Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. MATERIAL AND METHODS: Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37ºC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. RESULTS: All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective, and induced a significant amelioration of radiotherapy side effects, such as mucositis and candidosis. CONCLUSION: These results highlights the importance of the initial dental treatment for patients who will be subjected to radiotherapy for head and neck cancer treatment

Emprego de redes complexas para modelar e analisar a disseminação de microrganismos da familia enterobacteriaceae em pacientes mantidos em unidades de terapia intensiva

Nowadays the studies of different methodologies to interfere in the growing and spread of serious infections and systemic status in institutionalized patients those kept on intensive therapy units are relevant to understanding these complex systems and bring benefits to several health areas, particularly public health. In this study, it was analyzed the clinical and microbiological data from patients hospitalized in intensive therapy units. The interaction between patients and caregivers was modeled and analyzed using dynamic system model and complex network theory, identifying outbreaks values of microorganisms of Enterobacteriaceae Family.El desarrollo y la utilización de diferentes metodologías de interferencia en el crecimiento y la propagación de las infecciones graves y sistemáticas en institucionalizado y se mantienen en pacientes de la unidad de cuidados intensivos, el proceso es de gran importancia para muchas áreas de la salud, especialmente para la salud pública. En este estudio, se analizaron los datos clínicos y microbiológicos de los pacientes hospitalizados en unidades de cuidados intensivos. La interacción entre los pacientes y los cuidadores fue modelada y analizada usando modelos de sistemas dinámicos y modelos de redes complejas. A través de este análisis, fue posible identificar los valores de umbral del proceso de la evolución de la familia Enterobacteriaceae.O desenvolvimento e uso de diferentes metodologias na interferência do processo de crescimento e disseminação de infecções sérias e sistêmicas, em pacientes institucionalizados e mantidos em unidades de tratamento intensivo, é de grande importância para diversas áreas da saúde, principalmente para saúde pública. Neste estudo foram analisados dados clínicos e microbiológicos de pacientes hospitalizados em unidades de terapia intensiva. A interação entre pacientes e cuidadores foi modelada e analisada através de modelos de sistemas dinâmicos e modelos de redes complexas. Através desta análise foi possível identificar valores limiares do processo da disseminação de microrganismos da Família Enterobacteriaceae

Enterococcus spp. em espécimes clínicos de pacientes atendidos em unidades de terapia intensiva

The relationship between the occurrence of enterococci in the oral microbiota and serious infections in patients hospitalized in intensive care units (ICU) has been established. This study evaluated the presence of Enterococcus faecalis and other species of this genus in the mouths of patients on ICU, correlating it with oral and systemic conditions. Data on health and socioeconomic, medication use, medical and family history of patients maintained for 72 hours in the ICU, diagnosed with severe infection or who have developed this condition after the entry to the unit were obtained. Fifty patients provided intraoral and extraoral clinical samples for analysis (above and subgingival biofilm, saliva and buccal mucosa, followed by obtaining samples of respiratory secretions for patients with pneumonia, and blood and urine for sepsis). The presence of target microorganisms was performed by polymerase chain reaction (PCR) and culture using selective media. The chi-square and Mann-Whitney tests were used for statistical analysis, and the significance level was 5%. The intraoral clinical conditions of the patients showed poor. E. faecalis was significantly more frequent microorganism, followed by E. faecium. The use of broadspectrum antimicrobial action was associated with the presence of these opportunistic microorganisms. These bacteria were more frequent in patients with periodontitis or gingivitis. The results showed that enterococci associated with serious infectious processes may originate from resident microbiota of patients and its prevalence is not elevated in healthy individuals.La relación entre la presencia de enterococos en las infecciones graves y la microbiota bucal en pacientes ingresados en unidades de cuidados intensivos (UCI) ha sido establecida. En este estudio se evaluó la presencia de Enterococcus faecalis y otras especies de este género en la boca de los pacientes en la UCI, en correlación con las condiciones orales y sistémicas. Los datos sobre la salud y socioeconómico, uso de medicamentos, antecedentes médicos y familiares de pacientes mantenidos durante 72 horas en la UCI, con diagnóstico de infección severa o que han desarrollado esta enfermedad después se obtuvieron ingreso a la unidad. Cincuenta pacientes proporcionaron las muestras clínicas intraorales y extraorales para el análisis (biofilm supragingival y subgingival, la saliva y mucosa bucal, seguido de la obtención de muestras de secreciones respiratorias de los pacientes con neumonía, y la sangre y la orina de los marcos sépticas). La presencia de microorganismos diana se realizó mediante la reacción en cadena de polimerasa (PCR) y cultivo usando medios selectivos. Las pruebas de chi-cuadrado y U de Mann-Whitney se utilizaron para el análisis estadístico, y el nivel de significación fue del 5%. Las condiciones clínicas intraorales de los pacientes mostraron pobres. E. faecalis fue significativamente microorganismo más frecuente, seguido de E. faecium. El uso de amplio espectro de acción antimicrobiana se asoció con la presencia de estos microorganismos oportunistas. Estas bacterias fueron más frecuentes en los pacientes con periodontitis y gingivitis. Los resultados mostraron que los enterococos asociada con procesos infecciosos graves puede originarse a partir de la microbiota residente de los pacientes y su prevalencia no es elevada en individuos sanos.A relação entre a ocorrência de enterococos na microbiota bucal e infecções graves em pacientes internados em unidades de terapia intensiva (UTI) vem sendo estabelecida. Esse estudo avaliou a presença de Enterococcus faecalis e outras espécies desse gênero na boca de pacientes mantidos em UTI, correlacionando-a com condições bucais e sistêmicas. Foram obtidos dados referentes às condições de saúde e socioeconômicas, uso de medicamentos, história médica e familiar de pacientes mantidos por mais de 72 horas em UTI, com diagnóstico de infecção grave ou que desenvolveram essa condição após entrada na referida unidade. Cinquenta pacientes forneceram amostras clínicas intrabucais e extrabucais para análise (biofilme supra e subgengival, saliva e mucosas bucais, seguida da obtenção de amostras de secreções respiratórias para os pacientes com pneumonia e, sangue e urina para os quadros septicêmicos). A presença dos microrganismos alvos foi realizada pela reação em cadeia da polimerase (PCR) e por cultura empregando-se meios seletivos. Os testes de Qui-Quadrado e de Mann-Whitney foram utilizados na análise estatística, e o nível de significância foi de 5%. As condições clínicas intrabucais dos pacientes se mostraram precárias. E. faecalis foi o microrganismo significativamente mais frequente, seguido de E. faecium. O uso de antimicrobianos com amplo espectro de ação mostrou-se associado à presença desses microrganismos oportunistas. Essas bactérias foram mais frequentes nos pacientes com periodontite ou gengivite. Os resultados mostraram que os enterococos associados aos processos infeciosos graves podem se originar da microbiota residente dos pacientes e que sua prevalência não é elevada em indivíduos saudáveis

Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37oC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective, and induced a significant amelioration of radiotherapy side effects, such as mucositis and candidosis. These results highlights the importance of the initial dental treatment for patients who will be subjected to radiotherapy for head and neck cancer treatment