The feasibility of telehealth in the monitoring of head and neck cancer patients: a systematic review on remote technology, user adherence, user satisfaction, and quality of life.

OBJECTIVES: This systematic review aimed to analyze the use of telehealth in monitoring patients with head and neck cancer regarding the application used, user adherence to technology, user satisfaction, and user quality of life. MATERIALS AND METHODS: A search strategy was developed using the PICO acronym and the terms "Head and Neck Cancer," "Telehealth," "Mobile Application," and "Supportive Care." A broad literature search was performed on PubMed, Cochrane Library, Scopus, Web of Science, Lilacs, and Embase databases and on grey literature through Open Grey, Google Scholar, and Jstor, for studies comparing the monitoring of head and neck cancer patients with telehealth apps to the monitoring performed in a traditional way at health units. No study design, publication status, publication time, or language restrictions were applied. Pairs of reviewers worked independently for study selection and risk of bias assessment. The protocol was registered in PROSPERO and the PRISMA checklist used for reporting the review. RESULTS: We found 393 references in the databases, 325 after duplicate removal; 19 met the criteria for full-text reading; 08 studies were included for qualitative synthesis. Although there was heterogeneity regarding the technology used, the studies included showed that remote monitoring and/or self-management of symptoms through mobile applications was feasible for most patients, with satisfactory degrees of acceptability, satisfaction, usability, and adherence. The health-related quality of life improved with the use of remote technologies for telehealth, associated with low to moderate self-efficacy, higher personal control, and higher knowledge of health with clinically acceptable levels of accuracy compared to traditional clinical evaluation. Even when the data presented were not statistically significant, patients reported improvement in health-related quality of life after the intervention. CONCLUSIONS: Telehealth monitoring through the use of remote technologies presents itself as an alternative way of educating and supporting patients during the treatment of Head and Neck Cancer (HNC). There is the need for a more user-friendly interface, adequate user experience assessment, and the concrete applicability of telehealth technologies for monitoring patients with HNC in order to legitimize the cost-effectiveness of developing long-term multicenter longitudinal studies term.

Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women.

Purpose: The aim of this study was to compare the fractal dimension (FD) measured at 2 bone sites (second cervical vertebra and mandible) on cone-beam computed tomography (CBCT). The research question was whether FD could serve as an accessory tool to refer postmenopausal women for densitometric analysis. Therefore, the reliability and accuracy of FD were evaluated. Materials and Methods: In total, 103 postmenopausal women were evaluated, of whom 52 had normal bone mineral density and 51 had osteoporosis, according to dual X-ray absorptiometry of the lumbar spine and hip. On the CBCT scans, 2 regions of interest were selected for FD analysis: 1 at the second cervical vertebra and 1 located at the mandible. The correlations between both measurements, intra- and inter-observer agreement, and the accuracy of the measurements were calculated. A P value less than 0.05 was considered to indicate statistical significance for all tests. Results: The mean FD values were significantly lower at the mandibular region of interest in osteoporotic patients than in individuals with normal bone mineral density. The areas under the curve were 0.644 (P=0.008) and 0.531 (P=0.720) for the mandibular and vertebral sites, respectively. Conclusion: FD at the vertebral site could not be used as an adjuvant tool to refer women for osteoporosis investigation. Although FD differed between women with normal BMD and osteoporosis at the mandibular site, it demonstrated low accuracy and reliability.

The role of teledentistry in oral cancer patients during the COVID-19 pandemic: an integrative literature review.

OBJECTIVES: This integrative review aimed to assess the benefits of the use of teledentistry for patients undergoing treatment of oral and head and neck cancer during the COVID-19 pandemic. MATERIALS AND METHODS: We searched in PubMed, Cochrane, Scopus, Web of Science, Lilacs, Embase, Open Grey, Google Scholar, and Jstor databases for studies referring to the management, control, and assistance, through teledentistry, to patients with oral and head and neck cancer during the COVID-19 pandemic. RESULTS: We found 356 references in the databases, 209 after duplicates removal, 23 met criteria for full-text reading, and 11 studies were included for qualitative synthesis, in four categories: virtual visits, use of remote technology, patient's satisfaction, multidisciplinary approach in teledentistry. We found that 78% of patients currently preferred teledentistry; 92% of patients would recommend the use of video consultation to other patients. The continuity of dental care, the reduction of patient visits to the hospital, the reduction of the risk of infection with the coronavirus, and limitation of face-to-face consultations to protect health professionals are benefits that reinforce the use of teledentistry by health institutions. Two studies showed patients' satisfaction with the use of teledentistry in monitoring cancer patients and showed an improvement in quality of life. CONCLUSIONS: The teledentistry, as a remote technology for monitoring patients with oral and head and neck cancer, is well accepted by patients in preliminary studies. Although these studies pointed out some benefits of using remote technologies for the care of cancer patients, further robust scientific evidence is still needed in this regard.

Dento-osseous anomalies in patients with familial adenomatous polyposis: A follow-up study.

OBJECTIVE: The aim of this longitudinal study was to characterize the dento-osseous phenotype of eleven familial adenomatous polyposis (FAP) patients and twenty-two family members from four Brazilian families who were followed over nine years and to investigate adenomatous polyposis coli (APC) gene variants using a targeted next-generation sequencing approach. MATERIALS AND METHODS: Medical and dental history, oral examination, and panoramic radiography were performed to diagnose and follow up the dento-osseous anomalies. The anomalies were evaluated following the validated diagnostic tool dental panoramic radiographic score (DPRS), a system developed for high-risk FAP patients. Patients diagnosed with dento-osseous anomalies underwent cone-beam computed tomography. For genetic analysis, DNA was isolated from patients' saliva. RESULTS: Dento-osseous anomalies were identified in ten of the eleven FAP patients by panoramic radiograph evaluation. DPRS ≥ 7 (significant changes) was found in 81.8% (9/11) of FAP patients. The follow-up showed an increase in osseous jaw lesions in two young patients during adolescence. Dento-osseous anomalies were not found in non-FAP patients. A novel heterozygous nonsense pathogenic variant in APC exon 5 (c.481C > T; p.Gln161*) was identified in family 2, and a heterozygous splice-site pathogenic variant was identified in family 1 (c.532-1G > A). CONCLUSION: Our study expands the mutation spectrum of the APC gene and provides evidence that dento-osseous screening by imaging is a putative tool for early diagnosis of FAP. Also, the detection of dento-osseous anomalies in young patients with increasing osseous lesions during adolescence highlights the need for dental follow-up of high-risk FAP children. CLINICAL RELEVANCE: Dental radiographs are important for the screening and the follow-up of dento-osseous anomalies associated with FAP. It can also contribute to the early diagnosis of the disease.

A new cone-beam computed tomography-driven index for osteoporosis prediction.

OBJECTIVE: To verify whether mandibular cortical analyses accurately distinguish postmenopausal women with normal bone mineral density (BMD) from women with osteoporosis by means of a cone-beam computed tomography (CBCT)-driven composite osteoporosis index (three-dimensional mandibular osteoporosis index-3D MOI). MATERIAL AND METHODS: The comparison was performed between 52 women with normal BMD and 51 women with osteoporosis according to dual-energy X-ray absorptiometry (DXA) examination of the lumbar spine and hip. Mandibular cortical width (MCW) and cortical quality were evaluated on cross-sectional and panoramic reconstructed images. ANOVA, ROC curves and accuracy measurements were used for statistical analyses, as well as a predictive model combining the quantitative and qualitative analyses and age. RESULTS: All CBCT-driven measurements presented good to moderate intra- and interobserver agreements. MCW values were significantly lower in women with osteoporosis. Postmenopausal women with osteoporosis were 8 times more likely to have the cortex classified as C3, and 2.4 times more likely to have MCW thinner than 2.75 mm. The area under the ROC curve was 0.8 for the predictive model. CONCLUSIONS: The newly developed 3D MOI enables distinguishing women with osteoporosis from those with normal BMD with good sensitivity and specificity. CLINICAL RELEVANCE: Whenever a CBCT scan is performed for specific clinical indications, a 3D MOI may be performed to qualitatively and quantitatively assess the condition of the mandibular cortex. This may be surely helpful to assess the osteoporosis status in the ageing population and more specifically in peri- or postmenopausal women.

A Conservative Approach for Localized Spongiotic Gingivitis Hyperplasia Using Photodynamic Therapy: A Case Report and Review of the Literature.

OBJECTIVE: To describe a clinical case of successful conservative management of Localized Juvenile Spongiotic Gingivitis Hyperplasia (LJSGH) using photodynamic therapy (PDT) and reviews the current literature on this pathology. BACKGROUND DATA: LJSGH is a recently described rare disease with controversial treatment results. As of today, 13 publications report surgical treatment approaches. The use of CO2 laser and cryotherapy was reported only in one study. The use of PDT was not previously reported. PATIENTS AND METHODS: A 9-year-old male patient was referred to our institution with the chief complaint of asymptomatic "inflamed gingiva" starting 1 year before. Clinical examination revealed an erythematous line accompanying the gingival contour, with a certain degree of hyperplasia. The diagnosis of LJSGH was performed based on clinical features and later confirmed histopathologically. A novel approach using PDT was then proposed. The photosensitizer was methylene blue, and a semiconductor laser diode was used. RESULTS: One week after starting PDT, gingival hyperplasia was partially reduced. Immediately after the end of treatment, a significant reduction of gingival hyperplasia was observed. PDT proved to be safe, quick and painless, with no esthetic harm. CONCLUSIONS: This case illustrates the benefit of a more conservative approach as opposed to surgical procedure, with good clinical response and decreased morbidity over a 2-year follow-up period.

Biomarkers in the assessment of oral mucositis in head and neck cancer patients: a systematic review and meta-analysis.

PURPOSE: The aim of this study was to evaluate the capability of biomarkers to predict the risk of oral mucositis in head and neck cancer patients, as well as to assess the correlation between these biomarkers and the severity of mucositis. METHODS: The search was performed at LILACS, PubMed, Science Direct, Scopus, and Web of Science. A search of the gray literature was performed on Google Scholar, OpenGrey, and ProQuest. The methodological quality of the included studies was assessed using the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool, and the evidence quality was assessed by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system. RESULTS: After a two-step selection process, 26 studies met the eligibility criteria. In total, 27 biomarkers were evaluated, and the most frequent were the epidermal growth factor (EGF), C-reactive protein (CRP), genetic polymorphisms, tumor necrosis factor alpha (TNF-α), and erythrocyte sedimentation rate (ESR). The meta-analysis showed an expression of polymorphisms in XRCC1 (32.66%), XRCC3 (31.00%), and RAD51 (39.16%) genes, as well as an expression of protein biomarkers (39.57%), in patients with an increased risk of developing oral mucositis. CONCLUSIONS: Dosing biomarkers before starting radiation therapy may be a promising method to predict the risk of developing mucositis and allow radiosensitive patients to have a customized treatment. Although there is currently limited evidence to confirm the putative implementation of serum and salivary biomarkers to assess the correlation between them and the severity of mucositis, this current review provides new research directions.

Cone-beam computed tomography and microtomography for alveolar bone measurements.

PURPOSE: To compare cone-beam computed tomography (CBCT) and microtomography (micro-CT) for alveolar bone measurements. METHODS: Forty teeth and alveolar bone blocks of five pigs were scanned on a micro-CT with a 9.05 µm pixel size, and on a CBCT device at 0.125 mm voxel size. One height and four thickness measurements were performed twice in standardized slices by two radiologists to verify reliability. Agreement between imaging methods was assessed by correlation coefficients, Bland-Altman plots, and the difference was tested by a Wilcoxon signed-rank test. RESULTS: Regarding intra- and interobserver agreements, all bone measurements presented excellent precision values for micro-CT, but interobserver agreement for CBCT presented good to moderate values. Bone height differed about 0.3 mm, but no statistically significant differences were found for the bone thickness measurements. CONCLUSION: CBCT underestimated bone height. No statistically significant differences were found for bone thickness. Regions of thin bone tissue may not be visualized on CBCT images. There are risks of underestimating bone measurements with CBCT and assuming bone loss that does not exist clinically. Although the difference of the bone height measurement was small, the clinical relevance must be analyzed on how to interpret CBCT.

Dento-osseous anomalies associated to familial adenomatous polyposis mimicking florid cemento-osseous dysplasia.

Familial adenomatous polyposis (FAP) is a colorectal cancer syndrome characterized by the development of multiple polyps of the colon and rectum with high risk of malignant transformation. The extraintestinal manifestations such as dento-osseous changes are associated with FAP. This is a case report of a 36-year-old female patient who was referred for dental treatment with the initial diagnosis of florid cemento-osseous dysplasia (FCOD). However, the association of the imaging dento-osseous findings with the medical history confirmed the diagnosis of FAP. The paper illustrates the clinical characteristics and imaging findings associated with FAP, and also discusses misdiagnosis based exclusively on imaging features.

Relationships between mandibular cortical indexes, bone mineral density, and osteoporotic fractures in Brazilian men over 60 years old.

OBJECTIVE: The aim of this study was to assess relationships between panoramic indexes, bone mineral density (BMD), and osteoporotic fractures in men >60 years old. STUDY DESIGN: Body height and weight, body mass index, lumbar spine and hip BMD, and the presence of osteoporotic fractures were determined in the 127 studied men. Dental panoramic radiographs (DPRs) were used for measuring mandibular cortical indexes. RESULTS: BMDs were lower in patients with thinning and resorption of mandibular cortex. No association was found between mandibular indexes and the presence of osteoporotic fractures. In a forward stepwise logistic regression model, the odds of having a T score ≤-2.5 was increased by 1.97 times for every 1-mm reduction in average mandibular cortical width. CONCLUSIONS: DPRs could show pronounced thinning of the inferior mandibular cortices in men >60 years old. However, there was no apparent association between vertebral fragility fractures and the appearance of mandibular cortex in elderly men.