Contribution of benzodiazepines in dental care of patients with special needs

Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Analise quantitativa da dose de radiação incidente em orgãos criticos durante a tomografia linear utilizada para o planejamento de implante dental intra-osseo

Orientador: Agenor Montebello FilhoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O presente estudo teve o propósito de determinar o valor das doses de radiação incidentes em determinadas regiões consideradas críticas. Para isso foi usado o sistema de dosimetria "termoluminescente com cristais de fluoreto de lítio LiF- 700 em pacientes submetidos a tomografia linear utilizada para o planejamento cirúrgico do implante dental intra-ósseo. Os resultados evidenciaram que os índices de radiação incidentes nos órgãos críticos estudados, decorrentes de cortes tomográficos lineares apresentaram diferenças significativas entre si. A região que recebeu maior dose foi a tireóide que variou de 3,35 mGy à 5,26 mGy e o menor índice de radiação foi para as gõnadas com proteção do avental plumbífero que foi de 0,51 mGy à 1,02 mGYAbstract: The aim of this study was to determine the value of the radiation doses that fali in certain aereas in order to do this termoluminescent dosimetry ( LiF - 700 ) was used on pacients submitted to tomàgraphy examination on the oral surgery to dental implant. The results yielded that the levei of radiation on organs, after the acquirement of slices showed.significant variability among them. The thyroid was the part that received more radiation ranging from 3,35 mGy to 5,26mGy and the minor levei was for the gonod ranging 0,51 mGy to 1.02 mGy with the protection leaded apronMestradoRadiologiaMestre em Ciência

Avaliação da localização do canal mandibular por meios de exames tomografico (linear, Pluridirecional e computadorizados de alta resolução) em comparação com a anatomia ossea topografica

Orientador: Agenor Montebello FilhoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Este estudo teve por objetivo avaliar a localização do canal mandibular em imagens obtidas de crânios secos por meio de exames tomográficos lineares, pluridirecionais e computadorizados de alta resolução em relação com a anatomia óssea topográfica. Foram utilizadas 1I mandíbulas secas de humanos pertencentes a Área de Radiologia da Faculdade de Odontologia de Piracicaba FOP-UNICAMP que possuiam extremo livre posterior e reabsorção óssea alveolar moderada tipo B segundo LINDH, C et al ( 1995 ) . Foram analizados 22 (Vinte e dois) Canais mandibulares Inferiores ( CM) e 88 ( Oitenta e oito) medidas foram realizadas. Em cada mandíbula foram feitas 04 ( medidas) : V1 - que correspondeu a distância do rebordo alveolar remanescente ao centro do CM ; V2 - distância da cortical externa da base mandibular ao centro do CM ; H1 distância do centro do CM à cortical externa lingual; H2 - distância do centro do CM à cortical externa vestibular. Foram confeccionados guias radiográficos nas regiões de interesse antes da exposição, sendo esferas metálicas de 3,0 mm de diâmetro para os exames convencionais e guias com guta percha para as tomografias computadorizadas de alta resolução. Os aparelhos utilizados foram ORTHOPHOS CD PLUS da SIRONA com os programas pl9 e p20 de cortes pluridirecionais transversais com kV de 60 e 09 mA e espessura do corte de 3,0mm, o tomógrafo Linear Denar Quint Sectograph com cefalostato e kV 52 e mA 50 e espessura dos cortes de 2,5mm e intervalo entre os cortes de 3,0mm. O tomógrafo computadorizado de alta resolução foi o SOMA TOM HiQ-S da Siemens com cortes coronais diretos que foi baseado no protocólo de FARIA CR-IMP ( 1999). Após obtidas as imagens foram realizadas as medidas com paquímetro MITUTOYO e comparadas com as peças seccionadas obtidas e nossos resultados após aplicado análise de variância e teste de Tuckey foram para a tomografia linear de: A distância V1- 13,19mm ; V2 - 8,73mm ;H1 - 5,11mm e H2 -6,44mm .Tomografia Computadorizada de : V1 11,12mm ; V2 - 7,55mm ; H1 - 5,22mm e H2 - 6,22mm. Pluridirecional de : VI - I5,85mm ; V2 - 1O,17mm ; HI6,45mm e H2 - 8,l0mm. E os dados anatômicos de V1 - 13,O4mm ; V2 - 8,7mm ; HI- 5,36mm e H2 - 6,18mm .Baseado nos resultados das medidas o canal mandibular à 3,5cm posterior ao forame mentoniano apresentou-se mais próximo da cortical lingual e a técnica que apresentou maior precisão nas medidas quando comparadas com a anatomia óssea topográfica foi a Tomografia Linear, pois esta não apresentou diferença estatisticamente significante. Já a tomografia computadorizada demonstrou dados com uma discrepância mínima em relação a anatomia óssea topográfica apresentando diferença estatísticamente significante nas medidas verticais e a técnica pluridirecional apresentou diferença estatísticamente tanto nas medidas verticais como nas horizontais. Logo nosso estudo conclui que a técnica tomográfica mais apurada no que diz respeito as dimensões verticais e horizontais para o planejamento de implantes osteointegráveis foi a Tomografia LinearAbstract: The aim of this study was compare the vertical and horizontal dimensions in images obtained from dried skulls by means of three types of tomographic exams: linear; transversal pleuridirectional panoramic and computerized high resolution with bone topographic anatomy. The selection of a precise radiographic method proved to be of great importance in the planning of osteointegradable implants. Such approach would imply the reduction of traumatic lesions to noble structures of the maxillomandibular complex during surgery. With this purpose, eleven dried mandibles ITom the Radiology Department of the Dentistry University of Piracicaba.( FOP, Unicamp) were analyzed. All of these presented an edentuous posterior and type B alveolar bone reabsorption according to LINDH, C et al.( 1995 ). Twenty two inferior alveolar canals ( CAI ) were selected and 88 measurements were accomplished. Four measurements were made on each mandible: V1,which corresponded the distance of the alveolar ridge to the center of the CAI; V2, the distance of the external cortical of the mandibular base to the center of the CAI; RI, the distance of the center of the CAI to the external lingual cortical; m, the distance from the center of the CAI to the external bucal cortical. Radiographic guides were built at regions of interest before the exposition of metallic step ( 4mm diameter) for conventional exams. Also, gutta percha guides were introduced for high resolution computerized tomography making possible the elimination of artifacts. The equipment used were the SIRONA, Orthophos CD plus, with pI9 and p20 programs of transversal pleuridirectional slices (60kV and 09 mA and slice thickness of 3,0 mm), the Linear Denar Quint Sectograph tomographer with cefalostat ( 52kV and 50 mA and slice thickness of 2,5 mm and intervals between slices of 3,0mm) and the Siemens, SOMATOM HiQ-S computerized high resolution tomographer, opting for direct coronal slices that were based on the FARIA CR-IMP ( 1999 ) protoco1. After images were obtained, measurements were made with a MITUTOYO paquimeter and compared to the sliced mandibles. The mean results of the measurements were later applied to varience analysis and Tuckey test. The following results were obtained for linear tomography: VI - 13,19 mm; V2 - 8,73 mm; Hl 5,11mm; H2 - 6,44 mm. As for computed tomography: V1- 11,12 mm; V2 - 7,55 mm; H1 - 5,22 mm; H2 - 6,22 mm; while pleuridirectional tomography: V1- 15,85 mm; V2 - 10,17 mm; H1 - 6,45 mm; H2 - 8,10 mm. Further more, the anatomic measurements: VI - 13,04 mm; V2 - 8,70 mm; H1 - 5,36 mm; H2 - 6, 18mm. These results have not proved a significant statistical difference between the mean results of measurements in linear tomography exams. However, the exams computed tomography, once these presented a minimal discrepancy with a significant statistical different in the vertical mensurement when compared to the real anatomic measurements and pluridirectional presented significant statistical difference in alI of the mensurements Fina1ly, this subject conc1udes that linear tomography was more accurate for dental osteointegradable planningDoutoradoRadiologia OdontologicaDoutor em Radiologia Odontológic

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. Objective: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. Methods: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. Results: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). Conclusions: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care

Atendimento odontológico para pacientes com Síndrome de Sjögren: diretrizes e atualizações para Odontologia

.Objetivo: objetivo deste trabalho é revisar a literatura e propor diretrizes de atendimento odontológico atualizadas ao paciente portador da Síndrome de Sjögren (SS). Material e Métodos: realizamos um protocolo direcionado ao tratamento odontológico para o paciente portador da SS e uma busca bibliográfica a partir do formulário de busca da Biblioteca Virtual em Saúde, onde fazem parte as seguintes bases de dados: Literatura Internacional em Ciências da Saúde (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Eletronic Library Online (SciELO), PubMed, Scopus, Web of Science e Grey literature. Utilizou-se como descritores específicos desta pesquisa: Síndrome de Sjögren; glândula salivar menor; cintilografia; sialometria; saúde oral, além disso, foi realizado uma busca bibliográfica, com o período de publicação variando entre os anos de 1952 a 2019. Resultados: a SS é uma doença sistêmica inflamatória crônica, de provável etiologia autoimune, com distribuição mundial. As glândulas lacrimais e salivares são os principais órgãos afetados pela infiltração linfo-plasmocitária, originando disfunções que desencadeiam quadro clássico de xeroftalmia e xerostomia. Diante disto, a hipótese deste estudo se baseia na seguinte assertiva que um protocolo direcionado ao tratamento odontológico ao paciente portador da SS pode contribuir para melhora da sua saúde oral e prognóstico terapêutico da doença. Conclusões: cabe ao Cirurgião-Dentista aliviar os sinais e sintomas da xerostomia, realizar controle de cárie e prevenir a doença periodontal, por isso a importância de um minucioso exame clínico seguido de indicação de um protocolo de atendimento odontológico direcionado aos portadores da síndrom

Doenças peri-implantares: atualização para odontologia

Objective: this study aims to present and describe the main pathological, benign and malignant alterations of the peri-implant mucosa. Material and Methods: an integrative review of the literature was carried out using the following descriptors: peri-implant pathology; reactive lesion dental implant; carcinoma dental implant; peri-implant disease dental implant; reactive lesion by dental implant; oral squamous cell carcinoma around dental implants; peri-implant disease; pathology; for the elaboration of the search strategy in the databases PubMed, LILACS, MEDLINE and SciElo to obtain the scientific productions. Results: conditions such as peri-implant mucositis and peri-implantitis are poorly reported in the literature, which makes it difficult to estimate their real prevalence. Among the benign reactive lesions, the pyogenic granuloma and peripheral giant-cell granuloma stand out, described as the most frequently associated with the implants. Regarding neoplasia, cases of hemangioma and OSCC were published, suggesting a possible influence of the implant in the development of these conditions. Conclusion: the occurrence of several pathologies associated with dental implants was observed in the literature, which demonstrates the importance of a detailed clinical examination, associated, in certain situations, with histopathological examination for an accurate diagnosis and adequate management of the various peri-implant diseases.Objetivo: este estudo tem como objetivo apresentar e descrever as principais alterações patológicas, benignas e malignas da mucosa peri-implantar. Material e Métodos: uma revisão integrativa da literatura foi realizada utilizando os seguintes descritores: patologia peri-implantar; implante dentário de lesão reativa; implante dentário de carcinoma; implante dentário de doença peri-implantar; lesão reativa por implante dentário; carcinoma oral de células escamosas ao redor de implantes dentários; doença peri-implantar; patologia; para a elaboração da estratégia de busca nas bases de dados PubMed, LILACS, MEDLINE e SciElo para obtenção das produções científicas. Resultados: condições como mucosite peri-implantar e peri-implantite são pouco relatadas na literatura, o que dificulta a estimativa de sua real prevalência. Dentre as lesões reativas benignas, destacam-se o granuloma piogênico e o granuloma periférico de células gigantes, descritos como os mais frequentemente associados aos implantes. Em relação à neoplasia, foram publicados casos de hemangioma e CECO, sugerindo uma possível influência do implante no desenvolvimento dessas condições. Conclusão: a ocorrência de diversas patologias associadas a implantes dentários foi observada na literatura, o que demonstra a importância de um exame clínico detalhado, associado, em determinadas situações, a exame histopatológico para um diagnóstico acurado e manejo adequado das diversas doenças peri-implantare