Photobiomodulation by low-level laser therapy in patients with obstructive sleep apnea: Study protocol clinical trial (SPIRIT compliant).

Obstructive sleep apnea (OSA) increases morbidity and mortality and it is associated with an increased cardiovascular risk. The gold standard treatment for OSA is positive airway pressure therapy (CPAP). However, it is an expensive treatment and several patients do not adapt to CPAP. GOAL: The researchers will verify the effects of low-level laser therapy (LLLT) on OSA, when applied to the soft palate and on the tongue base. METHODS: The researchers will select individuals of both sexes aged 30 to 60 years old who are sedentary and that present a high risk of OSA by the Berlin questionnaire. The evaluations pre and post interventions will be polysomnography; anthropometric and body composition measurements (Bioimpedance); metabolic syndrome risk factors (International Diabetes Federation); physical capacity (VO2 peak at the cardiopulmonary exercise test, CPET); endothelial function (flow-mediated dilatation, FMD); autonomic control (heart rate variability and sympathovagal balance). Those diagnosed with moderate and severe OSA (apnea/hypopnea index, AHI ≥15 events/h) will be invited to participate in the study and they will be randomized into 2 groups: LLLT treatment or placebo (C). The LLLT group will receive applications at 8 points on the soft palate and on the base of the tongue for 8 seconds for each point. The applications of LLLT will occur twice a week, with a minimum interval of 2 days between the applications for 2 months, when using a Therapy Plus NS 13678 Laser. The C group will have similar applications, but with the device turned off. EXPECTED RESULTS: In the individuals with OSA, photobiomodulation through LLLT will decrease the AHI. Additionally, when LLLT is applied in the oral cavity, a highly vascularized region, this may cause improvements in the vascular function and in the autonomic and hemodynamic control. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of March 11, 2019 (CAAE: 06025618.2.0000.5511 - Acceptance Number: 3.191.077). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-42v548). This study is not yet recruiting. Issue date: November 4, 2019.

Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study. / Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto.

Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Effect of GaAlAs low-level laser therapy on mouth opening after orthognathic surgery.

To evaluate low-level laser therapy (LLLT) as an adjunct to enhance postoperative mouth opening after orthognathic surgery. Prospective clinical trial of 82 patients allocated into an intervention group (laser, LG) and a control group (no laser, CG) and subgroups according to the procedure type : (1) surgically assisted rapid maxillary expansion (SARME); (2) maxillary surgery; (3) mandibular surgery; or (4) bimaxillary surgery. LG patients received LLLT immediately after surgery and every 24 h thereafter for 3 days, using a gallium-aluminum-arsenide (GaAlAs) diode laser (780 nm, 28 spots, 14 on each side of the face, output power 2 J/spot). Maximum mouth opening was measured using digital calipers at five time points: preoperative baseline and postoperative days 2, 7, 14, and 21. ANOVA was used to evaluate difference in mouth opening across groups. Significance was accepted at P ≤ 0.05. Final average mouth opening differed between women (GL1 = 94.24%, GC1 = 89.54%, GL2 = 69.39%; GC2 = 68.46%; GL3 = 65.11%; GC3 = 58.64%; GL4 = 61.85%; GC4 = 57.11%) and men (GL1 = 86.92%, GC1 = 102.44%, GL2 = 77.56%; GC2 = 81.65%; GL3 = 80.29%; GC3 = 67.63%; GL4 = 66.93%; GC4 = 55.31%). There were no significant differences between the SARME and isolated maxillary/mandibular surgery groups. In the bimaxillary groups, average mouth opening was increased in all patients who received LLLT, significantly so in male patients. LLLT with a GaAlAs diode laser (780 nm) did not affect postoperative mouth opening after SARME, isolated maxillary surgery, or isolated mandibular surgery. However, it improved mouth opening in men who had undergone bimaxillary orthognathic surgery.

Sunlight-induced genotoxicity and damage in keratin structures decrease tadpole performance.

The increased incidence of solar ultraviolet (UV) radiation, an environmental genotoxic agent, due to ozone depletion or deforestation may help to explain the enigmatic decline of amphibian populations in specific localities. In this work, we evaluated the importance of DNA repair performed by photolyases to maintain the performance of treefrog tadpoles after acute and chronic treatments with environmental-simulated doses of solar UVB and UVA radiation. Immediately after UV treatments, tadpoles were exposed to a visible light source to activate photolyases or kept in dark containers. The biological effects of UV treatments were evaluated through morphological, histological, locomotor and survival analyzes of Boana pulchella tadpoles (Anura: Hylidae). The results indicate that tadpole body weight suffered influence after both UVB and UVA treatments, although the body length was bit affected. The locomotor performance of UVB-exposed tadpoles was significantly reduced. In addition, UVB radiation induced a severe impact on tadpole skin, as well as on keratinized structures of mouth (tooth rows and jaw), indicating that these should be important effects of solar UV radiation in the reduction of tadpole performance. Furthermore, photolyases activation was fundamental for the maintenance of tadpole performance after chronic UVB exposures, but it was relatively inefficient after acute exposures to UVB, but not to UVA radiation. Therefore, this work demonstrates how the UV-induced genotoxicity and structural alterations in the skin and oral apparatus affect tadpole performance and survival.

Programa terapêutico fonoaudiológico para abertura de boca em pacientes com câncer de boca e orofaringe em radioterapia adjuvante: estudo piloto / Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study

RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.

ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Confecção de dispositivo intraoral para proteção de tecidos bucais durante a radioterapia / Preparation of intraoral device for protection of oral tissues during radiotherapy

Estima-se que no Brasil para os anos de 2016 e 2017, o diagnóstico de câncer em região de boca e laringe atingirá mais de 22 mil pessoas. Os principais tratamentos para esta doença são quimioterapia, cirurgia e radioterapia realizados de forma associada ou não. O tratamento antineoplásico gera diversos efeitos colaterais que prejudicam muito a qualidade de vida do paciente. Avaliando a radioterapia, os principais efeitos colaterais são: a mucosite oral, disgeusia e trismo, além do desenvolvimento de hipossalivação, cáries de radiação e osteorradionecrose. A Radioterapia de Intensidade Modulada de Feixe (IMRT) possibilita o tratamento oncológico com diferentes isodoses de radiação conforme a necessidade da região, possibilitando emitir menor quantidade de radiação em tecido livre do tumor próximo ao foco principal de tratamento, diferente dos tratamentos radioterápicos convencionais mais antigos. Nosso objetivo foi desenvolver um dispositivo intraoral confeccionado com resina acrílica para afastar tecido sadio do foco principal de radioterapia por IMRT, separando mecanicamente o palato, língua e assoalho bucal em pacientes com câncer em região de boca e orofaringe. Os pacientes foram divididos em dois grupos: controle (GC) sem uso do dispositivo intraoral e análise (GA) com uso do dispositivo intraoral. Os pacientes do GC foram avaliados através da retrospectiva de seus prontuários, o GA foi acompanhado durante planejamento e todo o tratamento radioterápico por IMRT. Foram avaliados grau de mucosite oral seguindo critérios da OMS (GC e GA) e OMAS (GA), questionário sobre impacto da saúde bucal na qualidade de vida antes e depois (GA) das sessões de radioterapia, sexo, idade, tratamentos antineoplásicos concomitantes, doses de radiação (GC e GA), desenvolvimento de disgeusia (GA) e trismo (GA). Ocorreu maior tendência na gravidade de mucosite oral para pacientes do GC. Os testes estatísticos foram significantes com p < 0,05 para menor grau de desenvolvimento de eritema e úlceras em mucosa bucal em GA. Todos os pacientes do GA desenvolveram disgeusia no período entre 7 e 14 dias após a última sessão de radioterapia. A capacidade de abertura bucal pós tratamento radioterápico no GA foi diminuída em média 8,35%. A avaliação do impacto da saúde bucal na qualidade de vida antes e após tratamento foi significativo em três dimensões e na avaliação geral do questionário. O planejamento de distribuição das isodoses em região de tumor e áreas adjacentes através de tomografia computadorizada foi facilitado pelo uso de dispositivo intraoral devido afastamento mecânico de estruturas bucais não comprometidas pelo câncer. A diminuição dos efeitos colaterais causados pela radioterapia melhoram a qualidade de vida durante e após o tratamento. A estabilização da posição de boca e língua durante a radioterapia deixou o tratamento mais confortável para os pacientes, além de beneficiar o trabalho do médico radioterapeuta e físico médico. (AU)

In Brazil, between 2016 and 2017, the cancer diagnosis in the mouth and larynx region is estimated to reach more than 22,000 people. The main treatment for this disease are chemotherapy, surgery and radiotherapy done in a conjunct way or not. The antineoplastic treatment generates several side effects that do much harm to the patient welfare. In radiotherapy, the main side effects are oral mucositis, dysgeusia and trismus, besides the salivation development, radiation cavities and osteoradionecrosis. The radiotherapy by IMRT allows the cancer treatment with different radiation isodoses according to the region allowing a reduced amount of free tumor region emission close to the main focus treatment, different from the older conventional radiotherapeutic treatment. Our goal was to develop an intraoral device using acrylic resin to put away healthy tissue from the IMRT treatment main focus, separating mechanically palate, tongue and mouth floor in mouth and oropharynx neoplasm region patients. The patients compused two groups: control (CG) without intraoral stent and analysis (AG) with intraoral stent usage. The CG patients were evaluated throughout their medical records historic; the AG was accompanied during planning and all the IMRT radiotherapeutic treatment. The oral mucositis degrees were evaluated according WHO (CG and AG) and OMAS (AG) criteria, survey about mouth health impact on welfare before and after (AG) the radiotherapy sessions, gender, age, concomitant antineoplastic treatment, radiation doses (CG and AG), dysgeusia treatment (AG) and trismus (AG). Higher incidence of oral mucositis severity to CG patients occurred; the statistic tests were significant with p < 0.05 to minor erythema and ulcer development degree in mouth mucosa in AG. In all AG patients developed dysgeusia in the period between 7 and 14 days after the last radiotherapy session. The mouth opening after radiotherapeutic treatment diminished a mean of 8.35%. The impact of mouth health on welfare before and after treatment was not significant. The isodoses distribution planning in tumor and nearby areas regions throughout computed tomography was eased by the intraoral stent usage due to mechanically spacing from the mouth structures not harmed by cancer. The side effects diminishing caused by radiotherapy improve welfare during and after the treatment and the mouth and tongue position stabilization during the radiotherapy left the treatment more comfortable for the patients, besides benefitting the medical radiotherapist and the medical physicist work. (AU)

Antifungal susceptibility in vitro determined by the Etest® for Candida obtained from the oral cavity of irradiated and elderly individuals.

This study aimed to evaluate the in vitro antifungal susceptibility of Candida species of head-and-neck-irradiated patients (Group 1), non-institutionalized (Group 2) and institutionalized elders (Group 3) using Etest® methodology. Candida was isolated from saliva and presumptively identified by CHROMagar Candida(r), confirmed by morphological criteria, carbohydrate assimilation (API 20C AUX®) and genetic typing (OPE 18). The collection was made from 29, 34 and 29 individuals (Groups 1, 2 and 3, respectively) with 67 isolates. Etest® strips (ketoconazole, itraconazole, fluconazole, amphotericin B and flucytosine) on RPMI (Roswell Park Memorial Institute) agar, on duplicate, were used to evaluate susceptibility. ATTC (American Type Culture Collection) 10231 (Candida albicans) was used as quality control. Among the 67 isolates of Candida species, most were susceptible to azoles, flucytosine and amphotericin B. None of the isolates showed resistance and dose-dependent susceptibility to amphotericin B. There were nine strains resistant to itraconazole, six to fluconazole and two to ketoconazole and ten dose-dependent, mainly to flucytocine. The highest MIC (minimum inhibitory concentration) to C. albicans, C. tropicalis, C. parapsilosis was 2.671 µg.mL-1, 8.104 µg.mL-1, 4.429 µg.mL-1, all for flucytosine. C. krusei and C. glabrata were associated with higher MIC for azoles and C. glabrata with higher MIC to flucytosine. In summary, susceptibility to all tested antifungal agents was evident. The isolates were more resistant to itraconazole and dose-dependent to flucytosine. A comparison of C. albicans in the three groups showed no outliers. Higher MIC was associated with C. krusei and C. glabrata.

Antifungal Susceptibility In Vitro Determined by the Etest(r) for Candida Obtained from the Oral Cavity of Irradiated and Elderly Individuals

This study aimed to evaluate the in vitro antifungal susceptibility of Candida species of head-and-neck-irradiated patients (Group 1), non-institutionalized (Group 2) and institutionalized elders (Group 3) using Etest(r) methodology. Candida was isolated from saliva and presumptively identified by CHROMagar Candida(r), confirmed by morphological criteria, carbohydrate assimilation (API 20C AUX(r)) and genetic typing (OPE 18). The collection was made from 29, 34 and 29 individuals (Groups 1, 2 and 3, respectively) with 67 isolates. Etest(r) strips (ketoconazole, itraconazole, fluconazole, amphotericin B and flucytosine) on RPMI (Roswell Park Memorial Institute) agar, on duplicate, were used to evaluate susceptibility. ATTC (American Type Culture Collection) 10231 (Candida albicans) was used as quality control. Among the 67 isolates of Candida species, most were susceptible to azoles, flucytosine and amphotericin B. None of the isolates showed resistance and dose-dependent susceptibility to amphotericin B. There were nine strains resistant to itraconazole, six to fluconazole and two to ketoconazole and ten dose-dependent, mainly to flucytocine. The highest MIC (minimum inhibitory concentration) to C. albicans, C. tropicalis, C. parapsilosis was 2.671 μg.mL-1, 8.104 μg.mL-1, 4.429 μg.mL-1, all for flucytosine. C. krusei and C. glabrata were associated with higher MIC for azoles and C. glabrata with higher MIC to flucytosine. In summary, susceptibility to all tested antifungal agents was evident. The isolates were more resistant to itraconazole and dose-dependent to flucytosine. A comparison of C. albicans in the three groups showed no outliers. Higher MIC was associated with C. krusei and C. glabrata.

Esse estudo objetivou avaliar a susceptibilidade antifúngica in vitro de espécies de Candida obtidas de pacientes irradiados em cabeça e pescoço (Grupo 1), idosos não institucionalizados (Grupo 2) e idosos institucionalizados (Grupo 3) usando a metodologia Etest(r). Candida foi isolada da saliva e identificada presuntivamente pelo teste CHROMagar Candida(r), confirmada pelo critério morfológico, assimilação de carboidratos API 20C AUX(r) e identificação genética (OPE 18). A coleta foi feita em 29, 34 e 29 indivíduos (Grupos 1, 2 and 3, respectivamente) com 67 isolados. As fitas de Etest(r) (cetoconazol, itraconazol, fluconazol, anfotericina B and flucitosina) em meio ágar RPMI (Roswell Park Memorial Institute), em duplicata, foram utilizados para avaliar a susceptibilidade. A ATTC (American Type Culture Collection) 10231 (Candida albicans) foi usada como controle de qualidade. Dos 67 isolados de espécies de Candida, a maioria foi susceptíveis aos azoles, flucitosina e anfotericina B. Nenhum dos isolados mostrou resistência ou susceptibilidade dose-dependente a anfotericina B. Houve nove espécies resistentes ao itraconazol, seis ao fluconazol e duas ao cetoconazol e dez dose-dependentes, principalmente a flucitosina. Os maiores valores de MIC (mínima concentração inibitória) para C. albicans, C. tropicalis, C. parapsilosis foram, respectivamente, 2,671 μg.mL-1, 8,104 μg.mL-1, 4, 429 μg.mL-1, todos para a flucitosina. C. krusei e C. glabrata foram associadas a um maior MIC para azoles e C. glabrata com maior MIC para flucitosina. Em resumo, a susceptibilidade a todos os antifúngicos testados foi evidente. Os isolados foram mais resistentes ao itraconazol e dose dependentes para a flucitosina. A comparação para C. albicans nos três grupos não mostrou diferença. Os maiores valores de MIC estavam relacionados a C. krusei e C. glabrata.

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.

A review of the biological and clinical aspects of radiation caries.

AIM: The aim of this article is to review the clinical and biological features underlying the development and progression of radiation caries. BACKGROUND: Although radiotherapy (RT) plays an important role in the management of patients with head and neck cancer (HNC), it is also associated with several undesired side effects such as radiation caries which is a common, yet serious, complication. To review the condition, the Pubmed database was searched using the keywords "radiotherapy," "radiation," "caries," "hyposalivation," "prevention" and "management". Only studies published in the English language were selected. Cross-referencing identified additionally relevant studies. REVIEW RESULTS: RT leads to alterations in the dentition, saliva, oral microflora, and diet of patients. Consequently, irradiated patients are at increased risk for the development of a rapid, rampant carious process known as radiation caries. Motivation of patients, adequate plaque control, stimulation of salivary flow, fluoride use, and nutritional orientation are essential to reduce the incidence of radiation caries and ultimately improve the quality of life for HNC patients. CONCLUSION: Radiation caries is an aggressive side effect of RT. Dentists play an important role in the prevention of the condition via comprehensive oral healthcare before, during, and after the active cancer therapy. CLINICAL SIGNIFICANCE: Dentists should understand the clinical and biological aspects underlying radiation caries to prevent the development of lesions and provide optimal treatment when needed.

Avaliação clínica da frequência de complicações orais e sua relação com a qualidade de higiene bucal em pacientes pediátricos submetidos a tratamento antineoplásico / Clinical evaluation to the frequency of oral complications and its relation with the quality of buccal hygiene in pediatric patients submitted to antineoplastic treatment

Este estudo tem como objetivo avaliar e identificar a presença de complicações orais agudas decorrentes do tratamento antineoplásico além de correlacionar com a condição de saúde bucal em 59 pacientes pediátricos submetidos a tratamento antineoplásico no CEONH/HUOC, com idade entre 0 e 18 anos. O aspecto clínico da mucosa bucal foi avaliado em intervalos semanais, no leito, sob luz artificial, com o auxílio de abaixador de língua, do início ao término do tratamento oncológico. Para a avaliação clínica da mucosite utilizou-se o critério de toxicidade aguda da World Health Organization (WHO). A saúde bucal foi avaliada na primeira consulta, através da inspeção visual e foi classificada como favorável ou desfavorável. Dos 59 pacientes, 36 (61 por cento) apresentavam saúde bucal favorável. Das complicações orais que acometeram os pacientes com qualidade de higiene bucal desfavorável, a candidíase correspondeu a 45,2 por cento, nos pacientes que apresentaram qualidade de higiene bucal favorável, a candidíase correspondeu a 26,1 por cento das complicações orais. A mucosite também foi mais freqüente nos pacientes com qualidade de higiene bucal desfavorável, 28,6 por cento das complicações orais. A orientação aos pacientes e seus responsáveis sobre a necessidade e importância de uma higiene bucal rigorosa é indispensável, considerando que a saúde bucal é um dos fatores que favorecem o aparecimento e aumento da severidade das complicações orais agudas decorrentes do tratamento antineoplásico.

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis.

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including profilatic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1 percent) patients developed radiation caries and 5 out of 23 cases (21.3 percent - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental condictions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

Pacientes portadores de carcinomas espinocelulares em cabeça e pescoço necessitam receber tratamento odontológico antes da radioterapia. Mesmo pacientes que visitam regularmente consultórios odontológicos requerem especial atenção incluindo profilaxias e tratamentos curativos. Os objetivos desse estudo foram avaliar a condição odontológica de 40 pacientes de baixo nível sócio-econômico antes da radioterapia em cabeça e pescoço e discutir o tratamento odontológico realizado. Os pacientes foram acompanhados durante o tratamento oncológico. Antes da radioterapia, 28 pacientes eram dentados e doze edêntulos, sendo que todos esses apresentavam péssimas condições sistêmicas e higiene oral deficiente. O tratamento mais comumente empregado foi a extração dentária e 23 pacientes tiveram a média de 8,6 dentes extraídos (Grupo I). Um em 9 (11,1 por cento) pacientes desenvolveram cárie por radiação e 5 em 23 (21,73 por cento) osteorradionecrose, sendo um caso associado a extrações dentárias prévias à radioterapia e outros de origem multifatorial. Pacientes de baixo nível socioeconômico com carcinoma espinocelular em cabeça e pescoço receberam múltiplas extrações dentárias devido à condição dentária precária e má higienização. O tratamento odontológico não preveniu a osteorradionecrose, que apresenta origem multifatorial na maioria dos casos.

Seqüelas orais da radioterapia: atuaçäo da odontologia na prevençäo e tratamento / Oral damage of radiotherapy: preventive dentistry and treatment

Os autores mostram a importância da participaçäo multidisciplinar no tratamento do paciente oncológico no que diz respeito à prevençäo e tratamento da seqüelas orais decorrentes da irradiaçäo de cabeça e pescoço. Os principais efeitos secundários säo: xerostomia, mucosite, cárie de radiaçäo e osteorradionecrose; cabendo ao cirurgiäo-dentista agir preventivamente no sentido de evitar o aparecimento dessas seqüelas ou amenizar seus afeitos.