Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

ABSTRACT Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment.

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.

DNMT3B (rs2424913) polymorphism is associated with systemic lupus erythematosus alone and with co-existing periodontitis in a Brazilian population

Abstract The association between Periodontitis and Systemic Lupus Erythematosus (SLE) has been primarily based on their similar pathophysiology and both are associated with genetic polymorphisms. Objectives: To investigate an association between the methylation-related gene polymorphisms DNMT3B (rs2424913) and MTHFR (rs1801133) to Systemic Lupus Erythematosus (SLE) and Periodontitis. Methodology: In total, 196 individuals of all genders aged 24 to 60 years old were allocated into four groups based on their systemic and periodontal status, namely: Healthy control (n=60), periodontitis (n=51), SLE (n=47), and SLE + periodontitis (n=38). Individuals with SLE were stratified according to disease activity (SLEDAI) in inactive or active. We performed polymorphism analysis using PCR-RFLP with genomic DNA from mouthwash. We analyzed data using Fisher's Exact, Chi-square test, and regression models. Results: Periodontal status were similar in subjects with periodontitis alone and combined with SLE. SLE patients with periodontitis had a longer SLE diagnosis than SLE only (p=0.001). For DNMT3 B polymorphism, the periodontitis, SLE, and Inactive SLE + periodontitis groups showed a higher frequency of T allele and TT genotypes compared to healthy controls (p<0.05). Regression analyses showed that the TT genotype is a strong risk factor for periodontitis (OR=4.53; CI95%=1.13-18.05) and also for SLE without periodontitis (OR=11.57; CI95%=3.12-42.84) and SLE with periodontitis (OR=5.27; CI95%=1.25-22.11) when compared to control. Conclusion: SLE patients with periodontitis had a longer length of SLE diagnosis. The DNMT3B (rs2424913) polymorphism was associated with periodontitis and SLE alone or combined with periodontitis. Our study contributes to understanding the genetic mechanisms involved in periodontitis and SLE susceptibility.

ABCG2 polymorphism, age and leukocyte count may contribute to oral mucositis in oncopediatric patients

Abstract The study investigated the relationship between genetic polymorphisms and the development of oral mucositis in pediatric patients undergoing chemotherapy involving methotrexate. A longitudinal study was conducted with 64 patients, and oral mucositis was evaluated by the modified Oral Assessment Guide, which aims to diagnose and classify oral mucositis. Epithelial cells were obtained by mouthwash and DNA was extracted. The polymorphisms MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) and ABCG2 (rs2231142) were analyzed by PCR-RFLP method. Demographic, hematological and biochemical data were collected from medical records. Statistical analysis was performed using the SPSS software adopting a p-value of 0.05. Male sex predominated (56.2%), and the mean age was 10.8 years (± 4.9). Oral mucositis affected 65.6% of the patients, of which 61.9% developed the severe form of the disease. For the ABCG2 gene (rs2231142), the rare A allele and CA genotype were more frequent in individuals with mucositis (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). The severity of the disease was mainly observed in younger patients (median = 9 years; p=0.02). Patients with severe oral mucositis presented lower leukocytes count (median = 2.150 mm3) compared to patients with the mild/moderate form (median = 4.200 mm3; p=0.03). Female patients and each 10,000-platelet increase were protective factors against the onset of oral mucositis (p=0.02). It is concluded that rs2231142 polymorphism increases the likelihood of oral mucositis and younger patients and patients with low leukocytes counts are more likely to develop severe form.

Resumo O presente estudo investigou a relação entre cinco polimorfismos genéticos e o desenvolvimento de mucosite oral em pacientes pediátricos recebendo quimioterapia com metrotexato. O estudo longitudinal foi conduzido com 64 pacientes e a mucosite oral avaliada pelo Oral Assessment Guide modificado, que tem como objetivo diagnosticar e classificar a mucosite oral. Células epiteliais bucais foram obtidas por bochecho e o DNA foi extraído. Os polimorfismos MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) e ABCG2 (rs2231142), foram analisados pela técnica de PCR-RFLP. Dados demográficos, hematológicos e bioquímicos foram coletados a partir de registros médicos. Análise estatística foi realizada utilizando o software SPSS adotando um valor de p=0,05. Observou-se que, o sexo masculino foi predominante (56,2%), e a idade média foi de 10,8 anos (± 4.9). A mucosite oral acometeu 65,6% dos pacientes, dos quais, 61,9% desenvolveram a forma grave da doença. Para o gene ABCG2 (rs2231142), o alelo raro A e o genótipo CA foram mais frequentes em indivíduos com mucosite (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). A gravidade da doença foi observada principalmente em pacientes mais jovens (mediana = 9 anos; p=0.02). Além disso, os pacientes com mucosite oral grave apresentaram menor contagem de leucócitos (mediana = 2150 mm3) em comparação aos pacientes com a forma leve/moderada (mediana = 4200 mm3; p=0.03). Pacientes do sexo feminino e aumento a cada 10.000 plaquetas foram fatores de proteção contra o aparecimento de mucosite oral (p=0.02). Concluiu-se que a presença do polimorfismo rs2231142 aumenta o risco de o paciente desenvolver a mucosite oral, bem como pacientes mais jovens e menor contagem de leucócitos contribui com a severidade.

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Abstract This study aimed to evaluate the factors associated with the occurrence of severe oral mucositis (SOM) in pediatric oncology patients during the chemotherapeutic treatment. This is a nested case-control to a prospective cohort that monitored 105 patients for 10 consecutive weeks after the beginning of the chemotherapy treatment. Logistic regression was used to identify the factors associated with SOM, by group of malignancy (hematologic or solid tumors) (Sig.=5%). To patients with hematologic tumors were found factors associated with SOM in two weeks of treatment: in the 6th week (increase in frequency of chemotherapy doses (OR=3.02)) and in the 7th week (female sex (OR=21.28); and increase in frequency of chemotherapy doses (OR=2.51)); and to patients with solid tumors were found factors associated with SOM in five weeks of treatment: in the 1st week (female sex (OR=14.43); age increase (OR=1.24)); in the 2nd week (Miscellany (OR=6.39)); in the 5th week (Antimetabolites (OR=17.44); Miscellany (OR=45.42); and platelets reduction (OR=1.12)); in the 6th week (creatinine increase (OR=1.63)); and in the 7th week (creatinine increase (OR=2.39)). For patients with hematologic tumors, to be female, and the increase in the frequency of chemotherapy doses increased the risk for SOM and for patients with solid tumors, to be female, the increase in age and in level blood concentration of creatinine, the reduction in number of platelets and the use of chemotherapy with miscellany and antimetabolites agents were associated with an increase in risk for occurrence of SOM.

Resumo Este estudo objetivou avaliar os fatores associados com a ocorrência de mucosite oral grave (SOM) em pacientes pediátricos oncológicos durante o tratamento quimioterápico. Trata-se de um estudo de caso-controle aninhado a uma coorte prospectiva que monitorou 105 pacientes por 10 semanas consecutivas após o início do tratamento quimioterápico. Regressão logística foi utilizada para identificar os fatores associados com a MOG, por grupo de malignidade (tumores hematológicos ou sólidos) (Sig.=5%). Para pacientes com tumores hematológicos foram encontrados fatores associados com a MOG em duas semanas de tratamento: na 6ª semana (aumento na frequência de doses de quimioterapia (OR=3,02)) e na 7ª semana (sexo feminino (OR=21,28); e aumento na frequência de doses de quimioterapia (OR=2,51)); e para pacientes com tumores sólidos foram encontrados fatores associados com MOG em cinco semanas de tratamento: na 1ª semana (sexo feminino (OR=14,43), aumento na idade (OR=1,24)); na 2ª semana (Miscelânea (OR=6,39)); na 5ª semana (Antimetabólitos (OR=17,44); Miscelânea (OR=45,42); e redução de plaquetas (OR=1,12)); na 6ª semana (aumento na creatinina (OR=1,63)); e na 7ª semana (aumento na creatinina (OR=2,39)). Para pacientes com tumores hematológicos, ser do sexo feminino e o aumento na frequência de doses de quimioterapia aumentou o risco para MOG; e, para pacientes com tumors sólidos, ser do sexo feminino, o aumento na idade e nos níveis de concentração sanguínea de creatinina, a redução no número de plaquetas e o uso de quimioterapia com agentes das classes Miscelânea e Antimetabólitos estiveram associados com o aumento no risco para a ocorrência de MOG.

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Abstract Objective: This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment. Methodology: This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases. Results: Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6th until the 10th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors. Conclusion: It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

Occurrence and Severity of Oral Mucositis in Brazilian Pediatric Cancer Patients

Abstract Objective: To determine the occurrence and severity of oral mucositis (OM) and the factors associated with the onset of severe oral mucositis (SOM) in pediatric cancer patients. Material and Methods: This was a longitudinal and prospective study with 85 children and adolescents (aged 0 to 19 years) admitted to the Pediatric Oncology Sector of Napoleão Laureano Hospital between November 2016 and July 2019. The patients' sociodemographic and epidemiological information, as well as hematological and biochemical parameters, were obtained from their medical charts. The oral mucosa of study participants was assessed through the modified Oral Assessment Guide (OAG) at baseline and after the 2nd, 5th and 10th week of antineoplastic treatment. Data were analyzed by Chi-square test to determine the factors associated with the occurrence of SOM (p<0.05). Results: The occurrence of OM was more frequent in the 2nd (60%), 5th (40.9%) and 10th week (43.2%) of antineoplastic treatment. During the follow-up period, SOM was more frequent in the 5th week (34.7%), followed by the 2nd (32.3%) and 10th weeks (29.7%). There was no association between the occurrence of SOM and the patient's age, type of tumor, chemotherapy regimen, and hematological and biochemical parameters. Conclusion: The occurrence of oral mucositis in pediatric cancer patients was significant, especially in the 2nd week of antineoplastic treatment. Severe oral mucositis was more prevalent in the 5th week of treatment and was not associated with any of the study variables.

Aplicabilidade do volume da câmara pulpar para a estimativa de idade em adultos a partir de tomografias computadorizadas de feixe cônico: um estudo piloto / Applicability of the pulp chamber volume for the estimation of age in adults from Cone Beam Computed Tomography: a pilot study

Introdução: A demanda forense de estimativa de idade em indivíduos vivos repercutiu no desenvolvimento de metodologias fundamentadas em recursos imaginológicos, notadamente, a Tomografia Computadorizada de Feixe Cônico (TCFC). Objetivo: Avaliar a aplicabilidade do volume da câmara pulpar para estimar a idade em indivíduos adultos através de imagens de TCFC. Material e Método: Estudo cego e transversal com 26 TCFC, que apresentaram incisivos central e lateral superiores (ICS; ILS), 2º pré-molar superior (2PMS), incisivo lateral (ILI), canino (CI) e 1º pré-molar inferior (1PMI) hígidos. Em cada dente, mediu-se o comprimento dental, pulpar e radicular, e a largura radicular e pulpar em três níveis (junção amelo-cementária (A), meio da raiz (C) e entre as duas anteriores (B)), no plano sagital e coronal. Calculou-se razões entre as medidas pulpares e dentais, procedendo-se à análise de regressão linear (α=5%). Resultados: Das 108 medições, duas demonstraram maior correlação com a idade: comprimento pulpar do ILI, no corte sagital (R2=0,273), e largura pulpar no nível C do 1PMI, no corte coronal (R2=0,289). Obteve-se maior poder de estimativa com a média das razões entre a largura pulpar e dental do ICS e ILS nos três níveis no sentido sagital (R2=0,374), seguido da razão do comprimento polpa/dente do ILI (R2=0,368). Conclusão: As medidas da câmara pulpar em TCFC apresentam aplicabilidade moderada para estimar a idade. O cálculo de razões melhora o poder de estimativa, devendo-se privilegiar os incisivos superiores e o incisivo lateral inferior. Pretende-se aumentar a amostra para realizar validação cruzada das equações geradas

Introduction: The forensic demand of age estimation in living individuals had repercussions on the development of methodologies substantiated on imaging resources, notably, the Cone-beam Computed Tomography (CBCT). Objective: To evaluate the applicability of pulp chamber volume to estimate age in adults individuals through CBCT's images. Material and methods: blind and transverse study with 26 CBCT, that presented maxillary central, lateral incisors and second premolar, and mandibular lateral incisor, canine and first premolar healthy. In each tooth, was measured the dental, pulp and radicular length, and the pulp and radicular width in three levels (enamel-cementum junction (A), middle of the root (C) and between the two previous ones (B)), in the sagittal and coronal plane. Reasons were calculated between pulp and dental measurements, proceeding to linear regression analysis (α=5%). Results: 2 out of 108 measurements demonstrated greater correlation with age: pulp length of mandibular lateral incisor, in sagittal cut (R²=0,273), and pulp width at level C of mandibular first premolar, in coronal cut (R²=0,289). Greater estimative power was obtained with the average between pulp and dental width of maxillary central and lateral incisors in the three levels in sagittal direction (R²=0,374), followed by the reason of dental/pulp length of mandibular lateral incisor (R²=0,368). Conclusion: measurements of pulp chamber in CBCT presented moderate applicability to estimate age. The calculation of the reasons improves the estimation's power, and the maxillary incisors and mandibular lateral incisor should be privileged. It's intended to increase the sample to perform the cross-validation of the equations generated.

Social, Educational and Dental Profiles of Brazilian Patients with Special Needs Attended at a Center for Dental Specialties

Objective: To identify the profiles of patients with special needs attended at a Center for Dental Specialties. Material and Methods: This was a cross-sectional and quantitative study using an inductive approach, and a comparative and statistical procedure for analysis of the patients with special needs. Information concerning socioeconomic, medical and dental conditions was collected. The data were analyzed using IBM SPSS, adopting a significance level of 5%. Results: It was observed that 58.6% of the users were males, single (54.7%), in the age group from 19 to 59 years (41.1%), being 97.4% without schooling. The most frequent clinical diagnoses were: deviations in intelligence (18.4%), behavioral deviations (18.4%) and physical defects (17.9%). We observed for oral health the presence of gingivitis (33.0%), and healthy gums (47.8%); the presence of caries (64.9%), with restored teeth (28.5%), and edentulism (12.3%). Dental intervention procedures were initiated with emphasis on: fluoride applications (39.7%) and subgingival scraping (34.9%). Topical fluoride applications (p=0.010) and prophylaxis (p=0.010) were realized in patients without autism. Also, prophylaxis (p=0.007) was more frequently performed and gingival alterations were more often verified (p=0.020) in patients without Down's syndrome. Conclusion: The users of the patients with special needs dental service can be generally described as male, single, aged between 19 and 54 years, with the special conditions of intelligence and behavioral deviation.

Oral health actions in the primary health care network of northeastern brazil in relation to oral cancer / Ações de saúde frente ao câncer bucal na atenção básica do nordeste brasileiro

ABSTRACT Objective: To describe oral health actions against oral cancer promoted by Primary Health Care Teams in northeastern Brazil. Methods: This is a descriptive and inferential study based on data related to detection, referral, registration, follow-up and documents related to these actions in the External Evaluation of the 1st and 2nd Program for Improving Access and Quality of Primary Care Cycles. Results: Overall, 5,599 and 7,700 teams were evaluated, respectively, in the first and second cycles, with the highest and lowest concentrations in the states of Bahia / Maranhão and Bahia / Sergipe. In all, 58.9% / 79.7% Health Teams conducted campaigns to detect oral lesions and referred suspected cases of oral cancer, and 43.9% / 23% of them recorded and followed suspicious / confirmed cases and only 20.7% / 16.2% had documents proving these records in the respective cycles. There was statistical significance in the comparisons of actions and the evaluation cycles (p ? 0.01). Conclusion: Health teams in northeastern Brazil need to improve actions related to detection, referral, registration, follow-up and verification of oral health documents related to oral cancer.

RESUMO Objetivo: Descrever as ações em saúde bucal frente ao câncer de boca promovidas pelas Equipes de Saúde da Atenção Básica do nordeste brasileiro. Métodos: Estudo descritivo e inferencial a partir de dados referentes à detecção, encaminhamento, registro, acompanhamento e documentos comprovatórios relacionados a estas ações relativos ao 1º e 2º Ciclo de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Os dados foram analisados pelos testes Qui-Quadrado e McNemar (?=0,05). Resultados: Foram avaliadas 5.559 e 7.700 equipes, respectivamente, nos 1º e 2º ciclos, sendo, a maior e menor concentração na Bahia/Maranhão e Bahia/Sergipe. 58,9%/79,7% das Equipes realizam campanhas para detecção de lesões bucais e encaminham os casos suspeitos de câncer de boca. Além disso, 43,9%/23% delas registram e acompanham os casos suspeitos/confirmados e apenas 20,7%/16,2% possuem documentos que comprovem esses registros, nos respectivos ciclos. Houve significância estatística nas comparações das ações e os ciclos de avaliação (p ? 0,01). Conclusão: As Equipes de Saúde na região nordeste necessitam melhorar as ações referentes à detecção, encaminhamento, registro, acompanhamento e documentos comprovatórios em saúde bucal frente ao câncer de boca.

Salivary Flow in Pediatric Cancer Patients Compared to Healthy Children and Adolescents

Abstract Objective: To verify differences between salivary flow in pediatric cancer patients before starting antineoplastic treatment and in healthy pediatric patients. Material and Methods: This is an observational, cross-sectional, paired study with sample of 120 children and adolescents (3-18 years). Thirty pediatric cancer patients were selected for convenience at "Napoleão Laureano" Hospital (G1). Another group was composed of 90 individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, matched by age (G2). Data collection was performed in two steps for both groups. Information regarding pediatric cancer patients was obtained by interview with parents / guardians and searching medical records, while in the other group by interview with parents / guardians. Saliva collection was performed using standard method in both groups: unstimulated salivary flow rate (USFR) being the mean volume expelled in 1 minute. Data were analyzed by the Shapiro-Wilk, Kolmogorov-Smirnov and Mann-Whitney tests (α = 5%) Results: Mean USFR for G1 and G2 was 0.52 mL / min and 0.66 mL / min, respectively (p>0.05) and, in both groups, significant difference was observed (p <0.05) between the mean USFR values of its subgroups, and values of adolescents being higher than those of children Conclusion: There is no difference in unstimulated salivary flow of pediatric cancer patients before starting antineoplastic treatment compared with healthy pediatric patients.

Candida on oral cavity of pediatric individuals with ALL and its susceptibility to nystatin and amphotericin B / Candida na cavidade oral de indivíduos pediátricos com LLA e sua susceptibilidade à nistatina e à anfotericina B

ABSTRACT Objective: The aim of this study was to evaluate the prevalence of Candida colonizationon oral cavity of pediatric individuals with acute lymphocytic leukemia (ALL) and its susceptibility/resistance to nystatin and amphotericin B. Methods: This was a cross sectional study with observational, descriptive and analytic approach. Saliva was collected from40 individuals diagnosed with ALL and from40 healthy subjects, as a comparative group, matched by age and gender with ALL group. The mean age for both groups were 8 years-old. The isolation and identification of the Candidaspecies were performed using the CHROMagarCandidaTM and confirmed by polymerase chain reaction. The samples were subjected to antifungal susceptibility by microdilution assay for nystatin and amphotericin B. Salivary alterations and chemotherapy-induced oralmucositis were evaluated using modifiedOral Assessment Guide. Results: The positivity to Candida was higher inALL individuals (32.5%,13/40)than in a comparative group(2.5%, 1/40) (p<0.001). Candida albicans was the most prevalent strain (86.6%). The mucositis was directly associated with positive Candidacolonization (p=0.017) in the ALL group but not related with salivary alterations (p= 0.479). Six strains of C. albicans (54.5%), on ALL group, were resistant to nystatin and all strains were not susceptible to amphotericin B. Conclusion: Candida colonization was associated with ALL condition and with oral mucositis in these individuals. C. albicans was the prevalent strain and most samples were resistant to antifungal agents tested, nystatin and amphotericin B.

RESUMO Objetivo: o objetivo deste estudo foi avaliar a prevalência e colonização de Candida na cavidade oral de indivíduos pediátricos com leucemia linfocítica aguda (LLA) e sua susceptibilidade/resistência à nistatina e à anfotericina B. Métodos: estudo transversal observacional com abordagem descritiva e analítica. A saliva foi coletada de 40 indivíduos diagnosticados com LLA e de 40 indivíduos saudáveis, como grupo comparativo, combinados por idade e sexo com o grupo LLA. A idade média para ambos os grupos foi de 8 anos de idade. O isolamento e a identificação das espécies de Candida foram realizados utilizando o CHROMagarCandidaTM e confirmados pela reação em cadeia da polimerase. As amostras foram submetidas a susceptibilidade antifúngica por meio de ensaio de microdiluição para nistatina e anfotericina B. As alterações salivares e a mucosite oral induzida por quimioterapia foram avaliadas utilizando o Guia de avaliação modificada. Resultados: A positividade para Candida foi superior aos indivíduos in situ (32,5%, 13/40) do que em um grupo comparativo (2,5%, 1/40) (p <0,001). Candida albicans foi a cepa mais prevalente (86,6%). A mucosite foi diretamente associada à colonização positive por Candida (p = 0,017) no grupo LLA, mas não relacionada com alterações salivares (p = 0,479). Seis estirpes de C. albicans (54,5%), no grupo LLA, eram resistentes à nistatina e todas as cepas não eram suscetíveis à anfotericina B. Conclusão: A colonização por Candida foi associada à condição LLA e à mucosite oral nesses indivíduos. C. albicans era a cepa predominante e a maioria das amostras eram resistentes aos agentes antifúngicos testados, nistatina e anfotericina B.

Profile of patients attended by the speech therapists of the home care service / Perfil dos usuários atendidos pela fonoaudiologia do serviço de atenção domiciliar

ABSTRACT Objective: to ascertain the profile of home care service (HCS) users with speech and language complaints in João Pessoa, Paraíba (PB). Methods: a descriptive and quantitative study using an indirect documentation technique based on an analysis of primary source documents, characterized as a documentary study, conducted at a HCS, in João Pessoa, PB, that stores user information in the form of medical records. All patient records included by the HCS from June 2012 to June 2016 were analyzed. After the eligibility criteria were applied, the sample consisted of 114 medical records. The collected data were entered into a Microsoft Excel spreadsheet to generate descriptive statistics using IBM SPSS (version 21.0). Results: most patients were males (59.6%), elderly (62.3%), had been diagnosed with a stroke (57.9%),had histories of dysphagia (76.3%), speech problems (58.8%), swallowing disorders (80.7%), and abnormal chewing (77.2%). Dysphagia is often associated with stroke, predominantly among males and the elderly. Conclusion difficulty in swallowing, or dysphagia, is often associated with stroke, predominantly in the presence of the sociodemographic and clinical variables associated with men and the elderly.

RESUMO Objetivo: verificar o perfil dos usuários com queixas fonoaudiológicas do serviço de atenção domiciliar do município de João Pessoa, Paraíba. Métodos: trata-se de um estudo transversal, descritivo, natureza quantitativa, mediante técnica de documentação indireta a partir da análise de documentos de fontes primárias, sendo caracterizado, portanto, como estudo documental. A pesquisa foi realizada junto ao serviço de atenção domiciliar (SAD) do município de João Pessoa/PB, que dispõe de informações dos usuários armazenadas em forma de prontuários. Todos os prontuários dos pacientes atendidos pelo SAD no período de junho de 2012 a junho de 2016 foram analisados, e após os critérios de elegibilidade, amostra ficou constituída por 114 prontuários. Os dados coletados foram inseridos em uma planilha do Microsoft Excel para realização de estatística descritiva no Software IBM SPSS (versão 21.0). Resultados: verificou-se que a maioria dos pacientes atendidos foi do sexo masculino (59,6%), idosos (62,3%) e diagnosticados com acidente vascular encefálico (57,9%). Além disso, apresentaram histórico de disfagia (76,3%), problemas de fala (58,8%), deglutição alterada (80,7%) e mastigação alterada (77,2%). A disfagia está frequentemente associada aos AVE's apresentando predomínio de indivíduos do sexo masculino e idosos. Conclusão: concluiu-se que a alteração de dificuldade de deglutição, ou seja, a disfagia está frequentemente associada aos AVE's apresentando o predomínio das variáveis sociodemográficas e clínicas de homens e idosos.

Prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor: estudo controlado / Prevalence of tooth injuries in patients with neuropsychomotor disorder

Introdução: Lesões dentárias por trauma constituem experiências angustiantes em crianças, que promovem alterações tanto físicas quanto emocionais e psicológicas. Objetivo: Avaliar a prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor e comparar a indivíduos normorreativos. Material e método: Avaliaram-se 120 indivíduos, sendo 60 com alterações neuropsicomotoras (grupo de estudo) e 60 normorreativos (grupo controle), de ambos os sexos, de 2 a 15 anos de idade, assistidos na Fundação de Apoio ao Deficiente do Governo do Estado da Paraíba. Os dados foram coletados por meio de questionário estruturado e exame clínico. Foi realizada análise descritiva e inferencial (teste t-student; teste Exato de Fisher), adotando-se um nível de significância de 5%. Resultado: A prevalência de traumatismos dentários observada em pacientes com distúrbio neuropsicomotor foi de 20,0%, enquanto que no grupo controle foi de 16,6% (p>0,05); no grupo controle a ocorrência foi maior no sexo masculino. Os grupos diferiram quanto ao tipo de atividade no momento do trauma (p<0,05) em relação à etiologia (p<0,05) e em relação ao local de ocorrência (p<0,05). Para ambos os grupos, os dentes mais afetados foram os incisivos centrais superiores. As fraturas de esmalte, seguidas pelas de esmalte e dentina sem exposição pulpar foram as lesões mais comuns nos dois grupos. Conclusão: A prevalência de traumatismos dentários em indivíduos com alteração neuropsicomotora é similar à de indivíduos normorreativos, com maior ocorrência no sexo feminino, em fase anterior à adolescência, durante atividades de rotina.

Introduction: Traumatic dental injuries are distressing experiences in children, which promote both physical, emotional and psychological changes. Objective: To evaluate the prevalence of dental trauma in patients with neuropsychomotor disorder and to compare to normoreactive individuals. Material and method: 120 individuals, 60 neuropsychomotor changes (study group) and 60 normorreatives (control group), of both sexes, from 2 to 15 years old, assisted in the Foundation of Support to the Disabled of the Government of the State of Paraíba. Data were collected through a structured questionnaire and clinical examination. Descriptive and inferential analysis (t-student test; Fisher's exact test) was performed, adopting a significance level of 5%. Result: The prevalence of dental trauma observed in patients with neuropsychomotor disorder was 20.0%, whereas in the control group it was 16.6% (p>0.05); in the control group the occurrence was higher in males. The groups differed according to the type of activity at the moment of the trauma (p<0.05) in relation to the etiology (p<0.05), and in relation to the place of occurrence (p<0.05). For both groups, the most affected teeth were the maxillary central incisors. Enamel fractures, followed by enamel and dentin fractures without pulp exposure were the most common lesions in both groups. Conclusion: The prevalence of dental trauma in individuals with neuropsychomotor alterations is similar to that of normorreative individuals, with a higher occurrence in females, in preteen phase, during routine activities.

Predictors for oral cancer in Brazil / Preditores para o câncer oral no Brasil

Introduction: The incidence of lip, oral cavity and oropharynx cancer in Brazil is one of the highest worldwide. Objective: This study aimed to identify predictors for oral cancer in Brazil between 2010 and 2013. Method: Through a time series study in which 14,959 primary head and neck cancer diagnoses were evaluated. The variables of interest were gender, age, race, education level, family history of cancer, alcohol consumption, smoking, and previous cancer diagnosis. The outcome variable was divided into "oral cancer" and "cancer of other head and neck regions." The data were analysed by multiple binary logistic regression; α=5%. Result: The protective factor was: approximately 12 years of education (OR = 0.85). The risk factors were: being an ex-consumer (OR=1.19) or consumer (OR=1.11) of alcohol, tobacco use (OR=1.35) and a prior diagnosis of cancer that went untreated (OR=1.21). Conclusion: Was concluded that the oral cancer had the following predictors compared to other types of head and neck cancer during the same period: approximately 12 years of education (protective factor) and ex-consumer or consumer of alcohol, smoking and previous diagnosis of cancer that went untreated (risk factors).

Introdução: A incidência de câncer de lábio, cavidade bucal e orofaringe no Brasil é uma das maiores do mundo. Objetivo: Este estudo teve como objetivo identificar preditores para o câncer bucal no Brasil entre 2010 e 2013. Método: Mediante um estudo de série temporal em que foram avaliados 14.959 diagnósticos primários de câncer de cabeça e pescoço. As variáveis de interesse foram: gênero, idade, raça, nível de escolaridade, histórico familiar de câncer, consumo de álcool, tabagismo e diagnóstico anterior de câncer. A variável desfecho foi dividida em "câncer de boca" e "câncer de outras regiões de cabeça e pescoço". Os dados foram analisados por regressão logística binária múltipla; α = 5%. Resultado: O fator de proteção foi: ter aproximadamente 12 anos de escolaridade (OR = 0,85). Os fatores de risco foram: ser um ex-consumidor (OR = 1,19) ou consumidor (OR = 1,11) de álcool, tabagismo (OR = 1,35) e o diagnóstico prévio de câncer sem tratamento (OR = 1,21). Conclusão: Concluiu-se que o câncer bucal possui os seguintes preditores em comparação com outros tipos de câncer de cabeça e pescoço durante o mesmo período: ter aproximadamente 12 anos de estudo (fator de proteção) e ser ex-consumidor ou consumidor de álcool, tabagismo e ter tido um diagnóstico prévio de câncer sem tratamento (fatores de risco).

Synovial sarcoma: case report / Sarcoma sinovial: relato de caso

ABSTRACT Introduction: Synovial sarcomas are rare and aggressive neoplasms located in the head and neck region and usually occurs in young adults. Presentation of case: This report presents a case of synovial sarcoma in a 15-year-old male patient who sought medical treatment for painful symptoms and associated dysphagia. The lesion was nodular, extensive, localized in the parotid region, and extended to the left cervical region. The patient was treated in a referral hospital with a treatment protocol that initially included chemotherapy for six months and surgery to attempt to excise the lesion, but the surgery was ineffective because removal could have damaged important vital structures. The Computed Tomography scan showed a hypodense area with diffuse growth and no involvement of the facial bones and the histopathological analysis revealed pleomorphic and oval spindle cells with rounded epithelial cells that formed nests surrounded by fibrous tissue. The Immunohistochemistry analysis was conclusive for the diagnosis of a high-grade SS in the parotid and left cervical regions. The medical team opted for palliative treatment with cervical radiotherapy. The patient remained hospitalized for four months after the surgery and died after 15 months since the diagnosis for compromise of airway by fast tumor growth. Conclusion: The synovial sarcoma, when diagnosed late may reduce the survival of patients because of the complications that tumor growth can bring to the prognosis and quality of life.

RESUMO Sarcomas sinoviais são neoplasias raras e agressivas, localizadas na região da cabeça e pescoço e geralmente ocorrem em adultos jovens. Relato do caso: este relato apresenta um caso de sarcoma sinovial em um paciente de 15 anos que procurou tratamento médico para sintomas dolorosos e associados à disfagia. A lesão era nodular, extensa, localizada na região da parótida e estendida à região cervical esquerda. O paciente foi tratado em um hospital de referência com um protocolo de tratamento que inicialmente incluiu quimioterapia por seis meses e cirurgia para tentar excisar a lesão, mas a cirurgia foi ineficaz porque a total remoção do tumor poderia comprometer estruturas vitais importantes. A tomografia computadorizada mostrou uma área hipodensa com crescimento difuso, sem envolvimento dos ossos faciais, e a análise histopatológica revelou células fusiformes pleomórficas e ovais, com células epiteliais arredondadas formando ninhos rodeados por tecido fibroso. A análise imunohistoquímica foi conclusiva para o diagnóstico de um sarcoma sinovial de alto grau na região cervical parotídea esquerda. A equipe médica optou pelo tratamento paliativo com radioterapia cervical. O paciente permaneceu hospitalizado por quatro meses após a cirurgia e faleceu 15 meses após o diagnóstico, devido à obstrução das vias aéreas pelo rápido crescimento tumoral residual. O sarcoma sinovial, quando diagnosticado tardiamente pode reduzir a sobrevida dos pacientes por causa de complicações que o crescimento do tumor pode trazer para o prognóstico e qualidade de vida.

Clinical and Metabolic Effects of two Periodontal Therapeutic Modalities in Diabetic Patients with Residual Pockets

Objective: To evaluate the metabolic control and compare the clinical effects between non-surgical and surgical therapies on periodontal treatment of residual pockets of type 2 diabetic patients. Material and Methods: 352 periodontal sites in 16 type 2 diabetic subjects with residual pockets of similar depths were randomly selected, whose contralateral quadrants were divided into G1 and G2 undergoing surgical and nonsurgical therapy, respectively, and evaluated 3 and 6 months after the first intervention. The data were analyzed by Statistical Package of Social Science (SPSS) version 20.0, using descriptive and inferential statistical methods. Fisher's exact test was used to verify differences between means obtained in the clinical parameters between G1 and G2. The significance level adopted was 5%. Results: The mean Hb1Ac values of patients were significantly reduced and the mean PD and CIL values were reduced in G1 with no significant difference when compared to G2. Conclusion: Periodontal treatment was effective in metabolic control of type 2 diabetic patients and that both therapies, surgical and non-surgical, behaved similarly when compared.

Motor Alterations Favor the Occurrence of Oral Mucositis in Pediatric Oncology Patients

Objective: To identify the predictive factors for the appearance of oral mucositis (OM) in pediatric oncology patients based on their motor alterations. Material and Methods: This study was an observational, cross-sectional study with 2-19-year-old patients undergoing treatment at the pediatric oncology outpatient service of the Napoleão Laureano Hospital in João Pessoa, Brazil. The convenience sample consisted of 42 patients aged 2 to 19 years with a first diagnosis of cancer and under treatment. The instruments used were a questionnaire with sociodemographic questions - the modified Oral Assessment Guide (OAG) - and some categories of the International Classification of Functioning Disability and Health (CIF), applied by a calibrated examiner (Kappa>0.65). The data were organized in Excel spreadsheet and analyzed descriptively and inferentially using logistic regression (α=5%). Results: Most patients were female (52.4%, n=22), mean age of 11.6 years, median 12.0 years, self-declared as non-white (61.9%, n=26), non-white (66.7%, n=28), family monthly income of up to 2 Brazilian minimum wages (88.1%, n = 37). Most patients presented hematologic neoplasia (54.8%, n=23) with acute lymphoid leukemia (36.6%; n=15) and most of them were subjected to chemotherapy (45.2%; n = 19). OAG identified oral mucositis in a few cases (23.8%, n=10). Logistic regression and odds ratio showed that individuals with moderate and mild difficulty in changing basic body position had, respectively, 19.7 and 30.8 times more chances of developing oral mucositis. In patients with severe motor impairment, this risk is 17.3 times greater and those with mild difficulty in taking care of the bodily parts had an increase of 33.4 times the risk for oral mucositis. Conclusion: The deficit in motor activities increased the chances of developing oral mucositis.

Conhecimento de graduandos em odontologia sobre o processo de esterilização e o monitoramento biológico / Knowledge of undergraduates in dentistry on the sterilization process and biological monitoring

Introdução: O acadêmico de Odontologia, assim como o cirurgião-dentista, têm a obrigação moral, ética e legal com o atendimento aos pacientes, respeitando todos os princípios de forma a evitar infecções cruzadas. Objetivo: Analisar o conhecimento de acadêmicos de odontologia sobre o processo de esterilização e monitoramento biológico. Material e método: Trata-se de um estudo quantitativo, exploratório e descritivo por documentação direta realizado com alunos matriculados no quarto período do curso de Odontologia do Centro Universitário de João Pessoa. Os dados foram coletados mediante aplicação de questionários, tabulados em uma plataforma do microsoft Excel e analisados mediante estatística descritiva no software estatístico IBM SPSS (21.0). Resultados: A maioria dos participantes foram do sexo feminino (71,7%). 76,1% souberam diferenciar uma estufa de uma autoclave, 54,3% não sabiam o que é um artigo crítico, 76,1% não souberam diferenciar artigo crítico, não crítico e semicrítico, 76,1% afirmaram saber como lavar o material corretamente, 67,4% não fazem a desinfecção dos materiais antes de lavá-los e 71,5% usam luvas de látex para a lavagem dos materiais. 34,8% responderam corretamente ao tempo de validade da esterilização de um material (34,8%) e 73,9% têm interesse em capacitação para o correto processo de esterilização. Além disso, 52,2% entendem o que é monitoramento biológico. Conclusão: Os acadêmicos mostraram ter conhecimento e interesse a respeito da temática, porém a aplicação prática ainda encontra-se aquém do preconizado para evitar a contaminação cruzada

Introduction: Students of dentistry, as well as the dentist, have the legal, ethical and moral obligation to the patient care, respecting all principles in order to avoid cross-infection. Objective: To analyze the academic knowledge of dentistry on the sterilization process and biological monitoring. Material and method: This is a quantitative study, exploratory and descriptive by direct documentation conducted with students enrolled in the fourth quarter of the Dentistry course at University Center of João Pessoa. The data were collected through questionnaires, tabulated on a platform of microsoft Excel and analyzed through descriptive statistics in IBM SPSS statistical software (21.0). Results: Most of the participants were female (71.7%). 76.1% knew how to differentiate a stove from an autoclave, 54.3% did not know what is a critical article, 76.1% did not know differentiate a critical article, a not critical and a semi-critical one, 76.1% stated knowing how to wash the material correctly, 67.4% don't make the disinfection of materials before washing them and 71.5% use latex gloves for washing of materials. 34.8% responded correctly to the shelf life of a material sterilization (34.8%) and 73.9% are interested in training for the correct sterilization process. In addition, 52.2% understand what is biological monitoring. Conclusion: Academics showed to have knowledge and interest about the subject, but the practical application is still less than the recommended to avoid cross-contamination

Use of the Chronological Dental Mineralization Table of Nicodemo, Moraes and Medici Filho (1974) to Estimate Age by Undergraduate Dentistry Students

Objective: To evaluate the agreement and applicability of the Chronological Dental Mineralization Table of Nicodemo, Moraes and Medici Filho (1974) to estimate age held by undergraduate Dentistry students at the Federal University of Paraíba. Material and Methods: Field research applied with a sample of 50 students according to inclusion and exclusion criteria. Sequentially, 3 panoramic radiographs were exposed (actual age known only by teachers), and students were instructed to interpret them from the selection of 2-4 teeth under formation. Data were analyzed using SPSS software (Statistical Package for Social Sciences), version 20.0, adopting significance level of 5%. Results: Most students chose 3 teeth, with percentages of 56.0% (n = 28); 38.0% (n = 19) and 58.0% (n = 29) for radiographs 1, 2 and 3, respectively. Teeth selected with greater frequency were: 47 (20.1%, n = 33) and 45 (19.5%, n = 32) - radiography 1; 38 (22.7%, n = 32) and 18 (13.4%, n = 19) - radiography 2; and 47 (17.9%; n = 26) and 36 (13.7%; n = 20) - radiography 3. The agreement between estimated and actual ages was 60.0% for radiography 1, 12.0% for radiography 2 and 32.0% for radiography 3. Age was underestimated in 40.0% (n = 20) and 88.0% (n = 44) in radiographs 1 and 2, respectively. Overestimation of the actual age occurred only in radiography 3 (68.0%; n = 34). The linear regression analysis revealed that it is possible to estimate the actual age from the maximum age stipulated by training students with 88.1% success rate. Conclusion: The method is applicable; however, the correlation between estimated and actual ages varied considerably among radiographs, and maximum estimated values were closer to the actual age than minimum values.