MedNEXT Journal of Medical and Health Sciences

Use of cannabidiol in the treatment of compulsion eating and obesity: a systematic review

2024-09-18T01:54:41+00:00

Introduction: Obesity represents a multifactorial disease that causes serious public health problems. There are more than 2.50 billion overweight and obese people in the world, and Brazil is in fifth place in the world ranking. In this context, a factor associated with eating disorders is anxiety, which affects 33.7% of the general population. In this sense, cannabidiol (CBD) was identified 50 years ago and has effects that can change mood, sensation, perception, tension, appetite, and pain. Also, CBD showed anxiolytic, antipsychotic, neuroprotective, anti-inflammatory, and antiemetic properties. Objective: It was to analyze, through a systematic review, the main considerations and results in animal and human models of the use of cannabidiol in anxiety and obesity. Methods: The model followed for the systematic review was PRISMA. The search strategy was performed in PubMed, Embase, Ovid and Cochrane Library, Web Of Science, Science Direct Journals (Elsevier), Scopus (Elsevier), and OneFile (Gale) databases. Results: In the context of anxiety and binge eating and the consequent increase in the incidence of obese people, the activation of CB1 receptors improves feeding, modulating the activity of hypothalamic neurons and, subsequently, the release of orexigenic and anorexigenic neuropeptides. Thus, in obesity, the endocannabinoid system (ECS) is generally down- regulated in central and peripheral tissues, as indicated by high and/or overexpression of the CB1 receptor. Therefore, CBD is beneficial for anxiety-related disorders. Thus, CBD has been shown to have anxiolytic, antipsychotic, and neuroprotective properties. Conclusion: Growing evidence indicates that CBD acts as an antipsychotic and anxiolytic, and several reports suggest neuroprotective effects. Furthermore, CBD attenuates the harmful effects of trans-Δ9tetrahydrocannabinol, both acutely and chronically, including psychotogenic, anxiogenic, and deleterious cognitive effects. This suggests that CBD may improve the disease trajectory of individuals with early psychosis and cannabis misuse in particular.

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

2024-09-14T12:25:19+00:00

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Major considerations of food insecurity in the family and community medicine scenario: a systematic review

2024-09-04T00:56:10+00:00

Introduction: In the scenario of food insecurity (FI), food is a fundamental human right, and it is up to the State to ensure the permanence of public food policies. AI has worsened in Brazil, and hunger is even more present in the lives of Brazilians in 2022. According to data from the new National Survey on Food Insecurity in the Context of the COVID-19 Pandemic in Brazil, only 4 out of 10 families have full access to food in the country, and hunger already affects 33.1 million people. Objective: It was to highlight the major considerations of food insecurity in the family and community medicine scenario during the COVID-19 pandemic through a systematic literature review. Methods: The present study followed a concise systematic review model, following the systematic review rules (PRISMA). The literary search process was carried out from May to June 2024 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The low quality of evidence was attributed to case reports, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: It was founded 119 studies that were submitted to the eligibility analysis, then, 12 of the 27 total studies were selected for this systematic review. It was concluded that the implementation of actions for income generation and the promotion of adequate and healthy food are imperative, as well as the return of regulatory actions in the face of food inflation, with emphasis on the constitution of food stocks and the stimulus to production from diversified family-based agriculture. Public health-based policies and strategies are needed to identify the most vulnerable subgroups, strengthen and improve access to food assistance programs, and promote awareness of and access to healthy foods and beverages to improve food security, nutrition, and cardiovascular health. Still, food insecurity is associated with depression, diabetes, poor adherence to medication, and worse glycemic control.

The importance of red aesthetics in dental implants: a systematic review

2024-08-30T01:39:35+00:00

Introduction: Aesthetics region should be defined as any area to be restored visible in the patient's smile. The charge or immediate function is a prerequisite for the present implant's primary stability in your installation. Thus, to maintain the gingival architecture, understanding biological principles governing is essential to remodeling, as well as alveolar bone soft tissue. The gingival tissues' health, color, and texture are critical to the long-term success and the aesthetic value of treatment. Objective: It was to review the literature and discuss the major factors supporting the red aesthetic excellence before and after the rehabilitation of former regions, and the use of dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion:128 articles were found, 44 articles were evaluated in full and 32 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=81.5%>50%. It was concluded RED aesthetics has become a primary factor in the patient's expectations, and the duty of the surgeon's professional knowledge of the fundamental aspects in achieving this aspect. A correct treatment plan to meet the restorative and surgical protocols appropriate, thus being able to achieve satisfactory results is required.

Major root endodontic treatments: a systematic review

2024-08-30T01:32:11+00:00

Introduction: In the root canal treatment scenario, irrigation is one of the most important aspects of the biomechanical preparation of the root canal. A condition for successful endodontic retreatment is adequate cleaning of the root canals, therefore, special attention should be paid to the technique used to remove the filling material, the most commonly used being cement, pastes, and gutta-percha cones. Objective: This study aimed to present the main root endodontic treatments to analyze and compare the techniques for removing pulp tissue debris resulting from root preparation and microorganisms from the canals of the root canal system, seeking complete cleaning and asepsis. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 129 articles were found, 39 were evaluated and 21 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 25 studies with a high risk of bias and 27 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =91.5% >50%. It was concluded that the system of root canal instrumentation with rotary files maintains the quality of root preparation and, at the same time, reduces the number of files required to obtain a canal, which would consequently reduce the operative time and also considerably reduce the risk of torsion fracture within the root canal than with files. Irrigation plays a fundamental role in the success of endodontic treatment. Although hypochlorite is the most important irrigant solution, no irrigant can perform all the tasks required by irrigation. A detailed understanding of the mode of action of various solutions is important for optimal irrigation. Within the limitations of this study, the use of the self-adjusting file with the combination of EDTA and NaOCl improved Ca(OH)₂ removal. Passive ultrasonic irrigation and the self-adjusting file were more effective in removing Ca(OH)₂ from the lateral sulci in the apical parts of the root canal than the EndoVac and conventional syringe irrigation systems.

Relationship between the caries-cardiovascular disease axis and immunological aspects: a systematic review

2024-08-30T01:21:03+00:00

Introduction: According to the World Dental Federation, the hypothesis is that more than 90.0% of the world's population will have any oral disease in their lifetime. In addition, only 60.0% of the population has access to oral hygiene. In childhood and adolescence, caries and periodontal diseases are the most common diseases in the world, and in Brazil, caries is the main oral health problem. Many recent studies have focused on the association between dental caries and systemic diseases such as cardiovascular disease. Objective: It was to systematically analyze the world literature to list the main considerations regarding the relationship between the axis of caries and cardiovascular diseases, highlighting the immunological aspects. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 148 articles were found, 40 studies were evaluated, and 25 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 22 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =92.7% >50%. It was concluded that there is an important network and cascade of defense events between immunological processes and caries disease. Thus, it is necessary to have a healthy immune response to reduce the incidence of cavities. Dental caries was independently associated with the risk of ischemic stroke and death, with the effect being greatest in African-American participants. Regular dental care was associated with a lower chance of cavities, highlighting its relevance in preventing these events. Higher scores of decayed, missing, and filled teeth correlated positively with increased prevalence of cardiovascular disease. Among patients with type 2 diabetes, dental disease, and oral hygiene care are important determinants of the development of heart failure.

Main findings from the use of ozone therapy alone or combined with conventional treatments in root canal treatment: a systematic review

2024-08-29T23:00:17+00:00

Introduction: The positive effects of ozone on biological properties include antimicrobial, immunostimulating, and biosynthetic impacts used in the treatment and maintenance of good oral hygiene. Ozone results in alteration in the metabolism of cells by raising the partial pressure of oxygen in tissues which improves the transporting capacity of oxygen in the blood. Ozone causes more blood supply to the ischemic zones due to surgical interventions like tooth extractions and implant placement. In this context of decontamination of root and periapical canals, ozone has emerged as an important sanitizer. Objective: It was to develop a systematic review of the literature to list the main findings of the use of ozone therapy alone or combined with conventional treatments in the treatment of root canals. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, 35 articles were evaluated in full and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=88.5%<50%. Results and Conclusion: It is concluded that ultrasonic and sonic ozone activation resulted in less pain in patients undergoing single-session endodontics compared to no ozone treatment. Ozonated olive oil with zinc oxide and olive oil paste with zinc oxide demonstrated good clinical and radiographic success for pulpectomy of primary teeth. Furthermore, low-intensity laser and ozone therapy are useful methods for postoperative pain in vital symptomatic teeth, but they are not superior to each other.

Major clinical outcomes of rapid maxillary expansion in bucomaxillofacial surgery: a systematic review

2024-08-29T21:17:07+00:00

Introduction: The techniques of surgically assisted rapid maxillary expansion (SARME) and non-surgically assisted rapid maxillary expansion (NSARME) are used to correct maxillary development through palatal disjunction. Objective: It was analyzed using a systematic review of the literature on the main considerations of the rapid expansion of the maxilla, evidencing its main indications, contraindications, types of expanders, as well as the main dental and skeletal alterations by them produced. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were found, 34 articles were evaluated in full and 22 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=73.8%>50%. It was concluded there is still no consensus on which is the best jaw-breaker, and it is necessary to increase the number of clinical and randomized studies, with eligibility criteria that can homogenize the participants. In addition, the literature has clearly shown that bucomaxillofacial surgeons must have the knowledge and clinical experience to be able to indicate the best procedure for each patient, that is, the rapid expansion of the non-surgical or surgical maxilla.

Major approaches and clinical evidence of oral and maxillofacial regenerative treatments for the process of osteonecrosis associated with the use of bisphosphonates: a systematic review

2024-08-29T21:09:34+00:00

Introduction: Bone tissue is a specialized connective tissue made up of cells and a mineralized extracellular matrix. To reduce the excessive resorption observed in these pathologies, more rigorous studies have been carried out in pre-clinical and clinical studies to improve antiresorptive medications that allow the treatment or prevention of bone metabolism pathologies. Thus, anti-resorptive agents, such as Bisphosphonates (BFs) and Denosumab (DN), as well as some angiogenesis inhibitors, can induce osteonecrosis of the jaw. Objective: It was to develop a systematic review to specify the main approaches and clinical evidence on the process of osteonecrosis associated with the use of bisphosphonates, as well as the main oral and maxillofacial regenerative treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 36 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=77.7%>50%. It was concluded that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if a surgical procedure is necessary, the use of new adjuvant therapies such as hyperbaric camera, teriparatide, pentoxifylline, and alpha-tocopherol can be proposed.

Major aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants: a systematic review

2024-08-29T19:47:54+00:00

Introduction: Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. Dental patients receiving bisphosphonate treatment are at higher risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ), necessitating dentists' awareness of these risks. Objective: It was to highlight the main aspects of the use of bisphosphonates and the formation of osteonecrosis in the involvement of dental implants, as well as possible treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found, 40 articles were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=89.5%>50%. Therefore, the present study suggests that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if surgery is necessary, the use of these new adjuvant therapies, such as lowlevel laser therapy and magnetotherapy, can be proposed in the treatment of BRONJ. It is essential to increase our caseload and also involve other institutions in the use of these new effective and safe therapies in BRONJ.

Main clinical approaches to the use of silane in restoration repairs with resin: a systematic review

2024-08-29T19:39:27+00:00

Introduction: The repair in the composite clinical procedure is handy and allows the removal of the damaged portion of the restoration without requiring complete replacement of the same, allowing the preservation of sound tooth structure. Objective: The objective of this study was to review the literature evaluating the use of silane in repairs of composite resin restorations and the procedures to be followed. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, 43 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 07 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=74.5%>50%. In the literature review was noted that the preference for maintaining part of the restoration and repair of the clinical protocol should be thoroughly evaluated and implemented to increase the predictability of the procedure. The restorative material should unite, not only to tooth structure but also already present in the resin preparation. Thus, silanes and resins without charge are traditionally used as coupling agents in repairs. The advantages of this procedure compared with total replacement, and the possibility of obtaining a good integrity and longevity of the restoration involved were discussed. It was concluded that the adhesion between the existing and the new resin increment of resin can be enhanced by employing a silane, associated or not with an adhesive system.

Risk factors for anti-infliximab antibody formation among patients with inflammatory bowel disease

2024-08-01T01:58:04+00:00

Introduction: Infliximab (IFX) is an effective therapy for inflammatory bowel disease (IBD), but it may be associated with a high rate of primary and secondary failure. Approximately 30% of patients lose their response. One loss of response to anti-drug antibody (ADA) development is the most common cause of this loss. Objective: This study aims to demonstrate the incidence of antibody formation against infliximab when used to treat inflammatory bowel disease (IBD) and risk factors that may be associated with its formation, to find if there are correlations between antibody formation and patient characteristics, other co-medication, infliximab level, doses, duration, etc., and the subsequent correlation of antibody formation to Primary nonresponse, Secondary failure, Maintained response, and finally, to assess the overall clinical impact on the patients. Methods: A retrospective study included 61 participants who were treated with Infliximab (IFX) for inflammatory bowel disease and received follow-up at... Patients were recruited, and relevant demographic, clinical, and laboratory data were recorded from patients’ files, themselves, or the patient's family. as the antibody level was drawn for all patients, and therefore those with positive antibodies who met our criteria entered the exposure group, while the negative patients were in the non-exposure group. Results: There were 61 patients with IBD under infliximab therapy; 82% had Crohn's disease, and the rest had ulcerative colitis. Patient factors significantly associated with lower maintenance infliximab doses include age, smoking, aminosalicylates, and secondary non-response. Those of younger ages were more likely to develop infliximab-anti-drug antibodies (IFX-ADA) (OR, 95% CI; 1.12,1.007-1.25), and those who needed the use of amino-salicylates showed more tendency to develop IFX-ADA (OR, 95% CI; 0.03,0.01-0.74), AS 11.8% of participants with negative antibodies had used amino-salicylates compared to the other group, in which 3.7% of them used this. Higher doses (342.3 ± 94.54 mg) helped to obtain a better outcome by reducing the prevalence of ADA formation. Conclusion: IFX-ADA is significantly influenced by maintenance infliximab dose, age, smoking, aminosalicylates, and secondary non-response. There should be a decreasing IFX dose interval strategy. Aminosalicylates may help reduce the formation of IFX-ADA. Key messages of your article: Infliximab (IFX) is an effective therapy for inflammatory bowel disease (IBD), but it may be associated with a high rate of primary and secondary failure. This study aims to demonstrate the incidence of antibody formation against infliximab when used to treat inflammatory bowel disease (IBD) and the risk factors that may be associated with its formation to assess the overall clinical impact on patients. There should be a decreasing IFX dose interval strategy and Higher starting doses that may improve outcomes for IFX-treated patients with Crohn's disease and ulcerative colitis. Aminosalicylates may help reduce the formation of IFX-ADA.

Association of anxiety and depression with breast implant illness syndrome (BII): a prospective observational cross-sectional study

2024-07-14T20:38:11+00:00

Introduction: Breast Implant Illness syndrome (BII), popularly known as “silicone disease”, has no defined pathophysiology or recognition by the WHO. It consists of systemic symptoms such as joint pain, muscle pain, confusion, memory loss/cognitive problems, chronic fatigue, and immune diseases. In some more recent studies, anxiety and depression have been observed as an incident characteristic of the syndrome. Objective: It was to relate the appearance of anxiety and depression pathologies with the development of Breast Implant Illness syndrome in women with breast implants. Methods: To prepare the following prospective observational cross-sectional study, 132 women who had breast implants were interviewed and answered an online questionnaire with 18 questions about the breast implant that was disseminated through social networks. To obtain the data, questions about pre-operative and post-operative signs and symptoms were crossed, this data was subsequently struck and finally, another cross was carried out with the other unknown, symptoms were diagnosed by doctors. Results: The validation analysis of the questionnaire proposed in this study using Cronbach's alpha (α) statistical technique showed that the reliability rating was high, with alpha (α)=0.82. It was noted that 31% of women who did not have any characteristic signs and symptoms presented after placement and of these 22 women were diagnosed by doctors. And at the other intersection, it was clear that 25% presented depression after the placement of the breast implant and 23 of these women were diagnosed by doctors. Conclusion: It can be stated that anxiety and depression are pathologies associated with Breast Implant Illness syndrome.

Major clinical results of orthognatic surgery in obstructive sleep apnea syndrome: a systematic review

2024-07-12T01:03:50+00:00

Introduction: Obstructive sleep apnea involves obstruction or narrowing of an individual's airways during sleep and is associated with several comorbidities. Management can be surgical or non-surgical, and Phase II of the Stanford Protocol for surgical management involves maxillomandibular advancement. Objective: To conduct a concise systematic review to present the main considerations and clinical results of orthognathic surgery in obstructive sleep apnea syndrome. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from April to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 110 articles were found, 41 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the global assessment resulted in 28 studies with a high risk of bias and 28 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =88.5% >50%. Maxillomandibular advancement surgery is a successful treatment for obstructive sleep apnea, but there are still concerns about cosmetic results due to the major advances involved. Bimaxillary advancement osteotomy significantly increases oropharyngeal volume and contracted superficial areas, which remain stable between 6 months and 1 year postoperatively.

Current clinical considerations of the use of guided bone regeneration for dental implants through the use of CAD-CAM systems: a systematic review

2024-07-03T00:26:09+00:00

Introduction: It is estimated that up to 40% of osseointegrated implants require guided bone regeneration (GBR) as part of the patient's rehabilitation. Bone loss or insufficiency presents a major challenge for osseointegration. In this sense, the use of CAD-CAM systems (Computer-Aided Design/Computer-Aided Manufacturing) is highlighted in this process. Objective: It elucidated the current clinical considerations of the use of guided bone regeneration for dental implants through the use of CAD-CAM systems. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=79.5%>50%. Guided bone regeneration is well documented and constitutes a predictable and successful approach to lateral and vertical bone augmentation of atrophic ridges. Thus, guided bone regeneration is considered one of the most commonly applied methods to reconstruct alveolar bone and to treat peri-implant bone deficiencies, as well as to replace lost bone and allow the implant to be fully integrated and maintained during functional loading. The use of digital tools for the automated fabrication of implant parts (CAD-CAM) is an optimizing reality in Dentistry. CAD-CAM enables highquality, standardized, accurate, and detail-perfect prosthetic restorations. The use of metallic implants in the morse cone system in association with zirconia abutments guarantees a final product with mechanical resistance, biocompatibility, and aesthetics. Also, immunomodulatory guided bone regeneration membranes are developed mainly by improving macrophage recruitment and aggregation as well as regulating macrophage polarization.

Major functions and importance of dental surgeons in the hospital environment and intensive care units: a concise systematic review

2024-07-03T00:20:24+00:00

Introduction: Contemporary dental care must be comprehensive, aimed not only at dental treatment but also at assessing the patient's health status. In this sense, hospital dentistry is gaining importance in the multidisciplinary health team, which is essential for the therapy and quality of life of hospitalized patients. Objective: A systematic review was carried out to highlight the main functions and importance of the dental surgeon in the hospital environment and intensive care units. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 89 articles were found, 45 articles were evaluated in full and 15 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR2. Most studies did not show homogeneity in their results, with X²=75.8%>50%. It was concluded that it is necessary to train and qualify the entire hospital team and the dental surgeon so that oral health is offered to patients, as well as knowing the impact caused by oral problems on the systemic health of patients and implementing specific protocols on the subject in all aspects. The dentist must promote the general health of the hospitalized individual, based on interdisciplinary planning developed together with other health professionals, as well as assess the patient's main needs and contribute to the quality of life of these individuals. According to the literature consulted, we can conclude how important the role of the dentist is as an integral part of the multidisciplinary healthcare team in ICU, as their presence could minimize such problems in hospitalized patients. Its insertion in hospitals would contribute to the maintenance of the patient's oral and general health, as well as the use of appropriate procedures during their hospitalization.

Factors related to H. pylori infection in Nablus region: cross sectional analysis from west bank

2024-06-28T13:04:51+00:00

H. pylori infection is common infection in developing countries and is associated with gastric and extra-gastric complications was not studied before in Occupied Palestinian territories. We wanted to measure the prevalence of H. pylori infection in a sample from Nablus region in West Bank and to study risk factors and clinical outcomes. We found that 122 patients who visited medical laboratories in Nablus were recruited to participate in the study. A questionnaire was collected from the study group on information that included; demographic variables, diseases history, blood groups. A sample of stool was collected and evaluated for H. pylori infection using H. pylori Antigen Test. SPSS software was used to perform statistical analysis of the study. 41.8% of the study participants had H. pylori infection. Patients without Diabetes mellitus type were less likely to have H. pylori infection (OR= 0.15(95% CI, 0.04, 0.60, p=0.008). Also, not having GI was associated with less H. pylori infection OR= 0.40, 95% CI, 0.39, 1.75, p=0.018). H. pylori infection was more common in patients with O blood group, but this did not reach statistical significance. Smoking and hygiene practices were not related to H. pylori infection. In conclusion, H. pylori infection is prevalent in Nablus and is associated with higher risk for Diabetes and GI problems.

Major aspects of minimally invasive endodontic surgery using microsurgery: a systematic review

2024-06-18T21:54:30+00:00

Introduction: Knowledge about endodontic infections has increased significantly over the last 50 years and, although many issues still require elucidation, endodontics has become the dental science that has the most improved approaches and technologies to increase the success and longevity of treatments dental organs. Endodontic microsurgery has produced highly successful results in preserving teeth with persistent or recurrent cases of periapical periodontitis that could not be successfully treated by non-surgical endodontic approaches. Objective: It was to list the main clinical considerations of minimally invasive endodontic surgery using apical microsurgery, as well as point out the success rate of this technique. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, 50 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=58.5%<50%. It was concluded that the success of apical endodontic surgery in terms of healing existing periapical pathology, together with a good long-term prognosis, depends on correct diagnosis and planning, as well as the association of surgical techniques, well-executed protocols, and biocompatible materials. The apical endodontic microsurgery approach is predictable and has a high success rate, which resulted from the introduction of cone beam computed tomography, microscope, ultrasonic instruments, and materials such as mineral trioxide aggregate (MTA) and bioceramics for retro-fillings.

Pilot study about the use of alternative materials to teach surgical skills to medical students: a cross-sectional observational study

2024-06-04T12:50:39+00:00

Introduction: Suturing is an important surgical procedure in which tissue margins are joined after incision or laceration, it is a fundamental medical skill and requires extensive practice to improvement, especially during the medical educational process. In the Basic Surgical Skills Course training suture is one of the foundations to learn hospital procedure techniques, that are essential during the routine of a medical professional. Objective: This study aims to evaluate the capability that EVA, eggplant, elastic tape, and chicken thigh must mimic basic surgical scenarios and replace expensive materials during the medical education of undergraduates and the development of the skills needed as future health professionals. Methods: This is a cross-sectional descriptive observational study, which evaluated students during the surgical skills class to perform suture practice on materials such as EVA, eggplant, elastic tape, and chicken thigh. Results: The materials were evaluated as useful components for training suturing practice. However, eggplant, and elastic tape were considered superior materials. Furthermore, practicality of use correlated with greater instrumental knowledge. Conclusions: The use of alternative materials for training surgical sutures is more accessible because of the low cost, however the results represent a prototype of an analysis that requires an expansion in the number of samples to better determine the cause-effect conditions.

Major outcomes of clinical and experimental studies to highlight the importance of using silane in composite resin restorations in modern dentistry: a systematic review

2024-06-01T19:02:50+00:00

Introduction: Dental restorations are often placed due to caries or fractures, and composite resin is often the material of choice to restore teeth. Several factors may play a role related to the application of silane coupling agents, such as the type of silane (hydrolyzed or non-hydrolyzed) and the service life of the defective composite resin restoration being repaired. Objective: It was to analyze the main outcomes of clinical and experimental studies to highlight the importance of using silane in composite resin restorations in modern dentistry. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 111 articles were found, 36 articles were evaluated in full and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=78.4%>50%. It was concluded that the previous application of silane reduced the bond strength values. The two-bottle adhesive showed better results than single-bottle or self-etching systems for composite resin repairs. Furthermore, the association of preheated hydrofluoric acid/silane applied or not with electric current promoted different values of micro shear resistance, types of fracture, and contact angles in the resin cement/ceramic connection. Silane application is essential for surfaces conditioned by hydrofluoric acid, but the use of adhesive is optional when silane is applied.

Major maxillary sinus augmentation techniques for dental implant: a systematic review

2024-05-31T00:17:02+00:00

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. It will increase its volume towards the location where the roots existed and this will often make it difficult or unfeasible to restore implants in that location. Various surgical techniques can be used to reconstruct the atrophic alveolar ridge, techniques alone or associated with autogenous, allogeneic, xenogeneic grafts, and alloplastic biomaterials. Objective: It was to develop a systematic review to list the main clinical and surgical approaches to bone elevation techniques for dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, 35 articles were evaluated in full and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=71.6%>50%. It was concluded that the placement of the implant with the simultaneous use of PRP or PRF creates a good relationship between the hard tissue and the soft tissue. The Bio-Oss® biomaterial is one of the most used in guided bone regeneration procedures in regenerative dentistry, and its particles become an integral part of the newly formed bone structure and retain their volume in the long term. Furthermore, Bio-Oss® offers a lot of space for the formation of blood vessels (angiogenesis) and the deposit of neoformed bone, helping the growth of osteoblasts. Notable studies have shown results on the combined use of Bio-Oss® and PRF. Also, it is possible to develop a pre-operative planning method, associated with the area of implant dentistry, using digital images. Furthermore, the conventional surgical guide has some advantages such as being cheaper, simpler, and easier to perform, however, it leads to a greater operative risk for the patient. However, the accuracy of the location to be implanted is not the best and there is a greater probability of this guide becoming worn out, due to the contact of the drills with it.

Major clinical outcomes of minimally traumatic and aesthetic post-tooth extraction: a systematic review

2024-05-22T13:24:59+00:00

Introduction: After tooth extraction, the alveolar ridge will commonly decrease in volume and change morphologically. These changes can be difficult or even impede the placement of dental implants and prosthetic rehabilitation. Minimizing bone remodeling means optimizing the aesthetics and functional aspects, and mainly, the success of implant treatment. To avoid residual ridge resorption different techniques and bone graft materials have been proposed. Objective: A systematic review was carried out to identify the main clinical outcomes of minimally traumatic and aesthetic tooth extraction. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 189 articles were found, 45 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies with a high risk of bias and 41 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=72.5%>50%. The present study suggests that the alveolar graft technique may increase the risk of disease transmission, cost, and time of treatment. Several studies have stated that the graft material is not fully incorporated into the newly formed bone, indicating less vital bone tissue. Spontaneous scarring is still the most used feature since, in intact alveoli and small defects, it is a procedure that does not present significant losses that justify the use of edge preservation techniques. In larger defects, techniques after spontaneous healing, such as a block graft, can be used without the drawbacks of alveolar grafting, such as delayed healing and poor bone quality. The use of a buccal subepithelial connective tissue graft for extraction sockets in the anterior maxilla can be considered a predictable approach to preserving the contour of the alveolar ridge

Major considerations and outcomes of clinical studies on the treatment of temporomandibular disorders using prostheses: a systematic review

2024-05-22T13:17:21+00:00

Introduction: The temporomandibular joint (TMJ) can be affected by end-stage pathologies, such as arthritic disease, trauma, and ankylosis. Around 70% of the general population has suffered at least one symptom of temporomandibular disorder (TMD), which constitutes TMJ disease that may be related to the joints, muscles, ligaments, bones, teeth, and psychological aspects. As a treatment, the implantation of a total alloplastic TMJ prosthesis is an innovative approach. Objective: It was to present the main considerations and outcomes of clinical studies on the treatments of temporomandibular disorders using customized or prefabricated prostheses. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 121 articles were found, 40 articles were evaluated in full and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=57.8%>50%. It was concluded that stock and CAD/CAM prostheses suggested great improvements in mouth opening and pain reduction as a result of the rehabilitation of TMJ function. The results showed comparable data for both types of prosthesis design at 6 months postoperatively. However, the additional advantages of custom prosthetics, along with increasing access to digital technology, will likely result in custom devices dominating the market in TMJ total joint replacement systems. The custom-made combined prosthesis with custom design and 3D printing fabrication represents a safe and reliable implantable reconstruction method for combined TMJ-skull base injuries.

Dentistry and palliative care: a concise systematic review

2024-05-22T12:41:34+00:00

Introduction: In recent decades, there has been a change in the age pyramid, through progressive population aging. This aging presents itself as a risk factor for several diseases, such as cancer and chronic degenerative diseases. Patients should be regularly questioned and evaluated regarding their oral health conditions. Patients in palliative care present severe functional restrictions and impairment of oral functions, which is even more common when the disease itself already affects the oral cavity, such as head and neck cancer. Objective: It was to carry out a systematic review to present the main considerations and clinical importance of palliative care in dentistry. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Atotal of 129 articles were found, 45 articles were evaluated in full and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 32 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=77.8%>50%. It was concluded that understanding the importance of the dentist in caring for patients with diseases that threaten the continuity of life, through relieving suffering and promoting quality of life, based on oral health. Thus, with the work of the multidisciplinary health team, the patient, their family members, and caregivers will have adequate assistance, based on the particularities of each case.

Squamous cell carcinoma, are healthcare professionals prepared to identify it? A case report

2024-05-15T03:04:46+00:00

Squamous cell carcinoma (SCC), also known as squamous cell carcinoma, is a type of cancer that originates in the squamous cells of the skin and has different stages according to the involved cellular layer. In the early stage, the process begins with chronic sun exposure, leading to DNA damage in the squamous cells of the epidermis. Initiating in pre-cancerous lesions such as actinic keratosis, occurring in the outermost layers of the epidermis. In the intermediate stage, squamous cells undergo additional mutations, becoming cancerous but still restricted to the epithelial layer without invading deeper structures. While it is only in the epidermis, it is considered carcinoma in situ, as it is confined to this cellular layer and has not invaded the basement membrane. In the advanced stage, cancer cells invade the deeper layers of the epidermis, crossing the basement membrane, becoming basal cell cancer, and can reach the dermis. After reaching the dermis, cancer cells have the potential to spread to distant areas from the primary site, where the metastasis process begins and occurs, potentially affecting regional lymph nodes and other organs. In addition to the layers of the skin, cancer cells can spread to other tissues and organs, forming metastases that are cellular copies of their site of origin. At all stages, it is crucial to emphasize that the progression of squamous cell carcinoma involves progressive genetic mutations that confer malignant characteristics to the cells. Early diagnosis and treatment are essential to improve recovery prospects. Furthermore, prevention by avoiding alcohol, tobacco, and adequate sun protection plays a crucial role in reducing the risk of developing this type of cancer. Therefore, the present study aims to present a clinical case report on Labial Squamous Cell Carcinoma and the main considerations for preparing health professionals for the identification and diagnosis of LSCC.

Mental health status among corporate- and public sector health care workers in India during COVID-19 pandemic (second-wave): Impact of awareness, work satisfaction, risky work-environment practices and social media usage on DASS-21 & IES-R scores

2024-05-14T21:08:23+00:00

Introduction: With the advent of coronavirus pandemic, health care workers (HCWs) faced numerous professional, financial, and emotional challenges in addition to social stigma. Objective: It was intended to analyse the correlation of depression, anxiety, and stress among corporate and public sector HCWs, with awareness, risky work environment practises, work-environment satisfaction and social media preferences. Materials and Methods: Doctors, nurses and paramedical staff in critical care, obstetrics, neuro-anaesthesia and neurosurgery wards/ICUs in a public and corporate sector hospital were administered DASS-21 (depression-anxiety-stress scale), IES-R (impact of event scale-revised) and a common perception-based survey to assess the HCW awareness (AWA), work environment satisfaction (WES), risky work environment practises (RWE) and social media preferences (SM scale). Results: In corporate sector, being a nurse correlated with higher scores of stress (rs =1, p=0), DASS (rs =0.34, p=.114), depression (rs =0.54, p=.007), anxiety (rs =0.42, p=.041) and IES-R (rs =0.34, p=0.13). SM score negatively correlated with anxiety (rs =0.58, p=0.045), stress (rs =0.418, p=.041), DASS (rs =0.62, p=.001) and IES-R (rs =0.45, p=.031). In public sector, female HCWs had higher DASS (t=2.61, p=.018), anxiety (t=2.2, p=.03), stress (t=-2.11, p=.011) and IES-R (t=-1.86, p=0.07). AWA score negatively correlated with anxiety (R=-0.56, p= .005), DASS (rs=-0.48, p=.004) depression (p= .283), stress (p= .11) and IES-R (p= .101). RWE score strongly correlated with anxiety (rs =0.39, p= .027). Depression (D total, p= .010) and IES-R (p= .024) were significantly higher in public sector HCWs. Anxiety (A total, p= .108) and stress (S total, p= .246) were lower in corporate sector HCWs. Conclusion: Corporate sector nurses and female HCWs in the public sector showed significantly higher stress, depression, and anxiety scores. Increasing awareness about disease could mitigate stress, anxiety, and depression while prevailing social media preferences aggravate anxiety, stress, and depression.

Major considerations and outcomes of clinical studies on the treatment of temporomandibular disorders using prostheses: a systematic review

2024-05-10T13:47:12+00:00

Optimization of facial aesthetics through orthognathic treatment: a systematic review

2024-04-30T13:54:06+00:00

Introduction: In the aesthetics scenario, facial optimization is considered an essential outcome of orthognathic treatment (OT) due to its potential advantages in reducing the duration and cost of treatment, providing early aesthetic improvement, and increasing patient satisfaction. Objective: It presents a systematic review study listing the main optimizations of facial aesthetics through orthognathic surgery, to highlight the importance of this treatment for improving patients' comfort and quality of life. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 179 articles were found, 45 articles were evaluated in full and 39 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=69.5%>50%. It was concluded space maintenance is one of the most important activities in the prevention of malocclusion. The maintenance of the lost space is of paramount importance to ensure normal eruption and development of the dentition. Aesthetic/functional rehabilitation is necessary until the eruption of permanent successor teeth occurs. A practical option to obtain this rehabilitation is through the installation of aesthetic or functional space maintainers. There are several requirements, such as maintaining the desired interproximal space, not interfering with the occlusion of the opposing teeth nor with the eruption of the permanent tooth, allowing sufficient mesiodistal space for the permanent tooth alignment to erupt, not inferring in phonetics and chewing and present a simple framework and be easily sanitized. Thus, the neuromuscular stability of the stomatognathic system may be impaired by the presence of deleterious habits.

Outcomes of clinical studies of mindset and lifestyle in sports performance: a systematic review

2024-04-29T21:44:56+00:00

Introduction: The athlete's lifestyle and mindset become an integral part of sports performance. The quest to improve the performance of world-class athletes involves understanding the attributes, skills, strategies, support, environment, and lifestyles of elite performers. Objective: It was to develop a systematic review to highlight the main outcomes of clinical studies of mindset and lifestyle in sports performance. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 151 articles were found, and 34 articles were evaluated in full, and 27 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies with a high risk of bias and 44 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=61.9%>50%. It was concluded that champion athletes attribute their good mindset as the main predictor of competitive success. Furthermore, championship performance requires a particular way of life that integrates mindset, performance factors, lifestyle, and relationships. High-performance strategies include using sharp mental rehearsal skills and practice retrieval.

Major evidence of the relationship of cardiovascular disease and tooth extraction: a systematic review

2024-03-27T14:20:13+00:00

Introduction: Cardiovascular diseases can present a congenital origin, that is present from birth, such as interatrial and interventricular communication, defects of the artery, coronary arteries, or acquired coronary artery anomalies that involve several risk factors such as smoking, alcohol, old age, and sedentary lifestyle. Thus, the acquired ones are the most frequent in the routine of a dental practice, so the dentist should be able to attend to those patients who need special care, regarding the correct use of medications due to the risk of drug interactions, the type of local anesthetic to be used and the management of patients who use anticoagulant therapy. Objective: It was to develop a concise systematic review to highlight the main clinical outcomes of the relationship between cardiovascular diseases and tooth extraction. Methods: The research and development of the work were carried out from December 2023 to February 2024 in the databases Scopus, PubMed, Science Direct, and Scielo, following the PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was based on the Cochrane instrument (Funnel Plot). Results and Conclusion: A total of 112 studies were found that were subjected to eligibility analysis. The final sample had 36 eligible studies and 21 studies were described in the systematic review. Most studies showed homogeneity in their results, with X² =63.9% >50%, with p<0.05. It was concluded that the virtual reality technique was effective in controlling blood pressure and heart rate within an acceptable range and can help in the management of blood pressure and heart rate during tooth extraction in patients with hypertension. It is necessary for the dental treatment of these patients with heart disease a good knowledge of the subject and requires medical and dental coordination. Dental surgeons need to be prepared to identify possible medical and dental emergencies and take steps to prevent or treat them effectively and quickly.