Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate

Abstract The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. Objective: To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. Methodology: This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. Results: No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Conclusion: Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

Aim: to verify the relation between endodontic treatment of teeth adjacent to the cleft area and the rehabilitation of patients with unilateral cleft lip and palate, at the Hospital for Rehabilitation of Craniofacial Anomalies. Methods: the present split-mouth study was composed of 406 individuals with complete unilateral cleft lip and palate who had completed the rehabilitation process in a single tertiary cleft center (55.9% males). The information was collected from the dental history on the patients' records and radiographs. The frequency of endodontic treatment in the upper incisors and canines was calculated for the cleft and non-cleft sides. The comparison between sides was performed by the chi-square test (p <0.05). Results: endodontic treatment was more frequent in teeth adjacent to the cleft than in contralateral teeth. The frequency of endodontic treatment in at least one tooth adjacent to the cleft was 18.97%, and 11.6% on the contralateral side. It was observed that endodontic treatment was necessary in 63.5% of patients who had been submitted to orthodontic treatment, 42.4% of those rehabilitated with fixed partial dentures and 12.0% of patients who underwent dental reshaping of teeth adjacent to the cleft. The treatments performed included vital pulp therapy (46.1%), non-vital pulp therapy (46.8%) and endodontic retreatment (7.1%). Conclusion: in individuals with complete cleft lip and palate, teeth close to the bone defect area and used for rehabilitation treatment presented greater need of endodontic intervention

Prevalence of cleft lip and palate in Bauru, SP ­ concordance among registries of HRAC/USP, DNV and SINASC / Prevalência da fissura labiopalatina em Bauru, SP ­ concordância entre os registros do HRAC/USP, DNV e SINASC

Objective: Congenital defects, including cleft lip and palate, increase the morbidity and mortality in the affected population. This study aimed to determine the prevalence of cleft lip and palate in the city of Bauru, Brazil, by evaluation of registry in the Brazilian Livebirth Certificate (DNV) and the Information System on Livebirths (SINASC), and analyzed the concordance of diagnosis compared with registries of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC/USP), located in the same city. Material and Methods: This retrospective observational study comprised analysis of all DNVs and identification of individuals with clefts born and living in Bauru, comparing with data from HRAC/USP. The prevalence was calculated by dividing the number of children born with clefts in the study period by the total number of livebirths registered. The reporting of different types of clefts was compared by the chi-square test. Results: Overall, 50,898 DNV were evaluated, among which there were 25 reported cases of cleft lip and/or palate. In the same period, HRAC/USP registered 77 cases born in Bauru, representing 67.5% of underreporting of the occurrence of clefts. Cleft palate was the most prevalent (34.9%), followed by cleft lip and palate (31.7%) and cleft lip (30.2%), mostly affecting males (58.5%). The reporting of cleft palate (16.12%) was lower compared to cleft lip (43.75%) and cleft lip and palate (54.54%). Conclusion: The study revealed predominance of cleft palate, with significant underreporting of clefts in the public health system, especially for cleft palate as compared to cleft lip and cleft lip and palate (AU)

Objetivo: Os defeitos congênitos, incluindo fenda labial e palatina, aumentam a morbidade e mortalidade na população afetada. Este estudo teve como objetivo determinar a prevalência de fissura labiopalatina na cidade de Bauru, Brasil, por meio da avaliação do registro na Certidão de Nascimento de Vivos (DNV) e no Sistema de Informação de Nascidos Vivos (SINASC), e analisar a concordância do diagnóstico em comparação com registros do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC / USP), localizado na mesma cidade. Material e Métodos: Este estudo observacional retrospectivo compreendeu a análise de todas as DNVs e a identificação dos indivíduos com fissuras nascidos e residentes em Bauru, comparando com os dados do HRAC / USP. A prevalência foi calculada dividindo-se o número de filhos nascidos com fissura no período do estudo pelo total de nascidos vivos registrados. O relato de diferentes tipos de fissuras foi comparado pelo teste do qui-quadrado. Resultados: No geral, foram avaliadas 50.898 DNV, entre as quais houve 25 casos notificados de fenda labial e / ou palatina. No mesmo período, o HRAC / USP registrou 77 casos nascidos em Bauru, representando 67,5% de subnotificação da ocorrência de fissuras. A fenda palatina foi a mais prevalente (34,9%), seguida da fenda labiopalatina (31,7%) e fenda labial (30,2%), ocorrendo principalmente no sexo masculino (58,5%). O relato de fissura palatina (16,12%) foi menor em comparação com fissura labial (43,75%) e fissura labiopalatina (54,54%). Conclusão: O estudo revelou predomínio de fissura palatina, com subnotificação significativa de fissuras no sistema público de saúde, principalmente para fenda palatina em relação à fenda labial e labiopalatina. (AU)

Relação entre reabsorções dentárias e enxerto alveolar em dentes adjacentes à área da fissura / Relationship between root resorption and alveolar graft in teeth adjacent to the cleft lip and palate area

Objetivo: avaliar, radiograficamente, a prevalência, extensão e severidade da reabsorção dentária em dentes adjacentes à área de fissura após enxerto ósseo alveolar. Métodos: radiografias de 200 indivíduos com fissura unilateral e bilateral, alveolar e palatina, foram analisadas para se investigar a presença de reabsorção dentária relacionada com o enxerto ósseo. No total, 1.315 radiografias foram analisadas (periapical, oclusal e radiografias panorâmicas), obtidas a partir de 200 indivíduos com fissura labiopalatina unilateral e bilateral completa ubmetidos a cirurgia de enxerto, disponíveis a partir dos arquivos da Seção de Radiologia do HRAC-USP. Resultados: entre os 200 indivíduos, 33 tinham reabsorções dentárias externas. Dessas, 15 estavam presentes nas radiografias pré-operatórias e 18 só depois do enxerto ósseo. No geral, 30 reabsorções localizaram- se no terço apical da raiz e 3 no terço cervical; o incisivo central esquerdo foi o mais afetado. Não foram observadas reabsorções dentárias no terço médio da raiz e nenhuma reabsorção afetou mais de um terço. Não existiu diferença estatisticamente significativa entre a idade do paciente durante a cirurgia de enxerto ósseo e a presença de reabsorção dentária externa. Conclusões: a prevalência da reabsorção dentária em dentes adjacentes à área da fissura em indivíduos submetidos a enxerto ósseo foi baixa (16,5%). O terço apical da raiz foi o local mais frequente de reabsorção radicular externa, e não houve reabsorções afetando mais de um terço da raiz. (AU)

Male individuals with Robin Sequence: emerging significant association with ABO and RhD blood group phenotypes

ABSTRACT Background: This study investigated the association of Robin Sequence with ABO and RhD blood group phenotypes. Methods: A retrospective cross-sectional study was performed of a cohort of Robin Sequence patients of the Hospital de Reabilitação de Anomalias Craniofaciais - Universidade de São Paulo (USP), Brazil. The study group was composed of 339 individuals of both genders with Robin Sequence referred for specific treatment. A control group was composed of 1780 individuals without syndromes. The groups were compared using the Pearson' chi-square test (χ 2) with statistical significance being defined for an alpha error of 5% (p-value < 0.05). Results: A comparison of gender found a significant difference for the AB phenotype between groups (p-value = 0.007). Comparing blood type by gender there was no significant difference within the same group (p-value = 0.117 and 0.388 respectively, for Robin Sequence and the control group). When comparing the AB blood type between groups, there was no difference for females (p-value = 0.577), but there was a significant difference for males (p-value = 0.0029). Conclusions: This study showed that the population with Robin Sequence had different patterns related to gender concerning the phenotypic distribution of ABO and RhD blood group phenotypes. Robin Sequence is more common among females. The AB phenotype was significantly higher in males with Robin Sequence than in males of the Control Group. The prevalence of the RhD-negative phenotype is higher in individuals with Robin Sequence. This result suggests a possible association of ABO and RhD phenotypes with Robin Sequence that should be better investigated by molecular studies, as it deserves greater attention.

Evaluation of photobiomodulation therapy associated with guided bone regeneration in critical size defects. In vivo study

Abstract The repair of bone defects raises the interest of investigators in several health specialties. Grafting techniques with bone substitutes and laser therapies have been investigated to replace autogenous bone and accelerate the bone healing process. Objective To evaluate the effect of photobiomodulation therapy (PBMT) associated with guided bone regeneration (GBR) in critical size defects. Material and Methods The study was conducted on 80 male rats (Rattus norvegicus albinus, Wistar) submitted to surgical creation of a critical size defect on the calvaria, divided into eight study groups: group C (control - only blood clot); group M (collagen membrane); group PBMT (photobiomodulation therapy); group AB (autogenous bone); group AB+PBMT; group AB+M; group PBMT+M; group AB+PBMT+M. The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric analysis and statistical analyses were performed (Tukey test, p<0.05). Results All groups had greater area of newly formed bone compared to group C (9.96±4.49%). The group PBMT+M (achieved the greater quantity of new bone (64.09±7.62%), followed by groups PBMT (47.67±8.66%), M (47.43±15.73%), AB+PBMT (39.15±16.72%) and AB+PBMT+M (35.82±7.68%). After group C, the groups AB (25.10±16.59%) and AB+M (22.72±13.83%) had the smallest quantities of newly formed bone. The area of remaining particles did not have statistically significant difference between groups AB+M (14.93±8.92%) and AB+PBMT+M (14.76±6.58%). Conclusion The PBMT utilization may be effective for bone repair, when associated with bone regeneration techniques.

The maxillary lateral incisor in the rehabilitation of cleft lip and palate

Abstract Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

Child feeding after palatoplasty: role of nursing staff in the training and evaluation of caregivers / Alimentação da criança após palatoplastia: o papel da equipe de enfermagem na formação e avaliação dos cuidadores

Objective ­ To promote and evaluate the ability of caregivers in child feeding during the postoperative period after palatoplasty. Methods ­ The sample comprised 44 caregivers of children with cleft lip and palate, trained during hospitalization and evaluated on hospital discharge concerning the care related to child feeding after palatoplasty. The study was conducted in 2010, using a constructed and validated instrument. The ability of caregivers was evaluated using a quantitative instrument and associated with socioeconomic factors. The Fisher exact test was used to analyze the significance of differences between paired samples. Results ­ Among the caregivers, 86% were able for feeding after palatoplasty, and the socioeconomic factors and type of cleft did not influence the acquisition of abilities. Conclusions ­ Most caregivers were able for the care; the socioeconomic factors analyzed did not influence the ability for self-care; and 24 hours of hospitalization were sufficient for achievement of abilities related to care.

Objetivo ­ Promover e avaliar a capacidade dos cuidadores na alimentação da criança durante o período pós-operatório após palatoplastia. Métodos ­ A amostra foi composta por 44 cuidadores de crianças com fissura labiopalatina, treinados e avaliados durante a internação na alta hospitalar sobre os cuidados relacionados com a alimentação da criança após palatoplastia. O estudo foi realizado em 2010, utilizando um instrumento construído e validado. A capacidade dos cuidadores foi avaliada utilizando um instrumento quantitativo e associado aos fatores socioeconômicos. O teste exato de Fisher foi utilizado para analisar a significância das diferenças entre amostras pareadas. Resultados ­ Entre os cuidadores, 86% foram capazes de alimentação após a palatoplastia, e os fatores socioeconômicos e tipo de fissura não influenciou na aquisição de habilidades. Conclusões ­ A maioria dos cuidadores eram capazes para o atendimento; os fatores socioeconômicos analisados não influenciaram a capacidade de auto-atendimento; e 24 horas de internação foram suficientes para a realização de habilidades relacionadas ao cuidado.

Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty / Dúvidas de cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios de queiloplastia e palatoplastia dudas de cuidadores de niños con fisura labiopalatina acerca de los cuidados posoperatorios de queiloplastia y palatoplastia / Dúvidas de cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios de queiloplastia e palatoplastia

Objective To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. Method Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. Results Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%). Conclusion The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound. .

Objetivo Identificar as principais dúvidas dos cuidadores de crianças com fissura labiopalatina sobre os cuidados pós-operatórios das cirurgias de queiloplastia e palatoplastia. Método Estudo transversal realizado em um hospital de referência, entre os meses de setembro a novembro de 2012. A amostra constou de 50 indivíduos divididos em dois grupos, sendo 25 cuidadores de crianças submetidas à queiloplastia e 25 crianças submetidas à palatoplastia. As dúvidas foram identificadas por meio de entrevista, realizada durante a consulta de Enfermagem pré-operatória, e, posteriormente, foram categorizadas por similaridade. Utilizou-se a análise estatística descritiva para construção dos resultados. Resultados Observou-se que, em relação à queiloplastia, as dúvidas foram sobre alimentação (36%), higienização e cicatrização (24% cada), e dor e infecção (8% cada). Quanto à palatoplastia, as dúvidas se relacionaram à: alimentação (48%), higienização (24%), dor (16%), sangramento (8%) e infecção (4%). Conclusão Evidenciou-se a preocupação dos cuidadores em relação à alimentação e aos cuidados com a ferida pós-operatória. .

Objetivo Identificar las principales dudas de los cuidadores de niños con fisura labiopalatina acerca de los cuidados posoperatorios de las cirugías de queiloplastia y palatoplastia. Método Estudio transversal llevado a cabo en un hospital de referencia, entre los meses de septiembre a noviembro de 2012. La muestra constó de 50 individuos divididos en dos grupos, siendo 25 cuidadores de niños sometidos a la queiloplastia y 25 niños sometidos a la palatoplastia. Las dudas fueron identificadas por medio de entrevista, realizada durante la consulta de Enfermería preoperatoria y, posteriormente, fueron categorizadas por similaridad. Se utilizó el análisis estadístico descriptivo para la construcción de los resultados. Resultados Se observó que, con respecto a la queiloplastia, las dudas fueron acerca de la alimentación (36%), higienización y cicatrización (24% cada), y dolor e infección (8% cada). En cuanto a la palatoplastia, las dudas estuvieron relacionadas con: la alimentación (48%), higienización (24%), dolor (16%), sangrado (8%) e infección (4%). Conclusión Se evidenció la preocupación de los cuidadores con respecto a la alimentación y los cuidados con la herida posoperatoria. .

Enamel defects in permanent first molars and incisors in individuals with cleft lip and/or palate / Defectos de esmalte en primeros molares e incisivos en individuos con fisura labial y/o palatina

Background. Enamel defects are common in deciduous and permanent maxillary incisors of individuals with lip and palate cleft, and their occurrence has been associated with the cleft, especially when the alveolus is affected. Objective. To compare the prevalence of enamel defects in permanent maxillary and mandibular central incisors and first molars of individuals with cleft lip and palate, cleft palate, and without clefts. Materials and methods. The study analyzed the case of 150 individuals -50 with cleft lip and palate, 50 with cleft palate and 50 without clefts-, of both genders and aged 6 to 12 years. The frequency, extent, and location of enamel alterations on the buccal aspect of teeth were evaluated by the modified DDE index. Results. There was a greater manifestation of enamel defects in maxillary incisors and molars in groups with clefts, with statistically significant difference compared with the noncleft group. Conclusions. The occurrence of enamel defects was common in permanent incisors and molars and was significantly associated with clefts.

Antecedentes. Los defectos de esmalte son comunes en los incisivos superiores deciduos y permanentes de individuos con fisura de labio y paladar; su ocurrencia ha sido asociada con la fisura, especialmente cuando el alveolo es afectado. Objetivo. Comparar la prevalencia de defectos de esmalte en incisivos centrales y primeros molares superiores e inferiores permanentes de individuos con fisura labiopalatina, fisura palatina y sin fisura. Materiales y métodos. El estudio analizó el caso de 150 individuos -50 con fisura labiopalatina, 50 con fisura palatina y 50 sin fisura- de ambos géneros entre 6 y 12 años. La frecuencia, extensión y localización de las alteraciones de esmalte en la superficie vestibular de los dientes fue evaluado por el índice DDE modificado. Resultados. Hubo mayor manifestación de defectos de esmalte en incisivos y molares superiores en los grupos con fisuras, con diferencia estadística significativa comparada con el grupo sin fisura. Conclusiones. La ocurrencia de defectos de esmalte fue común en incisivos y molares permanentes y estuvo significativamente asociada a las fisuras.

Prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate

OBJECTIVE: This study aimed at carrying out a radiographic analysis on the prevalence of dental anomalies of number (agenesis and supernumerary teeth) in permanent dentition, in different subphenotypes of isolated cleft palate pre-adolescent patients. METHODS: Panoramic radiographs of 300 patients aged between 9 and 12 years, with cleft palate and enrolled in a single treatment center, were retrospectively analyzed. The sample was divided into two groups according to the extension/severity of the cleft palate: complete and incomplete . The chi-square test was used for intergroup comparison regarding the prevalence of the investigated dental anomalies (P < 0.05). RESULTS: Agenesis was found in 34.14% of patients with complete cleft palate and in 30.27% of patients with incomplete cleft palate. Supernumerary teeth were found in 2.43% of patients with complete cleft palate and in 0.91% of patients with incomplete cleft palate. No statistically significant difference was found between groups with regard to the prevalence of agenesis and supernumerary teeth. There was no difference in cleft prevalence between genders within each study group. CONCLUSION: The prevalence of dental anomalies of number in pre-adolescents with cleft palate was higher than that reported for the general population. The severity of cleft palate did not seem to be associated with the prevalence of dental anomalies of number. .

OBJETIVO: o propósito deste estudo foi avaliar radiograficamente a prevalência das anomalias dentárias de número (agenesias e supranumerários), na dentição permanente, em diferentes subfenótipos da fissura isolada de palato, em pacientes pré-adolescentes. MÉTODOS: foram investigadas, de forma retrospectiva, 300 radiografias panorâmicas de pacientes com fissura palatina (pós-forame), de 9 a 12 anos de idade, matriculados em um mesmo centro. A amostra foi dividida em dois grupos de acordo com a extensão/gravidade da fissura palatina: completa e incompleta. O teste qui-quadrado foi utilizado para comparação intergrupos das prevalências de anomalias avaliadas (p < 0,05). RESULTADOS: a agenesia dentária foi encontrada em 34,14% dos pacientes com fissura pós-forame completa e em 30,27% com fissura pós-forame incompleta. A prevalência de dentes supranumerários correspondeu a 2,43% nos pacientes com fissura palatina completa e a 0,91% no grupo com fissura palatina incompleta. Não houve diferença estatística significativa entre os grupos quanto à prevalência de agenesias dentárias e supranumerários. Não se observou diferença sexual quanto à prevalência de fissura dentro de cada grupo de estudo. CONCLUSÃO: os pacientes pré-adolescentes com fissura palatina apresentam maior prevalência de anomalias dentárias em relação à população em geral. A gravidade da fissura palatina parece não se associar com a prevalência de anomalias dentárias de número. .

Sequência de Robin e suas repercussões sobre a microbiota bucal: revisão de literatura / Robin sequence and its repercussions on the oral microbiota: literature review

A cavidade bucal é a principal porta de entrada dos micro-organismos existentes no meio externo para o interior do corpo humano. A sequência de Robin é descrita como uma tríade de anomalias, caracterizada por micrognatia (hipodesenvolvimento mandibular) e glossoptose (deslocamento posterior da língua, que causa obstrução na faringe), com ou sem fissura palatina associada. Diante disso, o objetivo do presente estudo foi realizar uma revisão de literatura enfatizando as características principais e peculiares da microbiota bucal de crianças com sequência de Robin. A dificuldade respiratória, de ingestão de nutrientes, aleitamento materno insuficiente, otites recorrentes, entre outras complicações, ocorrem com frequência em crianças com essa patologia, influenciando a composição da microbiota bucal. A associação da palatoplastia e o uso de antibiótico intensificam as mudanças nessa microbiota. Novas investigações devem ser realizadas, para verificar quais fatores relacionados com a malformação craniofacial, ao tratamento cirúrgico e ao uso de antimicrobianos estariam implicados na alteração da microbiota bucal descrita neste trabalho, bem como suas repercussões clínicas...

Evaluation of fecal microorganisms of children with cleft palate before and after palatoplasty

This study isolated and quantified intestinal bacteria of children with cleft palate before and after palatoplasty. A prospective study was conducted from May 2007 to September 2008 on 18 children with cleft palate, aged one to four years, of both genders, attending a tertiary cleft center in Brazil for palatoplasty, to analyze the effect of surgical palate repair on the concentration of anaerobes Bacteroides sp, Bifidobacterium sp and microaerophiles Lactobacillus sp in feces of infants with cleft palate before and 24 hours after treatment with cefazolin for palatoplasty. There was significant reduction of Lactobacillus sp (p < 0.002), Bacteroides sp (p < 0.001) and Bifidobacterium sp (p = 0.021) after palatoplasty, revealing that surgery and utilization of cefazolin significantly influenced the fecal microbiota comparing collections before and after surgery. However, due to study limitations, it was not possible to conclude that other isolated factors, such as surgical stress, anesthetics and other medications used in palatoplasty might have a significant influence on the microbiota. Considering the important participation of the intestinal microbiota on both local and systemic metabolic and immunological activities of the host, professionals should be attentive to the possible influence of these changes in patients submitted to cleft repair.

Programmatic actions in oral health: coping with social inequities

Inequities are health imbalances that are avoidable, unfair and unnecessary. Studies on health inequities address the need for emergency care related to oral-dental lesions from external causes, toothache or prevalence of oral lesions, taking into account the differences between individuals and/or populations in terms of risk conditions to acquiring disease or access to health services. Inequities may be caused by the health service itself, because diseases affect socially deprived individuals more frequently and severely, especially because of multimorbidity. In the current Brazilian public health situation, programmatic actions are based on technological knowledge, especially epidemiology, focused on specific pathologies or disease risk groups, and relate closely to the organization of programmed demand. Moreover, programmatic actions should strategically use technological devices, without disregarding technical and policy flexibility, and should be closely related to inter-subjectivity and ethics, in order to develop emancipating capabilities. An action having this structure could make it easier to achieve Universality, Equity and Integrality.

Mechanisms and clinical management of pain

Pain is an unpleasant, sensitive and emotional experience associated with or described in terms of tissue lesion, and may be acute or chronic. It may also be classified as nociceptive, neuropathic or psychogenic. Nociceptive pain involves the transformation of environmental stimuli into action potentials carried to the central nervous system, where they are modulated and integrated up to final interpretation in the cerebral cortex. Neuropathic pain may arise as a consequence of the direct lesion of axons, or of an increase in the production of neurotrophic factors. Chronic pain is always associated with anxiety and some degree of depression. Drug therapy should be selected according to its efficacy; nonetheless, the professional should also consider the tolerability and adverse effects that may occur, for example, in elderly individuals. It is necessary to emphasize the safety-considering the possibility of drug interactions-and define the posology to promote better adherence. However, the treatment of neuropathic pain should not be limited to the use of analgesic drugs, which are just one among several options enabling patients to participate in bio-psycho-social rehabilitation programs.

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Lõe and O'Leary), clinical attachment level, gingival index (according to Silness and Lõe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Oral findings in patients with Apert Syndrome

INTRODUCTION: The Apert syndrome is a rare disorder of autosomal dominant inheritance caused by mutations in the FGFR2 gene at locus 10q26; patients with this syndrome present severe syndactyly, exophthalmia, ocular hypertelorism and hypoplastic midface with Class III malocclusion, besides systemic alterations. Most investigations available on the Apert syndrome address the genetic aspect or surgical management, with little emphasis on the oral aspects. OBJECTIVE: to investigate the oral findings, including dental anomalies, ectopic eruption of the maxillary permanent first molars and soft tissue alterations, in subjects with Apert syndrome. MATERIALS AND METHODS: clinical and radiographic examination of nine patients with Apert syndrome, aged 6 to 15 years, not previously submitted to orthodontic or orthognathic treatment. RESULTS: dental anomalies were present in all patients, with one to eight anomalies per individual. The most frequent anomalies were tooth agenesis, mainly affecting maxillary canines, and enamel opacities (44.4 percent for both). Ectopic eruption of maxillary first molars was found in 33.3 percent of patients; lateral palatal swellings were observed in 88.8 percent of patients. CONCLUSIONS: The occurrence of typical lateral palatal swellings agrees with the literature. The high prevalence of dental anomalies and ectopic eruption may suggest a possible etiologic relationship with the syndrome.

INTRODUÇÃO: A síndrome de Apert é um distúrbio raro de herança autossômica dominante causado por mutações no lócus 10q26 do gene FGFR2; pacientes com esta síndrome apresentam sindactilia severa, exoftalmia, hiperteleorbitismo e hipoplasia da face média com má oclusão de Classe III, além de alterações sistêmicas. A maior parte dos estudos disponíveis sobre a síndrome de Apert aborda o aspecto genético ou manejo cirúrgico, com pouca ênfase nos aspectos bucais. OBJETIVO: investigar os achados bucais, incluindo anomalias dentárias, irrupção ectópica dos primeiros molares permanentes superiores e alterações de tecido mole, em indivíduos com síndrome de Apert. MATERIAIS E MÉTODOS: exame clínico e radiográfico de nove pacientes com síndrome de Apert, de 6 a 15 anos de idade, não anteriormente submetidos a tratamento ortodôntico ou ortognático. RESULTADOS: anomalias dentárias estavam presentes em todos os pacientes, com uma a oito anomalias por indivíduo. As anomalias mais freqüentes foram agenesia dentária, principalmente afetando os caninos superiores, e opacidades de esmalte (44,4 por cento para ambos). Foi observada irrupção ectópica dos primeiros molares superiores em 33,3 por cento dos pacientes; foram observados aumentos volumétricos laterais da mucosa palatina em 88,8 por cento dos pacientes. CONCLUSÕES: a ocorrência de aumentos volumétricos laterais típicos da mucosa palatina concorda com a literatura. A alta prevalência de anomalias dentárias e irrupção ectópica pode sugerir uma possível relação etiológica com a síndrome.

Pattern of disocclusion in patients with complete cleft lip and palate

OBJECTIVE: to analyze the pattern of disocclusion during excursive mandibular movements and presence or absence of occlusal interferences and occlusal pathologies (gingival recession and abfraction). METHOD: examination of 120 individuals divided into two groups, as follows: Group 1 - 90 patients with complete cleft lip and palate (study group), subdivided into 30 patients with complete left unilateral cleft lip and palate, 30 patients with complete right unilateral cleft lip and palate and 30 patients with complete bilateral cleft lip and palate; Group 2 - 30 individuals without clefts (control group). RESULTS: 58.8 percent of patients in Group 1 presented unilateral or bilateral canine guidance, 26.6 percent presented unilateral or bilateral group function and 54.4 percent presented lateral movements through the posterior teeth. Regarding protrusive movements, 80 percent presented anterior guidance and 20 percent presented posterior guidance. In Group 2, 69.6 percent of individuals presented unilateral or bilateral canine guidance, 43.2 percent presented unilateral or bilateral group function and only 13.3 percent presented lateral movements through the posterior teeth; 3.4 percent presented protrusion through the posterior teeth. CONCLUSIONS: there was no difference in the pattern of disocclusion between subgroups of patients with clefts. Group 2 presented predominance of bilateral group function, whereas Group 1 presented a higher prevalence of posterior guidance during lateral movements. Protrusion occurred primarily through anterior guidance in Group 2 and through the posterior teeth in Group 1. There was high prevalence of occlusal interferences at the molar area for both groups, yet with no correlation with occlusal pathologies (recession and abfraction).

OBJETIVO: avaliar o padrão de desoclusão apresentado nos movimentos excursivos mandibulares e a presença ou não de interferências oclusais e patologias relacionadas à oclusão (recessão gengival e abfração). MÉTODO: exame de 120 indivíduos, divididos em 2 grupos: Grupo 1 - 90 pacientes com fissura completa de lábio e palato, subdivididos em 30 pacientes com fissura completa de lábio e palato unilateral esquerda, 30 pacientes com fissura completa de lábio e palato unilateral direita e 30 com fissura completa de lábio e palato bilateral; e Grupo 2 - 30 indivíduos sem fissuras (grupo controle). RESULTADOS: 58,8 por cento do Grupo 1 apresentaram guia canina uni ou bilateralmente, 26,6 por cento apresentaram desoclusão com função em grupo uni ou bilateral e 54,4 por cento realizaram estes movimentos laterais através dos dentes posteriores; 80 por cento dos pacientes do Grupo 1 realizava protrusão pelos dentes anteriores e 20 por cento pelos posteriores. Para o Grupo 2, guia canina uni ou bilateral foi observada em 69,6 por cento dos indivíduos, 43,2 por cento apresentaram função em grupo uni ou bilateral e somente 13,3 por cento realizaram os movimentos laterais pelos dentes posteriores. Apenas 3,4 por cento dos indivíduos do Grupo 2 apresentaram protrusão pelos dentes posteriores. CONCLUSÕES: não houve diferença estatisticamente significativa no padrão de desoclusão entre os subgrupos de pacientes com fissuras. O Grupo 2 apresentou predominância de função em grupo bilateral, enquanto o Grupo 1 apresentou maior prevalência de guia posterior durante os movimentos laterais. A protrusão ocorreu principalmente por guia anterior no Grupo 2 e pelos dentes posteriores no Grupo 1. Houve alta prevalência de interferências oclusais na região de molares para ambos os grupos, entretanto sem correlação com patologias oclusais (recessão e abfração).