Complicações da comunicação buco-sinusal em cirurgias bucais: fatores de riscos, complicações e intervenções / Complications of oral-sinusal communication in oral surgery: risk factors and interventions

A comunicação buco-sinusal, uma conexão direta entre boca e seios maxilares, ocorre comumente pela extração de dentes próximos ao seio maxilar e outros procedimentos. O diagnóstico precoce é crucial para prevenir complicações graves. A abordagem terapêutica varia conforme o tamanho do defeito, presença de infecção e localização específica. Realizou-se uma breve revisão de literatura qualitativa abordando as principais complicações da comunicação buco sinusal na cirurgia bucal e como intervi-las. Buscou-se artigos científicos indexados nas seguintes bases de dados: Google Scholar, Pubmed e Biblioteca Scielo com lapso temporal de 2013 a 2023. Foram utilizados para esta busca os seguintes descritores: Comunicação buco-sinusal; Complicações; Seio maxilar. Os critérios de inclusão desta pesquisa foram artigos em inglês, português e espanhol, sendo selecionados 26 trabalhos. Os principais critérios de exclusão foram artigos com mais de 10 anos de publicação. A prevenção e gestão eficaz das complicações na comunicação oral em cirurgias são essenciais. Identificar fatores de risco, usar técnicas cirúrgicas precisas e agir imediatamente diante de sinais de comunicação com os seios da face são medidas cruciais para garantir a segurança do paciente e aprimorar os resultados cirúrgicos.

Oral-sinusal communication, a direct connection between the mouth and maxillary sinuses, commonly occurs due to the extraction of teeth close to the maxillary sinus and other procedures. Early diagnosis is crucial to prevent serious complications. The therapeutic approach varies according to the size of the defect, presence of infection and specific location. A brief qualitative literature review was carried out looking at the main complications of oral sinus communication in oral surgery and how to intervene. We searched for scientific articles indexed in the following databases: Google Scholar, Pubmed and Scielo Library with a time span from 2013 to 2023. The following descriptors were used for this search: Oral-sinus communication; Complications; Maxillary sinus. The inclusion criteria for this study were articles in English, Portuguese and Spanish, and 26 papers were selected. The main exclusion criteria were articles published more than 10 years ago. The prevention and effective management of oral communication complications during surgery are essential. Identifying risk factors, using precise surgical techniques and acting immediately in the event of signs of communication with the sinuses are crucial measures to ensure patient safety and improve surgical outcomes.

Etiopatogenia e tratamento da osteonecrose dos maxilares induzida por medicamentos: aspectos essenciais ao dentista / Etiopathogenesis and treatment of medication-related osteonecrosis of the jaw: essential aspects for the dentist

A osteonecrose dos maxilares induzida por medicamentos (MRONJ) caracteriza-se por exposição óssea ou osso que pode ser sondado através de fístula intra ou extraoral, em região maxilofacial, e que não cicatriza dentro de oito semanas. A MRONJ é uma condição rara e debilitante que pode causar dor, disfagia e odor desagradável na cavidade oral, afetando pacientes com histórico ou sob uso contínuo de terapia antirreabsortiva, isolada ou associada a imunomoduladores ou drogas antiangiogênicas, mas sem histórico de radioterapia nos maxilares. O objetivo desta revisão narrativa de literatura é compilar os principais aspectos sobre a etiopatogenia da MRONJ e as opções terapêuticas disponíveis. A etiologia da MRONJ é multifatorial, complexa, e não está totalmente compreendida, não havendo um tratamento definitivo, mas diversas modalidades terapêuticas que visam o controle da dor e da progressão da osteonecrose. Conclui-se com essa revisão que o entendimento da etiopatogenia da MRONJ pelo cirurgião-dentista lhe permite adotar medidas preventivas, bem como o conhecimento das modalidades terapêuticas disponíveis lhe possibilita oferecer o manejo adequado para seu paciente, conforme o estágio da doença.

Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed bone or bone that can be probed through an intra or extraoral fistula, in the maxillofacial region, which does not heal within eight weeks. MRONJ is a rare and debilitating condition that can cause pain, dysphagia and unpleasant odor in the oral cavity, affecting patients with a history or continuous use of antiresorptive therapy, alone or associated with immunomodulators or antiangiogenic drugs, but without a history of radiotherapy to the jaws. The aim of this narrative literature review is to compile the main aspects about the etiopathogenesis of MRONJ and the available therapeutic options. The etiology of MRONJ is multifactorial, complex, and is not fully understood, with no definitive treatment, but several therapeutic modalities that aim to control pain and the progression of osteonecrosis. It is concluded from this review that the understanding of the etiopathogenesis of MRONJ by the dental surgeon allows him to adopt preventive measures, as well as the knowledge of the therapeutic modalities available allows him to offer the appropriate management for his patient, depending on the stage of the disease.

Práticas integrativas e complementares de saúde em Sergipe / Integrative and complementary health practices in Sergipe

A atenção primária em saúde (APS) é o primeiro nível de atenção em saúde, sendo um elo entre a população e o setor de saúde. Tem-se buscado a humanização dos atendimentos, e essa mudança, refletida pelas mudanças da sociedade, trouxe a implementação da Política Nacional de Práticas Integrativas e Complementares (PNPIC) no SUS. O objetivo deste trabalho foi realizar uma análise da tendência da quantidade das práticas integrativas e complementares realizadas nas regionais de saúde de Sergipe de 2017 a 2023, associando com a cobertura da atenção primária. Foi realizada análise de dados secundários através do Departamento de Informática do Sistema Único de Saúde (DATASUS), como forma de organização no período de junho/2015 a junho/2023 por regional de saúde de Sergipe. As análises dos dados foram descritivas e de correlação e por meio de análise de série temporal. A regional de saúde de Lagarto foi a que mais executou as práticas integrativas e complementares no período analisado e algumas regionais não tiveram continuidade na realização destas práticas. A regional de saúde com maior cobertura de APS foi Itabaiana. Não foi possível observar associação entre o número de práticas e a cobertura de atenção primária. Com o intuito de que o atendimento aos indivíduos seja cada vez mais humanizado, e em virtude da realização das práticas integrativas ter baixo índice ou descontinuidade em algumas regiões de Saúde de Sergipe, é relevante que os profissionais de saúde busquem conhecimentos sobre essas práticas, como também, os gestores em saúde incentivem esta ação.

Primary health care (PHC) is the first level of health care, being a link between the population and the health sector. The aim has been to humanize care, and this change, reflected by changes in society, has led to the implementation of the National Policy on Integrative and Complementary Practices (PNPIC) in the SUS. The objective of this work was to carry out an analysis of the trend in the number of integrative and complementary practices carried out in the health regions of Sergipe from 2017 to 2023, associating it with primary care coverage. Secondary data analysis was carried out through the Department of Informatics of the Unified Health System (DATASUS), as a form of organization from June/2015 to June/2023 by health region in Sergipe. Data analyzes were descriptive and correlational and through time series analysis. The Lagarto health region was the one that carried out the most integrative and complementary practices in the period analyzed and some regions did not continue to carry out these practices. The health region with the highest PHC coverage was Itabaiana. Observing an association between the number of practices and primary care coverage was impossible. With the aim that care for individuals is increasingly humanized, and because the implementation of integrative practices has a low rate or discontinuity in some Health regions of Sergipe, health professionals must seek knowledge about these practices as well as health managers encourage this action.

Mixolipoma en cavidad bucal: reporte de caso / Myxolipoma in the oral cavity: case report

Introducción: El lipoma es una neoplasia benigna común en tejidos blandos, pero poco frecuente en cavidad bucal. El mixolipoma es un subtipo histológico raro, caracterizado por adipocitos maduros y abundantes sustancias mucoides. Suele presentarse como nódulos submucosos blandos, móviles, recubiertos por mucosa intacta, crecimiento lento y asintomáticos hasta que crecen causando incomodidad. Reporte de caso: Hombre de 74 años habitante de la calle que presentó en fondo de surco en mucosa labial inferior lesión nodular de 2 cm de diámetro, que se desarrolló durante dos años, causando molestias al comer y fue eliminada quirúrgicamente. El estudio histopatológico mostró tejido adiposo maduro y zonas de aspecto mixoide, sin evidencia de atipia, red vascular plexiforme o lipoblastos, en la inmunohistoquímica los adipocitos maduros exhibieron marcada positividad para la proteína S-100 y negatividad para CD34, las células endoteliales mostraron positividad para CD34, confirmando el diagnóstico de mixolipoma. Conclusión: Es esencial que los proveedores de atención médica estén familiarizados con las manifestaciones clínicas del mixolipoma e incluirlo en los posibles diagnósticos ante la presencia de nódulos en la cavidad oral. Asimismo, no se debe subestimar la importancia de educar y concienciar sobre la salud bucal de los habitantes de la calle.

Introduction: Lipoma is a common benign neoplasm in soft tissues, but rare in the oral cavity. Myxolipoma is a rare histological subtype, characterized by mature adipocytes and abundant mucoid substances. It usually presents as soft, mobile submucosal nodules, covered by intact mucosa, slow growing and asymptomatic until they grow causing discomfort. Case report: This is the case of a 74-year-old street dweller who presented with a nodular lesion, 2 cm in diameter, at the bottom of the groove in the lower labial mucosa. The lesion developed over two years and caused discomfort when eating. It was surgically removed. The histopathological study showed mature adipose tissue and areas with a myxoid appearance, without evidence of atypia, plexiform vascular network or lipoblasts, in immunohistochemistry the mature adipocytes exhibited marked positivity for the S-100 protein and negativity for CD34, the endothelial cells showed positivity for CD34, confirming the diagnosis of myxolipoma. Conclusion: It is essential that healthcare providers are familiar with the clinical manifestations of myxolipoma and include it in the possible diagnoses in the presence of nodules in the oral cavity. Likewise, the importance of educating and raising awareness about the oral health of street dwellers should not be underestimated.

Hemi-craneotomía y hemimandibulectomía izquierda como tratamiento del ameloblastoma multiquístico, manejo multidisciplinario. Reporte de caso / Left hemi-craneotomy and hemimandibulectomy as treatment of multicystic ameloblastoma, multidisciplinary management. Case report

El ameloblastoma multiquístico, una neoplasia odontogénica de crecimiento lento, pero comportamiento agresivo, suele manifestarse en la mandíbula, generando deformidades faciales, pérdida dentaria y desplazamiento de tejidos adyacentes. Este estudio tiene como objetivo describir el tratamiento quirúrgico multidisciplinario del ameloblastoma multiquístico en una localización inusual, destacando el compromiso de estructuras vitales y los estudios complementarios necesarios para un diagnóstico preciso. Se presenta el caso de un paciente masculino con una lesión en la hemicara izquierda, que se había desarrollado durante aproximadamente ocho meses, abarcando desde la región temporoparietal hasta la región maseterina ipsilateral. La evaluación clínica y radiológica inicial sugirió la posibilidad de un ameloblastoma multiquístico, confirmado posteriormente mediante biopsia. Como parte del equipo multidisciplinario del Hospital San Vicente Fundación de Medellín, se optó por una resección quirúrgica radical, que incluyó hemi-craneotomía y hemi-mandibulectomía, seguida de una reconstrucción exitosa. Se señala la importancia de un abordaje coordinado entre cirujanos maxilofaciales, estomatólogos y otros especialistas, así como la relevancia de los estudios complementarios para determinar el curso terapéutico óptimo. La cirugía reconstructiva demostró ser efectiva tanto en la restauración funcional como estética, aunque destaca los desafíos inherentes a la gestión de localizaciones poco comunes de esta enfermedad.

Multicystic ameloblastoma, a slow-growing but aggressive odontogenic neoplasm, usually manifests in the mandible, causing facial deformities, tooth loss and displacement of adjacent tissues. This study aims to describe the multidisciplinary surgical management of multicystic ameloblastoma in an unusual location, highlighting the involvement of vital structures and the complementary studies necessary for an accurate diagnosis. We present the case of a male patient with a lesion in the left hemiface, which had developed over approximately eight months, spanning from the temporoparietal region to the ipsilateral maseterine region. Initial clinical and radiological evaluation suggested the possibility of multicystic ameloblastoma, subsequently confirmed by biopsy. As part of the multidisciplinary team of the Hospital San Vicente Fundación de Medellín, a radical surgical resection was chosen, including hemi-craniotomy and hemi-mandibulectomy, followed by successful reconstruction. The importance of a coordinated approach between maxillofacial surgeons, stomatologists and other specialists is emphasized, as well as the relevance of complementary studies to determine the optimal therapeutic course. Reconstructive surgery proved to be effective in both functional and cosmetic restoration, although it highlights the challenges inherent in managing rare locations of this disease.

Abordagens cirúrgicas para cisto dentígero: revisão de literatura / Surgical approaches for dentigerous cyst: literature review

O objetivo desta revisão integrativa foi elaborar uma avaliação qualitativa da literatura existente sobre as modalidades de tratamento utilizadas para cistos dentígeros em pacientes pediátricos. O presente estudo trata-se de uma revisão integrativa da literatura na qual utilizou-se as bases de dados PubMed, BVS (Biblioteca Virtual em Saúde), LILACS, e SciELO. Como critérios de inclusão estavam os artigos publicados na íntegra, relatos de caso clínico, revisões sistemáticas e de meta-análise publicados nos últimos 10 anos, disponível nos idiomas português ou inglês, que abordassem a temática. Os critérios de exclusão foram: resumos, anais, editoriais, cartas ao editor, reflexão, duplicidade, artigos com detalhamento incompleto. O cisto dentígero é o tipo mais comum dos cistos odontogênicos de desenvolvimento e o segundo mais frequente entre todos que ocorrem nos maxilares, representando cerca de 20% de todos os cistos revestidos por epitélio nos ossos gnáticos. Clinicamente pode estar associado a qualquer dente impactado, porém ele envolve com mais frequência os terceiros molares inferiores. Acomete pacientes entre 10 a 30 anos de idade, com predileção pelo sexo masculino, sendo na maioria dos casos detectados em exames radiográficos de rotina. O tratamento baseia-se nas técnicas de descompressão, marsupialização e enucleação. O prognóstico para os cistos dentígeros é altamente favorável e não há chance de recorrência após a remoção completa. Assim, a decisão terapêutica deve ser tomada de forma adequada para cada caso, levando em consideração a localização anatômica, extensão clínica, tamanho, idade, remoção do dente não irrompido e possibilidades de acompanhamento.

The aim of this integrative review was to carry out a qualitative assessment of the existing literature on the treatment modalities used for dentigerous cysts in pediatric patients. This study is an integrative literature review using the PubMed, VHL (Virtual Health Library), LILACS and SciELO databases. The inclusion criteria were articles published in full, clinical case reports, systematic reviews and meta-analysis published in the last 10 years, available in Portuguese or English, which addressed the subject. The exclusion criteria were: abstracts, annals, editorials, letters to the editor, reflection, duplication, articles with incomplete details. The dentigerous cyst is the most common type of developmental odontogenic cyst and the second most frequent of all those that occur in the jaws, accounting for around 20% of all epithelium-lined cysts in the gnathic bones. Clinically, it can be associated with any impacted tooth, but it most often involves the lower third molars. It affects patients between 10 and 30 years of age, with a predilection for males, and in most cases it is detected during routine radiographic examinations. Treatment is based on decompression, marsupialization and enucleation. The prognosis for dentigerous cysts is highly favorable and there is no chance of recurrence after complete removal. Therefore, the therapeutic decision must be made appropriately for each case, taking into account the anatomical location, clinical extension, size, age, removal of the unerupted tooth and follow-up possibilities.

Aplicação clínica da laserterapia de baixa potência na atenção primária à saúde / Clinical praxis of low-level laser therapy in primary health care

LASER é um acrônimo que sumariza a amplificação da luz por emissão estimulada de radiação (eletromagnética). O Programa Saúde em Ação equipou diversas Unidades Básicas de Saúde com aparelhos de laser diodo. Cirurgiões Dentistas têm aplicado a laserterapia de baixa potência para acelerar a remissão de várias condições clínicas, sem necessidade de encaminhamento imediato para Atenção Secundária. O objetivo deste artigo é apresentar protocolos de laserterapia de baixa potência empregados por Cirurgiões Dentistas da Atenção Primária à Saúde de Campinas-SP, por meio da ilustração com casos clínicos atendidos em consultas de urgência. Aplicações para ulceração traumática e desordem temporomandibular foram realizadas em uma senhora de 60 anos de idade, que aguardava a substituição das próteses totais. Irradiou-se por laser vermelho (660nm) com energia de 1J as margens da ulceração. Após palpação da articulação e dos músculos mastigatórios para mapeamento, os pontos álgicos foram irradiados por laser infravermelho (808nm) com energia de 4J. Um homem de 50 anos de idade queixava-se de paralisia hemifacial havia 10 dias. A tentativa de recuperação do nervo facial ocorreu com irradiação por laser infravermelho com energia de 8J por ponto, em 22 pontos dos ramos do nervo facial. Em ambos os casos, a regressão do quadro clínico desconfortável foi observada. Os Profissionais do Sistema Único de Saúde (SUS) que são aptos ao uso dos equipamentos para laserterapia de baixa potência podem utilizar este recurso de modo seguro e bem sucedido, observando comprimento de onda do laser e doses protocolares para cada alteração a ser tratada.

LASER is an acronym which means light amplification by stimulated emission of radiation (electromagnetic). Many Primary Health Care Units received diode laser devices from the Brazilian Health in Action Program. Dental practitioners have applied low-level laser therapy for accelerating the resolution of several clinical problems, without the need to prompt referral for Secondary Attention. This manuscript aimed at presenting low-level laser therapy protocols, used by Dentists in Primary Health Care Units from Campinas-SP, illustrated with case reports of urgency consultations. Applications for traumatic ulcers and temporomandibular disorder were performed in a 60-year-old woman who was waiting for dental prosthesis replacement. Red laser irradiation (660nm) with 1J energy was delivered at the margins of the ulcer. Upon articular and masticatory muscles palpation for mapping, trigger points were irradiated with infrared laser (808nm), 4J energy. A 50-year-old man complained of hemifacial paresis for 10 days. The recovery attempt of the facial nerve was carried out by infrared laser irradiation with 8J energy per point in 22 points of the facial nerve branches. In both case reports, regression of the uncomfortable clinical problem was noted. Professionals from the Unified Health System (SUS) who are able to use a low-level laser device may safe and successfully operate this equipment, selecting the appropriate laser wavelength and protocol doses for managing each clinical problem.

Angina bolhosa hemorrágica: uma revisão de literatura / Hemorrhagic angina bullosa: a review of the literature

Introdução: A angina bolhosa hemorrágica (ABH) é uma condição rara caracterizada pelo surgimento súbito de bolhas de sangue nas mucosas orais e orofaringe. Objetivo: Este trabalho tem como propósito fornecer uma análise abrangente das características clínicas, etiológicas e histopatológicas da angina bolhosa hemorrágica, além de abordar métodos de diagnóstico e opções de tratamento. Materiais e métodos: Foi realizada uma busca por artigos científicos publicados de 2010 a 2023, nas bases de dados Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) e ScienceDirect. Foram coletados artigos em inglês e português utilizando as palavras-chave "angina bolhosa hemorrágica", "estomatite bolhosa hemorrágica benigna", "hemorrhagic bullous angina" e "benign hemorrhagic bullous stomatitis". Conclusão: A ABH é escassamente documentada na literatura, com muitos dados ausentes ou subnotificados. Embora seja uma condição benigna com rápida evolução espontânea, o procedimento diagnóstico deve ser rigoroso para descartar outras possíveis lesões.

Introduction: Bullous hemorrhagic angina (ABH) is a rare condition characterized by the sudden appearance of blood blisters on the oral mucosa and oropharynx. Objective: This work aims to provide a comprehensive analysis of the clinical, etiological and histopathological characteristics of hemorrhagic bullous angina, in addition to addressing diagnostic methods and treatment options. Materials and methods: A search was carried out for scientific articles published between 2010 and 2023, in the Scientific Electronic Library Online (SciELO), US National Library of Medicine (PubMed) and ScienceDirect databases. Articles were found in English and Portuguese using the keywords "hemorrhagic bullous angina", "benign herrhagic bullous stomatitis", "hemorrhagic bullous angina" and "benign herrhagic bullous stomatitis". Conclusion: ABH is scarcely documented in the literature, with many data missing or underreported. Although it is a benign condition with rapid spontaneous evolution, the diagnostic procedure must be rigorous to rule out other possible lesions.

Fechamento de comunicação bucossinusal com retalho de corpo adiposo de bochecha: relato de caso clínico / Closure of bucosinusal communication with cheek adipose body flap: Clinical case report

A comunicação bucossinusal (CBS) é uma complicação relativamente frequente na prática odontológica que ocorre em procedimentos cirúrgicos, principalmente, exodontias dos molares superiores. O diagnóstico dessa comunicação é feito através de exames clínicos intraorais, empregando a manobra de Valsava, e para a confirmação do diagnóstico, utiliza-se exame radiográfico. A literatura cita inúmeros métodos de tratamento, entretanto não evidenciam a técnica específica para cada caso, entre esses métodos existe o retalho com o corpo adiposo da bochecha, que apresenta alto índice de sucesso no fechamento das CBS. Quando a CBS é fechada incorretamente ou de forma tardia o paciente fica propício a desenvolver quadros de sinusite crônica ou aguda, além de fístulas bucossinusais. Portanto, deve-se identificar e tratar essa comunicação de imediato para evitar o desenvolvimento de outras complicações. O objetivo do presente trabalho é apresentar um caso clínico de um paciente com comunicação bucossinusal atendido na clínica odontológica da Unidade de Ensino Superior de Feira de Santana (UNEF), com a finalidade de demostrar a técnica cirúrgica utilizando a rotação do corpo adiposo da bochecha (Bola de Bichat).

The bucosinusal communication (BCS) is a relatively frequent complication in dental practice that occurs in surgical procedures, especially extractions of the upper molars. The diagnosis of this communication is made through intraoral clinical examinations, using the Valsava maneuver, and for the confirmation of the diagnosis, radiographic examination is used. The literature cites numerous methods of treatment, however they do not evidence the specific technique for each case, among these methods there is the graft with the adipose body of the cheek, which has a high success rate in the closure of the CBS. When the CBS is closed incorrectly or late, the patient is prone to develop chronic or acute sinusitis, in addition to bucosinusal fistulas. Therefore, this communication should be identified and treated immediately to prevent the development of other complications. The objective of the present study is to present a clinical case of a patient with bucosinusal communication attended at the dental clinic of Unidade de Ensino Superior de Feira de Santana (UNEF), with the purpose of demonstrating the surgical technique using the rotation of the adipose body of the cheek (Bichat ball).

Assessing the impact of oral health disease on quality of life in Ecuador: a mixed-methods study.

Introduction: Globally, oral health diseases surpass all other non-communicable diseases in prevalence; however, they are not well studied in underserved regions, where accessibility to dental services and oral health education is disparately worse. In Ecuador, further research is needed to understand such disparities better. We aimed to assess the effect of oral health disease on individuals' quality of life and how social disparities and cultural beliefs shape this. Methods: Individuals 18 or older receiving care at mobile or worksite clinics from May to October 2023 were included. A mixed-methods approach was employed, involving semi-structured interviews, Oral Health-Related Quality of Life (OHRQoL) measures, and extra-oral photographs (EOP). Results: The sample (n = 528) included mostly females (56.25%) with a mean age of 34.4 ± 9.44. Most participants (88.26%) reported brushing at least twice daily, and less than 5% reported flossing at least once per day. The median OHRQoL score was 4 (min-max), significantly higher among individuals ≥40 years old, holding high school degrees, or not brushing or flossing regularly (p < 0.05). Identified barriers to good oral health included affordability, time, and forgetfulness. Participants not receiving care with a consistent provider reported fear as an additional barrier. Participants receiving worksite dental services reported these barriers to be alleviated. Dental providers were the primary source of oral hygiene education. Most participants reported oral health concerns, most commonly pain, decay, dysphagia, and halitosis - consistent with EOP analysis. Discussion: Findings underscore a need for multi-level interventions to advance oral health equity.

Perceptions of the mouthguard in basketball, rugby, and soccer players. Qualitative study at a public university in Colombia.

BACKGROUND/AIM: Orofacial and dental injuries in athletes, both amateur and professional, are highly prevalent. Mouthguards are devices to prevent this type of injury; however, athletes believe that the mouthguard limits their performance in the game and decreases their confidence. This study analyzed the perception that some basketball, rugby and soccer players from a public university in Colombia have about the use of mouthguards. MATERIAL AND METHODS: Comprehensive qualitative study with ethnographic approach. Twenty-nine players participated. Three data collection tools were used: semi-structured interviews, field diary and discussion groups. Content analysis was carried out using a categorical matrix and triangulation of sources. RESULTS: Participants perceive the mouthguard as a device to prevent orofacial and dental injuries, but unattractive to wear during competitions. Factors that determine the use or non-use of the mouthguard are player comfort and adaptability, communication and economic cost. CONCLUSIONS: Players' perception of mouthguards in soccer, basketball and rugby is multifactorial, and is mediated by the idea of contact risk during sports practice, prevention of orofacial injuries, influence on sports performance, comfort and adaptability to the mouthguard.

Exploring the relationship between anxiety, patient characteristics and pain outcomes in oral surgery under local anesthesia: The measurement problem.

BACKGROUND: Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment. OBJECTIVES: The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery. MATERIAL AND METHODS: This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure. RESULTS: General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain. CONCLUSIONS: Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.

Oral focal mucinosis: A systematic review.

Oral focal mucinosis (OFM) is a rare lesion first described in 1974, but the aetiology remains unknown. Clinically, OFM presents as an asymptomatic nodular lesion and the similarity of clinical features to other soft tissue injuries makes the diagnosis difficult. The aim of this study was to integrate the demographic, clinical, and histopathological characteristics from previously published cases of OFM into a systematic review. Electronic searches without publication date restriction were performed in the following databases: Embase, PubMed, Medline, Web of Science, and Scopus. Case reports or case series of OFM published in English and presenting enough clinical and histopathological information were included. This systematic review identified 42 studies from 12 countries, comprising 113 cases of OFM. This lesion affected more females than males, usually in the fourth decade of life. The gingiva was the most common anatomical location, followed by the palate. Clinical presentation was most often an asymptomatic nodule. Imaging exams revealed that most cases did not have bone involvement. Surgical removal was the treatment of choice for most cases and only one recurrent case was reported. In conclusion, OFM is an uncommon pathology, and its diagnosis depends on histopathological analysis. The lesion could be included as a differential diagnosis of benign soft tissue lesions of the oral cavity, especially those affecting the gingiva.

Monoterpene antifungal activities: evaluating geraniol, citronellal, and linalool on Candida biofilm, host inflammatory responses, and structure-activity relationships.

Introduction: Despite the rising concern with fungal resistance, a myriad of molecules has yet to be explored. Geraniol, linalool, and citronellal are monoterpenes with the same molecular formula (C10H18O), however, neither the effect of these compounds on inflammatory axis induced by Candida spp. nor the antibiofilm Structure-Activity Relationship (SAR) have been well-investigated. Herein we analyzed geraniol, linalool and citronellal antifungal activity, cytotoxicity, and distinctive antibiofilm SAR, also the influence of geraniol on Candida spp induced dysregulated inflammatory axis, and in vivo toxicity. Methods: Minimal inhibitory (MIC) and fungicidal (MFC) concentrations against Candida spp were defined, followed by antibiofilm activity (CFU-colony forming unit/mL/g of dry weight). Cytotoxic activity was assessed using human monocytes (THP-1) and oral squamous cell (TR146). Geraniol was selected for further analysis based on antifungal, antibiofilm and cytotoxic results. Geraniol was tested using a dual-chamber co-culture model with TR146 cells infected with C. albicans, and THP-1 cells, used to mimic oral epithelium upon fungal infection. Expression of Candida enzymes (phospholipase-PLB and aspartyl proteases-SAP) and host inflammatory cytokines (interleukins: IL-1ß, IL-6, IL-17, IL-18, IL-10, and Tumor necrosis factor-TNF) were analyzed. Lastly, geraniol in vivo toxicity was assessed using Galleria mellonella. Results: MIC values obtained were 1.25-5 mM/mL for geraniol, 25-100 mM/mL for linalool, and 100-200 mM/mL for citronellal. Geraniol 5 and 50 mM/mL reduced yeast viability during biofilm analysis, only 500 mM/mL of linalool was effective against a 72 h biofilm and no biofilm activity was seen for citronellal. LD50 for TR146 and THP-1 were, respectively: geraniol 5.883 and 8.027 mM/mL; linalool 1.432 and 1.709 mM/mL; and citronellal 0.3006 and 0.1825 mM/mL. Geraniol was able to downregulate expression of fungal enzymes and host pro-inflammatory cytokines IL-1ß, IL-6, and IL-18. Finally, safety in vivo parameters were observed up to 20 mM/Kg. Discussion: Despite chemical similarities, geraniol presented better antifungal, antibiofilm activity, and lower cytotoxicity when compared to the other monoterpenes. It also showed low in vivo toxicity and capacity to downregulate the expression of fungal enzymes and host pro-inflammatory cytokines. Thus, it can be highlighted as a viable option for oral candidiasis treatment.

Oral health-related quality of life in Fanconi anemia: a cross-sectional study.

PURPOSE: To evaluate the oral health-related quality of life (OHRQoL) of individuals diagnosed with Fanconi anemia (FA). METHODS: A cross-sectional study was conducted with FA patients from two Brazilian referral centers. Participants underwent a complete dental, periodontal, and oral mucosa examination, as well as assessment of resting salivary flow. The short version of the Oral Health Impact Profile (OHIP-14) questionnaire was administered. Descriptive and bivariate analyses were performed, followed by multivariate analysis to examine the impact of independent variables on OHRQoL. RESULTS: The study included 20 (57.1%) males and 15 (42.9%) females, with a mean age of 18.9 years. Oral leukoplakia (OL) was found in 18 individuals. The overall OHIP-14 score was 9.9 ± 10.5. Individuals aged ≥ 16 years had higher OHIP-14 scores, indicating worse OHRQoL for physical pain (p = 0.007), psychological discomfort (p = 0.001), physical disability (p = 0.03), psychological disability (p = 0.001), handicap (p = 0.004), and overall score (p = 0.007). Females reported more negative OHRQoL than males for physical pain (p = 0.02), psychological discomfort (p = 0.03), psychological disability (p = 0.009), and overall score (p = 0.02). Individuals with OL had an overall OHIP-14 score 1.83 times higher than those without OL (95% CI: 1.02-3.28; p = 0.04). Lower salivary flow correlated with higher overall OHIP-14 scores (95% CI: 0.14-0.84; p = 0.01). CONCLUSION: This study represents the first attempt to evaluate OHRQoL in individuals with FA. The presence of OL and reduced salivary flow were identified as predictors of a negative impact on OHRQoL. It is imperative to integrate patients' quality of life in the clinical treatment protocols for the FA population.

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments. MATERIALS AND METHODS: The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias. RESULTS: After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34). CONCLUSION: Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited. CLINICAL RELEVANCE: Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Oral Janus Kinase Inhibitors in Pediatric Atopic Dermatitis.

PURPOSE OF REVIEW: To analyze the efficacy and safety of Janus kinase inhibitors (JAKi) in the treatment of pediatric AD. RECENT FINDINGS: Adolescents with moderate and severe atopic dermatitis (AD) need systemic therapies, as stated several recent practice guidelines. (JAKi) have shown their efficacy in the treatment of adult AD, however, there is a lack of information concerning efficacy and safety of their use in pediatric AD. We found that the JAKi's abrocitinib (ABRO), baricitinib (BARI), and upadacitinib (UPA), are all an effective treatment option with a very fast onset of action for adolescents with moderate-to-severe AD. BARI was not effective in children between 2 and 10 years with moderate-to-severe AD. Fortunately, major safety issues with JAKi in adolescents with AD have not been documented in the trials, so far, contrasting with the reports in adults with AD, where these events have very rarely occurred. There are some reports of herpes zoster (HZ) infection in adolescents on JAKi, but it is not a major safety concern. Acne is a relatively common AE with UPA in adolescents; however, it is responsive to standard treatment. This review will help the clinician to choose among the JAKi according to the needs and clinical features of patients with moderate and severe AD. In the following years, with the advent of new biologicals and JAKi, these therapies will fall into place in each phase of the evolution of patients with AD.

SEOM clinical guidelines on venous thromboembolism (VTE) and cancer (2023).

The Spanish Society of Medical Oncology (SEOM) last published clinical guidelines on venous thromboembolism (VTE) and cancer in 2019, with a partial update in 2020. In this new update to the guidelines, SEOM seeks to incorporate recent evidence, based on a critical review of the literature, to provide practical current recommendations for the prophylactic and therapeutic management of VTE in patients with cancer. Special clinical situations whose management and/or choice of currently recommended therapeutic options (low-molecular-weight heparins [LMWHs] or direct-acting oral anticoagulants [DOACs]) is controversial are included.

Metformin Radiosensitizing Effect on Hypoxic Oral Squamous Cell Carcinoma Cells by GAPDH and TAGLN2.

OBJECTIVE: Tumor hypoxia is associated with a poorer prognosis in cancer patients and can diminish the efficacy of radiation therapy (RT). This study investigates the potential of metformin to enhance radiosensitivity in hypoxic cancer cells. METHODS: Preliminary experiments were conducted to validate the impact of hypoxia on radiation response. Reactive oxygen species (ROS) levels, cell migration, and cell death were assessed in hypoxic, radiated cells treated with metformin. Proteomic and ontological analyses were employed to identify molecular targets associated with the radiosensitizing effect of metformin. Proteomic and ontological findings were validated through patient samples and in vitro studies. RESULTS: Metformin amplified cell death, induced DNA fragmentation, decreased cell migration, and elevated ROS levels in hypoxic, radiated cells. Proteomic analyses revealed that GAPDH and TAGLN2 were identified as pivotal targets linked to the radiosensitizing effect of metformin. Oral cancer patients exhibited elevated levels of TAGLN2 and reduced levels of GAPDH. Metformin downregulated TAGLN2 and upregulated GAPDH in hypoxic, radiated cells. Additionally, metformin reduced levels of mutated p53. CONCLUSIONS: This study suggests that metformin can enhance radiosensitivity in hypoxic cells, operating through modulation of GAPDH and TAGLN2. Furthermore, metformin effectively reduces mutated p53 levels in radiated cells under hypoxic conditions.

Effects of artemisinin and cisplatin on the malignant progression of oral leukoplakia. In vitro and in vivo study.

OBJECTIVES: Chemoprevention can be a treatment for potentially malignant lesions (PMLs). We aimed to evaluate whether artemisinin (ART) and cisplatin (CSP) are associated with apoptosis and immunogenic cell death (ICD) in vitro, using oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) cell lines, and whether these compounds prevent OL progression in vivo. METHODS: Normal keratinocytes (HaCat), Dysplastic oral cells (DOK), and oral squamous cell carcinoma (SCC-180) cell lines were treated with ART, CSP, and ART + CSP to analyze cytotoxicity, genotoxicity, cell migration, and increased expression of proteins related to apoptosis and ICD. Additionally, 41 mice were induced with OL using 4NQO, treated with ART and CSP, and their tongues were histologically analyzed. RESULTS: In vitro, CSP and CSP + ART showed dose-dependent cytotoxicity and reduced SCC-180 migration. No treatment was genotoxic, and none induced expression of proteins related to apoptosis and ICD; CSP considerably reduced High-mobility group box-1 (HMGB-1) protein expression in SCC-180. In vivo, there was a delay in OL progression with ART and CSP treatment; however, by the 16th week, only CSP prevented progression to OSCC. CONCLUSION: Expression of proteins related to ICD and apoptosis did not increase with treatments, and CSP was shown to reduce immunogenic pathways in SCC-180, while reducing cell migration. ART did not prevent the malignant progression of OL in vivo; CSP did despite significant adverse effects.