Submandibular Gland Pathogenesis Following SARS-CoV-2 Infection and Implications for Xerostomia.

Although SARS-CoV-2 induces mucin hypersecretion in the respiratory tract, hyposalivation/xerostomia has been reported by COVID-19 patients. We evaluate the submandibular gland (SMGs) pathogenesis in SARS-CoV-2-infected K18-hACE2 mice, focusing on the impact of infection on the mucin production and structural integrity of acini, ductal system, myoepithelial cells (MECs) and telocytes. The spike protein, the nucleocapsid protein, hACE2, actin, EGF, TNF-α and IL-1ß were detected by immunofluorescence, and the Egfr and Muc5b expression was evaluated. In the infected animals, significant acinar hypertrophy was observed in contrast to ductal atrophy. Nucleocapsid proteins and/or viral particles were detected in the SMG cells, mainly in the nuclear membrane-derived vesicles, confirming the nuclear role in the viral formation. The acinar cells showed intense TNF-α and IL-1ß immunoexpression, and the EGF-EGFR signaling increased, together with Muc5b upregulation. This finding explains mucin hypersecretion and acinar hypertrophy, which compress the ducts. Dying MECs and actin reduction were also observed, indicating failure of contraction and acinar support, favoring acinar hypertrophy. Viral assembly was found in the dying telocytes, pointing to these intercommunicating cells as viral transmitters in SMGs. Therefore, EGF-EGFR-induced mucin hypersecretion was triggered by SARS-CoV-2 in acinar cells, likely mediated by cytokines. The damage to telocytes and MECs may have favored the acinar hypertrophy, leading to ductal obstruction, explaining xerostomia in COVID-19 patients. Thus, acinar cells, telocytes and MECs may be viral targets, which favor replication and cell-to-cell viral transmission in the SMG, corroborating the high viral load in saliva of infected individuals.

Salivary Changes, Systemic Conditions, and Medication Use in Independently-Living Aged: A Cross-Sectional Study

ABSTRACT Objective: To determine the unstimulated salivary flow, pH, and buffering capacity and their associations with systemic conditions and medication use in independently living aged. Material and Methods: This cross-sectional study included 72 participants with a minimum of 60 years recruited in Belo Horizonte, Brazil. A questionnaire was used to collect age, sex, presence of systemic diseases, and medications in continuous use. Salivary data collection was performed to determine unstimulated salivary flow, pH, and buffering capacity. Descriptive, bivariate, and multivariate analyses were performed (p<0.05). Results: Most of the sample had at least one systemic disease (81.9%) and used at least one medication (79.2%). Female participants (p=0.01), those with five or more systemic diseases (p<0.01), and hypertension (p=0.04) had reduced salivary flow. Participants with systemic diseases (p=0.02), taking any medication (p=0.04), in a polypharmacy regimen, and presenting hypertension (p=0.02) had more acidic salivary pH. Participants with diabetes had average salivary buffering capacity (p=0.02). In the adjusted multiple regression models, no explanatory variable was significantly associated with the salivary outcomes. Conclusion: Systemic alterations and medication use appear to be related to salivary changes in older adults. Integrative assessment of older adults is fundamental to identifying and controlling the factors that may modify their salivary characteristics.

Covid-19 and oral diseases: Crosstalk, synergy or association?

The coronavirus disease 2019 (Covid-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin-converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid-19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid-19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid-19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid-19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS-CoV-2 exhibits tropism for endothelial cells and Covid-19-mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid-19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune-mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid-19 subjects, indicating SARS-CoV-2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS-CoV-2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.

Evaluation of the correlation between side effects to oral mucosa, salivary glands, and general health status with quality of life during intensity-modulated radiotherapy for head and neck cancer.

PURPOSE: The aim of this study was to evaluate the distribution of acute clinical complications that involve the oral cavity (oral mucositis and salivary flow), general health status (Karnofsky performance status scale (KPS) and weight), and quality of life using the worst performance throughout radiotherapy treatment by intensity-modulated radiation therapy (IMRT) in the head and neck region and to evaluate the correlation between these variables. METHODS: This prospective, longitudinal study evaluated 32 patients who were undergoing IMRT for head and neck tumors. The measures were collected weekly through standardized protocols and a quality of life questionnaire (UW-QOL version 4). RESULTS: The worst performance for all variables was concentrated in treatment weeks 2 and 5. Regarding quality of life, the emotional dimensions were the most affected (pain 62.86; activity 55; recreation 43.57; mood 49.97; shoulder 57.06; anxiety 42.91). There were a higher number of moderate mucositis correlations with quality of life (mucositis × KPS 0.002; mucositis × weight loss 0.03; mucositis × pain 0.001; mucositis × activity 0.002; mucositis × recreation 0.001; mucositis × swallowing 0.002; mucositis × saliva 0.006; mucositis × mood 0.007; mucositis × anxiety 0.002). CONCLUSIONS: IMRT treatment severely deteriorated the patients' quality of life. There were important correlations between the clinical variables and quality of life, especially mucositis.

Effectiveness of Transcutaneous Electrical Nerve Stimulation Therapy on whole Salivary Flow in Patients with Xerostomia and Healthy Adults

ABSTRACT Objective: To evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on whole salivary flow in patients with xerostomia and healthy adults. Material and Methods: Thirty subjects with a history of xerostomia and subjects withunstimulated salivary flow equal to or less than 0.5 ml in 5 min were included in the study group, and 30 healthy subjects were included in the control group. Low forced spitting unstimulated saliva was collected for five minutes in a test tube fitted with a funnel. Then electrode pads of the TENS unit were applied bilaterally on skin overlying the parotid glands and at optimal intensity, stimulated saliva was collected for 5 minutes with the same method in a separate graduated test tube. The salivary flow rate (per minute) was calculated by dividing the amount of collected saliva (volume in mL) by the duration of collection period (5 minutes) and the salivary flow rates prior and after electrostimulation were compared for both groups. The Student's t-test (unpaired and paired) was performed for group-wise comparisons. Results: In study group, the mean unstimulated salivary flow rate was 0.07 ± 0.01 mL/min. There was an 85.71% increase in salivary flow (0.13 ± 0.03 mL/min) during the TENS application and the difference was highly significant (p<0.001). In control group, the mean unstimulated salivary flow rate was 0.37 ± 0.07 mL/min. There was a 21.62% increase in salivary flow (0.45 ± 0.07 mL/min) during the TENS application and the difference was highly significant (p<0.001). An increase in mean salivary flow rate both in males and females after TENS application in both groups (p<0.001) was noted. The difference between unstimulated, stimulated and mean difference in salivary flow rate between males and females was notstatistically significant in both groups (p<0.05). Conclusion: TENS can be an effective therapy in increasing whole salivary flow rates in patients with xerostomia.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation.

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1ß) tissue levels, and positive immunostaining for TNF-α, IL-1ß, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Amifostine reduces inflammation and protects against 5-fluorouracil-induced oral mucositis and hyposalivation

Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.

Peculiar histopathological features in minor salivary gland in lupus erythematosus.

Salivary glands (SGs) can be affected by lupus erythematosus (LE). Many authors debate whether this condition is a secondary manifestation of Sjögren syndrome (SS) or a glandular aspect of LE. The present study investigated the histopathological aspects of biopsied minor salivary glands from LE patients to analyze their peculiar features that lead to xerostomia. Twenty-three minor labial salivary gland (MLSG) cases were included in the study; the diagnosis of LE was rendered according to the American College of Rheumatology criteria. Twenty-three healthy MLSGs were used as a control, for comparison. Regarding lupus MLSG, the presence of hyalinization and thickening of ductal basement membrane, perivascular inflammatory infiltrate, epithelial spongiosis with no ductal lymphocytic aggression, vacuolar degeneration of the ductal cells and acinar serous metaplasia were statistically significant compared to the control group. In the LE group, there was a statistically significant correlation between acinar atrophy and acinar fibrosis; acinar atrophy and ductal ectasia; acinar fibrosis and ductal ectasia; ductal atrophy and ductal spongiosis with no lymphocytic focus, interstitial inflammatory infiltrate intensity and vasculitis as well as vascular thrombi and vasculitis. There were no morphological differences between the three subtypes of lupus analyzed. Minor salivary glands from patients diagnosed with LE present peculiar histopathological changes and may be a multisystemic presentation.

Manifestações bucais em pacientes submetidos a tratamento quimioterápico / Manifestaciones orales en pacientes sometidos a quimioterapia / Oral manifestations in patients undergoing chemotherapy

Introdução: a quimioterapia é um tratamento anticâncer fundamentado na utilização de fármacos que induzem a morte das células neoplásicas. A literatura descreve que lesões bucais podem surgir em consequência do tratamento quimioterápico. Objetivo: identificar as manifestações bucais em pacientes submetidos à quimioterapia atendidos no serviço de referencia em oncologia da região sul do estado do Ceará-Brasil. Métodos: o presente estudo, do tipo transversal descritivo, avaliou 73 pacientes acometidos por algum tipo de neoplasia maligna e em tratamento quimioterápico no período de janeiro de 2013 a dezembro de 2014. Os dados clinico-patológicos como idade, gênero, diagnóstico da neoplasia maligna, tipos de tratamentos anticâncer, esquema medicamentoso quimioterápico, entre outros, foram obtidos a partir dos prontuários médicos. Foram ainda realizados exames intrabucais em todos os indivíduos desse estudo por um único examinador especialista em Estomatologia. Resultados: dos 73 pacientes 29 (39,7 porcento) eram do gênero masculino e 44 (60,3 porcento) do gênero feminino, com idade média de 57,7 anos, sendo 37 (50,7 porcento) dos pacientes fumantes. A mama foi o local mais prevalente de acometimento do câncer (35,6 porcento). Os fármacos mais utilizados na terapia quimioterápica foram a aredia em 23,3 porcento dos casos (n= 17) e o paclitaxel em 17,8 porcento (n= 13). Em relação às manifestações bucais, dos 73 pacientes do estudo, 44 (60,2 porcento) apresentaram algum tipo de desconforto bucal. A maioria dos pacientes, 77,3 porcento (n= 34), foram diagnosticados com xerostomia e em 22,7 porcento (n= 10) foram observados mucosite. Conclusão: as manifestações bucais encontradas em pacientes em tratamento quimioterápico foram a xerostomia e a mucosite, sendo a xerostomia a condição patológica bucal mais prevalente(AU)

Introducción: la quimioterapia es un tratamiento basado en el uso de fármacos anticancerígenos que inducen la muerte de las células cancerosas. La literatura describe lesiones bucales pueden surgir como resultado de la quimioterapia. Objetivo: identificar las manifestaciones bucales en pacientes sometidos a quimioterapia atendidos en el servicio de referencia en oncología en Estado del Ceará-Brasil. Métodos: se evaluaron 73 pacientes afectados por algún tipo de malignidad tratada con quimioterapia a partir de enero de 2013 hasta el mes de diciembre del 2014. Los datos clínicos y patológicos (edad, sexo, diagnóstico de malignidad, tipos de tratamientos con fármacos de quimioterapia contra el cáncer, entre otros), se obtuvieron de los registros médicos. También se realizaron exámenes bucales en todos los sujetos de este estudio por el experto en estomatología. Resultados: de los 73 pacientes 29 (39,7 por ciento) eran hombres y 44 (60,3 por ciento) mujeres, con una edad media de 57,7 años, y 37 (50,7 por ciento) eran fumadores. La mayor prevalencia del cáncer se observó en la mama (35,6 por ciento). Los fármacos más frecuentemente utilizados en el tratamiento de quimioterapia fueron aredia en 23,3 por ciento de los casos (n= 17) y paclitaxel en el 17,8 por ciento (n= 13). En relación con las enfermedades bucales, de los 73 pacientes estudiados, 44 (60,2 por ciento) tenían algún tipo de malestar bucal. La mayoría de los pacientes (77,3 por ciento; n= 34) fueron diagnosticados con xerostomía y 22,7 por ciento (n= 10) con mucositis. Conclusión: las lesiones bucales que se encontraron en los pacientes sometidos a quimioterapia fueron a xerostomía y mucositis. La xerostomía fue la condición patológica bucal más frecuente(AU)

Introduction: chemotherapy is a treatment based on the use of anticancer drugs that induce the death of cancer cells. The literature describes oral lesions may arise as a result of chemotherapy. Objective: to identify the oral manifestations in patients undergoing chemotherapy treated at the reference service in oncology southern state of Ceará - Brazil. Methods: we evaluated 73 patients affected by some type of malignancy and chemotherapy from January of 2013 to December of 2014. The clinical and pathological data such as age, gender, diagnosis of malignancy, types of treatments anticancer chemotherapeutic drug treatment, among others,were obtained from medical records. Were also carried out oral examinations in all subjects of this study by the same examiner specialist in stomatology. Results: of the 73 patients 29 (39.7 percent) were male and 44 (60.3 percent) females with a mean age of 57.7 years, and 37 (50.7 percent) of smokers. Regarding malignancy, the mama was the most prevalent location (35.6 %). The drugs most frequently used in chemotherapy treatment were aredia in 23.3 percent of cases (n= 17) and paclitaxel in 17.8 percent (n= 13). In the oral manifestations, of the 73 patients studied, 44 (60.2 percent) had some type of oral discomfort. Most patients, 77.3 percent (n= 34) were diagnosed with xerostomia and 22.7 percent (n= 10) were observed mucositis. Conclusion: oral lesions found in patients undergoing chemotherapy were xerostomia and mucositis. Xerostomia being the most prevalent oral pathological condition(AU)

Effects of saliva on early post-tooth extraction tissue repair in rats.

The aim of the present study was to perform a biochemical, histological, and histomorphometrical evaluation of the mechanisms involved in tissue repair in rats subjected to submandibulectomy-induced hyposialia, 24, 48, and 72 hours of post-tooth extraction. We studied the correlation between the lack of submandibular saliva and the modulation of inflammatory mediators involved in tissue repair, such as prostaglandin E2 , nitric oxide (NO), and tumor necrosis factor alpha (TNF-α). Rats with hyposialia showed a delay in socket healing, slow replacement of the clot with granulation tissue, and fewer cells and collagen fibers, concomitant with a longer inflammatory process, as compared to controls. The lack of saliva induced by submandibulectomy modified the levels of prostaglandin E2 , NO, and TNF-α, and tissue response in the early stages of wound healing compared to controls, and could thus determine alterations in later osteogenic response. Our results allow concluding that hyposialia modulates the parameters of inflammation studied here, and that it is essential for optimal healing. Therefore, these findings provide evidence for the importance of submandibular saliva to final bone socket healing.

Análise de fatores clínico-demográficos, psicológicos, hormonais e genéticos na síndrome da ardência bucal e ardor bucal secundário / Analysis of clinical and demographic, psychological, hormonal and genetic factors in burning mouth syndrome and secondary burning mouth

A síndrome da ardência bucal (SAB) é uma condição clínica pouco esclarecida caracterizada por sensação espontânea de ardência, dor ou prurido na mucosa oral, sem alterações locais ou sistêmicas identificáveis. Sua etiopatogenia é incerta, não havendo até o momento uma padronização dos critérios utilizados para o seu diagnóstico. O presente estudo objetivou verificar a associação de fatores psicológicos, hormonais e genéticos com a SAB no sentido de propor uma melhor caracterização de sua natureza. Além de uma análise descritiva da amostra estudada, os aspectos analisados foram especificamente os níveis de estresse e sua fase, depressão, e ansiedade, compondo os fatores psicológicos; mensuração dos níveis séricos de cortisol e desidroepiandrosterona (DHEA); bem como a verificação sobre a ocorrência de polimorfismos no gene da Interleucina-6 (IL6). Foram realizadas análises comparativas entre um grupo de pacientes com SAB e um grupo composto por indivíduos com ardor bucal secundário (AB). Os resultados revelaram diferenças estatisticamente significativas entre os dois grupos com relação aos seguintes aspectos: xerostomia (p=0,01) e hipossalivação em repouso (p<0,001), que foram mais prevalentes no grupo SAB; sintomas de depressão (p=0,033), também mais presentes no grupo SAB; e dosagem de DHEA, que apresentou níveis mais reduzidos no grupo SAB (p=0,003). A dosagem desse hormônio mostrou-se amplamente sensível e específica para o diagnóstico da síndrome em estudo, sendo verificado que níveis séricos de DHEA abaixo de 0,37µg/mL para mulheres, utilizando-se os procedimentos propostos na pesquisa, possuem um Odds Ratio de 4,0 95 por cento IC (0,37 a 2,71)]. Foi verificado ainda que o alelo C do polimorfismo rs2069849 da IL-6 pode representar um alelo de risco para a ocorrência de ardor bucal em ambos os grupos, no entanto, não se pode garantir sua real implicação nos processos inflamatórios da SAB.

The burning mouth syndrome (BMS) is a clinical condition characterized by spontaneous burning sensation, pain or itching in the oral mucosa without identifiable local or systemic changes. Its pathogenesis is uncertain, with no observable standardization in previous literature of the criteria used for its diagnosis. The present study aimed to determine demographic, psychological, hormonal and genetic factors in patients with BMS and secondary burning mouth to propose a better characterization of the nature and classification of this condition. Besides a descriptive analysis of the sample of 163 individuals, were analyzed the levels of stress and its phase, depression and anxiety; measurement of serum levels of cortisol and dehydroepiandrosterone (DHEA), as well as checking on the occurrence of polymorphisms in the gene of interleukin-6 (IL6). Comparative analysis between a group of patients with BMS and a group of individuals with secondary burning mouth (BM) were performed. The results revealed statistically significant differences between the two groups with respect to the following aspects: xerostomia (p=0.01) and hyposalivation at rest (p<0.001), which were more prevalent in the BMS group; symptoms of depression (p=0.033), more present in the BMS group, and dosage of DHEA, which showed lower levels in BMS patients (p=0.003). The dosage of this hormone was largely specific and sensitive for the diagnosis of the studied syndrome, and was verified that serum levels of DHEA below 0.37 pg/mL in women, using the procedures proposed in this research, have an Odds Ratio of 4.0 95 per cent Cl (0.37 to 2.71)]. These results suggest a possible influence of depression and decreased levels of the hormone DHEA in the pathogenesis of BMS. (AU)

Associações entre fatores de risco e complicações bucais em pacientes com câncer de cabeça e pescoço tratados com radioterapia associada ou não à quimioterapia / Association between risk factors and oral complications in patients with head and neck cancer treated with radiotherapy combined or not with chemotherapy

Objetivo: descrever as reações adversas que ocorreram em pacientes durante a radioterapia associada ou não à quimioterapia, bem como avaliar suas possíveis associações com fatores de risco. Métodos: neste estudo longitudinal prospectivo foram examinados 28 pacientes antes, durante e após completar seis meses do término do tratamento oncológico. Os dados coletados foram idade, gênero, cor da pele, tabagismo, etilismo. Sobre o tumor, foram registrados a localização, a classificação TNM (tamanho do tumor, presença de linfonodo acometido e metástase à distância), o tipo histológico, o grau de diferenciação, o número de frações da radioterapia e o tratamento oncológico proposto. Os pacientes foram encaminhados ao Projeto de Oncologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais e receberam adequação do meio bucal antes do tratamento oncológico. Durante a radioterapia foram coletados dados relativos à presença de mucosite, xerostomia, disfagia, ardência e candidose. Após análise descritiva dos dados, as associações entre efeitos adversos durante a radioterapia e fatores de risco foram verificadas usando os testes do Qui-quadrado e Exato de Fisher (p menor que 0,05). Resultados: foi encontrada maior frequência de pacientes do sexo masculino (78,6%), leucoderma (71,4%) com carcinoma de células escamosas (78,6%). A prevalência da mucosite grau I, II e III, xerostomia, disfagia, candidose e ardência foram de 10,7%; 82,2%; 7,1%; 96,4%; 53,6%; 28,6% e 57,1%, respectivamente. Associação estatisticamente significativa foi encontrada somente entre presença ou ausência de maxilares irradiados e mucosite (p=0,03). Conclusão: efeitos adversos ocorreram durante a radioterapia associada ou não à quimioterapia em pacientes com câncer em região de cabeça e pescoço. Associação significativa foi verificada entre o local de irradiação e a presença de mucosite.

Objective: This study described the adverse reactions that occurred in patients during radiotherapy combined or not with chemotherapy, and assessed their possible associations with risk factors. Method: Using a prospective cross-sectional design, 28 patients were evaluated before, during and six months after the end of cancer treatment. The following data were collected: age, gender, ethnicity, smoking and alcohol consumption. Information recorded about the tumor included primary site of tumor, TNM classification (tumor size, lymph node status and distant metastasis), histological type, differentiation grade, number of fractions of radiotherapy and oncologic treatment protocol. The patients were referred to the Oncology Project of the School of Dentistry of the Federal University of Minas Gerais, and had their oral cavity prepared for cancer treatment. During radiotherapy, data were collected with respect to mucositis, xerostomia, dysphagia, burning sensation, and candidosis. After descriptive analysis of data, the associations between adverse effects raised during radiotherapy and risk factors were verified using the Chi-square and Fisher's Exact Test (p less than 0.05). Results: There was a predominance of male (78.6%), Caucasian (71.4%) patients with squamous cell carcinoma (78.6%). The prevalence of mucositis grades I, II, III, xerostomia, dysphagia, candida infections and burning sensation was 10.7%, 82.2%, 7.1%, 96.4%, 53.6%, 28.6% and 57.1%, respectively. A statistically significant association was found only between the presence or absence of irradiation of jaws and mucositis (p=0.03). Conclusion: Oral complications occurred during radiotherapy in combination or not with chemotherapy in patients with cancer in the head and neck region. A significant association was found between the site of irradiation and the presence of mucositis.

Boca seca, mucositis, problemas dentales y del gusto en la alimentación del niño con cáncer / Dry mouth, mucositis, dental problems and taste power in children with cancer

En niños con cáncer, la quimioterapia y la radioterapia de ciertos tumores de cabeza y cuello, reducen la producción de saliva generando sensación de boca seca, ulceraciones bucales y mucositis. Los problemas dentales se resumen en caries, boca seca y endurecimiento de los músculos de la cara. Así mismo, la quimioterapia, la radiación y el cáncer mismo, ocasionan cambios en el sentido del gusto del niño con cáncer. Todos estas circunstancias se reflejan en el bajo consumo de nutrientes y desarrollo a futuro de desnutrición para lo cual es necesario estar alerta y proponer medidas preventivas.

In children with cáncer, chemotherapy and radiotherapy of ceratin tumors of the head and neck, reduce the production of saliva causing dry mouth, mouth ulcers and mucositis. Dental problems of children with cancer are summarized in caries, dry mouth and tightening of the muscles of the face. Likewise, chemotherapy, radiation and the cancer itself, cause changes in taste of the child with cancer. All these circumstances are reflected in the low nutrient intake and future development of malnutrition for which it is necessary to be vigilant and to suggestpreventive measures.

Cell apoptosis and proliferation in salivary glands of Sjögren's syndrome.

BACKGROUND: Sjögren's syndrome (SS) occurs associated with parotid neoplasm, non-Hodgkin's B-cell lymphoma, which could impair the condition or be life-threatening for patients. The aim of this work was to analyze cell proliferation and apoptosis modifications in acinar, ductal and inflammatory infiltrate in salivary glands (SG) in patients with Sjögren Syndrome, keratoconjunctivitis, or stomatitis sicca or in healthy subjects, to establish parameters that indicate the likelihood of malignancy of the disease in populations at risk. METHODS: A study was performed with n = 58 histological samples of lower lip SG from patients diagnosed with SS, keratoconjunctivitis, or stomatitis sicca (SICCA) and from healthy subjects (C). Ki67 and caspase-3 immunolabeling were performed. RESULTS: The most important result was significant differences between the three study groups in Ki67 and caspase-3 markers (P < 0.0001) in infiltrated lymphocytes. CONCLUSION: The results of this work are indicative of a high degree of proliferation (85%) in infiltrated lymphocytes (IL) associated with SS which, according the literature, could be considered a risk. Furthermore, the markers used in this work are widely known and represent a lower cost than others and can be used to determine risk groups within the population of SS patients, enabling their follow-up.

Xerostomia, hyposalivation and sialadenitis in patients with chronic hepatitis C are not associated with the detection of HCV RNA in saliva or salivary glands.

OBJECTIVE: Salivary gland disorders in patients with chronic hepatitis C (CHC) have been considered oral extrahepatic manifestations, reinforcing the hepatitis C virus (HCV) as a sialotropic virus. Hence, the authors investigated the prevalence of HCV RNA in saliva and salivary glands and its possible association with xerostomia, hyposalivation and sialadenitis in patients with CHC. PATIENTS AND METHODS: In 65 patients with confirmed CHC, the HCV RNA was investigated by nested RT-PCR in saliva samples and minor salivary glands. Xerostomia, hyposalivation, clinical and histopathological evidence of sialadenitis were also evaluated. Univariate and multivariate analyses were employed to verify associations. RESULTS: HCV RNA was detected in the saliva of 26/65 (40.0%) patients and in 12/65 (18.5%) salivary glands. Xerostomia was reported by 23/65 (35.4%) patients, and hyposalivation was diagnosed in 13/65 (20.0%) patients. Sialadenitis was confirmed by histopathological features in 31/65 (47.7%) patients. Twelve (38.7%) of the 31 patients with sialadenitis presented HCV RNA in saliva and 2/31 (6.5%) in salivary glands. No associations were found between xerostomia, hyposalivation or sialadenitis and the detection of HCV RNA in saliva or in salivary glands. CONCLUSIONS: Although xerostomia, hyposalivation and sialadenitis are frequent findings in CHC patients, our study did not confirm the association between the detection of HCV RNA in saliva or salivary glands with these salivary gland disorders. However, an indirect role of HCV by immune-mediated virus mechanisms in the pathogenesis of salivary gland disorders in this group of patients cannot be ruled out.

Xerostomia in Sjögren's syndrome and lupus erythematosus: a comparative histological and immunofluorescence study of minor salivary glands alterations.

BACKGROUND: Xerostomia is a symptom that can be triggered by chronic diseases such as Sjögren's syndrome (SS) and lupus erythematosus (LE). Many authors regard most cases of salivary hypofunction in LE to secondary SS. Others believe that salivary changes in patients with LE might reflect a multisystem presentation of the disease. The present study compared histopathological and direct immunofluorescence (DIF) alterations in salivary glands of patients with xerostomia and diagnosis of LE or SS. METHODS: Twenty-eight salivary gland biopsies from patients with xerostomia and diagnosed with LE or SS were submitted to histopathological and DIF exams. RESULTS: From the 28 patients, 16 had SS and 12 had LE. In SS, a moderate to intense sialadenitis was detected, with infiltration and destruction of excretory salivary ducts. In LE, mild/moderate sialadenitis with thickening and hyalinization of the ductal basement membrane was observed. DIF revealed that 50% of SS patients presented intercellular ductal IgA deposits, whereas 58% of LE patients showed deposits of IgG in the ductal basement membrane. CONCLUSIONS: Alterations in salivary glands of LE patients may be a specific manifestation of the disease (lupus sialadenitis), reflecting its multisystemic presentation, instead of an association of secondary SS and LE.

Manifestaciones bucales más frecuentes en pacientes diabéticos atendidos en el Instituto Autónomo Hospital Universitario de Los Andes / Oral manifestations more common in diabetic patients treated at the Instituto Autónomo Hospital Universitario of Los Andes

La diabetes mellitus (DM) es un desorden metabólico caracterizado por una hiperglicemia crónica debida a la resistencia periférica a la insulina, disfunción secretora de esta hormona o ambas. Lo cual produce alteraciones en el metabolismo de carbohidratos, lípidos y proteínas. El paciente diabético presenta ciertas características que le confieren alto riesgo de padecer enfermedades cardiovasculares, cerebrales, renales, oculares y manifestaciones en cavidad bucal, en las que predominan las infecciones debido a la alteración del sistema inmunológico. Este artículo tiene como objetivo determinar las manifestaciones bucales más frecuentes de pacientes diabéticos que asisten a la consulta odontológica. Las cuales deben ser tomadas en cuenta para realizar el diagnostico y tratamiento odontológico apropiado. En este sentido, se presenta el estudio de casos clínicos de 35 pacientes diabéticos atendidos en la Unidad de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (I.A.H.U.L.A). El estudio constó de la elaboración de la historia clínica con su respectivo examen clínico y examen radiográfico, monitoreo de niveles de glucosa en sangre, el establecimiento del diagnóstico y el tratamiento odontológico requerido en cada caso. Se encontró que, la gingivitis predominó en 97,1%, seguida de caries dental en 91,43% y periodontitis en 85,71% de los casos. Se concluyó que los pacientes diabéticos presentan alta incidencia de lesiones bucales, prevaleciendo una relación altamente significativa entre la periodontitis y los pacientes diabéticos mayores de 40 años

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to peripheral resistance to insulin, secretory dysfunction of this hormone or both, which cause alterations in the metabolism of carbohydrates, lipids and proteins. The diabetic patient shows certain characteristics that confer high risk for cardiovascular disease, cerebral, renal, and ocular manifestations in oral cavity, in which predominate infections due to alteration of the immune system. This article aims to explore the most common oral manifestations of diabetic patients attending the dental consultation that should be taken into account to make the diagnosis and appropriate dental treatment. In this sense, it presents a study of 35 clinical cases of type 2 diabetic patients treated at the Unit of the Institute of Endocrinology University Hospital of Los Andes (IAHULA). The study consisted of the development of the medical history with their clinical and radiographic examination, monitoring of blood glucose levels, the establishment of diagnosis and dental treatment required for each case. It was found that gingivitis was predominant in 97.1% , followed by 91.43% in dental caries and periodontitis with 85.71% of cases. It was concluded that diabetic patients have high incidence of oral lesions, and highly significant prevalence between periodontitis and diabetic patients older than 40 years

Burning mouth syndrome: a discussion about possible etiological factors and treatment modalities

Although several studies discuss the contributing factors associated with the burning mouth syndrome (BMS), there is still controversy with regard to its etiology. Therefore, in the majority of cases, the establishment of an adequate diagnosis and consequently the best treatment modality is complicated. In order to assist the clinician in the establishment of the correct diagnosis and management of BMS, this article reviews the literature, providing a discussion on the various etiologic factors involved in BMS, as well as the best treatment modalities for this condition that have showed to be the most effective ones in randomized clinical trials. In addition, the authors discuss some clinical characteristics in the differential diagnosis of BMS and other oral diseases. It is important for the clinician to understand that BMS should be diagnosed only after all other possible causes for the symptoms have been ruled out.

Quantitative analysis of Langerhans' cells in oral chronic graft-vs.-host disease.

BACKGROUND: The Langerhans cells (LCs) are scattered throughout the epithelium of skin and mucosa and have been associated with the graft-vs.-host disease (GVHD), which is the highest cause of morbidity and mortality in patients who underwent bone marrow transplant (BMT). This study aims at quantifying the LCs in the oral chronic GVHD (cGVHD). METHODS: Microscopic sections from biopsies carried out in the buccal mucosa of 40 patients who underwent allogenic BMT and developed (20) or not (20) oral cGVHD (Groups 1 and 2, respectively) were utilised. For the control group, free surgical margins of 20 biopsies of non-inflammatory lesions in the buccal mucosa (Group 3) were used. The sections were studied in routine colouration and immunostained for CD1a. RESULTS: Group 1 (with cGVHD) presented a greater number of Langerhans' cells/mm(2) (50.6 +/- 37.2) when compared with the other groups (Group 2, 23.11 +/- 19.7; Group 3, 16.6 +/- 17.3). CONCLUSION: Our results suggest a greater recruitment of LCs in patients transplanted with cGVHD, probably as a result of cytokines secreted by the inflammatory cells.