To extract or not extract teeth prior to head and neck radiotherapy? A systematic review and meta-analysis.

PURPOSE: Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT. METHODS: The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01). CONCLUSION: It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.

Extraoral photobiomodulation for prevention of oral and oropharyngeal mucositis in head and neck cancer patients: interim analysis of a randomized, double-blind, clinical trial.

PURPOSE: To assess the safety and efficacy of prophylactic extraoral photobiomodulation (PBM) for the prevention of oral and oropharyngeal mucositis (OM) on clinical outcomes and survival in patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC). METHODS: OOPSCC patients who received radiotherapy (RT) were prospectively randomized to two groups: prophylactic extraoral PBM and placebo. OM grade (NCI), pain (VAS), analgesia, and anti-inflammatory prescriptions were assessed weekly. Quality of life questionnaires (QoL) were performed at the first and last day of RT. Following RT, participants were evaluated quarterly for oncological outcomes follow-up. RESULTS: Fifty-five patients met the inclusion criteria. The first occurrence of OM was observed at week 1, for the placebo group (p = 0.014). Later, OM onset and severity was observed for the PBM group, with first occurrence at week 2 (p = 0.009). No difference in severe OM incidence was observed (p > 0.05). Lower mean pain score was noted at week 7 for the PBM group (2.1) compared to placebo group (4.5) (p = 0.009). Less analgesics (week 3; p = 0.009/week 7; p = 0.02) and anti-inflammatory prescription (week 5; p = 0.0346) were observed for the PBM group. Better QoL scores were observed for the PBM group at last day of RT (p = 0.0034). No difference in overall survival among groups was observed in 1 year of follow-up (p = 0.889). CONCLUSION: Prophylactic extraoral PBM can delay OM onset, reduce pain, and reduce analgesic and anti-inflammatory prescription requirements. Extraoral PBM was associated with better QoL. There was no evidence of PBM impact on oncological outcomes. TRIAL REGISTRATION: TRN:RBR-4w4swx (date of registration: 01/20/2020).

Telediagnosis of oral lesions using smartphone photography.

OBJECTIVE: The objective of this observational study was to evaluate telediagnosis of oral lesions using smartphone photography. MATERIALS AND METHODS: Individuals with visible oral lesions composed a convenience sample. The lesions were photographed using a smartphone camera and emailed along with clinical information to three evaluators, who formulated up to two diagnostic hypotheses for each case. A total of 235 photographs from 113 clinical cases were obtained. The evaluators answered questions regarding referral decisions, requests for additional tests, diagnostic difficulties, and image quality. The diagnostic hypotheses were compared to the gold standard by means of percent agreement and kappa coefficient. Consensual face-to-face diagnoses of three specialists-when only a clinical diagnosis was necessary-or histopathological results-when a biopsy was necessary-were considered the gold standard. RESULTS: The telediagnosis was similar to the gold standard in 76% of the cases, and kappa coefficients showed almost perfect agreement (k = 0.817-0.903). The evaluators considered that referrals could have been avoided on an average of 35,4% of the cases. CONCLUSION: Diagnosis of oral lesions using images taken with a smartphone showed almost perfect agreement and diagnostic accuracy comparable to face-to-face diagnosis.

Coronaviridae-Old friends, new enemy!

Coronaviridae is a family of single-stranded positive enveloped RNA viruses. This article aimed to review the history of these viruses in the last 60 years since their discovery to understand what lessons can be learned from the past. A review of the PubMed database was carried out, describing taxonomy, classification, virology, genetic recombination, host adaptation, and main symptoms related to each type of virus. SARS-CoV-2 is responsible for the ongoing global pandemic, and SARS-CoV and MERS-CoV were responsible for causing severe respiratory illness and regional epidemics in the past while the four other strains of CoVs (229-E OC43, NL63, and HKU1) circulate worldwide and normally only cause mild upper respiratory tract infections. Given the enormous diversity of coronavirus viruses in wildlife and their continuous evolution and adaptation to humans, future outbreaks would undoubtedly occur. Restricting or banning all trade in wild animals in wet markets would be a necessary measure to reduce future zoonotic infections.

Cost-effectiveness of photobiomodulation therapy for the prevention and management of cancer treatment toxicities: a systematic review.

PURPOSE: To identify and summarize the evidence on the cost-effectiveness of photobiomodulation (PBM) therapy for the prevention and treatment of cancer treatment-related toxicities. METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Scopus, MEDLINE/PubMed, and Embase were searched electronically. RESULTS: A total of 1490 studies were identified, and after a two-step review, 4 articles met the inclusion criteria. The included studies analyzed the cost-effectiveness of PBM therapy used in the context of lymphedema for breast cancer and oral mucositis (OM) induced by chemotherapy and radiotherapy. Better outcomes were associated with PBM therapy. The incremental cost-effectiveness ratio ranged from 3050.75 USD to 5592.10 USD per grade 3-4 OM case prevented. PBM therapy cost 21.47 USD per percentage point reduction in lymphedema in comparison with 80.51 USD for manual lymph drainage and physical therapy. CONCLUSION: There is limited evidence that PBM therapy is cost-effective in the prevention and treatment of specific cancer treatment-related toxicities, namely, OM and breast cancer-related lymphedema. Studies may have underreported the benefits due to a lack of a comprehensive cost evaluation. This suggests a wider acceptance of PBM therapy at cancer treatment centers, which has thus far been limited by the number of robust clinical studies that demonstrate cost-effectiveness for the prevention and treatment of toxicities.

Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis was carried out to verify evidence regarding the efficacy and safety of the clinical applicability of natural products in the prevention and treatment of oral mucositis induced by chemotherapy and/or radiotherapy. METHODOLOGY: An electronic research according to the PICOS strategy, using the terms "natural products" and "oral mucositis," was carried out at Pubmed, Cochrane, Embase, and "gray literature." The stages of eligibility, data extraction, and quality assessment of the studies were carried out independently and in duplicate. RESULTS: The number of studies identified as eligible was 151, including 47 randomized controlled trials, reporting a total of 3075 participants undergoing some therapy with natural products on oral mucositis. The included clinical trials covered a variety of 31 types of natural products. Considering the risk of bias of the clinical trials, 24 studies (51.1%) were considered to have a low overall risk of bias, nine (19.1%) were at moderate risk, and 14 clinical trials (29.8%) were at high risk of bias. Honey was the most assessed natural agent. Fourteen studies (3.4%) reported that natural agents reduced pain. CONCLUSION: The results of the meta-analysis support a positive effect of honey and Aloe vera in reducing mucositis in patients receiving cancer therapy. CLINICAL RELEVANCE: The results found add relevant information to the scientific community regarding the prevention and treatment of mucositis. Graphical abstract.

Evaluation of a mucoadhesive pilocarpine tablet for the treatment of xerostomia: a randomized, double-blind, crossover clinical trial.

The objectives of this study were to determine the effectiveness of a mucoadhesive tablet of pilocarpine, 5 mg, for the treatment of xerostomia and verify its pharmacokinetic profile. The randomized, double-blind, crossover clinical trial involved 25 older adults (60 to 80 years) with xerostomia and hyposalivation who were randomly divided into groups A and B. Once daily, for 7 days, group A used a mucoadhesive tablet containing pilocarpine, while group B used a mucoadhesive tablet without the active ingredient (first intervention). After 7 days of washout (no treatment), use of the medications resumed for 7 days, with a crossover between groups (second intervention). Xerostomia was evaluated through a shortened version of the Summated Xerostomia Inventory-Dutch Version, and the unstimulated salivary flow (USF) and stimulated salivary flow (SSF) of the patients were measured. The patients were evaluated at baseline and 7, 14, and 21 days. Then, the pharmacokinetic profiles of mucoadhesive and conventional oral pilocarpine tablets were compared using saliva obtained from 8 patients. Both of the interventions resulted in a significant reduction in Summated Xerostomia Inventory scores and a significant increase in the mean USF (P < 0.05). A statistically significant increase in the mean SSF only occurred when pilocarpine was administered (P < 0.05). No significant adverse effects were found. The mucoadhesive tablet resulted in much higher salivary concentrations of pilocarpine than did the conventional oral tablet. Both formulations of the mucoadhesive tablet, with or without pilocarpine, relieved patients' dry mouth symptoms. Trial registration: Registro Brasileiro de Ensaios Clinicos (ReBEC) No. RBR-9qdnws.

Dental changes in children with congenital Zika syndrome.

OBJECTIVE: To describe oral alterations in children with congenital Zika syndrome (CZS). METHODS: This was a case series, whose research instrument was a structured questionnaire, associated with the use of medical record data and extra and intraoral clinical examination. RESULTS: Thirty-two children were evaluated, the majority male (18/32%-56.3%), mean age 22 months (SD = 2.71). It was also observed that the majority of the patients (19/32%-59.4%) presented a low family income. All the children had a mean head circumference of 29.43 cm (SD = 1.42). Regarding the alterations, an ogival-shaped palate was observed in 14 children (43.7%), and delayed chronology of eruption was observed in 15 children (46.9%), of whom 7 children (21.9%) did not present eruption of the upper left lateral incisor (p = .0002) and upper right lateral incisor (p = .002) until the moment of analysis. Additionally, 03 children with yellowish dental pigmentation were identified in erupted teeth after the onset of phenobarbital use. Enamel hypoplasia was identified in 9 children (28.1%) and only one child with ankyloglossia. CONCLUSION: CZS may present delayed chronology of eruption, ankyloglossia, ogival-shaped palate, and enamel hypoplasia, requiring dental follow-up aimed at prevention, promotion, and rehabilitation of the health of these children.

Increase in the nitric oxide release without changes in cell viability of macrophages after laser therapy with 660 and 808 nm lasers.

The aim of this study was to evaluate the influence of low-level laser therapy (LLLT) with different parameters and wavelengths on nitric oxide (NO) release and cell viability. Irradiation was performed with Ga-Al-As laser, continuous mode and wavelengths of 660 and 808 nm at different energy and power densities. For each wavelength, powers of 30, 50, and 100 mW and times of 10, 30, and 60 s were used. NO release was measured using Griess reaction, and cell viability was evaluated by mitochondrial reduction of bromide 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) to formazan. LLLT promoted statistically significant changes in NO release and MTT value only at the wavelength of 660 nm (p < 0.05). LLLT also promoted an increase in the NO release and cell viability when the energy densities 64 (p = 0.04) and 214 J/cm2 (p = 0.012), respectively, were used. LLLT has a significant impact on NO release without affecting cell viability, but the significance of these findings in the inflammatory response needs to be further studied.

Efficacy of Nd:YAG and GaAlAs lasers in comparison to 2% fluoride gel for the treatment of dentinal hypersensitivity.

Lasers demonstrate excellent therapeutic action and are often employed in dentistry for the treatment of diverse clinical conditions. The aim of this study was to compare the efficacy of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser, gallium-aluminum-arsenide (GaAlAs) laser, and 2% neutral fluoride gel in the treatment of dentinal hypersensitivity. Twenty-three patients were evaluated, involving a total of 48 quadrants with at least 1 tooth with dentinal hypersensitivity (89 teeth total). Pain intensity was recorded on a visual analog scale at the time of clinical examination (baseline), immediately after treatment, and 1 week posttreatment. Teeth were treated with 60 seconds of 2% neutral fluoride gel application or 60 seconds of laser treatment-Nd:YAG laser at a distance of 0.5 cm (unfocused; 1 W and 10 Hz for 60 seconds, perpendicular to the cervical surfaces) or GaAlAs laser in contact (40 mW; 4 J/cm²; spot: 0.028 cm²; 15 seconds per point on 4 points [mesial, medial, distal, and apical])-as well as sham treatments so that patients remained blind to their treatment group. All treatments provided adequate pain reduction immediately posttreatment, but laser treatments resulted in significantly greater reductions in pain intensity.

Impact of oral mucositis on oral-health-related quality of life of patients diagnosed with cancer.

INTRODUCTION: Oral mucositis (OM) has been described as the oral complication most frequently associated with antineoplastic therapy. However, the influence on the quality of life of affected patients is still unclear. OBJECTIVE: To evaluate the impact of OM on the oral-health-related quality of life (OHRQoL) of patients diagnosed with cancer, who developed chemotherapy- and/or radiotherapy-induced OM. METHODS: This is a cross-sectional evaluation of QoL using oral health impact profile-14 (OHIP-14). The study group comprised a sample of 60 patients diagnosed with cancer, who developed OM during the treatment. The instrument (OHIP-14) composed of seven dimensions was used: functional limitation, physical pain, psychological discomfort, physical deficiency, psychological deficiency, social incapacity, and deficiency. RESULTS: The internal consistency of OHIP-14 measured by the Cronbach's α coefficient was of 0.76. Physical pain attained the highest score (worst quality of life) among the studied dimensions 60.8% (292/480), followed by physical limitation 52.7% (253/480), and psychological discomfort 50.8% (244/480). The dimension 'social limitation' obtained the lowest score 27.2% (131/480). There was statistically significant difference as regards gender (P = 0.021) for physical pain, with greater impact among patients of the male gender. CONCLUSION: Oral-health-related quality of life is significantly affected by OM in individuals diagnosed with cancer.

Mapping the legacy of the world workshop on oral medicine: a 35-year global bibliometric analysis.

OBJECTIVE: This study utilized bibliometric methodologies to explore the body of research presented at the World Workshop on Oral Medicine (WWOM) over the past 35 years. METHODS: A systematic tracking of articles across 8 editions of WWOM was conducted using databases such as Web of Science, Scopus, and PubMed. Comprehensive bibliographic analysis and data visualization were executed through Bibliometrix, Rstudio, and VOSviewer, facilitating an in-depth examination of citation metrics and collaborative networks. RESULTS: The investigation revealed that WWOM, held in 6 cities spanning four countries and addressing 33 distinct topics, demonstrated an annual citation growth rate of 8.29%, with an average of 49.31 citations per article. Notably, WWOM IV garnered the highest number of citations (1,342), reaching its peak in 2021 with 365 citations. Key contributors to the most-cited articles include Al-Hashimi, Dawes, and Syrjänen et al. Since its inception, the workshops have engaged 505 faculty members from 37 nations, with significant participation from the Americas and Europe, notably the United States and the United Kingdom, which also led in terms of publications. Network analysis delineated 6 country clusters, underscoring robust connections between the US and the UK. Co-authorship analysis revealed 18 clusters involving 267 authors. CONCLUSION: The influence of the WWOM on the field of oral medicine is clearly demonstrated by the outcomes of its publications, reflecting a collaborative effort to enhance comprehension and treatment modalities for patients with oral diseases. The study's findings provide insights into future research directions within the WWOM legacy.

Intrahost genetic variability of human herpes virus-8.

Studies were conducted to determine whether HHV-8 hyperactivity could be the consequence of the propensity of the host to multiple HHV-8 infection. The aim of the present work was to investigate HHV-8 intrahost genetic variability. HHV-8 subgenomic DNA was amplified by PCR from patients infected with HIV, health care workers (HCW) and bone marrow transplant recipients (BMT), and from oral lesional tissues of AIDS-Kaposi's sarcoma (KS) patients. As controls, blood from HIV-negative health care workers, and the cell lines BC-1, BC-2, and BCP-1 were used. Clones derived from amplicons originating from DNA fragments in open reading frame (ORF) 26 and ORF K1 were isolated. For each ORF, intra-specimen nucleotide sequence differences were determined. The extent of HHV-8 variation in clones derived from blood of patients infected with HIV was significantly higher than in blood from health care workers or post-bone marrow transplantation patients or in AIDS-KS tissue. Among the clones derived from the latter three categories of specimens, sequence variations were not significant. It is concluded that HIV-infected individuals can have multiple of HHV-8, but AIDS-KS lesions are associated with infection by a single HHV-8 variant or a small group of related variants.

Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review.

OBJECTIVE: Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation. STUDY DESIGN: A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed. RESULTS: Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term "PBM" was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements. CONCLUSIONS: The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.

Clinical outcomes of dental implants in head and neck cancer patients: An overview.

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of dental implants (DIs) in patients with head and neck cancer (HNC) treated with radiotherapy (RT), isolated chemotherapy, or bone modifying agents (BMAs). STUDY DESIGN: This study was registered in the Prospective Register of Systematic Reviews (CRD42018102772); conducted via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; and based on PubMed, Scopus, Embase, Cochrane Library, Web of Science, and gray literature searches. The selection of studies was performed in 2 phases by 2 independent reviewers. The risk of bias (RoB) was assessed by the Measurement Tool to Assess the Methodological Quality of Systematic Reviews 2. RESULTS: Twenty systematic reviews were included in the qualitative analysis. The majority scored as having high RoB (n = 11). Primary DIs placement in the mandible of patients with HNC subjected to RT doses <50 Gy was associated with better survival rates. CONCLUSIONS: The placements of DIs could be considered safe in patients with HNC in sites of alveolar bone that received RT (≤5000 Gy); however, no conclusions could be made in patients with cancer managed by chemotherapy or BMAs. Due to the heterogeneity of studies included, the recommendation for DIs placement in patients with cancer should be carefully considered. Future better controlled randomized clinical trials are required to provide enhanced clinical guidelines for best patient care.

Chloroquine-induced hyperpigmentation of the hard palate.

This article reports a rare case of extensive palatal pigmentation secondary to long-term chloroquine treatment. Chloroquine was originally used as an antimalarial agent, but it is now widely used as an adjunct in the treatment of autoimmune diseases. Adverse effects of chloroquine usually include skin changes such as bullous pemphigoid, exacerbation of psoriasis, and pigmentation of the skin and mucous membranes as well as retinopathy, gastrointestinal alterations, and neuromuscular disorders. Extensive oral pigmentation is an uncommon feature of an adverse drug effect, and diagnosis should be based on clinicopathological findings.

Cervicofacial necrotizing fasciitis following periodontal abscess.

Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

Mandibular desmoplastic ameloblastoma: case report.

Desmoplastic ameloblastoma (DA) is a tumor characterized by unique clinical, radiological, and histopathologic features, mostly an abundance of densely collagenous stroma with small nests and islands of odontogenic epithelium. Due to its aggressive, highly invasive nature, there is a tendency to treat DA with bone resection. This article reports and discusses an uncommon case of mandibular DA, focusing on the importance of early, effective treatment.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial.

Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Systemic conditions associated with increased risk to develop oral squamous cell carcinoma: Systematic review and meta-analysis.

This study aimed to map systemic alterations predisposing to oral squamous cell carcinoma (OSCC) onset. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were used to access (1) reports of OSCC co-occurring in patients with systemic conditions, (2) prevalence of OSCC among these patients, and (3) clinicopathological profiles. Data from more than 1 million patients worldwide showed that Fanconi's anemia, xeroderma pigmentosum, dyskeratosis congenital, chronic fatigue syndrome, and patients post bone marrow transplantation (BMT) present increased risk for OSCC development. The overall prevalence of OSCC in syndromic patients and post-BMT were 0.65% (95% CI = 0.13-3.11, p < 0.01) and 5.83% (95% CI = 0.00-30.90, p < 0.01), respectively. The certainty of the evidence was moderate. This study demonstrated that some systemic conditions predispose to OSCC. These results present an impact on the screening of OSCC in systemically compromised patients.