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Background The authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction. Methods The authors selected patients who underwent kidney transplants more than 6 months ago (study group) and patients who had not (control group) older than 18 years who needed to undergo extraction of erupted teeth. The same oral surgeon performed all tooth extractions while the patients were under local anesthesia. Another blind researcher examined the patients 3, 7, and 21 days after tooth extraction. The first end point was occurrence of complications (local acute infection, alveolitis, increased bleeding), and the second end point was socket reepithelialization on day 21. Results Forty-five tooth extractions were performed on 38 study group participants and 61 on 57 control group participants. There was no statistical difference between the groups regarding the incidence of any complication or delayed socket epithelialization. Conclusions The results of this pilot study suggest that there is no difference in postoperative healing after tooth extractions between stable kidney transplant patients and control patients. Practical Implications This is the first prospective study assessing the frequency of postoperative complications after tooth extraction in kidney transplant recipients. This clinical trial was registered at ClinicalTrials.gov . The registration number is NCT02547753.

The objective of this study was to quantify intraoperative bleeding in patients with cirrhosis and correlate it with clinical characteristics and laboratory coagulation tests.A case-control study was carried out with 74 patients with cirrhosis who were submitted to preoperative coagulation tests (complete blood count, platelet count, prothrombin time/international normalized ratio, thrombin time, activated partial thrombin time, platelet aggregation, fibrinogen, protein C, protein S, antithrombin, and von Willebrand factor level and activity). The levels of nitrogen compounds that can affect the platelet function were determined in saliva and blood by using automated enzymatic-colorimetric assays.Patients with cirrhosis had changes in almost all coagulation tests. The average volumes of intraoperative bleeding and blood lost per minute in the study group (5.36 mL/min and 0.19 mL/min, respectively) were greater than those in the control group (3.05 mL/min and 0.11 mL/min, respectively; P.05). In the control group, ascites (P = .012) and presence of periapical lesion (0.034) were positively correlated with bleeding (mL/min). With regard to coagulation tests and nitrogen compounds, only a positively moderate correlation with the platelet aggregation test was observed.No patients had hemorrhagic events and it was not possible to correlate a greater amount of bleeding with coagulation tests or nitrogen compounds in the study group.

Objective To clinically assess the socket healing after tooth extraction and the occurrence of intra- and postoperative complications in chronic kidney failure (CKF) patients on hemodialysis (HD) by comparing them to a control group. Study desing This is a prospective study involving 48 patients with CKF on HD (study group – SG) and 29 participants without CKF (control group – CG) undergoing tooth extractions. No prophylactic antibiotic was given to the participants. One calibrated dentist evaluated all individuals at 3, 7, 21, and 60 days after the tooth extractions and assessed hemostasis time, occurrence of local or distant infection, epithelization, and deposition of alveolar bone. Results In the SG, 87 teeth were extracted through 65 interventions, and in the CG, 76 teeth were extracted through 36 interventions. Bleeding beyond 30 minutes was observed in 12 interventions (18.5%) on SG participants and was controlled with local hemostatic agents. None of the groups had individuals presenting postoperative infectious complications at the surgical site or a distance. After 21 days, we observed delayed epithelialization in 29.9% (26/87) of the individuals of SG compared to 3.9% (3/37) of those of CG (P Conclusions Individuals with CKF on hemodialysis tend to heal up well following dental extractions. They did not have an increased risk of infectious complications after simple tooth extractions, but they showed prolonged bleeding events more often than controls. Additional research studies using larger sample sizes of patients with CKF on hemodialysis are needed to confirm our findings. Clinical relevance This pilot study contributes to dentists ability to provide better dental management for people with chronic kidney failure undergoing hemodialysis through understanding the course of healing following dental extractions.

This study aimed to analyse the clinical and histopathological characteristics of focal oral melanocytic lesions in a Brazilian reference service in Oral and Maxillofacial Pathology.A cross-sectional study was conducted over an 18-year period. Demographic data and clinical features were collected from the archives, and all biopsy specimens diagnosed as oral melanocytic lesions were retrieved and reviewed.We identified 339 melanocytic lesions. Of these, 191 were melanotic macules, 112 melanocytic nevi, 14 mucosal lentigo simplex, 12 melanomas, 9 solar lentigos, and 1 melanoacanthoma. Lesions occurred mostly in white-skinned (74.2%) women (65.2%). The main reported clinical aspect was the macule (67.4%), and the most affected site was the lip vermilion (25.4%), followed by the palate (22.9%). Melanomas were larger in size and were observed in older patients with an overall shorter time of onset. The most frequent subtypes of melanocytic nevi were intramucosal (44.6%), compound (24.1%), and blue nevus (20.5%). They showed a heterogeneous architectural pattern with the presence of the three cell types.The most frequent lesions are melanotic macule and nevus, especially the intramucosal subtype. Patients are usually white-skinned women presenting a small, long-lasting, macular lesion on the lip vermilion or palate.

Objective: To assess and compare radiographically alveolar bone after tooth extractions in individuals undergoing renal dialysis (CKF), those submitted to kidney transplantation (KT) and those without kidney disease (CG) by using fractal dimension and pixel intensity. Materials and methods: 54 periapical radiographs of 17 control individuals, 40 periapical radiographs of 12 KT individuals and 156 periapical radiographs of 48 CKF individuals were analysed at 7 and 60 days after tooth extraction. Image J software was used to determine the alveolar bone density based on fractal dimension and pixel intensity, which expresses the structural complexity of the trabecular bone. Results: The difference in fractal dimension after tooth extractions made at 7 and 60 days was significantly smaller in KT individuals (0.03) compared to control (0.12) and CKF (0.11) ones (P < 0.05), which indicates a gain in the trabecular bone in the alveolus. In KT individuals, the serum levels of calcium showed a moderately negative correlation with fractal difference (r = - 0.517) and pixel intensity (r = - 0.589) at 60 days, including a difference in pixel intensity at 7 and 60 days (- 0.667). Conclusions: Gain in trabecular bone complexity and alveolar bone density were lower in KT individuals, thus being correlated with the serum levels of parathormone, creatinine and calcium. Clinical relevance: As prevalence of CKD increases worldwide and advancements in treatment of this disease improves life expectancy, it’s important to know how socket bone healing happens in these individuals, to future oral rehabilitation with osseointegrated implants.

To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs. Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1β, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann–Whitney’s test and Spearman’s correlation were used. Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 β (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI. RANKL, OPG, IL-1β, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI. This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

BACKGROUND The present study aimed to investigate the prevalence of calcified atheromas in carotid arteries (CACA) on panoramic radiographs of patients with liver cirrhosis (LC). METHODS AND RESULTS A case-control study of 67 individuals with LC (case group) and 67 healthy individuals (control group), matched by gender and age, was performed. In addition to demographic information, data on LC were also collected for the case group. Panoramic radiographs were evaluated by two previously calibrated examiners. The sample consisted predominantly of male individuals (n = 50; 74.62%), with mean age of 55 years old. In the case group, the mean value for the model of end-stage liver disease was 16, and the major aetiology of LC was alcoholism (n = 26; 38.8%). Thirteen (19.4%) LC patients had CACA, whereas only four (5.9%) healthy patients had this condition. LC patients are 3.72 times more likely to have CACA compared to healthy individuals (P = .02). The presence of nephropathies increases the risk of development of atheromas by 18.58 times in cirrhotic individuals (P = .04). CONCLUSIONS Cirrhotic patients are more likely to have CACA compared to healthy patients, and this risk increases significantly when kidney disease is involved.

The aim of this study was to verify the presence and severity of sublingual varices in patients with cirrhosis and the correlation between these varices and nitrogen compounds (i.e., ammonia, urea and nitric oxide) in blood and saliva.This is a case-control observational study of 52 patients with cirrhosis and 52 normoreactive individuals, aimed at assessing the presence (degrees 0 and 1) and severity (mild, moderate, and severe) of sublingual varices. Medical records of the patients with cirrhosis, including complications of cirrhosis, were also obtained. Blood and saliva were collected to evaluate the presence of nitrogen compounds by means of automated enzymatic colorimetric assays.The cirrhosis group had a higher prevalence (n = 39; 75%) compared with controls (n = 22; 42.3%) as well as higher severity (moderate n = 12 [23.1%]; and severe n = 16 [30.0%]) (P = .001 and P.001, respectively). Of the 39 patients with cirrhosis and sublingual varices, 84.6% had gastroesophageal varices. No correlations were found between the presence/severity of sublingual varices and cirrhotic complications/nitrogen compounds.The prevalence and severity of varices were higher in the cirrhosis group, but no correlations between the presence/severity of sublingual varices and nitrogen compounds were found.

Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them.To describe the oral conditions of post-renal transplant children and adolescents.Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions.A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug-induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience.Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus.

Serum increase of nitrogenous compounds (NC) in cirrhotic patients has been associated with the development of hepatic encephalopathy (HE). However, the relation between NC in saliva and HE is unclear. The objective of this study is to measure the levels of nitric oxide and urea in the blood and saliva in 38 cirrhotic patients and correlate them with clinical characteristics and presence and grades of HE.Automated enzymatic colourimetric assays were performed to determine the levels of NC. Diagnosis and severity of HE were determined based on the West Haven criteria and by using the inhibitory control test.HE was diagnosed in 89.47% of the patients, with the majority (60.50%) presenting covert HE. With regard to the measurement of NC, although nitric oxide is moderately correlated with its amount in blood and saliva (r = 0.630; P 0.001), only salivary levels were associated with the presence of ascites and ecchymosis (P = 0.013 and P = 0.030, respectively). In patients with HE, the serum levels of urea were higher (P = 0.013) than those in patients without HE or minimal HE.Nitrogenous compounds in the saliva were correlated with neither the presence nor grades of HE, whereas in the blood, only urea was positively correlated with the severity and presence of HE.Saliva is an excellent fluid for diagnosing several diseases, but it does not seem to be able to collaborate with the identification of HE.

Resumo O objetivo do estudo foi avaliar o impacto da cárie dentária na qualidade de vida de pré-escolares. A população foi constituída por pré-escolares com idade de 5 anos, matriculados em instituições públicas e privadas de Teresina, PI, Brasil. Instrumento de qualidade de vida validado para população brasileira (Pediatric Quality of Life Inventory - PedsQL™) foi aplicado para as crianças e responsáveis, além de questionário socioeconômico-demográfico para os responsáveis. No exame dentário o índice ceod foi utilizado para avaliar a experiência de cárie. Das 566 crianças examinadas, 50,2% apresentaram experiência de cárie. Foi observada associação entre experiência de cárie e pior qualidade de vida no domínio de saúde bucal na percepção das crianças (RR= 0,981; IC95% = 0,97-0,99) e dos pais (RR= 0,955; IC95% = 0,94-0,97). De acordo com a percepção das crianças, cárie em dentes posteriores foi associada a pior qualidade de vida no domínio capacidade física (RR= 0,985; IC95% = 0,97-0,99). Concluiu-se que experiência de cárie impactou negativamente na QVRSB (qualidade de vida relacionada à saúde bucal) no domínio saúde bucal da criança de acordo com a percepção das crianças e dos pais. Cárie localizada em molares impactou negativamente na QVRSB no domínio capacidade física segundo a percepção das crianças.

Aims Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X-chromosome, occurring in about 1 in 2000 to 1 in 3000 live-born girls. We present a case of a 14-year-old girl with TS, who was referred to our outpatient clinic in 2016 because of an ectopic eruption. Methods and results Dental clinical examination and radiographic investigation revealed eight supernumerary teeth, short roots, enamel hypoplasia, increased overjet, rotation and displacement of teeth, moderate gingivitis and morphological alteration of the upper right central incisor. Dental treatment included extraction of erupted supernumerary teeth, composite resin restoration, supragingival scaling and oral hygiene for plaque control. Conclusions The unpublished finding of supernumerary teeth in our patient has led us to suggest the investigation of this dental developmental anomaly in other patients with Turner syndrome.

To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs.Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1β, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used.Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 β (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI.RANKL, OPG, IL-1β, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI.This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

Background: 68Ga DOTATATE PET/CT (68Ga-PET) has been proposed as a superior method in identifying ectopic ACTH syndrome (EAS). However, recent systematic review suggests its sensitivity is not as high as believed (1). We report a challenging case of EAS whose source was uncovered only after repeated 68Ga-PET. Clinical Case: A 15-year-old male presented with rapid onset of typical features of Cushing’s syndrome (CS) and metabolic impairment. Hormone evaluation confirmed severe ACTH-dependent CS. Pituitary transsphenoidal surgery was performed due to positive responses in desmopressin stimulation and high dose dexamethasone suppression test, in addition to a 4 mm nodule in pituitary MRI. No tumor was found in surgical specimen and no hormonal improvement was observed after surgery. Inferior petrosal sinus sampling demonstrated no central to peripheral ACTH gradient. Neck US, thorax/abdomen/pelvis CT were negative and PET-CT/FDG was inconclusive. OctreoScan® identified anomalous uptake on left mediastinum and led the patient to a thoracic surgery (TS) with nodule resection at left hilum. Pathology confirmed ACTH positive 10 mm neuroendocrine tumor (NET) infiltrating a lymph node. The patient had transient clinical and hormonal improvement, with recurrence 7 months later. Thoracic CT (T-CT) showed a 7 mm nodule on inferior segment of superior left lobe, PET-CT/FDG and OctreoScan® were negative but abnormal uptake was verified by 68Ga-PET in subcarinal area. A sub centimetric lymph node was resected and pathology confirmed ACTH positive NET, although the patient did not achieve remission. Octreotide LAR, cabergoline and ketoconazole did not control hypercortisolism and bilateral adrenalectomy was performed. Then, T-CT showed stable lung nodule and 2nd 68Ga-PET was negative. One year later, T-CT evidenced growth of lung nodule to 15 mm and 3rd 68Ga-PET demonstrated for the first time, abnormal uptake in this area. The patient underwent resection of left superior lung lobe along with ipsilateral hilar lymph nodes, and histopathology study revealed an ACTH-secreting atypical pulmonary carcinoid tumor with Ki67 of 10% and 5 out of 11 lymph nodes affected. ACTH fell from 288 to 64 pg/mL after surgery. Conclusion: Despite the high sensitivity attributed to 68Ga-PET, false negatives have been reported. In the present case, primary tumor was evidenced by 68Ga-PET seven years after the first resection of a metastatic lymph node, in the 3rd 68Ga-PET assessment and after tumor growth. This adds to the evidence that further studies are needed to better assess the accuracy of 68Ga-PET for EAS. Reference: [1] Varlamov et al. Diagnostic utility of Gallium-68-somatostatin receptor PET/CT in ectopic ACTH-secreting tumors: a systematic literature review and single-center clinical experience. Pituitary 2019; 22:445–455

Objective: To determine the prevalence and factors associated with malocclusion in the primary dentition of preschool children in a city of Brazilian Northeast. Material and Methods: A cross-sectional study was conducted with 566 five-years-old preschool children who were enrolled in public and private preschools in the city of Teresina, Piaui, Brazil. Data were collected using a sociodemographic questionnaire administrated to parents/caregivers and clinical oral examination of the children was performed. Foster and Hamilton Index for primary teeth was used for the diagnosis of malocclusions. Descriptive analysis was carried out and Poisson regression was used to assesses the association with independent variables. Results: The prevalence of malocclusion was 51.2%. The most frequent types were Class II canines (17% and 16.8%), increased overjet (15.2%) and reduced overbite (14%). Anterior crossbite was present in 3.5% of the preschool children evaluated. There was an association between malocclusion and low family income (PR = 1.22; 95% CI = 1.01-1.47). Conclusion: The prevalence of malocclusion in the primary dentition was high and associated with a low family income.

Little is known about the prevention and management of acquired coagulopathies, such as those affecting cirrhotic patients. The objective of this analytic retrospective observational study was to evaluate patients on the liver transplant waiting list according to the following outcomes: (1) presence of unusual intraoperative bleeding (>10min after routine haemostatic procedures); and (2) presence of postoperative haemorrhagic complications. The outcomes were analysed according to clinical and laboratory variables. A total of 190 visits were performed for extraction of 333 teeth (ranging from 1 to 9 teeth per visit), with platelet count ranging from 16,000 to 216,000 and international normalized ratio (INR) below 3. Twelve cases (6.31%) had unusual intraoperative bleeding and 12 had postoperative haemorrhagic complications. All the events were controlled by local measures. Intraoperative bleeding was associated with low count of platelets (P=0.026). However, this counting could explain only 16% (adjusted R2=0.16) of the cases of bleeding (P=0.44), meaning that platelet function changes might be involved. Our results show that cirrhotic patients presenting platelet count above 16,000 and INR below 3 need no previous blood transfusion, with local measures being enough to manage haemorrhagic events.

Background The etiology of molar-incisor hypomineralization (MIH) remains unknown. Studies indicate that it is multifactorial, and that genetic and environmental factors are involved. Research with twins provides important subsidy to investigate the Influence of genetics and environmental factors that act during pregnancy on the etiology of alterations. Aim This cross-sectional study evaluated the agreement of molar incisor hypomineralization (MIH) between monozygotic and dizygotic twin pairs and the association with environmental factors. Design The sample consisted of 167 pairs of twins (8–15 years old), 94 monozygotic and 73 dizygotic. The parents answered a questionnaire on sociodemographic data and pre-, peri-, and postnatal health. A dental examination was performed by two calibrated examiners (Kappa ≥0.88) for MIH diagnosis, following the criteria proposed by the European Academy of Pediatric Dentistry in 2003. Results The prevalence of MIH was 29.3%. There was greater concordance of MIH between monozygotic twins for affected first molars and permanent incisors (P = 0.0012) and pairs of twins assessed (P = 0.0211). The presence of MIH was associated with family income between one and two wages (P = 0.009, prevalence ratio [PR] = 3.82, confidence interval [CI 95%] 1.40–10.44), above two wages (P = 0.007, PR = 4.60, 95% CI: 1.51–14.05), and gestational hemorrhage (P = 0.032, PR = 5.70, 95% CI: 1.16–28.14). Conclusions The greater concordance in the diagnosis of MIH among monozygotic twins indicates a genetic influence, although environmental factors, such as family income and hemorrhage during pregnancy, are also associated with the occurrence of MIH.

Tuberous sclerosis complex (TSC) is a rare autosomal-dominant multisystemic disorder caused by mutation in the TSC1/TSC2 genes. TSC is characterized by cognitive impairment, seizures, and the presence of benign tumors in multiple organs, including oral mucosa. Among oral findings, enamel hypoplasia, oral fibromas, cleft palate, and alterations of maxillary bone trabeculation are the most frequent. The present report describes the case of a melanodermic female, 41 years old, showing dermatologic and neurologic signs of TSC, with a medical history of epilepsy, cognitive deficit, chronic renal failure, arterial hypertension, cardiac arrhythmia, anemia, and hypothyroidism. Intra-oral exam showed multiple papular lesions in the bilateral buccal mucosa with a diagnosis of inflammatory fibrous hyperplasia and red macule on the hard palate, not associated with prothesis use and without change during the period of treatment. The exfoliative cytologic test was negative for candidiasis, and dental treatment was performed to promote a better quality of life for the patient.

A doença renal crônica é o distúrbio metabólico decorrente de declínio progressivo e irreversível da função renal. A fase final dessa doença é conhecida como insuficiência renal crônica (IRC) que demanda o início da terapia renal substitutiva, geralmente, a hemodiálise (HD). O manejo clínico odontológico de pessoas com IRC pode representar um desafio para o cirurgião-dentista, especialmente quando são realizados procedimentos odontológicos invasivos. Apesar da escassez de estudos e de evidências clínicas e científicas que investiguem o risco de complicações pós-exodônticas em pessoas com IRC, muitos autores ainda recomendam aos dentistas o uso de antibióticos profiláticos nesses indivíduos. Por isso, o objetivo desse estudo foi avaliar clínico e radiograficamente o processo de reparação alveolar pós-exodôntica em indivíduos com IRC submetidos à HD, comparativamente a um grupo controle sem IRC, sem a prescrição do antibiótico profilático. Trata-se de um estudo observacional prospectivo que incluiu 48 indivíduos com IRC em HD para compor o grupo de estudo (GE) e 29 indivíduos controles sem IRC para compor o grupo controle (GC). O mesmo cirurgião dentista aplicou o questionário sobre a história médica, realizou o exame clínico odontológico, solicitou exames laboratoriais (hemograma, coagulograma, ureia, creatinina, cálcio total, fosfatase alcalina e paratormônio). Todos os participantes foram submetidos à exodontias de dentes erupcionados, sempre pelos mesmos cirurgiões dentistas, sem uso de antibiótico profilático, durante o período de outubro de 2016 a dezembro de 2018. As avaliações pós-operatórias foram realizadas 3, 7, 21 e 60 dias após as exodontias. No GE, foram realizadas exodontias em 65 tempos cirúrgicos distintos, totalizando 87 extrações. No GC, foram realizadas 76 exodontias em 36 tempos cirúrgicos. No GE, houve um atraso significativo na epitelização da ferida cirúrgica, observada aos 21 dias após a exodontia (29,9% versus 3,9%, p < 0,001) e 2 complicações hemorrágicas pós-operatórias. Não foram observadas complicações de origem infecciosa em nenhum caso de nenhum grupo. O atraso na epitelização do alvéolo no GE foi significativamente associado a uma menor contagem de neutrófilos e maior tempo de HD (p < 0,05). A presença de espículas ósseas na região do alvéolo, 21 dias após a exodontia foi associada a valores menores de cálcio sérico (p < 0,05). Na avaliação radiográfica, nos indivíduos do GE, observamos menor densidade óssea medida pela intensidade de pixels e menor complexidade da estrutura óssea na dimensão fractal aos 60 dias após a exodontia, comparado ao GC (p < 0,001). Concluiu-se que a reparação alveolar após exodontias em indivíduos com IRC submetidos à hemodiálise é similar a dos controles, havendo apenas atraso na epitelização da ferida cirúrgica que não impactou na reparação final do alvéolo. Pode se esperar em alguns casos a ocorrência de eventos hemorrágicos em indivíduos com IRC em HD, mas esses eventos não foram estatisticamente mais frequentes nesse grupo em comparação ao grupo controle. A neoformação óssea alveolar após exodontias em indivíduos com IRC difere quanto a diminuição da densidade e da complexidade das estruturas ósseas. Nossos resultados permitem inferir que a IRC e o tratamento de HD não representam um fator de risco para ocorrência de complicações infecciosas pós-exodônticas, o que não suporta o uso sistemático de profilaxia antibiótica para esses indivíduos, antes de extrações dentárias. Chronic kidney disease is the metabolic disorder resulting from progressive and irreversible decline of the renal function. The final stage of this disease is known as chronic kidney failure (CKF) that demands the start of renal replacement therapy, usually hemodialysis (HD). The clinical management of people with CKF can represent a challenge for dentists, especially when performing invasive dental procedures. Despite the lack of studies and clinical or scientific evidences that investigate the risk of post-extraction complications in people with CKF, several authors still recommend that dentists prescribe the use of prophylactic antibiotics to these individuals. Thus, our study aimed to assess clinically and radiographically the process of post-extraction socket healing in individuals with CKF submitted to HD, comparing to a control group without CKF, without the prescription of the prophylactic antibiotic. It was a prospective observational study that included 48 individuals with CKF in HD to compose the study group (SG) and 29 control subjects without CKF to form the control group (CG). The same dentist applied the questionnaire on medical history of the patient, conducted the clinical odontological exam and requested laboratory tests (hemogram, coagulogram, urea, creatinine, total calcium, alkaline phosphatase and parathyroid hormone). All participants were submitted to exodontia of erupted teeth, always by the same dental surgeons, without the use of prophylactic antibiotics, during the period from October 2016 to December 2018. Postoperative assessments were conducted 3, 7, 21 and 60 days after the extractions. On the SG, teeth extractions were performed in 65 distinct surgical times, totaling 87 extractions. On the CG, 76 extractions were performed in 36 surgical times. In SG there was a significant delay in surgical wound epithelization, which is observed 21 days after exodontia (29.9% versus 3.9%, p

Background: Lipodystrophy syndromes are characterized by loss of body fat. Although classical Familial Partial Lipodystrophy (FPLD) and Congenital Generalized Lipodystrophy (CGL) have different clinical presentations, we have encountered a unique case where the distinction was quite challenging. Clinical Case: Our patient first presented to an endocrinologist at age 19 with secondary amenorrhea and hypothyroidism. After normalization of TSH, further investigation revealed central hypogonadism, hypertriglyceridemia (>3,000 mg/dL, normal

Background Developmental enamel defects (DDE) represent one of the prevalent oral problems in childhood; however, few studies have evaluated its impact on quality of life in the children's own perception. Aim To evaluate the DDE impact on quality of life of 5-year-old children. Methods This cross-sectional observational study assessed 566 children aged 5 years old, in Teresina, Piaui, Brazil, according to their self-perceptions. Children answered the Pediatric Quality of Life Inventory™ Version 4.0 and Oral Health Scale. The dmft index, modified DDE index and Foster and Hamilton criteria were used to diagnose dental caries, DDE and malocclusion, respectively. A single examiner performed the clinical examination. Descriptive analyses and Poisson regression with robust variance were performed. Results The prevalence of DDE was 33.7%. For children's self-reports, the presence of DDE had a negative association with oral health-related quality of life (OHRQoL; PR 1.09, 95% CI 1.02-1.15). Enamel hypoplasia had a negative impact on the physical function (PR 1.05; 95% CI 1.01-1.10) and oral health (PR 1.06, 95% CI 1.01-1.11) domains. Diffuse opacity had a negative impact on the social aspect (PR 1.09, 95% CI 1.02-1.18). Conclusions Enamel defects had a negative impact on OHRQoL according to the self-reports of the children.

Background To evaluate oral, craniofacial and systemic characteristics of eight patients with Kabuki syndrome (KS), aged between 3 and 16 years old. Material and Methods In this retrospective study, medical records of all patients were reviewed for information on family history, growth and development, medications in use, general systemic complications and oral and craniofacial characteristics. Results The medical alterations found included recurrent infections such as pneumonia and otitis media (n = 6), cardiovascular malformations (n = 4), kidney abnormalities (n = 2), epilepsy (n = 2) and visual deficiency (n = 2). The individuals exhibited dental caries (n = 5), agenesis (n = 5), delayed tooth eruption (n = 4), cleft lip/palate (n = 2) enamel hypoplasia (n = 2), fusion (n = 1) and microdontia (n = 1). Conclusions There was a great diversity of oral, craniofacial and systemic characteristic among the KS patients, suggesting that an inter-disciplinary approach should be taken for their dental treatment. Key words:Kabuki syndrome, oral manifestations, medical alterations.

Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X chromosome, occurring in about 1 in 2,000 to 1 in 3,000 live-born girls. We present a case of a 14-year-old girl with TS, who was referred to our outpatient clinic in 2016 because of an ectopic eruption. Dental clinical examination and radiographic investigation revealed 8 supernumerary teeth, short roots, enamel hypoplasia, increased overjet, rotation and displacement of teeth, moderate gingivitis, and morphologic alteration of the upper right central incisor. Dental treatment included extraction of erupted supernumerary teeth, composite resin restoration, supragingival scaling, and oral hygiene for plaque control. The unpublished finding of supernumerary teeth in our patient has led us to suggest the investigation of this dental developmental anomaly in other patients with Turner syndrome.

Objective: To evaluate clinically the postextraction socket healing in patients with chronic kidney failure (CKF) undergoing hemodialysis (HD) and in a control group of individuals. Study Design: This was a prospective observational study that included 48 individuals with CKF in HD to compose the study group (SG) and 29 patients in the control group (CG) without CKF. A questionnaire on medical history, clinical examination, and laboratory tests were applied. All participants were subjected to extractions of erupted teeth, without antibiotic prophylaxis. Postoperative evaluations were performed 3, 7, 21, and 60 days after the extractions. Results: In the SG, we performed 87 extractions in 65 surgeries, and, in the CG, 76 extractions were performed in 36 surgeries. In the SG, there was a significant delay in surgical wound epithelization (29.9% vs 3.9%, P

O objetivo do presente estudo foi relatar um caso clínico de abordagem multimodal para a reabilitação oral de paciente do sexo masculino, 69 anos, irradiado em cabeça e pescoço (radioterapia conformacional 3D, dose total de radiação de 70Gy), após metástase em laringe de câncer de intestino. Na consulta inicial, o paciente queixava-se de ausências dentárias e sensação de boca seca. Além do mais, foram observadas lesões de cárie de radiação na maior parte dos dentes, os quais também exibiam grande destruição coronária. O plano de tratamento consistiu na exodontia do dente 27 com auxílio de terapia fotodinâmica antimicrobiana para cicatrização do alvéolo, seguida da realização de tratamento endodôntico com subsequente sepultamento de raízes residuais, restaurações e reabilitação com próteses parciais removíveis. O manejo odontológico de pacientes pós-irradiados em cabeça e pescoço deve ser cuidadosamente planejado e conduzido por uma equipe odontológica interdisciplinar, considerando as sérias consequências resultantes dos efeitos deletérios da radioterapia na cavidade oral. Desta forma, pode-se mitigar o impacto negativo da radioterapia na qualidade de vida destes pacientes.

Objective The life expectancy of people positive for human immunodeficiency virus (HIV) has increased since the advent of combined antiretroviral therapy (CART). There was a decrease in opportunistic infections in this population, but on the other hand, there were side effects to medications and medical conditions related to longevity. The main of this prospective study was to determine the prevalence of selected comorbidities that may affect the delivery of oral health care to patients positive for HIV. Methods The authors examined 439 patients positive for HIV who had sought dental treatment from 2006 to 2007 and from 2016 to 2017. The authors abstracted patients' self-reported clinical comorbidities and laboratory-verified HIV-related and hematologic values. Results A total of 96.2% percent of the study patients had at least 1 comorbidity. Comorbidity prevalence was 44% percent for psychiatric disorders, 41% for lipodystrophy, and 39% for anemia. Lipodystrophy and psychiatric disorders were more prevalent on patients seen from 2016 to 2017 (P Conclusions Patients positive for HIV under CART have a broad range of comorbidities that may affect the provision of oral health care.

Background Among the complex of HTLV-associated diseases, Sjogren's syndrome (SS) is one of the most controversial. This work aims to detect morphological and inflammatory alterations, including clues of the presence of HTLV-1, in minor salivary glands of patients with dryness symptoms. Methods We have assessed HTLV-1-seropositive patients (HTLV-1 group) and patients with SS (SS group). We used formalin-fixed, paraffin-embedded minor salivary gland tissue to evaluate the morphological aspects and, by means of immunohistochemistry, the presence of Tax protein, CD4, CD8 and CD20 cells. Additionally, viral particles and proviral load were analysed by PCR. Results The HTLV-1 group had the highest prevalence of non-specific chronic sialadenitis (85.71%; P = 0.017) and greater amount of T CD8+ cells. In the SS group, focal lymphocytic sialadenitis (80%; P = 0.017) prevailed, with a greater amount of B CD20+ . Both immunohistochemistry and PCR identified the Tax protein and its gene in the salivary glands of both groups and in similar proportions. Conclusion The results indicate that HTLV-1-seropositive patients have different patterns of morphological/inflammatory alterations, suggesting a likely difference in the process of immune activation.

The objective of this study was to evaluate the impact of dental caries on the quality of life of preschool children. The population was made up of preschoolers aged 5 years, enrolled in public and private institutions of Teresina, PI, Brazil. The Pediatric Quality of Life Inventory (PedsQL™) was applied to children and caregivers, as well as a socioeconomic-demographic questionnaire for those responsible. In the dental examination the ceod index was used to evaluate the caries experience. Of the 566 children examined, 50.2% presented with caries experience. It was observed an association between caries experience and poorer quality of life in the oral health domain in the children's perception (RR = 0.981, 95% CI = 0.97-0.99) and parents (RR = 0.955, 95% CI = 0, 94-0.97). According to the children's perception, caries in the posterior teeth was associated with poorer quality of life in the physical capacity domain (RR = 0.985, 95% CI = 0.97-0.99). It was concluded that caries experience had a negative impact on the OHRQoL (oral health-related quality of life) in children's oral health according to the perception of children and parents. Caries located in molars had a negative impact on HRQoL in the physical ability domain according to the children's perception.O objetivo do estudo foi avaliar o impacto da cárie dentária na qualidade de vida de pré-escolares. A população foi constituída por pré-escolares com idade de 5 anos, matriculados em instituições públicas e privadas de Teresina, PI, Brasil. Instrumento de qualidade de vida validado para população brasileira (Pediatric Quality of Life Inventory - PedsQL™) foi aplicado para as crianças e responsáveis, além de questionário socioeconômico-demográfico para os responsáveis. No exame dentário o índice ceod foi utilizado para avaliar a experiência de cárie. Das 566 crianças examinadas, 50,2% apresentaram experiência de cárie. Foi observada associação entre experiência de cárie e pior qualidade de vida no domínio de saúde bucal na percepção das crianças (RR= 0,981; IC95% = 0,97-0,99) e dos pais (RR= 0,955; IC95% = 0,94-0,97). De acordo com a percepção das crianças, cárie em dentes posteriores foi associada a pior qualidade de vida no domínio capacidade física (RR= 0,985; IC95% = 0,97-0,99). Concluiu-se que experiência de cárie impactou negativamente na QVRSB (qualidade de vida relacionada à saúde bucal) no domínio saúde bucal da criança de acordo com a percepção das crianças e dos pais. Cárie localizada em molares impactou negativamente na QVRSB no domínio capacidade física segundo a percepção das crianças.

The objective was to determine the prevalence of molar incisor hypomineralization (MIH) among individuals between 7 and 15 years old infected or noninfected with human immunodeficiency virus (HIV). The study was conducted with 33 HIV-infected individuals (study group; SG) and 66 non-HIV-infected schoolchildren (control group; CG), paired by gender and age. Data collection was based on medical records (SG), a questionnaire for caregivers and oral examination for diagnosis of MIH (European Academy of Pediatric Dentistry criteria) and caries (DMFT index and ICDAS). Data were analyzed with Mann-Whitney, chi-square, and Fisher's exact tests and logistic regression. In SG, MIH (45.5%) and caries (87.9%) had higher prevalence. MIH was associated with use of protease inhibitors in SG (OR: 2.14; 95% CI: 1.21 to 3.77) and incubator need in CG (OR: 2.80; 95% CI: 1.71 to 9.10). HIV-infected patients had a higher prevalence of MIH and dental caries in the permanent dentition.

To determine the frequency of Enamel Development Defects (DDE) and associated factors in children and adolescents infected with HIV. A case-control study was conducted in HIV-infected patients (n = 52), aged 3 to 15, and a control group formed by preschool and schoolchildren (n = 104) matched according to gender, age and household income. Data on medical history, neonatal and maternal conditions were obtained. For diagnosis of enamel defects was used modified DDE Index. DDE frequency was 61.5% in the case group and 58.7% in the control group (p = 0.569). Infection of the genitourinary tract and maternal hemorrhage were factors associated with DDE in the case and control groups, respectively. An association was observed between the use of antiretroviral regimens with protease inhibitors or efavirenz and DDE in the permanent dentition. Children and adolescents HIV-infected showed a DDE frequency similar to healthy patients, but factors associated with this condition were different between the groups.

The objective was to evaluate the history of traumatic dental injury (TDI) among children with and without autism spectrum disorders (ASD) at the Centro Integrado de Educação Especial (CIES), in Teresina, Brazil. The dental records of 228 children, 114 with ASD (SG = study group) and 114 without ASD (CG = control group), paired by age, gender and socioeconomic characteristics between January 2007 and September 2014 were reviewed. Data were analyzed using chi-square test and multivariate logistic regression (alpha = 5.0%). Dental trauma in SG was lower than in the CG (24.6% and 41.2%, respectively, p = 0.007). The risk of trauma was lower among males in SG (OR: 0.35; 95%CI: 0.18 to 0.67). The likelihood of TDI in SG was 3.17 higher in females than that of males (p = 0.040). The prevalence of TDI was lower in ASD individuals compared to controls. Dental trauma was higher among ASD girls than ASD boys.

To determine the prevalence of molar-incisor hypomineralization (MIH) in children and possible factors associated with this disorder.This was a cross-sectional observational study of 594 11- to 14-year-olds from Teresina, Piauí, Brazil. The diagnosis of MIH was made based on criteria set by the European Academy of Pediatric Dentistry. To investigate possible associated factors, mothers completed a questionnaire. A descriptive analysis of the data, chi-square, Mann-Whitney, and Fisher tests and Poisson regression (PR) were performed.The prevalence of MIH was 18.4 percent (95 percent confidence interval [CI] equals 15.20 to 21.50). The maxillary molars were the teeth most affected by MIH (36.1 percent). MIH patients showed a higher number of mean DMF-T (PR equals 2.18; 95 percent CI equals 1.46 to 2.85) than those not affected by the condition. There was an association between MIH and preterm birth (PR equals 1.76; 95 percent CI equals 1.22 to 2.12) and between MIH and respiratory distress at birth (PR equals 1.83; 95 percent CI equals 1.25 to 2.18).The prevalence of MIH in schoolchildren was 18.4 percent. Those with MIH had a greater mean DMF-T than those without MIH. Preterm birth and respiratory distress were associated with MIH.

Objetivo: avaliar tendências de busca dos usuários da internet por informações sobre cárie dentária e defeitos de esmalte. Material e Métodos: trata-se de estudo retrospectivo que utilizou a ferramenta Google Trends Search Application como instrumento de busca. Foram utilizados os descritores “dental caries” e “enamel defects” para obtenção de informações no período de janeiro de 2004 e dezembro de 2015. Os resultados foram expressos pelo índice Search Volume Index. Foram utilizados os testes Kruskal-Wallis e pós-teste de Dunn, com nível de significância de 5%, para a análise dos dados. Resultados: para o termo “dental caries”, os maiores volumes de busca foram observados nos meses de março, abril e maio (62.33 ± 14.73, 63.58 ± 13.19, 63.00 ± 13.24, respectivamente) e os menores, nos meses de julho, agosto e dezembro (44.92 ± 8.82, 46.83 ± 9.94, 40.67 ± 5.55) (p < 0,001). Não foram observadas diferenças no volume de buscas entre meses do ano para o termo “enamel defects” (p = 0,694). Na análise por ano, foram observadas diferenças significativas para cárie dentária (p < 0,001), a partir de 2007 o volume de busca reduziu significativamente quando comparado aos anos anteriores. O mesmo não foi observado para defeitos de esmalte (p = 0,492). Conclusão: houve tendência de diminuição no número de buscas por informações sobre cárie dentária, ao passo que se mantêm constantes as buscas sobre defeitos de esmalte.

INTRODUCTION: Many people suffering from mental disorders fail to adequately perform self-care, especially in relation to personal hygiene and in particular to oral hygiene. For these individuals, the prevention and ongoing clinical monitoring are essential. OBJECTIVE: To investigate the oral diseases that most affect patients with mental disorders attended in the Dental College of the Federal University of Piauí (UFPI). METHODOLOGY: Patients treated during the 2nd half of 2011 and 1st half of 2012 were examined. The DMFT index was used for evaluation of dental caries and the CPI index for periodontal evaluation. The statistical analyzes were performed with SPSS (Statistical Package for the Social Sciences), version 18.0, using a descriptive statistics to determine averages, standard deviations and frequencies. RESULT: 67.50% of the 40 patients had contact with the surgeon dentist for over one year, 95% performed their own oral hygiene and 70% did not use dental floss. The average of DMFT was 14.18. Of the patients, 49.13% needed of restorations of one surface and 60% needed dental prosthesis. Moreover, 33.75% of sextants evaluated had periodontal pockets. CONCLUSION: It can be noticed that patients with mental illness have a high risk of developing oral disorders, however, few carriers visite a dental professional regularly. In addition, the delay to seek treatment and lack of staff training, lead to solutions often crippling. INTRODUÇÃO: Muitas pessoas acometidas por transtornos mentais não conseguem realizar o auto cuidado adequadamente, principalmente em relação à higiene pessoal e em particular à higiene oral. Para esses indivíduos, a prevenção e o acompanhamento clínico contínuo são fundamentais. OBJETIVO: Investigar as afecções bucais que mais afetam os pacientes portadores de transtornos mentais, atendidos na faculdade de odontologia da Universidade Federal do Piauí (UFPI). METODOLOGIA: Pacientes atendidos durante o 2º semestre de 2011 e 1º semestre de 2012 foram examinados. O índice CPOD foi utilizado para avaliação da cárie dentária e o índice CPI para avaliação periodontal. As análises estatísticas foram feitas no Programa SPSS (Statistical Package for the Social Sciences), versão 18.0, utilizando-se da estatística descritiva na determinação de médias, desvio-padrão e frequências. RESULTADO: 67,50% dos 40 pacientes tiveram contato com o cirurgião-dentista há mais de um ano, 95% realizavam a própria higiene oral e 70% não usavam fio dental. A média do CPOD foi de 14,18. 49,13% dos pacientes necessitavam de restaurações de uma superfície e 60% necessitavam de prótese dentária. Além disso, 33,75% dos sextantes avaliados apresentavam bolsa periodontal. CONCLUSÃO: Pode-se perceber que os portadores de doença mental apresentam um elevado risco de desenvolver desordens orais, entretanto, poucos portadores visitam um profissional da odontologia com regularidade. Além disso, a procura tardia por tratamento e a falta de preparo dos profissionais, levam a soluções muitas vezes mutiladoras.