Dental anomalies in children submitted to antineoplastic therapy

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Instituto da Criança ITACI Hemato-oncology Service, Dentistry DepartmentSão Leopoldo Mandic Campinas School of DentistryUniversidade Federal de São Paulo (UNIFESP) School of Medicine Pediatric Oncology Institute, GRAACC-IOP, Department of DentistryUniversidade Estadual Paulista Júlio de Mesquita Filho (UNESP) Instituto de Ciência e Tecnologia (http://www.fosjc.unesp.br/)Faculdade de Medicina da Universidade de São Paulo Department of PediatricUNIFESP, School of Medicine Pediatric Oncology Institute, GRAACC-IOP, Department of DentistrySciEL

Systematic Review of Laser and Other Light Therapy for the Management of Oral Mucositis in Cancer Patients

Background The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis. Methods A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based onthe evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. Results A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm2 (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence. Conclusions The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings

The teeth morphologic altered through panoramic radiographs in children with cancer after treatment with chemotherapy and/or radiotherapy

Objetivo: Avaliar, por meio de radiografia panorâmica, a prevalência das alterações morfológicas dentais em crianças portadoras de câncer que foram submetidas à quimioterapia isolada e/ou quimioterapia mais radioterapia. Métodos: pacientes com câncer matriculados no 10P-GRAACC-UNIFESP/EPM, no período de março de 1996 a fevereiro de 2004, foram admitidos neste estudo retroprospectivo, não randomizado, uninstitucional. Neste período, radiografias de 310 pacientes foram solicitadas e 183 pacientes preencheram os critérios de elegibilidade. Foi avaliada a freqüência radiográfica de microdontia, taurodontia, anodontia, macrodontia, raiz rombuda e raiz atilada. Resultados: 137 (74,9 por cento) pacientes foram considerados avaliáveis e 46 (25,1 por cento) não avaliáveis. Os pacientes avaliáveis foram distribuídos em dois grupos: o de neoplasias linfoproliferativas (60,6 por cento) e o de portadores de tumores sólidos (39,4 por cento). Quanto ao sexo, 79 eram do sexo feminino e 58, do masculino. A idade média, ao início do tratamento, foi de 5 anos e seis meses. Foram encontradas anomalidades dentais em 39 (28,5 por cento) pacientes e em 98 (71,5 por cento) não se encontrou nenhuma anomalidade. As anomalidades encontradas foram: microdontia 7,3 por cento (n=10); anodontia 5,8 por cento (n=8); taurodondia 13,9 por cento (n=19); macrodontia 5,1 por cento (n=7); raiz rombuda 1,5 por cento (n=2) e raiz afilada 3,6 por cento (n=5). Destes pacientes, 21,9 por cento (n=30) tinham uma alteração; 4,4 por cento (n=6), duas alterações e 2,2 por cento (n=3), três alterações. Conclusão: a taurodontia foi a alteração mais freqüente nas crianças e adolescentes que receberam tratamento antineoplásico, sendo suas taxas significativamente superiores às da população saudável. As alterações dentais reforçam a necessidade de o odontólogo pesquisar, sistematicamente, estas alterações neste grupo especial de paciente.BV UNIFESP: Teses e dissertaçõe

Conducta odontológica en pacientes pediátricos portadores de leucemia Dental care for pediatric patients with leukemia

En el paciente infantil portador de leucemia pueden ocurrir diversas alteraciones sistémicas o bucales como consecuencia de la propia condición patológica o debido a los tratamientos a que son sometidos como drogas quimioterápicas o de la radioterapia. El papel del cirujano dentista en la atención a estos pacientes especiales es de vital importancia en lo que se refiere al diagnóstico, tratamiento y prevención de las manifestaciones bucales tanto precoces como tardías. En este trabajo se realiza una revisión de la literatura sobre aspectos importantes de la leucemia en niños, abordando las formas y fases del tratamiento, las manifestaciones bucales y las conductas terapéuticas preventivas y curativas existentes hacia las mismas.Several sistemic alterations may take place in children patients with leucemia due to the neoplasia or to antineoplastic treaments (chemotherapy or radiotherapy). The role of the dental surgeon is of vital importance on the diagnosis, treatment and prevention of the early or late oral manifestations. So, the main of this work is to revise the current literature about the important aspects of the leukemia in children as treatment phases, oral manifestation and current preventive and therapeutic approach to them

Effects of Glycine on Collagen, PDGF, and EGF Expression in Model of Oral Mucositis

Oral mucositis is frequently a toxic effect of chemotherapeutic and/or radiotherapeutic treatment, resulting from complex multifaceted biological events involving DNA damage. The clinical manifestations have a negative impact on the life quality of cancer patients. Preventive measures and curative treatment of mucositis are still not well established. The glycine has anti-inflammatory, immunomodulatory, and cytoprotective actions, being a potential therapeutic in mucositis. The objective was to evaluate the effects of glycine on the expression of collagen and growth factors, platelet and epidermal in a hamster model oral mucositis. The mucositis was induced by the protocol of Sonis. There were 40 hamsters used, divided into two groups: Group I-control; Group II-supplemented with 5% intraperitoneal glycine, 2.0 mg/g diluted in hepes. Histopathological sections were used to perform the immune-histochemical method, the evaluation of collagen expression, and the growth factors: Epidermal growth factor (EGF) and platelet (PDGF). It was observed that the group supplemented with glycine experienced higher amounts of collagen expression and predominance type of collagen I. The glycine group presented lower immunoexpression of the growth factors, EGF and PDGF. The group supplemented with glycine showed a marked healing process of the oral mucosite, demonstrated by the predominance of collagen type I and reduction of growth factors, EGF and PDGF

Cyclooxygenase-2 and vascular endothelial growth factor expression in 5-fluorouracil-induced oral mucositis in hamsters: evaluation of two low-intensity laser protocols

The aim of this study was to investigate the mechanisms whereby low-intensity laser therapy may affect the severity of oral mucositis.A hamster cheek pouch model of oral mucositis was used with all animals receiving intraperitoneal 5-fluorouracil followed by surface irritation. Animals were randomly allocated into three groups and treated with a 35 mW laser, 100 mW laser, or no laser. Clinical severity of mucositis was assessed at four time-points by a blinded examiner. Buccal pouch tissue was harvested from a subgroup of animals in each group at four time-points. This tissue was used for immunohistochemistry for cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and factor VIII (marker of microvessel density) and the resulting staining was quantified.Peak severity of mucositis was reduced in the 35 mW laser group as compared to the 100 mW laser and control groups. This reduced peak clinical severity of mucositis in the 35 mW laser group was accompanied by a significantly lower level of COX-2 staining. the 100 mW laser did not have an effect on the severity of clinical mucositis, but was associated with a decrease in VEGF levels at the later time-points, as compared to the other groups. There was no clear relationship of VEGF levels or microvessel density to clinical mucositis severity.The tissue response to laser therapy appears to vary by dose. Low-intensity laser therapy appears to reduce the severity of mucositis, at least in part, by reducing COX-2 levels and associated inhibition of the inflammatory response.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Expt Surg, BR-04023062 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Med Laser Ctr, INCOR HC, BR-05403000 São Paulo, BrazilUniv Connecticut, Ctr Hlth, Sect Oral Med, Dept Oral Hlth & Diagnost Sci MC1605, Farmington, CT 06030 USAUniv São Paulo, Inst Phys, Dept Nucl Phys, BR-05315970 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Expt Surg, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-04023062 São Paulo, BrazilWeb of Scienc

Effects of Low-Level Laser Therapy on Collagen Expression and Neutrophil Infiltrate in 5-Fluorouracil-Induced Oral Mucositis in Hamsters

Background and Objectives: Several studies have suggested that low-level laser therapy (LLLT) can ameliorate oral mucositis, however, the mechanisms involved are not well understood. The aim of this study was to investigate the mechanisms of action of LLLT on chemotherapy-induced oral mucositis, as related to effects on collagen expression and inflammation Materials and Methods: A hamster cheek pouch model of oral mucositis was used with all animals receiving intraperitoneal 5-fluorouracil, followed by surface irritation. Animals were randomly allocated into three groups, and treated with an InGaAIP diode laser at a wavelength of 660 nm and output power of 35 or 100 mW laser, or no laser Clinical severity of mucositis was assessed at four time-points by a blinded examiner Buccal pouch tissue was harvested from a subgroup of animals in each group at four time-points. Collagen was qualitatively and quantitatively evaluated after picrosinus staining. The density of the neutrophil infiltrate was also scored Results: Peak clinical severity of mucositis was reduced in the 35 mW laser group as compared to the 100 mW and control groups The reduced peak clinical severity of mucositis in the 35 mW laser group was accompanied by a decrease in the number of neutrophils and an increase in the proportion of mature collagen as compared to the other two groups. The total quantity of collagen was significantly higher in the control (no laser) group at the day 11 time-point, as compared to the 35 mW laser group, consistent with a more prolonged inflammatory response in the control group. Conclusion: This study supports two mechanisms of action for LLLT in reducing mucositis severity. The increase in collagen organization in response to the 35 mW laser indicates that LLLT promotes wound healing In addition, LLLT also appears to have an anti-inflammatory effect, as evidenced by the reduction in neutrophil infiltrate Lasers Surg Med 42 546-552, 2010. (C) 2010 Wiley-Liss, Inc.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundacao de Amparo a Pesquisa de Sao Paulo (FAPESP

Gorlin-Goltz Syndrome and Neoplasms: A Case Study

Gorlin syndrome is a rare autosomal dominant disorder exhibiting high penetrance and variable expressivity. It is characterized by facial dysmorphism, skeletal anomalies, multiple basal cell carcinomas, odontogenic keratocysts (OKC), palmar and plantar pits, bifid ribs, vertebral anomalies and a variety of other malformations. Various neoplasms', such as medulloblastomas, meningiomas, ovarian and cardiac fibromas are also found in this syndrome. Objective: To describe a twelve-year-old patient with Gorlin-Goltz syndrome, with basal cell carcinomas and promyelocytic leukemia developed after receiving craniospinal radiation for a medulloblastoma. Mild ribs as well as mandibular and maxillar OKC were also diagnosed. Conclusion: The patient with Gorlin-Goltz syndrome should receive close follow-up for early detection of malformations and malignant neoplasias.Univ Fed Sao Paulo, Med Sch Sao Paulo, Pediat Oncol Inst, GRAACC, Sao Paulo, SP, BrazilSao Paulo State Univ, Hosp Clin, Sao Paulo, BrazilUniv Fed Sao Paulo, Med Sch Sao Paulo, Pediat Oncol Inst, GRAACC, Sao Paulo, SP, BrazilWeb of Scienc