Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the efficacy of 2 protocols of exercise therapy to avoid reduction in mouth opening (MO) in patients undergoing radiotherapy for head and neck cancer. STUDY DESIGN: This was a randomized, controlled, double-blind, 3-arm, parallel-group, prevention clinical trial. Ninety patients were randomized into 3 groups to perform exercises during radiotherapy treatment: intervention group 1 (G1); intervention group 2 (G2); and control group (CG). Maximum MO was measured before (T0), immediately after (T1), and at 12 months (T2) after completion of radiotherapy treatment. Generalized estimating equations model complemented by the least significant difference test was applied to group comparisons. RESULTS: There was no significant difference in MO measure between the groups at the 3 assessment time points (P = .264). The difference in MO measure from baseline to 12 months after having completed radiotherapy was -1 mm in CG (95% confidence interval [CI] -4.0 to 2.0); 1.3 mm in G1 (95% CI -1.7 to 4.3); and 0.5 mm in G2 (95% CI -3.4 to 4.4). CONCLUSIONS: It was not possible to conclude that the exercise protocols performed in this study are more effective than the usual guidance to prevent reduction in MO in patients undergoing radiotherapy for head and neck cancer.

Jaw mobility changes in patients with upper aerodigestive tract cancer undergoing radiation therapy

BACKGROUND: Radiation therapy is a therapeutic modality widely used for treatment of upper aerodigestive tract (UADT) neoplasms. However, its action is not restricted to tumor cells, and it may cause a variety of adverse reactions, including reduced jaw mobility. MATERIAL AND METHODS: A prospective cohort study was conducted to assess changes in jaw mobility in patients with UADT cancer undergoing radiation therapy. RESULTS: Fifty-six patients completed the study. The results showed a significant reduction in mouth opening (p < 0.001), right lateral excursion (p = 0.038) and left lateral excursion (p = 0.035) of the jaw, a significant increase in the presence (p < 0.001) and severity of oral mucositis (p < 0.001), and a significant decrease in performance status (p < 0.001) after radiation therapy. Thirty-six patients (64.3%) exhibited reduction in mouth opening after treatment. The variables significantly associated with mouth opening reduction on bivariate analysis were: modification of diet (p = 0.037), radiation field (p = 0.024), presence of mucositis (p = 0.003), and reduction in performance status (p = 0.007). After adjustment by the multivariate model, the only variables that remained significantly associated with reduction in mouth opening were presence of mucositis (p = 0.018) and reduction in performance status (p = 0.47). CONCLUSIONS: These findings indicate that patients with upper aerodigestive tract cancer experience reduced jaw mobility after radiation therapy, which is strongly correlated with mucositis and reduced functional ability

Jaw mobility changes in patients with upper aerodigestive tract cancer undergoing radiation therapy.

BACKGROUND: Radiation therapy is a therapeutic modality widely used for treatment of upper aerodigestive tract (UADT) neoplasms. However, its action is not restricted to tumor cells, and it may cause a variety of adverse reactions, including reduced jaw mobility. MATERIAL AND METHODS: A prospective cohort study was conducted to assess changes in jaw mobility in patients with UADT cancer undergoing radiation therapy. RESULTS: Fifty-six patients completed the study. The results showed a significant reduction in mouth opening (p<0.001), right lateral excursion (p=0.038) and left lateral excursion (p=0.035) of the jaw, a significant increase in the presence (p<0.001) and severity of oral mucositis (p<0.001), and a significant decrease in performance status (p<0.001) after radiation therapy. Thirty-six patients (64.3%) exhibited reduction in mouth opening after treatment. The variables significantly associated with mouth opening reduction on bivariate analysis were: modification of diet (p=0.037), radiation field (p=0.024), presence of mucositis (p=0.003), and reduction in performance status (p=0.007). After adjustment by the multivariate model, the only variables that remained significantly associated with reduction in mouth opening were presence of mucositis (p=0.018) and reduction in performance status (p=0.47). CONCLUSIONS: These findings indicate that patients with upper aerodigestive tract cancer experience reduced jaw mobility after radiation therapy, which is strongly correlated with mucositis and reduced functional ability.

Avaliação da densidade óptica da superfície oclusal através de radiografias digitalizadas e sua relação com a presença de lesões de cárie em molares decíduos / Occlusal surface optical density measurement in digitized radiographs and the presence of caries in deciduous molars

O objetivo deste estudo foi comparar o desempenho de dois sistemas de medição de densidade óptica numa amostra composta por segundos molares decíduos, assim como relacionar a presença de lesão de cßrie dentinária na superfície oclusal de segundos molares decíduos com os valores de densidade óptica desta superfície, utilizando dois programas de computador. Para isso foi realizada a medição da densidade óptica de 28 radiografias padronizadas de segundos molares decíduos em dois programas de computador diferentes. Os resultados obtidos com o programa Digora® for Windows 2.1 foram comparados com os obtidos no programa Image Tool for Windows 3.0. Ainda, os valores de densidade óptica encontrados foram relacionados aos diagnósticos obtidos com o exame dos dentes no estereomicroscópio. Os programas Digora e Image Tool apresentaram valores de densidade óptica semelhantes, sem diferença estatisticamente significativa. Ainda, a densidade óptica observada nos dentes que não apresentavam lesões de cßrie dentinßrias na superfície oclusal foi diferente daquela cujos dentes possuiam lesão em dentina (p = 0,035). Entretanto, com os resultados obtidos neste estudo não foi possível estabelecer intervalos de densidade óptica correspondentes a superfícies oclusais com presença ou ausência de lesões de cßrie em dentina.

The role of basic oral care and good clinical practice principles in the management of oral mucositis.

BACKGROUND: The Basic Oral Care Group is one of eight subcommittees functioning within the Mucositis Study Group Guidelines Panel of the Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO). The Basic Oral Care Group, comprised of the four authors of this paper, represented the disciplines of nursing (DBM, JJ), dentistry (MEPC), and pediatric dentistry (PW). This group reviewed research and clinical literature to update the original 2004 Mucositis Management Guidelines in the areas of basic oral care, bland rinses, protocols and education, and good clinical practices such as pain management, oral assessment, oral care, and dental care. MATERIALS AND METHODS: Over 100 articles published between 2000 and 2005 were identified, and 32 of these were useful for the analysis. Each article was rated by at least two authors using a structured rating form and systematic determination of levels of evidence, based on the American Society of Clinical Oncology criteria. Discussion at the 2005 MASCC/ISOO Geneva pre-conference meeting of the Guidelines Panel resulted in the development of consensus on the interpretation of the literature. RESULTS: Based on the literature and on Panel discussions, a revision of the original guidelines for protocols and education was produced by the group, and they developed a set of recommendations related to good clinical practices. CONCLUSIONS: Although research remains scanty for components of basic oral care, bland rinses, protocols, and education, the original 2004 guidelines with the help of newer literature from 2000 to 2005 and expert consensus among the Guidelines Panel enabled the development of useful clinical practice guidelines for managing oral mucositis in patients receiving cancer treatment with radiation and/or chemotherapy.

A utilização de um disjuntor palatal modificado na fase de dentição decídua: relato de um caso clínico / A modifyed rapid maxillary expansion in deciduous dentition: a case report

O presente trabalho relata um caso clínico de uma paciente de 4 anos de idade tratada na Disciplina de Odontopediatria da FO-UFRGS portadora de mordida cruzada posterior por atresia de maxila. A técnica utilizada foi a expansão rápida da maxila (ERM) que tem por objetivo o aumento da dimensão transversal da arcada dentária superior, através da abertura da sutura palatina mediana. Foram abordados neste artigo os aspectos clínicos e radiográficos antes e depois da disjunção e após 60 dias de contenção