Osteoporosis is a systemic disorder characterized by generalized decrease in bone mineral density. Dental implantology is a specialty with high predictability when both quantity and quality of the bone are respected. Therefore, the diagnosis and the implant treatment in patients with osteoporosis are important. In the current study, a literature review about osteoporosis and dental implant therapy was conducted. PubMed, Cochrane, ISI, Dentistry Oral Science, SciELO, and Bireme databases were consulted over the last 20 years. English- and Portuguese-language articles were included in this revision. Some authors stated that the osteoporotic bone is similar to the proposed model of bone type IV. Randomized clinical studies reported implant failure in patients with osteoporosis after menopause. Studies that contraindicate the use of implants in patients with osteoporosis infer that the impaired bone metabolism led to reduction of bone healing around the implants. Nevertheless, other authors believe that the presence of osteoporosis is not a definitive condition to contraindicate the therapy with dental implants. In these cases, the dentist should perform a proper treatment planning, modifying the implant geometry, and use larger implant diameter and with surface treatment. Thus, osteoporosis is not a contraindication for implant surgery because an accurate analysis of bone quality by means tomography is performed.

Introdução: a Odontologia Hospitalar é aquela exercida dentro de um ambiente hospitalar visando à inclusão do Cd na equipe multidisciplinar com o objetivo de participar do processo de cura e melhora da qualidade de vida, independentemente do tipo de doença que acomete o paciente. Objetivo: revisar os protocolos de atendimento a pacientes hospitalizados já publicados. A partir dessa revisão, será proposto um protocolo de atuação da Odontologia junto aos serviços de saúde, dentro de uma rotina de inspeção clínica e cuidados preventivos aos pacientes internados, por meio da instituição de um protocolo de atendimento às enfermarias, setor de doenças infecto-parasitárias, maternidade, centros de terapia intensiva e unidades coronarianas. Materiais e métodos: será realizada uma estratégia de busca detalhada para os bancos de dados pesquisados: PubMed, ISI, Bireme, Scielo, Cochrane, Dentistry Oral Science. A partir dessa revisão, os dados serão organizados e será apresentada uma proposta de protocolo de atendimento a pacientes hospitalizados. Resultados: foram encontrados poucos artigos e protocolos de atendimento ao paciente hospitalizado publicados, portanto os autores sugerem o protocolo da tabela 1, que poderá auxiliar o CD na prática da Odontologia Hospitalar. Conclusão: a odontologia precisa atuar em uma Equipe de Saúde em que os profissionais estejam conscientes de que as diferentes especialidades devem se inter-relacionar para o tratamento integral do paciente que se encontra em ambiente hospitalar.

ObjectivesThis study evaluated the resistance to antimicrobials of aerobes and facultative anaerobes isolated from patients wearing complete dentures, patients with gingivitis and periodontitis, and periodontally health subjects. Material and methodsThree hundred and four isolates were tested. The minimal inhibitory concentrations of the drugs were evaluated through the agar dilution method using Mueller-Hinton agar. ResultsThe most active antimicrobial drugs were the carbapenems (meropenem and imipenem), and resistance to these drugs was restrict to 1.6-2.3% of the isolates, as well as ciprofloxacin and rifampin. Microbial resistance to ampicillin, amoxicillin/clavulanic acid, cefoxitin, cephalothin, amikacin, chloramphenicol and nalidixic acid was particularly high. In most cases, the resistance to β-lactams was mediated by the production of hydrolytic enzymes, especially in gram-negative enteric rods, while enterococci did not evidence production of these enzymes. The association amoxicillin/clavulanic acid was not effective in 28.3% of the tested isolates. ConclusionsThe results of this investigation confirmed that the oral cavity of patients with periodontitis and gingivitis, and particularly edentulous patients wearing complete dentures, could harbor microorganisms with several antimicrobial resistance markers, and these microorganisms are frequently implicated in multiresistant, systemic, oral or nosocomial infections.

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Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37 o C for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.

A doença renal crônica é uma síndrome clínica decorrente da perda lenta, progressiva e irreversível da taxa de filtração glomerular, fazendo o paciente necessitar de uma terapia de reposição permanente, a fim de evitar a uremia, que significa o acúmulo de substâncias indesejáveis no sangue. Seu diagnóstico se dá não só pelos sinais e sintomas clínicos como também pelos exames laboratoriais de sangue e urina, em que os valores de ureia e de creatinina estarão aumentados. O cuidado ao paciente deverá ser multiprofissional, sendo o seu tratamento instituído pelo médico de acordo com a progressão da perda da função renal, existindo quatro maneiras, como o tratamento conservador (pré-diálise), a diálise peritoneal, a hemodiálise e, por fim, o transplante renal. É importante e necessário que esses pacientes tenham uma boa saúde bucal para evitar possíveis infecções na cavidade bucal, principalmente durante a hemodiálise, o pré-transplante e o pós-operatório. A doença renal crônica pode apresentar várias manifestações bucais, as quais não são específicas e sim secundárias às manifestações sistêmicas como doença periodontal, xerostomia, lesões na mucosa, infecções bucais entre outras. Uma vez que a função renal está prejudicada, a conduta do cirurgião-dentista deverá ser complexa e delicada e ele precisará adquirir todo o conhecimento para realizar um bom atendimento. Este artigo tem como objetivos abordar conceitos e implicações sobre a doença renal crônica, destacar as alterações bucais, evidenciar as condutas odontológicas e estabelecer um protocolo de atendimento ao paciente acometido por esta desordem.Descritores: Saúde Bucal; Insuficiência Renal Crônica; Doenças Periodontais.

In order to confirm the post-traumatic etiology of the anquilose, we got the medical records from the hospital where the patient received the first treatment. The records, at that time, reported facial trauma with bilateral condylar fracture and comminuted symphyseal fracture which was reduced and fixed followed by maxillomandibular fixation that remained for 45 days. After collecting all the information needed for diagnosis, surgical treatment was proposed through arthroplasty. The patient was placed on immediate post-operative jaw physiotherapy, and 12 months after surgery, his mouth opening improved to 35 mm. Thus, in our case, ankylosis may have been developed as a sequel of the mandibular fractures.

osteomyelitis of the mandible and maxilla are common in developing countries and their treatment may be long-standing and difficult. Thus, the aim of this study was to discuss the main biological aspects of the chronic osteomyelitis of the jaws of especial interest for dental team. These infections are associated with a complex microbiota composed mainly by anaerobic bacteria, sometimes associated with microorganisms originated from the skin and digestive tract. These data suggest that chronic osteomyelitis of the mandible and maxilla should be treated as anaerobic infections in most cases. In addition, local surgical treatments are relevant in the therapy outcome, associated to the use of antimicrobial agents, and the failure to accomplish them is a major cause of treatment failure.