ABSTRACT
Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of São Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus spp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.
Subject(s)
Brain Abscess , Focal Infection, Dental , Anti-Bacterial Agents/therapeutic use , Brain Abscess/diagnostic imaging , Brain Abscess/drug therapy , Brain Abscess/etiology , Drainage , Focal Infection, Dental/complications , Focal Infection, Dental/drug therapy , HumansABSTRACT
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.
Subject(s)
Pemphigus , Administration, Oral , Humans , Intensive Care Units , Mouth Mucosa , Quality of LifeABSTRACT
Introduction: The COVID19 pandemic brought a new panorama for the realization of dental treatment for the general population due to the risk of cross infection in the dental office, aerosol formation and insertion of new personal protective equipment. Emergency and emergency dental criteria were defined to limit the flow of patients in the office in order to improve biosafety conditions among patients. Objective: to describe the dental procedures pertinent to outpatient special care or during hospitalization in the COVID19 pandemic, changes in care and implement biosecurity criteria. Basic procedures: The dental care of the special patient suffers changes, mainly referring to the difficulty of access to the offices, interruption of the conditioning process and difficulty to perform outpatient sedation and sedation with nitrous oxide. Dental care during hospitalization is essential in this patient due to prolonged time of tracheal oro intubation, traumatic oral lesions, preparation of specific oral care protocols, removal of mouth infectious and installation of mouth protectors. Conclusion: Change of care, inclusion of individual protection equipment and new knowledge about the COVID19 allows us to safely assist the patient with special needs both in the dental office and in hospital environment, providing quality of life, oral comfort and reducing oral infections during and after the pandemic. (AU)
Introdução: A pandemia por COVID19 trouxe um novo panorama para a realização do tratamento odontológico para a população em geral devido ao risco de infecção cruzada no consultório odontológico, formação de aerossóis e inserção de novos equipamentos de proteção individual. Critérios de emergência e urgência odontológicos foram definidos para limitar o fluxo de pacientes no consultório com o objetivo de melhoras as condições de biossegurança entre os pacientes. Objetivo: Citar os procedimentos odontológicos pertinentes ao atendimento de paciente com necessidades especiais em âmbito ambulatorial ou hospitalar durante a pandemia por COVID19, alterações nos fluxos de atendimentos e cuidados inerentes a assistência. Procedimentos básicos: O atendimento odontológico do paciente com necessidades especiais sofreu alterações, principalmente referente a dificuldade de acesso aos consultórios, interrupção do processo de condicionamento e dificuldade para a realização de sedação ambulatorial e sedação com óxido nitroso. A assistência odontológica durante a hospitalização por COVID19 é fundamental devido ao tempo prolongado de intubação oro traqueal - lesões orais traumáticas, elaboração de protocolos de cuidados bucais específicos, remoção de focos infecciosos bucais e instalação de protetores bucais. Conclusão: Mudanças nas rotinas de atendimento, inclusão de equipamentos de proteção individual e de novos conhecimentos sobre a COVID19 faz com que possamos atender com segurança o paciente com necessidades especiais tanto no consultório odontológico quando em ambiente hospitalar, proporcionando qualidade de vida, conforto oral e redução das infecções bucais durante e após a pandemia. (AU)
Subject(s)
Dental Care , Needs Assessment , Dental Service, Hospital , Pandemics , Hospitals, Special , Intensive Care UnitsABSTRACT
BACKGROUND: Pseudohypoparathyroidism (PHP) is a genetic disorder characterized by resistance to the peripheral action of PTH due to maternally inherited heterozygous inactivating mutations in the coding sequence of Gsα or intronic regions of GNAS leading to aberrant splice variants (PHP1A), or methylation defects at GNAS (PHP1B). Brachydactyly is a clinical feature associated with both PHP1A and PHP1B, although it is more frequent in PHP1A patients. Loss-of-function mutations in PTHLH, the gene coding for parathyroid hormone related protein (PTHrP) were previously described in some patients with brachydactyly. Primary failure of tooth eruption (PFE) is related to some syndromes involving skeletal development, but it is also known as a nonsyndromic autosomal dominant condition. Previous studies showed that familial nonsyndromic PFE is caused by heterozygous mutations in the gene encoding the G protein-coupled receptor (PTH1R) for PTH and PTHrP. Thus, we hypothesized that PTHrP resistance could result in failure of tooth eruption (FTE) and/or brachydactyly in PHP. SUBJECTS AND METHODS: Nineteen patients with a molecular diagnosis of PHP underwent dental panoramic radiography (DPR), hand radiography and had their PTHrP levels measured. Patients with alterations at DPR were submitted to clinical dental evaluation. RESULTS: Nine patients had FTE and 7 patients had brachydactyly; 4 patients presented both features and none of them presented high PTHrP levels. Fourteen patients had PTHrP levels within the normal range and only one patient had slightly elevated PTHrP levels. Additionally, three novel GNAS mutations were described. CONCLUSION: We described the dental abnormalities in a large series of PHP patients that were followed in a single tertiary center. No relationship between plasma PTHrP levels and failure of tooth eruption, dental manifestations of PHP or brachydactyly was found. It is important that doctors pay attention to dental manifestations of the disease in order to refer patients to a proper care with dentists.
