Nathalie Pepe Medeiros de Rezende

Medical problems and oral care of patients with Down syndrome: a literature review.

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.

Oral care and nosocomial pneumonia: a systematic review

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

Diagnosing secondary syphilis in a patient with HIV

hoke. As he was in full spinal immobilisation he was unable o maintain his own airway without continuous suction and aw thrust. He was in considerable pain from the mobility of is mandible. Because of the bleeding, pain, and difficulty managing is airway it was necessary to reduce and stabilise the anteior fracture of the mandible. However, there was no oral nd maxillofacial equipment for many miles. A straightened aper clip was used as a temporary bridle to stabilise and educe the fracture, which reduced the pain and blood loss, nd enabled the airway to be maintained safely. Local anaesthetic with epinephrine was infiltrated into the ubmucosal space of the left anterior mandible. One end of a traightened paper clip of 0.5 mm diameter was inserted with eedle holders between the lower left premolar teeth and the ame end was passed back out through the gap between two entral incisor teeth. While the fracture was reduced manually ith the teeth in occlusion, the paper clip was wound tight in clockwise fashion. Fig. 1 shows a radiograph of the paper lip in place. The paper clip allowed the patient to be transferred safely o the regional maxillofacial unit. We think that this simple technique (with appropriately esigned equipment) should be part of standard training in mergency medicine (and Advanced Trauma Life Support) nd would encourage current trainees in emergency medicine o spend some time on attachment in oral & maxillofacial urgery. Emergency departments with or without on-site oral maxillofacial services should maintain a small collection f appropriate equipment for such emergencies and be cometent in their use.

Mandibular lesion in an HIV-positive patient.

patient’s CD4 cell count was 58 cells/mm 3 and his viral load was 13,000 copies/mL, his antiretroviral treatment had been changed to zidovudine, didanosine, and nevirapine. An oral examination showed a papillomatous lesion in the alveolar mucosa and interdental papilla, between the lower right canine and first premolar. The lesion was histologically diagnosed as condyloma acuminatum. The lower left first and second premolars had increased mobility, which was also observed in the adjacent alveolar bone. Although the surrounding gingival and alveolar mucosae were erythematous, painful, and swollen, no periodontal pocket was observed during periodontal probing or on panoramic radiographs. The hypothesis of alveolar bone fracture was rejected, because the patient denied any trauma to the affected region (Figs 1A,B). Periapical radiographs showed a radiolucent line that enveloped both the lower left canine and first premolar, from the alveolar ridge to the apical region (Figs 1C,D). Laboratory tests were performed. The levels of lipoproteins, cholesterol, triglycerides, glycemia, bilirubin, and antiphospholipid antibodies were normal, as was the platelet count. Although the patient presented with mild anemia, blood-coagulation tests and a complete blood count were within the reference range. Liver and renal function tests were normal, and his venereal disease research laboratory was negative.

Primary Sjögren syndrome in a 2-year-old patient: role of the dentist in diagnosis and dental management with a 6-year follow-up.

BACKGROUND. Primary Sjögren syndrome is a rare autoimmune disease, especially in children, mainly affecting girls (77%), and usually diagnosed around 10 years of age. Diagnosis during childhood is difficult, especially because of the diversity of the clinical presentation and difficulty obtaining reliable history data, accounting for a higher frequency of underdiagnosed cases. Differential conditions should be considered, especially the ones that promote xerostomia, such as diabetes, ectodermal dysplasia, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, sarcoidosis, lymphoma, HIV and HTLV infection. Conditions associated with parotid enlargement should also be excluded, including juvenile recurrent parotitis (JRP), sialadenosis, sarcoidosis, lymphoma, infectious parotitis caused by streptococcal and staphylococcal infections, viral infections (paramyxovirus, Epstein-Barr virus, cytomegalovirus, and parvovirus), and diffuse infiltrative lymphocytosis syndrome (associated with HIV infection), and rare congenital conditions, such as polycystic parotid disease. CASE REPORT. A paediatric female patient was referred to our clinic for dental treatment complaining about dry mouth, oral discomfort, and dysphagia. The patient presented five of the required criteria to establish the diagnosis of pSS, including ocular symptoms, oral symptoms, evidence of keratoconjunctivitis sicca, focal sialadenitis confirmed by minor salivary gland biopsy, and evidence of major salivary gland involvement. Our patient did not have positive SS-A and SS-B autoantibodies. According to the literature, about 29% of individuals with pSS can present seronegativity for SS-A (anti-Ro) antibodies and about 33% can present seronegativity for SS-B (anti-La) antibodies. CONCLUSION. To the best of our knowledge, this is the youngest patient reported in the scientific English literature with pSS. Primary Sjögren syndrome has a wide clinical and immunologic spectrum and may progress with increased morbidity. Clinicians must be aware of the development of pSS in such an early age and exclude all possible differential findings to provide early diagnosis and treatment.

Oral manifestations and rehabilitation in Fraser syndrome: A case report: ORAL MANIFESTATIONS AND REHABILITATION

Fraser syndrome (FS) is a rare recessive autosomal genetic disorder characterized by multisystemic malformations typically comprising cryptophthalmos, syndactyly, and renal defects. We report the case of a 16-year-old patient who exhibited facial asymmetry, short roots, hypodontia, and malocclusion. Oral rehabilitation included orthodontics, exodontia, and osseointegrated dental implants to improve the patients self-esteem and eating function. We suggest short roots and hypodontia assessment in patients with FS.

Kostmann syndrome: oral aspects and 10-year follow-up case report.

Kostmann syndrome (KS) is an autosomal recessive disorder characterized by a low neutrophil count and recurrent bacterial infections, including periodontal disease. This report describes the case of a 5-year-old female KS patient treated with regular infusions of granulocyte stimulating factor (granulokine), with primary complaint of gingival bleeding and tooth mobility, and followed up for 10 years. Conventional periodontal treatment and some extractions were performed, after neutrophil function tests using flow cytometry. The invasive procedures were carried out at an outpatient clinic under antibiotic prophylaxis due to a low neutrophil count and an impaired neutrophil function presented. During the 10-year follow-up period, despite episodes of recurrent gingivitis and periodontitis the present report describes the positive outcome of dental treatment of a patient with KS.

Pathology Quiz Case 3

A MALE PATIENT WHO WAS 34 YEARS OLD, A smoker, and human immunodeficiency virus (HIV)-seropositive for the past 15 years visited this service complaining of an oral lesion. His medical record disclosed seropositivity for hepatitis C virus (HCV) and a history of oral candidiasis, neurocryptococcosis, and herpes zoster. The patient was using stavudine, lamivudine, tenofovir, and lopinavir. His CD4 cell count was 406 cells/mm, and he had an undetectable HIV viral load. From the clinical perspective, the patient exhibited a painless red spot that was approximately 3 cm in diameter on the right side of the cheek mucosa that had appeared 3 years earlier (Figure 1). An incisional biopsy was performed, followed by histopathological analysis (Figure 2), p53 immunohistochemical analysis (Dako Inc), and human papillomavirus (HPV) in situ hybridization (ISH) (Dako Inc) (Figure 3). The histological sections revealed a fragment of mucosa with hyperkeratosis, acanthosis, and exocytosis that emitted blunt projections toward the lamina propria. Cellular alterations indicating viral infection, such as binucleated cells and koilocytes, were observed across the epithelium. In situ hybridization with a wide-spectrum probe was positive for HPVand for HPV-specific types 6/11, 16/18, and 31/33. Immunohistochemical analyses of p53 exhibited weak expression. The lesion was surgically removed and did not relapse after a 7-year follow-up. Currently, the patient’s CD4 count is 786 cells/mm, and the viral load is undetectable. What is your diagnosis?