Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review.

Background: Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility. Objective: Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure. Methods: A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool. Results: A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41]. Conclusions: Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.

Introducción: La periodontitis es potencialmente dañina en el perioperatorio debido a que el biofilm genera un ambiente para que las bacterias se propaguen y colonicen otras áreas anatómicas, lo que puede generar un riesgo potencial de infección, retraso en la cicatrización, aumento de la morbilidad e incluso inducir avulsión en pacientes intubados, y aspiración o ingestión posterior de dientes con mayor movilidad. Objetivo: Asociar la presencia de periodontitis y complicaciones postoperatorias en pacientes sometidos a un procedimiento médico quirúrgico intrahospitalario. Métodos: Se realizó una revisión sistemática a partir de estudios extraídos de PubMed y Scopus el 10 de junio de 2020, basándose en la estrategia de búsqueda de Población, Intervención, Comparación y Resultados. Como criterios de inclusión, los estudios debían incluir todos los términos desagregados de la pregunta de investigación, tener una fecha de publicación menor a 15 años y la población objetivo debía haber sido sometida a intervenciones médico-quirúrgicas hospitalarias electivas. Los criterios de exclusión correspondieron a no presentar un diseño de estudio observacional analítico o experimental, no haber realizado un diagnóstico clínico periodontal de los sujetos de estudio y no expresar en los resultados la presencia de complicaciones médico-hospitalarias posoperatorias. Se evaluó la calidad de los artículos complementando la guía STROBE y Newcastle Ottawa, y el riesgo de sesgo complementando la guía STROBE y la herramienta del manual de Colaboración Cochrane. Resultados: Se obtuvo un total de 131 artículos, los cuales fueron sometidos a un proceso de selección, dando como resultado 5 estudios observacionales analíticos finales. Se realizó un metaanálisis y se determinó que la periodontitis fue un factor de riesgo de complicaciones posoperatorias después de procedimientos quirúrgicos con un OR = 4,76; IC95% [1,11-20,41]. Conclusiones: Optimizar las guías para evaluar la calidad y el riesgo de sesgo puede hacer compleja su comparación con otros estudios, sin embargo, se determinó de manera estadísticamente significativa que los pacientes con periodontitis tienen mayor riesgo de generar complicaciones posoperatorias luego de una cirugía médico hospitalaria.

Oral squamous cell carcinoma (OSCC) tumors from heavy alcohol consumers are associated with higher levels of TLR9 and a particular immunophenotype: Impact on patient survival.

Oral squamous cell carcinoma (OSCC) is one of the most frequent types of oral cancer in developing countries and its burden correlates with exposure to tobacco and excessive alcohol consumption. Toll like receptors (TLRs) are major sensors of inflammatory stimuli, from both microbial and sterile causes and as such, they have been related to tumor progression and metastasis. Here, we evaluated the expression of TLR2, 4 and 9 as well as CD3+, CD8+ and Granzyme B+ cell infiltration by immunohistochemistry in oral samples of 30 patients with OSCC, classified according to their consumption of alcohol. Our findings indicate that there is a significant association between heavy alcohol consumption and tumors with higher expression levels of TLR9. Moreover, patients with TLR9high tumors, as well as those who indicated high consumption of alcohol exhibited a diminished overall survival. TCGA data analysis indicated that TLR9high tumors express a significant increase in some genes related with the oral cavity itself, inflammation and tumor promotion. Our analysis of tumor infiltrating leukocytes demonstrated that the major differences perceived in heavy alcohol consumers was the location of CD8+ T cells infiltrating the tumor, which showed lower numbers intratumorally. Our data suggest the existence of a pathogenic loop that involves alcohol consumption, high TLR9 expression and the immunophenotype, which might have a profound impact on the progression of the disease.

Sexually transmitted infections in oral cavity lesions: Human papillomavirus, Chlamydia trachomatis, and Herpes simplex virus.

Objective: Provide evidence of HPV, C. trachomatis, and HSV infection in the oral cavity from patients with different types of stomatological lesions. Materials and Methods: Oral swabs samples were collected from a total of 318 patients. The infectious agents were analyzed using the PCR technique. HPV genotyping and HSV type were studied using the RFLP method. Results: We studied 137 benign lesions (B), 96 potentially malignant disorders (PMD) and 85 oral squamous cell carcinomas (OSCC). The prevalence of HPV was 34%. The most frequently genotypes detected were 6 low risk and 16 high risk. The prevalence of C. trachomatis was 16% and HSV 3%. Co-infections were detected mostly in benign lesions as following: HPV-C. trachomatis in 4%, C. trachomatis- HSV in 1.8% and HPV-HSV in 0.3%. Conclusion: This report is the first contribution to the identification and genotype characterization of HPV in a scenario little studied in our area, and it also contributes to improving our understanding on sexually transmitted infectious agents and their associations with the oral cavity. Besides, we detect the presence of C. trachomatis and HSV and co-infection with HPV in the oral cavity, which they should be taken into account for diagnostic and treatment purposes.

Alcohol y salud: ¿Alcohol y salud?: revisión bibliográfica / Alcohol and health: alcohol and health?: review of the literature

El consumo excesivo de bebidas alcohólicas constituye un serio problema sanitario y social. En los últimos años se han destacado sus propiedades anticancerosas, antioxidantes y protectoras contra la enfermedad cardíaca coronaria, lo que ha generado controversias entre beneficios y perjuicios de su consumo. Los efectos tóxicos sobre el sistema nervioso central lideran el cuadro de la intoxicación aguda, mientras que los efectos del consumo crónico afectan prácticamente todo el organismo, alterando numerosas funciones aún en etapas tempranas de la vida. Los profesionales de las ciencias de la salud tienen un rol clave en la prevención de los daños producidos por este hábito tan difundido.

Effect of two mouthwashes on salivary ph.

To analyze the effect of two mouthwashes on salivary pH and correlate it with age, buffer capacity and saliva flow rate in healthy volunteers, a crossover phase IV clinical study involving three age-based groups was designed. Two commercial mouthwashes (MW), Cool Mint ListerineR (MWa) and Periobacter R (MWb) were used. The unstimulated saliva of each individual was first characterized by measuring flow rate, pH, and buffer capacity. Salivary pH was evaluated before rinsing with a given MW, immediately after rinsing, 5 minutes later, and then every 10 min (at 15, 25, 35 min) until the baseline pH was recovered. Paired t-test, ANOVA with a randomized block design, and Pearson correlation tests were used. Averages were 0.63 mL/min, 7.06, and 0.87 for flow rate, pH, and buffer capacity, respectively. An immediate significant increase in salivary pH was observed after rinsing, reaching average values of 7.24 (MWb) and 7.30 (MWa), which declined to an almost stable value 15 minutes. The great increase in salivary pH, after MW use shows that saliva is a dynamic system, and that the organism is capable of responding to a stimulus with changes in its composition. It is thus evident that pH of the external agent alone is not a good indicator for its erosive potential because biological systems tend to neutralize it. The results of this study enhance the importance of in vivo measurements and reinforce the concept of the protective action of saliva.

Effect of two mouthwashes on salivary pH

Etários de adultos voluntarios sanos, para analizar el efecto de dos colutorios sobre el pH salival y relacionarlo con la edad la capacidad buffer y el flujo salival. Se utilizaron dos marcascomerciales de colutorios (MW), ListerineCoolMint® (MWa) y eriobacter® (MWb). Primero se caracterizó la saliva sin estimular de cada individuo, se le midió el volumen minuto, el pH y la capacidad buffer. El pH salival se evaluó antes del buche con cada MW, inmediatamente después del enjuague bucal, 5 minutos después y luego cada 10 minutos (a los 15,25, 35 min) hasta que el pH inicial se recuperó. Para el análisis estadístico de los datos se utilizaron: ANOVA en bloque,test t apareado y el test de correlación de Pearson. Al caracterizar la saliva, se obtuvieron los siguientes valores promedio: 0.63 mL/min, 7.06 y 0.87 de volumen minuto,pH, y capacidadbuffer. Luego del enjuague se observó un incremento inmediato y significativo del pH salival alcanzando valores de 7.24 (MWb) y 7.30 (MWa) para descender a un valor estable luegode 15 minutos. El importante incremento del pH salival luego del uso del colutorio, muestra que la saliva es un sistema dinámico y que el organismo es capaz de responder a estímulos con cambios en su composición. Se hace evidente que el pH del agente externo, no es un buen indicador de su potencialerosivo sobre los elementos dentarios ya que los sistemas biológicos tienden a neutralizarlo. Los presentes resultadosponen de manifiesto la importancia de las mediciones en vivo y refuerzan el concepto de la función protectora de la saliva...

Nitric oxide synthase 2 (NOS2) expression in histologically normal margins of oral squamous cell carcinoma.

UNLABELLED: The activity of Nitric Oxide Synthase 2 (NOS2) was found in oral squamous cell carcinomas (OSCC) but not in normal mucosa. Molecular changes associated to early carcinogenesis have been found in mucosa near carcinomas, which is considered a model to study field cancerization. The aim of the present study is to analyze NOS2 expression at the histologically normal margins of OSCC. STUDY DESIGN: Eleven biopsy specimens of OSCC containing histologically normal margins (HNM) were analyzed. Ten biopsies of normal oral mucosa were used as controls. The activity of NOS2 was determined by immunohistochemistry. Salivary nitrate and nitrite as well as tobacco and alcohol consumption were also analyzed. The Chi-squared test was applied. RESULTS: Six out of the eleven HNM from carcinoma samples showed positive NOS2 activity whereas all the control group samples yielded negative (p=0.005). No statistically significant association between enzyme expression and tobacco and/or alcohol consumption and salivary nitrate and nitrite was found. CONCLUSION: NOS2 expression would be an additional evidence of alterations that may occur in a state of field cancerization before the appearance of potentially malignant morphological changes.

Development of questionnaire on dentists’ knowledge of HIV/AIDS

Aim: This study aimed to construct and evaluate the cross-cultural adaptation of DK-HIV-Q in an Argentine Spanish version. Methods: A translation and back translation of the DK-HIV-Q questionnaire were completed, as the original questionnaire had been formulated in Portuguese by a Brazilian researcher. The DKHIV-Q was tested in two pilot studies conducted with Argentine dentists. Results: The committee of experts, consisting of three bilingual dentists, an epidemiology dentist, a general clinical dentist, and an oral pathology specialist, fully agreed on the conceptual relevance of the general domain and the 4-domain structure for the DK-HIV-Q, such as the declarative knowledge of the transmission of HIV/AIDS, the declarative knowledge of oral manifestations of HIV/AIDS, the procedural knowledge of proper dental practice, and the proceduralknowledge of infection control measures. A final version of the DK-HIV-Q showed a satisfactory degreeof semantic accuracy and semantic equivalence with the original version, and proved to be satisfactorilyconceptual and useful as an initial indicator for a subsequent study of construct validity. Conclusion: Thisstudy described the specific details of the construction of the DK-HIV-Q and aspects of the content validity process, which is one of the main procedures to be considered by healthcare researchers and professionals who are interested in using reliable and appropriate measurements and instrument scales for given populationgroups, such as HIV/AIDS patients.

Mouthrinses containing alcohol and oral cancer: revision of epidemiological studies / Colutorios que contienen alcohol y cáncer bucal: revisión de estudios epidemiológicos

The strong association between alcohol usage and the development of oral cancer (OC) has been reported in numerous papers. As some mouthrinses contain significant amounts of ethanol, a possible relationship to this pathology has been considered. The purpose of the present paper is to analyze several epidemiological studies which evaluated the association between commercial mouthrinses and the etiology of OC. Although some authors report an association, most of the studies are unclear and sometimes contradictory. The controversial aspects regarding the role of alcohol in OC may also make difficult to find a clear relationship between the use of mouthrinses containing alcohol and OC.

Existen numerosas publicaciones que informan una fuerte asociación entre el consumo de alcohol y el desarrollo del cáncer oral (CO). Debido a que algunos colutorios contienen cantidades significativas de etanol se ha considerado una posible relación entre su uso y esta patología. El propósito del presente trabajo es analizar algunos estudios epidemiológicos en los cuales se evaluó la posibilidad de que los colutorios comerciales puedan estar involucrados en la etiología del CO. Aunque algunos autores informan asociación, la mayoría de los estudios son poco claros y algunas veces contradictorios. Los aspectos controversiales respecto al papel del alcohol en el CO, dificultan el hallazgo de una relación directa entre el uso de los colutorios que contienen alcohol y el CO.

Oral cancer mortality in the province of Cordoba, Argentine Republic in the period 1975-2000. A comparative study with other populations.

UNLABELLED: Malignant neoplasm (MN) mortality worldwide ranks among the first four causes of death, in the 1990 decade (1-4). The aim of this work is to study the eight most frequent MN mortality rates, and especially that one caused by oral cancer (OC) in the province of Cordoba, Argentine Republic, in the period between 1975 and 2000, in order to analyze its characteristics and compare with other populations in America and Europe. MATERIAL AND METHODS: The data were provided by the provincial and national Health Ministry and Globocan 2000. RESULTS: The highest male rates were those of Slovakia and France, prevailing lung and bronchus tumors; whereas in females the highest rate was that of breast cancer in the United Kingdom and Germany, and lung cancer in the United States. Regarding to OC in the populations under study, Slovakia and France held the highest rates for both sexes, being Cordoba and Argentina among the lowest values, especially in women. Tongue was the most frequent site in Cordoba (43.5%), followed by salivary glands (23.7%). Male prevailed over female and the oldest ages were observed in the period 1995-2000. The mortality rates by MN in all sites increased 6.6% in both sexes, and by OC 77% in women within the period under study in Cordoba. Oral cancer is a serious problem for public health causing great morbidity and mortality, a situation that has not improved in decades. Mortality rates are an important tool towards implementation and planning of health policies and programs for cancer prevention.

Necrotizing sialometaplasia: report of five cases.

Necrotizing sialometaplasia (NS) is a self-limiting inflammatory disease, that involves salivary glands, more frequently the minor ones. Although its etiopathogenesis remains still unknown some authors suggest that a physico-chemical or biological injury on the blood vessels may produce ischemic changes, leading to infarction of the gland and its further necrosis. Its clinical and histologic feature resemble malignancy. Clinically it may appear like an ulcer with slightly elevated irregular borders and necrotic base. Histologic features are squamous metaplasia of ducts and acini and a pseudoepitheliomatous hyperplasia of the overlying mucosa. These characteristics may induce to an inapropiated diagnosis of malignant neoplasia. A correct diagnosis to avoid mutilant surgical treatments is essential, considering that it is a self-limiting disease. In this report we describe five cases of NS in females, located in minor glands of the palate.

Antifungal topical therapy in oral chronic candidosis. A comparative study.

The aim of the present paper was to evaluate the effect of fenticonazole and to compare it with that of ketoconazole and nystatin in the topical treatment of oral chronic candidosis. Eighty patients diagnosed with erythematous chronic candidosis were divided into four groups, according to the cream they were provided with 3% fenticonazole, 2% fenticonazole, 100000UI nystatin, and 2% ketoconazole in orabase respectively. A clinical assessment was made at 7, 15, 30 and 45 days. Fifty-one of them finished the trial. ANOVA, Kruskall Wallis and Wilcoxon tests were applied for statistical analysis. There was a significative decrease of the oral lesions in all groups (p 0.0001). The remission grade was also analysed according to the localisation: lesions in the buccal mucosa and in the comissure all the patients achieved complete resolution, whereas tongue and palate lesions showed a significative decrease in all the treatments (p 0.00001). Fenticonazole proved to be as effective as nystatin and ketoconazole in topical treatment of oral candidosis.

Study of the vascular pattern in oral lichen planus

El liquen plano de la mucosa bucal es una afección relativamente frecuente. Su etiopatogenia permanece aún desconocida, pudiendo en su evolución sufrir transformación carcinomatosa, por ello reviste especial interés el estudio de parámetros que aporten nuevos conocimientos sobre la biología de esta afección. En el presente trabajo se analizó el patrón vascular del liquen plano bucal, empleando una metodología que permitió la utilización de parámetros cuantificables. Una parte del material biopsico tomado para diagnóstico histopatológico de rutina, fue utilizado para la marcación de paredes vasculares, mediante la técnica histoenzimática para demostración de actividad ATPasica. Las preparaciones fueron luego proyectadas y cuantificadas en un analizador de imágenes magnético, semiautomático. Los parámetros estereológicos estudiados indicaron que no existe un aumento vascular en el liquen con respecto a las mucosas normales o a las leucoplasias, dado que el conteo de paredes vasculares no mostró diferencias significativas. En cambio se observó un marcado aumento en el área vascular. La conjunción de estos parámetros indica que el liquen es una lesión más congestiva que las otras dos condiciones estudiadas. Estos hallazgos indican que las modificaciones del patrón vascular podrían jugar un rol en la etiopatogenia del liquen plano bucal y sugieren que la observación de estos cambios podrían ser un elemento útil en el diagnóstico histopatológico