Dental consensus on HSCT - Part II: dental Care during HSCT

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Dental consensus on HSCT - Part II: dental Care during HSCT.

During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Effect of photobiomodulation therapy on reducing the chemo-induced oral mucositis severity and on salivary levels of CXCL8/interleukin 8, nitrite, and myeloperoxidase in patients undergoing hematopoietic stem cell transplantation: a randomized clinical trial.

Oral mucositis (OM) is the most common debilitating complication among patients undergoing hematopoietic stem cell transplantation (HSCT). Photobiomodulation therapy (PBM) has shown beneficial effects in the treatment of OM, but few studies have evaluated its biological effects. This study evaluated the effect of PBM on the reduction of OM severity in patients undergoing HSCT and its relation to the modulation of the inflammatory response. Fifty-one patients were randomly assigned to two groups: PBM [submitted to PBM from admission (AD) to D+7] (n = 27) and control (n = 24) [received oral hygiene]. OM severity was assessed daily using the WHO scale. Saliva samples were collected on AD, D+7, and hospital discharge (HD) to measure CXCL8/interleukin 8, using cytometric bead array analysis and nitrite (NO) and myeloperoxidase (MPO) using colorimetric methods. PBM significantly reduced the severity of OM from D+7 to D+11 (p < 0.05). All non-interventional patients (controls) who developed grade 2 or higher OM induced an increase of CXCL8 in saliva (n = 14) on D+7. PBM led to a decrease in CXCL8 on D+7 in 85% of patients, while 70.8% of patients in the control group presented an increase in this chemokine (p = 0.007). NO decreased from AD to D+7 in the PBM group (p > 0.05). MPO significantly decreased on D+7 in both groups (p < 0.05). PBM brought about a reduction in the severity of OM in patients undergoing HSCT, and this reduction was associated with a decrease in CXCL8 salivary levels.

Tumor marrom em maxila associado ao hiperparatireoidismo secundário: relato de caso clínico / Brown tumour of the jaws associated with secondary hiperparathyroidism: case report

O tumor marrom é uma lesão intraóssea benigna focal associada ao hiperparatireoidismo. Ocorre preferencialmente em ossos longos, costelas e pelve, porém, eventualmente pode acometer maxila e mandíbula. O prognóstico está associado à causa e ao tipo de hiperparatireoidismo, com isso é de grande importância o diagnóstico precoce para que seja estabelecido o quanto antes a terapêutica adequada. Apesar destas lesões serem raras nos ossos gnáticos e quando presentes estarem associadas principalmente ao hi per pa ratireoidismo primário e em mulheres com mais de 50 anos de idade, propusemos relatar um caso de tumor marrom secundário do hiperparatireoidismo em paciente do gênero masculino e de 36 anos de idade.

The brown tumor is a focal benign intraosseous lesion associated with hyperparathyroidism. Preferably occurs in long bones, ribs and pelvis, however, may eventually affect the jaws. The prognosis is associated with the cause and type of hyperparathyroidism, with that It is very important for an early diagnosis so it can soon be established an appropriate therapy. Although these are rare injuries on the gnathic bones and when present are mainly associated with primary hyperparathyroidism and in women over 50 years old, we proposed to report a case of secondary hyperparathyroidism brown tumor in a 36 years old male patient.

The Impact of Low-Level Laser Therapy on Oral Mucositis and Quality of Life in Patients Undergoing Hematopoietic Stem Cell Transplantation Using the Oral Health Impact Profile and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaires.

OBJECTIVE: The aim of this study was to assess the impact of low-level laser therapy (LLLT) on oral mucositis (OM) and quality of life (QoL) of hematopoietic stem cell transplantation (HSCT) patients. BACKGROUND DATA: OM related to high-dose chemotherapy is often associated with increased risk of mortality and impaired QoL in HSCT patients. LLLT has shown promising effects in the prevention and treatment of chemotherapy-induced OM. There is a dearth of literature focused on subjective aspects involving OM and QoL in patients receiving LLLT. METHODS: Thirty-nine patients were randomly assigned to two groups: control (n=19) and laser (n=20). LLLT was performed from the 1st day of the conditioning regimen until day 7 post-HSCT (D+7). OM severity was evaluated in all patients [World Health Organization (WHO) scale]. A blinded observer collected subjective outcomes from patients on admission (AD), D+7 and at discharge (DC). QoL was assessed using the Oral Health Impact Profile (OHIP-14) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaires. Statistical analyses included descriptive, bivariate and multivariate (generalized estimating equation) tests. RESULTS: The overall FACT-BMT (p=0.074) and OHIP-14 (p=0.749) scores were not associated with the use of laser therapy. Both instruments showed a deterioration in QoL for the whole sample on D+7. The laser group presented less severe OM than the control group (p<0.001). CONCLUSIONS: LLLT did not influence the oral and general health-related QoL of patients undergoing HSCT, although it was clinically effective in reducing the severity of chemotherapy-induced OM.

Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are submitted to a conditioning regimen of high-dose chemotherapy, with or without radiation therapy, which usually results in oral ulcerations and mucosal barrier breakdown. Oral mucositis (OM) is a common and debilitating toxicity side effect of autologous and allogeneic HSCT. The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on the severity of OM and inflammatory mediator (TNF-α, IL-6, IL-1ß, IL-10, TGF-ß, metalloproteinases, and growth factors) levels in saliva and blood of HSCT patients. Thirty patients were randomly assigned to two groups: control (n = 15) and laser (n = 15). LLLT was applied from the first day of the conditioning regimen until day 7 post-HSCT (D + 7). Saliva and blood were collected from patients on admission (AD), D-1, D + 3, D + 7, and on marrow engraftment day (ME). Clinical results showed less severe OM in the laser group (p < 0.05). The LLLT group showed increased matrix metalloproteinase 2 (MMP-2) levels in saliva on D + 7 (p = 0.04). Significant differences were also observed for IL-10 on D + 7 and on ME in blood plasma, when compared to the control group (p < 0.05). No significant differences were seen in saliva or blood for the other inflammatory mediators investigated. LLLT was clinically effective in reducing the severity of chemotherapy-induced OM in HSCT patients, and its mechanism of action does not seem to be completely linked to the modulation of pro- or anti-inflammatory cytokines, growth factors or matrix metalloproteinases.

The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial.

BACKGROUND DATA AND OBJECTIVE: Patients who have received high doses of chemotherapy, either alone or in combination with total body irradiation often cite oral mucositis (OM) as the most debilitating side effect. The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) on the prevention of conditioning-induced OM in hematopoietic stem cell transplantation (HSCT). METHODS: We randomized 42 patients who underwent autologous or allogeneic HSCT. A low-level InGaAlP diode laser was used, emitting light at 660 nm, 40 mW, and 4 J/cm(2). An evaluation of OM was carried out using the World Health Organization scale. RESULTS AND CONCLUSION: In the LLLT group, 57.1% of patients had an OM grade 0, 9.6% had grade 1, and 33.3% had grade 2, whereas in the control group, only 4.8% of patients were free of OM (grade 0). Our results indicate that the preventive use of LLLT in patients who have undergone HSCT is a powerful instrument in reducing OM incidence.

O papel do laser de baixa intensidade e da cloredidina 0, 12% no tratamento da mucosite bucal em crianças leucêmicas submetidas à quimioterapia / The utilization of the low energy laser and chlorexidine 0, 12% in the management of oral mucositis due to chemotherapy unn children with leukemia

No tratamento das leucemias é utilizada a quimioterapia, que apresenta vários efeitos colaterais. A mucosite bucal é a principal causa de dor durante a quimioterapia e a complicação mais comum dotratamento para neoplasias hematológicas. Esse estudo teve o objetivo de avaliar o uso do laser debaixa intensidade e da clorexidina 0,12% no tratamento da mucosite bucal decorrente de quimioterapiaem crianças leucêmicas. A amostra foi constituída por 10 crianças (Grupo Experimental) com leucemia aguda submetidas à quimioterapia e portadoras de mucosite bucal Graus I, II ou III, atendidas noHospital Araújo Jorge da Associação de Combate ao Câncer em Goiás. Também fazia parte da amostra, dados de 24 prontuários de pacientes infantis com leucemia aguda, tratados no mesmo hospital, que apresentaram mucosite bucal como intercorrência do tratamento de quimioterapia. Os pacientes do Grupo Experimental foram aleatoriamente distribuídos para receber o tratamento 1 (clorexidina 0,12%) ou 2 (laser). A presença e o grau de mucosite eram avaliados pelo mesmo examinador. Para comparação, os dados de prontuários de pacientes previamente tratados foram registrados, sendo que para estes, era utilizado apenas o tratamento sintomático da mucosite bucal. Os registros, da mesma forma, eram anotados quanto à presença e grau de mucosite. A mucosite bucal foi menos freqüente e teve menor tempo de duração no grupo que recebeu tratamento (clorexidina ou laser) do que no gruposem tratamento. A associação das várias formas de tratamento (higiene bucal, clorexidina e laser) leva à redução do número de episódios de mucosite bem como menor duração das lesões

Chemotherapy, which presents several side effects, is used in the management of leukemia. Oral mucositis is the main cause of pain during chemotherapy and is the most common complication in the management of hematological cancer. The aim of the current study was to investigate the utilization of the low-energy laser and the use of chlorexidine 0,12% in the management of oral mucositis due to chemotherapy in children with leukemia. The study group was composed of 10 children with acute leukemia, who developed oral mucositis grade I, II, or III, and who underwent chemotherapy at the Araújo Jorge Hospital at the Combat Cancer Association of Goias. 24 case records of infant patients with acute leukemia, who were managed at the already mentioned hospital, and who developed oral mucositis as intercurrence of chemotherapy, were also included. The patients in the Study Group were randomized tobe treated with 1 (chlorexidine 0,12%) or 2 (laser). The presence and the degree of mucositis being evaluated by the same examiner. For comparison, data in the charts of patients previously treated were registered. For these patients, just the symptomatic treatment of the oral mucositis was used. The data about the presence and degree of mucositis were equally logged. Oral mucositis was less frequent and had a shorter period of duration in the treated group (chlorexidine or laser) than in the untreated group. The association of various forms of treatment (oral hygiene, chlorhexidine and laser) decreases the number of mucositis occurrences and shortens duration of the lesions