Candida spp. In Linear gingival erythema lesions in HIV-Infected children: report of six cases

Introduction: Linear gingival erythema (LGE), formally referred to as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infected individuals These lesions have been recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. Dubliniensis, have also been identified in some HIV-infected subjects. Objective: This case report reveals the presence of typical LGE lesions in six HIV-infected children, and also investigates the etiologic agent through microbiological exams and correlates this oral manifestation with the patients' systemic conditions. Case report: Microbiological analyses showed growth for Candida spp in all patients; all of whom had severe immunosuppression. However, the regression of lesions was noted after antifungal medication. Conclusion: The presence of LGE in pediatric patients with AIDS may be a predictive marker in the progression of AIDS or it may be the first clinical manifestation of HIV infection in children. Hence it is important for dentists to be aware of such lesions.

Introdução: O eritema gengival linear (LGE), normalmente referido como gengivite do HIV, é a forma mais comum de doença periodontal presente em indivíduos infectados pelo HIV. Recentemente, estas lesões foram consideradas como uma possível forma de candidíase oral eritematosa causada por Candida. Albicans . Outras espécies, como C. tropicalis, C. stellatoidea,C. krusei, C. parapsilosis, C. glabrata e C. Dubliniensis também foram identificadas em indivíduos infectados pelo HIV associadas ao LGE. Objetivo: O presente artigo mostra a presença de lesões típicas de LGE em seis crianças infectadas pelo HIV e também investigou o agente etiológico das lesões orais através de exames microbiológicos, correlacionando o LGE com as condições sistêmicas dos pacientes. Case report: Análises microbiológicas mostraram crescimento positivo para Candida spp em todos os pacientes, os quais possuiam imunossupressão grave. Adicionalmente, a regressão total das lesões foi observada após medicação tópica antifúngica. Conclusão: A presença de LGE em pacientes pediátricos com AIDS pode ser um marcador preditivo da progressão.

Protocolo de atendimento odontológico para bebês no município de Brumadinho - Minas Gerais / Protocol of dental core for babies in the city of Brumadinho - Minas Gerais

O modo de se evitar a instalação da cárie, uma das doenças de maior prevalência na infância, é por meio de programas preventivos. Partindo desse princípio, em 2010, foi implementado no município de Brumadinho, Minas Gerais, um programa de atenção odontológica para bebês. Nesse artigo, relata-se como se deu a implementação do programa no município e ilustra-se passo a passo o atendimento de um bebê do nascimento à sua primeira consulta odontológica. É possível concluir que é totalmente viável a inclusão de crianças durante o primeiro ano de vida em programas de saúde bucal nos serviços de saúde pública. Tais programas devem ter um protocolo próprio ou de referência e equipe capacitada para o atendimento de bebês.

The way to prevent the installation of dental caries, one of the most prevalent diseases of childhood, is through prevention programs. Based on this principie, in 2010, was implemented in the city of Brumadinho, Minas Gerais, a program of dental care for babies. In this article is reported how was the implementation of this program in the city and illustrates each step in caring for a baby from birth to their first dental visit. It is possible to conclude that it is very possible the inclusion of children during the first year of life in oral health programs in public health services. Such programs must have a specific protocol or reference and staff trained to care for babies.

Abordagem de lesão de cárie proximal em dentes decíduos anteriores pela técnica de abrasão: relato de caso / Injury approach to tooth cavity in proximate previous deciduoud teeth by abrasion technique: case report

O tratamento de lesões cariosas em superfícies proximais de dentes decíduos anteriores normalmente é de difícil execução. O sucesso está relacionado à dificuldade no preparo da cavidade, escolha da cor do material restaurador e da técnica restauradora propriamente dita. O caso clínico apresentado relata uma abordagem alternativa para lesões proximais em dentes decíduos com o uso da técnica da abrasão da superfície cariada, com acompanhamento clínico e radiográfico de 07 meses. Conclui-se que, a proposta é uma alternativa eficaz para paralisação de lesões cariosas proximais em dentes decíduos anteriores.

The treatment of proximal carious lesions in primary teeth is usually difficult to implement. The success is related to cavity preparation, the proper color choice of the restorative material and the restorative technique itself. This case report describes for proximal carious lesions in primary teeth alternative approach, by using abrasion technique of the decayed surface and with the technique of surface abrasion of decayed, with clinical and radiographic follow-up of 07 months. It is concluded that, the abrasion technique can be effective to arrest proximal carious lesions in primary anterior teeth.

Abordagem de lesão de cárie proximal em dentes decíduos anteriores pela técnica de abrasão: relato de caso / Alternative approach to proximal carious lesion in anterior teeth using the abrasion technique: case report

O tratamento de lesões cariosas em superfícies proximais de dentes decíduos anteriores normalmente é de difícil execução. O sucesso está relacionado à dificuldade no preparo da cavidade, escolha da cor do material restaurador e da técnica restauradora propriamente dita. O caso clínico apresentado relata uma abordagem alternativa para lesões proximais em dentes decíduos com o uso da técnica da abrasão da superfície cariada, com acompanhamento clínico e radiográfico de 07 meses. Conclui-se que, a proposta é uma alternativa eficaz para paralisação de lesões cariosas proximais em dentes decíduos anteriores.

The treatment of proximal carious lesions in primary teeth is usually difficult to implement. The success is related to cavity preparation, the proper color choice of the restorative material and the restorative technique itself. This case report describes for proximal carious lesions in primary teeth alternative approach, by using abrasion technique of the decayed surface and with the technique of surface abrasion of decayed, with clinical and radiographic follow-up of 07 months.It is concluded that, the abrasion technique can be effective to arrest proximal carious lesions inprimary anterior teeth.

Manifestações bucais em criança portadora de anemia aplásica: relato de caso clínico / Oral manisfestations in child with aplastic anemia: case report

A anemia aplásica é um distúrbio hematológico considerado raro, caracterizado pela insuficiência das células hematopoiéticas precursoras da medula óssea capaz de causar uma deficiência na produção de eritrócitos, granulócitos e plaquetas. O presente relato objetivou descrever as manifestações bucais da anemia aplásica idiopática em uma criança e abordar o manejo odontológico destes pacientes...

Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the era of highly active antiretroviral therapy.

OBJECTIVES: To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART). METHODS: Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression. RESULTS: Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). Mean CD4%, immune-status and history of recurrent oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P < 0.05) and a positive correlation between number of CDT and Candida cfu-counts in HIV+ and HIV-. Mean CD4% and immune-status had no influence on Candida isolation. Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). CONCLUSIONS: The HIV infected children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.

Comparison of techniques to evaluate the quantification of Candida spp. in HIV-infected children.

This study sought to compare techniques used to make a quantified evaluation of Candida spp. in children infected with HIV. Twenty-four HIV-infected children (age 3 to 13) were selected. Three sterilized swabs were used for each child: one for the dorsum of the tongue, one for the hard palate mucosa, and one for the right jugal mucosa; each swab was rubbed for 10 seconds and transferred to sterilized test tubes containing 1 mL of 0.9% saline solution. Candida spp. growth was observed in 95.8% of all samples, including 95.7% of tongue samples (Group T), 87.0% of saliva samples, 56.6% of hard palate mucosa samples (Group P), and 47.8% of right jugal mucosa samples (Group J). There was no statistical difference in Candida spp. growth between saliva samples and Group T samples, although both had higher growth compared to Groups P and J (p < 0.05; chi(2)). Regarding the sensitivity of each site for positive Candida spp. growth, Group T samples showed 69.5%, while saliva samples showed 52.2%, Group P samples showed 21.7%, and Group J samples showed 13.04%, with no significant statistical difference between Group T and saliva; however, both were more sensitive than Groups J and P (p < 0.05, chi(2)). It was concluded that whole stimulated saliva and swabbing the tongue were considered satisfactory for measuring Candida spp. in HIV-infected children.

Reduction of Candida species colonization in the oral cavity of children infected with human immunodeficiency virus after dental treatment.

OBJECTIVES: The objective of this study was to evaluate Candida species in the oral mucosa before and after dental treatment in children infected with human immunodeficiency virus (HIV) and investigate the relation of these yeasts with cavitated carious lesions, immune suppression, and use of antiretroviral drugs. METHODS: Specimens of oral mucosa (M1) and dentin were collected, using a swab and dental curette respectively, from 30 HIV-infected children. Dental treatment (tooth-brushing, fluoride application, restoration of all carious lesions and extractions, if needed) was performed, and at posttreatment (M2, mean 30 days after baseline) another sample of oral mucosa was collected. RESULTS: Candida colony-forming unit (CFU) values were greater in dentin when compared with oral mucosa before dental treatment (M1), and a reduction of these fungi was observed in oral mucosa after dental treatment (M2) (P < .05). Cavitated carious lesions and caries in dentin were positively correlated with CFU in M1 (P < .05). C. albicans was the most prevalent of the Candida species. A relationship between the level of immune suppression and use of antiretroviral drugs with the prevalence of yeasts was not observed (P > .05). CONCLUSION: The decrease in CFU at M2 and the high prevalence of these yeasts in dentin indicates that cavitated lesions in this population can serve as a niche for colonization and proliferation of Candida species in HIV-infected children.

Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A in HIV-infected children.

OBJECTIVES: The aim was to examine the impact of antiretroviral therapy on the prevalence of oral candidiasis, recovery of oral Candida spp. , and salivary levels of total secretory immunoglobulin A (SIgA) and Candida-specific SIgA in human immunodeficiency virus (HIV)-infected children. STUDY DESIGN: Sixty-six HIV+ and 40 HIV- children were cross-sectionally examined for the presence of oral lesions. Whole stimulated saliva samples were collected for the identification of Candida spp. using culture and measurement of total and specific SIgA using enzyme-linked immunosorbent assay (ELISA). RESULTS: The HIV+ children had a higher prevalence of oral candidiasis (P < .05), higher frequency of detection of Candida spp. (P < .05), and higher levels of total (P < .05) and Candida-specific SIgA (P < .001) than the HIV- children. Among the HIV+ subjects, antiretroviral users had lower viral loads (P < .001) and lower levels of Candida spp. (P < .05) and total SIgA (P < .05) compared with antiretroviral nonusers. CONCLUSIONS: The use of antiretroviral therapy was associated with decreases in the prevalence of oral candidiasis. This diminished exposure to Candida spp. was accompanied by decreases in levels of total and Candida-specific SIgA.

Strategies for addressing restorative challenges in HIV-infected children.

The complete caries removal of deep/extensive dentin carious lesions with conventional procedures (high- and low-speed bur) may increase the risk of pulp exposure. In children with systemic diseases, such as HIV-infected children, the dental treatment proposed for the primary dentition with pulp involvement is tooth extraction once endodontic therapies cannot be guaranteed successfully. Therefore, the objective of this study was to describe 3 cases of alternative techniques for caries removal in extensive and/or deep dentin carious lesions in the primary dentition of HIV-infected children: (1) atraumatic restorative treatment (ART); (2) Carisolv; and (3) Papacarie.

Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric dentistry: a review.

This review aims at describing and comparing materials commonly used in root canal therapy, the cytotoxicity, histopathological, microbiological and clinical aspects ofa iodoform-based paste (Guedes-Pinto Paste-GPP) used in endodontic treatment of primary teeth. GPP has shown excellent biocompatibility to pulp fibroblasts and mild inflammatory reactions, having been well-tolerated by the periapical and connective tissues. Moreover, GPP bactericidal and bacteriostatic effects against many oral microorganisms were also demonstrated. Regarding clinical trials, the GPP technique has achieved success rates when considering clinical and radiographic examinations. In the face of all the above mentioned results, this paper would like to propose the use of this endodontic material as a root canal filling for primary teeth.

Orofacial manifestations of Robinow's syndrome: a case report in a pediatric patient.

Robinow's syndrome (Online Mendelian Inheritance in Man [OMIM] 268310), or fetal facies syndrome, is a rare genetic disorder causing autosomal dominant and recessive forms. This syndrome includes a series of anomalies such as short stature, characteristic facial dysmorphism (fetal facies), genital hypoplasia, and mesomelic brachymelia. The purpose of the present case is to describe the orofacial manifestations of the syndrome in a pediatric patient: craniofacial features, triangular mouth and a long upper lip philtrum, ankyloglossia, a shortened tongue devoid of tongue tip, a geographic tongue, arched palate, gingival hyperplasia, dental abnormalities (misaligned and crowded teeth), and delayed tooth eruption.

Severe tongue injury in an adolescent with epilepsy: a case report.

Epilepsy and other neurological disorders can have profound social, physical and psychological consequences, especially when they begin in childhood. Moreover, seizure episodes may cause fractures, burns, head injuries and oral injuries. This report presents a case history of an adolescent with a severe tongue injury related to epileptic seizures and outlines the proposed treatment, which included use of a maxillary silicone bite guard that allowed healing of the tongue injury within a few months.

Pasta Guedes-Pinto. Revisão de literatura: 26 anos de estudo sobre citotoxicidade, citotóxicos, histopatológicos, microbiológicos e clínicos / Guedes-Pinto Paste. Literature review: 26 years of

A escolha do material na terapia pulpar de dentes decíduos é um princípio básico importante no sucesso do tratamento. Além do conhecimento do potencial de toxidade do material, das reações hitológicas e do uso clínico, é imprescindível o conhecimento dos mecanismos biológicos pelo qual o material induz reparo. Este estudo teve como objetivo compilar em uma revisão de 26 anos, estudos sobre os aspectos citotóxicos, histopatológicos, microbiológicos e clínicos da Pasta Guedes-Pinto, que é uma associação de fármacos, utilizada em terapia pulpar em dentes decíduos, e indicada pela maioria das faculdades de Odontologia do país.

Low-level-laser therapy as an alternative treatment for primary herpes simplex infection: a case report.

Gingivostomatitis is the most common primary and symptomatic clinical manifestation of HSV-1 infection. Painful oral lesions appear as ulcerative erosions on the gingiva, palate, buccal mucosa, and tongue, leading to eating and drinking difficulties with an evolution between 10-14 days. This paper describes a case of a 19-month-old boy with severe painful Gingivostomatitis lesions. Low level laser therapy (LLLT) was used with an immediate outcome.

Examining dentinal carious lesions as a predisposing factor for the oral prevalence of Candida spp in HIV-infected children.

PURPOSE: The aims of this study were to verify the oral prevalence of Candida spp in HIV-infected children, and investigate the association between Candida colonization and dentinal caries lesions. METHODS: Whole stimulated saliva was collected from 62 HIV-infected children (group 1) and 40 seronegative siblings (group 2), followed by oral examination to determine: dmft/dmfs scores, DMFT/DMFS scores, the number of dentinal carious teeth (D+) and the presence of oral candidiasis. The salivary samples were cultured, and plates with positive isolation (G+) were classified as mild growth, moderate growth, and strong growth. Data was analyzed using chi-square, Mann-Whitney, and Spearman tests for correlations. RESULTS: The patients' mean age was 8.8 for group 1 and 8.0 years for group 2. In group 1, 61% of the subjects had AIDS. Eighty percent of HIV-infected children (N=50) were positive for Candida growth, having a mean CD4% of 22, those who were Candida-free (N=12) presented a mean CD4% of 21. Correlation was observed between the mean D+ and G+ in groups 1 and 2 (P<.05, Mann-Whitney test), but not between the mean dmft/dmfs-DMFT/DMFS in group 1 (P>.05, Mann-Whitney test). Association of G+ and the D+ was noted in group 1 (P<.05; chi-square test). Positive correlation between high Candida counts and an increase in D+ was demonstrated in groups 1 and 2 (P<.05). CONCLUSIONS: Dentinal carious lesions may be associated with Candida spp colonization in HIV-infected children.