The efficacy of combining adjuvants with non-surgical periodontal therapy in individuals with type 2 diabetes: A Bayesian network meta-analysis.

AIM: This Bayesian network meta-analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM). MATERIALS AND METHODS: A systematic search was done up to February 2023 comparing sub-gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full-mouth probing depth reported at 3- to 6-month post-treatment. RESULTS: Seventy-two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c. CONCLUSIONS: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence.

Should supragingival scaling be performed separately prior to subgingival scaling and root planning in nonsurgical periodontal therapy? A systematic review of randomized trials.

OBJECTIVE: To systematically evaluate randomized controlled trials (RCTs), with at least 6 months of follow-up, on whether professional mechanical plaque removal (PMPR) including supragingival scaling should be performed prior and separately from subgingival scaling and root planning (SRP) in nonsurgical periodontal therapy (NSPT), in terms of clinical and patient-reported outcomes (PROs) (CRD42020219759). METHODS: The MEDLINE, EMBASE, CENTRAL, LILACS and Web of Science electronic databases, as well as grey literature sources, were searched by two independent reviewers up to May 2023. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random-effects pairwise meta-analyses compared the changes in probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BoP) of a stepwise NSPT approach (PMPR prior and separately from SRP) and conventional one-step NSPT through mean differences (MDs) and associated confidence intervals (95% CI). RESULTS: Two RCTs were included, including data of 77 participants with severe periodontitis. One RCT presents high risk of bias and the other has some concerns. No significant differences were found between the stepwise approach and performing both steps simultaneously for any clinical outcomes, with overall very low certainty on evidence. No adverse effects were detected and there was no data on PROs. CONCLUSIONS: There is very-low certainty evidence of no significant difference on PPD and BoP reductions and CAL gain between supragingival scaling performed prior and separately from SRP and conventional one-step NSPT.

Qualidade de vida e imagem corporal após cirurgia bariátrica e de contorno corporal / Quality of life and body image after bariatric and body contouring surgery

Introdução: A procura pela cirurgia de contorno corporal após a cirurgia bariátrica se deve em grande parte a uma insatisfação com a imagem corporal prejudicada pela flacidez e excesso de pele decorrente da grande perda ponderal. O objetivo deste estudo foi avaliar a qualidade de vida e a imagem corporal de pacientes submetidos a cirurgia bariátrica e posteriormente a cirurgia de contorno corporal em uma clínica privada. Método: Este estudo transversal comparou 4 grupos distintos de 21 pacientes cada, pareados por índice de massa corporal e idade antes de realizarem a cirurgia bariátrica. Foram divididos nos tempos antes/depois da cirurgia bariátrica e antes/depois da cirurgia de contorno corporal, formando assim os grupos A, B, C e D, respectivamente. Foi utilizado o questionário SF-36 para avaliação da qualidade de vida e a Escala de Silhuetas proposta por Kakeshita para avaliação da imagem corporal. Para o nível de significância, foi escolhido p<0,05. Resultados: Houve melhora em todos os domínios do SF-36 após a cirurgia bariátrica. Os pacientes que procuraram a cirurgia de contorno corporal apresentaram o menor valor do componente de saúde mental, com pouca alteração após a cirurgia de contorno corporal. Quase todos os grupos superestimaram a sua silhueta, exceto para o grupo de 6 meses após a cirurgia bariátrica, que se viu menor. Conclusão: Pacientes bariátricos que procuram a cirurgia de contorno corporal apresentam escores inferiores de qualidade de vida relacionada à saúde mental e que permanecem menores após a cirurgia de contorno corporal. A distorção da imagem corporal e expectativas irreais podem justificar esse achado.

Introduction: The demand for body contouring surgery after bariatric surgery is largely due to dissatisfaction with body image impaired by sagging and excess skin resulting from massive weight loss. This study aimed to evaluate the quality of life and body image of patients undergoing bariatric surgery and body contouring surgery in a private clinic. Method: This cross-sectional study compared 4 groups of 21 patients, matched by body mass index and age before undergoing bariatric surgery. They were divided into times before/after bariatric surgery and before/after body contouring surgery, thus forming groups A, B, C, and D, respectively. The SF-36 questionnaire assessed the quality of life, and the Silhouette Scale proposed by Kakeshita to assess body image. For the significance level, p<0.05 was chosen. Results: There was an improvement in all SF-36 domains after bariatric surgery. Patients who sought body contouring surgery had the lowest mental health component value, with little change after body contouring surgery. Almost all groups overestimated their silhouette, except for the group of 6 months after bariatric surgery, which saw itself as smaller. Conclusion: Bariatric patients seeking body contouring surgery have lower mental health-related quality of life scores that remain lower after body contouring surgery.

Differences in the subgingival microbial composition associated with alcohol intake: A systematic review.

Objectives: This study aimed to conduct a systematic evaluation of the literature on whether individuals exposed to alcohol intake present differences in the subgingival microbial composition compared to those unexposed. Methods: Five databases (MEDLINE, EMBASE, LILACS, SCOPUS and Web of Science) and one source of grey literature (Google Scholar) were searched by two independent reviewers up to December 2022 according to pre-specified eligibility criteria. No restrictions were imposed regarding the date and language of publication and the periodontal status of the participants. The Newcastle-Ottawa Scale was used for methodological quality appraisal and a narrative synthesis was performed. Results: Eight cross-sectional studies and one cross-sectional analysis nested in a cohort were considered for qualitative analysis, including data of 4636 individuals. Overall, the studies exhibited considerable heterogeneity in terms of characteristics of the participants and microbiological methods. Four studies have high methodological quality. Exposed individuals have higher overall quantity of periodontal pathogens in shallow and moderate to deep pockets. Findings on richness, relative abundance, alpha- and beta-diversity were limited and inconclusive. Conclusion: The subgingival microbiota of individuals exposed to alcohol intake has higher overall quantity of red (i.e., P. gingivalis) and orange-complex (i.e., F. nucleatum) bacteria when compared to those unexposed.

Xerostomia impacts oral health-related quality of life in individuals with end-stage renal disease / Xerostomia impacta a qualidade de vida relacionada à saúde bucal de indivíduos em estágio final de doença renal crônica

ABSTRACT Objective: This two-centre cross-sectional study aimed to evaluate whether xerostomia occurrence is associated with oral health-related quality of life (OHRQoL) in patients with end-stage renal disease (ESRD) after the adjustment for potential confounders. Methods: Oral examinations were performed by calibrated examiners for untreated dental caries, periodontitis and tooth loss in 180 adults with ESRD. The presence of xerostomia was determined using the global question "How often does your mouth feel dry?". OHRQoL was evaluated by the simplified version of the Oral Health Impact Profile (OHIP14) questionnaire. Multivariate zero-inflated negative binomial regression analysis was used to calculate the incidence rate ratios (IRR) for the nonzero scores and odds ratios (OR) of having no impact in OHIP14 scores according to the presence of exposure. Results: In the adjusted model, xerostomia (IRR = 1.57; 95% CI: 1.12 to 2.20) was associated with poorer OHRQoL. The adjusted domain-specific analysis revealed that xerostomia occurrence significantly impacted the psychological disability and social disability, and the chance of having no impact was lower for the psychological discomfort domain (OR = 0.84; 95% CI: 0.12 to 0.98). Conclusion: Xerostomia exert an impact on OHRQoL in patients with ESRD, mainly in the psychological and social disabilities constructs.

RESUMO Objetivo: Este estudo transversal realizado em dois centros teve como objetivo avaliar se a ocorrência de xerostomia está associada à qualidade de vida relacionada à saúde bucal (QVRSB) em pacientes com doença renal crônica em estágio final (DRCEF) após o ajuste para potenciais fatores de confusão. Métodos: Exames bucais foram realizados por examinadores calibrados para cárie dentária não tratada, periodontite e perda dentária em 180 adultos com DRCEF. A presença de xerostomia foi determinada por meio da pergunta global "Com que frequência você fica com a boca seca?". A QVRSB foi avaliada pela versão simplificada do questionário Oral Health Impact Profile (OHIP-14). A análise multivariada de regressão binomial negativa inflacionada por zero foi usada para calcular as taxas de incidência (IRR) para os escores diferentes de zero e os razões de chance (OR) de não haver impacto nos escores do OHIP-14 de acordo com a presença dA exposição. Resultados: No modelo ajustado, a xerostomia (IRR = 1,57; IC 95%: 1,12 a 2,20) foi associada a pior QVRSB. A análise específica por domínio revelou que a ocorrência de xerostomia impactou significativamente a incapacidade psicológica e a incapacidade social, e a chance de não haver impacto foi menor para o domínio desconforto psicológico (OR = 0,84; IC95%: 0,12 a 0,98). Conclusão: A xerostomia exerce impacto sobre a QVRSB em pacientes com DRCEF, principalmente nos construtos de deficiência psicológica e social.

Prevalence of malocclusion in public school students in the mixed dentition phase and its association with early loss of deciduous teeth.

OBJECTIVE: To determine the prevalence of malocclusion and its association with the early loss of deciduous teeth and other factors in children in the mixed dentition phase, aged six to eight years, enrolled in public schools in southern Brazil. METHODS: A cross-sectional study was conducted with a representative sample of 528 children from municipal public schools in 2009. Data collection involved a clinical examination for the determination of early tooth loss, dental caries, tongue pressure and malocclusion (outcome), as well as the administration of a questionnaire. Poisson regression analysis with robust variance was used to model the association between malocclusion and the independent variables. RESULTS: The prevalence of malocclusion and early tooth loss was 69.1% and 21.8%, respectively. In the raw data analysis, malocclusion was associated with age, early tooth loss, dental caries and tongue pressure. After the adjustment, the likelihood of malocclusion was greater among children older than eight years, those who exerted tongue pressure on the teeth and those with early tooth loss. The likelihood of malocclusion was 24% greater among children with early tooth loss, compared to those without tooth loss. CONCLUSION: The early loss of deciduous teeth was associated with the occurrence of malocclusion in the children studied.

Association between tamoxifen and tooth loss in women with breast cancer.

OBJECTIVES: Investigate the effect of tamoxifen on the occurrence of tooth loss (TL) in breast cancer (BC) survivors. METHODS: A cross-sectional study was conducted with 140 BC survivors using tamoxifen therapy. Sociodemographic, medical, and dental data were evaluated. TL was determined using the M component of the Decayed, Missing and Filled Teeth (DMFT) index. Logistic regression models were run to determine associations between the independent variables and outcome (TL). RESULTS: Mean TL was 12.96 (SD 8.88). Only three participants had lost no teeth and 10.7% were completely edentulous. Participants who used tamoxifen for more than 1 year had a higher mean missing teeth (13.99 vs. 10.45; P = 0.030). After the adjustments, the occurrence of more than 12 missing teeth was 2.75-fold higher among women who used tamoxifen for more than 1 year (95% CI: 1.06-7.12). Moreover, age over 65 years, referral for treatment by the public healthcare system, less use of dental services, xerostomia, and a lower occurrence of dental caries remained associated with the loss of more than 12 teeth. CONCLUSION: Longer use of tamoxifen was associated with greater tooth loss in breast cancer survivors. CLINICAL RELEVANCE: Based on estimates of the increase in cases of breast cancer, the prolonged use of tamoxifen for the treatment of this disease can exert an impact on oral health through the occurrence of tooth loss. These findings can contribute to the planning and implementation of oral health care and prevention strategies for such patients.

Alcohol Intake Influences the Occurrence and Progression of Periodontitis Differently According to Sex and Country Sociodemographic Development: A Two-Stage Systematic Review.

AIMS: To conduct an overview and systematic evaluation of prospective cohort studies on whether alcohol intake is associated with the incidence and progression of periodontitis. METHODS: Nine databases were searched by two independent reviewers up to November 2021 according to prespecified eligibility criteria. Risk of Bias in Systematic Reviews and Risk of Bias in Non-Randomized Studies of Interventions were used for risk of bias assessment and certainty of evidence was assessed using the GRADE approach. Random-effects pair-wise meta-analyses were performed with data from cohort studies on the effects of higher levels of alcohol intake compared with current non-drinking to determine risk ratios (RR) and confidence intervals of periodontitis. RESULTS: The four systematic reviews were at high risk of bias and concluded that alcohol intake is associated with periodontitis regardless of the study design. Five reports from seven cohort studies contributed to the meta-analyses and no statistically significant differences were found for higher levels of consumption regarding the risk of periodontitis, except for men from countries with low- and high-middle socio-demographic index (RR = 1.30, 95% CI: 1.13-1.46), with low certainty evidence. CONCLUSION: Higher levels of alcohol consumption seem to be part of the causal mechanism of periodontitis when cooccurring with male sex in underdeveloped countries. No conclusion can be drawn regarding alcohol use disorders or patterns of consumption.

Prevalence of malocclusion in public school students in the mixed dentition phase and its association with early loss of deciduous teeth

ABSTRACT Objective: To determine the prevalence of malocclusion and its association with the early loss of deciduous teeth and other factors in children in the mixed dentition phase, aged six to eight years, enrolled in public schools in southern Brazil. Methods: A cross-sectional study was conducted with a representative sample of 528 children from municipal public schools in 2009. Data collection involved a clinical examination for the determination of early tooth loss, dental caries, tongue pressure and malocclusion (outcome), as well as the administration of a questionnaire. Poisson regression analysis with robust variance was used to model the association between malocclusion and the independent variables. Results: The prevalence of malocclusion and early tooth loss was 69.1% and 21.8%, respectively. In the raw data analysis, malocclusion was associated with age, early tooth loss, dental caries and tongue pressure. After the adjustment, the likelihood of malocclusion was greater among children older than eight years, those who exerted tongue pressure on the teeth and those with early tooth loss. The likelihood of malocclusion was 24% greater among children with early tooth loss, compared to those without tooth loss. Conclusion: The early loss of deciduous teeth was associated with the occurrence of malocclusion in the children studied.

RESUMO Objetivo: Determinar a prevalência de má oclusão em crianças de seis a oito anos de idade no município de Florianópolis (Santa Catarina, Brasil), e a sua associação com a perda precoce de dentes decíduos. Métodos: Esse estudo transversal avaliou uma amostra representativa de 528 crianças de escolas públicas municipais de Florianópolis, no ano de 2009. Os dados foram coletados por meio de exame clínico (perda dentária precoce, cárie dentária, interposição lingual e má oclusão - que foi o desfecho do estudo) e de um questionário. A regressão de Poisson com variância robusta foi utilizada para modelar a associação entre má oclusão e as variáveis independentes. Resultados: A prevalência de má oclusão e de perda dentária precoce foi, respectivamente, de 66,7% e 21,8%. Na análise dos dados brutos, a má oclusão foi associada com a idade, perda dentária precoce e cárie dentária. Após ser feito o ajuste, crianças com mais de 7 anos, com interposição lingual e perda dentária precoce apresentaram maior probabilidade de ter má oclusão. Crianças com perda dentária precoce apresentaram probabilidade 24% maior de ter má oclusão do que aquelas sem perda dentária. Conclusões: A perda precoce de dentes decíduos foi associada à ocorrência de má oclusão nas crianças estudadas.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil.

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

Prevalence of hyposalivation and associated factors in survivors of head and neck cancer treated with radiotherapy.

Hyposalivation and sensation of dry mouth (xerostomia) are one of the most common adverse effects in the treatment of patients with head and neck cancer. OBJECTIVE: This study evaluates the prevalence of late hyposalivation and associated factors in survivors of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx treated with radiotherapy with or without concomitant chemotherapy. METHODOLOGY: A cross-sectional study was conducted with 88 patients who had concluded radiotherapy at least three months before the study, at a referral center for the treatment of head and neck cancer in the Southern region of Brazil. Hyposalivation was evaluated based on the stimulated salivary flow rate using the spitting method. Multivariate analysis using binary logistic regression was performed to determine the associations between hyposalivation and clinical and demographic variables. RESULTS: Hyposalivation was found in 78.41% of the sample and the mean radiation dose was 63.01 Gy (±9.58). In the crude model of the multivariate analysis, hyposalivation was associated with higher doses of radiation (p=0.038), treatment with concomitant radiotherapy and chemotherapy (p=0.005), and time elapsed since the end of radiotherapy (p=0.025). In the adjusted model of the multivariate analysis, hyposalivation was only associated with dose and time elapsed. Patient who received higher doses of radiation had a 4.25-fold greater chance of presenting hyposalivation, whereas a longer time elapsed since the end of radiotherapy exerted a 75% protective effect against the occurrence of hyposalivation. CONCLUSION: Hyposalivation is a highly prevalence late-onset side effect of radiotherapy in patients treated for head and neck cancer, with a greater chance of occurrence among those who received higher doses of radiation and those who ended therapy less than 22 months before our study. Concomitant chemotherapy and radiotherapy does not seem to increase the chances of hyposalivation compared to radiotherapy alone.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis.

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.

Use of crack cocaine increases tooth loss.

PURPOSE: To evaluate the occurrence of tooth loss among crack cocaine users. METHODS: A cross-sectional study was conducted with 106 crack cocaine users and 106 controls matched for age, gender, and tobacco use. Data were collected on socio-demographic characteristics, drug use, use of dental services, dental caries, periodontal disease, and the outcome (tooth loss). RESULTS: Crack cocaine users had a greater frequency of tooth loss (55.7% vs. 36.8%), severity of dental caries and periodontal disease and less use of dental services than the controls (P< 0.05). After adjustments, tooth loss was 46% more frequent among crack cocaine users (PR= 1.46; 95%, CI: 1.10-1.93) as well as significantly more frequent among non-whites, those older than 24 years of age and those with high dental caries severity. Occurrence of tooth loss was significantly higher among crack cocaine users. These findings can contribute to the planning and implementation of prevention strategies and oral health care for individuals with a chemical dependence. CLINICAL SIGNIFICANCE: The use of crack cocaine had a negative impact on the oral health of its users, leading to tooth loss and a greater severity of dental caries. These findings should be considered when planning prevention strategies to improve oral health in individuals addicted to crack cocaine.

C-reactive protein levels are associated with periodontitis and periodontal inflamed surface area in adults with end-stage renal disease.

BACKGROUND: Several studies have shown the relationship between periodontal disease and chronic kidney disease, but there is little evidence to assess the impact of the amount of inflamed periodontal tissue on the levels of systemic inflammatory markers. So the aim of this study is determine the association between high-sensitivity C-reactive protein (hsCRP) and both periodontitis and periodontal inflamed surface area (PISA) in adults with end-stage renal disease (ESRD). METHODS: Cross-sectional study was conducted with 176 adults with ESRD on regular hemodialysis. The participants were submitted to a full-mouth periodontal examination to determine the occurrence of periodontitis and PISA. Regression analysis was performed to test the independent association between periodontal conditions and serum hsCRP levels. RESULTS: A total of 98.9% of the participants had periodontitis, with stages III and IV found in 26.1% and 52.9%, respectively. Mean hsCRP and PISA was 6.57 (SD: 6.03) mg/L and 217.15 (SD: 271.50), respectively. In the adjusted analysis, mean serum hsCRP levels were significantly higher in patients with stage III and IV generalized periodontitis compared with no/localized/generalized stages I-II (7.67 mg/L versus 5.72 mg/L, P = 0.028). After adjustments for confounding variables, individuals with PISA >490.56 mm2 (85th percentile) had a 3.26-fold greater chance of having hsCRP above 5 mg/L than their counterparts (OR = 3.26; 95% CI: 1.25 to 8.49). CONCLUSION: The inflammatory burden imposed by periodontitis can increase serum hsCRP levels in adults with end-stage renal disease.

Clinical and sociodemographic factors that affect the quality of life of survivors of head and neck cancer.

OBJECTIVE: The present cross-sectional study evaluated the quality of life of patients treated with 3-D conformal radiotherapy for cancer of the mouth, oropharynx, hypopharynx, or larynx and investigated possible associations with clinical and sociodemographic variables using multivariate analysis. METHODS: The sample was composed of 90 patients who had completed treatment at least 3 months earlier. Data were collected from April 2016 to May 2017. The patients were clinically evaluated with regard to stimulated salivary flow, trismus, and radiation caries. Sociodemographic data and data related to the disease (stage, location of primary tumor, and radiation dose) were collected from the patient charts. Quality of life was assessed using the Brazilian version of the University of Washington Quality of Life (UW-QOL) questionnaire. Poisson logistic regression was performed to determine the mean ratio and test associations with the clinical and sociodemographic variables. RESULTS: The mean total of the UW-QOL was 814.88 (± 224.58). Patient age, staging of cancer, hyposalivation, and trismus were associated with quality of life. Patients with tumors in the advanced stage, those with hyposalivation and those with trismus respectively had 11% (CI 0.80-0.98), 12% (CI 0.79-0.99), and 15% (CI 0.77-0.94) lower UW-QOL scores, indicating poorer quality of life. CONCLUSION: Survivors of head and neck cancer experience a negative impact on quality of life associated with trismus, hyposalivation, advanced stage tumors, and a younger patient age. The present findings underscore the importance of a specific approach focused on these aspects to ensure better quality of life in the long term.

Oral health-related quality of life in breast cancer survivors.

OBJECTIVE: The aim of the present study was to evaluate oral health-related quality of life (OHRQoL) among breast cancer survivors and identify possible factors associated with the outcome. METHODS: A cross-sectional study was conducted with 151 women in follow-up at a hospital after treatment for breast cancer. Data were collected on socio-demographic characteristics, general health, and breast cancer. Clinical examinations were performed to determine caries experience using the decayed, missing, and filled teeth (DMFT) index. The Oral Health Impact Profile (OHIP-14) questionnaire was administered for the assessment of OHRQoL. Logistic regression analysis was performed to identify associated factors after adjustments for confounding variables. RESULTS: The mean OHIP-14 score was 12.8 (SD 10.92). The prevalence of negative impact was 58.9%. A negative impact was associated with depression, the diagnosis of breast cancer, chemotherapy, number of restored teeth, and xerostomia (p < 0.05). In the adjusted analysis, only the oral variables remained significantly associated with the outcome. CONCLUSION: A greater number of restored teeth and xerostomia exert a negative impact on the OHRQoL of women who have survived breast cancer, which suggests the need for special attention to the oral health of this population.

Oral lesions and associated factors in breast cancer survivors.

AIM: To evaluate the prevalence of oral lesions (OL) and associated factors among survivors of breast cancer (BC). METHODS: A cross-sectional study involving 150 BC survivors was conducted at a public hospital in southern Brazil. Data were collected on socioeconomic aspects, treatment characteristics and oral problems. The decayed, missing and filled teeth index and the occurrence of OL were evaluated. Logistic regression was performed to determine independent variables associated with the outcome. RESULTS: 24% of the women had at least 1 OL and 33.3% of these had more than one lesion. Melanotic macule was the most prevalent lesion. Duration of tamoxifen use, radiotherapy, missing teeth and xerostomia were associated with the occurrence of OL (P < .05). In the adjusted analysis, women with more than 13 missing teeth and xerostomia had 2.39-fold (95% confidence interval [CI], 1.06-5.40) and 2.71-fold (95% CI, 1.14-6.42), respectively, greater odds of exhibiting OL. CONCLUSION: Approximately 1/4 of the BC survivors exhibited OL, which were associated with tooth loss and xerostomia. These findings could assist in the establishment of oral health strategies for women with BC.

Association between trismus and dysphagia-related quality of life in survivors of head and neck cancer in Brazil.

OBJECTIVES: The aim of this study was to evaluate the association between trismus and other radiation-associated conditions with dysphagia-related quality of life in patients who have undergone radiotherapy of the head and neck. STUDY DESIGN: This cross-sectional study included 88 patients who had squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and had been treated with 3-dimensional (3-D) conformal radiotherapy, which had been completed at least 3 months earlier. Clinical data were obtained from medical records. Trismus, hyposalivation, and radiation caries were evaluated clinically. Dysphagia-related quality of life (DRQoL) was investigated by using the M. D. Anderson Dysphagia Inventory (MDADI). Binary logistic regression was performed to determine associations between DRQoL and both demographic and clinical variables. RESULTS: The mean total MDADI score was 67.33 ± 15.47, and the physical domain was the most affected (60.28 ± 19.00). Patients with cancer of the mouth and oropharynx had worse scores (P = .001). Trismus was associated with poorer DRQoL in all domains of the MDADI (P = .001) and with a greater chance of moderate to profound swallowing limitation (P = .024). CONCLUSIONS: Trismus and tumors located in the mouth and oropharynx were associated with poor swallowing function, exerting a negative impact on DRQoL.

Histological and inflammatory analysis to diagnostic method of proximal gingivitis by flossing.

OBJECTIVES: The aim of this study was to assess with histological and inflammatory analysis the use of flossing as a diagnostic method for detecting proximal gingivitis. MATERIAL AND METHODS: This is a diagnostic accuracy paper composed of two different studies. In the first study, three groups were identified based on papilla status: bleeding (+) with both methods (N = 26); bleeding (+) with dental floss, but no bleeding (-) with probing (N = 26); and no bleeding (-) with either method (N = 26). One papilla from all 78 participants was biopsied and analyzed for the determination of inflammatory infiltrate and percentage of collagen fibers. Sensibility, specificity, positive and negative predictive, and accuracy values were analyzed. In the second study, the volume of gingival crevicular fluid (GCF) was analyzed in 49 participants with flossing+/probing- and flossing-/probing- at contralateral proximal sites. The GCF volume was compared between these sites (n = 172). RESULTS: Significantly greater frequencies of moderate/intense inflammation were found in the flossing+/probing+ (100%) and flossing+/probing- (92.3%) groups compared to those in the flossing-/probing- (0%) group. Significantly different percentages of collagen fibers were found among the three groups (flossing+/probing+ (40.90 ± 3.68); flossing+/probing- (45.78 ± 4.55); flossing-/probing- (60.01 ± 36.66)) (P < 0.001). Dental floss increased the balance between sensitivity and specificity values and showed highest positive predictive (100%) and accuracy (97%) values. Among the 172 sites evaluated, positive bleeding sites had a significantly greater volume of GCF (38 (27-68)) than negative sites (25 (16-51)) (P < 0.001). CONCLUSIONS: The findings suggest that flossing can be used as a diagnostic method for proximal gingivitis in subjects with no history of periodontitis. CLINICAL RELEVANCE: Dental floss can be used as a complementary diagnostic method for proximal gingivitis in adults without clinical attachment loss in clinical practice as well as epidemiology studies.

Antimicrobial activity of Melaleuca alternifolia nanoparticles in polymicrobial biofilm in situ.

Microbial biofilms represent a challenge in the treatment of infections, due to the low efficacy of the antimicrobials. This study evaluated the antimicrobial effect of nanoparticles of Melaleuca alternifolia (TTO) in dental biofilm. Thirty-eight volunteers used an oral device in situ in situ including four bovine enamel specimens for 07 days. From the fifth day four solutions were applied randomly for each specimen: Physiological Saline Solution (0.85% NaCl) (C+), Chlorhexidine 0.12% (CHX), M. alternifolia oil 0.3% (TTO), and a nanoparticle solution of 0.3% M. alternifolia oil (NPTTO). The nanoparticles of TTO were characterized for pH, IPD, medium size, zeta potential and Transmission Electron Microscopy. Antimicrobial activity was evaluated by viable microorganisms count and the structure of the biofilm by atomic force microscopy. The NPTTO presented pH 6.4, particle diameter of 197.9 ± 1 nm, polydispersion index of 0.242 ± 0.005, zeta potential of -7.12 mV and ±0:27 spherical shape. The C+ resulted in 100% of bacterial vitality, while CHX, TTO and NPTTO showed 34.2%, 51.4% and 25.8%, respectively. The AFM images showed biofilms with an average roughness of 350 nm for C+, 275 nm for CHX, 500 nm for TTO and 100 nm for NPTTO. The NPTTO demonstrated excellent antimicrobial activity in the biofilm formed in situ and will possibly be used in future for the treatment/prevention of oral biofilms.