Oral findings in children on liver transplantation programming: a scoping review.

OBJECTIVE: To identify oral characteristics found in children with liver disease in programming for liver transplantation. DATA SOURCE: The methodology was written according to PRISMA-ScR. We adopted the methodological framework and recommendations for this type of review by Arksey and O'Malley and the Joanna Briggs Institute. The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). A systematic search (Medline/PubMed, Scopus, Web of Science, and ProQuest) was conducted to identify studies that met the inclusion criteria: systematic reviews; prospective clinical trials (parallel or crossover group designs); observational studies (cohort, case-control, and cross-sectional studies); clinical case series; and case reports evaluating children with liver disease in preparation for transplantation. The last search was conducted in July 2021, and no restrictions were imposed as to language or year of publication. Studies presenting mixed data with post-transplant evaluation, and studies evaluating not only liver transplantation but also other solid organs were excluded. Screening, inclusion, and data extraction were performed by two reviewers independently. A narrative synthesis was conducted to describe the findings of the study. DATA SYNTHESIS: The bibliographic search identified 830 references. A total of 21 articles were read in their entirety after the inclusion criteria assessment. Finally, after evaluating the exclusion criteria, only 3 studies were considered for the qualitative analysis. CONCLUSIONS: Children with liver disease in preparation for transplantation may present enamel defects, tooth pigmentation, caries, gingivitis, and opportunistic infections such as candidiasis.

Case-control study analyzing the relationship between oral microcirculation and oral mucositis and pain in patients under antineoplastic therapy.

The study aimed to evaluate the relation between microcirculation of the genian region using laser Doppler flowmetry and oral mucositis (OM) and pain in individuals undergoing antineoplastic therapy. A case-control clinical study was conducted with the participants divided into three groups: chemotherapy (CTG), radiation therapy and chemotherapy group (RCTG), and control group (CG). Pain was assessed by visual analog scale; OM was classified by oral mucositis assessment and WHO scales. The blood flow was assessed by laser Doppler flowmetry. Kruskal-Wallis statistical test, Friedman test, and Spearman test were used for statistical analysis of this study. CTG (7 individuals/25.93%) showed the worst manifestations of OM between 2nd and 4th evaluations (OM-WHO: T2, p = 0.006; T3, p = 0.006; T4, p = 0.003; OM-OMAS: T2, p = 0.004; T3, p = 0.000; T4, p = 0.011), and increased blood flow over time, with the exception of the 3rd evaluation (p = 0.138). The RCTG (9 individuals/33.33%) showed the worst manifestations of oral mucositis on the 4th week (OM-WHO and OM-OMAS: p = 0.000) with a decrease in blood flow (p = 0.068). The decreased blood flow is associated with greater severity of oral mucositis and greater pain intensity.

Desafios atuais na conduta clínica em pacientes com Hipertensão Arterial Sistêmica ­ HAS / Urrent challenges in the clinical management of patients with Systemic Arterial Hypertension - SAH

INTRODUÇÃO: A hipertensão arterial sistêmica (HAS) é uma doença crônica, geralmente silenciosa e de alta prevalência. O cirurgião-dentista (CD) tem papel importante no acompanhamento e detecção de HAS subdiagnosticada. Além disso, a realização de procedimentos odontológicos em pacientes hipertensos, gera diversas dúvidas quanto à conduta, principalmente relacionadas com o limiar de pressão arterial (PA) e complicações que possam surgir durante o atendimento. OBJETIVO: Descrever estratégias de conduta e intervenção durante o atendimento odontológico de pacientes com HAS. METODOLOGIA: Foi realizada uma revisão integrativa por meio da busca nas bases de dados PUBMED/MEDLINE®, SCOPUS® e Web of Science com os seguintes descritores, "Hypertension AND Dental care AND Oral health". Foram incluídos os artigos que abordassem conduta odontológica em paciente com HAS, estivessem em inglês, disponíveis on-line e sem restrição de período. RESULTADOS: Foram encontrados 570 artigos que, depois da aplicação dos critérios de inclusão e exclusão, resultaram em sete artigos para leitura de texto completo. Verificou-se que todos eles tinham origem nos Estados Unidos da América, sendo que seis estudos eram revisões. CONCLUSÃO: Os estudos mostraram que não há necessidade de suspender os procedimentos odontológicos em pacientes assintomáticos com PA abaixo de 180-110 mmHg. Entretanto, sempre é preciso avaliar o perfil de risco, a presença de sintomas cardiovasculares, a extensão do procedimento odontológico, a necessidade de protocolo de redução de ansiedade e considerar o risco e benefício da intervenção.

Laser doppler flowmetry as a method of analysis for the evaluation of chemo - induced oral mucositis: a pilot study / Flujometría por láser doppler como método de análisis para la evaluación de la mucositis oral inducida por quimioterapia: un estudio piloto

Background: Oral mucositis (OM) is an inflammation of the oral mucosa due to cancer therapy that compromises the patient's quality of life. Laser Doppler flowmetry (LDF) is a non-invasive method to monitor microvascular blood flow (BF) in real-time. Purpose: Develop a method to evaluate BF in the genian region cheek in patients undergoing chemotherapy by LDF and compare the degrees of OM and pain with evaluation of BF. Material and methods: Evaluation of OM was performed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales and the visual analog scale for pain evaluation. For flowmetry analysis, a laser Doppler flowmeter (moorVMSTM™, 780 nm wavelength and VP3 probe), fixed by an acrylic resin support was used; VP3 probe was positioned on the genian region and the patient's head was stabilized with a neck pillow for an accurate measurement. The Wilcoxon test was used to compare the flowmetry results at the studied times. The Pearson correlation coefficient was used to evaluate relationships between BF and the WHO, OMAS and visual analog scales. Results: Eleven patients of both sexes, aged between 30 and 78 years, with OM were included. An increase in cutaneous BF was observed at the initial times of OM, with progressive reduction during the chemotherapy cycle. There was a statistical difference (p<0.05) between time point T0 (first consultation) and time point T6 (last consultation). Conclusion: The method developed in this pilot study is effective, reliable, and reproducible, and allows the evaluation of BF dynamics in the genian region using LDF of patients undergoing chemotherapy at risk of developing OM.

Antecedentes: La mucositis oral (MO) es una inflamación de la mucosa oral debido a la terapia del cáncer, que compromete la calidad de vida del paciente. La flujometría láser Doppler (FLD) es un método no invasivo para monitorear el flujo sanguíneo microvascular (FS) en tiempo real. Objetivo: Desarrollar un método para evaluar la FS en la mejilla de la región geniana en pacientes sometidos a quimioterapia por FLD y comparar los grados de MO y dolor con la evaluación del FS. Material y Métodos: La evaluación de la MO se realizó utilizando las escalas de la Organización Mundial de la Salud (OMS) y la Escala de Evaluación de la Mucositis Oral (OMAS) y la escala analógica visual para la evaluación del dolor. Para el análisis de flujometría se utilizó un flujómetro láser Doppler (moorVMSTM™, longitud de onda de 780 nm y sonda VP3), fijado por un soporte de resina acrílica; La sonda VP3 se colocó en la región geniana y la cabeza del paciente se estabilizó con una almohada para el cuello para una medición precisa. Se utilizó la prueba de Wilcoxon para comparar los resultados de la flujometría en los tiempos estudiados. Se utilizó el coeficiente de correlación de Pearson para evaluar las relaciones entre FS y las escalas de la OMS, OMAS y analógicas visuales. Resultados: Se incluyeron 11 pacientes de ambos sexos, con edades comprendidas entre 30 y 78 años, con MO. Se observó un aumento del FS cutáneo en los momentos iniciales de la MO, con reducción progresiva durante el ciclo de quimioterapia. Hubo una diferencia estadística (p<0.05) entre el momento T0 (primera consulta) y el momento T6 (última consulta). Conclusión: El método desarrollado en este estudio piloto es efectivo, confiable y reproducible, y permite evaluar la dinámica del FS en la región geniana utilizando FLD de pacientes sometidos a quimioterapia con riesgo de desarrollar MO.

The impact of medication-related osteonecrosis of the jaws on the quality of life in cancer patients.

BACKGROUND: To evaluate the impact of oral health on the quality of life (QOL) of individuals undergoing cancer treatment at the time of diagnosis of medication-related osteonecrosis of the jaw (MRONJ). MATERIAL AND METHODS: The present cross-sectional study analyzed patients with MRONJ from 2013 to 2019. The collected data included demographic data, base disease, medications associated with MRONJ, route of administration and time of use, signs, symptoms, and tomographic features of acute MRONJ, staging according to American Association of Oral and maxillofacial Surgeons position paper 2014 (AAOMS), type of dental treatment performed, outcome, and the responses to the Oral Health Impact Profile questionnaire (OHIP-14). Statistical analysis was performed using the Tukey test to study the association between oral condition and the QOL. A p-value of less than 0.05 was considered statistically significant. RESULTS: The sample consisted of 16 medical records of patients with MRONJ. Psychological discomfort showed alarmingly significant results (p< 0.001) with strong negative impact on the QOL of the patients. Functional limitation was the least affected dimension (p = 0.747). The other dimensions did not show statistically significant results. CONCLUSIONS: MRONJ compromises oral health and negatively impacts the QOL, especially with respect to the psychological discomfort (worry and stress). The OHIP-14 questionnaire proved to be an effective tool in the assessment of this impact. Key words:Medication-related osteonecrosis of the jaw, quality of life, oral health, OHIP-14.

CBCT does not reduce neurosensory disturbances after third molar removal compared to panoramic radiography: a systematic review and meta-analysis.

OBJECTIVES: The current dentistry scenario is showing an increase in the availability of cone-beam computed tomography (CBCT) in dental offices. Oral surgeons are using three-dimensional information as an additional tool to assess preoperative data for lower third molar (LTM) removal in moderate and high-risk cases of inferior alveolar nerve (IAN) injury diagnosed through the panoramic radiography (PR). The aim of this study is to identify whether CBCT examination reduces neurosensoric disturbances (ND) following the removal of the LTM when compared to PR. MATERIALS AND METHODS: PubMed, Embase, Web of Science, Science Direct, and Scopus electronic databases were searched for studies published up to February 2019. The gray literature was also searched including papers that eventually met the eligibility criteria. Meta-analysis was performed using the comprehensive meta-analysis software, p < 0.05 considered significant. RESULTS: Among the search, 6 studies met all eligibility criteria. There was no statistically significant difference between the two groups (PR and CBCT) in all six studies regarding reducing ND (95%. Confidence interval, 0,788-1734; heterogeneity: Q = 10,361; I2 = 22.788%). CONCLUSIONS: CBCT was not superior to PR in avoiding ND. However, further studies are necessary with standardized parameters for a better comparability between variables in the studies. CLINICAL RELEVANCE: To better understand the CBCT clinical applicability in LTM removal to avoid unnecessary extra radiation when compared to PR to the patient and to improve patient's prognosis.

Percepção de estudantes de graduação sobre a importância da disciplina Odontologia para pacientes com necessidades especiais / Perception of graduation students about the importance of Dentistry's discipline for patients with special needs

Pessoascom necessidades especiais (PNE) representam 10% da população mundialesuas particularidades,somadasàfalta de conhecimentosteóricose experiência clínica,fazemcom que os cirurgiões-dentistas se sintam inaptos para atendê-los. Sendo assim, o objetivo desse estudo foi identificar a importância percebida pelos estudantes de Odontologia sobre a disciplina Odontologia para Pacientes com Necessidades Especiais(OPNE). Trata-se de um estudo exploratório, descritivo e qualitativo, que realizou a coleta de dados por meio de questionáriosaplicados a29estudantes ao final da disciplinaoptativade OPNE da Faculdade de Odontologia de Bauru (FOB). Os estudantes reconhecem que a ausência de contato com PNE durante o cursoacarretará insegurança profissional para realizar o atendimento odontológico desses pacientes, dificultando assim o acesso a saúde bucal desta população. A disciplina de OPNE, neste estudo, possibilitouao estudantede aprender, conviver e realizar atendimento odontológico adequado e humanizado ao PNE (AU).

People with special needs (PSN) represent 10% of the world population and their particularities, added with the lack of theoretical knowledge and clinical experience, make dentists feel unable to attend to them.Therefore, the objective of this study was to identify the importance of dentistry students in the discipline of dentistry for patients with special needs (DPSN).This is an exploratory, descriptive, and qualitative study, for which data were collectedthrough a questionnaire administeredto 29students at the end of the DPSNdiscipline atthe Bauru School of Dentistry(BSD).Students recognizedthat the lack of contact with PSN during the course may cause professional insecurity in providingdental care to these patients, thus making access to oral healthcaredifficult for this population. The DPSN discipline in this study enabled studentsto learn, live with,and provide adequate and humanized dental care to the PSNpopulation (AU).

Risk profile for antiangiogenic agent-related osteonecrosis of the jaws.

To establish the profile of patients who developed antiangiogenic agent-related osteonecrosis of the jaws, and identify the treatments currently used in dental management. We searched the PubMed®/Medline® and Scopus databases using the words "osteonecrosis AND antiangiogenic therapy", with the following inclusion criteria: articles published in English, case reports, available online, and for an unlimited period. Of the 209 articles retrieved, 18 were selected, for a total of 19 case reports, since one article included two cases that met the inclusion criteria for this study. Medication-related osteonecrosis of the jaws is characterized by exposure of necrotic bone in the oral cavity that does not heal over a period of 8 weeks in patients with no previous history of radiation therapy. Antiangiogenic drugs are indicated in the treatment of certain tumors, since they stop the formation of new blood vessels, controlling tumor growth and the chance of metastasis. Dental prevention is essential in patients who will be put on antiangiogenic agents, to minimize the risk for osteonecrosis.

Risk profile for antiangiogenic agent-related osteonecrosis of the jaws / Perfil de risco para osteonecrose dos maxilares associada a agentes antiangiogênicos

ABSTRACT To establish the profile of patients who developed antiangiogenic agent-related osteonecrosis of the jaws, and identify the treatments currently used in dental management. We searched the PubMed®/Medline® and Scopus databases using the words "osteonecrosis AND antiangiogenic therapy", with the following inclusion criteria: articles published in English, case reports, available online, and for an unlimited period. Of the 209 articles retrieved, 18 were selected, for a total of 19 case reports, since one article included two cases that met the inclusion criteria for this study. Medication-related osteonecrosis of the jaws is characterized by exposure of necrotic bone in the oral cavity that does not heal over a period of 8 weeks in patients with no previous history of radiation therapy. Antiangiogenic drugs are indicated in the treatment of certain tumors, since they stop the formation of new blood vessels, controlling tumor growth and the chance of metastasis. Dental prevention is essential in patients who will be put on antiangiogenic agents, to minimize the risk for osteonecrosis.

RESUMO Traçar o perfil dos pacientes que desenvolveram osteonecrose dos maxilares associada a agentes antiangiogênicos e identificar os tratamentos realizados atualmente no manejo odontológico. Foi realizada busca nas bases de dados PubMed®/Medline® e Scopus por meio dos descritores "osteonecrosis AND antiangiogenic therapy", sendo utilizados os critérios de inclusão: artigos publicados em inglês, relato de caso, disponíveis on-line e por período ilimitado. Após análise dos 209 artigos encontrados, foram selecionados 18 artigos para este estudo, resultando em 19 relatos de caso, visto que um dos artigos apresentou dois casos que se enquadravam nos critérios de inclusão. A osteonecrose dos maxilares associada a medicamentos é caracterizada pela exposição de osso necrótico na cavidade oral que não cicatriza em um período de 8 semanas em pacientes que não foram submetidos à radioterapia. Os medicamentos antiangiogênicos são indicados no tratamento de alguns tumores, pois impedem o crescimento de novos vasos sanguíneos, controlando o crescimento do tumor e a chance de metastização. Torna-se imprescindível a realização de prevenção odontológica do paciente a ser submetido a uso de antiangiogênicos visando a minimizar as chances de desenvolvimento da osteonecrose.

Emergências cardiovasculares agudas: prevenção, diagnóstico e manejo odontológico / Acute cardiovascular emergencies: prevention, diagnosis and dental management

As emergências cardiovasculares agudas são complicações cardíacas com altos índices de mortalidade e podem ocorrer durante o atendimento odontológico de cardiopatas. Contribuir com medidas de prevenção, diagnóstico e manejo odontológico de emergências cardiovasculares agudas durante o tratamento dentário através de uma revisão integrativa. A anamnese minuciosa associada a medidas de controle de estresse/ ansiedade são as principais formas de prevenir a ocorrência de eventos cardíacos no consultório odontológico. Durante a crise, o conhecimento dos principais sinais e sintomas é fundamental no diagnóstico diferencial de cardiopatias agudas e, após estabelecido, devem-se iniciar os primeiros socorros básicos através do acionamento do serviço de emergência, seguido pelo posicionamento corporal adequado do paciente e administração dos protocolos farmacológicos específicos para cada situação. O consultório odontológico deve obrigatoriamente possuir os equipamentos necessários para monitorização dos sinais vitais durante o evento cardiovascular agudo e garantir a disponibilização de oxigênio para que o cirurgião-dentista possa iniciar os protocolos de ressuscitação caso o paciente evolua para uma parada cardiorrespiratória. O manejo odontológico das emergências cardiovasculares agudas inicia-se com cuidados preventivos específicos, realização do diagnóstico correto da cardiopatia aguda, tomada de conduta adequada das complicações cardíacas que possam ocorrer durante o tratamento odontológico, objetivando a diminuição da morbimortalidade dessas emergências

Acute cardiovascular emergencies are cardiac complications with high mortality rates, and can occur during the dental care of cardiac patients. To contribute to the prevention, diagnosis and dental management of acute cardiovascular emergencies during dental treatment, through an integrative review. A detailed anamnesis, associated with measures of stress/anxiety control, are the main ways to prevent the occurrence of cardiac events in the dental office. During the crisis, a knowledge of the main signs and symptoms is fundamental in the differential diagnosis of acute heart diseases and once established, basic first aid should be given, activating the emergency services followed by the appropriate body positioning of the patient and administration of specific pharmacological protocols for each situation. The dental office must have the equipment needed to monitor the vital signs during the acute cardiovascular event, and ensure the availability of oxygen, so that the dental surgeon can initiate resuscitation protocols if the patient goes into cardiopulmonary arrest. Dental management of acute cardiovascular emergencies begins with specific preventive care, a correct diagnosis of acute cardiopathy, and correct management of cardiac complications that can occur during dental treatment, aiming to reduce the morbidity and mortality of these emergencies