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Moura AEO, Besseler MO, Pérez-de-Oliveira ME, Normando AGC, Neves ILI, Neves RS, Vargas PA, Azeka E, Santos-Silva AR, Montano TCP. Prevalence and clinical characteristics of oral lesions in heart transplant patients induced by sirolimus and everolimus: a systematic review and meta-analysis on a global scale. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:37-52. [PMID: 37925270 DOI: 10.1016/j.oooo.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Sirolimus (SRL) and everolimus (EVL) are increasingly included in immunosuppressive protocols after heart transplantation. They present some side effects, including the appearance of painful lesions in the oral cavity. Therefore, this systematic review aimed to verify the global prevalence and clinical characteristics of oral lesions induced by SRL and EVL in heart transplant patients. STUDY DESIGN A systematic review was performed using 5 main electronic databases (Medline/PubMed, SCOPUS, EMBASE, Web of Science, and LILACS), in addition to the gray literature. Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools, and the certainty of evidence was evaluated through GRADE assessment. RESULTS Seventeen studies (860 patients) were included in the qualitative analysis. Of these, 11 studies were pooled in a meta-analysis of prevalence. The worldwide prevalence of oral lesions induced by SRL and EVL in heart transplant patients was 10.0%, and most lesions were described as ulcers >1.0 cm, related to significant pain. CONCLUSIONS Oral lesions induced by SRL and/or EVL, although not very prevalent, have a relevant impact on patient's lives and the continuity of treatment.
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Affiliation(s)
- Anne Evelyn Oliveira Moura
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Mariana Oliveira Besseler
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Maria Eduarda Pérez-de-Oliveira
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Itamara Lucia Itagiba Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Ricardo Simões Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Estela Azeka
- Pediatric Cardiology Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Tânia Cristina Pedroso Montano
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas, Medical School, University of São Paulo (HCFMUSP), São Paulo, Brazil
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Guardieiro B, Santos-Paul MA, Furtado RHDM, Dalçóquio T, Salsoso R, Neves ILI, Neves RS, Cavalheiro Filho C, Baracioli LM, Nicolau JC. Comparison between two different local hemostatic methods for dental extractions in patients on dual antiplatelet therapy: a within-person, single-blind, randomized study. J Evid Based Dent Pract 2023; 23:101863. [PMID: 37689449 DOI: 10.1016/j.jebdp.2023.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) provides additional risk reduction of ischemic events compared to aspirin monotherapy, at cost of higher bleeding risk. There are few data comparing new techniques for reducing bleeding after dental extractions in these patients. PURPOSE This study investigated the effectiveness of the HemCon Dental Dressing (HDD) compared to oxidized cellulose gauze. MATERIALS AND METHODS This randomized study included 60 patients on DAPT who required at least two dental extractions (120 procedures). Each surgical site was randomized to HDD or oxidized regenerated cellulose gauze as the local hemostatic method. Intra-oral bleeding time was measured immediately after the dental extraction and represents our main endpoint for comparison of both hemostatic agents. Prolonged bleeding, platelet reactivity measured by Multiplate Analyser (ADPtest and ASPItest) and tissue healing comparison after 7 days were also investigated. RESULTS Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes, P=0.001). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%), P=0.03]. There was poor correlation between platelet reactivity and intra-oral bleeding time. CONCLUSIONS In patients on DAPT, HDD resulted in a lower intra-oral bleeding time compared to oxidized cellulose gauze after dental extractions. Moreover, HDD also seems to improve healing conditions.
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Affiliation(s)
- Bruno Guardieiro
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Marcela Alves Santos-Paul
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Remo Holanda de Mendonça Furtado
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil; Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Talia Dalçóquio
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Rocío Salsoso
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Itamara Lúcia Itagiba Neves
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Ricardo Simões Neves
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Cyrillo Cavalheiro Filho
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Luciano Moreira Baracioli
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - José Carlos Nicolau
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
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Sarra G, Neves ILI, Moreira MS, Santos‐Paul MA, Montano TCP, Carvalho CMA, Neves RS. Implications in oral health care for recovered cardiac patients: Long‐term effects of COVID‐19 pandemic. Oral Dis 2022; 28 Suppl 1:981-982. [DOI: 10.1111/odi.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Giovanna Sarra
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
- Department Restorative Dentistry School of Dentistry University of Sao Paulo (USP) Sao Paulo Brazil
| | - Itamara Lucia Itagiba Neves
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
| | - Maria Stella Moreira
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
- Post Graduation Program School of Dentistry Ibirapuera University Sao Paulo Brazil
| | - Marcela Alves Santos‐Paul
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
| | - Tânia Cristina Pedroso Montano
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
| | - Cíntia Maria Alencar Carvalho
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
| | - Ricardo Simões Neves
- Dental Unit Faculdade de Medicina Instituto do Coração (InCor) Hospital das Clínicas HCFMUSP Universidade de São Paulo Sao Paulo Brazil
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Moreira MS, Neves ILI, de Bernoche CYSM, Sarra G, Dos Santos-Paul MA, Campos Neves da Silva F, Schroter GT, Montano TCP, de Carvalho CMA, Neves RS. Bilateral paresthesia associated with cardiovascular disease and COVID-19. Oral Dis 2022; 28 Suppl 1:912-915. [PMID: 32640483 PMCID: PMC7361440 DOI: 10.1111/odi.13539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Maria Stella Moreira
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Post Graduation Program, School of Dentistry, Ibirapuera University, São Paulo, SP, Brazil
| | - Itamara Lucia Itagiba Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Yanet San Martin de Bernoche
- Cardiovascular Intensive Care Unit, Cardiovascular Department, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giovanna Sarra
- Department Restorative Dentistry, School of Dentistry, University of Sao Paulo (USP), São Paulo, SP, Brazil
| | - Marcela Alves Dos Santos-Paul
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Campos Neves da Silva
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriella Torres Schroter
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tânia Cristina Pedroso Montano
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Cíntia Maria Alencar de Carvalho
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Simões Neves
- Dental Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Montano TCP, Wanderley MIA, Sampaio RO, Alves CGB, Neves ILI, Lopes MA, Tarasoutchi F, Strabelli TMV, Neves RS, Grinberg M, Santos-Silva AR, Siciliano RF. Demographic, cardiological, microbiologic, and dental profiles of Brazilian patients who developed oral bacteria-related endocarditis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:418-425. [PMID: 34400124 DOI: 10.1016/j.oooo.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Infective endocarditis (IE) may cause devastating complications with high morbidity and mortality rates. The aim of the present study was to study the demographic, cardiological, microbiologic, and dental profiles of patients with oral bacteria-related IE. STUDY DESIGN We present a retrospective study of patients with oral bacteria-related IE treated at Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil, between January 2009 and December 2019. RESULTS Of the 100 patients included, 70% were male with a mean age of 45.4 years at diagnosis. The most affected sites were aortic and mitral valves, 60% in prosthetic heart valves, 34% in native valves, and 3% in pacemakers. The most common cause of valvular disease was rheumatic cardiopathy (51.9%), and the most frequent complications were valvular and perivalvular damage (26%). Streptococcus viridans was the most common species (96%), dental caries were present in 57% of the patients, 78% had tooth loss, 45% had apical periodontitis, and 77% were at high/moderate risk for periodontal disease. CONCLUSION Oral bacteria-related IE among Brazilians was predominant in the prosthetic heart valves of young male adults previously affected by rheumatic cardiopathy. Streptococcus viridans was the main cause of IE, which was linked to patients with a poor oral health status.
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Affiliation(s)
- Tânia Cristina Pedroso Montano
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Unidade de Odontologia, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roney Orismar Sampaio
- Unidade de Valvopatias, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Itamara Lúcia Itagiba Neves
- Unidade de Odontologia, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Unidade de Valvopatias, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tânia Mara Varejão Strabelli
- Unidade de Controle de Infecção Hospitalar, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Simões Neves
- Unidade de Odontologia, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Max Grinberg
- Unidade de Controle de Infecção Hospitalar, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Rinaldo Focaccia Siciliano
- Unidade de Valvopatias, Instituto do Coração, Hospital das Clínicas, HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Oliveira ACG, Neves ILI, Sacilotto L, Olivetti NQS, Santos-Paul MAD, Montano TCP, Carvalho CMA, Wu TC, Grupi CJ, Barbosa SA, Pastore CA, Samesima N, Hachul DT, Scanavacca MI, Neves RS, Darrieux FCC. Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single-Center Study. J Am Heart Assoc 2019; 8:e012361. [PMID: 31319747 PMCID: PMC6761655 DOI: 10.1161/jaha.119.012361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Brugada syndrome and long-QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life-threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life-threatening arrhythmias in patients with channelopathies. Methods and Results We performed a randomized, double-blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty-eight-hour Holter monitoring was performed, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty-six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long-QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9±15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute (P=0.008). In patients with long-QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms (P=0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life-threatening arrhythmias occurred during dental treatment. Conclusions The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life-threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03182777.
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Affiliation(s)
- Ana Carolina Guimarães Oliveira
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Itamara Lucia Itagiba Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Luciana Sacilotto
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Natália Quintella Sangiorgi Olivetti
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Marcela Alves Dos Santos-Paul
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tânia Cristina Pedroso Montano
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cíntia Maria Alencar Carvalho
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tan Chen Wu
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cesar José Grupi
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Sílvio Alves Barbosa
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Carlos Alberto Pastore
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Nelson Samesima
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Denise Tessariol Hachul
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Maurício Ibrahim Scanavacca
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Ricardo Simões Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Francisco Carlos Costa Darrieux
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
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Santos-Paul MA, Neves RS, Gowdak LHW, de Paula FJ, David-Neto E, Bortolotto LA, Ramires JAF, De Lima JJG. Cardiovascular risk reduction with periodontal treatment in patients on the waiting list for renal transplantation. Clin Transplant 2019; 33:e13658. [PMID: 31271675 DOI: 10.1111/ctr.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/13/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular mortality is increased in chronic kidney disease, a condition with a high prevalence of periodontal disease. Whether periodontitis treatment improves prognosis is unknown. METHODS The effect of periodontal treatment on the incidence of cardiovascular events and death in 206 waitlist hemodialysis subjects was compared with that in 203 historical controls who did not undergo treatment. Patients were followed up for 24 months or until death or transplantation. RESULTS The prevalence of moderate/severe periodontitis was 74%. Coronary artery disease correlated with the severity of periodontal disease (P = .02). Survival free of cardiovascular events (94% vs 83%, log-rank 0.009), coronary events (97% vs 89%, log-rank = 0.009), and cardiovascular death (96% vs 87%, log-rank = 0.037) was higher in the evaluated group. Death by any cause did not differ between groups. Multivariate analysis showed that treatment was associated with reduction in cardiovascular events (HR 0.43; 95% CI 0.22-0.87), coronary events (HR 0.31; 95% CI 0.12-0.83), and cardiovascular deaths (HR 0.43; 95% CI 0.19-0.98). CONCLUSION Periodontal treatment reduced the 24-month incidence of cardiovascular events and cardiovascular death, suggesting that periodontal treatment may improve cardiovascular outcomes. We suggest that periodontal screening and eventual treatment may be considered in patients with advanced renal disease.
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Affiliation(s)
- Marcela A Santos-Paul
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Simões Neves
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Luis Henrique W Gowdak
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Flávio J de Paula
- Urology, Renal Transplant Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Elias David-Neto
- Urology, Renal Transplant Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Bortolotto
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - José Antonio F Ramires
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose Jayme G De Lima
- Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Santos-Paul MAD, Neves ILI, Neves RS, Ramires JAF. Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study. Clinics (Sao Paulo) 2015; 70:185-9. [PMID: 26017649 PMCID: PMC4449474 DOI: 10.6061/clinics/2015(03)06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/05/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease.
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Affiliation(s)
| | | | - Ricardo Simões Neves
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Dutra RMF, Neves ILI, Neves RS, Atik E, Santos UDP. Peripheral oxygen saturation, heart rate, and blood pressure during dental treatment of children with cyanotic congenital heart disease. Clinics (Sao Paulo) 2014; 69:314-8. [PMID: 24838895 PMCID: PMC4012232 DOI: 10.6061/clinics/2014(05)03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/12/2013] [Accepted: 10/03/2013] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES In this observational study, we evaluated the peripheral oxygen saturation (SpO2), heart rate, and blood pressure of children with cyanotic congenital heart disease who were undergoing dental extraction. METHODS Forty-four patients between the ages of 6 and 12 years who underwent upper primary tooth extraction were included in the study. Of these, 20 patients were in the cyanotic congenital heart disease group and 24 were in the control group. RESULTS Peripheral oxygen saturation, heart rate, and systolic blood pressure in the cyanotic congenital heart disease group varied quite significantly during the treatment protocol (p<0.05), with values of 80.5% (±7.6) to 82.8% (±7.8), 95.3 beats per minute (bpm) (±11.3) to 101.3 bpm (±9.8), and 93.6 mm Hg (±13,3) to 103.8 mm Hg (±12.7), respectively. The variations in the control group during the procedure were also significant. CONCLUSIONS The changes observed during the study protocol, although statistically significant, were mild and lacked clinical relevance. The results indicate that dental treatment of children with cyanotic heart disease using a standardized protocol in decentralized offices without the support of a surgical center is safe.
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Affiliation(s)
- Rosane Menezes Faria Dutra
- Heart Institute (InCor), Pulmonary Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Itamara Lucia Itagiba Neves
- Heart Institute (InCor), Dentistry Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Simões Neves
- Heart Institute (InCor), Dentistry Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edmar Atik
- Heart Institute (InCor), Cardiology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ubiratan de Paula Santos
- Heart Institute (InCor), Pulmonary Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Aguiar AAD, Sampaio RO, Sampaio JLDM, Spina GS, Neves RS, Moreira LFP, Grinberg M. Efeito da penicilina G a cada três semanas sobre o surgimento de Streptococcus viridans resistentes à penicilina na microflora oral. Arq Bras Cardiol 2012; 98:452-8. [DOI: 10.1590/s0066-782x2012005000038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 12/01/2011] [Indexed: 11/22/2022] Open
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Neves ILI, Avila WS, Neves RS, Giorgi DMA, Santos JFKD, Oliveira Filho RM, Grupi CJ, Grinberg M, Ramires JAF. Maternal-fetal monitoring during dental procedure in patients with heart valve disease. Arq Bras Cardiol 2010; 93:463-742. [PMID: 20084307 DOI: 10.1590/s0066-782x2009001100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.
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Affiliation(s)
- Itamara Lucia Itagiba Neves
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Cáceres MTF, Ludovice ACPP, Brito FSD, Darrieux FC, Neves RS, Scanavacca MI, Sosa EA, Hachul DT. Effect of local anesthetics with and without vasoconstrictor agent in patients with ventricular arrhythmias. Arq Bras Cardiol 2009; 91:128-33, 142-7. [PMID: 18853053 DOI: 10.1590/s0066-782x2008001500002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/18/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The routine use of local anesthetics associated to vasoconstrictors for the dental treatment of patients with cardiopathies is still controversial, due to the risk of adverse cardiovascular effects. OBJECTIVE To evaluate and compare the hemodynamic effects of the use of local anesthetics with a non-adrenergic vasoconstrictor in patients with ventricular arrhythmia, when compared to the use of anesthetics without vasoconstrictor. METHODS A prospective randomized study evaluated 33 patients with positive serology for Chagas' disease and 32 patients with coronary artery disease that presented complex ventricular arrhythmia at Holter monitoring (>10 EV/h and NSVT), of which 21 were females, aged 54.73 + 7.94 years, submitted to routine dental treatment with pterygomandibular anesthesia. These patients were divided in two groups: group I received prilocaine 3% associated with felypressin 0.03 IU/ml and group II received lidocaine 2% without vasoconstrictor. The number and complexity of extrasystoles were analyzed, as well as the heart rate and systemic arterial pressure of the patients on the day before, one hour before, during the procedure and one hour after the dental procedure. RESULTS No hemodynamic alterations or increase in the number and complexity of the ventricular arrhythmia related to the anesthetic used in the dental procedure were observed in either group. CONCLUSION The results suggest that prilocaine 3% associated to a felypressin 0.03 IU/ml can be safely used in patients with Chagas' disease or coronariopathy with complex ventricular arrhythmia.
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Laragnoit AB, Neves RS, Neves ILI, Vieira JE. Locoregional anesthesia for dental treatment in cardiac patients: a comparative study of 2% plain lidocaine and 2% lidocaine with epinephrine (1:100,000). Clinics (Sao Paulo) 2009; 64:177-82. [PMID: 19330241 PMCID: PMC2666461 DOI: 10.1590/s1807-59322009000300005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/01/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study analyzes hemodynamic changes in patients with cardiac valvular diseases submitted to dental treatment under local anesthesia containing epinephrine. METHODS This randomized clinical trial was performed at the Dental Division of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brazil). Patients were separated into two groups with the help of an aleatory number table: 2% plain lidocaine (PL, n= 31) and 2% lidocaine with epinephrine (1:100,000) (LE, n= 28). Blood pressure, heart rate, oxygenation and electrocardiogram data were all recorded throughout the procedure. State and trait anxiety levels were measured. RESULTS Fifty-nine patients were selected for the LE group (n=28), with an average age of 40.3 +/- 10.9, or for the PL group (n=31), age 42.2 +/- 10.3. No differences were shown in blood pressure, heart rate and pulse oximetry values before, during and after local anesthesia injection between the two groups. State and trait anxiety levels were not different. Arrhythmias observed before dental anesthesia did not change in shape or magnitude after treatment. Complaints of pain during the dental procedure were more frequent within the PL group, which received a higher amount of local anesthesia. CONCLUSION Lidocaine with epinephrine (1:100,000) provided effective local anesthesia. This treatment did not cause an increase in heart rate or blood pressure and did not cause any arrhythmic changes in patients with cardiac valvular diseases.
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Affiliation(s)
- Alessandra Batistela Laragnoit
- Division of Dental Care, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Ricardo Simões Neves
- Division of Dental Care, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Itamara Lúcia Itagiba Neves
- Division of Dental Care, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Joaquim Edson Vieira
- Division of Anesthesia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. Tel.: 55 11 3082.4076,
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Neves RS, Neves ILI, Giorgi DMA, Grupi CJ, César LAM, Hueb W, Grinberg M. Efeitos do uso da adrenalina na anestesia local odontológica em portador de coronariopatia. Arq Bras Cardiol 2007; 88:545-51. [PMID: 17589629 DOI: 10.1590/s0066-782x2007000500008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/13/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature, and there is concern regarding risk of cardiac decompensation. OBJECTIVE To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease. METHODS Sixty-two patients were included in the study, ages ranging from 39 to 80 (mean 58.7 +/- 8.8), 51 (83.2%) of whom were male. Thirty patients were randomly assigned to receive 2% lidocaine with epinephrine (epinephrine group), and the remaining patients, 2% lidocaine without epinephrine (non-epinephrine group) for local anesthesia. All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography. Three periods were considered in the study: 1) baseline--recordings obtained during the 60 minutes prior to the procedure; 2) procedure--recordings obtained from the beginning of anesthesia to the end of the procedure and 3) 24 hours. RESULTS There was an increase in blood pressure in both groups during the procedure, compared with baseline values; but when the two groups were compared no significant difference was detected between them. Heart rate remained unchanged in both groups. No ST-segment depression > 1 mm occurred either at baseline or during the procedure. Seven patients (12.5%) experienced more than ten arrhythmia episodes per hour during the procedure, four (13.8%) in the non-epinephrine group and three (11.1%) in the epinephrine group. CONCLUSION No difference was observed in blood pressure, heart rate, or evidence of ischemia and arrhythmias in either group. The use of vasoconstrictor has proved to be safe within the range of the present study.
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Mansur AJ, de Faria EF, Neves RS, Rett SM, Grinberg M, Bellotti G, Pileggi F. [Dental procedures during anticoagulant administration]. Arq Bras Cardiol 1989; 52:35-7. [PMID: 2818238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Thirty-six patients on chronic anticoagulant therapy were submitted to dental surgery. The ages ranged between 20 and 68 (mean 43.5) years; twenty (55.6%) patients were female and 16 (44.4%) were female. Phenindione was administered to 33 (91.7%) patients, warfarin to one (2.7%) and hydroxycoumarin to two (5.6%). Mechanical heart valve prosthesis occurred in 23 (64%) patients, bioprosthesis in two (5.5%), mitral stenosis submitted to commissurotomy in two (5.5%) and other valvular heart disease occurred in nine patients (25%). Eighty-three elective procedures were performed. Anticoagulant drugs were stopped from two to seven days before, in order to prothrombin time reach 60%. Abnormal bleeding that was easily controlled with local measures occurred in two patients. Sixteen emergency procedures were performed without stopping anticoagulant treatment. Abnormal bleeding was observed in one patient and it subsided after local care. Thus, safe odontologic procedures may be carried on in patients during treatment with oral anticoagulants.
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Mansur AJ, Neves RS, Grinberg M, Avila WS, Laurindo FR, Pileggi F. [Odonto-stomatological health in patients with heart valve diseases. A concern also for the cardiologist]. Arq Bras Cardiol 1984; 43:47-9. [PMID: 6525078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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