Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life.

OBJECTIVE: To evaluate the prevalence and characteristics of orofacial pain in oral and oropharyngeal cancer (OOC), at diagnosis. MATERIAL AND METHODS: a) Study group (SG; n = 74) patients with cancer were divided into 2 subgroups: oral cancer (OC) and oropharyngeal cancer (OPC); b) control group (CG; n = 74) patients within dental care. STUDY DESIGN: An Orofacial Pain Assessment, verbal descriptive scale, Helkimo dysfunction index, Quality of Life questionnaire, and Karnofsky performance status (KPS) was used for evaluation. RESULTS: The mean age was 58.46 years (79.7% male) in SG, 58.61 years (20.3% male) in CG. The pain within the SG was indicated by the following: prevalence = 91.9% (21.6% in stages 0, I, or II; 70.3% in III or IV); reason for seeking care = 50.1%; main complaint = 55.4%; most important issue in the past 7 days = 74.3%; breakthrough-like pain = 64.9%; main features: chewing or swallowing as triggering factors, wake up patient, variable duration, independent of daytime, multiple descriptors, and earache. The following indexes were worse within the SG: clinical dysfunction, quality of life, and KPS. In addition, the OC subgroup reported toothache-like pain and burning; whereas the OPC subgroup reported heavy swallowing as triggering factor, throat as location, and a bilateral earache. CONCLUSION: At diagnosis, orofacial pain, including breakthrough-like pain, was prevalent in patients with OOC, and the pattern was heterogeneous. Predominantly, the pain was moderate to severe, related to stage of cancer, and already compromising the patients' quality of life and functionality.

Cuidados bucais em paciente com fibrose pulmonar idiopática sob cuidados paliativos. Relato de caso / Oral care in idiopathic pulmonary fibrosis patient in palliative care. Case report

A Fibrose Pulmonar Idiopática (FPI) é uma doença crônica do interstício pulmonar que se manifesta por fibrose progressiva com alta prevalência de insuficiência respiratória. Como toda doença crônica e progressiva, a FPI necessita de acompanhamento por uma equipe multiprofissional de Cuidados Paliativos (CP) a fim de proporcionar um cuidado integral, considerando todas as queixas e necessidades do paciente. Em uma enfermaria de CP de um hospital terciário, um paciente do sexo masculino, 77 anos, foi admitido por FPI avançada para controle de sintomas e cuidados de fim de vida. Durante a oroscopia realizada pela equipe, recebeu diagnóstico de candidíase oral, onde foi solicitada avaliação do cirurgião-dentista. Na avaliação odontológica, queixou-se de língua ressecada e perda do paladar. Paciente acamado, dispneico em repouso, em uso contínuo de máscara de venturi e lábios ressecados, com presença de placas brancas ressecadas (resíduos alimentares) em palato duro e mole, mucosa jugal e gengival, língua ressecada com saburra e hipossalivação. Foi realizada a higiene oral, prescrição de substituto salivar e hidratante labial. O procedimento foi longo e intermitente devido à dificuldade do paciente de se manter sem o suporte de oxigênio. Após o procedimento, o paciente relatou melhora de 90% dos sintomas bucais. Conclusão: O caso apresentou as alterações bucais e os cuidados odontológicos em um paciente com FPI e também evidenciou a importância da avaliação especializada realizada pelo cirurgião-dentista inserido em uma equipe multiprofissional em CP, que, além do diagnóstico diferencial, proporcionou alívio dos sintomas bucais e conforto ao paciente em sua fase final de vida

Idiopathic Pulmonary Fibrosis (IPF) is a chronic interstitial lung disease manifested by progressive fibrosis with a high prevalence of respiratory failure. As all chronic and progressive diseases, IPF needs follow-up by a multidisciplinary Palliative Care (PC) team in order to provide comprehensive care considering all patient's complaints and needs. In a PC inpatient unit of a tertiary hospital, a 77-year-old male patient was admitted because of advanced IPF for symptom control and end-of-life care. During the oroscopy done by the team, he was diagnosed with oral candidiasis, where evaluation by the dentist was requested. In the dental evaluation, he complained of dry tongue and taste loss. Bedridden patient, dyspnea at rest, in continuous use of venturi mask and dry lips, dry white plaques (food residues) in hard and soft palate, jugal and gingival mucosa, dry tongue with oral coating and hyposalivation. Oral hygiene was performed, salivary substitute and lip moisturizer were prescribed. The procedure was long and intermittent due to the difficulty of the patient with staying without oxygen support. After the procedure, the patient reported 90% improvement in oral symptoms. Conclusion: The case showed the oral disorders and dental care in a patient with IPF and highlighted the importance of specialized evaluation performed by the dentist inserted in a multidisciplinary PC team which, besides the differential diagnosis, provided symptom relief of the mouth and comfort to the patient in his end of life

Avaliação da efetividade de um protocolo de cuidados odontológicos no alívio da dor, sintomas bucais e melhora da qualidade de vida em pacientes com câncer de cabeça e pescoço em cuidados paliativos: ensaio clínico não-controlado / Assessment of the effectiveness of a dental care protocol in relieving pain and oral symptoms and improving the quality of life of head and neck cancer patients in palliative care: non-controlled clinical trial

INTRODUÇÃO: Doentes com câncer de cabeça e pescoço têm sérias restrições funcionais e grande comprometimento das funções bucais. Esses problemas tornam-se complexos quando o câncer é incurável, exigindo exclusivamente cuidados paliativos. Nesta condição, os sintomas habituais agravam-se necessitando de atenção e cuidados especiais. Foi realizado um ensaio clínico não-controlado, incluindo doentes com câncer avançado de cabeça e pescoço exclusivamente em cuidados paliativos, com o objetivo de caracterizar a sua condição clínica orofacial; avaliar a funcionalidade, a qualidade de vida relacionada à saúde e a efetividade de um protocolo de cuidados odontológicos (preventivos, curativos e paliativos) no controle da dor e das queixas orofaciais, na qualidade de vida, prognóstico e sobrevida desses doentes. MÉTODOS: Avaliação Odontológica através da Ficha Clínica da Equipe de Dor Orofacial/ATM - HCFMUSP, Prontuário médico, Escala Visual Analógica (EVA), Índice gengival, Avaliação quanto à presença de cálculo dentário, Avaliação da mobilidade dentária, Escala de Numérica de Dor (END), Classificação do odor das feridas, Avaliação do edema lingual, Índice CPO-D, Questionário de Qualidade de Vida da Universidade de Washington (UW-QOL), Escala de Desempenho Funcional de Karnofsky (KPS) e o Palliative Prognostic Index (PPI). RESULTADOS: Foram incluídos 40 doentes, entre setembro de 2006 e abril de 2009, com média de idade de 60,4±10,8 anos, sendo 90% do gênero masculino; quanto ao tumor, 100,0% eram carcinomas; 65,0% localizavam-se na orofaringe; 52,5% apresentavam metástases; quanto à condição clínica, 72,5% tinham doenças cardiovasculares; 45,0% eram traqueostomizados; 22,5% utilizavam sonda nasogástrica; a média do escore do KPS pré-tratamento odontológico foi de 69,5±14,5. As queixas principais mais relatadas foram: dor em 67,5% e disfagia em 22,5%, com uma mediana de 3,0 queixas por doente. Os sinais mais encontrados foram as lesões bucais em 70,0%, lesões...

INTRODUCTION: Patients with head and neck cancer have severe functional restrictions. Oral function is critically compromised. These problems become complex when the cancer is untreatable and the patient receives only palliative care. In this circumstance, the usual symptoms worsen and require special attention and care. A non-controlled clinical trial was done with advanced head and neck cancer patients receiving only palliative care. The objectives were to characterize their clinical orofacial condition; assess their functionality; assess their health-related quality of life; and assess the effectiveness of a dental care protocol (preventive, curative and palliative) in controlling pain and orofacial and quality of life complaints, and its effectiveness on prognosis and survival. METHODS: Dental assessment followed the clinical protocol used by the Orofacial/TMJ Pain Team - HCFMUSP. Data were also collected from the patients' medical records. Further assessment included administration of the Visual Analogue Scale (VAS), Gingival Index, Numeric Pain Scale (NPS), University of Washington quality of life questionnaire (UW-QOL), Karnofsky Performance Scale (KPS) and Palliative Prognostic Index (PPI); assessment of dental calculus, tooth mobility, tongue swelling, decaying, missing and filled teeth (DMFT); and lesion odor classification. RESULTS: A total of 40 patients were included between September 2006 and April 2009, with a mean age of 60.4±10.8 years. Of these, 90% were males. All patients had carcinomas, 65.0% were in the oropharynx and 52.5% had metastasized. Most (72.5%) of the patients also had cardiovascular diseases, 45.0% had undergone a tracheotomy and 22.5% used a nasogastric probe. The mean KPS score before dental treatment was 69.5±14.5. The main complaints were: pain (67.5%) and dysphagia (22.5%), with a median of three complaints per patient. The most common signs were oral lesions (70.0%), extraoral lesions (52.5%), drooling (45.5%)...