Clinical dental management of the head and neck irradiated patient: topics of interest for clinicians

To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods: Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results: Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions: The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended

Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis

This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

Experiência da radioterapia na perspectiva do paciente com câncer de cabeça e pescoço: revisão integrativa / Radiotherapy experiences from the perspective of head and neck cancer patients: integrative literature review / Experiencia del la radioterapia en la perspectiva del paciente con câncer de cabeza y cuello: revisión integrativa

Objective: The study's purpose has been to summarize the knowledge about primary studies that investigated radiotherapy experiences from the perspective of head and neck cancer patients. Methods: It is an integrative literature review. Results: The final sample consisted of 13 studies that were published from 1998 to 2015. Through the studies thematic analysis were identified four major themes, as follows: "physical consequences of radiotherapy", "psychological and emotional repercussions of radiotherapy", "lack of information about the treatment and posture of the health professional regarding the treatment adverse effects" and "support networks". Conclusion: The studies showed that the radiotherapy treatment had important negative repercussions in the patients' life regarding the reactions and readjustments, and also the roles played family wise, all due to the treatment. There was also an important knowledge gap on the subject, then demonstrating the need for new studies with a qualitative approach, aiming to better understand this experience, therefore, producing care improvement

Objetivo: Sintetizar o conhecimento de estudos primários que investigaram a experiência da radioterapia, na perspectiva do paciente com câncer de cabeça e pescoço. Método: Revisão integrativa da literatura. Resultados: Amostra final composta por 13 estudos publicados entre 1998 a 2015. Pela análise temática dos estudos foram identificados quatro temas maiores: "repercussões físicas da radioterapia", "repercussões psicológicas e emocionais da radioterapia", "falta de informação sobre o tratamento e a postura do profissional de saúde perante os efeitos adversos do tratamento" e "redes de apoio". Conclusão: Os estudos evidenciaram que o tratamento radioterápico trouxe repercussões negativas importantes na vida dos pacientes frente às reações e rearranjos na vida e nos papéis desempenhados dentro da família, decorrentes do tratamento. Verificou-se também uma lacuna importante de conhecimento sobre a temática, demonstrando a necessidade de novos estudos, com abordagem qualitativa, para melhor compreensão desta experiência, refletindo em aprimoramento da assistência

Objetivo: Sintetizar el conocimiento de estudios primarios que investigaron la experiencia de la radioterapia, en la perspectiva del paciente con cáncer de cabeza y cuello. Método: Revisión integrativa de la literatura. Resultados: La muestra final consistió en 13 estudios publicados entre 1998 y 2015. En el análisis temático de los estudios se identificaron cuatro temas más grandes: "repercusiones físicas de la radioterapia", "repercusiones psicológicas y emocionales de la radioterapia", "falta de información sobre el tratamiento y la la postura del profesional de la salud ante los efectos adversos del tratamiento y las redes de apoyo. Conclusión: Los estudios evidenciaron que el tratamiento radioterápico trajo repercusiones negativas importantes en la vida de los pacientes frente a las reacciones y reajustes en la vida y en los papeles desempeñados dentro de la familia, derivados del tratamiento. Se verificó también una laguna importante de conocimiento sobre la temática, demostrando la necesidad de nuevos estudios, con abordaje cualitativo, para una mejor comprensión de esta experiencia, reflejando en el perfeccionamiento de la asistencia

Manejo terapêutico e preventivo da osteorradionecrose: revisão integrativa da literatura / Therapeutic and preventative management of osteoradionecrosis: integrative literature review

Objetivo: O objetivo deste estudo foi realizar uma revisão integrativa da literatura com o intuito de discutir sobre o manejo preventivo e terapêutico da ORN. Material e Métodos: Para isso foi realizada buscas nas bases de dados: Medical Literature Analysis (PubMed / MEDLINE) e Biblioteca Virtual em Saúde (BVS). A amostra final foi composta por 12 estudos publicados entre 2011-2015. Resultados: Esses estudos mostraram aspectos relacionados à prevenção e às diversas formas de tratamento da ORN, tais como oxigenoterapia hiperbárica, abordagem farmacológica e cirúrgica. Conclusão: Considera-se fundamental os cuidados odontológicos preventivos antes da radioterapia e o desenvolvimento de estudos controle, randomizados, que tenham como objetivo avaliar qual a terapêutica mais eficaz no tratamento da ORN.

Objective: The aim of this study was to perform an integrative review of the literature with intent to discuss the preventive and therapeutic management of ORN. Material and Methods: For this search was conducted in the databases: Medical Literature Analysis (PubMed / MEDLINE) and Biblioteca Virtual emSaúde (BVS). The sample consisted of 12 studies published between 2011-2015. Results: Studies have shown aspects related to prevention, treatment of ORN with hyperbaric oxygen therapy to pharmacological treatment of ORN and surgical treatment. Conclusion: It is considered essential preventive dental care before radiotherapy and development control, randomized studies that aim to assess the most effective therapy in the treatment of ORN.

Tratamento da mucosite oral com laser de baixa potência: revisão sistemática de literatura / Low power laser therapy in the treatment of oral mucositis: Systematic literature e review

Verificar qual o melhor protocolo de aplicação da laserterapia de baixa potência para prevenção e tratamento da mucosite oral químio e rádio induzida. Revisão sistemática de literatura sobre laserterapia na prevenção e tratamento da mucosite oral rádio e químio induzida. Foram utilizadas as indexações "mucositis", "lowpower laser therapy", na busca de estudos clínicos randomizados dos últimos 10 anos nas bases de dados de referência: PubMed, LILACS e Cochrane Library. A pesquisa resultou em 16 estudos clínicos randomizados sobre laserterapia de baixa potência, sendo consenso a aplicação 5 vezes por semana, com densidade de energia variada entre 1,3 e 6,0 J/cm². O presente estudo identificou que a laserterapia reduz o tempo de cicatrização e os graus de mucosite oral, apesar de ainda serem necessários mais estudos para definir o protocolo de atuação.

To determine what the best low-level laser therapy application protocol for prevention and treatment of oral mucositis. A systematic review of literature on laser therapy in the prevention and treatment of oral mucositis radio and chemo-induced. The indexes were used "mucositis", "low power laser therapy", selecting randomized clinical trials of the last ten years in the reference databases were PubMed, LILACS and Cochrane Library. The search resulted in 16 randomized clinical trials on low level laser therapy, and the application consensus 5 times a week, using varied energy density between 1.3 to 6.0 J/cm². The present study found that laser therapy reduces the healing time and the degree of oral mucositis, though still need further studies to define the performance protocol.