Miel en el manejo de la mucositis inducida por quimioterapia y radioterapia en niños / Honey in the management of mucositis induced by chemotherapy and radiotherapy in children

La mucositis es una respuesta inflamatoria del epitelio de la mucosa a los efectos citotóxicos de la quimioterapia y la radioterapia, que causan dolor y ulceración oral severa. En los estudios de los últimos años se ha propuesto el uso de la miel en el manejo de la mucositis oral inducida por quimioterapia y radioterapia en pacientes pediátricos. La miel reduce la severidad y duración de la mucositis, reduce el dolor y es un producto agradable a los niños. Por tanto, podría ser un producto eficaz tanto en la profilaxis como en el tratamiento de la mucositis oral. Sin embargo, la pequeña cantidad de investigaciones realizadas en humanos no es suficiente para establecer recomendaciones generalizadas. Por ello, se debe aumentar las investigaciones en este campo. Con ello se podrá examinar la eficacia y posibles complicaciones a corto y largo plazo, explorar su posible efecto sinérgico con otras terapias, analizar su rentabilidad económica y el tipo de miel más adecuado. De esta forma, los profesionales sanitarios podrán ofrecer a los pacientes pediátricos los mejores cuidados basados en las últimas evidencias científicas demostradas.

Mucositis is an inflammatory response of the mucosal epithelium to the cytotoxic effects of chemotherapy and radiation therapy, causing pain and severe oral ulceration. In the studies of recent years, the use of honey has been proposed in the management of oral mucositis induced by chemotherapy and radiotherapy in pediatric patients. Honey reduces the severity and duration of mucositis, reduces pain and is a child-friendly product. Therefore, it could be an effective product both in the prophylaxis and in the treatment of oral mucositis. However, the small amount of human research is not enough to establish widespread recommendations. Therefore, research in this field should be increased. With this, it will be possible to examine the efficacy and possible complications in the short and long term, explore its possible synergistic effect with other therapies, analyze its economic profitability and the most appropriate type of honey. In this way, healthcare professionals will be able to offer pediatric patients the best care based on the latest scientific evidence.

Diagnóstico, etiologia e tratamento das doenças peri-implantares / Diagnosis, etiology, and treatment of peri-implant diseases

Sendo a mucosite e a peri-implantite as lesões mais recorrentes ao redor de implantes, e cada vez mais frequentes no consultório odontológico, faz-se necessária uma compreensão abrangente sobre seus principais fatores etiológicos, métodos de prevenção e modalidades de tratamento para uma correta conduta clínica. A presente revisão da literatura visa, de forma clara e sintetizada, identificar e ressaltar as principais causas de mucosite e peri-implantite descritas na literatura, orientar o cirurgião-dentista na obtenção do diagnóstico, informar o leitor sobre as principais modalidades de tratamento e destacar a importância da terapia de suporte para a manutenção da saúde peri-implantar. A busca eletrônica nas bases de dados Scopus, PubMed e Web of Science foi orientada pelos seguintes tópicos: definição de mucosite e peri-implantite, prevalência, obtenção do diagnóstico, fatores de risco, modalidades de tratamento e terapia de suporte. Os resultados da busca indicaram: 1) a mucosite peri-implantar pode ocorrer em 80% dos indivíduos, e a peri-implantite em até 56%; 2) não há uma única ferramenta para o diagnóstico das doenças peri-implantares, mas sim uma associação destas; 3) a etiologia da peri-implantite parece ser multifatorial, e alguns indivíduos parecem ser mais propensos ao seu desenvolvimento do que outros; 4) a mucosite pode se resolver apenas com a remoção e desinfecção não cirúrgica dos fatores locais, enquanto que na peri-implantite a terapia cirúrgica é adotada quando os sítios afetados não respondem à terapia básica; e 5) a terapia de suporte é imprescindível na determinação do sucesso a longo prazo no tratamento das doenças peri-implantares.

As the mucositis and peri-implantitis are the most recurrent lesions around implants and these increasingly frequent in the dental office, a comprehensive understanding of its main etiological factors, prevention methods and treatment modalities is necessary for proper clinic conduct. This literature review aims, in a clearly and synthesized form, identify and highlight the main causes of mucositis and peri-implantitis described in the literature, guide the dentist in getting the diagnosis, inform the reader about the main types of treatment and highlight the importance of supportive therapy for maintenance of the peri-implant health. The electronic search in Scopus databases, PubMed and Web of Science was guided by the following topics: definition of mucositis and peri-implantitis, prevalence, diagnosis, risk factors, treatment modalities and supportive therapy. The search results indicated that: 1) peri-implant mucositis can occur in 80% of individuals, peri-implantitis up to 56%; 2) there isn't a unique tool for the diagnosis of peri-implant disease, but a association of tools; 3) etiology of peri-implantitis appears to be multifactorial, and some individuals appear to be more prone to their development than others; 4) mucositis can be solved only with the non-surgical removal and disinfection of factors, while in peri-implantitis surgical therapy is used where the affected sites do not respond to primary therapy; and 5) supportive therapy is essential in determining the long-term success in the treatment of peri-implant diseases.

Gel de própolis mucoadesivo versus solução de cloridrato de benzidamina na prevenção da mucosite oral em pacientes irradiados em região de cabeça e pescoço. Ensaio clinico, cego, randomizado: fase II / Propolis mucoadhesive gel versus Benzydamine Hydrochloride Solution to Prevention of Oral Mucositis in Patients Irradiated in Head and Neck Region. A phase II study randomized and blind

Os efeitos colaterais mais conhecidos em cavidade bucal, durante a radioterapia para o tratamento de câncer em região da cabeça e pescoço, são a mucosite e a candidose. Essas alterações são potencializadas pela hipossalivação em decorrência de alterações nas glândulas salivares. Existem diversos protocolos para o controle da mucosite, hipossalivação e candidose bucais nesses pacientes, entretanto, nenhum deles é totalmente eficaz. A Própolis possui atividade analgésica, anti-inflamatória, antifúngica e cicatrizante. Essas características farmacológicas conferem à Própolis um grande potencial para prevenir as alterações na cavidade bucal dos pacientes que serão submetidos à radioterapia. O objetivo deste trabalho foi avaliar a efetividade do Gel contendo Própolis na prevenção da mucosite e candidose em comparação com o cloridrato de benzidamina. Vinte e seis pacientes foram incluídos no estudo. Os pacientes foram aleatorizados em dois grupos, sendo que o grupo 1 usou o cloridrato de benzidamina e o grupo 2 o gel de Própolis. Tanto os pacientes do grupo 1 , como os pacientes do grupo 2 usaram os produtos 3 (três) vezes ao dia, durante todo o período da radioterapia e duas semanas após o término do tratamento e todos foram avaliados semanalmente. Os resultados obtidos mostraram que 84,6% dos pacientes eram do sexomasculino e que 19,2% dos pacientes mantinham o hábito de fumar e consumir bebidas alcoólicas. A dose média de radioterapia foi 6466,1 Gys. Após a análise final dos dados, observou-se que o Gel de Própolis apresentou melhor efetividade na prevenção da mucosite, a partir da 17a sessão de radioterapia, quando comparado ao grupo cloridrato de benzidamina. Setenta e oito por cento (78,6%) dos pacientes avaliaram o produto como bom, enquanto 85,7% o indicariam para pacientes com a mesma condição. O estudo mostrou que o controle da inflamação na mucosa bucal pelo Gel contendo Própolis foi melhor...

The best known side effects in the oral cavity during radiotherapy for the treatment of cancer in the head and neck, are mucositis and candidiasis. These changes are enhanced by hyposalivation due to changes in the salivary glands. There are many protocols for the control of mucositis, hyposalivation, and oral candidiasis in these patients however, none iscompletely effective. Propolis has analgesic, anti-inflammatory, antifungal and healing activity. These pharmacological characteristics give propolis great potential to prevent changes in the oral cavity of patients undergoing radiotherapy. The aim of this study was to evaluate the effectiveness of the gel containing propolis in preventing mucositis and candidiasis compared with benzydamine hydrochloride. Twenty-six patients were included in this study. Patients were divided into two groups with group 1 used the benzydamine hydrochloride and group 2 gel propolis. Both group used the products three times a day during the whole period of radiotherapy and two weeks after the end of treatment and all patients were evaluated weekly...

Laser phototherapy as a treatment for radiotherapy-induced oral mucositis

Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with λ660 nm, 40 mW, ∅=4 mm², in contact mode, 5 x 2.4 J/cm² per point, 14.4 J/cm² per session. For treating the lesion on the patient's nasal mucosa, LPT (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² per point, 6.3 J/cm² per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm²) with the λ660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks. Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.

A mucosite oral é um efeito colateral prejudicial da radioterapia na região de cabeça e pescoço. Existem estudos que evidenciam o efeito benéfico do uso da luz laser no tratamento da mucosite oral. O objetivo deste caso clínico foi o de avaliar a eficácia da fototerapia laser no tratamento da mucosite oral em um paciente sendo submetido a radioterapia, após a remoção cirúrgica de um carcinoma escamocelular, com invasão óssea da maxila. As lesões do palato e das comissuras labiais foram tratadas com λ660 nm, 40 mW, ∅=4 mm², em contato, 5 x 2.4 J/cm² por ponto, 14.4 J/cm² por sessão. Na lesão existente na mucosa nasal a fototerapia laser (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² por ponto, 6.3 J/cm² por sessão, em contato) foi utilizada na área externa do nariz. Uma dose única (2.4 J/cm²) com o laser λ660 nm e os parâmetros descritos anteriormente foi aplicado na entrada de cada narina. A fototerapia laser foi utilizada 3 vezes por semana, durante 4 semanas. Os resultados do tratamento são indicativos de que o uso da fototerapia laser em mucosite oral foi efetiva e permitiu ao paciente continuar o tratamento radioterápico sem interrupções. Entretanto, estudos clínicos controlados são necessários para se estabelecer os protocolos, para tratamento e prevenção da mucosite oral, utilizando fototerapia laser.

[Effect of local hypothermia in prevention or reduction of chemotherapy induced mucositis signs]

Oral mucositis frequently occurs in patients undergoing cancer chemotherapy. It is hypothesized that Oral Cooling with ice chips or cubes cause local vasoconstriction thus cause less exposure to agents and then mucositis development. In this study, this theory was examined on 14 patients in 3 consecutive cycles in which stomatitis developed in the 1 st cycle of treatment. The purpose of the present study was to evaluate the Ice-Therapy [mouth-cooling] in prevention or decreasing symptoms of chemotherapeutic-related stomatitis. Date was obtained on a total of 100 out-patients initiating chemotherapy regimens. The patients reported different rates of stomatitis received ice cubes in their 2nd cycle of treatment during the drug infusion and a few minutes after it. In the next cycle, the same patients were evaluated without mouth cooling. The severity of mucositis were measured based on the patient's judgment and scaled on WHO grading system in the 7th and 10th days. Statistically, comparison of severity rates of mucositis between 3 consecutive cycles were performed by mean, p value, GAMMA coefficient and Friedman test. Statistical approach of data between 3 cycles determined that severity rates of mucositis have been decreased significantly between 1st and 2nd cycles[p<0.01, gamma coefficient: 65%] But this relationship has not been obtained in comparison between 2nd and 3rd cycles so it has been speculated that Oral Cooling has no useful effect on the prevention of chemotherapy-induced mucositis. Oral Cooling has no evidence of benefit in improvement or decreasing of the chemotherapy induced lesions

Low energy laser for prevention of oral mucositis in patients receiving radiotherapy and/or chemotherapy in Pernambuco Cancer Hospital

Oral mucositis induced by antineoplastic therapy causes wide-range pain and discomfort resulting in decreased quality of life. The present study evaluated the benefits of low intensity laser and 0.12% chlorhexidine gluconate in the prevention of oral mucositis induced by radiation, associated or not with chemotherapy, and considered degrees/severity, time of appearanceof the lesions and functional loss. Eighty-four outpatients were considered and 49 were included in this study and dividedinto two groups: Group 1 received laser treatments in three stages, starting three days before treatment until the end of therapy. Group 2 was instructed to do daily mouth rinses with chlorhexidine gluconate. The prevalence of clinical mucositis was 49%, and of functional mucositis, 28.6%, when the two groups were considered together. This percentage was smaller in the laser group, 44% for the clinical mucositis group and 24% for the functional. The two protocols were well tolerated andshowed benefits, mainly from the point of view of functionality, and delayed the onset and development of mucositis.