Possible adverse effects of low-level laser on oral and oropharyngeal cancer cells: A scope review.

BACKGROUND: The effects of laser therapy on normal cells are well known and accepted, but the impact of this therapy on malignant cells are not yet fully understood. This review aims to map and outline what the scientific literature addresses on the effects of laser therapy on malignant cells. METHODS: This review article followed the guidelines of the PRISMA-ScR protocol, being all the search, analysis, and selection of articles based on it. RESULTS: After all application of the predetermined criteria, five studies were included, dated between the years 2013 and 2021. With the complete reading of the selected studies, 100% of the articles were classified as category III of the Agency for Healthcare as Research and Quality classification. Similar themes among the papers included were investigated and compared. In these five studies, the visible red and near infrared wavelengths were used, and energy densities varied between 1 and 5 J/cm2 . It was observed that low-level laser could alter the expression of cell proliferation and migration proteins, such as cyclin D1, E-cadherin, and ß-catenin. In addition, changes related to increased cell viability and metabolism were also identified. CONCLUSION: The low-level laser seems to positively regulate the proliferative, migratory, and viability capacity of neoplastic cells, depending on the protocol used. All these studies included in the review are equivalent to in vitro studies; the cells are not in such a complex environment as is an organized tissue, making it necessary to carry out more complex tests, such as in vivo research.

Might Zika virus-associated microcephaly's severity impact deciduous tooth eruption and orofacial structures?

OBJECTIVE: to investigate the impact of the severity of microcephaly caused by the Zika virus (MCZ) on tooth eruption and orofacial structures of children. DESIGN: This case series study developed the research at the Mens Sana Rehabilitation Center, Arcoverde, Brazil. The study included 27 children diagnosed with MCZ. We performed the data collection in June 2018 through a questionnaire answered by the legal guardians, followed by a clinical examination of the children. The data were analyzed by the Mann-Whitney and Fisher's exact tests (p = 0.05). RESULTS: The final sample was composed of 20 children. Of these, 13 (35.0%) had severe microcephaly, 5 (30.0%) had altered sequence of tooth eruption, 10 (50.0%) had delayed eruption, and the mean number of decayed teeth was 2.3. The most identified orofacial changes were teeth grinding habit (65.0%), difficult chewing (50.0%), and non-nutritive sucking (50.0%). The Mann-Whitney test showed that the severity of microcephaly did not affect tooth eruption (p = 0.581). The Fisher's exact test showed that the severity of microcephaly was not associated with orofacial changes (p > 0.05). CONCLUSIONS: The severity of MCZ does not seem to influence changes in deciduous tooth eruption and the presence of orofacial anomalies.

Agravos de saúde bucal na população quilombola brasileira: uma revisão de escopo

[RESUMO]. Objetivo. Delinear o panorama atual acerca dos agravos de saúde bucal da população quilombola no Brasil. Métodos. Uma busca foi realizada nas bases de dados Biblioteca Virtual em Saúde (BVS), PubMed, EMBASE, Scopus, Web of Science, Science Direct e SciELO, além de busca manual no Google Scholar, sem restrições de período. Foram incluídos artigos publicados em inglês, português ou espanhol descrevendo pesquisas realizadas no Brasil sobre saúde bucal em indivíduos que se autodeclararam quilombolas de comunidades reconhecidas pelo poder público. Analisou-se ainda a qualidade da evidência nos estudos incluídos. Resultados. Foram selecionados 14 estudos, todos com desenho transversal e classificados como nível IV de evidência científica (evidência proveniente de estudos descritivos ou estudos com abordagem qualita- tiva), ou seja, qualidade moderada-baixa. Seis estudos foram desenvolvidos na região Nordeste do Brasil e nove foram publicados entre 2016 e 2021. Sobre os agravos de saúde bucal, houve alta frequência de cárie dentária e altos índices de experiência da doença. O edentulismo e a doença periodontal também foram frequentes, afetando indivíduos jovens, adultos e idosos. Conclusão. Foi alta a prevalência de cárie dentária, edentulismo e doenças periodontais descrita na literatura sobre quilombolas no Brasil, demonstrando a necessidade de melhorar a assistência odontológica nesse grupo populacional.

[ABSTRACT]. Objective. To describe the current scenario of oral health in quilombola communities in Brazil. Methods. A search was performed in the Virtual Health Library (VHL), PubMed, EMBASE, Scopus, Web of Science, Science Direct, and SciELO, without date limits. Articles published in English, Portuguese, or Spanish were included if they described research performed in Brazil to investigate oral health in individuals self- declared as belonging to officially recognized quilombola communities. The quality of evidence of included studies was analyzed. Results. Fourteen studies were selected for inclusion, all with cross-sectional design and classified as level IV scientific evidence (evidence from descriptive studies or studies with a qualitative approach), i.e., moderate- low quality. Six were developed in the Northeast region of Brazil and nine were published between 2016 and 2021. Regarding oral health problems, a high frequency was detected for dental caries, with high indices of disease experience. Edentulism and periodontal disease were also frequent, affecting youth, adults, and older individuals. Conclusion. A high prevalence of dental caries, edentulism, and periodontal disease was observed, suppor- ting the need to improve dental care in this population group.

[RESUMEN]. Objetivo. Describir el panorama actual de los trastornos de salud bucodental de la población quilombola de Brasil. Métodos. Se realizó una búsqueda en las bases de datos de la Biblioteca Virtual en Salud (BVS), PubMed, EMBASE, Scopus, Web of Science, Science Direct y SciELO, además de una búsqueda manual en Google Scholar, sin restricciones del período. Se incluyeron artículos publicados en español, inglés o portugués descriptivos de investigaciones realizadas en Brasil sobre la salud bucodental de personas que se autode- nominan quilombolas pertenecientes a comunidades reconocidas por el poder público. También se analizó la calidad de la evidencia científica de los estudios incluidos. Resultados. Se seleccionaron 14 estudios, todos con un diseño transversal y clasificados en el nivel IV de evidencia científica (evidencia proveniente de estudios descriptivos o estudios con un enfoque cualitativo), es decir, de mediana y baja calidad. Se realizaron seis estudios en la región nordeste de Brasil y se publi- caron nueve en el período 2016-2021. En cuanto a los trastornos de salud bucodental, se observó una alta frecuencia de caries dental y altas tasas de prevalencia de esa enfermedad. El edentulismo y la enfermedad periodontal también fueron frecuentes y afectaron a jóvenes, adultos y personas mayores. Conclusión. Se observó una alta prevalencia de caries dental, edentulismo y enfermedades periodontales descritas en la literatura científica sobre la población quilombola de Brasil, lo que demuestra la necesidad de mejorar la atención dental prestada a ese grupo de la población.

Access to information on oral hygiene and mothers' practices of children with microcephaly caused by Zika virus.

OBJECTIVE: To verify whether access to information about oral hygiene influenced the practices of caregivers of children with microcephaly caused by Zika virus (ZIKV). METHODS: A case series study was developed at the Mens Sana Rehabilitation Center, in the municipality of Arcoverde, Pernambuco, Brazil. The study universe included the mothers of 32 children with microcephaly caused by Zika virus. Data collection took place in June 2018 and was carried out through a structured questionnaire. The variables studied comprised socioeconomic issues, habits, diet, and knowledge about oral hygiene. Fisher's Exact and Pearson's Chi-square tests were used with a significance level of 5%. RESULTS: Out of 32 individuals eligible to participate in the study, only 27 were selected. Most mothers reported receiving information about oral hygiene from their infants (63.0%). Fisher's Exact and Pearson's Chi-square tests showed that access to oral hygiene information was associated with mother's education, family income, regular visits to the dentist, frequency of tooth brushing, age at which the infant started brushing, and brushing time (p < 0.05). CONCLUSION: Access to information about oral hygiene positively influenced the oral health care of mothers with their children with microcephaly caused by ZIKV.

Racial disparity and prognosis in patients with mouth and oropharynx cancer in Brazil

Background: Oral and oropharyngeal cancer (OPC) is an important cause of morbidity and mortality worldwide.Populations in situations of social vulnerability tend to have higher incidences of cancer, a higher proportion oflate diagnosis, greater difficulties in accessing health services, and, consequently, worse prognosis. The aim ofthis study was to evaluate the relationship between race/skin color and OPC prognosis in Brazil.Material and Methods: This is a cross-sectional epidemiological study using OPC data from the National CancerInstitute between the years 2000 and 2019. The selected variables were: gender, race/skin color, age, education,smoking and alcohol consumption, stage of the disease and disease status at the end of the 1st treatment.Results: 154,214 cases were recorded. Black men, in the 6th decade of life, were the most affected population.Blacks had a lower level of education when compared to non-blacks (p<0.001). Blacks were more exposed tosmoking and alcohol consumption (p<0.001). At the time of diagnosis, the black population was at the most advanced stage when compared to non-blacks (p<0.001). At the end of the 1st treatment, more black patients haddisease in progression, as well as more black patients died (p<0.001). Conclusions: Blacks had a worse prognosisfor OPC in Brazil. Despite the limitations, these results are important to elucidate the scenario of health disparitiesin relation to the race/skin color of the Brazilian population. (AU)

Orofacial features in children with microcephaly associated with Zika virus: A scoping review.

OBJECTIVE: To analyze published scientific evidence about the most common orofacial disorders in children with microcephaly associated with ZIKV infection. METHODS: Through a scoping review, we respond to the search question was formulated: "What are the orofacial alterations in children with microcephaly associated with ZIKV?" It was performed a search in PubMed, EMBASE, Scopus, and Health Virtual Library. It was selected papers wrote in English, Portuguese, or Spanish. An evidence quality analysis was performed using the Agency for Healthcare Research and Quality classification. RESULTS: It was included 11 studies performed in the Brazilian Northeast region. The studies were carried out between 2018 and 2020. The main related alterations were delay in the tooth-eruption and deformation in the oral structures. CONCLUSION: The results observed in our work show moderate scientific evidence regarding the association of ZIKV with orofacial alterations in children with microcephaly due to the classifications of the quality of evidence of each one of the included studies. The main changes reported were in the chronology of tooth eruption, alteration in teeth, and oral structures.

High prevalence of oral potentially malignant disorders and risk factors in a semi-urban brazilian city: a population-based cross-sectional study / Alta prevalencia de trastornos orales potencialmente malignos y factores de riesgo en un ciudad brasileña semiurbana: un estudio transversal de base poblacional

Background: Oral Potentially Malignant Disorders (OPMDs) are defined as lesions with a greater likelihood ofprogressing to cancer. Population-based studies that evaluate the prevalence of OPMDs are scarce in Brazil. Theaim of the present study was to determine the prevalence of OPMDs and associated risk factors in a semi-urbanBrazilian population.Material and Methods: This is a cross-sectional study, whose universe included individuals aged 40 years or olderresiding in a medium-sized city of northeastern Brazil. Data collection was divided into two steps: interview andoral examination. The outcome variable was the presence of OPMDs. The predictor variables were sociodemo-graphic characteristics and risk habits. The bivariate analysis was performed through chi-square test. The crudeprevalence ratios (PR) and its respective 95% confidence intervals (CI) were calculated. Poisson regression analy-sis with robust variance was used to calculate adjusted PRs and 95% CI.Results: Three hundred fourteen individuals were included in the study. When asked about risk habits, 58.9%reported being current smokers or ex-smokers and 62.2% reported being current drinkers or ex-drinkers. Theprevalence of OPMDs was 7.6% and was significantly higher among individuals with black skin color (p < 0.001),alcohol users (p = 0.017), and individuals with both tobacco and alcohol habits (p = 0.012).Conclusions: Therefore, the population in the present study had a high frequency of risk habits associated withPMDs of the oral cavity.(AU)

Avaliação do conhecimento de cirurgiões-dentistas da atenção básica sobre estomatologia / Knowledge evaluation of primary health care dentists concerning oral medicine

Objetivo: Avaliar o nível de conhecimento em Estomatologia dos cirurgiões-dentistas (CD) que atuam na Atenção Básica de um município de Pernambuco, Brasil. Métodos: Este é um estudo observacional, indutivo, estatístico e de abordagem quantitativa. A população do estudo envolve os CD atuantes nas Unidades Básicas de Saúde do município. Os dados foram coletados através de um questionário elaborado pelos pesquisadores, contendo 27 perguntas sobre as lesões orais mais comuns, diagnóstico clínico e condutas frente a diagnósticos clínicos específicos. O nível de conhecimento foi mensurado a partir da média de acertos dos profissionais. Os dados coletados foram processados por meio do uso do programa estatístico IBM SPSS 20.0®. Resultados: A amostra obtida foi de treze CD. A média dos acertos nos conhecimentos específicos em Estomatologia foi de 17 (± 3,109). Quanto à classificação do desempenho geral, a maioria dos profissionais (69,2%) teve um desempenho regular. Quanto aos conhecimentos específicos sobre diagnóstico clínico, estes foram classificados como alto para a maioria (53,8%). Em relação aos conhecimentos específicos sobre as condutas adequadas frente às lesões, a classificação do desempenho foi baixa para a maioria dos participantes (84,6%). Conclusão: De modo geral, os CD obtiveram um desempenho regular de conhecimento em Estomatologia. Recomenda-se o desenvolvimento de mais pesquisas devido à escassez de discussões sobre o tema na literatura.

Aim: To evaluate the level of knowledge on oral medicine of dentists who work in Primary Health Care in the city in the state of Pernambuco, Brazil. Methods: This is an observational, inductive, statistical study with a quantitative approach. The study population involves dentists working in the Basic Health Units of the city. The data were collected through a questionnaire prepared by the researchers, containing 27 questions about the most common oral lesions, clinical diagnoses, and conduct towards specific clinical diagnoses. The level of knowledge was measured from the mean of correct answers by the professionals. Collected data were processed using the IBM SPSS 20.0® statistical program. Results: This study's sample counted on the participation of thirteen dentists. The mean of correct answers regarding specific knowledge on Oral Medicine was 17 (± 3.109). As for the classification of general performance, most professionals (69.2%) performed regularly. As for specific knowledge about clinical diagnosis, the knowledge was classified as high for the majority (53.8%). About the appropriate behaviors in relation to injuries, the performance classification was low for most participants (84.6%). Conclusion: In general, dentists obtained a regular knowledge on Oral Medicine. Further research is recommended due to the scarcity of discussions on the topic in the literature.

Conhecimento e uso da biossegurança por profissionais de saúde bucal do SUS do Sertão Pernambucano / Knowledge and use of biosafety by professionals of oral health of the SUS of Sertão Pernambucano

Objetivo: Avaliar o conhecimento e o uso dos procedimentos que envolvem a biossegurança por cirurgiões dentistas e assistentes de saúde bucal em um município do sertão de pernambucano, buscando averiguar a compreensão da necessidade e da importância da utilização da biossegurança. Métodos: Estudo observacional descritivo realizado através de questionário aplicado para os profissionais da área odontológica vinculados ao Sistema Único de Saúde (SUS) do município de Arcoverde, Pernambuco, Brasil. A amostra foi constituída de 29 profissionais da área odontológica que responderam ao questionário, sendo 9 dentistas e 20 auxiliares. Resultados: Cem por cento dos profissionais afirmam lavar as mãos antes e depois dos procedimentos. Apenas 20% dos ASB lavam o instrumental em pia fora do consultório; 90% costumam fazer a assepsia da cadeira odontológica após cada atendimento; 95% costumam fazer a assepsia da cuspideira e do equipo/cárter após cada atendimento. Conclusão: Os profissionais possuem conhecimento satisfatório acerca da biossegurança no consultório odontológico. Contudo, deve-se uma atenção especial ao uso de luvas estéreis e de campo cirúrgico durante os procedimentos necessários, bem como à disponibilização de equipamentos de proteção individual aos pacientes, a fim de minimizar o risco de contaminação cruzada.

Aim: To assess the knowledge and use of procedures that involve biosafety by dental surgeons and oral health assistants in a municipality in the backlands of the state of Pernambuco, Brazil, seeking to ascertain the understanding of the need and importance of using biosafety. Methods: This work was a descriptive observational study conducted through a questionnaire applied to dental professionals linked to the Unified Health System (SUS) in the municipality of Arcoverde, Pernambuco, Brazil. The sample consisted of 29 dental professionals who answered the questionnaire, including 9 dentists and 20 assistants. Results: One hundred percent of the professionals say they wash their hands before and after the procedures. Only 20% of ASBs wash the instruments in a sink outside the office; 90% usually perform asepsis of the dental chair after each visit; 95% usually clean the spit and the equipment / sump after each visit. Conclusion: The professionals have satisfactory knowledge about biosafety in the dental office. However, special attention should be paid to the use of sterile gloves and the surgical field during the necessary procedures, as well as the provision of personal protective equipment for patients to minimize the risk of cross contamination.

Perfil dos Pacientes Atendidos no Curso de Odontologia do Sertão de Pernambuco: Perfil dos Pacientes Atendidos no Sertão / Profile of Patients Attended at a Dental School in the Sertão of Pernambuco: Profile of Patients Attended in the Sertão

Introdução: Descrever o levantamento epidemiológico que traça o perfil dos pacientes adultos atendidos na clínica do curso de Odontologia, campus Arcoverde, da Universidade de Pernambuco. Metodologia: Estudo transversal em que foi realizada uma análise retrospectiva de 275 prontuários correspondentes aos anos de 2015 a 2017. Foram descritos: dados demográficos; queixa principal; hábito (tabagismo); presença de variação da normalidade e lesões em cavidade oral; necessidade de tratamento por especialidade e número de tratamentos concluídos. Os dados foram tabulados, e a análise estatística foi realizada no programa Statistical Package for the Social Sciences. Resultados: O gênero feminino foi o que mais procurou atendimento (64,7%), e a 3ª década de vida foi a mais atendida. As especialidades com maior necessidade pelos pacientes foram a Dentística e a Periodontia, e o hábito de fumar de alguns pacientes esteve relacionado com uma maior necessidade de tratamento periodontal. Além disso, os homens apresentaram maior necessidade desse tipo de tratamento que as mulheres. A variação da normalidade mais prevalente foi a linha alba (25,5%). As lesões mais comuns diagnosticadas clinicamente foram a leucoplasia (15%) e a queilite actínica (15%), e os homens apresentaram maior frequência da presença de lesões que as mulheres, assim como as pessoas que eram tabagistas e que trabalhavam expostas ao sol. Conclusões: A definição do perfil epidemiológico dos pacientes atendidos poderá auxiliar no planejamento de ações e qualificação da assistência... (AU)

Introduction: To describe the epidemiological profile of adult patients attended at the dental school of the Arcoverde campus, University of Pernambuco. Methodology: In this cross-sectional study, 275 medical records from the period from 2015 to 2017 were analyzed retrospectively. They included the following information: demographic data, main complaint, habit (smoking), presence of alterations and lesions in the oral cavity, need for specialty treatment, and number of treatments completed. The data were tabulated and the Statistical Package for the Social Sciences was used for statistical analysis. Results: Women most frequently sought care (64.7%) and the third decade of life was the most attended. The specialties most needed by the patients were Dentistry and Periodontics, and the smoking habits of some patients were related to a greater need for periodontal treatment. In addition, men presented a greater need for this type of treatment than women. The most prevalent alteration was linea alba buccalis (25.5%). The most common clinically diagnosed lesions were leukoplakia (15%) and actinic cheilitis (15%), and men were more frequent in presenting with lesions than women, as were people who smoked and worked in the sun. Conclusions: Defining the epidemiological profile of past patients may help in the planning of health actions and improvement of assistance... (AU)

Cárie de radiação: efeitos da radioterapia na estrutura dentária / Caries de radiación: efectos de la radiación en la estructura dental / Radiation caries: effects of radiotherapy on dental structure

Introdução: Pacientes submetidos à radioterapia para tratamento de neoplasias malignas na região de cabeça e pescoço são propensos a desenvolver complicações orais como a cárie de radiação, que evolui rapidamente e é altamente destrutiva.É reconhecido que o seu desenvolvimento está associado a alterações pós-radioterápicas nas glândulas salivares maiores, o que resulta em hipossalivação e alteração nos constituintes salivares. No entanto, tem sido aceito que danos diretos causados pela radiação à estrutura dentária podem acelerar a progressão da cárie e estudos têm demonstrado alterações morfológicas e físicas em dentes humanos após radioterapia. Objetivo: Propõe-se apresentar um caso de cárie de radiação e os efeitos diretos da radioterapia na estrutura dentária. Relato de caso: Paciente masculino, 60 anos de idade, com queixa principal de fragilidade dentária; relatou história de carcinoma epidermóide em língua há 18 meses e que o protocolo de tratamento aplicado foi quimioterapia (38 sessões), radioterapia (38 sessões) e cirurgia. Ao exame físico, dentre as alterações observadas, destacou-se a presença de regiões cervicais dentárias enegrecidas com coroas bastante fragilizadas em todos os dentes remanescentes, características de cárie de radiação. Foi realizado um tratamento atraumático, que está em acompanhamento. Conclusões: A cárie de radiação tem como principal fator etiológico alterações salivares qualitativas e quantitativas. A discussão sobre os efeitos diretos da radioterapia sobre a estrutura dentária ainda é bastante polêmica na literatura odontológica. Desta forma, sugere-se que mais estudos sejam realizados de forma sistemática, de maneira mais completa e padronizada(AU)

Introducción: Los pacientes sometidos a radioterapia para el tratamiento de tumores malignos en la cabeza y el cuello son propensos a desarrollar complicaciones bucales, tales como caries de radiación que evoluciona rápidamente y es altamente destructiva. Se reconoce que el desarrollo se asocia con cambios posradioterapia en las glándulas salivales, que resulta en hiposalivación y el cambio en los componentes salivales. Sin embargo, se ha aceptado que los daños por radiación directa a la estructura dental puede acelerar la progresión de la caries y los estudios han demostrado cambios morfológicos y físicos en los dientes humanos después de la radioterapia. Objetivo: presentar un caso de caries de radiación y los efectos directos de la radiación en la estructura dental. Presentación del caso: Paciente masculino de 60 años de edad, se quejaba de fragilidad dental, con historia notificada de carcinoma de células escamosas en la lengua hace 18 meses y con protocolo de tratamiento aplicado de quimioterapia (38 sesiones), terapia de radiación (38 sesiones) y cirugía. En el examen físico, de los cambios observados, se destacó la presencia de regiones cervicales dentarias negruzcas con coronas bastante frágiles en todos los dientes restantes, características de caries de radiación. El tratamiento atraumático se realizó y el paciente está bajo observación. Conclusiones: los cambios cuantitativos y cualitativos salivales actúa como el factor causal principal de la caries por radiación. La discusión acerca de los efectos directos de la radiación sobre la estructura del diente es todavía muy controvertido en la literatura dental. Por lo tanto, se sugiere que se realicen estudios adicionales de manera sistemática, más completa y estandarizada(AU)

Introduction: Patients undergoing radiotherapy as treatment for malignant head and neck tumors are prone to develop oral complications such as radiation caries, which evolves rapidly and is highly destructive. Such development is known to be caused by post-radiotherapy alterations in salivary glands resulting in hyposalivation and changes in salivary components. However, it has been accepted that damage by direct radiation to the dental structure may hasten the progress of caries development, and studies have shown the morphological and physical changes occurring in human teeth after radiotherapy. Objective: Present a case of radiation caries and the direct effects of radiation on dental structure. Case presentation: A 60-year-old male patient complains of dental fragility. The patient was diagnosed with squamous-cell carcinoma of the tongue 18 months ago and indicated chemotherapy (38 sessions), radiotherapy (38 sessions) and surgery. Physical examination revealed among other changes the presence of blackish cervical areas with quite fragile crowns in all remaining teeth, which are characteristic of radiation caries. Non-traumatic treatment was performed and the patient is now under observation. Conclusions: Salivary quantitative and qualitative changes are the main cause of radiation caries. Discussion about the direct effects of radiation on dental structure is still quite controversial in the literature on the topic. It is therefore suggested to conduct further studies in a more systematic, complete and standardized manner(AU)

Cárie de radiação: efeitos da radioterapia na estrutura dentária / Caries de radiación: efectos de la radiación en la estructura dental / Radiation caries: effects of radiotherapy on dental structure

Introdução: Pacientes submetidos à radioterapia para tratamento de neoplasias malignas na região de cabeça e pescoço são propensos a desenvolver complicações orais como a cárie de radiação, que evolui rapidamente e é altamente destrutiva.É reconhecido que o seu desenvolvimento está associado a alterações pós-radioterápicas nas glândulas salivares maiores, o que resulta em hipossalivação e alteração nos constituintes salivares. No entanto, tem sido aceito que danos diretos causados pela radiação à estrutura dentária podem acelerar a progressão da cárie e estudos têm demonstrado alterações morfológicas e físicas em dentes humanos após radioterapia. Objetivo: Propõe-se apresentar um caso de cárie de radiação e os efeitos diretos da radioterapia na estrutura dentária. Relato de caso: Paciente masculino, 60 anos de idade, com queixa principal de fragilidade dentária; relatou história de carcinoma epidermóide em língua há 18 meses e que o protocolo de tratamento aplicado foi quimioterapia (38 sessões), radioterapia (38 sessões) e cirurgia. Ao exame físico, dentre as alterações observadas, destacou-se a presença de regiões cervicais dentárias enegrecidas com coroas bastante fragilizadas em todos os dentes remanescentes, características de cárie de radiação. Foi realizado um tratamento atraumático, que está em acompanhamento. Conclusões: A cárie de radiação tem como principal fator etiológico alterações salivares qualitativas e quantitativas. A discussão sobre os efeitos diretos da radioterapia sobre a estrutura dentária ainda é bastante polêmica na literatura odontológica. Desta forma, sugere-se que mais estudos sejam realizados de forma sistemática, de maneira mais completa e padronizada(AU)

Introducción: Los pacientes sometidos a radioterapia para el tratamiento de tumores malignos en la cabeza y el cuello son propensos a desarrollar complicaciones bucales, tales como caries de radiación que evoluciona rápidamente y es altamente destructiva. Se reconoce que el desarrollo se asocia con cambios posradioterapia en las glándulas salivales, que resulta en hiposalivación y el cambio en los componentes salivales. Sin embargo, se ha aceptado que los daños por radiación directa a la estructura dental puede acelerar la progresión de la caries y los estudios han demostrado cambios morfológicos y físicos en los dientes humanos después de la radioterapia. Objetivo: presentar un caso de caries de radiación y los efectos directos de la radiación en la estructura dental. Presentación del caso: Paciente masculino de 60 años de edad, se quejaba de fragilidad dental, con historia notificada de carcinoma de células escamosas en la lengua hace 18 meses y con protocolo de tratamiento aplicado de quimioterapia (38 sesiones), terapia de radiación (38 sesiones) y cirugía. En el examen físico, de los cambios observados, se destacó la presencia de regiones cervicales dentarias negruzcas con coronas bastante frágiles en todos los dientes restantes, características de caries de radiación. El tratamiento atraumático se realizó y el paciente está bajo observación. Conclusiones: los cambios cuantitativos y cualitativos salivales actúa como el factor causal principal de la caries por radiación. La discusión acerca de los efectos directos de la radiación sobre la estructura del diente es todavía muy controvertido en la literatura dental. Por lo tanto, se sugiere que se realicen estudios adicionales de manera sistemática, más completa y estandarizada(AU)

Introduction: Patients undergoing radiotherapy as treatment for malignant head and neck tumors are prone to develop oral complications such as radiation caries, which evolves rapidly and is highly destructive. Such development is known to be caused by post-radiotherapy alterations in salivary glands resulting in hyposalivation and changes in salivary components. However, it has been accepted that damage by direct radiation to the dental structure may hasten the progress of caries development, and studies have shown the morphological and physical changes occurring in human teeth after radiotherapy. Objective: Present a case of radiation caries and the direct effects of radiation on dental structure. Case presentation: A 60-year-old male patient complains of dental fragility. The patient was diagnosed with squamous-cell carcinoma of the tongue 18 months ago and indicated chemotherapy (38 sessions), radiotherapy (38 sessions) and surgery. Physical examination revealed among other changes the presence of blackish cervical areas with quite fragile crowns in all remaining teeth, which are characteristic of radiation caries. Non-traumatic treatment was performed and the patient is now under observation. Conclusions: Salivary quantitative and qualitative changes are the main cause of radiation caries. Discussion about the direct effects of radiation on dental structure is still quite controversial in the literature on the topic. It is therefore suggested to conduct further studies in a more systematic, complete and standardized manner(AU)

Low Survival Rates of Oral and Oropharyngeal Squamous Cell Carcinoma.

AIM: To assess the epidemiological and clinical factors that influence the prognosis of oral and oropharyngeal squamous cell carcinoma (SCC). METHODS: One hundred and twenty-one cases of oral and oropharyngeal SCC were selected. The survival curves for each variable were estimated using the Kaplan-Meier method. The Cox regression model was applied to assess the effect of the variables on survival. RESULTS: Cancers at an advanced stage were observed in 103 patients (85.1%). Cancers on the tongue were more frequent (23.1%). The survival analysis was 59.9% in one year, 40.7% in two years, and 27.8% in 5 years. There was a significant low survival rate linked to alcohol intake (p = 0.038), advanced cancer staging (p = 0.003), and procedures without surgery (p < 0.001). When these variables were included in the Cox regression model only surgery procedures (p = 0.005) demonstrated a significant effect on survival. CONCLUSION: The findings suggest that patients who underwent surgery had a greater survival rate compared with those that did not. The low survival rates and the high percentage of patients diagnosed at advanced stages demonstrate that oral and oropharyngeal cancer patients should receive more attention.

Identification of AgNORs and cytopathological changes in oral lichen planus lesions.

OBJECTIVE: To evaluate cytopathological changes in epithelial cells of the oral mucosa of patients with oral lichen planus (OLP) compared with patients without OLP. SUBJECTS AND METHODS: Swabs were collected from the oral mucosa of 20 patients with OLP (case group) and 20 patients without OLP (control group) using liquid-based cytology. After Papanicolaou staining, the smears were characterized based on Papanicolaou classification and degree of maturation. Nuclear area (NA) measurements, cytoplasmic area (CA) measurements, and the NA/CA ratio were determined from 50 epithelial cells per slide. For quantification of argyrophilic nucleolar organizer regions (AgNORs), the smears were stained with silver nitrate, and the number of AgNORs was counted in 100 cells. RESULTS: In both groups, there was a predominance of Papanicolaou Class I nucleated cells in the superficial layer. The average values of NA (p>0.05) and CA (p=0.000) were greater in the case group (NA=521.6, CA=22,750.3) compared with the control group (NA=518.9, CA=18,348.0). The NA/CA ratio was 0.025 for the case group and 0.031 for the control group (p=0.004). There was no significant difference between the mean AgNORs values of both groups (p>0.05). CONCLUSION: The oral mucosa of patients with OLP exhibited significant cytomorphometric changes. However, there was no evidence of malignancy.

Immunoexpression of EGFR and EMMPRIN in a series of cases of head and neck squamous cell carcinoma.

BACKGROUND: The epidermal growth factor receptor (EGFR) and the extracellular matrix metalloproteinase inducer (EMMPRIN) have been identified as oncologically important targets. This study aimed to evaluate the immunoexpression of EGFR and EMMPRIN in a series of cases of head and neck squamous cell carcinoma (HNSCC). METHODS: Forty-five cases of HNSCC were selected for this study and evaluated with anti-EGFR and anti-EMMPRIN antibodies. The percentage of positive cells was determined assessing to the following categories: score 1 (staining in 0-50% of cells), score 2 (staining in 51-75% of cells), and score 3 (staining in >75% of cells). Immunostaining intensity was graded according to the following parameters: score 1 (absent/weak expression) and score 2 (strong expression). RESULTS: For EGFR, a predominance of high median scores was observed in cases of both histological grades of malignancy and in different clinical stages (p>0.05). For EMMPRIN, a statistically significant difference was observed between the histological grades of malignancy (p=0.030). Regarding the immunostaining intensity of EMMPRIN, it was observed a predominance of score 1 in cases with stages I/II, whereas most cases with stages III/IV presented score 2 (p=0.032). Considering the anatomical location, most cases of buccal floor presented higher median score of EMMPRIN in comparison with the other sites (p=0.015). CONCLUSIONS: These findings suggest that both proteins are potential targets for cancer therapy and EMMPRIN can be used as a prognostic marker of a more aggressive biological behavior in patients with HNSCC.

Avaliação de polimorfismos funcionais nos genes de reparo XRCC1, APEX1, XPD e XPF em carcinomas de células escamosas orais / Evaluation of functional polymorphisms in the repair genes XRCC1, APEX1, XPD and XPF in oral squamous cell carcinomas

As vias de reparo por excisão de base (BER) e por excisão de nucleotídeo (NER) desempenham um papel crucial na manutenção da integridade genômica. Polimorfismos em genes das vias BER e NER, que modulam a capacidade de reparo do DNA, podem estar relacionados ao risco de desenvolvimento e prognóstico do câncer oral. O presente trabalho teve como objetivo investigar a frequência de polimorfismos de nucleotídeos simples, em dois genes da via de reparo do DNA por excisão de base (XRCC1 ­ rs25487 e APEX1 ­ rs1130409) e dois genes da via de reparo por excisão de nucleotídeo (XPD ­ rs13181 e XPF ­ rs1799797), em pacientes com carcinoma de células escamosas oral (CCEO), buscando associações com o risco de desenvolver esta neoplasia maligna e o seu prognóstico. Um total de 92 amostras de DNA de pacientes com CCEO e 130 controles foram genotipadas utilizando o método da reação em cadeia da polimerase em tempo real. O software estatístico GraphPad Prism version 6.0.1. foi utilizado para a aplicação dos testes apropriados. Odds ratio (OR) e hazard ratio (HR), e seus intervalos de confiança (IC) de 95%, foram calculados pela regressão logística. A avaliação do prognóstico foi realizada por meio da curva de Kaplan-Meier e análise multivariada de Cox. A presença das variantes polimórficas nos genes XRCC1, APEX1, XPD, e XPF não foram associadas ao risco de desenvolver CCEO. A interação da presença da variante polimórfica com o hábito de fumar não foi significativa para nenhum dos polimorfismos analisados. Já a presença do polimorfismo em XPD, somada ao hábito de beber, aumentou o risco de desenvolver CCEO (OR 1,86, 95% IC: 0,86 ­ 4,01, p=0,03). Apenas o SNP do APEX1 (rs1130409) esteve associado a uma diminuição da sobrevida específica (HR 3,94, 95% IC: 1,31 ­ 11,88, p=0,01). O presente estudo sugere uma interação entre o consumo de álcool e a presença do polimorfismo estudado no gene XPD. Além disso, indica um pior prognóstico para pacientes que possuem o polimorfismo estudado em APEX1 (AU).

Base excision repair (BER) and nucleotide excision repair (NER) pathways play critical role in maintaining genome integrity. Polymorphisms in BER and NER genes which modulate the DNA repair capacity may affect the susceptibility and prognosis of oral cancer. This study was conducted with genomic DNA from 92 patients with oral squamous cell carcinomas (OSCC) and 130 controls. The cases were followed up to explore the associations between BER and NER genes polymorphisms and the risk and prognosis of OSCC. Four single-nucleotide polymorphisms (SNPs) in XRCC1 (rs25487), APEX1 (rs1130409), XPD (rs13181) and XPF (rs1799797) genes were tested by polymerase chain reaction ­ quantitative real time method. The GraphPad Prism version 6.0.1 statistical software was applied for statistical analysis of association. Odds ratio (OR), hazard ratio (HR), and their 95 % confidence intervals (CIs) were calculated by logistic regression. Kaplan-Meier curve and Cox proportional hazard model were used for prognostic analysis. The presence of polymorphic variants in XRCC1, APEX1, XPD and XPF genes were not associated with an increased risk of OSCC. Gene-environment interactions with smoking were not significant for any polymorphism. The presence of polymorphic variants of the XPD gene in association with alcohol consumption conferred an increased risk of 1.86 (95% CI: 0.86 ­ 4.01, p=0.03) for OSCC. Only APEX1 was associated with decreased specific survival (HR 3.94, 95% CI: 1.31 ­ 11.88, p=0.01). These results suggest an interaction between polymorphic variants of the XPF gene and alcohol consumption. Additionally APEX1 may represent a prognostic marker for OSCC (AU).

Aspectos clínicos e prevenção das mucosites bucais - revisão / Clinical aspects and prevention of oral mucositis - Review

Objetivo: O objetivo do presente trabalho é realizar uma revisão de literatura sobre as mucosites bucais. Revisão de literatura: O termo "mucosite bucal" surgiu em meados de 1980, sendo definido como a inflamação dos tecidos moles induzida pela toxicidade sistêmica ocasionada pela quimioterapia antineoplásica, causando injúria às células da camada basal da mucosa bucal. A presença dessa lesão reduz a qualidade de vida e o estado nutricional do paciente, aumentando seu grau de morbidade e interferindo no tratamento oncológico. Diante desses fatores, destaca-se a importância de se desenvolverem métodos preventivos caracterizados principalmente por técnicas simples de higienização bucal padronizada, bochechos regulares com digluconato de clorexidina 0,12% e utilização da laserte-rapia de baixa intensidade. Os métodos preventivos apresentam resultados distintos na literatura científica, porém todos agem sobre fatores importantes na causa e agravamento das mucosites bucais, como as citocinas inflamatórias e infecções microbianas secundárias. Considerações finais: O cirurgião-dentista, com base na presente revisão de literatura, é um dos primeiros profissionais a diagnosticar as mucosites bucais, que deve abranger seu conhecimento ao atuar em ambientes hospitalares como os serviços de oncologia, oferecendo tratamento preventivo adequado.

Histological diagnosis of oral lesions with cutting needle biopsy: a pilot study.

OBJECTIVES: The aim of this pilot study was to evaluate the effectiveness of cutting needle biopsy in the diagnosis of solid oral lesions. MATERIAL AND METHODS: The biopsies were carried out on seven patients who presented with solid oral lesions with sizes ranging from 2 to 6 cm. Specimens were obtained from each lesion before conventional biopsies using a cutting needle with 18-gauge x 9 cm (MD TECH, Gainesville, FL, USA). A total of 64 specimens processed by hematoxylin-eosin staining method, were obtained. Afterwards, the analysis was performed by an oral pathologist, in two different stages, with and without the clinical history of each lesion. Then, these answers were compared with the final histological diagnosis. RESULTS: Results presented by the descriptive analysis showed that the correct diagnosis using cutting needle biopsy without the clinical history of lesions was registered in 37.5% of cases, while with the clinical history in 76.6%. CONCLUSIONS: Despite the promising results as a potential technique for biopsies and histological diagnosis of oral lesions, the cutting needle biopsy should be analyzed carefully in those cases.