Eduardo Costa Studart Soares

Postoperative bleeding after dental extraction in liver pretransplant patients.

PURPOSE The aim of this prospective observational study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation and the efficacy of the association of tranexamic acid and absorbable hemostatic sponges. PATIENTS AND METHODS All individuals referred for oral health evaluation requiring extraction were considered in this study. Patients were included in the analysis when the blood examinations showed a platelet count of 30,000/mm(3) or greater and an international normalized ratio (INR) of 3.0 or less. In group 1 local pressure was applied by use of gauze soaked with tranexamic acid, and in group 2 gauze without tranexamic acid was used. Absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure. RESULTS In the 23 patients included in this study, 84 simple extractions were performed during 35 dental surgical procedures. The main preoperative blood tests found the following: a mean hematocrit level of 34.54% (SD, 5.84%; range, 21.7%-44.4%), platelet counts from 31,000/mm(3) to 160,000/mm(3), and a mean INR of 1.50 (SD, 0.39; range, 0.98-2.59). Postoperative bleeding occurred during only 1 procedure (2.9%), and local pressure with gauze was effective for achieving hemostasis. No statistically significant difference in the time to hemostasis was found between the 2 groups. CONCLUSIONS This study found a low risk of bleeding for tooth extractions in patients with liver cirrhosis, INRs of 2.50 or less, and platelet counts of 30,000/mm(3) or greater. Blood transfusions were not needed, and in the case of postoperative bleeding, the use of local hemostatic measures was satisfactory.

Giant salivary calculus of the submandibular gland

A54-year-old woman was seen at our department with a painless swelling on the right submandibular region that had lasted for 4 months. Physical examination revealed a hard elongated mass along the right Wharton’s duct and a reduced salivary flow. An occlusal radiograph showed a radiopaque, cylindrical, and elongated sialolith inside Wharton’s duct. It was carefully dissected with the patient under local anesthesia and a yellow 2.5-cm long specimen was obtained (Fig 1). The submandibular salivary gland was preserved. This procedure was approved by Institutional Review Boards, and the subject gave informed consent to the work. Microscopic analysis confirmed the initial diagnosis. The patient was reassessed 15 days after surgery for the evaluation. At that time, the right submandibular gland was found to be normal and a clear salivary flow could be observed. One year after the surgical procedure, the patient shows no signs or symptoms of xerostomia, and salivary flow is normal.

Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review

PURPOSE To conduct a systematized review of the literature about the main methodologies used to evaluate the biomechanical fixation systems with titanium plates in fractures of the mandibular condyle. METHODS A systematized review of literature was performed in the electronic databases PubMed, EMBASE, LILACS and MEDLINE without restriction of the publication date. The eligibility criteria were laboratory studies involving mandibular condyle fractures, studies using titanium plates, biomechanical studies, in vitro and computational studies involving the finite element method (FEM). RESULTS Eleven articles that met the eligibility criteria were selected, including seven articles involving in vitro studies and four studies with biomechanical analysis by using FEM. CONCLUSION Although few articles have used the finite element method, the results of in vitro studies were similar to those found in computational studies, regarding to the stable use of two titanium miniplates.

Rare hybrid odontogenic tumor in a 2-year-old child.

Hybrid odontogenic tumors are rare conditions that can affect the oral maxillofacial region and usually occur in adults as an asymptomatic swelling. Hybrid odontogenic tumors exclusively involving adenomatoid odontogenic tumor (AOT) and calcifying cystic odontogenic tumor (CCOT) are rare, with only 4 reported cases. In addition, there are only few studies describing the presence of abortive enamel in AOT and, to our knowledge, CCOT was not present in any of them. We described a rare case of AOT associated with CCOT and abortive enamel formation in a 2-year-old child, a condition not well described in the international literature. Secretory cell activity was assessed by periodic acid-Schiff and Congo red stains.

Local hemostatic measures in anticoagulated patients undergoing oral surgery: a systematized literature review

PURPOSE To conduct a systematized review of the literature about the main local hemostatic measures to control postoperative bleeding in anticoagulated patients. METHODS A systematized review of literature was performed in the electronic database Medline (PubMed) without restriction of the publication date. The eligibility criteria were studies involving maintenance of the anticoagulant therapy, prospective studies, retrospective studies, randomized clinical trials, controlled clinical studies, comparative studies, multicentric studies or case-control studies. Studies discontinuing anticoagulant therapy, case reports, literature reviews, in vitro studies, animal experiments and articles written in language not compatible with the search strategy adopted in this work were excluded. RESULTS Twenty-four articles that met the adopted eligibility criteria were selected, enrolling 3891 subjects under anticoagulant therapy. A total of 171 cases of hemorrhage was observed. Tranexamic acid was the main local hemostatic measure used to controlling of postoperative bleeding. CONCLUSION The local hemostatic measures proved to be effective according to previously published studies. Nevertheless, further clinical studies should be conducted to confirm this effectiveness.

Metastatic prostate adenocarcinoma associated with numb chin syndrome.

Metastatic tumors to the oral cavity are rare and account for approximately 1% of all malignant oral neoplasms. About 765 cases have been published in the English- and Chinese-language literature since 1950, with less than 6% of these cases corresponding to prostate cancer metastasis. Because of their uncommon incidence, the diagnosis of oral metastases, especially those originating from the prostate gland, may represent a challenge for general dentists, oral pathologists, and oral radiologists. Thus, the aim of this study was to describe an interesting case of prostate adenocarcinoma metastasizing to the posterior mandible. In addition, association with numb chin syndrome present in this case was discussed.

Maxillary cementoblastoma in a child.

Cementoblastoma is a rare benign tumor that almost always occurs in the premolar or molar region and more commonly in the mandible than in the maxilla. We present a unique incisor maxillary cementoblastoma in an 11-year-old child not previously described. To our knowledge, only 2 maxillary cases, both related to canine teeth, were described in the international literature. Thus, the aim of this article was to discuss the clinical presentation, diagnosis, and subsequent treatment of a patient with a cementoblastoma in the anterior maxillary region.

Dental trauma: knowledge and attitudes of community health workers.

Background The international literature emphasizes the importance of evaluating the knowledge of different groups such as teachers, students, dentists, physicians, parents, and athletes regarding dental injuries. In Brazil, community health workers are professionals who can reach a wide variety of people and who have a marked influence on prevention and health promotion strategies. The objective of this study was to investigate the knowledge and attitudes of community health workers regarding dental trauma. Methods A questionnaire consisting of 19 questions divided into 3 parts was applied: demographic characteristics, knowledge, and attitudes. Data from 206 respondents were analyzed using descriptive statistics and logistic regression models. Results Approximately 28% of the participants reported to have been called to assist individuals with dental trauma. Only 42 subjects had received education on dental injuries, with 34 of them being instructed by a dentist. In cases of tooth avulsion, only 1.9% of the health workers reported that they would search for the tooth and reimplant it. The most frequently indicated storage media for avulsed teeth were nonphysiological media (69.42%). Conclusions The educational level of the community health workers somehow influenced their knowledge (P < 0.001) and attitude (P = 0.016) regarding dental injuries. Educational programs for this group are needed to improve the management of traumatic dental injuries.

Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: A prospective, double-blind study

PURPOSE To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal. METHODS A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests. RESULTS Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal. CONCLUSION There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Simultaneous occurrence of dentigerous cyst and residual cyst in the maxilla

The cysts that originate in the remnants of dental lamina or enamel organ are known as odontogenic cysts. They are of great interest to otolaryngologists due to their proximity to the maxillary sinus and adjacent areas.1 Radicular cysts represent 72.5% of all odontogenic cysts, followed by dentigerous cysts (DC) (22.2%), and residual cysts (RC) (4.26%).2 The options for treatment of cystic lesions involve curettage, enucleation, marginal resection,3 and endoscopic surgery, which is a viable alternative, especially in cases of extension to the maxillary sinus.4 A PubMed and EBSCOhost search did not retrieve any studies analyzing the simultaneous occurrence of DC and RC. This article reports a case involving the association a DC and a RC in the upper jaw of an edentulous patient.