Oral management of pemphigus vulgaris in the intensive care unit.

Pemphigus vulgaris (PV) is a rare and potentially lethal autoimmune disease that affects the skin and mucous membranes. Injuries caused by the disease cause pain, risk of infection, and other complications that result in a high mortality rate. Frequently, management of the PV requires intensive care and a multidisciplinary approach. Oral lesions of PV are usually the first clinical signs of the disease and the last lesions to heal, requiring treatment by a specialized dental team. The aim of this study was to report two clinical cases of PV with involvement of the oral mucosa. The patients were admitted to an intensive care unit, and underwent multidisciplinary management of their condition along with low-level laser therapy. Both cases demonstrated the importance of specialized dental care in improving the quality of life of patients with PV.

Oral Health of Children with Congenital Heart Disease at a Pediatric Health Science Centre.

PURPOSE: This study aimed to examine the oral health status of seniors residing in Providence Health Care (PHC) long-term care facilities in 2002 and 2012. METHODS: Staff dentists with the University of British Columbia Geriatric Dentistry Program made a complete oral health assessment of 799 elderly residents of 7 long-term care PHC facilities in 2002 and 381 residents in the 5 remaining PHC facilities in 2012. The 2012 data were divided into those for 275 residents who had received treatment in previous years and 106 new residents. All consenting residents were examined by dentists using the clinical oral disorder in elders (CODE) index detailing their medical and oral health status and medications. On completion of the oral health assessment, the dentist documented the need for specific dental treatment and reassessment. RESULTS: Comparing the cohorts from 2002 and 2012, the mean age of the residents who had CODE assessments increased from 85 years to 86 years, the proportion of men increased from 31% to 35%, the mean number of medical conditions per resident remained unchanged (2.6 to 2.5), but the mean number of prescribed medications has increased from 4.0 to 4.6. The percentage of residents with natural teeth increased from 56% to 76%. The proportion of edentulous residents recommended for denture-related treatment decreased from 21% to 10%. The 106 new residents in 2012 had higher treatment needs than the 275 original residents, but fewer required extractions than in 2002. Although the mean number of teeth per resident examined increased from 14.6 to 17.4 over the study period, the need for restorations remained at 20%, and the need for extraction of teeth decreased from 22% to 6%. The proportion of residents with healthy periodontium increased from 14% to 21%, but the need for dental hygiene services increased from 43% to 80%. CONCLUSIONS: The profile of long-term care residents who consented to an oral health assessment changed over the first decade of the new millennium, with an increase in mean age and number of prescribed medications, number of retained natural teeth and the need for dental hygiene services, but a decrease in the need for extractions.

Tooth abnormalities in pediatric patients submitted to antineoplastic treatment for central nervous system neoplasms / Anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central

Objective: The aim of this study was to evaluate the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms. Material and methods: This crosssectional study assessed thirty-one patients, median age 14.2 years (range 5 - 25), who were off therapy for at least one year, comparatively with a control group of thirty-one healthy patients matched for age with the study group. Tooth abnormalities were evaluated by panoramic radiographs. Results: There was no statistical significant evidence that patients of the study group (age range 5 - 25 years) have more frequency of tooth abnormalities comparatively with controls. However, in children who were diagnosed before five years of age, microdontia was the most common abnormality with statistically significant difference (P = 0.037). Root shortening grade III was observed in patients over 10 years of age at the time of radiographic examination, also with statistical significance (P = 0.046). Conclusions: There was no difference in the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms, comparatively with the control group. However, the findings of this study highlight the importance of giving parents and patients orientation about maintenance of good oral hygiene and proper treatment.

Objetivo: O objetivo deste estudo foi avaliar a frequência de anormalidades dentárias em pacientes pediátricos tratados para neoplasias do sistema nervoso central. Material e Métodos: Este estudo transversal avaliou trinta e um pacientes, com média de idade de 14,2 anos (entre 5 – 25 anos), que estavam fora de terapia há pelo menos um ano, comparativamente com um grupo controle composto por 31 pacientes saudáveis pareados por idade com o grupo de estudo. As anormalidades dentárias foram avaliadas por meio de radiografias panorâmicas. Resultados: Não houve evidência estatisticamente significante de que pacientes do grupo de estudo (entre 5 – 25 anos) apresentam maior frequência de anormalidades dentárias quando comparados aos pacientes do grupo controle. No entanto, em crianças diagnosticadas antes dos cinco anos de idade, microdontia foi a anormalidade mais comumente encontrada, com diferença estatisticamente significante (P=0.037). Encurtamento radicular grau III foi observado em pacientes com mais de 10 anos de idade ao exame radiográfico, também com significância estatística (P=0.046). Conclusão: Não houve diferença na frequência de anormalidades dentárias em pacientes pediátricos submetidos a tratamento antineoplásico para neoplasias do sistema nervoso central, comparativamente ao grupo controle. No entanto, os achados deste estudo ressaltam a importância de reconhecer os efeitos dentários tardios do tratamento antineoplásico em crianças com câncer e deste modo orientar pacientes e responsáveis sobre cuidados de higiene bucal e sobre opções de tratamento apropriado.

Dental anomalies in children submitted to antineoplastic therapy.

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Dental anomalies in children submitted to antineoplastic therapy

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Dental approach in the pediatric oncology patient: characteristics of the population treated at the dentistry unit in a pediatric oncology brazilian teaching hospital.

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.

Dental approach in the pediatric oncology patient: characteristics of the population treated at the dentistry unit in a pediatric oncology brazilian teaching hospital

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54 percent (n=100) of the patients had blood cancers, 46 percent (n=86) had solid tumors and 63 percent were undergoing anticancer therapy. The proportion of males (52.7 percent) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2 percent). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.

Necessidade de cuidados paliativos odontológicos em crianças com doenças crônicas (PAP)

O cuidado paliativo em crianças é uma abordagem multidisciplinar que tem como objetivo melhorar a qualidade de vida de crianças com doenças que limitam a vida e seus familiares, por meio do controle sintomático, cuidado psicossocial, espiritual e suporte durante o luto. A cavidade oral é frequentemente acometida nos pacientes em cuidados paliativos e diversas alterações bucais podem aparecer, podendo ser decorrentes da própria doença, pela terapêutica indicada ou por um transtorno concorrente. Podem aparecer durante todo o curso da doença, porém são mais prevalentes durantes as terapias e em sua fase terminal. Em geral, os problemas bucais que afetam a população pediátrica também estão presentes em crianças e adolescentes em cuidados paliativos, no entanto, podem se manifestar de maneira mais intensa e freqüente pelo comprometimento do estado de saúde geral do paciente, tipo de dieta, medicações, hospitalização prolongada, higiene deficiente e outros. Os problemas bucais se não tratados podem resultar em dor, desconforto e comprometimento nutricional, com impacto na evolução e prognóstico da doença. O dentista contribui para o alívio e controle dos sintomas, minimizando a dor e o sofrimento das crianças e seus familiares, com cuidados de suporte e simples intervenções a fim de assegurar uma boca limpa, livre de dor e infecções. Assim, o objetivo deste trabalho é apresentar um projeto de pesquisa para avaliar as necessidades de cuidados paliativos em crianças com doenças crônicas e caracterizar a amostra.