Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT)

Aims: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT).Materials and Methods: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index)DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O’Leary’s Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. Results: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. Conclusions: The state of prior oral health can influence decisively the mucositis suffered during transplantation (AU)

La Ortopantomografía como método para la detección de las placas de ateroma calcificadas. Revisión de la literatura / Panoramic radiograph as a method for detecting calcified atheroma plaques. Review of literature

Los accidentes cerebrovasculares (ACV) constituyen la tercera causa de muerte en los países industrializados, tras la cardiopatía isquémica y el cáncer. Se trata pues de un importante problema de Salud pública, no sólo por su elevada incidencia, sino también por el alto costo que genera la rehabilitación física y psicológica de estos pacientes. El Odontoestomatólogo, como profesional de la salud, debe implicarse ante esta situación y contribuir, dentro de sus posibilidades, a la detección precoz de los pacientes con riesgo de sufrir un ACV. Desde la década de los ochenta, distintos autores han descrito la posibilidad de detectar las placas de ateroma calcificadas localizadas en la bifurcación de la arteria carótida a través de la ortopantomografía (OPG). De este modo, las posibilidades del Odontoestomatólogo en este campo han sido ampliadas. Esta nueva aplicación de la OPG, sin embargo, debe superar ciertos obstáculos antes de poder afianzarse como una nueva medida de cribaje de pacientes con riesgo de sufrir un ACV. Entre éstos estaría, por una parte, la valoración del auténtico significado clínico, a nivel pronóstico, de la calcificación de las placas de ateroma al igual que su utilidad como factor predictor de aparición de cuadros de ACV y por otra, el realizar un correcto diagnóstico diferencial con otras estructuras calcificadas que pueden aparecer en la ortopantomografía

Cerebrovascular accident (CVA) is the third cause of death in industrialized countries, following cardiovascular disease and cancer. It is therefore a significant public health issue, not only due to its high incidence, but also to the high costs involved in the physical and psychological rehabilitation of these patients. Dental Practitioners, as health care providers, ought to play their part in this issue and contribute, within their means, to the early detection of patients at risk of having a CVA. Since the eighties, different authors have described the possibility of detecting calcified atheroma plaques located at carotid artery bifurcation through panoramic radiograph. In this way, the Dental Practitioner’s possibilities in this field have been extended. However, this new use of panoramic radiograph must overcome certain obstacles before it is implemented as a new screening method for patients at risk of having a CVA. Amongst these, we would have, on the one hand, the assessment of the real clinical significance, as regards prognosis, of atheroma plaque calcification as well as its usefulness as a factor for predicting the appearance of CVA symptoms and, on the other hand, the possibility of making a correct differential diagnosis regarding other calcified structures that may appear on panoramic radiograph

Valoración de la mucositis secundaria a tratamiento oncohematológico mediante distintas escalas. Revisión / Measurement of secondary mucositis to oncohematologic treatment by means of different scale. Review

La mucositis oral es la inflamación que tiene lugar en el epiteliooral, a consecuencia de los tratamientos antineoplásicostales como la radioterapia, la quimioterapia o el transplante demédula ósea, siendo muy frecuente en los tratamientos de losprocesos oncohematológicos. Las consecuencias de esta inflamación,no sólo afectan a la calidad de vida del paciente, sinoque además puede suponer una limitación en la aplicación deltratamiento, así como un aumento de la estancia hospitalaria yde los gastos terapéuticos. Un obstáculo principal a la hora deestudiar la mucositis, ha sido la falta de un sistema adecuadopara su valoración mediante el examen oral. Los métodos desarrolladospara medir y cuantificar los cambios producidos enel epitelio oral, como consecuencia del tratamiento del cáncer,van desde los más sencillos, tales como escalas generales concuatro o cinco grados de severidad que permiten relacionar lamucositis con el estado de salud oral, hasta llegar a las escalasespecíficas de tratamiento, en las que se distingue el tipo detratamiento antineoplásico que dio lugar a la mucositis, pasandopor las escalas de múltiples variables, en las que se valorandistintos aspectos y se estudia su correspondencia con el estadode salud oral y su función, obteniendo una puntuación globalde severidad de la mucositis; es importante el establecimientode una escala común para la valoración de la mucositis, no sólocon fines clínicos sino también para la investigación del gradode toxicidad de los distintos regímenes terapéuticos que danlugar a mucositis

Oral mucositis is the inflammation that takes place in the oralepithelium, as a result of antineoplastic treatments such as radiotherapy,chemotherapy or bone marrow transplant, being veryfrequent in these treatments for oncohematologic disease. Theconsequences of this inflammation, not only affect the qualityof life of the patient, but can also suppose a limitation in the applicationof the treatment, as well as an increase in the hospitalstay and therapeutic costs. A main obstacle for the study of themucositis, has been the lack of a system adapted for its valuationby means of the oral examination. Methods developed tomeasure and quantify the changes produced in oral epitheliumas a result of treatment of cancer can be very varied from moresimple methods, such as general scales with four or five degreesof severity that link the mucositis to the state of oral health, tospecific scales of treatment. In this last type of scale the type ofantineoplastic treatment that gave rise to the mucositis is identifiedgiving a global severity score for the mucositis.The establishment of a common scale for the evaluation ofmucositis is important, not only for clinical purposes but alsofor the investigation of the degree of toxicity of the differenttherapeutic regimes that give rise to the mucositis