Lesões orofaciais em mulheres vítimas de violência não fatal: uma revisão integrativa / Orofacial injuries in women victims of non-fatal violence: an integrative review

Introdução: Grande proporção dos atos violentos praticados contra as mulheres resulta em lesões maxilofaciais. A região facial é o local mais recorrente das violências físicas, uma vez que o violentador deseja evidenciar a fragilidade da vítima e distanciá-la socialmente, causando danos psicológicos, estéticos e morais. Objetivo: Analisar as regiões craniofaciais mais afetadas e o perfil das mulheres que sofreram violência não fatal. Método: Trata-se de uma revisão integrativa da literatura, com identificação de artigos nas bases SciELO, MEDLINE via PubMed, LILACS e BBO, usando os descritores "violência doméstica", "injúria facial", "traumatismo facial" e suas variantes nos idiomas inglês e português. Resultados: Foram selecionados 14 estudos. A idade das mulheres variou de 16 a 64 anos, com a maioria tendo ocupações domésticas e dependência financeira do cônjuge ou parceiro. Todos os estudos abordavam a região de cabeça e pescoço como o local mais acometido por lesões, por se tratar de uma região vulnerável. A órbita foi considerada a estrutura anatômica mais acometida mencionada em quatro estudos, seguida por boca, nariz e mandíbula. Hematomas e equimoses foram as lesões mais encontradas, identificadas em 9 estudos. Além disso, 13 estudos relataram o uso de instrumento contundente durante as agressões. Outras lesões como fraturas dentais, avulsão dentária, fraturas faciais e edema foram encontradas com menos frequência. Conclusão: O terço superior da face foi o mais atingido, em especial a órbita, e o tipo de injúria mais comum foram as equimoses e hematomas geralmente provocados pelos parceiros.

Introduction: A large proportion of violent acts against women result in maxillofacial injuries. The facial region is the most recurrent site of physical violence because the abuser wishes to highlight the victim's frailty and distance it socially, causing psychological, aesthetic and moral damage. Objective: To analyze the most affected craniofacial regions and the profile of women who have suffered non-fatal violence. Method: This is an integrative literature review, with identification of articles in SciELO, MEDLINE/ PubMed, LILACS and BBO, using the keywords "domestic violence", "facial injury", "facial trauma" and its variants in English and Portuguese. Results: 14 studies were selected. The age of the women ranged from 16 to 64 years, with the majority having domestic occupations and financial dependence on their spouse or partner. All studies mentioned the head and neck region as the location most affected by injuries, as it is a vulnerable region. The orbit was the most affected anatomical structure mentioned in four studies, followed by the mouth, nose and mandible. Bruises were the most frequently found lesions, identified in nine studies. In addition, 13 studies reported the use of a blunt instrument during attacks. Other injuries such as dental fractures, tooth avulsion, facial fractures and edema were found less frequently. Conclusion: The upper third of the face was the most affected, especially the orbit, and the most common type of injury was bruises usually caused by partners

Can shielded brackets reduce mucosa alteration and increase comfort perception in orthodontic patients in the first 3 days of treatment? A single-blind randomized controlled trial.

INTRODUCTION: Orthodontic patients can experience pain and discomfort on the oral mucosa from trauma caused by friction with the brackets and the wires. In this split-mouth design, single-blind randomized controlled trial, we aimed to investigate whether brackets with a self-snapping customized plastic shield would induce less mucosa alteration and discomfort than those without the shield. METHODS: The overall sample comprised 42 patients (22 female, 20 male) from a government-funded orthodontic practice, with a mean age of 16.7 years. Eligibility criteria included, among others, no history of mouth ulcers or systemic diseases. Customized shields for the maxillary and mandibular brackets were fabricated and inserted on one side of the mouth. The null hypothesis was that bracket shielding would have no advantage. The primary outcomes were mucosal and discomfort assessments. As the secondary outcome, the numbers of spontaneous detachments of the shields were reported. Treatment allocation was mainly implemented using a random number table for selection of the intervention side. Only the raters in charge of assessing the oral mucosa were blinded to the side of the mouth where the shields had been placed. The mucosa was assessed by 3 calibrated raters at the following time points: immediately before bracket placement (baseline assessment, T0), 3 days after delivering the shields (direct assessment of intervention, T1), and 4 days after removal of the shields (indirect assessment of intervention, T2). The raters used a newly devised yardstick in which the higher the score, the more severe the alteration. Discomfort was assessed at T1 and T2 using a visual analog scale. The Mann-Whitney U test was performed at the 5% level of significance. RESULTS: Of 60 patients, 42 were eligible, and 35 were randomly selected to have one side of the mouth receive the intervention. Two patients discontinued the intervention at T1, and 5 stopped at T2. Seven additional patients were recruited and completed all time points. Thus, 42 patients participated at T0, 40 at T1, and 35 at T2. Thirty-five patients participated at all time points. At T1, no statistically significant difference in terms of mucosa alteration was observed between the 2 sides (median of all differences [MD], 0.0; 95% CI, 0.0-1.0; P = 0.11). The same occurred at T2 (MD, 0.0; 95% CI, 0.0-0.0; P = 1.00). The comfort level was statistically higher at T1 on the shielded side (MD, 14.0; 95% CI, 1.0-36.0; P = 0.04), whereas no difference was observed at T2 (MD, 0.0; 95% CI, 0.0-1.0, P = 0.81). No serious harm was observed. CONCLUSIONS: The customized bracket shields were effective in reducing discomfort during the first 3 days of orthodontic treatment despite no significant difference in terms of visible mucosa alteration. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: Expenses for the fabrication of the shields were covered by the main author (L.P.B.P.). Orthodontic materials were from the Center for Dental Specialties in Cajazeiras, Brazil.

Association between tooth size and interarch relationships in children with operated complete unilateral cleft lip and palate.

BACKGROUND: To evaluate mesiodistal tooth width of patients with UCLP comparing tooth size in different Goslon Yardstick scores and between cleft and noncleft sides. METHODS: The Department of Orthodontics at Bauru Dental School and Hospital of Rehabilitation of Craniofacial Anomalies - University of Sao Paulo. Hundred forty-four pairs of dental casts of patients with UCLP. These dental casts were divided into 3 groups: group I (patients with Goslon rating of 1 and 2), group II (Goslon rating of 3) and group III (Goslon rating of 4 and 5). The control group consisted of 40 pairs of dental casts of noncleft Class I patients at the same age range. Mesiodistal width of maxillary permanent central incisors, lateral incisors and first molars were measured using a digital caliper. Intergroup comparisons were performed using ANOVA followed by Tukey tests. T tests were used to compare tooth size between cleft and noncleft sides (p <0.05). RESULTS: Differences for tooth size were observed between individuals with different Goslon Yardstik scores. Mesiodistal widths of maxillary central incisors in subjects of Group III were significantly smaller compared to Group I and to the control group. The lateral incisors at the cleft side were smaller than the antimere. CONCLUSIONS: Mesiodistal tooth size was smaller in poor Goslon yardstick scores. Cleft and noncleft sides demonstrated similar maxillary tooth size except for the lateral incisor.

Comparison of friction produced by two types of orthodontic bracket protectors.

INTRODUCTION: Fixed orthodontic appliances have been regarded as a common causative factor of oral lesions. To manage soft tissue discomfort, most orthodontists recommend using a small amount of utility wax over the brackets in order to alleviate trauma. This in vitro study aimed at evaluating friction generated by two types of bracket protectors (customized acetate protector [CAP] and temporary resin protector [TRP]) during the initial stages of orthodontic treatment. METHODS: An experimental model (test unit) was used to assess friction. In order to measure the friction produced in each test, the model was attached to a mechanical testing machine which simulated maxillary canines alignment. Intergroup comparison was carried out by one-way ANOVA with level of significance set at 5%. RESULTS: The friction presented by the TRP group was statistically higher than that of the control group at 6 mm. It was also higher than in the control and CAP groups in terms of maximum friction. CONCLUSIONS: The customized acetate protector (CAP) demonstrated not to interfere in friction between the wire and the orthodontic bracket slot.

Complications of misdiagnosis of maxillary canine ectopic eruption.

Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption.

Orthodontic movement of a maxillary incisor through the midpalatal suture: a case report.

Orthodontic space closure is a treatment alternative when a maxillary central incisor is missing. The objective of this report was to present an unusual treatment in which a right maxillary central incisor was moved through the midpalatal suture to replace the absent contralateral tooth. The biologic aspects and clinical appearance of the recontoured lateral and central incisors were analyzed. The position of the examined teeth and the appearance of the surrounding soft tissues were satisfactory; however, the upper midline frenulum deviated to the left. The incisor was successfully moved with no obvious detrimental effects as observed on the final radiographs. In the radiographic and tomographic examinations, the midline suture seemed to have followed the tooth movement. The patient expressed satisfaction with the results. It was concluded that orthodontic movement of the central incisor to replace a missing contralateral tooth is a valid treatment option, and the achievement of an esthetic result requires an interdisciplinary approach, including restorative dentistry and periodontics.