Oral complications of head and neck radiotherapy: the importance of the dental surgeon / Complicações orais da radioterapia de cabeça e pescoço: a importância do cirurgião-dentista

ABSTRACT Objective: radiotherapy can lead to different adverse effects in the oral epithelial cells. This article aimed to address the main oral manifestations associated with radiotherapy of head and neck neoplasms, highlighting the importance of the dental practitioners' participation within the skilled multidisciplinary personnel to treatment. Methods: Research was conducted in the PubMed, Lilacs, SciELO, and Google Scholar databases using the keywords "head and neck radiotherapy", "oral manifestations'', and "head and neck neoplasm". Eighteen out of 533 articles published between 2015 and 2022 were selected after duplicates removal and eligibility criteria application. Results: xerostomia, hyposalivation, trismus, dysgeusia, dysphagia, dentin hypersensitivity, fungal and viral infections, radiation caries, osteoradionecrosis, mucositis, periodontal alterations, and tooth development abnormalities were the most frequently reported oral effects of radiotherapy. Conclusions: The participation of dentists in the multidisciplinary team that treats patients with head and neck cancers is fundamental since several oral complications of radiotherapy are observed. Dentists can prevent, reduce and treat some detrimental effects whether the patient is followed-up since the beginning of radiotherapy.

RESUMO Objetivo: A radioterapia pode levar a diferentes efeitos adversos nas células epiteliais orais. Este artigo teve como objetivo abordar as principais manifestações bucais associadas à radioterapia de neoplasias de cabeça e pescoço, destacando a importância da participação do cirurgião-dentista na equipe multidisciplinar apta ao tratamento. Métodos: foi realizada uma busca nas bases de dados PubMed, Lilacs, SciELO e Google Acadêmico utilizando as palavras-chave "radioterapia cabeça e pescoço", "manifestações orais" e "neoplasma de cabeça e pescoço". Dezoito dos 533 artigos publicados entre 2015 e 2022 foram selecionados após a remoção das duplicatas e aplicação dos critérios de elegibilidade. Resultado: xerostomia, hipossalivação, trismo, disgeusia, disfagia, hipersensibilidade dentinária, infecções fúngicas e virais, cárie de radiação, osteorradionecrose, mucosite, alterações periodontais, e anormalidades do desenvolvimento dentário foram os efeitos orais da radioterapia mais relatados. Conclusão: A participação dos dentistas na equipe multidisciplinar que atende pacientes com câncer de cabeça e pescoço é fundamental, pois são observadas diversas complicações bucais da radioterapia. Os dentistas podem prevenir, reduzir e tratar alguns efeitos deletérios se o paciente for acompanhado desde o início da radioterapia.

Illustrated booklet of Brazilian sign language for dentistry.

AIMS: This manuscript aimed to produce an illustrated booklet of Brazilian sign language (LIBRAS) booklet to facilitate the communication between dentists (and academics) and deaf patients during dental treatment and other healthcare promotion activities. METHODS AND RESULTS: A literature review was conducted to select signs, symptoms, and diseases related to dentistry expressed in LIBRAS; in addition, photographs were taken to illustrate and produce the booklet. The booklet (in PDF format) was made available on an open-access website and printed copies were freely distributed at the dental clinics of the Federal University of Pará. CONCLUSION: Learning of specific LIBRAS is extremely important to guarantee social inclusion and improve dental treatment of deaf patients.

Drug protocols for patients with special needs: a review of the literature / Protocolos farmacológicos em pacientes portadores de necessidades especiais: uma revisão de literatura

ABSTRACT There is a great need for dental surgeons to be trained to proceed with patients needing some kind of special care. This study aimed to perform a review of the literature on drug protocols concerning how to treat patients with special needs, within the different areas in which dentists may be engaged. The methodology employed was to review articles dealing with the subjects of diabetes mellitus, chronic renal failure, hemophilia, cardiac patients, which were focused on areas of dentistry. A total of 33 articles were selected. Several specific protocols were found on how to act during a consultation of several systemic diseases or in special cases, in order to achieve success during treatment, to avoid drug interactions or to create emergency situations. It was possible, in some cases, to find a consensus between the sequences or the drug of first choice for patients. Serious errors can occur if a dentist is not capable in serious cases. The creation of a protocol for these patients in the different dental specialties would reduce the number of failed treatments, thus increasing the safety and effectiveness of the treatments.

RESUMO Há uma grande necessidade dos cirurgiões-dentistas estarem capacitados para proceder diante de pacientes com algum tipo de cuidado especial. Esse trabalho teve como objetivo realizar uma revisão de literatura sobre protocolos farmacológicos de como tratar pacientes portadores de necessidades especiais, dentro das diversas áreas que os cirurgiões-dentistas podem atuar. Métodos: Foi adotada como metodologia a revisão de artigos nos temas de Diabetes Mellitus, insuficiência renal crônica, hemofilia, pacientes cardiopatas, no período de 1980 a 2017 todos voltados para áreas da odontologia. Resultados: Foram selecionados 33 artigos da temática. Foram encontrados vários protocolos específicos para agir durante uma consulta de diversas doenças sistêmicas ou em casos especiais, afim de conseguir o sucesso durante o tratamento, evitar interações medicamentosas ou criar situações de emergências. Foi possível verificar, em alguns casos, um consenso entre as sequências ou o medicamento de primeira escolha para os pacientes portadores de necessidades especiais. Podem acontecer erros graves caso algum cirurgião-dentista não esteja capacitado para realizar a consulta nesses casos graves. A criação de um protocolo para esses pacientes nas diversas especialidades odontológicas diminuiria a quantidade de tratamentos com insucesso, assim aumentando a segurança e a eficácia dos tratamentos.

Prevalence of calcified carotid artery atheromas in panoramic radiographs of HIV-positive patients undergoing antiretroviral treatment: a retrospective study.

OBJECTIVE: This study investigated the prevalence of calcified carotid artery atheromas (CCAAs) in panoramic radiographs of HIV-positive patients. STUDY DESIGN: A retrospective cross-sectional study was performed to evaluate the presence of CCAA in 300 panoramic radiographs. Qualitative variables were compared using the χ(2) test or Fisher exact test, as needed. The Mann-Whitney or Student t test was used for the quantitative variables. RESULTS: In the studied group, 8.2% presented CCAA. Among these patients, most used lopinavir/ritonavir (P = .0459), had a greater mean age (P = .0081), and displayed a lower nadir CD4 (P = .0195). The use of lopinavir/ritonavir increased the chances of CCAA by approximately 2.8-fold compared with those who did not use medication (odds ratio, 2.79; 95% confidence interval, 1.12-6.95; P = .045). CONCLUSIONS: The variables that were associated with the identification of CCAA are compatible with the known atherogenic risk factors in patients with HIV.

Radiographic evaluation of maxillofacial region in oncology patients treated with bisphosphonates.

OBJECTIVE: This study aimed to identify radiographic alterations in patients administered bisphosphonate treatment that would permit early diagnosis of osteonecrosis of the jaw. STUDY DESIGN: A prospective study was conducted with clinical and radiographic analysis of 60 patients divided into 2 groups. Thirty patients treated with zoledronate were included in group 1, and 30 patients that had never been treated with bisphosphonate were included in group 2. Digital panoramic radiographs were performed on all patients and subsequently evaluated by 2 radiologists. RESULTS: Data analysis revealed that patients treated with zoledronate presented a statistically significant increase in the number of radiographic abnormalities compared with the control group. Female patients presented significantly more alterations than male patients, and the posterior region of the mandible was the most affected region. CONCLUSIONS: Analysis of the data obtained revealed that the use of panoramic radiographs facilitates early identification of bone alterations, which can improve early diagnosis of bisphosphonate-associated osteonecrosis of the jaw.

Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections.

Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Recently, bisphosphonates have been used to treat central giant cell lesions. A case of a 36-year-old male with a central giant cell lesion crossing the mandibular midline was treated with intralesional corticosteroids combined with alendronate sodium for the control of systemic bone resorption. The steroid injections and the use of bisphosphonates were stopped after seven months when further needle penetration into the lesion was not possible due to new bone formation. After two years, the bony architecture was near normal, and only minimal radiolucency was present around the root apices of the involved teeth. The patient was followed up for four years, and panoramic radiography showed areas of new bone formation. Thus far, neither recurrence nor side effects of the medication have been detected.

Granuloma piogênico: relato de caso atípico em lábio inferior / Pyogenic granuloma: reporting of atypical case on lower lip

Revisar a literatura e relatar um caso clínico incomum de granuloma piogênico emlábio inferior. Relato de caso: paciente do gênero feminino de 53 anos de idade, com lesão emlábio inferior, há cerca de sete anos, apresentou características clínicas que induziram aoincorreto diagnóstico de hemangioma. Os achados histopatológicos exibiram tecidogranulomatoso com intensa proliferação vascular. A lesão foi removida e a paciente apresentaseem proservação clínica. Considerações finais: apesar das características clínicas dessa lesãonão serem determinantes, é importante relatar a diferença entre cada caso, sendo que apenascom o exame histopatológico podem-se ter diagnósticos mais precisos

To review the literature and report an unusual case of Pyogenic Ggranuloma onlower lip. Case report: female patient of 53 years of age, with lesions on the lower lip aboutseven years, had clinical features that led to an incorrect diagnosis of hemangioma. Thehistopathological findings showed granulomatous tissue with intense vascular proliferation. Thelesion was removed and the patient comes in clinic attend. Final considerations: although theclinical features of this lesion are not determinative, it is important to report the differencebetween each case and only with histological examination can be accurate diagnosis.

Epidemiological and oral manifestations of HIV-positive patients in a specialized service in Brazil.

The purpose of this study was to evaluate the prevalence of oral lesions in HIV-positive patients attending the Specialized Service for Infectious-contagious Diseases and Parasitoses of the Health Secretariat of the State of Pará (URE-DIPE/SESPA), in the city of Belém, PA, Brazil. A total of 79 HIV-positive patients (53 males and 26 females) were examined. Clinical and epidemiological evaluations were done by correlating the lesions with gender, race, chronological age, risk behavior and prevailing immune status (CD4+ cells count). Lesion location and the presence of associated factors, such as alcohol use, smoking and denture wearing, were quantified individually for each type of lesion using a diagnostic pattern based on the clinical aspects. Approximately 47% of the patients (n=37) presented some type of oral lesion. Candidiasis (28%) and periodontal disease (28%) were the most common, followed by cervical-facial lymphadenopathy (17.5%). Other lesions observed were hairy leukoplakia, melanin hyperpigmentation, ulcerative stomatitis (aphthous), herpes simplex, frictional keratosis and pyogenic granuloma. This analysis presented some relevance as to the statistical data. Concerning CD4+ cells, most lesions manifested with the reduction of the CD count. There were a larger number of HIV-positive female heterosexual patients. Alcohol and/or smoking were strongly associated with the occurrence of hairy leukoplakia in these patients. Candidiasis and periodontal disease were the most common oro-regional clinical manifestations in the patients.

Epidemiological and oral manifestations of HIV-positive patients in a specialized service in Brazil

The purpose of this study was to evaluate the prevalence of oral lesions in HIV-positive patients attending the Specialized Service for Infectious-contagious Diseases and Parasitoses of the Health Secretariat of the State of Pará (URE-DIPE/SESPA), in the city of Belém, PA, Brazil. A total of 79 HIV-positive patients (53 males and 26 females) were examined. Clinical and epidemiological evaluations were done by correlating the lesions with gender, race, chronological age, risk behavior and prevailing immune status (CD4+ cells count). Lesion location and the presence of associated factors, such as alcohol use, smoking and denture wearing, were quantified individually for each type of lesion using a diagnostic pattern based on the clinical aspects. Approximately 47% of the patients (n=37) presented some type of oral lesion. Candidiasis (28%) and periodontal disease (28%) were the most common, followed by cervical-facial lymphadenopathy (17.5%). Other lesions observed were hairy leukoplakia, melanin hyperpigmentation, ulcerative stomatitis (aphthous), herpes simplex, frictional keratosis and pyogenic granuloma. This analysis presented some relevance as to the statistical data. Concerning CD4+ cells, most lesions manifested with the reduction of the CD count. There were a larger number of HIV-positive female heterosexual patients. Alcohol and/or smoking were strongly associated with the occurrence of hairy leukoplakia in these patients. Candidiasis and periodontal disease were the most common oro-regional clinical manifestations in the patients.

Radiographic study of dental anomalies in brazilian patients with neuropsychomotor disorders

The purposes of this study were to investigate radiographically the dental and maxillomandibular in patients with neuropsychomotor disorders and determine the role of panoramic radiographs for quantitative and qualitative analyses of dental alterations. A total of 322 panoramic radiographs from 190 males and 132 females aged 4 to 57 years were obtained from the files of the Center for Care to Patients with Special Needs (CAPE; Dental School, University of São Paulo) and subdivided into syndromes, special needs, neurological, neuromuscular or cerebral disorders, and sequels of diseases. 32 percent of dental alterations were in tooth position, with 69 percent of this group associated with tooth rotation. The mandible accounted for 54.62 percent of alterations. The male gender (55.85 percent) and the permanent dentition (78.7 percent) were most affected. Panoramic radiographs were proved to be well suited for quantitative evaluation of dental anomalies of epidemiological nature. Panoramic radiographs are important diagnostic resources when applied to patients with special needs because of the difficulty to place intraoral films and held them correctly positioned during the radiographic technique.

Radiographic study of dental anomalies in Brazilian patients with neuropsychomotor disorders.

The purposes of this study were to investigate radiographically the dental and maxillomandibular in patients with neuropsychomotor disorders and determine the role of panoramic radiographs for quantitative and qualitative analyses of dental alterations. A total of 322 panoramic radiographs from 190 males and 132 females aged 4 to 57 years were obtained from the files of the Center for Care to Patients with Special Needs (CAPE; Dental School, University of São Paulo) and subdivided into syndromes, special needs, neurological, neuromuscular or cerebral disorders, and sequels of diseases. 32% of dental alterations were in tooth position, with 69% of this group associated with tooth rotation. The mandible accounted for 54.62% of alterations. The male gender (55.85%) and the permanent dentition (78.7%) were most affected. Panoramic radiographs were proved to be well suited for quantitative evaluation of dental anomalies of epidemiological nature. Panoramic radiographs are important diagnostic resources when applied to patients with special needs because of the difficulty to place intraoral films and held them correctly positioned during the radiographic technique.

Avaliação do efeito inibidor tumoral do óleo resina de copaíba in natura (Copaifera reticulata) e manipulado artesanalmente no modelo de carcinogênese bucal experimental DMBA induzida / Evaluation of the tumor inhibitive effect of in natura (Copaifera reticulata) and hand prepared oil in the DMBA-induced oral carcinogenesis model

A Medicina natural tem se apresentado como alternativa para a cura de inúmeras doenças que afetam a população, utilizando-se de plantas da flora brasileira; muito embora ainda não sejam totalmente esclarecidos os princípios ativos, mecanismo de ação e características de citotoxicidade destes produtos. Uma dessas substâncias é um óleo extraído de uma árvore de grande porte da familia Leguminosea e encontrado em todo o Brasil, denominado óleo de Copaíba cujo uso é bastante difundido pela população da região amazônica, e com as seguintes comprovações científicas: diurético, laxante, antitetânico, anti-séptico do aparelho urinário, cicatrizante, antiinflamatório e inibidor tumoral. Com esse propósito avaliou-se o comportamento quimiopreventivo do óleo resina de Copaíba na forma natural e manipulado artesanalmente no desenvolvimento de neoplasias DMBA induzidas na mucosa bucal de hamsters sírios dourados (Mesocricetus auratus). Oitenta animais foram divididos em cinco grupos experimentais: (Grupo I: DMBA; Grupo II: óleo de Copaíba in natura; Grupo III Óleo de Copaíba manipulado; Grupo IV: DMBA + óleo de Copaíba in natura e Grupo V: DMBA + óleo de Copaíba manipulado artesanalmente). Procedeu-se a aplicação das substâncias experimentais, precedido por rígida observação clínica respeitando-se os períodos de 7, 13 e 20 semanas respectivamente. Após os intervalos cronológicos os animais foram mortos e os espécimes linguais avaliados morfologicamente. Os resultados demonstraram que as substâncias experimentais apresentaram estreita associação com o peso dos animais; lesões de aspecto macroscópico e microscópico mais significativo foram observadas no grupo I quando comparado ao grupo IV e V, respectivamente, sugerindo um efeito inibidor das duas apresentações do óleo de Copaíba. Não encontramos diferença estatística significante entre a capacidade de inibição tumoral quando comparamos o grupo IV e o grupo V,respectivamente. A ocorrência das lesões bucais não se mostrou...

Retardo mental severo: características de interesse odontológico e relato de caso / Severe mental retardation: significant aspects in dentistry and case report

Os autores, por meio de revisão da literatura e relato de caso clínico, reportam as caraterísticas gerais do retardo mental severo definido como funcionamento intelectual significantemente inferior à média, que é avaliado pelo coeficiente de inteligência (QI), acompanhado de limitações significativas no funcionamento adaptativo das habilidades diárias. A partir da apresentação de um paciente portador de um quadro de retardo mental severo com marcantes alterações craniofaciais e dentárias que compareceu à Clínica de Estomatologia do curso de odontologia da Universidade Federal do Pará (UFPa) para tratamento, serão apresentadas e discutidas as características genéticas, clínicas, radiográficas e uma proposta de tratamento odontológico da condição

Rarefaçöes ósseas periapicais - novos avanços tecnológicos visando uma maior acurácia na interpretaçäo radiográfica / Periapical bone rarefactions - new technological developments for greater accuracy in radiographic interpretation

Os autores relatam os diferentes aspectos das rarefaçöes ósseas periapicais, visando estabelecer a etiologia, características clínicas e radiográficas; respaldados por uma revisäo de literatura, onde se procurou abordar os avanços tecnológicos como recursos auxiliares na elaboraçäo do diagnóstico destas periapicopatias, obtendo-se assim uma maior acurácia na interpretaçäo radiográfica