O papel da infecção e inflamação na etiopatogênese da osteonecrose dos maxilares induzida por medicamentos / The role of infection and inflammation in the etiopathogenesis of medication-related osteonecrosis of the jaw

Objetivo: O objetivo desta revisão de literatura é evidenciar o papel da infecção e inflamação na etiopatogenia da osteonecrose dos maxilares induzida por medicamentos (MRONJ). Revisão da literatura: A MRONJ é uma condição rara e grave que impacta negativamente a vida dos pacientes afetados. Sua etiopatogenia é multifatorial e ainda não foi totalmente compreendida. Uma das hipóteses propostas para explicá-la sugere que, além da inibição do turnover ósseo pelos medicamentos antirreabsortivos, a infecção associada à exodontia e a inflamação local desempenham papel decisivo no desencadeamento da condição. O entendimento da etiopatogenia da MRONJ permite ao cirurgião-dentista a identificação dos pacientes com risco maior para a doença, assim como o auxilia no monitoramento e escolha do manejo mais adequado. No campo da pesquisa, ele pode aprimorar estudos pré-clínicos e aprofundar a investigação de biomarcadores para diagnóstico precoce de MRONJ. Considerações finais: Conhecer a contribuição da infecção e inflamação na etiopatogênese da MRONJ é fundamental para orientar a pesquisa e a adoção de estratégias preventivas para os pacientes em risco, e de manejo e monitoramento adequado para aqueles já acometidos. (AU)

Aim: The aim of this literature review is to highlight the role of infection and inflammation in the etiopathogenesis of drug-induced osteonecrosis of the jaw (MRONJ). Literature review: MRONJ is a rare and serious condition that negatively impacts the lives of affected patients. Its etiopathogenesis is multifactorial and has not yet been fully understood. One of the hypotheses proposed to explain it suggests that, in addition to the inhibition of bone turnover by antiresorptive drugs, the infection associated with tooth extraction and local inflammation play a decisive role in triggering the condition. Understanding the etiopathogenesis of MRONJ allows the dentist to identify patients at higher risk for the disease, as well as assisting in monitoring and choosing the most appropriate management. In research, it can improve preclinical studies and deepen the investigation of biomarkers for early diagnosis of MRONJ. Conclusion: Knowing the contribution of infection and inflammation in the etiopathogenesis of MRONJ is essential to guide research and the adoption of preventive strategies for patients at risk, and adequate management and monitoring for those already affected.(AU)

Diagnosis of juvenile idiopathic arthritis with asymptomatic involvement of the temporomandibular joint: A case report.

Juvenile idiopathic arthritis (JIA) is a broad term that describes a group of heterogeneous rheumatologic diseases, mainly characterized by inflammation in the joints of children and young people up to 16 years of age. Its etiology is still not well understood and the diagnosis, essentially clinical, begins with the exclusion of other joint diseases. When the disease affects the temporomandibular joint, diagnosis is a challenge, as many patients are asymptomatic. The objective of this paper is to present a case of JIA with severe involvement of the temporomandibular joint and to discuss the clinical, radiographic, laboratory findings and the importance of early diagnosis. The lack of diagnosis of active arthritis in the temporomandibular joint in patients with JIA can cause irreversible effects such as micrognathia, malocclusion and reduced maximum mouth opening. Early diagnosis of temporomandibular joint involvement in JIA is important and needs to be investigated early in the clinical manifestation of systemic disease. Laboratory tests and clinical history are important to define treatment and prognosis, but not to predict temporomandibular joint arthritis. Imaging exams are important diagnostic tools to identify morphological changes in soft and hard tissues of the temporomandibular joint.

Sensitivity and specificity of salivary pipecolic acid in head and neck squamous cell carcinoma

Aim: The aim of the present preliminary case-control study was to test the sensitivity and specificity of salivary pipecolic acid in predicting head and neck squamous cell carcinoma (HNSCC). Methods: High-performance liquid chromatography was used for the analysis of non-stimulated saliva samples from 40 individuals: 20 in the case group (recently diagnosed with untreated HNSCC) and 20 in the control group (individuals without cancer). Both groups included patients taking daily oral hypoglycemic drugs (comorbidity). The case and control groups were matched at a proportion of 1:1 for sex and comorbidity. Results: Mean salivary levels of pipecolic acid were 169.38 ng/ mL in the case group and 114.66 ng/mL in the control group (p<0.001). Individuals who took oral hypoglycemic drugs had higher levels of pipecolic acid in both the case and control groups (p<0.001). The receiver operating characteristic curve analysis revealed 90% sensitivity and 65% specificity for head and neck cancer, with an area under the curve of 0.838 between the case and control groups. Conclusions: Pipecolic acid had high sensitivity for the diagnosis of HNSCC but low specificity in the sample analyzed. Our findings suggest that salivary pipecolic acid levels are associated with glucose homeostasis. Studies with larger samples are required to evaluate the specificity of this metabolite

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.

Late radiation effects in survivors of head and neck cancer: State of the science.

Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.

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.

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients.

The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

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.

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients

Abstract The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

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.

Study of Pathological Changes in the Dental Follicle of Disease-Free Impacted Third Molars.

BACKGROUND: The prophylactic extraction of third molars is a common practice in dental offices, but divergent opinions are found in the literature regarding the indication of this procedure. The aim of the present study was to determine the prevalence of pathological changes associated with the pericoronal tissue of asymptomatic impacted third molars that could justify prophylactic extraction. MATERIALS AND METHODS: A cross-sectional observational study was conducted in which 109 pericoronal tissues with no radiographic evidence of pathology were histopathologically analyzed. The specimens were fixed in 10% formalin, embedded in paraffin, stained with hematoxylin and eosin and analyzed individually by two pathologists. RESULT: The frequency of inflammatory infiltrate in the dental follicle of patients older than 20 years of age was significantly higher than that of younger patients (p = 0.004), demonstrating an association between inflammation in the dental follicle and patient age. The occurrence of squamous metaplasia was also greater in patients older than 20 years (p = 0.042), demonstrating that the prevalence of squamous metaplasia increases with age. A significant association was also found between inflammation and squamous metaplasia (p < 0.001). CONCLUSION: Pathological changes may be present in the dental follicle of impacted third molars even in the absence of clinical or radiographic signs of disease.

Reação liquenoide oral ao amálgama: uma lesão ainda vista / Oral lichenoid reaction to amalgam: a lesion still seen

O amálgama dental ainda é amplamente utilizado na prática odontológica, apesar do acordo assinado na Convenção de Minamata, na qual 140 países comprometeram-se a reduzir o uso do mercúrio. O uso desse material restaurador pode desencadear reações liquenoides orais (RLO) cujas lesões apresentam semelhanças clínicas e histológicas com líquen plano oral (LPO), dificultando o diagnóstico. Aqui relatamos o caso de uma paciente do sexo feminino, de 72 anos, que foi encaminhada com uma lesão na mucosa bucal esquerda, com 10 meses de evolução e queixa de dor. A lesão era adjacente ao segundo molar inferior esquerdo que tinha uma restauração de amálgama. A paciente não apresentava doença sistêmica ou hábitos deletérios e não estava usando drogas continuamente. O diagnóstico clínico presuntivo foi RLO versus LPO. Sessenta dias após a substituição da restauração do amálgama, observou-se a regressão completa da lesão e o diagnóstico final de RLO foi realizado. A avaliação clínica associada aos resultados obtidos após a substituição do material suspeito pode ser suficiente para estabelecer o diagnóstico, embora em alguns casos seja necessária a avaliação histopatológica.

Dental amalgam is still widely used in dental practice, despite the agreement signed at the Minamata Convention, in which 140 countries have committed to reducing the use of mercury. The use of this restorative material may trigger oral lichenoid reactions (OLR) whose lesions show clinical and histological similarities with oral lichen planus (OLP), making diagnosis difficult. Here we report the case of a female patient, 72-year-old, who was referred with a lesion in the left buccal mucosa, with 10 months of evolution and complaint of pain. The lesion was adjacent to the second lower left molar which had an amalgam restoration. The patient had no systemic disease or deleterious habits and was not using drugs continuously. The presumptive clinical diagnosis were OLR versus OLP. Sixty days after the replacement of amalgam restoration the complete regression of the lesion was observed and the final diagnosis of OLR was done. Clinical assessment associated with the results obtained after the replacement of suspect material may be sufficient to establish the diagnosis, although in some cases it may be necessary histopathological evaluation.

Pré-hipertensão, hipertensão arterial e fatores associados em pacientes odontológicos: estudo transversal na cidade de Santa Maria-RS, Brasil / Pre-hypertension, hypertension and associated factors in dental patients: a cross-sectional study in Santa Maria-RS, Brazil

Introdução: A hipertensão arterial sistêmica é um dos mais importantes fatores de risco de doenças cardiovasculares e uma das doenças crônicas mais prevalentes no Brasil e na população mundial. Objetivo: Avaliar a prevalência de hipertensão e pré-hipertensão, fatores associados e adesão ao tratamento anti-hipertensivo em uma amostra de pacientes odontológicos de uma faculdade particular do Rio Grande do Sul, Brasil. Material e Método: Participaram deste estudo 250 pacientes de ambos os gêneros, com idade igual ou superior a 18 anos. Foram obtidos dados demográficos, história de hipertensão arterial e outras doenças sistêmicas, informações sobre o uso de medicação anti-hipertensiva e tabagismo, e realizadas medidas antropométricas. A adesão ao tratamento foi avaliada pelo teste de Morisky e Green. Três aferições de pressão arterial foram realizadas por um Cirurgião-Dentista e a medição média das últimas duas tomadas foi utilizada na presente análise. Resultado: A idade média dos pacientes foi de 46,6 (±13,8) anos. Trinta por cento apresentavam pré-hipertensão e 36%, hipertensão arterial sistêmica. Destes, 28,9% não conheciam sua condição de hipertensão. A hipertensão mostrou associação estatisticamente significante com aumento da idade (p<0,001) e diabetes (p=0,009). Dentre os pacientes em tratamento anti-hipertensivo, 58,1% não eram aderentes, enquanto 41,9% não estavam com a pressão arterial controlada. Conclusão: Na presente amostra, observou-se uma alta prevalência de pré-hipertensão e hipertensão não diagnosticadas, bem como alta taxa da doença não controlada. Estes resultados apontam para a importância ...

Introduction: Hypertension is one of the most important risk factors for cardiovascular diseases and one of the most prevalent chronic diseases in Brazil and in the world population. Objective: Assess the prevalence of hypertension and prehypertension, associated factors and adherence to antihypertensive therapy in a sample of dental patients of a private dentistry school in the state of Rio Grande do Sul, Brazil. Material and Method: The participants of this study were 250 patients of both genders, aged over 18 years. Demographic data, history of hypertension and other systemic diseases, information about the use of antihypertensive drugs and smoking were obtained, and anthropometric measurements were performed. Adherence to treatment was evaluated by Morisky-Green test. Three blood pressure measurements were made by a dentist, and the average of the last two measurements was used in this analysis. RESULT: The mean age of patients was 46.6 (±13.8) years. Thirty percent had prehypertension and 36% had hypertension. Of these hypertensive patients, 28.9% were unaware of their hypertensive condition. Hypertension was statistically associated with increasing age (p<0.001) and diabetes (p=0.009). Among patients on antihypertensive treatment, 58.1% were non-adherent, whilst 41.9% had no controlled blood pressure. Conclusion: In the present study we observed a high prevalence of prehypertension and undiagnosed hypertension, as well as high rate of uncontrolled disease. These results point to the importance of blood pressure measurements during dental visits. .

Craniofacial and dental manifestations of triple X syndrome associated with congenital hypothyroidism: a case report.

Triple X syndrome (47,XXX) is a numerical chromosomal alteration that affects 1/1,000 women, in which the woman is born with an extra X chromosome. Some oral changes have been reported in the literature, as hypodontia, influence on deposition of crown enamel and discrepancies in cephalometric measurements. Other systemic complications may lead to oral abnormalities similar to those seen in triple X patients, such as congenital hypothyroidism (CH). This paper reports a triple X syndrome case associated with CH later treated. Besides delay in cognitive and intellectual development, the patient had changes in teeth development and in cephalometric measurements with deficiencies in the maxilla and mandible. This is the first report of a triple X syndrome associated with CH. Both conditions may result in changes in dentofacial development.

Apicotomy as treatment for failure of orthodontic traction.

Objective. The purpose of this study was to present a case report that demonstrated primary failure in a tooth traction that was subsequently treated with apicotomy technique. Case Report. A 10-year-old girl had an impacted upper right canine with increased pericoronal space, which was apparent on a radiographic image. The right maxillary sinus showed an opacity suggesting sinusitis. The presumptive diagnosis was dentigerous cyst associated with maxillary sinus infection. The plan for treatment included treatment of the sinus infection and cystic lesion and orthodontic traction of the canine after surgical exposure and bonding of an orthodontic appliance. The surgical procedure, canine position, root dilaceration, and probably apical ankylosis acted in the primary failure of the orthodontic traction. Surgical apical cut of the displaced teeth was performed, and tooth position in the dental arch was possible, with a positive response to the pulp vitality test. Conclusion. Apicotomy is an effective technique to treat severe canine displacement and primary orthodontic traction failure of palatally displaced canines.

Extrusão dentária com finalidade restauradora / Tooth extrusion for restorative purpose

O objetivo deste trabalho é revisar a literatura sobre o tracionamento dentário para fins restauradores, apresentar considerações biológicas e mecânicas sobre este procedimento e demonstrar através de casos clínicos a aplicabilidade das técnicas.

The objective of this work is to revise the literature about dental traction for restorative purposes, to present biological and mechanical considerations on this procedure and to demonstrate through clinical cases the applicability of the technique.

Galectin-3 immunoprofile in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma of salivary glands.

Adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA) are malignant neoplasms of salivary glands, which are similar in histologic patterns but very different in clinical behavior, treatment and prognosis. Galectin-3 is a multifunctional protein of a growing family of beta-galactoside-binding animal lectins, which is implicated in a variety of biological events such as tumor cell adhesion, proliferation, differentiation and angiogenesis. This protein was found to be implicated in cellular transformation and a correlation between its expression and cancer progression and metastasis has been described. The aim of this study was to determine the galectin-3 immunoprofile in 14 cases of ACC (2 cases of tubular subtype, 4 cases of solid subtype and 8 cases of cribriform subtype) and in 12 cases of PLGA with different histologic patterns, including lobular, tubular and cribriform aspects. Moreover, slides of normal salivary glands were included. In normal salivary glands there was strong nuclear and cytoplasmic staining for galectin-3 in ductal luminal cells. ACC showed specific staining in luminal cells mainly in the nuclei. In the tubular subtype of ACC, galectin-3 strongly stained luminal cells of the ductiform structures. The cribriform and solid subtypes showed a few positive luminal cells of small ducts present in the cribriform structures and in solid nests respectively. In the cases of PLGA, independent of the histologic architecture, all tumor cells revealed a positive cytoplasmic reaction. Galectin-3 expression seems to be related to cell differentiation more than to tumor progression and prognosis in the neoplasms studied.