Social Determinants of Health in Imaging-based Cancer Screening: A Case-based Primer with Strategies for Care Improvement.

Health disparities, preventable differences in the burden of disease and disease outcomes often experienced by socially disadvantaged populations, can be found in nearly all areas of radiology, including emergency radiology, neuroradiology, nuclear medicine, image-guided interventions, and imaging-based cancer screening. Disparities in imaging-based cancer screening are especially noteworthy given the far-reaching population health impact. The social determinants of health (SDoH) play an important role in disparities in cancer screening and outcomes. Through improved understanding of how SDoH can drive differences in health outcomes in radiology, radiologists can effectively provide patient-centered, high-quality, and equitable care. Radiologists and radiology practices can become active partners in efforts to assist patients along their imaging journey and overcome existing barriers to equitable cancer screening care for traditionally marginalized populations. As radiology exists at the intersection of diagnostic imaging, image-guided diagnostic intervention, and image-guided treatment, radiologists are uniquely positioned to design these strategies. Cost-effective and socially conscious strategies that address barriers to equitable care can improve both public health and equitable health outcomes. Potential strategies include championing supportive health policy, reducing out-of-pocket costs, increasing price transparency, improving education and outreach efforts, ensuring that appropriate language translation services are available, providing individualized assistance with appointment scheduling, and offering transportation assistance and childcare. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Spiritual Well-Being and Death Anxiety: A Cross-Sectional Study Among Iranian Patients With Acute Coronary Syndrome.

Acute coronary syndrome (ACS) patients experience a tremendous psychological burden, typically in the form of death worry due to acute medical conditions and the possibility of mortality. The unfavourable conditions of ACS patients cause them to reconsider the meaning of life and their spiritual well-being. This study evaluated the association between death anxiety and spiritual well-being in a total of 241 ACS patients in Shahroud, northeast of Iran. The data were collected using the Templer Death Anxiety Scale, and the Spiritual Well-being Scale by convenience sampling method. All patients indicated a high degree of death anxiety, and roughly half reported a moderate level of spiritual well-being. There was a significant and direct correlation between death anxiety and spiritual well-being levels. Older age, single status, and non-smoking were other predictors of good spiritual well-being. A multidisciplinary health team should identify and implement approaches to promote spiritual well-being and reduce mental suffering.

Artificial Intelligence-Augmented Pediatric Lung POCUS: A Pilot Study of Novice Learners.

OBJECTIVE: Respiratory symptoms are among the most common chief complaints of pediatric patients in the emergency department (ED). Point-of-care ultrasound (POCUS) outperforms conventional chest X-ray and is user-dependent, which can be challenging to novice ultrasound (US) users. We introduce a novel concept using artificial intelligence (AI)-enhanced pleural sweep to generate complete panoramic views of the lungs, and then assess its accuracy among novice learners (NLs) to identify pneumonia. METHODS: Previously healthy 0- to 17-year-old patients presenting to a pediatric ED with cardiopulmonary chief complaint were recruited. NLs received a 1-hour training on traditional lung POCUS and the AI-assisted software. Two POCUS-trained experts interpreted the images, which served as the criterion standard. Both expert and learner groups were blinded to each other's interpretation, patient data, and outcomes. Kappa was used to determine agreement between POCUS expert interpretations. RESULTS: Seven NLs, with limited to no prior POCUS experience, completed examinations on 32 patients. The average patient age was 5.53 years (±1.07). The median scan time of 7 minutes (minimum-maximum 3-43; interquartile 8). Three (8.8%) patients were diagnosed with pneumonia by criterion standard. Sensitivity, specificity, and accuracy for NLs AI-augmented interpretation were 66.7% (confidence interval [CI] 9.4-99.1%), 96.5% (CI 82.2-99.9%), and 93.7% (CI 79.1-99.2%). The average image quality rating was 2.94 (±0.16) out of 5 across all lung fields. Interrater reliability between expert sonographers was high with a kappa coefficient of 0.8. CONCLUSION: This study shows that AI-augmented lung US for diagnosing pneumonia has the potential to increase accuracy and efficiency.

Necessity of Fine-Needle Aspiration in Probably Benign Sonographic Appearance of Thyroid Nodules.

INTRODUCTION: The management of thyroid nodules has been proposed based on US features and information obtained from Fine-Needle Aspiration Cytology (FNAC). In this study, we checked the diagnostic value of ultrasound in comparison with FNAC in probably benign nodules of thyroid. MATERIALS AND METHODS: Patients with thyroid nodules referred to the Radiology department from 2015 to 2020, were classified into five types based on the American College of Radiology/thyroid imaging reporting and data system (TI-RADS) standards. The patients with TI-RADS III-V were examined by FNA biopsy. Subsequently, the collected data of 535 patients having thyroid nodules with TI-RADS III were statistically analyzed. RESULTS: The mean age of the patients was estimated at 46.57. The analysis of TI-RADS III cases examined by the FNA biopsy revealed that 99.1% of the cases were diagnosed with benign lesions. The mean size of benign and malignant nodules was 27mm and 41mm, respectively. There was no significant correlation between the size of the nodules or patients age, and thyroid malignancy (P-values > 0.05). CONCLUSION: There was a very low chance of malignancy (0.9%) in thyroid nodules with thyroid imaging classification of TI-RADS III. Furthermore, no meaningful correlation was observed between the size of the nodules and their malignancy. Therefore, the use of FNAC, based on the current guidelines, on thyroids for nodules larger than 2.5 cm might need to be revised.

Evaluación de tres técnicas para el manejo de conducta odontológica en pacientes con trastorno del espectro autista / Evaluation of three techniques for the dental behavior management in autistic spectrum disorder patients

Objetivo. Evaluar tres técnicas para el manejo de conducta: Desensibilización Sistemática (DS), Método Treament and Education of Autistic and related Communication Handi-capped Children (TEACCH) y la técnica Decir, Mostrar, Hacer (DMH), durante la atención dental a personas con trastorno del espectro autista (TEA). Métodos. Participaron 18 personas del Noreste de México con diagnóstico de TEA, con un rango de 13 a 15 años divididos en tres grupos según la técnica TEACCH, DS y DMH con seis personas por grupo. A los participantes se les realizó una profilaxis dental empleando la técnica de manejo de conducta y comunicación según el grupo, la conducta se evaluó usando las escalas Frankl ́s Behavior Rating Scale (FBRS) y Comfort Behavior Scale (CBS). Se usaron las pruebas Chi cuadrado, ANOVA y t de Student para comparar los resultados. Resultados. La conducta evaluada con la escala de Frankl, fue definitivamente positiva en los grupos TEACCH (33,3%) y DS (16,7%). Conducta positiva semejante en los tres grupos (66,7%). Conducta negativa semejante en DS y DMH (16,7%). Conducta definitivamente negativa solo en el grupo DMH (16,7%). En la escala CBS, solo el grupo DMH presentó aumento del tono muscular (p= 0,013) y tensión facial no sostenida (p= 0,001), al compararlo con TEACCH y DS. Conclusiones. Las tres tecnicas utilizadas son efectivas para el manejo de conducta de las personas con TEA durante el tratamiento dental, sin embargo en la técnica DMH se observó conducta definitivamente negativa y respuesta corporal-conductual que refleja tensión emocional.

Objective. Evaluate three behavior management techniques: Systematic Desensitization (SD), the Treament and Education of Autistic and related Communication Handicapped Children (TEACCH) and Tell, Show, Do (TSD) Method, during dental care for people with Autism Spectrum Disorder (ASD). Methods. Eighteen people from Northeast Mexico diagnosed with autism spectrum disorder participated, with a range of 13 to 15 years, divided in to three groups, according to the TEACCH, SD and TSD technique with six participants per group. A dental prophylaxis was performed on the participants, using the behavior management and communication technique according to the group, the behavior was evaluated using the Frankl's behavior rating scale (FBRS) and Comfort Behavior Scale (CBS). Chi square, ANOVA and Student's t tests were used to compare the results. Results. Behavior evaluated with Frankl scale was definitely positive in TE-ACCH (33.3%) and DS (16.7%) groups. Similar positive behavior in the three groups (66,7%). Similar negative behavior in DS and DMH (16.7%). Definitively negative behavior only in the DMH group (16.7%). With CBS scale, only the DMH group presented increased muscle tone (p= 0.013) and evident not sustained tension in some facial muscles (p= 0.001), when compared with TEACCH and DS by ANOVA analysis. Conclusions. The three techniques evaluated are effective for managing behavior of people with ASD during dental treatment, however, in DMH technique, definitely negative behavior and a corporal-behavioral response were observed, reflecting emotional stress.

Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle.

OBJECTIVE:: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. MATERIAL AND METHODS:: The patients were in the range of 6-17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. RESULTS:: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (p<0.05). In this group, supernumerary deciduous teeth (2.83%), giroversion of permanent teeth (2.31%), and partial anodontia (1.82%) were the most frequent dental anomalies. In addition, an increase was observed in the mandibular angle size in the FXS group (p<0.05). CONCLUSION:: We conclude that knowledge of dental radiographic changes is of great importance for dental surgeons to plan the treatment of these individuals.

Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle

ABSTRACT Fragile X syndrome (FXS) is a disorder linked to the chromosome X long arm (Xq27.3), which is identified by a constriction named fragile site. It determines various changes, such as behavioral or emotional problems, learning difficulties, and intellectual disabilities. Craniofacial abnormalities such as elongated and narrow face, prominent forehead, broad nose, large and prominent ear pavilions, strabismus, and myopia are frequent characteristics. Regarding the oral aspects, deep and high-arched palate, mandibular prognathism, and malocclusion are also observed. Objective: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. Material and Methods: The patients were in the range of 6–17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. Results: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (p<0.05). In this group, supernumerary deciduous teeth (2.83%), giroversion of permanent teeth (2.31%), and partial anodontia (1.82%) were the most frequent dental anomalies. In addition, an increase was observed in the mandibular angle size in the FXS group (p<0.05). Conclusion: We conclude that knowledge of dental radiographic changes is of great importance for dental surgeons to plan the treatment of these individuals.

Momento atual da odontologia para pessoas com deficiência na América Latina: situação do Chile e Brasil / Current status of the dental care provided to disabled people in Latin America: Chilean and Brazilian scenarios

A saúde é um fator essencial para a qualidade de vida do ser humano. Baseado nesse fato a Convenção Internacional sobre os direitos das pessoas com deficiência da ONU aponta que as Pessoas em Situação de Incapacidade têm o direito de desfrutar o mais alto padrão atingível de saúde sem discriminação; assim, o estado deve tomar as medidas adequadas para garantir seu acesso aos serviços de saúde. No Chile 20% da população adulta apresenta algum grau de deficiência, ou seja, aquela que em relação ao seu desenvolvimento físico, mental, intelectual, sensorial ou outras condições,mostram restrições à participação plena e ativa na sociedade. Quanto à distribuição por gênero, as mulheres apresentam maior prevalência de pessoas com algum grau de deficiência em relação aos homens. No Brasil, aproximadamente 24% da população brasileira (45.606.048 de pessoas) apresenta algum tipo de deficiência, pelo menos uma das deficiências investigadas, incluindo as deficiências auditiva, física, visual, intelectual, transtorno do espectro autista, ostomias e mobilidade reduzida.Desses indivíduos, 25.800.681 de pessoas (56,5%) são mulheres e 19.805.367 (43,5%) são homens.De acordo com o estudo da situação global da pessoa com deficiência, a saúde bucal geralmente é ruim e o acesso a cuidados odontológicos é limitado. No Chile e no Brasil, cárie e doença periodontal, estão dentro das patologias orais de maior prevalência, que aumentam com a idade eque surgem de forma desigual, afetando principalmente população de periferia e de baixa renda.Assim, tanto o Chile como o Brasil têm desenvolvido projetos que visam contribuir para que a pessoa com deficiência consiga ser atendida em suas necessidades específicas na área da saúde bucal.

Health care is an essential factor for the quality of life of human beings. Based upon this fact, information about the rights of disabled people presented by the WHO International Convention shows that people with disabilities must have the opportunity to access the highest level of health care withoutany prejudice. Furthermore, the State must guarantee such accessibility. In Chile 20% of the adult population presents some degree of disability; which means, a person who shows some limitation inregard to his/her physical, mental, intellectual, sensorial or other condition, and restricted participation in the society. In regard to the gender distribution, 14.8% of the man population and 24.9% of the woman population present some degree of deficiency. In Brazil, approximately 24.0% of the population(45.606.048 people) presents some deficiency (at least one of the searched deficiencies), including hearing,physical, visual, intellectual, autism disorder, ostomies and restricted mobility impairments. In this group, 25.800.681 people (26.5%) are women and 19.805.367 people (21.2%) are men.In general, according to the global assessment of the health condition of disabled people, theiroral health is poor and their access to dental care is limited. Then, Chile and Brazil have developed projects to specifically contribute to the oral health of disable people. In this direction, Brazil has formulated public policies to guarantee autonomy and wider support of the health system, and of the education and work systems as well, improving the quality of life of disabled people.

Chlorhexidine spray as an adjunct in the control of dental biofilm in children with special needs.

The aim of this study was to evaluate the clinical effectiveness of .12% chlorhexidine applied via spray and the acceptance. A total of 26 individuals with mental health issues, aged 7-14, were included into two groups: placebo (control, n = 13) and chlorhexidine (experimental, n = 13). Both groups received two daily applications of spray during 2 months. The periodontal conditions were evaluated by the simplified oral hygiene index (OHI-S) and gingival index (GI). The evaluation of acceptance of the application method (spray) was assessed by questionnaire. Data were analyzed with nonparametric tests, with a significance level of 5%. Regarding the OHI-S index, only the experimental group showed significant change during the evaluations (p < 0.001). Regarding the GI, both groups showed significant changes during the evaluations. The method of application was well accepted by patients and caregivers, and .12% chlorhexidine solution applied via spray significantly reduced the rates of dental and gingival biofilm.

Análise histológica da mucosite bucal induzida por metotrexato: estudo piloto experimental em camundongos / Preliminary histological analysis of methotrexate-induced oral mucositis: experimental study in mice

Objective: This in vivo experimental study evaluated the effect of methotrexate on the oral mucosa of mice. Methodology: A total of 28 adult BALB/c mice were randomly assigned into a control and an experimental group. Mice in the experimental group were immuno-suppressed with 2.5 mg/kg of methotrexate for three consecutive days. One mouse from each group was sacrificed each day for 10 days. Samples from ventral mucosal tongue surface were collected and prepared for histomorphometric analysis, by staining with hema-toxylin/eosin. Three microscopic s per section were analyzed, in order to evaluate the mean epithelial cells layer thickness and counting of blood vessels. To eva-luate the existence of inflammatory infiltration, values of 0 and 1 were used for absence or presence, respec-tively. Results: The results showed that the treatment did not induce clinical signs of mucositis in the ventral mucosal tongue region. The histological examination showed that the mean number of blood vessels was si-milar in control and experimental samples (p < 0.001), and that there was absence of inflammatory infiltration. However, the thickness of the epithelial cell layer of experimental samples was significantly lower than in control samples. Conclusion: This study showed that, in the mouse model, methotrexate-induced mucositis histological result in manifestations in the ventral tongue region.

Toriello Carey syndrome: genetic, clinical, and oral considerations: a case report.

Toriello Carey syndrome is a rare recessive autosomal disease whose clinical manifestations are more evident in males. Some authors report that the general characteristics of this disease are agenesis of the corpus callosum, mental disability, convulsions, atrial septal defect, pulmonary artery stenosis, pyloric stenosis, and hypospadias. Facial and cranial alterations may occur, including hypertelorism, telecanthus, divergent strabismus, malformed ears, anteverted nares, retrognathism, and cleft palate. This paper reports on a 13-year-old male with Toriello Carey syndrome and leucoderma, and describes his oral problems and his dental care.

Programa lúdico-pedagógico para o controle do biofilme dental em indivíduos com deficiência visual / Playful-teaching program for the control of dental biofilm in the visually impaired

Objetivo: Desenvolver um programa de prevenção e motivação odontológica para deficientes visuais, utilizando materiais lúdico-pedagógicos. Além disso, buscou comparar a eficácia do mesmo através do índice de higiene oral simplificado (IHOS) e do índice gengival (IG), em um grupo de cegos (grupo experimental) e portadores de visão subnormal (grupo controle). Materiais e Métodos: Foram avaliados 15 indivíduos com deficiência visual da Associação de Pais e Amigos dos Deficientes Visuais (APADEV), de Caxias do Sul/RS, de ambos os sexos e idades entre 13 e 49 anos. Foram divididos em dois grupos: cegos(grupo experimental) e portadores de visão subnormal (grupo controle). Durante seis encontros (inicial, 15, 45, 75, 105 e 120 dias), todos os participantes receberam as mesmas informações e participaram das mesmas atividades conduzidas pelo mesmo examinador (kappa=0,86). Após cada atividade realizava-se o IG e IHOS. Os dados foram avaliados considerando-se o nível de significância de 5% e utilizando-se os testes de Friedman e Mann-Whitney. Resultados: Em relação ao IHOS, houve diminuição do índice com diferença significativa para o grupo controle durante os momentos de 15 a 105 dias (p<0,01), o que não ocorreu como grupo experimental (p=0,77). Na avaliação do IG, observou-se diminuição do índice ao longo de todo o período no grupo controle (p<0,01). No grupo com deficiência visual o IG diminuiu entre 75 e 105 dias. Para o IHOS não houve diferenças estatisticamente significantes. Conclusão: Os indivíduos com visão subnormal apresentaram um efeito melhor (IG e IHOS) após o programa quando comparados com os indivíduos cegos.

Evaluation of the mechanical and chemical control of dental biofilm in patients with Down syndrome.

OBJECTIVE: To evaluate the mechanical and chemical control of dental biofilm in patients with Down syndrome, using different experimental dentifrices. MATERIAL AND METHODS: Forty institutionalized children between ages 7 and 13 years in the mixed dentition phase participated in this study. An experimental cross-over, blind clinical trial was used, having the following protocols: fluoridated dentifrice (protocol G1); fluoridated dentifrice + chlorhexidine (protocol G2); fluoridated dentifrice + chlorhexidine + plaque-disclosing agent (protocol G3); and fluoridated dentifrice + plaque-disclosing agent (protocol G4). Each experimental stage lasted 10 days with a 15-day washout. The evaluated parameters were Plaque Index and gingival bleeding. RESULTS: The initial clinical conditions between each stage were similar. Statistical differences were observed (P < 0.001) for the clinical conditions evaluated before and after the treatments. The dentifrices containing plaque-disclosing agent, irrespective of their association with chlorhexidine, produced a greater reduction in the final plaque index. As for gingival bleeding, the dentifrice containing erythrosine and the one containing chlorhexidine produced similar results. The dentifrice containing an association of chlorhexidine and erythrosine gave the best results. CONCLUSION: With the methodology employed, it was possible to conclude that the combination of drugs (chlorhexidine, fluorine and erythrosine) within one dentifrice can be useful in controlling dental biofilm and in the reduction of gingival bleeding.

Contaminação de escovas dentais usadas em crianças com autismo / Contamination in toothbrushes used in children with infanil autism

Inttrodução - As escovas dentais, depois de utilizadas tornam-se contaminadas por diferentes microrganismos, promovendo a disseminação destes na cavidade bucal e no ambiente. Material e Métodos - O estudo teve por objetivo comparar a contaminação das escovas dentais apóstrinta dias de uso em 36 crianças, livres de cárie, com 7 a 10 anos, ambos os sexos, sendo 18 crianças autistas (Grupo 1) e 18 crianças não portadoras de necessidades especiais (Grupo 2). Cada criança recebeu uma nova escova para ser utilizada apenas na escola; após 30 dias as escovas foram recolhidas para análise microbiológica. A escovação das crianças do Grupo 1 era supervisionada pelo cuidador, e no Grupo 2 não havia supervisão. As cabeças das escovas foram introduzidas em tubos de ensaio contendo 10 mL de solução fisiológica, homogeneizadas e a suspensão obtida foi diluída até 10-³. alíquotas de 0,1 mL foram semeadas em duplicata em ágarBrain Heart Infusion (BHI) e as placas incubadas a 37°C/48h. Após incubação, determinou-se o número de microrganismos presentes em ufc/mL. Resultados - Diferenças estatisticamente significantes foram observadas entre os grupos (Mann-Whitney, p < 0,05), quanto ao número total de microrganismos viáveis. As escovas do Grupo 1 acumularam menor quantidade de microrganismos em comparação as escovas do Grupo 2. Conclusão - Os resultados sugerem que as crianças com necessidades especiais não realizavam a escovação, o que levou a um menor acúmulo de microrganismos nas escovas

Alterações sistêmicas na Síndrome de Down e cuidados no atendimento odontológico / Systemic alternations in Down's Syndrome and the carefulness during the dental treatment

O propósito deste estudo foi avaliar a prevalência das alterações sistêmicas de 61 prontuários de pacientes com Síndrome de Down, entre 0 a 30 anos, sem distinção racial, sexo e condições socioeconômicas, atendidos no Curso de Especialização em Odontologia para Pacientes com Necessidades Especiais da Abeno. As alterações sistêmicas encontradas com maior freqüência foram: distúrbio visual (55,74%), cardiopatia congênita (49,18%) e problemas do aparelho respiratório, representados pela pneumonia (40,99%) e bronquite (24,59%) ao lado de outras. Portanto, o cirurgião-dentista deve realizar anamnese direcionada e o paciente apresentando qualquer alteração sistêmica, procedimentos específicos deverão ser instituídos com o objetivo de realizar um tratamento odontológico adequado e seguro tanto preventivo quanto curativo e/ou reabilitador.

The purpose of this study was to evaluate the prevalence of the systemic alteration in 61 patients' records with Down's syndrome, with ages between O to 30 years old, without race distinction, sex and economic-partner conditions. They were attended during the Specialization Course in Dentistry for Special Care Patients - Abeno Systemic alterations were found with high prevalence: visual disturbance (55,74%), congenital heart diseases (49,18%) and respiratory system problems which were represented by pneumonia (40,99%) and bronchitis (24,59%). In conclusion, the dentist should do a good questionnaire. If the patient has some systemic alteration, specific procedure will be established and an appropriate and safe dental treatment should be done.

Síndrome de Treacher Collins: características clínicas e relato de caso / Treacher Collins syndrome: clinical aspects and a case report

A síndrome de Treacher Collins (STC) é também conhecida como Disostose Mandibulofacial. É uma síndrome crânio-facial que apresenta alterações bilaterais e simétricas de estruturas originadas do primeiro e segundo arcos branquiais e placódios nasais. Sua prevalência ao nascimento é de 1 para 25.000 a 1 para 50.000. A origem é genética e a transmissão é autossômica dominante com expressividade variável. No presente trabalho, os autores apresentam o relato de um paciente portador da síndrome de Treacher Collins que compareceu ao Grupo de Estudo e Atendimento a Pacientes Especiais - GEAPE, do Departamento de Ortodontia e Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo para tratamento odontológico.

Síndrome de Carpenter com inteligência normal: apresentação de caso clínico e conduta odontológica / Carpenter's syndrome: clinical case with normal intelligence and odontological conduct

O presente trabalho apresenta os aspectos clínico e odontológico de um caso da Síndrome de Carpenter ou acrocefalopolisindactilia tipo II, de um menino brasileiro de 4 anos e 2 meses de idade, com desenvolvimento de inteligência normal. Observou-se ausência de alguns dentes permanentes, bruxismo, palato profundo e ogival e mordida cruzada unilateral.

Manifestações orais da esclerodermia sistêmica progressiva (escleroderma): relato de caso e revisão da literatura / Oral manifestations of systemic sclerosis (scleroderma): case report and literature review

A esclerodermia sistêmica é uma doença do tecido conjuntivo com variada expressão clínica que acomete múltiplos sistemas. Caracteriza-se pela abundante fibrose da pele, veias e órgãos viscerais e, como aspecto clínico predominante, observa-se a instabilidade vascular. Os autores têm como objetivo apresentar os aspectos clínicos gerais e as manifestações bucais de um caso de esclerodermia sistêmica progressiva, com a finalidade de alertar os profissionais sobre esta patologia e sobre a importância da integração do cirurgião-dentista dentro de uma equipe multidisciplinar. No presente relato foram avaliadas pelo exame clínico as alterações orofaciais, dos tecidos moles e do fluxo salivar. Os elementos dentários e tecido ósseo foram também avaliados pelo exame clínico complementado pelo radiográfico. As manifestações orais encontradas na esclerodermia sistêmica progressiva foram a presença de um alto índice de doença de cárie e de determinadas alterações que podem interferir no tratamento odontológico, como a limitada abertura de boca, enrijecimento da língua e encurtamento do freio lingual, problemas mucogengivais, aumento do espaço do ligamento periodontal, reabsorção patológica do rebordo alveolar e da cabeça do côndilo da mandíbula, disfunção da articulação temporomandibular e dificuldade de reparação tecidual. O fluxo salivar encontrado situava-se dentro dos limites da normalidade