O papel da infecção e inflamação na etiopatogênese da osteonecrose dos maxilares induzida por medicamentos / The role of infection and inflammation in the etiopathogenesis of medication-related osteonecrosis of the jaw

Objetivo: O objetivo desta revisão de literatura é evidenciar o papel da infecção e inflamação na etiopatogenia da osteonecrose dos maxilares induzida por medicamentos (MRONJ). Revisão da literatura: A MRONJ é uma condição rara e grave que impacta negativamente a vida dos pacientes afetados. Sua etiopatogenia é multifatorial e ainda não foi totalmente compreendida. Uma das hipóteses propostas para explicá-la sugere que, além da inibição do turnover ósseo pelos medicamentos antirreabsortivos, a infecção associada à exodontia e a inflamação local desempenham papel decisivo no desencadeamento da condição. O entendimento da etiopatogenia da MRONJ permite ao cirurgião-dentista a identificação dos pacientes com risco maior para a doença, assim como o auxilia no monitoramento e escolha do manejo mais adequado. No campo da pesquisa, ele pode aprimorar estudos pré-clínicos e aprofundar a investigação de biomarcadores para diagnóstico precoce de MRONJ. Considerações finais: Conhecer a contribuição da infecção e inflamação na etiopatogênese da MRONJ é fundamental para orientar a pesquisa e a adoção de estratégias preventivas para os pacientes em risco, e de manejo e monitoramento adequado para aqueles já acometidos. (AU)

Aim: The aim of this literature review is to highlight the role of infection and inflammation in the etiopathogenesis of drug-induced osteonecrosis of the jaw (MRONJ). Literature review: MRONJ is a rare and serious condition that negatively impacts the lives of affected patients. Its etiopathogenesis is multifactorial and has not yet been fully understood. One of the hypotheses proposed to explain it suggests that, in addition to the inhibition of bone turnover by antiresorptive drugs, the infection associated with tooth extraction and local inflammation play a decisive role in triggering the condition. Understanding the etiopathogenesis of MRONJ allows the dentist to identify patients at higher risk for the disease, as well as assisting in monitoring and choosing the most appropriate management. In research, it can improve preclinical studies and deepen the investigation of biomarkers for early diagnosis of MRONJ. Conclusion: Knowing the contribution of infection and inflammation in the etiopathogenesis of MRONJ is essential to guide research and the adoption of preventive strategies for patients at risk, and adequate management and monitoring for those already affected.(AU)

Sensitivity and specificity of salivary pipecolic acid in head and neck squamous cell carcinoma

Aim: The aim of the present preliminary case-control study was to test the sensitivity and specificity of salivary pipecolic acid in predicting head and neck squamous cell carcinoma (HNSCC). Methods: High-performance liquid chromatography was used for the analysis of non-stimulated saliva samples from 40 individuals: 20 in the case group (recently diagnosed with untreated HNSCC) and 20 in the control group (individuals without cancer). Both groups included patients taking daily oral hypoglycemic drugs (comorbidity). The case and control groups were matched at a proportion of 1:1 for sex and comorbidity. Results: Mean salivary levels of pipecolic acid were 169.38 ng/ mL in the case group and 114.66 ng/mL in the control group (p<0.001). Individuals who took oral hypoglycemic drugs had higher levels of pipecolic acid in both the case and control groups (p<0.001). The receiver operating characteristic curve analysis revealed 90% sensitivity and 65% specificity for head and neck cancer, with an area under the curve of 0.838 between the case and control groups. Conclusions: Pipecolic acid had high sensitivity for the diagnosis of HNSCC but low specificity in the sample analyzed. Our findings suggest that salivary pipecolic acid levels are associated with glucose homeostasis. Studies with larger samples are required to evaluate the specificity of this metabolite

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients

Abstract The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

Reação liquenoide oral ao amálgama: uma lesão ainda vista / Oral lichenoid reaction to amalgam: a lesion still seen

O amálgama dental ainda é amplamente utilizado na prática odontológica, apesar do acordo assinado na Convenção de Minamata, na qual 140 países comprometeram-se a reduzir o uso do mercúrio. O uso desse material restaurador pode desencadear reações liquenoides orais (RLO) cujas lesões apresentam semelhanças clínicas e histológicas com líquen plano oral (LPO), dificultando o diagnóstico. Aqui relatamos o caso de uma paciente do sexo feminino, de 72 anos, que foi encaminhada com uma lesão na mucosa bucal esquerda, com 10 meses de evolução e queixa de dor. A lesão era adjacente ao segundo molar inferior esquerdo que tinha uma restauração de amálgama. A paciente não apresentava doença sistêmica ou hábitos deletérios e não estava usando drogas continuamente. O diagnóstico clínico presuntivo foi RLO versus LPO. Sessenta dias após a substituição da restauração do amálgama, observou-se a regressão completa da lesão e o diagnóstico final de RLO foi realizado. A avaliação clínica associada aos resultados obtidos após a substituição do material suspeito pode ser suficiente para estabelecer o diagnóstico, embora em alguns casos seja necessária a avaliação histopatológica.

Dental amalgam is still widely used in dental practice, despite the agreement signed at the Minamata Convention, in which 140 countries have committed to reducing the use of mercury. The use of this restorative material may trigger oral lichenoid reactions (OLR) whose lesions show clinical and histological similarities with oral lichen planus (OLP), making diagnosis difficult. Here we report the case of a female patient, 72-year-old, who was referred with a lesion in the left buccal mucosa, with 10 months of evolution and complaint of pain. The lesion was adjacent to the second lower left molar which had an amalgam restoration. The patient had no systemic disease or deleterious habits and was not using drugs continuously. The presumptive clinical diagnosis were OLR versus OLP. Sixty days after the replacement of amalgam restoration the complete regression of the lesion was observed and the final diagnosis of OLR was done. Clinical assessment associated with the results obtained after the replacement of suspect material may be sufficient to establish the diagnosis, although in some cases it may be necessary histopathological evaluation.

Pré-hipertensão, hipertensão arterial e fatores associados em pacientes odontológicos: estudo transversal na cidade de Santa Maria-RS, Brasil / Pre-hypertension, hypertension and associated factors in dental patients: a cross-sectional study in Santa Maria-RS, Brazil

Introdução: A hipertensão arterial sistêmica é um dos mais importantes fatores de risco de doenças cardiovasculares e uma das doenças crônicas mais prevalentes no Brasil e na população mundial. Objetivo: Avaliar a prevalência de hipertensão e pré-hipertensão, fatores associados e adesão ao tratamento anti-hipertensivo em uma amostra de pacientes odontológicos de uma faculdade particular do Rio Grande do Sul, Brasil. Material e Método: Participaram deste estudo 250 pacientes de ambos os gêneros, com idade igual ou superior a 18 anos. Foram obtidos dados demográficos, história de hipertensão arterial e outras doenças sistêmicas, informações sobre o uso de medicação anti-hipertensiva e tabagismo, e realizadas medidas antropométricas. A adesão ao tratamento foi avaliada pelo teste de Morisky e Green. Três aferições de pressão arterial foram realizadas por um Cirurgião-Dentista e a medição média das últimas duas tomadas foi utilizada na presente análise. Resultado: A idade média dos pacientes foi de 46,6 (±13,8) anos. Trinta por cento apresentavam pré-hipertensão e 36%, hipertensão arterial sistêmica. Destes, 28,9% não conheciam sua condição de hipertensão. A hipertensão mostrou associação estatisticamente significante com aumento da idade (p<0,001) e diabetes (p=0,009). Dentre os pacientes em tratamento anti-hipertensivo, 58,1% não eram aderentes, enquanto 41,9% não estavam com a pressão arterial controlada. Conclusão: Na presente amostra, observou-se uma alta prevalência de pré-hipertensão e hipertensão não diagnosticadas, bem como alta taxa da doença não controlada. Estes resultados apontam para a importância ...

Introduction: Hypertension is one of the most important risk factors for cardiovascular diseases and one of the most prevalent chronic diseases in Brazil and in the world population. Objective: Assess the prevalence of hypertension and prehypertension, associated factors and adherence to antihypertensive therapy in a sample of dental patients of a private dentistry school in the state of Rio Grande do Sul, Brazil. Material and Method: The participants of this study were 250 patients of both genders, aged over 18 years. Demographic data, history of hypertension and other systemic diseases, information about the use of antihypertensive drugs and smoking were obtained, and anthropometric measurements were performed. Adherence to treatment was evaluated by Morisky-Green test. Three blood pressure measurements were made by a dentist, and the average of the last two measurements was used in this analysis. RESULT: The mean age of patients was 46.6 (±13.8) years. Thirty percent had prehypertension and 36% had hypertension. Of these hypertensive patients, 28.9% were unaware of their hypertensive condition. Hypertension was statistically associated with increasing age (p<0.001) and diabetes (p=0.009). Among patients on antihypertensive treatment, 58.1% were non-adherent, whilst 41.9% had no controlled blood pressure. Conclusion: In the present study we observed a high prevalence of prehypertension and undiagnosed hypertension, as well as high rate of uncontrolled disease. These results point to the importance of blood pressure measurements during dental visits. .

Extrusão dentária com finalidade restauradora / Tooth extrusion for restorative purpose

O objetivo deste trabalho é revisar a literatura sobre o tracionamento dentário para fins restauradores, apresentar considerações biológicas e mecânicas sobre este procedimento e demonstrar através de casos clínicos a aplicabilidade das técnicas.

The objective of this work is to revise the literature about dental traction for restorative purposes, to present biological and mechanical considerations on this procedure and to demonstrate through clinical cases the applicability of the technique.

Caninos superiores impactados: revisão de literatura e relato de caso clínico / Impacted maxillary canines: a review of literature and clinical case report

O processo de desenvolvimento dos caninos é dentre todos os dentes o mais demorado e de trajeto mais longo. Dessa forma, não é raro que diversos fatores possam intervir na sua irrupção causando impactação dentária. A impactação de caninos superiores ocorre com certa freqüência e pode estar associada a causas sistêmicas e/ou locais. Quanto ao posicionamento do dente impactado, este pode ser por vestibular ou por palatino sendo este último mais comumente encontrado. O diagnóstico precoce dessa anomalia é fundamental para o correto desenvolvimento da dentição/oclusão e para um tratamento mais eficaz e menos prolongado. O objetivo deste trabalho é demonstrar um caso clínico de impactação de canino superior e realizar uma revisão de literatura sobre os diversos aspectos desta anomalia desde seu diagnósticoClínico e radiográfico até as diferentes alternativas de tratamento.

The canine development process is the most delayed process of all teeth and also the one that takes the longest path until its eruption. This is why it is not rare that many factors may interfere on canine eruption causing impaction. Maxillary canine’s impaction occurs with certain frequency and can De associated to systemic and/or- local factors. The impacted teeth may belocated in different positions and it is named according to it: buccal or palatal. The last one, palatal, is the most common. Early diagnosis of this anomaly is of major importance to have a proper occlusion development and to have a more efficient and short treatment. The aim of this paper is to show a clinical case of maxillary canine impaction and review the literature on different aspects from its clinical and radiographic diagnosis to different treatment alternatives.