Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy

Abstract Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa. Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years. Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa. Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.

Genotoxicidade e citotoxicidade dos raios x em crianças submetidas à radiografia panorâmica / Genotoxicity and cytotoxicity of x-rays in children exposed to panoramic radiography

RESUMO Objetivo: Analisar a genotoxicidade e a citotoxicidade produzidas por raios X no epitélio da mucosa oral de crianças durante a obtenção da radiografia panorâmica. Métodos: A amostra foi constituída por 30 crianças saudáveis, sendo 19 do sexo feminino e 11 do masculino, com faixa etária de 4 a 10 anos (média de 7 anos de idade). As células epiteliais da mucosa oral foram coletadas por meio de citologia esfoliativa em base líquida imediatamente antes e após sete dias da obtenção da radiografia panorâmica. Os esfregaços foram processados e corados utilizando a técnica de Feulgen Rossenbeck modificada. Foram analisadas e quantificadas projeções nucleares dos tipos bud e broken egg, alterações genotóxicas na forma de micronúcleo e alterações citotóxicas dos tipos picnose, cariólise e cariorrexe. Resultados: A frequência de picnose, bud e broken egg foi significativamente maior após a exposição aos raios X (p<0,05), porém não houve diferença estatisticamente significante em relação ao sexo, bem como nas demais alterações estudadas. Conclusões: A exposição aos raios X emitidos durante a obtenção da radiografia panorâmica pode induzir à morte celular no epitélio da mucosa oral de crianças. Não foi encontrado indício significativo de efeito genotóxico.

ABSTRACT Objective: To assess the genotoxicity and cytotoxicity produced by X-rays in the epithelium of the oral mucosa of infants exposed to panoramic radiography. Methods: The sample consisted of 30 healthy children, 19 females and 11 males, ranging in age from 4 to 10 years (average of 7 years of age). Oral mucosa cells were collected by liquid-based cytology immediately before and after seven days following the exposure to panoramic radiography. Smears were processed and stained using the modified Feulgen Rossenbeck technique. Bud and broken egg nuclear projections, changes in the form of micronuclei, and genotoxic and cytotoxic changes of pyknosis, karyorrhexis and karyolysis were analyzed and quantified. Results: The frequency of pyknosis, buds and broken eggs was significantly higher after exposure to X-rays (p<0.05), but there was no statistically significant difference regarding gender, as well as in the other changes studied. Conclusions: Exposure to X-rays emitted during submission to panoramic radiography may induce cell death in the epithelium of children's oral mucosa. No evidence was found for a significant genotoxic effect.

Expresión de TGFß1 por fibroblastos de mucosa oral expuestos a radiación ultravioleta B / TGF1 expression by oral mucosa fibroblasts exposed to ultraviolet ß1 radiation

El objetivo de este estudio fue evaluar el efecto de la radiación ultravioleta (UV) B sobre la expresión del factor de crecimiento transformante (TGF) ß1 por fibroblastos de mucosa oral, con el objetivo de dilucidar si este tipo celular puede contribuir a la expresión de TGFß1 en bermellón labial sobreexpuesto a la radiación UV. Se obtuvieron cultivos primarios de fibroblastos desde explantes de mucosa bucal, los que fueron irradiados con una dosis única de luz UVB (60 mJ/cm2). Se midió proliferación celular con el método MTT, y la expresión de TGFß1, a nivel de ARN mensajero (normalizado a GAPDH) por RT-PCR y a nivel de proteína mediante inmunofluorescencia. Se observó una disminución de la proliferación celular de los fibroblastos de mucosa oral a las 24 hrs post-irradiación en relación a los fibroblastos no irradiados (P<0,05, Mann Whitney). No se encontraron diferencias entre los fibroblastos control y los irradiados en la expresión de TGFß-1 ni a nivel de mensajero (0,5 y 6 h post-irradiación), ni de proteína (24 h post-irradiación). Los resultados sugieren que los fibroblastos de mucosa oral presentan una disminución de su proliferación en respuesta a una dosis única de radiación UVB, sin que se afecte la expresión de TGFß-1, la que fue similar a los fibroblastos no irradiados. Esto sugiere que los fibroblastos contribuirían a la producción de TGFß-1 en respuesta a la exposición crónica a UVB del bermellón labial.

The objective of this study was to characterize the effect of Ultraviolet (UV) B irradiation on the expression of transforming growth factor (TGF) ß1 by oral mucosa fibroblasts, in order to assess if these cells contribute to the production of TGFß-1 in UV-irradiated lip vermillion. Primary cultures of fibroblasts were obtained from oral mucosa explants, and were irradiated with a single dose of UVB light (60 mJ/cm2). The effects of UVB radiation on cell proliferation was evaluated by the MTT method. The effects of UVB on the expression of TGF-ß1 was analyzed by RT-PCR (normalized to GAPDH) and by immunofluorescence. The results showed a decrease in the proliferation of UVB-irradiated fibroblasts as compared to controls at 24h post-irradiation (p<0.05). No variations in the expression of TGFß1, both at the mRNA and protein level, were observed between control and UVB-irradiated fibroblasts during the first 24 h after irradiation. Oral mucosa fibroblasts have reduced proliferation in response to a single dose of UVB, but their expression of TGFß1 was not affected. This suggests that oral mucosa fibroblasts may contribute to the production of TGFß1 in the lip vermillion independent of UVB exposure.

Láser Doppler y su uso en odontología / Laser Doppler and its use in dentistry

El efecto Doppler es la base científica de la flujometría láser Doppler. El efecto fue descrito por primera vez en el año de 1842 por el físico austriaco Christian Doppler en su tratado Über das farbige licht der doppelsterne und einige andere gestirne des himmels (Sobre el color de la luz en estrellas binarias y otros astros). Este principio ha permitido desarrollar técnicas y aparatos que han sido empleados en el ramo médico para medir la perfusión en diversos órganos y tejidos del cuerpo, y que han sido útiles como método diagnóstico. En la odontología, poco a poco comienza a reportarse información acerca del uso del Doppler en las diversas estructuras bucodentales, y ha demostrado ser no invasivo y de gran utilidad diagnóstica. Son pocos los estudios reportados en la rama de la odontología en cuanto a esta nueva tecnología; es importante comenzar líneas de investigación apoyadas en ella para beneficio de los pacientes.

The Doppler eff ect, the scientifi c basis of laser Doppler fl owmetry, wasfi rst described in 1842 by Austrian physicist Christian Doppler in histreatise Über das farbige Licht der doppelsterne und einige andere gestirnedes Himmels (On the Colored Light of the Binary Stars and SomeOther Stars of the Heavens). This principle has led to the developmentof techniques and devices that have been used in the fi eld of medicineto measure perfusion in various organs and tissues, and have provideda useful method of diagnosis. In dentistry, information on the use ofthis method in the various structures of the mouth has slowly begunto be published. As a result, the need for its continued use in the fi eldof oral health has become evident, given that it has proven to be noninvasiveand extremely useful in diagnosis. It is a diagnostic technique that is commonly used in healthcare and has been widely developedin the fi eld of medicine, yet there have been few reported studies of it suse in dentistry, which is an important step towards opening new linesof research based on this new technology for the benefi t of patients.

Cell phone radiation effects on cytogenetic abnormalities of oral mucosal cells

The aim of this study was to evaluate the effects of exposure to cell phone electromagnetic radiation on the frequency of micronuclei, broken eggs cells, binucleated cells, and karyorrhexis in epithelial cells of the oral mucosa. The sample was composed of 60 cell phone users, who were non-smokers and non-drinkers, and had no clinically visible oral lesions. Cells were obtained from anatomical sites with the highest incidence of oral cancer: lower lip, border of the tongue, and floor of the mouth. The Feulgen reaction was used for quantification of nuclear anomalies in 1,000 cells/slide. A slightly increase in the number of micronucleated cells in the lower lip and in binucleated cells on the floor of the mouth was observed in individuals who used their phones > 60 minutes/week. The analysis also revealed an increased number of broken eggs in the tongue of individuals owning a cell phone for over eight years. Results suggest that exposure to electromagnetic waves emitted by cell phones can increase nuclear abnormalities in individuals who use a cell phone for more than 60 minutes per week and for over eight years. Based on the present findings, we suggest that exposure to electromagnetic radiation emitted by cell phones may interfere with the development of metanuclear anomalies. Therefore, it is demonstrated that, despite a significant increase in these anomalies, the radiation emitted by cell phones among frequent users is within acceptable physiological limits.

Analysis of micronuclei in buccal epithelial cells in patients subjected to panoramic radiography.

Context: Ionizing radiation is a well-known carcinogen in humans. Chromosomal aberrations and formation of micronuclei in cell cytoplasm are early biological evidence of carcinogenesis. Aims: This study was undertaken to assess the genotoxic effect of panoramic radiography in the buccal epithelial cells. Materials and Methods: The study included 60 healthy individuals (median age 23.5 years; age range 12-65 years) who underwent panoramic radiographic examination. Exfoliated buccal epithelial cells were obtained immediately before and 10 days after radiation exposure. The cells were stained with Giemsa and evaluated for micronuclei by scoring 1000 cells per sample. Statistical analysis used: The paired 't ' test was used to find out the significance of difference in the number of micronuclei before and after x-ray exposure. The Karl Pearson correlation coefficient was used to find out the correlation between age and micronucleated cell frequencies and number of micronucleus per 1000 cells. The ANOVA test was used to find out if there were significant differences in micronucleated cell frequencies between different age-groups. Student's unpaired 't' test was used to find out the significance of difference in micronucleated cell frequencies and number of micronucleus per 1000 cells between genders. Results: The paired 't' test showed that micronucleated cell frequencies (P = 0.02) and number of micronucleus per 1000 cells (P = 0.047) were significantly higher after radiographic exposure. The mean number of micronucleated cells before and after radiation exposure were 0.48 ± 0.14 and 0.51 ± 0.15, respectively. There was statistically significant increase in the frequency of micronuclei in buccal epithelial cells after exposure to panoramic radiography. The correlation of micronucleus frequency with age and gender was statistically nonsignificant. Conclusions: The results indicate that panoramic radiography may induce genotoxic effects in buccal epithelial cells. Considering this risk, panoramic radiography should be used cautiously.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Laser phototherapy as a treatment for radiotherapy-induced oral mucositis

Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with λ660 nm, 40 mW, ∅=4 mm², in contact mode, 5 x 2.4 J/cm² per point, 14.4 J/cm² per session. For treating the lesion on the patient's nasal mucosa, LPT (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² per point, 6.3 J/cm² per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm²) with the λ660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks. Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.

A mucosite oral é um efeito colateral prejudicial da radioterapia na região de cabeça e pescoço. Existem estudos que evidenciam o efeito benéfico do uso da luz laser no tratamento da mucosite oral. O objetivo deste caso clínico foi o de avaliar a eficácia da fototerapia laser no tratamento da mucosite oral em um paciente sendo submetido a radioterapia, após a remoção cirúrgica de um carcinoma escamocelular, com invasão óssea da maxila. As lesões do palato e das comissuras labiais foram tratadas com λ660 nm, 40 mW, ∅=4 mm², em contato, 5 x 2.4 J/cm² por ponto, 14.4 J/cm² por sessão. Na lesão existente na mucosa nasal a fototerapia laser (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² por ponto, 6.3 J/cm² por sessão, em contato) foi utilizada na área externa do nariz. Uma dose única (2.4 J/cm²) com o laser λ660 nm e os parâmetros descritos anteriormente foi aplicado na entrada de cada narina. A fototerapia laser foi utilizada 3 vezes por semana, durante 4 semanas. Os resultados do tratamento são indicativos de que o uso da fototerapia laser em mucosite oral foi efetiva e permitiu ao paciente continuar o tratamento radioterápico sem interrupções. Entretanto, estudos clínicos controlados são necessários para se estabelecer os protocolos, para tratamento e prevenção da mucosite oral, utilizando fototerapia laser.

Single exposure of human oral mucosa fibroblasts to ultraviolet B radiation reduces proliferation and induces COX-2 expression and activation

The lip vermillion constitutes a transition tissue, between oral mucosa and skin, where oral mucosal cells from epithelial and connective tissue compartments are exposed to ultraviolet (UV) sunlight. Fibroblasts are abundant resident cells of the connective tissue which are key regulators of extracellular matrix composition, as well as, epithelial and endothelial cell function. UVB light, an inherent component of sunlight, causes several alterations in skin fibroblasts, including premature senescence and increased cyclooxygenase (COX)-2 expression. To assess if UVB irradiation had similar effects on fibroblasts derived from human oral mucosa (HOM), primary cultures of HOM fibroblasts were irradiated with a single dose of 30 or 60 mJ/cm²of UVB light or sham-irradiated. Fibroblast proliferation was assessed from 3 to 48 hrs after UVB-irradiation utilizing [³H]-thymidine incorporation and MTT assays. In addition, COX-2 mRNA expression was detected by RT-PCR, and PGE2 production was assessed using enzyme immunoassay from 0.5 to 24 hrs after UVB-irradiation. The results showed a significant decrease in proliferation of UVB-irradiated HOM fibroblasts as compared to controls as measured by both [³H]-thymidine incorporation and MTT assays (p<0.001). HOM fibroblasts had increased COX-2 mRNA expression at 0.5 and 12 hrs after irradiation, and PGE2 production was elevated at 12 and 24 hrs post-irradiation as compared to controls (p<0.05). The results showed an inhibitory effect of a single dose of UVB irradiation on HOM fibroblast proliferation with an increase in COX-2 expression and activation. Therefore, photodamaged fibroblasts may play and important role in the pathogenesis of UV-induced lesions of the lip.

Criterios de evaluación odontológica pre-radioterapia y necesidad de tratamiento de las enfermedades orales post-radioterapia en cabeza y cuello / Pre-radiotherapy dental evaluation criteria and treatment needs of oral side effects after head and neck radiotherapy

El objetivo de esta revisión es presentar criterios de evaluación odontológica pre-radioterapia y cuáles son las principales necesidades de tratamiento de estos pacientes después del tratamiento de radiación. Fueron revisados artículos en inglés, español y portugués entre 1995 y 2009 indexados en Pubmed y Scielo. Las palabras claves fueron: cáncer oral y radioterapia, complicaciones de la radioterapia en cabeza y cuello, evaluación oral pre-radioterapia. Los efectos colaterales de la radioterapia en la región de cabeza y cuello pueden ser temporales o tardíos. Aquellos que son tardíos, como la caries de radiación y la osteorradionecrosis pueden estar directamente relacionados con el hecho de no haber realizado una evaluación odontológica previa y pueden afectar severamente la calidad de vida del paciente.La participación del cirujano-dentista en el equipo multidisciplinario y la evaluación odontológica de los pacientes que serán sometidos a radioterapia en la región de cabeza y cuello son de vital importancia en mejorar la calidad de vida post-operatoria de estos pacientes.

The objective of this review is to present pre-radiotherapy evaluation criteria and the main needs for treatment of these patients after the radiation therapy. Were revised articles in English, Spanish and Portuguese language between 1995 and 2009 indexed in Pubmed and Scielo. The keywords were oral cancer and radiotherapy, complications in head and neck radiotherapy, oral pre-radiotherapy evaluation.The adverse complications of radiotherapy in head and neck area could be temporary or late. The late effects, such as radiation caries and osteorradionecrosis could be directly associated with the fact that previous dental evaluation was not performed and can severely affect the post-operatory quality of life. The participation of the dentist in the multidisciplinary team and dental evaluation of the patients that will receive radiotherapy in the head and neck area are of vital importance to improve the post-operatory quality of life of these patients.

effect of ethanolic extract of propolis on radiation-induced mucositis in rats

To assess the efficacy of ethanolic extract of propolis in radiation-induced mucositis in rats. This study was performed in the Dental Faculty, Shahid Rajaee Hospital of Babol University of Medical Sciences, Babol, Mazandaran, Iran from August 2008 to September 2009, It was carried out on 21 male Wistar rats, age 7-11 weeks, and weighing 160 +/- 20g. They were divided into 3 groups. Group A received intraperitoneal [ip] injections of 100 mg/kg ethanolic extract of propolis [EEP], group B received ip injections of 200 mg/kg EEP, and the control group [group C] received 10% ethanol [10ml/kg [ip]] just before x-ray irradiation. All rats were irradiated in the head and neck region by an x-ray device at a dose rate of 15 gray [Gy] for 9 minutes and 39 seconds. The daily injection continued for the next 10 days, and the lips and tongues of the rats were examined daily to assess the intensity of lesions induced by irradiation. In group C, the first signs of ulcers appeared on the first day, while they appeared on the fourth day in group B, and third day in group A. The severity of ulcers was greatest in group C, and least in group B. Propolis is effective in reducing and delaying radiation-induced mucositis in an animal model, however, further study and evaluation is required

In vivo autofluorescence characteristics of pre- and post-treated oral submucous fibrosis: A pilot study.

Aims and Objectives: To compare the autofluorescence spectra of oral submucous fibrosis (OSF) with normal mucosa, the autofluorescence spectra of OSF before and after treatment with intralesional dexamethasone and hyaluronidase, the clinical improvement following treatment with the changes in autofluorescence spectra and to prove that autofluorescence spectroscopy is a good method for diagnosis and assessment of treatment effectiveness in OSF. Materials and Methods: The study was conducted at the Department of Oral Medicine and Radiology, Tamilnadu Government Dental College and Hospital, Chennai and Division of Medical Physics and Lasers, Department of Physics, Anna University, Chennai in 20 patients seeking medical management for symptomatic OSF and 20 patients who had dental caries only without any oral mucosal diseases and oral habits were used as normal controls. Their ages ranged from 20 to 40 years, including both male and female. In vivo fluorescence emission spectra were obtained using a handheld optical fiber probe attached to a Fluoromax-2 spectrofluorometer. Results: The fluorescence spectrum of OSF had an intense fluorescence emission at 385 nm with a secondary emission peak at 440 nm compared with that of the normal oral mucosa. The average fluorescence spectrum of the post treated OSF mucosa had a lesser intensity around 385 nm and a higher intensity around 440 nm than that of the pre treated OSF mucosa, thereby mimicking the normal oral mucosa. All the three clinical parameters (maximal mouth opening, tongue protrusion and the severity of burning sensation) showed a high statistical significance, with P < 0.001, as in the case of classification of pre treated OSF mucosa from the post treated OSF mucosa using the autofluorescence technique. Conclusion: The change in the fluorescence emission spectrum for both normal and OSF mucosa before and after treatment can be explained by analyzing the changes in the fluorescence intensity of the endogenous fluorophores.

Hiperplasia epitelial focal: enfermedad de Heck / Focal epithelial hyperplasia: Heck´s disease

La hiperplasia epitelial focal (HEF) o enfermedad de Heck, es una afección de la mucosa bucal poco frecuente, producida por el virus del papiloma humano (HPV) subtipos 13 y 32, en un sujeto genéticamente predispuesto. Se presenta en indígenas americanos, afecta a ambos sexos y a edades tempranas. Se caracteriza por pápulas o nódulos múltiples en la cavidad bucal, especialmente en la mucosa labial, yugal y lingual. La evolución es variable y la transformación maligna es posible, pero excepcional. Comunicamos el caso de un paciente de padres bolivianos, con lesiones de un año de evolución, que fue tratado con terapia láser, con buenos resultados

Mucosite bucal rádio e quimioinduzida / Radiation therapy and chemotherapy-induced oral mucositis

O aumento da intensidade da quimioterapia e radioterapia no tratamento do câncer tem elevado a incidência de efeitos colaterais, em especial da mucosite bucal. OBJETIVO E MÉTODO: Através de revisão bibliográfica realizou-se atualizar informações quanto à definição, características clínicas, incidência, etiologia, patofisiologia, morbidade associada, prevenção e tratamento dessa manifestação clínica. RESULTADOS: Estudos atuais definem a mucosite bucal como uma inflamação e ulceração dolorosa bastante freqüente na mucosa bucal apresentando formação de pseudomembrana. Sua incidência e severidade são influenciadas por variáveis associadas ao paciente e ao tratamento a que ele é submetido. A mucosite é conseqüência de dois mecanismos maiores: toxicidade direta da terapêutica utilizada sobre a mucosa e mielossupressão gerada pelo tratamento. Sua patofisiologia é composta por quatro fases interdependentes: fase inflamatória/vascular, fase epitelial, fase ulcerativa/bacteriológica e fase de reparação. É considerada fonte potencial de infecções com risco de morte, sendo a principal causa de interrupção de tratamentos antineoplásicos. Algumas intervenções mostraram-se potencialmente efetivas para sua prevenção e tratamento. Entretanto, faz-se necessária a realização de novos estudos clínicos mais bem conduzidos para obtenção de melhor evidência científica acerca do agente terapêutico de escolha para o controle da mucosite bucal, permitindo a realização da quimioterapia e radioterapia do câncer em parâmetros ideais.

Tincreasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. AIM AND METHODS: a bibliographical review was conducted on the definition of oral mucositis, its clinical findings, the incidence, its etiology, the pathofisiology, associated morbidity, prevention and treatment. RESULTS: current studies define oral mucositis as a very frequent and painful inflammation with ulcers on the oral mucosa that are covered by a pseudo membrane. The incidence and severity of lesions are influenced by patient and treatment variables. Oral mucositis is a result of two major mechanisms: direct toxicity on the mucosa and myelosuppression due to the treatment. Its pathofisiology is composed of four interdependent phases: an initial inflammatory/vascular phase; an epithelial phase; an ulcerative/bacteriological phase; and a healing phase. It is considered a potential source of life-threatening infection and often is a dose-limiting factor in anticancer therapy. Some interventions have been shown to be potentially effective to prevent and treat oral mucositis. Further intensive research through well-structured clinical trials to obtain the best scientific evidence over the standard therapy of oral mucositis is necessary to attain ideal parameters for radiotherapy and chemotherapy.

Reduced incidence and severity of acute radiation mucositis by WF10 (IMMUNOKINE) as adjunct to standard of cure in the management of head & neck cancer patients.

OBJECTIVE: To evaluate the role of WF10-immunotherapy in reducing oro-pharyngeal complications in head and neck cancer chemoradiotherapy. MATERIAL AND METHOD: Thirteen patients were enrolled and assigned either to WF10- (n = 6) or control group (n = 7). After completion of their initial (neoadjuvant) chemotherapy, patients received WF10 intravenous infusions at 0.5 mL/kg body weight/day for five consecutive days and repeated every 3 weeks, concomitantly to standard radiotherapy (6,600-7,500 cGy, 200 cGy/day). Control patients received radiotherapy alone. RESULTS: Patients in the WF10-group had a lower incidence of oro-pharyngeal complications grade > 2, including oral mucositis (1 vs. 5), dysphagia (2 vs. 7), oral pain (3 vs. 5), taste alteration (4 vs. 6) and weight loss (2 vs. 4). The statistical significances were achieved for the parameters of oral mucositis (p = 0. 048) and dysphagia (p = 0.009). CONCLUSION: WF10 appears to reduce severity of oro-pharyngeal complications associated with standard chemoradiotherapy for head and neck cancer.

Prevenção e tratamento da mucosite oral induzida por radioterapia: revisão de literatura / Prevention and treatment of radiotherapy-induced oral mucositis: a literature review

A prevenção e o tratamento da mucosite oral conseqüente à radioterapia ainda não estão bem estabelecidos. Neste sentido, este estudo tem como objetivos: identificar na literatura científica as medidas para prevenção e tratamento da mucosite oral em pacientes com câncer submetidos a tratamento radioterápico; analisar o nível de evidência dos estudos levantados; identificar, dentre as medidas de prevenção e de tratamentos propostos na literatura, aqueles que estão relacionados ao escopo das intervenções de enfermagem; analisar criticamente os resultados desses estudos e suas implicações para a prática de enfermagem. Trata-se de uma revisão sistemática de literatura, sem meta-análise, que utilizou as seguintes bases de dados: Bireme, Medline, Cancerlit, Scirus, Periódicos Capes, Free Medical Journal, Highwire Press, SciELO, Medscape, no recorte temporal de 2000 a 2005. Constatou-se que o enfermeiro tem a possibilidade de melhorar a qualidade de vida do paciente promovendo sua educação, implementando e supervisionando programas de cuidados orais e orientando para a higiene, a prevenção e o tratamento da mucosite oral, inclusive o manejo da dor. Não foram encontradas publicações nacionais de enfermagem sobre o tema. Considerou-se então que as pesquisas e as publicações com a experiência do enfermeiro na prevenção e no tratamento da mucosite oral, em radioterapia, e suas implicações para o paciente e o cuidado de enfermagem são de extrema necessidade e relevância para uma atuação profissional baseada em evidências e, portanto, necessitam ser realizadas.

Evaluation of some oral postradiotherapy sequelae in patients treated for head and neck tumors

The aim of this study was to evaluate the oral sequelae of radiotherapy in patients treated between 1999 and 2003 for head and neck tumors. One-hundred patients (24 women, 76 men) ranging in age from 30 to 83 years (mean 59.2 years) were examined. Time since radiotherapy ranged from 1 to 72 months (mean 28 months). The total mean radiation dose received by the patients was 5,955 cGy. The evaluation protocol included anamnesis, intraoral and extraoral examination, measurement of stimulated salivary flow and salivary pH. Symptoms reported by the patients included dry mouth (68 percent), dysphagia (38 percent), and dysgeusia (30 percent). In 64 percent of the patients, the mean stimulated salivary flow rate was less than 0.7 ml/min. The mean salivary pH was 6.97 (± 0.714). Stimulated salivary flow increased with increasing postradiotherapy time (p < 0.05). The prevalence of mucositis was associated with higher radiation doses (p < 0.05), and the prevalence of atrophic candidiasis was related to a longer post-treatment period (p < 0.05). Two cases of recurrence of the primary tumor were detected during the study. The main effect of radiotheraphy in the head and neck region was a reduction of the salivary flow rate, even though our study demonstrated that there was a modest late improvement of the salivary flow.

O objetivo deste estudo foi avaliar as seqüelas bucais provocadas pela radioterapia em pacientes com neoplasias de cabeça e pescoço, tratados entre 1999 e 2003. Foram examinados 100 pacientes (24 mulheres e 76 homens), com idades entre 30 e 83 anos (média de 59,2 anos). O tempo desde a radioterapia variou de 1 a 72 meses (média de 28 meses). A média da dose total de radiação recebida pelos pacientes foi de 5.955 cGy. O protocolo de avaliação consistiu de anamnese, exame físico, aferição do fluxo salivar estimulado e pHmetria da saliva. Os sintomas referidos foram boca seca (68 por cento), disfagia (38 por cento) e disgeusia (30 por cento). Em 64 por cento dos indivíduos o valor médio do fluxo salivar estimulado esteve abaixo de 0.7 ml/min. O pH médio da amostra foi de 6.97 (± 0.714). O fluxo estimulado e a ocorrência de candidíase atrófica aumentaram conforme o aumento do tempo pós-radioterapia (p < 0.05). A ocorrência de mucosite esteve associada a maiores doses de radiação (p < 0.05). Dois casos de segundo tumor primário foram diagnosticados. O principal efeito da radioterapia na região de cabeça e pescoço foi a redução do fluxo salivar, apesar de nosso estudo ter demonstrado que há uma melhora tardia do fluxo salivar.

Complicações bucais da radioterapia em cabeça e pescoço / Oral complications of radiotherapy in the head and neck

A radioterapia é uma forma terapêutica amplamente utilizada para o tratamento das neoplasias malignas da cabeça e pescoço. Porém, altas doses de radiação em extensos campos que irão incluir a cavidade bucal, maxila, mandíbula e glândulas salivares freqüentemente resultam em diversas reações indesejadas. Dentre as complicações da radioterapia estão a mucosite, candidose, disgeusia, cárie por radiação, osteorradionecrose, necrose do tecido mole e xerostomia. OBJETIVO: O objetivo deste artigo é fazer uma breve revisão das reações adversas que podem ser detectadas durante o tratamento radioterápico em região de cabeça e pescoço. MÉTODO: A literatura pertinente que trata do assunto foi revisada. FORMA DE ESTUDO: Revisão de literatura. RESULTADOS: A radioterapia ainda está associada a diversas reações adversas, que afetam de forma significativa a qualidade de vida dos pacientes. CONCLUSÕES: O tratamento multidisciplinar, incluindo a equipe médica, o cirurgião-dentista, o fonoaudiólogo, o nutricionista e o psicólogo é a melhor alternativa para minimizar ou mesmo prevenir tais complicações.

Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapyÆs complications. AIM: The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region. BASIC METHOD USED: Review of relevant literature. STUDY DESING: Literature review. RESULTS: Radiotherapy is still associated with several side effects, significantly affecting patientsÆ quality of life. CONCLUSIONS: A multidisciplinary treatment, including physicians, dentists, speech therapits, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions.

Prevenção e controle das seqüelas bucais em pacientes irradiados por tumores de cabeça e pescoço / Prevention and control of sequels in the mouth of patients treated with radiation therapy for head and neck tumors

A cirurgia e a radioterapia são os principais métodos de tratamento das neoplasias de cabeça e pescoço. Dentre os efeitos colaterais resultantes da interação da radiação ionizante sobre os tecidos, temos dermatite, mucosite, xerostomia, candidíase, alteração do paladar, disfagia, cárie, trismo e osteorradionecrose. OBJETIVO: Avaliar a condição odontológica dos pacientes, através de protocolo que permita impedir ou minimizar os efeitos da radiação sobre os tecidos da cavidade bucal. MATERIAIS E MÉTODOS: Realizou-se acompanhamento odontológico, antes, durante e até 180 dias após a radioterapia, em 12 pacientes submetidos a cirurgia e radioterapia, ou radioterapia exclusiva. RESULTADOS: Efeitos como dermatite, mucosite, alteração do paladar e disfagia cresceram em proporção a partir da segunda semana de tratamento até o final das aplicações, decrescendo visivelmente quando do término, chegando próximos aos valores basais após 180 dias. Quanto à xerostomia, a redução ocorreu mais lentamente e com menor efetividade. Cárie, trismo e osteorradionecrose não foram observados durante o período de avaliação. CONCLUSAO: O acompanhamento odontológico sistemático, junto com medidas preventivas como adequação bucal prévia, orientações sobre higienização, utilização de bochechos de água bicarbonatada, chá de camomila, aplicação tópica de flúor, contribuíram para promover melhores condições de restabelecimento em pacientes com neoplasia da região de cabeça e pescoço submetidos à radioterapia.

Detecção de lesões neoplásicas induzidas em mucosa oral de hamster utilizando espectroscopia de fluorescência / Detection of induced neoplastic lesions in the oral mucosa of hamsters using fluorescence spectroscopy

OBJETIVO: Este trabalho teve por objetivo a utilização da técnica de espectroscopia de fluorescência induzida por laser para a caracterização de tecido normal e neoplásico em mucosa jugal de hamster, visando diagnosticar tecidos neoplásicos in vivo. MÉTODOS: O carcinógeno DMBA foi aplicado na bochecha direita de 31 hamsters com 150 ± 10g, três vezes por semana durante 12 semanas. Um animal foi mantido como controle (sem aplicação da droga). Após este período, os animais foram submetidos à espectroscopia de fluorescência induzida por laser de argônio (488nm), acoplado a um cabo de fibras ópticas. A autofluorescência do tecido foi guiada pelo cabo de fibras e analisada por um espectrógrafo e uma câmera CCD 1024X256 pixels, cobrindo a faixa espectral de 550nm a 700nm. Os espectros foram coletados na área da lesão induzida e na bochecha contralateral (normal) de todos os animais, além do animal de controle. Subseqüente à espectroscopia, foi realizada a biópsia da lesão para a análise histopatológica. Dois algoritmos de diagnóstico dos espectros de tecido neoplásico, baseados na razão entre regiões espectrais e na técnica de análise das componentes principais (PCA) foram implementados. RESULTADOS: Foi demonstrada a existência de um pico intenso na região de 630nm nos tecidos neoplásicos (atribuído à protoporfirina IX), quando comparados com o tecido normal. O algoritmo baseado na razão entre regiões espectrais obteve 100 por cento de sensibilidade e especificidade. O algoritmo baseado na PCA obteve 94 por cento e 100 por cento de sensibilidade e especificidade, respectivamente. CONCLUSÕES: Este trabalho indica que a autofluorescência de tecidos da mucosa oral poderá ser utilizada como uma técnica não-invasiva de diagnóstico, com alta sensibilidade e especificidade.