Ellen Cristina Gaetti Jardim

Occurrence of tooth injuries in patients treated in hospital environment in the region of Aracatuba, Brazil during a 6-year period

Dental trauma has been considered as a public health problem that affects mainly children and youngsters and due to its impact on the patients quality of life. This study presents the results of a 6-year survey of the occurrence and characteristics of dental trauma in patients admitted to the Service of Surgery and Oral and Maxillofacial Traumatology of the School of Dentistry of Araçatuba (UNESP, Brazil) after emergency care in hospital facilities in the region of Araçatuba, SP, Brazil. For such purpose, the clinical files of patients treated at the Service between 1999 and 2005 were reviewed. Information regarding gender, age, number of traumatized teeth, etiology and diagnosis of the trauma was collected from the files of patients with tooth injuries and recorded in case report forms specifically designed for this purpose. The results showed that from a total of 4112 patients admitted to the Service within the surveyed period, 266 (6.5%) had tooth injuries (172 males - 64.7%; 94 females - 35.3%). The total number of traumatized teeth was 496. Most patients belonged to the 16-20 year-old age group (20.3%) and the most frequent causes of tooth injuries were bicycle accidents (28.6%), motorcycle accidents (19.2%) and falls (18.8%). Injuries to the periodontal tissues were the most frequent type of tooth injuries (408 teeth; 82.26%), occurring in 118 primary and 290 permanent teeth. Among the injuries to the periodontal tissues, avulsion was the most common (32.86%) (29.41% for primary and 34.0% for permanent teeth), followed by extrusive luxation (19.15%) (25.21% for primary and 17.24% for permanent teeth). In conclusion, in the surveyed population, cases of tooth injuries were more frequent in males aged 16-20 years old due to cyclist accidents with predominance of injuries to the periodontal tissues, in particular, avulsions.

Sialolithiasis of the submandibular gland.

Sialolithiasis of the salivary gland is a benign pathology that occurs most frequently in the submandibular gland because of its anatomic features. Depending on the sialolith size and calcification degree, it can be visible in radiographic examinations. Commonly, patients may experience pain and/or edema, when the ducts are obstructed. The authors report the case of sialolithiasis of the submandibular gland in a 42-year-old, female, white-skinned patient, noticed during routine dental examination. Following diagnosis confirmed by clinical and radiographic examinations, the treatment plan consisted of surgery for removal of the calcified mass. The prognosis is often good, and generally there is no recurrence.

Comparative analysis of 2-flap designs for extraction of mandibular third molar.

Objective: The objective of the study was to analyze 2-flap designs for surgical extraction of third molar, evaluating the periodontal status of the second lower molar. Study Design: Forty-five lower third molars were extracted from 24 patients. In 23 teeth, a vertical incision to the mandibular ramus was used (technique A), whereas 22 teeth were submitted to classic L-shaped flap (technique B) with controls at 60 and 90 days postoperatively. Results: Pearson correlation coefficient analysis showed a significant correlation only between immediate preoperative probing depth variables from techniques A and B in the studied surfaces. Statistical significances in the preoperative (vestibular) and postoperative day 60 (distovestibular and vestibular) were noted. In contrast, Student t-test showed no statistical difference in probing depths between preoperative and postoperative values, as well as no statistically significant difference regarding the type of incision alone. Conclusions: Technique A allowed a less traumatic surgery, guaranteeing a more comfortable postoperative period.

Vestibuloplasty by modified kazanjian technique in treatment with dental implants

AbstractDentists are often faced with extensively resorbed mandibular ridges with shallow buccal vestibule and high insertion of the mentalis muscle in relation to the crest of the ridge, causing the displacement of the prosthesis. Vestibuloplasty techniques aim at eliminating the muscle insertions, reposition the mucosa, and increase the area chapeável, giving more stability to the prosthesis. Among the techniques to deepen the vestibule are submucosal vestibuloplasties by secondary epithelialization and with mucosal and skin grafts. We will discuss vestibuloplasty by secondary epithelialization with emphasis on the so-called modified Kazanjian technique. This technique provides an appropriate result and does not require hospitalization, additional surgery at the donor, or prolonged periods without the use of prosthesis.

The Use of 2.4-mm Locking Plate System in Treating Comminuted Mandibular Fracture by Firearm

Maxillofacial trauma caused by firearms has considerably increased, in which the mandibular body is the site of highest incidence of firearm projectiles. In these cases, the use of titanium plates and screws allows the early restoration of form and function of the mandible with stable and predictable results. Recently, conventional plates have been extensively used to treat comminuted mandibular fractures. Nevertheless, the conventional system presents several limitations such as screw compression against the bone interface and the necessity of precise fit of plate to the bone. To overcome such drawbacks, the locking plates have emerged. The present clinical case reported the operative treatment of mandibular fracture caused by firearm projectiles with the use of locking plate. The indications, advantages, and disadvantages of this system are presented.

Epidemiologic Evaluation of Mandibular Fractures in the Rio de Janeiro High-Complexity Hospital

AbstractThe aim of this study was to gather data on trauma etiology and mandibular fracture localization in patients who presented at the General Hospital of Nova Iguaçu, Rio de Janeiro, Brazil. From March 2007 to December 2008, 95 patients with mandibular fracture were registered in a medical form, at the Bucomaxillofacial Surgery Department of the General Hospital of Nova Iguaçu, Rio de Janeiro, Brazil. Concerning mandibular fracture etiology, 21.05% were caused by motorcycle accidents, followed by interpersonal violence without use of weapons (punches, kicks, bumps with the head, blows with the elbow, etc) (16.84%) and interpersonal violence with firearm (14.73%). It was found that 52.63% of the patients had a single fracture line. The most affected fracture area was the parasymphysis (26.02%), followed by the condyle (22.60%) and mandibular angle (18.49%). Concerning the injury area, 24.21% were directed to the mandibular symphysis, 22.17% of the patients did not remember the injury area, and 18.94% had multiple injuries. When the injury was directed to the symphysis, the result was more condyle fractures (11.64%), and injuries at the mandibular angle resulted in fractures at the angle itself (8.90%). The most common fracture cause was traffic accidents, mainly motorcycle accidents, and the most affected areas were the parasymphysis and the condyle. The mandible isolated fractures occurred in half of the cases. Motorcycle accidents resulted in more fractures in the parasymphysis area, and when the symphysis area is affected by injuries, the result is a higher percentage in condyle fractures.

Odontogenic Keratocyst Tumor: Report of Two Cases

El ano 2005 quiste odontogenico fue clasificado como un tumor queratoquiste odontogenico (TQO) debido a su agresividad y recurrencia. El TQO tiene las caracteristicas del tumor: crecimiento lento, no causa metastasis y proporciona una gran destruccion osea. El objetivo de este estudio fue examinar los aspectos relacionados con el diagnostico, pronostico y tratamiento del TQO mediante la presentacion de dos casos. Ambos casos fueron inicialmente sometidos a descompresion debido al gran tamano de la lesion y la proximidad de esta con estructuras anatomicas importantes, con el objetivo de prevenir las fracturas patologicas. Se llevo a cabo un seguimiento clinico-radiografico y despues de tener una regresion de la lesion postdescompresion, los pacientes fueron sometidos la enucleacion total.

Particularities in the Surgical Technique of Calvaria Graft

Los injertos de calvaria proporcionan una buena cantidad de hueso para la reconstruccion del maxilar atrofico, y tienen menores tasas de morbilidad y reabsorcion en comparacion con la cresta iliaca. El objetivo de este trabajo es presentar la tecnica para la obtencion de un injerto del craneo. Inicialmente, la profundidad de la osteotomia se determina mediante una fresa manualmente, lo que establece los limites de las estructuras del craneo (tabla externa, diploe y tabla interna), lo que hace la eliminacion de bloques oseos mas facil y segura. Por lo tanto, las osteotomias de los bloques se hacen con mayor seguridad, evitando las complicaciones inherentes a la tecnica quirurgica. Se presenta el caso de un paciente hombre de 65 anos que se nego a ser sometido a injerto de cresta iliaca, optando por la boveda craneal, a pesar de ser calvo, que es una contraindicacion para esta modalidad de tratamiento. Una sutura cuidadosa asociada con la colocacion de malla de titanio para mantener la conformacion del craneo del paciente en la region del defecto oseo creado despues de obtencion del injerto, deja un buen resultado cosmetico en el sitio donante. El uso de malla de titanio para la re-anatomizacion de defectos oseos creados en los injertos esta bien indicada para pacientes calvos.

Contaminação Microbiana das Soluções de Processamento Radiográfico: Risco de Infecção Cruzada

Departamento de Patologia e Propedeutica Clinica Faculdade de Odontologia Universidade Estadual Paulista (UNESP), Aracatuba/SP

Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment

OBJECTIVE This case-control study aimed to evaluate the effects of conventional radiotherapy (RT) on the prevalence and populations of oral microorganisms in head and neck cancer patients who did not receive adequate preventive dental care. It was hypothesized that side effects of radiotherapy could be associated with radiation dose, microbiological aspects, and socioeconomic conditions of the patients. DESIGN Twenty-eight dentate patients with head and neck cancer submitted to RT were included in the study. Radiation dose received varied from 4320 to 7020 cGy. Patients with the same demographic and health conditions, but no history of cancer or antineoplastic treatment were used as controls. Clinical examinations were carried out before RT, 15-22 days after starting RT, immediately after and 6 months after RT. Supra and subgingival biofilms were collected and cultivated onto selective and non-selective media. Isolates were identified by biochemical and physiological characteristics. Stimulated and unstimulated salivary flow rate and saliva buffer capacity were also determined. RESULTS Mucositis, dermatitis, xerostomia, dysgeusia, dysphagia and candidiasis were common after starting RT and during the treatment period. Xerostomia was followed by a decrease in salivary pH and buffer capacity, which showed association with the increase of cariogenic cocci and yeast populations, which were also associated with deterioration of hygiene. Candida and family Enterobacteriaceae showed increased prevalence with RT, and were associated with the occurrence of mucositis and xerostomia. CONCLUSIONS Modifications in oral biofilms of irradiated patients showed association with xerostomia and hygiene conditions, which reinforces the necessity of improving patient compliance to oral health care programs.