Dental consensus on HSCT - Part II: dental Care during HSCT

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Brazilian dental consensus on dental management in hematopoietic stem cell transplantation− Part I− pre-HSCT

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

Dentistry consensus on HSCT - Part III: Special topics - Dentistry on HSCT

ABSTRACT Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team.

Assessment of oral health condition in recipients of allogeneic hematopoietic cell transplantation

ABSTRACT Objective: The objective of this study was to evaluate the oral health condition and dental treatments performed in patients in pre-allogeneic HCT. Method: The records of patients treated during 2018 at a Brazilian HCT service were reviewed. The following oral health data were obtained: 1. Decayed, missing and filled teeth / correlated index for primary dentition (DMFT/dmft); 2. Quality of oral hygiene and 3. Dental pathologies: 3.1 Periodontal infectious focus, 3.2 Endodontic infectious focus and 3.3 Carie incidence. All dental procedures performed were surveyed. Results: Thirty-three patients were included, with a mean age of 28.42 (±16.37), 20 male (60%) and 13 female. The average DMFT/dmft found in this study was 10.24 (± 8.37), similar to the index found in the population in southeastern Brazil. The younger study population presented a DMFT/dmft considered high, when compared to the general population. A total of 27.2% of the patients had active caries lesions, 33.3%, foci of periodontal infection, 15.1%, endodontic infectious focus and 40%, poor oral hygiene. Almost half of the patients (48.4%) had to undergo dental intervention, 24.2% needing periodontal scaling, 21.2%, fillings and 12.1%, tooth extractions. Conclusion: We conclude that the studied population had an important incidence of dental pathologies and infectious conditions that could complicate throughout HCT, especially in younger patients, therefore presenting a high demand for dental treatment in the pre-HCT. Studies that assess the impact of dental conditioning on the outcomes of HCT with an emphasis on dental infectious complications, days of hospitalization and survival are necessary."

Laryngeal Cancer Attributable Factors and the Influence on Survival Rates: A Single Brazilian Institution Experience

Abstract Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

Um despertar para a necessidade de aprimoramento dos profissionais da Atenção Básica à Saúde no diagnóstico de lesões orais / Awareness for need of improvement in knowledgement about oral lesions for professionals in primary health care

Objetivo: O objetivo desse estudo foi avaliar a eficácia do diagnóstico e tratamento de lesões orais entre diferentes níveis de saúde. Material e Métodos: Todas as informações foram obtidas dos prontuários médicos de um Hospital Universitário e de fichas do Sistema Público de Regulação, considerando as características clínico-demográficas tal como, doenças orais diagnosticadas, sistema de referência e terapia empregada. A avaliação foi baseada na relação entre diagnóstico final, hipótese diagnóstica e prioridade para agendamento da consulta, também foi considerado o tempo decorrido entre o encaminhamento e o primeiro atendimento, data do diagnóstico final e início da terapia. Depois, a hipótese diagnóstica preenchida por profissionais de saúde do nível primário e terciário foram comparadas e a concordância entre ambos foi determinada. Resultados: Cerca de 51% dos encaminhamentos preenchidos pelos profissionais da atenção primária estavam incompletos, ou a hipótese diagnóstica estava descrita de forma inadequada. No nível terciário, o tempo médio entre o encaminhamento e a primeira consulta foi de 23 dias, a média entre o diagnóstico final e o início do tratamento foi de 22 dias. O tratamento cirúrgico foi o mais rápido (31 dias) quando comparado a radioterapia para lesões malignas (81 a 100 dias). Conclusão: É necessário melhorar o treinamento de profissionais de saúde da Atenção Básica no reconhecimento de lesões orais malignas. Claramente, o preenchimento adequado das hipóteses de diagnóstico, com o grau de prioridade correspondente acelera o diagnóstico e tratamento do paciente.

Objective: this study aims to evaluate the efficacy of diagnosis and treatment of oral lesions between different healthcare levels. Material and Methods: all information was obtained from the medical records of a University Hospital and Public Health Regulation System regarding clinical-demographic features such as oral diseases diagnosed, referral system and therapy employed. Evaluation was based on the relationship between final diagnosis, diagnostic hypothesis and the priority of medical appointments, time between referral and first appointment, date of final diagnosis and therapy onset. Latter, diagnostic hypothesis fulfilled between primary and tertiary healthcare providers were compared and the agreement between both were determined. Results: about half (51%) of the medical forms filled by primary healthcare professionals were incomplete, or diagnostic hypothesis was inadequately described. At the tertiary healthcare level, mean time between referral and first appointment was 23 days, and mean time between the final diagnosis and treatment was 22 days. Surgical treatment was faster (31 days) when compared to radiotherapy for malignant lesions (81 to 100 days). Conclusion: it is necessary to improve training of healthcare professionals in the primary healthcare regarding the recognition of malignant oral lesions. Clearly, appropriate filling of the diagnostic hypothesis with the corresponding degree of priority accelerates the diagnosis and treatment of the patient.

Protocolo de atendimento odontológico a pacientes usuários de terapia antitrombótica / Dental care protocol for patients using antithrombotic therapy

Muitos pacientes que necessitam de intervenção odontológica, atualmente, são usuários de terapia medicamentosa antitrombótica. Essa condição se mostra prevalente, considerando que problemas cardiovasculares afetam grande parte da população. Objetivo: construir um protocolo clínico para o Serviço de Odontologia e Estomatologia do Hospital das Clínicas de Ribeirão Preto da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, a partir de evidências científicas. Revisão de literatura: foi realizada uma pesquisa bibliográfica nas bases de dados eletrônicas Scientific Eletronic Library Online (SciELO) e Public MedLine (PubMed), nos idiomas português e inglês, do período entre 2013 e 2017. Após obtenção dos periódicos, foram selecionados os que se tratavam de estudos clínicos e seguiu-se com tradução, leitura e análise dos artigos. Com base nas evidências científicas, optou-se por construir o protocolo a partir da classe de medicamento utilizada pelos usuários de terapia antitrombótica (antiagregantes plaquetários, anticoagulantes orais e novos anticoagulantes orais) e orientações (pré, intra e pós-operatórias) para cada procedimento odontológico. Considerações finais: o protocolo clínico estabeleceu parâmetros para condutas clínicas e cirúrgicas em atendimento ambulatorial e hospitalar, possibilitando o cuidado integral aos usuários de terapia antitrombótica. Futuros estudos clínicos são necessários para validação e adequação para seu uso em diferentes serviços. (AU)

Several patients who require dental intervention are current users of antithrombotic drug therapy. This condition is prevalent, considering that cardiovascular problems affect a large portion of the population. Objective: this study aimed to construct a clinical protocol for the Service of Dentistry and Stomatology of the Clinics Hospital of Ribeirão Preto from the Medical School of Ribeirão Preto of the University of São Paulo, Brazil, based on scientific evidence. Literature review: a bibliographic review was performed in the Scientific Electronic Library Online (SciELO) and Public MedLine (PubMed) electronic databases, in the Portuguese and English languages, for the period of 2013 through 2017. After obtaining the journals, the clinical studies were selected, followed by the translation, reading, and analysis of the articles. Based on the scientific evidence, we decided to build the protocol from the class of medication of the users of antithrombotic therapy (antiplatelet agents, oral anticoagulants, and new oral anticoagulants), and guidelines (pre-, intra-, and postoperative) for each dental procedure. Final considerations: the clinical protocol established parameters for clinical and surgical procedures in outpatient and hospital care, allowing comprehensive care to users of antithrombotic therapy. Further clinical studies are required to validate and adequate the use of this therapy in different services. (AU)

Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Complete denture biofilm after brushing with specific denture paste, neutral soap and artificial saliva

This study compared the levels of biofilm in maxillary and mandibular complete dentures and evaluated the number of colony-forming units (cfu) of yeasts, after using auxiliary brushing agents and artificial saliva. Twenty-three denture wearers with hyposalivation and xerostomia were instructed to brush the dentures 3 times a day during 3 weeks with the following products: Corega Brite denture dentifrice, neutral liquid soap, Corega Brite combined with Oral Balance (artificial saliva) or tap water. For biofilm quantification, the internal surfaces of the dentures were disclosed, photographed and measured using a software. For microbiological analysis, the biofilm was scrapped off, and the harvested material was diluted, sown in CHROMagar™ Candida and incubated at 37°C for 48 h. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05). Mandibular dentures presented a mean biofilm percentage (µ=26.90 ± 21.10) significantly greater than the maxillary ones (µ=18.0 ± 15.0) (p<0.05). Brushing using Corega Brite combined with Oral Balance (µ=15.87 ± 18.47) was more effective (p<0.05) than using the denture dentifrice (µ=19.47 ± 17.24), neutral soap (µ=23.90 ± 18.63) or tap water (control; µ=32.50 ± 20.68). For the microbiological analysis, the chi-square test did not indicate significant difference between the hygiene products for either type of denture. The more frequently isolated species of yeasts were C. albicans, C. tropicalis and C. glabrata. In conclusion, mandibular dentures had more biofilm formation than maxillary ones. Denture brushing with Corega Brite dentifrice combined with the use of Oral Balance was the most effective method for reduction of biofilm levels, but the use of products did not show difference in yeast cfu counts.

Este estudo comparou os níveis de biofilme em próteses totais maxilares e mandibulares, e analisou o número de unidades formadoras de colônias de leveduras, após o uso de agentes auxiliares da escovação e saliva artificial. Vinte e três usuários de próteses totais com hipossalivação e xerostomia foram orientados a escovar as dentaduras 3 vezes ao dia durante 3 semanas com os seguintes produtos: Corega Brite (dentifrício para prótese), sabonete líquido neutro, Corega Brite associado com o uso do Oral Balance (saliva artificial) ou água de torneira. Para a quantificação do biofilme, as superfícies internas das próteses totais foram evidenciadas, fotografadas e o biofilme quantificado com o auxílio de um software. Para a análise microbiológica, o biofilme foi removido por escovação, coletado, diluído, semeado em meio seletivo CHROMagar™ Candida e incubado a 37°C por 48 h. A análise de variância para dois fatores (p<0,05%) mostrou que as próteses mandibulares apresentaram uma média de porcentagem de biofilme (µ=26,90±21,10) maior que as maxilares (µ=18±15). O teste complementar de Tukey (0,46; p<5%) mostrou que a escovação com Corega Brite e Oral Balance (µ=15,87 ± 18,47) foi mais efetiva que o dentifrício (µ=19,47 ± 17,24), sabonete neutro (µ=23,90 ± 18,63), ou água de torneira (controle; µ=32,50 ± 20,68). Em relação á análise microbiológica, o teste de Qui-Quadrado não indicou diferença entre os produtos de higiene, para ambas as próteses. As espécies de leveduras mais comumente isoladas foram C. albicans, C. tropicalis e C. glabrata. Em conclusão, as próteses mandibulares apresentaram mais biofilme do que as maxilares. Além disso, a escovação das próteses com o Corega Brite associado ao uso do Oralbalance foi o método mais efetivo na redução dos níveis de biofilme, entretanto o uso dos produtos não demonstrou diferença no número de ufc de leveduras.

Levantamento do grau de instruções e dos materiais e métodos de higiene utilizados por usuários de próteses totais / Rising of the instructions degree and of materials and methods of hygiene used by complete dentures users

O objetivo desse trabalho foi realizar um estudo longitudinal a respeito dosmateriais e métodos de higiene utilizados por usuários de próteses totais, bem como avaliar ograu de instruções dos mesmos. O levantamento dos dados foi realizado por meio da aplicaçãode questionário e posterior tabulação dos dados. Foram entrevistados 98 usuários de prótesestotais no ano de 1989 e 100, no ano de 2004 atendidos na Faculdade de Odontologia de RibeirãoPreto-USP. Os resultados foram analisados por meio da comparação dos dados e pelo Teste dasProporções. Em 1989, 93,87% dos entrevistados relataram utilizar escova dental e dentifrício parahigiene de próteses totais. No ano de 2004, 95% dos usuários relataram utilizar o mesmo métodode higiene. Quanto ao grau de instrução, mais de 80% dos pacientes não receberam orientaçãoquanto à higienização ou quanto à necessidade de visita periódica ao cirurgião-dentista no ano de1989, mas em 2004 pôde-se notar que houve uma melhora significativa nesse quadro, uma vezque 52% dos pacientes não receberam orientação quanto à higienização e 77% não receberamorientação quanto à visita periódica ao cirurgião-dentista. Por meio deste estudo verificou-se queo método mais utilizado consiste no método mecânico, uma vez que são aqueles regularmenteencontrados no mercado, porém, estes não são específicos para higienização de próteses totais.Embora o grau de instrução tenha melhorado ao longo dos anos, a higiene oral de usuários deprótese total ainda é precária, havendo necessidade de maior atenção ao idoso, não somente porparte do cirurgião-dentista, mas também de indústrias de produtos de higiene oral, para que osdesdentados totais tenham acesso aos produtos específicos para este fim, podendo assim, controlarde forma adequada sua saúde oral.

The goal of this work was to accomplish a longitudinal study concerning aboutof the materials and methods of hygiene used by complete dentures users, as well as to evaluatethe instructions degree of the same. The rising of the data was accomplished by means of thequestionnaire and posterior table application of the data. They were interviewed 98 completedentures users in year of 1989 and 100, in year of 2004 attended in to Odontology Faculty ofRibeirão Preto. The results were analyzed by means of the comparison of the data and by theProportions Test. In 1989, 93.87% of the interviewees related use dental brush and toothpastefor complete denture hygiene. In year of 2004, 95% of the users related use the same hygienemethod. Regarding the instruction degree, more than 80% of the patients did not receive orientationregarding cleansers or regarding the need to periodic visit to the surgeon-dentist in year of 1989,but in 2004 could notice that there was a significant improvement in this picture, once that 52% of the patients did not receive orientation regarding cleansers and 77% did not receive orientationregarding the periodic visit to the surgeon-dentist. For half of this study it verified that the usedmethod consists in mechanical method, once that are those methods are not regularly found in themarket, however, these are not specific for denture complete hygiene. Although the instructiondegree has improved along years, the users’ oral complete denture hygiene is precarious, therebeing need to larger attention to the senior, not only by the surgeon-dentist, but also of productsindustries of oral hygiene, so that the total toothless have access to the specific products for thisend, could this way, control of adequate your form oral health.

Avaliação da densitometria óssea de tecido ósseo neoformado após distração osteogênica mandibular / Evaluation of the neoformed osseous densitry after mandibular osteogenic distraction

OBJETIVO: avaliar radiograficamente a qualidade óssea no local da distração osteogênica. METODOLOGIA: vinte ratos foram divididos em 2 grupos: Distração Osteogênica (DO) e Controle (C). Os animais do grupo DO foram submetidos à osteotomia da mandíbula, fixação de um aparelho distrator e aplicação de força de distração osteogênica. Os animais do grupo C serviram como controle para a avaliação do tecido ósseo produzido pela técnica da distração osteogênica. As mandíbulas desses animais foram segmentadas transversalmente, tiveram seus segmentos separados em 2,5mm de forma aguda no ato cirúrgico e fixados nessa posição. Nos 2 grupos, os animais foram sacrificados com 2 e 6 semanas após o término da DO (5 animais em cada período). As mandíbulas foram radiografadas simultaneamente, sobre o mesmo filme radiográfico. As imagens obtidas foram digitalizadas e submetidas à análise de densitometria óssea. RESULTADOS E CONCLUSÕES: os grupos DO e C não apresentaram diferenças estatísticas na neoformação óssea nos períodos analisados. As mandíbulas dos dois grupos apresentaram consolidação incompleta na segunda semana e consolidação completa 6 semanas após a distração osteogênica e estabilização. As diferenças encontradas entre esses dois períodos foram significativas apenas para o grupo DO.

Comparison of two cleansing pastes for the removal of biofilm from dentures and palatal lesions in patients with atrophic chronic candidiasis

Foram comparadas duas pastas, específica para prótese total e convencional para dentes naturais, quanto à habilidade de remoção de biofilme e cura de lesões do palato em pacientes com Candidíase Atrófica Crônica. Avaliou-se também o grau de correlação entre biofilme e grau de eritema. Vinte e quatro pacientes (45-80 anos) foram distribuídos em: a) pasta específica (produto experimental); b) pasta convencional (pasta dental Sorriso). Para ambos os grupos foram fornecidas escovas dentais de cerdas macias. Assuperfícies internas (próteses superiores) foram evidenciadas (fluoresceína 1%) e fotografadas (45º) em 4 visitas (0, 15, 30 e 60 dias). Os slides foram escaneados e as áreas (total e biofilme) foram medidas (software Image Tool). Sobre slides avaliou-se o grau de eritema empregando-se o Índice Tecidual de Prótese. Houve redução significativa (1%) dos níveis de biofilme (análise de variância) entre as primeiras (0 e 15 dias) e últimas visitas (45 e 60 dias) e dos escores de eritema (Kruskal—Wallis) da primeira para quarta vistita para ambas pastas. O teste de Mann-Whitney mostrou diferença estatística entre as pastas para os níveis de biofilme e igualdade estatística para os escores de eritema. Os valores de correlação entre níveis de biofilme e grau de eritema foram de 0,3801 (pasta específica) e 0,3678 (pasta convencional). A pasta específica mostrou-se efetiva, mostrando que é possível a manutenção da higiene de próteses totais com o uso regular de higienizador em forma de pasta.