Are salivary flow rates associated with histopathologic aspects in patients with rheumatoid arthritis?

Abstract The aim of this retrospective cross-sectional study was to verify the association between salivary flow rates (SFR) and the histopathologic aspects of labial salivary glands (LSG) in patients with rheumatoid arthritis (RA). Patients presenting rheumatologic diseases referred for oral evaluation were included in the study if they had RA and had SFR measured and LSG biopsy performed. Patients were excluded if they had systemic conditions that affect SFR or if they were being treated for hyposalivation. Cases without enough material for histopathologic analysis were also excluded. Data were collected through questionnaires, oral examination, resting and stimulated SFR, and LSG biopsies. A histopathologic reevaluation was carried out in order to seek for additional histopathologic aspects. Fifty-one patients met the inclusion criteria. The mean age was 53.5 years (25-77), and 94.1% were women. The median resting and stimulated SFRs were 0.24 mL/min and 1.02 mL/min, respectively. The presence of lymphocytic focus and fibrosis were significantly associated with stimulated SFR, but not with resting SFR. The odds ratio of patients who had hyposalivation for presenting a positive lymphocytic focus was 7.33 (confidence interval CI: 1.53-35.23) by the stimulated technique, and 2.56 (CI: 0.57-11.40) in resting SFR. In the medical records, 14 (31.80%) patients had been diagnosed with secondary Sjögren's syndrome. In conclusion, stimulated SFR represent a good screening test to predict lymphocytic focus in LSG in patients with RA, which represents the most specific test to diagnose Sjögren's syndrome.

O que o Cirurgião-Dentista Precisa Saber Sobre a Doença de Crohn? / What do Dentists Need to Know About Cronh's Disease?

A doença de Crohn é descrita como uma doença inflamatória intestinal de alta complexidade, caracterizando-se por apresentar lesões e inflamações transmurais que podem acometer todo o trato gastrointestinal. A doença de Crohn pode apresentar manifestações bucais, tais como lesões na mucosa, alterações do fluxo salivar e envolvimento periodontal. Para este artigo de revisão, foi realizada uma busca de literatura nas bases de dados PubMed, Scielo e Academic Google, com espaço temporal de 2010 a 2020, utilizando palavras-chaves obtidas de acordo com o descritor em ciência da saúde. Foi encontrado que as lesões bucais estão presentes em cerca de 46,75% dos pacientes jovens e 22% dos pacientes idosos com doença de Crohn, podendo ser bastante incômodas, persistentes e de difícil tratamento. Apresentam-se com diversos aspectos clínicos como: ulcerações lineares ou aftosas, nodularidades da mucosa e aumento de volume labial. Essas lesões estão diretamente relacionadas com a doença, mas algumas lesões podem surgir de forma indireta, como complicação da doença de Crohn ou como efeitos adversos do tratamento. As manifestações bucais podem ser os primeiros sinais da doença de Crohn, logo, o reconhecimento de seus aspectos clínicos pode contribuir para um diagnóstico precoce. Cabe ao cirurgião-dentista reconhecer, diagnosticar e tratar, junto a uma equipe multiprofissional, as manifestações bucais da doença de Crohn, promovendo melhoras no quadro clínico dos pacientes.

Crohn's disease is described as a complex inflammatory bowel disease, characterized by transmural lesions and inflammation that can affect the entire gastrointestinal tract. Crohn's disease can present oral manifestations, such as mucosal lesions, changes in salivary flow rates and periodontal involvement. For this review, a literature search was carried out using PubMed, Scielo and Scholar Google platforms, within the time range from 2010 to 2020, using keywords obtained according to the Health Science Descriptor. We found that oral lesions are present in approximately 46.75% of young patients and 22% of elderly patients with Crohn's disease, which can be uncomfortable, persistent and difficult to treat. They are associated with various clinical aspects such as: linear or aphthous ulcers, mucosal nodularities and increased lip volume. These lesions are directly related to the disease, but some lesions may appear indirectly, as a complication of Crohn's disease or as adverse effects of the treatment. Oral manifestations can be the first signs of Crohn's disease, so the recognition of its clinical aspects can contribute to an early diagnosis. Dentists should be able to recognize, diagnose and treat, along with a multidisciplinary team, the oral manifestations of Crohn's disease, promoting improvements in the patient's clinical condition.

Periodontal management of a patient with chronic kidney disease: a case report

The association between periodontal disease and chronic kidney disease (CKD) has been recognized over the years. Gingival overgrowth may be a side effect of some of the drugs prescribed for patients with CKD. Objective: The objective of this manuscript was to report the dental management of a patient with chronic renal disease who presented periodontitis and gingival overgrowth. Case report: A 55 years old male patient sought dental treatment, and was diagnosed with generalized periodontitis in advanced stage and gingival overgrowth. The overgrowth was associated to the use of amlodipine, a longacting calcium channel blocker. The treatment consisted of interruption of amlodipine, sessions of oral hygiene instruction and basic periodontal therapy. Thereafter, conventional periodontal therapy, with scaling and root planning of the four hemiarches, surgical periodontal therapy and gingivectomy of the overgrowth were performed. Considering periodontal sites with a probing depth (PD) > 4mm at baseline, mean PD was reduced (baseline: 5.94 ± 1.80; follow-up: 2.76 ± 1.38), as well as mean clinical attachment loss (baseline: 5.55 ± 1.51; followup: 4.52 ± 1.47). Periodontal disease was controlled and there was no recurrence of gingival overgrowth after 18 months of follow-up. Conclusion: The management of the reported patient with CKD and periodontal involvement included discontinuation of amlodipine, basic and advanced periodontal therapy and gingivectomy. Proper oral hygiene may help to prevent recurrence of the gingival overgrowth and to maintain periodontal health.

Introdução: A associação entre doença periodontal e doença renal crônica (DRC) tem sido reconhecida nos últimos anos. O crescimento gengival excessivo pode ser um efeito colateral de alguns medicamentos prescritos para pacientes com DRC. Objetivos: O objetivo deste estudo foi relatar o manejo odontológico de um paciente com DRC que apresentava periodontite e aumento gengival. Relato do caso: Um paciente do sexo masculino, 55 anos, procurou atendimento odontológico e foi diagnosticado com periodontite generalizada em estágio avançado e crescimento gengival associado ao uso de anlodipina, um bloqueador dos canais de cálcio de ação prolongada. O tratamento consistiu em interrupção da anlodipina, sessões de instruções de higiene bucal e terapia periodontal básica. Posteriormente, foi realizada terapia periodontal convencional, com raspagem e alisamento radicular dos quatro hemiarcos, seguida de cirurgia periodontal a retalho e gengivectomia. Considerando os sítios periodontais com profundidade de bolsa à sondagem (PBS) > 4mm no início do tratamento, a média de PBS foi reduzida (início: 5,94 ± 1,80; final: 2,76 ± 1,38), bem como a média do nível clínico de inserção (início: 5,55 ± 1,51; final: 4,52 ± 1,47). A doença periodontal foi controlada e não houve recorrência do crescimento gengival após 18 meses de acompanhamento. Conclusão: O tratamento odontológico deste paciente com DRC e envolvimento periodontal incluiu a interrupção da anlodipina, terapia periodontal básica e avançada e gengivectomia. A higiene bucal adequada pode ajudar a prevenir a recorrência do crescimento gengival excessivo e a manutenção de um estado periodontal saudável.

Mapping of supernumerary elements in patients seeking orthodontic treatment

Dimension, number and shape alterations are frequently observed dental anomalies. Objective: The aim of this study was to map the frequency, the preferred location and the most prevalent types of supernumerary teeth, in the studied population. In addition, to assess the interference that supernumerary teeth may cause in the ectopic eruption of the normal dental series teeth. Methods: This is an observational retrospective study. Data collection was performed by evaluation of dental records of patients treated in an orthodontic clinic. Patients' radiographs, photographs and gypsum dental models were analyzed and data recorded in protocol files, by previously trained undergraduate and postgraduate students. Records from 1984 to 2019 were evaluated, and evaluation lasted two months. Data were stored in Microsoft Office Excel (version 2016) for descriptive analysis. Results: From the 920 patients' records analyzed, 2.7% presented at least one supernumerary tooth, with preferred location on the anterior maxillary area and mandibular parapremolar area. The most prevalent type was the supplemental tooth, with normal eruption orientation and normal alveolar location. Conclusion: The supernumerary teeth of the studied population showed little interference in the ectopic eruption of the normal dental series. Most of the supernumerary teeth were impacted, and, approximately one third of the supernumerary teeth showed deviated eruptions.

Introdução: Alterações de dimensão, número e forma são anomalias dentárias comumente observadas. Objetivo: O objetivo foi mapear a frequência de dentes supranumerários na população estudada, sua localização preferida e os tipos mais prevalentes. Além disso, avaliar a interferência que os dentes supranumerários podem causar na erupção ectópica da série dental normal. Métodos: A pesquisa possui desenho retrospectivo observacional. A coleta de dados foi realizada pela avaliação de prontuários odontológicos dos pacientes atendidos em uma clínica ortodôntica. Foram analisados radiografias, fotografias e modelos de gesso dental dos pacientes e as informações foram registradas em arquivos de protocolo do estudo. A coleta de dados foi realizada por uma estudante de graduação e uma da pós-graduação, previamente calibradas. A coleta durou dois meses e foram avaliados registros de 1984 a 2019. Os dados foram tratados no programa Microsoft Office Excel (version 2016) com análise descritiva dos dados. Resultados: Dos 920 prontuários analisados, 2,7% apresentavam pelo menos um dente supranumerário, com localização preferida na área superior anterior e na área parapremolar mandibular. O tipo mais prevalente foi o dente suplementar, com orientação de erupção normal e localização alveolar normal. Conclusão: Os dentes supranumerários da população estudada neste estudo mostraram pouca interferência na erupção ectópica da série dental normal. A maioria dos dentes supranumerários estava em posição de impactação. E, aproximadamente um terço dos dentes supranumerários apresentaram desvios de erupção.

Oral health status of patients with multiple myeloma

ABSTRACT Objective: To describe the oral health status of patients with multiple myeloma and compare to a control group. Materials and methods: The medical history of the studied subjects was obtained from the medical records and through interviews. Trained examiners evaluated the oral mucosa, teeth, periodontium and imaging aspects. The dental status was evaluated by the decayed, missing and filled teeth index. The presence of bone lesions was investigated with cone beam computer tomography images of the jaws. Results: The most common oral mucosa features were paleness (31%) and coated tongue (14.3%) in the multiple myeloma group (N = 42); and coated (21.4%) and fissured tongue (10.7%) in the control group (N = 28). The mean DMFT index of patients with multiple myeloma was high, but not significantly different from controls (14.57 versus 19.69, p = 0.975). Hypodense lesions suggestive of multiple myeloma were observed in the jaws of 73.8% of the patients. Hypodense lesions related to teeth were detected in 33.3% of the patients and in 53.6% of the controls (p = 0.832). Conclusions: The studied population of multiple myeloma patients presented many oral health issues that needed attention. Thus, oral care should be included in the routine treatment to improve the quality of the oral status in these patients.

The frequency of oral conditions detected in hematology inpatients

ABSTRACT Background: Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. Objective: To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. Methods: Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. Results: Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. Conclusion: This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.

Osteoporosis, tooth loss and functional dentition in elderly women: a cross-sectional study

Objectives: The objective of this study was to investigate whether osteoporosis is an indicator of missing teeth and lack of functional dentition in elderly women. Methods: A cross-sectional study involving women aged more than 60 years was performed at the Brazilian's Navy Dental Center (Odontoclínica Central da Marinha) , Rio de Janeiro, Brazil. Demographic data and general health status information of the group were obtained through individual interviews. In addition, the number of natural teeth was recorded in oral examination. Women presenting at least one tooth were divided in groups presenting or not osteoporosis. The number of natural teeth was compared between groups, with adjustment for smoking and diabetes mellitus. The association between functional dentition and osteoporosis was evaluated using odds ratios (ORs) and their respective 95% confidence intervals. Results: Data on oral examination were available for 256 of the 360 elderly women registered in the database. The groups were composed by 55 women with osteoporosis and 201 not presenting osteoporosis. The prevalence of chronic diseases and smoking, was similar between groups. The mean number of teeth for osteoporotic women was significantly lower than in those without this disease (14,69 ± 7,69 versus 18,19 ± 7,20, p= 0.002), remaining significant after adjustment for potential confounders. Women without osteoporosis exhibited greater chance to present functional dentition than those with osteoporosis (OR = 2.10, 95% CI [1.21 to 3.66], p =0.006). Conclusion: Osteoporosis was an indicator for tooth loss and lack of functional dentition in the studied population of elderly women.

Objetivos: O objetivo deste estudo foi investigar se a osteoporose é um indicador de perda dentária e de falta de dentição funcional em idosas. Métodos: Um estudo transversal envolvendo mulheres com mais de 60 anos foi realizado na Odontoclínica Central da Marinha, Rio de Janeiro, Brasil. Dados demográficos e médicos foram obtidos através de entrevistas individuais. Os dentes naturais foram contados no exame oral. Mulheres com um ou mais dentes foram divididas em dois grupos: com e sem osteoporose. O número de dentes naturais foi comparado entre os grupos, com controle para tabagismo e diabetes mellitus. A associação entre a dentição funcional e a osteoporose foi avaliada por meio de odds ratios (OR) e seus respectivos intervalos de confiança de 95%. Resultados: Dentre 360 idosas cadastradas no banco de dados, 256 tinham registro de exame oral. Os grupos foram compostos por 55 mulheres com osteoporose e 201, sem. A prevalência de doenças crônicas e tabagismo foi semelhante entre os grupos. O número médio de dentes para mulheres com osteoporose foi significativamente menor do que as que não tinham a doença (14,69 ± 7,69 versus 18,19 ± 7,20, p = 0,002), permanecendo significativo após o ajuste para possíveis fatores de confundimento. Mulheres sem osteoporose tiveram maior chance de apresentar dentição funcional do que as outras (OR = 2,10, IC 95% [1,21-3,66], p = 0,006). Conclusão: A osteoporose foi um indicador de perda dentária e de ausência de dentição funcional na população estudada.

Can dentists detect multiple myeloma through oral manifestations?

Abstract Objective: To review published data on oral manifestations of multiple myeloma. Methods: An electronic database search was performed of articles published from 1971 to November 2016 in order to identify studies that reported oral manifestations of patients with multiple myeloma. Case reports and case series with oral manifestations of multiple myeloma in English were included in the study. An additional search was performed of the references of the selected articles. Results: Thirty-seven articles that reported 81 patients with oral manifestations of multiple myeloma were selected: 30 case reports (82%) and seven case series (18%). The most common clinical features in the dental cavity were swelling (65.4%), bone pain (33.3%), paresthesia (27.1%) and amyloidosis lesions (11.1%). Osteolytic lesions detected on imaging exams were reported in the majority of the patients (90.1%) as plasmacytomas or 'punched-out' lesions. Conclusions: Swelling and osteolytic lesions represent the most common clinical and radiographic signs of the jaws relating to multiple myeloma, respectively.

Detection of human papillomavirus in dental biofilm and the uterine cervix of a pregnant adolescent / Detecção do papilomavírus humano em biofilme dental e no colo uterino de uma adolescente grávida

CONTEXT: Adolescence and pregnancy are considered to be risk factors for human papillomavirus (HPV) infection. The relationship between this infection in the uterine cervix and oral HPV infection is controversial. CASE REPORT: This report describes a case of a pregnant 16-year-old adolescent who presented HPV infection in the uterine cervix and the mouth. Smears were collected from the cervix and the tongue/palate. Dental biofilm samples were also collected. The microarray technique was used to detect HPV. The HPV 56 subtype was observed in the cervical smear and HPV 6 in dental biofilm. CONCLUSION: In this pregnant adolescent, HPV infection was present in both the cervix and the mouth, but the HPV subtypes infecting these two areas were different.

CONTEXTO: A adolescência e a gestação são consideradas fatores de risco para a infecção pelo papilomavírus humano (HPV). A relação entre essa infecção no colo do útero e na boca num mesmo paciente é controversa. RELATO DE CASO: Descrever o caso de uma adolescente grávida de 16 anos que apresentou a infecção pelo HPV no colo do útero e na boca. Esfregaços foram realizados no colo do útero e em língua/palato. Amostras de biofilme dental também foram coletadas. Para detectar o HPV, foi utilizada a técnica do microarranjo. O HPV 56 foi o subtipo encontrado no esfregaço cervical e o tipo HPV 6 no biofilme dental. CONCLUSÕES: Observamos, nessa adolescente grávida, a presença do HPV na boca e no colo do útero, mas os subtipos virais que infectavam essas duas regiões eram distintos.

Drugs or disease: evaluating salivary function in RA patients

Abstract Oral complications of RA may include temporomandibular joint disorders, mucosa alterations and symptoms of dry mouth. The aim of this study was to evaluate the salivary gland function of subjects with rheumatoid arthritis (RA) comparing it to healthy controls. Subjects with other systemic conditions known to affect salivary functions were excluded. A questionnaire was applied for the evaluation of xerostomia. Resting and chewing-stimulated salivary flow rates (SFR) were obtained under standard conditions. There were 145 subjects included of the study (104 RA and 38 controls). About 66.7% of the RA subjects and 2.4% in control group presented xerostomia. The median resting SFR were 0.24 ml/min for RA subjects and 0.40 mL/min for controls (p = 0.04). The median stimulated SFR were 1.31 mL/min for RA subjects and 1.52 ml/min for controls (p = 0.33). No significant differences were found between resting and stimulated SFR of RA subjects not using xerogenic medications and controls. There was significantly higher number of subjects presenting hyposalivation in the RA group than among controls, even when subjects using xerogenic medications were eliminated from the analysis. In conclusion, hyposalivation and xerostomia were more frequent among RA subjects not using xerogenic medication than among controls, although there were no significant differences in the median SFR between groups.

Early and late oral features of chronic graft-versus-host disease

Background: Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective: The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods: This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results: Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion: Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation. .

O uso do ácido epsilon amino caproico intra-alveolar para o controle do sangramento pós-exodontia em pacientes anticoagulados / The use of epsilon amino caproic acid intraalveolar to control bleeding after extraction in anticoagulated patients

Quando pacientes em uso de anticoagulantes são submetidos a exodontias, há risco de sangramento pós-operatório. A manutenção da terapia anticoagulante tem sido indicada desde que o INR esteja dentro dos níveis terapêuticos. Recursos adicionais para o controle do sangramento, como o uso de ácido épsilon amino capróico (EACA), podem ser adotados. O objetivo deste estudo foi relatar uma série de casos de exodontias seguidas de uso intra-alveolar de EACA, em pacientes em uso de anticoagulantes com INR & # 8804; 3.0. De 25 exodontias, apenas um paciente precisou de intervenção profissional para controlar o sangramento pós-operatório. Os resultados sugerem que o uso de EACA intra-alveolar, associado aos cuidados pós-cirúrgicos de rotina, pode contribuir para a hemostasia em pacientes em uso de anticoagulantes.

When patients on anticoagulants are submitted to dental extractions, there is risk of postoperative bleeding. The maintenance of anticoagulant therapy has been indicate donce the INR is within the therapeutic levels. Additional resources for bleeding control like the use of epsilon amino caproic acid (EACA) may be adopted. The objective of this study was to report a series of cases of tooth extractions followed by the intra-alveolar use of EACA, in patients using anticoagulants with INR ≤ 3.0. From 25 tooth extractions, only one patient needed professional intervention to control postoperative bleeding. The results suggest that the use of intra-alveolar EACA, associated with routine post-surgical care, may contribute to hemostasis in patients using anticoagulants.

Avaliação de aderência dos estudantes de Odontologia em relação ao controle de infecções / Evaluation of infection control adherence in Dental school students

O objetivo deste estudo foi verificar a aderência às normas de controle de infecção pelo corpo discente da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro (FO/UFRJ). Foram aplicados questionários aos alunos com atividades clínicas, abrangendo: proteção pessoal, barreiras, esterilização, desinfecção, descarte de material, atitudes e conhecimentos. Os resultados foram analisados de forma descritiva. A amostra foi de 169 alunos, 31,4% homens e 68,6% mulheres, com média de idade de 22 anos (± 2,18). A maior parte dos procedimentos de controle de infecções foi executada pela maioria dos alunos. Não houve diferença significativa entre os períodos em relação às condutas. A falta de tempo foi apontada como a causa mais frequente para o não cumprimento das normas.

Adenoid hypertrophy and open bite

Aim: To evaluate if the constricted airway passage, measured by the nasopharyngeal (NP) and oropharyngeal (OP) width, has a correlation to anterior open bite. Methods: Lateral cephalometric radiographs of 43 patients with anterior open bite (26 with mixed dentition and 17 with permanent dentition) and 30 patients with overbite (15 with mixed dentition and 15 with permanent dentition) were obtained from de Department of Pediatric Dentistry and Orthodontics of the Federal University of Rio de Janeiro for examination. Eight patients with syndromes were excluded from study. Cephalometric measurements were carried out using Dolphin Imaging & Management SolutionsTM software (Chatsworth, CA, USA). Measures of NP and OP were evaluated according to the McNamara’s soft tissue analysis and were correlated with the presence of open bite or overbite. Student’s t test and chi-square were used to assess statistical differences in continuous and dichotomic variables, respectively. Kruskal-Wallis test was employed to compare multiple variables. Results: Open bite patients showed significant decreased mean NP and OP values compared to overbite patients. Lack of labial seal was observed in all open bite patients. When patients with mixed and permanent dentitions were analyzed separately, the mean NP value was still significantly smaller in the open bite group. However, the mean OP values were smaller in the open bite group in both dentitions analysis, but were not statistically different. Conclusions: All patients with anterior open bite had reduced NP and OP measures compared to overbite patients, in spite of dentition.

Oral events related to low-dose methotrexate in rheumatoid arthritis patients

Low-dose methotrexate (MTX) is frequently used for patients with rheumatoid arthritis (RA). High doses of MTX frequently produce side effects. The aim of this study was to explore oral complications of low-dose MTX therapy in a population of RA patients. This is a cross-sectional study in which oral examination was performed on a population of RA patients. Patients undergoing MTX therapy (5-20 mg weekly) for at least six months were included in the study group, and RA patients being treated under another regimen were used as controls. The frequency of oral lesions was compared between groups. The chi-square test was used to compare frequencies. Relative risk (RR) and its confidence interval (CI) were established. Significance level was set at 0.05. Twenty-eight RA patients on a low-dose MTX regimen and 21 controls were enrolled in the study. Oral lesions were found in 22 patients (78.6 percent) undergoing MTX therapy, and in 5 patients (23.8 percent) undergoing other therapies (p < 0.001). There were no significant differences regarding age, gender or dosage. The most common oral events observed in patients in the MTX group were ulcerative/erosive lesions (60.7 percent) and candidiasis (10.7 percent). Patients in the control group presented lower prevalence of the same lesions (p < 0.001). The RR for developing oral lesions was 11.73 (CI 2.57 - 58.98), with low-dose MTX therapy. In conclusion, the prevalence of oral mucosa lesions in RA patients receiving low doses of MTX therapy is higher than in RA patients not receiving the drug.

Citotoxicidade de soldas ortodônticas à prata / Cytotoxic orthodontic welding of the silver

O objetivo do presente trabalho foi avaliar a citotoxicidade de soldas à prata. Foram avaliadas soldas à prata divididos em 4 grupos assim denominados: AAS (aço com aço sem polimento), AAC (aço com aço com polimento), ALS (aço com latão sem polimento) e ALC (aço com latão com polimento). Previamente, os corpos de prova foram esterilizados em luz ultravioleta (UV). Após isso os mesmos foram imersos em meio mínimo essencial de Eagle (MEM) por 24h, então procedeu-se a remoção do sobrenadante e colocação em contato com fibroblastos L929. Após contato com o meio as células foram incubadas por mais 24 h, então foram adicionados 100ml do corante vermelho neutro a 0,01%. Novamente as células foram incubadas por 3 hs para que as mesmas incorporasse o corante. Passado esse período as células foram fixadas e então realizada contagem de células viáveis em espectrofotômetro (BioTek, Winooski, Vermont, USA) em um comprimento de onda de 492nm (l = 492 nm). Os resultados demonstraram não haver diferenças estatísticas entre os grupos experimentais (AAS, AAC, ALS e ALC) (P>0.05). Diferenças estatísticas foram observadas entre os grupos C+ com os demais assim como o C- e CC com os grupos experimentais (P<0.05). Pode-se concluir com a realização desse trabalho que as soldas à prata são altamente citotoxicas e o polimento diminui sua citotoxicidade.

Traumatic bone cyst?: report of a case diagnosed after orthodontic treatment / Cisto ósseo traumático?: relato de caso diagnosticado após tratamento ortodôntico

Traumatic bone cyst is an uncommon lesion that may be incidentally diagnosed in routine dental treatment. Clinical features may comprehend asymptomatic lesion, with no bone expansion, most commonly located on the posterior mandible area. The lesion affects most often patients on second decade of life. Radiographically traumatic bone cyst it is manifested as a well-defined radiolucent area with a festooned pattern around the apexes of the adjacent teeth. Routine radiographies play an important role in diagnosing this lesion. In most of the cases the diagnosis is confirmed by the finding of an empty cavity during surgical management. Simple exploration of the cyst may be the curative procedure for this lesion. The present study reports a clinic case in which traumatic bone cyst had been diagnosed during final documentation at the end of the orthodontic treatment.

O cisto ósseo traumático é uma condição incomum que pode ser diagnosticada ao acaso em tratamento odontológico de rotina. Os aspectos clínicos envolvem lesão assintomática, sem expansão óssea, mais comumente localizada na região posterior da mandíbula, afetando preferencialmente indivíduos na segunda década de vida. Radiograficamente, o cisto ósseo traumático apresenta uma área radiolúcida bem definida, com padrão festonado ao redor dos ápices dos dentes adjacentes. As radiografias de rotina cumprem papel importante na identificação da lesão. A confirmação do diagnóstico é geralmente confirmada no ato cirúrgico, quando uma cavidade vazia é encontrada. Este relato de caso envolve uma situação clínica em que o cisto ósseo traumático foi diagnosticado a partir da documentação radiográfica ao final de um tratamento ortodôntico.

Manejo do paciente com hipossalivação / Management of hyposalivation patients

Inúmeras alterações sistêmicas, assim como uso de medicamentos poderão levar a um quadro de hipossalivação. Por sua vez, a redução do fluxo salivar propicia desconforto e aumenta a susceptibilidade a processos infecciosos. Para diminuir a morbidade causada pela hipossalivação propõe-se o uso de substitutos salivares e técnicas para o aumento do fluxo salivar, cuja indicação irá depender do fator etiológico e da gravidade da hipossalivação.

Many systemic conditions or impairments as the use of drugs may cause hyposalivation. When saliva is reduced, discomfort and infectious processes may occur as consequences. Salivary substitutes and some techniques for increasing salivary flow rates may be used in order to reduce morbidity from hyposalivation. The type of treatment will rely on the etiologic factors and severity of hyposalivation.

A prospective randomized trial to reduce oral Candida spp. colonization in patients with hyposalivation

Low salivary flow rates are associated with higher oral Candida spp. counts, which may predispose to oral candidiasis. The aim of this study was to compare the effect of stimulating salivary flow rates with that of a regimen of chlorhexidine mouth rinse on the intensity of Candida colonization in patients with reduced salivary flow rates. Thirty-one outpatients were randomized to stimulate salivary output (group 1) or to receive chlorhexidine mouth rinses (group 2). Evaluations were performed at baseline (T0), at end of treatment (T1), and 15 days after last day of treatment (T2). Chewing-stimulated whole saliva samples were collected at each visit. Group 1 showed a constant reduction in median cfu counts, although the difference was significant only between T0 and T2 (p = 0.004). Group 2 showed a reduction in median Candida cfu counts between T0 and T1 (p = 0.01), but the counts increased at T2 (p = 0.01), and the difference between T0 and T2 was not significant (p = 0.8). In conclusion, patients who received salivary stimulation showed reductions of Candida cfu counts in saliva and a trend for increasing salivary flow rates between baseline and end of study evaluations. The use of chlorhexidine mouth rinses dramatically reduced Candida cfu counts, but when patients discontinued treatment, intensity of colonization rose again.

O fluxo salivar reduzido está associado a maior quantidade de Candida spp. na boca, predispondo a candidíase. O objetivo deste estudo foi comparar o efeito da estimulação salivar ao efeito do uso de bochechos de clorexidina sobre a intensidade de colonização por Candida em pacientes com fluxo salivar reduzido. Trinta e um pacientes de ambulatório foram aleatoriamente incluídos nos protocolos de estimulação salivar (grupo 1) ou de bochecho com clorexidina (grupo 2). As avaliações foram realizadas no dia inicial (T0), ao final do tratamento (T1) e 15 dias após o final do tratamento (T2). A cada consulta foram coletadas amostras de saliva total estimulada. O grupo 1 mostrou uma redução constante nas contagens medianas de UFC de Candida, embora a diferença estatística tenha sido apenas entre T0 e T2 (p = 0,004). O grupo 2 mostrou redução nas contagens de UFC de Candida entre T0 e T1 (p = 0,01), mas a contagem de UFC aumentou em T2 (p = 0,01), sendo a diferença entre T0 e T2 não significante (p = 0,8). Concluiu-se que os pacientes que realizaram procedimentos de estimulação salivar apresentaram a quantidade de UFC de Candida salivar reduzida, além de apresentarem tendência ao aumento do fluxo. O uso de bochechos de clorexidina reduziu drasticamente a quantidade de UFC de Candida salivar, mas após o final do tratamento houve novo aumento.