Association of oral toxicity and taste changes during hematopoietic stem cell transplantation: a preliminary study.

PURPOSE: The aim of this study was to characterize the taste changes and taste bud atrophy observed in the period of neutropenia of HCT and to determine the influence of transplantation toxicity on these changes. METHODS: Autologous and allogeneic HCT patients (n = 51) were selected to perform taste acuity tests prior to conditioning (T0) and during neutropenia (T1). The frequency and time duration of oral mucositis, presence of tongue depapillation, and salivary flow rate were also evaluated. Quality of life was assessed using specific questionnaires. RESULTS: We observed a significant increase in hypogeusia (66.6%, p = 0.001) and dysgeusia (21.4%, p = 0.013) at T1, compared with T0. Bitter taste was the most altered, mainly when the patient underwent conditioning with melphalan (OR = 4.47, p = 0.049). Prolonged oral mucositis (≥ 8 days) (OR = 5.62, p = 0.039) and autologous transplantation (OR = 4.08, p = 0.033) were predictive factors for tongue depapillation. Changes in sour taste (OR = 10.70, p = 0.045) and reduced salivary flow (OR = 21.00, p = 0.013) were associated to body weight loss at T1. Taste changes significantly reduced the quality of life at T1, compared with T0. CONCLUSIONS: Frequency of hypogeusia was high in the neutropenia period of the HCT. None of the taste changes was determined by oral mucositis, tongue depapillation, or reduced salivary flow, but melphalan conditioning reduced the bitter taste sensation. Loss of body weight and poor quality of life were associated with taste changes and reduced salivary flow. Further studies are necessary to elucidate this association and the risk factors for taste changes in HCT.

Efficacy of cryotherapy associated with laser therapy for decreasing severity of melphalan-induced oral mucositis during hematological stem-cell transplantation: a prospective clinical study.

Melphalan followed by hematopoietic stem-cell transplantation (HSCT) is the standard treatment for multiple myeloma and other hematopoietic neoplasms. However, high doses of melphalan cause severe oral mucositis (OM). The objective was to verify the efficacy of cryotherapy plus laser therapy on reduction of OM severity. HSCT patients undergoing melphalan chemotherapy (n = 71) were randomly divided into two groups according to OM treatment: oral cryotherapy performed with ice chips for 1 h 35 min followed by low-level laser therapy (InGaAIP, 660 nm, 40 mW, 6 J/cm(2) ) (n = 54) and laser therapy alone with the same protocol (n = 17). A control group (n = 33) was composed of HSCT patients treated with melphalan who received no specific treatment for OM. OM scores and clinical information were collected from D0 to D + 11. The cryotherapy/laser therapy group showed the lowest OM scores (maximum Grade I) and the lowest mean number of days (8 days) with OM in comparison with the other groups (p < 0.001). OM Grades III and IV were present with high frequency only in the control group. The association of cryotherapy with laser therapy was effective in reducing OM severity in HSCT patients who underwent melphalan conditioning.

Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: clinical outcomes in a context of specialized oral care using low-level laser therapy.

OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation.

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.

Lasers in esthetic dentistry: soft tissue photobiomodulation, hard tissue decontamination, and ceramics conditioning.

The increasing concern and the search for conservative dental treatments have resulted in the development of several new technologies. Low and high power lasers can be cited as one of these new technologies. Low power lasers act at cellular level leading to pain reduction, modulation of inflammation, and improvement of tissue healing. High power lasers act by increasing temperature and have the potential to promote microbial reduction and ablation of hard and soft tissues. The clinical application of both low and high power lasers requires specific knowledge concerning laser interaction with biological tissues, so that the correct irradiation protocol can be established. The present case report describes the clinical steps of two metal-ceramic crowns development in a 60-year-old patient. Three different laser wavelengths were applied throughout the treatment with different purposes: Nd:YAG laser (1,064 nm) for dentin decontamination, diode (660 nm) for soft tissue biomodulation, and Er:YAG laser (2,940 nm) for inner ceramic surface conditioning. Lasers were successfully applied in the present case report as coadjutant in the treatment. This coadjutant technology can be a potential tool to assist treatment to reach the final success.

Microtensile bond strength to Er: YAG laser pretreated dentin / Avaliação da adesão em dentina irradiada pelo laser de Er: YAG

Objective: Although the effects of Er:YAG (erbium:yttrium aluminium garnet) laser on cavity preparation as well as on dentin bonding to composite have been described in the literature, the longevity of this bond is still unknown. So, this study evaluated the short-term microtensile bond strength to dentin samples after different protocols of surface treatment. Materials and Methods: 60 bovine incisors were cleaned, worn to expose a dentin area and subdivided into groups according to treatment conditions: surface treatment (no irradiation – control group; dentin irradiation with Er:YAG laser 250 mJ/4 Hz; 160 mJ/10 Hz), adhesive system (Clearfil SE Bond - Kuraray; Adper Single Bond 2 - 3M/ESPE), and storage time (24 h; 90 days). After adhesive procedures, a block of Z250 composite resin (3M/ESPE) was built-up on each tooth. The teeth were sectioned to obtain samples for the microtensile bond strength test. Half of the samples were tested 24 h after cutting, and the other half were stored in distilled water for 90 days before testing. Intergroup analysis was also performed considering the same variables using ANOVA for multiple comparisons with Tukey test with a significance level of 5%. Data showed weaker bond strength for groups previously treated with laser (p < 0.05) compared with control groups, and these were not influenced by adhesive system used, nor by storage period. Stereoscopic microscope observations showed that fractures occurred predominantly at the adhesive interface in the groups irradiated with the Er:YAG laser. Conclusion: Within the parameters and variables used in this study, the Er:YAG laser could not provide an additional improvement in dentin-resin bond strength, irrespective of the type of adhesive system used or the storage period evaluated.

Objetivo: Ainda que a ação do laser de Er:YAG no condicionamento e preparo do substrato dentinário, bem como na resistência de união à resina composta já tenha sido descrita na literatura, a longevidade da adesão decorrente deste processo ainda não está bem estabelecida. Material e Métodos: Neste estudo, ensaios de microtração foram realizados em palitos obtidos de 60 incisivos bovinos, subdivididos em 12 grupos constituídos pela combinação das variáveis: tratamento dentinário prévio com o laser de Er:YAG (250 mJ/ 4 Hz; 160 mJ / 10 Hz) e sem irradiação (grupo controle), sistema adesivo (Clearfil SE Bond /Kuraray; Adper Single Bond / 3M ESPE) e período de armazenagem (24 h; 90 dias). Os resultados mostraram menor resistência à microtração (com diferença estatisticamente significante p = 0,05) em relação aos grupos não tratados com o laser, não importando o sistema adesivo empregado, nem o período de armazenagem. A observação ao microscópio estereoscópico mostrou que as fraturas ocorreram predominantemente na interface adesiva para os grupos submetidos ao laser de Er:YAG. Conclusão: Portanto, a irradiação com o laser, nos parâmetros e variáveis utilizados e em comparação com os grupos controle, afetou negativamente a adesão à dentina, não havendo alteração relevante na longevidade da adesão para os períodos de armazenagem avaliados.

Utilização do laser de alta potência [Er: YAG] no tratamento de lesão cervical não-cariosa / Treatment of non carious cervical lesion with power laser [ER: Yag]

Em preparos cavitários conservadores de esmalte e dentina, assim como para remoção final de tecido cariado, os lasers de alta potência vêm demonstrando excelentes resultados. O presente caso clínico ilustra o tratamento de lesão cervical não-cariosa utilizando-se o laser ER: YAG. O passo-a-passo, as vantagens e as desvantagens da utilização do laser são descritos e discutidos. Pode-se concluir que a utilização do laser Er: YAG para a remoção de tecido duro em lesões cervicais não-cariosas é um procedimento seguro, confortável ao paciente e com vantagens em relação ao tratamento convencional.

For conservative cavity preparation in enamel and dentin, as well as for final caries removal, hight power laser has been shown excellent results. This clinical case shows a non carious cervical lesion treated with hight power laser [Er: YAG]. The clinical steps, the vantages and disadvantages of hight power laser are cited and discussed. In can be concluded that the use of Er: YAG for hard tissue removal in non carious lesions in a safe proceeding, comfortable for the patient and with several advantages to conventional treatment.