Lesões ulcerativas da boca: atualização para o clínico geral

A ulceração oral é uma queixa comum dos pacientes que são atendidos em ambulatórios. Com freqüência é difícil estabelecer um diagnóstico preciso e atingir o controle dos sinais e sintomas dos pacientes que apresentam ulceração oral. Os pacientes acometidos por ulceração oral são eventualmente encaminhados para os ambulatórios de gastroenterologia, entretanto, a maioria das úlceras não reflete doença gastrointestinal, e sim desordens sistêmicas que podem se apresentar com sinais e sintomas clínicos similares. O objetivo do presente artigo foi revisar aspectos da etiologia, diagnóstico e tratamento das desordens ulcerativas mais comuns da mucosa oral. Foi realizada uma busca no banco de dados MEDLINE da National Library of Medicine. A seleção dos artigos, coleta de dados e julgamento em termos da pertinência de inclusão foram realizadas pelos autores. Baseado na literatura pesquisada, foi concluído que existem várias doenças sistêmicas que podem apresentar sinais e sintomas clínicos semelhantes e o conhecimento de cada doença poderá guiar o clínico para uma intervenção apropriada.Oral ulceration is a common complaint of patients attending out-patient clinics. Because of the diversity in causes of oral ulceration, patients presenting with oral mucosal disease can be challenging to diagnose and manage. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics; however, in most instances the ulcers do not result from gastrointestinal disease. The aim of the present article is to review aspects of the etiology, diagnosis and management of common ulcerative disorders of the oral mucosa. A search in the National Library of Medicine computerized bibliographic database MEDLINE was performed. Selection of publications, extraction of data, and validity assessment were then performed by the authors. Based upon the searched literature, it is concluded that there are several systemic disorders that can present with similar clinical signs and symptoms, and knowledge of each disease is necessary for the clinician to provide proper management

Manifestações orais da sífilis

The past decade has shown a significant rise in the prevalence of infective syphilis in the developed world, and striking increases in its frequency have occurred in Eastern Europe, particularly the UK, and in the US. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Significant oral lesions such as gumma-associated bony destruction and a possible predisposition to oral squamous cell carcinoma are associated with tertiary disease. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. The aim of this report is to review syphilis-related oral lesions, as well as to summarize the relations between human immunodeficiency virus (HIV) and syphilis.A última década tem mostrado um aumento importante na prevalência de sífilis infecciosa nos países desenvolvidos e epidemias surgiram na Europa ocidental, particularmente no Reino Unido, bem como nos EUA. Embora as manifestações orais da sífilis sejam mais freqüentes na fase secundária da doença, todos os estágios podem apresentar lesões orais. A fase terciária da doença está associada a lesões orais significativas tais como destruição óssea associada à goma sifilítica e uma possível predisposição ao carcinoma espinocelular. Com o aumento da prevalência da sífilis infecciosa, há também um aumento gradual de crianças nascidas com sífilis congênita. Consequentemente esta patologia leva a anomalias faciais de ordem dentária, óssea, dermatológica e neurológica. O objetivo deste artigo é revisar as lesões orais associadas á sífilis, bem como discorrer brevemente sobre a relação entre a infecção pelo vírus da imunodeficiência humana (human immunodeficiency virus - HIV) e a sífilis

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 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

Periodontal Condition and Tooth Loss in Rheumatoid Arthritis Patients

Svrha rada: Parodontopatije i reumatoidni artritis (RA) slični su u osnovnim patološkim procesima. Kronična upala i disfunkcija sustava imunosti glavna su obilježja obiju bolesti koje potiču citokini kao medijatori upale. U ovoj studiji procijenjeno je stanje parodonta i gubitak zuba kod oboljelih od reumatoidnog artritisa te je njihovo stanje uspoređeno sa zdravim sudionicima u istraživanju. Materijali i metode: U istraživanju je sudjelovalo 106 pacijenata – 53 s dijagnosticiranim RA-om i 53 zdravih u kontrolnoj skupini. Svi su bili razvrstani prema spolu i dobi. Zabilježeni su i podaci o socijalno-ekonomskom statusu te o oralnom i sistemskom zdravlju. Klinički stomatološki pregled sastojao se od šest mjerenja svakog zuba. Vrijednosti dobivene za krvarenje pri sondiranju (BOP), dubina sondiranja (PD), razina kliničkog pričvrstka (CAL) i broj zuba zabilježeni su za svakog pacijenta. Dijagnoze parodontitisa postavljene su na temelju kriterija Američke akademije za parodontologiju (American Academy of Periodontology), a RA je dijagnosticiran prema mjerilima Američkoga studija reumatologije (American College of Rheumatology). Rezultati: Pacijenti s RA-om imali su mnogo viši postotak BOP-a te znatno veći CAL u usporedbi s kontrolnom skupinom (p < 0,001 za svaki indeks). U skupinama nije bilo razlike u gubitku zuba. Zaključak: Pacijenti s dijagnozom RA imali su lošije stanje parodonta nego sistemski zdravi.Aim: Periodontal disease and rheumatoid arthritis (RA) have similar underlying pathological processes. Chronic inflammation and immune dysfunction are central to both diseases, and both are modulated by cytokines, as mediators of inflammation. This study evaluated the periodontal condition and tooth loss in RA patients and compared them with systemically healthy patients. Material and Methods: In total, 106 subjects participated: 53 with RA and 53 healthy controls, paired by gender and age. We recorded socioeconomic data and information about oral and systemic health. Clinical examinations were performed at six sites per tooth. Bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and total number of teeth were recorded. The diagnosis of the periodontal condition followed the American Academy of Periodontology criteria. RA was diagnosed according to the American College of Rheumatology guidelines. Results: The RA group exhibited a significantly higher percentage of BOP and a significantly higher CAL compared with the control group (p < 0.001 for each). There was no difference in tooth loss between the groups. Conclusion: The RA patients exhibited worse periodontal conditions than systemically healthy patients

Quality assessment of systematic reviews regarding the effectiveness of zygomatic implants : an overview of systematic reviews

Oral rehabilitation of atrophic maxillae features high complexity, for which there are several therapeutic modalities reported on scientific literature. Zygomatic implant placement is a viable option that features low morbidity and allows immediate prosthetic loading. The purpose of the present study was to determine the methodological quality of systematic reviews that assessed the effectiveness of zygomatic implants placed in atrophic maxillae. Searches were conducted on Medline via Pubmed, LILACS, Dare Cochrane, Scopus, and Sigle via Open Grey up to June 2019. Seven systematic reviews were eligible for Overview and comprised a total of 2313 patients, 4812 zygomatic implants, and a 96,72% success rate. Common surgical complications, in decreasing order, were: maxillary sinusitis, peri-implant mucositis, prosthetic fracture, and infections. Methodological quality was assessed using the AMSTAR 2 tool, which revealed that six systematic reviews showed critically low methodological quality and one review was assessed as of low methodological quality. Zygomatic implants seem to be an adequate option for atrophic maxilla rehabilitation, however, new studies with a higher methodological rigor are needed to provide more reliable results to professionals and patients undergoing this modality of oral rehabilitation

Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation

Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019. The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment. Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures

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

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. 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). 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). 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

Mental health of dentistry students in pernambuco related to the COVID-19 pandemic

Introduction: The adaptation of control measures such as social distancing and isolation during the fight against the novel coronavirus disease (COVID-19) has caused dentistry students to experience emotional vulnerability and psychological distress. Objective: To investigate the factors affecting the mental health of dentistry students in Pernambuco, Brazil during social isolation, and to identify possible injuries and mitigating factors. Methodology: A cross-sectional survey was conducted in public and private institutions in Pernambuco using an electronic questionnaire. The study included 261 dentistry students of both genders from the first to the tenth period (over 18 years old). Results: The impact of the COVID-19 pandemic on the lifestyles, academic situation, and mental health of dentistry students participating in the survey affirmed the predominance of anxiety, stress, and negative thinking. Conclusion: The COVID-19 pandemic significantly affected the quality of life, academic progress, and mental health of dentistry students. Prevention and management strategies are necessary to minimize the impacts of psychological suffering

Association between periodontal disease, aterosclerosis and thickness of the intimate-medium carotid layer / Associação entre doença periodontal, aterosclerose e espessura da camada carotídea íntima-média

A doença coronariana tem grande impacto na saúde global, potencial morbidade e mortalidade, e assim como a doença periodontal apresenta alta prevalência. Além disso, as duas condições compartilham fatores de risco comuns, como tabagismo, diabetes melitus e idade. O objetivo deste estudo foi avaliar a associação entre doença periodontal, aterosclerose e espessura da íntima-média da carótida. Trata-se de um estudo observacional transversal realizado no Hospital de Urgência da Universidade de Pernambuco (PROCAPE) com amostra de 92 pacientes com idade entre 19 e 82 anos. Foi realizada anamnese e avaliação periodontal através do índice de placa, índice de sangramento, profundidade de sondagem, recessão gengival. A espessura da íntima-média da artéria carótida foi obtida por ultrassom. A prevalência de índice de periodontite foi de 74,2% e 11,8% de gengivite. Na análise bivariada houve correlação estatisticamente significativa entre doença periodontal e a presença de placa de ateroma, mas essa relação não se manteve na análise multivariada. A presença de placas de ateroma foi maior em pacientes com doença periodontal moderada a grave. Houve correlação estatisticamente significativa entre a presença de doença periodontal e a presença de placas de ateroma, bem como, aumento da espessura médio-intimal carotídea. No entanto, essa associação não foi verificada nas análises multivariadas

Alteration of dental enamel surface morphology and intrapulpal temperature in the debonding of ceramic devices with high-power lasers: systematic review and meta-analysis

A alta demanda por estética trouxe um aumento na procura por materiais cerâmicos na Odontologia, resultando na predileção entre os pacientes por braquetes ortodônticos cerâmicos. A baixa resistência à fratura e alta força de união desses dispositivos cerâmicos ao esmalte pode provocar danos irreversíveis à estrutura dental sadia durante o processo de descolamento. Nesse contexto, os lasers de alta potência, devido a sua capacidade de interação com os materiais resinosos que unem o braquete ao esmalte, têm sido estudados para contornar esses possíveis danos ao tecido dental. O objetivo da presente revisão sistemática é comparar os lasers de alta potência com os alicates ortodônticos no descolamento de braquetes cerâmicos, com enfoque na alteração da morfologia de superfície do esmalte e aumento de temperatura intrapulpar. Foi realizada uma busca sistematizada nas bases de dados Pubmed, Cochrane Central, Scopus, Lilacs e Single via Open Grey até agosto de 2020 (seguindo o protocolo estabelecido pelo PRISMA) e realizado o processo de avaliação do risco de viés. 1.134 artigos foram identificados e doze deles foram incluídos para avaliação final baseados nos critérios de inclusão e exclusão. Os lasers foram divididos em dois subgrupos para melhor análise dos dados: subgrupos lasers interaction by ablation (formado pelos lasers Er:YAG, Er,Cr:YSGG e Tm:YAP) e lasers interaction by termal softening (formado pelos lasers de diodo e CO2). As análises de alteração de surperfície do esmalte envolveram os testes de Adhesive Remanant Index (ARI) e Shear Bond Strengh (SBS); além disso, foi avaliado o aumento de temperatura intrapulpar durante a irradiação dos braquetes. Para o teste de ARI, o subgrupo lasers interaction by ablation apresentou melhor resultado do que o grupo controle (p=0.005); entretanto, em uma análise geral de todos os lasers de alta potência, não houve diferença estatisticamente significante em relação ao grupo controle (p=0.12); da mesma forma, não houve diferença estatisticamente significante entre os subgrupos testados (p=0.111). Na análise de SBS todos os lasers de alta potência reduziram a força de união (8.91 MPa), com menores valores para os lasers do subgrupo lasers interaction by ablation (9.28 MPa). Adicionalmente, a análise de temperatura mostrou que nenhum laser nos estudos selecionados atingiu o limiar crítico de 5,5°C. Mesmo havendo uma tendência aos lasers do subgrupo interaction by ablation sobre os do subgrupo interaction by termal softening de melhores resultados, não é possível afirmar qual o melhor comprimento de onda e parâmetros para descolamento de braquetes ortodônticos cerâmicos devido à pouca quantidade de estudos primários.The high aesthetic demand of the population brought an increase in the demand for ceramic materials in dentistry resulting in the predilection among patients for ceramic orthodontic brackets. The low fracture resistance and the need for greater bonding strength of these ceramic devices can cause irreversible damage to the healthy dental structure during the debonding process. With this, high-power lasers have been studied during the last decades to overcome these possible damages to dental tissue due to their capacity to interact with the resin materials responsible for bonding the bracket to the enamel. The objective of this systematic review is to compare high-power lasers with orthodontic pliers in the debonding of ceramic brackets by evaluating enamel surface alteration and temperature increase. A systematic search was performed in the Pubmed, Cochrane Central, Scopus, Lilacs, and Single databases via Open Grey until August 2020, following the protocol established by Prisma and the assessment process risk of bias. 1,134 articles were identified and twelve of them were included for final evaluation based on inclusion and exclusion criteria. The lasers were divided into two subgroups for better data analysis. First subgroup lasers interaction by ablation formed by lasers Er:YAG, Er,Cr:YSGG and Tm:YAP, and the second subgroup lasers interaction by thermal softening formed by the diode and CO2 lasers. The enamel surperficial alteration analyses involved the Adhesive Remanant Index (ARI) and Shear Bond Strengh (SBS) tests, and intrapulpal temperature increase was evaluated during bracket irradiation. For the ARI test, the subgroup lasers interaction by ablation presented better than the control group (p=0.005); however, in a general analysis of all high-power lasers there was no statistically significant difference concerning the control group (p=0.12) in the same way there was no statistically significant difference between the subgroups tested (p=0.111). In the SBS analysis, all high-power lasers reduced the shear bond strength (8.91 MPa), with favoritism to lasers of the subgroup lasers interaction by ablation (9.28 MPa). Additionally, temperature analysis showed that no laser in the selected studies reached the critical threshold of 5.5°C. Even though there is a tendency to laser interaction by ablation on lasers interaction by thermal softening, we cannot affirm the best wavelength and parameters for debonding of ceramic orthodontic brackets due to the limited amount of primary studies