Unstimulated salivary flow and oral streptococci in pediatric patients with hematological tumors: A longitudinal study.

AIMS: To evaluate the unstimulated salivary flow (USF) and salivary colonization of total Streptococcus spp. (TS) and mutans-group (MS) in pediatric patients with hematological tumors. Correlations of salivary and microbiological changes with chemotherapy and patient-related factors were also verified. METHODS AND RESULTS: Eligible children (n = 31) were evaluated before (control) and after (2, 5, and 10-weeks) the chemotherapy protocol was applied. Saliva samples were collected by the traditional spitting method to determine the USF (ml/min). Salivary TS and MS were determined by colony-forming units (CFU ) counts in a selective medium. The caries experience was evaluated by DMFT/dmft indexes. Data were submitted to Student's t-test, one-way ANOVA, and correlation tests (α = 0.05). The USF rate at baseline was 0.89 (±0.73) ml/min with up to 20% reduction during the follow-up and did not differ statistically during chemotherapy (p  > .05). Chemotherapy did not modify the salivary TS load (p > .05), but induced a dysbiotic shift with higher MS counts (∼ 5 fold-increase) at 10-weeks (p < .05). There is a correlation of USF with age (r = .390) and SM load with caries experience (rs  = -.540) at 5-weeks. CONCLUSION: Chemotherapy may promote a specific increase of mutans-group streptococci without changing the Streptococcus spp. load and unstimulated saliva flow. Correlation reinforced the need for further enlightenment about the chemotherapy mechanisms in the salivary and microbiological parameters.

Integrated oral care contributes positively to the course of treatment of oncopediatric patients.

The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.

Impact of Saliva and Cariogenic Microbiota on the Chemotherapy-Induced Oral Mucositis in Oncopediatric Patients: A Preliminary Longitudinal Study.

This study aims to evaluate the salivary parameters and cariogenic microbiota of pediatric oncological patients and their correlation with severe oral mucositis (SOM). A preliminary longitudinal study included patients in the age range from 4 to 18 years (n = 26), with diagnosis of primary cancer, who were followed up before and after time intervals of two, five, and ten weeks of induction chemotherapy. Oral mucosa examinations were performed by means of the modified Oral Assessment Guide (OAG) by calibrated examiners (κ > 0.70). Saliva analysis (unstimulated saliva flow (USF), clinical saliva viscosity (CSV), and pH) and microbiological (total Streptococcus (TS) and Streptococcus of the mutans group (SMG)) tests were performed using unstimulated saliva. The data were analyzed by the Wilcoxon and Spearman Correlation tests (α = 5%). The patients were predominantly of the female sex (n = 15; 57.7%), adolescents (n = 15; 57.7%), and patients with hematological tumors (n = 21; 80.8%). SOM was more frequent in the tenth week (n = 7; 28.6%). The values of USF, CSV, pH, TS, and SMG were not changed by the institution of chemotherapy (p > 0.05). These values were correlated with SOM and the time, TS and SMG, and CSV and SMG. The salivary and microbiological parameters investigated did not influence the severity of oral mucositis in the pediatric patients oncological..

The effectiveness and acceptability of a portable pediatric sialometer: A new technique for saliva collection.

OBJECTIVE: To compare the effectiveness and acceptability of a newly developed pediatric sialometer as an alternative to the conventional spitting method. METHODS: A clinical study was carried out with healthy children (G1; n = 30) and oncological children (G2; n = 30). A newly developed pediatric sialometer was compared to the traditional spitting method to determine unstimulated salivary flow (mL/min), with a one-hour wash out period between sample collections. A semi-structured questionnaire was applied to G1 and G2 using the Facial Anxiety Scale to evaluate the device's acceptability. The children's behavior was also observed throughout saliva collection. The data were analyzed by Mann-Whitney U, Wilcoxon, Student's t and Chi-Square tests (α = 5%). RESULTS: There was no significant difference between groups and methods (P > 0.05). However, the saliva collected with the pediatric sialometer was clearer and had less apparent contamination. The device characteristics were rated positively, with high acceptability even among children with more difficult conditioning (G2) (P > 0.05). CONCLUSION: The newly developed pediatric sialometer presented herein can be an alternative option for saliva collection in pediatric dentistry, with good reproducibility and acceptability by children.

Salivary Flow in Pediatric Cancer Patients Compared to Healthy Children and Adolescents

Abstract Objective: To verify differences between salivary flow in pediatric cancer patients before starting antineoplastic treatment and in healthy pediatric patients. Material and Methods: This is an observational, cross-sectional, paired study with sample of 120 children and adolescents (3-18 years). Thirty pediatric cancer patients were selected for convenience at "Napoleão Laureano" Hospital (G1). Another group was composed of 90 individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, matched by age (G2). Data collection was performed in two steps for both groups. Information regarding pediatric cancer patients was obtained by interview with parents / guardians and searching medical records, while in the other group by interview with parents / guardians. Saliva collection was performed using standard method in both groups: unstimulated salivary flow rate (USFR) being the mean volume expelled in 1 minute. Data were analyzed by the Shapiro-Wilk, Kolmogorov-Smirnov and Mann-Whitney tests (α = 5%) Results: Mean USFR for G1 and G2 was 0.52 mL / min and 0.66 mL / min, respectively (p>0.05) and, in both groups, significant difference was observed (p <0.05) between the mean USFR values of its subgroups, and values of adolescents being higher than those of children Conclusion: There is no difference in unstimulated salivary flow of pediatric cancer patients before starting antineoplastic treatment compared with healthy pediatric patients.

Sutures modified by incorporation of chlorhexidine and cinnamaldehyde: anti-Candida effect, bioavailability and mechanical properties / Suturas modificadas pela incorporação de clorexidina e cinamaldeído: efeito anti-Candida, biodisponibilidade e propriedades mecânicas

Abstract Introduction Antimicrobial sutures are a therapeutic alternative for the control of oral infections. Objective Incorporate Chlorhexidine (CHX) and Cinnamaldehyde (CN) in sutures and evaluate the anti-Candida effect, release of antimicrobials and mechanical properties. Material and method Silk (S) and Polyglactin 910 (P) sutures were aseptically sectioned (20 mm) and immersed for incorporation in 0.12% CHX, 0.4% CN and 0.9% saline solutions under stirring for 60 minutes (n = 10 / group). Suspensions of 500 μL of Candida albicans (ATCC 90028/ 1 × 106 CFU/mL) were used to evaluate fungal adhesion after the 48 h period at 37°C. The release of CLX and CN were evaluated at 0, 24 and 48 hours (n=3/group) by UV-VIS spectrophotometer (275 nm). The tensile strength and displacement (n=5/group) were evaluated after incorporation (30 mm/min, 50N). Data were analyzed by Anova and Tukey (α = 5%). Result No anti-Candida effect was observed on S and P sutures incorporated with CLX and CN (p>0.05). However, progressive release was verified up to 48 after treatment with CLX (S = 0.075 / P = 0.073 μg/mL) and CN (S = 35.33 /P= 5.72 μg/mL). There was a decrease in tensile strength in S (CLX = 9.9 / CN = 9.9 N) and P (CLX = 14.4 / CN = 15.5 N) (p<0.05). No differences were observed for the displacement for S (CLX = 19.3 / CN=20.7 mm) and P (CLX = 16.2 / CN=15.8 mm) (p>0.05). Conclusion The incorporation of CLX and CN did not have a positive effect on the biological and mechanical properties of the sutures evaluated.

Resumo Introdução Fios de suturas com antimicrobianos são uma alternativa terapêutica para o controle de infecções orais. Objetivo Incorporar Clorexidina (CHX) e Cinamaldeído (CN) em fios de sutura e avaliar o efeito anti-Candida, liberação de antimicrobianos e as propriedades mecânicas. Material e método Fios de Seda (S) e Poliglactina 910 (P) foram seccionadas assepticamente (20 mm) e imersos para incorporação em CHX a 0,12%, CN a 0,4% e solução fisiológica a 0,9% sob agitação por 60 minutos (n = 10 / grupo). Suspensões de 500 μL de Candida albicans (ATCC 90028/1 × 106 UFC / mL) foram utilizadas para avaliar a aderência fúngica após o período de 48 horas a 37 ° C. A liberação de CLX e CN foi avaliada em 0, 24 e 48 horas (n = 3 / grupo) por espectrofotômetro UV-VIS (275 nm). A resistência à tração e o deslocamento (n = 5 / grupo) foram avaliados após a incorporação (30 mm / min, 50N). Os dados foram analisados ​​por Anova e Tukey (α = 5%). Resultado Não foi observado efeito anti-Candida nas suturas S e P incorporadas com CLX e CN (p> 0,05). No entanto, a liberação progressiva foi verificada até 48 após o tratamento com CLX (S = 0,075 / P = 0,073 μg / mL) e CN (S = 35,33 / P= 5,72 μg / mL). Houve uma diminuição na resistência à tração em S (CLX = 9,9 / CN = 9,9 N) e P (CLX = 14,4 / CN = 15,5 N) (p <0,05). Não foram observadas diferenças para o deslocamento para S (CLX = 19,3 / CN=20,7 mm) e P (CLX = 16,2 /CN= 15,8 mm) (p> 0,05). Conclusão A incorporação de CLX e CN não teve efeito positivo sobre as propriedades biológicas e mecânicas das suturas avaliadas.

The applicability of the Nicodemo, Moraes and Médici Filho`s method (1974) for age estimation among children, adolescents and young adults: a systematic review

Objective: It was evaluated the applicability of the Table of Permanent Teeth Mineralization among Brazilians for age estimation with forensic purposes. Method: The PRISMA guidelines (Preferred Report of Systematic Reviews and Meta-Analysis) were used for study design, and bibliographical searches were performed in the databases: Web of Science, Pubmed, Scopus, Cochrane, LILACS and SIGLE, according to PICO/PECO strategy. Results: A total of 10,280 records were retrieved from the databases, of which 20 articles were selected for full-text analysis after preliminary screening. Five articles plus one additional article selected by manual search were included in the final review, totaling six articles. The selected studies presented a cross-sectional design, five of which were developed in Brazil and two abroad. The assessment of methodological quality, performed with the use of QUADAS adapted by Lopes (2012), indicated that all six studies met more than 50% of the quality requirements and one of them met all the requirements. To compare the estimated and actual chronological age, four studies utilized correlation analysis while two employed descriptive statistics. The findings revealed discrepancy between the estimated age and the actual chronological age, which led the majority of authors to advocate a moderate use of the method as well as to indicate the use of correction factors for specific populations and its association with other age estimation methods. Conclusion: the existing evidence on the applicability of the Nicodemo, Moraes and Médici Filho's method (1974) for age estimation with forensic purposes is moderate, given the scarcity of studies and methodological heterogeneity between them.

Objetivo: Avaliou-se a aplicabilidade da Tabela Cronológica de Mineralização dos dentes permanentes em Brasileiros para estimativa da idade com fins forenses, por meio de uma revisão sistemática. Método: A pesquisa foi desenvolvida baseada no protocolo do Preferred Report of Systematic Reviews and Meta-Analysis (PRISMA). As buscas foram realizadas nas bases de dados: Web of Science, Pubmed, Scopus, Cochrane, Lilacs e Sigle, sendo a estratégia baseada no acrônimo PICO/PECO (MAIA; ANTONIO, 2012). Resultados: Foram recuperados 10.280 registros nas referidas bases, e após a triagem inicial 20 artigos seguiram para leitura na íntegra. Ao final, permaneceram 5 artigos e mais um foi adicionado por hand searching, perfazendo 6 artigos. Os estudos apresentaram delineamento seccional, sendo cinco realizados no Brasil e dois no exterior. A avaliação da qualidade metodológica, realizada com o auxilio do QUADAS adaptado por Lopes (2012), indicou que os 6 estudos apresentaram mais de 50% das respostas positivas, sendo que um atendeu a todos os requisitos. Para comparar as idades estimada com a cronológica, 4 dos artigos utilizaram análise de correlação e os demais, estatística descritiva. Os resultados demonstraram discrepâncias entre a idade estimada e a cronológica, fazendo com que a maioria dos autores indicasse o uso parcimonioso do método, procurando utilizar fatores de correção para populações específicas ou a sua associação a outros métodos de estimativa de idade. Conclusão: A evidência científica acerca da aplicabilidade do método de Nicodemo, Moraes e Médici Filho (1974) na estimativa de idade com fins forenses é moderada, sobretudo considerando a quantidade dos estudos existentes e a heterogeneidade metodológica entre eles.

Factors associated with oral biofilm in ICU patients with infectious diseases / Fatores associados à presença de biofilme oral em pacientes internados na UTI

Introduction: Hospitalization may cause a decline in oral health and affect the entire body. The intensive care unit (ICU) may be a favorable environment for oral biofilm to accumulate in critically ill patients. Objective: To identify factors associated with oral biofilm in ICU patients in a hospital for infectious diseases. Method: This was a retrospective, descriptive and inferential study with a quantitative approach. Data were collected from 178 medical records of patients from January 2012 to July 2015. Biofilm presence was assessed according to the Greene and Vermillion index. Potential influential factors were analyzed by logistic regression. Result: Among ICU patients, 69.1% were men, 60.7% had acquired immune deficiency (AIDS), 66.3% were ward patients, 50.6% were intubated, and 50.0% were sedated. The oral elements of the patients were mostly normal. The following characteristics were significantly associated with oral biofilm: changes in the lips, gums, cheeks, and palates and bleeding. Patients from the ward had a lower risk of biofilm. Conclusion: Increased oral biofilm accumulation was observed in patients with oral changes, and patient origin was associated with the presence of biofilm.

Introdução: A hospitalização pode provocar deterioração da saúde bucal, repercutindo em todo o corpo. A UTI pode ser um ambiente favorável ao acúmulo de biofilme oral em pacientes críticos. Objetivo: Identificar fatores associados à presença do biofilme em pacientes da UTI de um hospital de doenças infectocontagiosas. Método: Estudo retrospectivo, descritivo e inferencial, com abordagem quantitativa. Os dados foram obtidos em prontuários de pacientes da UTI, de janeiro de 2012 a julho de 2015. O biofilme foi avaliado de acordo com o índice de Greene e Vermillion. Os fatores influentes foram analisados por regressão logística. Resultado: Entre os pacientes da UTI, 69,1% eram homens, 60,7% pacientes com AIDS, 66,3% pacientes na enfermaria, 50,6% intubados e 50,0% sedados. Seus elementos orais eram na maioria normais. As seguintes características foram significativamente associadas a biofilmes orais: alterações orais nos lábios, gengivas, bochechas e palatos e sangramento. Pacientes da enfermaria apresentaram menor risco de apresentar biofilmes. Conclusão: o aumento do acúmulo de biofilme oral foi observado em pacientes com alterações na boca e a procedência do paciente foi associada à presença de biofilme.

Profile of Hospitalizations and Deaths from Craniofacial Fractures in Brazilian Children and Adolescents: An Ecological Study

Objective: To characterize the profile of hospitalizations and deaths related to craniofacial fractures in Brazilian children and adolescents. Material and Methods: This is an ecological cross-sectional study with inductive approach with comparative-descriptive procedure and indirect documentation technique. Data were obtained from the DATASUS / SIH-SUS website for the years 2010-2014, considering information for each state of the five Brazilian regions. Admission rates were calculated per 100,000 inhabitants, and data were analyzed by population rates, averages and absolute and relative frequencies. Results: The Northeastern region of Brazil showed the highest hospitalization rate (81.72), followed by the Northern (56.84), Southern (50.94), Midwestern (44.25) and Southeastern regions (30.28). In all regions, the years with the highest hospitalization rates were: 2010 for the Northern (13.17) and Southeastern regions (6.61), 2013 for the Northeastern (20.07) and Midwestern regions (10.17) and 2014 for the Southerner region (10.52). The highest hospitalization rates in all regions of the country in the last five years were observed for male children and adolescent. In relation to age group, higher rates were recorded from 15 to 19 years. Of the total of 27,244 hospitalizations (3.8%), 1028 patients died and 35.5% of them occurred in the Northeastern region. Considering the years under study, the average length of stay and average daily hospitalization cost were respectively 4.0 days and US$ 82.7. Conclusion: The Northeast region of Brazil had the highest hospitalization rate of children and adolescents by craniofacial fractures, and male adolescents and those aged 15-19 years were the most affected in different regions of the country. Costs of hospital admissions due to this type of injury are significant, with more deaths as a result of these injuries in Brazil in the last 5 years evaluated with the highest prevalence in the Northeastern region of Brazil.

Use of the Chronological Dental Mineralization Table of Nicodemo, Moraes and Medici Filho (1974) to Estimate Age by Undergraduate Dentistry Students

Objective: To evaluate the agreement and applicability of the Chronological Dental Mineralization Table of Nicodemo, Moraes and Medici Filho (1974) to estimate age held by undergraduate Dentistry students at the Federal University of Paraíba. Material and Methods: Field research applied with a sample of 50 students according to inclusion and exclusion criteria. Sequentially, 3 panoramic radiographs were exposed (actual age known only by teachers), and students were instructed to interpret them from the selection of 2-4 teeth under formation. Data were analyzed using SPSS software (Statistical Package for Social Sciences), version 20.0, adopting significance level of 5%. Results: Most students chose 3 teeth, with percentages of 56.0% (n = 28); 38.0% (n = 19) and 58.0% (n = 29) for radiographs 1, 2 and 3, respectively. Teeth selected with greater frequency were: 47 (20.1%, n = 33) and 45 (19.5%, n = 32) - radiography 1; 38 (22.7%, n = 32) and 18 (13.4%, n = 19) - radiography 2; and 47 (17.9%; n = 26) and 36 (13.7%; n = 20) - radiography 3. The agreement between estimated and actual ages was 60.0% for radiography 1, 12.0% for radiography 2 and 32.0% for radiography 3. Age was underestimated in 40.0% (n = 20) and 88.0% (n = 44) in radiographs 1 and 2, respectively. Overestimation of the actual age occurred only in radiography 3 (68.0%; n = 34). The linear regression analysis revealed that it is possible to estimate the actual age from the maximum age stipulated by training students with 88.1% success rate. Conclusion: The method is applicable; however, the correlation between estimated and actual ages varied considerably among radiographs, and maximum estimated values were closer to the actual age than minimum values.