Best practices in palliative dentistry to improve patients’ quality of life: a systematic review

Introduction: Palliative Care (PC) is an approach that promotes the quality of life of patients and their families who face life-threatening illnesses through the prevention and relief of suffering. Oral care plays an important role in patient comfort and effective palliative care strategies for relieving oral complications. Objective: This study aimed to analyze the main considerations of palliative care that should be applied by dentists to better understand the best practices of palliative dentistry to improve the quality of life of patients, as well as mitigate the increase in complications after the diagnosis of a disease. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 177 articles were found, and 50 articles were evaluated in full, and 18 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 24 studies with a high risk of bias and 27 that did not meet the GRADE and AMSTAR-2 criteria. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=85.7%>50%. It was concluded that the understanding of palliative care has changed. Previously, it was defined as an approach to the patient when there was nothing else to do. Still, it is currently defined as comprehensive care for a patient who presents with intense health-related suffering due to a serious, life-threatening illness. The goal of palliative care in dentistry is to improve the quality of life of patients, their families, and their caregivers. Based on the literature researched, it can be concluded that the most common oral conditions among palliative patients are xerostomia, candidiasis, mucositis, dysphagia, and dysgeusia. These conditions reduce the patient's quality of life, causing pain and discomfort. In addition, xerostomia is an important factor in the emergence of other conditions. Therefore, the presence of a dentist in the palliative care team is imperative to promote oral health

Levomepromazine-induced priapism: a description of clinical cases

Introduction: Priapism is defined as a persistent and painful erection without sexual stimulation that lasts at least 4 hours. Although rare, it can be triggered by some factors such as hemoglobinopathies, paraneoplastic syndromes, and the use of recreational drugs and antipsychotics, with atypical and typical antipsychotics being responsible for half of the medication-induced priapisms. Objective: The present study aimed to record two clinical cases of priapism after the administration of a typical antipsychotic, levomepromazine, in two patients who were hospitalized in a psychiatric institution. It is important to recognize this manifestation to guide patients about prolonged and pathological erection, to prevent not only possible complications but also to ensure good medication adherence. Clinical cases: This study was analyzed and approved by the Research Ethics Committee according to a substantiated opinion number 6.949.882, and the patient's consent through the Informed Consent Form. Patient 1: Upon admission, he was prescribed thiamine, lorazepam, and levomepromazine. After eight days of regular use of the medication, he presented with prolonged (>4h) painful penile erection without the presence of sexual stimulation or excitement and was diagnosed with priapism. Patient 2: In the final phase of treatment, stable, when after withdrawal of benzodiazepines he presented with initial insomnia, it was decided to optimize the dose of levomepromazine (already being used) from 75 mg to 100 mg at night. One day later, he presented with priapism and was referred to the emergency room and administered local analgesia. Final considerations: Based on the two clinical case reports described, it is possible to infer that priapism was generated as a consequence of the use of levomepromazine, since this type of adverse reaction can already be expected, although not so frequently, from the use of antipsychotics based on the existing literature

Major considerations and clinical outcomes of digital implant dentistry in guided bone regeneration: a systematic review

Introduction: It is estimated that up to 43% of osseointegrated implants require guided bone regeneration (GBR) as part of the patient's rehabilitation. Bone loss or insufficiency presents a major challenge for osseointegration. In this sense, the use of CAD-CAM systems (Computer-Aided Design/Computer-Aided Manufacturing) is highlighted in this process. Objective: It elucidated the current clinical considerations of the use of guided bone regeneration for dental implants through the use of CAD-CAM systems. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=79.5%>50%. Guided bone regeneration is well documented and constitutes a predictable and successful approach to lateral and vertical bone augmentation of atrophic ridges. Thus, guided bone regeneration is considered one of the most commonly applied methods to reconstruct alveolar bone and to treat peri-implant bone deficiencies, as well as to replace lost bone and allow the implant to be fully integrated and maintained during functional loading. The use of digital tools for the automated fabrication of implant parts (CAD-CAM) is an optimizing reality in Dentistry. CAD-CAM enables high-quality, standardized, accurate, and detail-perfect prosthetic restorations. The use of metallic implants in the morse cone system in association with zirconia abutments guarantees a final product with mechanical resistance, biocompatibility, and aesthetics. Also, immunomodulatory guided bone regeneration membranes are developed mainly by improving macrophage recruitment and aggregation as well as regulating macrophage polarization

Major evidence from the crosstalk between nutrology and lifestyle for healthy longevity: a systematic review

Introduction: Life expectancy worldwide has increased significantly. Centenarians represent a successful aging phenomenon. Genetic, environmental, and lifestyle factors can determine the life expectancy of humans. Certain healthy foods are associated with longer telomere lengths. Objective: It was to present the main evidence of the crosstalk between nutrition, lifestyle, and healthy longevity to promote health and improve quality of life in aging. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from May to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 133 articles were found. A total of 33 articles were evaluated in full and 31 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 23 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.5%>50%. It was concluded that many metabolic or chronic diseases have been implicated in poor diet and lifestyle. Improving diet quality is associated with reduced all-cause mortality, considering that multivitamin and multimineral supplements can improve life expectancy, such as nutrients such as melatonin and coenzyme Q10 and micronutrients. The synergistic relationship of nutrients to influence physiological and cognitive function. Low concentrations of vitamin D have been linked to accelerated decline in cognition across ethnicities. N-acetylcysteine can help treat schizophrenia, bipolar disorder, and depression by decreasing oxidative stress and reducing glutamatergic dysfunction, and has broader preclinical effects on mitochondria, apoptosis, neurogenesis, and telomere lengthening. A healthy (low-sugar) plant-based diet with a reduced intake of energy-dense meat and processed meat enables healthy longevity. Several mechanisms are involved in the aging process, highlighting AMPK (AMP-activated protein kinase), SIRT1 (sirtuin), mTOR (mammalian target of rapamycin), and insulin/IGF-1 (insulin-like growth factor-1), autophagy impaired, changes in epigenetics, chronic low-grade inflammation, and cellular changes, senescence (inflammation), oxidative stress and telomere shortening

Clinical considerations of regenerative processes in bucomaxillofacial surgery using stem cells from exfoliated deciduous teeth: a systematic review

Introduction: The World Health Organization forecasts that road accidents will be the third cause of facial trauma worldwide by 2025. To catalyze regenerative processes in oral and maxillofacial surgery, human oral mesenchymal stem cells (Stem Cells from Exfoliated Deciduous Teeth - SHEDs) have been discovered near the oral mucosal tissues and primary teeth. Objective: It was to analyze the main clinical considerations of regenerative processes in bucomaxillofacial surgery using stem cells from exfoliated deciduous teeth. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from July to August 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument.  Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X2=78.7%>50%. A total of 122 articles were found and submitted to eligibility analysis, with 14 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 29 studies that did not meet GRADE and AMSTAR2. The conclusion was that the integration of SHED cells with scaffolds consistently improves alveolar and maxillary bone regeneration compared to scaffold-only approaches, resulting in increased bone volume, density, osteogenesis, and angiogenesis. Thus, SHEDs have emerged as a promising alternative in regenerative and reconstructive medicine. These stem cells exhibit high differentiation potential and self-renewal capacity. These stem cells can be easily harvested from accessible and numerous sources, such as molars and extracted baby teeth, with minimal invasiveness, playing essential roles in clinical applications and pointing to the overcoming of complex challenges in restorative and reconstructive medicine

Major results of controlled clinical studies on the use of chlorhexidine in the success of endodontic treatment: a concise systematic review

Introduction: The efficacy of endodontic treatment is directly related to the elimination of bacteria. In the context of disinfection, sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) are recommended as irrigating solutions for the chemical-mechanical preparation of the root canal due to their broad-spectrum antimicrobial efficacy. Objective: This study aimed to develop a systematic review that addresses the main comparative clinical results of using chlorhexidine in the success of endodontic treatment. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from March to April 2025 in Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 176 articles were found, 36 articles were evaluated in full and 11 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 33 studies that did not meet GRADE and AMSTAR-2. It was concluded that most randomized controlled clinical trials showed that chlorhexidine effectively reduces bacterial load, with greater reductions associated with successful outcomes. Chlorhexidine 2% is effective for clinical and radiographic success and for antimicrobial activity in primary teeth undergoing pulpectomy. Nonsurgical root canal retreatment using foraminal enlargement and 2% chlorhexidine gel demonstrated high success rates. A relatively favorable impact of chlorhexidine on post-endodontic pain was observed, with significant therapeutic implications

Importance of computed tomography for identifying the second mesiobuccal canal in endodontic procedures: a systematic review of clinical studies

Introduction: Endodontists must have detailed knowledge of the typical anatomy of the dental structure and the atypical forms of external and internal root canals. The first permanent maxillary molar and the second permanent maxillary molar are the teeth with the greatest complexity of root canals, presenting higher rates of endodontic failure. Cone beam computed tomography (CBCT) has made it possible to visualize anatomical structures that are difficult to access in three dimensions, and has become a valuable aid as a complementary examination for endodontic diagnosis and treatment. Objective: This study aimed to address the main considerations and outcomes of clinical studies on the use of cone beam computed tomography in the identification and treatment of second mesiobuccal canals. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to November 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found, 14 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 46 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=91.5%<50%. Results and Conclusion: It was concluded that endodontic treatment success can be increased and clinicians’ time can be saved by using the newly developed AI-based models to identify variations in root canal anatomy before treatment. Patient gender, tooth type, and treatment modality play essential roles in identifying the MB2 canal. Furthermore, the availability of preoperative CBCT images was associated with a greater ability to localize the MB2 canal. Understanding the incidence of MB2 canals and the distribution pattern of canal orifices in the pulp floor can help clinicians quickly identify and locate MB2 canals

Economic impacts of the absence of a multidisciplinary nutritional therapy team (MNTT) in the public service of a state in the amazon region: a review

Introduction: Amapá is one of the newest states in the federation and one of the few that lacks a Multidisciplinary Nutritional Therapy Team (MNTT) in the public health service. These teams are mandatory in medium and high-complexity hospitals and are responsible for improving nutritional treatment and early management of malnutrition. Objective: This work consisted of a review of the literature and current legislation on the impacts of the absence of the MNTT service on the cost of medical care offered by the SUS in Amapá. Method: To assess the economic impact of the absence of MNTT, a review was conducted, gathering articles and legislation related to the proposed topic. The search terms included “nutritional therapy,” “multidisciplinary team nutritional therapy team” “multidisciplinary nutritional therapy team,” “enteral nutrition,” “parenteral nutrition,” and “Amapá.” Results: It is estimated that the state incurs additional costs related to malnutrition every month, ranging conservatively between R$956,267.52 and R$ 1,072,426.50. These costs could be saved with the presence of MNTT. Conclusion: Investing in the implementation of MNTT in Amapá’s public hospitals is necessary. These teams play a fundamental role in diagnosing, treating, and, most importantly, preventing nutritional diseases, leading to better allocation of public funds and improved patient care

Evaluation of the response to photobiomodulation and magnetotherapy in osteonecrosis of the jaws induced by the use of bisphosphonates: a systematic review

Introduction: Bisphosphonates are drugs that act on bone metabolism, inhibiting calcium precipitation and bone resorption. When used for long periods to control osteoporosis, these drugs can cause adverse effects, such as osteonecrosis of the jaws (Bisphosphonate-Related Osteonecrosis of the Jaws - BRONJ), which is more frequent in 8% to 12% of patients when administered intravenously. However, it should be noted that complications, when they occur, are very severe and mutilating, greatly impairing the quality of life of these patients. Energy-based devices (EBD), described in the biophotonic literature, reveal effective anti-inflammatory, analgesic, neoangiogenic, and reparative action. Objective: It was conducted a systematic review to present the main clinical considerations and consequences of the use of bisphosphonates in the occurrence of osteonecrosis of the jaw, as well as to discuss the treatments of photobiomodulation and magnetotherapy. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=88.5%>50%. It is concluded that with the increasing use of bisphosphonates against osteoporosis especially in cases of postmenopausal women with osteopenia, a proportionally higher incidence of the main adverse effect of these drugs in the maxillomandibular region, osteonecrosis of the jaw, has emerged. The "gold standard" therapy of choice proposed for this disease is surgical treatment. Complications, when present, are very severe and mutilating, greatly impairing the quality of life of these patients. Morbidities include extensive resections, secondary infections, lack of tissue for primary closure, dehiscence, and fistulas, which can evolve into multilateral wounds with serious consequences, such as sepsis. In this regard, photobiomodulation therapy and magnetotherapy demonstrated safety and efficacy in the treatment of bisphosphonate-related osteonecrosis of the jaw, through reduction of inflammatory signs, faster healing, and reduction of postoperative morbidity. Thus, it was demonstrated that only four applications of low-intensity laser and magnetotherapy were sufficient to reduce the inflammatory process in the surgical wound, stimulate the tissue repair process, and provide postoperative analgesia

Clinical findings of schistosomotic myeloradiculopathy: a systematic review

Introduction: Schistosomiasis is caused by a helminth of the genus Schistosoma. Schistosomal myeloradiculopathy (SMR) is the main ectopic manifestation of this species. The diagnosis of SMR is based on neurological symptoms of spinal cord injury, tests that indicate infection by the agent, and exclusion of other causes. Using magnetic resonance imaging of the spinal cord, the diagnosis of this ectopic form of the disease was facilitated. Objective: This was to develop a systematic review to present the main clinical outcomes of the diagnosis and treatment of schistosomal myeloradiculopathy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from January to February 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found. 22 articles were evaluated, and 16 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 38 studies with high risk of bias and 19 studies that did not meet GRADE. Most studies presented homogeneity in their results, with X2=83.8% >50%. It was concluded that among the main manifestations of schistosomiasis, schistosomal myeloradiculopathy is the most severe ectopic form of the disease, and should be suspected in patients with low back pain, lower limb strength and/or sensitivity disorders, or urinary tract disorders. Early diagnosis and treatment should be performed to reduce severe neurological sequelae. Treatment includes anti-schistosomiasis medications, corticosteroids, and/or surgery that significantly impacts the overall quality of life of affected individuals, reinforcing the importance of efforts to control and eradicate this debilitating disease and suggesting that multidisciplinary clinical management of patients with schistosomiasis would be more appropriate and could potentially improve patient quality of life