Head and neck cancer therapy-related oral manifestation management in the COVID-19 pandemic: a critical review

Abstract With the onset of the new coronavirus disease (COVID-19) pandemic, the dental treatment of patients at risk of infection has become quite challenging. In view of this, patients with head and neck cancer may present with oral complications due to anticancer therapy, making dental assistance necessary. Thus, the objective of the study was to review the literature and critically discuss important concerns about the treatment of patients with head and neck cancer during the COVID-19 pandemic. Because dental professionals are in close contact with the main viral transmission routes, this study presents recommendations for management and protection during clinical dental care. The main characteristics and transmission routes of COVID-19 are also discussed. Dental professionals should control pain and the side effects of antineoplastic treatment and use preventive measures for infection control. During this pandemic, patients with head and neck cancer should not undergo elective procedures, even if they do not have symptoms or a history of COVID-19; therefore, in asymptomatic or painless cases, only preventive actions are recommended. In symptomatic or painful cases, precautions for safe interventional treatments must be implemented by following the hygiene measures recommended by health agencies and using personal protective equipment. During health crises, new protocols emerge for cancer treatment, and professionals must act with greater attention toward biosafety and updated knowledge. It is important to offer adequate individualized treatment based on the recommendations of preventative and interventional treatments so that patients can face this difficult period with optimized quality of life.

Effect of fluoride application during radiotherapy on enamel demineralization

Abstract Radiation-related caries are one the most undesired reactions manifested during or after head and neck radiotherapy. Fluoride application is an important strategy to reduce demineralization and enhance remineralizaton. Objective: To evaluate the effect of the topical application of fluoride during irradiation on dental enamel demineralization. Material and Methods: Thirty molars were randomly divided into three groups: Non-irradiated (NI), Irradiated (I), Irradiated with fluoride (IF). Each group was subdivided according to the presence or absence of pH-cycling (n=5). In the irradiated groups, the teeth received 70 Gy. The enamel's chemical composition was measured using Fourier Transform Infrared Spectrometry (organic matrix/mineral ratio - M/M and relative carbonate content - RCC). Vickers microhardness (VHN) and elastic modulus (E) were evaluated at three depths (surface, middle and deep enamel). Scanning electron microscopy (SEM) was used to assess the enamel's morphology. Results: The FTIR analysis (M/M and RCC) showed significant differences for irradiation, pH-cycling and the interaction between factors (p<0.001). Without pH-cycling, IF had the lowest organic matrix/mineral ratio and relative carbonate content. With pH-cycling, the organic matrix/mineral ratio increased and the relative carbonate content decreased, except for IF. VHN was influenced only by pH-cycling (p<0.001), which generated higher VHN values. ANOVA detected significant differences in E for irradiation (p<0.001), pH-cycling (p<0.001) and for the interaction between irradiation and pH-cycling (p<0.001). Increased E was found for group I without pH-cycling. With pH-cycling, groups I and IF were similar, and showed higher values than NI. The SEM images showed no morphological changes without pH-cycling. With pH-cycling, fluoride helped to maintain the outer enamel's morphology. Conclusions: Fluoride reduced mineral loss and maintained the outer morphology of irradiated and cycled enamel. However, it was not as effective in preserving the mechanical properties of enamel. Radiotherapy altered the enamel's elastic modulus and its chemical composition.

Degree of conversion and bond strength of resin-cements to feldspathic ceramic using different curing modes

Abstract Resin cements have led to great advances in dental ceramic restoration techniques because of their ability to bond to both dental structures and restorative materials. Objective The aim of this study was to assess the performance of resin cements when different curing modes are used, by evaluating the degree of conversion and bond strength to a ceramic substrate. Material and Methods Three resin cements were evaluated, two dual-cured (Variolink II and RelyX ARC) and one light-cured (Variolink Veneer). The dual-cured resin cements were tested by using the dual activation mode (base and catalyst) and light-activation mode (base paste only). For degree of conversion (DC) (n=5), a 1.0 mm thick feldspathic ceramic disc was placed over the resin cement specimens and the set was light activated with a QTH unit. After 24 h storage, the DC was measured with Fourier transform infrared spectroscopy (FTIR). For microshear bond strength testing, five feldspathic ceramic discs were submitted to surface treatment, and three cylindrical resin cement specimens were bonded to each ceramic surface according to the experimental groups. After 24 h, microshear bond testing was performed at 0.5 mm/min crosshead speed until the failure. Data were submitted to one-way ANOVA followed by Tukey test (p<0.05). Scanning electron microscopy (SEM) was used for classifying the failure modes. Results Higher DC and bond strength values were shown by the resin cements cured by using the dual activation mode. The Variolink II group presented higher DC and bond strength values when using light-activation only when compared with the Variolink Veneer group. Conclusion The base paste of dual-cured resin cements in light-activation mode can be used for bonding translucent ceramic restorations of up to or less than 1.0 mm thick.

Degree of Conversion and Mechanical Properties of Resin Cements Cured Through Different All-Ceramic Systems

Abstract: The aim of this study was to verify the degree of conversion (DC), Vickers microhardness (VH) and elastic modulus (E) of resin cements cured through different ceramic systems. One 1.5-mm-thick disc of each ceramic system (feldspathic, lithium dissilicate and zircônia veneered with feldspathic) was used. Three dual-cured (Allcem, Variolink II and RelyX U200) and one chemically-cured (Multilink) resin cements were activated through ceramic discs. For dual-cured resin cements was used a conventional halogen light-curing unit (Optilux 501 at 650 mW/cm2 for 120 s). Samples cured without the ceramic disc were used as control. The samples were stored at 37 °C for 24 h. ATR/FTIR spectrometry was used to evaluate the extent of polymerization in the samples (n=5). Micromechanical properties - VH and E - of the resin cements (n=5) were measured with a dynamic indentation test. Data were statistically analyzed with two-way ANOVA, Tukey's test and Pearson's correlation (α=0.05). DC was affected only by the type of resin cement (p=0.001). For VH, significant interaction was detected between resin cement and ceramic (p=0.045). The dual-cured resin cements showed no significant differences in mean values for E and significantly higher values than the chemically-cured resin cement. The degree of conversion and the mechanical properties of the evaluated resin cements depend on their activation mode and the type of ceramics used in 1.5 mm thickness. The dual-cured resin cements performed better than the chemically-cured resin cement in all studied properties.

Resumo: O objetivo deste estudo foi mensurar grau de conversão (GC), microdureza Vickers (VH) e módulo de elasticidade (E) de cimentos resinosos polimerizados através de diferentes sistemas cerâmicos. Um disco de 1,5 mm de espessura de cada sistema cerâmico (cerâmica feldspática, dissilicato de lítio e zircônia coberto por cerâmica feldspática) foi utilizado. Três cimentos resinosos duais (Allcem, Variolink II e RelyX U200) e um cimento resinoso quimicamente ativado (Multilink) foram ativados através dos discos de cerâmica. Para os cimentos resinosos duais foi utilizado um aparelho de lâmpada halógena (Optilux 501 a 650 mW/cm2 por 120 s). Amostras polimerizadas sem a interposição do disco de cerâmica foram utilizadas como controle. As amostras foram armazenadas a 37 °C durante 24 h. ATR/FTIR foi utilizado para avaliar a extensão da polimerização nas amostras (n=5). Propriedades micromecânicas - VH e E - dos cimentos resinosos (n=5) foram medidas com um teste dinâmico de indentação. Os dados foram analisados através de análise de variância a dois fatores, teste de Tukey e correlação de Pearson (α=0,05). O GC foi afetado somente pelo tipo de cimento resinoso (p=0,001). Para VH, houve interação entre o tipo de cimento resinoso e o tipo de cerâmica (p=0,045). Os cimentos resinosos duais não apresentaram diferenças significativas nos valores médios de E e valores significativamente maiores que o cimento resinoso quimicamente ativado. O grau de conversão e as propriedades mecânicas dos cimentos resinosos avaliados dependem do seu modo de ativação e do tipo de cerâmica usada na espessura de 1,5 mm. Os cimentos resinosos duais desempenharam melhor que o cimento resinoso quimicamente ativado em todas as propriedades estudadas.