Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

Biological agent in prevention of ocular recurrence in Behçets disease: a case report.

INTRODUCTION: Ocular involvement in Behçets disease (BD) is characterized by recurrent inflammatory attacks leading to poor long-term visual prognosis. The development of biologic agents has heralded a new era in the management of BD uveitis enabling more targeted immune modulation with greater efficacy and has now become the first line agents. OBJECTIVE: To report a case of young gentleman with Behçets disease whose ocular recurrence was controlled with injection Adalimumab. CASE: A 31-year-old male with recurrent oral and genital ulcers with bilateral recurrent uveitis was diagnosed as bilateral ocular Behçet's disease based on positive HLA B51typing and ferning pattern in FFA. He was on oral Prednisolone and Cyclosporine and was advised for biological agents. On presentation to us, he had anterior uveitis with pseudophakia and secondary open angle glaucoma in right eye and posterior sub capsular cataract in left eye. After starting Inj Adalimumab with oral Methotrexate, he ocular inflammation was under control and patient underwent uneventful cataract surgery in left eye. Over 1-year follow-up, the patient is on remission, on injection Adalimumab with the steroid tapered off. CONCLUSION: Biological agents like Adalimumab is effective in controlling recurrences in Behçet's disease.

Reliability and efficacy of palifermin in prevention and management of oral mucositis in patients with acute lymphoblastic leukemia: a randomized, double-blind controlled clinical trial.

BACKGROUND: Myeloablative and hematopoietic stem cells transplantation therapy (HSCT) often acts as side-effect to oral mucositis (OM) with no effective treatment. This randomized-controlled trial analyzed the efficacy of palifermin, administered as a dose during HSCT therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia (ALL). METHODS: In this study forty-six patients (9-15 years) with B-cell acute lymphoblastic leukemia (B-ALL) were analyzed. The patients underwent allogenic HSCT conditioned by myeloablative regimen. Subsequently to randomization, patients in the palifermin group were assigned to receive palifermin, 60 mg/kg, intravenously as a single dose 3 days before and after transplant conditioning regimen cycle. The patients in the Control group received only a placebo treatment. Maximum severity of OM, incidence and duration of ulcerative OM, incidence and duration of severe OM limitations were evaluated. RESULTS: A statistically significant reduction in the incidence of OM up to grade 3 in the palifermin group compared to the control group was discovered. There was also a reduction, confirmed at 60 days, in the degree of severity of mucositis in the palifermin group, with an average of 1.54 grade in the palifermin group, and of 2.16 in the Control group and in the use of opioid analgesics. CONCLUSIONS: This study indicates that a single dose of palifermin used as primary prophylaxis during HSTC therapy can prevent severe OM in pediatric patients with ALL and used as secondary prophylaxis can prevent the recurrence of severe OM in high-risk patients with previous mucosal injury and improves the quality of life in pediatric patients with ALL.

Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood.

Wegener granulomatosis (WG) is a cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)-associated, multi-system, necrotizing granulomatous vasculitis. Inflammation of the nasal or oral mucosa, and lung and kidney involvements are typical in the course of the disease. In rare cases, pituitary involvement may occur and cause panhypopituitarism. Pituitary involvement is very rare, and only two pediatric case reports have been published to date out of a total of 24 cases. This is a case report of an adolescent patient who presented with panhypopituitarism symptoms and was later diagnosed with WG. A 16-year-old female patient complained of fever, headache, purulent nasal discharge and severe muscle and joint pain. Additionally, she had polyuria and polydipsia. Investigations revealed a pituitary mass and panhypopituitarism. Positivity of c-ANCA and renal biopsy result compatible with WG confirmed the diagnosis.

Miniscrew covering: an alternative to prevent traumatic lesions.

During orthodontic treatment with miniscrews, complications such as aphthous ulceration, soft-tissue coverage of the miniscrew head, soft-tissue inflammation, infection, and peri-implantitis can occur. Good hygiene can prevent inflammation by infection but does not prevent traumatic oral mucosal lesions at the buccal mucosa. The purpose of this article was to describe the use of a physical barrier--a light-cured temporary filling material--to cover the miniscrew head and prevent soft-tissue trauma.

[Planning dental care and orthodontic treatment for children afflicted with malignant hematological diseases]. / Planification des soins bucco-dentaires et des traitements ODF chez les enfants atteints d'une hémopathie maligne.

THE PROBLEM: In France, cancer affects 1 to 3% of all children and represents the second most frequent cause of mortality among children younger than fifteen. Malignant blood diseases are the most frequently occurring childhood cancers. Although their mortality rate has been tending to decrease, they often seem to develop after "opportunistic" latent infections persist, undetected, in un-eradicated sites that may be of dental origin. This infectious risk, frequently undiagnosed in hospitals, should be of concern to both general dentists and orthodontists. OBJECTIVES: General dentists and orthodontists each have specific roles to play in teaching children about oral health at an early age and in detecting and eradicating infection as well as in seeing at risk children in regular follow-up visits. DISCUSSION: Dentists should examine children on regularly scheduled preventive appointments and treat dental caries when they discover it. Orthodontists, who see the children they are treating on frequently scheduled appointments, should always be on the alert for incipient caries in their patients and be careful to make the appliances they wear as well fitting and non-irritating as possible to minimize the risk of inflammation and development of sore spots. Both dentists and orthodontists should teach their patients how to maintain healthy diets and good oral hygiene. They may be called upon to provide local relief for acute lesions that chemotherapy sometimes causes in the soft tissues of patients with hematological cancers and to modify irritating appliances.

Interventions for preventing oral mucositis for patients with cancer receiving treatment.

BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers). OBJECTIVES: To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo or no treatment. SEARCH STRATEGY: Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 16 February 2011), CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 16 February 2011), EMBASE via OVID (1980 to 16 February 2011), CINAHL via EBSCO (1980 to 16 February 2011), CANCERLIT via PubMed (1950 to 16 February 2011), OpenSIGLE (1980 to 2005) and LILACS via the Virtual Health Library (1980 to 16 February 2011) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. SELECTION CRITERIA: Randomised controlled trials of interventions to prevent oral mucositis in patients receiving treatment for cancer. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, results and risk of bias were independently extracted, in duplicate, by two review authors. Authors were contacted for further details where these were unclear. The Cochrane Collaboration statistical guidelines were followed and risk ratios calculated using random-effects models. MAIN RESULTS: A total of 131 studies with 10,514 randomised participants are now included. Overall only 8% of these studies were assessed as being at low risk of bias. Ten interventions, where there was more than one trial in the meta-analysis, showed some statistically significant evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to either a placebo or no treatment. These ten interventions were: aloe vera, amifostine, cryotherapy, granulocyte-colony stimulating factor (G-CSF), intravenous glutamine, honey, keratinocyte growth factor, laser, polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste and sucralfate. AUTHORS' CONCLUSIONS: Ten interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for further well designed, and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.

Interventions for preventing oral mucositis for patients with cancer receiving treatment.

BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers). OBJECTIVES: To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo or no treatment. SEARCH STRATEGY: Electronic searches of Cochrane Oral Health Group and PaPaS Trials Registers (to 1 June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 1 June 2010), EMBASE via OVID (1980 to 1 June 2010), CINAHL via EBSCO (1980 to 1 June 2010), CANCERLIT via PubMed (1950 to 1 June 2010), OpenSIGLE (1980 to 2005) and LILACS via the Virtual Health Library (1980 to 1 June 2010) were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. SELECTION CRITERIA: Randomised controlled trials of interventions to prevent oral mucositis in patients receiving treatment for cancer. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, results and risk of bias were independently extracted, in duplicate, by two review authors. Authors were contacted for further details where these were unclear. The Cochrane Collaboration statistical guidelines were followed and risk ratios calculated using random-effects models. MAIN RESULTS: A total of 131 studies with 10,514 randomised participants are now included. Nine interventions, where there was more than one trial in the meta-analysis, showed some statistically significant evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis, compared to either a placebo or no treatment. These nine interventions were: allopurinol, aloe vera, amifostine, cryotherapy, glutamine (intravenous), honey, keratinocyte growth factor, laser, and polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste. AUTHORS' CONCLUSIONS: Nine interventions were found to have some benefit with regard to preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for further well designed, and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.

Attenuation of radiation- and chemoradiation-induced mucositis using gamma-D-glutamyl-L-tryptophan (SCV-07).

OBJECTIVE: To evaluate the efficacy of a novel immunomodulating peptide (SCV-07) in attenuating the course of radiation-induced mucositis in an established animal model of oral mucositis (OM). MATERIAL AND METHODS: In three separate experiments, golden Syrian hamsters received either an acute radiation challenge to the buccal mucosa of eight fractionated doses of 7.5 Gy of radiation over a 2-week-period, or a combination of acute radiation and cisplatin. In each experiment, animals were treated with varying doses or schedules of SCV-07 or placebo. OM was scored in a blinded fashion using digital images obtained during the experimental period. RESULTS: We found that SCV-07 reduced the severity and duration of both acute and fractionated radiation-induced OM. Similarly, when radiation and chemotherapy were used to induce OM, treatment with SCV-07 significantly reduced the duration of ulcerative OM. The therapeutic benefit was dependent on both dose and schedule of administration. CONCLUSION: Taken together, we found SCV-07 was able to modify the duration and severity of oral mucositis and was dependent on schedule and dose.

[Inflammatory changes of oral cavity proceeding appearance of clinical symptoms of Crohn's disease]. / Zmiany zapalne w jamie ustnej wyprzedzajace wystapienie objawów choroby Lesniowskiego-Crohna. Opis przypadku.

Crohn's disease belongs to the inflammatory bowel diseases. Inflammatory changes can be located in any part of the gastrointestinal tract including rarely oral cavity. We present a case of a 21 years old woman with unhealed by the local treatment, and verified by histological examination, inflammatory changes of oral cavity. These changes had proceed the diagnosis of typical changes in gastrointestinal tract for 6 months. Changes were located in terminal ileum and colon and were confirmed by colonoscopic, histologic and radiologic studies. Standard therapy of Crohn's disease with antiinflammatory and immunosuppressive drugs led to the healing of oral changes. We point out on the necessity of proper differential diagnosis of problematic unhealing changes, particularly with ulcerations of oral mucosa in young patients. Dental examination with histological confirmation of mucosal changes may be helpful in proper diagnosis of Crohn's disease in the young group of patients.

Melatonin in diseases of the oral cavity.

BACKGROUND: Melatonin is the principal secretory product of the pineal gland. It has immunomodulatory and antioxidant activities, stimulates the proliferation of collagen and osseous tissue and acts as a protector against cellular degeneration associated with aging and toxin exposure. Arising out of its antioxidant actions, melatonin protects against inflammatory processes and cellular damage caused by the toxic derivates of oxygen. As a result of these actions, melatonin may be useful as a co-adjuvant in the treatment of certain conditions of the oral cavity. METHODS: An extensive review of the scientific literature was carried out using PubMed, Science Direct, ISI Web of Knowledge and the Cochrane base. RESULTS: Melatonin, which is released into the saliva, may have important implications for oral diseases. Melatonin may have beneficial effects in certain oral pathologies including periodontal diseases, herpes viral infections and Candida, local inflammatory rocesses, xerostomia, oral ulcers and oral cancer. CONCLUSIONS: Melatonin may play a role in protecting the oral cavity from tissue damage caused by oxidative stress. The experimental evidence suggests that melatonin may have utility in the treatment of several common diseases of the oral cavity. However, more specific studies are necessary to extend the therapeutic possibilities to other oral diseases.

Colchicine mouth washings to improve oral mucositis in patients with hematological malignancies: a clinical trial.

OBJECTIVE: Oral mucositis (OM) is a frequently encountered problem as a complication of cancer treatment. We investigated whether daily washings with colchicine solution improved mucositis in patients with hematological malignancies undergoing chemotherapy. METHODS: This study was a one-arm, nonrandomized clinical trial that used a historical control group. Patients were included in the study from the first day of mucositis and followed up until discharge. Patients received 2 mg colchicine mouthwashes daily for 5 days or saline solution. OM was assessed once daily until symptom resolution, using the WHO grading scale of 0-4 and a visual analogue scale. We determined that at least 40 patients in the colchicine group would be needed to detect a 20% difference in the duration of OM between Groups A and B, with a 95% confidence level and a power of 80%. RESULTS: 82 patients were included in the final analysis, 40 in the colchicine group and 42 in the control group. Median duration of OM was significantly different among groups; 9 days (range 1-17 days) for the control group versus 6 days (range 3-13 days) for those exposed to colchicine mouthwash (p = .028). The median days of regression of mucosal lesions were significantly different (p = .047) among the control group (7 days [range 3-20]) compared to the colchicine group (4 days [range 2-14]). SIGNIFICANCE OF RESULTS: Although our findings suggest that colchicine mouthwash is helpful in reducing the severity and duration of chemotherapy-induced OM, randomized trials are needed to confirm these results.

Prevención del cáncer bucal: lesiones cancerizables de la cavidad bucal / Prevention of oral cancer: cancerous lesions of the oral cavity

El cáncer bucal representa el 3 por ciento de los tumores malignos humanos. En nuestro país, la sobrevida es del 39 por ciento a los 5 años, lo que significa la muerte de la mayoría de los pacientes (61 por ciento) a los cinco años. Mundialmente, existen campañas con el fin de concientizar a la población sobre la existencia y prevención del cáncer bucal. La forma de prevenirlo es reconocer por parte del odontólogo, las lesiones que más frecuentemente pueden transformarse en cáncer, como ser el liquen no reticular en su forma erosiva, atrófica y queratósica, la ulceración traumática, la queilitis crónica y la leucoplasia. En este artículo se darán pautas claras y simples para reconocer, identificar y controlar las mencionadas lesiones, con el objetivo de orientar el diagnóstico precoz.

Reduction of radiochemotherapy-induced early oral mucositis by recombinant human keratinocyte growth factor (palifermin): experimental studies in mice.

PURPOSE: To study the effect of recombinant human keratinocyte growth factor (rHuKGF or palifermin) on oral mucositis induced by radiochemotherapy in a mouse model. METHODS AND MATERIALS: Cis-diamminedichloroplatinum (cisplatin) and/or 5-fluorouracil were given before single dose irradiation, combined with palifermin before or after the treatment, or both. Daily fractionated irradiation for 2 weeks was followed by graded test doses. With additional chemotherapy in Week 1, palifermin was given before radiotherapy and at the end of the first week, or additionally at the end of Week 2. Radiochemotherapy in Week 2 was combined with palifermin at the end of Weeks 1 and 2, Weeks 1, 2, and 3, or additionally before radiotherapy. Ulceration of mouse tongue mucosa was analyzed as the endpoint. RESULTS: The dose associated with ulcer induction in 50% of the mice (ED(50)) for single-dose irradiation was 11.5 +/- 0.7 Gy. Palifermin increased the ED(50) to about 19 Gy in all protocols tested. Similar values were observed when chemotherapy was added before irradiation. With fractionated irradiation, palifermin increased the ED(50) for test irradiation from 5.7 +/- 1.5 Gy to 12-15 Gy, depending on the administration protocol. With chemotherapy in Week 1, two palifermin injections had no significant effect, but a third injection increased the ED(50) to 13 Gy. With chemotherapy in Week 2, all palifermin protocols resulted in ED(50) values of 13-14 Gy. CONCLUSION: A marked increase in oral mucosal radiation tolerance by palifermin was found, which was preserved in combinations with chemotherapy using cisplatin and/or 5-fluorouracil.

Prevention of oral mucositis in paediatric patients treated with chemotherapy; a randomised crossover trial comparing two protocols of oral care.

This study compared the efficacy of two protocols for oral care using either chlorhexidine or benzydamine as oral rinses to alleviate mucositis in children undergoing chemotherapy. Eligible participants were randomised to receive either protocol for 3 weeks in a two-period crossover design. The occurrence of ulcerative lesions and severity of mucositis were measured at baseline and twice weekly, using the modified Oral Assessment Guide (OAG). Data were continuously analysed by plotting them directly on predefined sequential charts. According to this sequential analysis, the study could be terminated at the 34th within subject comparison, with a statistically significant reduction in ulcerative lesions (P<0.05) and severity of mucositis (P<0.05) in children on the chlorhexidine protocol. These findings suggest that chlorhexidine together with oral care might be helpful in alleviating mucositis when given prophylactically to children on chemotherapy, but the therapeutic benefit needs to be confirmed in a larger trial.

Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia.

This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12% chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12% chlorhexidine mouth rinse (p < 0.05 by Fisher's exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy.

Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia

This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12 percent chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12 percent chlorhexidine mouth rinse (p < 0.05 by Fisher's exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy