Thyciana Rodrigues Ribeiro

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.

Association of free amino acids with caries experience and mutans streptococci levels in whole saliva of children with early childhood caries

OBJECTIVE The aim of the present study was to identify the free amino acid content in whole saliva of children with (CE) and without early childhood caries (CF) (ECC), correlating these findings with caries experience and mutans streptococci (MS) levels in saliva. DESIGN Seventy-eight healthy children, both genders, 6-71 months age, were selected to participate in the study. Following examination for dmft scores calculation, unstimulated whole saliva was collected from all 78 participants, stored at -80 degrees C, and used for amino acid analysis, on a Biochem 20 plus amino acid analyzer. Stimulated whole saliva was collected from 52 children, transported, diluted and plated on MSB agar medium for detection of MS in cfu/mL. RESULTS Forty different free amino acids were identified in whole saliva, with great variation in their concentration. A statistically significant relation was found between caries experience and the presence of free proline and glycine. While proline (p=0.0182) was more frequently absent in the CF group, the absence of glycine (p=0.0397) was more often observed in the CE group. In the presence of higher levels of MS, free glycine reduced the risk of experiencing dental caries (p=0.0419). Conversely, the presence of proline was found to increase the risk of experiencing the disease (p=0.0492). CONCLUSIONS The presence of free proline and absence of free glycine in children with ECC, highly contaminated with MS, increased the chances of experiencing dental caries in the present population. Further studies are needed to better understand this phenomenon.

Growth inhibition of Walker carcinosarcoma 256 with alcoholic extract of green tea leaves (Camellia sinensis)

PURPOSE To evaluate the antitumor activity of alcoholic extracts of green tea (Camella sinensis). METHODS Four groups of six Wistar rats were inoculated intramuscularly with 10(6) Walker tumor cells/mL. During 10 days, the animals received by gavage either 0.9% saline solution (Group I; negative control), solution containing 20 mg/Kg of tamoxifen (Group II; positive control), solution containing 0.07 g/Kg alcoholic extract of C. sinensis (Group III), or solution containing 0.14 g/Kg alcoholic extract of C. sinensis (Group IV). Following euthanasia on the tenth day, the tumor, liver, kidneys and spleen were excised and weighed, and tumor volume and tumor growth inhibition were quantified. RESULTS The average weight of the animals was greater in Group IV than in Group II (p=0.0107). Tumor weight was smaller in Group IV than in Group I (p=0.0062), but did not differ from Group II. Tumor volume was smaller in Groups II and IV than in Group I (p=0.0131). Tumor growth inhibition was observed in Groups II (44.67% ± 32.47), III (16.83% ± 53.02) and IV (66.4% ± 25.82) (p>0.05). The groups did not differ with regard to the weight of the excised organs. CONCLUSION Alcoholic extracts of green tea have antitumor activity.

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.

Clinical approach in familial hypophosphatemic rickets: report of three generations

Familial hypophosphatemic rickets is a hereditary disease characterized by the involvement of several family members, transmitted in most cases as an X-linked dominant trait. Oral manifestations can be the first evidences for an adequate and early diagnosis of X-linked hypophosphatemic rickets (XLHR). The present report describes the main systemic manifestations, oral findings and dental management in three generations of an affected family. Oral exams, laboratorial and histologic evaluations, cone-beam computed tomographies, panoramic and periapical radiographs were performed to properly institute the most adequate treatment strategy. The knowledge of clinical signs and symptoms of XLHR is essential for the correct diagnosis of this disease, and for the establishment of preventive and comprehensive dental care.

Asymptomatic bilateral elongated and mineralized stylohyoid complex: Report of one case

The stylohyoid process is a cylindrical bony structure surrounded by important anatomical structures including vessels and nerves. Calcification and elongation of the stylohyoid ligament complex over 30 mm may be associated with neck and facial pain, known as Eagles syndrome. However, a bilateral ossified and elongated stylohyoid complex may be devoid of symptoms. We report a 79-year-old symptom-free female who presented on a routine conventional dental radiographic exam an 80.96 mm pseudoarticulated stylohyoid complex in the left side and an 75.85 mm on the other. On CAT scan, both processes were calcified.

Red blood cell and leukocyte alloimmunization in patients awaiting kidney transplantation

Objective To determine the rates of red blood cell and leukocyte alloimmunization in patients with chronic kidney disease awaiting kidney transplantation. Methods In this cross-sectional and prospective study, the serum of 393 chronic kidney disease patients on a transplant waiting list in Ceará, Northeastern Brazil were tested for red cell and leukocyte antibodies. In addition, demographic, clinical and laboratory data were collected. Results The average age in the sample of 393 patients was 34.1 ± 14 years. Slightly more than half (208; 52.9%) were male. The average numbers of transfusions and gestations were 3.1 ± 3.3 and 1.6 ± 6, respectively. One third (33.6%) were alloimmunized: 78% with leukocyte antibodies, 9.1% with red cell antibodies and 12.9% with both. Red cell antibodies were detected in 29 cases (7.4%), 17 of whom were women, who had received more transfusions than the males (p-value < 0.0001). The most frequently detected red cell antibodies belonged to the Rh (24.1%) and Kell (13.8%) blood group systems. Leukocyte antibodies were detected in 30.5% of cases, 83 of whom were women, who had received more transfusions than the males (p-value < 0.0001) and were more reactive to panel reactive antibodies (p-value < 0.0001). The mean alloreactivity to panel reactive antibodies was 47.7 ± 31.2%. Conclusion Chronic kidney disease patients on the transplant waiting list in Ceará, Brazil, display high rates of red cell (7.4%) and leukocyte (30.5%) alloimmunization. In this sample, alloimmunization was significantly associated with the number of transfusions and gender.

Lingual Frenulum Phenotypes in Brazilian Infants With Congenital Zika Syndrome

Objective: The present study aimed to evaluate lingual frenulum in children affected by congenital Zika syndrome (CZS) and to analyze the association of lingual frenulum phenotypes with other variables. Design: This present work had a cross-sectional, descriptive study design. Setting: This study was carried out in Fortaleza (Brazil). The health professionals provided tertiary level of care. Data collection occurred during a multidisciplinary task force for evaluating infants affected by CZS in December 2 to 3, 2016. Patients: Fifty-four patients with CZS (1-12 months old; 32 girls and 22 boys) were recruited from a population of 70 infants. Interventions: A multidisciplinary group comprised of speech-language pathologist/audiologists and pediatric dentists evaluated all patients through an intraoral examination and a specific tongue maneuver protocol for infants. Main Outcome Measures: Lingual frenulum visibility was the primary outcome measure. Before initiating the study, we hypothesized that children with CZS had an absent lingual frenulum. Results: Lingual frenula were visible in 34 (63%) infants, whereas in 20 (37%) infants lingual frenula visibility required a specific maneuver to retract the tongue. Six of 20 infants presented posteriorly positioned lingual frenula that were visible after maneuver. Lingual frenula were covered by mucous tissue in 14 infants. Presence of posterior frenulum was associated with dysphagia (P = 0.038). However, the presence of dysphagia in a multivariate model did not associate with the presence of a posterior lingual frenulum (P = .069) or neurologic symptoms (P = .056). Conclusion: Children with CZS showed predominance of a posterior lingual frenula covered by an overlapping curtain-like mucous membrane.

An adult blind man presenting severe impairment of the right finger, ecchymosis in the thorax region, and haemorrhagic blisters on the oral mucosa.

Editor Thrombocytopenia is defined as a reduced platelet count within blood (<100 9 10 units/L), generating a primary haemostatic defect. This condition may be observed in diseases associated with (i) impaired platelet production (e.g. aplastic anaemia, myelodysplastic syndrome, chemotherapy), and (ii) increased splenic sequestration (e.g. splenomegaly, disseminated intravascular coagulation, thrombotic microangiopathy). Immune thrombocytopenic purpura (ITP) consists of an acquired immune-mediated disorder with severe dermatological manifestations in which auto-antibodies establish a direct link with specific glycoproteins expressed on platelet surfaces, such as IIbIIIa and Ib-IX, promoting platelet destruction by macrophages from the reticuloendothelial system. A 56-year-old blind man residing in a low-income rural district in the city of Sobral (Brazil), presented to the Stomatology Service of the Federal University of Cear a (Sobral Campus, Brazil) for a dental appointment complaining of oral discomfort. Patient reported a last dental visit 5 years before the present consultation, at the same time in which complete blindness had been diagnosed as a result of uncontrolled systemic hypertension, and untreated glaucoma. The primary care physician had previously screened patient for dietary restrictions, alcohol consumption, drug abuse, hepatitis B/C, HIV infection and diabetes (plasma glucose, 86.9 mg/dL; laboratory reference value, 66– 99 mg/dL), and patient’s medical chart/labs did not confirm the presence of these conditions. Physical examination showed reddened stains and ecchymosis in the thorax region, haemorrhagic petechiae on the fingers, and severe impairment of the right finger (Fig. 1). On intraoral exam, haemorrhagic blisters were observed on the lower lip and left buccal mucosa (Fig. 1), in addition to palatal petechiae and spontaneous gingival bleeding. To investigate any pre-existing blood dyscrasias, a complete haemogram was requested. The haemogram showed a low platelet count of 14 000 units/mm3 (laboratory reference value of 150 000–450 000 units/mm3) and a normal total white blood cell count of 6.1 9 10/mm (laboratory reference value of 4–10 9 10/mm). All other laboratory values were within normal limits: red blood cell count (RBC) of 4.32 9 10/mm; haemoglobin (Hgb) of 13.4 g/dL; and a haematocrit (Hct) of 40.3%. In view of these clinical findings, presence of severe thrombocytopenia, and need for dental extractions, the patient was referred to the Regional Center of Hematology and Hemotherapy of Sobral (Brazil) for medical evaluation and appropriate diagnosis. New laboratory exams confirmed the existence of persistent thrombocytopenia (35 000 units/mm), with normal values for RBC (4.47 9 10/mm), Hgb (14.6 g/dL), Hct (42.6%), mean corpuscular volume (95 fL) and total leucocyte count (6200 cells/mm). Thus, the final diagnosis was ITP. Presently, corticosteroid therapy was the elected treatment alternative (prednisone: 80 mg/day), which leads the patient to a gradual regression of oral lesions, re-establishing platelet counts to acceptable levels after a 24-month follow-up period (initial: 14,000 units/mm3; final: 118,000 units/mm3). In this case, the patient reported interruption and irregular use of the prescribed medication, increasing the severity of thrombocytopenia

Unusual Occurrence of Tongue Sensorial Disorder after Conservative Surgical Treatment of Lymphoepithelial Cyst

Lymphoepithelial cyst is a rare lesion of the oral cavity, with the mouth floor being the most common site of occurrence. The therapeutic approach of choice is the surgical treatment, which has rare cases of postoperative complications. The aim of this study is to report the case of a 53-year-old patient who came to Dental Service in the Federal University of Ceará complaining of a small nodular lesion (0.5 cm) located in the ventral tongue. Excisional biopsy was performed and the surgical specimen was submitted for anatomopathological analysis, which found that there was an oral lymphoepithelial cyst. The patient returned after seven days for suture removal and reported loss of sensitivity around the ventral tongue. We prescribed Citoneurin for ten days; however, there was not any significant improvement of the sensitivity. Low frequency laser therapy sessions were applied. The only postoperative symptom was dysesthesia, where there is only a sensitivity decrease. Currently, the patient has a postoperative period of 1 year without recurrence of the lesion. Although previous reports have no described tongue sensorineural disorders associated with this lesion, the occurrence of this event may be related to an unexpected anatomical variation of the lingual nerve.