Interleukin-17 plays a role in dental pulp inflammation mediated by zoledronic acid: a mechanism unrelated to the Th17 immune response?

Abstract Objective To evaluate the influence of RORγT inhibition by digoxin on inflammatory changes related to interleukin-17 (IL-17) in the pulp of rats treated with zoledronate (ZOL). Methodology Forty male Wistar rats were divided into a negative control group (NCG) treated with saline solution, a positive control group (PCG) treated with ZOL (0.20 mg/kg), and three groups treated with ZOL and co-treated with digoxin 1, 2, or 4 mg/kg (DG1, 2, and 4). After four intravenous administrations of ZOL or saline solution in a 70-day protocol, the right molars were evaluated by histomorphometry (number of blood vessels, blood vessels/µm2, cells/µm2, total blood vessel area, and average blood vessel area) and immunohistochemistry (IL-17, TNF-α, IL-6, and TGF-β). The Kruskal-Wallis/Dunn test was used for statistical analysis. Results PCG showed an increase in total blood vessel area (p=0.008) and average blood vessel area (p=0.014), and digoxin treatment reversed these changes. DG4 showed a reduction in blood vessels/µm2 (p<0.001). In PCG odontoblasts, there was an increase in IL-17 (p=0.002) and TNF-α (p=0.002) immunostaining, and in DG4, these changes were reversed. Odontoblasts in the digoxin-treated groups also showed an increase in IL-6 immunostaining (p<0.001) and a reduction in TGF-β immunostaining (p=0.002), and all ZOL-treated groups showed an increase in IL-17 (p=0.011) and TNF-α (p=0.017) in non-odontoblasts cells. Conclusion ZOL induces TNF-α- and IL-17-dependent vasodilation and ectasia, and the classical Th17 response activation pathway does not seem to participate in this process.

Intraoral device for sociodigital inclusion of patient with quadriplegia / Dispositivo intraoral para inclusão sócio-digital de paciente com tetraplegia

Introduction: The use of computers, tablets, and cell phones with the Internet by people with quadriplegia from spinal cord injuries is much lower when compared to the general population. The quality of life of these people can be substantially improved through access to these technologies, which would allow a quadriplegic to take advantage of the rapid evolution of information and communication. Many of these individuals have the function of preserved neck and mouth muscles, and it is possible to manipulate intraoral devices as an adaptation tool. Case Report: We report an intraoral device installation in a patient with quadriplegia, a victim of a firearm accident, who had a great desire to reuse the tablet for internet access. A device made of acrylic resin, similar to a myorelaxant plate, was designed to allow the use of a computer that was comfortable and at the same time, the patient could talk and not harm the dental structures. The person responsible agreed to participate in the research and signed the consent form. In addition, the work was submitted to an ethics committee. Considerations: The ideal intra-oral device for patient rehabilitation should be inexpensive, easy to adapt and promote muscle relaxation besides allowing the patient to expand their abilities and digitally increase their autonomy for society.

Introdução: O uso de computadores, tablets e celulares com internet por pessoas com tetraplegia por lesão medular é muito menor quando comparado à população geral. A qualidade de vida dessas pessoas pode ser, substancialmente, melhorada por meio do acesso a essas tecnologias, o que permitiria aos tetraplégicos aproveitar a rápida evolução da informação e da comunicação. Muitos desses indivíduos têm a função de músculos cervicais e bucais preservados, sendo possível a manipulação de dispositivos intraorais como ferramenta de adaptação. Relato de Caso: Relatamos a instalação de um dispositivo intraoral em um paciente com tetraplegia, vítima de acidente com arma de fogo, que tinha grande desejo de reutilizar o tablet para acesso à internet. Um dispositivo feito de resina acrílica, semelhante a uma placa miorrelaxante, foi projetado para permitir o uso de um computador que fosse confortável e, ao mesmo tempo, o paciente pudesse falar e não prejudicar as estruturas dentárias. O responsável concordou em participar da pesquisa e assinou o termo de consentimento. Além disso, o trabalho foi submetido a um comitê de ética. Considerações: O dispositivo intraoral ideal para a reabilitação do paciente deve ser barato, de fácil adaptação e promover o relaxamento muscular, além de permitir que o paciente amplie suas habilidades e aumente sua autonomia pessoal, digitalmente para a sociedade.

Development and professional validation of an App to support Oral Cancer Screening

Abstract The objective of this study was to develop and validate an App for identifying risk factors for oral cancer. To this end, we developed an App (OCS: Oral Cancer Screening) with predictors of Oral Cancer (OC) and algorithm assembly to estimate the risk of its development. Methodology: Simulated clinical cases were designed so that 40 professionals with expertise in oral diagnostics could validate the algorithm and test its usability (SUS: System Usability Score) and acceptability (TAM: Technology Acceptance Model). Cronbach's alpha coefficient, Friedman/Dunn tests, and Spearman correlation evaluated the SUS and TAM scales. ROC curve was plotted to estimate the cutoff point of the algorithm in suggesting a high risk for OCS of the simulated cases. Chi-square and Fisher's exact tests were additionally used (p<0.05, SPSS v20.0). Results: Professionals with expertise in oral diagnosis had usability of 84.63±10.66 and acceptability of 84.75±10.62, which correlated positively (p<0.001, r=0.647). Acting in clinical areas of dentistry (p=0.034) and history of performing OC risk factor orientation (p=0.048) increased acceptability while acting in higher education increased usability (p=0.011). The cutoff point suggested by the App after validation of the simulated clinical cases showed high sensitivity of 84.8% and lower specificity of 58.4%. Conclusion: The OCS was effective and with adequate sensitivity, usability, and acceptability and may contribute to the detection of early oral lesions.

Resumo O objetivo deste estudo foi desenvolver e validar um aplicativo para identificação de fatores de risco para câncer bucal. Para tanto, desenvolvemos um aplicativo (OCS: Oral Cancer Screening) com preditores de Câncer Oral (CO) e montagem de algoritmo para estimar o risco de seu desenvolvimento. Metodologia: Casos clínicos simulados foram projetados para que 40 profissionais com expertise em diagnóstico oral pudessem validar o algoritmo e testar sua usabilidade (SUS: System Usabilidade Score) e aceitabilidade (TAM: Technology Acceptance Model). O coeficiente alfa de Cronbach, os testes de Friedman/Dunn e a correlação de Spearman avaliaram as escalas SUS e TAM. A curva ROC foi traçada para estimar o ponto de corte do algoritmo ao sugerir um alto risco para OCS dos casos simulados. Os testes do qui-quadrado e exato de Fisher foram usados adicionalmente (p<0,05, SPSS v20.0). Resultados: Profissionais com expertise em diagnóstico oral tiveram usabilidade de 84,63±10,66 e aceitabilidade de 84,75±10,62, que se correlacionaram positivamente (p<0,001, r=0,647). Atuar em áreas clínicas da odontologia (p=0,034) e histórico de realização de CO orientação de fator de risco (p=0,048) aumentaram a aceitabilidade enquanto atuar no ensino superior aumentou a usabilidade (p=0,011). O ponto de corte sugerido pelo App após validação dos casos clínicos simulados apresentou alta sensibilidade de 84,8% e baixa especificidade de 58,4%. Conclusão: O OCS foi eficaz e com sensibilidade, usabilidade e aceitabilidade adequadas e pode contribuir para a detecção de lesões orais precoces.

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients / Fatores prognósticos e sobrevida global em um seguimento de 15 anos de pacientes com tumores malignos da glândula salivar: uma análise retrospectiva de 193 pacientes

Abstract Introduction Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Resumo Introdução Os tumores malignos das glândulas salivares são entidades patológicas incomuns, representam menos de 5% das neoplasias de cabeça e pescoço. O prognóstico dos pacientes com tumores malignos das glândulas salivares é altamente variável e alguns fatores clínicos podem influenciar significativamente a sobrevida global. Objetivo Analisar as características clinicopatológicas e sociodemográficas que influenciam a sobrevida em pacientes com tumores malignos das glândulas salivares. Método Este estudo retrospectivo analisou sexo, idade, etnia, nível de escolaridade, localização do tumor, tamanho do tumor, envolvimento linfonodal, metástase distante, margens, tipo de tratamento, estado civil, método de acesso à assistência médica e sobrevida global em 15 anos de 193 pacientes com tumores malignos das glândulas salivares. Foram usados os testes X2, log-rank Mantel-Cox, regressão multinomial e regressão logística de Cox (SPSS 20.0, p < 0,05). Resultados Os tipos histológicos mais comuns foram adenocarcinoma (32,1%), carcinoma adenoide cístico (31,1%) e carcinoma mucoepidermoide (18,7%). A taxa de sobrevida global em 15 anos foi de 67,4%, com média de 116 ± 6 meses. A análise univariada revelou que sexo masculino (p = 0,026), idade > 50 anos (p = 0,001), origem de referência do sistema público de saúde (p = 0,011), estádio T (p = 0,007), estádio M (p < 0,001)), estágio clínico (p < 0,001), margens cirúrgicas comprometidas (p = 0,013) e quimioterapia (p < 0,001) foram associados a um prognóstico ruim. As análises multivariadas também mostraram que a idade > 50 anos foi associada independentemente a um prognóstico ruim (p = 0,016). O nível de escolaridade foi o único fator mais prevalente em pacientes idosos (p = 0,011). Conclusão Pacientes com tumores malignos das glândulas salivares acima de 50 anos apresentam pior prognóstico e associação independente com baixo nível de escolaridade.

Analysis of a Brazilian cross-cultural adaptation of the FACE-Q SFAOS in facial harmonization in dentistry

Abstract: The FACE-Q SFAOS is an instrument developed for esthetic facial procedures and has been validated in patients undergoing rhinoplasty. It consists of ten items that assess the current perception of facial appearance regarding symmetry, harmony, proportion, freshness or vitality, and self-perception of appearance; these items are perhaps important to guide demands in orofacial harmonization (OFH). We aimed to validate the FACE-Q SFAOS scale among professionals working with OFH and verify its acceptance for use in clinical practice. Altogether, 25 OFH specialists were included to evaluate the FACE-Q SFAOS scale and the new technology acceptability model (TAM). Internal validity was measured using Cronbach's α coefficient. Both scales were associated with clinical experience and perceived usefulness using Spearman's correlation and Fisher's exact or chi-square tests (SPSS 20.0, p < 0.05). The FACE-Q SFAOS (α = 0.927) and TAM (α = 0.941) scales demonstrated good internal validity, and most professionals demonstrated good acceptance (TAM >70 = 64%). The mean FACE-Q SFAOS and TAM scores were 64.00±17.03 and 74.60±20.66, respectively. Practitioners with more than two years of experience (p=0.032) who believed the scale was useful for lip filler evaluation (p = 0.017) demonstrated greater acceptance. The number of indications on the scale was directly correlated with higher levels of acceptance (p = 0.002, r = 0.594). Thus, the FACE-Q SFAOS scale has good reproducibility and acceptance among OFH specialists; however, acceptability was shown to be dependent on perceived usability.

Radiographic evaluation of dental anomalies in patients with congenital Zika virus syndrome

Abstract: Numerous studies have reported abnormalities in the development of oral structures in congenital infections that also involve microcephaly. In this context, it is necessary to identify possible dental anomalies of shape and/or number in patients with Zika virus syndrome using radiography. The study population consisted of 35 children born with congenital ZIKV who underwent intraoral radiographic examinations for 24 consecutive months. A modified periapical technique was performed in an occlusal position for the maxilla and mandible. Categorical data were expressed as absolute and percentage frequencies and compared using Pearson's Chi-square test, with a 95% confidence interval. Of the entire sample, eight children (22.8%) had dental anomalies of shape and/or number, and four children (11.4%) presented with both anomalies, with agenesis of the upper and lower deciduous/permanent incisors and dental form modifications, such as microdontia and anomalous cusps. When we considered age and sex, there was no statistically significant difference between patients who presented with agenesis and those who presented with modifications. Children with congenital Zika virus syndrome were more likely to have dental modifications in the number and shape of their teeth, and it is essential to implement medium- to long-term monitoring to diagnose other possible alterations throughout the development of the mixed and permanent dentition, favoring their treatment.

Influence of preoperative hospital stay in the antimicrobial resistance profile of oral microbiotic / Influência do tempo de permanência hospitalar pré-operatória no perfil de resistência a antimicrobianos da Microbiota oral

Objective: Verify whether there was a relationship between the occurrence of multidrug-resistant bacterial strains and the length of stay in the preoperative period. Methods: Clinical samples of the oral surfaces of the teeth and/or cheek mucosa were collected in the oral cavity of 37 patients who underwent elective cardiac surgery in the preoperative period from May to July 2019. The clinical samples collected were subjected to identification of colonies and antimicrobial sensitivity tests. Results: We observed that the patients who stayed for more than 60 days in that hospital had 17 times more likely to develop multi-resistant strains (Multi-Rs) than those that have not remained. Conclusions: We realized that the longer the patient stays in the hospital, the greater the chances of bacterial strains Multi-Rs. Therefore, it is important to try to reduce the length of hospital stay so that there is no increase in the occurrence of multiresistant strains in these patients

Objetivo: Verificar se houve relação entre a ocorrência de cepas bacterianas multirresistentes e o tempo de internação no pré-operatório. Métodos: Amostras clínicas das superfícies orais dos dentes e / ou mucosa jugal foram coletadas na cavidade oral de 37 pacientes submetidos à cirurgia cardíaca eletiva no período pré-operatório de maio a julho de 2019. As amostras clínicas coletadas foram submetidas à identificação de colônias e testes de sensibilidade antimicrobiana. Resultados: Observamos que os pacientes que permaneceram por mais de 60 dias naquele hospital tiveram 17 vezes mais chance de desenvolver cepas multirresistentes (Multi-Rs) do que os que não permaneceram. Conclusões: Percebemos que quanto mais tempo o paciente permanece internado, maiores são as chances de cepas bacterianas Multi-Rs. Portanto, é importante tentar reduzir o tempo de internação hospitalar para que não haja aumento na ocorrência de cepas multirresistentes nesses pacientes.

Distance education in dentistry in Brazil: a critical STROBE-based analysis

Abstract The COVID-19 pandemic has forced dentistry schools (DSs) to adapt their teaching techniques to digital platforms. Therefore, we aimed to evaluate distance classes in the Brazilian DS curriculum. After an online search of higher education institutions (HEIs) with DS on the e-Ministry of Education (MEC) platform, we included institutions with at least one graduated class to extract the age/localization of the DS, funding, number of authorized seats, MEC-grade, ENADE-score, and workload. HEIs' webpages were consulted to identify the curriculum, subjects offered in the distance education (DE) format, extracurricular programs, scientific events, postgraduate programs, and institutional YouTube channels. Chi-square/Fisher's tests plus binary logistic regression were performed (SPSS 20.0, p < 0.05). Of the 241 DSs evaluated, 82 (34.0%) offered distance classes, and a high prevalence was observed in the southeast region (p <0.001) and private HEIs (p = 0.001). HEIs with distance classes had lower ENADE scores (p = 0.004), lower workload (p = 0.007), and higher workload for optional subjects (p = 0.016), doctoral programs (p = 0.041), specialization courses (p = 0.017), and institutional YouTube channels (p < 0.001). Southern dental schools (p < 0.001), lower workload (p = 0.022), optional subjects (p = 0.033), and institutional YouTube channels (p = 0.005) were independently associated with distance classes. In one-third of the Brazilian DSs, distance classes and institutional YouTube channels were strongly associated variables. The association of distance learning with lower workload and low academic performance draws attention to the need for regulatory bodies for controlling the quality of DE.

Histórico de Consumo de Álcool como Fator Preditivo de Sobrevida em Pacientes com Carcinoma de Células Escamosas de Boca e Orofaringe: Follow-up de 15 Anos / Alcohol Consumption History as a Predictive Factor of Survival in Patients with Mouth and Oropharyngeal Squamous Cell Carcinoma: Follow-up of 15 Years / Historia del Consumo de Alcohol como Factor Predictivo para la Supervivencia en Pacientes con Carcinoma de Células Escamosas Bucales y Orofaríngeas: Seguimiento de 15 Años

Introdução: O carcinoma de células escamosas é o tumor de maior importância na região de cabeça e pescoço, em razão da sua incidência e mortalidade. Sabe-se que fatores como consumo de álcool estão relacionados à diminuição da sobrevida de tumores tanto estimulando a progressão tumoral como causando comorbidades importantes, sendo um fator relevante para estudo. Objetivo: Avaliar a influência do histórico de álcool em características clinicoprognósticas de pacientes com carcinoma de células escamosas de boca e orofaringe (CCEBO). Método: Estudo de coorte, retrospectivo, no qual 156 prontuários de pacientes etilistas e 78 prontuários de pacientes não etilistas com CCEBO diagnosticados no Hospital Haroldo Juaçaba, em Fortaleza, Ceará, foram avaliados, entre 2000 e 2014, para análise de dados como idade, sexo, raça, localização do tumor, estadiamento TNM, tratamentos realizados e sobrevida em 15 anos por meio dos testes X², Long-Rank e modelos de regressão multinomial e de Cox (SPSS 20,0; p<0,05). Resultados: Houve maior prevalência de homens entre os pacientes etilistas (p<0,001), com tumores T3-T4 (p=0,003), linfonodos positivos (p=0,006) que realizaram tratamentos paliativos (p<0,001) e menor prevalência abaixo de 65 anos (p<0,001), quando havia histórico familiar de câncer (p=0,043). A sobrevida dos pacientes etilistas foi menor (p=0,040) e os fatores que diminuíram a sobrevida de maneira independente foram sexo masculino (p=0,042), estadiamento T3-T4 (p=0,004), metástase linfonodal (p=0,012), idade >65 anos (p=0,035) e localização na língua (p=0,042). O sexo masculino foi independentemente associado ao etilismo (p<0,001). Conclusão: O álcool é um fator de prognóstico em pacientes com CCEBO, mostrando maior prevalência em pacientes T3-T4 e, assim, influenciando negativamente no prognóstico.

Introduction: Squamous cell carcinoma is the most important tumor in the head and neck region, due to its incidence and mortality. It is known that factors as alcohol consumption are related to the decrease of the survival of tumors, either stimulating tumor progression or causing considerable comorbidities, being an important study factor. Objective: Evaluate the influence of alcohol history on clinical and prognostic characteristics of patients with mouth oropharynx squamous cell carcinoma (MOSCC). Method: A retrospective cohort study in which 156 charts of alcoholic patients and 78 medical charts of non-alcoholic patients with MOSCC diagnosed at Haroldo Juaçaba Hospital in Fortaleza, state of Ceará were evaluated between 2000 and 2014 for data analysis such as age, gender and race, tumor location, TNM staging, treatments performed and 15-year survival through X², Long-Rank and Cox and multinomial regression models (SPSS 20.0; p <0.05). Results: Men were more prevalent among alcoholic patients (p <0.001), with T3/4 tumors (p = 0.003), positive lymph nodes (p = 0.006) who submitted to palliative treatments (p<0.001) and lower prevalence under 65 years (p <0.001), when there was a family history of cancer (p = 0.043). The survival of alcoholic patients was lower (p = 0.040) and the factors that independently reduced survival were male sex (p = 0.042), T3-T4 staging (p = 0.004), lymph node metastasis (p = 0.012), age> 65 years (p = 0.035) and tumor in the tongue (p = 0.042). Male sex was independently associated with alcohol consumption (p<0.001). Conclusion: Alcohol is a prognostic factor in patients with MOSCC, showing a higher prevalence in T3-T4 patients and, thus, negatively influencing the prognosis.

Introducción: El carcinoma de células escamosas es el tumor de mayor importancia en la región de cabeza y cuello, debido a su incidencia y mortalidad. Se sabe que factores como el consumo de alcohol están relacionado con la disminución de la supervivencia de tumores tanto estimulando la progresión tumoral, como provocando comorbilidades considerables, siendo un factor de estudio importante. Objetivo: Evaluar la influencia del historial del consumo de alcohol en las características clínicas-pronósticas de pacientes con carcinoma de células escamosas oral y orofaringe (CCEOO). Método: Estudio retrospectivo en el que se evaluaron 156 registros médicos de pacientes consumidores de alcohol y 78 de pacientes no alcohólicos con CCEOO diagnosticados en el Hospital Haroldo Juaçaba, en Fortaleza, Ceará, entre 2000 y 2014, para el análisis de datos como edad, sexo raza, escolaridad, los antecedentes familiares, vínculo matrimonial, registro en el servicio, ubicación del tumor, clasificación de TNM, los tratamientos realizados y la supervivencia durante 15 años a través de las pruebas X² Long-Rank y modelos de regresión multinomial y de Cox (SPSS 20.0; p<0,05). Resultados: Hubo una mayor prevalencia de hombres entre pacientes alcohólicos (p<0,001), con tumores T3-T4 (p=0,003), ganglios linfáticos positivos (p=0,006), y realizó tratamientos paliativos (p<0,001) y menor prevalencia en paciente menores de 65 años (p <0,001); cuando se presentaron antecedentes familiares de cáncer (p=0,043). La supervivencia de los pacientes alcohólicos fue menor (p=0,040); y los factores que disminuyeron la supervivencia de forma independiente fueron hombres (p=0,042); estadificación t3-t4 (p=0,004); metástasis a ganglios linfáticos (p=0,012); edad > 65 años (p=0,035); localización de la lengua (p=0,042). El sexo masculino se asoció independientemente con el consumo de alcohol (p<0,001). Conclusión: El alcohol define el pronóstico en pacientes con CCEOO, muestra una mayor prevalencia en pacientes con T3-T4, por lo tanto, influye negativamente en el pronóstico.

Pneumonia and the role of dentistry on ICU Staff: 8-year analysis of health indicators

Ventilator-associated pneumonia (VAP) is one of the most prevalent healthcare-associated infections (HAI) and causes of death in intensive care units (ICUs), and studies have shown its relation to oral health. Aim: To report the impact of the incorporation of dental professionals into multidisciplinary ICU staff on the incidence of VAP. Methods: A retrospective observational study was carried out to collect and analyze health indicators of patients in the ICUs from 2011 to 2018 and to differentiate these indicators between the periods before and after the participation of dental staff in the ICU. This study was approved by the Research Ethics Committee. Results:The average number of monthly ICU admissions was 105.89 ± 169.72, and the discharge was 105.21 ± 168.96, with a monthly average number of deaths within 24 h of 38.61 ± 62.27. The average number of monthly HAI-related deaths decreased from 2011 to 2018, followed by a reduction in cases of HAI per month. The average monthly number of HAIs related to mechanical ventilation (MV) decreased, and the same was observed for the infection density of HAIs related to MV (p < 0.001). In multivariate analysis, there was a significant decrease in the number of HAIs related to MV (p = 0.005). Conclusion: Although a reduction in the number of admissions or complexity of cases was not observed in the study period, multidisciplinary staff practices were essential for controlling HAIs and the presence of dental professionals can assist in the control of HAIs related to MV

Gastric toxicity of Alendronate and Methotrexate in Walker 256 carcinosarcoma jaw model / Toxicidade gástrica de Alendronato e Metotrexato em modelo de carcinossarcoma de Walker 256 em mandíbula

Introduction: Experimental animal models represent a key tool used to elucidate the mechanisms of action and toxicity of anticancer drugs. Objective: The purpose was to establish a correlation of neoplastic growth with the combinatorial therapeutic application of sodium alendronate (ALD) and methotrexate (MTX), and to evaluate the gastrointestinal toxicity of these drugs, in the rat Walker 256 carcinosarcoma inoculation model. Methods: Female rats were selected and randomly distributed into 5 groups (n=10): negative control (NC), positive control (PC), MTX-treated group, ALD-treated group, and MTX-ALD-treated group (MTX/ALD). Tumor cells were inoculated as a suspension of 1x106cells/mL into the alveolar cavities produced by exodontia procedures. The following parameters were evaluated: body weight, tumor volume and percentage of tumor inhibition, and gastrointestinal toxicity. Results: The body weight variation was statistically significant between NC animals and PC animals, and between NC animals and ALD-treated group (p<0.01). Tumor volume variation was statistically significant between PC animals, MTX-treated group and MTX/ALD-co-treated group (p<0.05). Analysis of gastric toxicity of MTX-treated group reveled slight reduction of chief (Ch) and parietal (Pr) cellular populations; ALD-treated group exhibited gastric mucosa without histological alterations of Ch cells but intense reduction of Pr cellular population; and MTX/ALD-co-treated group presented reduction of Ch and Pr cellular populations. Conclusions: ALD does not elicit significant antitumor effects on Walker 256 carcinosarcoma cells and decreases antitumor effects of MTX due to toxicity on the gastric epithelium, which is intensified with MTX association.

Introdução: Modelos experimentais em animais representam um instrumento fundamental para elucidar os mecanismos de ação e toxicidade de drogas anticâncer. Objetivo: estabelecer uma correlação do crescimento neoplásico com a aplicação terapêutica combinatória de alendronato de sódio (ALD) e metotrexato (MTX), e avaliar a toxicidade gastrointestinal dessas drogas, no modelo de inoculação de carcinossarcoma de Walker 256 em ratos. Métodos: Ratas fêmeas foram selecionadas e distribuídas aleatoriamente em 5 grupos (n = 10): controle negativo (NC), controle positivo (PC), grupo tratado com MTX, grupo tratado com ALD e grupo tratado com MTX-ALD (MTX/ALD). As células tumorais foram inoculadas como uma suspensão de 1x106 células/mL nas cavidades alveolares produzidas por procedimentos de exodontia. Os seguintes parâmetros foram avaliados: peso corporal, volume tumoral e porcentagem de inibição tumoral e toxicidade gastrointestinal. Resultados: A variação do peso corporal foi estatisticamente significante entre animais NC e animais PC, e entre animais NC e grupo tratado com ALD (p <0,01). A variação do volume tumoral foi estatisticamente significativa entre animais PC, grupo tratado com MTX e grupo tratado com MTX / ALD (p <0,05). A análise da toxicidade gástrica do grupo tratado com MTX revelou uma ligeira redução das populações celulares principais (Ch) e parietais (Pr); o grupo tratado com ALD exibiu mucosa gástrica sem alterações histológicas de células Ch mas intensa redução da população celular Pr; e o grupo tratado com MTX / ALD apresentou redução das populações celulares Ch e Pr. Conclusões: O ALD não provoca efeitos antitumorais significativos nas células do carcinossarcoma Walker 256 e diminui os efeitos antitumorais do MTX devido à toxicidade no epitélio gástrico, que é intensificada com a associação MTX.

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Abstract Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

Prostituição, HIV/Aids e vulnerabilidades: a "cama da casa" e a "cama da rua" / Prostitution, HIV / AIDS and vulnerability: the "house bed" and "street bed"

Resumo Introdução Este estudo busca compreender os limites e barreiras associados à prevenção e ao teste de diagnóstico do HIV entre profissionais do sexo feminino. Métodos Foram analisadas as narrativas sobre a relação entre práticas sexuais, prostituição, amor e família, associadas à prevenção das doenças sexualmente transmissíveis. Utilizou-se a metodologia qualitativa do Rapid Anthropological Assessment (Avaliação antropológica rápida). A população pesquisada foi de 37 mulheres profissionais do sexo com idade entre 18 e 50 anos de Fortaleza, Ceará. Resultados A análise apontou que a decisão de realizar ou não o teste anti-HIV está muito mais vinculada à construção subjetiva sobre quem é o parceiro, cliente ou não, do que ao risco de se ter uma relação desprotegida. A compreensão provocou junto às participantes uma reflexão sobre a necessidade de gerenciar seus riscos de modo integral. Conclusão Conclui-se que estudar a produção de sentido pode contribuir para uma maior adesão dessas mulheres a práticas que, ao mesmo tempo, sejam seguras e viáveis, independentemente do parceiro.

Abstract Introduction This study seeks to understand the limits and barriers associated with prevention and diagnosis of HIV among female sex professionals. Methods We analyzed the narratives on the relationship between sexual practices, prostitution, love and family, associated with the prevention of sexually transmitted diseases. We used the qualitative methodology of Rapid Anthropological Assessment. The population studied included 37 female sex professionals, age between 18 and 50 years, from Fortaleza, Ceará. Results The analysis pointed out that the decision to be or not be tested for HIV is linked to the subjective construction of who their partner is, customer or not, rather to the risk of having unprotected intercourse. The better understanding led the participants to reflect on the need to fully manage the risks. Conclusion We conclude that studying the production of meaning can contribute to greater adherence of these women to practices that are simultaneously safe and sustainable, regardless of the partner.

Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report

SUMMARY Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.

Assessment of the quality of life of elderly with diagnosis of oral squamous cell carcinoma submitted to combined modality therapy / Avaliação da qualidade de vida de idosos com diagnóstico de carcinoma oral de células escamosas, submetidos à terapia combinada

Introduction: Evaluating the quality of life allows a more accurate clinical control as well as the provision of prognostic information for specific groups. This study was designed to evaluate the quality of life of elderly diagnosed with oral squamous cell carcinoma submitted to combined modality therapy. Methods: This is a retrospective and observational study, with cross-sectional quantitative character. A total of 206 records of patients with head and neck cancer treated between April 2013 and October 2014 were analyzed. Eleven patients over six months of treatment completion were included in the study. The questionnaire of quality of life of the University of Washington (UW-QOL) was applied. The data were collected regarding the social-demographic, clinical-pathological and therapeutic profiles, and the non-stimulated salivary flow was measured. Statistical analysis of quantitative data was performed by the Spearman nonlinear correlation, considering a confidence of 95%. Results: Chewing, saliva and speech showed the lowest scores (31.8; 42.3; 60.6, respectively). Statistically significant correlation was found between: shoulder and mood (r=0.787); swallowing and chewing (r=0.761); completion time of radiotherapy and recreation (r=0.659); activity and recreation (r=0.653); pain and swallowing (r=0.626); chewing and speech (r=0.607); age and speech (r=-0.617). Conclusions: Elderly with oral squamous cell carcinoma diagnosis sunmitted to combined modality therapy presented the areas related to chewing, saliva and speech as the most committed ones. Older individuals have greater impairment of speech, as well as those with longer completion of radiotherapy have better results related to the recreation area. (AU)

Introdução: A avaliação da qualidade de vida permite controle clínico confiável e provisão prognóstica para grupos específicos. Este estudo foi desenhado para avaliar a qualidade de vida de idosos com diagnóstico de carcinoma oral de células escamosas submetidos à terapia combinada. Método: Trata-se de estudo observacional e retrospectivo, de caráter quantitativo com corte transversal. Foi analisado um total de 206 prontuários de pacientes com câncer de cabeça e pescoço tratados entre abril de 2013 e outubro de 2014. Onze pacientes com mais de seis meses de conclusão do tratamento foram incluídos no estudo. O questionário de qualidade de vida da Universidade de Washington (UW-QOL) foi aplicado. Foram coletados dados relacionados ao perfil sociodemográfico, clínicopatológico e terapêutico, e foi mensurado fluxo salivar não estimulado. A análise estatística dos dados quantitativos foi realizada por meio da correlação não linear de Spearman, considerando uma confiança de 95%. Resultados: Mastigação, saliva e fala apresentaram os menores escores (31,8; 42,3; 60,6, respectivamente). A correlação estatisticamente significante foi observada entre: ombro e humor (r=0,778); deglutição e mastigação (r=0,761); tempo de conclusão da radioterapia e recreação (r=0,659); atividade e recreação (r=0,653); dor e deglutição (r=0,626); mastigação e fala (r=0,607); idade e fala (r=-0,617). Conclusões: Idosos com carcinoma oral de células escamosas, submetidos à terapia combinada, apresentaram áreas relacionadas à mastigação, à saliva e à fala como as mais acometidas. Indivíduos mais velhos apresentaram maior comprometimento da fala, assim como os que apresentavam maior tempo de conclusão da radioterapia apresentaram melhores resultados relacionados à recreação. (AU)

TNF-alpha expression, evaluation of collagen, and TUNEL of Matricaria recutita L. extract and triamcinolone on oral ulcer in diabetic rats

ABSTRACT Diabetes mellitus (DM) is a disease associated with delayed wound healing of oral ulcers by increased expression of proinflammatory cytokines and cellular apoptosis. Objective to evaluate the influence of Tumor Necrosis Factor alpha (TNF-α) and apoptosis in rats with DM treated with chamomile extract or triamcinolone. Material and Methods Wistar male rats (210.0±4.2 g) were divided into five groups: negative control group (NCG) without diabetes; positive control group (PCG) with DM (alloxan, 45 mg/kg); and groups treated with chamomile extract (normoglycemic= NCG group and diabetic= DCG group) and with triamcinolone (TG). Traumatic ulcers were performed on all animals that received topical triamcinolone, chamomile extract or saline 12/12 hours for ten days. Results On days five and ten the animals were euthanized and the ulcers were analyzed by light microscopy, TUNEL assay, and immunohistochemically (TNF-α). The NCG (p=0.0062), PCG (p=0.0285), NCG (p=0.0041), and DCG (p<0.0001) groups were completely healed on the 10th day, however, there was no healing on the TG (p=0.5127) group. The TNF-α expression showed a significant reduction from the 5th to the 10th day in NCG (p=0.0266) and DCG (p=0.0062). In connective tissue, the TUNEL assay showed a significant reduction in the number of positive cells in NCG (p=0.0273) and CNG (p=0.0469) and in the epithelium only in CDG (p=0.0320). Conclusions Chamomile extract can optimize the healing of traumatic oral ulcers in diabetic rats through the reduction of apoptosis in the epithelium and TNF-α expression.

Evaluation of oral conditions in patients with neurodegenerative diseases treated in geriatric centers / Avaliação das condições orais em pacientes com doenças neurodegenerativas atendidos em centros geriátricos

ABSTRACT Objective: To compare the general clinical conditions and oral alterations, and also evaluate the prosthesis, in subjects diagnosed with Alzheimer's disease (AD) or Parkinson's disease (PD), attended at two geriatric centers in the city of Fortaleza - Ceará. Methods: 70 patients were analyzed (between 57 to 91 years) with AD and PD, through evaluation of neurological medical records and oral clinical examination. Variables as sex, age, race, comorbidities, oral manifestations and prosthetic conditions were observed. A total of 20 elderly patients without neurological disease consisted the control group (CG). Fisher's exact test and Kruskal-Wallis were used as statistical analysis. Results: In both groups, blood hypertension was the most frequent comorbidity. As for the oral examination in the group with AD, it was observed that 54.2% had periodontal disease, 34.2% caries. Similar results were found in PD patients (31.4%; 22.8% - respectively). However, no difference was observed between the groups, as the systemic and oral manifestations in both geriatric centers (p> 0.05). Was identified more than half of the subjects (57.7%) using dentures, and 86.5% of these had become maladaptive, with some kind of defect. There was statistical difference in the presence of associated oral pathology, denture stomatitis, between dementia and control group (p = 0.0213). Conclusion: Elderly patients with AD and PD have poor oral health, as well as those without neurodegenerative diseases. However, have more defects and disorders associated with the use of removable dentures.

RESUMO Objetivo: Comparar as condições sistêmicas e orais, além de avaliar as próteses removíveis, associadas aos portadores de Doença Alzheimer e Doença Parkinson, atendidos em dois centros geriátricos situados no município de Fortaleza - Ceará. Métodos: Foram analisados 70 pacientes (entre 57 à 91 anos) com Doença Alzheimer e Doença Parkinson, por meio de avaliação de prontuários neurológicos e exame clinico oral. Tendo sido observadas variáveis de sexo, idade, raça, comorbidades, condições orais e protéticas. Um total de 20 pacientes idosos sem doenças neurológicas consistiu no Grupo Controle. Foi utilizado teste exato de Fischer como análise estatística. Resultados: Em ambos os grupos estudados, a Hipertensão arterial foi a comorbidade mais frequente. Quanto ao exame oral, no grupo com Doença Alzheimer, foi observado que 54.2% apresentou doença periodontal, 34.2% doença cárie. Achados semelhantes foram encontrados em pacientes com Doença Parkinson (31,4%; 22,8% - respectivamente). Entretanto, não foi observada diferença entre os grupos estudados, quanto as manifestações sistêmicas e orais nos dois centros geriátricos (p>0.05). Foi identificado que mais da metade dos pacientes avaliados nesse estudo (57,7%), utilizavam alguma prótese removível, sendo que 86,5% dessas apresentavam-se mal adaptadas, com algum tipo de defeito, principalmente nos idosos Institucionalizados (p= 0.034). Verificou-se, também, diferença estatística na presença de estomatite protética, entre os grupos demência e grupo controle (p= 0.0213). Conclusão: Idosos portadores de Doença Alzheimer e Doença Parkinson tem deficiente saúde bucal, assim como aqueles sem as doenças neurodegenerativas. No entanto, apresentam mais imperfeições e patologias associadas ao uso de próteses removíveis.

Dentists' protective measures against occupational and sexual exposure to hepatitis B virus / Perfil de proteção de cirurgiões-dentistas frente à transmissão ocupacional e sexual do vírus da Hepatite B

Objective: This study investigated the sexual and occupational exposure of dentists to hepatitis B virus. Methods: The study used a self-administered, structured, and anonymous questionnaire to collect data from 318 dentists who attended the International Congress of Dentistry held in 2009. The findings were tabulated and associations between variables were determined by the chi-square and Fisher-Freeman-Halton tests. Results: Most (84.9%) dentists used all the personal protective equipment. Roughly 68.0% had experienced percutaneous injuries but only 36.4% sought specialized care. An unimpressive 75.8% of the sample received the three doses of the hepatitis B vaccine, and a meager 27.0% was tested for hepatitis B surface antibodies (anti-HBs). Only 20.1% of the study dentists used condoms and those with more years of practice were less likely to use them (p=0.006). Conclusion: The results show that the study sample is at sexual and occupational risk of hepatitis B infection.

Objetivo: Comparar os riscos de transmissão sexual do Vírus da Hepatite B e o perfil de proteção profissional de cirurgiões-dentistas. Métodos: Questionário auto-aplicável, estruturado e anônimo foi respondido por 318 profissionais participantes de Congresso Internacional de Odontologia, em 2009. Os achados foram agrupados em tabelas, e a associação de variáveis foi feita por meio do teste qui-quadrado e teste de Fisher-Freeman-Halton. Resultados: Foi observado que 84,9% dos profissionais relataram utilizar todos os Equipamentos de Proteção Individual.Aproximadamente 68,0% já se feriram com instrumento pérfuro-cortante, mas apenas 36,4% procuraram serviço especializado. A prevalência de vacinação completa contra hepatite B foi 75,8%, todavia somente 27,0% realizaram o teste de conversão sorológica(anti-HBs). Quanto ao uso de preservativo, apenas 20,1% afirmaram ter utilizado esse insumo e o tempo de formado foi estatisticamente significante quando associado à menor frequência na utilização (p = 0,006).Conclusão: Os resultados revelaram possível vulnerabilidade dos dentistas para hepatite B nos âmbitos sexual e profissional.

Expression of S-100, EMA, CD34 and presence of mast cells in eight oral neurofibromas, and a review of 127 cases of the literature / Expressão de S-100, EMA, CD34 e presença de mastócitos em oito neurofibromas orais e revisão de 127 casos da literatura

INTRODUCTION: The rarity of oral neurofibromas (ONs) generates problems regarding their epidemiological and immunohistochemical characterization. OBJECTIVES: The aim of this study was to evaluate the expression of different markers in ONs and review epidemiologic data reported in the literature. MATERIAL AND METHODS: Clinicopathologic, immunohistochemical (markers S-100, epithelial membrane antigen [EMA], CD34) and histochemical (modified-Ziehl-Neelsen-method) studies were performed in eight cases of ON diagnosed in the Department of Pathology and Legal Medicine (DPML), Universidade Federal do Ceará (UFC), Ceará, Brazil, between 1994 and 2010. RESULTS: Oral neurofibromas represented 0.2% of the oral lesions diagnosed by our service in 16 years, and the buccal mucosa was the most frequent oral site (71.4%). Seven (87.5%) and 8 (100.0%) cases were positive for S-100 and CD34, respectively, and none for EMA. Mast cells were identified in seven cases (87.5%). The literature search indicated that solitary ONs are more common and occur preferentially in females, affecting patients between 30 and 40 years old. The alveolar ridge is the most commonly involved site. CONCLUSION: S-100- and CD34 markers proved to be of great value as a diagnostic tool, unlike EMA staining. Identification of mast cells in most cases suggests their involvement in this tumor pathogenesis. The clinicopathologic data retrieved from the literature enabled the establishment of a more consistent epidemiological profile.

INTRODUÇÃO: A rara ocorrência de neurofibromas orais (NO) gera problemas com relação à caracterização epidemiológica e imuno-histoquímica dessas lesões. OBJETIVOS: Avaliar a expressão celular de diferentes marcadores em NO e revisar dados epidemiológicos reportados na literatura. MATERIAL E MÉTODOS: Estudos clinicopatológico, imuno-histoquímico (marcadores S-100, epithelial membrane antigen [EMA] e CD-34) e histoquímico (método Ziehl-Neelsen modificado) foram realizados em oito casos de NO diagnosticados no Departamento de Patologia e Medicina Legal (DPML) da Universidade Federal do Ceará (UFC), Ceará, Brasil, entre 1994 e 2010. RESULTADOS: Os NO representaram 0,2% das lesões bucais diagnosticadas pelo serviço em 16 anos; mucosa jugal foi a localização mais frequente (71,4%); sete (87,5%) e oito (100%) casos apresentaram positividade para S-100 e CD-34, respectivamente, e nenhum para EMA. Adicionalmente, mastócitos foram identificados em sete casos (87,5%). A revisão de literatura indicou que NO solitários são mais comuns e ocorrem preferencialmente em mulheres, afetando pacientes entre 30 e 40 anos. O rebordo alveolar é a localização intraoral mais comum. CONCLUSÃO: Os marcadores S-100 e CD34 provaram ser de grande valor como ferramentas diagnósticas, diferente da coloração EMA. A identificação de mastócitos na maioria dos casos sugere seu envolvimento na patogênese desse tumor. Os dados clinicopatológicos da revisão de literatura ajudaram no estabelecimento de um perfil epidemiológico mais consistente.

Evaluation of oral diseases in a population of special needs patients / Avaliação das doenças orais em uma população de pacientes com necessidades especiais

Objective: To evaluate the oral health status of a population of patients with special needs cared for in the specialization course of the Brazilian Association of Dentistry, Ceará Branch. Methods: In this cross-sectional, descriptive study the indexes DMFT and CPI were used to evaluate dental caries and periodontal disease, respectively, from August 2009 through March 2010. The need for dental treatment and other soft tissue lesions were also investigated. Results: 88 patients selected by convenience sampling were examined intraorally, and the mean age was 43.8 ± 16. Most of the patients fell within the group of systemic diseases (68.1%), especially cardiovascular diseases (15.9%). The mean DMFT index was 17.54 ± 7.13, and 87.5% of patients presented active dental caries. According to the highest degree of periodontal condition observed in the individual, the dental tartar (index 2) was present in a greater number of patients (50.9%). Regarding the need for dental treatment, 68.1% of patients needed restorative treatment, 43.1% of patients needed surgery (extractions) and 21.5% of patients needed endodontic treatment. There were no soft-tissue abnormalities in most patients (89.7%). Conclusion: The examined patients showed a high prevalence of oral diseases such as dental caries and gingivitis/periodontitis, and therefore a great need for dental treatment. Given the results, it becomes important to stimulate dental care and preventive practices focused on this segment of the population.

Objetivo: Avaliar a condição de saúde bucal de uma população de pacientes com necessidades especiais atendida no curso de especialização da Associação Brasileira de Odontologia, Seção Ceará.Métodos: Nesse estudo de natureza descritiva e transversal utilizou-se os índices CPO-D e IPC para avaliação das doenças cárie e periodontal, respectivamente, entre os meses de Agosto de 2009 e Março de 2010. Necessidades de tratamento dentário e outras lesões em tecidos moles orais também foram investigadas. Resultados: Realizaram-se exames bucais em 88 pacientes selecionados por conveniência, sendo a média de idade correspondente a 43,8 ± 16 anos. A maioria se enquadrava no grupo de doenças sistêmicas (68,1%), destacando-se as diseases cardiovasculares (15,9%). O índice CPO-D médio foi 17,54 ± 7,13, com 87,5% dos pacientes apresentando cárie ativa. Segundo o maior grau de condição periodontal observado no indivíduo, o cálculo dental (índice 2) foi o que esteve presente em um maior número de pacientes (50,9%). Quanto às necessidades de tratamento dental, 68,1% deles necessitaram de tratamento restaurador, 43,1% de tratamento cirúrgico (exodontias) e 21,5% de tratamento endodôntico. Não foram encontradas anormalidades em tecido mole na maioria dos pacientes (89,7%). Conclusão: Os pacientes examinados possuíam alta prevalência de doenças orais, como cárie e gengivite/periodontite e, conseqüentemente, grande necessidade de tratamento odontológico. Diante dos resultados, torna-se importante motivar a atenção odontológica e as práticas preventivas voltadas para essa parcela da população.