Halitosis, reduced salivary flow and the quality of life in pre-kidney transplantation patients

Halitosis is a condition that affects 50% of adults and one third of patients with chronic kidney disease. The aim of this study was to evaluate oral manifestations and volatile sulfur compounds (VSCs) associated with halitosis and quality of life in pre-kidney transplantation candidates. The organoleptic test (OT) and halimetry (HA) (before and after cysteine mouthwash) were performed in patients with the Oralchroma® device, stimulated (SE) and non-stimulated sialometry (SN), Tongue Coating Index (TCI). The OHIP-14 questionnaire was administered to assess the impact of oral health on quality of life. Fourteen individuals with a mean age of 49.64 ± 13.35 years were evaluated. In the organoleptic test, 57.14% of the individuals presented halitosis. Oralchroma results showed that dimethyl sulfide was above the threshold in 85.71% of the individuals, while hydrogen sulfide and methyl mercaptan were above threshold in 28.57%; after the use of cysteine, hydrogen sulfide was present in 100% of the cases, dimethyl sulfide in 57.14% and methyl mercaptan in 50%. In the non-stimulated sialometry, 57.14% of the individuals presented hyposalivation and 21.42% in the stimulated. Regarding the tongue coating index, 100% of the individuals presented tongue coating, with a mean of 7.64. The assessment of impact of oral health on quality of life showed a negative impact in all dimensions. Tongue coating, in association with hydrogen sulfide, was the main cause of halitosis in the study subjects, and hyposalivation may contribute to higher tongue-coating indices. These oral changes negatively affect the quality of life for pre-kidney transplantation patients

Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis

Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP. All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions. The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change. In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs

PREVALÊNCIA DOS QUESTIONÁRIOS DE SAÚDE GLOBAL E SAÚDE BUCAL NA AVALIAÇÃO DA QUALIDADE DE VIDA EM PACIENTES COM CÂNCER DE CABEÇA E PESCOÇO SUBMETIDOS À RADIOTERAPIA

Head and neck cancer (HNC) represents a group of malignant tumors and radiotherapy (RT) is a highly used treatment, however it has side effects such as oral mucositis, trismus, xerostomia and / or hyposalivation, among others. Questionnaires were developed to assess the quality of life (QOL) of these patients and the objective of this review was to assess the prevalence of questionnaires for assessing oral and general health of patients undergoing RT for HNC in the literature. Searches in the PubMed® and Lilacs databases were performed with the keywords: “Oral health”, “Quality of life”, “Head and neck neoplasms”, “Radiotherapy”,“Oral health”, “Quality of life”, "Head and neck neoplasms" and "Radiotherapy"; inclusion criteria: articles from QOL questionnaires in patients with HNC treated with RT with/without other antineoplastic treatments; study type: randomized, non-randomized, viability, cross-sectional, linear regression, prospective, longitudinal prospective and randomized prospective; available online; period: 2000-2020, published in Portuguese/English. Total of 18 articles selected using general and global health questionnaires in a patient with HNC. It is concluded that the questionnaire of the European Organization for Research and Treatment of Cancer (specific version for HNC H & 35 was the most applied followed by its version focused on global health (C30).Cáncer de cabeza y cuello (CCC) representa grupo de tumores malignos y la radioterapia (RxT) es tratamiento muy utilizado, sin embargo tiene efectos secundarios como mucositis oral, trismo, xerostomia, hiposalivación, entre otros. Se desarrollaron cuestionarios para evaluar la calidad de vida (CdV). El propósito de esta revisión fue evaluar la prevalencia de cuestionarios para evaluar la salud bucal y general de los pacientes sometidos a RxT para CCC en la literatura. Las bases de datos: PubMed® y Lilacs, con las palabras clave: “Salud bucal”, “Calidad de vida”, “Neoplasias de cabeza y cuello” y “Radioterapia” y “Salud bucal”, “Calidad de vida”, "Neoplasias de cabeza y cuello","Radioterapia"; criterios de inclusión: artículos de cuestionarios de calidad de vida en pacientes con CCC tratados con RxT con/sin otros tratamientos antineoplásicos; tipo de estudio: aleatorizado, no aleatorizado, de viabilidad, transversal, de regresión lineal, prospectivo, prospectivo longitudinal y prospectivo aleatorizado; disponible en linea; período: 2000-2020 y publicado en portugués/inglés. Total de 18 artículos seleccionados mediante cuestionarios de salud general y global. Se concluye que el cuestionario de la Organización Europea para la Investigación y el Tratamiento del Cáncer (versión específica para CCC H&35 fue el más aplicado seguido de su versión para la salud global (C30).O câncer de cabeça e pescoço (CCP) é um grupo de tumores malignos, de alta gravidade e a radioterapia é um tratamento altamente empregado nesse tipo de doença, mas possui efeitos colaterais como trismo, diminuição da função das glândulas salivares dentre outros. Assim houve a necessidade de estudos e criação de questionários para avaliar a qualidade de vida desses pacientes. O objetivo dessa revisão foi avaliar a eficácia dos questionários para avaliação da saúde bucal e geral dos pacientes submetidos a radioterapia de cabeça e pescoço. Após uma criteriosa seleção foram encontrados 18 artigos que realizaram estudos utilizando questionários de saúde geral e global em paciente com CCP. Assim concluímos que os questionários de avaliação da qualidade de vida voltados para saúde global e bucal são de suma importância para abranger o paciente de forma ampla e completa, ambos eficazes no auxílio no restabelecimento da qualidade de vida

Contribution of the CBCT in the diagnosis and treatment plan of odontogenic maxillary sinusitis: Cases Reports

Objective: Report two cases of Odontogenic Maxillary Sinusitis (OMS), diagnosed exclusively by Cone Bean Computed Tomography (CBCT). Case Report 1: A 48 years-old woman referred diffuse pain across the face and upper left first molar (ULFM) with carious lesion. The panoramic X-Ray showed a periapical lesion with delimited limits in the ULFM and opacification of the left maxillary sinus (OPMS). Only in CBCT there were relationship between ULFM periapical lesion and the maxillary sinus through cortical rupture of the maxillary sinus floor, thickening the maxillary sinus mucosa (TMSM). The OMS was diagnosed as a periapical cyst invol- ving the ULFM. She was referred to endodontic treatment. Case Report 2: A 33 years-old man referred diffuse pain though the face and in upper right first molar (URFM). The panoramic X-Ray showed a bone rarefaction without limits and vertical bone loss around the roots of URFM. The CBCT showed the same features of Case 1. Due the great TMSM a differential diagnosis between periodontal disease and maxillary sinus tumor was done. The diagnose of OMS and periodontal disease was done. The maxillary sinus was surgery explored though the oral communication of the dental extraction and the remaining communication. Conclusion: The CBCT impro- ved the details of infectious focus, alveolar bone and maxillary sinus involvement as well a better anatomical visualization between the affected teeth and the maxillary sinus which were not observed on 2D x-rays images.Objetivo: Relatar dois casos de Sinusite Maxilar Odontogênica (SMO), diagnosticados exclusivamente por Tomografia Computadorizada de Feixe Cônico (TCFC). Relato de Caso 1: Mulher, 48 anos de idade, referiu dor difusa em face e primeiro molar superior esquerdo (PMSE) com lesão cariosa. A radiografia panorâmica mostrou uma lesão periapical bem delimitada na região do PMSE e opacificação do seio maxilar esquerdo (OSME). Apenas na TCFC houve relação entre a lesão periapical do PMSE e o seio maxilar através da ruptura cortical do assoalho do seio maxilar, espessando a mucosa do seio maxilar (EMSM). A SMO foi diagnosticada como um cisto periapical envolvendo o PMSE. Ela foi encaminhada para tratamento endodôntico. Relato de Caso 2: Homem de 33 anos referiu dor difusa na face e no primeiro molar superior direito (PMSD). A radiografia panorâmica mostrou uma rarefação óssea sem limites e perda óssea vertical ao redor das raízes da PMSD. A TCFC mostrou as mesmas características do Caso 1. Devido o grande EMSM, foi feito um diagnóstico diferencial entre a doença periodontal e o tumor do seio maxilar. O diagnóstico de SMO e doença periodontal foi feito. O seio maxilar foi a cirurgia explorada através da comunicação oral da extração dentária e da comunicação remanescente. Conclusão: A TCFC proporcionou detalhes do foco infeccioso odontogênico, comprometimento do osso alveolar e seio maxilar, assim como uma melhor visualização anatômica entre os dentes afetados e o seio maxilar, os quais não foram observados nas imagens radiográficas 2D

Use of L-PRF as an adjuvant in the treatment of osteonecrosis of the jaw by medication: systematic review

A osteonecrose dos maxilares associada medicamentos foi descrita inicialmente em 2003, porém até hoje não se tem um protocolo estabelecido para o seu tratamento, porem o objetivo das intervenções é manter a qualidade de vida dos indivíduos e sobretudo diminuir a chance de infecções e recidivas. Desde a descoberta até os dias atuais surgiram novas técnicas que o auxiliam no tratamento destes indivíduos e dentre elas está o uso do L-PRF como adjuvante no tratamento cirurgico, que é um concentrado plaquetário rico em fibrina, leucócitos e fatores de crescimento que ajudam no processo de reparo dos tecidos moles. O objetivo deste estudo foi observar a eficácia do uso do L-PRF no tratamento cirúrgico da OMAM e assim, demonstrar cientificamente se pode ser uma alternativa no tratamento de pacientes com essa condição. A presente revisão sistemática foi conduzida de acordo com as diretrizes PRISMA e o protocolo para esta revisão sistemática foi registrado no PROSPERO (CRD42021273730). Foram realizadas buscas nas bases de dados online: PubMed, Embase, Web of Science, Scopus, BVS, Cochane Library e nas bases de dados da literatura cinza: OpenGrey, ProQuest, IBICT/BDTD e Google Schoolar, sendo coletados trabalho até o período de setembro de 2021. Um total de 488 publicações, após os critérios de inclusão e posterior triagem de títulos e resumo, 475 artigos foram excluídos e 13 artigos foram selecionados para leitura completa. Outros 7 foram excluídos devido a incompatibilidade do tipo de estudo e não possuía texto completo para leitura. Ao final, 6 trabalhos preencheram os critérios de inclusão e foram selecionados para o trabalho. Apesar de poucos estudos na literatura para ter um embasamento com um elevado grau de evidência científica, e pontos que precisam ser melhorados em trabalhos futuros sobre esse tema, pode-se afirmar que o uso do L-PRF como adjuvante no tratamento cirúrgico da OMAM é um a boa opção terapêutica, para um problema que compromete gravemente a qualidade de vida dos pacientes, devido ao seu custo benefício, facilidade na obtenção e a taxa de sucesso dos trabalhos apresentados.Drug-associated osteonecrosis of the jaws was initially described in 2003, but until today there is no established protocol for its treatment, but the objective of interventions is to maintain the quality of life of individuals and, above all, reduce the chance of infections and recurrences. Since the discovery until the present day, new techniques have emerged that help in the treatment of these individuals and among them is the use of L-PRF as an adjuvant in surgical treatment, which is a platelet concentrate rich in fibrin, leukocytes and growth factors that help in the soft tissue repair process. The aim of this study was to observe the effectiveness of using L-PRF in the surgical treatment of OMAM and thus scientifically demonstrate whether it can be an alternative in the treatment of patients with this condition. This systematic review was conducted in accordance with PRISMA guidelines and the protocol for this systematic review was registered in PROSPERO (CRD42021273730). Searches were carried out in online databases: PubMed, Embase, Web of Science, Scopus, BVS, Cochane Library and in gray literature databases: OpenGrey, ProQuest, IBICT/BDTD and Google Schoolar, with work being collected up to the period of September 2021. A total of 488 publications, after the inclusion criteria and subsequent screening of titles and abstract, 475 articles were excluded and 13 articles were selected for full reading. Another 7 were excluded due to incompatibility of the type of study and did not have the full text for reading. In the end, 6 works met the inclusion criteria and were selected for the work. Despite the few studies in the literature to have a basis with a high degree of scientific evidence, and points that need to be improved in future works on this topic, it can be stated that the use of L-PRF as an adjuvant in the surgical treatment of OMAM is one is a good therapeutic option for a problem that seriously compromises the quality of life of patients, due to its cost-effectiveness, ease of obtaining and the success rate of the studies presented