Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation

BACKGROUND: Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. MATERIAL AND METHODS: A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. RESULTS: The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF > 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. CONCLUSION: Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures

No disponible

Impact of xerostomia on the quality of life of patients submitted to head and neck radiotherapy

BACKGROUND: The aim of the present work was to evaluate the impact of xerostomia on the quality of life of patients who underwent radiotherapy in the head and neck region. MATERIAL AND METHODS: This was a cross-sectional, quantitative study. The sample comprised 40 patients whose xerostomia was classified through the xerostomia inventory and the quality of life evaluated through the oral health impact profile questionnaire (OHIP). RESULTS: The majority of participants were male (75%), mean age 58.7 years. According to the degree of severity of the xerostomia, the average score among the participants was 36 points, this being considered moderate xerostomia. A significant impact was observed, with the median score 11 points, with the highest scores in the domains related to functional limitation, physical pain and physical disability. The majority of the participants (97.5%) had reduced salivary flow after the end of radiotherapy. There was a significant positive correlation between the degree of xerostomia and reduced quality of life, Pearson correlation 0.5421, (p < 0.05). CONCLUSION: Based upon the results it is concluded that xerostomia has a negative impact on the quality of life of patients who undergo radiotherapy in the head and neck region

No disponible

Oral features of systemic sclerosis: A case-control study.

OBJECTIVE: The aim of this study was to evaluate the orofacial parameters of systemic sclerosis (SSc) and its related systemic features. SUBJECTS AND METHODS: A descriptive case-control study was performed from November 2015 to October 2016. Ninety-three individuals were included and divided into SSc group (n = 50) and healthy controls (C, n = 43). RESULTS: Systemic sclerosis individuals were mostly women (43/50, 86%), with a mean age of 46 years (±11.6 years). Telangiectasia (42/50, 84%) and reduced mouth opening (35/50, 70%) were the most frequent orofacial findings. The periodontitis frequency was much higher in SSc individuals than in healthy controls (90.7% × 48.83%; p < .001). In addition, SSc individuals presented a distinctive pattern of periodontitis, with low probing pocket depth (2 ± 0.65 mm × 2 ± 0.24; p < .001), higher gingival recession (4 ± 2.13 × 0.14 ± 0,22; p < .001), higher periodontal attachment loss (6 ± 1.34 mm × 2 ± 0.43, p < .001), and lower gingival bleeding index values (7.05 ± 7.25 × 21.57 ± 15.66; p < .001). CONCLUSIONS: Orofacial manifestations were common in SSc and included a unique pattern of periodontal manifestation, characterized by lower gingival bleeding index, higher periodontal attachment loss, and low probing depth.

Small palatal swelling: an uncommon presentation of intraoral schwannoma.

Schwannomas are uncommon benign tumors arising in the nerve-supporting Schwann cells. Intraoral lesions usually present in the tongue or floor of the mouth as a submucosal nodule, while the palate is rarely affected. A 26-year-old white man presented with an asymptomatic submucosal fibroelastic nodule in the hard palate. The 2 × 2-cm lesion was covered by normal-appearing mucosa. Under the working diagnosis of minor salivary gland tumor, an incisional biopsy was performed, and analysis revealed an encapsulated tumor with a well-defined biphasic pattern: hypercellular areas with spindled cells arranged in palisades and less cellular areas formed by irregular arranged masses of elongated cells and fibers. The diagnosis of schwannoma was rendered, and the lesion was excised together with periosteum. No recurrence was observed after 30 months of follow-up. Palatal nodules usually present as minor salivary gland tumors; rarer lesions, such as schwannomas, represent a clinical diagnostic challenge. Clinicians should consider schwannoma in the differential diagnosis for palatal nodules and manage them with incisional biopsy and prompt treatment.

Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series.

Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions.

Serologic profile and clinical markers of Sjögren syndrome in patients with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to evaluate the clinical relevance of rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) in patients with Sjögren syndrome (SS) secondary to rheumatoid arthritis (RA). METHODS: The study included 118 individuals, and the subjects were divided into three groups: rheumatoid arthritis (RA; n = 46), RA with secondary Sjögren syndrome (RA/SS; n = 20) and healthy controls (C; n = 52). Clinical and laboratory characteristics, including ocular, oral, and serum markers, anti-CCP, and rheumatoid factor (RF), were compared in addition to biopsy of labial minor salivary glands. RESULTS: The RA group exhibited unstimulated salivary flow rate, and Schirmer test results were similar to those for C and higher than those for RA/SS (P < .05). Furthermore, the frequency of xerophthalmia and xerostomia was similar among the RA and C groups, and much higher in the RA/SS group (P < .05). Anti-CCP positivity and serum levels were similar in both RA groups, irrespective of SS diagnosis (RA × RA/SS; P > .05). RF presented a similar frequency and serum level between the RA and RA/SS groups (P > .05). CONCLUSIONS: Secondary SS seems to be a cluster of oral and ocular symptoms among patients with RA. Anti-CCP and RF are not relevant to evaluate the presence of SS among these patients.

Seroprevalence of herpes virus associated with the presence and severity of oral mucositis in children diagnosed with acute lymphoid leukemia.

INTRODUCTION: Acute lymphoid leukemia (ALL) is the hematologic neoplasia most commonly diagnosed in children. Among the secondary side effects of chemotherapy, mucositis is the most frequent complication. The aim of this study was to evaluate the seroprevalence of herpes viruses HSV-1, EBV, and CMV and the presence and severity of oral mucositis in children and adolescents diagnosed with ALL. METHODOLOGY: Ninety-two patients diagnosed with ALL were evaluated. Serum samples were collected before chemotherapy and tested by ELISA method. Presence of mucositis was observed on the first day before antineoplastic therapy (D0) and on 7th day post-therapy (D7). Classification of mucositis intensity was performed according to toxicity criteria established by the National Cancer Institute. RESULTS: 70.7% of the patients presented mucositis on the D7, and of these, 60% were classified as Grade I and 40% as Grade II; of the 92 individuals tested, 59 (64.1%) presented antibodies for HSV-1, 57 (62%) for EBV, 75 (81.5%) for CMV_IgG, and 21 (22.8%) for CMV_IgM. Using a logistic regression model, the presence of HSV-1 was observed to be 4.10 times greater in Grade II mucositis severity than in Grade I (P = 0.03). CONCLUSION: Based on the findings of this study, it was possible to conclude that infection by the herpes viruses HSV-1, EBV, and CMV is ubiquitous in the studied population and that HSV-1 may be a risk factor for aggravating the severity of mucositis.

Oral and genital HPV genotypic concordance between sexual partners.

OBJECTIVES: The aim of this study was to verify human papillomavirus (HPV) transmission and genotype concordance among heterosexual couples. MATERIALS AND METHODS: Thirty-one married couples were evaluated. All male subjects presented with clinically diagnosed HPV-related malignant or potentially malignant lesions and underwent peniscopy and penile swab. Their female counterparts underwent swabs of the uterine cervix and oral mucosa. HPV-DNA detection was performed by polymerase chain reaction and restriction fragment length polymorphism. RESULTS: HPV-DNA was detected in the penis, vagina/cervix, and oral cavity of 16 couples (51.61%). Of these, HPV-DNA concordance was observed in 14 couples (87.5%). HPV-DNA was amplified in penile and oral sites of 14 couples. Of these, 13 couples reported fellatio (92.85%), most of them (10 couples, 76.9%) without condom use. HPV-DNA concordance was observed in 7/10 of these couples (70%). The three couples (100%) who reported use of condom during fellatio were HPV-DNA discordant (p = 0.025). CONCLUSIONS: Lifetime number of female sexual partners and detection of HPV-DNA in the penile mucosa are surrogate markers of exposure to HPV during marriage. Consistent use of condoms may reduce the risk of HPV transmission. CLINICAL RELEVANCE: Oral acquisition of HPV from oro-genital contact is influenced by lack of condom use and previous sexual behavior of the male partner. In addition, oral transmission of the virus due to fellatio is as common as genital transmission.

Noma in an immunocompromised patient.

Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery.

Bilateral lymphoepithelial cyst of the tongue: a case report.

A lymphoepithelial cyst (LC) is a rare occurrence in the oral cavity, lined by a keratinized stratified squamous epithelium that is surrounded by diffuse lymphoid tissue, that often contains lymphoid follicles. The clinical aspect of oral LC includes an asymptomatic yellowish nodule (less than 10 mm) with regular surface and soft consistency. It usually affects the floor of the mouth and the ventral and posterolateral surfaces of the tongue in adult male patients. To date, approximately 280 cases of LC in the oral cavity have been reported in the literature; however, none of them appear bilaterally. This article presents the histopathological and immunohistochemical findings of a unique bilateral LC in the posterolateral region of the tongue.

Juvenile Sjögren syndrome: distinctive age, unique findings.

Juvenile Sjögren's syndrome is a rare condition that affects children and adolescents with distinctive clinical features. Parotid swelling usually precedes regular oral and ocular symptoms, while typical serological findings may be absent. Hence, diagnosing juvenile Sjögren's syndrome may be challenging to the attending pediatric dentist, and long-term management without proper diagnosis may be jeopardized. The purpose of this report was to detail the features of an adolescent with primary Sjögren's syndrome diagnosed 12 years after the onset of the disease. An updated literature review highlighted the unusual aspects of the pediatric form of the disease.

Estomatologia: atualização para o clínico geral, parte I: diagnóstico e tratamento das lesões da boca / Oral medicine: atualization for the dentist, part I: diagnosis and treatment of orofacial diseases

O objetivo do presente trabalho é alertar o cirurgião-dentista, mais especificiamente o clínico geral, para os recentes avanços no diagnóstico e tratamento das lesões que acometem a cavidade oral. A literatura pertinente foi revista, com maior ênfase nas referências mais atualizadas. Este artigo inicia uma série, onde as lesões de boca, divididas em grupos de acordo com suas características clínicas, serão abordadas detalhadamente

Estomatologia: atualização para o Clínico geral, parte II: lesÕes brancas da cavidade oral / Oral medicine: an update for the general dental practitioner, part II: oral cavity's white lesions

As lesões brancas mais comumente encontradas na cavidade oral podem ser classificadas de acordo com a etiologia em congênitas e adquiridas, sendo essas últimas divididas em infecciosas e não-infecciosas. O objetivo do presente trabalho é descrever de forma sucinta a etiologia, as características clínicas, o diagnóstico diferencial, o tratamento e o prognóstico das referidas lesões. Foi realizado um levantamento bibliográfico, dando ênfase às citações mais atualizadas

Estomatologia: atualização para o clínico geral, parte III: lesões pigmentadas da cavidade oral / Oral medicine: an update for the general dental practitioner, part III: oral cavity's pigmented lesions

As lesões pigmentadas mais comumente encontradas na cavidade oral podem ser classificadas de acordo com a presença ou ausência de melanina. O objetivo do presente trabalho é descrever de forma sucinta a etiologia, as características clínicas, o diagnóstico diferencial, o tratamento e o prognóstico das referidas lesões. Foi realizado um levantamento bibliográfico, dando ênfase às citaçòes mais atualizadas

Síndrome da boca ardida: uma alternativa terapêutica baseada no uso da vitamina B associada a um neuroregenerador / The burning mouth syndrome: one therapeutic alternative based in the use or vitamine B associate with neuroregeneration

A síndrome da boca ardida é uma condição caracterizada pela sensação de dor e ardor bucal com ausência de sinais clínicos específicos e com mucosa bucal em estado de normalidade, considerada de etiologia variada ou inespecífica, estando relacionada a diversos fatores, dentre eles a avitaminose B, anemia ferropriva, diabetes não-compensada, fatores hormonais (principalmente no climatério e menopausa) e hábitos nocivos à saúde bucal (fumo e álcool). Este trabalho levantou a incidência desta síndrome na clínica de estomatologia da UFPE, durante o período de julho de 1996 a julho de 1997, bem como aplicou uma terapêutica a base de vitamina B associada a um neuroregenerador e observou sua eficácia