Evaluation of the dentists’ knowledge on medical urgency and emergency

This study aimed at evaluating how well dentists understand medical emergency/urgency procedures and issues during dental treatment at a hospital specialized in cleft lip and palate. It comprised a hundred dentists from the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil, from different dental specialties. A questionnaire was applied to evaluate their knowledge of medical emergencies/urgencies from June through September 2011. The questionnaire was anonymous, confidential and constructed with closed questions and either yes-no or multiple-choice responses. Results showed that most professionals (87%) were trained in basic life support (BLS), but only 43% considered themselves capable of providing first aid and performing the necessary maneuvers. Most participants (94%) claimed that they knew the difference between medical urgencies and emergencies, and 69% had BLS training in their undergraduate courses, as opposed to 37%, during their specialization. Some participants (23%) mentioned that they had received knowledge of the subject during extracurricular courses and/or graduate courses (12%). Only 9% had not been educated on the subject; however, all participants showed interest in attending a course in BLS. In regard to assessing training that dentists who attended BLS courses received, 49% were satisfied and 42% were dissatisfied. Results of the present study emphasize that dentists from HRAC/USP have little knowledge about BLS procedures to perform them. Dentists must gain adequate education and training to minimize possible technical, ethical and legal problems associated with dental practice. It is necessary to improve both knowledge and practice in order to become well-qualified practitioners

Tratamento odontopediátrico: necessidades especiais de crianças com fissuras labiopalatinas

Introdução: Indivíduos com fissura labiopalatina apresentam crescimento e desenvolvimento característico da face e sistema estomatognático e têm necessidades especiais com relação ao tratamento odontológico. Materiais e métodos: Discutir os principais achados e peculiaridades do tratamento odontológico para crianças com fissura labiopalatina, com base em revisão da literatura e apresentação de casos. Resultados e Discussão: A prevalência de cárie em crianças com fissuras labiopalatinas é maior comparada a indivíduos sem fissuras. Vários fatores podem contribuir para o maior risco de cárie, incluindo fatores inerentes ao próprio defeito combinados com hábitos deletérios e permissividade dos pais para compensar a presença da fissura. A região anterior apresenta um sulco vestibular fibrótico, por tanto deve-se aplicar anestésico tópico antes da injeção da solução anestésica, seguido por injeção lenta e cuidadosa. A papila pode ser penetrada com a agulha anestésica para obtenção de anestesia inicial da região palatina antes da injeção direta no palato, para evitar dor e desconforto. No tratamento de dentes na região da fissura, pode ser necessário anestesiar ambos os segmentos, anterior e posterior à fissura alveolar. Em indivíduos com fissura palatina não operada, deve-se tomar cuidado para evitar aspiração de fragmentos dentários e material restaurador. Sempre que possível, o dique de borracha deve ser utilizado como medida protetora. Conclusão: O conhecimento sobre estes aspectos permite que os cirurgiões dentistas ofereçam assistência odontológica adequada para estes indivíduos, fornecendo condições favoráveis para melhorar sua higiene bucal, estética e função, proporcionando importante colaboração para sua reabilitação integral

In vivo evaluation of tissue response to new endodontic sealers

Introduction: The sealers can be in direct contact with the periapical tissues. Thus, these materials must have appropriate physical and biological properties, providing conditions for repair to occur. Objective: The aim of this study was to evaluate the response of rat subcutaneous tissue to endodontics sealers. Material and methods: Three materials comprised the groups: group I – Zinc Oxide, Eugenol and Iodoform paste, group II – Portland cement with propylene glycol, and group III – MTA Fillapex® (Angelus). These materials were placed in polyethylene tubes and implanted into dorsal connective tissue of Wistar rats for seven and 15 days. The specimens were stained with hematoxylin and eosin and evaluated regarding to inflammatory reaction parameters through a light microscope. The data were compared using Kruskal-Wallis test with significance level of 5%. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated observers for all experimental periods. Results: The histological evaluation showed that all the materials caused a moderated inflammatory reaction at seven days which decreased with time. A greater inflammatory reaction was observed at seven days in group I. The other specimens had significantly less inflammatory cells when compared to this group. Tubes with MTA Fillapex® presented some giant cells, macrophages and lymphocytes after seven days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The group II showed similar results to those observed in MTA Fillapex® already at seven days. At 15 days the inflammatory reaction presented was almost absent at the tissue, with many collagen fibers indicating normal tissue healing. Statistical analysis showed a significant statistical difference amongst the group I (seven days) and II (15 days) (p < 0.05). In the other groups no (Continue)(Continuation) significant statistical differences were observed. Conclusion: MTA Fillapex® and Portland cement with propylene glycol were more biocompatible than the other tested cement

Preoperative dental treatment for children with cleft lip and palate

Introduction: Children with cleft lip and palate present diverse risk factors to dental caries and some differentiated needs concerning the dental treatment. This paper will describe the stages of definitive dental treatment before cheiloplasty, aiming at oral health adequacy for a child with cleft lip and palate. Material and methods: The paper will present a literature review with emphasis on the dental particularities and risk factors, including a case report to illustrate the preoperative dental treatment required before primary repair surgeries. Results and discussion: The male boy of African descent first attended HRAC-USP at the age of eight years, without previous treatment, presenting complete right cleft lip and palate. The intraoral clinical examination revealed presence of seveal carious lesions and need of extractions. The dental treatment planning comprised several sessions and was initiated by pediatric dental management, followed by anmalgam and glass ionomer restorations and tooth extractions, beginning by regions with smaller lesions and where local anesthetics causes less discomfort. The anterior teeth close to the cleft area were extracted under general anesthesia immediately before cheiloplasty. Conclusion: The definitive preoperative dental treatment with complete removal of carious tissue is fundamental for patients with cleft lip and palate, because dental caries is an infectious disease and, if present, it may contaminate the primary surgery and even compromise its outcomes.CAPE

Growth analysis of palatal shelves between pre-cheiloplasty and pre-palatoplasty stages

Introduction: The treatment of cleft lip and palate patient must be efficient with minimal damage to facial growth and satisfactory speech result, achieving the psychosocial rehabilitation of the patient. However, the cleft causes distinct levels of change on maxillary growth pattern either by the effect of the defect itself or the rehabilitative process. Generally, study casts, photographs and tridimensional images have been used to evaluate the growth. 3D scanner devices for digitizing study models allow the obtainment of the measurement of the deepness and inclination of palatal shelves and facilitate the study logistic with the reliability of the results. Objective: The aim of this study was to evaluate the size of palatal shelves at two distinct stages: prior to cheiloplasty (stage 1) and prior to palatoplasty (stage 2) in complete unilateral cleft lip and palate patients. Methods: Dental casts from 267 patients with unilateral cleft lip and palate. The palatal shelves were measured at two stages through the scanned images of the casts, by using Adobe Photoshop CS2 software. The measurements of palatal shelves were compared between stage 1 and stage 2. Results: There were an increase of size of palatal shelves in 159 patients (59.5%), a decrease of size of palatal shelves in 102 patients (38.2%), and in 6 patients (2.2%) there were no changes of the sizes. In average, the size of increase of palatal shelves was 0.21 cm; the decrease was 0.15 cm. Conclusion: Considering the small numeric difference, the results suggested that there were no clinical differences in the size of palatal shelves between stage 1 (prior to cheiloplasty) and 2 (prior to palatoplasty).FAPESP 2012/1465

Quality of life in children with cleft lip and palate: pilot study

Objects: The quality of life and oral health of cleft lip and palate children has gain increasingly interest because oral disorders may present negative effect on the quality of life of these individuals. Accordingly, questionnaires aiming to evaluate the impact of oral health on the well-being have been developed and adapted. The present study aimed to evaluate the quality of life and oral health (CPQ8-10) of cleft lip and palate children. Methods and results: Forty-two children were selected, aging from 8 to 10 years-old, at mixed dentition. The children selected were divided into groups according to the type of cleft: Group I - Cleft Lip (n = 7); Group II - Cleft Lip and Palate (n=28); Group III - Cleft Palate (n=7). Each child filled in a questionnaire about the impact of oral disease on quality of life (CPQ8-10). Generally, Group I children affirmed that their teeth are "very good" = 28.57%, and "good" = 42.85%. The participants of Group II and III reported "a little" = 42.5% and 57.14%, respectively, with a greater discomfort with their dental conditions. Concerning to the halitosis perception, Group III exhibited the highest percentage ("sometimes" = 42.85%), followed by Group II ("sometimes" = 32.14%) and Group I ("sometimes" = 14.28%). Conclusion: The pilot study conduction was satisfactorily and the methodology is recommended for a larger sample. To date, it is suggested that the cleft type did not influence on the perception of the patients regarding to the quality of life

Eruption chronology, eruption sequence and hypodontia of permanent teeth in white brazilian children with total unilateral cleft lip and palate

Para se avaliar a cronologia, a seqüência de erupção e a prevalência de agenesias dentárias em indivíduos portadores de fissura transforame incisivo unilateral. examinou-se 477 pacientes regularmente matriculados no HRAC - USP, brasileiros, leucodermas, de ambos os sexos, na faixa etária de 5 a 14 anos. Foram realizados exames clínico e radiográfico. A cronologia e a seqüência de erupção foram estabelecidas para cada sexo. Os indivíduos do sexo feminino mostraram, para todos os dentes superiores e inferiores, idade média de erupção menor em relação aos indivíduos do sexo masculino. O incisivo lateral e o canino, ambos superiores e adjacentes à fissura apresentaram idade média de erupção significantemente maior em relação aos seus homólogos do lado não fissurado. A prevalência de agenesias dentárias foi de 63,86% para o sexo feminino e de 50,5% para o sexo masculino, sendo estatisticamente significante. Os indivíduos portadores de fissura apresentaram idade média de erupção maior em relação aos indivíduos não fissurados para a maioria dos dentes permanentes, em todos os hemiarcos e em ambos os sexos.Clinical and radiographic examination of 477 patients with unilateral cleft lip and palate, age 5 to 14 years, were performed to determine the chronology, sequence of eruption, and frequency of missing permanent teeth. Female subjects showed a lower mean age of tooth eruption than males. Superior lateral incisors and canines on the affected side showed mean age of eruption significantly higher than their similar on the non-affected side. The frequency of hypodontia was significant higher in girls (63,86%) than in boys (50,5%). The mean tooth eruption age for cleft lip and palate patients compared with the general population was delayed for most permanent teeth, on all quadrants and both sex

Eruption chronology, eruption sequence and hypodontia of permanent teeth in white brazilian children with total unilateral cleft lip and palate

Para se avaliar a cronologia, a seqüência de erupção e a prevalência de agenesias dentárias em indivíduos portadores de fissura transforame incisivo unilateral. examinou-se 477 pacientes regularmente matriculados no HRAC - USP, brasileiros, leucodermas, de ambos os sexos, na faixa etária de 5 a 14 anos. Foram realizados exames clínico e radiográfico. A cronologia e a seqüência de erupção foram estabelecidas para cada sexo. Os indivíduos do sexo feminino mostraram, para todos os dentes superiores e inferiores, idade média de erupção menor em relação aos indivíduos do sexo masculino. O incisivo lateral e o canino, ambos superiores e adjacentes à fissura apresentaram idade média de erupção significantemente maior em relação aos seus homólogos do lado não fissurado. A prevalência de agenesias dentárias foi de 63,86% para o sexo feminino e de 50,5% para o sexo masculino, sendo estatisticamente significante. Os indivíduos portadores de fissura apresentaram idade média de erupção maior em relação aos indivíduos não fissurados para a maioria dos dentes permanentes, em todos os hemiarcos e em ambos os sexos.Clinical and radiographic examination of 477 patients with unilateral cleft lip and palate, age 5 to 14 years, were performed to determine the chronology, sequence of eruption, and frequency of missing permanent teeth. Female subjects showed a lower mean age of tooth eruption than males. Superior lateral incisors and canines on the affected side showed mean age of eruption significantly higher than their similar on the non-affected side. The frequency of hypodontia was significant higher in girls (63,86%) than in boys (50,5%). The mean tooth eruption age for cleft lip and palate patients compared with the general population was delayed for most permanent teeth, on all quadrants and both sex