Mandibular fracture in medication-associated osteonecrosis following infliximab therapy: A case report.

INTRODUCTION: Medication-associated osteonecrosis of the jaws (MRONJ) is characterized by the presence of exposed bone or an intraoral or extraoral fistula in the maxillofacial region in patients with a history of treatment with anti-resorptive and anti-angiogenic drugs, such as monoclonal antibodies, and without a history of radiotherapy or metastatic diseases in the area. OBJECTIVE: The aim of this study is to report a case of a pathological mandibular fracture in an area of MRONJ in a patient diagnosed with Crohn's disease treated with infliximab. CASE REPORT: A 53-year-old male patient, an active smoker for 35 years, diagnosed with Crohn's disease, undergoing intravenous administration of infliximab 300 mg for 1 year and 3 months, with no previous history of anti-angiogenic or anti-resorptive medication, presenting with an extraoral fistula in the submandibular region for 4 months, with painful symptoms, diagnosed as MRONJ. He was initially treated conservatively, using antimicrobial photodynamic therapy (aPDT), antibiotic therapy, and the PENTO protocol. However, the patient evolved with a pathological fracture in the mandibular parasymphysis, requiring surgical reconstruction. FINAL CONSIDERATIONS: Pathological fracture of the mandible is a complication of MRONJ that compromises the patient's quality of life. The management of patients with MRONJ is complex and challenging.

Fanconi anemia and hematopoietic stem cell transplant as risk factors for oral squamous cell carcinoma: A case report with a 12-year follow-up.

Fanconi anemia is a rare disorder resulting from defects in genes responsible for DNA damage responses. It is characterized by congenital anomalies, aplastic anemia, and a predisposition to cancer. Currently, hematopoietic stem cell transplant (HSCT) is the only curative treatment available for bone marrow failure; however, HSCT increases oral squamous cell carcinoma (OSCC) risk. Here we report the case of a patient diagnosed with Fanconi anemia in childhood who was treated with HSCT and later diagnosed with multiple OSCCs during a 12-year follow-up. Despite multiple surgical interventions and radiotherapy regimens, the patient`s health deteriorated. Management of individuals with Fanconi anemia is challenging and must be provided by a multidisciplinary healthcare team to ensure better staging, treatment planning, and coordination.

Dental Care for a Child with Congenital Hydrocephalus: A Case Report with 12-Month Follow-Up.

Hydrocephalus affects the central nervous system as a result of progressive ventricular dilatation from the accumulation of cerebrospinal fluid in the brain's lateral ventricles. This paper reports on the oral characteristics of a child with congenital hydrocephalus, discusses her complex dental care needs, and presents dental management of this case. Despite the complex and challenging dental needs, this child received dental treatment in a chairside approach without general anesthesia. A thorough knowledge of the patient's medical condition, together with expert clinical skills, was indispensable for managing the child and improving the quality and length of her life.

Perfil de cirurgiões-dentistas e demandas de qualificação em UNACON e CACON no estado Rio de Janeiro / Profile of dentists and qualification demands in Unacon and CACON in Rio de Janeiro state

Objetivo: Analisar o perfil dos cirurgiões-dentistas que atuam nos hospitais habilitados em oncologia no âmbito do estado do Rio de Janeiro e identificar demandas de qualificação nessa área. Métodos: Trata-se de estudo exploratório descritivo do tipo survey destinado a gestores e profissionais dos hospitais habilitados em oncologia do estado do Rio de Janeiro. A análise dos dados foi realizada por meio de estatística descritiva. Resultados: Responderam aos formulários 14 gestores e 85 cirurgiões dentistas. Apesar do número de profissionais atuando nas unidades participantes, poucos são os profissionais que prestam o cuidado direto ao paciente oncológico. Os profissionais possuem, comparando com a média nacional, faixa etária mais elevada (47 anos), maior tempo de experiência profissional (24 anos) e de vínculo com a instituição (14 anos). Além disso, a maioria dos profissionais são especialistas (91,8%) e alguns fizeram mestrado (30,6%) e doutorado (3,5%). Apesar dos profissionais atuarem em unidades habilitadas para o cuidado oncológico, somente sete (8,2%) declararam terem feito cursos em oncologia. Diante da estrutura das instituições, a utilização da estratégia de ensino a distância pode otimizar os esforços e superar as dificuldades, porém, é necessário planejamento pedagógico coerente com o perfil dos profissionais. Conclusão: Os dados apontam para a necessidade de ampliação e qualificação da rede de cuidado odontológico aos pacientes oncológicos.(AU)

Aim: To analyze the profile of dentists who work in cancer hospitals in the state of Rio de Janeiro, Brazil, and identify skill requirements in this area. Methods: This is a descriptive-exploratory, surveylike study geared toward managers and professionals in cancer hospitals in the state of Rio de Janeiro. Data analysis was performed using descriptive statistics. Results: Fourteen managers and 85 dentists answered the questionnaire. Despite the adequate number of professionals working in the participating units, few professionals actually provide direct care to cancer patients. Compared to the national average, the professionals are of an older age (47 years), and have a longer professional experience (24 years) and a longer time working at the institution (14 years). In addition, most professionals are experts (91.8%), while some have completed their Masters (30.6%) and Ph.D. (3.5%). Although the professionals work in cancer care units, only seven (8.2%) reported having taken courses in oncology. Given the structure of the institutions, the use of a distance learning strategy could optimize efforts and overcome difficulties; however, pedagogical planning that is consistent with the profile of the professionals is necessary. Conclusion: The data point out the need for the expansion and qualification of the dental care network for cancer patients.(AU)

Evaluation of oral diseases in a population of special needs patients / Avaliação das doenças orais em uma população de pacientes com necessidades especiais

Objective: To evaluate the oral health status of a population of patients with special needs cared for in the specialization course of the Brazilian Association of Dentistry, Ceará Branch. Methods: In this cross-sectional, descriptive study the indexes DMFT and CPI were used to evaluate dental caries and periodontal disease, respectively, from August 2009 through March 2010. The need for dental treatment and other soft tissue lesions were also investigated. Results: 88 patients selected by convenience sampling were examined intraorally, and the mean age was 43.8 ± 16. Most of the patients fell within the group of systemic diseases (68.1%), especially cardiovascular diseases (15.9%). The mean DMFT index was 17.54 ± 7.13, and 87.5% of patients presented active dental caries. According to the highest degree of periodontal condition observed in the individual, the dental tartar (index 2) was present in a greater number of patients (50.9%). Regarding the need for dental treatment, 68.1% of patients needed restorative treatment, 43.1% of patients needed surgery (extractions) and 21.5% of patients needed endodontic treatment. There were no soft-tissue abnormalities in most patients (89.7%). Conclusion: The examined patients showed a high prevalence of oral diseases such as dental caries and gingivitis/periodontitis, and therefore a great need for dental treatment. Given the results, it becomes important to stimulate dental care and preventive practices focused on this segment of the population.

Objetivo: Avaliar a condição de saúde bucal de uma população de pacientes com necessidades especiais atendida no curso de especialização da Associação Brasileira de Odontologia, Seção Ceará.Métodos: Nesse estudo de natureza descritiva e transversal utilizou-se os índices CPO-D e IPC para avaliação das doenças cárie e periodontal, respectivamente, entre os meses de Agosto de 2009 e Março de 2010. Necessidades de tratamento dentário e outras lesões em tecidos moles orais também foram investigadas. Resultados: Realizaram-se exames bucais em 88 pacientes selecionados por conveniência, sendo a média de idade correspondente a 43,8 ± 16 anos. A maioria se enquadrava no grupo de doenças sistêmicas (68,1%), destacando-se as diseases cardiovasculares (15,9%). O índice CPO-D médio foi 17,54 ± 7,13, com 87,5% dos pacientes apresentando cárie ativa. Segundo o maior grau de condição periodontal observado no indivíduo, o cálculo dental (índice 2) foi o que esteve presente em um maior número de pacientes (50,9%). Quanto às necessidades de tratamento dental, 68,1% deles necessitaram de tratamento restaurador, 43,1% de tratamento cirúrgico (exodontias) e 21,5% de tratamento endodôntico. Não foram encontradas anormalidades em tecido mole na maioria dos pacientes (89,7%). Conclusão: Os pacientes examinados possuíam alta prevalência de doenças orais, como cárie e gengivite/periodontite e, conseqüentemente, grande necessidade de tratamento odontológico. Diante dos resultados, torna-se importante motivar a atenção odontológica e as práticas preventivas voltadas para essa parcela da população.