Orientador: Silvia Regina Brandalise / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T00:03:46Z (GMT). No. of bitstreams: 1 Biancalana_Helenice_M.pdf: 2127698 bytes, checksum: c684b76f616b7c6c6ee06e1debd4e145 (MD5) Previous issue date: 2006 / Resumo: INTRODUÇÃO: Doença Falciforme é uma anemia hemolítica genético-hereditária, causada por uma mutação do gene da hemoglobina, que altera sua estabilidade e característica físico-química, resultando numa hemácia que, sob determinadas condições, tem seu formato alterado para forma de foice. A identificação da doença falciforme no período neonatal possibilita medidas preventivas efetivas para redução de sua morbidade e mortalidade. Programas incluindo ações educativas e preventivas multidisciplinares para o atendimento de crianças com doença falciforme visam melhorar a qualidade de vida dessa população infantil, onde a odontologia, com suas especialidades, tem papel relevante no que se refere à prevenção e à manutenção da saúde. O objetivo desta pesquisa foi identificar as manifestações bucais em crianças portadoras de doença falciforme. MÉTODOS: A população estudada foi composta por 150 crianças entre 1 e 59 meses de idade, sendo 30 com doença falciforme (DF) em acompanhamento no Centro Infantil de Investigações Hematológicas Dr. Domingos A. Boldrini e o grupo Controle formado por 120 crianças saudáveis, da mesma faixa etária em acompanhamento na clínica de prevenção em odontopediatria da Unicastelo. As 150 crianças foram submetidas ao exame clínico intra-oral. A análise estatística foi realizada utilizando-se o software SAS versão 8.2. Os dados foram avaliados descritivamente através do cálculo de freqüências absolutas (n), relativas (%) e de média, desvio-padrão e mediana para as variáveis contínuas, e a utilização do teste de Qui-Quadrado. O estudo das associações e diferenças entre as variáveis estudadas e o grupo Controle foi realizado através dos testes exato de Fisher, Qui-Quadrado de Yates e de Mann-Whitney e, calculado o risco relativo para expressar a magnitude entre os grupos, doente e sadio, na cronologia da erupção dentária. O nível de significância foi de 5%. RESULTADOS: Não houve diferenças significativas nas associações entre os grupos DF e Controle em relação às alterações da mucosa bucal (p = 0,99), à relação terminal dos segundos molares (p = 0,65), com prevalência do degrau mesial para mandíbula, 16,7% no grupo DF e 36,7% no grupo Controle. Quanto à hipoplasia de esmalte dentário, estatisticamente, os valores não foram significativos (p = 0,81), assim como à presença de cárie (p = 0,12). A associação entre os grupos DF e Controle em relação à cronologia de erupção dentária demonstrou valor estatisticamente significativo (p < 0,001). Quanto à associação das intercorrências clínicas no grupo DF com as manifestações bucais, houve resultado estatisticamente significativo entre diarréia aguda e cronologia de erupção dentária (p = 0,015). CONCLUSÕES: As crianças do grupo DF em relação ao grupo Controle não apresentaram manifestações bucais quanto à alteração da mucosa, hipoplasia de esmalte dentário e lesão de cárie. Mas, em relação à cronologia, foi possível afirmar que houve um pequeno atraso de erupção dentária no grupo DF, havendo associação entre a intercorrência clínica da doença falciforme, diarréia aguda, com a cronologia de erupção dentária / Abstract: INTRODUCTION: Sickle cell disease is a genetically inherited hemolytic anemia produced by a mutation in the gene for the hemoglobin, which modifies its stability and physical-chemical features, resulting in a red cell that presents, under certain conditions, its format altered to a sickle shape. The identification of the sickle cell disease at the neonatal period allows for effective preventive measures for the reduction of its morbidity and mortality. Programs including multidisciplinary educational and preventive actions for the attendance of children with sickle cell disease aim at improving life quality of this young population, where dentistry and its specialties play a relevant role in terms of health prevention and maintenance. The purpose of this work was to identify the oral manifestations in children with sickle cell disease. METHODS: The population studied was comprised of 150 children between 1 and 59 months, 30 of them with sickle cell disease (SCD) and being followed at the Hematological Investigation Children¿s Center Dr. Domingos A. Boldrini and the control group comprised of 120 healthy children, of the same age, being followed at the pediatric dentistry prevention clinic of Unicastelo. The 150 children were submitted to an intra-oral clinical examination. The statistical analysis was carried out using the software SAS version 8.2. The data were evaluated descriptively using absolute (n), relative (%) and average frequency calculation, standard deviation and median for the continuous variables, and the Qui-Square test. The study of the associations and differences between the variables studied and the control group was carried out using the Qui-Square Yates test, the Fisher exact test and the Mann-Whitney test, and the relative risk to express the magnitude between the groups, sick and healthy, in the tooth eruption chronology was calculated. The significance level was 5%. RESULTS: There were no significant differences in the associations between the SCD and the control groups as regards the oral mucosa alterations (p = 0.99), the terminal relation of the second molars (p = 0.65), with prevalence of the tip forward for mandible, 16.7% in the sickle cell disease group and 36.7% in the control group. There were no significant values as regards hypoplasia of the dental enamel (p = 0.32), as well as to the presence of caries (p = 0.12). The association between the SCD group and the control group concerning the tooth eruption chronology presented a statistically significant value (p < 0.001). As regards the association of clinical intercurrences and oral manifestations in the children with SCD group, there was a statistically significant result between acute diarrhea and the tooth eruption chronology (p = 0.015).CONCLUSIONS: The children of the SCD group as compared to the control group didn¿t present oral manifestations regarding mucosa alteration, hypoplasia of the dental enamel and carious lesion. However, as for the chronology, we can asseverate that there was a little delay of the tooth eruption in the SCD group, with an association between clinical intercurrences of the sickle cell disease, acute diarrhea and the tooth eruption chronology / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

As doenças bucais ocupacionais e os acidentes de trabalho requerem medidas de prevenção implantadas no sistema de gestão de segurança e saúde no trabalho, a fim de estabelecer um ambiente de trabalho mais seguro. No caso do ambiente de trabalho apresentado no presente estudo, equacionar prevenção de doenças bucais ocupacionais é uma tarefa árdua. A legislação vigente exige da empresa, elaborar e manter um Programa de Prevenção de Riscos Ambientais (PPRA), visando preservar e manter a segurança e saúde de seus trabalhadores, em consonância com as demais normas regulamentadoras e com os demais requisitos legais, adentrando nesta interface a Odontologia do Trabalho. Por meio do conhecimento técnico-científico da Odontologia do Trabalho, este trabalho propõe incluir nas diretrizes para elaboração e implementação de um PPRA em um processo específico de galvanoplastia os riscos químicos com potencial de inferir na saúde bucal do trabalhador. Obtendo a associação entre a identificação no PPRA dos riscos ambientais e dos possíveis agravos e comprometimento da saúde bucal do trabalhador. Concluindo ser viável a contribuição da odontologia do trabalho na elaboração do PPRA visando à prevenção da saúde bucal dos que neste ambiente laboram; sendo necessário o monitoramento do binômio ambiente laboral e saúde bucal do trabalhador, a análise dos critérios para o estabelecimento de limites de tolerância, a eficácia dos equipamentos de proteção e a descrição dos riscos à saúde bucal na ficha de informação de segurança de produto químico. / Oral diseases and occupational accidents require prevention measures to be implemented in the systems of health and safety management at the workplace for a safer work environment. In the case of the work environment presented in this study, the prevention of occupational oral diseases is a daunting task. The current Brazilian legislation requires companies to establish and enforce a program named Occupational Hazard Prevention Program (PPRA) to help keep good safety and health conditions of their workers in line with regulatory standards and other legal requirements. This paper aims to include potentially damaging chemical risks to oral health of workers in the guidelines of the PPRA program and use them in a specific electroplating process. Through technical and scientific research, this work seeks to associate PPRA identification of environmental risks and its hazards to the possible risk of compromising the oral health of workers. It concludes by proving the positive contribution of dentistry labour in PPRA especially in the prevention of oral health damage, the requirement of monitoring the binomial work environment to maintain a good oral health of workers, analysis of criteria to establish tolerance limits, studies to assess efficiency level of equipment, and description of chemical products risks to oral health to be included in the safety guideline forms.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-18T11:28:47Z No. of bitstreams: 1 mirelleneryhenrique.pdf: 3757005 bytes, checksum: f81cbf74fa9d4f4e52254d53c930d9aa (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-01T18:23:14Z (GMT) No. of bitstreams: 1 mirelleneryhenrique.pdf: 3757005 bytes, checksum: f81cbf74fa9d4f4e52254d53c930d9aa (MD5) / Made available in DSpace on 2016-07-01T18:23:14Z (GMT). No. of bitstreams: 1 mirelleneryhenrique.pdf: 3757005 bytes, checksum: f81cbf74fa9d4f4e52254d53c930d9aa (MD5) Previous issue date: 2012-03-29 / Este estudo investigou a presença de cândida em manifestações bucais de pacientes com doença renal crônica em pré-diálise, em hemodiálise e em indivíduos saudáveis, utilizando-se de parâmetros clínicos e microbiológicos. Foram selecionados 34 pacientes portadores de doença renal crônica que foram divididos em dois grupos: GE1 – 20 em pré-diálise e; GE2 – 14 em hemodiálise. Para o terceiro grupo (GE3), foram selecionados aleatoriamente 14 indivíduos saudáveis que estavam aguardando atendimento odontológico em clínica particular. Todos os participantes selecionados passaram por uma anamnese e os mesmos responderam a alguns questionamentos sobre a saúde de um modo geral e sobre hábitos particulares de alimentação e hábitos nocivos. A verificação das manifestações bucais foi realizada de forma visual e devidamente fotografada e anotada. Durante o exame intrabucal, nas áreas que apresentavam diagnóstico sugestivo de candidíase, foi coletado material com swab para exame microbiológico, utilizando-se a técnica da Alça Calibrada, onde o meio foi o CHROMagarTM Cândida, para detectar o crescimento de três tipos de cândida: C. albicans, C. krusei e C. tropicalis. Para obtenção dos resultados foi utilizada a prova de Qui-Quadrado, ANOVA (com Post-Hoc LSD) e o teste t de Student, todos com nível de significância de p < 0,05. Das manifestações bucais diagnosticadas, aquela mais frequentemente encontrada foi a “Língua fissurada” com 78,6% no GE2; 60,0% no GE1 e 26,7% no GE3. A “Língua saburrosa” foi a segunda manifestação bucal mais observada, sendo 71,4% no GE2 e 45,0% no GE1. O GE2 foi o grupo que mais apresentou manifestações bucais. Com relação ao diagnóstico visual de candidíase nas manifestações bucais, o GE2 foi prevalente com 28,6%, seguido do GE1 com 25,0%. A C. albicans esteve presente com 17,6% nos pacientes com DRC, sendo 10,0% para o GE1 e 28,6% para o GE2. No GE3 não foi observada a presença de C. albicans. Desta forma, pode-se concluir que nas manifestações bucais observadas, o microrganismo C. albicans esteve presente nos pacientes com doença renal crônica em pré-diálise e hemodiálise, porém sem significância para afirmar que o mesmo seja oportunista para desencadear a candidíase. / This study investigated the presence of oral manifestations of candidiasis in patients with chronic kidney disease in predialysis, hemodialysis and healthy subjects, using the clinical and microbiological parameters. We selected 34 patients with chronic kidney disease who were divided into two groups: EG1 – 20 in pre-dialysis; EG2 – 14 on hemodialysis. For the third group (EG3) were randomly selected 14 healthy subjects who were waiting for dental care in private practice. All selected participants underwent an interview and they answered some questions about health in general and on particular habits of diet and harmful habits. Verification of oral manifestations was performed visually and duly photographed and recorded. During the examination intraoral areas with the diagnosis suggestive of candidiasis, swab material was collected for microbiological examination, using the technique of calibrated loop where the medium was CHROMagarTM Candida, to detect the growth of three types of bleach: C. albicans, C. krusei and C. tropicalis. To obtain the results we used the chi-square test, ANOVA (with post-hoc LSD) and Student's t test, all with a significance level of p < 0.05. Of oral lesions diagnosed, that was the most frequently found "Fissured tongue" with 78.6% in EG2, 60.0% and 26.7% in the EG1 and EG3. The "Tongue furred" was the second most frequent oral manifestation, being 71.4% and 45.0% in the EG2 and EG1. The EG2 was the group that presented oral manifestations. With respect to visual diagnosis of candidiasis in the oral manifestations, the EG2 was prevalent in 28.6%, followed by EG1 with 25.0%. The C. albicans was present in 17.6% in patients with chronic kidney disease, and to GE1 10.0% and 28.6% for EG2. EG3 was not observed in the presence of C. albicans. Thus, it can be concluded that oral manifestations observed in the microorganism C. albicans was present in patients with chronic kidney disease in predialysis and hemodialysis, but no significance to claim that it is opportunistic to trigger candidiasis.

Magister Scientiae Dentium - MSc(Dent) / BACKGROUND: The scourge of HIV and AIDS on the people of Lesotho is a huge public health problem faced by the country’s Ministry of Health and in 2005 the national adult HIV prevalence rate was 23% (WHO, 2009). It is estimated the one in every four adults in the country is HIV positive and in 2012, new HIV infection per year was estimated to be 18,000 (MoH Lesotho, 2014). The 2014 health reform by the Ministry of Health, Lesotho plans to capacitate village health workers (VHWs) to play an important role in addressing Lesotho's most urgent health crises which are: to reduce child mortality, to improve maternal health, to combat HIV/AIDS and other diseases. This is because VHWs and primary health care nurses (PHC nurses) are in vital positions to identify, manage or refer such patients for appropriate care. Studies have shown that between 74.4% - 90% of HIV infected people present with at least one oral lesions in the course of the disease. Health care workers need to have adequate knowledge of these conditions for effective management thereof. AIM: To determine the knowledge, attitudes and practices of nurses and VHW in Butha-Buthe district with respect to oral HIV/AIDS manifestations. METHODOLOGY: A descriptive cross-sectional survey was conducted on one hundred and forty-one Village health workers and nurses in Butha-Buthe district of Lesotho. A self– administered questionnaire was used to gather information on demographic characteristics of the participants and their knowledge, attitudes and practices regarding the management of oral lesions associated with HIV. Analysis was done using the SPSS statistical software package. Descriptive statistics such as frequency distributions and cross tabulations was generated and the results were summarized in tables and figures. RESULTS: The ages of the participants ranged between 21 and over 50 years. There majority were female (83.7%). And two thirds had a secondary school education. The healthcare providers that had ten years or less of service accounted for 59.6% of the respondents and 0.7% had more than 30 years of service. Most of the respondents (97.9%) had previous knowledge on oral lesions related to HIV/AIDS but only (8.2 %) reported having received knowledge through training institutions. The majority (79.3%) identified oral candidiasis (OC) as the most common lesion found in people living with HIV/AIDS while lesions of NOMA, aphthous ulceration, Kaposi’s sarcoma and herpes zoster were the least identified lesions by the respondents. The findings showed that 67.4% of the participants washed their hands routinely with water only whereas 66.7% routinely washed their hands with antiseptics. However, a majority of them (96.5%) said that they washed their hands with water and soap routinely. CONCLUSION: There are however gaps in the knowledge, attitude and practices of nurses and VHWs in Butha-Buthe district to oral HIV/AIDS manifestations. Improvement in the knowledge and ability of these cadres of health care providers to recognize and manage such lesions can be done through an introduction of such training in their school curriculum. It may also be necessary to continuously have seminars aimed at training and retraining these cadres of health workers on this topic. It is also worrisome that a high number of the participants indicated they didn’t strictly adhere to standard precautions as stipulated by WHO. It may be necessary to conduct studies to assess reasons for their infection control practices.

Les manifestations orales de la maladie de Crohn sont bien établies chez les adultes. Toutefois, aucune étude ne s’est concentrée sur les manifestations orales pathologiques chez la population infantile. En ce qui concerne la santé dentaire, très peu d’études ont évalué la prévalence de carie chez les patients atteints de la maladie de Crohn. Les objectifs de cette étude sont de décrire les manifestations orales des enfants et des adolescents atteints de la maladie de Crohn et tout lien possible avec le stade de la maladie (active ou rémission) ainsi que de déterminer s’il existe un lien entre la prévalence de carie et le score de potentiel cariogène de la diète des patients. Hypothèses • Les manifestations buccodentaires décrites chez les adultes sont présentes chez les enfants et adolescents du groupe de Ste-Justine. • Il existe différentes manifestations propres à la population infantile. • L’indice carieux des enfants atteints de la maladie de Crohn est supérieur à celui des enfants en bonne santé. • L’indice de potentiel cariogène est élevé chez les patients atteints de la maladie de Crohn • Le stade de la maladie influence la prévalence des manifestations. Méthodologie Un certificat d’éthique à la recherche fut obtenu de l’hôpital Ste-Justine. Sur 40 patients recrutés, 21 sujets (9 filles, 12 garçons) âgés de 5,1 à 17,3 ans ont participé à l’étude de type transversale. Un questionnaire médical, un examen buccal complet, l’analyse des journaux alimentaires ainsi qu’une revue des dossiers médicaux a permis d’établir la prévalence des lésions pathologiques, la prévalence de carie (indice CAO) et le score de potentiel cariogène (SPC) selon la méthode du Dre Monique Julien. Résultats Les analyses statistiques démontrent: • Aucune différence significative entre le CAO des patients atteints de la maladie et celui du groupe contrôle. • Aucune manifestation orale autre que celles présentées dans la littérature. • 57% des patients ont rapporté avoir eu des ulcères buccaux au cours de la maladie. • Les patients en phase active ne sont pas différents de ceux en rémission en ce qui concerne les manifestations orales, le CAO et le SPC. • Les enfants qui prennent du méthotrexate ont un CAO plus élevé. • Les patients qui ont plus de caries n’ont pas nécessairement une diète plus cariogène. Conclusion Selon les résultats de notre étude, nous n’avons pas observé de manifestations orales propre à la population infantile. De plus, les enfants atteints de la maladie ne semblent pas être un groupe à risque de carie dentaire. Davantage d’études sont nécessaires sur les manifestations orales de la maladie de Crohn chez la population pédiatrique. / Oral manifestations of Crohn’s disease are well documented in adults. However, no studies have investigated the oral manifestations of this condition in children and adolescents. Regarding oral health, only a few studies have evaluated the prevalence of dental caries in these patients. The objectives of this study are to describe the oral manifestations of Crohn’s disease in children and establish a link between the state of the disease (active and in remission) with the prevalence of dental caries and the cariogenicity of the diet of these children. Hypotheses • The oral manifestations described in adults are present in children and adolescents of the Ste-Justine group. • There are different oral manifestations in children. • Children with Crohn’s disease have more dental caries than children in good health. • The cariogenicity index of the diet is high in patients with Crohn’s disease • The state of the disease has an effect on the prevalence of the oral manifestations. Methodology An ethic’s certification was obtained from Ste-Justine Hospital. Of 40 recruited patients, 21 patients (9 girls, 12 boys) ranging in age from 5.1 to 17.3 years of age participated in our transversal study. A medical history, a complete oral exam, a diet analysis and a review of the medical chart gave us the opportunity to record the presence of oral manifestations, the prevalence of dental caries (DMFT) and the cariogenicity score (SPC). The DMFT of Crohn’s disease patients was compared with the DMFT of Quebec children establish in the Dr. Brodeur epidemiological study conducted in 1996. The patients were also divided into two groups according to the state of the disease (active or remission) to evaluate if it affected the prevalence of oral lesions, the DMFT and the SPC. Results The statistics show : • No significant difference between the DMFT of Crohn’s disease patients and the control group. • No oral manifestations other than those published in the adult literature. • 57% of patients reported to have ulcers at some time during the disease • The patient in the active phase is not different then those in remission ones regarding oral manifestations, DMFT and SPC. • Children taking methotrexate have a higher DMFT • Patients with a higher DMFT do not necesserarily have a higher SPC Conclusion The results of our study do not demonstrate any new oral manifestations in Crohn’s disease in children that have not already been described in adults. In addition, children with Crohn’s disease do not seem to be at high risk for dental caries. Further studies are necessary on the oral manifestations of Crohn’s disease in the pediatric population.

A Doença do Refluxo Gastroesofágico (DRGE), comumente observada em crianças e adolescentes, é uma das causas intrínsecas mais frequentes do desgaste erosivo. O objetivo dessa pesquisa foi realizar um estudo exploratório e analítico em crianças e adolescentes com idade entre 10 e 15 anos com DRGE e identificar possíveis diferenças entre grupos Casos e Controles quanto à presença de halitose, fluxo salivar, pH, capacidade tampão da saliva, lesões de desgaste erosivo e cárie dentária, classificação socioeconômica e qualidade de vida. Trinta voluntários participaram da pesquisa, sendo 15 do grupo Caso e 15 do grupo Controle. Informações sexo e idade foram coletadas durante a anamnese. A presença de halitose foi verificada por meio de avaliação organoléptica. A avaliação salivar foi realizada pelo fluxo salivar estimulado e o pH e a capacidade tampão (técnica de Ericsson), medidos com um pHmetro digital. Para a classificação econômica, utilizou-se o Critério de Classificação Econômica Brasil 2014 (CCEB/2014). Os voluntários responderam um questionário sobre qualidade de vida, validado no brasil (Child-OIDP) para faixa etária de 11-14 anos de idade. Além disso, foi realizado exame clínico para detecção de desgaste erosivo e cárie dentária de acordo com os índices BEWE e ICDAS, respectivamente. Os dados foram analisados pelo software STATA 9. As variáveis categorizadas sexo, idade, halitose e classificação socioeconômica e as variáveis numéricas fluxo salivar, capacidade tampão e pH não apresentaram diferença estatística entre os grupos (p > 0,05). O grupo Caso apresentou diferença significativa comparado ao grupo Controle para as variáveis BEWE e ICDAS. Apenas o desgaste erosivo e a presença de lesões de cárie foram associados a DRGE. O BEWE e o ICDAS podem ser considerados métodos auxiliares para o diagnóstico de pacientes com refluxo patológico. A relação interdisciplinar entre os profissionais de saúde, em especial, cirurgiões dentistas e médicos gastroenterologistas, é essencial para melhor conduta médica-odontológica de pacientes com Doença do Refluxo Gastroesofágico. / Gastroesophageal Reflux Disease (GERD), commonly observed in children and adolescents is one of the most common intrinsic causes of the erosive wear. The aim of this research was to conduct an exploratory and analytical study in children and adolescents aged between 10 and 15 years with GERD and to identify possible differences between Cases and Controls groups for the presence of halitosis, salivary flow, pH, saliva buffering capacity, erosive wear and dental caries, socioeconomic classification and quality of life. Thirty volunteers participated in this study, but fifteen were in the Case group and fifteen were in the Control group. Information about age and sex were collected during the anamnesis. The presence of halitosis was verified by organoleptic evaluation. The salivary tests were performed by saliva stimulated salivary flow; pH and buffering capacity (by Ericsson technique) were measured with a digital pH meter. Economic classification was evaluated by Economic Classification Criteria Brazil 2014 (CCEB/2014). The volunteers answered a questionnaire about quality of life, validated in Brazil (Child-OIDP) for the age group of 11-14 years. Furthermore, the clinical examination was conducted to erosive wear and caries detection in accordance with BEWE and ICDAS index, respectively. The data were analysed by Stata 9.0 software. Categorical variables sex, age, halitosis and socioeconomic classification and numeric variables salivary flow, buffer capacity and pH had not statistical difference between groups (p > 0.05). The Case group had significant difference compared to the Control group using BEWE and ICDAS variables. Only erosive tooth wear and carious lesions were associated with GERD. The BEWE and ICDAS can complement the methods for the diagnosis of patients with pathological reflux. The interdisciplinary relationship between dentists and gastroenterologists is essential for better medical and dental management of patients with Gastroesophageal Reflux Disease.

RESUMO Além das manifestações sistêmicas que acometem os pacientes portadores de Diabetes Mellitus (DM), como angiopatias, cardiopatias, retinopatias, nefropatias e hipertensão arterial, estes pacientes apresentam também respostas diminuídas a infecção, quando descompensados, fazendo que o transcurso da doença se desenvolva de forma diferenciada do paciente normoglicêmico. Esta característica irá se apresentar, também, na cavidade bucal, fato este que deverá alertar o cirurgião dentista quanto ao manejo adequado destes pacientes, eliminando os riscos de complicações durante e pós-tratamento. Para tanto, é necessário conhecer a prevalência das manifestações bucais que mais acometem estes indivíduos, assim como as complicações sistêmicas associadas, as quais irão intervir nesta conduta. O objetivo deste trabalho foi apresentar uma população, já sabidamente, portadora de DM tipo 2, caracterizando as alterações sistêmicas e as manifestações bucais apresentadas por estes pacientes no momento em que se apresentaram para atendimento odontológico. Foram examinados 372 participantes, na 4ª Campanha gratuita de prevenção, educação e detecção em diabetes realizada pela Associação Nacional de Assistência ao Diabético – ANAD – no ano de 2001, com idade entre 32 a 87 anos, sendo 191 do sexo masculino e 181 do sexo feminino,. Primeiramente foi preenchido um questionário contendo informações auto-referidas sobre alterações metabólicas pré-existentes e também transcrito para a ficha o valor da glicemia e pressão arterial. Procurou-se verificar se estes participantes estavam em acompanhamento médico, odontológico e se utilizavam algum tipo de medicação para controle da glicemia. A percepção de condições de saúde bucal também foi questionada e classificada em aval positivo e negativo, com escalas. Posteriormente foi realizado exame bucal. Os resultados mostram que 46% se apresentaram com hipertensão arterial, a retinopatia e a neuropatia foi observada em 31% dos participantes, angiopatia em 20%, cardiopatia em 19% e nefropatia em 10%. Dos participantes, 80% realizavam acompanhamento médico e 37% realizavam acompanhamento odontológico, sendo que 78% utilizavam medicação para o controle da glicemia. Em relação à auto-percepção das condições de saúde bucal, 38,5% avaliavam positivamente e 37,5% avaliavam negativamente. Quanto às manifestações bucais, os achados mais expressivos foram: exposição radicular com sensibilidade (57%), gengivite (45%) e diminuição de fluxo salivar (44%). Concluímos que em função das múltiplas e freqüentes manifestações bucais apresentadas por estes pacientes, os cirurgiões dentistas devem receber formação específica para o diagnóstico e desenvolvimento desses agravos, informação esta que deverá capacitá-lo inclusive para o atendimento sob a agravante de sua condição clínica alterada. / SUMMARY Beyond the systemic manifestations that occur the carrying patients of Diabetes Mellitus (DM), as angiopathies, cardiopathies, retinopathies, nephropathies and hypertension, these patients also present diminished answers the infection, when uncontrolled, making that the course of the illness if develops of differentiated form of the normoglycemic patient. This characteristic will go to present itself, also, in the buccal socket, fact this that will have to alert to the surgeon dentist how much to the adequate handling of these patients, eliminating the risks of complications during and post-cure. For in such a way, it is necessary to know the prevalence of the buccal manifestations that more occur these individuals, as well as the systemic complications associates, which will go to endanger in this behavior. The objective of this work was to present a population, already sabidamente, carrier of DM type 2, characterizing the systemic alterations and the buccal manifestations presented by these patients at the moment where if they had presented for dental attendance. We examined 372 participants, in 4ª gratuitous Campaign of prevention, education and detention in diabetes carried through by the National Association of Assistance to the Diabetic – ANAD -. in the year of 2001, with age it enters 32 87 years, being 191 of the masculine sex and 181 of the feminine sex. First was filled a questionnaire also contends auto-cited information on preexisting metabolic alterations and transcript for the fiche the value of the glycemia and arterial pressure. It was looked to verify if these participants were in medical, dental accompaniment and if they used some type of medication for control of the glycemia. The perception of conditions of buccal health also was questioned and classified in positive and negative endorsement, with scales. Later buccal examination was carried through. The results show that 46% if had presented with hypertension, the retinopathy and the nephropathy was observed in 31% of the participants, angiopathy in 20%, cardiopathy in 19% and nephopathy in 10%. Of participants, 80% they carried through medical accompaniment and 37% carried through dental accompaniment, being that 78% used medication for the control of the glycemia. In relation to the auto-perception of the conditions of buccal health, 38.5% evaluated positively and 37.5% evaluated negative. How much to the buccal manifestations, the findings meaningfuls had been: exposition to radicular with sensitivity (57%), gengivitis (45%) and reduction of flow to salivary (44%). We conclude that in function of the multiple and frequent buccal manifestations presented by these patients, the dentist must receive specific formation for the diagnosis and development from these torts, information this that will have to also enable it to the attendance under the aggravating one of its modified clinical condition.

Crianças e adolescentes transplantados renais (TR) necessitarão de cuidado odontológico rotineiro ou exibirão alterações bucais relacionadas tanto com algumas das doenças de base, como relacionadas com o transplante e tratamento imunossupressor. O objetivo deste estudo foi conhecer a saúde bucal e identificar as alterações bucais de crianças e adolescentes TR, buscando possíveis relações com a doença de base que levou ao TR, o tempo de transplante e com o esquema imunossupressor adotado. Foi realizada anamnese e exame clínico para avaliar a experiência de cárie (índice CPOD/ceo-d), defeitos de esmalte (índice DDE modificado), condição periodontal (índice IPC modificado) e presença de alterações em tecidos moles. Trata-se de um estudo observacional transversal realizado no período de agosto de 2017 a junho de 2018 em receptores de TR entre 2 a 17 anos de idade acompanhadas no Hospital do Rim em São Paulo, Brasil. Foram incluídos 120 participantes, dos quais 63 (52,5%) eram do sexo masculino e com média de idade de 12,78 ± 3,9 anos. As causas mais comuns de falência renal foram de causa desconhecida 28 (23,3%) e válvula de uretra posterior (VUP) 14 (11,7%). Sangramento gengival foi observado em 115 (95,8%) participantes, cálculo dentário em 69 (57,5%), experiência de cárie em 51 (42,5%), defeitos de esmalte em 49 (40,8%), hiperplasia gengival medicamentosa (HGM) em 20 (16,7%), xerostomia em 15 (12,5%) e lesões de tecidos moles em 5 (4,2%), dentre elas úlceras, língua geográfica e verruga bucal. A maioria dos participantes da pesquisa (55%) necessitava de algum tratamento odontológico. O uso de amlodipina e anticonvulsivantes esteve associado à presença de HGM, enquanto que o tratamento com o imunossupressor everolimus esteve associado à presença de ulceração (p<0,05). Concluímos que a doença periodontal e a doença cárie foram as mais frequentes, levando a significativa necessidade de tratamento odontológico na população estudada. Grande parte das alterações bucais observadas foram relacionadas à doença de base (insuficiência renal), em especial os defeitos de esmalte. As infecções oportunistas bucais foram raras e o tratamento medicamentoso esteve associado à presença de ulceração (uso de everolimus) e à presença de HGM (uso de amlodipina e de anticonvulsivantes). / Renal transplanted children and adolescents need dental care on a routine basis as there are oral changes related to some underlying diseases as well as to the transplantation itself and immunosuppressive therapy. The objective of the present study is to know and identify the oral health of these patients in order to seek possible relationships with the underlying disease which led to kidney transplantation, transplantation time and adopted immunosuppressive approach. Anamnesis and clinical examination were conducted to evaluate the presence of caries lesions (DMFT/dmf-t indexes), enamel defects (modified DDE index), periodontal condition (modified IPC index) and presence of soft tissue changes. This is an observational, cross-sectional study performed between August 2017 and June 2018 in which renal transplant recipients aged 2-17 years old were followed up at the São Paulo Hospital of Kidney in Brazil. A total of 120 participants were included, with 63 (52.5%) being males with mean age 12.78±3.9 years old. Unknown causes of renal failure involved the majority of the cases, that is, 28 (23.3%), whereas posterior urethral valve (PUV) involved 14 cases (11.7%). Gingival bleeding was observed in 115 (95.8%) participants, dental calculus in 69 (57.5%), caries experience in 51 (42.5%), enamel defects in 49 (40.8%), drug-related gingival hyperplasia (DRGH) in 20 (16.7%), xerostomia in 15 (12.5%) and soft tissue lesions in 5 (4.2%), such as ulcers, geographic tongue and oral wart lesions. The majority of the participants (55%) needed some dental treatment. The use of amlodipine and anticonvulsants has been associated with the presence of DRGH, whereas the immunosuppressant everolimus associated with ulceration (p < 0.05). We have concluded that periodontal disease and caries lesions were the most frequent oral conditions, leading to significant need for dental treatment in the population studied. Most of the oral changes observed were related to the underlying disease (i.e. renal failure), especially enamel defects. Oral opportunistic infections were rarely observed and drug treatment was associated with the presence of ulceration (use of everolimus) and DRGH (use of amlodipine and anticonvulsivants).

Les manifestations orales de la maladie de Crohn sont bien établies chez les adultes. Toutefois, aucune étude ne s’est concentrée sur les manifestations orales pathologiques chez la population infantile. En ce qui concerne la santé dentaire, très peu d’études ont évalué la prévalence de carie chez les patients atteints de la maladie de Crohn. Les objectifs de cette étude sont de décrire les manifestations orales des enfants et des adolescents atteints de la maladie de Crohn et tout lien possible avec le stade de la maladie (active ou rémission) ainsi que de déterminer s’il existe un lien entre la prévalence de carie et le score de potentiel cariogène de la diète des patients. Hypothèses • Les manifestations buccodentaires décrites chez les adultes sont présentes chez les enfants et adolescents du groupe de Ste-Justine. • Il existe différentes manifestations propres à la population infantile. • L’indice carieux des enfants atteints de la maladie de Crohn est supérieur à celui des enfants en bonne santé. • L’indice de potentiel cariogène est élevé chez les patients atteints de la maladie de Crohn • Le stade de la maladie influence la prévalence des manifestations. Méthodologie Un certificat d’éthique à la recherche fut obtenu de l’hôpital Ste-Justine. Sur 40 patients recrutés, 21 sujets (9 filles, 12 garçons) âgés de 5,1 à 17,3 ans ont participé à l’étude de type transversale. Un questionnaire médical, un examen buccal complet, l’analyse des journaux alimentaires ainsi qu’une revue des dossiers médicaux a permis d’établir la prévalence des lésions pathologiques, la prévalence de carie (indice CAO) et le score de potentiel cariogène (SPC) selon la méthode du Dre Monique Julien. Résultats Les analyses statistiques démontrent: • Aucune différence significative entre le CAO des patients atteints de la maladie et celui du groupe contrôle. • Aucune manifestation orale autre que celles présentées dans la littérature. • 57% des patients ont rapporté avoir eu des ulcères buccaux au cours de la maladie. • Les patients en phase active ne sont pas différents de ceux en rémission en ce qui concerne les manifestations orales, le CAO et le SPC. • Les enfants qui prennent du méthotrexate ont un CAO plus élevé. • Les patients qui ont plus de caries n’ont pas nécessairement une diète plus cariogène. Conclusion Selon les résultats de notre étude, nous n’avons pas observé de manifestations orales propre à la population infantile. De plus, les enfants atteints de la maladie ne semblent pas être un groupe à risque de carie dentaire. Davantage d’études sont nécessaires sur les manifestations orales de la maladie de Crohn chez la population pédiatrique. / Oral manifestations of Crohn’s disease are well documented in adults. However, no studies have investigated the oral manifestations of this condition in children and adolescents. Regarding oral health, only a few studies have evaluated the prevalence of dental caries in these patients. The objectives of this study are to describe the oral manifestations of Crohn’s disease in children and establish a link between the state of the disease (active and in remission) with the prevalence of dental caries and the cariogenicity of the diet of these children. Hypotheses • The oral manifestations described in adults are present in children and adolescents of the Ste-Justine group. • There are different oral manifestations in children. • Children with Crohn’s disease have more dental caries than children in good health. • The cariogenicity index of the diet is high in patients with Crohn’s disease • The state of the disease has an effect on the prevalence of the oral manifestations. Methodology An ethic’s certification was obtained from Ste-Justine Hospital. Of 40 recruited patients, 21 patients (9 girls, 12 boys) ranging in age from 5.1 to 17.3 years of age participated in our transversal study. A medical history, a complete oral exam, a diet analysis and a review of the medical chart gave us the opportunity to record the presence of oral manifestations, the prevalence of dental caries (DMFT) and the cariogenicity score (SPC). The DMFT of Crohn’s disease patients was compared with the DMFT of Quebec children establish in the Dr. Brodeur epidemiological study conducted in 1996. The patients were also divided into two groups according to the state of the disease (active or remission) to evaluate if it affected the prevalence of oral lesions, the DMFT and the SPC. Results The statistics show : • No significant difference between the DMFT of Crohn’s disease patients and the control group. • No oral manifestations other than those published in the adult literature. • 57% of patients reported to have ulcers at some time during the disease • The patient in the active phase is not different then those in remission ones regarding oral manifestations, DMFT and SPC. • Children taking methotrexate have a higher DMFT • Patients with a higher DMFT do not necesserarily have a higher SPC Conclusion The results of our study do not demonstrate any new oral manifestations in Crohn’s disease in children that have not already been described in adults. In addition, children with Crohn’s disease do not seem to be at high risk for dental caries. Further studies are necessary on the oral manifestations of Crohn’s disease in the pediatric population.

p. 1-122 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T18:00:49Z No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T16:51:40Z (GMT) No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) / Made available in DSpace on 2013-05-04T16:51:40Z (GMT). No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) Previous issue date: 2008 / Esta tese apresenta o resultado da investigação sobre manifestações clínicas orais em indivíduos infectados pelo HIV, analisando suas implicações na condição de saúde em crianças e adultos. Também investigou o papel da candidíase oral pseudomembranosa como possível preditora da progressão para a Aids. Foram desenvolvidos três estudos: o primeiro de corte transversal realizado por meio de uma revisão de prontuários clínicos dos indivíduos com 13 anos de idade ou mais assistidos pelo serviço de odontologia do Centro de Referência Estadual de Aids (CREAIDS), em Salvador-Bahia. O segundo, também de corte transversal semelhante ao primeiro, porém com indivíduos menores de 13 anos de idade atendidos no CREAIDS. O terceiro estudo desenhado como coorte histórica foi desenvolvida com dados sócio-demográficos, clínicos, terapêuticos e imunológicos de menores de 13 anos de idade acompanhados pelo serviço de pediatria médica deste Centro de Referência. Os resultados estão apresentados na forma de 03 (três) artigos e demonstram redução na freqüência das manifestações orais associadas com a infecção pelo HIV ao longo do período estudado (2003 a 2005), tanto em adultos quanto em crianças, principalmente nos grupos que utilizavam terapia anti-retroviral (TARV). Estas manifestações foram mais freqüentes em indivíduos que apresentaram alteração imunológica, caracterizada por elevados níveis da carga viral plasmática e redução da contagem dos linfócitos T CD4 +. As manifestações orais foram mais freqüentes em adultos com baixa escolaridade Além disso, foram observadas altas taxas de cárie dentária nestas populações. No entanto, entre as crianças, a cárie dentária mostrou-se associada à ocorrência de lesões orais. Foi observado ainda que a forma “persistente” da candidíase oral pseudomembranosa está associada com alteração imunológica severa e apresentou uma menor mediana de tempo até o diagnóstico de Aids em relação a candidíase episódica ou não candidíase. Esta pesquisa confirma a tendência observada na maioria dos estudos de menor proporção de manifestações orais em indivíduos infectados pelo HIV que utilizam a TARV. No entanto, estes indivíduos apresentam importantes necessidades de cuidados à saúde bucal / Salvador