Enfermedad periodontal en oncológicos: Factor indicativo de exodoncias?

En este estudio se verificó las indicaciones de exodoncias en pacientes con cáncer en región de cabeza e cuello, que serán sometidos a radioterapia, en el servicio de Oncología de la Facultad de Odontología da Universidad Federal de Minas Gerais. Fueran evaluadas 114 historias clínicas y radiografías panorámicas y periapicales y fueran divididos de acuerdo con las indicaciones de exodoncias. Estas indicaciones fueron por caries, enfermedad periodontal, asociaciones de caries y periodontitis, falta de soporte para prótesis, diente incluidos, dientes extruidos, y en algunos casos dientes con indicaciones de extracciones exclusivamente por causa de la radioterapia. Los resultados mostraron que la mayor parte de indicaciones de exodoncias fueron debido a caries (21,05%) y enfermedades periodontales (26,31%). Debido a la predisposición a la pérdida de inserción periodontal y al riesgo de su progresión, pacientes que serán sometidos a la radioterapia de cabeza y cuello deberán ser evaluados en relación a la condición periodontal y a las indicaciones de exodoncia. Este estudio mostró que el diagnóstico de la enfermedad periodontal fue el principal factor relacionado con la indicación de exodoncias previamente al tratamiento oncológico.

The aim of this study was to describe the indication of the exodontias in patients with head embedded tooth, extruded tooth and some cases when indication is because of radiotherapy. The results show that caries (21, 05%) and periodontitis (26, 31%) were the biggest indications of exodontias in these patients. Due to a tendency of attachment loss and bone destruction and the risk of progression, patients that will be under head and neck radiotherapy should be evaluated on the periodontal status e tooth extraction indications. This study shows that the diagnosis of periodontal disease was the main indication to teeth extractions previous to oncological treatment.

Candida oral colonization and infection in Brazilian patients undergoing head and neck radiotherapy: a pilot study.

OBJECTIVE: The aim of this study was to verify the profile of Candida species responsible for colonizing and infecting the oral cavity of Brazilian patients undergoing radiotherapy (RT). STUDY DESIGN: Saliva samples were collected from 21 patients before, during, and immediately after RT. Each sample was distributed in agar Sabouraud dextrose/chlorophenicol and incubated at 37 degrees C for 18 hours. Emerging colonies were identified biochemically and through the germinative tube test. Patients were examined weekly to identify clinical candidiasis. RESULTS: Candida colonization continuously increased during RT. Infection occurred in 52% of the patients, and baseline colonization was higher in infected patients. A shift toward non-albicans species was observed in both infected and noninfected patients. CONCLUSIONS: RT leads to increased colonization and infection by Candida. The shift toward non-albicans species was unrelated to antifungal therapy. There may be epidemiological differences between infected and noninfected patients.

Oral complications of radiotherapy in the head and neck.

UNLABELLED: Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapys complications. AIM: The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region. BASIC METHOD USED: Review of relevant literature. STUDY DESIGN: Literature review. RESULTS: Radiotherapy is still associated with several side effects, significantly affecting patients quality of life. CONCLUSIONS: A multidisciplinary treatment, including physicians, dentists, speech therapists, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions.

Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth.

The incidence of occult neck metastasis in early stage tumours of the tongue and floor of the mouth varies from 20% to 30%, and the survival rates in 5 years from 73% to 97%. This study analyzes the rates of occult metastasis and prognostic factors for clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. The records of patients with squamous cell carcinoma of the tongue and floor of the mouth, without prior treatment and treated by surgery between 1965 and 1998 were reviewed. All cases were re-staged and the surgical specimens were reviewed. This study included 193 patients, 145 men (75.1%), with ages ranging from 29 to 89 years old (mean, 60 years). The tumour site was the tongue in 132 cases (68.4%), the floor of the mouth in 45 (23.3%) and both in 16 (8.3%). With regard to stage, 85 cases were at clinical stage I (44.0%) and 108, clinical stage II (56.0%). One hundred and seventeen patients (60.6%) were submitted to a neck dissection and 27 (23.1%) had metastasic lymph nodes (pN+). The only factor associated with the presence of occult metastasis for all patients was the presence of muscular infiltration (p = 0.020); for tongue tumours the presence of vascular embolization (p = 0.043) and the presence of desmoplastic reaction (p = 0.050); for floor of the mouth tumours and T2 tumors, the histological grade (p = 0.025 and p = 0.035, respectively). Disease-free survival in 5 years was 66.4% and overall survival in 5 years 68.5%. The only factor associated with disease-free survival was the presence of muscular infiltration (p = 0.019) and with overall survival were gender (p = 0.002) and clinical stage (p = 0.031). Tumours of the tongue and floor of the mouth in the initial stages, which had muscular infiltration showed a higher probability of occult metastasis and lower disease-free survival; T2 tumours showed a worse survival as did patients of the male gender.