Pacientes em processo diagnóstico de câncer de cabeça e pescoço: aspectos psicológicos, percepções e expectativas

Pós-graduação em Saúde Coletiva - FMB

Medicina defensiva: uma prática necessária?

We discuss the reasons why Defensive Medicine is widely used in Brazil and worldwide. The Defensive Medicine is characterized by excessive use of complementary tests, the use of supposedly safer therapeutic procedures, the frequent referral of patients to other specialists and by the refusal to care for critically ill patients and with greater potential for complications. This is a practice that aims to defend the doctor from legal suits. The way the processes are conducted by the judiciary certainly contributes to the consolidation of this foolish practice. The slow pace of justice in our country, associated with the unpreparedness of judges and legal experts in the analysis of cases, leads to an emotional exhaustion of the parties involved. Furthermore, poor training of doctors in our country values the use of sophisticated diagnostic and treatment methods, rather than a thorough clinical examination and appropriate communication with the patient. Besides inefficient in protecting the doctor, Defensive Medicine has severe consequences to the patient and to society, since it generates an additional invaluable cost to medical practice, determines greater suffering to the patient and causes deterioration of the doctor-patient relationship, which has always been marked by trust, respect and personhood.

Significados atribuídos por graduandos de enfermagem aos cuidados paliativos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Atenção odontológica no Programa Saúde da Família (PSF)de Campos de Goytacazes - RJ após um ano de implantação: a visão dos atores sociais envolvidos

Pós-graduação em Odontologia Preventiva e Social - FOA

Prevalence of Oral Lesions in Hospitalized Patients with Infectious Diseases in Northern Brazil

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Para, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Para, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P > 0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.

Enteral nutrition feeding alters antioxidant activity in unstimulated whole saliva composition of patients with neurological disorders

Patients with neurological disorders have an increased risk of oral and systemic diseases due to compromised oral hygiene. If patients lose the ability to swallow and chew food as a result of their disorder, enteral nutrition is often utilized. However, this type of feeding may modify salivary antioxidant defenses, resulting in increased oxidative damage and the emergence of various diseases. The aim of this study was to evaluate the effects of enteral nutrition on biochemical parameters in the unstimulated whole saliva composition of patients with neurological disorders. For this, enzymatic (superoxide dismutase - SOD; glutathione peroxidase - GPx) and non-enzymatic (uric acid; ferric ion reducing antioxidant power - FRAP) antioxidant activity, as well as a marker for oxidative damage (thiobarbituric acid reactive substances - TBARS) were analyzed. Unstimulated whole saliva was collected from 12 patients with neurological disorders and tube-feeding (tube-fed group - TFG), 15 patients with neurological disorders and normal feeding via the mouth (non-tube-fed group - NTFG), and 12 volunteers without neurological disorders (control group - CG). The daily oral hygiene procedures of TFG and NTFG patients were similar and dental care was provided monthly by the same institution's dentist. All patients exhibited adequate oral health conditions. The salivary levels of FRAP, uric acid, SOD, GPx, TBARS, and total protein were compared between studied groups. FRAP was increased (p < 0.05) in the NTFG (4651 +/- 192.5 mmol/mL) and the TFG (4743 +/- 116.7 mmol/mL) when compared with the CG (1844 +/- 343.8 mmol/mL). GPx values were lower (p < 0.05) in the NTGF (8.24 +/- 1.09 mmol/min/mg) and the TFG (8.37 +/- 1.60 mmol/min/mg) than in the CG (15.30 +/- 2.61 mmol/min/mg). Uric acid in the TFG (1.57 +/- 0.23 mg/dL) was significantly lower than in the NTFG (2.34 +/- 0.20 mg/dL) and the CG (3.49 +/- 0.21 mg/dL). Protein was significantly lower in the TFG (5.35 +/- 0.27 g/dL) than in the NTFG (7.22 +/- 0.57 g/dL) and the CG (7.86 +/- 0.54 g/dL). There was no difference in the salivary flow rate and SOD between groups. Enteral nutrition in patients with neurological disorders was associated with lower oxidative damage, resulting in increased salivary. antioxidant capacity. These results emphasize the importance of oral care for this population to prevent oral and systemic diseases. (C) 2014 Elsevier Ltd. All rights reserved.

Prevalence and severity of orofacial pain in pregnant women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Condição periodontal, perda dentária e diferenças socioeconômicas em adultos e idosos brasileiros

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Confecção e montagem do set-up ortodôntico

Diagnosis and planning stages are critical to the success of orthodontic treatment, in which the orthodontist should have many elements that contribute to the most appropriate decision-making. The orthodontic set-up is an important resource in the planning of corrective orthodontics therapy. It consists of the repositioning of the teeth previously removed from the study dental casts and reassembled on its remaining basis. When properly made, the set-up allows a three-dimensional preview of problems and limitations of the case, assisting in decision-making regarding tooth extractions in cases with problems of space, amount of anchorage loss extent and type of tooth movement, discrepancy of dental arch perimeter, discrepancy of inter-arch tooth volume, among others, indicating the best option for treatment. This paper outlines the most important steps for its confection, an evaluation system and its application in the preparation of orthodontic treatment planning.

Tratamento estético periodontal: revisão de literatura sobre alguns tipos de cirurgias

Currently, periodontal aesthetics has been prized for harmony of the smile. The clinical crown lengthening, gingival excess or altered passive eruption, is effectively corrected by periodontal surgery. The purpose of this paper is to show, through a literature review, some types of surgery on clinical crown lengthening and root coverage. Clinical crown lengthening is done to Change the size of the anterior teeth and to optimize the cosmetic result of treatment with new coronal restoration and other cosmetic dental care. In general, the treatment plan and the choice of operative technique begin with careful clinical examination. Recessions tissue can be defined as a displacement of the gingival margin toward the junction mucogingival exposing the root surface. These, when present, impacting on patient comfort by providing the occurrence of cervical dentin hypersensitivity, and the esthetic, the amendment of the gum line. Successful treatment of recessions is based on knowledge of its etiology and assessment of predictability of surgical techniques that aim to root coverage. Through literature review, we can conclude that the types of surgery most often used are: 1) to increase the clinical crown, gingivectomy, flap surgery and gingivoplasty osteotomy, and 2) for root coverage, the use will depend on the amount of gum keratinized and especially the classification of Miller.

Resolução por retratamento não cirúrgico de dente com lesão periapical: relato de caso clínico

The development and maintenance of periapical lesion occurs as a result of bacterial infection of the root canal system. Faced with the failure of endodontic treatment, retreatment is the first option with great potential for success, when performed with proper disinfection of the root canal system. Case report: Patient aged 39 years needing dental care show at clinical examination moderate gingival bleeding in the region of tooth 22 and the presence of radiographic periapical bone rarefaction due to unsatisfactory endodontic treatment. It was indicated the endodontic retreatment. We performed procedures to remove the filling material, root canal preparation using manual and mechanical techniques and completion with the use of root canal medication based on calcium hydroxide. After root canal filling, clinical and radiographic success were demonstrated for the case. Conclusion: We conclude that the non-surgical retreatment with disinfection and proper use of medication to the base of calcium hydroxide promoted success after outcome monitoring for 2 years and 8 months (AU)

Retardo na procura do tratamento odontológico e percepção da saúde bucal em mulheres grávidas

The objective was to assess in women with children under 5 years old what happened to your pregnancy in relation to dental care, coupled with a probable correlation between the level of their knowledge on dental health and possible reasons which lead or have led to a late seeking such treatment. The interviews were conducted in an environment of health center in the city center and the Odontoly Faculty in Araraquara. Among the interviews mothers, 57% refused the dental treatment during pregnancy. It appears on mothers that are afraid to perform a dental treatment during pregnancy. The misinformation on this issue often associated with this belief in the medical field that dental care during the first three months of pregnancy is harmful to the baby. Such information passed on to mothers leads to a hesitancy with dental treatment during this period. The educational level of mothers did not interfere in this pursuit, and 24.5% of them avoid treatment during pregnancy. The difference, however, is between those mothers of high educational level, performing oral prevention before pregnancy.

Effect of polymerization methods and thermal cycling on color stability of acrylic resin denture teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The Fresh Frozen Bone Allograft (FFBA) to reconstruc the atrophic maxilla: evaluation of the clinical and histological viability at six and nine months in the maxillary sinus

This work aimed to analyze clinically and histologically the allogen bone graft behavior at 6 and 9 months. A leukoderm, female, 55 years old patient sought dental care for oral rehabilitation with dental implants and implant supported fixed prosthesis in the maxilla. Bilateral sinus lifting procedure were performed in a same patient, the analysis were made after 6 and 9 months, respectively. At 6 months, there was lack of a better bone remodeling in the region, associated to the presence of fibrous connective tissue within the collected tissue, showing us that this is not the best stage of tissue maturation to place dental implants. The 9 months period showed an improvement, with a more organized bone tissue surrounding particles of homogenous bone, what possibly had increased implant stability at the time of surgery. There is no doubt about the increase of clinical applications of FFBA, but there are no studies available regarding the standardization of time to load implants inserted in allografts. So papers with long-term monitoring are necessary to eliminate questions that still remain to be answered.

Tumor odontogênico queratocístico: relato de caso

Introduction: The odontogenic keratocyst tumor (OKT) derived from dental lamina rests with particularities and specific histological features, with high rates of relapse and aggressive clinical behavior. Presents certain predilection for males, affecting the mandible of 60% to 80% of cases may be related to impacted tooth 25 to 45% of cases. Objective: To highlight the clinical, histopathological and imaging procedures of the OKT, as well as discuss the treatment of this injury. Case Report: To report a case of 10 years of age to look for the orthodontist to correct anterior open bite was observed in panoramic radiography radiolucent area in the region of the body of the mandible associated with pathological inclusion of the lower premolar. It was performed an incisional biopsy of the lesion and the histopathologic diagnosis was odontogenic keratocyst tumor. It was performed a CT scan to assess the extent of the injury and its relation to anatomic structures. How to conduct, we opted for the extraction of the deciduous molar and enucleation of the lesion, preserving the premolar included. The same goes on clinical and radiographic control 18 months, after removal of OKT obtaining the eruption of premolar that was involved in the injury. Final Comments: It is necessary to adopt protocols that include dental care knowledge of oral diagnosis, medical history and careful clinical evaluation without forgetting the need for histopathological confirmation.