3D radiotherapy in the parotid gland and its dosimetric relationship with salivary flow and quality of life in patients with head and neck cancer

Aim: Hyposalivation and dry mouth affect the quality of life in patients with Head and Neck Cancer, who did the treatment with radiotherapy. Thus this study has the objective to evaluate the dosimetric relationship between 3D radiotherapy and changes in salivary flow, xerostomia and quality of life in patients with head and neck cancer according to the volume of the irradiated parotid gland. Methods: 23 patients with cancer in the head and neck area and in need of 3D radiotherapy were followed up during radiotherapy treatment, and the parotid gland (PG) design was also performed in radiotherapy planning. Questionnaires were carried out to determine xerostomia and quality of life, while the salivary flow was determined through calculations regarding the collection and weighing of saliva. Such data were collected in three moments: before the beginning of the radiotherapy treatment (D0), in the middle of the treatment (D1) and at the end of it (D2). The numerical variables are represented by measures of central tendency and measures of dispersion. Results: when associating the salivary flow, the xerostomia questionnaire and the OHIP-14, a statistically significant difference was found (p-value <0.001), as well as when comparing some volumes of irradiated PG with the OHIP-14. However, no relationship was found between dosimetric data, xerostomia and hyposalivation. Conclusion: patients undergoing 3D radiotherapy for malignant neoplasms in the head and neck region had decreased salivary flow, increased complaints of dry mouth and decreased quality of life. However, it was not possible to establish a statistically significant correlation between these findings and the volumes of irradiated parotids

Evaluation of the salivary flow of patients undergoing conventional radiotherapy for head and neck cancer.

The purpose of this cross-sectional, quantitative study was to evaluate the salivary flow of 20 patients undergoing conventional 2-dimensional radiotherapy in the head and neck region. Unstimulated salivary flow was measured with the spitting technique. In addition, xerostomia was evaluated through the Eisbruch grading system and the Xerostomia Inventory (XI). The patients were evaluated 3 times: D0, before the first radiotherapy session; D17, after the 17th radiotherapy session; and D35, after the last radiotherapy session. Most of the patients in the present study were men (70%). The larynx was the most frequent site of cancer in this sample (45%). The most prevalent oral alteration during radiotherapy was odynophagia (75%). The analysis of subjective symptoms of xerostomia revealed no statistically significant differences (P = 0.059). However, statistically significant differences in the XI were found, with scores increasing from D0 to D17 and D35 (P = 0.004). With regard to the objective symptoms of xerostomia, most patients started treatment in grade 1 and remained in the same category at the end of radiation. There was a slight increase in salivary volume during treatment, an atypical finding that can probably be explained by the use of low-level laser, which was applied to prevent oral mucositis in all of the patients. The mean total radiation dose (65 Gy) received by the patients in the present sample did not appear to influence the XI values or salivary volume. The data reinforced the subjective nature of xerostomia, which is not always related to hyposalivation.

Pentoxifylline, tocopherol, and sequestrectomy are effective for the management of advanced osteoradionecrosis of the jaws-a case series.

BACKGROUND: The aim of the present study was to evaluate the efficacy of pentoxifylline and tocopherol for the management of osteoradionecrosis of the jaws. METHODS: Twenty-five patients diagnosed with osteoradionecrosis of the jaws treated with pentoxifylline 400 mg + tocopherol 400 mg three times daily (tid) were evaluated. Clinical records and image tests were reviewed. All patients were previously submitted to head and neck radiation therapy and presented with a clinical and radiographic diagnosis of osteoradionecrosis of the jaws. RESULTS: Following therapy with pentoxifylline and tocopherol, 76% (19/25) of the patients showed complete mucosal healing, in which 47.3% (9/19) did not undergo sequestrectomy. From this particular group, 77.7% (7/9) were in stage I and 33.3% (3/9) used the protocol for up to 3 months. Among those who underwent to sequestrectomy, complete mucosal healing was observed in 52.7% (10/19). Among these, 60% (6/10) were in stage I and 100% of the patients were using the protocol for more than 3 months. In all other patients, partial healing of the mucosa was observed since they presented advanced disease. These represented 24% of the sample (6/25), 66.6% (4/6) were in stage III, and 60% (4/6) used the protocol for over 6 months. CONCLUSION: Pentoxifylline and tocopherol may provide effective management of osteoradionecrosis of the jaws, and the association with sequestrectomy may avoid major surgical procedures.

Photobiomodulation for mucosal repair in patients submitted to dental extraction after head and neck radiation therapy: a double-blind randomized pilot study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of photobiomodulation therapy (PBMT) on the mucosal healing of patients submitted to simple dental extractions after head and neck radiation therapy (HNRT). METHODS: Forty surgical procedures were randomly assigned into two groups: G1: dental extraction + PBMT (n = 19) and G2: dental extraction + sham-PBMT (n = 21). All patients received antibiotic therapy and the surgical alveolotomy to promote primary closure of the surgical site. Group 1 was submitted to PMBT according to the following parameters: 808 nm, 40 mW, 100 J/cm2, 70 s, 2.8 J/point, 14 J/session, and area of 0.028cm2. The primary outcome was complete mucosal lining at 14 days, and the secondary outcomes were the presence of infection, postoperative pain, and analgesics intake at 7 days. The patients were evaluated every 7 days until 28 days. RESULTS: Alveolar mucosal lining was faster in G1, and at 14 postoperative days, 94.7% patients evolved with complete alveolar mucosal lining compared to no patient from G2 (p < 0.001). Patients from G1 reported postoperative pain less frequently (G1 = 4, 21.1% × G2 = 14, 66.7%, p = 0.005), and also reported lower intake of analgesic pills at D7 (21.1% × 66.7%, p = 0.005%). PBMT had a significant positive impact on both postoperative pain (NNT = 2.192, CI95% = 1.372-5.445) and mucosal healing (NNT = 1.056, CI95% = 0.954-1.181). CONCLUSIONS: This preliminary study strongly supports the use of PMBT to promote surgical alveolar mucosal lining in a shorter time and with less postoperative pain.

Impact of xerostomia on the quality of life of patients submitted to head and neck radiotherapy

BACKGROUND: The aim of the present work was to evaluate the impact of xerostomia on the quality of life of patients who underwent radiotherapy in the head and neck region. MATERIAL AND METHODS: This was a cross-sectional, quantitative study. The sample comprised 40 patients whose xerostomia was classified through the xerostomia inventory and the quality of life evaluated through the oral health impact profile questionnaire (OHIP). RESULTS: The majority of participants were male (75%), mean age 58.7 years. According to the degree of severity of the xerostomia, the average score among the participants was 36 points, this being considered moderate xerostomia. A significant impact was observed, with the median score 11 points, with the highest scores in the domains related to functional limitation, physical pain and physical disability. The majority of the participants (97.5%) had reduced salivary flow after the end of radiotherapy. There was a significant positive correlation between the degree of xerostomia and reduced quality of life, Pearson correlation 0.5421, (p < 0.05). CONCLUSION: Based upon the results it is concluded that xerostomia has a negative impact on the quality of life of patients who undergo radiotherapy in the head and neck region

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Increase in the nitric oxide release without changes in cell viability of macrophages after laser therapy with 660 and 808 nm lasers.

The aim of this study was to evaluate the influence of low-level laser therapy (LLLT) with different parameters and wavelengths on nitric oxide (NO) release and cell viability. Irradiation was performed with Ga-Al-As laser, continuous mode and wavelengths of 660 and 808 nm at different energy and power densities. For each wavelength, powers of 30, 50, and 100 mW and times of 10, 30, and 60 s were used. NO release was measured using Griess reaction, and cell viability was evaluated by mitochondrial reduction of bromide 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) to formazan. LLLT promoted statistically significant changes in NO release and MTT value only at the wavelength of 660 nm (p < 0.05). LLLT also promoted an increase in the NO release and cell viability when the energy densities 64 (p = 0.04) and 214 J/cm2 (p = 0.012), respectively, were used. LLLT has a significant impact on NO release without affecting cell viability, but the significance of these findings in the inflammatory response needs to be further studied.

Impact of oral mucositis on oral-health-related quality of life of patients diagnosed with cancer.

INTRODUCTION: Oral mucositis (OM) has been described as the oral complication most frequently associated with antineoplastic therapy. However, the influence on the quality of life of affected patients is still unclear. OBJECTIVE: To evaluate the impact of OM on the oral-health-related quality of life (OHRQoL) of patients diagnosed with cancer, who developed chemotherapy- and/or radiotherapy-induced OM. METHODS: This is a cross-sectional evaluation of QoL using oral health impact profile-14 (OHIP-14). The study group comprised a sample of 60 patients diagnosed with cancer, who developed OM during the treatment. The instrument (OHIP-14) composed of seven dimensions was used: functional limitation, physical pain, psychological discomfort, physical deficiency, psychological deficiency, social incapacity, and deficiency. RESULTS: The internal consistency of OHIP-14 measured by the Cronbach's α coefficient was of 0.76. Physical pain attained the highest score (worst quality of life) among the studied dimensions 60.8% (292/480), followed by physical limitation 52.7% (253/480), and psychological discomfort 50.8% (244/480). The dimension 'social limitation' obtained the lowest score 27.2% (131/480). There was statistically significant difference as regards gender (P = 0.021) for physical pain, with greater impact among patients of the male gender. CONCLUSION: Oral-health-related quality of life is significantly affected by OM in individuals diagnosed with cancer.

Noma in an immunocompromised patient.

Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery.

Bilateral lymphoepithelial cyst of the tongue: a case report.

A lymphoepithelial cyst (LC) is a rare occurrence in the oral cavity, lined by a keratinized stratified squamous epithelium that is surrounded by diffuse lymphoid tissue, that often contains lymphoid follicles. The clinical aspect of oral LC includes an asymptomatic yellowish nodule (less than 10 mm) with regular surface and soft consistency. It usually affects the floor of the mouth and the ventral and posterolateral surfaces of the tongue in adult male patients. To date, approximately 280 cases of LC in the oral cavity have been reported in the literature; however, none of them appear bilaterally. This article presents the histopathological and immunohistochemical findings of a unique bilateral LC in the posterolateral region of the tongue.

Intrahost genetic variability of human herpes virus-8.

Studies were conducted to determine whether HHV-8 hyperactivity could be the consequence of the propensity of the host to multiple HHV-8 infection. The aim of the present work was to investigate HHV-8 intrahost genetic variability. HHV-8 subgenomic DNA was amplified by PCR from patients infected with HIV, health care workers (HCW) and bone marrow transplant recipients (BMT), and from oral lesional tissues of AIDS-Kaposi's sarcoma (KS) patients. As controls, blood from HIV-negative health care workers, and the cell lines BC-1, BC-2, and BCP-1 were used. Clones derived from amplicons originating from DNA fragments in open reading frame (ORF) 26 and ORF K1 were isolated. For each ORF, intra-specimen nucleotide sequence differences were determined. The extent of HHV-8 variation in clones derived from blood of patients infected with HIV was significantly higher than in blood from health care workers or post-bone marrow transplantation patients or in AIDS-KS tissue. Among the clones derived from the latter three categories of specimens, sequence variations were not significant. It is concluded that HIV-infected individuals can have multiple of HHV-8, but AIDS-KS lesions are associated with infection by a single HHV-8 variant or a small group of related variants.

Juvenile Sjögren syndrome: distinctive age, unique findings.

Juvenile Sjögren's syndrome is a rare condition that affects children and adolescents with distinctive clinical features. Parotid swelling usually precedes regular oral and ocular symptoms, while typical serological findings may be absent. Hence, diagnosing juvenile Sjögren's syndrome may be challenging to the attending pediatric dentist, and long-term management without proper diagnosis may be jeopardized. The purpose of this report was to detail the features of an adolescent with primary Sjögren's syndrome diagnosed 12 years after the onset of the disease. An updated literature review highlighted the unusual aspects of the pediatric form of the disease.

Herpesvírus humano: tipos, manifestações orais e tratamento / Human herpes virus: types, oral manifestations and treatment

Os herpes vírus humanos (HHV) fazem parte de uma família -Herpesviridae- e têm como seu hospedeiro, unicamente, o homem. São ubíquos e latentes e, uma vez ocorrida a primo-infeção, permanecem no organismo do indíviduo afetado durante toda a sua vida. O presente trabalho se constitui em uma revisão de literatura com o objetivo de abordar os tipos de HHV e seus tratamentos, com ênfase nas manifestações orais. Os HSV 1 e 2 estão geralmente associados à Gengivoestomatite Herpética Primária, Herpes Labial Recorrente e Herpes Intraoral Recorrente. O HHV-3 provoca a Varicela e, por reinfecção, pode ser a causa do surgimento do Herpes-zóster. O HHV- 4 está diretamente ligado à Mononucleosa Infecciosa, ao Linfoma de Burkitt e ao Carcinoma Nasofaríngeo. O HHV-5 pode levar a má-formações congênitas. O HHV-6 provoca o exantema súbito e está associado à esclerose múltipla, o que demonstra seu forte potencial neuro-invasivo. O HHV-7 correlaciona-se ao vírus da AIDS, uma vez que, para ambos, a molécula CD4 é essencial a fim de funcionar como receptor, e o HHV-8 está estreitamente ligado ao Sarcoma de Kaposi. Nenhuma das terapias usadas para o tratamento representa uma cura para a infecção do vírus, uma vez que elas atuam apenas na sua fase ativa. O conhecimento dos tipos virais, das suas características clínicas e manifestações orais são de suma importância para o correto diagnóstico da doença, para a obtenção de sucesso no tratamento e, consequentemente, para a manutenção da saúde populacional.

The human herpes viruses (HHV) take part of a virus family - Herpesviridae- and these viruses have human as only host. They are ubiquitous and latents, and once the primary infection has occurred, they stay within the host's organism for their entire life. This paper is a review about the human herpes viruses types, their treatments and emphasizes their oral manifestations. The HSV 1 and 2 are usually associated to Primary Herpetic Gingivostomatitis, Recurrent Labial Herpes and Reccurent Intra-Oral Herpes. The HHV-3 causes Varicella, mainly in children, and, by reinfection, can be the cause of the appearance of Herpes-zoster. The HHV-4 is directly linked to Infectious Mononucleosis, Burkitt Lymphoma and Nasopharyngeal Carcinoma. The HHV-5 can lead to congenital malformations. The HHV-6 causes sudden rash and is associated with multiple scleroszis, which shows its strong neuro-invasive potential. The HHV-7 is related to AIDS virus because, for both, the CD4 molecule is essential to act as receiver. The HHV-8 is closely linked to Kaposi's Sarcoma. None of the therapies used as treatment gives a cure to the viral infection, once the drugs only have their effect during the virus active phase. The knowledge of the types of herpes virus, its clinical characteristics and oral manifestations is of paramount importance for the correct diagnosis of the disease to obtain treatment success and, consequently, maintenance of population health.

Manifestações orais e maxilofaciais secundárias à bulimia nervosa: uma revisão sistemática / Oral and maxillofacial manifestations secondary to bulimia nervosa: a systematic review

Introdução: A bulimia nervosa é um tipo de transtorno alimentar (fortemente associado à questão do padrão de beleza corporal contemporâneo) que atinge cerca de 1 a 2% da população, com maior prevalência no gênero feminino, apresentando uma gama de alterações importantes e características que acometem a região oral e maxilofacial.Objetivo: Realizar uma revisão da literatura a cerca das publicações sobre as manifestações bucomaxilofaciais secundárias à bulimia nervosa, demonstrando as alterações mais comuns e alertando o cirurgião-dentista para o diagnóstico precoce da doença. Método: 54 artigos científicos indexados (Medline, Lilacs, Scielo e Ibecs) sobre: bulimia nervosa, odontologia, erosão dentária e saúde bucal, entre 2005 e 2010, sofreram leitura crítica para aquisição de informações contidas de interesse ao estudo. Os artigos poderiam ser de revisão da literatura, relato de caso, série de casos ou pesquisa clínica. Foram excluídos aqueles artigos que não discorreram nem citaram pelo menos uma manifestação maxilofacial secundária a bulimia nervosa. Os resultados foram tabulados e estatisticamente tratados de forma descritiva. Resultados: Com base nos critérios de inclusão e exclusão, 31 artigos que falavam especificamente a cerca das manifestações bucomaxilofaciais secundárias à bulimia nervosa foram selecionados. Pôde-se notar um elevado número de publicações envolvendo revisões de literatura em comparação às pesquisas clínicas. O perfil epidemiológico dos pacientes revelou as mulheres adultas jovens como grupo de risco, associado às mais prevalentes manifestações como: erosão e sensibilidade dental, aumento no índice de cárie, mucosite, queilite e gengivite. Conclusão: As manifestações bucomaxilofaciais secundárias à bulimia nervosa podem acometer em graus variados as estruturas duras e moles desta região anatômica. Dentre todas as alterações, a erosão dental foi a mais prevalente em tecido duro e a mucosite em tecido mole.

Introduction:Bulimia nervosa is an eating disorder (strongly associated with the contemporary beauty standard body) that affects about 1 to 2% of the population, often female and aged younger. This disorder induces several important changes in the oral and maxillofacial region. Objective: To review the literature about the oral and maxillofacial manifestations secondary to bulimia nervosa, showing the most common changes and alerting the dentist to early diagnose. Method: 54 scientific articles indexed (Medline, Lilacs, Scielo and Ibecs) about: bulimia nervosa, dentistry, dental erosion and oral health, between 2005 and 2010, suffered critical analysis to acquire interest information for the study. The articles could be review, case report, case series and clinical research. Those article that didn't cite at least one oral or maxillofacial manifestation secondary to bulimia nervosa were excluded. The results were tabulated and statistically treated descriptively. Results: According to inclusion and exclusion criteria, 31 articles about oral and maxillofacial manifestations secondary to bulimia nervosa were selected, and the most publications were literature review. The epidemiological profile showed that the young adult women are a risk group. Erosion and tooth sensitivity, increase rates caries, mucositis, cheilitis and gingivitis were more prevalent clinical manifestations. Conclusion: Oral and maxillofacial manifestations secondary to bulimia nervosa may involve hard and soft structures of this anatomical region. Of all the changes, the dental erosion was more prevalent in the hard tissue and mucositis was more prevalent in the soft tissue.

Morphological analysis of the enamel organ in rats treated with fluoxetine.

PURPOSE: Previous studies have evaluated the presence of serotonin in the dental epithelia and mesenchyme during odontogenesis, suggesting its participation in tooth development. MATERIALS AND METHODS: Here, we used fluoxetine, a selective serotonin re-uptake inhibitor, at a dose of 10 mg/kg, administered for 20 days during pregnancy in 12 Wistar rats to examine the influence of this drug on the development of the enamel organ of the upper first molars of rat fetuses at 17 days of intra-uterine life (i.u.l.), and at one, five and ten days postpartum. The pregnant rats were anesthetized with xylazine at 10 mg/kg and ketamine at 25 mg/kg. The fetuses were removed and beheaded; their jaws were removed, and the upper jaws were exposed. The tissues were fixed in Bouin's fixative, decalcified in 5% nitric acid for 4 - 12 h, conventionally processed for microscopy, and embedded in paraffin. Serial sections of approximately 5 mum were obtained and stained with hematoxylin and eosin, as well as periodic acid-Schiff. RESULTS AND CONCLUSION: Morphological analysis showed no structural changes in the experimental group compared to the controls, suggesting that, at the dose used, fluoxetine does not interfere with serotonin-mediated development of the enamel organ or the process of amelogenesis.

Morphological analysis of the enamel organ in rats treated with fluoxetine

Purpose: Previous studies have evaluated the presence of serotonin in the dental epithelia and mesenchyme during odontogenesis, suggesting its participation in tooth development. Materials and methods: Here, we used fluoxetine, a selective serotonin re-uptake inhibitor, at a dose of 10 mg/kg, administered for 20 days during pregnancy in 12 Wistar rats to examine the influence of this drug on the development of the enamel organ of the upper first molars of rat fetuses at 17 days of intra-uterine life (i.u.l.), and at one, five and ten days postpartum. The pregnant rats were anesthetized with xylazine at 10 mg/kg and ketamine at 25 mg/kg. The fetuses were removed and beheaded; their jaws were removed, and the upper jaws were exposed. The tissues were fixed in Bouin's fixative, decalcified in 5 percent nitric acid for 4 - 12 h, conventionally processed for microscopy, and embedded in paraffin. Serial sections of approximately 5 mm were obtained and stained with hematoxylin and eosin, as well as periodic acid-Schiff. Results and conclusion: Morphological analysis showed no structural changes in the experimental group compared to the controls, suggesting that, at the dose used, fluoxetine does not interfere with serotonin-mediated development of the enamel organ or the process of amelogenesis.