Prevenção e Detecção Precoce do Câncer de Boca: Screening em Populações de Risco / Prevention and Early Detection of Oral Cancer: Screening in Risk Populations

Objetivo: Avaliar a viabilidade de programa de prevenção e diagnóstico precoce do câncer de boca direcionado a grupos considerados de risco para esta enfermidade, como tabagistas e etilistas crônicos.Método: No período entre junho de 2000 e julho de 2002, o programa foi realizado em pacientes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e grupos de apoio comunitários, estruturado em palestras periódicas, exame bucal dos interessados e encaminhamento quando necessário para exames complementares e tratamento.Resultados: Foram examinadas 509 pessoas, das quais 215 pertenciam ao sexo masculino (42,2%), 59,7% eram brancos e com média de idade de 49,8 anos. Destas, 131 apresentaram lesão fundamental na boca, que foram encaminhadas à Faculdade de Odontologia da Universidade de São Paulo (FOUSP), para realização de exame complementar. Dos 48 (38,7%) pacientes que compareceram ao ambulatório, 11 foram submetidos à biópsia. Os achados das biópsias foram de hiperqueratose em 3, hiperplasia papilomatosa em 2, hiperplasia fibrosa em 3, um caso de displasia leve, um adenocarcinoma e um carcinoma epidermóide. À citologia esfoliativa, 5 pacientes tiveram o diagnóstico de classe I e 11 como classe II de Papanicolau.Conclusão: O elevado número de lesões fundamentais diagnosticadas demonstra ser de extrema importância o exame oral periódico de pacientes de risco, entretanto o método proposto, como deslocamento de equipes específicas para o rastreamento dos pacientes, mostrou-se bastante trabalhoso e oneroso para ser efetivamente incorporado em serviços de atenção à saúde. Por outro lado, serviços de atenção permanente em conjunto à atuação periódica de campanhas de esclarecimento a população, foram considerados os métodos de maior resultado para o diagnóstico precoce do câncer de boca

Objective: To evaluate a viability of a program for prevention and early diagnosis of oral cancer directed to groups considered at risk for this disease, such as chronic smokers and alcoholics.Method: The program was conducted between June 2000 and July 2002 with patients of the University Hospital of the Medical School of the University of São Paulo (HCFMUSP) and communitarian support groups, structured in the form of periodic lectures, oral exam for those who had interest, and, if necessary, referral for complementary exams and treatment.Results: 509 people were examined, of which 215 (42.2%) were males and 59.7% were Whites with mean age of 49.8 years. From these, 131 presented a fundamental lesion in the mouth and were referred to School of Dentistry of the University of São Paulo (FOUSP) for a complimentary exam. From the 48 (38.7%) patients that attended the University outpatient service, 11 were subjected to biopsy. Results of the biopsies were hyperkeratosis in 3 cases, papillomatous hyperplasia in 2, fibrous hyperplasia in 3, mild dysplasia in 1, adenocarcinoma in 1 and epidermoid carcinoma in 1. Based on the results of exfoliative cytology, 5 patients had diagnosis of Papanicolau class I and 11 of Papanicolau class II.Conclusion: The large number of fundamental lesions diagnosed demonstrates that periodic oral exam of high-risk patients is of paramount importance. However, the method proposed in this study, involving the transport of specific teams for screening of patients, appeared to be too demanding and costly to be effectively incorporated in public health attention services. On the other hand, permanent attention services together with periodic informative campaigns to the population were considered the methods with better results for the early diagnosis of oral cancer

Effect of laser phototherapy on recurring herpes labialis prevention: an in vivo study.

Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

City-level gender differentials in the prevalence of dental caries and restorative dental treatment.

This study assesses gender differentials in the distribution of dental caries and restorative treatment at the city level in order to discuss gender inequities in health. We retrieved data for caries prevalence and dental service utilisation by 11- and 12-year-old girls and boys in 131 towns in the state of São Paulo, Brazil, 1998. We also gathered aggregate population data for these towns, and information already held by the health authority regarding the provision of dental services. Results of data analysis indicated that girls presented higher caries indices in permanent teeth than boys of the same age, concurrent with a higher utilisation of dental care. When studying aggregate data at the city level, we gathered evidence reinforcing the hypothesis that the higher prevalence of caries in girls is attributable to their earlier eruption of permanent teeth, with no significant association between this excess and indices of socio-economic status at the city level. However, indices assessing the discrepant incorporation of dental services between genders were higher in towns with a poorer profile of socio-economic status. We also observed that towns whose public health service was more effective in providing dental care presented a more equitable gender distribution of dental services. Public resources destined to dental assistance contributed to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between girls and boys.

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children.

AIM: This study assesses disparities in the oral health status of Brazilian black and white children. PARTICIPANTS: 11- and 12-year-old schoolchildren living in 131 cities of the State of São Paulo, Brazil. METHODS: Spatial data analysis of city-level indexes of oral health, socio-economic status and provision of dental services. MAIN OUTCOME MEASURES: Ethnic ratios of the DMFT and the care index. RESULTS: White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio-economic status. Cities with higher per-capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care. CONCLUSION: The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per-capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.

Spatial analysis to identify differentials in dental needs by area-based measures.

OBJECTIVES: To examine the association between tooth decay and dental treatment needs in 5-12-year-old schoolchildren in São Paulo with area-level indicators of social development. METHODS: The present study refers to a representative sample of children from the city of São Paulo, Brazil, comprising 2491 girls and boys attending public and private schools in different areas of the city. The assessment of caries and treatment needs followed the international methodological standards prescribed by the World Health Organization. We used spatial data analysis to describe epidemiological measures distributed by small areas, and to explore hypotheses of ecological association between caries indexes and indicators of social development. RESULTS: Schoolchildren in central districts were less affected by tooth decay and presented fewer dental treatment needs when compared to those in peripheral deprived areas. At the spatial level, average family income, unemployment rate, household overcrowding, and an index of inequality of income distribution were significantly correlated with variables measuring children's caries experience. CONCLUSIONS: The heterogeneous distribution of caries indexes by areas of the city indicates higher levels of dental decay in areas of social deprivation. The delimitation of areas with increased risk of caries and greater dental treatment needs should be helpful to public health services for the formulation of policies and the targeting of resources to address these problems.