Influência da via hippo no reparo da mucosite oral quimicamente induzida em modelo murino submetida a tratamento com laser, geleia real ou própolis / Influence of the hippo pathway on the repair of chemically induced oral mucositis in a murine model subjected to treatment with laser, royal jelly or propolis

A via hippo é uma via de transdução de sinal altamente conservada que está implicada no desenvolvimento, homeostase e regeneração celular/tecidual. A YAP tem papel fundamental na via hippo uma vez que junto com a TAZ ativam fatores de transcrição que levam ao crescimento, diferenciação e migração celular. O mecanismo de fosforilação da YAP/TAZ pela LATS1/LATS2 cria um sítio de ligação para manter a YAP no citoplasma (fosforilada) impedindo suas funções a nível nuclear. Diante das importantes funções desta via no reparo e crescimento tecidual, esta pesquisa avaliou se a via hippo exerceu influência na resposta ao tratamento da MO através da expressão das proteínas YAP e LATS2 em mucosite oral (MO) quimicamente induzida pelo 5- fluoracil (5-FU), em modelo murino, tratada com própolis (P), geleia real (GR) ou laser (L) comparadas ao grupo controle (C), sem tratamento. Foram utilizadas amostras de ratos machos wistar divididos nos seguintes grupos: C, P, GR e L (intraoral 6 J/cm2 ) separados em três tempos experimentais: dias 08, 10 e 14. O perfil de imunomarcação foi feito por escores padronizados entre 0 a 3 levando em consideração a marcação nuclear e/ou citoplasmática. Na análise de imunomarcação da YAP, no dia 08, o grupo controle obteve os escore 0 e 1 na maioria das amostras, já nos dias 10 e 14 a maior parte das amostras obteve os escore 2 e 3. Nos grupos experimentais (L, GR e P), o escore 2 prevaleceu em todos os tempos experimentais. Para LATS2 houve prevalência do escore 2 tanto no grupo controle quanto nos grupos teste em todos os tempos experimentais. Em relação a análise estatística da imunoexpressão da proteína YAP, verificou-se diferença estatítica significativa (p= 0,020), apenas no dia 08 entre o grupo controle comparado aos grupos experimentais (L, GR e P). Já para LATS2 nenhuma diferença estatística foi encontrada. Na avaliação estatística dos diferentes tempos experimentais dentro um mesmo grupo, só foi encontrada diferença estatística significativa no grupo laser e apenas para LATS2 (p=0,025). Adicionalmente foi realizada a correlação de spearman, entre YAP e LATS2 para todos os grupos, porém não houve associação estatística significativa. A maior imunoexpressão de YAP e LATS2 (escores 2 e 3) observada nos grupos experimentais, indica que a via hippo é ativada e parece influenciar o processo de reparo nas mucosites orais quimioinduzidas e tratadas pelos diferentes métodos (AU).

The hippo pathway is a highly conserved signal transduction pathway that is implicated in cell/tissue development, homeostasis and regeneration. YAP plays a key role in the hippo pathway since, together with TAZ, they activate transcription factors that lead to cell growth, differentiation and migration. The YAP/TAZ phosphorylation mechanism by LATS1/LATS2 creates a binding site to keep YAP in the cytoplasm (phosphorylated) preventing its functions at the nuclear level. Given the important functions of this pathway in tissue repair and growth, this research evaluated whether the hippo pathway exerted influence on the response to OM treatment through the expression of YAP and LATS2 proteins in oral mucositis (OM) chemically induced by 5-fluororacil (5- FU), in a murine model, treated with propolis (P), royal jelly (GR) or laser (L) compared to the control group (C), without treatment. Samples of male Wistar rats divided into the following groups were used: C, P, GR and L (intraoral 6 J/cm2) separated into three experimental times: days 08, 10 and 14. The immunostaining profile was performed by standardized scores between 0 to 3 taking into account nuclear and/or cytoplasmic labeling. In the YAP immunostaining analysis, on day 08, the control group obtained scores 0 and 1 in most samples, while on days 10 and 14 most samples obtained scores 2 and 3. In the experimental groups (L, GR and P), score 2 prevailed at all experimental times. For LATS2 there was a prevalence of score 2 both in the control group and in the test groups at all experimental times, showing a very heterogeneous expression. Regarding the statistical analysis of YAP protein immunoexpression, there was a statistically significant difference (p= 0.020), only on day 08 between the control group compared to the experimental groups (L, GR and P). As for LATS2, no statistical difference was found. In the statistical evaluation of the different experimental times within the same group, a statistically significant difference was only found in the laser group and only for LATS2 (p=0.025). Additionally, the Spearman correlation was performed between YAP and LATS2 for all groups, but there was no statistically significant association. The greater immunoexpression of YAP and LATS2 (scores 2 and 3) observed in the experimental groups indicates that the hippo pathway is activated and seems to influence the repair process in chemoinduced oral mucositis treated by different methods (AU).

Probióticos associados ao tratamento das doenças periodontais: revisão de literatura / Probiotics associated with the treatment of periodontal diseases: literature review

Objetivo: revisar a literatura sobre o tratamento dasdoenças periodontais associado a probióticos, identificandoas funcionalidades e os principais agentes microbianosempregados. Material e método: foi realizadabusca nas bases de dados eletrônicas PubMed e ScienceDirect, empregando os termos de busca probiotics eperiodontal diseases. Como critérios de inclusão, foramselecionadas pesquisas clínicas originais e ensaios clínicospublicados em português ou inglês. Resultados:após pesquisa e minuciosa revisão por título e resumode cada estudo, 40 ensaios clínicos randomizados foramselecionados para avaliação dos desfechos observados.Todos os estudos empregaram probióticos associadosa raspagem, alisamento e polimento coronorradicular.A cepa bacteriana mais utilizada é o Lactobacillus reuteri.Foi demonstrado que os probióticos conferem potencialauxilio ao tratamento das lesões periodontais.Embora os parâmetros avaliados nem sempre sejam beneficiadospelo tratamento, o uso dos microrganismosbenéficos reduziu a necessidade de intervenção cirúrgicaprincipalmente em pacientes com bolsas profundas.Considerações finais: A utilização dos probióticosse mostra segura e traz pequenos ganhos auxiliares notratamento das doenças que acometem o periodonto.Desenhos de estudos com rigor metodológico e amostrasrepresentativas são encorajados visando analisar etestar os benefícios desses agentes. (AU)

Objective: this study aimed to review the literature on the treatment of periodontal diseases associated with probiotics, identifying functionalities and the most used microbial agents. Material and method: a search was performed in the main electronic databases PubMed and Science Direct using the search terms "Probiotics" and "Periodontal diseases". The inclusion criteria were original clinical researches and clinical trials published in Portuguese and English. Results: after the research and meticulous revision for the title and abstract of each study, 40 randomized clinical trials were selected for evaluation of the outcomes observed. All studies used probiotics associated with scaling and crown-root planning and polishing. The most used bacterial strain was Lactobacillus reuteri. It was shown that probiotics provide potential assistance for the treatment of periodontal lesions. Although the parameters evaluated are not always favored by the treatment, the use of the beneficial microorganisms reduced the need for surgical intervention, especially in patients with deep pockets. Final considerations: the use of probiotics is safe and promotes small additional improvements in the treatment of periodontal diseases affecting the periodontium. Study designs with methodological rigor and representative samples are encouraged, aiming to analyze and test the benefits of such microbial agents. (AU)

Probiotic therapy reduces inflammation and improves intestinal morphology in rats with induced oral mucositis

Abstract The aim of the present study was to evaluate the effect of systemic administration of probiotics (PROB) on the progression of experimentally induced oral and intestinal mucositis in rats immunosuppressed by chemotherapy (5-fluorouracil: 5-FU). Twenty-four rats were divided into the following groups (n=6): GC (control), GPROB, G5FU and G5-FU/PROB. Groups GPROB and G5-FU/PROB received 1 g of probiotic incorporated into each 100 g of feed (Bacillus subtilis, Bifidobacterium bifidum, Enterococcus faecium and Lactobacilllus acidophilus), beginning 30 days before oral mucositis induction. Groups G5FU and G5-FU/PROB received 60 mg/kg of 5-FU on days 0 and 2. The left oral mucosa of each animal was irritated by mechanical trauma (days 1 and 2). On days 3 and 7, three animals from each group were sacrificed, and their oral mucosa and small intestine were biopsied and processed for histopathological analysis. Groups G5-FU and G5-FU/PROB showed ulcerated oral lesions at day 3, with progression in group G5-FU and regression in group G5-FU/PROB at day 7. Histologically, less severe signs of inflammation in the oral mucosa were observed in group G5-FU/PROB than in group G5-FU. Regarding the intestine, villus-related defects of lesser magnitude were observed in group G5-FU/PROB, compared with group G5-FU. Group GPROB showed greater villus height than group GC. It can be concluded that probiotic supplementation reduced oral and intestinal inflammation in immunosuppressed rats with experimentally induced mucositis, and may protect the intestine from changes induced by chemotherapy, thus contributing to overall health.

Oral and systemic manifestations, and dental management of a pediatric patient with tetralogy of fallot: a case report / Características sistémicas, orales y manejo dental de paciente pediátrico con tetralogía de fallot: reporte de caso

Abstract: introduction: tetralogy of Fallot is a congenital heart disease and the most common cyanotic heart defect in children. It is clinically characterized by a ventricular septal defect, pulmonary stenosis, overriding aorta over ventricular septal defect and right ventricular hypertrophy. There is little or no information about the oral manifestations in patients with this pathology. A report and discussion of a pediatric patient diagnosed with Tetralogy of Fallot, its clinical manifestations, oral findings and dental management are presented. Case Report: A four-year-old male patient diagnosed with Tetralogy of Fallot and epileptic attacks. The patient has deciduous teeth with many severe early childhood caries, stomatitis and cyanotic mucous membranes, root fragments, periapical abscess and noticeable enamel hypoplasia. Conclusions: In agreement with other authors, children with systemic diseases such as Tetralogy of Fallot have a higher rate of caries, poor oral hygiene, high susceptibility to other infections and bacterial endocarditis, cyanotic mucous membranes and enamel hypoplasia. Primary prevention is critical, proper dental hygiene, regular dental check-ups and the use of antibiotic prophylaxis are particularly important, especially in high-risk patients.

Resumen: introducción: la tetralogía de Fallot es la patología cardíaca congénita y defecto cardiaco cianótico más común en niños. Clínicamente se caracteriza por una comunicación interventricular, estenosis pulmonar, cabalgamiento de la aorta sobre la comunicación interventricular e hipertrofia del ventrículo derecho. Existe poca o nula información sobre las manifestaciones orales de pacientes con esta patología. Se relata el informe y discusión de un paciente pediátrico diagnosticado con tetralogía de Fallot, sus manifestaciones clínicas, hallazgos orales y manejo dental. Refiriendo además la condición de salud oral del paciente antes y después de los procedimientos dentales. Reporte del Caso. Paciente masculino de 4 años, diagnosticado con Tetralogía de Fallot y crisis epilépticas. Presenta dentición temporal con múltiples caries de la infancia temprana severa, estomatitis y mucosas cianóticas, restos radiculares, absceso periapical y una evidente hipoplasia del esmalte. Conclusiones. En concordancia con otros autores, los niños con enfermedades sistémicas como tetralogía de Fallot tienen un mayor índice de caries, higiene oral deficiente, alta susceptibilidad a otras infecciones y a endocarditis bacteriana, mucosas cianóticas e hipoplasia del esmalte. La prevención primaria es decisiva, higiene dental apropiada, revisiones odontológicas habituales y uso de antibioprofilaxis son significativos sobre todo en pacientes de alto riego.

Paradigmas associados às doenças peri-implantares: O que se sabe e o que ainda precisa ser pesquisado / Paradigms associated with peri-implant diseases: what is known and what still needs to be researched

A doença peri-implantar é um processo inflamatório de etiologia bacteriana que pode acometer os tecidos ao redor dos implantes. Quando a inflamação atinge exclusivamente os tecidos moles circundantes é denominada mucosite peri-implantar, e quando há também a perda do osso de suporte é denominada peri-implantite. Má higiene oral, tabagismo e histórico prévio de doença periodontal são fatores de risco para a doença peri-implantar. Os parâmetros básicos de diagnóstico e tratamento das doenças peri-implantares são delineados pelos utilizados nas doenças periodontais, principalmente devido às similaridades etiológicas encontradas entre elas. Porém, algumas características dos implantes, como a sua morfologia, rugosidade de superfície e desenho protético, criam condições específicas que desafiam os profissionais a ter protocolos ideais de identificação e tratamento das doenças peri-implantares. O objetivo deste trabalho foi realizar uma revisão da literatura sobre o diagnóstico, os fatores de risco e os tratamentos atualmente pesquisados.

Tratamiento de la mucositis oral en pacientes oncológicos: revisión de la literatura y experiencia en el Hospital General de México / Management of oral mucositis in patients with cancer: review of literature and experience in the General Hospital of Mexico

La mucositis es la reacción secundaria a la quimioterapia y/o radioterapia, existen múltiples opciones terapéuticas para tratar esta complicación, no se cuenta con un tratamiento definido por lo que el objetivo de esta revisión es el de agrupar las distintas maneras de abordar la mucositis oral y su efecto así como compartir la experiencia que se tiene en el Hospital General de México. Dentro de los tratamientos más utilizados se encuentra el empleo de fármacos protectores de mucosa, crioterapia, factores de crecimiento entre otros, el efecto deseado es retrasar la aparición de la lesión así como disminuir la severidad de las mismas, no todas las opciones se encuentran disponibles para el personal médico por lo que se deben de conocer las distintas opciones terapéuticas y la solidez científica con la que cuentan.

Mucositis is the secondary reaction to chemotherapy and / or radiotherapy, there are multiple therapeutic alternatives to treat this complication, there doesn't exist a specific therapy so the aim of this review is to coordinate the various ways of treating oral mucositis and its effect and to share the experience at the General Hospital of Mexico. Within the most widely used treatments is the use of mucosal protective drugs, cryotherapy, growth factors, among others, the main effect is to delay the onset of injury and decrease the severity of them, not all options are available for medical staff so they must know the different Iptherapeutic alternatives and the scientific soundness for each option.

Fatores relacionados ao surgimento e gradação da mucosite oral radioinduzida / Factores relacionados con la aparición y la clasificación de la mucositis oral inducida por la radiación / Factors related to the occurrence and classification of radiation-induced oral mucositis

Introdução: a mucosite Oral é considerada uma das complicações mais comuns da terapia antineoplásica de cabeça e pescoço. Caracteriza-se pelo eritema e edema da mucosa seguidos, geralmente, pela ulceração e descamação. Objetivo: avaliar os fatores relacionados ao surgimento e gradação da mucosite em pacientes submetidos à radioterapia na região de cabeça e pescoço. Métodos: foi realizado um estudo transversal, com amostra composta por 22 pacientes com diagnóstico de câncer de cabeça e pescoço, submetido a tratamento de radioterapia. Os pacientes foram avaliados durante 4 semanas para se observar o surgimento e gradação da mucosite durante o tratamento antineoplásico os fatores como idade, consumo de álcool e tabaco, comorbidades como diabetes, hipertensão, cardiopatias, assim como níveis de higiene oral. Resultados: de acordo com os resultados do Coeficiente ñ de Sperman, U Mann-Whitney e Kruskal-Wallis a mucosite oral se desenvolveu em 95,45 porcento dos pacientes submetidos à radioterapia de cabeça e pescoço, com maior gradação entre os fumantes quando comparados com os não fumantes, com diferença estatisticamente significativa (p = 0.034). Conclusão: estes resultados sugerem que não há associação entre idade, consumo de álcool, comorbidades como diabetes, hipertensão, cardiopatias e nível de higiene oral com o surgimento e gradação da mucosite. Já os pacientes tabagistas apresentam graus mais elevados de mucosite oral radioinduzida no momento do surgimento(AU)

Introducción: la mucositis oral es una de las complicaciones agudas más comunes que resulta de la terapia antineoplásica de cabeza y cuello. Se caracteriza por eritema y edema de la mucosa, seguidos comúnmente por ulceración y descamación. Objetivo: evaluar los factores relacionados con la aparición y la clasificación de la mucositis oral en pacientes sometidos a radioterapia de cabeza y cuello. Métodos: se realizó un estudio longitudinal incluyendo 22 pacientes con diagnóstico de cáncer en la cabeza y cuello sometidos a radioterapia. Los pacientes fueron evaluados por 4 semanas y se controló la aparición y la clasificación de la mucositis oral durante el tratamiento antineoplásico. Resultados: de acuerdo con las pruebas del coeficiente ñ de Spearman, U de Mann-Whitney y Kruskal Wallis, la mucositis oral estuvo presente en el 95,45 por ciento de los pacientes que se sometieron a radioterapia de cabeza y cuello, pero el grado de mucositis oral fue mayor entre los fumadores, en comparación con aquellos que no eran fumadores, con diferencia estadísticamente significativa (p = 0,034). Conclusión: los resultados sugieren que no hubo asociación entre la edad, el consumo de alcohol, comorbilidades y nivel de higiene oral con la aparición y la clasificación de la mucositis. Los fumadores tuvieron niveles más altos de mucositis oral radio-inducida en el momento de su aparición(AU)

Introduction: oral mucositis is considered the most common acute complication resulting from head and neck antineoplastic therapy. It is characterized by erythema and mucosa edema, commonly followed by ulceration and peeling. Objective: this study aimed to assess the factors related to the onset and grading of oral mucositis in patients undergoing radiotherapy for head and neck cancer. Methods: a longitudinal study was conducted, comprising 22 patients with a diagnosis of head and neck malignancy undergoing radiotherapy. These patients were evaluated during 4 weeks and they were checked for the onset and grading of oral mucositis during antineoplastic treatment. Results: according to coefficient ñ tests by Spearman, U Mann-Whitney and Kruskal-Wallis, oral mucositis developed in 95.45 percent of patients who underwent head and neck radiotherapy, with higher grading among smokers compared with those of non-smokers, with statistically significant difference (p = 0.034). Conclusion: these results suggest that there was no association between age, alcohol consumption and patients' oral hygiene with the onset and grading of mucositis. Smokers were found to show higher grading of radiation-induced oral mucositis on its onset(AU)

Efeito da clorexidina e do laser de baixa potência na prevenção e no tratamento da mucosite oral / Effect of chlorhexidine and low power laser in the prevention and treatment of oral mucositis

Introdução: A mucosite oral é um dos efeitos colaterais mais frequentes do tratamento oncológico, sendo responsável pelo maior declínio na qualidade de vida dos pacientes e causando importante morbidade. Objetivo: Este estudo tem como objetivo avaliar o efeito preventivo da clorexidina e o efeito terapêutico do laser de baixa potência em pacientes sob terapia antineoplásica, nos centros de oncologia da cidade de Feira de Santana, Estado da Bahia. Material e método: Foram avaliados 74 pacientes em tratamento quimio e/ou radioterápico, divididos em quatro grupos: grupo experimental I (n = 37), pacientes submetidos a bochechos com digluconato de clorexidina; grupo experimental II (n = 07), pacientes com mucosite oral submetidos a bochechos com digluconato de clorexidina e ao laser de baixa potência; grupo controle I (n = 37), pacientes submetidos ao protocolo dos centros de oncologia, e grupo controle II (n  =  15), pacientes com mucosite submetidos ao protocolo dos centros de oncologia. Cada paciente foi avaliado ao final do tratamento, por meio de exame local, para detecção de mucosite. Resultado: Dos 74 pacientes, 22 desenvolveram mucosite, sendo 07 dos grupos controles (I e II) e 15 dos grupos experimentais (I e II). Dos pacientes que desenvolveram mucosite, 07 foram tratados com o laser. Conclusão: A solução de clorexidina não preveniu a instalação da mucosite oral, apesar de ter diminuído a gravidade das lesões. Com relação ao tempo de permanência das lesões, observou-se a importância do uso do laser no manejo da mucosite (p = 0,0106).

Background: The oral mucositis is one of the most frequent side effects of oncology treatment and is responsible for the largest decline in quality of life of patients and causing significant morbidity. Objective: This study aimed to evaluate the preventive effect of chlorhexidine and treatment of low-energy laser in patients under antineoplastic therapy in three oncology centers in the city of Feira de Santana, Bahia. Material and method: 74 patients were evaluated on chemotherapy or radiotherapy treatment, divided into four groups: experimental group I (n = 37), patients undergoing mouthwash with chlorhexidine digluconate; experimental group II (n = 07), patients with oral mucositis undergoing mouthwashes with chlorhexidine digluconate and low laser power, control group I (n = 37), submitted to the protocol of the centers of oncology and control group II (n = 15) patients with mucositis protocol submitted to the centers of oncology. Each patient was evaluated at the end of treatment by local examination for the detection of oral mucositis. Result: From 74 patients, 22 developed mucositis, where 07 of the control groups and 15 of experimental groups. From patients who developed mucositis, 07 were treated by laser. Conclusion: The chlorhexidine did not prevent the installation of oral mucositis, although it decreased the severity of injuries. Regarding the time of permanence of the injuries, the value found (p = 0.0106) demonstrated the importance of laser using in the management of oral mucositis.

Evaluation of the efficacy of zinc sulfate in the prevention of chemotherapy-induced mucositis: a double-blind randomized clinical trial

Oral mucositis is a serious complication of chemotherapy that results in painful debilitating inflammation, necessitating the administration of analgesics. There is no cure for mucositis. Some studies have evaluated the effect of zinc sulfate on mucositis. The present study aims to evaluate the effect of oral zinc sulfate on prevention of mucositis, xerostomia, and pain induced by chemotherapy. This double-blind, randomized controlled trial was carried out on 50 adult patients who underwent chemotherapy during 2008-2009. Patients were divided in two groups. Patients in the intervention group were administered three, 220 mg zinc sulfate capsules daily until the end of their chemotherapy treatment. Patients in the placebo group received three placebo capsules daily, which were similar in shape, taste, and color to the zinc sulfate capsules. Data were analyzed by SPSS version 17 software, using the independent samples t-test, Mann-Whitney U and Friedman tests. The incidence of grade 3 mucositis was lower in the zinc sulfate group. In the first follow up, grade 3 mucositis was detected in 10% of patients. In the placebo group, grade 3 mucositis was seen in 46.6% of patients. By the fourth follow up, grade 3 mucositis was detected in 3.33% of patients in the intervention group and in 20% of patient in the placebo group. At the end of the study there was no grade 3 mucositis detected in the zinc sulfate group, whereas there were 3.57% of patients in the placebo group with grade 3 mucositis. The results also showed that zinc sulfate decreased the effects of xerostomia and pain in patients under chemotherapy treatment. It can be concluded that zinc sulfate might decrease the intensity of mucositis

Peri-implantitis: revisión de la literatura / Peri-implantitis: literature review

La implantología oral inicia en la década de los 50s como resultado de experimentos científicos en tejido óseo. Actualmente los implantes dentales son una excelente opción de sustitución a dientes perdidos. Sin embargo, se encuentran expuestos a factores de riesgo que afectan su permanencia como: microbiológicos, ambientales (cigarrillo), genéticos, mecánicos, sistémicos (diabetes y osteoporosis) y farmacológicos. En razón a ello se han clasificado dos patologías peri-implantares: mucositis peri-implantar y peri-implantitis. Según el Sexto Consenso Europeo de Periodoncia se encuentran entre el 80%, y 28 a 56% respectivamente. El clínico debe conocer las causas de la lesión para orientar al paciente, establecer terapias de tratamiento y mantenimiento adecuadas y evitar el fracaso del tratamiento protésico. Las alteraciones que afectan la estabilidad de la oseointegración están determinadas en la planificación, inserción y fase de carga, teniendo en cuenta la presencia de biopelícula. En la actualidad se cuestiona el hecho de que los bifosfonatos interfieran en el éxito del implante y en la subsecuente osteonecrosis de los maxilares, por lo tanto no debe descartarse su análisis

Oral implantology began in the late 50s as a result of scientific experiments in bone tissue. Today dental implants are an excellent replacement option for lost teeth. However, they are exposed to risk factors affecting its continued operation as: microbiological, environmental (smoking), genetic, mechanical, systemic (diabetes and osteoporosis) and pharmacologic. Because it has identified two pathologies peri-implantares: peri-implant mucositis and peri-implantitis. According to the Sixth European Consensus of Periodontology found between 80% and 28-56% respectively. The clinician must know the causes of injury to guide patient treatment choices and establish appropriate maintenance and prevent failure of prosthetic treatment. Alterations that affect the stability of osseointegration are determined in the planning, integration and load step, taking into account the presence of biofilm. At present the fact that bisphosphonates interfere with with the success of the implant and the subsequent osteonecrosis of the jaw, so his analysis should not be dismisses

Tratamiento y prevención de la mucositis oral asociada al tratamiento del cáncer / Treatment and prevention of cáncer treatment related oral mucositis

One ofthe most common and troublesome complications ofmodern intensive anticancer treatments is oral mucositis. The purpose ofthis review is to summarize current evidente and clinical guidelines regarding its prevention and therapy. The use of keratinocyte growth factor-1, supplementary glutamine and other recently developed treatment modalities are discussed. The injury ofthe oral mucosa caused by antineoplastic agents promotes the local expression of múltiple pro-inflammatory and pro-apoptotic molecules and eventually leads to the development of ulcers. Such lesions predispose patients to several infectious and nutritional complications. Also, they lead to modification of treatment schedules, potentially affecting overall prognosis. Local cryotherapy with ice chips and phototherapy with low energy láser may be useful as preventive measures. Mouthwashes with allopurinol and phototherapy with low energy láser can be used as treatment. In radiotherapy, special radiation administration techniques should be used to minimize mucosal injury. Pain control should always be optimized, with the use ofpatient controlled analgesia and topical use of morphine. Supplemental glutamine should not be used outside of research protocols. Lastly, thorough attention should bepaid to general care and hygiene measures.

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.

Prevenção e tratamento da mucosite bucal: o papel fundamental do cirurgião-dentista: revisão / Prevention and treatment of oral mucositis: the fundamental role of dentist: review

OBJETIVO: Revisar a literatura sobre mucosite, a complicação não hematológica mais frequente e dose- limitante do tratamento oncológico, e o papel do cirurgião-dentista no manejo desta severa complicação. RESULTADOS: A condição é sequela da aplicação da rádio e/ou quimioterapia no epitélio da mucosa bucal, resultando em ulcerações dolorosas que dificultam a nutrição e a ingestão de líquidos, predispondo a infecções secundárias. As lesões da mucosite bucal podem levar à interrupção da terapia e à piora do prognóstico oncológico, o que torna evidente a responsabilidade da odontologia na equipe multidisciplinar. CONCLUSÃO: O uso de medidas adequadas para prevenir e tratar essa complicação, além de proporcionar melhora na qualidade de vida dos pacientes, é fundamental como parte da terapia oncológica. No tratamento da mucosite, enfatiza-se a manutenção de boa higiene bucal, controle da xerostomia e tratamento de infecções oportunistas como a candidose, os principais cuidados da competência do cirurgião dentista.

OBJECTIVE: To review the literature of mucositis, the most common and dose-limiting nonhematological complication to the oncologic treatment. RESULTS: This condition is caused by radio and/or chemotherapic effects in the epithelium of the oral mucosa, resulting in painful ulcerations that impair nutrition and liquid ingestion and increase the risk of secondary infections. For these reasons, oral mucositis lesions’ may lead to therapy interruption and to the worse of the oncological prognosis, hence highlighting the responsibility of the odontology in the multidisciplinary team. CONSLUSION: The use of adequate measures to prevent and treat this complication, beyond providing better life quality to the patients, is fundamental as part of the oncological therapy. In the treatment of mucositis, oral good hygiene maintenance, xerostomia control and treatment of opportunistic infections as candidosis dental surgeon’s care outstands.

Efeitos de terapias de estimulação mecânica e elétrica no fluxo salivar, na mucosite oral induzida por quimioterapia e no nível de citocinas na saliva de pacientes submetidos a TCTH / Effect of mechanical and electrical therapies on salivary flow in oral mucositis induced by chemotherapy and cytokine levels in saliva of patients undergoing HSCT

Objetivo. Avaliar os efeitos das terapias de estimulação salivar no fluxo salivar, da mucosite oral e nos níveis de citocinas salivares em pacientes que receberam transplante alogênico de células-tronco hematopoiéticas. modelo de estudo. Trinta e cinco pacientes foram randomizados em três grupos, classificados pelo tipo de terapia de estimulação salivar submetidos: O grupo do Hiperbolóide, da estimulação elétrica nervosa trancutânea (TENS), o da combinação desseas duas terapias; e do grupo controle. Saliva em repouso e estimulada foram coletadas de 7 dias antes, a 14 dias após transplante. Citocinas salivares foram avaliados pelo método ELISA...

Mucosite oral: perspectivas atuais na prevenção e tratamento / Oral mucositis: recent perspectives on prevention and treatment

A mucosite oral é resultante de toxicidade e um dos efeitos colaterais mais comuns da radioterapia e da quimioterapia, no tratamento oncológico e para o transplante de células tronco hematopoiéticas. Clinicamente estas alterações se caracterizam por atrofia epitelial, edema, eritema e pelo aparecimento de ulcerações, que podem acometer toda a mucosa bucal, gerando dor e desconforto, prejudicando a fala, a deglutição e a alimentação. Além da importante sintomatologia, as ulcerações aumentam o risco de infecção local e sistêmica, comprometem a função oral e interferem no tratamento antineoplásico, podendo levar à sua interrupção. O diagnóstico, prevenção e estratégias terapêuticas de suporte à mucosite oral são de competência do cirurgião-dentista. Através de análise crítica da literatura, o presente trabalho busca apresentar a mucosite oral, sua etiopatogenia, características clínicas e tratamentos propostos nos dias atuais para a sua resolução ou controle, destacando a importância da atuação do cirurgião-dentista no manejo desta entidade.

Oral mucositis is a result of toxicity and one of the most common side effects of radiotherapy and chemotherapy in cancer treatment and in hematopoietic stem cell transplantation. Clinically these changes are characterized by epithelial atrophy, edema, erythema and the appearance of ulcerations that can affect the entire oral mucosa, causing pain and discomfort, impairing speech, and swallowing food. In addition to the major symptoms, the ulcers increase the risk of local and systemic infection, compromising function and interfering with oral antineoplastic treatment and may lead to it being discontinued. The diagnosis, prevention and therapeutic strategies in providing support in cases of oral mucositis are the dentist's responsibility. Through critical analysis of literature, the aim of this article is to present oral mucositis, its pathogenesis, clinical features and treatments offered today to address or control the condition, highlighting the importance of dentist's role in its management.

Rehabilitation of exacerbated case of oral mucositis associated with renal failure following bone marrow transplantation.

Inflammation of oral mucosa induced by anti neoplastic drugs is an important, dose limiting and costly side effect of cancer therapy. Here is presented an exacerbated case of oral mucositis associated with renal failure in a patient who underwent bone marrow transplantation. The clinical aspects and an integrated rehabilitation program are discussed below.

Avaliação do uso do laser de baixa intensidade e do Light-Emitting Diode (LED) no comportamento de fibroblastos e na redução da incidência da mucosite bucal em crianças sob tratamento quimioterápico / Evaluation of the use of low-intensity laser and Light-Emitting Diode (LED) on the behavior of fibroblasts and in reducing the incidence of oral mucositis in children under chemotherapy

Avaliou-se o uso do laser de baixa intensidade e do Light-Emitting Diode (LED) no comportamento de fibroblastos e na redução da incidência da mucosite bucal em crianças sob tratamento quimioterápico. Para tanto, o estudo foi executado em dois períodos experimentais distintos. No primeiro período, foi realizada a análise da viabilidade de fibroblastos Balb/c 3T3 cultivados sob déficit nutricional irradiados com laser vermelho (660nm, 40mW), laser infravermelho (780nm, 50mW) e LED vermelho (637 ± 15nm, 40mW) por 4 e 8 segundos através dos ensaios de redução do MTT e captação do vermelho neutro. No segundo período experimental realizou-se ensaio clínico randomizado duplo-cego para avaliar a eficácia do laser vermelho (660nm, 40mW) e do LED vermelho (637 ± 15nm, 40mW) na redução da incidência e da severidade da mucosite bucal e da dor relacionada em crianças portadoras de câncer submetidas a quimioterapia utilizando-se o sistema de graduação da mucosite bucal da Organização Mundial de Saúde e a Escala de Dor de Faces Revisada associada à escala analógica visual. A análise estatística foi realizada utilizando-se o teste não paramétrico de Kruskal-Wallis e analise de variância do modelo linear geral com nível de significância de 5% (p = 0,05). Observou-se com a redução do MTT uma tendência de aumento da proliferação celular relacionado diretamente com o tempo de irradiação, no entanto, não significante estatisticamente. Após 72 horas, os grupos que apresentaram maior proliferação celular foram: grupo irradiado com laser infravermelho, grupo irradiado com LED, grupo irradiado com laser vermelho, grupo controle positivo e grupo controle negativo. Já através da captação do vermelho neutro, após 72 horas o grupo que apresentou maior proliferação celular foi o grupo controle positivo (cultivado sob condições nutricionais ideais) seguido pelo grupo irradiado com laser infravermelho, grupo controle negativo e grupos irradiados com LED e laser vermelho.

The use of low-intensity laser and Light-Emitting Diode (LED) on the behavior of fibroblasts and in reducing the incidence of oral mucositis in children under chemotherapy were evaluated. The study was performed in two separate experiments. In the first moment, the viability of fibroblasts Balb/c 3T3 cultured under nutritional stress irradiated with red laser (660nm, 40mW), infrared laser (780nm, 50mW) and red LED (637 ± 15nm, 40mW) for 4 and 8 seconds was analyzed through the MTT and neutral red assays. The second experiment carried out was a double-blind randomized clinical trial aiming to assess the effectiveness of red laser (660nm, 40mW) and red LED (637 ± 15nm, 40mW) in reducing the incidence and severity of oral mucositis and related pain in children with cancer undergoing chemotherapy using the World Health Organization oral mucositis grading system and the Faces Pain Scale - Revised associated with a visual analogue scale. Statistical analysis was performed using the Kruskal-Wallis nonparametric test and ANOVA with a significance level of 5% (p = 0.05). It was observed with the MTT assay a trend of cell proliferation increase directly related to the irradiation time, however, not statistically significant. After 72 hours, the groups that showed higher cell proliferation were: infrared laser irradiated group, LED irradiated group, red laser irradiated group, positive control group and negative control group. By the neutral red assay, though, after 72 hours the group that showed higher cell proliferation was the positive control (grown under ideal nutritional conditions) followed by the group irradiated with infrared laser, the negative control group and groups irradiated with red laser and LED. By analyzing the results and considering the used parameters and phototherapy protocol, it is plausible to conclude that phototherapy with lowintensity laser and light emitting diode (LED) showed no toxicity at...

[Effect of local hypothermia in prevention or reduction of chemotherapy induced mucositis signs]

Oral mucositis frequently occurs in patients undergoing cancer chemotherapy. It is hypothesized that Oral Cooling with ice chips or cubes cause local vasoconstriction thus cause less exposure to agents and then mucositis development. In this study, this theory was examined on 14 patients in 3 consecutive cycles in which stomatitis developed in the 1 st cycle of treatment. The purpose of the present study was to evaluate the Ice-Therapy [mouth-cooling] in prevention or decreasing symptoms of chemotherapeutic-related stomatitis. Date was obtained on a total of 100 out-patients initiating chemotherapy regimens. The patients reported different rates of stomatitis received ice cubes in their 2nd cycle of treatment during the drug infusion and a few minutes after it. In the next cycle, the same patients were evaluated without mouth cooling. The severity of mucositis were measured based on the patient's judgment and scaled on WHO grading system in the 7th and 10th days. Statistically, comparison of severity rates of mucositis between 3 consecutive cycles were performed by mean, p value, GAMMA coefficient and Friedman test. Statistical approach of data between 3 cycles determined that severity rates of mucositis have been decreased significantly between 1st and 2nd cycles[p<0.01, gamma coefficient: 65%] But this relationship has not been obtained in comparison between 2nd and 3rd cycles so it has been speculated that Oral Cooling has no useful effect on the prevention of chemotherapy-induced mucositis. Oral Cooling has no evidence of benefit in improvement or decreasing of the chemotherapy induced lesions

Use of therapeutic laser for prevention and treatment of oral mucositis

Oral mucositis (OM) affects patients who are submitted to hematopoietic stem cell transplantation (HSCT) due to high doses of chemotherapy and/or radiotherapy. The purpose of this investigation was to perform a comparative study of the frequency and evolution of OM among patients subjected to therapeutic laser and to the conventional therapy (use of mouthwash called "Mucositis Formula"). The patients were subjected to a myeloablative conditioning regimen before the allogeneic HSCT. Twenty-two patients were selected and divided into 2 groups: group I was irradiated with InGaAlP laser (660 nm) and GaAlAs laser (780 nm), 25 mW potency, 6.3J/cm² dose, in 10-s irradiation time, followed to conventional treatment; group II was subjected only to the conventional treatment. Both World Health Organization (WHO) scale and the Oral Mucositis Assessment Scale (OMAS) were used to evaluate the results. Data were analyzed by the non-parametric Wilcoxon test, with p<0.05 considered as statistically significant. Group I presented a lower frequency of OM (p=0.02) and lower mean scores, according to WHO and OMAS scales (p<0.01 and p=0.01, respectively). In conclusion, laser reduced the frequency and severity of OM, suggesting that therapeutic laser can be used both as a new form of prevention and treatment of OM.

A mucosite oral (MO) afeta pacientes que são submetidos ao transplante de células-tronco hematopoéticas (TCTH) devido as altas doses de quimioterapia e/ou radioterapia. A proposta desta investigação foi realizar um estudo comparativo da freqüência e a evolução da MO entre os pacientes submetidos ao laser terapêutico e da terapia convencional (uso de solução de bochecho chamada "Fórmula para Mucosite").Os pacientes foram submetidos ao regime de condicionamento mieloablativo antes da realização do TCTH alogênico.Vinte e dois pacientes foram selecionados e divididos em 2 grupos: grupo I foi irradiado com laser AlGaInP (660 nm) e laser GaAlAs (780 nm), potência de 25 mW, dose de 6,3J/cm², tempo 10 s, seguido do tratamento convencional; grupo II submetido apenas ao tratamento convencional. Ambas as escalas da World Health Organization (WHO) e Oral Mucositis Assessment Scales (OMAS) foram utilizadas para avaliar os resultados. Os dados foram analizados pelo teste não-paramétrico de Wilcoxon, com p<0,05 considerado estatisticamente significante. O grupo I apresentou menor frequência de MO (p=0,02) e menor média de acordo com as escalas WHO e OMAS (p<0,01 e p=0,01, respectivamente). Em conclusão, o laser reduziu a frequência e gravidade da MO, sugerindo que o laser terapêutico pode ser usado para ambos como uma nova forma de prevenção e tratamento da MO.

Effect of nursing intervention on eliminating radiology induced oral mucositis in head and neck cancer patients

Oral health is often affected by medical conditions and some cancer treatments. This is often underreported, undiagnosed as problematic and inadequately treated. The study aimed to portray the effect of nursing interventions on eliminating radiology induced oral mucositis in Head and Neck Cancer Patients. The study was conducted in Mansoura Main University Hospital, Medical Oncology Department. A convenient sample of sixty adult head and neck cancer patients were randomly assigned to a study [A] and control groups [B] of 30 patients each. Oral care intervention protocol has been designed and used to reduce the incidence and duration of oral mucositis [OM] in the study group. The study results revealed improvement in oral health status in the 7th day of observations in the study group after oral care intervention. There were nearly equal alterations in both groups in the 1st day of observation [36.66%with mild and 63.33% with severe alterations in study group and 33.33% of mild and 66.66% of severe alterations in the control group respectively. Moreover; there was no significant differences among both groups prior to oral care interventions performed to the study group in the 1st day, [p = 0.79]. However, on the 4th day of observation, there were significant differences among both groups [p = 0.3]. Patients in oral care intervention group showed an improvement on the 7th day. According to the results observed, professional and home oral hygiene should be used and adhered also evidence-based clinical practice guidelines presented as a benchmark for nurses to use for routine care for appropriate patients and as a springboard to challenge clinical investigators to conduct high quality trials in oral hygiene and oral care .Nursing management must take an integrated approach as well; nursing care research must be conducted to achieve high quality nursing management of mucositis and other oral complications