Endocardite infecciosa bacteriana originada a partir de procedimentos odontológicos / Infective bacterial endocarditis derived from dental procedures

Introdução: A endocardite infecciosa bacteriana (EIB) é uma infecção séria das válvulas cardíacas ou das superfícies endoteliais do coração. É causada por proliferação bacteriana nas superficies cardíacas alteradas. Na flora presente na cavidade bucal existem microorganismo que são usualmente agentes causais da EIB, como: estreptococos alfa-hemolíticos, enterococos (Streptococcus faecalis), pneumococos, estafilococos e estreptococos do grupo A. As manipulações dentárias constituem a causa principal de bacteriemia transitória, podendo desencadear EIB. Objetivo: O objetivo proposto no presente artigo foi o de realizar uma uma revisão bibliográfica, envolvendo artigos originais e de revisão sobre a repercussão provocada por procedimentos odontológicos no desencadeamento da EIB. Método: Foram utilizadas para consulta as bases de dados: Scopus, Lilacs, correspondente aos anos de 2005 a 2012, nos idiomas inglês e português. Foram encontrados 34 artigos, dos quais sete foram excluídos por não satifazerem aos critérios de inclusão adotados. Resultados: Em 75% dos artigos consultados, tornou-se clara a evidenciação do perigo eminente que há de, concomitantemente a uma intervenção dentária que conduza ao sangramento, propiciar-se o aparecimento de manisfestação sistêmica desfavorável, como bacterimia com posterior instalação de EIB. Conclusão: Conclui-se que é de extremada importância a conscientização por parte do cirurgião dentista de que ao intervir, mesmo na prática de um procedimento simples, poder propiciar, concomitantemente, o aparecimento de manisfestação sistêmica desfavorável à saúde geral dos seus pacientes e que o cirurgião dentista deve estar atualizado quanto aos protocolos e ter bom senso, evitando a banalização do uso de antibiótico, restrigindo o seu uso aos casos de estrita necessidade.

Introduction: Bacterial endocarditis (IBE) is a serious infection of the heart valves or heart endothelial surface. It is caused by bacterial growth on modified cardiac surfaces. In the flora present in the oral cavity, there are microorganisms which are usually causal agents of IBE, as alpha-hemolytic streptococci, enterococci (Streptococcus faecalis), pneumococci, staphylococcus and group A streptococcus. The dental manupulations are the main cause of transient bacterimia, potentially triggering IBE. Objective: The proposed objective of this article was to conduct a literature review, involving original and review articles on the impact caused by dental procedures in triggering the IBE. Method: We used to query the databases: PubMed, Scopus, Lilacs for the years 2005 to 2012 in English and Portuguese. It was found 34 articles, of which seven were excluded because they did not meet the inclusion criteria adopted. Results: In 75% of the articles found, it became clear, evidence of imminent danger that simultaneously a dental intervention that leads to bleeding, to provide the appearence of adverse systemic manifestations such as bacterimia with subsequent installation of IBE. Conclusion: It was concluded that it is of extreme importance the awareness of the dentist that to intervene, even in the practive of a practice of a simple procedure , he or she can foster the emergence of an unfavorable concomitant systemic manisfestation to the overall health of their patients and the dentist must be update regarding the protocols and have common sense, avoiding the trivialization of antibiotic use, restricting its use to cases of strict necessity.

Step-down beds in ENT and maxillofacial surgery.

The organisation and delivery of critical care services have come under scrutiny in recent years with media attention focusing on a shortage of intensive care beds and a lack of appropriately trained nurses to staff them (Wright 2000). The provision of these services is under review nationally, prompting a new approach to the organisation of intensive care and high dependency beds (DoH 2000, Scottish Executive 2000). In Lanarkshire in the specialties of ear, nose and throat (ENT) and maxillofacial surgery, access to these facilities was restricted and not always available or appropriate for these patients' needs. This article illustrates how nurses brought about real change by proposing a possible solution to establish two step-down beds in the ward. Establishing these beds not only provided many benefits for patients, but also gave nurses the opportunity to gain advanced skills and ultimately increased job satisfaction.

[The current status and problems of nursing for outpatients department of oral surgery of dental university hospitals in Japan].

Recently, the need for outpatient nursing services attached to general clinics has increased because of the shortening of hospitalization periods and the promotion of home care. The number of outpatients in the field of oral surgery is expected to continue increasing as the number of elderly patients increases and hospitalization periods decrease; therefore, the quality of outpatient nursing services must be improved. In the present study, a questionnaire was distributed to dental university hospitals, to clarify the present condition of outpatient nursing services in the department of oral surgery. The results of the survey showed that nurses routinely provide treatment at oral surgery outpatient clinics, where they perform pre-hospitalization orientations, consultations, and instruction and guidance for patients. Outpatient nurses must be able to help a wide range of patients, from children to the elderly; the contents of the consultations, instructions and guidance performed by the nurses, are also wide-ranging, including social life issues and oral disability rehabilitation. Thus, the various types of support care performed by nurses play an important role in the efficacy of oral surgery outpatient clinics, by contributing to maintenance and improvement of patients' social life and quality of life. However, the survey also found that outpatient services sometimes suffer from a lack of resources, including personnel and facilities. Furthermore, a fee-charging system for nursing services does not presently exist. Active cooperation between dental professionals and oral surgery clinic nurses, and strong appeals to hospital administrative departments, are thus necessary to resolve these problems.

Intensive nursing care of patients with a microvascular free flap after maxillofacial surgery.

This article provides an introduction to the care of patients following maxillofacial surgery, many of whom undergo the complexities of microvascular flap surgery and need careful nursing assessment in the postoperative period. A brief introduction to this surgery illustrates some of the potential reasons for admission to the intensive care unit. The nursing care is vital to maintain the survival of the flap, the details of which are discussed along with factors which potentially contribute to flap failure. Other considerations such as haemodynamic stability, postoperative complications, the importance of education and other options for postoperative management also form further points for discussion.