RESUMEN

Introducción: la odontología es un campo indispensable para el ser humano, de no existir, se complica la prevención y atención de las patologías orales, resultando en estructuras dentales y bucales enfermas. La cantidad de pacientes diagnosticados con trastorno del espectro autista (TEA) que acuden a consulta odontológica va en aumento, lo cual genera ansiedad en el cirujano dentista al no contar con la capacitación adecuada para la atención de estos pacientes. Existen técnicas que ayudan al manejo correcto del comportamiento de los pacientes con trastorno del espectro autista como decir-mostrar-hacer, sedación consciente, TEACCH y desensibilización. Objetivo: explicar las técnicas para la atención de pacientes con trastorno del espectro autista durante la consulta odontológica. Conclusiones: aprender a tratar a los pacientes con trastorno del espectro autista es de suma importancia, ya que para ellos una simple consulta inicial podría convertirse en una experiencia traumática. Es necesario que todos los odontólogos conozcan las técnicas de manejo de conducta para que traten con profesionalidad a pacientes con trastorno del espectro autista debido al aumento de la prevalencia de personas diagnosticadas con este padecimiento (AU)

Introduction: dentistry is an indispensable field for the human being, if it did not exist, the prevention and care of oral pathologies would be complicated, resulting in diseased dental and oral structures. The number of patients diagnosed with autism spectrum disorder (ASD) who come to a dental office is increasing, which generates anxiety in the dentist surgeon because they do not have adequate training to care for these patients. There are techniques that help to correctly manage the behavior of patients with autism spectrum disorder such as tell-show-do, conscious sedation, TEACCH and desensitization. Objectives: explain the techniques for the care of patients with autism spectrum disorder during the dental consultation. Conclusions: learning to treat patients with autism spectrum disorder is extremely important, since for them a simple initial consultation could become a traumatic experience. It is necessary that all dentists know behavior management techniques so that they treat patients with autism spectrum disorder professionally due to the increase in the prevalence of people diagnosed with this condition (AU)

Asunto(s)

RESUMEN

ABSTRACT Objective: To analyse pharmacological overlap in patients with autism spectrum disorder (ASD) under conscious sedation in a dental office environment, identifying any potential risks and complications. Material and Methods: A critical review was conducted by selecting articles from online databases (Pubmed and Lilacs), using a search algorithm and eligibility criteria. The Medscape® platform was used to verify interactions between drugs commonly used by patients with ASD and medications used for sedation in paediatric dentistry. Results: Due to their polydrug use, children with ASD are at risk of complications, namely Serotonin Syndrome (SS), Neuroleptic Malignant Syndrome (NMS), increase or decrease of the QT interval (QTi) and Torsade de Pointes (TdP), due to pre-existence of metabolic syndrome, deepening the sedation level or even leading to a decrease in the sedative capacity of the drugs used. Conclusion: It is essential to assess better drug interaction in ASD patients submitted to sedation. The severity of the disorder and the need for sedation for dental treatment are directly proportional. However, increases in sedative doses tend to increase risks and complications in children with ASD.

Asunto(s)

RESUMEN

BACKGROUND: Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitisation, have been proposed, and uncontrolled case series appear promising. OBJECTIVES: To assess the effects of different interventions for vaginismus. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to August 2012. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched reference lists and conference abstracts. We contacted experts in the field regarding unpublished material. SELECTION CRITERIA: Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control. DATA COLLECTION AND ANALYSIS: The review authors extracted data which we verified with the trial investigator where possible. MAIN RESULTS: Five studies were included, of which four with a total of 282 participants provided data. No meta-analysis was possible due to heterogeneity of comparisons within included studies as well as inadequate reporting of data. All studies were considered to be at either moderate or high risk of bias. The results of this systematic review indicate that there is no clinical or statistical difference between systematic desensitisation and any of the control interventions (either waiting list control, systematic desensitisation combined with group therapy or in vitro (with women under instruction by the therapist) desensitisation) for the treatment of vaginismus. The drop-out rates were higher in the waiting list groups. AUTHORS' CONCLUSIONS: A clinically relevant effect of systematic desensitisation when compared with any of the control interventions cannot be ruled out. None of the included trials compared other behaviour therapies (e.g. cognitive behaviour therapy, sex therapy) to pharmacological interventions. The findings are limited by the evidence available and as such conclusions about the efficacy of interventions for the treatment of vaginismus should be drawn cautiously.

Asunto(s)

RESUMEN

Diante das mudanças no estilo de vida no mundo moderno e do envelhecimento da população mundial, um aumento na ocorrência de lesões cervicais não-cariosas vem ocorrendo. Como consequência, destaca-se a hipersensibilidade dentinária cervical, queixa comum entre os adultos e que representa um dos problemas mais críticos e persistentes em Odontologia. Este estudo clínico randomizado, longitudinal teve como objetivo avaliar diferentes protocolos de tratamento para hipersensibilidade dentinária com laser de baixa potência (com diferentes dosagens), laser de alta potência, agente dessensibilizante e associações, por um período de 06 meses. Após a análise dos padrões de inclusão e exclusão dos voluntários participantes do estudo, foram selecionados aqueles que apresentaram dor consequente de lesões cervicais não-cariosas. As lesões foram divididas em nove grupos (n=10), totalizando 90 dentes tratados e avaliados: G1: Gluma Desensitizer (Heraeus Kulzer), G2: Laser de baixa potência com baixa dosagem (Photon Lase, DMC, três pontos de irradiação vestibulares e um ponto apical: 30 mW, 10 J/cm2, 9 segundos por ponto com o comprimento de onda de 810nm. Foram realizadas três sessões com um intervalo de 72 horas), G3: Laser de baixa potência com alta dosagem (aplicação em um ponto cervical e um ponto apical: 100 mW, 90 J/cm2, 11 segundos por ponto com o comprimento de onda de 810nm.

Foram realizadas três sessões com um intervalo de 72 horas entre as irradiações), G4: Laser de baixa potência com baixa dosagem + Gluma Desensitizer, G5: Laser de baixa potência com alta dosagem + Gluma Desensitizer, G6: Laser de Nd:YAG (Power LaserTM ST6, Lares Research®, em contato com a superfície dental: 1,0W, 10 Hz e 100 mJ, 85 J/cm2, com o comprimento de onda de 1064nm. Foram realizadas quatro irradiações de 15 segundos cada nos sentidos mesio - distal e ocluso - apical, totalizando uma irradiação de 60 segundos com intervalos de 10 segundos entre as irradiações), G7: Laser de Nd:YAG + Gluma Desensitizer, G8: Laser de Nd:YAG + Laser de baixa potência com baixa dosagem, G9: Laser de Nd:YAG + Laser de baixa potência com alta dosagem. O nível de sensibilidade de cada voluntário foi avaliado através da escala visual analógica de dor (VAS) com auxílio do ar da seringa tríplice e exploração com sonda após 5 minutos, 1 semana, 1, 3 e 6 meses do tratamento. Os dados foram coletados e submetidos à análise estatística que detectou diferenças estatisticamente significativas entre os tempos estudados (p<0,05). A partir da diferença de dor, observou-se que para ambos os estímulos, o protocolo com agente dessensibilizante Gluma Desensitizer e o Laser de Nd:YAG apresentaram efeitos imediatos de redução de dor, a partir do primeiro momento de sua aplicação e irradiação, respectivamente. Para os lasers de baixa potência, observou-se que os efeitos de diferentes dosagens foram distintos, porém ambos foram eficientes em reduzir a dor até os 6 meses de acompanhamento clínico. Após este período, observou-se que o protocolo com maior redução e menor aumento de dor ao longo do tempo foi a combinação do Gluma Desensitizer com o laser de Nd:YAG. Desse modo, pode-se concluir que todos os protocolos dessensibilizantes foram eficazes em reduzir a hipersensibilidade dentinária, porém com efeitos diferentes.

Due to changes in lifestyle in the modern world and the world's population becoming older, an increase in the occurrence of non-carious cervical lesions is increasing. As a result, dentin hypersensitivity can be highlighted as a common complaint among adults and represents one of the most critical and persistent problems in dentistry. So, this randomized longitudinal clinical study aimed to assess different treatment protocols for dentinal hypersensitivity with low power laser (with different dosages), high-power laser, desensitizing agent and its associations, for a period up to 06 months. After the analysis of inclusion and exclusion criteria, volunteers were selected by those who presented pain consequent of non-carious cervical lesions. Lesions were divided into nine groups (n=10), totalizing 90 treat and evaluated teeth: G1: Gluma Desensitizer (Heraeus Kulzer), G2: Low Level Laser with low dosage (Photon Lase, DMC, irradiations on three cervical vestibular points and an apical point: 30mW, 10J/cm2, 9 seconds per point, with the wavelength of 810nm, in three sessions with 72 hours intervals), G3: Low Level Laser with high dosage (one cervical point and an apical point application: 100 mW, 90 J/cm2, 11 seconds by point, with the wavelength of 810nm. Three sessions were performed with 72 hours interval), G4: Low Level Laser with low dosage + Gluma Desensitizer, G5: Low Level Laser with high dosage + Gluma Desensitizer, G6: Nd:YAG Laser (Power LaserTM ST6, Lares Research®, in contact made with the protocol of 1.0 W, 10 Hz and 100 mJ, 85 J/cm2, with the wavelength of 1064nm.

Four irradiations were performed, each for 15 seconds, in mesio-distal and ocluso-apical directions, totaling an irradiation of 60 seconds with 10 seconds intervals), G7: Nd:YAG Laser + Gluma Desensitizer, G8: Nd:YAG Laser + Low Level Laser with low dosage, G9: Nd:YAG Laser + Low Level Laser with high dosage. The sensitivity level of each volunteer was analyzed by visual analog scale (VAS) with the aid of cold air stimuli and exploration probe in 5 minutes, 1 week, 1, 3 and 6 months after treatment. Data were collected and subjected to statistical analysis that detected statistically significant differences between the various times of studied (p<0,05). It was observed that for air stimuli, the protocol with Gluma Desensitizer.

Asunto(s)

RESUMEN

OBJETIVO: Revisar de forma sistemática os estudos controlados e meta-análises que envolveram tratamento cognitivo ou comportamental do transtorno obsessivo-compulsivo publicados na última década. MÉTODO: Análise sistemática de ensaios clínicos randomizados e meta-análises indexados no Medline e PsycInfo. RESULTADOS: Os estudos avaliados confirmam que a exposição e prevenção de resposta e a terapia cognitiva são eficazes no tratamento do transtorno obsessivo-compulsivo de crianças, adolescentes e adultos. Em adultos, o uso concomitante de inibidores da recaptação da serotonina e exposição e prevenção de resposta ou terapia cognitiva não foi associado a um efeito adicional na resposta ao tratamento. No transtorno obsessivo-compulsivo infantil, o uso combinado de inibidores da recaptação da serotonina e exposição e prevenção de resposta foi superior aos dois tratamentos isoladamente. A exposição e prevenção de resposta associada à terapia cognitiva resultou em benefícios significativos em pacientes com predominância de pensamentos obsessivos e sua modalidade em grupo também produziu redução significativa dos sintomas obsessivos e compulsivos. CONCLUSÃO: Atualmente, as terapias de base cognitivo-comportamental são as mais adequadas para o tratamento do transtorno obsessivo-compulsivo; porém, mais estudos envolvendo follow-up em longo prazo, tratamento em grupo e uso concomitante de medicação são necessários.

OBJECTIVE To perform a systematic review of controlled trials and meta-analysis that involved cognitive and/or behavioral treatment for obsessive-compulsive disorder. METHOD: A systematic review of randomized controlled trials and meta-analysis published on the last decade and indexed on Medline and PsycInfo. RESULTS: Studies have confirmed that exposure and response prevention and cognitive therapy are effective methods for the treatment of obsessive-compulsive disorder in children, adolescents and adults. Among adults, the combined use of serotonin-reuptake inhibitors and exposure and response prevention or cognitive therapy was not associated with any additional therapeutic effect. Among children, the combination of serotonin-reuptake inhibitors and exposure and response prevention are superior to either treatment alone. Exposure and response prevention associated with cognitive therapy may result in significant benefits to patients with predominant obsessive thoughts and its group modality also reduces obsessive-compulsive symptoms. CONCLUSION: At the present time, cognitive and behavioral therapies have shown to be highly effective psychotherapeutic approaches for the treatment of obsessive-compulsive disorder. Nevertheless, more studies are still needed, mainly those focusing on long-term follow-up, group-treatment and the combined use with serotonin-reuptake inhibitors.

Asunto(s)

RESUMEN

OBJECTIVE: To perform a systematic review of controlled trials and meta-analysis that involved cognitive and/or behavioral treatment for obsessive-compulsive disorder. METHOD: A systematic review of randomized controlled trials and meta-analysis published on the last decade and indexed on Medline and PsycInfo. RESULTS: Studies have confirmed that exposure and response prevention and cognitive therapy are effective methods for the treatment of obsessive-compulsive disorder in children, adolescents and adults. Among adults, the combined use of serotonin-reuptake inhibitors and exposure and response prevention or cognitive therapy was not associated with any additional therapeutic effect. Among children, the combination of serotonin-reuptake inhibitors and exposure and response prevention are superior to either treatment alone. Exposure and response prevention associated with cognitive therapy may result in significant benefits to patients with predominant obsessive thoughts and its group modality also reduces obsessive-compulsive symptoms. CONCLUSION: At the present time, cognitive and behavioral therapies have shown to be highly effective psychotherapeutic approaches for the treatment of obsessive-compulsive disorder. Nevertheless, more studies are still needed, mainly those focusing on long-term follow-up, group-treatment and the combined use with serotonin-reuptake inhibitors.

Asunto(s)

RESUMEN

A massagem classica e definida como uma compressao metodica e ritmica do corpo, ou parte dele, para que se obtenha efeitos terapeuticos, didaticamente divididos em circulatorios, neuromusculares, metabolicos, mecanicos e psicologicos. Tambem podem ser divididos em local, por liberacao local de substancias vasoativas - e geral, quando a massagem e realizada em todo o corpo...

Asunto(s)

RESUMEN

BACKGROUND: Identifying predictors of treatment outcome can suggest ways to improve treatment delivery and understanding of its mechanism of action. METHOD: Predictors of treatment outcome were sought among 46 out-patients with obsessive-compulsive disorder who completed a nine-week randomised controlled trial of two forms of exposure therapy with ritual prevention. RESULTS: In both exposure conditions the best predictor of good outcome at the end of treatment (week 9) and of follow-up (week 32) was early compliance in doing exposure homework within a week of starting treatment. A weaker predictor of good outcome at follow-up was within-session reduction in anxiety from weeks 0 to 4. CONCLUSION: The strongest and most consistent predictor of better outcome to weeks 9 and 32 was compliance with exposure and ritual prevention in the first week of treatment.

Asunto(s)