Is the use of Pentoxifylline and Tocopherol effective in the treatment of Osteoradionecrosis of the jaws or for the treatment of medicationosteonecrosis of the jaw? An overview.

PURPOSE: The aim of the present study was to determine the methodological quality of systematic reviews that evaluated the effectiveness of pentoxifylline and tocopherol (PENTO) in the treatment of osteoradionecrosis of the jaw (ORNJ) and medication-related osteonecrosis of the jaw (MRONJ). METHODS: Searches were performed in Databases including PubMed, Scopus, LILACS, DARE, Cochrane Library, and SIGLE through OpenGrey until March 2024, were evaluated by two independent reviewers to answer the following question: Is the use of PENTO protocol effective in the treatment of ORNJ or for the treatment of MRONJ? RESULTS: A total of 256 articles were initially identified; however, following the use of appropriate inclusion and exclusion criteria, five systematic reviews were identified for detailed analysis. The final study sample comprised 588 patients: 397 patients with ORN and 197 patients with MRONJ who were treated with PENTO. The total recovery of individuals who used the PENTO protocol was 62,2 % for ORN and 100 % for MRONJ, with a follow-up period of 1 month to 10 years. The methodological quality of the studies was assessed using the AMSTAR 2 tool, in which four were of low quality and 1 moderate quality. CONCLUSION: The treatment of ORN and MRONJ with pentoxifylline and tocopherol has shown good results in the studies presented, with a partial or total reduction in bone exposure. However, the low quality of the relevant reports highlights the need for primary and secondary studies with better methodological rigor to reduce bias and provide reassurance for this treatment option.

Effectiveness of dental implants in patients undergoing radiotherapy for head and neck cancer: An umbrella review.

OBJECTIVE: The objective of this overview is to evaluate the effectiveness of dental implants placed in patients who underwent radiotherapy for the treatment of head and neck cancer, as well as to assess the methodological quality of the included systematic reviews. METHODS: The study was conducted in four PubMed, Lilacs, Dare Cochrane and Google Scholar databases until July 2022, using the descriptors "Radiotherapy," "Dental implants," and "Head and Neck Cancer." RESULTS: 958 studies were found in the initial search and after applying the inclusion and exclusion criteria, fifteen systematic reviews were selected to compose this overview and had their methodological quality evaluated by the AMSTAR 2 tool. RESULTS: 24,996 implants in 5487 patients were evaluated with a rate of success rate of 86.2% in patients who underwent radiotherapy and 95.2% in patients who did not undergo radiotherapy. Only one of the systematic reviews was of high quality according to AMSTAR 2. CONCLUSION: Oral rehabilitation with dental implants in patients with a history of head and neck cancer undergoing radiotherapy is a valid therapy. However, given the level of evidence found, further studies with better design are necessary to provide greater confidence in the clinical decision.

3D radiotherapy in the parotid gland and its dosimetric relationship with salivary flow and quality of life in patients with head and neck cancer

Aim: Hyposalivation and dry mouth affect the quality of life in patients with Head and Neck Cancer, who did the treatment with radiotherapy. Thus this study has the objective to evaluate the dosimetric relationship between 3D radiotherapy and changes in salivary flow, xerostomia and quality of life in patients with head and neck cancer according to the volume of the irradiated parotid gland. Methods: 23 patients with cancer in the head and neck area and in need of 3D radiotherapy were followed up during radiotherapy treatment, and the parotid gland (PG) design was also performed in radiotherapy planning. Questionnaires were carried out to determine xerostomia and quality of life, while the salivary flow was determined through calculations regarding the collection and weighing of saliva. Such data were collected in three moments: before the beginning of the radiotherapy treatment (D0), in the middle of the treatment (D1) and at the end of it (D2). The numerical variables are represented by measures of central tendency and measures of dispersion. Results: when associating the salivary flow, the xerostomia questionnaire and the OHIP-14, a statistically significant difference was found (p-value <0.001), as well as when comparing some volumes of irradiated PG with the OHIP-14. However, no relationship was found between dosimetric data, xerostomia and hyposalivation. Conclusion: patients undergoing 3D radiotherapy for malignant neoplasms in the head and neck region had decreased salivary flow, increased complaints of dry mouth and decreased quality of life. However, it was not possible to establish a statistically significant correlation between these findings and the volumes of irradiated parotids

Is HIV positive a risk factor or contraindication in dental implant therapy?

HIV pathogenesis affects TCD4+ lymphocytes, causing impairment of the immune system. Thus, the consequent immunological fragility of individuals with the disease and the absence of studies that serve as a guide for clinicians' decision-making make many healthcare professionals recognize it as a synonym of contraindication for oral rehabilitation treatments with dental implants.

Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.

Detection of the presence of Epstein−Barr virus and cytomegalovirus using polymerase chain reaction in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is an advanced and irreversible renal failure that contributes to increased mortality worldwide. Patients who undergo dialysis are more susceptible to developing infections due to their general condition. Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) are associated with oral and systemic manifestations. The most modern and accurate technique to detect the presence of these viruses is polymerase chain reaction (PCR), which can predict viral reactivation even before the onset of symptoms and identify subclinical infections. This study aimed to detect the presence of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) in patients with chronic kidney disease (CKD) undergoing hemodialysis using real-time polymerase chain reaction (PCR). Methods: An epidemiological and observational case-control study was conducted. Two groups were considered (case group: patients on hemodialysis from the Nephrology Services of the Hospital das Clínicas of UFPE and Hospital Maria Lucinda and control group: healthy patients without CKD from the Department of Stomatology of the UFPE to evaluate the viruses presence using the real-time PCR technique. Results:Of the hemodialysis patients (n=54), 29 (53.70%) tested positive for CMV and only 10 (18.51%) for EBV, while in the healthy group (n=55), eight (14.54%) were positive for EBV and none for CMV. In neither group were systemic characteristics or oral manifestations observed due to the presence of viruses. Conclusion: The EBV and CMV viruses have a higher prevalence in hemodialysis patients. However, these patients did not present oral or systemic manifestations. (AU)

Is it necessary to use bone grafts to prevent defects at the lower border of the mandible after mandibular advancement?-a systematic review.

INTRODUCTION: Defects in the lower border of the mandible may represent an aesthetic problem after mandibular advancement in orthognathic surgery. The use of bone grafts has been reported in the literature as a possibility to reduce these defects in the postoperative period. OBJECTIVE: The objective of this systematic review is to answer the following research question: Is it necessary to use bone grafts to prevent defects at the lower border of the mandible after mandibular advancement? METHODS: The literature search was conducted on MEDLINE via PubMed, Scopus, Central Cochrane, Embase, LILACS, and Sigle via Open Gray up until December 2020. Five studies were eligible for this systematic review, considering the previously established inclusion and exclusion criteria. RESULTS: 1340 mandibular osteotomies were evaluated, with a mean advance of 8 mm, being 510 with bone graft (42 defects), 528 without graft (329 defects), and 302 with an alternative technique (32 defects). Regarding the type of bone graft used, three articles used xenogenous or biomaterial grafts and two allogenous bone grafts. The results of the meta-analysis showed a reduction in the presence of defects in the bone graft group: OR 0.04, 95% CI = 0.01, 0.19; p = 0.0005, (I2 = 87%; p < 0.0001). CONCLUSION: The use of bone grafts seems promising in reducing defects in the lower border of the mandible after mandibular advancement. New controlled prospective studies with a larger number of participants are needed to ensure the effectiveness of this procedure.

Is low-level laser therapy effective in the treatment of herpes labialis? Systematic review and meta-analysis.

The objective of this systematic review is to evaluate the effectiveness of low-level laser therapy in the treatment of herpes labialis. The searches were carried out independently by 2 researchers and the articles were selected through the electronic databases according to the inclusion and exclusion criteria previously established. Initially, 480 articles were found, of which 7 randomized clinical trials and 1 clinical trial were selected. In total, 928 patients were included. In the meta-analysis, the mean healing time for laser use was significant, showing a mean reduction of 1.37 [CI 95% = 0.92 to 1.82] days for tissue healing (p < 0.0001). In the meta-analysis to evaluate the time for crust formation, there was no significant difference between the groups and no significant reduction in the mean time for crust formation (p = 0.150). Only one of the selected studies had a low risk of bias. The use of low-level laser proved to be effective in the treatment of herpes labialis. However, due to the high risk of bias in the included studies, there is a need to carry out new standardized studies to prove the effectiveness of this therapy.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial.

Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Oropharyngeal Geometry of Maxilectomized Patients Rehabilitated with Palatal Obturators in the Trans-surgical Period: Repercussions on the Voice.

INTRODUCTION: Patients undergoing maxillectomies may present alterations in the stomatognathic functions involved in oral communication. Rehabilitative treatment should favor the rescue of these functions, through surgical flaps, obturator prostheses or both. OBJECTIVES: The present study aims to present the impact of the use of the palatal obturator on the oropharyngeal geometry and on the voice of patients undergoing maxillectomies, after adaptation to trans-surgical palatine obturators (TPO). METHODS: Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated during surgery were evaluated. The oropharyngeal geometry was measured by acoustic pharyngometry and the vocal parameters were evaluated through auditory-perceptual and acoustic analyses. The comparison between the results with and without TPO was analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements and acoustic parameters using Spearman's correlation coefficient, all with a significance level of 5%. RESULTS: There was a decrease in the following oropharyngeal measurements with the use of TPO: length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal and vocal tract and area of ​​the oropharyngeal junction. There was no difference in the length of the oral cavity and in the glottic area between situations with and without TPO. In the vocal evaluation, changes in intelligibility and resonance were observed in the situation without TPO and, in only one case, mild hypernasality was detected in the situation with TPO. CONCLUSIONS: It is concluded that the use of TPO brought the oropharyngeal measurements closer to normal values ​​and provided an improvement in speech intelligibility and vocal resonance in maxilectomized individuals.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial

Abstract Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Resumo A osteotomia Le Fort I é amplamente utilizada em cirurgia ortognática para corrigir as deformidades maxilares. No entanto, esse tipo de osteotomia pode estar relacionado ao aumento da largura da base alar. Os objetivos do presente estudo foram comparar duas técnicas de sutura da base alar após a realização da osteotomia Le Fort I, bem como observar qual tipo apresenta melhor resultado no controle do alargamento da base alar após o reposicionamento maxilar em cirurgia ortognática. Foi realizado um ensaio clínico randomizado com 40 pacientes alocados aleatoriamente em dois grupos de intervenção: grupo 1 - pacientes submetidos à técnica de sutura interna e grupo 2 - pacientes submetidos à técnica de externa. Dos 40 pacientes, 65% eram do sexo feminino e 35% do masculino. A média de idade dos pacientes foi de 30,25 no grupo I e 28,6 no grupo II. Houve aumento da largura da base alar em ambos os grupos, com diferença significativa entre as médias (P <0,001). Foi possível comparar a evolução das médias da largura da base alar entre o grupo I e o grupo II. Assim, observou-se que a técnica externa (grupo II) controlou melhor a largura da base alar após a osteotomia Le Fort I. Não foi possível relacionar o alargamento da base alar com o tipo de movimentação maxilar realizado (P> 0,05). No geral, a sutura da base alar é um componente essencial das osteotomias Le Fort para controlar o alargamento da base alar. Nesse estudo, a técnica externa foi mais eficaz quando comparada à técnica interna no controle do alargamento da largura da base alar.

Coronaviridae-Old friends, new enemy!

Coronaviridae is a family of single-stranded positive enveloped RNA viruses. This article aimed to review the history of these viruses in the last 60 years since their discovery to understand what lessons can be learned from the past. A review of the PubMed database was carried out, describing taxonomy, classification, virology, genetic recombination, host adaptation, and main symptoms related to each type of virus. SARS-CoV-2 is responsible for the ongoing global pandemic, and SARS-CoV and MERS-CoV were responsible for causing severe respiratory illness and regional epidemics in the past while the four other strains of CoVs (229-E OC43, NL63, and HKU1) circulate worldwide and normally only cause mild upper respiratory tract infections. Given the enormous diversity of coronavirus viruses in wildlife and their continuous evolution and adaptation to humans, future outbreaks would undoubtedly occur. Restricting or banning all trade in wild animals in wet markets would be a necessary measure to reduce future zoonotic infections.

Is Sjogren's syndrome a risk factor/contraindication for dental implants? An umbrella review.

INTRODUCTION: There have been concerns that longstanding oral dryness secondary to Sjogren's syndrome may increase the risk of failure of dental implants. AIMS: The aim of the present study was to determine the level of methodological quality of systematic reviews that evaluated the effectiveness of dental implants in patients diagnosed with Sjogren's syndrome. METHODS AND RESULTS: Databases of PubMed/Medline, LILACS, Science Direct and Dare Cochrane to October 2020 were evaluated. A total of 833 articles were initially identified but following use of appropriate inclusion and exclusion criteria 4 papers were identified for detailed analysis. An eventual study sample comprised 722 implants placed in 189 patients with a 95.22% success rate, the minimum follow-up time was 45.2 ± 23.8 months and the maximum 125.5 months. The studies were assessed for their methodological quality by the AMSTAR 2 tool, in which 3 had critically low quality and one low quality. CONCLUSION: Oral rehabilitation with dental implants in patients with Sjogren's syndrome seems to have a high success rate; however, the low quality of relevant reports highlights the need for primary and secondary studies with better methodological design in order to reduce bias and provide reassurance for this treatment option.

Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was carried out to verify evidence regarding the efficacy and safety of the clinical applicability of natural products in the prevention and treatment of oral mucositis induced by chemotherapy and/or radiotherapy. METHODOLOGY: An electronic research according to the PICOS strategy, using the terms "natural products" and "oral mucositis," was carried out at Pubmed, Cochrane, Embase, and "gray literature." The stages of eligibility, data extraction, and quality assessment of the studies were carried out independently and in duplicate. RESULTS: The number of studies identified as eligible was 151, including 47 randomized controlled trials, reporting a total of 3075 participants undergoing some therapy with natural products on oral mucositis. The included clinical trials covered a variety of 31 types of natural products. Considering the risk of bias of the clinical trials, 24 studies (51.1%) were considered to have a low overall risk of bias, nine (19.1%) were at moderate risk, and 14 clinical trials (29.8%) were at high risk of bias. Honey was the most assessed natural agent. Fourteen studies (3.4%) reported that natural agents reduced pain. CONCLUSION: The results of the meta-analysis support a positive effect of honey and Aloe vera in reducing mucositis in patients receiving cancer therapy. CLINICAL RELEVANCE: The results found add relevant information to the scientific community regarding the prevention and treatment of mucositis. Graphical abstract.

Pentoxifylline, tocopherol, and sequestrectomy are effective for the management of advanced osteoradionecrosis of the jaws-a case series.

BACKGROUND: The aim of the present study was to evaluate the efficacy of pentoxifylline and tocopherol for the management of osteoradionecrosis of the jaws. METHODS: Twenty-five patients diagnosed with osteoradionecrosis of the jaws treated with pentoxifylline 400 mg + tocopherol 400 mg three times daily (tid) were evaluated. Clinical records and image tests were reviewed. All patients were previously submitted to head and neck radiation therapy and presented with a clinical and radiographic diagnosis of osteoradionecrosis of the jaws. RESULTS: Following therapy with pentoxifylline and tocopherol, 76% (19/25) of the patients showed complete mucosal healing, in which 47.3% (9/19) did not undergo sequestrectomy. From this particular group, 77.7% (7/9) were in stage I and 33.3% (3/9) used the protocol for up to 3 months. Among those who underwent to sequestrectomy, complete mucosal healing was observed in 52.7% (10/19). Among these, 60% (6/10) were in stage I and 100% of the patients were using the protocol for more than 3 months. In all other patients, partial healing of the mucosa was observed since they presented advanced disease. These represented 24% of the sample (6/25), 66.6% (4/6) were in stage III, and 60% (4/6) used the protocol for over 6 months. CONCLUSION: Pentoxifylline and tocopherol may provide effective management of osteoradionecrosis of the jaws, and the association with sequestrectomy may avoid major surgical procedures.

Photobiomodulation for mucosal repair in patients submitted to dental extraction after head and neck radiation therapy: a double-blind randomized pilot study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of photobiomodulation therapy (PBMT) on the mucosal healing of patients submitted to simple dental extractions after head and neck radiation therapy (HNRT). METHODS: Forty surgical procedures were randomly assigned into two groups: G1: dental extraction + PBMT (n = 19) and G2: dental extraction + sham-PBMT (n = 21). All patients received antibiotic therapy and the surgical alveolotomy to promote primary closure of the surgical site. Group 1 was submitted to PMBT according to the following parameters: 808 nm, 40 mW, 100 J/cm2, 70 s, 2.8 J/point, 14 J/session, and area of 0.028cm2. The primary outcome was complete mucosal lining at 14 days, and the secondary outcomes were the presence of infection, postoperative pain, and analgesics intake at 7 days. The patients were evaluated every 7 days until 28 days. RESULTS: Alveolar mucosal lining was faster in G1, and at 14 postoperative days, 94.7% patients evolved with complete alveolar mucosal lining compared to no patient from G2 (p < 0.001). Patients from G1 reported postoperative pain less frequently (G1 = 4, 21.1% × G2 = 14, 66.7%, p = 0.005), and also reported lower intake of analgesic pills at D7 (21.1% × 66.7%, p = 0.005%). PBMT had a significant positive impact on both postoperative pain (NNT = 2.192, CI95% = 1.372-5.445) and mucosal healing (NNT = 1.056, CI95% = 0.954-1.181). CONCLUSIONS: This preliminary study strongly supports the use of PMBT to promote surgical alveolar mucosal lining in a shorter time and with less postoperative pain.

High prevalence of syphilis in a female prison unit in Northeastern Brazil.

Objective To determine the prevalence of syphilis and the associated risk factors in a female prison unit. Methods This was a cross-sectional study including 113 women whom data were collected in two stages: first, blood test to check for syphilis seropositivity; and then collection of information through a form to assess risk situations for sexually transmitted infections. Results Overall, syphilis prevalence was found to be 22.1% among the female prison population (n=25) and 28.6% among pregnant women. A statistically significant relationship was found between syphilis infection and previous history of sexually transmitted infections (p=0.04). However, most participants diagnosed with the disease were unaware of a history of sexually transmitted infection in the last 12 months (n=20/80.0%). The use of condom with fixed partners was considered to be a protective factor (odds ratio of 0.76; 95% of confidence interval 0.68-0.85). Conclusion The prevalence of syphilis among the female prison population was high, particularly among pregnant women. Preventive and therapeutic measures as well as appropriate prenatal care can minimize the impact of syphilis in prison systems and, consequently, improve such health outcomes nationwide.