involving skeletal, craniofacial deformities together with gastrointestinal and cardiac malformations. Here with, dental management of a case with CDLS syndrome is described.

Odontología y gestión del conocimiento en tiempos tecnológicos: una vision multidisciplinaria / Dentistry and knowledge management in technological times: a multidisciplinary perspective

El presente artículo analiza la gestión de algunos avances en biotecnología dental, como un modelo que simula la naturaleza dentaria mediante procedimientos de alta tecnología. Por otro lado, orienta el desarrollo de la práctica dental a la realización de tratamientos innovadores, competitivos y productivos, con visión multidisciplinaria. Pretende dar a conocer las alternativas biotecnológicas de mayor relevancia y mostrar cómo estos conocimientos pueden ser aplicados en gestión y manejo de información. Por tal motivo, el objetivo de la investigación se enfoca en la evolución de la odontología y sus especializaciones desde un punto de vista científico como arte y ciencia dental, en vista del progreso técnico y tecnológico.

This article discusses the management of some advances in biotechnology dental, As a model that simulates the nature of dental procedures using high technology. On the other hand, it allows the development of the dental practice focused on the realization of innovative treatments, competitive and productive, especially with multidisciplinary vision. This new model is intended to raise awareness of the alternatives most important biotechnological, and show how such knowledge can be applied in management and information management. All this motivates the objective of the research study the evolution of dentistry and their specializations from a scientific point of view as art and in dental science view technical and technological evolution.