A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol.

OBJECTIVE: To evaluate the occurrence and severity of oral complications, number of radiotherapy (RT) interruptions and quality of life (QoL) in a population of head and neck cancer patients receiving a preventive oral care program (POCP) and photobiomodulation therapy (PBMT). METHODS: Prospective cohort of 61 head and neck cancer patients undergoing radiochemotherapy were monitored and submitted to a POCP that included oral hygiene and plaque control, removal of infection foci, dental restorations, periodontal therapy, fluorotherapy, oral hydration, and denture removal at night, combined with daily PBMT. Outcomes included occurrence of adverse effects such as severity of oral mucositis (OM) and oral symptoms (pain, solid and fluid dysphagia, odynophagia, dysgeusia), quality of life impacts, and interruptions of radiotherapy (RT) due to symptoms. Disease-free and overall survival rates were evaluated. RESULTS: There was a significant improvement in oral health conditions between initial assessment and the two longitudinal assessments (p < 0.05), which indicates that the POCP was effective for plaque control and reduction of gingival inflammation. All participants were free of OM at the beginning of the RT regimen and only 45.9% after the 7th session, and few patients ranked the highest score of OM. For all symptoms related to OM, there was a progressive increase of severity until the 14th RT session, which remained stable until the completion of the RT regimen. The same effect was observed for the quality of life measures. Discontinued RT due to OM occurred in only three patients (5%), and the maximum duration was 10 days. The overall survival rate was 77% and disease-free survival was 73.8%. Lower survival time was observed for patients with no response to RT (p < 0.01). CONCLUSIONS: The findings of this study suggest a positive effect of an oral preventive care program for head and neck cancer patients submitted to RT. The PBMT associated with a rigorous POCP resulted in satisfactory control of oral adverse effects, reduction of quality of life impacts, and interruption of RT regimen due to severe OM.

[Perception of adverse reactions of chemotherapy and hormone therapy by women treated for breast cancer]. / Perception des effets indésirables de la chimiothérapie et de l'hormonothérapie par les femmes prises en charge pour un cancer du sein.

INTRODUCTION: In Europe, breast cancer is the most common cancer among women. His treatment (TTT) can have a significant impact on daily life. AIMS: Explore the experienced short-term side effects (SE) of chemotherapy and hormonal therapy by women themselves, the information delivered and the place of the general practitioner (GP). METHOD: Qualitative study by individual interview, conducted from January to May 2015, with 14 women followed for no metastatic breast cancer after chemotherapy and possible initiation of hormone therapy, at the Cancer Institute of the Loire (France). RESULTS: The SE of chemotherapy, except vomiting, have appeared very trying (fatigue, pains oral and cutaneous involvement), punctuated and accentuated by the cures. They were resounding on daily life, requiring family or professional assistance. Falling dander, considered stigmatizing, violated the person and femininity. The women have estimated to be well informed. They had appreciated the initial response of the pivot nurse. The least expected SE of hormone therapy, hot flashes and articular pains might limit activities. To counteract these side effects, mostly accepted to prevent recidivism, a remedy for complementary therapies was frequent. The GP was solicited for some SE, sometimes for complementary medicine (CM). CONCLUSION: Over the cures, women suggested support meetings, a more sustainable action of the pivot nurse, a better attention to their complaints and a more personalized information. The development of TTT less EI provider was desired. The effect of CM on SE should be explored.

Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy.

The aim of this study was to assess the effect of low level laser therapy on reducing the occurrence and severity of oral complications in patients with head and neck cancer undergoing radiotherapy. Sixty head and neck cancer outpatients from a cancer hospital receiving radiotherapy were selected and randomly assigned into two groups. The laser group was irradiated with an InGaAlP laser and the control received sham laser. The assessment of complications (oral mucositis, pain) was carried out one week after starting radiotherapy, and at the fifteenth and thirtieth sessions of radiotherapy. All patients from both groups showed some degree of oral mucositis. Better outcomes were observed in the laser group when compared with the control in the follow-up sessions, indicating lower degrees of oral mucositis, pain and higher salivary flow (p < .05). These findings support the use of laser therapy as an adjuvant treatment for the control of oral complications.

Healing acceleration in hamsters of oral mucositis induced by 5-fluorouracil with topical Calendula officinalis.

OBJECTIVE: This study assessed the potential of topical Calendula officinalis extract on the healing of oral mucositis induced by 5-fluorouracil (5-FU) in hamsters. STUDY DESIGN: Oral mucositis was induced in 60 male hamsters by 5-FU (60 mg/kg) on days 0, 5, and 10 of the study. The cheek pouch was scratched with a sterile needle on days 1 and 2. On days 12-17, 5% and 10% C. officinalis gel and gel base groups were treated and then compared with a control group. Macroscopic and microscopic scores and weights were evaluated. RESULTS: Microscopic and macroscopic scores of mucositis were lower in the 5% and 10% C. officinalis gel groups than in the gel base and control groups (P < .05). Weight gain was noted in the treatment groups compared with the gel base and control groups (P < .05). CONCLUSIONS: Calendula officinalis extract accelerated the healing of oral mucositis in hamsters.

Prevention and management of oral complications ofhead and neck cancer treatment / Prevenção e administração das complicações bucais do tratamentooncológico de cabeça e pescoço

Introduction: Radiotherapy (RT) and chemotherapy (CT) are therapeutic methods widely used in patients with malignancies in the head and neck regions. However, these therapies are able to induce significant acute and late toxicities to oral structures and surrounding tissues. Objective: To describe the acute and chronic oral complications of RT and CT in head and neck, showing the way the dentist can handle them. Materials and methods: Virtual Health Library (VHL) – Bireme: LILACS, IBECS, MEDLINE and BBO, PubMed, SciELO, Brazilian Digital Library of Theses and Dissertations (BDTD), Capes database journals and renowned oral medicine books. The search strategies used included the following words: radiotherapy, chemotherapy, adverse effects and treatment. Thirty-two references were selected between 1990 and 2012 for the development of this study. Results: Both therapies are associated with adverse effects that significantly affect the patients’ quality of life. Their adverse effects are dose-dependent and may occur from the first week of treatment. Among the most important complications are included the oral mucositis, radiodermatitis, hypossialia, hypogeusia, radiation caries, opportunistic infections, developmental abnormalities, osteoradionecrosis and trismus. A preliminary evaluation of the oral health status and the accompanying by the dentist during treatment may act to prevent and reduce the damage to oral tissues. Conclusion: The multidisciplinary treatment, including medical team, dental surgeon, speech therapist, psychologist and nutritionist is the best alternative to minimize or even prevent many complications resulting from physical and psychological anticancer treatment.

Introdução: A radioterapia (RT) e a quimioterapia (QT) são terapias amplamente empregadas em pacientes portadores de neoplasias malignas em região de cabeça e pescoço. No entanto, são métodos capazes de provocar toxicidades significativas às estruturas orais e tecidos adjacentes. Objetivo: Descrever as complicações bucais agudas e crônicas da RT e QT em cabeça e pescoço, evidenciando a maneira com que o cirurgião-dentista (CD) pode abordá-los. Materiais e métodos: Biblioteca Virtual em Saúde (BVS) – Bireme: LILACS, IBECS, MEDLINE e BBO - PubMed, SciELO, Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), Base Periódicos Capes e livros renomados da área estomatológica. A estratégia de busca utilizada incluiu as seguintes palavras: radioterapia, quimioterapia, efeitos adversos e tratamento. Foram selecionadas 32 referências entre 1990 e 2012 para o desenvolvimento deste estudo. Resultados: Ambas as terapias estão associadas a reações adversas que afetam de forma significativa a qualidade de vida dos pacientes. Seus efeitos adversos são dose-dependentes e podem manifestar-se a partir da primeira semana de tratamento. Entre as complicações orais mais importantes estão a mucosite, radiodermite, hipossialia, hipogeusia, cárie de radiação, infecções oportunistas, anormalidades do desenvolvimento, osteorradionecrose e trismo. A avaliação prévia da condição bucal e o acompanhamento pelo CD durante o tratamento podem atuar na prevenção e redução dos danos causados aos tecidos bucais. Conclusão: O tratamento multidisciplinar, incluindo equipe médica, cirurgiãodentista, fonoaudiólogo, nutricionista e psicólogo é a melhor alternativa para minimizar ou mesmo prevenir diversas complicações físicas e psicológicas advindas do tratamento antineoplásico.

Monitoring of selenium in oral cavity argyria - a clinical and microscopic study.

OBJECTIVE: Argyria is generally classified as localized or generalized condition. Distinct pigmentation of the oral mucosa in the vicinity of amalgam fillings is often referred to as amalgam tattoos. Pigmented areas can also be associated with silver-containing corrosion products of dental alloys used for prosthetic restorations. Silver-containing electron dense particles (Ag-EDPs) are frequently found in pigmented areas. We attempted to correlate results of the elemental composition of Ag-EDPs with excerpts from health profiles of our study paticipants. DESIGN/SETTING: Eight patients with diagnosed signs of localized argyria were investigated in this study. Biopsies from distinctly pigmented gingival areas were subjected to histological examination, electron microscopy and x-ray microanalysis. RESULTS: Elemental composition of Ag-EDPs determined by x-ray microanalysis showed mainly silver in combination with sulfur or selenium or a combination of both chalcogens. Elemental analyzes results of Ag-EDPs were analyzed along with excerpts from the patient's clinical records. Two patients with low or undetectable selenium in the Ag-EDPs suffered from autoimmune thyroiditis, Parkinson's disease, bronchial asthma, and allergies to molds, pollen and dust. CONCLUSIONS: We suggest that selenium in Ag-EDPs is a product of the detoxification process for Ag(+) ions in gingival tissue and that it may reflect the availability of endogenous selenium for physiological processes in the human body. Its presence or absence might thus be used as another marker of a patient's health status.

The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth.

BACKGROUND: The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. METHODS: The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). RESULTS: The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). CONCLUSIONS: ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant chemotherapy in breast cancer patients.

OBJECTIVE: The aim of the study was to examine oral mucosal lesions, microbial changes, and taste disturbances induced by adjuvant chemotherapy (CT) in breast cancer patients during and 1 year after treatment. STUDY DESIGN: Forty-five consecutive breast cancer patients, eligible for adjuvant CT with cyclophosphamide, epirubicin or methotrexate, and 5-fluorouracil were followed before, during, 6 months and 1 year after CT and were compared to a control group of 31 breast cancer patients not receiving adjuvant CT. RESULTS: During CT, oral mucosal lesions developed including erythema (n = 10, 22%) and ulceration (n = 7, 16%). Five patients (11%) were diagnosed with oral candidosis. Scores of dental bacterial plaque and gingival inflammation increased during CT and the oral microbial composition changed towards a more acidophilic flora. Taste disturbances were experienced by 84% (n = 38) of the patients in the CT group. CONCLUSION: In breast cancer patients, moderate-intensive adjuvant CT caused oral mucosal lesions, oral candidosis, taste disturbances and a more acidophilic oral microflora. These adverse effects were temporary and the majority of the patients were mildly affected.

[Adverse drug effects in the oral region]. / Legemiddelbivirkninger i munnhulen.

Syphilis was previously termed "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. This role has been taken over by drugs, and this also applies to adverse drug reactions in the oral region. Accordingly, a careful drug history, including identification of any prescription, over-the-counter, or herbal medicines used, may give an important clue to the differential diagnosis of oral diseases when the aetiology is not apparent. Virtually all drugs have the potential to cause oral adverse reactions, but some have a greater ability to do so than others. Among the numerous adverse oral manifestations are xerostomia, taste disturbances and ulceration. The reactions are often non-specific, but they may mimic specific disease states such as erythema multiforme, lichen planus and pemphigus. Drug-induced gingival hyperplasia is an example of a quite characteristic and easily recognisable oral side effect. This article briefly describes some of the presentations and mechanisms of oral manifestations of drug therapy and the drugs that most commonly are responsible. Just like approved pharmaceuticals, herbal medicines are also associated with adverse oral manifestations. Finally we comment on some of the more recent reports on osteonecrosis of the jaws associated with the use of bisphosphonates.

An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations.

Herbal medication in the United States is a popular form of therapy. This paper provides an overview of the utilization of herbal supplements with particular emphasis on possible interactions with oral health drugs and oral manifestations. Herbal supplements are regulated by the Dietary Supplement Health and Education Act (DSHEA), which limits their regulation by the U.S Food and Drug Administration (FDA). A number of studies indicate that there is a progressive increase in the utilization of herbal supplements. The majority of consumers of these products are white, middle-aged women who have some college education. Many of the consumers use pharmaceutical drugs concurrently, but most do not inform their health-care providers about their use of herbal supplements. Various herbal supplements have been reported or are suspected to interact with certain oral health drugs, the most important one being 1) bromelain, cayenne, chamomile, feverfew, dong quai, eleuthro/Seberian ginseng, garlic, ginkgo, ginger, ginseng and licorice interacting with aspirin; 2) aloe latex, ephedra, ginseng, rhubarb, cascara sagrada, licorice, and senna interacting with corticosteriods; 3) kava, St. John's wort, chamomile, and valerian interacting with central nervous system (CNS) depressant drugs; and 4) herbs acting on the gastrointestinal system, altering the absorption of several orally administered drugs. Further, the use of some herbal supplements has been reported to be associated with oral manifestations, including aphthous ulcers, lip and tongue irritation, and swelling with feverfew; gingival bleeding with feverfew and ginkgo; tongue numbness with echinacea; xerostomia with St. John's wort; oral and lingual dyskinesia with kava; and salivation with yohimbe. These potential effects of herbal supplements in conjunction with factors related to regulation restrictions suggest that the use of these products may be associated with various adverse reactions that can affect oral health and treatment. Dental hygienists should inform themselves about herbal supplements in order to offer appropriate oral health care to individuals who take these substances.

Hierbas medicinales y graves efectos adversos: angioedema de úvula causado por uso de Ecballium elaterium / Herbal medicines and severe adverse effects: uvular angioedema caused by Echballium elaterium

Herbal medicine is a growing alternative for established medicine. Many plants and herbs are currently in use for a myriad of diseases and symptoms. However, there are many reports in the literature of life-threatening adverse effects of these drugs. We report a 39 years old male, that consulted for pain in the nostrils and severe nasal obstruction, that appeared two hours after instilling Ecballium elaterirum in the nostrils. On physical examination, uvular edema was observed. The patient was successfully managed with intravenous betametasone and chlorphenamine.

Evaluation of the efficacy of a feed additive to ameliorate the toxic effects of 4,15-diacetoxiscirpenol in growing chicks.

The possible protective effect of a feed additive (Mycofix) against the toxic effects of 4,15-diacetoxiscirpenol (DAS) in growing broiler chickens was investigated in a 21-d fully randomized trial consisting of seven dietary treatments (control with no DAS or Mycofix added, 1 ppm DAS alone, 1 ppm DAS supplemented with 0.75 g/kg Mycofix, 1 ppm DAS supplemented with 1.5 g/kg Mycofix, 2 ppm DAS alone, 2 ppm DAS supplemented with 0.75 g/kg Mycofix, and 2 ppm DAS supplemented with 1.5 g/kg Mycofix). When no feed additive was included, both levels of dietary DAS significantly decreased BW and feed intake and caused oral lesions, with the effect of 2 ppm DAS being more severe. When 1 ppm DAS was added to the diet, supplementation of Mycofix protected against the adverse effects of DAS on feed intake and BW at both levels of inclusion (0.75 and 1.5 g/kg); however, no protection against oral lesions was obtained by Mycofix supplementation. This finding suggests that the adverse effect of DAS on performance is not due to the oral lesions per se but it is likely the result of the systemic absorption of the mycotoxin. When 2 ppm dietary DAS was present in the diet, only partial protection on BW and feed intake was obtained by Mycofix supplementation. More studies are required to determine if a higher dose of Mycofix could be capable of counteracting the adverse effects of 2 ppm dietary DAS on chicken performance.

Oral manifestations of drug therapy.

The oral cavity may be the target organ for a number of diverse abnormalities that develop from side effects of medications. Because of the widespread and increasing use of prescription, over-the-counter, and herbal remedies, it is becoming increasingly likely that the dentist will encounter soft tissue or dental pathologies that represent a complication of a therapeutic agent. The more common abnormalities that may occur include gingival hyperplasia, tooth discoloration, candidiasis, chemical injuries, and altered taste perception. The dental practitioner is often the primary health care provider who can recognize, diagnose, treat, and/or prevent these conditions.

[Herbal medicines and severe adverse effects: uvular angioedema caused by Echballium elaterium]. / Hierbas medicinales y graves efectos adversos: angioedema de úvula causado por uso de Ecballium elaterium.

Herbal medicine is a growing alternative for established medicine. Many plants and herbs are currently in use for a myriad of diseases and symptoms. However, there are many reports in the literature of life-threatening adverse effects of these drugs. We report a 39 years old male, that consulted for pain in the nostrils and severe nasal obstruction, that appeared two hours after instilling Ecballium elaterirum in the nostrils. On physical examination, uvular edema was observed. The patient was successfully managed with intravenous betametasone and chlorphenamine.

[An epidemiologic examination on the prevalence of the periodontal diseases and oral pigmentation in Yusho patients in 1998].

An epidemiologic examination was carried out to reveal the prevalence of the periodontal diseases and oral pigmentation in patients with Yusho 30 years after PCBs exposure. The results obtained were as follows. 1) 69 patients out of 71 patients with Yusho, who were measured periodontal pocket depth using Ramfjord' methods, had at least one tooth with periodontal pocket deeper than 3 mm. Similarly, 241 teeth out of a total 348 examined teeth showed periodontal pocket with more than 3 mm depth. 2) Oral pigmentation was observed in 46 out of 79 patients with Yusho. In this study, gingival pigmentation was most predominant among oral pigmentation. In addition, it is of particular interest that oral pigmentation tended to be observed at a much higher frequency in younger patients with Yusho.

[An epidemiologic examination on the prevalence of the periodontal diseases and oral pigmentation in Yusho patients in 1996].

An epidemiologic examination was carried out to reveal the prevalence of the periodontal diseases and oral pigmentation in patients with Yusho 28 years after PCB exposure. The results obtained were as follows. 1) 162 teeth out of a total of 309 examined teeth had a periodontal pocket deeper than 3 mm, although 32 teeth out of 162 teeth had a periodontal pocket deeper than 4 mm. 2) Oral pigmentation was observed in 47 out of 82 patients with Yusho. It was particularly noteworthy that gingival pigmentation was observed at a much higher frequency in younger patients while pigmentation of the buccal mucosa, the lips or the palate was observed at a much higher frequency in older patients.