How can the dental surgeon promote oral health in patients submitted to chemotherapy? / Como o cirurgião dentista pode promover saúde bucal em pacientes submetidos à quimioterapia?

Lesions that affect the oral cavity resulting from chemotherapy can lead to systemic impairment, increasing the length of hospital stay, impairing the patient's quality of life. Through a integrative review, this work aims to show the conduct and importance of dentists in promoting oral health and preventing an oral infectious focus. The search was performed in the Pubmed, Cochrone, SciElo and Virtual Health Library (VHL) databases, using the descriptors in English, oral care and Chemotherapy and Cancer treatment and dentistry, filtering only articles in English and published between 2006 and 2021. The search located six hundred and twenty articles, but only seven met the search criteria. One author used a mouthwash containing propolis where 65% of patients were cured on the seventh day after the onset of oral mucositis (OM) lesions. One author used cryotherapy with chamomile infusion, patients who underwent this approach did not pass grade I, being effective in reducing the occurrence of OM, and the other two authors proposed a protocol for oral cavity care. All authors obtained satisfactory results.(AU)

As lesões que acometem a cavidade oral decorrente ao tratamento quimioterápico podem levar a um comprometimento sistêmico aumentando o tempo de internação hospitalar, prejudicando a qualidade de vida do paciente. O foco principal do cirurgião-dentista é identificar e remover fontes de infecção na cavidade oral antes do início da quimioterapia, controlar as possíveis lesões durante o tratamento. Após o tratamento quimioterápico, o paciente retornará para os cuidados dentários gerais, proporcionando manutenção da saúde bucal e prevenção de complicações ao longo prazo do tratamento do câncer. Através de uma revisão integrativa o objetivo desse trabalho é mostrar a conduta e a importância do cirurgião-dentista para promover saúde bucal e prevenir um foco infeccioso oral. A busca foi realizada nas bases de dados Pubmed, Cochrone, SciElo e Biblioteca virtual em saúde (BVS), foram utilizados os descritores em inglês, oral care and Chemotherapy and Cancer treatment and dentistry, filtrando somente os artigos na língua inglesa, estudos com seres humanos e os artigos publicados no intervalo de 2006-2021. A busca com os descritores citados encontrou seiscentos e vinte artigos, entretanto somente sete estavam dentro dos critérios da pesquisa. Um autor utilizou bochecho de própolis, outro crioterapia com infusão de camomila e os outros dois propuseram protocolo de cuidados com a cavidade oral. Todos os autores obtiveram resultados satisfatórios. (AU)

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis.

INTRODUCTION: The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere. MATERIAL AND METHODS: For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system. RESULTS: The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Impaction of primary tooth molar in mandibule ­ case report / Primeiro molar decíduo impactado em mandíbula - relato de caso

Tooth impaction results from a mechanical blocking that prevents the tooth from erupt. This situation is frequently associated to permanent tooth as wisdom teeth and canines. Impaction of a primary tooth can be associated to systemic or local etiologic factors. Treatment options could include dental extraction, removal of lesion associated without removing the primary tooth and others. The aim of this article is to present a rare case report of an impacted primary tooth in a 42 yearold man, with no complain of swelling. Extra oral examination revealed no alteration of normality. The panoramic radiograph showed a primary tooth impacted in the left body of the mandible. Most of the time the cause for non-eruption of primary tooth is the presence of a mechanical obstacle, not anatomical, in its trajectory. The surgical intervention is a possibility, but it can stay unaltered with no problems related to the impacted tooth. Many times the professional experience and the activity together in various areas of knowledge are the most important and wise conduct to be taken in health care.(AU)

A impactação dental resulta de um bloqueio mecânico que impede o dente de erupcionar. Esta situação está frequentemente associada à dentes permanentes como os terceiros molares e os caninos. Impactação de um dente decíduo pode estar associada a fatores sistêmicos ou locais. Opções de tratamento podem incluir extração dental, remoção da lesão associada sem remoção do dente decíduo, entre outros. O objetivo deste artigo é apresentar um raro relato de caso de um dente decíduo impactado em um paciente do gênero masculino, 42 anos de idade, sem queixas de inchaço. A avaliação extra-bucal não mostrou alterações de normalidade. A radiografia panorâmica evidenciou um dente decíduo impactado em corpo de mandíbula, lado esquerdo. Na maioria dos casos a causa para não erupção de um dente decíduo é a presença de um obstáculo mecânico, não anatômico, em sua trajetória de erupção. A intervenção cirúrgica é uma possibilidade, mas pode permanecer inalterada sem problemas relacionados ao dente impactado. Em muitos casos a experiência profissional e a atividade em conjunto com várias áreas do conhecimento são as condutas mais importantes e sábias a serem tomadas no cuidado em saúde.(AU)

Non-familial Cherubism – Report of a case / Querubim não familiar - Relatório de caso

The Cherubism is a rare disease that affects the middle and lower third of the facein individuals at the time of childhood. It is a rarehereditary benign bone disease with an autosomal dominant inheritance. The familial distribution may affect different generations and isolated nonfamilial cases have also been reported in literature. Lesions appear as cystic multilocular radiolucencies, histologically, they resemble central giant cell granluloma and hyperpara thyroidism brown tumorwith numerous randomly distributed multinuclea tedgiant cells and vascular spaces within a fibrous connective tissue stroma. Objective: The aim of this study is to report the importance of the diagnosis of this pathology and the variety of treatments availablein the literature, thus guiding to an individualized treatment. Case Report: Caucasian 8 years-oldfemale, in good general condition, was referred to Service of Oral and Maxillofacial Surgery of Erasto Gaertner Hospital (EGH), Curitiba – PR, Brazil, complaining of bilateral swelling of the maxilla and mandible since 4 years-old. Apparently, the girl isthe first one who developed the genetic pathologyin at least 4 generations of her family. After biopsy, cherubism diagnosis was confirmed and the treatment of choice was periodic monitoring. Discussion: Cherubism studies with long-term follow-up with clinical and radiographic documentation indicate that the spontaneous resolution of bone lesions israre. Treatment of cherubism is controversial and various modalities have been reported as the use of calcitonin, osseous plasty surgery, curettage, orthognathic surgery, liposuction and palliative treatments. Conclusion: cherubism is a rarecondition that affects individuals in childhood that lead to some facial alterations, those patients need an special care and an well trained team to treat these disease more carefully and wisely noting that exist a series of option of new treatments in this cases...

Introdução: O Querubismo é uma doença rara que afeta o terço médio e inferior da face em indivíduos no momento da infância. É uma doença óssea hereditária benigna com herança autossômica dominante sendo que a distribuição familial pode afetar diferentes gerações, todavia casos não-familiares isolados também foram relatados na literatura. As lesões apresentam se radiograficamente como cistos multiloculados radiolúcidos e histologicamente se assemelham ao granuloma central de células gigantes e ao tumor marrom do hiper paratireoidismo com numerosas células gigantes multinucleadas distribuídos aleatoriamente e espaços vasculares dentro de um estroma de tecido conjuntivo fibroso. Objetivos: O objetivo deste estudo é relatar a importância do diagnóstico desta patologia e da variedade de tratamentos disponíveis na literatura, orientando dessa maneira a um tratamento individualizado. Relato de Caso: Mulher, caucasiana, 8 anos de idade, em bom estado geral. Foi encaminhada ao Serviço de Cirurgia Bucomaxilofacial do Hospital Erasto Gaertner (EGH), Curitiba - PR, Brasil, com queixa de inchaço bilateral da maxila e da mandíbula desde os 4 anos de idade. Em avaliação notou-se que menina é a primeira pessoa que desenvolveu a patologia empelo menos quatro gerações de sua família. Após biópsia o diagnóstico de cherubism foi confirmado e o tratamento de escolha foi a monitorização periódica. Discussão: estudos de cherubism a longo prazo de follow-up com documentação clínica e radiográficas indicam que a resolução espontânea das lesões ósseas são raras. O tratamento do cherubism é controverso e diversas modalidades têm sido relatados como o uso de calcitonina, a cirurgia de plastia óssea, curetagem cirurgia ortognática, lipoaspiração e tratamentos paliativos...

Clinical assessment of oral mucositis and candidiasis compare to chemotherapic nadir in transplanted patients.

Oral mucositis is a chief complication in patients undergoing hematopoietic stem cell transplantation (HSCT). It is considered a toxic inflammatory reaction that interferes with the patient's recuperation and quality of life. Oral candidiasis is a common fungal infection observed in dental practice, particularly in immunocompromised patients. The aim of this study was to evaluate the presence of oral mucositis and oral candidiasis in patients who underwent HSCT and their correlation with the chemotherapeutic nadir (lowest possible outcome). We evaluated patients with different diagnoses who underwent HSCT at the Hospital Erasto Gaertner. No chemotherapeutic nadir curves could be associated with mucositis, and patients had different presentations of mucositis. No patient developed oral candidiasis during hospitalization. Together with cell counts, we collected demographic data including age, oral hygiene, habits harmful to health, and the use of oral prostheses. It was observed that patients who smoked cigarettes before hospitalization showed less mucositis, resulting in no feeding problems or other comorbid conditions due to the effect of mucositis. However, the nadir of the chemotherapy curve, in isolation, is not a predictive tool for the appearance (or no appearance) of oral mucositis.

Myiasis in maxillofacial region: series of three cases

Introduction: Myiasis is a disease caused by larvae of flies in organs and tissues of man or other vertebrate animals, where they install and evolve as parasites. The human myiasis is common in tropical countries, most frequently affecting rural people, immunocompromised patients and those with psychiatric disorders. It has great destructive potential and needs adequate prevention and treatment for resolution or non-occurrence of this manifestation. Objective: This paper aims to report a series of three cases of patients with presence of myiasis in face: 1) firearm injury postoperative complication in the mandible in a drug user patient; 2) wound after trauma in the region of the upper lip in a patient using illicit drugs; and 3) complication due to poor oral hygiene of a patient with neurological and motor deficits. Case report: The care required by these patients is different because this complication is easily prevented by basic and personal health care, although it represents a complicating factor for surgical procedures and/or dental care. Conclusion: The role of health professionals in patients with special needs and/or drug addiction become sometimes a challenge for dental practice, requiring individualized attention to each patient.

Hiperplasia adenomatoide de glândulas salivares menores: relato de dois casos / Adenomatoid hyperplasia of minor salivary glands: a report of two cases

A hiperplasia adenomatoide de glândulas salivares menores é uma lesão benigna rara que pode ser confundida com outras neoplasias de glândulas salivares. Apresenta-se como um pequeno nódulo firme ou como massa exofítica, geralmente indolor, com mucosa de aparência normal, levemente avermelhada ou azul. Histologicamente, observa-se a presença de agregados acinares relativamente normais e lóbulos da mucosa em maiores quantidades, causando aumento do volume e, por vezes, dor. Relato do caso: São relatatos dois casos de hiperplasia adenomatoide de glândula salivar menor, sendo um em menino de 12 anos de idade, em mucosa bucal esquerda, e o outro em mulher de 44 anos de idade em mucosa labial; uma revisão dos relatos anteriores já descritos na literatura também é apresentada. O aparecimento clínico do tumor é indistinguível em comparação com neoplasia da glândula salivar; assim, o exame patológico é essencial para o diagnóstico definitivo desta patologia. Nos dois casos descritos, o tratamento escolhido foi o acompanhamento clínico após diagnóstico; não foram observadas alterações no período de 2 anos desde a primeira consulta...

Adenomatoid hyperplasia of minor salivary glands is a rare benign lesion that can be mistakenly diagnosed as other types of salivary gland neoplasms. It presents as a small firm nodule or as an exophytic mass, usually painless with normal mucosa, and slightly red or blue. Histologically, aggregates of relatively normal acinar lobule mucosa can be seen in larger amounts than expected, causing increased volume and sometimes pain. Case report: This article describes two cases of adenomatoid hyperplasia of minor salivary glands, the first in the left buccal mucosa of a 12 year-old boy and the second in the labial mucosa of a 44 year-old woman, and a review of previous reports of this pathology in English literature. The clinical appearance of the tumor is indistinguishable from salivary gland neoplasms and pathological examination is therefore essential for definitive diagnosis of this pathology. In both cases the treatment chosen after diagnosis was follow up and no changes were observed over 2 years from the first appointment...

Prevalence of oral lesions in 25 years of Oral Cancer Prevention campaigns in Paraná State, Brazil, 1988 to 2013

Introduction: Epidemiological studies add up as a large area of scientific research and play an important role revealing the prevalence of the several diseases in the place where they applied. Public and health professionals have become more aware of the importance of oral mucosal lesions. Objective: To determine the frequency of the oral lesions and determinate the epidemiological profile of patients attending the prevention of oral cancer campaigns in the state of Paraná, Brazil, between 1988 and 2013. Material and methods: A prospective study was conducted evaluating 25 years of oral cancer prevention campaigns in the state of Paraná, Brazil, between 1988 and 2013. All patients were evaluated in a systematic way and were older than 30 years, answering one questionnaire with data relating to harmful health habits, family history of cancer, family income, frequency of visits to dentists and knowledge on the subject. Results: A total of 22,300 patients were evaluated during the 25 years of projects and 3,731 had oral lesions, while 18,569 patients had no oral alterations during the evaluation. Among those patients, 13779 (61.78%) were female and 8521 (38.78%) were male, 843 (22.59%) were smokers, 578 (15.49%) used alcohol and in 1386 (37.14%) had the habit of using yerba mate. The prevalence of lesions occurred as follows: 533 (14.28%) cases of lesions with aspect of leukoplakia, 1095 (29.34%) inflammatory lesions, 1934 (51.83%) of traumatic origin and 169 (4 5%) classified as other. Conclusion: The campaigns have brought benefits to the health of the elderly population but it is still not enough to make up for low levels of oral lesions appearance. Education of the population should in this way be approached more seriously and effectively.

Significance of p16 positive expression in oropharyngeal cancers.

BACKGROUND: The involvement of HPV in oral and oropharyngeal carcinogenesis was first proposed in 2004, based on epithelial HPV tropism and detection of HPV genotypes in oral squamous cell carcinoma samples. While 60-70% of oropharynx tumors may be HPV-positive, only 10 to 19% of tumors of the oral cavity, larynx and hypopharynx appear to have HPV infection. The aim of the study was to evaluate HPV infection associated with oropharyngeal cancer. MATERIALS AND METHODS: Seventy-eight cases were selected for p16 immunoexpression reactions, and demographic data were collected for comparisons. RESULTS: Most patients were over 60 years old, and 64.1% were smokers. Immunohistochemistry results showed that 86.3% of cases stained positive for p16 protein. CONCLUSION: The oropharyngeal cancer profile at Erasto Gaertner Hospital presented a high index of smokers over 60 years as well a high number of p16+ tumors, for what we can not determinate the main etiologic factor, but can be aware of the number of patients that presented HPV infection. Since prevention is still the best way to deal with cancer disease, it is important to analyze the interaction of these two etiologic factors and how to detect lesions at an early stage.

Prevalence of oral lesions in elderly patients on oral cancer prevention campaigns in Paraná state Brazil 1989-2013 / Prevalência de lesões orais em pacientes idosos atendidos em campanhas de prevenção de câncer bucal no estado do Paraná, Brasil entre 1989 - 2013

Objective: recently, there has been a rapid aging process of the world population. Despite of a longer permanence of natural teeth and a reduction of oral diseases caused by the improvement of life conditions and the provision of health care, the prevalence of oral diseases in the elderly is still considered significant. Therefore, the aim of this study is to evaluate the epidemiological profile of elderly patients (above 60 years old) attended in 25 years of campaigns oral cancer prevention in the Paraná state, Brazil, between 1989 and 2013. Material and Methods: Patients, volunteers, were evaluated during 25 years of oral cancer prevention by the campaign team and all patients were evaluated in a methodical way with inspection of all intra-oral areas. Results: a total of 22,909 patients were attended during the 25 years of projects. Of these, 6,134 were older than 60 years old, with appearance of 1,523 oral lesions during the examination and 4,611 patients had no oral alterations during the dentist evaluation, among those were found injuries by traumatic origin, inflammatory lesions and others types of injury. Conclusion: it is clear the necessity for specialized care and active surveillance of these patients, since it is a consensus in the literature that the best treatment is early diagnosis. It is also necessary the development of epidemiological studies of the elderly population, which are scarce and difficult to elaboration of plans for effective action to meet the specific demands of this age group.

Objetivo: a população mundial atualmente sofre com um rápido processo de envelhecimento. Apesar de uma maior permanência dos dentes naturais e da redução de doenças bucais causadas pela melhoria das condições de vida e da prestação de cuidados de saúde, a prevalência de doenças bucais em idosos ainda é considerado significativa. Portanto, o objetivo deste estudo é avaliar o perfil epidemiológico dos pacientes idosos (acima de 60 anos) que foram atendidos em 25 anos de campanhas de prevenção do câncer de boca no estado do Paraná, Brasil, entre 1989 e 2013. Material e Métodos: Os pacientes foram selecionados voluntariamente e avaliados durante 25 anos de prevenção de câncer bucal pela equipe participante, os quais foram avaliados de forma metódica com a inspeção de todas as áreas intra-orais. Resultados: um total de 22.909 pacientes foram atendidos durante os 25 anos de projetos. Destes, 6.134 tinham mais de 60 anos, com presença de 1.523 pacientes com lesões orais durante o exame e 4.611 pacientes sem alterações orais durante a avaliação do dentista. As lesões encontradas tinham origem traumática, inflamatórias e outras. Conclusão: é evidente a necessidade de atendimento especializado e da busca ativa desses pacientes, uma vez que é um consenso na literatura de que o melhor tratamento de lesões orais é o diagnóstico precoce. Também é necessário o desenvolvimento de estudos epidemiológicos da população idosa, que são escassos e difíceis de elaboração assim como a realização de planos de ação eficazes para atender às demandas específicas desta faixa etária.

Unilateral Gingival Fibromatosis: a case report / Fibromatose Gengival Unilateral: um relato de caso

The gingival fibromatosis is a slow and progressive benign proliferation, which affects the gingival tissues. It may present a genetic inheritance and association with some syndromes. There are conservative and radical treatments, ranging from hygiene care to bloc resection of the affected bone. This case scenario is a 07 year-old child, who presented a nodular unilateral hyperplastic lesion in the right mandible, with sessile base and approximately 5 cm in its largest diameter. The patient presented difficulty of lip closure and slight swelling in the right area of the face. The tomographic image showed infiltration in buccal and lingual cortical of right mandible and tooth displacement. After lesion removal, the histopathologic diagnosis of fibromatosis was confirmed, with no relapse after 20 months of follow-up.

A Fibromatose Gengival é uma proliferação benigna, lenta e progressiva, que afeta os tecidos gengivais. Pode apresentar herança genética e associação à uma série de síndromes. Existem tratamentos conservadores e radicais, desde cuidados com higiene à ressecção em bloco do tecido ósseo afetado. Este é o caso clínico de uma criança, que apresentou lesão hiperplásica unilateral em mandíbula, com deslocamento dentário. Após remoção, o diagnóstico de hiperplasia gengival foi confirmado e não há recidiva da lesão até o momento.

Large desmoplastic fibroma: case report using microvascularized fibula graft for reconstruction / Fibroma desmoplásico de grandes proporções: relato de caso usando enxerto microvascularizado de fibula para reconstrução

The Desmoplastic Fibroma is a benign rare tumor of fibroblastic origin, representing only 0.03% of benign bone tumors. Displays aggressive behavior and high rates of recurrence, which makes the treatment more aggressive. The authors present a case of an 11 years-old female, complaining of increased volume in the jaw. The patient had an extensive swelling of the left mandibular body with invasion of the border of the tongue and floor of the mouth at the same side. She had a history of 4 recurrences at the same site. Image exams revealed expansive lesion in body and ramus of the mandible with involvement of soft tissue on the lingual side of the lesion. The treatment was excision of the lesion with extra oral access and reconstruction with microvascularized fibula graft. The patient has been followed for 2 years with no clinical or radiographic signs and without recurrence

O Fibroma Desmoplásico é um tumor benigno raro de origem fibroblástica que representa apenas 0,03% dos tumores ósseos benignos. Apresenta comportamento agressivo e elevadas taxas de recorrência, o que torna o seu tratamento mais agressivo. Os autores apresentam um relato de caso de uma paciente do sexo feminino de 11 anos de idade com queixa de aumento de volume em mandíbula. A mesma apresentou extensa expansão do corpo mandibular esquerdo, com invasão da borda da língua e assoalho da boca do mesmo lado, com histórico de quatro recorrências na mesma localização. Os exames de imagem revelaram lesão expansiva no corpo e ramo da mandíbula com envolvimento dos tecidos moles do lado lingual da lesão. O tratamento foi a excisão da lesão com acesso extra-oral e reconstrução com enxerto microvascularizado de fíbula. A paciente apresenta seguimento de 2 anos sem sinais clínicos ou radiográficos de recidiva.

Implications of the use of bisphosphonates in dental treatment - experience of the service of oral and maxillofacial surgery, Erasto Gaertner Hospital, Curitiba, Brazil

Introduction: Bisphosphonates (BP) are effective drugs in the prevention and treatment of various bone pathologies, acting in the regulation of osteoclast function through different mechanisms. Despite the success in the treatment of various diseases, these drugs have the ability to induce an avascular necrosis of bone tissue, especially in the maxilla and mandible. Objective: Due the significant increase number of cases of patients with oral complications associated with BP therapy in the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, the study aimed to report our experience in the care of these patients. Material and methods: Patients submitted to BP therapy were enrolled prospectively between the years of 2011 and 2012. Clinical examination was performed in all patients to evaluate dental health as well oral mucosa. All patients are under follow-up in our service. Results: 26 patients who used BP were attended in the ambulatory. Twenty-three patients used BP for oncological indication and three for osteoporosis. Most of patients were women (6666%) with average age of 56 years old. The most frequent medication used was Pamidronate (54%), followed by Zoledronic acid (30%) and Alendronate (15%). Ten patients showed bone exposition, most of then in the mandible (80%), with an average time of one year of exposure. Conclusion: Dentists should advise their patients about the use of BP and the implications for oral health and treatments. These patients must have periodic consultations for evaluation and early detection of osteonecrosis associated to BP for adequate treatment.