Evaluación del estatus del tejido pulpar postratamiento oncológico / Assessment of the status of the pulp tissue post oncological treatment

La OMS cataloga al cáncer como uno de los principales problemas en el ámbito mundial, los pacientes sometidos a terapia oncológica son más vulnerables a desarrollar complicaciones en los tejidos de la cavidad bucal entre las que tenemos: mucositis, infecciones, osteorradionecrosis. En el manejo endodóntico hay que tomar en consideración que los trata- mientos como yodoterapia, radioterapia y quimioterapia pueden generar efectos sobre el complejo dentinopulpar. El objetivo de este artículo es determinar el estatus del tejido pulpar postratamiento oncológico mediante la revisión sistemática en bases de datos de gran relevancia científica, como PubMed, Scielo, Medigraphic, Science direct. Se concluye que el sistema estomatognático es un receptor importante de estos efectos y secuelas en pacientes con terapia oncológica, el tejido pulpar no está libre de estas secuelas ya que genera daño celular, como la hipovascularidad, hipocelularidad e hipoxia la cual incrementa el riesgo de necrosis de la región (AU)

The WHO lists cancer as one of the main problems worldwide, patients undergoing oncological therapy are more vulnerable to developing complications in the tissues of the oral cavity among which we have: mucositis, infections, osteoradionecrosis. In endodontic management, it should be taken into consideration that treatments such as iodine therapy, radiotherapy, and chemotherapy can generate effects on the dentin-pulp complex. This article aims to determine the status of the pulp tissue after oncologic treatment. Through a systematic review in databases of great scientific relevance, such as PubMed, Scielo, Medigrafhic, Science direct. It is concluded that the stomatognathic system is an important receptor of these effects and sequelae in patients with oncological therapy, the pulp tissue is not free of these sequelae as it generates cellular damage because of the hypo vascularity, hypocellularity, and hypoxia which increases the risk of necrosis of the region (AU)

Protective effect of polysaccharides isolated from the seeds of Cuscuta chinensis Lam. on 5-fluorouracil-induced intestinal mucositis in mice

Purpose: To evaluate the protective effect of Cuscuta chinensis Lam. polysaccharides (PCCL) on 5-fluorouracil-(5-FU)-induced intestinal mucositis (IM) in mice. Methods: PCCL was orally administered at a dose of 20 mg·kg­1 for 7 days and its protective effect on 5-FU-induced IM (5-FU, 50 mg·kg­1 for 5 days) was evaluated by monitoring changes in body weight, degree of diarrhea, levels of tissue inflammatory factors (tumor necrosis factor α, interleukin 6, and interleukin 1ß levels), apoptosis rates, and the expression levels of caspase-3, Bax and Bcl-2. Results: The severity of mucosal injury (as reflected by body weight changes, degree of diarrhea, height of villi, and damage to crypts) was significantly attenuated by PCCL administration. PCCL also reduced the levels of tissue inflammatory factors, the apoptosis rate, and the expression of caspase-3 and Bax, and increased Bcl-2 expression. Conclusions: PCCL administration may be significantly protective against 5-FU-induced IM by inhibiting apoptosis and regulating the abnormal inflammation associated with it.

Babao Dan Alleviates 5-Fluorouracil-Induced Intestinal Damage via Wnt/β-Catenin Pathway / 中国结合医学杂志

OBJECTIVE@#To evaluate the protective function of Babao Dan (BBD) on 5-flurouracil (5-FU)-induced intestinal mucositis (IM) and uncover the underlying mechanism.@*METHODS@#A total of 18 male mice were randomly divided into 3 groups by a random number table, including control, 5-FU and 5-FU combined BBD groups, 6 mice in each group. A single intraperitoneal injection of 5-FU (150 mg/kg) was performed in 5-FU and 5-FU combined BBD groups on day 0. Mice in 5-FU combined BBD group were gavaged with BBD (250 mg/kg) daily from day 1 to 6. Mice in the control group were gavaged with saline solution for 6 days. The body weight and diarrhea index of mice were recorded daily. On the 7th day, the blood from the heart of mice was collected to analyze the proportional changes of immunological cells, and the mice were subsequently euthanized by mild anesthesia with 2% pentobarbital sodium. Colorectal lengths and villus heights were measured. Intestinal-cellular apoptosis and proliferation were evaluated by Tunel assay and immunohistochemical staining of proliferating cell nuclear antigen, respectively. Immunohistochemistry and Western blot were performed to investigate the expressions of components in Wnt/β-catenin pathway (Wnt3, LRP5, β-catenin, c-Myc, LRG5 and CD44).@*RESULTS@#BBD obviously alleviated 5-FU-induced body weight loss and diarrhea, and reversed the decrease in the number of white blood cells, including monocyte, granulocyte and lymphocyte, and platelet (P<0.01). The shortening of colon caused by 5-FU was also reversed by BBD (P<0.01). Moreover, BBD inhibited apoptosis and promoted proliferation in jejunum tissues so as to reduce the intestinal mucosal damage and improve the integrity of villus and crypts. Mechanically, the expression levels of Wnt/β -catenin mediators such as Wnt3, LRP5, β-catenin were upregulated by BBD, activating the transcription of c-Myc, LRG5 and CD44 (P<0.01).@*CONCLUSIONS@#BBD attenuates the adverse effects induced by 5-FU via Wnt/β-catenin pathway, suggesting it may act as a potential agent against chemotherapy-induced intestinal mucositis.

Mucositis periimplantaria asociada a ortodoncia correctiva / Peri-implant mucositis associated to corrective orthodontics

Introducción: Los minitornillos de ortodoncia son dispositivos temporales de anclaje utilizados ampliamente en ortodoncia correctiva. Sin embargo, se ha reportado en la literatura que su tasa clínica de éxito no es completa debido a que pueden existir fallas relacionadas con la pérdida de su estabilidad. Varios factores pueden comprometer el anclaje y están relacionados con el tipo de implante, su manejo quirúrgico y el hospedero. Dentro de este último, se encuentra la inflamación del tejido periimplantario o mucositis que, aunque reversible, es necesario su tratamiento temprano para evitar su progresión a la afectación de tejido duro (periimplantitis). Objetivo: Describir un caso clínico de mucositis periimplantaria asociada a un dispositivo de anclaje ortodóntico temporal. Presentación del caso: Paciente femenina que acudió a la consulta por presentar dolor en la zona anterior del maxilar superior. Durante el examen intraoral se observó que usaba aparatos de ortodoncia con mecanismo de anclaje: dos minitornillos de ortodoncia ubicados al nivel de los caninos superiores. Se realizó la remoción quirúrgica de los minitornillos de ortodoncia, se le indicó el uso de antibióticos y se realizó estudio histopatológico para descartar malignidad. Se diagnosticó con mucositis periimplantaria. Conclusiones: La remoción quirúrgica de los minitornillos de ortodoncia es una excelente alternativa para evitar la progresión de la lesión hacia los tejidos duros. A través de esta técnica lograron eliminar signos de dolor, enrojecimiento y sangrado(AU)

Introduction: Orthodontic miniscrews are temporary anchorage devices widely used in corrective orthodontics. However, it has been reported in the literature that their clinical success rate is not high, due to failures related to the loss of stability. Anchorage may be affected by factors associated to the type of implant, its surgical management and the host. Host-related factors include peri-implant tissue inflammation or mucositis, which though reversible, its early treatment is necessary to prevent expansion into and damage to the hard tissue (peri-implantitis). Objective: Describe a clinical case of peri-implant mucositis associated to a temporary orthodontic anchorage device. Case presentation: A female patient attends clinical consultation with pain in the anterior zone of her upper maxilla. Intraoral examination revealed the presence of orthodontic appliances with an anchorage mechanism: two orthodontic miniscrews located at the level of the upper canines. Surgical removal was performed of the orthodontic miniscrews, antibiotics were indicated and histopathological testing was conducted to rule out malignancy. The patient was diagnosed with peri-implant mucositis. Conclusions: Surgical removal of orthodontic miniscrews is an excellent alternative to prevent the progress of the lesion into hard tissues. Pain signs, reddening and bleeding were all eliminated with the technique applied(AU)

Use of wide-field optical fluorescence for visualization of oral biofilm in a patient with peri-implant mucositis: a new approach / Uso da fluorescência óptica de campo amplo para visualização de biofilme oral em paciente com mucosite peri-implantar: uma nova abordagem

ABSTRACT Peri-implant diseases, caused by bacteria from biofilm related to dental implants, are one of the main causes of late loss of implants. In this sense, peri-implant diseases are divided into peri-implant mucositis, when it affects only the soft tissues, and peri-implantitis, when there is a bone involvement, which can lead to the failure of dental implant therapy. Thus, biofilm removal is essential for peri-implant health, allowing long-term success in implant therapy. To improve the visualization of oral biofilm, which is usually transparent or colorless, disclosing agents have been routinely used. However, disclosing agents have allergenic potential and can cause staining extrinsically in restorative and prosthetic materials, leading to aesthetic impairment. Thus, the use of fluorescence has been studied as an alternative for visualization of oral biofilm. Therefore, this report describes the use of wide-field optical fluorescence for visualization of oral biofilm associated with implants and teeth, in a routine appointment and follow-up of a partially edentulous patient with peri-implant mucositis. In addition, this report showed wide-field optical fluorescence can be used in a clinical routine of care of patients with dental implants. In this sense, wide-field optical fluorescence allowed easy and immediate visualization of the mature oral biofilm for its adequate removal, evaluation of the quality of restoration to sealing of screw access-hole of implant and identification of cariogenic lesions, without risk of allergic reactions or staining of prostheses and restorations.

RESUMO Doenças peri-implantares, causadas por bactérias de biofilme relacionadas a implantes dentários, são uma das principais causas de perda tardia de implantes. Nesse sentido, as doenças peri-implantares são divididas em mucosite peri-implantar, quando afeta apenas tecidos moles, e peri-implantite, quando há comprometimento ósseo, o que pode levar ao fracasso da terapia com implantes dentários. Assim, a remoção do biofilme é essencial para a saúde peri-implantar, permitindo sucesso a longo prazo na terapia com implantes. A fim de melhorar a visualização do biofilme oral, que geralmente é transparente ou incolor, agentes reveladores têm sido rotineiramente utilizados. No entanto, esses agentes têm potencial alergênico e podem causar manchas extrinsecamente em materiais restauradores e protéticos, levando a prejuízo estético. Assim, o uso da fluorescência tem sido estudado como alternativa para visualização do biofilme oral. Este relato descreve o uso da fluorescência óptica de campo amplo para visualização do biofilme oral associado a implantes e dentes em uma consulta de acompanhamento de rotina de uma paciente parcialmente edêntula com mucosite peri-implantar. Além disso, este relato evidenciou que a fluorescência óptica de campo amplo pode ser utilizada dentro da rotina clínica de atendimento de pacientes com implantes dentários. Nesse sentido, a fluorescência óptica de campo amplo permitiu a visualização fácil e imediata do biofilme oral maduro para sua remoção adequada, a avaliação da qualidade da restauração do selamento do orifício de acesso do parafuso do implante e a identificação de lesões cariogênicas, sem risco de reações alérgicas ou manchamento de próteses e restaurações.

Lymphocyte B and Th17 chemotactic cytokine levels in peri-implant crevicular fluid of patients with healthy, peri-mucositis, and peri-implantitis implants / Niveles de citoquinas quimiotácticas de linfocitos B y Th17 en el fluido crevicular periimplantario de pacientes con implantes sanos, perimucositis y periimplantitis

Peri-implantitis is one of the leading causes of implant failure and loss, and its early diagnosis is not currently feasible due to the low sensitivity of currents methods. In the current exploratory cross-sectional study, we explored the diagnostic potential of lymphocyte B and Th17-chemotactic cytokine levels in peri-implant crevicular fluid (PICF) in 54 patients with healthy, peri-mucositis, or peri-implantitis implants. Peri-implant crevicular fluid was collected, and the levels of the molecules under study were quantified by Luminex assay. The concentrations of CCL-20 MIP-3 alpha, BAFF/BLYS, RANKL and OPG concentration in PICF were analyzed in the context of patient and clinical variables (smoking status, history of periodontitis, periodontal diagnosis, implant survival, suppuration, bleeding on probing, periodontal probing depth, clinical attachment level, mean of implant probing depth, and plaque index). Patients with peri-implantitis, appear to have an overregulation of the RANKL/BAFF-BLyS axis. This phenomenon needs to be investigated in depth in further studies with a larger sample size.

La periimplantitis es una de las principales causas de falla y pérdida del implante, y su diagnóstico temprano no es factible debido a la baja sensibilidad de los métodos actuales. En este estudio transversal exploratorio, se estudió el potencial diagnóstico de los niveles de citocinas quimiotácticas de linfocitos B y Th17 en el líquido crevicular periimplantario (LCPI) en 54 pacientes con implantes sanos, peri-mucositis o periimplantitis. Se recogió líquido crevicular periimplantario y se cuantificaron los niveles de las moléculas estudiadas mediante Luminex assay. Las concentraciones de CCL-20 MIP-3 alfa, BAFF/BLYS, RANKL y la concentración de OPG en LCPI se analizaron en el contexto de las variables clínicas y del paciente (tabaquismo, antecedentes de periodontitis, diagnóstico periodontal, supervivencia del implante, supuración, sangrado al sondaje, profundidad de sondeo periodontal, nivel de inserción clínica, media de la profundidad de sondeo del implante e índice de placa). Los pacientes con periimplantitis parecen tener una sobrerregulación del eje RANKL/BAFF-BLyS. Este fenómeno debe investigarse en profundidad en futuros estudios con un tamaño de muestra mayor.

Effect of topical 2% eucalyptus extract on 5-fu-induced oral mucositis in male golden hamsters

Abstract Oral mucositis is a common inflammatory complication among patients with cancer. This study evaluated the histopathological, stereological, and antioxidant markers of 2% eucalyptus extract in induced oral mucositis in male golden hamsters. In this animal study, oral mucositis was induced in 30 male golden hamsters by 5-FU (60 mg/kg) on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle once daily on days 3 and 4. On days 14-17, 2% eucalyptus hydroalcoholic extract gel and Calendula officinalis extract gel groups were treated and then compared with a non-treated control group. The histopathological and stereological scores and the pouch content of malondialdehyde, as well as the activities of glutathione and myeloperoxidase in the pouch tissue, were evaluated. Histopathologic scores of oral mucositis were lower in the eucalyptus gel group than those of the calendula and control groups (p<0.05). Also, a lower malondialdehyde level and higher myeloperoxidase and glutathione activities were detected in the eucalyptus group in comparison to the calendula and control groups (p<0.001). The thickness of the mucosa and submucosa increased in the eucalyptus group. The numerical density of the fibroblast and the volume density of the collagen significantly increased in the eucalyptus group. In conclusion, the use of eucalyptus hydroalcoholic extract may be associated with reduced intensity of oral mucositis, diminished concentration of malondialdehyde, increased activity of myeloperoxidase and glutathione, increased volume of mucosa and submucosa, increased fibroblast and collagen in the induced oral mucositis in golden hamsters undergoing 5-FU consumption.

Resumo A mucosite oral é uma complicação inflamatória comum em pacientes com câncer. Este estudo avaliou os marcadores histopatológicos, estereológicos e antioxidantes de Eucalyptus 2% na mucosite oral induzida em hamsters dourados machos. Neste estudo em animais, a mucosite oral foi induzida em 30 hamsters golden masculinos por 5-FU (60 mg / kg) nos dias 0, 5 e 10 do estudo. A bolsa da bochecha foi arranhada com uma agulha estéril uma vez ao dia nos dias 3 e 4. Nos dias 14 a 17, os grupos de gel de eucalipto a 2% e curativos à base de gel foram tratados e comparados com um grupo controle. Foram avaliados os escores histopatológicos e estereológicos e o conteúdo de malondialdeído na bolsa, bem como as atividades de glutationa e mieloperoxidase no tecido da bolsa. Os escores histopatológicos de mucosite foram menores no grupo de gel de eucalipto a 2% do que os do gel e do grupo controle (p <0,05). Além disso, um nível mais baixo de malondialdeído e maiores atividades de mieloperoxidase e glutationa foram detectadas no grupo tratado com eucalipto em comparação aos grupos à base de gel e controle (p <0,001). A espessura da mucosa e submucosa aumentou no grupo Eucalyptus. A densidade numérica do fibroblasto e a densidade do volume do colágeno aumentaram significativamente nos grupos tratados com eucalipto. Em conclusão, o uso do extrato hidroalcoólico de Eucalyptus pode estar associado a menor intensidade de mucosite oral, diminuição da concentração de malondialdeído, aumento da atividade de mieloperoxidase e glutationa, aumento do volume de mucosa e submucosa, aumento de fibroblastos e colágeno na mucosite oral induzida em hamsters dourados em consumo de 5 UF.

A case report of a successfully treated Myoplasma-induced rash and mucositis (MIRM) in a 10-year old Filipino

@#Introduction: Erythema multiforme has been known as an infection or drug-associated mucocutaneous eruption characterized by target lesions. A clinical entity, known as Mycoplasma-induced rash and mucositis seen mostly in the pediatric population is emerging and may be associated with atypical pneumonia caused by Mycoplasma pneumoniae. This presents with features overlapping with erythema multiforme and SJS-TEN spectrum but with a different trigger, prognosis, and recurrence rate. Case summary: Target lesions in the clinical setting are usually characteristically associated with erythema multiforme, a mucocutaneous condition associated with an underlying infectious trigger. We present a case of a 10-year-old Filipino boy who was initially diagnosed with erythema multiforme major. Eventual testing for the etiology of the underlying infection, Mycoplasma pneumoniae, proved to be a useful diagnostic that gave a better grasp on the case’s mechanism, sequela, and prognosis. The patient was admitted for pneumonia and his presenting mucositis was severe. Cutaneously, he had atypical target and few target lesions on the trunk and extremities. He was diagnosed as a case of Mycoplasma-induced rash and mucositis (MIRM) and treated with antibiotics and systemic steroids for which he recovered fully in three weeks. MIRM should be separated from erythema multiforme, Stevens Johnsons syndrome and toxic epidermal necrolysis as it follows a different disease course. Conclusion: Mycoplasma-induced rash and mucositis is now considered a distinct entity despite it having overlapping features with erythema multiforme and SJS-TEN spectrum. It presents usually in the younger age group with absent to sparse atypical vesiculobullous or targetoid lesions, significant mucosal involvement, and confluent necrosis on histology. It is important to identify it as a trigger because of its more frequent and severe mucosal sequelae. Management includes symptomatic relief, antibiotic therapy with a macrolide in the presence of pneumonia and systemic steroids when mucositis is severe. Majority of patients achieve full recovery.

Avaliação dos efeitos da Suplementação do Ácido Graxo ômega 3 em modelo de tumor de mama murino e mucosite induzida por 5-Fluouracil / Evaluation of the effects of Omega 3 Fatty Acid Supplementation in a model of murine breast tumor and mucositis induced by 5-Fluouracil

O ômega 3 é um ácido graxo poliinsaturado utilizado como agente terapêutico no tratamento de diversas doenças. Evidências sugerem efeito anti-inflamatório com sua utilização. A escolha do tratamento eficiente que minimize os efeitos adversos do tratamento oncológico tem sido desafiadora para a prática clínica. Dessa forma, ele seria interessante na prevenção e / ou tratamento da mucosite, uma inflamação que acomete as mucosas da boca ao ânus, decorrente da utilização de quimioterápico e radioterápico. As consequências deste agravo vão desde a perda de peso, anorexia e odinofagia, ao aumento do risco de translocação bacteriana, em virtude do aumento da permeabilidade intestinal (PI). Tais complicações podem levar à interrupção do tratamento quimioterápico até que o paciente se restabeleça. Trabalhos anteriores do nosso grupos de pesquisa demonstraram que o ômega 3 foi capaz de atenuar a perda de peso e reduzir a PI pela regulação da apoptose de células intestinais. Entretanto, possíveis efeitos da suplementação do ômega 3 no tumor não foram investigados. O presente estudo avaliou o efeito deste composto na mucosite induzida por quimioterápico em modelo de tumor de mama murino. Para tanto, camundongos Balb/c foram divididos nos grupos controle (CTL), controle tumor (CTLTU), tumor ômega 3 (TUW3), tumor 5-fluouracil (TU5FU) e tumor 5-fluouracil ômega 3 (TU5FUW3). Nos animais dos grupos com tumor foi realizada a inoculação das células tumorais (dia 1) e, uma vez que os tumores já se encontravam palpáveis (dia10), os grupos TUW3 e TU5FUW3 iniciaram a suplementação com ômega 3 pela ração por 10 dias, enquanto os demais animais receberam ração controle. Ao final desse período, os animais dos grupos TU5FU e TU5FUW3 receberam injeção intraperitoneal de 5-FU (300mg/kg) para indução da mucosite, enquanto os demais animais receberam a injeção de solução salina. Após 72 horas, os animais foram eutanasiados para coleta de dados. A suplementação com ômega 3 não foi capaz de prevenir a perda de peso em decorrência da mucosite. Entretanto, os animais do grupo TU5FUW3 apresentaram redução da PI por meio da recuperação das junções firmes ZO-1 e ocludina, além da preservação da arquitetura dos vilos. Os animais do grupo CTLTU também apresentaram aumento da PI e redução da expressão das proteínas de junção, provavelmente pela liberação de citocinas TNF-α e IL-1ß, conforme dosagem destas no baço. Nos animais suplementados com ômega 3 foi observado redução do tamanho do tumor e do número de metástases tumorais, além de redução da proliferação de células tumorais e aumento da afinidade das células tumorais ao quimioterápico, levando à apoptose destas. Este processo de citotoxicidade seletiva foi observado pela redução da toxicidade hepática. Diante desses resultados, pode-se concluir que a suplementação de ômega 3, por período de dez dias, foi capaz de atenuar os efeitos da mucosite induzida por quimioterápico, sem causar prejuízo à sua atividade antitumoral.

Omega 3 is a polyunsaturated fatty acid used as a therapeutic agent in the treatment of various diseases. It is widely accepted that its use can exert an anti-inflammatory effect. Thus, it would be interesting in the prevention and treatment of mucositis, which is described as an inflammation that affects mucosal membranes from the mouth to the anus, due to the use of chemotherapy and radiotherapy. Patients who suffer from this outcome, usually presents weight loss, anorexia and odynophagia,also there is an increased risk of bacterial translocation, due to the increase of the intestinal permeability (IP). Such complications can lead to the interruption of chemotherapy treatment until the patient is recovered. Previous work has shown that omega 3 was able to reduce weight loss and reduce IP by reducing intestinal cell apoptosis. However, the effects of omega 3 supplementation from the diet on the tumor remains unknown. This study aimed to investigate the effect of this compound on chemotherapy-induced mucositis in the murine breast tumor model. For that, BALB/ c mice were divided into the control (CTL), tumor control (CTLTU), omega 3 tumor (TUW3), 5-fluouracil tumor (TU5FU) and 5-fluouracil omega 3 tumor (TU5FUW3) groups. Tumor cells were inoculated (day 1) and, since they were already palpable (day 10), groups TUW3 and TU5FUW3 started receiving the chow supplemented with omega 3 for 10 days, while the other animals received control chow. At the end of this period, animals from groups TU5FU and TU5FUW3 received an intraperitoneal injection of 5-FU (300mg / kg) to induce mucositis, while the other animals received an injection of saline. After 72 hours, all animals were euthanized for data collection. Omega 3 supplementation was not able to prevent weight loss due to mucositis. However, animals from TU5FUW3 group showed a reduction in IP by recovering the tight-junctions ZO-1 and occludin, and by preventing the mucosal damage. Animals from CTLTU group also showed increased PI and reduced expression of tight-junction proteins, probably due to the release of cytokines TNF-α and IL-1ß, according to their dosage in the spleen. In addition, our results have demonstrated that animals supplemented with omega 3, have shown a reduction in the size of the tumor and the number of metastasis in lungs. We have found that the reduction was mediated through a reduction in the proliferation of tumor cells and also by an increased affinity of tumor cells to the chemotherapeutic drug, leading to their apoptosis. This selective cytotoxicity process leads to the reduction of liver toxicity. Given these results, we can conclude that omega 3 supplementation, for ten days, was able to attenuate the effects of chemotherapy-induced mucositis, without causing damage to its antitumor activity.

Effect of vertical soft tissue thickness on clinical manifestation of peri-implant tissue in patients with periodontitis / 北京大学学报(医学版)

OBJECTIVE@#To observe and investigate the effect of vertical soft tissue thickness on the peri-implant tissue condition and the prevalence of peri-implant disease in patients with history of periodontitis.@*METHODS@#Among 210 patients who showed initial interest of implant therapy, 92 patients were included in this study and received implant surgery during 2010 and 2015. Sixty-six patients with 66 implants finally came back for T2 evaluation. Prior to the implant therapy, all the patients had received periodontal treatment. During the implant placement surgery, the distance from palatal soft tissue edge to the alveolar crest, which was defined as vertical soft tissue thickness (VT), was measured after the buccal full thickness flap was elevated. According to the cut off point which was adopted from the operating characteristic curve, 66 implants within 66 patients were divided into two groups, which were called normal group (VT≤4.5 mm) and thick group (VT>4.5 mm), respectively. Information of the patient's general status, periodontal situation and implant information were recorded. After a follow-up period of 42.9 months, the parameters of peri-implant tissue and condition of peri-implant disease were recorded. Mann-Whitney U test as well as Chi-square test were used to compare the parameters between two groups. Moreover, Kaplan-Meier method was chosen to draw the event(peri-implantitis)-free survival curve.@*RESULTS@#The survival rate of the implants was 100%. At the end of the follow-up examination(T2), the parameters including max PDi, mean PDi, max BIi, mean BIi, mean MBL, MBL at distal side, MBL at mesial side, mean PLIi presented significantly higher values in thick group than in normal group (P < 0.05). Moreover, the prevalence of peri-implantitis and peri-implant disease (peri-implant mucositis & peri-implantitis) in thick group was respectively 34.8% and 73.9%, which was significantly higher than 2.3% and 48.8% respectively in normal group (P<0.05). The prevalence of peri-implant mucositis did not show significant difference in the two groups. In addition, Kaplan-Meier analysis showed that there was significant difference between the event-free survivals of the two groups.@*CONCLUSION@#The vertical soft tissue thickness around implants in patients with periodontitis has a significant effect on the health of the peri-implant tissue. Excessive vertical soft tissue thickness may result in deeper peri-implant probing depth as well as more peri-implant marginal bone loss, and eventually increase the risk of peri-implant disease. The vertical remodeling of soft tissue may be a new direction to indicate the role of periodontitis in peri-implant tissue condition. Moreover, the biological mechanism of the association between soft tissue thickness and peri-implantitis risk as well as effective approaches to prevent the adverse effect of excessive soft tissue thickness on peri-implant tissue is necessary to be investigated.

Effect of cryotherapy in preventing mucositis associated with the use of 5-fluorouracil / Efeito da crioterapia na prevenção de mucosite associada ao uso de 5-fluorouracil / Efecto de la crioterapia en la prevención de mucositis asociada al uso de 5-fluorouracilo

Objective: to evaluate the effect of oral cryotherapy compared to physiological serum on the development of oral mucositis in outpatient cancer patients using the 5-fluorouracil antineoplastic agent. Method: this is a controlled, randomized, double-blind, and multi-center clinical trial, conducted with 60 patients undergoing chemotherapy. The experimental group (n=30) used oral cryotherapy during the infusion of the 5-FU antineoplastic agent, while the control group (n=30) performed mouthwash with physiological serum at their homes. The oral cavity of the participants was assessed at three times: before randomization, and on the 7th and 14th days after using 5-FU. For data analysis, descriptive analyses and the ANOVA, paired t, and McNemar tests were used. Results: there was no statistically significant difference between the experimental and control groups in the assessments regarding the grade of mucositis. However, cryotherapy presented the chance to reduce the presence of intragroup mucositis, between the first and second assessments (p=0.000126). Conclusion: cryotherapy did not obtain statistical significance in relation to oral hygiene with serum, but it proved to be effective intragroup. Record number: RBR-4k7zh3

Objetivo: avaliar o efeito da crioterapia oral em comparação ao soro fisiológico no desenvolvimento de mucosite oral em pacientes oncológicos ambulatoriais em uso de antineoplásico 5-fluorouracil. Método: trata-se de um ensaio clínico controlado, randomizado, duplo-cego, multicêntrico, realizado com 60 pacientes em tratamento quimioterápico. O grupo experimental (n=30) fez uso de crioterapia oral durante a infusão do antineoplásico 5-FU, ao passo que o grupo controle (n=30) realizou bochechos com soro fisiológico em domicílio. A cavidade oral dos participantes foi avaliada em três momentos: antes da randomização, no 7° dia e no 14° dia após o uso do 5-FU. Para a análise dos dados, utilizaram-se análises descritivas e os testes ANOVA, t pareado e McNemar. Resultados: não houve diferença estatística significante entre os grupos experimental e controle nas avaliações quanto ao grau de mucosite. No entanto, a crioterapia teve a chance de reduzir a presença de mucosite intragrupo, entre a primeira e segunda avaliação (p=0,000126). Conclusão: a crioterapia não obteve significância estatística em relação à higiene oral com soro, porém se mostrou efetiva intragrupo. Número de registro: RBR-4k7zh3

Objetivo: evaluar el efecto de la crioterapia oral, comparándola con el suero fisiológico, sobre el desarrollo de mucositis oral en pacientes ambulatorios con cáncer en tratamiento con el antineoplásico 5-fluorouracilo. Método: se trata de un ensayo clínico controlado, aleatorizado, a doble ciego y multicéntrico, realizado con 60 pacientes en tratamiento de quimioterapia. El grupo experimental (n=30) utilizó crioterapia oral durante la administración del agente antineoplásico 5-FU, mientras que el grupo control (n=30) realizó enjuagues con suero fisiológico en su domicilio. La cavidad oral de los participantes se evaluó en tres momentos: antes de la aleatorización, y al 7º y 14º día después de la administración de 5-FU. Para el análisis de los datos, se utilizaron análisis descriptivos y las pruebas ANOVA, t pareada y McNemar. Resultados: en lo que respecta al grado de mucositis, no se registraron diferencias estadísticamente significativas entre el grupo experimental y el de control en las evaluaciones. Sin embargo, la crioterapia exhibió la posibilidad de reducir la presencia de mucositis intragrupo entre la primera y la segunda evaluación (p=0,000126). Conclusión: la crioterapia no alcanzó significancia estadística en comparación con la higiene oral con suero. Sin embargo, demostró ser efectiva intragrupo. Número de registro: RBR-4k7zh3

Miel en el manejo de la mucositis inducida por quimioterapia y radioterapia en niños / Honey in the management of mucositis induced by chemotherapy and radiotherapy in children

La mucositis es una respuesta inflamatoria del epitelio de la mucosa a los efectos citotóxicos de la quimioterapia y la radioterapia, que causan dolor y ulceración oral severa. En los estudios de los últimos años se ha propuesto el uso de la miel en el manejo de la mucositis oral inducida por quimioterapia y radioterapia en pacientes pediátricos. La miel reduce la severidad y duración de la mucositis, reduce el dolor y es un producto agradable a los niños. Por tanto, podría ser un producto eficaz tanto en la profilaxis como en el tratamiento de la mucositis oral. Sin embargo, la pequeña cantidad de investigaciones realizadas en humanos no es suficiente para establecer recomendaciones generalizadas. Por ello, se debe aumentar las investigaciones en este campo. Con ello se podrá examinar la eficacia y posibles complicaciones a corto y largo plazo, explorar su posible efecto sinérgico con otras terapias, analizar su rentabilidad económica y el tipo de miel más adecuado. De esta forma, los profesionales sanitarios podrán ofrecer a los pacientes pediátricos los mejores cuidados basados en las últimas evidencias científicas demostradas.

Mucositis is an inflammatory response of the mucosal epithelium to the cytotoxic effects of chemotherapy and radiation therapy, causing pain and severe oral ulceration. In the studies of recent years, the use of honey has been proposed in the management of oral mucositis induced by chemotherapy and radiotherapy in pediatric patients. Honey reduces the severity and duration of mucositis, reduces pain and is a child-friendly product. Therefore, it could be an effective product both in the prophylaxis and in the treatment of oral mucositis. However, the small amount of human research is not enough to establish widespread recommendations. Therefore, research in this field should be increased. With this, it will be possible to examine the efficacy and possible complications in the short and long term, explore its possible synergistic effect with other therapies, analyze its economic profitability and the most appropriate type of honey. In this way, healthcare professionals will be able to offer pediatric patients the best care based on the latest scientific evidence.

Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review / Diálise peritoneal com múltiplas trocas bem-sucedida em paciente com grave toxicidade hematológica por metotrexato: relato de caso e revisão de literatura

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.

Resumo Apesar de sua toxicidade, o metotrexato é um medicamento eficaz no controle de várias doenças. A mielossupressão, um de seus principais efeitos adversos, aumenta em gravidade e frequência nos pacientes com insuficiência renal. Apresentamos o caso de um homem de 68 anos de idade com doença renal terminal relacionada à vasculite associada ao ANCA em diálise peritoneal, que recebeu a medicação em dose baixa em função da atividade da doença e que teve como complicação pancitopenia grave com mucosite, tratada com medidas de suporte e diálise peritoneal com múltiplas trocas. Revisamos 20 casos publicados até o presente momento sobre pancitopenia associada a metotrexato em pacientes em diálise. Foi identificada alta morbidade e mortalidade, razão pela qual seu uso nesse tipo de paciente não é recomendado. No entanto, quando esta complicação ocorre, uma opção terapêutica pode ser o uso de diálise peritoneal com múltiplas trocas, além da terapia de suporte para toxicidade medicamentosa. Maiores estudos são necessários para demonstrar o papel da diálise peritoneal com múltiplas trocas na remoção desse medicamento.

Validación de un instrumento para medir la calidad de vida en niños con mucositis orofaríngea en tratamiento por cáncer / Validation of an instrument to measure the quality of life in children with oropharyngeal mucositis undergoing cancer treatment

Resumen Introducción: La mucositis orofaríngea (MO) es una de las principales complicaciones del tratamiento oncológico que reduce significativamente la calidad de vida (CV) del paciente. El objetivo fue traducir, adaptar de manera cultural y validar una nueva versión en español del instrumento Oropharyngeal Mucositis-Specific Quality-of-Life (OMQoL) en pacientes pediátricos. Métodos: Estudio transversal de validación, multicéntrico, realizado para la traducción y adaptación del OMQoL del inglés al español en pacientes de entre 8 y 16 años con MO. Se midió la confiabilidad mediante el Alfa de Cronbach; la validez del contenido y el constructo, con un análisis factorial exploratorio; y la validez convergente, con las correlaciones de las escalas para MO de la Organización Mundial de la Salud (OMS), la Oropharingeal Mucositis Assessment Scale (OMAS) y con el Pediatric Quality of Life-3 (PedsQL-3) módulo cáncer en español. Resultados: Participaron en el estudio 193 niños con una media de edad de 10.91 ± 2.38 años, de los cuales 101 (52.3%) fueron de sexo femenino. En esta muestra, 80 niños (41.5%) presentaron leucemia aguda linfoblástica y 111 (57.5%) presentaron MO grado 2 y 3. El análisis factorial resultó con cuatro dimensiones con cargas > 0.40. De los 31 ítems del OMQoL, seis fueron eliminados. El Alfa de Cronbach del OMQoL español fue de 0.954. Las correlaciones de Spearman (r) con las escalas de la OMS y OMAS fueron significativas (r = −0.720 y r = −0.689; p<0.01, respectivamente); con el PedsQL-3 módulo cáncer existió una moderada correlación (r = 0.426; p < 0.01). Conclusiones: La nueva versión del OMQoL en español demostró propiedades psicométricas adecuadas, y resulta un instrumento confiable y válido para medir la CV en niños con MO.

Abstract Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients. Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish. Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = −0.720 and r = −0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01). Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.

Cuidados bucais de pacientes oncológicos pediátricos e o uso da laserterapia no tratamento de mucosites / Oral Care of Pediatric Cancer Patients and the Use of Laser Therapy in the Treatment of Mucosites

Objetivo: realizar uma revisão de literatura sobre as principais manifestações orais e possibilidades terapêuticas no âmbito odontológico em pacientes oncológicos pediátricos, destacando-se a laserterapia como principal forma de tratamento. Material e métodos: Foi realizada uma pesquisa nas bases de dados Web of Science, PubMed e Cochrane Library, onde foram selecionados artigos de revisões sistemáticas, metanálise e ensaios clínicos, entre os períodos e 2009 a 2019. Resultados: Foram selecionados 41 artigos que abordam as propriedades da laserterapia de baixa intensidade no auxílio ao tratamento de pacientes oncológicos pediátricos. Conclusão: Os estudos evidenciam que o laser de baixa intensidade é satisfatório do ponto de vista clínico e funcional, mostrando-se especialmente eficaz no tratamento da mucosite oral de pacientes pediátricos sob oncoterapia, promovendo uma melhora da qualidade de vida destes pacientes

Objective: to perform a literature review on the main oral manifestations and therapeutic possibilities in dentistry in pediatric cancer patients, highlighting laser therapy as the main form of treatment. Material and methods: the search were made in the Web of Science, PubMed and Cochrane Library databases, where articles from systematic reviews, meta-analysis and clinical trials published between 2009 and 2019 were selected. Results: we selected 41 articles that address the properties of low-intensity laser therapy in the treatment of pediatric cancer patients. Conclusion: studies show that low-level laser is clinically and functionally satisfactory and is especially effective in treating oral mucositis in pediatric patients undergoing oncotherapy, promoting an improvement in the quality of life of these patients

The Effects of Oral Cryotherapy on Oral Mucositis, Reactive Oxygen Series, Inflammatory Cytokines, and Oral Comfort in Gynecologic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial / 간호학회지

PURPOSE: The purpose of this study was to examine the effects of oral cryotherapy on oral mucositis, reactive oxygen series, inflammatory cytokines, and oral comfort in patients undergoing chemotherapy for gynecologic cancers. METHODS: Participants were randomly assigned to the experimental group (n=25, receiving oral cryotherapy during chemotherapy) and the control group (n=25, receiving the usual care consisting of 0.9% normal saline gargles three times before meals). Oral mucositis was assessed using the oral assessment guide, while oral comfort was assessed using the oral perception guide. Reactive oxygen series was measured as total oxidant stress, and the level of two inflammatory markers, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were examined. The data were analyzed using t-test, chi-square test, Fisher's exact test, Mann-Whitney U-test, and repeated measures analysis of variance. RESULTS: There was a significant difference in the oral mucositis score, reactive oxygen series score, TNF-α level, and oral comfort score between the two groups, and there were significant changes over time and in the group-by-time interactions. There was a significant difference in the IL-6 score between the two groups, but there were no significant changes over time or in the group-by-time interactions. CONCLUSION: The study results revealed that oral cryotherapy was more effective than the usual care regime of normal saline gargles for reducing oral mucositis, reactive oxygen series, and inflammatory cytokines and for improving oral comfort in gynecologic cancer patients undergoing chemotherapy.

Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) patients need parenteral nutrition because of nausea, vomiting, and mucositis caused by conditioning regimens. The demand for glutamine increases during the HSCT period. We evaluated the effects of glutamine-containing parenteral nutrition on the clinical outcomes of HSCT patients. METHODS: In this retrospective analysis, we reviewed HSCT patients from Seoul National University from August 2013 to July 2017. Depending on their glutamine supplementation status, 91 patients were divided into 2 groups: glutamine group (N=44) and non-glutamine group (N=47). We analyzed the rate of weight change, infection (clinically/microbiologically documented), complications (duration of mucositis and neutropenia, acute graft versus host disease), and 100-days mortality in each group. RESULTS: Regarding the clinical characteristics of the patients, there were no significant differences between the 2 groups except that there was a larger proportion of myeloablative conditioning regimen in the glutamine group (P=0.005). In the glutamine group, the average number of days of glutamine use, parenteral nutrition, and mucositis was 7.6±1.4, 14.6±9.9, and 13.3±9.5, respectively. Furthermore, multivariate analysis revealed odds ratios of 0.37 (95% CI, 0.14–0.96; P=0.042) and 0.08 (95% CI, 0.01–0.98; P=0.048) for clinically documented infection and 100-days mortality, respectively, in the glutamine group. CONCLUSION: Results showed that the glutamine group had less clinically documented infection and 100-days mortality than the non-glutamine group, but the other outcomes did not show significant differences. The extended duration of glutamine supplementation according to the period of total parenteral nutrition and mucositis should be considered.

A Typical Case of Mycoplasma pneumoniae-induced Rash and Mucositis Confused with Stevens-Johnson Syndrome / 대한피부과학회지

No abstract available.