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OBJECTIVES: Serum increase of nitrogenous compounds (NC) in cirrhotic patients has been associated with the development of hepatic encephalopathy (HE). However, the relation between NC in saliva and HE is unclear. The objective of this study is to measure the levels of nitric oxide and urea in the blood and saliva in 38 cirrhotic patients and correlate them with clinical characteristics and presence and grades of HE. MATERIAL AND METHODS: Automated enzymatic colourimetric assays were performed to determine the levels of NC. Diagnosis and severity of HE were determined based on the West Haven criteria and by using the inhibitory control test. RESULTS: HE was diagnosed in 89.47% of the patients, with the majority (60.50%) presenting covert HE. With regard to the measurement of NC, although nitric oxide is moderately correlated with its amount in blood and saliva (r = 0.630; P < 0.001), only salivary levels were associated with the presence of ascites and ecchymosis (P = 0.013 and P = 0.030, respectively). In patients with HE, the serum levels of urea were higher (P = 0.013) than those in patients without HE or minimal HE. CONCLUSIONS: Nitrogenous compounds in the saliva were correlated with neither the presence nor grades of HE, whereas in the blood, only urea was positively correlated with the severity and presence of HE. CLINICAL RELEVANCE: Saliva is an excellent fluid for diagnosing several diseases, but it does not seem to be able to collaborate with the identification of HE.

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OBJECTIVE: To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs. MATERIALS AND METHODS: Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1ß, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used. RESULTS: Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 ß (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI. CONCLUSION: RANKL, OPG, IL-1ß, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI. CLINICAL RELEVANCE: This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

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OBJECTIVE: The aim of this study was to verify the presence and severity of sublingual varices in patients with cirrhosis and the correlation between these varices and nitrogen compounds (i.e., ammonia, urea and nitric oxide) in blood and saliva. STUDY DESIGN: This is a case-control observational study of 52 patients with cirrhosis and 52 normoreactive individuals, aimed at assessing the presence (degrees 0 and 1) and severity (mild, moderate, and severe) of sublingual varices. Medical records of the patients with cirrhosis, including complications of cirrhosis, were also obtained. Blood and saliva were collected to evaluate the presence of nitrogen compounds by means of automated enzymatic colorimetric assays. RESULTS: The cirrhosis group had a higher prevalence (n = 39; 75%) compared with controls (n = 22; 42.3%) as well as higher severity (moderate n = 12 [23.1%]; and severe n = 16 [30.0%]) (P = .001 and P < .001, respectively). Of the 39 patients with cirrhosis and sublingual varices, 84.6% had gastroesophageal varices. No correlations were found between the presence/severity of sublingual varices and cirrhotic complications/nitrogen compounds. CONCLUSIONS: The prevalence and severity of varices were higher in the cirrhosis group, but no correlations between the presence/severity of sublingual varices and nitrogen compounds were found.

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Knowledge of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is mostly based on adult cases, however bisphosphonates are also currently recommended for different paediatric diseases resulting in osteoporosis. The aim of this study was to review the literature on the risk of developing BRONJ in children and adolescents. The PubMed, LILACS, Web of Science, Scopus, and Cochrane databases were searched using the key words "bisphosphonates", "osteonecrosis", "jaw", and "children". Literature reviews, case reports, abstracts, theses, textbooks, and book chapters were excluded. Studies involving children and young adults (younger than 24 years of age) were included. A total of 56 publications were identified. After applying the eligibility criteria, only seven articles remained. Although no cases of osteonecrosis were identified, all studies had weaknesses such as a limited sample size or the absence of risk factors for the development of osteonecrosis. There is general consensus that this subject should be of concern and that further studies should be conducted before any definitive opinion is reached. It is believed that patients with secondary osteoporosis who use bisphosphonates continuously should be followed up during adulthood, since bone turnover decreases over the years.

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Objetivo: Avaliar a saúde bucal de pacientes com cirrose hepática em fila de transplante. Materiais e Método: Foram avaliados 103 pacientes cirróticos quanto às características sócio-demográficas e histórico médico da cirrose hepática (etiologia, tempo de inclusão na fila de transplante, valor do MELD - Model for End-Stage Liver Disease, complicações da cirrose e medicações em uso). A avaliação da saúde oral foi feita através do índice de higiene oral simplificado (IHO-S), do índice de cárie dental (CPOD) e da sialometria. Foram realizadas análises descritivas após a tabulação dos dados. Resultados: A população estudada apresentava idade média de 54 anos, o sexo masculino era o mais prevalente e apenas 44% concluíram o ensino fundamental. Hepatite C e cirrose alcoólica foram as etiologias que, com mais frequência, levaram os pacientes a indicação de transplante hepático. Varizes esofágicas, ascite e hipertensão portal foram as complicações mais frequentes. O CPOD médio da população estudada foi considerado alto (23,3). Conclusão: A saúde bucal de pacientes cirróticos em fila de transplante não é satisfatória. Estudos longitudinais são necessários para investigar a relação entre focos de infecção oral e a ocorrência de infecções no pós-transplante hepático.

Objectives: To assess the oral health of patients waiting for a liver transplantation. Material and Methods: A total of 103 cirrhotic patients were evaluated for socio-demographic characteristics and medical history of liver cirrhosis (etiology, time of inclusion in the transplant list, MELD - Model for End Liver Disease - value, complications of cirrhosis and routine medications in use). In addition, simplified oral hygiene index (IHO-S), dental caries index (DMFT) and sialometry were performed to verify oral health. After tabulation of the data, descriptive analyzes were performed. Results: The mean age was 54 years, the male gender was the most prevalent and the elementary school was completed by only 44% of the studied population. Hepatitis C and alcoholic cirrhosis were the etiologies that, more frequently, led the patients to indication for liver transplantation. Esophageal varices, ascites and portal hypertension were the complications of cirrhosis most observed. The mean DMFT of the studied population was considered high (23.3 ). Conclusions: The oral health of cirrhotic patients in the waiting list for transplantation is not satisfactory. Longitudinal studies are needed to investigate the relationship between foci of oral infections and the occurrence of infections post-transplant liver.

Objetivo: Evaluar la salud bucal de pacientes con cirrosis hepática en fila de trasplante. Material y Métodos: Fueron evaluados 103 pacientes cirróticos en cuanto a las características sociodemográficas e historial médico de cirrosis hepática (etiología, tiempo de inclusión en fila de trasplante, valor del MELD - Model for End-Stage Liver Disease, complicaciones de la cirrosis y medicaciones en uso). Así mismo fueron realizados los siguientes índices para evaluación de la salud bucal: índice de higiene oral simplificado (IHO-S), índice de caries dental (CPOD) y sialometría. Fueron realizados análisis descriptivos después de la tabulación de datos. Resultados: La población estudiada presentaba edad media de 54 años, el sexo masculino era el más prevalente y sólo el 44% concluyeran la educacion fundamental. La hepatitis C y la cirrosis alcohólica fueron las etiologias que con más frecuencia, llevaron a los pacientes a indicación de trasplante hepático. Las complicaciones de la cirrosis más observadas fueron várices esofágicas, ascitis e hipertensión portal. El CPOD medio de la población estudiada fue considerado alto, comparado con personas normoreactivas del mismo grupo etáreo (23,3 y 16,75 respectivamente ). Conclusiones: La salud bucal de pacientes cirroticos en fila de trasplante no es satisfactoria. Estudios longitudinales son necesarios para investigar la relación entre focos de infección bucal y la ocurrencia de infecciones en el post transplante hepático.

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Introdução. Alguns estudos sugerem que crianças com doença hepática podem apresentar alterações nos tecidos dentários como pigmentação amarelada ou esverdeada, hipoplasia de esmalte e atraso de erupção dentária. A avaliação e o tratamento odontológico são importantes tanto previamente quanto após o transplante hepático. Neste sentido, mais estudos são importantes para confirmação destes achados. Objetivo. Avaliar prospectivamente a condição de saúde bucal e identificar as possíveis alterações odontológicas e bucais apresentadas pelos pacientes pediátricos pré-transplante hepático. Materiais e métodos. Estudo prospectivo que consistiu em examinar 50 pacientes pediátricos (até 18 anos) que estavam em programação de transplante hepático no A.C. Camargo Cancer Center entre setembro de 2013 e maio de 2014. Dados demográficos e sobre a condição geral dos pacientes foram coletados dos prontuários. Dados da condição odontológica como presença de pigmentação dentária por bilirrubina, hipoplasia de esmalte, cronologia de erupção, malformações dentárias, ceo-d e CPO-D ou alterações bucais foram avaliados nas consultas prévias ao transplante. Resultados. A idade dos pacientes variou entre 3 e 205 meses, média de 48,6 meses e mediana de 19,5 meses. Vinte e nove (58%) pacientes eram do gênero feminino e atresia das vias biliares foi a doença de base mais frequente. Dos 50 pacientes, 39 pacientes possuiam pelo menos um dente, 18 (46%) necessitaram de tratamento odontológico, e 15 (38,5 %) apresentaram cárie. Os índices de ceo-d e CPO-D foram respectivamente 1,5 e 2,6. Pigmentação dentária por bilirrubina foi observada em 18 pacientes (46%) e todos eram colestáticos (p= 0,043). Dos 39 pacientes dentados, hipoplasia de esmalte foi encontrada em 4 (10%), e 13 pacientes (29%) de 45 avaliados apresentaram atraso na erupção dentária. Alterações da mucosa bucal foram estudadas nos 50 pacientes, 15 (30%) apresentaram lábios fissurados, 13 (26%) lábios ressecados, 7 (14%) lábios edemaciados e 1 paciente (2%) apresentou lesões ulceradas na mucosa bucal. Níveis séricos de fósforo foram menores nos pacientes que tinham atraso na cronologia de erupção (p= 0,006), dosagem de fosfatase alcalina foi menor nos pacientes que apresentaram lábios ressecados (p= 0,032) e lábios fissurados (p= 0,035) e dosagem de bilirrubina direta foi maior nos pacientes que apresentaram pigmentação dentária (p= 0,049). Conclusão. Os índices de ceo-d e CPO-D relataram prevalência baixa de cárie segundo a Organização Mundial de Saúde. A pigmentação dentária por bilirrubina foi a alteração odontológica mais frequente e parece estar associada aos pacientes colestáticos. Com relação às alterações de mucosa bucal foi observado que pacientes previamente ao transplante podem apresentar alterações lábiais que não eram comentadas na literatura.

Introduction. Some studies suggest that children with liver disease may show changes in dental tissues such as yellow or green pigmentation, enamel hypoplasia and delay tooth eruption. The evaluation and dental treatment are both important before and after liver transplantation. Thereby, further studies are important to confirm these findings. Objective. Evaluate prospectively the oral health status and identify possible dental and oral changes presented by pediatric patients in program to liver transplant. Materials and methods. This was a prospective study to examine 50 patients (18 years) who were in program to liver transplant at the AC Camargo Cancer Center between September 2013 and May 2014. Demographic data and the general condition of the patients were collected from medical records. Dental conditions as the presence of dental pigmentation bilirubin, enamel hypoplasia, chronology of eruption, dental malformations, dmft and DMFT or oral changes were evaluated in oral exam prior to transplantation. Results. The patients' ages ranged from 3 to 205 months, average 48.6 months and median of 19.5 months. Twenty-nine (58%) patients were female and biliary atresia was the most frequent underlying disease. Of the 50 patients, 39 patients possessed at least one tooth, 18 (46%) required dental treatment, and 15 (38.5%) had caries. The indices dmft and DMFT were respectively 1.5 and 2.6. Tooth discoloration caused by hyperbilirubinemia was observed in 18 patients (46%) and all were cholestatics (p = 0.043). Of the 39 dentate patients, enamel hypoplasia was found in 4 (10%), and 13 patients (29%) of 45 evaluated had delay tooth eruption. Oral mucosa lesions were studied in 50 patients, 15 (30%) had fissured lips, 13 (26%) dry lips, 7 (14%) swollen lips and 1 patient (2%) had ulcerated lesions in the oral mucosa. Serum phosphorus levels were lower in patients who had delay in the chronology of eruption (p = 0.006), alkaline phosphatase was lower in patients with dry lips (p = 0.032) and fissured lips (p = 0.035) and bilirubin direct was higher in patients who had dental pigmentation (p = 0.049). Conclusion. The indices dmft and DMFT reported low prevalence of caries according to the World Health Organization. Tooth discoloration caused by hyperbilirubinemia was the most frequent dental alteration and appears to be linked to cholestatics patients. Regarding the oral mucosa alterations was observed that patients before transplantation may have lip alterations that were not commented in the literature.

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