Kinetics of neutrophil extracellular traps and cytokines in oral mucositis and Candida infection.

OBJECTIVE: This study investigated the concentrations of neutrophil extracellular traps (NET) and salivary cytokines (IL-1ß, IL-6, IL-8/CXCL8, TNF, and TGF-ß1) in patients undergoing chemotherapy and their associations with oral mucositis (OM) and Candida infection. MATERIALS AND METHODS: This prospective longitudinal study performed at a Brazilian service included 60 adults diagnosed with hematolymphoid diseases. Saliva samples were collected on days D0, D3, D10, and D15. Cytokines were analyzed by ELISA and NET formation by identification of the myeloperoxidase-DNA complex. Oral Candida spp. was cultured. RESULTS: OM occurred in 43.3% of patients and oral candidiasis in 20%. However, 66% of individuals had positive cultures for C. albicans. Higher concentrations of IL-6, IL-8/CXCL8, and TNF and lower concentrations of TGF-ß1 were observed in patients with OM. C. albicans infection contributed to the increase in IL-8/CXCL8, TGF-ß1, and TNF. Individuals with OM or with oral candidiasis had significant reductions in NET formation. In contrast, individuals with C. albicans and with concomitant C. albicans and OM exhibited higher NET formation. CONCLUSION: The kinetics of cytokine levels and NET formation in chemotherapy-induced OM appears to be altered by Candida infection, even in the absence of clinical signs of oral candidiasis.

Association of anxiety and depression with oral mucositis: A systematic review.

OBJECTIVE: Anxiety and depression are frequent conditions among individuals undergoing antineoplastic therapy, but their relationship with oral mucositis is unclear. This systematic review evaluated the potential association of anxiety and depression with frequency and severity of chemo/radiotherapy-induced oral mucositis. MATERIALS AND METHODS: Electronic searches were undertaken in five databases supplemented by manual scrutiny and gray literature searches in three other databases. The risk of bias was assessed using the Joanna Briggs Institute tool. RESULTS: Eight observational studies conducted on 954 individuals (male-to-female ratio: 1.1:1; age range: six-82 years). Three (37.5%) studies included patients with solid tumors, two (25%) studies included hematopoietic/lymphoid tissue tumors, and two (25%) studies comprised mixed types of malignant neoplasms. Eight different instruments were used to assess oral mucositis, while seven different instruments were used to evaluate anxiety and depression. Associations of anxiety and/or depression with oral mucositis severity were reported in six (75.0%) studies. Oral mucositis-related symptoms, especially pain, were linked with depression in three (37.5%) studies. CONCLUSION: A relatively low number of cases and data heterogeneity hamper definitive conclusion about the potential association between anxiety/depression and oral mucositis. Further studies that could guide more personalized treatments are warranted to investigate this plausible bidirectional interaction.

Proposal of a prophylactic photobiomodulation protocol for chemotherapy-induced oral and oropharyngeal mucositis: a randomized clinical trial.

Photobiomodulation therapy (PBMT) is widely used in oncology settings, but lack of assessment standardization is the main barrier to optimization of clinical protocols. This study analyzed three PBMT protocols for preventing oral and oropharyngeal mucositis (OM) in patients undergoing chemotherapy (CT) and/or hematopoietic stem cell transplantation (HSCT). This is a preliminary randomized blind clinical trial. Group 1 received intraoral prophylactic PBMT, Group 2 received intraoral and oropharyngeal PBMT, and Group 3 received intraoral, oropharyngeal, and extraoral PBMT. The applications were from the first day of CT to day + 10. Clinicodemographic data, CT regimens, types of HSCT, hematological exams, occurrence/severity of OM, odynophagia, and OM-related opportunistic infections were assessed. Sixty participants (age range: 18-74 years) were included; 70% of them underwent CT and 30% HSCT. About 43.3% of patients had OM, while odynophagia was reported by 23.3%. Both Groups 1 and 2 revealed better results. Multivariate analysis showed that HSCT directly influenced the occurrence of OM. Individuals who had undergone allogeneic HSCT were 1.93 times more likely to develop OM (p < 0.001). Group 3 exhibited a higher frequency of OM, albeit of lower grades. This group consisted of half the population who had undergone HSCT, had the highest percentage of melphalan use, and had the lowest mean leukocyte count. The three proposed protocols were effective in preventing and reducing OM, with good tolerance and no reported adverse effects. PBMT is a safe and effective approach to OM prophylaxis in adults undergoing CT/HSCT.

Adenocarcinoma of mammary origin in the maxillary gingiva: a case report and brief literature review.

Maxillofacial metastases are rare but represent advanced disease progression and a poor prognosis. The primary purpose of this article is to describe a patient with previously diagnosed and treated invasive ductal breast carcinoma who developed a metastatic lesion in the maxillary gingiva. In addition, this article presents a brief literature review of case reports on metastatic breast cancer manifestations in the gingiva. In the present case, a 68-year-old woman had been diagnosed and treated for invasive ductal breast carcinoma. At the 6-month follow-up after treatment for breast cancer, she complained of pain in the right leg and spine, swelling in the right arm associated with redness, and a nodular growth in the maxillary gingiva that was painful, friable, and associated with tooth mobility. Imaging examinations and microscopic analysis of an oral biopsy specimen revealed disease progression to the oral cavity, femur, lung, and brain. Because of the advanced disease, the patient died within a few weeks. The literature review identified 6 articles that reported varied clinical presentations of metastatic breast cancer in the gingiva. Invasive ductal carcinoma was the most common histologic type. Routine dental follow-up of patients with cancer is essential for the identification and diagnosis of oral lesions to ensure early intervention for lesions that may be distant metastases mimicking benign lesions.

Influence of anxiety/depression on chemotherapy-induced oral mucositis and related quality of life: A prospective cohort study.

OBJECTIVE: The impact of anxiety and depression on chemotherapy-induced oral mucositis has not been extensively explored in the literature. The aim of the present study was to evaluate anxiety/depressive symptoms, health-related quality of life, and oral health-related quality of life and their association with oral mucositis among individuals receiving chemotherapy. METHODS: This is a prospective longitudinal study carried out at a Brazilian referral service. The Hospital Anxiety and Depression Scale (HADS), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Oral Health Impact Profile questionnaire (OHIP-14) were applied at D0 (before chemotherapy) and D15 of chemotherapy. Clinicodemographic data and oral mucositis severity scores were evaluated. RESULTS: A total of 37 individuals (median age: 49 years) were included in the study. Nearly 38% of patients developed chemotherapy-induced oral mucositis and had higher anxiety/depression scores at baseline. Oral mucositis had a negative impact on oral health-related quality of life regarding functional limitation, physical pain, physical disability, and handicap. CONCLUSION: Anxiety/depressive symptoms are associated with oral mucositis that affects overall health and oral health-related quality of life.

Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies.

Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies

Abstract Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Panorama Atual dos Programas de Residência Multiprofissional em Oncologia para Cirurgiões-Dentistas do Brasil / Current Portrait of Multiprofessional Residency Programs in Oncology for Dentist in Brazil / Panorama Actual de los Programas de Residencia Multiprofesional en Oncología para Cirujanos-Dentistas en Brasil

Introdução: Os Programas de Residência Multiprofissional constituem-se uma estratégia fundamental para a ampliação da capacidade para o enfrentamento do câncer. Objetivo: Analisar o panorama atual dos Programas de Residência Multiprofissional em Oncologia para cirurgiões- -dentistas no Brasil, bem como o número de profissionais egressos desses cursos, a partir de dados informados pelo Ministério da Educação (MEC). Método: Trata-se de um estudo quantitativo, exploratório. A primeira fase consistiu na solicitação à Equipe Técnica da Residência Multiprofissional do MEC do Brasil da relação de todos os Programas de Residência Multiprofissional em Oncologia que incluíssem a categoria profissional da odontologia. Adicionalmente, foi realizada busca manual. Na segunda fase, realizaram-se contato por e-mail e busca pelos editais disponíveis na Internet dos casos em que não houve resposta. Os dados investigados foram a presença de Programa ativo, inclusão da categoria profissional da odontologia, número de vagas ofertadas e de egressos para cada ano entre 2010 e 2020, que foram analisados descritivamente. Resultados:Foram identificados 13 Programas de Residência Multiprofissional em Oncologia para cirurgiões-dentistas, distribuídos em 12 centros, situados em dez cidades de oito Estados brasileiros, sobretudo, na Região Sudeste. Seis Programas foram implementados em 2010, seis em 2016 e um em 2020. No cenário Brasileiro, entre 2010 e 2020, foram ofertadas 216 vagas e formados pouco mais de 114 profissionais especializados nessa área. Conclusão: Ressalta-se a necessidade do incremento de centros, Programas e vagas para Residências Multiprofissionais em Oncologia para cirurgiões-dentistas no Brasil, bem como do reconhecimento da Oncologia como uma especialidade odontológica.

Introduction: Multiprofessional Residency programs represent a fundamental strategy to increase the capacity of cancer management. Objective: To analyze the current portrait of Multiprofessional Residency programs in oncology for dental surgeons in Brazil, as well as the number of professionals graduating from these courses, based on data reported by the Ministry of Education (MEC). Method: Quantitative, exploratory study. The first phase consisted in requesting to the Brazilian MEC Technical Team of Multiprofessional Residency to list all the Multiprofessional Residency Programs in Oncology that included the professional category of dentistry. Additionally, a manual search was performed. In the second phase, a contact was made by e-mail and a search in the available Internet public notices of the unanswered cases was conducted. The data searched and analyzed descriptively consisted in the existence of an active program, inclusion of the professional dentistry category, number of vacancies offered and graduates for each year between 2010 and 2020. Results: Thirteen Multiprofessional Residency programs in oncology for dental surgeons were identified, distributed in 12 centers, located in ten cities in eigtht Brazilian states, mainly in the Southeast region. Six programs were implemented in 2010, six in 2016 and one in 2020. In the Brazilian scenario, between 2010 and 2020, a total of 216 vacancies were offered and just over 114 professionals specialized in this area completed the academic formation. Conclusion: It is emphasized the necessity to increase the quantity of centers, programs and vacancies for Multiprofessional Residencies in Oncology for dental surgeons in Brazil, as well as the recognition of oncology as a dental specialty

Introducción: Los Programas de Residencia Multiprofesional constituyen una estrategia fundamental para expandir la capacidad de enfrentar el cáncer. Objetivo:Analizar el panorama actual de los Programas de Residencia Multiprofesional en oncología para cirujanos-dentistas en Brasil, así como el número de profesionales que concluyeron estos cursos, con base en datos reportados por el Ministerio de Educación (MEC). Método: Este es un estudio cuantitativo exploratorio. La primera fase consistió en pedirle al Equipo Técnico de Residencia Multiprofesional del MEC del Brasil que enumerara todos los Programas de Residencia Multiprofesional en Oncología que incluían la categoría profesional de odontología. Además, se realizó una búsqueda manual. En la segunda fase, se contactó por correo electrónico y se buscaron los avisos disponibles en Internet de los casos en que no hubo respuesta. Los datos investigados fueron la presencia de Programa activo, inclusión de la categoría profesional odontología, número de vacantes ofrecidas y número de graduados para cada año entre 2010 y 2020, que fueron analizados descriptivamente. Resultados: Se identificaron 13 Programas de residencia multiprofesional en oncología para cirujanos dentistas, distribuidos en 12 centros, ubicados en diez ciudades de ocho estados brasileños, principalmente en la región Sudeste. Se implementaron seis Programas en 2010, seis en 2016 y uno en 2020. En el escenario brasileño, entre 2010 y 2020, se ofrecieron 216 vacantes y se capacitaron poco más de 114 profesionales especializados en esta área. Conclusión: Se enfatiza la necesidad de aumentar el número de centros, Programas y vacantes para residencias multiprofesionales en oncología para dentistas en Brasil, así como del reconocimiento de la oncología como especialidad odontológica

Abordagem Cirúrgica de Osteorradionecrose Mandibular Causada por Fratura Idiopática / Surgical Approach of Mandible Osteoradionecrosis Caused by Idiopathic Fracture / Abordaje Quirúrgico de Osteorradionecrosis Mandibular Causada por Fractura Idiopática

Introdução: A osteorradionecrose acomete de 1% a 6% dos pacientes submetidos à radioterapia e é considerada a complicação oral mais grave advinda dessa modalidade terapêutica. Relato do caso: Trata-se de um homem, 65 anos, com diagnóstico de carcinoma de células escamosas em assoalho bucal esquerdo, tratado com cirurgia e radioterapia adjuvante. Na avaliação odontológica inicial, não foram observadas alterações clínicas ou radiográficas. Duas semanas após o término da radioterapia, o paciente relatou ter acordado com dor intensa em mandíbula, sem relato de trauma ou queda. A radiografia panorâmica evidenciou fratura no corpo mandibular esquerdo, sugerindo fratura idiopática durante o sono. Após dez dias, houve exposição óssea intraoral do coto distal e preconizou-se tratamento conservador com analgesia, osteotomia superficial sob anestesia local e antibioticoterapia profilática. O paciente evoluiu com secreção purulenta, fístula extraoral e eliminação de sequestro ósseo, após cinco meses, confirmando o diagnóstico de osteorradionecrose. Diante desse quadro, após 11 meses do diagnóstico da fratura, optou-se pela intervenção cirúrgica de mandibulectomia redutora de coto distal. Depois de sete meses de acompanhamento pós-cirúrgico, o paciente encontra-se sem evidências clínicas e radiográficas de osteorradionecrose. Conclusão: O tratamento da osteorradionecrose é considerado desafiador para os dentistas que lidam com essa sequela da radioterapia. Portanto, destaca-se a importância da capacitação do dentista para atuar em todas as etapas do tratamento oncológico

Introduction: Osteoradionecrosis of the jaws affects 1% to 6% of patients undergoing radiotherapy and is considered the most severe oral complication resulting from this therapeutic modality. Case report: This is a 65-year-old man diagnosed with squamous cell carcinoma in the left oral floor, treated with surgery and adjuvant radiotherapy. In the dental evaluation, no clinical or radiographic changes were observed. Two weeks after the radiotherapy, the patient reported severe pain in the mandible, with no report of trauma or fall. The panoramic radiograph showed a fracture in the left mandibular body, suggesting an idiopathic fracture while asleep. After ten days, there was intraoral bone exposure of the distal portion of the mandible and conservative treatment with analgesia, superficial osteotomy under local anesthesia and prophylactic antibiotic therapy was performed. The patient evolved with purulent secretion, extraoral fistula and elimination of bone sequestration, after five months, confirming the diagnosis of osteoradionecrosis. Thereby, 11 months after the fracture diagnosis, the patient underwent a surgical intervention with partial mandibulectomy of the distal portion. After seven months of post-surgical follow-up, the patient presents neither clinical or radiographic evidence of osteoradionecrosis. Conclusion: The treatment of osteoradionecrosis is considered challenging for dentists who deal with this side effect of radiotherapy. Therefore, the importance of training the dentist to work in all stages of cancer treatment is highlighted.

Introducción: La osteorradionecrosis afecta del 1% al 6% de los pacientes sometidos a radioterapia y se considera la complicación oral más grave resultante de esta modalidad terapéutica. Relato del caso: Hombre, 65 años, diagnosticado con carcinoma de células escamosas en el suelo de boca izquierdo, tratado con cirugía y radioterapia adyuvante. La evaluación odontológica no presentó alteraciones clínicas o radiográficas. Dos semanas después de concluir la radioterapia, él informó haber despertado con un fuerte dolor en la mandíbula, sin historia de trauma o caída. La radiografía panorámica mostró una fractura en el cuerpo mandibular izquierdo, lo que sugirió una fractura idiopática durante el sueño. Diez días después, hubo exposición ósea intraoral del muñón distal y fue empleado tratamiento conservador con analgesia, osteotomía superficial bajo anestesia local y antibiótico profiláctico. El paciente evolucionó con secreción purulenta, fístula extraoral y eliminación de secuestro óseo, pasados cinco meses, confirmando el diagnóstico de osteorradionecrosis. Así, pasados 11 meses del diagnóstico de fractura, fue indicada intervención quirúrgica de mandibulectomía reductora del muñón distal. Después de siete meses de la cirugía, no hay evidencias clínicas o radiográficas de osteorradionecrosis. Conclusión: El tratamiento de la osteorradionecrosis se considera un desafío para los dentistas que se ocupan de esta secuela de la radioterapia. Por lo tanto, se destaca la importancia de capacitar al dentista, para que trabaje en todas las etapas del tratamiento oncológico