Dental treatment in a patient with epidermolysis bullosa

Epidermolysis bullosa (EB) is a rare inherited group of genodermatoses characterized by mucocutaneous fragility and blister formation, either spontaneously or as a result of minimal mechanical trauma. The repetition of these episodes in the oral cavity leads to atrophy of the mucosa, causing microstomia, ankyloglossia, tongue denudation, and vestibule obliteration, characteristics that make dental treatment difficult. Patients with EB are at high risk for caries due to the presence of dental anomalies; they also tend to have a soft diet and difficulties with mechanical removal of the dental biofilm. This case report presents a patient diagnosed with EB and describes the difficulties faced by the clinician during dental treatment as well as the measures adopted to safely manage the patient's dental care.     

Dental treatment of a patient with Opitz G/BBB syndrome

Opitz G/BBB syndrome is a genetic condition characterized by several abnormalities along the midline of the body, such as hypertelorism, craniofacial deformities, and dysphagia. This study reports the clinical features of Optiz syndrome and its importance in the knowledge of patients who are developmentally challenged as a whole, in order to establish adequate dental treatment for a certain clinical case. A 19‐year‐old patient visited the Paulista University for a dental treatment. The extraoral examination revealed ocular hypertelorism (wide‐spaced eyes), oblique eyelids, epicanthus, low‐set cart, and intellectual disability. During the intraoral examination, large caries lesions were observed surrounding the braces of the fixed orthodontic appliance and poor oral hygiene. Preventive and restorative treatments were carried out. It was concluded that the knowledge of patients with special needs as a whole is mandatory for an adequate dental treatment. This is a case report that highlights the importance of dentist and interdisciplinary care attendance for all patient systems, the examination and analyses should not be restricted to the oral cavity.     

Dental treatment of an adult patient with a history of biliary atresia

Objective: Biliary atresia is a congenital disease treated by liver transplantation. Adults may have oral consequences of the medical therapy. Green teeth are oral manifestations of the induced hyperbilirubinemia. Gingival enlargement is associated with the immunosuppressive drug. This case report describes the successful treatment of an 18-year-old patient displaying severe green teeth and gingival enlargement. Method and Materials: The gingival enlargement was treated by reducing the pathogenic oral microflora through scaling and root planing of the teeth, gingival excision surgeries, and conversion from cyclosporin to tacrolimus. Results: Gingival enlargement and inflammation had completely disappeared after nonsurgical treatment for the maxilla and after surgical treatment for the mandible. The green coloration of the teeth was masked using composite restorations. Conclusion: This case report indicates that a patient's quality of life can be improved by a team approach combining pharmacologic and dental therapies. (Quintessence Int 2012;43:337?341) ;     

Dental treatment of patient with a cardiac pacemaker. Review of the literature.

Presented is a summarization of past and current literature that establishes a workable guideline for the treatment of the pacemaker wearer in the dental office. This guideline gives the practicing dentist a procedure for the management of such a patient.     

Dental patient with acromegaly: a case report

Acromegaly is an acquired disorder related to excessive production of growth hormone after epiphyseal closure of bones. It is characterized by progressive somatic disfigurement (mainly involving the face and extremities) and systemic manifestations. The prevalence is estimated at 1:140,000-250,000. Although acromegaly rarely manifests in the orofacial regions, it must be considered in patients who develop malocclusion after adolescence. Here, we present a case of acromegaly with brief review of the literature.     

Dental treatment of the liver transplant patient.

On the basis of recent developments, liver transplantation is no longer considered an experimental procedure. The history and current status of human liver transplantation are reviewed. The complications and side effects of the agents used for immunosuppression are presented. The dental treatment of the patient before and after liver transplantation is discussed in detail.     

Dental management of a child patient with Noonan's syndrome

This case report describes a 9-year-old Caucasian girl who required comprehensive dental treatment under general anaesthesia but gave a history of Noonan's syndrome. The patient was extremely needle phobic. Because of the association between Noonan's syndrome and underlying coagulopathies, for which no previous investigations were evident, dental treatment had to be postponed pending further investigation. The patient was referred to a haematologist and underwent coagulation screening, which revealed the presence of von Willebrand's disease. The patient was prescribed Desmopressin to raise plasma levels of factor VIII: C and von Willebrand's factor (VWF) in order that dental treatment, including extractions, could be carried out under an in-patient general anaesthetic. Clinical Relevance: Congenital heart defects and bleeding diatheses are regarded as a common association of Noonan's syndrome. Witt et al estimated that around one-third of the patients have an associated bleeding disorder, although a later report suggested that as many as 74% of the coagulation profiles could be abnormal. Most of the bleeding problems are reported to be mild, and resolve with age in some patients, but, clearly, they may cause problems during dental treatment, necessitating haematological investigations and a multidisciplinary approach.     

Dental management of a pediatric patient with myelodysplastic syndrome

Myelodysplastic syndrome in the pediatric population is an extremely rare-hematological disorder. An eleven-year-old girl with a remarkable, past medical history of myelodysplastic syndrome is presented. She was treated for a falling hematocrit and platelet count, with splenectomy as a lifesaving measure. The features of the syndrome and treatment options are described. The clinical protocol for the dental management of the pediatric patient with myelodysplastic syndrome is discussed.