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

Background

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.

Material and Methods

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.

Results

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.

Conclusions

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.

Key words:Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.

Effect of maxillary advancement on speech and velopharyngeal function of patients with cleft palate: Systematic Review and Meta-Analysis

This systematic review (SR) aimed to evaluate speech and velopharyngeal function (VPF) changes of patients with cleft palate (CLP) after maxillary advancement (MA) surgery. A two-phase PROSPERO-registered SR (CRD42019141370) was conducted following the PRISMA statements. Search strategies were developed for main databases (PubMed, Scopus, Web of Science, COCHRANE, LILACS, and EBSCOhost) and Grey literature information sources. The GRADE tool was used to evaluate the quality of evidence. From a total of 908 articles, 10 (205 men and 147 women; mean age ranging from 18.0 to 25.7 years) were selected for meta-analysis. Moderate to high risk of bias (Rob) was observed. The most common methods for outcomes evaluation were the Nasometer (speech) and nasoendoscopy (VPF). Speech changed from normal to hypernasal, and VPF worsening were reported in most studies. Comparing maxillary advancement interventions (osteogenic distraction versus Le Fort I), no statistically significant differences were found regarding benefit on speech and VPF. In summary, the effect of MA on speech and VPF remains controversial in CLP patients. The RoB, inconsistencies, and imprecisions severely affected the overall quality of evidence. Further adequately delineated clinical studies are necessary to investigate the potential effect of MA interventions on speech and VPF in CLP patients.

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

Background

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.

Material and Methods

Searches were conducted on Medline via Pubmed, LILACS, Dare Cochrane, Scopus, and Sigle via Open Grey up to June 2019.

Results

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.

Conclusions

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.

Key words:Zygomatic Implants, dental Implants, complications, oral rehabilitation.

Zika virus: oral healthcare implications

Zika virus (ZIKV) infection has been recognised since 1947, but just recently it became a worldwide major public health problem. The most common features of ZIKV infection are fever, cutaneous rash, arthralgia and conjunctivitis but most affected patients with the clinical disease present with only mild symptoms. However, severe neurological complications have been described: there is an occasional association with Guillain-Barre syndrome, and emerging data indicate an association between vertical transmission of ZIKV infection and microcephaly, but no specific orofacial manifestations have yet been reported. ZIKV is present in body fluids and has also been demonstrated in the saliva, but there is as yet no reliable evidence to support ZIKV transmission via this pathway. Transmission in oral health care should be effectively prevented using standard infection control measures. There are currently no specific treatments for Zika virus disease and no vaccines available, so prevention of ZIKV is based on vector control.

Current use and future perspectives of diagnostic and therapeutic lasers in Oral Medicine

Several diagnostic and therapeutic methods are based on the optical properties of lasers. In therapeutic applications, laser light is absorbed in a specific manner, whereas light is scattered, reflected, or transmitted from different structures. Improvements in laser technology allow new procedures and broaden the scope of applications for both diagnosis and therapy. The focus of laser application in Oral Medicine diagnosis should be early detection of oral squamous cell carcinoma. Novel modalities for the detection of oral malignancy are urgently needed, while others must be continuously improved. Optical coherence tomography and laser-induced fluorescence spectroscopy are currently being studied. In addition to diagnosis of non-malignant lesions, laser therapy has been used based upon the biological reactions and molecular wound healing mechanisms as an alternative for the treatment of a variety of oral soft tissue lesions. The aim of the present article is to review current knowledge and future perspectives of lasers in Oral Medicine.

Microcystin-induced oxidative stress in Laeonereis acuta (Polychaeta, Nereididae)

Oxidative stress induced by microcystins was evaluated in an estuarine worm, Laeonereis acuta (Nereididae). Ten organisms were exposed to lyophilized cells of a toxic Microcystisaeruginosa strain RST9501 ( approximately 2 microg/mL microcystins, MC); 10 were exposed to lyophilized cells of a nontoxic Aphanotece sp. strain RSMan92 and 10 were maintained without cyanobacterial cells. Exposure time was 48 h. The enzymatic antioxidant defenses, as well as the oxidative damage, were analyzed. Toxic and nontoxic cyanobacteria lowered catalase activity with no changes in glutathione reductase and glutathione-S-transferase activities. This may have led to toxin intracellular accumulation, which should favor oxidative stress generation, observed by the high lipid peroxide and DNA-protein crosslink levels in the group exposed to MC.

Knowledge and clinical expertise regarding oral cancer among Brazilian dentists

The aim of the present work was to assess the knowledge and attitudes of Brazilian General Dental Practitioners with regard to aspects of the aetiology, early diagnosis and prevention of oral cancer relevant for general dental practice. A convenience sample of 129 dentists in Brazil was randomly selected and asked to complete a questionnaire. Results of bi-variated analysis revealed that a self-perceived good knowledge regarding relevant aspects of oral cancer was statistically significantly associated with male gender (Chi square=4.59, P<0.05). Simple logistic regression revealed that male professionals were 2.9 times more knowledgeable than their female colleagues (OR=2.9, 1.1-8.1 95% CI, P=0.037), although, this association was not statistically significant when adjusted for age using multiple regression analysis (OR=2.7, 0.9-7.5 95% CI, P=0.059). There were no significant differences in relevant knowledge and attitudes of private compared with public dentists. Importantly, General Dental Practitioners who spent more than half of time of a patient's initial consultation undertaking a clinical examination were the more likely to detect oral cancer (Chi square=4.245, P=0.039) than those who set aside little time examining their patients. It is concluded that the knowledge of dentists in Brazil regarding relevant aspects of oral cancer is suboptimal, and may not be associated with any examined social-demographic variables. Further research is required to clarify the role of continuing professional education in improving the knowledge and attitudes of dentists relevant to oral cancer in Brazil.

Review article: orofacial granulomatosis

Orofacial granulomatosis is an uncommon clinicopathological entity describing patients who have oral lesions characterized by persistent and/or recurrent labial enlargement, oral ulcers and a variety of other orofacial features, who on lesional biopsy have lymphoedema and non-caseating granulomas. The aetiology of oral lesions with non-caseating granulomas includes oral Crohn's disease (some patients with oral lesions will develop typical bowel symptoms of Crohn's disease in ensuing months to years), tooth-associated infections, sarcoidosis and food or contact allergies. Treatment of orofacial granulomatosis is not reliably effective and may not be always necessary, although most patients do require some medical intervention.