Defectos bucodentales en personas con síndrome de Down: una prioridad en salud bucal / Oral-dental defects in people with Down's syndrome: a priority in oral health

RESUMEN El síndrome de Down con frecuencia se acompaña de defectos bucodentales que comprometen la función masticatoria y fonatoria del paciente. Las acciones de prevención y promoción de salud bucal, el diagnóstico precoz y seguimiento de estas enfermedades, contribuyen al logro del verdadero enfoque interdisciplinario que demandan estos pacientes, para lograr una plena inclusión social. Se realizó una búsqueda bibliográfica sobre el tema, con el objetivo de estructurar los referentes teóricos relacionados con los principales defectos bucodentales -congénitos y adquiridos- que afectan a la población con síndrome de Down, para lograr la prevención de estos defectos y el incremento de la calidad de vida de los pacientes. Los defectos bucodentales congénitos más frecuentes encontrados en la trisomía 21, fueron la microdoncia, la macroglosia y la erupción dental tardía. La enfermedad periodontal fue el defecto adquirido de mayor presentación, al que se asocian diversos factores de riesgo, muchos modificables. Las intervenciones tempranas en salud bucal pueden incrementar la calidad de vida de los niños y adultos que padecen este trastorno, ayudándolos a lograr un pleno desarrollo como seres humanos (AU).

ABSTRACT Down's syndrome is frequently accompanied by oral-dental defects compromising the masticatory and phonatory function of the patients. Oral health promotion and prevention actions, precocious diagnosis and follow-up of these diseases contribute to achieving the true interdisciplinary approach these patients demand to reach their full social inclusion. A bibliographic search on the theme was carried out, with the objective of structuring the theoretical referents related to the main oral-dental defects -congenital and acquired-, affecting the population with Down's syndrome to reach these defects prevention and increasing these patients' life quality. The congenital oral-dental defects more commonly found in trisomy 21 were microdontia, macroglossia, and delayed tooth eruption. Periodontal disease was more frequently found acquired defect, to which several risk factors are associated, many of them modifiable. Early interventions in oral health may improve the life quality of these children and adults, helping them to achieve a full development as human beings (AU).

Características clínicas orales en pacientes con distrofia muscular de Duchenne: estudio descriptivo / Oral characteristics of patients with Duchenne muscular dystrophy (DMD): descriptive study

Introducción: En su evolución, la DMD afecta el sistema estomatognático, situación no explorada en nuestro país. Objetivo: Describir características clínicas orales y asociación con edad, en pacientes con distrofia muscular de Duchenne (DMD). Pacientes y Método: Estudio descriptivo, transversal en 81 pacientes con DMD del Instituto Teletón Santiago, reclutados desde agosto a noviembre 2017, con consentimiento informado. Se efectuó examen clínico diagnóstico para determinar la presencia de caries clínicas (índice ceod/COPD), índice de higiene (Índice Green y Vermillion Simplificado), presencia de maloclusiones y asociaciones de variables orales con edad. Resultados: 65,4% de los pacientes no presentaban caries ni restauraciones, registrándose un promedio COPD = 1,7 ± 1,2 y ceod= 2,1 ± 1,6. El índice de higiene oral promedio fue de 1,9 ± 0,8 considerado como regular. 67,9% de los pacientes presentaba alguna maloclusión, existiendo una relación esta- dísticamente significativa entre presencia de mordida cruzada y grupo etario (p < 0,05). Conclusiones: La menor presencia de caries clínica en pacientes con DMD a lo referido en bibliografía para pacientes sanos, podría atribuirse a los controles periódicos odontológicos otorgados por Instituto Teletón San- tiago. El aumento de las maloclusiones con el avance de la edad, podría ser un indicador del progreso de la enfermedad, ya que los cambios en la función muscular masticatoria son dependientes del tiempo y producen aumento del ancho transversal mandibular originando las maloclusiones más prevalentes como la mordida cruzada y abierta. Palabras clave: Distrofia muscular Duchenne, caries, higiene oral, malo- clusiones.

Oral characteristics of patients with Duchenne muscular dystrophy (DMD). Descriptive study Introduction: In its evolution, Duchenne muscular dystrophy (DMD) affects the stomatognathic system, a condition that has not been studied in our country. Objective: To describe the oral clinical characteristics and age-related association in patients with DMD. Patiens and Method: Cross-sectional des- criptive study including 81 patients with DMD of Instituto Teletón Santiago, recruited from August to November 2017, with informed consent. A diagnostic clinical examination was performed to establish the presence of clinical cavities (DEFT, DMFT index), oral hygiene index (Green and Vermillion, simplified), presence of malocclusions, and age-related associations. Results: 65.4% of patients did not have caries or restorations, showing an average of DMFT = 1.7 ± 1.2, and DEFT= 2.1 ± 1.6. Average oral hygiene index was 1.9 ± 0.8.which is considered regular. 67.9% of the patients had some type of malocclusion, with a statistically significant relation between the presence of cross bite and age group (p < 0.05). Conclusions: Lower presence of clinical caries in DMD patients as referred to in bibliography for healthy patients, could be due to periodic dental controls provided by Instituto Teletón Santiago. Increased ca- ses of malocclusions with age may be an indicator of progress of the disease, because changes in the function of mastication muscles are time-dependent, and increase transverse jaw width, causing more prevalent malocclusions such as cross bite and open bite. Key words: Duchenne muscular dystrophy, caries, oral hygiene, malocclu- sions.

Frecuencia de Lesiones y Condiciones Orales en Pacientes Mayores de 18 Años en una Clínica de Atención Primaria en México / Frequency of Lesions and Oral Conditions in Patients Older than 18 Years in a Primary Care Clinic in Mexico

RESUMEN: La patología oral es el área de la odontología que se especializa en el diagnóstico y tratamiento de enfermedades orales. Se realizó un estudio transversal, en el cual fueron incluidos pacientes mayores de 18 años que acudieron a una clínica de atención primaria del departamento de estomatología de la universidad Autónoma de Ciudad Juárez, en México y a los cuales independientemente del motivo de consulta se les realizo historia clínica y exploración intraoral detallada. Fueron examinados 650 pacientes (424 mujeres y 226 hombres) con un rango de edad de 18 a 89 años (media=42.27). Las lesiones más frecuentes fueron la queratosis friccional (30,46 %) e hiperplasia fibrosa (6,92 %), la melanosis fisiológica (42,92 %) y los gránulos de Fordyce (36,46 %) fueron las condiciones más identificadas. En las lesiones de la mucosa oral que identificamos estuvo presente el factor traumático de manera crónica, es importante que el odontólogo este familiarizado con las lesiones más frecuentes, con su etiología, características clínicas y tratamiento de cada una de ellas.

ABSTRACT: Oral pathology it's the branch of medicine that focuses on the diagnosis and treatment of oral diseases. A cross-sectional study was carried out in which patients older than 18 years was included, that were attended in the primary care clinic at the stomatology department of the Autonomous University of Ciudad Juárez, in Mexico, and regardless of the reason for consultation the clinical history and intraoral examination was done We examined 650 patients (424 women and 226 men) with an age range of 18 to 89 years (mean=42.27). The most frequent oral lesion was the frictional keratosis (30.46 %), fibrous hyperplasia (6.92 %), physiological melanosis (42.92 %), and fordyce granules (36.46 %). In the oral mucosal lesions identified was present a chronic traumatic factor, it is important that the dental staff knows about the most frequent injuries, their etiology, clinical characteristics and treatment of each one.

Skin Carvings: Predictive Diagnosis in Modern Era.

The science and art of markings of the skin especially hands and feet’s is known as dermatoglyphics, where derma means skin and glyph mean carving. For centuries, the features of the hands have fascinated scholars, sages, theologians, doctors, and layman alike. In 1926 Cummins introduced the term “dermatoglyphics.” “Samudra Shastra” was known as ridge pattern study in ancient India. The epidermal ridge patterns were classified into “Chakra, Shankya, and Padma” which corresponds with the whorl, loop, and arch system of modern classification. All individuals have unique fingerprints which remain unchanged over the lifetime. Multiple genes determine fingerprint configurations and the study of fingerprints reveal vital genetic and medical information about an individual. Dermatoglyphics is considered as the window of congenital abnormalities and is a sensitive indicator of intrauterine anomalies. For preliminary investigations in conditions with a suspected genetic basis dermatoglyphic analysis is now beginning to prove itself as an extremely useful tool. In dentistry, various studies have been published on the dermatoglyphics. Here in this present review, the dermatoglyphic patterns of the palms and soles, the methods to record the palm and sole prints and various studies conducted among the dental disorders has been highlighted.

Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

A fasceíte necrotizante cervical (FNC) é uma infecção rara de tecidos moles, potencialmente fatal, caracterizada por necrose no tecido subcutâneo e fascia com progressão rápida. Um caso de FNC de origem odontogênica em um paciente diabético, complicado por dependência alcoólica e abuso de tabaco, é relatado junto a uma revisão da literatura. O procedimento de emergência compreendeu hidratação, administração de colóide, controle glicêmico e antibioticoterapia de amplo espectro, seguido de debridamento cirúrgico agressivo. Necrose no músculo platisma foi verificada por análise histopatológica. Cirurgia reconstrutiva foi feita após resolução da infecção e a ferida foi fechada com enxerto dérmico autógeno. O paciente teve um longo período de internação hospitalar, em parte devido ao abuso de substâncias, o que levou a uma recuperação difícil. Os princípios de diagnóstico imediato, debridamento cirúrgico agressivo, antibioticoterapia de amplo espectro e cuidados em terapia intensiva no tratamento da FNC foram confirmados no presente caso. Foi concluído que diante da ocorrência de FNC na presença de diabetes mellitus e de abuso de substâncias como álcool e tabaco, o profissional assistente deve considerar uma resposta mais difícil ao tratamento e maior tempo de internação.

Oral findings in patients with mucolipidosis type III

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

A mucolipidose tipo III é uma doença rara, autossômica recessiva, que faz parte de um grupo de doenças de depósito, decorrentes do erro inato do metabolismo das enzimas lisossômicas. Caracteriza-se pelo aparecimento progressivo de sinais e sintomas com repercussão no desenvolvimento físico e mental, bem como alterações visuais, cardíacas, esqueléticas e articulares. Apesar de achados bucais estarem bem relatados em associação à mucolipidose tipo II, esse artigo descreve achados radiográficos e histológicos de múltiplas lesões radiolúcidas, associadas a dentes inclusos nos maxilares, em uma jovem de 16 anos de idade com mucolipidose tipo III.

Prevalencia y mortalidad de las infecciones cervicofaciales odontógenas que requieren internación / Prevalence and mortality in cervicofacial odontogenic infections requiring hospitalization

En las unidades de media y alta complejidad se requiere de un equipo multidisciplinario dispuesto al abordaje de pacientes con infección odontógena complicada, que deberá seguir un protocolo de atención y tratamiento.

Ewing's sarcoma of the mandible in a young child

Ewing's sarcoma (ES) is a malignancy primarily affecting bone tissue that is commonly diagnosed in adolescents and young adults. Its occurrence in the head and neck region is unusual and generally involves the mandible and maxilla. An extensive review of the literature shows only few cases of the oral ES in patients under the age of 5. This paper reports a rare case of ES of the mandible in a 4-year-old girl, which had been previously misdiagnosed and treated as a dental abscess. In the clinical examination, a hard immobile expansive mass of 5 cm in diameter was observed on the left side of the mandible. Radiographic examination revealed a radiolucent lesion with ill-defined borders and wide vestibular bone plate destruction. Microscopically, the tumor was composed by monotonous small round cells that exhibited immunoreactivity for CD99, vimentin and pancytokeratin. The patient was subjected to multiagent chemotherapy with ifosfamide, carboplatin, etoposide, vincristine, cyclophosfamide and doxorrubycin (VAC/ICE regimen). However, after the first chemotherapeutic cycle, the patient died due to disseminated infection. This case elucidates the importance of professional knowledge of the relevant aspects of malignant lesions such as ES.

O sarcoma de Ewing é um tumor maligno primário do osso, comumente diagnosticado em adolescentes e adultos jovens. Sua ocorrência na região de cabeça e pescoço não é usual, e geralmente ocorre em maxila ou mandíbula. Após revisão extensiva da literatura, poucos casos foram identificados acometendo pacientes com menos de 5 anos de idade. Nós relatamos um caso raro de SE em uma criança de 4 anos de idade que foi previamente diagnosticada e tratada como abscesso dentoalveolar. Ao exame clínico, uma massa expansiva endurecida e imóvel de 5 cm de diâmetro foi observada no lado esquerdo da mandíbula. O exame radiográfico mostrou lesão radiolúcida, com bordas mal definidas e ampla destruição da tábua óssea vestibular. Microscopicamente, o tumor era composto por células pequenas e arredondadas que exibiam imunorreatividade para CD99, vimentina e pancitoqueratina. O paciente foi submetido à quimioterapia com ifosfamida, carboplatina, e etoposide além de vincristina, ciclofosfamida e doxorrubicina (regime VAC/IE). Entretanto, após o primeiro ciclo da quimioterapia, o paciente foi a óbito por infecção disseminada. Este caso salienta a importância do conhecimento profissional no diagnóstico de tumores malígnas tais como o SE.

Existen diferencias en la morfometría mandibular de pacientes candidatos a cirugía ortognática? parte 2: influencias del género / Are there differences in the mandibular morphometry in patients who are candidates for orthognathic surgery? part 2: influences of gender

El seno coronario recientemente ha asumido un papel importante en la clínica cardiológico, siendo ampliamente utilizado en procedimientos invasivos del corazón. Comúnmente, se utiliza en los implantes de los electrodos para el monitoreo epimiocárdico del ritmo cardiaco, a través de un ritmo biventricular establecido. Estos procedimientos invasivos no son posibles en los corazones con una atresia del ostium del seno coronario. En presencia de esta condición, se puede producir otra anomalía: el desarrollo de la vena de "Marchal" la cual es un vestigio de la vena cava superior izquierda (VCSI). Esto provoca que la sangre venosa del corazón pueda drenar en el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. La presencia de una VCSI trae dificultades a la hora de realizar un procedimiento invasivo con el fin de acceder al atrio derecho a través de la vena cava superior, usualmente hecho en la clínica cardiológica. Por otra parte, el cruzamiento de la VCSI sobre el atrio izquierdo es vulnerable en las intervenciones quirúrgicas cardiovasculares, confirmado por informes clínicos. En el presente estudio, 400 corazones fijados en formalina provenientes a cadáveres de sexo masculino, con edades comprendidas entre los 35 y 80 años, fueron investigados, en particular por la anatomía del seno coronario. El ostium obliterado del seno coronario al atrio derecho asociado con una VCSI persistente estuvo presente en sólo una muestra (0,25 por ciento). Se realizó un estudio del diámetro de estas estructuras dilatadas debido a que la sangre venosa drena desde el corazón hacia el atrio derecho, por una comunicación entre la VCSI y la vena braquicefálica izquierda. También se realiza una revisión de la literatura de estos casos y se discuten nuestros hallazgos en relación con su importancia clínica.

Individual facial features are to be associated with genetic and environmental influences, it is possible to identify clear differences between the facial patterns of men and women, where dentofacial deformities (FDA) will influence the surgical indications, surgical techniques and the final aesthetic results. We performed a cohort study with patients who consulted for orthognathic surgery between 2002 and 2008 in the Division of Oral and Maxillofacial Surgery of the FOP-UNICAMP. Examined panoramic radiographs used in surgical planning by linking the gender of the patient with mandibular morphometric characteristics specifically associated with the surgical techniques used in the correction of DDF, evaluations were conducted with descriptive statistics and Chi-Square test with statistical significance when p <0.05. Forty-six patients were studied, 26 patients being female and 20 male patients. It was not possible to identify statistical differences in the mandibular morphometry in both groups. In the descriptive analysis, the proportional differences between the groups were minimal. Finally, we note that there is no difference in Brazilian patients were male and female when compared Mandibular morphometric proportions.

Remoção química-mecânica da cárie dentária com o gel Papacárie®: relato de caso clínico / Chemomechanical caries removal with Papacárie® gel: case report

A Odontologia contemporânea visa desenvolver novos materiais e aprimorar as técnicas restauradoras para restabelecer a estética e a função, preservando o máximo de estrutura dentária. O uso extensivo de alta e baixa rotação deixou de ser técnica única de preparos cavitários, passando a contar com um aliado importante nessa etapa operatória, a remoção química-mecânica da cárie. Vários agentes foram testados, entre eles o gel Papacárie®, material de origem brasileira que em relação aos pesquisados anteriormente, acrescentou a vantagem do baixo custo, tornando-o compatível com a realidade nacional. O uso de curetas e produtos químicos permite a seleção do tecido necrótico que deve ser eliminado, mantendo o restante da dentina desorganizada, mas com capacidade de regeneração. Pelo fato da dentina necrótica ser morta, a remoção seletiva desse tecido torna a remoção de cárie indolor, dispensando o uso de anestesia. Estas qualidades são atraentes, especialmente no atendimento infantil por reduzir as freqüentes fobias ao tratamento odontológico. Objetiva-se descrever, nesse trabalho, o protocolo de aplicação do gel Papacárie® em criança portadora de lesões agudas de cárie.

New materials and techniques, aiming to reestablish esthetics and function, and to preserve the maximum of healthy structure, plow of major concern in dentistry today. The Papacarie® gel is a material developed to removes carious tissue, (and to further denaturation) of the infected and necrotic dentin, without removing its capacity of regeneration. The vantage of being the method performed without pain, with the uses of scarves, and without anesthetics and the uses of drills. It goes these reasons, this study have the objective presents the clinical marries using Papacarie® gel,with the presentation of his application protocol in sharp decay lesion. The pediatric patient, feminine gender, with 5 years of acts, leukoderma, presents lesion of sharp decays in the deciduous teeth 74 and 75 without pulp involvement. This technique was indicated due to its easy utilization, since it donate not require the uses of rubber dam, anesthetics and drills. Like this, that material an alternative in daily clinical treatment in lesion of sharp decays without pulp involvement, mainly in pediatric dentistry.

overview of odontogenic infections. When to refer?

Dental and Medical practitioners as well as specialists in medicine and dentistry are often faced with the challenge of managing patients with infections. These infections can range in their severity from those that may only require antibiotic therapy to those that may require aggressive surgical intervention. Oral and maxillofacial infections, in particular, have the tendency to spread rapidly along fascial planes and if left untreated they may lead to highly morbid clinical conditions with severe complications that may ultimately lead to death. Careful diagnosis and sound clinical judgment have the potential to reduce morbidity associated with odontogenic infections. The success of these treatments are, in part, dependent on the virulence of the pathogen involved, the resistance of the host and strict adherence to sound medical, pharmacological and surgical principles. An overview of the principles of antibiotic therapy, diagnostic laboratory and imaging studies and the principles of surgical management will be presented

[Rootless teeth; Report of a case]

In this case report, dental status of a boy aged eight years, referred to the pediatric department of dental school of Shiraz University of Medical Sciences is presented and explained. His main chief complaint was reduced number of the teeth. During clinical evaluation, hypodontia, and in radiographic examination, congenital missing and rootlessness of many permanent teeth were evident. The patient did not have any evidence of systemic diseases, developmental anomalies and/or syndromic defects

Assessment of oral health status and its association with some epidemiological factors in population of Nagpur, India.

Present cross sectional study was undertaken in field practice area of Urban Health Training centre, Bapunagar, Nagpur to assess oral health status of community and to study the relationship of some epidemiological factors with it. Observations of the present study reveal that dental caries (43.2%) and periodontal diseases (34.8%) were the most common dental disorders. Other disorders were dentofacial anamoly (24.2%), opacities and enamel disorders (18.7%) and oral mucosal lesions 7.1%). Oral precancerous lesions (2.4%) also found to be an important problem. Prevalence of oral cancer was 0.1%. In general oral problems were more common in lower socioeconomic group and in habiters i.e. ghutka chewers, pan, tobacco eaters, candies eaters. Also use of tooth brush and tooth powder for cleaning teeth were found to be associated with lower prevalence of oro-dental disorders. Most of the problems were common in younger and middle aged population except cancer and precancerous lesions which were common in middle and older population. But oral submucous fibrosis was exclusively found in younger and middle aged subjects.

DIAGFACE: um banco de conhecimentos e sistema especialista para o diagnóstico de patologias orofaciais / DIAGFACE: a knowledge base and expert system for the diagnosis of oral and facial pathologies

O presente trabalho relata um sistema de apoio à decisão em Odontologia, denominado DIAGFACE, desenvolvido com a finalidade de auxiliar o dentista no diagnóstico diferencial de cerca de 150 patologias orofaciais mais comumente encontradas na prática clínica em nosso meio. Sua característica fundamental é a estruturação de um flexível diálogo com o usuário, através de menus, palavras-chaves e perguntas em linguagem natural, em torno de um extenso banco de conhecimento, constituído de registros relacionais e de uma coleção de regras de produção, utilizando técnicas de busca linear e de encadeamento direto e reverso. O programa tem quantro módulos que permitem que o usuário faça consultas de quatro maneiras: pelos sintomas; pela região; pela patologia; por um sistema especialista baseado em regras.