Tooth Loss Related to Root Perforation: Legal Approach in Endodontic Practice / Perdida Dentaria Relacionada con una Perforación Radicular: Una Visión Legal en la Práctica Endodóntica

Most of the techniques used in endodontic treatment are limited to the internal space to the tooth, avoiding reaching the periapical region. However, some accidents can happen, such as fracture of endodontic instruments, perforation, leakage of material, tooth fracture among others, depending on the complexityof each case. The aim of this study was to report a case involving a tooth loss caused by root perforation. In this case, the patient filed a lawsuit against the former professional who had performed endodontic treatment requiring compensation for moral and material damages. In conclusion, the practice endodontic the clarification of the risks is crucial, considering the particularities of each case. Thus, it is suggested that the verbal and written information should be offered to patients.

La mayoría de las técnicas usadas en el tratamiento de endodoncia son limitadas hacia la cavidad dentinaria pulpar coronal y el canal radicular, evitándose alcanzar la región periapical alveolar. Sin embargo, algunos accidentes pueden ocurrir, tales como: fracturas de instrumentos de endodoncia, perforaciones radiculares, extravasación del material de obturación y fracturas dentarias entre otros. Cada uno involucra una respectiva complejidad. El objetivo de esta publicación fue reportar un caso donde ocurrió la pérdida de un diente permanente causado por una perforación radicular. En este caso la paciente presentó una demanda contra el profesional quién realizó el tratamiento de endodoncia, solicitando una compensación por daños morales y materiales. Se concluye que en la práctica de endodoncia, la especificación de los riesgos es crucial, considerándose las particularidades de cada caso. Así, se sugiere que una buena información verbal y escrita deberá ser proporcionada al paciente.

A glosa odontológica em uma operadora de grupo de grande porte / Dental services disallowance in a major health plan provider

Objetivo: verificar a frequência de glosa total e dos procedimentos odontológicos realizados pela rede credenciada de uma operadora de plano de saúde. Materiais e método: trata-se de um trabalho observacional transversal no qual foi realizado um levantamento retrospectivo em uma operadora de grupo exclusivamente odontológica no terceiro trimestre de 2012. A análise quantitativa agrupou os procedimentos baseando-se no rol da Agência Nacional de Saúde Suplementar. Os dados coletados foram tabulados e submetidos a análise estatística com intervalos com 95% de confiança e nível de significância de 5%. Resultados: dos 264.758 procedimentos faturados, 21.716 foram glosados; portanto, o percentual global de glosas em relação ao total de procedimentos foi de 8,20%. A maior frequência de glosas foi observada na radiologia (35,93%), seguida pela dentística (24,04%) e pela prevenção (16,70%). Do total de glosas, a endodontia e a prótese tiveram 4,77% e 2,32%, respectivamente. Entretanto, quando se analisou cada grupo do rol individualmente, 24,37% dos procedimentos da prótese e 22,23% dos procedimentos da endodontia foram glosados. Conclusão: a frequência total de glosa na operadora de plano de saúde foi 8,20%. Os procedimentos mais glosados foram de radiologia, dentística e prevenção. Quando se avaliou a frequência de glosa dentro de um mesmo grupo, a prótese e a endodontia foram as especialidades mais glosadas.

Objective: to observe the frequency of full disallowance and dental procedures performed by an accredited network of a Health Plan Provider. Materials and method: cross-sectional observational study in which we performed a retrospective survey in a group provider for dental care only, in the 3rd quarter of 2012. A quantitative analysis pooled the procedures based on the List of the National Supplementary Health Agency. The collected data were tabulated and subjected to statistical analysis with 95% confidence intervals, and significance level of 5%. Results: from the 264,758 procedures billed, 21,716 were disallowed, so the overall percentage of disallowances over the total number of procedures was 8.20%. The higher frequency of disallowances was seen in radiology (35.93%), followed by dentistry (24.04%), and prevention (16.70%). Endodontics and prosthesis were 4.77% and 2.32% respectively, from the total of disallowances. However, when we individually analyzed each group from the List, 24.37% of the prosthesis procedures, and 22.23% of the endodontic procedures were disallowed. Conclusion: the overall frequency of disallowance in the Health Plan Provider was 8.20%. The most disallowed procedures were radiology, dentistry, and prevention. When the frequency of disallowance within the same group was assessed, prosthesis and endodontics were the most disallowed specialties.

Piriform Aperture Morphometry and Nasal Bones Morphology in Brazilian Population by Postero-Anterior Caldwell Radiographys / Morfometría de la Apertura Piriforme y Morfología de los Huesos Nasales en la Población Brasileña por la Radiografía Postero-Anterior de Caldwell

Piriform aperture and nasal bone contribute to the formation of the nose. Its morphology varies according to ethnic group and gender. The piriform apertures and nasal bones of 97 individuals were examined radiographically through Caldwell radiographic technique and the types of nasal bones were classified according to Hwang et al. (2005). The width, height and area of piriform aperture were measured to demonstrate the difference according to gender. Statistical analysis was performed from the Student t test and analysis of variance (ANOVA). The most frequent type of nasal bone was A, and D was the most uncommon in both genders. In the Student t test significant differences between genders, height, width and area of the piriform aperture were obtained and were larger in males when compared to females. The dimensions of the piriform aperture were higher in males when compared to females, and therefore may be used as parameter for the distinction of gender in Brazilian population. The type A of nasal bone was the most frequent in the Brazilian population, contributing to ethnic differentiation in human identification.

La apertura piriforme y el hueso nasal contribuyen a la formación de la nariz. Su morfología varía de acuerdo a los grupos étnicos y al sexo. Este estudio evaluó la morfología de la apertura piriforme y el hueso nasal y su relación con el sexo. Las aperturas piriformes y los huesos nasales de 97 personas fueron examinados radiográficamente mediante la técnica radiográfica de Caldwell, y los tipos de huesos nasales se clasificaron de acuerdo con Hwang et al. (2005). Se midió el ancho, la altura y el área de la apertura piriforme para demostrar las diferencias por sexo. El análisis estadístico se realizó a partir de la prueba t de Student y análisis de varianza (ANOVA). El tipo más frecuente de hueso nasal fue la A, y la D fue la menos común, en ambos sexos. En la prueba t de Student se obtuvo diferencias significativas entre los sexos, altura, ancho y área de la apertura piriforme, las que fueron mayores en hombres en comparación a las mujeres. Las dimensiones de la apertura piriforme fueron mayores en los hombres que en las mujeres, por lo que se puede utilizar como parámetro para la distinción de sexo en la población brasileña. En la población brasileña el tipo A de hueso nasal fue el más frecuente, lo que contribuye para la diferenciación étnica en la identificación humana.

Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos / An analysis Pediatricians´ ethics stand in children victims of abuse and violence

O objetivo do presente trabalho é a avaliação de conhecimento do pediatra acerca das responsabilidades e condutas éticas em relação ao indivíduo infantil vítima de maus tratos e abuso. Foi elaborado um questionário semi-estruturado contendo questões relativas ao tempo de formação profissional, identificação da faculdade, preparo do profissional para atender crianças vítimas de maus tratos, os principais tipos de agressões identificados, conhecimentos das penalidades e das atitudes a serem tomadas após constatação da violência infantil. Foram distribuídos 270 questionários a pediatras que atuam nas cidades de Cuiabá, Rondonópolis e Cáceres, sendo que dos 270 enviados, apenas 96 retornaram devidamente respondidos (35,5%). Dos pediatras consultados, 50 eram do sexo feminino e 46 do masculino, e 63% dos mesmos tinham mais de dez anos de formados. Destes, 55% já tinham atendido crianças com características de maus tratos, tendo descrito os sinais e sintomas mais comuns: hematomas, sangramento vaginal e anal, medo excessivo, fraturas, agressividade, cicatrizes pelo corpo, mau desempenho nas atividades escolares, comprometimento nutricional, gagueira, queimaduras e crise convulsiva. Um percentual significativo dos pediatras entrevistados não apresentou condições de receber, avaliar e encaminhar as vítimas de maus tratos infantis, havendo a necessidade de maior treinamento com educação continuada na área médico-legal.

The aim of this work was to assess the pediatrician’s knowledge regarding their responsibility and ethic stand on children victims of violence and abuse. A semi-structured questionnaire was elaborated containing questions regarding professional experience, university, professional capability on receiving abused children, the main sort of aggressions suffered by children, penalties knowledge, and professional attitudes in cases of children violence or abuse. 270 questionnaires were sent to pediatricians from Cuiabá, Rondonópolis and Cárceres cities. 96 out of 270 questionnaires were given back and correctly answered (35.5%). According to gender, the pediatricians interviewed were 50 female and 46 male, 63% had more than 10 years of professional experience and 55% have already evaluated children victims of violence and abuse, describing as the most common lesions: bruise, vaginal and anal bleeding, excessive fear, fractures, aggressiveness, scars spread out all over the body, low scholarity development, nutritional impairment, stammer, burn and convulsive crises. Many of pediatricians interviewed did not consider themselves ready to receive, diagnose and conduct children victims of abuse and violence, showing the need of continuing medical education in forensic medicine.