Three photobiomodulation protocols in the prevention/treatment of radiotherapy-induced oral mucositis.

PURPOSE: To compare three Photobiomodulation protocols to prevent/treat oral mucositis associated to radiotherapy. METHODS: Seventy-three patients with cancer in oral cavity, oropharynx, and nasopharynx, who underwent RT with dose in facial fields equal or higher than 6000 cGy were randomized into three groups (mean RT dose = 66 cGy ±4.9). Protocols of Group 1 was 660 nm, 15 mW, 3.8 J/cm2, Group 2 660 nm, 25 mW, 6.3 J/cm2 both starting on the first day of radiotherapy, and group 3 660 nm, 15 mW, 3.8 J/cm2 for therapeutic purpose. The patients of group 1 and 2 were irradiated at 40 points daily covering non-keratinizing oral mucosa. The spot size (probe's tip surface size) was 0.040 cm2 for all groups. Oral mucositis was evaluated according to both WHO and NCI scales, and pain related to oral mucositis was scored using the VAS. RESULTS: Patients from group 1 presented with grade II oral mucositis later than groups 2 and 3 (p < 0.001). Moreover, groups 2 and 3 also presented with a mean higher of oral mucositis grade than group 1, p < 0.001. Pain scores were lower in group 1 (p = 0.002). CONCLUSIONS: The Photobiomodulation used in Group 1 was more effective than the protocols used in groups 2 and 3 in controlling the grade II oral mucositis intensity, and mean pain scores.

Surgical Therapy for Bisphosphonate-Related Osteonecrosis of the Jaw: Six-Year Experience of a Single Institution.

PURPOSE: Bisphosphonates are drugs commonly used to treat osteoporosis, hypercalcemia of malignancy, and bone metastases. In some cases, its administration has been associated with osteonecrosis of the jaws. The management of medication-related osteonecrosis of the jaw (MRONJ) has not been completely elucidated, and its treatment can vary from no or limited surgery to more extensive surgery. The objective of the present study was to evaluate the efficacy of surgical therapy for patients presenting with MRONJ. PATIENTS AND METHODS: A retrospective study was conducted that evaluated all MRONJ cases resulting from bisphosphonate use and treated by surgery from 2006 to 2012. All patients underwent surgery under general anesthesia. RESULTS: A total of 33 patients with 46 MRONJ sites were evaluated. Most of the patients were women, with an age range of 39 to 83 years (mean 65.6 ± 10.6). Complete healing of the MRONJ region was observed in 40 of the 46 sites (87%), with partial improvement (symptom control and reduction of the exposed bone area) observed in 3 sites (6.5%), for a 93.5% clinical benefit rate. Of the remaining regions, 2 showed no significant changes, and 1 presented with a worse aspect compared with the patient's preoperative condition. Such cases were located in the posterior mandible region. The number of applications and type of bisphosphonate did not influence the treatment response. CONCLUSION: The surgical approach to treating MRONJ showed a high rate of clinical control. Therefore, surgery should be considered as a therapy for some cases of this condition.

Avaliação da laserterapia na prevenção de mucosite oral relacionada àradioterapia: comparação entre os efeitos de diferentes protocolos de laserde baixa potência / Evaluation of laser therapy in the prevention of oral mucositis related to radiotherapy: comparison among the effects of three different lowpower laser protocols

O laser de baixa potência é uma nova opção terapêutica para a prevenção etratamento da mucosite oral. Este estudo consiste num ensaio clinico, randomizado eduplo-cego para comparar os efeitos de três diferentes protocolos de laser de baixapotência na prevenção e tratamento da mucosite oral radioinduzida para pacientescom tumores de boca, orofaringe e nasofaringe. Foram randomizados 73 pacientesdivididos em três grupos: Grupo A (660 nm/15 mW/3,8 J/cm²/4 mm²), Grupo B (660nm/ 25 mW/6,3 J/cm²/4 mm²) iniciando a laserterapia partir do primeiro dia deradioterapia (RxT) e Grupo C (660 nm/15 mW/3,8 J/cm²/4 mm²) iniciando alaserterapia quando os pacientes desenvolveram grau II de mucosite oral. Aavaliação da mucosite oral foi feita diariamente e semanalmente de acordo com oscritérios de classificação do Instituto Nacional do Câncer (National Cancer Institute -NCI) e da Organização Mundial da Saúde (OMS). A avaliação da dor foi feitadiariamente, antes da aplicação do laser com ajuda de uma escala visual analógica.Os pacientes do Grupo A demoraram em média 16,7 dias para apresentar mucositegrau II, com variação entre 9 e 29 dias, os pacientes dos Grupos B e C demoraramem média 10,5 dias, com variação entre 7 e 18 dias e entre 4 e 18 dias,respectivamente (p > 0.001)...

Introduction: Low-level laser therapy (LLLT) is a new therapeutic option formanagement of oral mucositis (OM) related to radiotherapy (RxT). Purpose. Thepurpose of this study was to compare the effects of three different LLLT protocols inthe prevention and treatment of OM in head and neck cancer patients. Method: Atotal of 73 patients with malignant neoplasms in the oral cavity, oropharynx ornasopharynx were evaluated. The patients were randomized into three LLLT groups:Group A (660 nm/15 mW/3.8 J/cm2/spot size 4 mm2), Group B (660 nm/25 mW/6.3J/cm2/spot size 4 mm2) starting on first day of RxT and Group C (660 nm/15mW/3.8 J/cm2/spot size 4 mm2) when patients developed grade II OM. They wereassessed daily and weekly using the NCI and WHO scales. Oral pain was scoreddaily with a visual analogue scale. Results: Group A had a mean time of 16.7 days(range 9–29 days) to present OM grade II, while Group B had 10.5 days (range 7–18days) and Group C had 10.5 days (range 4–18 days) (p>0.001). In addition, GroupsB and C also presented higher mucositis grade than Group A with significantdifferences found in weeks 2 (p<0.001), 3 (p<0.042) and 5 (p<0.007) for Group 2;weeks 2 (p<0.002), 3 (p<0.006), 4 (p<0.006) 5 (p<0.013) and 7 (p<0.046) for Group3. The patients in Group A reported lower pain levels (p=0,002). Conclusions:LLLT during RxT was found to be more effective in controlling the intensity of OMand pain in Group A (660 nm/15 mW/3.8 J/cm2/spot size 4 mm2).

Tratamento da hipertrofia muscular mastigatória com toxina botulínica tipo A / Masticatory muscles hypertrophy treatment with botulinum toxin type A

O tratamento da hipertrofia do músculo masseter e/ou temporal engloba métodos conservadores e cirúrgicos. A terapia com Toxina Botulínica Tipo A surgiu como um método alternativo de tratamento conservador. O propósito deste estudo foi revisar as características da Toxina Botulínica e os resultados de sua aplicação no tratamento da hipertrofia muscular mastigatória.

The treatment of the masseter and/or temporal muscles hypertrophy can be based on conservative and surgical approaches. The use of Botulinum Toxin A arised as an alternative conservative treatment. The purpose ofthe following study was to review Botulinum Toxin Type A characteristics and the results of its application in the treatment of masticatory muscles hypertrophy.

Metachronous bilateral dentigerous cysts associated with permanent first molars.

The occurrence of bilateral dentigerous cysts (DC) has been described as being associated mostly with third molars in adult patients. Very few reports show the bilateral occurrence of dentigerous cysts associated with first molars or premolars in childhood. The purpose of this report was to describe the case of a 5-year-old boy with bilateral mandibular dentigerous cysts associated with permanent first molars.