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Manifestações orais e novos métodos de diagnóstico em pacientes talassémicos: revisão integrativa
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Abstract(s)
A talassemia é um dos distúrbios genéticos mais comuns a nível global, com distribuições características de determinadas áreas geográficas, étnicas e socioculturais. Consiste num distúrbio na síntese da hemoglobina caracterizado pela produção reduzida ou ausente de uma das cadeias de globina com excesso relativo da outra. Estes desequilíbrios das cadeias de globina causam hemólise, o que resulta em anemia leve a grave. Tem um amplo espectro de gravidade clínica, para a classificação clínica dividimos a talassemia em talassemia maior (TM), talassemia intermédia (TI) e talassemia menor. O quadro clínico das talassemias além de incluir anemia grave e progressiva, entre outras características, apresenta também alterações esqueléticas e deformações ósseas resultantes de níveis elevados de ferro no sangue, da expansão da medula óssea causada pela hematopoiese e renovação rápida de células sanguíneas e manifestações a nível oral. Os pacientes talassémicos apresentam um elevado risco de cárie dentária e são suscetíveis à doença periodontal. Assim, medidas preventivas eficazes devem ser implementadas para minimizar a necessidade de procedimentos odontológicos extensivos. Esta revisão bibliográfica tem como objetivo identificar os novos métodos de diagnóstico não invasivo assim como as implicações da talassemia na cavidade oral. Neste sentido, o objetivo desta revisão integrativa é analisar as principais manifestações orais encontradas em pacientes talassémicos, bem como verificar quais os métodos de diagnóstico existentes na atualidade. Para tal será efetuada uma pesquisa bibliográfica nas bases de dados: PubMed, Science Direct e Google Scholar com combinações das seguintes palavras-chave: “talassemia”; “diagnostico não invasivo”; “doenças orais”; "doença dentaria". São definidos os seguintes critérios de inclusão: publicações escritas em português, italiano e inglês, com limite temporal dos últimos 15 anos (2009-2024), de modo a reunir informação pertinente sobre as implicações da talassemia na cavidade oral e os novos métodos de diagnóstico não invasivo. Serão excluídos os artigos que não estavam nas línguas escolhidas, duplicados, não realizados em humanos, sem disponibilidade na íntegra ou em que após a leitura do resumo e do corpo de texto, não servem o objetivo proposto. Através desta revisão integrativa verificou-se que existem estudos contrastantes que refletem a diversidade de resultados referentes às estruturas orais e maxilofaciais em pacientes talassémicos. Os pacientes talassémicos apresentam um elevado risco de cárie dentária e são suscetíveis à doença periodontal. Assim, medidas preventivas eficazes devem ser implementadas para minimizar a necessidade de procedimentos odontológicos extensivos. Contudo ainda há uma escassez de literatura sobre as manifestações orais, considerações dentárias e acompanhamento dentário em pacientes com talassemia, sendo necessário a realização de mais estudos neste âmbito e com uma maior amostra para evitar o viés.
Thalassemia is one of the most common genetic disorders worldwide, with characteristic distributions in certain geographical, ethnic, and sociocultural areas. It is a disorder of hemoglobin synthesis characterized by reduced or absent production of one of the globin chains, resulting in a relative excess of the other. These imbalances in globin chains cause hemolysis, leading to mild to severe anemia. It has a wide range of clinical severity and is clinically classified into major thalassemia (TM), intermediate thalassemia (TI), and minor thalassemia. The clinical presentation of thalassemia, in addition to including severe and progressive anemia among other features, also shows skeletal changes and bone deformities resulting from elevated iron levels in the blood, expansion of the bone marrow due to hematopoiesis, rapid renewal of blood cells, and manifestations in the oral cavity. Thalassemic patients are at high risk of dental caries and are susceptible to periodontal disease. Therefore, effective preventive measures should be implemented to minimize the need for extensive dental procedures. This literature review aims to identify new non-invasive diagnostic methods as well as the implications of thalassemia in the oral cavity. In this context, the objective of this integrative review is to analyze the main oral manifestations found in thalassemic patients, as well as to verify the diagnostic methods currently available. To this end, a bibliographic search will be conducted in the databases: PubMed, Science Direct, and Google Scholar using combinations of the following keywords: “thalassemia”, “non-invasive diagnostic”, “oral diseases”, and “dental diseases”. The following inclusion criteria are defined: publications written in Portuguese, Italian, and English, with a time limit of the last 15 years (2009–2024), in order to gather relevant information about the implications of thalassemia in the oral cavity and new non-invasive diagnostic methods. Articles will be excluded if they are not in the selected languages, are duplicates, not conducted in humans, not available in full text, or if, after reading the abstract and the main body, they do not serve the intended purpose. Through this integrative review, it was found that there are contrasting studies reflecting the diversity of findings regarding oral and maxillofacial structures in thalassemic patients. Thalassemic patients are at high risk of dental caries and are susceptible to periodontal disease. Therefore, effective preventive measures should be implemented to minimize the need for extensive dental procedures. However, there is still a lack of literature on oral manifestations, dental considerations, and dental follow-up in patients with thalassemia, highlighting the need for more studies in this field with larger sample sizes to avoid bias.
Thalassemia is one of the most common genetic disorders worldwide, with characteristic distributions in certain geographical, ethnic, and sociocultural areas. It is a disorder of hemoglobin synthesis characterized by reduced or absent production of one of the globin chains, resulting in a relative excess of the other. These imbalances in globin chains cause hemolysis, leading to mild to severe anemia. It has a wide range of clinical severity and is clinically classified into major thalassemia (TM), intermediate thalassemia (TI), and minor thalassemia. The clinical presentation of thalassemia, in addition to including severe and progressive anemia among other features, also shows skeletal changes and bone deformities resulting from elevated iron levels in the blood, expansion of the bone marrow due to hematopoiesis, rapid renewal of blood cells, and manifestations in the oral cavity. Thalassemic patients are at high risk of dental caries and are susceptible to periodontal disease. Therefore, effective preventive measures should be implemented to minimize the need for extensive dental procedures. This literature review aims to identify new non-invasive diagnostic methods as well as the implications of thalassemia in the oral cavity. In this context, the objective of this integrative review is to analyze the main oral manifestations found in thalassemic patients, as well as to verify the diagnostic methods currently available. To this end, a bibliographic search will be conducted in the databases: PubMed, Science Direct, and Google Scholar using combinations of the following keywords: “thalassemia”, “non-invasive diagnostic”, “oral diseases”, and “dental diseases”. The following inclusion criteria are defined: publications written in Portuguese, Italian, and English, with a time limit of the last 15 years (2009–2024), in order to gather relevant information about the implications of thalassemia in the oral cavity and new non-invasive diagnostic methods. Articles will be excluded if they are not in the selected languages, are duplicates, not conducted in humans, not available in full text, or if, after reading the abstract and the main body, they do not serve the intended purpose. Through this integrative review, it was found that there are contrasting studies reflecting the diversity of findings regarding oral and maxillofacial structures in thalassemic patients. Thalassemic patients are at high risk of dental caries and are susceptible to periodontal disease. Therefore, effective preventive measures should be implemented to minimize the need for extensive dental procedures. However, there is still a lack of literature on oral manifestations, dental considerations, and dental follow-up in patients with thalassemia, highlighting the need for more studies in this field with larger sample sizes to avoid bias.
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Keywords
Talassemia Diagnóstico não invasivo Doenças orais Doença dentária Thalassemia Non-invasive diagnostic Oral diseases Dental diseases