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

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

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

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

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

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

Oral findings in children on liver transplantation programming: a scoping review / Achados odontológicos em crianças em programação para o transplante hepático: revisão de escopo

Abstract Objective: To identify oral characteristics found in children with liver disease in programming for liver transplantation. Data source: The methodology was written according to PRISMA-ScR. We adopted the methodological framework and recommendations for this type of review by Arksey and O'Malley and the Joanna Briggs Institute. The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). A systematic search (Medline/PubMed, Scopus, Web of Science, and ProQuest) was conducted to identify studies that met the inclusion criteria: systematic reviews; prospective clinical trials (parallel or crossover group designs); observational studies (cohort, case-control, and cross-sectional studies); clinical case series; and case reports evaluating children with liver disease in preparation for transplantation. The last search was conducted in July 2021, and no restrictions were imposed as to language or year of publication. Studies presenting mixed data with post-transplant evaluation, and studies evaluating not only liver transplantation but also other solid organs were excluded. Screening, inclusion, and data extraction were performed by two reviewers independently. A narrative synthesis was conducted to describe the findings of the study. Data synthesis: The bibliographic search identified 830 references. A total of 21 articles were read in their entirety after the inclusion criteria assessment. Finally, after evaluating the exclusion criteria, only 3 studies were considered for the qualitative analysis. Conclusions: Children with liver disease in preparation for transplantation may present enamel defects, tooth pigmentation, caries, gingivitis, and opportunistic infections such as candidiasis.

RESUMO Objetivo: Identificar características bucais em crianças hepatopatas em programação para o transplante hepático. Fontes de dados: A metodologia foi descrita de acordo com o PRISMA-ScR. Adotamos a estrutura metodológica e recomendações para este tipo de revisão por Arksey e O'Malley e o Instituto Joanna Briggs. O protocolo foi registrado no Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). Uma pesquisa sistemática (Medline/PubMed, Scopus, Web of Science e ProQuest) foi conduzida para identificar estudos que preenchessem os critérios de inclusão: revisões sistemáticas; ensaios clínicos prospectivos (desenhos de grupos paralelos ou cruzados); estudos observacionais (coorte, caso-controle e estudos transversais); séries de casos clínicos; e relatos de casos que avaliam crianças com doenças hepáticas em preparação para o transplante. A última busca foi conduzida em julho de 2021, e não foram impostas restrições quanto ao idioma ou ano de publicação. Foram excluídos estudos que apresentavam dados mistos com avaliação pós-transplante e estudos que avaliavam não só o transplante de fígado, mas também de outros órgãos sólidos. O rastreio, inclusão e extração de dados foram realizados por dois revisores independentemente. Foi conduzida uma síntese narrativa para identificar os resultados do estudo. Síntese dos dados: A pesquisa bibliográfica identificou 830 referências. Foram lidos 21 artigos na íntegra após avaliação dos critérios de inclusão. Finalmente, após a avaliação dos critérios de exclusão, apenas três estudos foram considerados para análise. Conclusões Crianças com doença hepática em preparação para o transplante podem apresentar defeitos de esmalte, pigmentação dentária, cárie, gengivite além de infecções oportunistas como a candidíase.

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Severe oral mucositis relating to pain and worse oral condition among patients with solid tumors undergoing treatment with FOLFIRI and 5-FU: a retrospective study

ABSTRACT BACKGROUND: There is a need for studies that correlate the severity of oral mucositis (OM) with chemotherapy protocols, transient myelosuppression and oral health. OBJECTIVE: To analyze the severity of OM among individuals with solid tumors during hospitalization and its correlation with the type of chemotherapy, myelosuppression and oral health condition. DESIGN AND SETTING: Retrospective study at a public hospital in Bauru, state of São Paulo, Brazil, that is a regional referral center. METHODS: Individuals diagnosed with solid malignant tumors who received chemotherapy during hospitalization for completion of the antineoplastic treatment cycle or who presented complications resulting from this were assessed. RESULTS: Twenty-eight individuals (24.3%) manifested some degree of OM. The most prevalent degrees of OM according to the World Health Organization (WHO) and modified WHO classification were grades 2 (11.3%) and 5 (4.3%), respectively. It was observed that the higher the OM-WHO (P < 0.001; r = 0.306) and modified OM-WHO (P < 0.001; r = 0.295) classifications were, the greater the oral pain reported by the individuals was. Presence of mucositis in the upper lip and buccal mucosa contributed to increased severity of OM and worsening of swallowing during hospitalization. Thus, severe OM was associated with use of the FOLFIRI protocol (folinic acid, fluorouracil and irinotecan). CONCLUSION: Individuals with tumors who presented severe OM had greater severity of oral pain and worse oral health. Use of the FOLFIRI protocol was associated with higher prevalence of severe OM, while use of 5-fluorouracil (5-FU) was correlated with worse oral condition.

Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Cirurgia Guiada para Instalação de Implantes em Paciente Submetido à Radioterapia em Região de Cabeça e Pescoço / Guided Surgery for Implant Surgery in a Patient Undergoing Radiotherapy in Head and Neck Region / Cirugía Guiada para la Colocación de Implantes en Pacientes Sometidos a Radioterapia en la Región de la Cabeza y el Cuello

Introdução: O uso dos implantes osseointegrados para reabilitação de pacientes com dificuldade de adaptação de próteses convencionais mostra-se mais frequente a cada dia. Um grande grupo candidato à reabilitação com essa modalidade são os pacientes tratados para as neoplasias de cabeça e pescoço (CP). A irradiação na região de CP pode ser limitante para a instalação de implantes, porém a literatura apresenta evidências de técnicas e planejamentos favoráveis ao procedimento nesse grupo de pacientes. As técnicas menos traumáticas para intervenções na cavidade oral devem ser avaliadas, e os guias cirúrgicos para colocação de implantes podem ser aliados nesses procedimentos. Relato do caso: Paciente do sexo feminino, 64 anos, tratada com cirurgia, quimioterapia e radioterapia em cavidade oral para um carcinoma espinocelular (CEC) em língua e, em um segundo momento, diagnosticada e tratada com cirurgia para CEC em região de rebordo alveolar maxilar esquerdo por meio de hemipalatecmia, necessitava de reabilitação com implantes osseointegrados na região onde havia sido tratada com radiação primariamente. Realizou-se a cirurgia de colocação dos implantes com a tecnologia guiada para acarretar o mínimo trauma às estruturas bucais. Conclusão: O procedimento cirúrgico foi executado com sucesso. Atualmente, aguarda-se o período de osseointegração para a posterior reabilitação protética

Introduction: The use of osseointegrated implants for the rehabilitation of patients with difficulty fitting conventional prostheses is becoming more frequent every day. A great eligible group for rehabilitation with this modality are patients treated for head and neck cancer (HNC). Irradiation in the region of HN may be limiting for implants, but there are evidences in the literature of techniques and planning favorable to the procedure in this group of patients. Less traumatic techniques for interventions in the oral cavity should be evaluated, and surgical guides for implant placement may be allies in these procedures. Case report: A 64-year-old female patient, treated with surgery, chemotherapy and radiotherapy in the oral cavity for a squamous cell carcinoma (SCC) in the tongue and, in a second moment, diagnosed and treated with surgery for SCC in the region of the left maxillary alveolar ridge by means of hemipalatectomy, needed rehabilitation with osseointegrated implants in the region where she had been primarily treated with radiation. The implant placement surgery was then planned and performed using guided technology so that minimal trauma to the oral structures could occur. Conclusion: The surgical procedure was successfully performed, and the patient is now waiting for the osseointegration period for posterior prosthetic rehabilitation

Introducción: El uso de implantes osteointegrados para la rehabilitación de pacientes con dificultades de adaptación de las prótesis convencionales es cada vez más frecuente. Un gran grupo de candidatos a la rehabilitación con esta modalidad son los pacientes tratados por neoplasias de cabeza y cuello (CC). La irradiación en la región del CC puede ser limitante para la instalación del implante, sin embargo, la literatura presenta evidencias de técnicas y planificación favorables al procedimiento en este grupo de pacientes. Deben evaluarse técnicas menos traumáticas para las intervenciones en la cavidad oral, y las guías quirúrgicas para la colocación de implantes pueden ser un aliado en estos procedimientos. Caso clínico: Paciente de 64 años, mujer, tratada con cirugía, quimioterapia y radioterapia en la cavidad oral por un carcinoma de células escamosas (CCE) en la lengua y en un segundo momento diagnosticada y tratada con cirugía por CCE en la región de la cresta alveolar maxilar izquierda mediante hemipalatectomía, necesitó rehabilitación con implantes osteointegrados en la región donde había sido tratada principalmente con radiación. La cirugía de colocación de implantes se realizó con tecnología guiada para causar el menor traumatismo en las estructuras orales. Conclusión: La intervención quirúrgica se llevó a cabo con éxito. Actualmente se espera el periodo de osteointegración para la posterior rehabilitación protésica

Poor Oral Health Increases the Physical Pain, Psychological Discomfort and Social Incapacity of Individuals with Oncohaematological Diseases

ABSTRACT: The objective of this study was to evaluate the relationship between oral health status and its impact on quality of life, and to suggest dental management strategies in patients undergoing antineoplastic therapy for onco-hematological diseases. A retrospective study including 33 individuals (age 9-79 yr) was conducted. It was observed that the dimensions related to physical pain, psychological discomfort, and social incapacity had statistically significant values. The most frequently performed dental treatments were periodontal treatment (45.45 %), dental restoration (36.36 %), tooth extractio n (33.33 %), and endodontic treatment (24.24 %). Thus, poor oral health directly affects the quality of life. Dental management should consider the aspects of the disease and antineoplastic treatment while aiming for safe and effective dental care.

RESUMEN: El objetivo de este estudio fue evaluar la relación entre el estado de salud oral y su impacto en la calidad de vida, y sugerir estrategias de manejo odontológico en pacientes sometidos a terapia anti-neoplásica por enfermedades onco-hematológicas. Se realizó un estudio retrospectivo que incluyó a 33 personas (de 9 a 79 años de edad). Se observó que las dimensiones relacionadas con dolor físico, malestar psicológico e incapacidad social tuvieron valores estadísticamente significativos. Los tratamientos dentales realizados con mayor frecuencia fueron el tratamiento periodontal (45,45 %), la restauración dental (36,36 %), la extracción dentaria (33,33 %) y el tratamiento endodóntico (24,24 %). Así, la mala salud oral afecta directamente la calidad de vida. El tratamiento dental debe tener en cuenta los aspectos de la enfermedad y el tratamiento antineoplásico mientras se busca una atención dental segura y eficaz.

Oral Manifestation COVID-19 and the Rapid Resolution of Symptoms Post-Phtalox Treatment: a Case Series

ABSTRACT: The mouth plays a critical role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to the fact that both the tongue and salivary glands are conducive environments for the storage and spread of the virus. This case series aimed to describe the oral manifestations of coronavirus disease (COVID-19) and report the rapid response to Phtalox® treatment in all patients who tested positive for the virus. The patients were grouped based on whether according to convenience as soon as they tested positive for COVID-19. All patients had mouth ulcers and were advised to use 5 mL of Phtalox® mouthwash for 1 min, five times daily, in addition to standard COVID-19 treatment. Complete healing of mouth ulcers occurred in all patients diagnosed with COVID-19, and the mean duration for complete healing was 2.37 days. General improvement of COVID-19 symptoms was also observed. Based on the rapid recovery of mouth ulcers observed, we suggest that Phtalox® is effective as a complementary oral treatment for ulcers associated with COVID-19.

RESUMEN: La cavidad oral juega un papel fundamental en la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) debido al hecho de que tanto la lengua como las glándulas salivales son entornos propicios para el almacenamiento y la propagación del virus. Esta serie de casos tuvo como objetivo describir las manifestaciones orales de la enfermedad por coronavirus (COVID-19) e informar la rápida respuesta al tratamiento con Phtalox® en todos los pacientes que dieron positivo al virus. Los pacientes se agruparon en función de su conveniencia tan pronto como dieron positivo a COVID-19. Todos los pacientes tenían úlceras en la boca y se les recomendó utilizar 5 ml de enjuague oral Phtalox® durante 1 minuto, cinco veces al día, además del tratamiento estándar de COVID-19. La curación completa de las úlceras orales ocurrió en todos los pacientes diagnosticados con COVID-19, y la duración media para la curación completa fue de 2,37 días. También se observó una mejoría general de los síntomas de COVID-19. Con base en la rápida recuperación de las úlceras orales observadas, sugerimos que Phtalox® es eficaz como tratamiento oral complementario para las úlceras asociadas con COVID-19.

Treatment of oral chronic graft-versus-host disease: a retrospective cohort study / Tratamento da doença do enxerto contra hospedeiro crônica oral: um estudo de coorte retrospectivo

ABSTRACT Objective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment. Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only. Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042). Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.

RESUMO Objetivo Avaliar os pacientes com resposta completa da doença do enxerto contra hospedeiro crônica oral ao tratamento com imunossupressor. Métodos Vinte e nove pacientes submetidos ao transplante alogênico de células tronco hematopoiéticas, com doença do enxerto contra hospedeiro crônica oral, foram incluídos neste estudo retrospectivo, de setembro de 2012 a fevereiro de 2018. Os pacientes foram tratados com dexametasona para bochecho associada ao tacrolimo pomada, dexametasona para bochecho associada ao tacrolimo tópico, tratamento imunossupressor sistêmico, e dexametasona tópica apenas. Resultados O tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações usando dexametasona e imunossupressor sistêmico foi de 105, 42 e 42 dias, respectivamente (p=0,013). Quando a dexametasona estava associada ao tacrolimo e a medicação imunossupressora sistêmica, o tempo médio para resposta completa das lesões liquenóides, eritema e ulcerações foi de 91, 84 e 77 dias (p=0,011). Quando foi utilizada apenas dexametasona, o tempo médio para resposta completa das lesões liquenoides, eritema e ulcerações foi de 182, 140 e 21 dias, respectivamente (p=0,042). Conclusão Nosso estudo mostra que as lesões liquenoides requerem mais tempo para cicatrização completa. É notável que as lesões liquenoides tendem a responder melhor ao tratamento da dexametasona combinada com o tacrolimo e o imunossupressor sistêmico. Já o eritema e as ulcerações respondem melhor à dexametasona combinada com medicação imunossupressora sistêmica, e dexametasona apenas, respectivamente.

Use of audiovisual media to enhance patients' knowledge regarding the oral adverse effects of oncology treatment / Uso de mídia audiovisual para aprimorar o conhecimento dos pacientes sobre os efeitos adversos orais do tratamento oncológico

Objetivo: o presente estudo teve como objetivo avaliar a eficácia de alternativas didáticas, como a mídia audiovisual, na transmissão de informações sobre os efeitos adversos orais do tratamento oncológico em pacientes com câncer. Métodos: pacientes oncológicos foram divididos aleatoriamente em dois grupos: grupo controle (n = 40) e grupo audiovisual (n = 36). O grupo controle recebeu informações verbais sobre os efeitos colaterais orais do tratamento do câncer. Por outro lado, o grupo audiovisual recebeu a mesma informação verbal, juntamente com uma apresentação ilustrativa de mídia audiovisual. Além disso, foram aplicados questionários sobre o assunto antes e após a intervenção da equipe odontológica. Resultados: o presente estudo empregou o teste exato de Fisher para análise estatística, e os resultados mostraram similaridade estatística entre os dois grupos (P > 0,05). Ambas as abordagens educacionais alcançaram o objetivo pretendido. Conclusão: um diálogo bem conduzido pode criar uma compreensão adequada entre pacientes com câncer, melhorando a sua adaptação. Opcionalmente, o uso de técnicas inovadoras, como recursos audiovisuais, pode ser uma alternativa acessível e eficiente, que também pode ser usada na educação desses pacientes. Dessa forma, vídeos educacionais podem ser usados para melhorar a compreensão dos pacientes, a adesão a esquemas terapêuticos e a qualidade de vida, além de contribuir para um melhor prognóstico.(AU)

Objective: the present study aimed to evaluate the efficacy of didactic alternatives, namely the audiovisual media, in conveying information regarding the oral adverse effects of oncology treatment in cancer patients. Methods: cancer patients were randomly divided into two groups: control group (n = 40) and audiovisual group (n = 36). The control group received verbal information regarding the oral side effects of cancer treatment. Conversely, the audiovisual group received the same verbal information, along with an illustrative audiovisual media presentation. Additionally, questionnaires on the subject were administered before and after the intervention by the dental team. Results: the current study employed Fisher's exact test for statistical analysis, and the results showed statistical similarity between the two groups (P > 0.05). Both educational approaches achieved the intended objective. Conclusion: a well-conducted dialogue can create adequate awareness among cancer patients and improve adaptation. Optionally, the use of innovative techniques, such as audiovisual resources, was observed to be an accessible and efficient alternative that can also be used in patient education. Therefore, educational videos can be used to improve patients' understanding, adherence to therapeutic regimens, and quality of life and contribute to a better prognosis.(AU)

Laser doppler flowmetry as a method of analysis for the evaluation of chemo - induced oral mucositis: a pilot study / Flujometría por láser doppler como método de análisis para la evaluación de la mucositis oral inducida por quimioterapia: un estudio piloto

Background: Oral mucositis (OM) is an inflammation of the oral mucosa due to cancer therapy that compromises the patient's quality of life. Laser Doppler flowmetry (LDF) is a non-invasive method to monitor microvascular blood flow (BF) in real-time. Purpose: Develop a method to evaluate BF in the genian region cheek in patients undergoing chemotherapy by LDF and compare the degrees of OM and pain with evaluation of BF. Material and methods: Evaluation of OM was performed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales and the visual analog scale for pain evaluation. For flowmetry analysis, a laser Doppler flowmeter (moorVMSTM™, 780 nm wavelength and VP3 probe), fixed by an acrylic resin support was used; VP3 probe was positioned on the genian region and the patient's head was stabilized with a neck pillow for an accurate measurement. The Wilcoxon test was used to compare the flowmetry results at the studied times. The Pearson correlation coefficient was used to evaluate relationships between BF and the WHO, OMAS and visual analog scales. Results: Eleven patients of both sexes, aged between 30 and 78 years, with OM were included. An increase in cutaneous BF was observed at the initial times of OM, with progressive reduction during the chemotherapy cycle. There was a statistical difference (p<0.05) between time point T0 (first consultation) and time point T6 (last consultation). Conclusion: The method developed in this pilot study is effective, reliable, and reproducible, and allows the evaluation of BF dynamics in the genian region using LDF of patients undergoing chemotherapy at risk of developing OM.

Antecedentes: La mucositis oral (MO) es una inflamación de la mucosa oral debido a la terapia del cáncer, que compromete la calidad de vida del paciente. La flujometría láser Doppler (FLD) es un método no invasivo para monitorear el flujo sanguíneo microvascular (FS) en tiempo real. Objetivo: Desarrollar un método para evaluar la FS en la mejilla de la región geniana en pacientes sometidos a quimioterapia por FLD y comparar los grados de MO y dolor con la evaluación del FS. Material y Métodos: La evaluación de la MO se realizó utilizando las escalas de la Organización Mundial de la Salud (OMS) y la Escala de Evaluación de la Mucositis Oral (OMAS) y la escala analógica visual para la evaluación del dolor. Para el análisis de flujometría se utilizó un flujómetro láser Doppler (moorVMSTM™, longitud de onda de 780 nm y sonda VP3), fijado por un soporte de resina acrílica; La sonda VP3 se colocó en la región geniana y la cabeza del paciente se estabilizó con una almohada para el cuello para una medición precisa. Se utilizó la prueba de Wilcoxon para comparar los resultados de la flujometría en los tiempos estudiados. Se utilizó el coeficiente de correlación de Pearson para evaluar las relaciones entre FS y las escalas de la OMS, OMAS y analógicas visuales. Resultados: Se incluyeron 11 pacientes de ambos sexos, con edades comprendidas entre 30 y 78 años, con MO. Se observó un aumento del FS cutáneo en los momentos iniciales de la MO, con reducción progresiva durante el ciclo de quimioterapia. Hubo una diferencia estadística (p<0.05) entre el momento T0 (primera consulta) y el momento T6 (última consulta). Conclusión: El método desarrollado en este estudio piloto es efectivo, confiable y reproducible, y permite evaluar la dinámica del FS en la región geniana utilizando FLD de pacientes sometidos a quimioterapia con riesgo de desarrollar MO.

Impact of temporomandibular disorders on quality of life / O impacto das disfunções temporomandibulares na qualidade de vida / El impacto de las disfunciones temporomandibulares en la calidad de vida

Abstract Introduction: Temporomandibular dysfunction (TMD) may have a major impact on quality of life. Objective: Thus, this integrative review assessed the impact of TMD on quality of life. Method: An electronic and manual search was conducted to identify studies that evaluated the impact of TMD on an individual's quality of life. After the inclusion and exclusion criteria were met, seven articles were included and evaluated according to the quality of evidence using the Newcastle-Ottawa assessment. Results: The selected studies used different instruments to diagnose temporomandibular joint disorders and measure the quality of life. Only three studies used the RDC/TMD. As for quality of life, the most used instrument was the SF-36, followed by Br-MPQ and WHOQOL-Bref. Conclusion: The findings show that there is a negative impact of temporomandibular dysfunction on quality of life, especially regarding its severity. However, further studies are needed to confirm these results.

Resumo Introdução: A disfunção temporomandibular (DTM) pode ter um grande impacto na qualidade de vida das pessoas. Objetivo: Esta revisão integrativa avaliou o impacto da DTM na qualidade de vida da população. Método: Uma busca eletrônica e manual foi realizada para identificar estudos que avaliaram o impacto da DTM na qualidade de vida. Após os critérios de inclusão e exclusão serem estabelecidos, seis artigos foram incluídos e avaliados de acordo com a qualidade de evidências utilizando o Newcastle-Ottawa. Resultados: Os estudos selecionados utilizaram instrumentos distintos para diagnóstico da DTM e da mensuração da qualidade de vida. Os instrumentos de diagnóstico de DTM foram o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), índice Anamnético de Fonseca, índice de Helkimo e índice Anamnético de Fonseca juntamente com RDC/TMD. Quanto à qualidade de vida, o instrumento mais utilizado foi o SF-36, seguido de Br-MPQ e WHOQOL-Bref. Conclusão: Os achados mostram que existe um impacto negativo da DTM na qualidade de vida, principalmente quanto a sua gravidade. Entretanto, futuras pesquisas são necessárias para confirmar esses resultados.

Resumen Introducción: La disfunción temporomandibular (DTM) puede tener un gran impacto en la calidad de vida de las personas. Objetivo: Esta revisión integrativa evaluó el impacto de la DTM en la calidad de vida de la población. Método: Se realizó una búsqueda electrónica y manual para encontrar estudios que evalúen el impacto de la DTM en la calidad de vida. Después de establecer los criterios de inclusión y exclusión, seis artículos fueron incluidos y evaluados según la calidad de evidencias utilizando la escala Newcastle - Ottawa. Resultados: Los estudios seleccionados utilizaron diversos instrumentos para el diagnóstico de la DTM y para medir la calidad de vida. Los instrumentos de diagnóstico de la DTM fueron Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), índice Anamnésico simplificado de Fonseca, índice de Helkimo e índice Anamnésico simplificado de Fonseca con RDC/TMD. Respecto a la calidad de vida, el instrumento más utilizado fue el SF-36, seguido de Br-MPQ y WHOQOL-Bref. Conclusión: Los resultados mostraron que existe un impacto negativo de la disfunción temporomandibular en la calidad de vida, principalmente respecto a su gravedad. No obstante, futuras investigaciones son necesarias para confirmar esos resultados.

Delayed alveolar bone repair and osteonecrosis associated with Zoledronic Acid therapy in rats: macroscopic, microscopic and molecular analysis

Abstract Objective This study aims to evaluate bone repair and the development of the medication related osteonecrosis of the jaw (MRONJ) associated with the use of zoledronic acid in Wistar rats. Methodology 48 male Wistar rats were divided into four groups: ZA, treated with intraperitoneal zoledronic acid, 0.6 mg/kg every 28 days, totaling five doses; control (C), treated with 0.9% sodium chloride; ZA-surgical (SZA) and C-surgical (SC), submitted to extraction of the right upper molars 45 days after the first application. Alveolar bone repair was evaluated by macroscopic and histological analysis. Protein expression evaluations were performed by qPCR. Results Macroscopic evaluation showed that 91.66% (11) of the animals in the SZA group and 41.66% (5) from the SC group presented solution of epithelium continuity (P<0.05). All animals in the SZA group and none in the SC group had bone sequestration. The area of osteonecrosis was higher in the SZA group than in the SC group (P<0.05). In molecular evaluation, the SZA group presented changes in the expression of markers for osteoclasts, with increased RANK and RANKL, and a decrease in OPG. Conclusion The results highlighted strong and evident interference of zoledronic acid in bone repair of the socket, causing osteonecrosis and delayed bone remodeling.

Sclerotherapy as an esthetic indication in oral vascular malformations: a case series

Abstract Background The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. Objectives To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. Methods A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. Results A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. Study limitation Small sample size. Conclusions Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n = 16).