Modalidades de radioterapia empregadas para o câncer de cabeça e pescoço / Radiotherapy modalities used for head and neck cancer

O câncer de cabeça e pescoço (CCP) refere-se ao grupo de tumores que atingem a laringe, cavidade nasal, nasofaringe, orofaringe, cavidade oral e glândulas salivares. A radioterapia no paciente com CCP representa uma terapia para manutenção do órgão, através da destruição das células neoplásicas malignas. O objetivo do presente estudo foi identificar estratégias radioterápicas aplicadas ao paciente com CCP e seus respectivos efeitos colaterais em cavidade oral, além de investigar as principais modalidades utilizadas nos sistemas de saúde do Brasil. Tratou-se de uma revisão narrativa da literatura com busca ativa das bases eletrônicas PUBMED, LILACS e SCIELO. Após todas as etapas de refinamento, um total de 58 artigos foram incluídos na presente revisão. A radioterapia possui papel de destaque no tratamento do CCP. No entanto, por não ser um método terapêutico com alta especificidade, resulta em efeitos adversos ao tratamento como mucosite oral, trismo e disfunção salivar, que findam por reduzir a qualidade de vida do paciente. Dentre as principais técnicas radioterapêuticas utilizadas no Brasil, a IMRT e VMAT caracterizam-se como as formas mais avançadas da terapia em 3D, proporcionando doses equivalentes para cada área da lesão tumoral, poupando áreas teciduais circunvizinhas que não necessitam de irradiação. Além da toxicidade reduzida, uma maior sobrevida pode ser observada em pacientes tratados com essas técnicas. Um dos maiores desafios atuais na radioterapia contra o CCP é a proteção de tecidos saudáveis. Nesse sentido, a IMRT e VMAT apresentam superioridade em relação às demais técnicas.

Head and neck cancer (CCP) refers to the group of tumors that affect the larynx, nasal cavity, nasopharynx, oropharynx, oral cavity and salivary glands. Radiotherapy in patients with CCP represents a therapy for organ maintenance, through the destruction of malignant neoplastic cells. The aim of this study was to identify radiotherapy strategies applied to patients with CCP and their respective side effects in the oral cavity, and to investigate the main modalities used in health systems in Brazil. It was a narrative review of the literature with active search of electronic databases PUBMED, LILACS and SCIELO. After all stages of refinement, a total of 58 articles were included in this review. Radiotherapy has a prominent role in the treatment of CCP. However, because it is not a therapeutic method with high specificity, it results in adverse effects to treatment such as oral mucositis, trismus and salivary dysfunction, which end up reducing the quality of life of the patient. Among the main radiotherapeutic techniques used in Brazil, IMRT and VMAT are characterized as the most advanced forms of 3D therapy, providing equivalent doses for each area of the tumor sparing surrounding tissue areas that do not require irradiation. In addition to reduced toxicity, greater survival can be observed in patients treated with these techniques. One of the biggest current challenges in radiation therapy against CCP is the protection of healthy tissues. In this sense, the IMRT and VMAT present superiority in relation to the other techniques.

Avaliação laboratorial do sangue e da saliva de pacientes com doença renal crônica e manifestações orais: uma revisão sistemática / Laboratory evaluation of blood and saliva of patients with chronic kidney disease and oral manifestations: a systematic review

A cavidade oral é afetada pelo caráter multissistêmico das consequências da Doença Renal Crônica (DRC) e estima-se que cerca de 90% destes pacientes têm sintomas orais. Alterações laboratoriais sanguíneas e salivares são frequentemente observadas e por isso, investigações sobre correlações clínico-laboratoriais são fundamentais para o manejo e tratamento dos pacientes. Neste estudo foi realizada uma revisão sistemática para identificar e avaliar as principais alterações laboratoriais no sangue e na saliva de pacientes portadores de DRC que apresentam manifestações orais. A busca bibliográfica incluiu artigos das bases de dados eletrônicas PubMed, Scopus, Biblioteca Virtual em Saúde, Web of Science, Embase e literatura cinzenta, incluindo estudos caso-controle, transversais e de coorte. A análise do risco de viés seguiu a abordagem QUADAS-2. PROSPERO CRD42022250533 é o registro dessa revisão. As principais alterações laboratoriais encontradas foram o aumento das concentrações sanguíneas e salivares de ureia, creatinina, fosfato e diminuição das concentrações de cálcio e da taxa de fluxo salivar. As concentrações dessas substâncias no sangue e na saliva e a TGF estavam diretamente correlacionadas. Foi observada existência da correlação entre o aparecimento das manifestações orais e as alterações laboratoriais, principalmente xerostomia, disgeusia e hálito urêmico. Em conclusão, a literatura tem revelado que as principais alterações laboratoriais encontradas são aquelas descritas comumente na rotina laboratorial, que as concentrações dessas substâncias no sangue e na saliva estão diretamente correlacionadas com a TFG, e existe correlação entre o aparecimento das manifestações orais e as alterações laboratoriais. Grandes oportunidades estão abertas para a investigação sobre de novos marcadores.

The oral cavity is affected by the multisystemic nature of the consequences of Chronic Kidney Disease (CKD) and it is estimated that around 90% of these patients present oral symptoms. Blood and salivary laboratory changes are frequently observed and, therefore, investigations of clinical-laboratory correlations are essential for the management and treatment of these patients. This study was carried out as a systematic review to identify and evaluate the main laboratory changes in the blood and saliva of patients with CKD who present oral manifestations. The bibliographic search included articles from the electronic databases PubMed, Scopus, Virtual Health Library, Web of Science, Embase and gray literature, including case-control, cross-sectional and cohort studies. The risk of bias analysis advanced the QUADAS-2 approach. PROSPERO CRD42022250533 is the record of this review. The main laboratory changes found were an increase in blood and salivary concentrations of urea, creatinine, phosphate and a decrease in calcium concentrations and salivary flow. The concentrations of substances in blood and saliva and TGF were directly correlated. The existence of the manifestation was observed between the appearance of oral manifestations and laboratory changes, mainly xerostomia, dysgeusia and uremic breath. In conclusion, the literature revealed that the main laboratory changes found are those commonly described in laboratory routine, that the concentrations of these problems in blood and saliva are directly correlated with GFR, and there is a manifestation between the appearance of oral manifestations and laboratory changes. . Great opportunities are open for the investigation of new markers.

Odontopediatría en el paciente con enfermedad sistémica / Pediatric dentistry in patients with systematic disease

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)

This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)

Assessment of studies on oral manifestations and COVID-19: a meta-research study

This study aimed to evaluate how different study designs influences the presence and characteristics of diagnosis of oral manifestations in patients with COVID-19. Methods: This study is a meta-search conducted with studies evaluating the relationship between patients with oral manifestations and COVID-19. A search was conducted in three databases (PubMed, Web of Science, and Scopus), using terms specific to COVID-19 and oral lesions, including only primary studies. Study selection was undertaken by two reviewers independently. A descriptive analysis was performed. Results: The results included 55 studies in the data synthesis analysis. Most of the studies were case reports and case series. Some of the studies did not relate a biological test to confirm COVID-19. The ulcer lesion and that clinical examination by specialists were the most reported lesion in case reports and case series studies, while taste alterations and patient self-report were more reported in observational studies. Conclusions: This review concluded that the oral lesions in patients with COVID-19 differ according to the study design. The lack of high-quality scientific evidence in the dental literature on COVID-19 makes the findings inconsistent by the lack of sample selection criteria, diagnostic criteria and classification of oral lesions

Manifestaciones gingivales de sífilis secundaria: serie de casos / Gingival manifestations of secondary syphilis: case series

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sí- filis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las ca- racterísticas clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingi- vales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron le- siones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior ­tanto superior como inferior­, presentándose pla- cas rojas o blancas. Algunos casos también presentaban le- siones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis se- cundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria (AU)

Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral le- sions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present mul- tiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingi- val lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region ­both up- per and lower­, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of second- ary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be consid- ered when dealing with atypical gingivo-periodontal cases in everyday practice (AU)

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Implicações odontológicas oriundas do acometimento pela doença de Parkinson: abordagem das manifestações bucais / Dental implications arising from Parkinson's Disease: approach to oral manifestations

A Doença de Parkinson (DP) consta de patologia neurodegenerativa, progressiva em que inexiste cura. A nível sistêmico evidenciam-se distúrbios motores, advindo da manifestação de degeneração dos neurônios e a nível odontológico e bucal averigua-se repercussões desfavoráveis que levam ao desenvolvimento de problemas com a execução do autocuidado dos enfermos com a sua higienização oral, que mostra-se dificultada. O objetivo do presente artigo foi evidenciar como procedem as manifestações bucais e a abordagem odontológica dos pacientes portadores de Doença de Parkinson. Realizou-se estudo de revisão bibliográfica com busca nas bases de dados: Google Acadêmico, LILACS e levantamento de estudos e artigos que tratavam acerca das manifestações bucais oriundas da Doença de Parkinson. Em âmbito odontológico existem algumas manifestações orais advindas do acometimento pela DP, tais como: xerostomia, disfagia, sialorreia, cárie dentária, acúmulo de biofilme dental e doença periodontal, entre outras. Deveria haver uma conduta odontológica com a execução de tratamentos preventivos nesses pacientes, entretanto o que ocorre é o feitio de procedimentos curativos e mais invasivos, que são adotados em decorrência do quadro insatisfatório de saúde oral apresentado. Concluiu-se que a figura do cirurgião dentista é essencial na equipe de atendimento multiprofissional para tratamento dos pacientes portadores da DP, uma vez que o mesmo atuará evitando a instalação de agravantes e a piora do quadro de saúde bucal e periodontal realizando os procedimentos odontológicos necessários.

Parkinson's Disease (PD) consists of a neurodegenerative, progressive pathology in which there is no cure. At the systemic level, motor disorders are evidenced, arising from the manifestation of neuronal degeneration and at the dental and oral level, unfavorable repercussions are verified that lead to the development of problems with the execution of self-care of the sick with their oral hygiene, which is shown to be difficulty. The objective of this article was to show how the oral manifestations and the dental approach of patients with Parkinson's Disease proceed. A bibliographic review study was carried out with a search in the Google Scholar, LILACS databases and a survey of studies and articles that dealt with the oral manifestations arising from Parkinson's Disease. In the dental field, there are some oral manifestations resulting from PD involvement, such as: xerostomia, dysphagia, drooling, dental caries, accumulation of dental biofilm and periodontal disease, among others. There should be a dental approach with the implementation of preventive treatments in these patients, however, what happens is the nature of curative and more invasive procedures, which are adopted as a result of the unsatisfactory picture of oral health presented. It was concluded that the figure of the dental surgeon is essential in the multidisciplinary care team for the treatment of patients with PD, since he will act to avoid the installation of aggravating factors and the worsening of the oral and periodontal health condition by performing the necessary dental procedures.

Manejo odontológico de pacientes con el síndrome de Ehlers-Danlos: revisión narrativa / Dental management in patients with Ehlers-Danlos syndrome: a narrative review

El síndrome de Ehlers-Danlos es una enfermedad heredita- ria, producida por mutaciones cromosómicas que pueden llegar a tener un comportamiento autosómico dominante, recesivo o ligado al cromosoma X. Se caracteriza por defectos en las enzi- mas encargadas de la estructura y síntesis de colágeno. En vista de los 20 tipos de colágeno que existen, este síndrome es extre- madamente heterogéneo tanto en su presentación clínica como en su progresión y evolución. Dentro de los signos y síntomas habituales encontramos la hiperlaxitud articular, hiperelastici- dad de la piel e hiperequimosis de los vasos sanguíneos. Con relación a las complicaciones que pueden presentar es- tos pacientes, encontramos dislocaciones articulares, fragilidad en la piel, dolor articular, ruptura de grandes vasos sanguíneos, dificultad en la cicatrización y, en consecuencia, mayor inci- dencia de procesos infecciosos y de cicatrices poco estéticas. Presenta una incidencia de 1 caso cada 2.500-5.000 na- cidos vivos. Por ello, es fundamental que el odontólogo se encuentre familiarizado con el manejo médico-dental de estos pacientes, a fin de estar preparado para brindarles un trata- miento adecuado y responder ante las posibles complicacio- nes que se pueden presentar. En esta revisión se emplearon resultados extraídos manual- mente de artículos, indexados en las bases de datos PUBMED y EBSCO, que respondían a la búsqueda de los términos Ehlers-Danlos syndrome, dental management y oral surgery. El objetivo fue describir el manejo médico-odontológico del paciente con síndrome de Ehlers-Danlos hasta la fecha (AU)

Ehlers-Danlos syndrome is a hereditary disease, produced by chromosomal mutations that can have an autosomal behavior, which can be dominant, recessive or X-linked. It is characterized by defects in the enzymes responsible for the structure and syn- thesis of collagen. In view of the 20 existent types of collagen, this syndrome is extremely heterogeneous in its clinical presentation, as well as in its progression and evolution. Within the usual signs and symptoms, we find joint hyperlaxity, skin hyperelasticity and hyper-ecchymosis of the blood vessels. Regarding the complications that these patients can pres- ent, we find joint dislocations, skin fragility, joint pain, rupture of large blood vessels, difficulty in healing and, consequently, a higher incidence of infectious processes and unsightly scars. It presents an incidence of 1 case every 2.500-5.000 live births. Therefore, it is essential that the dentist is familiar with the medical-dental management of these patients, in order to be prepared to provide them with adequate treatment and re- spond to possible complications that may arise. In this review, results were manually extracted from ar- ticles, indexed in the PUBMED and EBSCO databases, that respond to the search for the terms Ehlers-Danlos syndrome, dental management and oral surgery. The aim was describing the medical-dental management of patients with Ehlers-Dan- los syndrome to date (AU)

Displasia frontonasal / Frontonasal dysplasia

Los trastornos del desarrollo son aquellos padecimientos que se manifiestan por defectos en la embriogénesis de la región afectada. La cara del ser humano comienza su formación alrededor de la cuarta semana de vida intrauterina y se manifiesta gracias a la fusión de cinco prominencias: dos pares conocidas como maxilar y mandibular, y una impar conocida como frontonasal. Cuando esta fusión no se lleva a cabo de una forma óptima, aparecen numerosas alteraciones del desarrollo como el labio y paladar hendido, y la displasia frontonasal. La displasia frontonasal produce frecuentemente afecciones oculares, nasales y orales. Dentro de las manifestaciones orales destacan una forma atípica de hendidura labial o palatina, afecciones dentales y alteraciones en el crecimiento de la cara. Dada la gran relación que este padecimiento tiene con la cavidad oral resulta importante que el odontólogo conozca la etiología y las características clínicas de este trastorno (AU)

Developmental disorders are those conditions that are manifested by defects in the embryogenesis of the affected region. The human face begins its formation around the fourth week of intrauterine life and is manifested thanks to the fusion of five prominences: two pairs known as maxillary and mandibular and odd one known as frontonasal. When this fusion is not carried out in an optimal way, numerous developmental alterations appear, such as cleft lip and palate and frontonasal dysplasia. Frontonasal dysplasia frequently produces ocular, nasal and oral affections. Among the oral manifestations, and atypical form of clef lip and/or palate, dental affections and alterations in the growth of the face stand out. Given the great relationship that this condition has with the oral cavity, it is important for the dentist to know the etiology and clinical characteristics of this disorder (AU)

Manifestações bucais em pacientes internados na UTI de um hospital público / Oral manifestations in patients admitted to the ICU of a Public Hospital

Introdução: durante a permanência em Unidades de Terapia Intensiva (UTIs), os pacientes internados apresentam maior vulnerabilidade a alterações na cavidade oral decorrentes do uso de equipamentos de respiração artificial e do estado imunocomprometido em que se encontram. Objetivo: identificar as principais manifestações bucais em pacientes internados em uma UTI bem como verificar o conhecimento dos profissionais responsáveis pela higienização bucal. Metodologia: trata-se de um estudo quantitativo descritivo com delineamento transversal. Os dados foram obtidos nos prontuários médicos dos pacientes e através de um exame clínico intraoral. Para os profissionais responsáveis pela higiene bucal, foi utilizado um questionário. As análises foram realizadas no programa SPSS versão 21.0 de forma descritiva. Resultados: as manifestações bucais com maior incidência foram saburra lingual, biofilme dentário, candidíase, devido a qualidade da higiene bucal prestada e a baixa imunidade. Os achados bucais e sistêmicos relacionados aos pacientes com maior tempo de internação foram ressecamento labial, queilite angular, língua despapilada, candidíase e pneumonia. Todos os profissionais responsáveis pela higienização bucal dos pacientes tinham formação técnica em enfermagem e desconheciam alterações importantes como biofilme dentário e pneumonia nosocomial. Conclusão: os dados deste estudo permitem concluir que apesar da constância com que é realizada a higienização bucal, verifica-se alta frequência de lesões bucais nos pacientes críticos da UTI. Evidenciando o papel da assistência da higienização bucal de qualidade, destacando a importância da atuação do cirurgião dentista em equipes multiprofissionais, visto que o risco de focos infecciosos bucais pode contribuir para o agravo e piora do quadro clínico dos pacientes.

Introduction: during the stay in Intensive Care Units (ICUs), hospitalized patients are more vulnerable to changes in the oral cavity resulting from the use of artificial respiration equipment and the immunocompromised state in which they are found. Objective: to identify the main oral manifestations in patients admitted to an ICU, as well as to verify the knowledge of professionals responsible for oral hygiene. Methodology: this is a descriptive quantitative study with cross-sectional design. Data were obtained from the patient's medical records and through an intraoral clinical examination. For professionals responsible for oral hygiene, a questionnaire was used. The analyses were performed in the SPSS version 21.0 program in a descriptive way. Results: the oral manifestations with the highest incidence were tongue coating, dental biofilm, candidiasis, due to the quality of oral hygiene provided and low immunity. Oral and systemic findings related to patients with longer hospital stays were lip dryness, angular cheilitis, depapilated tongue, candidiasis and pneumonia. All professionals responsible for oral hygiene of patients had technical training in nursing and were unaware of important alterations such as dental biofilm and nosocomial pneumonia. Conclusion: the data from this study allow us to conclude that despite the constancy with which oral hygiene is performed, there is a high frequency of oral lesions in critical ICU patients. Evidencing the role of quality oral hygiene assistance, highlighting the importance of the dentist's role in multidisciplinary teams, since the risk of oral infectious foci can contribute to the aggravation and worsening of the clinical condition of patients.

Oral lesions after infection by SARS CoV 2: two case reports / Lesiones bucales posteriores a infección por SARS CoV 2 presentación de dos casos

Introduction: The SARS CoV 2 infection has resulted in several health, economic, and social crises in all areas. The disease shows a substantial biological diversity in humans causing a series of sequels in the trans- or post-infection period in the entire organism. Case Report: The manifestations that occur in the oral cavity and pharynx have not been evaluated. In this study, two clinical cases are reported. The first patient, a 67-year-old male, presents erosive lesions on the dorsal surface of his tongue after SARS CoV 2 infection. Results: Therapy consisting of reinforcing oral cleaning, use of antifungal solutions, mouthwashes containing superoxidation solution and B complex was given to the patient. The reported lesions improved satisfactorily. The second case, a 47-year-old male patient, presented vesiculobullous lesions on the lingual and labial mucosa accompanied by severe painful symptoms after SARS CoV 2 infection. An incisional biopsy was performed. The histopathological result was compatible with pemphigus vulgaris, and the treatment protocol was started with 0.1% topical mometasone and 2g miconazole gel, observing adequate involution of the lesions after 20 days. Conclusions: The aim of this study is to report on the lesions affecting the oral cavity and pharynx in post-COVID patients with the aim of carrying out a thorough intraoral examination, establishing a clinical or histopathological diagnosis to implement a specific treatment plan in each case to improve the health and quality of life of the patients. Keywords: SARS-CoV-2; Oral manifestations; Oral ulcer; Pemphigus; Mouth; Mucous membrane.

Introducción: La infección por virus de SARS CoV 2 ha dejado a su paso una estela de crisis en materia de salud, económica, social y en todos los ámbitos a la fecha seguimos realizando la observación del comportamiento de la enfermedad en los seres humanos con una diversidad biológica importante y que ha traído como consecuencia una serie de secuelas que se presentan en el periodo trans o posterior a la infección en toda la economía corporal. Reporte de Caso: Se ha evaluado poco las manifestaciones que se presentan en la cavidad bucal y faringe; se presentan dos casos clínicos el primero paciente masculino de 67 años de edad posterior a la infección por SARS CoV 2 presenta diluciones de continuidad en bordes laterales de la lengua se indica terapia y refuerza limpieza bucal, antimicótico, colutorios con solución de superoxidación y complejo B, las úlceras involucionan de manera satisfactoria. Resultados: El segundo caso masculino de 47 años posterior a la infección por SARS CoV 2 debuta con lesiones vesículo-ampollosas en mucosa lingual, labial con sintomatología dolorosa severa, se realiza biopsia incisional donde el resultado histopatológico es compatible con pénfigo vulgar, se inicia protocolo de tratamiento con mometasona tópica al 0.1% y miconazol gel 2g observándose una adecuada involución de las lesiones a los 20 días. Conclusiones: El objetivo de este trabajo es poner en contexto de la comunidad médica y científica las lesiones concernientes a la cavidad bucal y faringe que están presentando los pacientes postcovid con el objetivo de realizar una exhaustiva exploración intraoral, establecer un diagnóstico clínico o histopatológico y con base en esto instaurar un plan de tratamiento específico en cada caso en particular con el fin fundamental de mejorar la salud y calidad de vida del paciente.

Oral Paracoccidioidomycosis, Clinical Characteristics, Diagnosis and Treatment

Paracoccidioidomycosis (PCM) is an infection caused by the dimorphic fungus Paracoccidioides brasiliensis, which has a predilection for hot and humid places; thus, this disease has a particularly high incidence in Brazil. Children, adolescents, and adults can be affected by acute/subacute or chronic PCM. To describe the clinical-pathological characteristics and treatment of a case of chronic PCM oral lesion. The oral examination of a 57-year-old male patient revealed moriform stomatitis on the perioral region (irregular shape), lips vermilion, and continuity with the jugal mucosa. After an incisional biopsy, the anatomopathological analysis confirmed the diagnosis of PCM. The patient was referred to a reference center for tropical diseases and treated with 400mg sulfamethoxazole and 80mg trimethoprim twice a day. Since some adverse effects were observed, the treatment was switched to 100mg of itraconazole twice a day. The follow-up examination revealed accelerated healing of the oral lesions and reduction of the inflammatory process. Stomatologists play a key role in the identification of PCM oral lesions and referral for adequate treatment by an infectious disease specialist. (AU)

Scurvy diagnosis due to gingival alterations: Case report

Introduction: Scurvy is a disease resulting from a severe vitamin C deficiency, and its diagnosis is often challenging owing to nonspecific symptoms. Objective: encouraging dentists to reflect on systemic causes that may influence the oral manifestations of diseases. Emphasize that despite a disease from the last century, today you can still find vitamin deficiencies, and report of a case of Scurvy with gingival alterations. Case Report: A 30-year-old female patient sought dental care because she experienced sensitivity in her gums and bleeding. Intraoral examination revealed a slightly swollen gingiva which was erythematous, with friable consistency, and bled upon probing. Diseases such as anemia, hypovitaminosis, and AIDS, were considered within the diagnostic hypothesis of gingivitis. After hematological investigation, a very low level of vitamin C was detected, and scurvy was diagnosed. Vitamin C supplementation was then initiated in addition to the control of oral hygiene. After four months, clinical improvement was observed. Conclusion: Althou-gh there are few cases in the literature, oral surgeons must be aware of oral alterations associated with scurvy. The search for local and systemic etiological factors is important because changes in general health have a direct impact on oral tissues. (AU)

Detection of the presence of Epstein−Barr virus and cytomegalovirus using polymerase chain reaction in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is an advanced and irreversible renal failure that contributes to increased mortality worldwide. Patients who undergo dialysis are more susceptible to developing infections due to their general condition. Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) are associated with oral and systemic manifestations. The most modern and accurate technique to detect the presence of these viruses is polymerase chain reaction (PCR), which can predict viral reactivation even before the onset of symptoms and identify subclinical infections. This study aimed to detect the presence of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) in patients with chronic kidney disease (CKD) undergoing hemodialysis using real-time polymerase chain reaction (PCR). Methods: An epidemiological and observational case-control study was conducted. Two groups were considered (case group: patients on hemodialysis from the Nephrology Services of the Hospital das Clínicas of UFPE and Hospital Maria Lucinda and control group: healthy patients without CKD from the Department of Stomatology of the UFPE to evaluate the viruses presence using the real-time PCR technique. Results:Of the hemodialysis patients (n=54), 29 (53.70%) tested positive for CMV and only 10 (18.51%) for EBV, while in the healthy group (n=55), eight (14.54%) were positive for EBV and none for CMV. In neither group were systemic characteristics or oral manifestations observed due to the presence of viruses. Conclusion: The EBV and CMV viruses have a higher prevalence in hemodialysis patients. However, these patients did not present oral or systemic manifestations. (AU)

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Norma técnica de salud para el uso del odontograma: NTS N° 188-MINSA/DGIESP-2022 / Technical health norm for the use of the odontogram: NTS N° 188-MINSA/DGIESP-2022

La publicación describe los criterios para el registro de datos de las características, anomalías patológicas de las piezas dentarias, así como el registro de procedimientos estomatológicos realizados para el uso y manejo del odontograma en las diferentes UPS, pudiendo ser utilizados en aspectos clínicos, legales, forenses, estadísticos, de investigación o docencia. Asimismo las pautas para estandarizar el gráfico y la nomenclatura básica para el registro de hallazgos clínicos en el odontograma, permitiendo a la comunidad de cirujanos dentistas manejar la misma información

Manifestaciones bucales en pacientes con medicación antihipertensiva / Oral manifestations in patients with antihypertensive medication

Objetivo: caracterizar las manifestaciones bucales en pacientes con medicación anti- hipertensiva que acuden al servicio estomatológico sur del municipio Morón, Ciego de Ávila, Cuba. Métodos: se realizó un estudio observacional, descriptivo, transversal, en el período enero 2019 a enero 2020. Se trabajó con la totalidad del universo, constituido por 162 pacientes. La información se recopiló de las historias clínicas estomatológicas individuales y de una ficha de recolección de datos creada por los autores de la investigación. Se estudiaron las variables grupo de edad, sexo, grupo de medicamentos antihipertensivos, dosis del medicamento, signos y síntomas clínicos, así como enfermedades bucales. Se utilizó estadística descriptiva (frecuencias absolutas y relativas porcentuales). Resultados: el 42,6 % representó el grupo de edad 35 a 59 años y el 53,7% al sexo femenino. Se observó que 88 pacientes (54,3 %) se encontraban medicados con inhibidores de la enzima convertidora de angiotensina; de ellos, 38 en su dosis mínima. La xerostomía estuvo presente en el 59,9 % de los casos. El 63,6 % presentó caries dental como enfermedad estomatológica. Conclusiones: existió predominio de la xerostomía y la caries dental en la mayoría de los pacientes.

Objective: To characterize the oral manifestations in patients with antihypertensive medication who attend the southern dental service of the Moron municipality, Ciego de Avila, Cuba. Method: An observational, descriptive, cross-sectional study was carried out in the period from January 2019 to January 2020. We worked with the entire universe which was made up of 162 patients. The information was collected from individual dental medical records and from a data collection form created by the authors of the research. The variables age group, sex, antihypertensive drug group, dose of antihypertensive drug, clinical signs and symptoms, and oral diseases were studied. Descriptive statistics were used (absolute and relative percentage frequencies). Results: 42,6 % represented the age group 35 to 59 years and 53,7 % the female sex. It was observed that 88 (54,3 %) patients were medicated with angiotensin converting enzyme inhibitors, 38 of them at their minimum dose. Xerostomia was present in 59,9% of the cases. 63,6 % presented dental caries as a dental disease. Conclusions: There was a predominance of xerostomia and dental caries in most of the patients.

La adenopatía como clave diagnóstica para la sífilis primaria. Informe de casos / Adenopathy as diagnostic key for primary syphilis. Case reports

Objetivo: Describir tres situaciones clínicas en las que se presentan distintas manifestaciones bucales para una misma entidad patológica. En los tres casos la sospe- cha diagnóstica de sífilis primaria se basó en la presencia de una adenopatía. Los estudios de laboratorio permitieron confirmar el diagnóstico de sífilis. Por su polimorfismo y variabilidad clínica en sus diferentes etapas evolutivas, la sífilis es descripta clásicamente como "la gran simuladora". Este artículo propone que la presencia de adenomegalias características puede ser una clave para orientar el diagnós- tico de la patología, lo cual no ha sido aún reportado en la literatura. Casos clínicos: Se presentan tres casos clínicos de pa- cientes que acudieron a una consulta estomatológica privada y al Servicio de Estomatología del Hospital Alemán de Bue- nos Aires. Los tres acuden con signos y síntomas diferentes, pero compartiendo la presencia de adenopatías múltiples, en las que se destaca un elemento ganglionar más voluminoso (AU)

Aim: To describe three clinical cases that present dif- ferent oral manifestations for the same pathological entity. In all three cases, the suspected diagnosis of primary syph- ilis was based on the presence of an adenopathy. Labora- tory studies confirmed the diagnosis of syphilis. Due to its polymorphism and clinical variability in the different evo- lutionary stages, syphilis is classically described as "the great simulator". This article proposes that the presence of characteristic adenomegalies can be a key to guide the di- agnosis, which has not yet been reported in the literature. Clinical reports: Three clinical cases of patients who attended a private stomatology consultation and the Stoma- tology Service of the Hospital Alemán de Buenos Aires are presented. The three patients showed different signs and symptoms but shared the presence of multiple adenopathies with a more voluminous ganglial element (AU)

Epidemiología y frecuencia de enfermedades de transmisión sexual y su repercusión en la mucosa bucal: una revisión narrativa / Epidemiology and frequency of sexually transmitted diseases and their impact on oral mucosa: a narrative review

El objetivo de la presente revisión fue analizar y compa- rar las publicaciones sobre la prevalencia de manifestaciones bucales de pacientes infectados por el Virus de la Inmuno- deficiencia Humana, Virus del Papiloma Humano y sífilis. Se seleccionaron los artículos más relevantes y se abordó la incidencia según sexo, edad, distribución geográfica y locali- zaciones anatómicas frecuentes. Se encontró que las lesiones orales más prevalentes producidas por el Virus de la Inmu- nodeficiencia Humana son la candidiasis oral, la leucoplasia vellosa y enfermedades periodontales, entre otras. La sífilis presentó una frecuencia de 7,5% de manifestaciones orales en la etapa primaria, 92,5% en la secundaria y rara vez lesio- nes en la terciaria. Las formas más prevalentes fueron parches mucosos, pápulas y úlceras. Las lesiones orales benignas rela- cionadas con el Virus del Papiloma Humano halladas fueron la verruga vulgar, el papiloma plano, el condiloma acuminado y la hiperplasia epitelial focal. La prevalencia de carcinomas orofaríngeos y orales fue del 33,6% y del 22,2% respectiva- mente. Se encontraron similitudes en el comportamiento se- xual y las vías de transmisión de las enfermedades analizadas, y se observó que son más prevalentes en adultos jóvenes de sexo masculino y en países en vías de desarrollo (AU)

The aim of this review was to analyze and compare pub- lications on the prevalence of oral manifestations in patients infected with Human Immunodeficiency Virus, Human Pap- illoma Virus and syphilis. The most reliable studies were se- lected, and incidence was evaluated according to gender, age, geographic location and frequent anatomic sites. It was found that the most prevalent Human Immunodeficiency Virus oral lesions were oral candidiasis, hairy leukoplakia and perio- dontal diseases, among others. Syphilis had a 7.5% preva- lence of oral manifestations in the primary stage, 92.5% in the secondary, and rarely lesions in the tertiary. The most prevalent forms were mucous patches, papules and ulcers. The benign oral lesions related to the Human Papilloma Vi- rus were verruca vulgaris, squamous papilloma, condyloma acuminatum and multifocal epithelial hyperplasia. The preva- lence of oropharyngeal and oral carcinomas were 33.6% and 22.2%, respectively. Similarities were found in sexual behavior and transmis- sion routes of the diseases analyzed, which were more preva- lent among young adult males, and in developing countries (AU)

Manifestações bucais em portadores de epidermólise bolhosa residentes em um município baiano / Oral manifestations of epidermolysis bullosa in a municipality of the state of Bahia

Introdução: a Epidermólise Bolhosa hereditária (EB) é uma doença rara, caracterizada por formações de bolhas na pele e nas mucosas que sofrem mínimos traumas ou aparecem espontaneamente. As principais divisões de EB são Epidermólise Bolhosa Simples, Epidermólise Bolhosa Juncional, Epidermólise Bolhosa Distrófica e a Síndrome de Kindler. As manifestações bucais geralmente encontradas nos pacientes com EB são as bolhas no epitélio oral, microstomia, anquiloglossia, doença periondontal, hipoplasia do esmalte, cárie dentária, atrofia da maxila e prognatismo mandibular, variando para cada tipo da doença. Objetivo: relatar as manifestações bucais dos portadores de Epidermólise Bolhosa residentes no município de Barra da Estiva. Metodologia: trata-se de um estudo transversal, quantitativo e descritivo que foi desenvolvido no município de Barra da Estiva ­ BA com a população de portadores de Epidermólise Bolhosa, através da realização de anamnese e exame clínico. Estatística descritiva foi utilizada para tabular os dados coletados. Resultados: foram analisados 5 portadores de Epidermólise Bolhosa, a maioria do sexo masculino (60%), com média de idade de 5,6 anos. As manifestações bucais encontradas foram bolhas orais (100%), anquiloglossia (100%), língua despapilada (100%), hipoplasia de esmalte (80%), cárie (40%) e abertura de boca limitada em média de 28,6 mm. Conclusão: os portadores de Epidermólise Bolhosa apresentaram manifestações orais características da doença, tendo como consequências maiores dificuldades para realizar higienização bucal e tratamento odontológico, sendo necessário conhecimento prévio dos cirurgiões-dentistas para o atendimento desses pacientes.

Introduction: inherited Epidermolysis Bullosa (EB) is a rare disease, characterized by blistering of the skin and mucous membranes that suffer minimal trauma or appear spontaneously. The main divisions of EB are Simple Epidermolysis Bullosa, Junctional Epidermolysis Bullosa, Dystrophic Epidermolysis Bullosa and Kindler Syndrome. The oral manifestations usually found in patients with EB are blisters in the oral epithelium, microstomy, ankyloglossia, periodontal disease, enamel hypoplasia, dental caries, atrophy of the jaw and mandibular prognathism, varying for each type of disease. Objective: to report the oral manifestations of Epidermolysis Bullosa patients living in the municipality of Barra da Estiva. Methods: cross-sectional study, quantitative and descriptive that was developed in the municipality of Barra da Estiva-BA with the population of people with Epidermolysis Bullosa, through anamnesis and clinical examination. Descriptive statistics was used to tabulate the data collected. Results: 5 children with Epidermolysis Bullosa were analyzed, most male (60%), with an average age of 5,6 years. Oral manifestations found were oral blisters (100%), anquiloglossia (100%), loss of papillae of the tongue (100%), enamel hypoplasia (80%), tooth decay (40%) and mouth opening limited to the average of 28.6 mm. Conclusion: epidermolysis Bullosa children presented oral manifestations common to the disease, leading to difficulties in performing oral hygiene and dental treatment, requiring prior knowledge of dental surgeons for the care of these patients.