Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

ABSTRACT Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment.

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.

Potential link between SARS-CoV-2 and Kawasaki disease: importance of dentists for the diagnosis

Abstract: Kawasaki disease (KD) is a vasculitis with predilection for coronary arteries. Due to a lack of reliable confirmatory laboratory tests, the diagnosis of KD is based on a characteristic pattern of clinical findings that appear in a typical temporal sequence. The diagnostic criteria have been periodically modified and the American Heart Association has proposed the most recent guidelines for its diagnosis. However, patients may have incomplete or atypical forms of KD and diagnosis can often be difficult. Because oropharyngeal manifestations are a common and important feature for diagnosing KD and recent studies have hypothesized a possible association between KD and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in this review we highlight the importance of dentists in the diagnosis of KD and its potential association with SARS-CoV-2.

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Abstract This study aimed to evaluate the factors associated with the occurrence of severe oral mucositis (SOM) in pediatric oncology patients during the chemotherapeutic treatment. This is a nested case-control to a prospective cohort that monitored 105 patients for 10 consecutive weeks after the beginning of the chemotherapy treatment. Logistic regression was used to identify the factors associated with SOM, by group of malignancy (hematologic or solid tumors) (Sig.=5%). To patients with hematologic tumors were found factors associated with SOM in two weeks of treatment: in the 6th week (increase in frequency of chemotherapy doses (OR=3.02)) and in the 7th week (female sex (OR=21.28); and increase in frequency of chemotherapy doses (OR=2.51)); and to patients with solid tumors were found factors associated with SOM in five weeks of treatment: in the 1st week (female sex (OR=14.43); age increase (OR=1.24)); in the 2nd week (Miscellany (OR=6.39)); in the 5th week (Antimetabolites (OR=17.44); Miscellany (OR=45.42); and platelets reduction (OR=1.12)); in the 6th week (creatinine increase (OR=1.63)); and in the 7th week (creatinine increase (OR=2.39)). For patients with hematologic tumors, to be female, and the increase in the frequency of chemotherapy doses increased the risk for SOM and for patients with solid tumors, to be female, the increase in age and in level blood concentration of creatinine, the reduction in number of platelets and the use of chemotherapy with miscellany and antimetabolites agents were associated with an increase in risk for occurrence of SOM.

Resumo Este estudo objetivou avaliar os fatores associados com a ocorrência de mucosite oral grave (SOM) em pacientes pediátricos oncológicos durante o tratamento quimioterápico. Trata-se de um estudo de caso-controle aninhado a uma coorte prospectiva que monitorou 105 pacientes por 10 semanas consecutivas após o início do tratamento quimioterápico. Regressão logística foi utilizada para identificar os fatores associados com a MOG, por grupo de malignidade (tumores hematológicos ou sólidos) (Sig.=5%). Para pacientes com tumores hematológicos foram encontrados fatores associados com a MOG em duas semanas de tratamento: na 6ª semana (aumento na frequência de doses de quimioterapia (OR=3,02)) e na 7ª semana (sexo feminino (OR=21,28); e aumento na frequência de doses de quimioterapia (OR=2,51)); e para pacientes com tumores sólidos foram encontrados fatores associados com MOG em cinco semanas de tratamento: na 1ª semana (sexo feminino (OR=14,43), aumento na idade (OR=1,24)); na 2ª semana (Miscelânea (OR=6,39)); na 5ª semana (Antimetabólitos (OR=17,44); Miscelânea (OR=45,42); e redução de plaquetas (OR=1,12)); na 6ª semana (aumento na creatinina (OR=1,63)); e na 7ª semana (aumento na creatinina (OR=2,39)). Para pacientes com tumores hematológicos, ser do sexo feminino e o aumento na frequência de doses de quimioterapia aumentou o risco para MOG; e, para pacientes com tumors sólidos, ser do sexo feminino, o aumento na idade e nos níveis de concentração sanguínea de creatinina, a redução no número de plaquetas e o uso de quimioterapia com agentes das classes Miscelânea e Antimetabólitos estiveram associados com o aumento no risco para a ocorrência de MOG.

SARS-CoV-2 and Saliva as a Diagnostic Tool: A Real Possibility

Abstract Covid-19 is a respiratory disease caused by the SARS-CoV-2 virus. The high rate of contagion and the spread of the virus in the population make the early detection of the pathogen the means for the adequate targeting of infection control measures. WHO directs sample collection on upper respiratory specimens, including nasopharyngeal and oropharyngeal swab or wash in ambulatory patients, as well as lower respiratory specimens: sputum and/or endotracheal aspirate or bronchoalveolar lavage, in addition to citing blood and feces. Among the various sample collection methods, saliva has been investigated and reported as a potential source for diagnosis. Thus, we propose to evaluate the current scenario, based on recent publications on the perspective of detecting SARS-CoV-2 in saliva as a diagnostic method for Covid-19. The detection of SARS-CoV-2 through saliva seems to be very promising, although obstacles such as the technique and the location of the collection and the sample size of the research carried out so far may present a limitation for its use. The current scenario presents saliva as a reliable method for the detection of SARS-CoV-2, due to the ease of obtaining the samples, the possibility of self-collection, low cost because there is no need to use specific equipment, in addition to reducing the risk of transmission for health professionals.

COVID-19 Pandemic: Oral Repercussions and its Possible Impact on Oral Health

Abstract Many viral infections cause oral manifestations, including disorders in odontogenesis, resulting in dental malformations. In this review, based on current knowledge, we will discuss the likely dental and oral consequences of COVID-19. In this article, we review currently available data associated with vertical transmission of COVID-19 and odontogenesis, oral manifestations, and the impact of COVID-19 pandemic on a diagnosis of oral diseases. Owing to the severity of the pandemic, the population's anxiety and fear of becoming infected with COVID-19 may underestimate the signs and symptoms of serious illnesses, besides discourage patients from seeking health, medical or dental services to determine the diagnosis of oral lesions. Thus, the COVID-19 pandemic could be an additional and aggravating factor for the delay of serious illness diagnosis, such as oral squamous cell carcinoma resulting in higher morbidity and worse prognosis. Several changes and oral lesions have been described as oral manifestations of COVID-19, such as dysgeusia, oral ulcers, petechiae, reddish macules, desquamative gingivitis, among others. Besides, it can cause major systemic changes and predispose opportunistic infections. As with other viral infections, oral manifestations, including dental anomalies, can occur as a direct result of SARS-CoV-2 infection. However, further studies are needed to guide and clarify possible oral changes.

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Abstract Objective: This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment. Methodology: This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases. Results: Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6th until the 10th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors. Conclusion: It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

COVID-19 pandemic and the impact on dental education: discussing current and future perspectives

Abstract Due to the COVID-19 pandemic crisis, many dental schools and instructors are rethinking the way they teach and interact with students. New perspectives regarding a change in face-to-face activities, social isolation and the reformulation of clinical activities result in a transition toward e-learning and e-teaching processes. In this review, we discuss some favorable aspects and difficulties associated with virtual teaching and learning, searching for available tools and techniques as well as new perspectives.

Condição de Saúde Bucal, Acesso aos Serviços Odontológicos e Avaliação do Cuidado Ofertado a Pacientes Pediátricos Oncológicos em um Hospital de Referência / Oral Health Status, Access to Dental Services and Assessment of Care Offered in Pediatric Oncology Patients in a Referral Hospital

Objetivo: Identificar as condições de saúde bucal, o acesso aos serviços odontológicos e analisar o cuidado em saúde bucal ofertado aos pacientes oncológicos pediátricos assistidos no Hospital Napoleão Laureano, em João Pessoa/PB. Materiais e Métodos: Procedeu-se um estudo transversal, cuja coleta de dados se deu mediante exame clínico, uso de questionário e realização de entrevista. Realizou-se análise descritiva dos dados, em valores absolutos e percentuais, e por meio da análise de conteúdo. Resultados: Dos 61 pacientes que compuseram a amostra, 52,5% eram do sexo masculino e a idade média foi de 9,7 anos. O ceod e CPOD médios foram, respectivamente, 2,8 ±3,3 e 1,7±1,5, verificando-se que 21,3% dos pacientes (n=13) nunca tinham ido ao dentista e o principal motivo de consulta dos demais foram revisões (26,2%, n=16). Para 41% dos pacientes (n=26), o último acesso à consulta odontológica ocorreu em consultório particular e 47,5% dos pacientes (n=29) já haviam recebido orientações sobre escovação dental. Na abordagem qualitativa, houve relatos de dificuldade no acesso físico aos serviços de saúde. Conclusão: Os pacientes oncopediátricos paraibanos apresentaram condição de saúde bucal satisfatória, buscaram a atenção odontológica para revisões, foram orientados quanto à escovação dental, estando eles satisfeitos com o atendimento odontológico ofertado. (AU)

Objective: To identify oral health conditions, access to dental services and analyze the oral health care offered to pediatric oncology patients assisted at the Hospital Napoleão Laureano, João Pessoa / PB. Material and Methods: A cross-sectional study was carried out, whose data collection was through clinical examination, questionnaire use and interviewing. A descriptive analysis of the data was performed, in absolute and percentage values, and through content analysis. Results: Of the 61 patients that composed the sample, 52.5% were male, with a mean age of 9.7 years, and mean of dmft and DMFT verified were 2.8 (± 3.3) and 1.7 (± 1.5), respectively. 21.3% of the patients (n = 13) had never been to the dentist and the main reason for consulting the others were revisions (26.2%, n = 16). 41% of the patients (n = 26) reported that the last dental office to which they had access was private and 47.5% of the patients (n = 29) had already received dental brushing guidelines. In the qualitative approach, there were reports of difficulties in physical access to health services. Conclusion: The pediatric oncology patients studied presented a satisfactory oral health condition, seeking dental care for reviews, were instructed on toothbrushing, being satisfied with the dental care offered. (AU)

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.

Candida on oral cavity of pediatric individuals with ALL and its susceptibility to nystatin and amphotericin B / Candida na cavidade oral de indivíduos pediátricos com LLA e sua susceptibilidade à nistatina e à anfotericina B

ABSTRACT Objective: The aim of this study was to evaluate the prevalence of Candida colonizationon oral cavity of pediatric individuals with acute lymphocytic leukemia (ALL) and its susceptibility/resistance to nystatin and amphotericin B. Methods: This was a cross sectional study with observational, descriptive and analytic approach. Saliva was collected from40 individuals diagnosed with ALL and from40 healthy subjects, as a comparative group, matched by age and gender with ALL group. The mean age for both groups were 8 years-old. The isolation and identification of the Candidaspecies were performed using the CHROMagarCandidaTM and confirmed by polymerase chain reaction. The samples were subjected to antifungal susceptibility by microdilution assay for nystatin and amphotericin B. Salivary alterations and chemotherapy-induced oralmucositis were evaluated using modifiedOral Assessment Guide. Results: The positivity to Candida was higher inALL individuals (32.5%,13/40)than in a comparative group(2.5%, 1/40) (p<0.001). Candida albicans was the most prevalent strain (86.6%). The mucositis was directly associated with positive Candidacolonization (p=0.017) in the ALL group but not related with salivary alterations (p= 0.479). Six strains of C. albicans (54.5%), on ALL group, were resistant to nystatin and all strains were not susceptible to amphotericin B. Conclusion: Candida colonization was associated with ALL condition and with oral mucositis in these individuals. C. albicans was the prevalent strain and most samples were resistant to antifungal agents tested, nystatin and amphotericin B.

RESUMO Objetivo: o objetivo deste estudo foi avaliar a prevalência e colonização de Candida na cavidade oral de indivíduos pediátricos com leucemia linfocítica aguda (LLA) e sua susceptibilidade/resistência à nistatina e à anfotericina B. Métodos: estudo transversal observacional com abordagem descritiva e analítica. A saliva foi coletada de 40 indivíduos diagnosticados com LLA e de 40 indivíduos saudáveis, como grupo comparativo, combinados por idade e sexo com o grupo LLA. A idade média para ambos os grupos foi de 8 anos de idade. O isolamento e a identificação das espécies de Candida foram realizados utilizando o CHROMagarCandidaTM e confirmados pela reação em cadeia da polimerase. As amostras foram submetidas a susceptibilidade antifúngica por meio de ensaio de microdiluição para nistatina e anfotericina B. As alterações salivares e a mucosite oral induzida por quimioterapia foram avaliadas utilizando o Guia de avaliação modificada. Resultados: A positividade para Candida foi superior aos indivíduos in situ (32,5%, 13/40) do que em um grupo comparativo (2,5%, 1/40) (p <0,001). Candida albicans foi a cepa mais prevalente (86,6%). A mucosite foi diretamente associada à colonização positive por Candida (p = 0,017) no grupo LLA, mas não relacionada com alterações salivares (p = 0,479). Seis estirpes de C. albicans (54,5%), no grupo LLA, eram resistentes à nistatina e todas as cepas não eram suscetíveis à anfotericina B. Conclusão: A colonização por Candida foi associada à condição LLA e à mucosite oral nesses indivíduos. C. albicans era a cepa predominante e a maioria das amostras eram resistentes aos agentes antifúngicos testados, nistatina e anfotericina B.

Prevalência de sinais e sintomas de disfunção temporomandibular em estudantes pré-vestibulandos: associação de fatores emocionais, hábitos parafuncionais e impacto na qualidade de vida / Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

Resumo O objetivo deste estudo foi avaliar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM), sua associação com gênero, hábitos parafuncionais, tensão emocional, ansiedade e depressão e, o seu impacto sobre a qualidade de vida relacionada com a saúde oral (QVRSO) em estudantes pré-vestibulandos de instituições públicas e privadas de João Pessoa/PB. A presença de sintomas de DTM foi determinada através de questionário anamnésico, contendo também questões relacionadas à presença de hábitos parafuncionais e tensão emocional. Um protocolo simplificado de avaliação clínica foi aplicado. Ansiedade e depressão foram determinadas através da escala Hospital Anxiety and Depression (HAD) e, a QVRSO avaliada por meio da versão resumida do Oral Health Impact Profile (OHIP-14). Foram realizados testes de Qui-quadrado, Exato de Fisher, Mann Whitney e Kruskal-Wallis. A presença de sinais e sintomas de DTM foi estatisticamente associada ao gênero feminino, hábitos parafuncionais, tensão emocional e ansiedade, e representou maior comprometimento da QVRSO. A elevada prevalência de sinais e sintomas de DTM entre os estudantes pré-vestibulandos sinaliza a necessidade de divulgação e esclarecimento de professores e alunos visando o diagnóstico precoce e a prevenção.

Abstract The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Effects of Zoledronic Acid in Experimental Periapical Lesions in Rats: An Imaging and Histological Analysis

Abstract The aim of this study was to assess the imaging and histological features of experimental periapical lesions, including the adjacent alveolar bone, in rats under zoledronic acid treatment. The study used 40 male Wistar rats distributed into 8 groups of 5 animals each: G1: induction of periapical lesion (PL) and weekly intraperitoneal administration (WIPA) of saline solution (0.9% NaCl) for 4 weeks; G2: PL induction and WIPA of zoledronic acid (0.15 mg/kg/week) for 4 weeks; G3: PL induction and WIPA of saline solution for 8 weeks; G4: PL induction and WIPA of zoledronic acid for 8 weeks; G5:WIPA of saline solution for 4 weeks and subsequent PL induction; G6: WIPA of zoledronic acid for 4 weeks and subsequent PL induction; G7: WIPA of saline solution for 8 weeks and subsequent PL induction; G8: WIPA of zoledronic acid for 8 weeks and subsequent PL induction. The administration of zoledronic acid or saline solution continued after PL induction until the euthanasia. Thus, cone beam computed tomography and histological analysis were performed. Statistical analyzes were performed by ANOVA and Kruskal-Wallis test. Groups treated with zoledronic acid showed significantly smaller size of PL than the groups treated with 0.9% NaCl (p<0.05). PLs were formed by chronic inflammation ranging from mild to moderate, with no difference between groups. In all specimens, no mandibular necrosis was observed. In conclusion, the presence of PLs apparently does not represent an important risk factor for the development of bisphosphonate-related osteonecrosis of the jaws.

Resumo O objetivo deste estudo foi avaliar as características histológicas e de imagem de lesões periapicais experimentais, incluindo o osso alveolar adjacente, em ratos sob tratamento com ácido zoledrônico. O estudo utilizou 40 ratos Wistar, machos, distribuídos em 8 grupos de animais cada: G1: indução de lesão periapical (LP) e administração intraperitoneal semanal (AIS) de solução salina (NaCl 0.9%) por 4 semanas; G2: indução de LP e AIS de ácido zoledrônico (0,15 mg/kg/week) por 4 semanas; G3: indução de LP e AIS de solução salina por 8 semanas; G4: indução de LP e AIS de ácido zoledrônico por 8 semanas; G5- AIS de solução salina por 4 semanas e subsequente indução de LP; G6- AIS de ácido zoledrônico por 4 semanas e subsequente indução de LP; G7: AIS de solução salina por 8 semanas e subsequente indução de LP; G8: AIS de ácido zoledrônico por 8 semanas e subsequente indução de LP. A administração de ácido zoledrônico ou solução salina continuou após indução de LP até a eutanásia. Após isso, tomografia computadorizada de feixe cônico e análise histológica foram realizadas. Análises estatísticas foram realizadas por ANOVA e teste de Kruskal-Wallis. Os grupos tratados com ácido zoledrônico mostraram LPs significativamente menores que os grupos tratados com NaCl 0.9% (p <0.05). LPs eram formadas por inflamação crônica variando de leve a moderada, sem diferença entre os grupos. Em todos os espécimes, necrose mandibular não foi observada. Em conclusão, a presença de LPs aparentemente não representa um fator de risco importante para o desenvolvimento de osteonecrose relacionada ao uso de bisfosfonatos.

Synovial sarcoma: case report / Sarcoma sinovial: relato de caso

ABSTRACT Introduction: Synovial sarcomas are rare and aggressive neoplasms located in the head and neck region and usually occurs in young adults. Presentation of case: This report presents a case of synovial sarcoma in a 15-year-old male patient who sought medical treatment for painful symptoms and associated dysphagia. The lesion was nodular, extensive, localized in the parotid region, and extended to the left cervical region. The patient was treated in a referral hospital with a treatment protocol that initially included chemotherapy for six months and surgery to attempt to excise the lesion, but the surgery was ineffective because removal could have damaged important vital structures. The Computed Tomography scan showed a hypodense area with diffuse growth and no involvement of the facial bones and the histopathological analysis revealed pleomorphic and oval spindle cells with rounded epithelial cells that formed nests surrounded by fibrous tissue. The Immunohistochemistry analysis was conclusive for the diagnosis of a high-grade SS in the parotid and left cervical regions. The medical team opted for palliative treatment with cervical radiotherapy. The patient remained hospitalized for four months after the surgery and died after 15 months since the diagnosis for compromise of airway by fast tumor growth. Conclusion: The synovial sarcoma, when diagnosed late may reduce the survival of patients because of the complications that tumor growth can bring to the prognosis and quality of life.

RESUMO Sarcomas sinoviais são neoplasias raras e agressivas, localizadas na região da cabeça e pescoço e geralmente ocorrem em adultos jovens. Relato do caso: este relato apresenta um caso de sarcoma sinovial em um paciente de 15 anos que procurou tratamento médico para sintomas dolorosos e associados à disfagia. A lesão era nodular, extensa, localizada na região da parótida e estendida à região cervical esquerda. O paciente foi tratado em um hospital de referência com um protocolo de tratamento que inicialmente incluiu quimioterapia por seis meses e cirurgia para tentar excisar a lesão, mas a cirurgia foi ineficaz porque a total remoção do tumor poderia comprometer estruturas vitais importantes. A tomografia computadorizada mostrou uma área hipodensa com crescimento difuso, sem envolvimento dos ossos faciais, e a análise histopatológica revelou células fusiformes pleomórficas e ovais, com células epiteliais arredondadas formando ninhos rodeados por tecido fibroso. A análise imunohistoquímica foi conclusiva para o diagnóstico de um sarcoma sinovial de alto grau na região cervical parotídea esquerda. A equipe médica optou pelo tratamento paliativo com radioterapia cervical. O paciente permaneceu hospitalizado por quatro meses após a cirurgia e faleceu 15 meses após o diagnóstico, devido à obstrução das vias aéreas pelo rápido crescimento tumoral residual. O sarcoma sinovial, quando diagnosticado tardiamente pode reduzir a sobrevida dos pacientes por causa de complicações que o crescimento do tumor pode trazer para o prognóstico e qualidade de vida.

Temporomandibular disorders and oral habits in high-school adolescents: a public health issue? / Disfunção temporomandibular e sua relação com hábitos parafuncionais em adolescentes estudantes do ensino médio: um problema de saúde pública?

ABSTRACT Objective: Determine the prevalence of signs and symptoms of temporomandibular disorder (TMD) and its relationship with parafunctional habits in a sample of adolescents. Methods: The sample consisted of 129 high school students, between 16 and 19 years old in public schools. Data were collected through: a questionnaire about parafunctional habits and TMD symptoms, the Fonseca's index (DMF) and a summarized protocol of clinical evaluation of the TMD signals. These data were analyzed in a descriptive way, using statistical analysis by Chi-square test (x2) and Fisher's Exact test. Results: 84.5% of individuals showed a degree of auto-reported dysfunction. The most frequent parafunctional habit was chewing gum (65.9%) while the habit of biting objects was significantly associated with the presence of TMD symptoms (p = 0.042). There was a statistically significant association between TMD symptoms with variables such as gender (p = 0.032) habits (p = 0.014) and emotional stress (p <0.01), besides the association between the need of treatment and gender (p = 0.002) and stress (p <0.01). In addition, there was an association between muscle tenderness, unilateral mastication (p = 0.045) and chewing ice / lollipop (p = 0.04). Conclusion: It was concluded that there was not only a high incidence of signs and symptoms of temporomandibular dysfunction and parafunctional habits in high school students, but also an association among them, becoming necessary to establish public policies of prevention and access to treatment for these problems for that specific age group.

RESUMO Objetivo: Verificar a prevalência de sinais e sintomas de disfunção temporomandibular e sua relação com hábitos parafuncionais em uma amostra de adolescentes. Métodos: A amostra foi constituída de 129 estudantes, de 16 a 19 anos de escolas públicas de ensino médio. Os dados foram coletados por meio de: um questionário sobre os hábitos parafuncionais e sintomas de disfunção temporomandibular, o Índice anamnésico DMF de Fonseca e um protocolo resumido de avaliação clínica de disfunção temporomandibular. Os dados foram analisados de forma descritiva, com a análise estatística realizada pelo Teste Qui-quadrado (x2) e Exato de Fisher. Resultados: Houve prevalência de 84,5% de indivíduos com algum grau de disfunção temporomandibular. O hábito parafuncional mais frequente foi o de mascar chicletes (65,9%) e o hábito de morder objetos teve associação significativa com a presença de disfunção temporomandibular (p=0,042) Houve associação estatisticamente significante entre sexo e disfunção temporomandibular (p=0,032), disfunção temporomandibular e hábitos (p=0,014), disfunção temporomandibular e tensão emocional (p<0,01) e tensão e necessidade de tratamento (p<0,01). Além disso, houve associação entre sensibilidade muscular e mastigação unilateral (p=0,045) e mastigação de gelo/pirulitos (p=0,04). Conclusão: Conclui-se que nos adolescentes do ensino médio houve alta prevalência de disfunção temporomandibular e hábitos parafuncionais, bem como a associação entre os dois, sendo necessário o estabelecimento de políticas públicas de prevenção e acesso a tratamento para esse problema e grupo etário específico.

Prevalence of Dentinal Defects after Root Canal Preparations in Molars with Reciproc and WaveOne Systems

Objective: To evaluate the prevalence of dentin defects, including partial and complete cracks and fractures, after root canal preparation in molars with Reciproc and WaveOne reciprocating instruments. Material and Methods: Fifty mandibular first and second molars with mature apices were selected to endodontic in vitro instrumentation. Ten teeth were unprepared and served as the control, and the remaining forty teeth were divided into two groups, being twenty corresponding to each reciprocating system. Reciproc and WaveOne systems were used in a reciprocating working motion, under the same conditions, to prepare the two mesial canals. Roots were then sectioned 2, 4 and 6 mm from the apex, and the cut surface was observed under a microscope using 20-fold magnification and checked for the presence of fractures and incomplete cracks. Results: none of the evaluated groups presented fractures, and the control group showed no incomplete cracks. Overall evaluation showed statistical differences between these two groups and the control group (p=0.017) for the prevalence of incomplete cracks, but no significant differences were obtained between Reciproc and WaveOne groups (p>0.05). Reciproc group presented more incomplete cracks on 4-mm sections compared with the control group on the same section (p=0.0326). Conclusion: Root canal preparation with both reciprocating instruments resulted in incomplete cracks, but not fractures. At the level of 4 mm from the apex of the canals, the Reciproc system produced significantly more incomplete cracks. Considering both systems, WaveOne utilization resulted in lesser structural alterations on dentin considering the middle portion of the roots.

Treatment of severe oral mucositis in a pediatric patient undergoing chemotherapy / Protocolo de tratamento da mucosite oral grave durante o tratamento quimioterápico em paciente pediátrico

This article reports the resolution of a case of severe oral mucositis and the treatment protocol that promoted complete remission of the lesions. A male 13-year-old patient with chondroblastic osteosarcoma in the left distal thigh and acute lymphoblastic leukemia undergoing cancer treatment with methotrexate presented with severe oral mucositis. The treatment protocol included the use of 10ml of a mucositis mouthwash and low-level laser therapy. The lesions remitted after five days of gargling with the mucositis mouthwash and two sessions of low-level laser therapy on the lesions. The use of a treatment protocol consisting of a mucositis solution associated with low-level laser therapy effectively resolved a case of severe chemotherapy-induced oral mucositis. The monitoring and treatment of oral mucositis lesions in children and adolescents undergoing chemotherapy are necessary to prevent the patient from suffering from induced comorbidities.

Esse artigo relata a resolução de um caso de mucosite oral grave e do protocolo de tratamento utilizado para a completa remissão das lesões. Paciente do sexo masculino, 13 anos, portador de osteossarcoma condroblástico na coxa esquerda distal e leucemia linfoblástica aguda apresentou um quadro de mucosite oral grave, encontrando-se sob tratamento antineoplásico fazendo uso de metotrexato. Adotou-se um protocolo de tratamento que incluiu a utilização diária de bochecho com 10ml de uma solução para mucosite e a aplicação de laser de baixa potência. A remissão das lesões de deu após 5 dias de utilização dos bochechos com a solução para mucosite e 2 sessões de irradiação das lesões com laser. A adoção do protocolo de tratamento com uma solução para mucosite associada à aplicação de laser de baixa potência se mostrou efetiva na resolução da mucosite oral grave decorrente da terapêutica antineoplásica. Faz-se necessário o monitoramento e tratamento de lesões por mucosite oral em crianças e adolescentes sob tratamento oncológico com quimioterápicos, a fim de que os pacientes não venham a sofrer em decorrência das comorbidades que são geradas.

Dirofilariasis involving the oral cavity: report of the first case from South America

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

Agreement between rapd, api20c aux, chromagar candida and microculture on oral candida identification

Aim: To measure the agreement of methods for identification of Candida species in oral cavity samples, comparing the CHROMagar Candida, microculture, API 20C AUX and RAPD techniques. Methods: Ninety-one colonies of Candida were isolated and presumptively identified in CHROMagar Candida, submitted to microculture, API 20C AUX and RAPD techniques. After this, agreement among methods using Kappa test was performed. Results: Agreement rates between RAPD and CHROMagar Candida, showed significant accuracy for C. albicans, C. tropicalis, C. dubliniensis and C. krusei (Kappa: 0.760, 0.640, 0.416 and 0.360, respectively, p<0.05). Comparing RAPD results with microculture, the highest agreement was for C. albicans (Kappa: 0.851 - p<0.05) but no significant agreement for C. lusitaniae, C. krusei and C. guilliermondii was obtained (p>0.05). The agreement was significant for all identified species when RAPD (OPE-18) and API 20C AUX (p<0.05) were used. Critical levels of agreement between RAPD and microculture were observed when C. lusitaniae, C. krusei and C. guilliermondii were identified.