Percorrer por autor "Laranjeira, Nuno"
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- Are cariogenic bacteria the major risk factor to dental caries in patients with ulcerative colitis?Publication . Rodrigues, Eduardo; Laranjeira, Nuno; Nunes, Gonçalo; Roque-Ramos, Lídia; Vieira, Ana; Fonseca, JorgeBackground – High prevalence of dental caries in ulcerative colitis (UC) has been attributed to diet and changes in salivary environment. Objective – We aimed to characterize the prevalence of dental caries, salivary flow rates, salivary buffering capacity and cariogenic bacteria counts of Mutans streptococci and Lactobacillus spp and to evaluate their relationship with drug therapy, disease activity and duration. Methods – A cross-sectional study was performed with UC patients followed in a tertiary center. Participants were submitted to a questionnaire (including demographic data, oral hygiene, eating habits) and a clinical observation with assessment of plaque index and Decayed, Missing and Filled Teeth index. Unstimulated/stimulated saliva was collected. Medical records, disease activity (Partial Mayo Score) and disease duration were collected. Laboratory data included salivary flow rates, salivary buffering capacity (CRT® buffer) and cariogenic bacteria count (Mutans streptococci and Lactobacillus spp) in saliva using the CRT® bacteria test (results: high or low counts). Results – Thirty UC patients were recruited. Oral hygiene routines were daily teeth brushing once or more (96.7%) and fluoride toothpaste (73.3%). Decayed, Missing and Filled Teeth index (mean 16.17±6.428) was not affected by the frequency of soft drinks, cakes, sweets and sugars between meals (P>0.2). Long-term disease showed a trend towards higher prevalence of caries (P=0.06). Most presented normal salivary flow rates, unstimulated (73.3%) and stimulated (60.0%), and high salivary buffering capacity (66.7%). Any association was found with age, gender, disease activity, disease duration and drug therapy. High Mutans streptococci and low Lactobacillus spp count were observed in 73.3% and 60% of patients, respectively. Patients with active disease (100%) and longer duration (88.9%) displayed higher Mutans streptococci count. Conclusion – The prevalence of dental caries observed in UC patients was significant and did not seem to be influenced by their eating habits. The high prevalence of Mutans streptococci count may be a major risk factor for dental caries and may be looked as part of the UC dysbiosis. Dental care of UC patients should be planned according with this microbiota variation
- Estética em Medicina Dentária a propósito de um caso clínicoPublication . Ferreira, Tiago; Laranjeira, Nuno; Alves, Ricardo
- Manifestações orais da colite ulcerosaPublication . Laranjeira, Nuno; Valido, Sara; Fonseca, Jorge; Coutinho, Ricardo; Leitão, JorgeA Doença Inflamatória Intestinal (DII) apresenta uma etiologia ainda desconhecida e abrange uma gama de entidades clínicas cuja especificidade principal passa pela inflamação crónica do tubo digestivo em diferentes localizações, sendo a Colite ulcerosa (CU) uma das doenças mais representativas. Os sintomas e a gravidade da CU são determinados através da extensão, da localização e do grau de atividade inflamatória. As manifestações extra-intestinais podem preceder, ser concomitantes ou surgir após as primeiras manifestações intestinais da CU e são importantes para o diagnóstico e o tratamento desta DII. Este artigo tem como objetivo rever a literatura que versa sobre as manifestações orais, nomeadamente a doença periodontal, a cárie e as lesões das mucosas.
- Manifestações orais da Doença de CrohnPublication . Laranjeira, Nuno; Valido, Sara; Coutinho, Ricardo; Fonseca, Jorge; Leitão, JorgeA Doença de Crohn (DC) é uma doença multifatorial, de etiologia ainda desconhecida, que afeta o tubo digestivo. Dada a sua associação a múltiplas manifestações extraintestinais, pode considerar-se uma doença sistémica, passível de atingir os vários órgãos e sistemas do organismo, incluindo a cavidade oral. São inúmeras as manifestações orais referidas na literatura que apresentam uma correlação direta ou indireta com a Doença de Crohn e englobam lesões ao nível periodontal, do tecido dentário e das mucosas. As manifestações orais da doença inflamatória intestinal (DII), onde se engloba a Doença de Crohn, constituem um problema clínico que exige multidisciplinaridade a fim de promover a melhoria de qualidade de vida nestes doentes. Neste artigo de revisão procurou-se averiguar na literatura quais são as manifestações orais que revelam uma maior associação com a doença e se demarcam como características chave para o diagnóstico precoce da DC.
- Manifestações orais em doentes com doença inflamatória intestinal. Estudo pilotoPublication . Laranjeira, Nuno; Valido, Sara; Meira, Tânia; Fonseca, Jorge; Freitas, João"Introdução: A doença inflamatória intestinal (DII), incluíndo a doença de Crohn (DC) e a colite ulcerosa (CU), apresenta manifestações orais descritas desde 1969. Objectivos: O presente estudo pretende, em doentes com DII: identificar, caracterizar e quantificar as lesões da mucosa oral; avaliar a presença e gravidade de doença periodontal; avaliar a presença e gravidade de cárie dentária; verificar uma possível relação entre estes achados e a presença de sintomatologia da doença intestinal. Materiais e Métodos: A amostra foi composta por trinta doentes previamente diagnosticados com DII. A observação intra-oral integrou a identificação de lesões ao nível da mucosa oral; a quantificação de dentes cariados, perdidos e obturados, utilizando o Índice de dentes Cariados, Perdidos e Obturados (CPO); a verificação da presença de placa bacteriana através do Índice de Higiene Oral Simplificado (IHO-S), e a avaliação da saúde periodontal através do Índice Periodontal Comunitário (CPI). As alterações identificadas foram comparadas com a sintomatologia da doença intestinal. Resultados: A amostra incluía 18 doentes com DC e 12 com CU, encontrando-se a maioria (24) em fase assintomática. Os hábitos de higiene oral dos doentes analisados assemelhavam-se aos da população portuguesa em geral, descritos em estudos anteriores. O índice de CPI apresentou uma média de 3,1±0,71, no qual o código mais frequente foi três (70%). A média do índice de CPO foi de 14,63. Para o IHO-S obteve-se uma média de 0,87±0,5. Cinco doentes (16.7%) apresentaram lesões nas mucosas, todos com sintomatologia intestinal. Conclusões: Os doentes observados com DII apresentam elevada prevalência de doença periodontal e de cárie dentária, configurando pior condição oral do que a encontrada em grandes estudos da população portuguesa em geral. Os valores obtidos apresentaram-se semelhantes para os doentes com CU e DC, não tendo sido verificada uma relação directa com a sintomatologia intestinal. Já a presença de lesões na mucosa oral em doentes com sintomatologia intestinal, sugere uma relação do seu aparecimento com a actividade da doença."
- Manifestações orais em doentes com doença inflamatória intestinal: estudo pilotoPublication . Laranjeira, Nuno; Valido, Sara; Meira, Tânia; Fonseca, Jorge; Freitas, JoãoIntrodução: A doença inflamatória intestinal (DII), incluíndo a doença de Crohn (DC) e a colite ulcerosa (CU), apresenta manifestações orais descritas desde 1969.
- Noise-induced gastric lesions : a light and electron microscopy study of the rat gastric wall exposed to low frequency noisePublication . Fonseca, Jorge; Martins-dos-Santos, José; Oliveira, Pedro; Laranjeira, Nuno; Águas, Artur; Castelo-Branco, Nuno"Context - Only a few studies evaluated the digestive alterations caused by low frequency noise (LFN) and most focused only on mucosal alterations. Objectives - To investigate the morphological injury of LFN-exposed gastric wall, beyond the epithelial layer. Methods - Wistar rats were exposed to low frequency noise (LFN), during increasing periods, 1 to 13 weeks. A control group was kept in silence. Gastric specimens were studied using: (i) light microscopy with hematoxylin-eosin and immunostaining for collagens; (ii) transmission electron microscopy; (iii) morphometry allowing statistical analysis. Results - Submucosa of all LFN-exposed animals exhibit increased thickness with fibrous proliferation. Transmission electron microscopy showed massive collagen deposition. Immunostaining identified collagen IV as responsible for the increased thickness. Morphometry allowed the demonstration of a significant difference of thickness between control and exposed groups. Vascular alterations included: i) intima proliferation and thickening, rupture of the internal elastic lamina, thrombotic changes; ii) thickening of the media; iii) after 9 weeks of LFN-exposure, we found new formed vessel presenting tortuous and twisted. There is a significant difference of arterial wall thickness between control and exposed groups. Conclusions - Deeper layers of gastric wall undergo alterations, including fibrosis of the submucosa caused by collagen IV deposition, an early marker of neoangiogenesis. Vascular alterations included thickening and thrombotic phenomena, but also images of newly formed vessels. This study suggests that, at least in the stomach, LFN-induced fibrosis could be linked with neoangiogenesis."
- Oral mucosa lesions and oral symptoms in inflammatory bowel disease patientsPublication . Laranjeira, Nuno; Fonseca, Jorge; Meira, Tânia; Freitas, João; Valido, Sara; Leitão, Jorge"Background - Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception. Objectives - The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease. Methods - Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn’s disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection. Results - The patients in the study group were more affected by oral symptoms (P=0.011), and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159). Patients in active phase were the most affected. No differences were detected between Crohn’s disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052). The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance. Conclusion - Oral mucosa’s lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy."
- Periodontal evaluation in patients diagnosed with inflammatory bowel diseasePublication . Laranjeira, Nuno; Coutinho, Ricardo; Freitas, João; Fonseca, Jorge; Leitão, JorgeInflammatory bowel disease (IBD) is a chronic condition affecting the digestive tract in different locations1. Crohn's disease (CD) and ulcerative colitis (UC) are the most common forms of IBD, both conditions are characterized by chronic inflammation at intestinal and systemic level that seems to arise in response to a variety of stimuli. The course of IBD is characterized by periods of activity and remission, and features a wide variety of manifestations, both at intestinal and extra-intestinal level, being the oral cavity one of the most affected areas. One of the oral diseases associate with IBD is periodontal disease (PD), the fact that both diseases display an aberrant immune response to the microbiota and have common pathogenic mechanisms led to various studies reporting its association.