Implementação e viabilização do acesso à saúde bucal da população em situação de rua no município de Japaratuba/SE / Implementation and facilitation of access to oral health for the homeless population in the city of Japaratuba/SE

O estudo tem caráter qualitativo, descritivo, com referencial teórico no construcionismo social e na qualificação/interação dos profissionais da Equipe de Saúde da Família (ESF) na implementação deste projeto. Foram utilizadas como etapas de intervenção a capacitação dos profissionais envolvidos na execução do projeto, levantamento cadastral do quantitativo da População em Situação de Rua, ações de promoção e prevenção em saúde bucal fora da Unidade Básica de Saúde, com orientações sobre higiene bucal, confecção e distribuição de material educativo, divulgação das ações em carro de som pelo município, acesso ao tratamento odontológico com agendamento da primeira consulta odontológica programada e a longitudinalidade do cuidado. Portando, almejou-se com esse projeto o acesso ao atendimento clínico odontológico a PSR, estreitando vínculo entre a ESF e a PSR, quebrando paradigmas sociais, proporcionando um acolhimento multiprofissional mais humanizado. Fazendo-se necessário fortalecer as equipes de saúde bucal e da Família por meio de educação permanente, de tal modo que o acesso a ações em serviços de saúde bucal para a População em Situação de Rua seja priorizado

A recurrent leiomyosarcoma of the buccal mucosa: An immunohistochemistry study and literature review.

Leiomyosarcoma is a rare type of cancer that affects smooth muscle tissue. Leiomyosarcomas are exceedingly rare in the oral cavity, particularly in the buccal mucosa. The diagnosis is challenging due to non-specific clinical features and significant overlap of morphological findings with several spindle cell tumors. We reported the clinicopathological and immunohistochemical features of a rare recurrent case of leiomyosarcoma in a 73-year-old female presenting clinically as a painful nodule on the posterior right buccal mucosa. Microscopically, the lesion showed atypical spindle cells arranged in a fascicular pattern and frequent mitotic figures. Immunohistochemistry showed strong positivity for vimentin, α-SMA, HHF35, h-caldesmon, and focal positivity for desmin. CD34 highlighted numerous blood vessels distributed throughout all tumor stroma. S-100 protein, myogenin, and pan-cytokeratin (AE1/AE3) were negative. Surgical excision followed by chemotherapy was carried out, and no recurrence was observed after 1 year of follow-up. Careful histopathological and immunohistochemistry analysis of these lesions is essential to ensure a correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up is strongly recommended.

Assessment of the LED phototherapy on femoral bone defects of ovariectomized rats: a Raman spectral study.

Osteoporosis is a disease characterized by the reduction of bone mineral density. LED wavelengths seem to have similar photo-stimulating effects to laser light. The aim of this study was to assess the Raman shifts: ∼ 960 (phosphate hydroxyapatite), ∼ 1,070 (carbonate hydroxyapatite), and ∼ 1,454 cm (-1) (lipids and proteins) on bone defects of ovariectomized rats treated or not with LED phototherapy (LED-PT). Thirty female rats were divided into four groups (Basal, OVX, OVX+Clot, and OVX+Clot+LED), then subdivided into two subgroups (15 and 30 days after surgery). Osteoporosis induction by ovariectomy (OVX) was performed in all groups, except for the normal basal group. Following development of osteoporosis, one surgical bone defect (5 mm(2)) was created on the femur of each animal. Defects were irradiated with LED light (λ = 850 ± 10 nm, P = 150 mW, CW, Ф = 0.5 cm(2), 20.4 J/cm(2) per session, t = 128 s, 163.2 J/cm(2) per treatment) at 48 h interval during 2 weeks. Raman measurements were taken at the surface of the defects 30 days after surgery. Significant difference between groups Basal, OVX+Clot, and OVX+Clot+LED for the peaks at ∼ 960 (p ≤ 0.001; 15 and 30 days), ∼ 1,070 (p ≤ 0.001; 15 and 30 days), and ∼ 1,450 cm(-1) (p = 0.002; 15 days; p = 0.004; 30 days) were detected. In addition, statistical differences were obtained between groups OVX, OVX+Clot, and OVX+Clot+LED for these same peaks at all time points (p ≤ 0.001). At 15 and 30 days, there were statistical differences between groups OVX+Clot and OVX+Clot+LED for the peaks at ∼ 960 (p ≤ 0.001), ∼ 1,070 (p ≤ 0.001; p = 0.003), and ∼ 1,450 cm(-1) (p ≤ 0.001; p = 0.002). The results of this study are indicative that infrared LED-PT improved the deposition of HA on bone defects of ovariectomized rats.

The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with miniplates: a histological and histomorphometric study on rabbits.

The aim of the present study was to assess, by light microscopy and histomorphometry, the repair of surgical fractures fixed with internal rigid fixation (IRF) treated or not with IR laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) = 16 J/cm(2), ϕ = 0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration. Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into 5 groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet, and had water ad libidum. The fractures in groups II, III, IV, and V were fixed with miniplates. Animals in groups III and V were grafted with hydroxyapatite and GBR technique used. Animals in groups IV and V were irradiated at every other day during two weeks (4 × 4 J/cm(2), 16 J/cm(2) = 112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken, routinely processed to wax, cut and stained with HA and Sirius red, and used for histological assessment. The results of both analyses showed a better bone repair on all irradiated subjects especially when the biomaterial and GBR were used. In conclusion, the results of the present investigation are important clinically as they are suggestive that the association of hydroxyapatite, and laser light resulted in a positive and significant repair of complete tibial fractures treated with miniplates.

The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with wire osteosynthesis: a comparative laser fluorescence and Raman spectral study on rabbits.

The aim of the present study was to assess, by Raman spectroscopy and laser fluorescence, the repair of surgical fractures fixed with wire osteosynthesis treated or not with infrared laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) =16 J/cm(2), ϕ=0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration. Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet, and had water ad libitum. The fractures in groups II, III, IV, and V were fixed with wires. Animals in groups III and V were grafted with hydroxyapatite (HA) and guided bone regeneration (GBR) technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) =112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. The Raman results showed basal readings of 1,234.38 ± 220. Groups WO+B+L showed higher readings (1,680.22 ± 822) and group WO+B the lowest (501.425 ± 328). Fluorescence data showed basal readings of 5.83333 ± 0.7. Groups WO showed higher readings (6.91667 ± 0.9) and group WO+B+L the lowest (1.66667 ± 0.5). There were significant differences between groups on both cases (p<0.05). Pearson correlation was negative and significant (R (2) = -0.60; p<0.001), and it was indicative that, when the Raman peaks of calcium hydroxyapatite (CHA) are increased, the level of fluorescence is reduced. It is concluded that the use of near-infrared lasertherapy associated to HA graft and GBR was effective in improving bone healing on fractured bones as a result of the increasing deposition of CHA measured by Raman spectroscopy and decrease of the organic components as shown by the fluorescence readings.

The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with miniplates: a Raman spectral study on rabbits.

The aim of the present study was to assess, by Raman spectroscopy, the repair of surgical fractures fixed with internal rigid fixation (IRF) treated or not with IR laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) = 16 J/cm(2), ϕ = 0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libitum. The fractures in groups II, III, IV and V were fixed with miniplates. Animals in groups III and V were grafted with hydroxyapatite and GBR technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) = 112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p < 0.001). Basal readings showed mean value of 1,234 ± 220.1. Group internal rigid fixation + biomaterial + laser showed higher readings (3,521 ± 2,670) and group internal rigid fixation + biomaterial the lowest (212.2 ± 119.8). In conclusion, the results of the present investigation are important clinically as spectral analysis of bone component evidenced increased levels of CHA on fractured sites by using the association of laser light to a ceramic graft.

Removal of oral lichen planus by CO2 laser.

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1 year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

Influence of laser phototherapy (λ660 nm) on the outcome of oral chemical carcinogenesis on the hamster cheek pouch model: histological study.

PURPOSE: This study aimed to evaluate, histologically, the effect of low-level laser therapy (LLLT) (λ660 nm) on DMBA chemically induced lesions of the oral mucosa of hamsters. BACKGROUND DATA: Squamous cell carcinoma (SCC) is the most common neoplasm of the oral cavity. It is aggressive, highly proliferative, invasive, and metastatic. There is evidence that LLLT similarly affects neoplasic and non-neoplasic cells. METHODS: Cancerous lesions were induced on the cheek pouch of 15 golden Syrian hamsters by using DMBA 3 times a week for 8 weeks. At the end of the cancer induction (8 weeks), animals in G1 were killed and the presence of tumors confirmed. Animals in G3 were irradiated (λ660 nm, 30 mW, CW, Ø=3 mm, area: 0.07 cm(2), 424 mW/cm(2), 133 sec, 56.4(2)J/ cm(2), 4J) at every other day for 4 weeks. G2 received no interventions for the same period. Samples were taken and underwent histological analysis by light microscopy. RESULTS: GI showed 100% well-differentiated SCC. G2 showed 20% moderately differentiated and 80% well-differentiated SCC. G3 showed 40% well-differentiated, 40% poorly differentiated, and 20% moderately differentiated SCC. Significant differences (p=0.02) in the amount of well-differentiated SCC were seen between G1 and G3 and between G3 and G2 (p=0.04). Significant difference was also seen between G3 and G1 and G2 with regard to the amount of poorly differentiated tumors (p=0.04). CONCLUSIONS: It is concluded that LLLT, within the parameters used in the present study, caused a significant progression of the severity of SCC in the oral cavity of hamsters.

Light microscopic description of the effects of laser phototherapy on bone defects grafted with mineral trioxide aggregate, bone morphogenetic proteins, and guided bone regeneration in a rodent model.

We carried out a histological analysis on bone defects grafted with mineral trioxide aggregate (MTA) treated or not with laser, bone morphogenetic protein (BMP), and guided bone regeneration (GBR). Benefits of the use of MTA, laser, BMPs, and GBR on bone repair are well known, but there is no report on their association with laser light. Ninety rats were divided into 10 groups each subdivided into 3. Defects on G II and I were filled with the blood clot. G II was further irradiated with LED. G III and IV were filled with MTA; G IV was further irradiated with laser. G V and VI, the defects filled with MTA and covered with a membrane (GBR). G VI was further irradiated with laser. G VII and VIII, BMPs were added to the MTA and group VIII further irradiated with laser. G IX and X, the MTA + BMP graft was covered with a membrane (GBR). G X was further irradiated with laser. Laser light (λ = 850 nm, 150 mW, 4 J/cm(2) ) was applied over the defect at 48-h intervals and repeated for 15 days. Specimens were processed, cut and stained with H&E and Sirius red and underwent histological analysis. Subjects on group X were irradiated. The results showed different tissue response on all groups during the experimental time. Major changes were seen on irradiated subjects and included marked deposition of new bone in advanced maturation. It is concluded that near infrared laser phototherapy improved the results of the use of the MTA on bone defects.

Removal of oral lichen planus by CO2 laser

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

O objetivo deste relato de caso é apresentar a remoção cirúrgica com o laser de CO2 de um líquen plano diagnosticado histologicamente. O líquen plano da cavidade oral é uma doença muco-cutânea crônica de etiologia desconhecida. Tratamentos diferentes têm sido usados para sua resolução. Uma paciente do sexo feminino de 46 anos de idade foi encaminhada para a Clinica de Laser da Faculdade de Odontologia da Universidade Federal da Bahia para a remoção de uma lesão na boca caracterizada pela presença de manchas brancas que estava causando dor e ardimento não havia respondido a tratamento com triamcinolone e corticoides durante 3 meses. O laser de CO2 foi utilizado para remover a lesão e o diagnóstico histopatológico conclusivo foi o de líquen plano de cavidade oral. A paciente foi acompanhada durante 1 ano sem sinal de recorrência da lesão. O uso do laser de CO2 foi considerado útil e efetivo no tratamento do líquen plano.

A feasible procedure in dental practice: the treatment of oral dysplastic hyperkeratotic lesions of the oral cavity with the CO2 laser.

OBJECTIVES: The aim of this work is to report some cases of surgical removal of hyperkeratotic lesions of the oral cavity with the CO(2) laser. BACKGROUND: Hyperkeratosis is an abnormal thickening of the stratum corneum caused by increased deposition of keratin, and its histopathologic features show wide variations. These changes are significant because they determine different biologic behavior. Several techniques are used to treat these lesions, including scalpel incision, electrosurgery, cryosurgery, photodynamic therapy, and some drugs. The use of surgical lasers has been proposed as an effective way of treating such lesions safely. The CO(2) laser is the most used laser on the oral cavity because of its affinity for water and high absorption by the oral mucosa. Several benefits of the use of the CO(2) laser are reported in the literature in regard to surgical procedures carried out on the oral cavity. PATIENTS AND METHODS: All patients had histopathologic diagnosis of hyperkeratosis and mild epithelial dysplasia and were routinely prepared for surgery under local anesthesia. The surgical procedures were carried out by using a CO(2) laser (Sharplan 20 C; Laser Industries, Tel Aviv, Israel, λ10,600 nm, φ∼2 mm, CW/RSP). The beam was focused to delimit each lesion, and then lesions were excised, and the removed specimens were sent for histopathology. At the end of the surgery, the beam was used in a defocused manner to promote better hemostasis. Neither sutures nor dressings were used after the surgery. No medication but mouthwashes was prescribed to all patients in the postoperative period. CONCLUSIONS: The use of the CO(2) laser does not reduce the risk of relapses of the lesion, but it is an easy-to-use technique and results in both a quick surgical procedure and trouble-free postoperative period and may be safely used in dental practice.

Surgical treatment of oral lymphangiomas with CO2 laser: report of two uncommon cases.

This paper reports the treatment of oral lymphangiomas with carbon dioxide CO2 Laser. Lymphangiomas are rare congenital lymphatic malformations. These lesions are most frequently diagnosed during childhood, are most commonly located in the head and neck region, and are extremely rare in the oral cavity. Oral lymphangiomas are of complex treatment due to the difficulty in performing a complete excision. CO2 laser is the most often used laser in the oral cavity due to its affinity with water and high absorption by the oral mucosa. Several benefits of the use of CO2 laser have been reported for surgical oral procedures. The cases reported herein were biopsy-proven lymphangiomas of the oral cavity. The surgical procedures were carried out under local anesthesia and a focused CO2 laser beam (λ10.600 nm, Φ ~2 mm, CW/RSP) was used. At the end of the surgery, the laser beam was used on a defocused mode to promote better hemostasis. Neither sutures nor dressings were used after surgery. No medication and only mouthwashes were prescribed to all patients on the postoperative period. There were no postsurgical complaints from the patients and no relapses of the conditions were observed after follow-up periods of 12 and 18 months. The use of CO2 laser was practical, easy to carry out and effective on the treatment of oral lymphangiomas, with no lesion recurrence.

Effects of laser photherapy on bone defects grafted with mineral trioxide aggregate, bone morphogenetic proteins, and guided bone regeneration: a Raman spectroscopic study.

We have used Raman analysis to assess bone healing on different models. Benefits on the isolated or combined use of mineral trioxide aggregate, bone morphogenetic proteins, guided bone regeneration and laser on bone repair have been reported, but not their combination. We studied peaks of hydroxyapatite and CH groups on defects grafted with MTA, treated or not with laser, BMPs, and GBR. Ninety rats were divided in 10 groups each, subdivided into three subgroups. Laser (λ850 nm) was applied at every other day for 2 weeks. Raman readings were taken at the surface of the defect. Statistical analysis (CHA) showed significant differences between all groups (p = 0.001) and between Group II and all other (p < 0.001), but not with Group X (p = 0.09). At day 21 differences were seen between all groups (p = 0.031) and between Groups VIII and X when compared with Groups VI (p = 0.03), V (p < 0.001), IV (p < 0.001), and IX (p = 0.04). At the end of the experimental period no significant differences were seen. On regards CH, significant differences were seen at the 15(th) day (p = 0.002) and between Group II and all other groups (p < 0.0001) but not with control. Advanced maturation on irradiated bone is because of increased secretion of calcium hydroxyapatite (CHA) that is indicative of greater calcification and resistance of the bone. We conclude that the association of the MTA with laser phototherapy (LPT) and/or not with GBR resulted in a better bone repair. The use of the MTA associated to IR LPT resulted in a more advanced and quality bone repair.

Tumor odontogênico queratocisto recidivante: tratamento cirúrgico conservador ou radical? relato de caso clínico / Recurrent odontogenic keratocyst tumor: conservative or radical surgical treatment? a clinical case report

O querotocisto odontogênico é um cisto de desenvolvimento epitelial dos maxilares, principalmente, a maxila e a mandíbula. O presente estudo tem por objetivo relatar um caso clínico de uma paciente de 20 anos de idade, faioderma, que apresenta uma lesão em região de ramo, ângulo e corpo mandibular do lado direito, assintomática e sem expansão das corticais ósseas, obtendo-se o diagnóstico de tumor odontogênico queratocisto...

The odontogenic keratocyst is a developmental cyst of the jaws. The aim of this paper is to report the surgical removal of such a lesion. A 20-year-old white female complained of a painless of a swelling on the right off her mandible, affecting the ramus, angle and body of the bone, which was diagnosed as an odontogenic keratocys...

Surgical treatment of oral lymphangiomas with CO2 laser: report of two uncommon cases

This paper reports the treatment of oral lymphangiomas with carbon dioxide CO2 Laser. Lymphangiomas are rare congenital lymphatic malformations. These lesions are most frequently diagnosed during childhood, are most commonly located in the head and neck region, and are extremely rare in the oral cavity. Oral lymphangiomas are of complex treatment due to the difficulty in performing a complete excision. CO2 laser is the most often used laser in the oral cavity due to its affinity with water and high absorption by the oral mucosa. Several benefits of the use of CO2 laser have been reported for surgical oral procedures. The cases reported herein were biopsy-proven lymphangiomas of the oral cavity. The surgical procedures were carried out under local anesthesia and a focused CO2 laser beam (l10.600 nm, f ~2 mm, CW/RSP) was used. At the end of the surgery, the laser beam was used on a defocused mode to promote better hemostasis. Neither sutures nor dressings were used after surgery. No medication and only mouthwashes were prescribed to all patients on the postoperative period. There were no postsurgical complaints from the patients and no relapses of the conditions were observed after follow-up periods of 12 and 18 months. The use of CO2 laser was practical, easy to carry out and effective on the treatment of oral lymphangiomas, with no lesion recurrence.

O objetivo deste trabalho é relatar o tratamento de linfangiomas orais com o laser de CO2. Os linfangiomas são raras malformações linfáticas congênitas que geralmente são diagnosticados na infância. São localizados preferencialmente na região de cabeça e pescoço, mas são extremamente raros na cavidade oral. As lesões da cavidade oral são de tratamento complexo, devido à dificuldade em exercer uma completa remoção. O laser de CO2 é o laser mais usado na cavidade oral devido à sua afinidade com a água e alta absorção pela mucosa oral. Diversos benefícios da utilização deste aparelho são relatados na literatura sobre a relação de procedimentos cirúrgicos realizados na cavidade oral. Os casos relatados são de linfangiomas comprovados por biópsia prévia. Os procedimentos cirúrgicos foram realizados sob anestesia local com um feixe de laser de CO2 no modo focado (20C Sharplan Laser Indústrias Israel, l10.600 nm, f ~2 mm, CW/RSP). Ao final da cirurgia foi utilizado um feixe de laser no modo desfocado, para promover uma melhor hemostasia. Nem suturas e curativos foram realizados após a cirurgia. Nenhuma medicação foi utilizada, somente anti-sépticos bucais foram prescritos para os pacientes no período pós-operatório. Não houve queixas no pós-operatório dos pacientes e nem recidivas após acompanhamentos de 12 e 18 meses. A utilização do laser de CO2 é um método prático, fácil e eficaz no tratamento de linfangiomas orais, sem recidiva nos períodos de acompanhamento.