Prevalence of tooth loss, bleeding on probing and malocclusion as oral disease indicators in Costa Rican male adolescents: a cross sectional study / Prevalencia de la pérdida de piezas dentales, del sangrado al sondeo y la maloclusión como indicadores de enfermedades orales en adolescentes varones costarricenses: un estudio transversal

The evidence to characterize oral health during adolescence in Costa Rica is limited. This lack of adequate research makes it difficult to develop appropriate health policies for this subgroup of the population. This is particularly important because adolescence is the period during which good health habits must take root in order to foster good physical and cognitive development. This study aims to determine the prevalence of tooth loss, bleeding on probing and malocclusion in Costa Rican male adolescents at the ''Colegio Técnico Profesional San Agustín'' (St. Augustine's Technical High School) located in the province of Cartago. Data was collected from 428 male adolescents aged 12-22 years in a cross-sectional study during 2019. Prevalence of tooth loss was calculated as the number of individuals having lost at least one tooth. The average number of teeth lost by individuals was also recorded. The bleeding on probing was an indicator used as a proxy parameter for monitoring periodontal health where the presence of bleeding on probing and calculus was also recorded. Malocclusion was measured using the Dental Aesthetic Index (DAI). The results showed that the prevalence of tooth loss, bleeding on probing and malocclusion was of 19%, 70.0% and 98%, respectively. It was also found that 81% of the participants had all their teeth, 11% had lost 1 tooth, 8% had lost more than one tooth of which 0.5% had lost more than 5 teeth. Considering a general classification of periodontal problems based on bleeding on probing and presence of calculus, the prevalence of periodontal problems increases to 92%. Regarding the DAI, the category identifying a very severe malocclusion was the most prevalent in the sample (88%). It is alarming the high prevalence of tooth loss, bleeding on probing, and malocclusions in a sample of Costa Rican male adolescents, compared to similar studies in other countries. The overarching conclusion of this study is that oral diseases represent an important health problem that urgently need proper public health action.

La evidencia para caracterizar la salud bucal durante la adolescencia en Costa Rica es limitada. Esta falta de investigación adecuada dificulta el desarrollo de políticas de salud convenientes para este subgrupo de la población. Esto es particularmente importante porque la adolescencia es el período durante el cual se deben arraigar buenos hábitos de salud para fomentar un buen desarrollo físico y cognitivo. Este estudio tiene como objetivo determinar la prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusión en adolescentes varones costarricenses del Colegio Técnico Profesional San Agustín ubicado en la provincia de Cartago. Se recopilaron datos de 428 adolescentes varones de 12 a 22 años en un estudio transversal durante 2019. La prevalencia de pérdida de piezas dentales se calculó como el número de individuos que habían perdido al menos una pieza dental. También se registró el número promedio de dientes perdidos por individuos. El sangrado al sondeo fue un indicador utilizado como parámetro para el seguimiento de la salud periodontal donde también se registró la presencia de sangrado al sondeo y cálculo dental. La maloclusión se midió utilizando el Índice Estético Dental (DAI, por sus siglas en inglés). Los resultados mostraron que la prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusión fue del 19%, 70,0% y 98%, respectivamente. También se encontró que el 81% de los participantes tenían todos sus dientes, el 11% había perdido 1 pieza dental, el 8% había perdido más de una pieza dental, de los cuales el 0,5% había perdido más de 5 piezas dentales. Considerando una clasificación general de problemas periodontales basada en sangrado al sondeo y presencia de cálculo, la prevalencia de problemas periodontales aumenta al 92%. En cuanto al DAI, la categoría que identifica una maloclusión muy severa fue la más prevalente en la muestra (88%). Es alarmante la alta prevalencia de pérdida de piezas dentales, sangrado al sondeo y maloclusiones en una muestra de adolescentes varones costarricenses, en comparación con estudios similares en otros países. La conclusión general de este estudio es que las enfermedades bucodentales representan un importante problema de salud que necesita urgentemente una acción adecuada de salud pública.

Angina bullosa hemorrhagica: report of two cases.

Angina bullosa hemorrhagica (ABH) is a rare benign condition that affects the oral and oropharyngeal mucosa. It is characterized by a rapid eruption of one or more red or magenta blood-filled bullae, which typically involves the soft palate. ABH is a self-limiting condition that heals spontaneously usually within 2 weeks without scarring. ABH is not related to any dermatologic, hematologic, systemic disorders, or other known causes. The etiopathogeneses of ABH are unknown, though several theories have been proposed. Trauma has been suggested as a potential cause for the development of ABH in susceptible individuals. Two cases are presented of ABH, and the differential diagnoses of oral vesiculobullous conditions is discussed. Cognizance and identification of this benign condition is important to prevent misdiagnosis and eventual unwarranted treatment.

Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria.

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.

Angina bullous haemorrhagica: Case report and review of literature.

Angina Bullosa Haemorrhagica (ABH) is a benign lesion of the oral cavity categorized by sudden onset of single or multiple blood filled lesions that burst leaving an ulcer that usually heals in 7-10 days without leaving a scar. We report a case of ABH diagnosed on the basis of history, clinical examination and blood, renal and liver function tests. The case findings and its management is discussed. Literature of the cases presented in the last 5 years was searched from Google Scholar and Pubmed. The review was summarized in a tabulated form.

Angina bullosa hemorrhagica: report of 7 cases and analysis of 199 cases from the literature.

Angina bullosa hemorrhagica (ABH) is a condition characterized by blood blisters in the oral or oropharyngeal mucosa. Typically, the first presentation of ABH is acute, and rupture of the blisters occurs after a few hours or days. Although its etiology is unclear, ABH is assumed to be associated with predisposing factors such as local trauma or chronic use of inhaled steroids. The diagnosis is defined clinically, based on the presentation and evolution of the lesions. The recommended treatment is symptomatic, but extensive lesions may present a risk of airway obstruction and may require surgical excision. This case series reports 7 cases of ABH and reviews 199 cases published in the English-language literature. The possible etiologic factors, predisposing factors, and differential diagnoses are discussed.

A Case of Acute Upper Airway Obstruction in a Pediatric Hemophilia A Patient Because of Spontaneous Retropharyngeal Hemorrhage.

We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. The possibility of spontaneous retropharyngeal or epiglottic hemorrhage or hematoma should be considered as a cause of rapidly progressing odynophagia and dyspnea by hemophilia patients.

Extração dentária em pacientes com doença arterial coronariana em terapia antiplaquetária dual / Tooth extraction in patients with coronary artery disease and on dual-antiplatelet therapy

A terapia antiplaquetária dual, cada vez mais tem sido utilizada como uma forma de abordagem terapêutica em pacientes com doença arterial coronariana (DAC), e principalmente em portadores de stents farmacológicos. Drogas antiplaquetárias, quando associadas, aumentam o risco de sangramento, isto faz com que muitos profissionais recomendem a suspensão da medicação antes de qualquer procedimento cirúrgico odontológico, entretanto, a suspensão desta terapia expõe os pacientes portadores de stent coronariano à riscos adversos de eventos trombóticos. Por consequência, permanece desafiador e controverso o manejo odontológico cirúrgico de pacientes coronariopatas em uso de terapia antiplaquetária dual. Diante disso, foi realizado uma pesquisa clínica com o objetivo de avaliar quantitativamente o sangramento trans-operatório de extração dentária de pacientes em uso de terapia antiplaquetária dual (AAS + clopidogrel). Este estudo caso-controle, incluiu 38 pacientes com DAC sob terapia antiplaquetária dual com AAS e clopidogrel (grupo de estudo = GE) e 35 pacientes com doença cardiovascular sem nenhum uso de medicação antiplaquetária (grupo controle = GC), ambos com indicação de extração dentária. No dia do procedimento cirúrgico, foi realizado exame de hemograma completo, coagulograma e agregação plaquetária por turbidimetria, utilizando agonistas de adrenalina, adenosina difosfato e ácido araquidônico, no GC e pelo Verifynow no GE, e no, trans-operatório mensurada a quantidade de sangramento por meio da coleta de sangue aspirado. O GE demonstrou um sangramento mais intenso do que o GC, estatisticamente significante, com média de quantidade de sangramento 1,0 e 0,6 ml/min, respectivamente. Métodos hemostáticos locais foram suficientes para controlar o sangramento e em nenhum dos casos houve episódios de hemorragia no trans e/ou pós-operatório

A agregação plaquetária, no GC, apresentou características de hipoagregabilidade, sendo estatisticamente significante apenas o efeito da adrenalina na quantidade de sangramento ocorrido durante o procedimento cirúrgico (p-valor 0,018). No GE, a agregação plaquetária não demonstrou resultados estatísticos significantes, no entanto, foram encontrados 11 (28,94%) pacientes considerados resistentes à terapia com ácido acetilsalicílico com valores de ARU entre 550 a 700 e 12 (31,57%) pacientes considerados não respondedores ao clopidogrel, com valores de PRU acima de 230. De acordo com os nossos resultados, pacientes portadores de DAC, em uso de terapia antiplaquetária dual, AAS + clopidogrel, apresentam maior quantidade de sangramento, mas que pode ser controlado com medidas hemostáticas locais, não sendo necessária a suspensão da terapia antiplaquetária para extração de até três dentes

Dual-antiplatelet therapy has been used as a therapeutic approach for patients with coronary artery disease (CAD), mainly for those bearing pharmacological stents. The association of antiplatelet a drug increases the risk of bleeding, and for that reason many professionals withdraw the medications prior to any dental surgical procedure. Though, when this therapy is discontinued, patients with coronary stent are exposed to adverse risks of thrombotic events. As a consequence, dental surgical management of patients with CAD and on dual-antiplatelet therapy remains challenging and controversial. On this basis, a clinical research was developed with the aim to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with CAD who are either undergoing dual-antiplatelet therapy (AAS + clopidogrel). This case-control study comprised 38 patients diagnosed with CAD and on dual-antiplatelet therapy, AAS and clopidogrel (study group = SG) and 35 patients with cardiovascular disease, but not on antiplatelet therapy (control group = CG), both requiring tooth extraction. A complete blood count, blood clotting test and platelet aggregation by turbidimetry using epinephrine agonists, adenosine diphosphate and arachidonic acid were carried out on the day of the operation in the CG and using the Verifynow in the SG. The amount of bleeding was measured during the intraoperative period by means of aspirated blood collection

The statistically significant mean volumes of bleeding were 1.0 e 0.6 mL/min for both SG and CG, respectively. The SG showed a more intense bleeding compared to the CG. Local hemostatic measures showed to suffice for controlling possible bleeding problems and in none of the procedures there were intra-operative and/ or post-operative bleeding episodes. Platelet aggregation, for the CG, demonstrated platelet hypoagregability, and only the epinephrine effect was statistically significant for the amount of bleeding during the surgical procedure (p-value 0.018). In the SG, platelet aggregation has not shown statistically significant values. Nonetheless, 11 patients (28.94%) were resistant to acetylsalicylic acid demonstrating ARU values between 550 and 700, 12 patients (31.57%) have not responded to clopidogrel therapy, and the PRU values were above 230. According to the results of this study, individuals with CAD and on dual-antiplatelet therapy (AAS + Clopidogrel), demonstrated a greater amount of bleeding, which can be minimized by using local haemeostatics and not suspending the antiplatelet drug for tooth extraction

Is anti-D immunoglobulin still a frontline treatment option for immune thrombocytopenia?

A 5-year-old boy presents with platelet count of 2×10(9)/L and clinical and laboratory evidence of immune thrombocytopenia. He has epistaxis and oral mucosal bleeding. Complete blood count reveals isolated thrombocytopenia without any decline in hemoglobin and he is Rh+. You are asked if anti-D immunoglobulin is an appropriate initial therapy for this child given the 2010 Food and Drug Administration "black-box" warning.

[Diagnosis and therapy of bleeding in ENT]. / Blutungen im HNO-Bereich.

Bleeding in the oral cavity, nose or ear are common events in the daily routine of ENT specialists. Apart from trivial cases that often get outpatient treatment, there are numerous cases of serious bleeding that require stationary treatment and if necessary, an operative or interventional therapy. In the following section the most frequent types of bleeding, their diagnosis and therapy will be explained.