RESUMEN
OBJECTIVE: To assess the efficacy of targeted therapy based on drug sensitivity testing (DST) results in patients with acute pulpitis (AP). METHODS: A total of 80 cases of AP were included retrospectively and divided into two groups: control (Ctrl) group (conventional drug palliative therapy, n=40) and experimental (Exp) group (DST + non-resistant drugs, n=40). The clinical data and laboratory examination data of patients, including bacterial culture data, drug sensitivity test results, Ca and P contents in dental pulp, visual analogue scale (AVS), treatment satisfaction, and dental pulp incidence, were collected and analyzed. RESULTS: Prevotella melaninogenica, Fusobacterium nucleatum, and Porphyromonas gingivalis exhibited higher resistance rates (RS) to penicillin and amoxicillin but no resistance to imipenem and metronidazole. The content of Ca and P in the dental pulp of the Exp group patients was significantly higher than that of the Ctrl group (P=0.006). The total response rate (95% vs. 77.5%, P=0.018) and overall patient satisfaction (92.5% vs. 80%, P=0.021) were also significantly higher in the Exp group than in the Ctrl group. Additionally, when the follow-up duration exceeded 1 year, the incidence of dental pulp reactions in the Exp group was significantly lower than that of the Ctrl group (P=0.026). CONCLUSIONS: These findings suggest that Gram-negative anaerobes are the predominant oral pathogens in patients with AP. Imipenem and metronidazole demonstrate the most effective anti-infective properties against these anaerobes. Utilizing DST to select non-resistant drugs for treatment prior to therapy effectively enhances clinical outcomes for patients with AP.
RESUMEN
Patients with Down syndrome may not be cooperative during dental treatment and, in cases of complex treatment, it is necessary to use oral or inhaled sedation and/or general anesthesia, which represent safe and efficient treatment resources. There are few reports about oral rehabilitation with dental implants in patients with Down syndrome in the literature. This paper presents the case of a patient with Down syndrome and moderate mental retardation who suffered avulsion of the maxillary left central incisor after a fall, and was treated by means of a single dental implant with immediate load carried out under general anesthesia. After 4 years of follow up, there has been improvement in the sleep obstructive apnea syndrome due to the use of a tongue crib adapted for providing esthetics and preserving the implant placed.
Pacientes portadores da Síndrome de Down podem não se mostrar cooperativos durante o tratamento odontológico, e nos casos de tratamento complexo, existe a necessidade da sedação medicamentosa e ou da anestesia geral, que representam recursos seguros e eficazes ao tratamento. Poucos relatos sobre reabilitação oral por meio de implantes em pacientes com Síndrome de Down são encontrados na literatura. Neste contexto, apresentamos um relato de caso de reabilitação oral em paciente portador da Síndrome de Down e deficiência mental moderada, através de implante unitário com carga imediata, sob anestesia geral. Após 4 anos de acompanhamento, observou-se melhora da síndrome da apnéia obstrutiva do sono, devido ao uso de grade lingual adaptada com finalidade estética e de preservação do implante colocado.