Identification of novel Factor XI mutations in a patient requiring dental extractions

Factor XI is a serine protease that participates in the intrinsic pathway of blood coagulation. Patients deficient in factor XI exhibit varying degrees of post operative bleeding following invasive surgical procedures such as dental extractions. Objectives: The aim of the study was to identify the specific mutations in a patient from a family with known factor XI deficiency. Methods: Samples were obtained from the patient, his mother and his father and subjected to DNA sequencing. Each protein coding exon 2-15 of the factor XI gene was amplified by polymerase chain reaction (PCR) followed by bidirectional sequencing utilizing di-deoxy chain termination chemistry. Results: The patient had a factor XI level of 20% of normal. Initial sequencing of factor XI from the patient identified a point mutation (646G>A) and a putative splice site mutation (1567+4A>T) in intron 13. These are novel previously unreported mutations. DNA sequence analysis of the mother revealed the 1567+4A>T mutation and the father exhibited the 646G>A mutation. As a consequence the treatment proceeded without serious bleeding complication and required administration only of transexamic acid though factor XI was available as haemostatic cover. Conclusion: The two mutations identified in this family are novel; further laboratory investigation of the functional consequences of those mutations is currently underway. Although factor XI deficiency is rare in the Northern Irish population this study highlights the techniques available to sequence and analyse this and similar haematological disorders.

Efeitos da Isradipina (LOMIR). Agente inibidor de canais de cálcio, no processo de reparo em feridas de extração dental: estudo histológico em ratos

In order to make a histological evaluation of the dental alveolus wound healing in presence of the Isradipine (Lomir/Sandoz Pharma), the new calcium channels blockers, forthy-eight albino rats were utilized. These animals were divided in two groups. The animals of group I were considered as control; in group II, after the dental extractions the rats received intraperitonial injections of 2,5 mg/Kg of isradipine, administered a single dose. From each group of animals were sacrificed at 3, 7, 14 and 21 post-operative days. The pieces were fixed, descalcified and embedded in paraffin. The blocks thus obtained were cut at 6 micrometers thick and sections were stained with hematoxylin and eosin for morphological study. According to the results obtained i t was verified that the treated animals did not alter of wound healing after dental extractions

Hypertension modifies OPG, RANK, and RANKL expression during the dental socket bone healing process in spontaneously hypertensive rats

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

Cirurgia oral em hipocoagulados

Monografia apresentada à Universidade Fernando Pessoa para obtenção do grau de Licenciado em Medicina Dentária

Avaliação do risco de ocorrência de lesões de reabsorção dentária em animais com gengivo-estomatite crónica felina

A gengivo-estomatite crónica felina é uma inflamação complexa crónica, com severidade e intensidade variáveis. Apesar de não estar definida a sua etiopatogenia, parece haver uma relação entre a inflamação e a ocorrência de lesões de reabsorção dentária, enquanto causa ou enquanto consequência da doença. O tratamento para as duas doenças é inespecífico, mas baseia-se na extração dentária, contornada ou não com tratamentos médicos. Este estudo teve como objetivo determinar a ocorrência de lesões de reabsorção dentária em gatos com gengivo-estomatite crónica e avaliar a existência de uma possível associação entre um padrão de estomatite crónica e a presença de lesões de reabsorção dentária. O objetivo secundário consistiu na determinação da percentagem de sucesso e o grau de satisfação dos proprietários, após a intervenção cirúrgica. Foram incluídos no estudo 27 gatos. Os critérios de inclusão consistiram no diagnóstico de genvivo-estomatite crónica, realização de um exame radiográfico intraoral completo de todos os dentes, seguido de tratamento cirúrgico, com extrações dentárias e, finalmente, a resposta, por parte dos proprietários, a um questionário. A ocorrência de lesões de reabsorção dentária neste estudo foi de 66,67%. Não foi possível estabelecer nenhuma associação entre a gengivo-estomatite crónica felina e o desenvolvimento de lesões de reabsorção dentária. Os padrões ulcerativos, proliferativos e o de estomatite caudal na gengivo-estomatite crónica felina mostraram risco acrescido para lesões de reabsorção dentária, mas sem significado estatístico. 70,37% dos animais atingiu a cura clínica e 29,63% obteve melhoria global, num período médio de 2 meses. O grau de satisfação dos proprietários obteve uma média de 4,52 valores, numa escala de 1 a 5. Apesar da prevalência elevada de lesões de reabsorção dentária, não foi possível identificar a gengivo-estomatite crónica felina, enquanto fator de risco para a sua ocorrência. À semelhança de estudos anteriores, a gengivo-estomatite crónica felina responde a tratamento cirúrgico com extrações dentárias.

Early childhood caries: current evidence for aetiology and prevention

Background: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. Objective: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. Methods: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. Conclusions: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.

Fístula oronasal em cão: reparo com flape simples associado a fator proteíco angiogênico purificado do látex de seringueira, veiculado com matriz de esponja de colágeno : estudo experimental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Controle de microrganismos cariogênicos em pacientes submetidos à radioterapia em região de cabeça e pescoço: estudo clínico e microbiológico, utilizando-se métodos mecânicos e químicos

Pós-graduação em Odontologia - FOA

Aparelho extrabucal como recurso auxiliar para alinhamento e nivelamento no tratamento orto cirúrgico de má oclusão classe III esquelética

When well indicated, the orthodontic surgical approach is the ideal treatment mean for Skeletal Class III adult patients. To improve facial esthetic results from orthognatic surgery, the leveling and alignment of maxillary dental arch must be achieved with minimal inclination and projection or even retro-inclination of anterior upper teeth. During a pre-surgical phase of 12 months, headgear bilateral force of 150 g/F was applied to the upper molars of a 22 years old male compliant patient with Class III skeletal malocclusion, to provide an upper teeth control of mesial tipping and projection during alignment and leveling. The ideal occlusal parameters required for surgical procedure were achieved without dental extractions permitting a total treatment period of 37 months. The outcomes remained stable over 3 years follow up after the removal of the appliance. The results indicate that, although headgear use depends greatly on patient compliance, when well indicated it is an interesting alternativetopromote dentaldecompensationon pre-surgical period, in order to allow surgical correction of skeletal Class III malocclusion.

Necessidade de ancoragem do grupo A e o controle biomecanico da mola T pré-ativada por curvatura para o fechamento de espacos

Contemporary orthodontics has sought, beyond the esthetic, occlusal and functional goals, treatments even faster and with less visits to the orthodontist — especially in patients that require dental extractions in which the generated space becomes a nuisance. The segmented arch technic (SAT), by the use of a "T" loop spring, has provided such results within these requirements. Therefore, this study aimed to appraise and demonstrate the confection, activation and biomechanical control of "T" loop spring, in the group with high anchorage necessity (group A), for retraction of anterior teeth; as well as to present a case report, with high anterior retraction necessity, treated with "T" loop spring.

Fechamento de fístula buco-sinusal usando tecido adiposo bucal

The Oro-antral Fistula is a common pathologic event, which occurs an opening or communication of the maxillary sinus with the oral cavity through dental extractions of upper posterior elements whose roots have close relationship with the maxillary sinus. This study aims to clarify the Surgeon Dentist about the possible etiological factors responsible for Oro-antral Communication, to identify its clinical and radiographic signs, to explain the Buccal Fat Pad’s anatomy and functioning and to describe the surgical technique adopted front of these cases. For this, the authors present a case of a patient who had a fistula in the region where there was a dental extraction of the upper posterior element. The treatment of Oro-antral Fistula using the buccal fat pad provides to be a safe and effective surgical method, because this element presents a rich blood supply and easy access. Many authors have found that this method have a broad application, large index of success, lower risk of infection, provides a comfortable post-operative for the patient. However, it needs to be done properly so that you have minimum incidence of failures, and this requires some caution on the part of professional.

A study of effectiveness of midazolam sedation for prevention of myocardial arrhythmias in endosseous implant placement

Purpose: The study aimed to assess electrocardiographic alterations during oral implant placement surgeries under local anesthesia (lidocaine chlorhydrate with epinephrine), using 15 mg of midazolam as an anxiolytic premedication. Material and methods: The study randomly selected 20 patients, aged 21-50 years old, requiring bilateral mandibular dental implants. Each patient was assessed using placebo on one side and midazolam on the contralateral side, with random, double-blinded distribution. The electrocardiogram recorded 12 static leads every 2 min, while D2 derivations were recorded continuously. Results: No statistically significant differences were observed between the placebo and midazolam when analyzing the morphological behavior of the electrocardiographic wave and the presence of arrhythmias during the experiment. However, under sedation, assessment of the behavior of electrocardiographic parameters during different stages of the procedure revealed statistically significant differences (P<0.05) for heart rate, P-wave amplitude and duration of the RR and QTc intervals. The arrhythmias detected were considered low risk for patients without systemic alterations and were observed in 53.3% of patients. The most frequently occurring alterations were tachycardia, bradycardia, supraventricular and ventricular extrasystoles and blocked atrial extrasystole, which were similar for both placebo and midazolam, with the greatest incidence during the initial, incision and bone drilling stages. Conclusion: The use of 15 mg of midazolam made no difference compared with the placebo. The use of 15 mg of midazolam did not show an advantage in the incidence of arrhythmias The anxiolytic premedication does not prevent myocardial arrhythmias in endosseous implant placement. The clinical significance of the arrhythmias may not represent serious risks.

Consent for third molar tooth extractions in Australia and New Zealand: A review of current practice

Background Informed consent is the legal requirement to educate a patient about a proposed medical treatment or procedure so that he or she can make informed decisions. The purpose of the study was to examine the current practice for obtaining informed consent for third molar tooth extractions (wisdom teeth) by Oral and Maxillofacial Surgeons in Australia and New Zealand. Methods An online survey was sent to 180 consultant Oral and Maxillofacial Surgeons in Australia and New Zealand. Surgeons were asked to answer (yes/no) whether they routinely warned of a specific risk of third molar tooth extraction in their written consent. Results 71 replies were received (39%). The only risks that surgeons agreed should be routinely included in written consent were a general warning of infection (not alveolar osteitis), inferior alveolar nerve damage (temporary and permanent) and lingual nerve damage (temporary and permanent). Conclusions There is significant variability among Australian and New Zealand Oral and Maxillofacial Surgeons regarding risk disclosure for third molar tooth extractions. We aim to improve consistency in consent for third molar extractions by developing an evidence-based consent form.

Impact of dental insurance on adults’ oral health care in Tehran, Iran.

The aim of the present study was to determine relationships between insurance status and utilization of oral health care and its characteristics and to identify factors related to insured patients’ selection of dental clinic or dentist. The study was based on cross-sectional data obtained through phone interviews. The target population included adults in the city of Tehran. Using a two-stage stratified random technique, 3,200 seven-digit numbers resembling real phone numbers were drawn; when calling, 1,669 numbers were unavailable (busy, no answer, fax, line blocked). Of the 1,531 subjects who answered the phone call, 224 were outside the target age (under 18), and 221 refused to respond, leaving 1,086 subjects in the final sample. The interviews were carried out using a structured questionnaire and covered characteristics of dental visits, the respondent’s reason for selecting a particular dentist or clinic and demographic and socio-economic background (gender, age, level of education, income, and insurance status). Data analysis included the Chi-square test, ANOVA, and logistic regression and the corresponding odds ratios (OR). Of all the 1,086 respondents, 57% were women, 62% were under age 35, 46% had a medium and 34% a high level of education, 13% were under the poverty line, and 70% had insurance coverage; 64% with the public, and 6% with a commercial insurance. Having insurance coverage was more likely for women (OR=1.5), for those in the oldest age group (OR=2.0), and for those with a high level of education (OR=2.5). Of those with dental insurance, 54% reported having had a dental visit within the past 12 months ; more often by those with commercial insurance in comparison with public (65% vs. 53% p<0.001). Check-up as the reason for the most recent visit occurred most frequently among those with commercial insurance (28%) compared with those having public insurance (16%) or being non-insured (13%) (p<0.001). Having had two or more dental visits within the past 12 months was most common among insured respondents, when compared with the non-insured (31% vs. 22% p=0.01). The non-insured respondents reported tooth extractions almost twice as frequently as did the insured ones (p<0.001). Of the 726 insured subjects, 60% selected fully out-of-pocket-paid services (FOP), and 53% were unaware of their insurance benefits. Of those who selected FOP, good interpersonal aspects (OR=4.6), being unaware of dental insurance benefits (OR=4.6), and good technical aspects (OR=2.3) as a reason had greater odds of selecting FOP. The present study revealed that dental insurance was positively related to demand for oral health care as well as to utilization of services, but to the latter with a minor extent. Among insured respondents, despite their opportunity to use fully or highly subsidized oral health care services, good interpersonal relationship and high quality of services were the most important factors when an insured patient selected a dentist or a clinic. The present findings indicate a clear need to modify dental insurance systems in Iran to facilitate optimal use of oral health care services to maximize the oral health of the population. A special emphasis in the insurance schemes should be focused on preventive care.