Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study

Abstract The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Effects of tobacco on the DNA of smokers and non-smokers affected by OSCC: systematic review and meta-analysis

Abstract Scientific evidence about genetic and molecular changes in oral squamous cell carcinoma (OSCC) among smokers and non-smokers is inconclusive. This systematic review and meta-analysis assessed the effects of tobacco on the DNA of individuals with OSCC based on protein mutations. Electronic searches were conducted on PubMed, Ovid, Web of Science, and Scopus to identify observational studies published up to January/2022. The Joanna Briggs Institute tool was used for the critical appraisal of studies. The certainty of the evidence was evaluated. Twenty-three studies assessing 4,060 individuals (2,967 smokers vs. 1,093 non-smokers) were included in this review. Fifteen groups of proteins/genes were investigated. Analysis of the quality of articles revealed low risk of bias in most studies. The certainty of the evidence was very low. The meta-analysis confirmed no significant difference between smokers and non-smokers with respect to damage to GSTM1 (OR: 0.60; 95%CI: 0.30-1.18), GSTT1 (OR: 1.18; 95%CI:0.49-2.83), hydrolase proteins (Ku70 and Ku80) (OR: 0.74; 95%CI: 0.18-3.05), and transferase proteins (GSTM1, GSTT1, GSTM3) (OR: 0.74; 95%CI: 0.47-1.18). Most of the studies included showed that smokers are more likely to exhibit genetic instability. However, the meta-analysis revealed that smokers do not necessarily have more genetic alterations in the DNA than non-smokers.

Mucosite oral quimioinduzida: aspectos clínicos, laboratoriais, qualidade de vida, ansiedade e depressão / Chemotherapy-induced oral mucositis: clinical and laboratory aspects, quality of life, anxiety, and depression

O presente estudo é fundamentado em três objetivos: 1. sintetizar informações sobre ansiedade/depressão de indivíduos em regimes antineoplásicos que desenvolveram mucosite oral por meio de uma revisão sistemática da literatura; 2. avaliar o perfil de citocinas inflamatórias e a formação de redes extracelulares de neutrófilos em amostras de saliva de pacientes em quimioterapia e suas associações com mucosite oral; e 3. investigar ansiedade/depressão e qualidade de vida e associações com mucosite oral quimioinduzida. No primeiro estudo, buscas eletrônicas foram realizadas em cinco bases de dados, complementadas por escrutínio manual e pesquisas na literatura cinzenta. Oito estudos observacionais foram incluídos e a amostra analisada foi de 954 indivíduos. Sete instrumentos diferentes foram aplicados para mensurar ansiedade e/ou depressão. Associações de ansiedade e/ou depressão com a gravidade da mucosite oral foram observadas em 75,0% dos estudos. Os outros dois estudos foram análises longitudinais prospectivas com indivíduos adultos com diagnóstico de doenças hematolinfóides e em tratamento quimioterápico e/ou condicionamento para transplante de células-tronco hematopoiéticas no Hospital das Clínicas da Universidade Federal de Minas Gerais. Os níveis de citocinas inflamatórias (IL-1, IL-6, IL-8, TNF-α e TGF-ß1) e a formação de redes extracelulares de neutrófilos foram analisados por ELISA e identificação do complexo mieloperoxidase-DNA, respectivamente. As coletas de saliva foram realizadas em quatro momentos: dias D0, D3, D10 e D15. Dos 60 pacientes avaliados, 26 (43,3%) desenvolveram algum grau de mucosite oral. Os níveis de concentração de citocinas revelaram diferenças entre indivíduos com e sem mucosite oral. Concentrações significativamente maiores de IL-6 e TNF-α e menores concentrações de TGF-ß1 foram identificadas naqueles que desenvolveram mucosite oral. Houve uma diminuição na formação das redes extracelulares de neutrófilos entre aqueles que tiveram mucosite oral. Entretanto, não foram identificadas diferenças estatísticas entre as concentrações de citocinas e a formação de redes extracelulares de neutrófilos com variáveis clínicas e gravidade da mucosite oral. No terceiro estudo, os instrumentos Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF e Oral Health Impact Profile (versão abreviada ­ OHIP-14) foram aplicados a 37 pacientes nos dias D0 e D15. Aproximadamente 38% (n=14) dos indivíduos desenvolveram mucosite oral e obtiveram escores mais altos de ansiedade/depressão no início da análise. A mucosite oral teve um impacto negativo na qualidade de vida relacionada à saúde bucal, particularmente nas dimensões limitação funcional, dor física e incapacidade física. Em conjunto, os dados deste estudo contribuem para medidas preventivas e redução de comorbidades em pacientes com mucosite oral induzida por esquemas quimioterápicos. As citocinas inflamatórias participam do desenvolvimento da mucosite oral e podem ser úteis como biomarcadores na predição e monitoramento. Ademais, sintomas de ansiedade e depressão estão associados à mucosite oral que, por sua vez, afetam a saúde geral e a qualidade de vida relacionada à saúde bucal.

The present study is based on three purposes: 1. to synthesize by means of a systematic literature review information about anxiety/depression in individuals undergoing antineoplastic therapy who developed oral mucositis; 2. to evaluate the profile of inflammatory cytokines and neutrophil extracellular trap formation in salivary samples from patients undergoing chemotherapy and its associations with oral mucositis; and 3. to investigate anxiety/depression and quality of life and their associations with chemotherapy-induced oral mucositis. In the first study, electronic searches were conducted on five databases, complemented by manual scrutiny and grey literature searches in three other databases. Eight observational studies conducted on 954 individuals were included. Seven different instruments were applied to measure anxiety and/or depression. Associations of anxiety and/or depression with the severity of oral mucositis were observed in 75.0% of the studies. The other two studies were prospective longitudinal analyses of adult individuals diagnosed with hematolymphoid diseases and undergoing chemotherapy treatment and/or conditioning for hematopoietic stem-cell transplantation at the Hospital das Clínicas of Universidade Federal de Minas Gerais. The levels of inflammatory cytokines (IL-1, IL-6, IL-8, TNF-α, and TGF-ß1) and neutrophil extracellular trap formation were analyzed by ELISA and by the identification of the myeloperoxidase-DNA complex, respectively. Saliva sampling was performed at four time-points, i.e. days D0, D3, D10, and D15. Of the 60 patients evaluated, 26 (43.3%) developed some degree of oral mucositis. Cytokine concentration levels revealed differences between individuals with and without oral mucositis. Significantly higher concentrations of IL-6 and TNF-α and lower concentrations of TGF-ß1 were identified in those who developed oral mucositis. There was a decrease in neutrophil extracellular trap formation among those who experienced oral mucositis. However, no statistical differences were identified between cytokine concentrations or neutrophil extracellular trap formation and clinical variables or severity of oral mucositis. In the third study, the Hospital Anxiety and Depression Scale, World Health Organization Quality of Life-BREF and Oral Health Impact Profile (short-form ­ OHIP-14) were the instruments applied to 37 patients on days D0 and D15. Nearly 38% (n=14) of individuals developed oral mucositis and had higher anxiety/depression scores at baseline. Oral mucositis had a negative impact on quality of life related to oral health, particularly functional limitation, physical pain, and physical disability. Taken together, the data from this study contribute to the application of preventive measures and the reduction of comorbidities in patients with chemotherapy-induced oral mucositis. Inflammatory cytokines participate in the development of oral mucositis and may be useful as biomarkers in prediction and monitoring. Moreover, anxiety and depressive symptoms are associated with oral mucositis, affecting, in turn, overall health and oral health-related quality of life

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Solução de Carnoy no tratamento de ceratocisto / Carnoy's solution in treatment of keratocyst

Introdução: O objetivo do trabalho é relatar um caso de ceratocisto associado à impactação dentária, o qual foi tratado com descompressão, seguido de enucleação da lesão e utilização de solução de Carnoy. Relato de caso: Paciente do sexo masculino, 14 anos, encaminhado para avaliação de lesão encontrada após exame imaginológico de rotina. O mesmo demonstrou extensa lesão radiolúcida localizada na região de ângulo e ramo da mandíbula, com presença do elemento 48 intralesional próximo a basilar. Foi realizado biópsia incisional e instalação de dispositivo de descompressão no mesmo tempo cirúrgico, o qual o resultado histopatológico foi de ceratocisto. Após 6 meses com o dispositivo, observou-se diminuição da lesão e melhora no posicionamento do dente incluso. Frente a boa resposta à descompressão, decidiu-se pela enucleação total da lesão, exodontia dos dentes 47 e 48, curetagem rigorosa e tereapia adjuvante com aplicação da solução de Carnoy. O paciente evoluiu bem, neoformação óssea na área operada e encontra-se em acompanhamento há 6 meses, sem sinais de recidiva. Considerações finais: O uso da descompressão cirúrgica em lesões císticas mandibulares minimiza os danos as estruturas circunvizinhas, riscos de fratura patológica e lesão nervosa. Em função das altas taxas de recidiva, a terapia adjuvante após a enucleção é imprescindível para essa lesão, sendo a aplicação da solução de Carnoy uma das técnicas com melhores resultados. Dessa forma, para aumentar a taxa de sucesso e minimizar as sequelas, o planejamento cirúrgico dos ceratocistos mandibulares extensos deve ser feito de forma criteriosa e cuidadosa... (AU)

Introduction: The objective of this study is to report a case of keratocyst associated with dental impaction, which was treated with decompression, followed by enucleation lesion and Carnoy solution. Case report: Male patient, 14 years old, referred for evaluation of lesion found after routine imaging. He showed extensive radiolucent lesion located in the region of the angle and branch of the mandible, with the presence of the intralesional element 48 near the basilar. An incisional biopsy was performed and a decompression device was installed during surgical time and the histopathological result was keratocyst. After 6 months of observation a reduction of the lesion and improvement in the positioning of the tooth even were noticed. Given the good response to decompression, it was decided to complete the enucleation of the lesion, extraction of teeth 47 and 48, rigorous curettage and adjuvant therapy with Carnoy's solution. Followed up for 6 months, patient evolved well creating a new bone formation in the operated area with no signs of relapse. Final considerations: The use of surgical decompression in cystic mandibular lesions minimizes damage to surrounding structures, pathological fracture risks, and nerve damage. Because of the high rates of recurrence, keratocysts require adjuvant therapy after enucleation and Carnoy's solution is one of the best performing techniques. Thus, to increase success rate and minimize sequelae, the surgical planning of extensive mandibular keratocysts should be done carefully and judiciously... (AU)

Immunohistochemical expression of TGF-ß1 and MMP-9 in periapical lesions

Abstract The objective of this study was to evaluate the expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-β1) in periapical lesion samples correlated with the intensity of the inflammatory infiltrate and thickness of the epithelial lining. Forty-five cases of periapical lesions (23 periapical granulomas and 22 radicular cysts) were subjected to morphological and immunohistochemical analyses using anti-MMP-9 and anti-TGF-β1 antibodies. The data were analyzed using the following tests: non-parametric Mann-Whitney, chi-square, Fisher's exact test and Spearman's correlation test (P<0.05). Analysis of inflammatory infiltrate revealed that 78% of periapical granulomas presented infiltrate grade III, in contrast with 32% of radicular cysts (P<0.001). Morphological evaluation of the epithelial thickness in radicular cysts revealed the presence of atrophic epithelium in 86% of the cysts. The immunostaining of MMP-9 was score 2 in 67% of the granulomas and 77% of the cysts. Both lesions were predominantly score 1 for TGF-β1. Significant differences were confirmed between the expression scores of TGF-β1 and MMP-9 in periapical granulomas (p = 0.004) and in radicular cysts (p < 0.001). Expression of TGF-β1 was different for periapical granulomas and radicular cysts. This immunoregulatory cytokine seems more representative in asymptomatic lesions. The extracellular matrix remodeling process dependent on MMP-9 seems to be similar for both periapical granulomas and radicular cysts. TGF-β1 and MMP-9 may play an important role in the maintenance of periapical lesions.

Síndrome de Stevens-Johnson associada à alopurinol e nimesulida: relato de caso / Stevens-Johnson Syndrome associated with allopurinol and nimesulide: case report

A síndrome de Stevens-Johnson (SSJ) é uma variante do eritema multiforme pela conformação e distribuição das lesões cutâneas e maior gravidade do envolvimento mucoso. É caracterizada pela ação de anticorpos IgG ou IgM específicos para drogas. Apresenta importante papel na Odontologia pois que muitas vezes as primeiras manifestações desta doença ocorrem na mucosa bucal. O objetivo deste trabalho é apresentar um relato de um paciente portador da SSJ, sexo masculino, 53 anos, com queixa inicial de dor e ardência bucal. Ao exame clínico verificou-se lesões e crostas hemorrágicas evidentes no vermelhão dos lábios e mucosa bucal. Relatou que foi atendido anteriormente em um serviço oftalmológico e diagnosticado com conjuntivite e que estava sob uso das seguintes medicações: alopurinol, nimesulida, sinvastatina, omeprazol e frontal. O quadro do paciente evoluiu rapidamente para as lesões em pele e por esta razão internado e submetido a protocolo do setor de queimados de um hospital particular. Atualmente o paciente apresenta as seguintes sequelas: cegueira do olho esquerdo, simbléfaro e pterígio nasal. O conhecimento dessa síndrome, pelo cirurgião-dentista é de fundamental importância, vez que, o estabelecimento do diagnóstico precoce pode minimizar as sequelas e até mesmo evitar casos extremos de óbito. Por fim, esclarecer e conscientizar os profissionais quanto ao uso indiscriminado de medicamentos, causa hoje reconhecida para esta síndrome... (AU)

The Stevens-Johnson syndrome (SJS) is a variant of erythema multiforme by the conformation and distribution of skin lesions and more severe mucosal involvement. It is characterized by the action of specific drugs for IgG or IgM antibodies. Plays an important role in dentistry since often the first manifestations of this disease occur in the oral mucosa. The objective of this paper is to present a report of a patient with SJS, male, 53 years, with an initial complaint of pain and burning mouth. On clinical examination there was injury and hemorrhagic crusts evident in the vermilion of the lips and buccal mucosa. Reported that previously serviced on an eye care center and diagnosed with conjunctivitis and was under use of the following medications: allopurinol,nimesulide, simvastatin, omeprazole and front. The patient's condition progressed rapidly to skin lesions and for this hospital and subjected to the burning of a private hospital sector protocol reason. Currently the patient has the following consequences: blindness of the left eye, nasal pterygium and symblepharon. Knowledge of this syndrome, the dentist is crucial, since the establishment of early diagnosis can minimize sequelae and even prevent extreme cases death. Finally, clarify and educate professionals about the indiscriminate use of medicines, now recognized to cause this syndrome... (AU)