Do tobacco and alcohol modify protective effects of diet on oral carcinogenesis?

Recent systematic reviews concluded that the frequent consumption of fruits and vegetables is inversely associated with the risk of oral cancer. We assessed this association, specifically comparing results obtained to nonsmokers and smokers, as well to nondrinkers and drinkers. We conducted a case-control study involving 296 patients with oral squamous cell carcinoma (cases) attended in 3 major hospitals of São Paulo, Brazil, paired with 296 controls, recruited from outpatient units of the same hospitals. Multivariate models assessed the effect of fruits and salads according to smoking and drinking. The intake of fruit was associated with the prevention of the disease in the specific assessment among light [odds ratio (OR) = 0.46; 95% confidence interval (CI) = 0.27-0.78) and heavy (OR = 0.30; 95% CI = 0.14-0.65) smokers. The same was observed for vegetables consumption. For nonsmokers, no fruit (OR = 50; 95% CI = 0.22-1.12) or vegetable (for tomato, OR = 0.53; 95% CI = 0.31-0.93) was associated with reduced risk of oral and oropharyngeal cancer. Similar results were found in the stratified analysis according to drinking status with OR = 0.51 (95% CI = 0.30-0.87) and 0.18 for fruits (95% CI = 0.07-0.45), respectively, for light and heavy drinkers. This observation suggests that the protective effect of fruit and salad intake may modulate the deleterious effects from tobacco and alcohol.

Application of telesimulation in a medical undergraduate course during the SARS-CoV-2 pandemic: a quantitative and retrospective study.

BACKGROUND: Because of the social isolation and distancing measures that were imposed to stop the spread of coronavirus disease 19 (COVID-19), new ways of teaching were implemented. OBJECTIVES: To describe the implementation of telesimulation and seek to assess students' perceptions regarding telesimulation. DESIGN AND SETTING: Retrospective quantitative study conducted within the hospital simulation at a private medical school in São Paulo, Brazil. METHODS: After telesimulation training, students answered a questionnaire that provided an overall assessment of this activity, self-assessment and assessments of the facilitators and infrastructure provided by the University. RESULTS: Among the students, 50% reported that the activity was below expectations and 45% reported that it was in line with their expectations. The strong points of the activity were the clinical cases, workload and teachers. The main challenge was students' difficulty in reflecting on their learning and the infrastructure. CONCLUSIONS: Since students have less experience and fewer clinical encounters than residents or professionals, they also face more difficulty. Although telesimulation may have provided a valid alternative to replace simulation training during the COVID-19 pandemic, more face-to-face activities should be offered to students, when possible.

Training in healthcare during and after COVID-19: proposal for simulation training.

INTRODUCTION: The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW: This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION: Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION: Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.

Recurrent sores by ill-fitting dentures and intra-oral squamous cell carcinoma in smokers.

OBJECTIVES: To examine whether denture use and recurrent sores caused by ill-fitting dentures are associated with intra-oral squamous cell carcinoma (IO-SCC) in individuals exposed to tobacco. METHODS: We conducted a hospital-based case-control study. The study population 124 patients wi th IO-SCC and the same number of controls (individually paired according to gender and age) recruited from outpatient units of the same hospital. Conditional logistic regression analysis assessed the effect of denture use and recurrent oral sores by ill-fitting dentures, adjusted by covariates on the lifetime exposure to alcohol and tobacco, socioeconomic standings, and dietary patterns. RESULTS: The use of dentures showed no association with IO-SCC [adjusted odds ratio (OR) 1.40, 95 percent confidence interval 0.51-3.87, P = 0.513] in an assessment controlled by socioeconomic position, lifetime exposure to alcohol and tobacco, and dietary patterns. However, the report of recurrent sores caused by ill-fitting dentures showed significant association with the disease (adjusted OR 4.58, 95 percent confidence interval 1.52-13.76, P = 0.007). CONCLUSIONS: The association between recurrent oral sores caused by ill-fitting dentures and squamous cell carcinoma of the mouth in smokers is in agreement with the hypothesis that the chronic physical irritation of oral mucosa contributes to the topical carcinogenic effect of tobacco, which must be taken into careful consideration in the planning of dental services for adults and the elderly.

Clinical simulation strategies for knowledge integration relating to initial critical recognition and management of COVID-19 for use within continuing education and health-related academia in Brazil: a descriptive study.

BACKGROUND: The COVID-19 pandemic has led to an immense need to develop training on case recognition and management, with a focus on patients' and health professionals' safety at several levels of healthcare settings in Brazil. Different simulation strategies can be included in the diverse clinical care phases for these patients. OBJECTIVE: To suggest a complete simulation-based training program for Brazilian hospitals and/or academic institutions at this moment of the pandemic. DESIGN AND SETTING: Descriptive analysis on possible simulated clinical cases using different methodologies, thereby supporting suspected or confirmed COVID-19 patients. METHODS: This was a reflective theoretical descriptive study on an educational program based on clinical simulation, with four practical phases at different performance and complexity levels. Wearing, handling and adequately disposing of personal protective equipment, along with specific respiratory procedures in different healthcare settings up to intensive care for seriously infected patients were addressed. RESULTS: This program was designed for application at different Brazilian healthcare levels through different clinical simulation strategies. Summaries of expected performance were suggested in order to standardize technical capacity within these simulation settings, so as to serve these levels. CONCLUSIONS: Developing training programs for situations such as the current COVID-19 pandemic promotes safety not only for patients but also for healthcare workers. In the present context, clear definition of which patients need hospital outpatient or inpatient care will avoid collapse of the Brazilian healthcare system. Institutions that do not have simulated environments can, through the examples described, adopt procedures to promote didactic information in order to help healthcare professionals during this time.

Análise de variáveis com potencial discriminante para classificação de escolas médicas / Analysis of discriminant variables for classification of medical schools

Resumo: Introdução: Este estudo metodológico pretendeu identificar em qual medida um conjunto de variáveis características de escolas médicas possui capacidade discriminante na classificação dos cursos por meio da análise de agrupamento. Nas últimas décadas, houve um aumento expressivo do número de vagas ofertadas para cursos médicos. Esse advento impôs desafios para os programas de avaliação, tanto pela necessidade de expandir o processo como pela necessidade de implantação de novos indicadores de qualidade. Objetivo: Esse estudo teve como objetivo propor técnicas de análise para aprimorar a capacidade discriminante na classificação de cursos médicos mediante variáveis objetivas relacionadas a aspectos estruturais e operacionais que possam ser incorporadas aos métodos já utilizados. Método: Trata-se de um estudo descritivo, analítico-metodológico e quantitativo que utilizou dados dos cursos médicos de São Paulo, em dezembro de 2020. Foi realizada análise por agrupamentos hierárquico e não hierárquico dos cursos para identificar variáveis com capacidade discriminante em busca de padrões que cooperem para a classificação das escolas médicas. As variáveis estudadas foram: início do curso, carga horária, regime letivo, metodologia, hospital universitário, categoria administrativa da instituição e gratuidade. Para a construção dos agrupamentos, adotaram-se o método de Ward e a distância euclidiana para estimar a discriminação entre os grupos. No agrupamento não hierárquico, a definição da quantidade de grupos foi determinada pela análise da diminuição da variância. Avaliou-se a correlação entre as variáveis por meio de mapas de calor. Resultado: As análises de agrupamento mostraram a existência de três grupos de escolas médicas por similaridade: um grupo composto por escolas mais antigas e com maior carga horária, e, nos outros dois, consideraram-se as escolas não gratuitas sem hospital universitário, diferenciando-se pela idade das escolas. Além disso, as correlações reforçaram que as variáveis adotadas cooperavam para a discriminabilidade entre grupos. Há reconhecida heterogeneidade entre os cursos de graduação no Brasil, e esse dado também se aplica aos cursos médicos que impõem desafios metodológicos para os processos de avaliação estabelecidos. Entretanto, a inclusão de variáveis requer métodos capazes de refinar a capacidade discriminante da análise. Conclusão: A análise aqui proposta mostrou-se capaz de identificar grupos de escolas médicas por meio de indicadores objetivos e pode auxiliar o processo de avaliação das escolas médicas.

Abstract: Introduction: This is a methodological study that aims to identify the extent to which a set of variables characteristic of medical schools have a discriminating capacity to classify the courses through cluster analysis. In the last two decades, there has been a significant increase of vacancies in medical courses. This advent has posed challenges for evaluation programs, both because of the need to expand the evaluation process and the need to implement new quality indicators. Objective: To propose analysis techniques to improve the discriminating capacity to classify medical courses through variables related to structural, operational, and objective aspects that can be incorporated into the already used methods. Method: Descriptive, analytical-methodological, quantitative study that used data from existing medical courses in December 2020, in the state of São Paulo. Analysis by hierarchical and non-hierarchical clustering of courses was performed to identify the discriminating elements that provide standards that cooperate for the classification of medical schools. The studied variables were: course start, workload, academic regime, methodology, University-Hospital, administrative category of the institution, gratuity. For the construction of the clusters, the Ward method and the Euclidean distance were used to estimate the discrimination between the groups. In the non-hierarchical clustering, the definition of the number of groups was determined by the analysis of the decrease in variance. The correlation between the variables was also evaluated through heatmaps. Results: The cluster analysis showed the existence of three groups of medical schools by similarity, with one group consisting of older schools with greater workload, and the other two consisting of private schools without a university-hospital, differing by the course time. Furthermore, the correlations reinforced that the adopted variables cooperated for the discriminability between the groups. Discussion: There is a known heterogeneity among undergraduate courses in Brazil and this also applies to medical courses, which poses methodological challenges for the established assessment processes. However, the inclusion of variables requires methods capable of refining the discriminant capacity of the analysis. Conclusion: The analysis proposed here proved to be capable of identifying groups of medical schools through objective indicators that can support the evaluation process of medical schools.

Application of telesimulation in a medical undergraduate course during the SARS-CoV-2 pandemic: a quantitative and retrospective study

ABSTRACT BACKGROUND: Because of the social isolation and distancing measures that were imposed to stop the spread of coronavirus disease 19 (COVID-19), new ways of teaching were implemented. OBJECTIVES: To describe the implementation of telesimulation and seek to assess students' perceptions regarding telesimulation. DESIGN AND SETTING: Retrospective quantitative study conducted within the hospital simulation at a private medical school in São Paulo, Brazil. METHODS: After telesimulation training, students answered a questionnaire that provided an overall assessment of this activity, self-assessment and assessments of the facilitators and infrastructure provided by the University. RESULTS: Among the students, 50% reported that the activity was below expectations and 45% reported that it was in line with their expectations. The strong points of the activity were the clinical cases, workload and teachers. The main challenge was students' difficulty in reflecting on their learning and the infrastructure. CONCLUSIONS: Since students have less experience and fewer clinical encounters than residents or professionals, they also face more difficulty. Although telesimulation may have provided a valid alternative to replace simulation training during the COVID-19 pandemic, more face-to-face activities should be offered to students, when possible.

Training in healthcare during and after COVID-19: proposal for simulation training

SUMMARY INTRODUCTION: The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW: This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION: Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION: Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.

Clinical simulation strategies for knowledge integration relating to initial critical recognition and management of COVID-19 for use within continuing education and health-related academia in Brazil: a descriptive study

ABSTRACT BACKGROUND: The COVID-19 pandemic has led to an immense need to develop training on case recognition and management, with a focus on patients' and health professionals' safety at several levels of healthcare settings in Brazil. Different simulation strategies can be included in the diverse clinical care phases for these patients. OBJECTIVE: To suggest a complete simulation-based training program for Brazilian hospitals and/or academic institutions at this moment of the pandemic. DESIGN AND SETTING: Descriptive analysis on possible simulated clinical cases using different methodologies, thereby supporting suspected or confirmed COVID-19 patients. METHODS: This was a reflective theoretical descriptive study on an educational program based on clinical simulation, with four practical phases at different performance and complexity levels. Wearing, handling and adequately disposing of personal protective equipment, along with specific respiratory procedures in different healthcare settings up to intensive care for seriously infected patients were addressed. RESULTS: This program was designed for application at different Brazilian healthcare levels through different clinical simulation strategies. Summaries of expected performance were suggested in order to standardize technical capacity within these simulation settings, so as to serve these levels. CONCLUSIONS: Developing training programs for situations such as the current COVID-19 pandemic promotes safety not only for patients but also for healthcare workers. In the present context, clear definition of which patients need hospital outpatient or inpatient care will avoid collapse of the Brazilian healthcare system. Institutions that do not have simulated environments can, through the examples described, adopt procedures to promote didactic information in order to help healthcare professionals during this time.

Tratamento Conservador de Osteorradionecrose de Mandíbula: Equidade e Racionalização de Recursos / Conservative Treatment of Mandibular Osteoradionecrosis: Equity and Rationalization of Resources

Relatar uma experiência de tratamento conservadore controle da ORN mandibular. Material e Métodos: Seis casosde ORN foram tratados com aplicação tópica diária desolução aquosa de gluconato de clorexidine à 0,12%, higienebucal rigorosa e eliminação de fatores irritantes à mucosa.As lesões orais de ORN tinham até 2cm no maior eixo. Oacompanhamento clínico foi realizado semanalmente até iníciode resposta ao tratamento e mensalmente após este período.A resposta à terapia foi classificada em: remissão total eparcial, aumento da lesão e ausência de resposta.Resultados: Dos seis pacientes, dois eram do sexo femininoe quatro do sexo masculino, com idades entre 39 a 78 anos.Todos os casos apresentaram resposta positiva tratamento,com três pacientes apresentando remissão parcial e trêscom remissão total. Após uma semana e meia, todos ospacientes relaram remissão total dos sinais prodrômicos daORN (dor e secreção purulenta). O tempo médio de tratamentofoi de 16,6 meses. Conclusão: Houve redução ou cura dosquadros clínicos dos casos acompanhados, e considera-seque esta evolução evitou o encaminhamento dos pacientespara câmara hiperbárica ou ainda a ressecção cirúrgica,deste modo, o tratamento relatado contribuiu para menormorbidade e racionalização de recursos do Sistema Únicode Saúde...

To report the results obtained in the conservativetreatment and control of mandibular ORN. Material andMethods: Six cases of ORN were treated with daily aqueoussolution of chlorhexidine gluconate 0.12% mouthwash,rigorous oral hygiene and removal of irritants to the mucosa.The oral lesions of ORN had up to 2 cm in greatest diameter.Clinical follow-up was conducted weekly until early responseto treatment and monthly, after that period. Response totherapy was classified as: total and partial remission,increased injury and absence of response. Results: Two ofthe six patients were female and four were male. Ages rangedfrom 39 to 78 years old. All cases showed some positiveresponse to the treatment, three patients had partial remissionand three patients had complete remission. In a week and ahalf, all patients presented total remission of ORN prodromalsigns (pain and purulent secretion). The average time oftreatment was 16.6 months. Conclusion: Reduction or totalheal of all ORN cases were achieved. It was noticeable thatthese results avoided indication of both hyperbaric oxygentherapy and surgical resection. Thus, thetreatment reported resulted in less morbidity to patients andrationalization of resources for the Public Health System...

Keratocyst: a case report with characterization by CT / Queratocisto: relato de um caso com caracterização pela TC

The odontogenic keratocyst, or OKC is the third most common odontogenic cyst categorized by the WorldHealth Organization classification. It?s a developmental, no inflammatory odontogenic cyst that arises from cell rests of dental lamina, although it has a difference in its mechanism of growth that gives a different radiographic appearance. OKCs have a high recurrence rate and develop more aggressively than any other jaw cysts. Patients in their second and third decades of life are affected most commonly. We present a 21-years-old female that an OKC affected in hera left mandible in huge ratio

O Queratocisto Odontogênico ou QTO é o terceiro mais comum cisto odontogênico classificado pela Organização Mundial de Saúde. É um cisto odontogênico, não inflamatório, de desenvolvimento resultante de restos celulares da lâmina dentária, embora tenha uma diferença em seu mecanismo de crescimento, o que da uma diferente aparência radiográfica. Os QTOs tem uma alta taxa de recidiva e desenvolve uma forma mais agressiva do que qualquer outro cisto da mandíbula. Pacientes da segunda e terceira década devida são os mais afetados. Nós apresentaremos um caso com um paciente de 21 anos de idade da qual o QTO afeta a mandíbula esquerda em uma dimensão enorme

Uso de oleato de etanolamina para hemangiomas da cavidade bucal: um estudo de cinco anos / Use of ethanolamine oleate for hemangioma in the oral cavity: a study of five years

Introdução: O hemangioma é uma lesão vascular, podendo representar uma neoplasia benigna dos vasos sanguíneos, um hamartoma ou uma malformação vascular (Neville et al. 1, 1998, Marcucci 2, 2005). O hemangioma representa 8% das lesões da cavidade oral do ambulatório da Universidade Cidade de São Paulo. (Prado et al. 3, 2010). Métodos: foram avaliados 178 prontuários da Clínica de Odontologia da Universidade Cidade de São Paulo no período de 2005 a 2010. Na análise avaliou-se o gênero acometido, a faixa etária, a localização e tamanho da lesão, e a quantidade de aplicações de oleato de etanolamina para regressão total da lesão Resultados: O gênero masculino foi o mais acometido com 54% dos casos, a 6ª e a 7ª décadas foram as mais prevalentes com uma média de 62 anos, o lábio inferior foi a região anatômica mais acometida e em 38% dos casos apenas uma aplicação foi necessária para a regressão total da lesão

Introduction: The hemangioma is a vascular lesion, which may represent a benign tumor of blood vessels, a hamartoma or a vascular malformation (Neville et al. 1, 1998, Marcucci 2, 2005) . Hemangioma accounts for 8% of lesions of the oral cavity (Prado et al. 3, 2010). Methods: We evaluated 178 medical records of clinical dentistry at the University City of São Paulo in the period 2005 to 2010. The analysis assessed the affected gender, age, location and size of the lesion, and the number of applications of ethanolamine oleate to total regression of the lesion Results: Male gender was the most affected with 54% of cases, the 6th and 7th decade were most prevalent with a mean of 62 years, the lower lip was the anatomic region most affected, an application was necessary in 38% of cases for regression of the lesion

Saúde bucal e qualidade de vida dos idosos / Oral health and quality of life in the elderly

Introdução: A população brasileira vem envelhecendo de forma rápida desde o início da década de 60, quando a estrutura etária da população começou a ser alterada. Em 1996 apenas 5% da população tinham 60 anos ou mais, enquanto que em 2020 é estimado que 9% da população serão de idosos. (Silva et al., 2000). O objetivo deste estudo é avaliar condições de saúde bucal dos idosos que residem na Vila dos Idosos, coletando informações sobre sua condição de vida, e tentando correlacionar o quanto a saúde bucal pode comprometer a qualidade de vida e autonomia desses idosos. Métodos: A coleta de dados foi ralizada por meio de questionários e exame clínico; foram entrevistados idosos acima de 60 anos, de ambos os sexos. Todas as entrevistas foram realizadas na própria Vila dos Idosos. Resultados: Os resultados mostram que a perda dentária ou o uso de próteses inadequadas implicam impactos negativos na qualidade de vida, especialmente no que se refere à preocupação, estresse decorrente de problemas na boca e à vergonha. Obteve-se na pesquisa que, de maneira geral, a saúde bucal em idosos encontra-se frágil, necessitando de maior atenção dos profissionais da área de saúde; entretanto, quando é analisada a autopercepção de saúde bucal a grande maioria avalia como muito boa ou boa. Conclusão: O achado mais importante do estudo foi que, apesar dos dados obtidos indicarem uma saúde bucal frágil que revela um comprometimento com a qualidade de vida, a grande maioria dos idosos avaliou positivamente a própria saúde. Isso talvez possa indicar que, para essa população, a saúde bucal está dissociada da saúde.

Introduction: The Brazilian population is aging rapidly since the early '60s, when the age structure of population began to change. In 1996 only 5% of the population had 60 years or more, whereas in 2020 it is estimated that 9% of the population will be elderly. (Silva et al., 2000). The aim of this study is to assess oral health status of the elderly who reside in the ôVila dos Idososõ, collecting information about the condition of their life, and trying to correlate if the oral status affetcts the quality of life and autonomy of the elder people. Methods: Through questionnaires, a search was conducted with elderly aged 60-90 years of age, both sexes to determine ow oral health affects quality of life. Results: The results show that tooth loss or the use of inadequate dentures involves negative impact on quality of life, especially with regard to the concern, stress arising from problems in the mouth and shame. Was obtained in the research, that in general, oral health in the elderly, is fragile, requiring greater attention to both health professionals, but also to public health. Conclusions: Concluding that through the data, they are indicating a commitment to quality of life.

Autopercepção da saúde bucal por idosos e a associação com indicadores clínicos / Oral health for elderly and association with clinical indicators

Este trabalho foi realizado na Vila dos Idosos, no bairro do Pari, município de São Paulo. Foram aplicados questionários em 91 idosos para avaliar a autopercepção da saúde bucal, seguido de exame clínico para a comparação dos resultados. Os resultados mostram que a autopercepção da saúde bucal tem pouca influência nas situações clínicas. Isso talvez se deva à pouca mais ênfase dada historiacamente a programas educativos e preventivos para a população idosa. Que é de fundamental importância, já que vem aumentado a cada ano sem que haja melhoria para as condições de vida dos idosos.

Questionnaires were administered to nine one elderly, aged 60-90 years of age, who reside in the ôVila dos Idososõ to assess self-perceived oral health, followed by clinical examination. The aim of this study was comparethe oral health status with what they think about theirs oral status. The results show that self-perceived oral health suffers little influence on the clinical situation. This may be due to historically low emphasis givento educational and preventative programs for the elderly population. What is of fundamental importance, since this population has increasedeach year.

Avaliação odontológica de pacientes com câncer de boca pré e pós tratamento oncológico - uma proposta de protocolo / Dental management of oral cancer patients before and after radiation trerapy a protocol purpose

Muitas complicações orais podem ser observadas em pacientes que receberam radioterapia no tratamento do câncer bucal. O cirurgião-dentista deve estar familiarizado com os protocolos disponíveis para o manejo destes pacientes,prevenindo suas futuras complicações e deterioração bucal. O objetivo deste trabalho foi identificar as possíveis complicações bucais em pacientes vitimas de câncer da cavidade bucal eorofaringe submetidos a radioterapia, e assim propor um protocolo de prevenção e controle destas seqüelas. Trinta indivíduos com carcinoma epidermóide foram incluídos. Doze destes pacientes receberam radioterapia e foram clinicamente avaliados tendo seus resultados comparados com 18 pacientes ainda não tratados. Os achados clínicos incluíram cáries,doença periodontal, fatores traumáticos, mucosite, trismo eosteorradionecrose. Os pacientes irradiados foram acompanhados por seis meses e seus fluxos e pH salivares foram determinados e comparados com o outro grupo. Os resultados mostraram que a ausência do fluxo salivar esteve presente em 17 por cento dos pacientes irradiados e ainda que a médiade fluxo salivar destes pacientes era bem mais baixa(0,2ml/min) que os não irradiados (1,4ml/min). A média do pH salivar dos pacientes irradiados foi de 6,03 não sendo considerado diferente estatisticamente do pH do grupo não irradiado (pH= 5.96). Quatro pacientes irradiados exibiram cárie de radiação (33por cento), nove desenvolveram trismo (75 porcento) eoito mucosite (67 porcento). Apenas um caso de osteorradionecrose foiverificado sei meses após a radioterapia. Assim, foi verificado que os efeitos da radiação são mais significantes com relação ao fluxo salivar do que com a alteração do pH; 1/3 dos pacientes irradiados apresentaram alterações importantes logo após a radioterapia e a osteorradionecrose, apesar de poder surgir logo após o tratamento, é normalmente observado um ano apósa radioterapia. A condição oral dos pacientes irradiados requerum tratamento multidisciplinar

Many oral complications are observed in radiotherapy treated cancer patient. Dentist must be familiar with the available treatment regimens for managing these conditions, and preventing future deterioration in oral health immediately after cancer diagnosis in order to control oral complications. The purpose of this study was to identify oral complications of the head and neck cancer patients before and after radiotherapy and to establish a protocol to prevent and control these sequelae. Thirty patients with squamous cell carcinoma of oral and oropharynx were included. Twelve of them received radiotherapy and were clinically evaluated and them compared to the remaining 18 who had not been treated yet. Clinical features included: presence of dental caries, periodontal disease, traumatic factors, mucositis, trismus and osteoradionecrosis. Irradiated patients were followed for six months. Salivary flow and pH were also determined and compared. Results showed that the absence of salivary flow was confirmed in 17% irradiated patients. The mean salivary flow of irradiated patients was 0.2ml/minute and 1.4 ml/minute in the non treated group. The mean salivary pH was 6.03 in irradiated patients, and showed to be comparable to the pH of non treated patients (pH= 5.96). Four irradiated patients (33%) presented radiation caries, 9 developed trismus (75%), and 8 had mucositis (67%). A single case of osteoradionecrosis six month after radiotherapy was observed. Though, radiation affects mainly salivary flow instead of salivary pH; 1/3 of irradiated patients present radiation caries, mucositis and trismus early after therapy. Osteoradionecrosis may be seen soon after radiotherapy although, it's usually observed one year after the treatment. Poor oral conditions observed in treated and non treated patients demanding a multidisciplinary group care.