Manejo odontológico de una paciente con síndrome de Apert / Dental management of a patient with Apert syndrome

El síndrome de Apert, marcado por la acrocéfalo-sindactilia, es una condición genética que genera deformidades dentofaciales incluyendo craneosinostosis, alteraciones faciales y malformaciones en extremidades. La mutación en el gen FGFR2, ya sea heredada o resultante de mutaciones esporádicas, desencadena esta compleja condición. La relevancia de abordar el síndrome de Apert se manifiesta no sólo en las implicaciones estéticas, sino también en su impacto en la salud oral. Romper con los paradigmas odontológicos actuales implica reconocer las particularidades de estos pacientes y proporcionar una atención especializada. La necesidad de una capacitación específica para los profesionales de la salud oral es evidente, permitiendo un enfoque integral que aborde la prevención y el tratamiento de las malformaciones craneofaciales asociadas. Superar los desafíos tradicionales implica adoptar una perspectiva inclusiva y personalizada en la atención odontológica. Esto no sólo mejora la calidad de vida de los pacientes con síndrome de Apert, sino que también destaca la importancia de una atención adaptada que trascienda los límites convencionales, ofreciendo soluciones innovadoras para las complejidades bucodentales asociadas a esta condición genética (AU)

Apert syndrome, marked by acrocephalosyndactyly, is a genetic condition that generates dentofacial deformities, including craniosynostosis, facial alterations and limb malformations. Mutation in the FGFR2 gene, whether inherited or resulting from sporadic mutations, triggers this complex condition. The relevance of addressing Apert syndrome is manifested not only in the aesthetic implications, but also in its impact on oral health. Breaking with current dental paradigms involves recognizing the particularities of these patients and providing specialized care. The need for specific training for dental health professionals is evident, allowing a comprehensive approach that addresses the prevention and treatment of associated craniofacial malformations. Overcoming traditional challenges means taking an inclusive and personalized perspective on dental care. This not only improves the quality of life of patients with Apert syndrome, but also highlights the importance of tailored care that transcends conventional boundaries, offering innovative solutions for the oral complexities associated with this genetic conditio (AU)

Anestesia general durante la atención odontológica a niños y personas con discapacidad / General anesthesia for the dental care of children and people with disabilities

Introducción: La anestesia general es considerada como una herramienta farmacológica que forma parte de las técnicas avanzadas en odontología para el manejo de la conducta de pacientes poco colaboradores o con alguna discapacidad física y/o mental, sirviendo como mecanismo de soporte en la ejecución de tratamientos odontológicos. Objetivo: Evaluar el uso de la anestesia general durante la atención odontológica a niños y personas con discapacidad. Métodos: Revisión sistemática de la literatura en la que se analizaron 17 estudios publicados entre el 2009 y el 2019, seleccionados de seis bases de datos (MedLine-PubMed, LILACS, SciELO, Clinical Key, IBECS y Cuiden). Para el estudio se tuvieron en cuenta las recomendaciones del Preferred Reporting Items for Systematic Reviews and Meta-Analyes (PRISMA) y se mantuvo el rigor ético y metodológico correspondiente. Resultados: Los resultados de la búsqueda permitieron caracterizar los estudios por año, país y abordaje metodológico. La evidencia muestra que el uso de la anestesia general como técnica odontológica es útil y eficaz para el manejo de conducta en pacientes pediátricos y discapacitados. Conclusiones: La anestesia general es una excelente alternativa como técnica odontológica para la resolución de problemas bucodentales en niños y personas con discapacidades físicas y/o mentales y en el mejoramiento de su calidad de vida(AU)

Introduction: General anesthesia is considered to be a pharmacological tool included among the advanced dental techniques used to manage uncooperative and physically and/or mentally disabled patients, as well as a support mechanism in the performance of dental treatments. Objective: Evaluate the use of general anesthesia for the dental care of children and people with disabilities. Methods: A systematic bibliographic review was conducted of 17 studies published from 2009 to 2019 in six databases: MedLine-PubMed, LILACS, SciELO, Clinical Key, IBECS and Cuiden. The study followed the recommendations contained in Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and maintained the corresponding ethical and methodological rigor. Results: Search results made it possible to characterize the studies by year, country and methodological approach. The evidence obtained shows that general anesthesia is useful and effective as a technique to control the behavior of children and people with disabilities during dental care. Conclusions: General anesthesia is an excellent alternative as a technique to solve the oral problems of children and people with physical and/or mental disabilities, thus improving their quality of life(AU)

Escala de triagem odontológica para pacientes com necessidades especiais / Dental screening scale for patients with special needs

Objetivo: elaborar e testar uma Escala de Triagem Odontológica para Pacientes com Necessidades Especiais (PNEs). Métodos: a escala foi elaborada a partir da experiência clínica de um centro de referência para aten-dimento odontológico a PNEs e de evidências científicas. Foi construída utilizando cinco critérios principais: comportamento, necessidade e possibilidade de estabilização protetora, urgência odontológica (dor), núme-ro e complexidade de procedimentos odontológicos e local do atendimento (acessibilidade). O instrumento foi testado em 14 PNEs, que participaram de uma triagem no Centro de Especialidades Odontológicas (CEO) Jequitibá, na Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel). Estudantes de gradua-ção a partir do oitavo semestre fizeram a aplicação, e o resultado da escala foi comparado ao parecer clínico realizado pelos pesquisadores experientes no atendimento a esses pacientes. Resultados: foi observada uma concordância em 85% dos casos. Conclusão: o instrumento apresentou desempenho comparável à avalia-ção de profissionais com expertise, e a escala pode ser um instrumento útil para ser empregado em serviços odontológicos que oferecem atendimento aos PNEs. A sua utilização em meio acadêmico também pode pro-porcionar o empoderamento dos critérios de avaliação pelos estudantes, proporcionando maior segurança em acolher, atender ou encaminhar esse público no seu futuro profissional. (AU)

Objective: to develop and test a dental screening scale to be used of patients with special needs (PSN). Method: the scale was developed based on the clinical experience of a reference center for dental care for PSN and scientific evidence. It was built using 5 main criteria: behavior, need and possibility of protective stabilization (PE), dental urgency (pain), number and complexity of dental procedures and place of care (accessibility). The instrument was tested on 14 PSN who participated in a screening at the Center for Dental Specialties (CEO) Jequitibá, Faculty of Dentistry, UFPEL. Undergraduate students from the eighth semester onwards applied and the result of the scale was compared to the clinical opinion carried out by experienced researchers in the care of these patients. Results: agreement was observed in 85% of cases. Conclusion: the instrument presented performance comparable to the evaluation of professionals with expertise and the scale can be a useful instrument to be used in dental services that offer care to PSN. Its use in academia can also provide the empowerment of assessment criteria by students, providing greater security in welcoming, serving or referring this audience in their professional future.

Lesiones cariosas en niños con discapacidad de 0-12 años en una población peruana / Carious lesions in children with disabilities aged 0-12 years from a Peruvian population

RESUMEN Introducción: Existen diversos indicadores y controversias en la prevalencia de caries en niños con y sin discapacidad. Objetivo: Determinar la prevalencia de lesiones de caries cavitadas y no cavitadas mediante el índice CPO-D/ceo-d y el registro de lesión de mancha blanca o lesión no cavitada activa en niños con y sin discapacidad de 0-12 años atendidos en el Centro Odontológico de la Universidad de San Martín de Porres entre los años 2010-2017, Lima, Perú. Métodos: Diseño observacional, transversal y retrospectivo. Población conformada por niños atendidos en la Especialidad de Odontopediatría del durante los años 2010-2017. Se identificaron 71 pacientes: 31 sin discapacidad y 40 con discapacidad. Se revisó el odontograma de la historia clínica, índice CPO-D/ceo-d y lesiones no cavitadas activas para determinar la presencia de caries dental. Resultados: En dentición decidua en niños sin discapacidad, el promedio del total de piezas afectadas (ceo-d + lesiones no cavitadas activas) fue de 15,83 y en los niños con discapacidad fue 11,64; en dientes deciduos de la dentición mixta en niños sin discapacidad se encontró un total de ceo-d de 7,86 y en niños con discapacidad presentaron un ceo-d de 8,20; en dientes permanentes de la dentición mixta en niños sin discapacidad se evidenció un CPO-D de 3,29 y en niños con discapacidad presentaron un CPO-D de 2,27. Solo se halló diferencia estadísticamente significativa del total de piezas afectadas, en dentición decidua de niños con y sin discapacidad (p = 0,013). Conclusiones: Los niños con discapacidad presentaron solo una mayor prevalencia de lesiones de caries cavitadas y no cavitadas en dientes deciduos de la dentición mixta, en contraste con los niños sin discapacidad (sin diferencia estadísticamente significativa). En el resto de las denticiones (decidua y permanente de la mixta) la prevalencia de lesiones de caries en pacientes con discapacidad fue menor, con diferencias estadísticamente significativas(AU)

ABSTRACT Introduction: There are various indicators of and controversies about the prevalence of dental caries in children with and without disabilities. Objective: Determine the prevalence of cavitated and uncavitated carious lesions based on the CPO-D/ceo-d index and the white spot lesion or active uncavitated lesion registry in children with and without disabilities aged 0-12 years attending the Dental Care Center at San Martín de Porres University in the period 2010-2017. Methods: A cross-sectional observational retrospective study was conducted of a population composed of the children attending the pediatric dental care service in the period 2010-2017. Seventy-one patients were identified: 31 without disabilities and 40 with disabilities. A review was done of the dental chart in the medical record, the CPO-D/ceo-d index and active uncavitated lesions to determine the presence of dental caries. Results: Average total affected deciduous teeth (ceo-d + active uncavitated lesions) was 15.83 in children without disabilities and 11.64 in children with disabilities; in mixed dentition deciduous teeth total ceo-d was 7.86 in children without disabilities and 8.20 in children with disabilities; in mixed dentition permanent teeth CPO-D was 3.29 in children without disabilities and 2.27 in children with disabilities. A statistically significant difference in the total affected teeth was only found in deciduous dentition of children with and without disabilities (p = 0.013). Conclusions: Children with disabilities only showed a greater prevalence of cavitated and uncavitated carious lesions in mixed dentition deciduous teeth, in contrast with children without disabilities (not a statistically significant difference). In the remaining dentitions (mixed deciduous and permanent) prevalence of carious lesions was lower in patients with disabilities, with statistically significant differences(AU)

Strategies and dental care in the treatment of patients with myelomeningocele.

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing oral medications. This paper reports the oral findings and dental treatment in a 15-year-old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients' mobility problems; prevention of latex-related allergic reactions; reduction of gag reflex during dental procedures.

Necesidad de tratamiento estomatológico en niños discapacitados de La Habana / Need for stomatological treatment in disabled children of Havana

Introducción: el paciente discapacitado constituye un grupo priorizado dentro de la atención estomatológica cubana ya que su salud bucal está influenciada por diversos factores. Objetivo: determinar factores de riesgo, enfermedades bucales, así como la necesidad de tratamiento estomatológico de los pacientes discapacitados según la categoría diagnóstica de la Escuela Especial "Luis Ramírez López". Método: estudio descriptivo transversal realizado en el período comprendido entre 2016-2017. El universo estuvo constituido por los 72 alumnos matriculados en la escuela. Resultados: la categoría diagnosticada que prevaleció fue el retraso mental leve con 79,2 por ciento. El 55,6 por ciento de la población estudiada presentó higiene bucal adecuada, siendo el retraso mental leve la categoría más representativa. El 62,5 por ciento de los niños presentó caries dental, el 60.0 por ciento enfermedad periodontal y el 33,3 por ciento maloclusión. De la población estudiada el 62,5 por ciento necesitó tratamiento conservador, el 33,3 tratamiento ortodóntico y el 9,7 tratamiento periodontal. Conclusiones: predominaron los niños con retraso mental leve, higiene bucal adecuada y caries dental, condicionando una alta necesidad de tratamiento conservador(AU)

Introduction: the disabled patient is a prioritized group in Cuban dental care since his or her oral health is influenced by several factors. Objective: to determine risk factors, oral diseases, as well as the need for stomatological treatment of disabled patients according to the diagnostic category of the Special School "Luis Ramirez Lopez". Method: a cross-sectional and descriptive study was conducted in the period 2016-2017. The universe was constituted by the 72 students enrolled in the school. Results: the diagnosed category that prevailed was mild mental retardation with 79.2 percent. 55.6 percent of the studied population presented adequate oral hygiene, with mild mental retardation being the most representative category. 62.5 percent of children had dental caries, 60.0 percent periodontal disease and 33.3 percent malocclusion. Of the population, 62.5 percent required conservative treatment, 33.3 orthodontic treatments and 9.7 periodontal treatments. Conclusions: children with mild Mental retardation predominated with adequate oral hygiene, dental caries also conditioning a high need for conservative treatment(AU)

Introdução: o paciente com deficiência é um grupo prioritário no atendimento odontológico cubano, uma vez que sua saúde bucal é influenciada por vários fatores. Objetivo: determinar fatores de risco, doenças bucais, bem como a necessidade de tratamento estomatológico de pacientes com deficiência de acordo com a categoria diagnóstica da Escola Especial "Luis Ramírez López". Método: estudo transversal no período 2016-2017. O universo consistiu de 72 alunos matriculados na escola. Resultados: A categoria que prevaleceu foi diagnosticado retardo mental leve, com 79, por cento. 55,6 por cento da população do estudo tinha a higiene oral, retardo mental leve adequada sendo a categoria mais representativa. 62,5 por cento das crianças tinham cárie dentária, doença periodontal 60,0 por cento e 33,3 por cento de má oclusão. Da população de estudo de 62,5 por cento tratamento conservador necessário, 33,3 e 9,7 tratamento ortodôntico tratamento periodontal. Conclusões: predominaram as crianças com retardo mental leve, boa higiene oral e cárie dentária, determinando uma alta necessidade de tratamento conservador. Método: estudo descritivo transversal, realizado no período 2016-2017. O universo foi constituído pelos 72 alunos matriculados na escola. Resultados: a categoria diagnosticada que prevaleceu foi o retardo mental leve com 79,2 por cento. 55,6 por cento da população estudada apresentavam higiene bucal adequada, sendo o retardo mental leve a categoria mais representativa. 62,5 por cento das crianças tinham cárie dentária, 60,0 por cento doença periodontal e 33,3 por cento maloclusão. Da população estudada, 62,5 por cento necessitaram de tratamento conservador, 33,3 tratamento ortodôntico e 9,7 tratamento periodontal. Conclusões: crianças com retardo mental leve, higiene bucal adequada e cárie dentária predominaram, condicionando grande necessidade de tratamento conservador(AU)

Necesidad de tratamiento estomatológico en niños discapacitados de La Habana / Necessidade de tratamento estomatológico em crianças deficientes em Havana / Need for stomatological treatment in disabled children of Havana

Introducción: el paciente discapacitado constituye un grupo priorizado dentro de la atención estomatológica cubana ya que su salud bucal está influenciada por diversos factores. Objetivo: determinar factores de riesgo, enfermedades bucales, así como la necesidad de tratamiento estomatológico de los pacientes discapacitados según la categoría diagnóstica de la Escuela Especial Luis Ramírez López. Método: estudio descriptivo transversal realizado en el período comprendido entre 2016-2017. El universo estuvo constituido por los 72 alumnos matriculados en la escuela. Resultados: la categoría diagnosticada que prevaleció fue el retraso mental leve con 79,2 por ciento. El 55,6 por ciento de la población estudiada presentó higiene bucal adecuada, siendo el retraso mental leve la categoría más representativa. El 62,5 por ciento de los niños presentó caries dental, el 60.0 por ciento enfermedad periodontal y el 33,3 por ciento maloclusión. De la población estudiada el 62,5 por ciento necesitó tratamiento conservador, el 33,3 tratamiento ortodóntico y el 9,7 tratamiento periodontal. Conclusiones: predominaron los niños con retraso mental leve, higiene bucal adecuada y caries dental, condicionando una alta necesidad de tratamiento conservador(AU)

Introduction: the disabled patient is a prioritized group in Cuban dental care since his or her oral health is influenced by several factors. Objective: to determine risk factors, oral diseases, as well as the need for stomatological treatment of disabled patients according to the diagnostic category of the Special School Luis Ramirez Lopez. Method: a cross-sectional and descriptive study was conducted in the period 2016-2017. The universe was constituted by the 72 students enrolled in the school. Results: the diagnosed category that prevailed was mild mental retardation with 79.2 percent. 55.6 percent of the studied population presented adequate oral hygiene, with mild mental retardation being the most representative category. 62.5 percent of children had dental caries, 60.0 percent periodontal disease and 33.3 percent malocclusion. Of the population, 62.5 percent required conservative treatment, 33.3 orthodontic treatments and 9.7 periodontal treatments. Conclusions: children with mild Mental retardation predominated with adequate oral hygiene, dental caries also conditioning a high need for conservative treatment(AU)

Introdução: o paciente com deficiência é um grupo prioritário no atendimento odontológico cubano, uma vez que sua saúde bucal é influenciada por vários fatores. Objetivo: determinar fatores de risco, doenças bucais, bem como a necessidade de tratamento estomatológico de pacientes com deficiência de acordo com a categoria diagnóstica da Escola Especial Luis Ramírez López. Método: estudo transversal no período 2016-2017. O universo consistiu de 72 alunos matriculados na escola. Resultados: A categoria que prevaleceu foi diagnosticado retardo mental leve, com 79,2 por cento. 55,6 por cento da população do estudo tinha a higiene oral, retardo mental leve adequada sendo a categoria mais representativa. 62,5 por cento das crianças tinham cárie dentária, doença periodontal 60,0 por cento e 33,3 por cento de má oclusão. Da população de estudo de 62,5 por cento tratamento conservador necessário, 33,3 e 9,7 tratamento ortodôntico tratamento periodontal. Conclusões: predominaram as crianças com retardo mental leve, boa higiene oral e cárie dentária, determinando uma alta necessidade de tratamento conservador. Método: estudo descritivo transversal, realizado no período 2016-2017. O universo foi constituído pelos 72 alunos matriculados na escola. Resultados: a categoria diagnosticada que prevaleceu foi o retardo mental leve com 79,2 por cento. 55,6 por cento da população estudada apresentavam higiene bucal adequada, sendo o retardo mental leve a categoria mais representativa. 62,5% das crianças tinham cárie dentária, 60,0 por cento doença periodontal e 33,3 por cento maloclusão. Da população estudada, 62,5% necessitaram de tratamento conservador, 33,3 tratamento ortodôntico e 9,7 tratamento periodontal. Conclusões: crianças com retardo mental leve, higiene bucal adequada e cárie dentária predominaram, condicionando grande necessidade de tratamento conservador(AU)

Atención odontológica a personas con discapacidad intelectual: una cuestión de derecho / Dental care for people with intellectual disabilities: a matter of law

En el planeta hay 100 millones de personas con alguna discapacidad yen México es el 6.2 por ciento de la población total. Estas personas son altamente vulnerables porque el entorno donde se desenvuelven no ofrece las condiciones para favorecer su integración y participación social, como el acceso a servicios médicos. De acuerdo con la Organización Mundialde la Salud, las personas con discapacidad son las menos atendidas en los Servicios Odontológicos, principalmente por inexperiencia del profesionista sobre el trato a estas personas, o bien por desconocimiento de los familiares-cuidadores de la importancia de mantener una boca sana. Las personas con discapacidad intelectual (PDI) constituyen un retopara el odontólogo, quien tiene que capacitarse para diseñar estrategiaspara su atención, ya que los tratamientos para este tipo de pacientes son específicos y poco convencionales. Adicionalmente conviene tomar precauciones en su atención dental, debido a que los PDI consumen diversos medicamentos, por lo que el odontólogo debe asegurarsecon otros especialistas para su manejo. Un punto medular sobre las características de la atención odontológica es que ésta tiene que generar confianza y enfrentar con paciencia y destreza a un PDI que cumpla con las expectativas del usuario, trato digno, calidez y confianza centrada en la prevención como principal criterio en la intervención odontológica, sobre todo en la supervisión de la higiene por parte de los familiares. Actualmente se habla de la relación médico-paciente participativa donde se define lo que corresponde a cada persona involucrada en el cuidado de la PDI, sin olvidar que esta atención conviene que sea en equipo. Así, ante este contexto, los odontólogos tendrían que formarseen el cuidado de la salud de las PDI quienes son sujetos de derecho,por tanto tienen que ser atendidos, respetados y tratados con dignidad.

On the planet, there are 100 million people with some disability andin Mexico; it is 6.2% of the total population. These people are highly vulnerable because the environment where they operate does not offer the conditions to favor their integration and social participation, such as access to medical services. According to the World Health Organization, people with disabilities are the least attended in the dental services, mainly because of the inexperience of the professional about the treatment of these people, or because the family/caregivers do notknow about the importance of maintaining a healthy mouth. People with intellectual disabilities (PIDs) are a challenge for the dentist,who has to be trained to design strategies for their care since the treatments for these types of patients are specific and unconventional.In addition, precautions should be taken in dental care, because PIDsconsume different medications, so the dentist must be sure with other specialists to handle them. A central point about the characteristicsof dental care is that it has to generate trust and face with patience and dexterity a PDIs that meets user expectations, dignified treatment, warmth, and confidence focused on prevention as the main criterion inthe intervention dental care, especially in the supervision of the hygieneby the relatives. At the moment we are talking about the participative doctor-patient relationship where it is defined that corresponds to eachperson involved in the care of the PDIs, without forgetting that this careshould be in a team. Thus in this context dentists should be trained inthe health care of the IDPs who are subjects of law, therefore have tobe attended, respected and treated with dignity.

Manejo odontológico del paciente con hipoacusia neurosensorial profunda bilateral / Dental management of patients with bilateral profound sensorineural hearing loss

Introducción: la hipoacusia es la disminución de la agudeza auditiva o de la capacidad para captar el sonido; esta puede ser neurosensorial, conductiva o mixta. La hipoacusia neurosensorial resulta de alteraciones en el oído interno, nervio auditivo o en los núcleos auditivos del tronco cerebral. El manejo de estos pacientes requiere disposición, conocimientos y calidez para el correcto desarrollo de la atención estomatológica. Objetivo: reportar el manejo odontológico de un paciente con hipoacusia neurosensorial profunda bilateral. Presentación del caso: paciente femenino de 7 años y 10 meses de edad con diagnóstico de hipoacusia neurosensorial profunda bilateral, quien acude a consulta por presentar dolor. A la inspección física, paciente mesofacial, perfil convexo. Intraoralmente se observan tejidos blandos clínicamente sanos, alteraciones de número y posición, caries moderada e higiene deficiente. Durante la inspección clínica la paciente se mostró poco cooperadora (Frankl II). El plan de tratamiento consistió en prevención, operatoria, ortopedia y cirugía. Para el manejo del paciente se incluyó un lenguaje de señas básico con uso de careta y sin cubreboca, modelado con otros pacientes. Se modificó la técnica decir, mostrar y hacer por mostrar/oler, tocar y hacer. Conclusiones: el odontopediatra debe tener las competencias necesarias para la atención integral de pacientes con capacidades diferentes. El manejo de la conducta y el cuidado multidisciplinario del paciente en edades tempranas es fundamental para el éxito del tratamiento. En el caso clínico que se presenta se resalta la efectividad del manejo conductual modificado, lo cual incrementó la posibilidad de éxito de la rehabilitación dental del paciente, así como de su seguimiento(AU)

Introduction: hearing loss is reduced auditory acuity or a decrease in the ability to perceive sound. It may be sensorineural, conductive or mixed. Sensorineural hearing loss results from alterations in the inner ear, the auditory nerve or the auditory brainstem nuclei. Dental management of these patients requires willingness, knowledge and warmth on the part of the dental practitioner. Objective: report the dental management of a patient with bilateral profound sensorineural hearing loss. Case presentation: a female patient aged 7 years and 10 months diagnosed with bilateral profound sensorineural hearing loss attends consultation for dental pain. At physical inspection, it is observed that the patient is mesofacial with a convex profile. Intraoral examination found clinically healthy soft tissue, tooth alterations in number and position, moderate decay and poor hygiene. During clinical inspection, the patient was uncooperative (Frankl II). Treatment consisted in prevention, restoration, orthopedics and surgery. Management of the patient included use of basic sign language and a mask without the practitioner wearing a facemask, and modeling with other patients. The technique of say, show and do was replaced by show / smell, touch and do. Conclusions: pediatric dentists should have the skills required for the comprehensive care of patients with different capabilities. Behavior management and multidisciplinary care of very young patients is essential for a successful treatment. The clinical case herein presented highlights the effectiveness of modified behavior management, which increased the chances of success in the patient's dental rehabilitation and follow-up(AU)

Manejo odontológico del paciente con hipoacusia neurosensorial profunda bilateral / Dental management of patients with bilateral profound sensorineural hearing loss

Introducción: la hipoacusia es la disminución de la agudeza auditiva o de la capacidad para captar el sonido; esta puede ser neurosensorial, conductiva o mixta. La hipoacusia neurosensorial resulta de alteraciones en el oído interno, nervio auditivo o en los núcleos auditivos del tronco cerebral. El manejo de estos pacientes requiere disposición, conocimientos y calidez para el correcto desarrollo de la atención estomatológica. Objetivo: reportar el manejo odontológico de un paciente con hipoacusia neurosensorial profunda bilateral. Presentación del caso: paciente femenino de 7 años y 10 meses de edad con diagnóstico de hipoacusia neurosensorial profunda bilateral, quien acude a consulta por presentar dolor. A la inspección física, paciente mesofacial, perfil convexo. Intraoralmente se observan tejidos blandos clínicamente sanos, alteraciones de número y posición, caries moderada e higiene deficiente. Durante la inspección clínica la paciente se mostró poco cooperadora (Frankl II). El plan de tratamiento consistió en prevención, operatoria, ortopedia y cirugía. Para el manejo del paciente se incluyó un lenguaje de señas básico con uso de careta y sin cubreboca, modelado con otros pacientes. Se modificó la técnica decir, mostrar y hacer por mostrar/oler, tocar y hacer. Conclusiones: el odontopediatra debe tener las competencias necesarias para la atención integral de pacientes con capacidades diferentes. El manejo de la conducta y el cuidado multidisciplinario del paciente en edades tempranas es fundamental para el éxito del tratamiento. En el caso clínico que se presenta se resalta la efectividad del manejo conductual modificado, lo cual incrementó la posibilidad de éxito de la rehabilitación dental del paciente, así como de su seguimiento(AU)

Introduction: hearing loss is reduced auditory acuity or a decrease in the ability to perceive sound. It may be sensorineural, conductive or mixed. Sensorineural hearing loss results from alterations in the inner ear, the auditory nerve or the auditory brainstem nuclei. Dental management of these patients requires willingness, knowledge and warmth on the part of the dental practitioner. Objective: report the dental management of a patient with bilateral profound sensorineural hearing loss. Case presentation: a female patient aged 7 years and 10 months diagnosed with bilateral profound sensorineural hearing loss attends consultation for dental pain. At physical inspection, it is observed that the patient is mesofacial with a convex profile. Intraoral examination found clinically healthy soft tissue, tooth alterations in number and position, moderate decay and poor hygiene. During clinical inspection, the patient was uncooperative (Frankl II). Treatment consisted in prevention, restoration, orthopedics and surgery. Management of the patient included use of basic sign language and a mask without the practitioner wearing a facemask, and modeling with other patients. The technique of say, show and do was replaced by show / smell, touch and do. Conclusions: pediatric dentists should have the skills required for the comprehensive care of patients with different capabilities. Behavior management and multidisciplinary care of very young patients is essential for a successful treatment. The clinical case herein presented highlights the effectiveness of modified behavior management, which increased the chances of success in the patient's dental rehabilitation and follow-up(AU)

Valoraciones de futuros estomatólogos sobre su formación para la atención al paciente sordo, La Habana, 2016 / Future odonatologists educational evaluation for the attention to the deaf patient, Havana, 2016

Introducción: La sordera es una disminución única y el interés que muestran los futuros estomatólogos por conocer la comunidad sorda es para brindar un tratamiento estomatológico más integral. Objetivo: Identificar las valoraciones de los futuros estomatólogos sobre su formación para la atención al paciente sordo. Material y Métodos: Se realizó un estudio descriptivo de corte transversal. Se estudió una población de 35 estudiantes de quinto año de Estomatología, con edad promedio de 22 años, de ambos sexos, pertenecientes al Instituto de Ciencias Básicas y Preclínicas Victoria de Girón del Municipio Playa en La Habana, en marzo de 2016. Estos recibieron el curso optativo Manejo odontológico del paciente sordo y posteriormente se les realizó una encuesta. Las variables estudiadas fueron: sexo, temas más interesantes del curso optativo recibido, satisfacción de las necesidades de aprendizaje específicas para la atención estomatológica al paciente sordo, necesidad de recibir el curso optativo como complemento del Plan de Estudios de la Carrera. Resultados: El sexo femenino fue el de mayor predominio con 74.3 por ciento. El tema más interesante fue la Lengua de Señas Cubana para 62.9 por ciento. El 65.7 por ciento de los estudiantes encuestados creen que lo impartido en el plan de estudios de la carrera no satisface las necesidades especiales de atención estomatológica del paciente sordo. En correspondencia, 91.4 por ciento considera que necesita recibir el curso optativo para complementar el plan de estudios. Conclusiones: La mayoría de los estudiantes de estomatología encuestados es del sexo femenino, se interesa por la Lengua de Señas Cubana y considera que necesita del curso optativo Manejo odontológico del paciente sordo, para complementar el plan de estudios de la carrera(AU)

Introduction: Deafness is a unique decline and the interest shown by future stomatologists to know the deaf community is related with their interest to provide a more comprehensive stomatological treatment. Objective: To identify future stomatologists' assessments of their training in the care of deaf patients. Material and Method: In March 2016, a cross-sectional descriptive study was carried out in a population of 35 students in the fifth year of stomatologys career from the Institute of Basic and Preclinical Sciences Victoria de Girón Playa Municipality in Havana, with an average age of 22 years, of both sexes. They received the optional training course Dental management of the deaf patient and then was performed a survey. The variables studied were: sex, more interesting subjects of the elective course received, satisfaction of the specific learning needs for the deaf patients stomatological attention, the need of receiving an optional course as a complement to their Career Curriculum. Results: The female sex was the most prevalent with 74.3 percent. The most interesting topic was the Cuban Signs Language for a 62.9 percent. 65.7 percent of the students surveyed believe that what it is taught in the career does not meet the special dental care needs of the deaf patient. Correspondingly, 91.4 percent consider that they need to receive an elective course as a complement of the curriculum. Conclusions: The majority of stomatology students surveyed were female, they shown an interest in the Cuban Signs Language and consider that they need the optional course Deaf patient dental management , to complement the curriculum of the course(AU)

Dental caries and associated factors in twins with Down syndrome: a case report.

Down syndrome (DS) is the most common genetic disorder in humans, but its incidence in monozygotic twins is extremely rare. The aim of this study was to determine the factors associated with dental caries in a pair of monozygotic twin girls with DS, where one had caries experience and the other did not. Clinical examination, salivary Streptococcus mutans (S. mutans) levels and their genotypic diversity, the biochemical composition of the dental biofilm, the frequency of sucrose consumption, and toothbrushing habits were assessed from the twin girls. Twin with caries experience showed higher levels of S. mutans in the saliva and lower concentrations of calcium, phosphate, and fluoride and higher concentrations of extracellular polysaccharides in the biofilm compared to her sister. Genotypic diversity of S. mutans was also higher in the twin with caries experience. Dental biofilm composition showed different patterns of cariogenicity between the two sisters, which may also by itself explain the difference in the dental caries between them.

Lecciones de parafunciones en lenguaje de señas para pacientes sordos o hipoacúsicos / Lessons about parafunctions in sign language for deaf or hard of hearing patients

Fundamento: las personas con trastornos auditivos severos o moderados no están exentas de presentar alteraciones parafuncionales y no existen propuestas informativas que los acerquen al tema.Objetivo: evaluar la utilidad de lecciones de parafunciones en lenguaje de señas para pacientes de estomatología sordos o hipoacúsicos.Métodos: se desarrolló un estudio cuasi experimental de febrero de 2014 a febrero de 2015. El universo de estudio lo conformaron 1 129 personas sordas o hipoacúsicas de la provincia de Camagüey, la muestra no probabilística quedó integrada por 513 pacientes del municipio de Camagüey, según criterios de inclusión. Se estructuró la investigación en cinco fases.Resultados: en un inicio predominó en el 83, 04 por ciento de los pacientes el nivel de información no satisfactorio. Después de impartidas las lecciones se alcanza un 97, 85 por ciento de estos, nivel de información satisfactorio. El 97, 61 por ciento del personal docente estuvo conforme con la propuesta. El 99, 02 por ciento de los pacientes sordos e hipoacúsicos, consideraron útiles las lecciones de parafunciones en lenguaje de señas.Conclusiones: el nivel de información sobre parafunciones resultó no satisfactorio en las personas sordas o hipoacúsicas antes de aplicar las lecciones en lenguaje de señas; después de estas, fue satisfactorio en la totalidad de los pacientes. La mayoría de los pacientes consideró útil la propuesta(AU)

Background: people with severe or moderate hearing disorders are not exempt from presenting parafunctional alterations. There are no informative proposals that lean toward the topic.Objective: to assess the utility of lessons about parafunctions in sign language for deaf and hard or hearing patients in stomatology.Methods: a quasi-experimental study from February 2014 to February 2015 was conducted. The universe was composed of 1129 deaf or hard of hearing people from Camagüey province. The non-probabilistic sample was made up by 513 patients from Camagüey municipality, according to inclusion criteria. The research was divided in five stages.Results: at the beginning, non-satisfactory level of information was predominant in 83, 04 percent of patients. After teaching the lessons, 97, 85 percent of patients reached satisfactory level. From the teaching staff, 97, 61 percent was satisfied with the proposal. Deaf and hard of hearing patients (99, 02 percent) considered the lessons about parafunctions useful in sign language.Conclusions: the level of information about parafunctions was non-satisfactory in deaf or hard of hearing people before applying the lessons in sign language. Once the lessons concluded, the level was satisfactory in the totality of patients. Professors and patients gave consent to the proposal(AU)

Use of a Picture Exchange Communication System for preventive procedures in individuals with autism spectrum disorder: pilot study.

The aim of the present study was to evaluate the use of the Picture Exchange Communication System (PECS) in individuals with autism spectrum disorder (ASD) in order to facilitate patient-professional communication during preventive procedures. In this study, 26 patients with ASD, between 5 and 19 years of age (10±3.3 y), were divided into two groups: G1 (n = 13) with no previous experience of dental treatment, and G2 (n = 13), with such previous experience. The initial approach followed the principles of the Son-Rise Program®. The seven PECSs presented the routine of the dental office: "room," "ground," "chair," "dentist," "mouth," "low," and "triple." Each PEC was used up to three times in order to acquire the skill proposed. It was verified that G2 required a greater number of times to achieve the acceptance of PECS "ground," "dentist," "mouth," and "triple" (p < .05). We concluded that PECS facilitated patient-professional communication during preventive procedures, including for ASD patients with previous dental experience.

Evaluación de la salud oral y de las características fenotípicas de individuos con síndrome de Down de diferentes agrupaciones en Monterrey, México / Assessing oral health and phenotypic characteristics of individuals with Down syndrome from a range of associations, in Monterrey, Mexico

Objetivo: El propósito de esta investigación fue identificar las condiciones de la salud oral de los integrantes con síndrome de Down de diferentes agrupaciones en Monterrey, México. Material y métodos: El tamaño de la muestra fue de 97 personas de ambos sexos, con edades entre los 3 y48 años (Me = 9.5). Las condiciones de la salud oral y manifestaciones clínicas propias se evaluaron de acuerdo con los criterios de la Organización Mundial de la Salud, adicionalmente se determinaron los índices de placa dental y gingival de Lõe y Silness. Resultados: El 53.75 por ciento presentó caries, 33.75 por ciento cálculos, se encontró apiñamiento en el 45.75 por ciento, mientras que el 85 por ciento reveló un tipo de alteración en el sector posterior, y se realizó un análisis de las manifestaciones clínicas propias del padecimiento. El índice de placa dental fue de 1.96 y el gingival de 1.91. Conclusiones: Existen condiciones de salud oral defi cientes de los participantes de este estudio, reafi rmándose la urgencia de diseñar y ejecutar programas de atención odontológica integral para pacientes con discapacidad

Objective:The aim of this study was to identify the oral health statusof people with Down syndrome belonging to various associations in Monterrey, Mexico. Material and methods: A sample of 97 individu-als aged from 3 to 48 (MA = 9.5) and of both sexes was selected. The subjects’ oral health status and clinical manifestations were assessed based on World Heart Organization criteria and we also calculated the Lõe-Silness dental plaque and gingival indexes. Results: A total of 53 .75% of the subjects had caries; 33.75% calculus; 45.75% crowding, and 85% presented some form of alteration in the poste-rior sector. The clinical manifestations of the disease in each patient were analyzed. The dental plaque index was 1.96 and the gingival index 1.91. Conclusions: The individuals in the study were found to have poor dental health, which is further evidence of the urgent need to design and implement comprehensive dental care programs for patients with disabilities.

Ortodontia interceptiva em pacientes especiais: relato de dois casos clínicos / Interceptive Orthodontics in special patients: two case reports

Geralmente, os pacientes portadores de necessidades especiais apresentam músculos orofaciais com função anormal, alteração no crescimento facial e na oclusão, prevalência de cárie e doença periodontal, além da má oclusão como um problema recorrente. A intervenção ortodôntica, quando indicada, tem um importante papel nesses tratamentos e deve ser realizado com a colaboração do paciente e, principalmente, de seus cuidadores. / Métodos / Esse trabalho apresenta dois casos clínicos, um caso de paralisia cerebral com mordida cruzada anterior e outro de Síndrome de Down com erupção ectópica e mordida cruzada anterior, ambos tratados por meio da Ortodontia Interceptativa no Módulo de Odontologia da Universidade Estadual do Sudoeste da Bahia. / Resultados / Os dois casos tiveram uma boa evolução e conclusão, a colaboração dos pais e dos pacientes permitiu que a má oclusão fosse revertida em menos de seis meses. / Conclusões / O tratamento ortodôntico, desde que bem conduzido, apresenta resultados semelhantes aos de pacientes convencionais, mas esse só é possível com a colaboração dos pais/cuidadores.

Behavior guidance techniques in Pediatric Dentistry: attitudes of parents of children with disabilities and without disabilities.

This study compared the parental acceptance of pediatric behavior guidance techniques (BGT). Forty parents of children without disabilities (Group A) and another 40 parents of children with disabilities (Group B) were selected. Each BGT was explained by a single examiner and it was presented together with a photograph album. After that parents evaluated the acceptance in: totally unacceptable, somewhat acceptable, acceptable, and totally acceptable. Results indicated that in Group A, the BGT based on communicative guidance was accepted by most participants. In Group B, just one mother considered totally unacceptable the voice control method and other two, tell-show-do. For both groups, the general anesthesia was the less accepted BGT. There was statistically significant difference in acceptance for protective stabilization with a restrictive device in Group B. Children's parents with and without disabilities accepted behavioral guidance techniques, but basic techniques showed higher rates of acceptance than advanced techniques.