Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

Fatores associados ao tempo entre o diagnóstico e o início do tratamento do câncer infantojuvenil / Factors associated with the time between diagnosis and initiation of childhood cancer treatment

Objetivou-se analisar a distribuição do câncer infantojuvenil e identificar fatores associados ao atraso no início do tratamento oncológico, na Paraíba, a partir dos Registros Hospitalares de Câncer, de 2010 a 2018. Estudo observacional, descritivo e analítico, com 896 registros de crianças e adolescentes (0-19 anos), identificando-se características epidemiológicas, clínicas e o cumprimento da Lei Federal 12.732/12 (lei dos 60 dias para início do tratamento). Os dados foram analisados pela regressão logística (α=5%). Constatou-se que 80,2% dos pacientes iniciaram o tratamento no tempo previsto por lei (≤ 60 dias). Observou-se que indivíduos de 10 a 19 anos, com tumores sólidos, submetidos à cirurgia e tratados em um dos quatro RHC's da Paraíba apresentam maiores chances de terem a terapia antineoplásica iniciada em um tempo superior a 60 dias. Conclui-se que o atraso no início do tratamento contra o câncer infantojuvenil está associado a características epidemiológicas e clínicas dos pacientes oncológicos pediátricos.

This study aimed to analyze the distribution of childhood cancer and identify factors associated with delay in starting cancer treatment, in the state of Paraíba, from the Hospital-Based Cancer Registries (HBCR), from 2010 to 2018. Observational, descriptive and analytical study, with 896 records of children and adolescents (0-19 years), identifying epidemiological and clinical characteristics and compliance with Federal Law 12732/12 (maximum of 60 days to start treatment). Data were analyzed by logistic regression (α=5%). The results showed that 80.2% patients started treatment within the time prescribed by law (≤ 60 days). Individuals aged 10 to 19 years, with solid tumors, undergoing surgery and treated in one of the four HBCR in Paraíba are more likely to have anticancer therapy initiated after 60 days. The delay in starting treatment against childhood cancer is associated with epidemiological and clinical characteristics of pediatric cancer patients.

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.

Relação entre Senso de Coerência e experiência de cárie dentária em crianças de 5 a 10 anos / Relationship between Sense of Coherence and dental caries experience in children aged 5-10 years

O presente trabalho teve como objetivo compreender a relação entre o Senso de Coerência (SOC) dos responsáveis e a experiência de cárie dentária dos escolares de 5 a 10 anos da Escola de Educação Básica da Universidade Federal da Paraíba (EEBAS/UFPB). Participaram do estudo 120 crianças e responsáveis. Os exames clínicos foram realizados na própria escola, após assinatura do Termo de Consentimento Livre e Esclarecido (TCLE) pelos responsáveis. Os responsáveis responderam o SOC-13. Os dados obtidos foram submetidos à análise estatística descritiva e inferencial. Foi encontrado que os valores de ceo-d e CPO-d variaram 0 a 8, com 76,2% de valor para o componente cariado. Não houve associação estatisticamente significante entre o SOC dos responsáveis e a experiência de cárie dos alunos. Também não foi encontrada relação entre o SOC e ceo-d, idade, sexo e série escolar. No entanto, o SOC parece ter uma influência significativa no comportamento e impactar em aspectos socioeconômicos... (AU)

This study aimed to comprehend the relationship between parental Sense of Coherence (SOC) and dental caries experience in children aged 5-10 years at the Basic School of Federal University of Paraiba. The sample was composed of 120 children and their parents. Clinical examinations were performed at the school, after signing the Term of Free and Informed Consent (TFIC) by the parents. The parental SOC was measured using the 13-item version (SOC-13). The data obtained were submitted to descriptive and inferential statistical analyses. The values of dmft and DMFT ranged from 0 to 8, with a predominance of the decayed component (76.2%). There was no statistically significant association between parental SOC and dental caries experience in the students. In addition, parental SOC was not significantly associated with dmft, age, gender, or school grade. Nonetheless, the SOC seems to have a significant influence on behavior and impact on socio-economic aspects... (AU)

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors

Abstract This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

Fatores associados ao acúmulo de biofilme visível em idosos institucionalizados / Factors associated with visible biofilm accumulation in institutionalized elders

O objetivo desse estudo foi avaliaro acúmulo de biofilme visível e verificar os fatores associados em idosos institucionalizados. Realizou-se um estudo transversal com idosos (n = 193) em instituições de longa permanência (n = 7) da região metropolitana de João Pessoa (PB). A presença de biofilme visível nos dentes e/ou nas próteses dentárias foi considerada como variável dependente. As variáveis independentes do estudo foram: características sociodemográficas, estado físico, hábitos de higiene e presença de agravos bucais. A influência das variáveis independentes sobre as variáveis dependentes foi analisada segundo regressão logística (α < 0,05). Foi possível perceber que a presença de biofilme dental visível (63,3%) está associada com idade superior a 80 anos (OR = 1,53), presença de cálculo dental (OR = 4,91) e frequência de escovação até uma vez ao dia (OR = 1,96). Diante disso, o acúmulo de biofilme visível está associado com avanço da idade, presença de cálculo dental e baixa frequência de higiene.

To evaluate the presence of visible biofilm accumulation and check associated factors in institutionalized elders. We conducted in a cross-sectional study with elders (n=193) from long-term care facilities (n=7) in the metropolitan region of João Pessoa-PB. The presence of visible biofilm in teeth and/or dentures was considered as dependent variable. The independent variables of the study were: socio-demographic characteristics, physical state, hygiene habits, and presence of oral diseases. The influence of independent variables on dependent variables was analyzed according to logistic regression (α<0.05). The presence of visible dental biofilm (IPV) (63.3%) is associated with age over 80 years (PR=1.53), presence of dental calculus (OR=4,91) and brushing frequency up to once a day (OR=1.96). The increase in visible biofilm is associated with advancing age, presence of dental calculus and low frequency of hygiene.

Occurrence and Severity of Oral Mucositis in Brazilian Pediatric Cancer Patients

Abstract Objective: To determine the occurrence and severity of oral mucositis (OM) and the factors associated with the onset of severe oral mucositis (SOM) in pediatric cancer patients. Material and Methods: This was a longitudinal and prospective study with 85 children and adolescents (aged 0 to 19 years) admitted to the Pediatric Oncology Sector of Napoleão Laureano Hospital between November 2016 and July 2019. The patients' sociodemographic and epidemiological information, as well as hematological and biochemical parameters, were obtained from their medical charts. The oral mucosa of study participants was assessed through the modified Oral Assessment Guide (OAG) at baseline and after the 2nd, 5th and 10th week of antineoplastic treatment. Data were analyzed by Chi-square test to determine the factors associated with the occurrence of SOM (p<0.05). Results: The occurrence of OM was more frequent in the 2nd (60%), 5th (40.9%) and 10th week (43.2%) of antineoplastic treatment. During the follow-up period, SOM was more frequent in the 5th week (34.7%), followed by the 2nd (32.3%) and 10th weeks (29.7%). There was no association between the occurrence of SOM and the patient's age, type of tumor, chemotherapy regimen, and hematological and biochemical parameters. Conclusion: The occurrence of oral mucositis in pediatric cancer patients was significant, especially in the 2nd week of antineoplastic treatment. Severe oral mucositis was more prevalent in the 5th week of treatment and was not associated with any of the study variables.

Does non-institutionalized elders have a better oral health status compared to institutionalized ones? A systematic review and meta-analysis / Idosos não-institucionalizados apresentam melhor saúde bucal comparado aos idosos institucionalizados? Uma revisão sistemática e meta-análise

Abstract This systematic review compared the oral health status between institutionalized and non-institutionalized elders. The following electronic databases were searched: PubMed (Medline), Scopus, Web of Science, Lilacs and Cochrane Library, in a comprehensive and unrestricted manner. Electronic searches retrieved 1687 articles, which were analyzed with regards to respective eligibility criteria. After reading titles and abstracts, five studies were included and analyzed with respect their methodological quality. Oral status of institutionalized and non-institutionalized elderly was compared through meta-analysis. Included articles involved a cross-sectional design, which investigated 1936 individuals aged 60 years and over, being 999 Institutionalized and 937 non-institutionalized elders. Studies have investigated the prevalence of edentulous individuals, the dental caries experience and the periodontal status. Meta-analysis revealed that institutionalized elderly have greater prevalence of edentulous (OR = 2.28, 95%CI = 1.68-3.07) and higher number of decayed teeth (MD = 0.88, 95%CI = 0.71-1.05) and missed teeth (MD = 4.58, 95%CI = 1.89-7.27). Poor periodontal status did not differ significantly between groups. Compared to non-institutionalized, institutionalized elders have worse dental caries experience.

Resumo Esta revisão sistemática comparou o estado de saúde bucal entre idosos institucionalizados e não institucionalizados. As seguintes bases de dados eletrônicas foram pesquisadas: PubMed (Medline), Scopus, Web of Science, Lilacs e Cochrane Library, de forma abrangente e irrestrita. Pesquisas eletrônicas recuperaram 1.687 artigos, que foram analisados com relação aos respectivos critérios de elegibilidade. Após a leitura de títulos e resumos, cinco estudos foram incluídos e analisados quanto à qualidade metodológica. A condição bucal de idosos institucionalizados e não institucionalizados foi comparada por meio de meta-análise. Os artigos incluídos envolveram um delineamento transversal, que investigou 1.936 indivíduos acima de 60 anos, sendo 999 institucionalizados e 937 não institucionalizados. Investigou-se a prevalência de edentulismo, a experiência de cárie e a condição periodontal. A meta-análise revelou que idosos institucionalizados possuem maior prevalência de edentulismo (OR = 2,28, IC95% = 1,68-3,07), maior número de dentes cariados (DM = 0,88, IC95% = 0,71-1,05) e de dentes perdidos (DM = 4.58, IC95% = 1,89-7,27). A condição periodontal ruim não diferiu significativamente entre os grupos. Comparados aos não institucionalizados, os idosos institucionalizados tem pior experiência de cárie.

Self-Medication for Toothache and its Associated Factors in Children and Adolescents

Objective: To evaluate self-medication for toothache and its associated factors in children and adolescents. Material and Methods: A cross-sectional study was carried out with 252 children/adolescents aged 6-16 years. A questionnaire was applied with questions related to demographic and socioeconomic characteristics; experience of, and self-medication for, toothache; as well as aspects related to the condition. Descriptive and inferential statistical analyses (Pearson's Chi-square test and Fisher's exact test) were performed, with a 5% significance level. Results: The prevalence of toothache was 41.7%. In 96 cases analyzed, there was prevalence of 69.8% of self-medication for toothache. There were no statistically significant associations between self-medication for toothache and variables related to the children/adolescents (gender and age), their parents or guardians (age and schooling), socioeconomic characteristics (family income and number of people in the household) and aspects related to toothache (fever, crying and school absenteeism) (p>0.05). The most commonly used drug was paracetamol (60.7%), whose choice was based to its previous use by the study population for conditions not related to toothache (47.8%). Conclusion: There was a high prevalence of self-medication for toothache in the study population. No independent variable was associated with self-medication practice.

Salivary Flow in Pediatric Cancer Patients Compared to Healthy Children and Adolescents

Abstract Objective: To verify differences between salivary flow in pediatric cancer patients before starting antineoplastic treatment and in healthy pediatric patients. Material and Methods: This is an observational, cross-sectional, paired study with sample of 120 children and adolescents (3-18 years). Thirty pediatric cancer patients were selected for convenience at "Napoleão Laureano" Hospital (G1). Another group was composed of 90 individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, matched by age (G2). Data collection was performed in two steps for both groups. Information regarding pediatric cancer patients was obtained by interview with parents / guardians and searching medical records, while in the other group by interview with parents / guardians. Saliva collection was performed using standard method in both groups: unstimulated salivary flow rate (USFR) being the mean volume expelled in 1 minute. Data were analyzed by the Shapiro-Wilk, Kolmogorov-Smirnov and Mann-Whitney tests (α = 5%) Results: Mean USFR for G1 and G2 was 0.52 mL / min and 0.66 mL / min, respectively (p>0.05) and, in both groups, significant difference was observed (p <0.05) between the mean USFR values of its subgroups, and values of adolescents being higher than those of children Conclusion: There is no difference in unstimulated salivary flow of pediatric cancer patients before starting antineoplastic treatment compared with healthy pediatric patients.

Antifungal Activity of Eugenol and its Association with Nystatin on Candida albicans

Objective: To evaluate the anti-Candida effect of eugenol and its antimicrobial interaction with nystatin. Material and Methods: The antimicrobial potential was assessed by microdilution technique (M27A3 reference method), by determining the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) against C. albicans (ATCC 90028). The possible action of eugenol on the fungal cell wall was evaluated with the assistance of the osmotic protector sorbitol (0.8 M). The antimicrobial interaction with nystatin was assessed through the checkerboard method. All tests were performed in triplicate. Results: All groups showed reductions in PI and GBI values and improvements in oral health knowledge, but IG1 and IG2 showed statistically significant differences in these variables compared to CG. Conclusion: The eugenol has antifungal activity against C. albicans and its mechanism of action is probably not related to damage to the fungal cell wall. Association between eugenol and nystatin was not found to be an advantageous possibility for growth inhibition of C. albican.

Prevalência de má oclusão em escolares de 7 a 9 anos de idade do Polo 1 da Rede Municipal de Ensino em João Pessoa-PB / Prevalence of malocclusion in 7-9-years-old children from Pole 1 of municipal schools in João Pessoa-PB

Introdução: A má oclusão, definida como alteração do crescimento e do desenvolvimento que afeta a oclusão dentária, é considerada um problema de saúde pública, pois apresenta alta prevalência e interfere negativamente na qualidade de vida das pessoas. Objetivo: Avaliar a prevalência de más oclusões em escolares de 7 a 9 anos de idade do Pólo 1 da Rede Municipal de Ensino de João Pessoa-PB. Material e Método: Foi realizado um estudo transversal com 162 escolares, selecionados de forma probabilística, de ambos os gêneros. Dentre as características da oclusão, foram observados: relação molar de Angle, sobressaliência, sobremordida, mordida aberta anterior, mordida cruzada e apinhamento. Os dados foram coletados por examinador calibrado (Kappa = 0,93), organizados em programa SPSS 13.0 e submetidos à análise descritiva e ao teste Qui-quadrado, com nível de significância de 5%. Resultado: 89,5% dos escolares apresentaram algum tipo de má oclusão; 48,1% da amostra foi classificada como tendo relação molar de Classe I, 32,1% Classe II e 17,9% Classe III. O apinhamento foi a má oclusão mais frequente (67,3%), seguido da sobressaliência acentuada (48,8%), sobremordida acentuada (41,9%), mordida cruzada posterior (11,7%), mordida cruzada anterior (11,7%) e mordida aberta anterior (11,7%). A mordida cruzada posterior foi estatisticamente mais frequente no gênero masculino e a sobressaliência acentuada apresentou associação com a Classe II de Angle. Conclusão: A população em tela apresentou alta prevalência de alterações oclusais, o que indica a necessidade de intervenção precoce, seja com programas preventivos e educativos, seja com programas de assistência.

Introduction: Malocclusion, defined as change in growth and development that affects dental occlusion, is considered a public health problem, because of its high prevalence and negative impact on quality of life. Objective: Assess the prevalence of malocclusion in children 7-9 years old from Pole 1 of the municipal schools in João Pessoa-PB. Material and Method: A cross-sectional study was conducted with a probabilistic random sample of 162 schoolchildren of both genders. The following oclusal findings were observed: molar classes, overjet, overbite, anterior open bite, crossbite and crowding. Data were collected by a calibrated examiner (Kappa = 0.93), organized by the SPSS 13.0 and subjected to descriptive analysis and chi-square test, with a significance level of 5%. Result: 89.5% of schoolchildren had some type of malocclusion. 48.1% of the sample were classified as having Class I, 32.1% Class II and 17.9% Class III. The crowding was the most frequent malocclusion (67.3%), followed by increased overjet (48.8%), increased overbite (41.9%), posterior crossbite (11.7%), anterior crossbite (11.7%) and anterior open bite (11.7%). A posterior crossbite was statistically more frequent in males. Class II was associated with increased overjet. Conclusion: This population presented high prevalence of malocclusion, which indicates the need for early intervention, with preventive and educational programs or assistance.

Cárie Dentária em Crianças e Adolescentes do Projeto Santo Amaro, Recife - Pernambuco - Brasil / Dental Caries among Children and Adolescents of the Santo Amaro Project, Recife - Pernambuco - Brazil

Objetivo: Investigar a experiência de cárie em crianças e adolescentes pertencentes a um projeto social desenvolvido pela Escola Superior de Educação Física da Universidade de Pernambuco (Projeto Santo Amaro), através dos índices CPO-D e ceo-d, no ano de 2003. Material e Métodos: Os dados foram coletados por 4 examinadoras (cirugiãs-dentistas) calibradas (Kappa intraexaminador = 1; Kappa interexaminadores = 0,83) e 2 anotadores (estudantes do Curso de Odontologia - FOP/UPE), através de exames clínicos intrabucais, realizados segundo os critérios da OMS (1997). Integraram a amostra 402 crianças, com idade entre 6 e 17 anos. A análise estatística abrangeu a obtenção das frequências absolutas e percentuais, as medidas de tendência central (média e mediana) e o desvio padrão como medida de dispersão. Resultados: O maior percentual de crianças e adolescentes (53,5 por cento) foi observado nos índices CPO-D e ceo-d igual a zero. A média do CPO-D foi 1,44 com valor mínimo de zero e máximo de 12. O ceo-d médio foi 1,35, com valor minímo de zero e máximo de 10. Para os dois índices, as medianas encontradas foram o valor zero. O desvio padrão foi de 2,19 para o índice CPO-D, e 1,53 para o ceo-d. Aos 7 anos de idade o ceo-d médio foi 1,88 e aos 12 anos, a média do CPO-D foi de 1,35. Conclusão: A experiência de cárie das crianças examinadas foi baixa, considerando que as médias dos índices CPO-D e ceo-d foram próximas à meta preconizada pela OMS para o ano 2010.