Effectiveness of Transcutaneous Electrical Nerve Stimulation Therapy on whole Salivary Flow in Patients with Xerostomia and Healthy Adults

ABSTRACT Objective: To evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on whole salivary flow in patients with xerostomia and healthy adults. Material and Methods: Thirty subjects with a history of xerostomia and subjects withunstimulated salivary flow equal to or less than 0.5 ml in 5 min were included in the study group, and 30 healthy subjects were included in the control group. Low forced spitting unstimulated saliva was collected for five minutes in a test tube fitted with a funnel. Then electrode pads of the TENS unit were applied bilaterally on skin overlying the parotid glands and at optimal intensity, stimulated saliva was collected for 5 minutes with the same method in a separate graduated test tube. The salivary flow rate (per minute) was calculated by dividing the amount of collected saliva (volume in mL) by the duration of collection period (5 minutes) and the salivary flow rates prior and after electrostimulation were compared for both groups. The Student's t-test (unpaired and paired) was performed for group-wise comparisons. Results: In study group, the mean unstimulated salivary flow rate was 0.07 ± 0.01 mL/min. There was an 85.71% increase in salivary flow (0.13 ± 0.03 mL/min) during the TENS application and the difference was highly significant (p<0.001). In control group, the mean unstimulated salivary flow rate was 0.37 ± 0.07 mL/min. There was a 21.62% increase in salivary flow (0.45 ± 0.07 mL/min) during the TENS application and the difference was highly significant (p<0.001). An increase in mean salivary flow rate both in males and females after TENS application in both groups (p<0.001) was noted. The difference between unstimulated, stimulated and mean difference in salivary flow rate between males and females was notstatistically significant in both groups (p<0.05). Conclusion: TENS can be an effective therapy in increasing whole salivary flow rates in patients with xerostomia.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Manifestações bucais em pacientes submetidos a tratamento quimioterápico / Manifestaciones orales en pacientes sometidos a quimioterapia / Oral manifestations in patients undergoing chemotherapy

Introdução: a quimioterapia é um tratamento anticâncer fundamentado na utilização de fármacos que induzem a morte das células neoplásicas. A literatura descreve que lesões bucais podem surgir em consequência do tratamento quimioterápico. Objetivo: identificar as manifestações bucais em pacientes submetidos à quimioterapia atendidos no serviço de referencia em oncologia da região sul do estado do Ceará-Brasil. Métodos: o presente estudo, do tipo transversal descritivo, avaliou 73 pacientes acometidos por algum tipo de neoplasia maligna e em tratamento quimioterápico no período de janeiro de 2013 a dezembro de 2014. Os dados clinico-patológicos como idade, gênero, diagnóstico da neoplasia maligna, tipos de tratamentos anticâncer, esquema medicamentoso quimioterápico, entre outros, foram obtidos a partir dos prontuários médicos. Foram ainda realizados exames intrabucais em todos os indivíduos desse estudo por um único examinador especialista em Estomatologia. Resultados: dos 73 pacientes 29 (39,7 porcento) eram do gênero masculino e 44 (60,3 porcento) do gênero feminino, com idade média de 57,7 anos, sendo 37 (50,7 porcento) dos pacientes fumantes. A mama foi o local mais prevalente de acometimento do câncer (35,6 porcento). Os fármacos mais utilizados na terapia quimioterápica foram a aredia em 23,3 porcento dos casos (n= 17) e o paclitaxel em 17,8 porcento (n= 13). Em relação às manifestações bucais, dos 73 pacientes do estudo, 44 (60,2 porcento) apresentaram algum tipo de desconforto bucal. A maioria dos pacientes, 77,3 porcento (n= 34), foram diagnosticados com xerostomia e em 22,7 porcento (n= 10) foram observados mucosite. Conclusão: as manifestações bucais encontradas em pacientes em tratamento quimioterápico foram a xerostomia e a mucosite, sendo a xerostomia a condição patológica bucal mais prevalente(AU)

Introducción: la quimioterapia es un tratamiento basado en el uso de fármacos anticancerígenos que inducen la muerte de las células cancerosas. La literatura describe lesiones bucales pueden surgir como resultado de la quimioterapia. Objetivo: identificar las manifestaciones bucales en pacientes sometidos a quimioterapia atendidos en el servicio de referencia en oncología en Estado del Ceará-Brasil. Métodos: se evaluaron 73 pacientes afectados por algún tipo de malignidad tratada con quimioterapia a partir de enero de 2013 hasta el mes de diciembre del 2014. Los datos clínicos y patológicos (edad, sexo, diagnóstico de malignidad, tipos de tratamientos con fármacos de quimioterapia contra el cáncer, entre otros), se obtuvieron de los registros médicos. También se realizaron exámenes bucales en todos los sujetos de este estudio por el experto en estomatología. Resultados: de los 73 pacientes 29 (39,7 por ciento) eran hombres y 44 (60,3 por ciento) mujeres, con una edad media de 57,7 años, y 37 (50,7 por ciento) eran fumadores. La mayor prevalencia del cáncer se observó en la mama (35,6 por ciento). Los fármacos más frecuentemente utilizados en el tratamiento de quimioterapia fueron aredia en 23,3 por ciento de los casos (n= 17) y paclitaxel en el 17,8 por ciento (n= 13). En relación con las enfermedades bucales, de los 73 pacientes estudiados, 44 (60,2 por ciento) tenían algún tipo de malestar bucal. La mayoría de los pacientes (77,3 por ciento; n= 34) fueron diagnosticados con xerostomía y 22,7 por ciento (n= 10) con mucositis. Conclusión: las lesiones bucales que se encontraron en los pacientes sometidos a quimioterapia fueron a xerostomía y mucositis. La xerostomía fue la condición patológica bucal más frecuente(AU)

Introduction: chemotherapy is a treatment based on the use of anticancer drugs that induce the death of cancer cells. The literature describes oral lesions may arise as a result of chemotherapy. Objective: to identify the oral manifestations in patients undergoing chemotherapy treated at the reference service in oncology southern state of Ceará - Brazil. Methods: we evaluated 73 patients affected by some type of malignancy and chemotherapy from January of 2013 to December of 2014. The clinical and pathological data such as age, gender, diagnosis of malignancy, types of treatments anticancer chemotherapeutic drug treatment, among others,were obtained from medical records. Were also carried out oral examinations in all subjects of this study by the same examiner specialist in stomatology. Results: of the 73 patients 29 (39.7 percent) were male and 44 (60.3 percent) females with a mean age of 57.7 years, and 37 (50.7 percent) of smokers. Regarding malignancy, the mama was the most prevalent location (35.6 %). The drugs most frequently used in chemotherapy treatment were aredia in 23.3 percent of cases (n= 17) and paclitaxel in 17.8 percent (n= 13). In the oral manifestations, of the 73 patients studied, 44 (60.2 percent) had some type of oral discomfort. Most patients, 77.3 percent (n= 34) were diagnosed with xerostomia and 22.7 percent (n= 10) were observed mucositis. Conclusion: oral lesions found in patients undergoing chemotherapy were xerostomia and mucositis. Xerostomia being the most prevalent oral pathological condition(AU)

Análise de fatores clínico-demográficos, psicológicos, hormonais e genéticos na síndrome da ardência bucal e ardor bucal secundário / Analysis of clinical and demographic, psychological, hormonal and genetic factors in burning mouth syndrome and secondary burning mouth

A síndrome da ardência bucal (SAB) é uma condição clínica pouco esclarecida caracterizada por sensação espontânea de ardência, dor ou prurido na mucosa oral, sem alterações locais ou sistêmicas identificáveis. Sua etiopatogenia é incerta, não havendo até o momento uma padronização dos critérios utilizados para o seu diagnóstico. O presente estudo objetivou verificar a associação de fatores psicológicos, hormonais e genéticos com a SAB no sentido de propor uma melhor caracterização de sua natureza. Além de uma análise descritiva da amostra estudada, os aspectos analisados foram especificamente os níveis de estresse e sua fase, depressão, e ansiedade, compondo os fatores psicológicos; mensuração dos níveis séricos de cortisol e desidroepiandrosterona (DHEA); bem como a verificação sobre a ocorrência de polimorfismos no gene da Interleucina-6 (IL6). Foram realizadas análises comparativas entre um grupo de pacientes com SAB e um grupo composto por indivíduos com ardor bucal secundário (AB). Os resultados revelaram diferenças estatisticamente significativas entre os dois grupos com relação aos seguintes aspectos: xerostomia (p=0,01) e hipossalivação em repouso (p<0,001), que foram mais prevalentes no grupo SAB; sintomas de depressão (p=0,033), também mais presentes no grupo SAB; e dosagem de DHEA, que apresentou níveis mais reduzidos no grupo SAB (p=0,003). A dosagem desse hormônio mostrou-se amplamente sensível e específica para o diagnóstico da síndrome em estudo, sendo verificado que níveis séricos de DHEA abaixo de 0,37µg/mL para mulheres, utilizando-se os procedimentos propostos na pesquisa, possuem um Odds Ratio de 4,0 95 por cento IC (0,37 a 2,71)]. Foi verificado ainda que o alelo C do polimorfismo rs2069849 da IL-6 pode representar um alelo de risco para a ocorrência de ardor bucal em ambos os grupos, no entanto, não se pode garantir sua real implicação nos processos inflamatórios da SAB

Os presentes resultados sugerem uma provável influência da depressão, bem como de níveis diminuídos do hormônio DHEA na SAB. (AU)

The burning mouth syndrome (BMS) is a clinical condition characterized by spontaneous burning sensation, pain or itching in the oral mucosa without identifiable local or systemic changes. Its pathogenesis is uncertain, with no observable standardization in previous literature of the criteria used for its diagnosis. The present study aimed to determine demographic, psychological, hormonal and genetic factors in patients with BMS and secondary burning mouth to propose a better characterization of the nature and classification of this condition. Besides a descriptive analysis of the sample of 163 individuals, were analyzed the levels of stress and its phase, depression and anxiety; measurement of serum levels of cortisol and dehydroepiandrosterone (DHEA), as well as checking on the occurrence of polymorphisms in the gene of interleukin-6 (IL6). Comparative analysis between a group of patients with BMS and a group of individuals with secondary burning mouth (BM) were performed. The results revealed statistically significant differences between the two groups with respect to the following aspects: xerostomia (p=0.01) and hyposalivation at rest (p<0.001), which were more prevalent in the BMS group; symptoms of depression (p=0.033), more present in the BMS group, and dosage of DHEA, which showed lower levels in BMS patients (p=0.003). The dosage of this hormone was largely specific and sensitive for the diagnosis of the studied syndrome, and was verified that serum levels of DHEA below 0.37 pg/mL in women, using the procedures proposed in this research, have an Odds Ratio of 4.0 95 per cent Cl (0.37 to 2.71)]. These results suggest a possible influence of depression and decreased levels of the hormone DHEA in the pathogenesis of BMS. (AU)

Associações entre fatores de risco e complicações bucais em pacientes com câncer de cabeça e pescoço tratados com radioterapia associada ou não à quimioterapia / Association between risk factors and oral complications in patients with head and neck cancer treated with radiotherapy combined or not with chemotherapy

Objetivo: descrever as reações adversas que ocorreram em pacientes durante a radioterapia associada ou não à quimioterapia, bem como avaliar suas possíveis associações com fatores de risco. Métodos: neste estudo longitudinal prospectivo foram examinados 28 pacientes antes, durante e após completar seis meses do término do tratamento oncológico. Os dados coletados foram idade, gênero, cor da pele, tabagismo, etilismo. Sobre o tumor, foram registrados a localização, a classificação TNM (tamanho do tumor, presença de linfonodo acometido e metástase à distância), o tipo histológico, o grau de diferenciação, o número de frações da radioterapia e o tratamento oncológico proposto. Os pacientes foram encaminhados ao Projeto de Oncologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais e receberam adequação do meio bucal antes do tratamento oncológico. Durante a radioterapia foram coletados dados relativos à presença de mucosite, xerostomia, disfagia, ardência e candidose. Após análise descritiva dos dados, as associações entre efeitos adversos durante a radioterapia e fatores de risco foram verificadas usando os testes do Qui-quadrado e Exato de Fisher (p menor que 0,05). Resultados: foi encontrada maior frequência de pacientes do sexo masculino (78,6%), leucoderma (71,4%) com carcinoma de células escamosas (78,6%). A prevalência da mucosite grau I, II e III, xerostomia, disfagia, candidose e ardência foram de 10,7%; 82,2%; 7,1%; 96,4%; 53,6%; 28,6% e 57,1%, respectivamente. Associação estatisticamente significativa foi encontrada somente entre presença ou ausência de maxilares irradiados e mucosite (p=0,03). Conclusão: efeitos adversos ocorreram durante a radioterapia associada ou não à quimioterapia em pacientes com câncer em região de cabeça e pescoço. Associação significativa foi verificada entre o local de irradiação e a presença de mucosite.

Objective: This study described the adverse reactions that occurred in patients during radiotherapy combined or not with chemotherapy, and assessed their possible associations with risk factors. Method: Using a prospective cross-sectional design, 28 patients were evaluated before, during and six months after the end of cancer treatment. The following data were collected: age, gender, ethnicity, smoking and alcohol consumption. Information recorded about the tumor included primary site of tumor, TNM classification (tumor size, lymph node status and distant metastasis), histological type, differentiation grade, number of fractions of radiotherapy and oncologic treatment protocol. The patients were referred to the Oncology Project of the School of Dentistry of the Federal University of Minas Gerais, and had their oral cavity prepared for cancer treatment. During radiotherapy, data were collected with respect to mucositis, xerostomia, dysphagia, burning sensation, and candidosis. After descriptive analysis of data, the associations between adverse effects raised during radiotherapy and risk factors were verified using the Chi-square and Fisher's Exact Test (p less than 0.05). Results: There was a predominance of male (78.6%), Caucasian (71.4%) patients with squamous cell carcinoma (78.6%). The prevalence of mucositis grades I, II, III, xerostomia, dysphagia, candida infections and burning sensation was 10.7%, 82.2%, 7.1%, 96.4%, 53.6%, 28.6% and 57.1%, respectively. A statistically significant association was found only between the presence or absence of irradiation of jaws and mucositis (p=0.03). Conclusion: Oral complications occurred during radiotherapy in combination or not with chemotherapy in patients with cancer in the head and neck region. A significant association was found between the site of irradiation and the presence of mucositis.

Boca seca, mucositis, problemas dentales y del gusto en la alimentación del niño con cáncer / Dry mouth, mucositis, dental problems and taste power in children with cancer

En niños con cáncer, la quimioterapia y la radioterapia de ciertos tumores de cabeza y cuello, reducen la producción de saliva generando sensación de boca seca, ulceraciones bucales y mucositis. Los problemas dentales se resumen en caries, boca seca y endurecimiento de los músculos de la cara. Así mismo, la quimioterapia, la radiación y el cáncer mismo, ocasionan cambios en el sentido del gusto del niño con cáncer. Todos estas circunstancias se reflejan en el bajo consumo de nutrientes y desarrollo a futuro de desnutrición para lo cual es necesario estar alerta y proponer medidas preventivas.

In children with cáncer, chemotherapy and radiotherapy of ceratin tumors of the head and neck, reduce the production of saliva causing dry mouth, mouth ulcers and mucositis. Dental problems of children with cancer are summarized in caries, dry mouth and tightening of the muscles of the face. Likewise, chemotherapy, radiation and the cancer itself, cause changes in taste of the child with cancer. All these circumstances are reflected in the low nutrient intake and future development of malnutrition for which it is necessary to be vigilant and to suggestpreventive measures.

Whole saliva physico-biochemical changes and quality of life in head and neck cancer patients following conventional radiation therapy: A prospective longitudinal study.

Background: We investigated the physico-biochemical changes in saliva and its relation to quality of life (QOL) in head and neck cancer patients following conventional radiation therapy (RT). Materials and Methods: 53 consecutive head and neck cancer patients underwent conventional RT using telecobalt photons. We analyzed objective sialometry and sialochemical parameters of salivary gland function and a physician reported Oral Assessment Protocol to assess the patients' QOL during (baseline, 3 and 6 weeks) and post RT (3 and 6 months). Statistical analysis was done using SPSS software (version 15.0; SPSS, Inc., Chicago, IL, USA). Results: Stimulated salivary flow rates had shown a consistent decline during and in post-RT analysis (P < 0.001). A significant correlation was seen between mean salivary flow rates at 6 months post-RT and mean salivary electrolytes and amylase levels during the same period (P < 0.001). Mean global QOL scores had significantly worsened during RT and were still significantly poorer at 6 months than initial pre-RT levels (P < 0.001). Further, significant correlation was established between salivary pH values with global QOL scores at 6 months (P = 0.05). Conclusions: Radiation-induced hyposalivation invariably persists and correlates with poor global QOL scores seen during and following conventional RT. Post RT, there is a trend for biochemical reversal toward pre-irradiation levels suggesting a subsiding inflammation or a probable functional recovery.

Manifestaciones bucales más frecuentes en pacientes diabéticos atendidos en el Instituto Autónomo Hospital Universitario de Los Andes / Oral manifestations more common in diabetic patients treated at the Instituto Autónomo Hospital Universitario of Los Andes

La diabetes mellitus (DM) es un desorden metabólico caracterizado por una hiperglicemia crónica debida a la resistencia periférica a la insulina, disfunción secretora de esta hormona o ambas. Lo cual produce alteraciones en el metabolismo de carbohidratos, lípidos y proteínas. El paciente diabético presenta ciertas características que le confieren alto riesgo de padecer enfermedades cardiovasculares, cerebrales, renales, oculares y manifestaciones en cavidad bucal, en las que predominan las infecciones debido a la alteración del sistema inmunológico. Este artículo tiene como objetivo determinar las manifestaciones bucales más frecuentes de pacientes diabéticos que asisten a la consulta odontológica. Las cuales deben ser tomadas en cuenta para realizar el diagnostico y tratamiento odontológico apropiado. En este sentido, se presenta el estudio de casos clínicos de 35 pacientes diabéticos atendidos en la Unidad de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (I.A.H.U.L.A). El estudio constó de la elaboración de la historia clínica con su respectivo examen clínico y examen radiográfico, monitoreo de niveles de glucosa en sangre, el establecimiento del diagnóstico y el tratamiento odontológico requerido en cada caso. Se encontró que, la gingivitis predominó en 97,1%, seguida de caries dental en 91,43% y periodontitis en 85,71% de los casos. Se concluyó que los pacientes diabéticos presentan alta incidencia de lesiones bucales, prevaleciendo una relación altamente significativa entre la periodontitis y los pacientes diabéticos mayores de 40 años

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to peripheral resistance to insulin, secretory dysfunction of this hormone or both, which cause alterations in the metabolism of carbohydrates, lipids and proteins. The diabetic patient shows certain characteristics that confer high risk for cardiovascular disease, cerebral, renal, and ocular manifestations in oral cavity, in which predominate infections due to alteration of the immune system. This article aims to explore the most common oral manifestations of diabetic patients attending the dental consultation that should be taken into account to make the diagnosis and appropriate dental treatment. In this sense, it presents a study of 35 clinical cases of type 2 diabetic patients treated at the Unit of the Institute of Endocrinology University Hospital of Los Andes (IAHULA). The study consisted of the development of the medical history with their clinical and radiographic examination, monitoring of blood glucose levels, the establishment of diagnosis and dental treatment required for each case. It was found that gingivitis was predominant in 97.1% , followed by 91.43% in dental caries and periodontitis with 85.71% of cases. It was concluded that diabetic patients have high incidence of oral lesions, and highly significant prevalence between periodontitis and diabetic patients older than 40 years

Burning mouth syndrome: a discussion about possible etiological factors and treatment modalities

Although several studies discuss the contributing factors associated with the burning mouth syndrome (BMS), there is still controversy with regard to its etiology. Therefore, in the majority of cases, the establishment of an adequate diagnosis and consequently the best treatment modality is complicated. In order to assist the clinician in the establishment of the correct diagnosis and management of BMS, this article reviews the literature, providing a discussion on the various etiologic factors involved in BMS, as well as the best treatment modalities for this condition that have showed to be the most effective ones in randomized clinical trials. In addition, the authors discuss some clinical characteristics in the differential diagnosis of BMS and other oral diseases. It is important for the clinician to understand that BMS should be diagnosed only after all other possible causes for the symptoms have been ruled out.