Endodontic treatment of odontogenic infection in a patient at risk of medication-related osteonecrosis of the jaw: a case report and review of treatment criteria.

Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon and severe condition in patients who are receiving treatment with antiresorptive and/or antiangiogenic drugs, which are frequently used to treat or prevent cancer metastases. The treatment of MRONJ is challenging because the choice of a specific dental treatment depends on several factors, including the systemic condition of the patient, type and dosage of medications, and clinical and radiographic characteristics of the dental lesions. This case report describes the conservative endodontic treatment of an odontogenic infection in a patient at risk of developing MRONJ owing to bisphosphonate treatment. Endodontic retreatment was performed to control the odontogenic infection and avoid tooth extraction. Certain factors favor the use of a conservative approach, such as a localized and small infection, the absence of systemic factors (such as metabolic disorders or medications) that can impair bone healing, and good oral hygiene.

Severe oral mucositis relating to pain and worse oral condition among patients with solid tumors undergoing treatment with FOLFIRI and 5-FU: a retrospective study.

BACKGROUND: There is a need for studies that correlate the severity of oral mucositis (OM) with chemotherapy protocols, transient myelosuppression and oral health. OBJECTIVE: To analyze the severity of OM among individuals with solid tumors during hospitalization and its correlation with the type of chemotherapy, myelosuppression and oral health condition. DESIGN AND SETTING: Retrospective study at a public hospital in Bauru, state of São Paulo, Brazil, that is a regional referral center. METHODS: Individuals diagnosed with solid malignant tumors who received chemotherapy during hospitalization for completion of the antineoplastic treatment cycle or who presented complications resulting from this were assessed. RESULTS: Twenty-eight individuals (24.3%) manifested some degree of OM. The most prevalent degrees of OM according to the World Health Organization (WHO) and modified WHO classification were grades 2 (11.3%) and 5 (4.3%), respectively. It was observed that the higher the OM-WHO (P < 0.001; r = 0.306) and modified OM-WHO (P < 0.001; r = 0.295) classifications were, the greater the oral pain reported by the individuals was. Presence of mucositis in the upper lip and buccal mucosa contributed to increased severity of OM and worsening of swallowing during hospitalization. Thus, severe OM was associated with use of the FOLFIRI protocol (folinic acid, fluorouracil and irinotecan). CONCLUSION: Individuals with tumors who presented severe OM had greater severity of oral pain and worse oral health. Use of the FOLFIRI protocol was associated with higher prevalence of severe OM, while use of 5-fluorouracil (5-FU) was correlated with worse oral condition.

Severe oral mucositis relating to pain and worse oral condition among patients with solid tumors undergoing treatment with FOLFIRI and 5-FU: a retrospective study

ABSTRACT BACKGROUND: There is a need for studies that correlate the severity of oral mucositis (OM) with chemotherapy protocols, transient myelosuppression and oral health. OBJECTIVE: To analyze the severity of OM among individuals with solid tumors during hospitalization and its correlation with the type of chemotherapy, myelosuppression and oral health condition. DESIGN AND SETTING: Retrospective study at a public hospital in Bauru, state of São Paulo, Brazil, that is a regional referral center. METHODS: Individuals diagnosed with solid malignant tumors who received chemotherapy during hospitalization for completion of the antineoplastic treatment cycle or who presented complications resulting from this were assessed. RESULTS: Twenty-eight individuals (24.3%) manifested some degree of OM. The most prevalent degrees of OM according to the World Health Organization (WHO) and modified WHO classification were grades 2 (11.3%) and 5 (4.3%), respectively. It was observed that the higher the OM-WHO (P < 0.001; r = 0.306) and modified OM-WHO (P < 0.001; r = 0.295) classifications were, the greater the oral pain reported by the individuals was. Presence of mucositis in the upper lip and buccal mucosa contributed to increased severity of OM and worsening of swallowing during hospitalization. Thus, severe OM was associated with use of the FOLFIRI protocol (folinic acid, fluorouracil and irinotecan). CONCLUSION: Individuals with tumors who presented severe OM had greater severity of oral pain and worse oral health. Use of the FOLFIRI protocol was associated with higher prevalence of severe OM, while use of 5-fluorouracil (5-FU) was correlated with worse oral condition.

Volatile sulphur compounds in people with chronic kidney disease and the impact on quality of life.

The objectives are to identify volatile sulphur compounds (VSCs) in individuals with Chronic Kidney Disease (CKD) and to relate quality of life and oral health. A case-control study with 32 individuals with CKD in haemodialysis in the study group (SG) and 32 healthy individuals in the control group (CG) was performed. The VSCs were identified by gas chromatograph before (BC) and after cysteine (AC) mouthwash and an organoleptic test. For oral health assessment, oral health index was used. For quality of life, the Oral Health Impact Profile (OHIP-14) and Medical Outcomes Study 36-Item Short Form Health Survery (SF-36) were used. The hydrogen sulphide AC, methyl mercaptan AC, tongue coating, dry mouth, plaque index, and DMFT were significantly higher in the SG. VSCs did not negatively affected the impact of oral health on the quality of life in the SG but did in the CG. As for the impact of general health on quality of life, methyl mercaptan BC and AC worsened overall health in vitality and mental health, respectively. Individuals with CKD have more halitosis than healthy individuals, and it is more related to methyl mercaptan. The halitosis worsened the general quality of life of individuals with CKD. The diagnosis and identification of the origin of halitosis is important to prevent one more factor that it worsened the global quality of life of patients with CKD.

Halitosis, reduced salivary flow and the quality of life in pre-kidney transplantation patients.

BACKGROUND: Halitosis is a condition that affects 50% of adults and one third of patients with chronic kidney disease. The aim of this study was to evaluate oral manifestations and volatile sulfur compounds (VSCs) associated with halitosis and quality of life in pre-kidney transplantation candidates. MATERIAL AND METHODS: The organoleptic test (OT) and halimetry (HA) (before and after cysteine mouthwash) were performed in patients with the Oralchroma® device, stimulated (SE) and non-stimulated sialometry (SN), Tongue Coating Index (TCI). The OHIP-14 questionnaire was administered to assess the impact of oral health on quality of life. RESULTS: Fourteen individuals with a mean age of 49.64 ± 13.35 years were evaluated. In the organoleptic test, 57.14% of the individuals presented halitosis. Oralchroma results showed that dimethyl sulfide was above the threshold in 85.71% of the individuals, while hydrogen sulfide and methyl mercaptan were above threshold in 28.57%; after the use of cysteine, hydrogen sulfide was present in 100% of the cases, dimethyl sulfide in 57.14% and methyl mercaptan in 50%. In the non-stimulated sialometry, 57.14% of the individuals presented hyposalivation and 21.42% in the stimulated. Regarding the tongue coating index, 100% of the individuals presented tongue coating, with a mean of 7.64. The assessment of impact of oral health on quality of life showed a negative impact in all dimensions. CONCLUSIONS: Tongue coating, in association with hydrogen sulfide, was the main cause of halitosis in the study subjects, and hyposalivation may contribute to higher tongue-coating indices. These oral changes negatively affect the quality of life for pre-kidney transplantation patients. Key words:Halitosis, chronic kidney disease, quality of life, kidney transplantation.

Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. OBJECTIVE: To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. DESIGN AND SETTING: Integrative review of BRONJ in a Brazilian population. METHODS: Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. RESULTS: Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). CONCLUSIONS: BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.

Severity of oral lichen planus and oral lichenoid lesions is associated with anxiety.

OBJECTIVES: Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient's quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL. PATIENTS AND METHODS: This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions. RESULTS: A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity. CONCLUSION: Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL. CLINICAL RELEVANCE: Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Desafios da abordagem interdisciplinar de indivíduo cardiopata grave com abcesso odontogênico agudo / Challenges of the interdisciplinary approach in an individual with severe heart disease and acute dental abcess

Os indivíduos sistemicamente comprometidos e com múltiplas comorbidades são um desafio para a abordagem cirúrgica. Pacientes com flutter atrial fazem uso de anticoagulantes para diminuir o risco de eventos tromboembólicos, porém há maior risco de hemorragia durante procedimentos cirúrgicos. As infecções de origem odontogênica podem ter disseminação hematogênica e agravar ainda mais o quadro clínico geral do indivíduo. A abordagem cirúrgica deve sempre visar à segurança e à qualidade de vida do paciente, levando em consideração os riscos e benefícios do procedimento e o preparo do profissional frente a possíveis acidentes e complicações, haja vista o risco de mortalidade perioperatória. O presente caso relata o desafio de estabelecer plano de tratamento e conduta diante de infecção odontogênica em indivíduo cardiopata grave polimedicado ASA IV com histórico de doença renal crônica sob hemodiálise, hipertensão arterial sistêmica, diabetes mellitus, anemia, insuficiência coronariana, flutter atrial, aterosclerose e pé diabético. Para o procedimento sob anestesia geral, foi instituída a terapia de ponte prévia, utilização de medidas hemostáticas locais e antibioticoterapia pré e pós-operatória. A atuação interdisciplinar mostrou-se essencial para estabelecer critérios de segurança e decidir o melhor momento para a atuação cirúrgica

Systemically compromised individuals with multiple comorbidities represent a challenge in terms of the surgical approach. Patients with atrial flutter take anticoagulants to reduce the risk of thromboembolic events, but there is a greater risk of hemorrhaging during surgical procedures. Infections of odontogenic origin may involve hematogenous dissemination and further aggravate the patient's overall clinical condition. The surgical approach should always target the patient's safety and quality of life, considering the risks and benefits of the procedure and the professional's preparedness to cope with possible accidents and complications, given the risk of perioperative mortality. This is a case report of the challenge of establishing a treatment plan and course of action for dental infection in an ASA IV polymedicated patient with a history of chronic kidney disease undergoing hemodialysis, systemic arterial hypertension, diabetes mellitus, anemia, coronary insufficiency, atrial flutter, atherosclerosis and diabetic foot. Prior bridge therapy, use of local hemostatic measures, and pre- and postoperative antibiotic therapy were instituted for the procedure to be carried out under general anesthesia. Interdisciplinary action has proved to be essential for establishing safety criteria and deciding on the best time for surgical intervention

Emergências cardiovasculares agudas: prevenção, diagnóstico e manejo odontológico / Acute cardiovascular emergencies: prevention, diagnosis and dental management

As emergências cardiovasculares agudas são complicações cardíacas com altos índices de mortalidade e podem ocorrer durante o atendimento odontológico de cardiopatas. Contribuir com medidas de prevenção, diagnóstico e manejo odontológico de emergências cardiovasculares agudas durante o tratamento dentário através de uma revisão integrativa. A anamnese minuciosa associada a medidas de controle de estresse/ ansiedade são as principais formas de prevenir a ocorrência de eventos cardíacos no consultório odontológico. Durante a crise, o conhecimento dos principais sinais e sintomas é fundamental no diagnóstico diferencial de cardiopatias agudas e, após estabelecido, devem-se iniciar os primeiros socorros básicos através do acionamento do serviço de emergência, seguido pelo posicionamento corporal adequado do paciente e administração dos protocolos farmacológicos específicos para cada situação. O consultório odontológico deve obrigatoriamente possuir os equipamentos necessários para monitorização dos sinais vitais durante o evento cardiovascular agudo e garantir a disponibilização de oxigênio para que o cirurgião-dentista possa iniciar os protocolos de ressuscitação caso o paciente evolua para uma parada cardiorrespiratória. O manejo odontológico das emergências cardiovasculares agudas inicia-se com cuidados preventivos específicos, realização do diagnóstico correto da cardiopatia aguda, tomada de conduta adequada das complicações cardíacas que possam ocorrer durante o tratamento odontológico, objetivando a diminuição da morbimortalidade dessas emergências

Acute cardiovascular emergencies are cardiac complications with high mortality rates, and can occur during the dental care of cardiac patients. To contribute to the prevention, diagnosis and dental management of acute cardiovascular emergencies during dental treatment, through an integrative review. A detailed anamnesis, associated with measures of stress/anxiety control, are the main ways to prevent the occurrence of cardiac events in the dental office. During the crisis, a knowledge of the main signs and symptoms is fundamental in the differential diagnosis of acute heart diseases and once established, basic first aid should be given, activating the emergency services followed by the appropriate body positioning of the patient and administration of specific pharmacological protocols for each situation. The dental office must have the equipment needed to monitor the vital signs during the acute cardiovascular event, and ensure the availability of oxygen, so that the dental surgeon can initiate resuscitation protocols if the patient goes into cardiopulmonary arrest. Dental management of acute cardiovascular emergencies begins with specific preventive care, a correct diagnosis of acute cardiopathy, and correct management of cardiac complications that can occur during dental treatment, aiming to reduce the morbidity and mortality of these emergencies