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BACKGROUND: Both zoledronic acid, a potent bisphosphonate, and the antiangiogenic drug sunitinib are included in anticancer protocols and have also been associated with jaw osteonecrosis. Our aim was to compare the effect of these drugs on tissue repair at tooth extraction sites. METHODS: Wistar rats were allocated into four groups: (1) sunitinib; (2) sunitinib/zoledronic acid; (3) zoledronic acid; (4) control group. The animals underwent tooth extractions and maxillae were macro- and microscopically analyzed. RESULTS: On macroscopic evaluation, the zoledronic acid group showed a significantly higher frequency of oral mucosal lesion; lesions in the sunitinib/zoledronic acid group were larger, albeit not significantly so. The sunitinib/zoledronic acid group had significantly less epithelium than the zoledronic acid and control group, but showed no significant difference compared to the sunitinib group. The sunitinib/zoledronic acid and zoledronic acid groups did not differ from each other, but had significantly less connective tissue and more non-vital bone and microbial colonies than sunitinib and control groups, whereas these latter two groups did not significantly differ from each other. Vital bone and inflammatory infiltrate did not significantly differ between groups. CONCLUSION: Sunitinib alone is not associated with non-vital bone, whereas the sunitinib/zoledronic acid combination and zoledronic acid alone are.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Ratos , Animais , Ácido Zoledrônico , Conservadores da Densidade Óssea/farmacologia , Sunitinibe , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Ratos Wistar , Difosfonatos/farmacologia , Extração DentáriaRESUMO
OBJECTIVE: To perform a literature review addressing the therapeutic strategies for salivary hypofunction. BACKGROUND: Qualitative and quantitative salivary dysfunctions predispose to changes in the oral mucosa and teeth, cause impairment to oral functions and negative impact on quality of life. MATERIALS AND METHODS: A MEDLINE/PubMed search was conducted using the terms "Xerostomia" AND, "Saliva Artificial" OR, "Citric Acid," "Malic Acid," "Chewing Gum," "Acupuncture" OR, "Pilocarpine" OR, "Bethanechol" OR, "Cevimeline" OR, "Hyperbaric Oxygen Therapy" OR, "Stem Cell Therapy" OR "Genetic Therapy" and their Mesh Terms. RESULTS: We selected 25 clinical trials investigating the effects of salivary substitutes, chewing gum, malic and citric acids, pilocarpine, cevimeline, bethanechol, acupuncture, hyperbaric oxygen therapy and regenerative therapies on salivary hypofunction. In most studies, the number of participants was low and the follow-up times short. The therapeutic modalities were classified according to the level of evidence on salivary dysfunction. CONCLUSIONS: Pilocarpine and cevimeline had the strongest evidence of beneficial effect on salivary hypofunction. Citric and malic acids increase salivary flow but also increase the risk of erosion and dental caries. There are no controlled clinical trials supporting the efficacy of acupuncture, stem cell therapy and gene therapy on salivary dysfunction, although clinical observations suggest a promising effect. There is no evidence supporting salivary substitutes, chewing gum, bethanechol or hyperbaric oxygen on the treatment of salivary hypofunction.
Assuntos
Agonistas Muscarínicos/uso terapêutico , Pilocarpina/uso terapêutico , Quinuclidinas/uso terapêutico , Tiofenos/uso terapêutico , Xerostomia/terapia , Terapia por Acupuntura , Betanecol/uso terapêutico , Goma de Mascar , Humanos , Oxigenoterapia Hiperbárica , Xerostomia/tratamento farmacológicoRESUMO
OBJECTIVES: To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy. METHODS: A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX). RESULTS: Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups. CONCLUSIONS: BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/sangue , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Radiografia Panorâmica , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To conduct a literature review on sodium alendronate, focusing on osteonecrosis of the jaws, a serious potential side effect. BACKGROUND: Sodium alendronate is a bisphosphonate that is widely used for the treatment of osteopenia, osteoporosis and Paget's disease. Like other bisphosphonates, it inhibits bone resorption by inactivating osteoclasts. Alendronate has evident benefits in the treatment of these diseases, but it is associated with jaw osteonecrosis, although less frequently compared with intravenous bisphosphonates. Therefore, some preventive measures should be taken to avoid this side effect. MATERIAL AND METHODS: We reviewed the literature regarding the pharmacological aspects, mechanism of action, indications of use and side effects of sodium alendronate, as well as the management of patients under this therapy. CONCLUSION: The benefits of sodium alendronate are scientifically proven, but a serious adverse effect is osteonecrosis. Therefore, it is crucial to prepare the oral cavity before bisphosphonate therapy, providing a careful dental evaluation and all needed dental treatment.
Assuntos
Alendronato/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Doenças Maxilomandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , HumanosRESUMO
O processo diagnóstico abrange uma série de dados durante a anamnese e exame físico do paciente. Quando não for possível definir o mesmo através do exame clínico, a solicitação de exames complementares torna-se imprescindível para estabelecer o diagnóstico conclusivo. Entre os métodos utilizados atualmente, podemos destacar a ultrassonografia, que é considerado um exame seguro, sem efeitos deletérios ao paciente e de baixo custo. Contudo, a ecografia não parece ser um exame solicitadorotineiramente pelo cirurgião-dentista. Acredita-se que o desconhecimentodos profissionais da odontologia em relação as suas indicações de uso e vantagens, possa favorecer esta prática. A partir das informações mencionadas, este estudo se propõe a avaliar, através do preenchimento de um instrumento (questionário) desenvolvido especificamente para este fim, o grau de conhecimento e utilização da ultrassonografia por cirurgiões--dentistas clínicos e especialistas que exerçam suas atividades profissionais nos últimos 12 meses.
The diagnostic process comprises a series of data during the patient?s case history and physical examination. When it is no possible define it through clinical examination, it is essential to request complementary exams to have a conclusive diagnosis. Among the currently used methods it is noteworthy to mention ultrasound, which is considered a safe examination, without deleterious effects to the patient and at low cost. However, ultrasound does not seem to be a routinely requested exam by adental surgeon. It is believed that the lack of knowledge of dental professionals regarding their intended use and advantages may favor this practice. From the above information, this study aims to evaluate, by completing an instrument (questionnaire) developed specifically for this purpose, the degree of knowledge and use of ultrasonography for clinical dental surgeons and specialists who have performed their professional activities in the last 12 months.
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Foi feito um levantamento epidemiológico buscando identificar, classificar e quantificar as patologias presentes na estrutura da língua dos pacientes atendidos no Serviço de Estomatologia e Prevenção do Câncer do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), contemplando um período de 35 anos. Método: estudo retrospectivo, executado a partir da análise de 5928 prontuários onde constavam lesões de língua. Resultados: encontrou-se uma gama variada de patologias, totalizando 7862 lesões localizadas na região, sendo estas classificadas em 14 grupos distintos. As lesões específicas da língua foram as mais frequentes, sendo a língua saburrosa a enfermidade com a maior casuística. A hiperplasia da mucosa, glossite rômbica mediana, hemangioma e carcinoma espinocelular somaram o maior número de casos respectivamente nos grupos de lesões traumáticas, infecções fúngicas, neoplasias benignas e malignas. O carcinoma espinocelular, tumor maligno mais prevalente na boca, comprometeu principalmente o bordo posterior da língua, preferentemente acometendo homens acima de 40 anos. Conclusão: a identificação de diversas lesões favorece o estabelecimento do diagnóstico precoce bem como o tratamento das enfermidades presentes e reforça a importância do exame sistemático desta área anatômica, no dia a dia do cirurgião-dentista.
Epidemiological data were obtained on tongue diseases of patients treated at the Oral Medicine and Maxilofacial Cancer Prevention Centre of São Lucas Hospital at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil, for a period of 35 years. Methods: a retrospective study was performed, assessing 5928 patients' folders which tongue lesions were observed. Results: a myriad of lesions, totalizing 7862 lesions could be found in the tongue, being classified into 14 distinct groups. Lesions that occur specifically in the tongue were the most frequent. Coated tongue was the lesion with most cases. Mucosal hyperplasia, median rombic glossitis, hemangioma and spindle cell carcinoma were, respectively, found to be the most frequent in cases of trauma, fungal infections, benign and malign tumors. Spindle cell carcinoma, the most prevalent malign tumor of the mouth, compromised mostly the posterior tongue border, being most occurrent in men aging over 40 years. Conclusion: the identification of various lesions allows the early diagnosis and proper treatment of diseases. It is important that the dental surgeon systematically proceeds with the examination of this important anatomic site.
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OBJECTIVE: This article is a review of the several types of complications due to facial fillers containing polymethylmethacrylate (PMMA). BACKGROUND: Polymethylmethacrylate facial fillers are used to soften the results of the ageing process and to augment tissue. Although considered safe for the most part by advocates, they have been associated with many adverse reactions such as ecchymosis, haematomas, swelling, itching, erythema, hypertrophic scarring, hypersensitivity, palpable nodules, tissue necrosis, blindness and foreign body granuloma. MATERIALS AND METHODS: The articles presented in this review are the result of a search and selection of literature from the National Center for Biotechnology Information (NCBI) database, which met the inclusion criteria for the study. CONCLUSION: Polymethylmethacrylate is widely used because it is inexpensive, readily accessible and simple to apply. However, some complications are severe and permanent and can be confused with other types of stomatological lesions.
Assuntos
Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Polimetil Metacrilato/efeitos adversos , Face , Humanos , Envelhecimento da Pele/efeitos dos fármacos , Dermatopatias/induzido quimicamenteRESUMO
BACKGROUND: The purpose of this study was to investigate the influence of diabetes and corticotherapy on the development of osteonecrosis of the jaws associated with sodium alendronate. METHODS: Rats were allocated into 4 groups of 11 animals each, representing different treatments: (1) alendronate; (2) alendronate and corticotherapy; (3) alendronate and diabetes; and (4) control. Tooth extractions were performed in all animals, and histological analysis was performed by hematoxylin and eosin staining and immunohistochemistry using anti-bone morphogenetic protein (BMP)-4 and anti-matrix metalloproteinase (MMP)-13 antibodies. RESULTS: On hematoxylin and eosin analysis, proportions of inflammatory infiltrate, microbial colonies, and osteonecrosis were significantly greater in the diabetes group. BMP-4 expression in connective tissue was higher in the corticosteroid group than the alendronate group. There were no significant differences between the other groups. MMP-13 expression did not differ between the groups analyzed. CONCLUSION: Diabetes but not corticotherapy is associated with jaw osteonecrosis in rats undergoing alendronate therapy and subjected to tooth extractions.
Assuntos
Corticosteroides/efeitos adversos , Alendronato/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Diabetes Mellitus Experimental/complicações , Corticosteroides/farmacologia , Alendronato/farmacologia , Animais , Biópsia por Agulha , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/farmacologia , Diabetes Mellitus Experimental/patologia , Modelos Animais de Doenças , Imuno-Histoquímica , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de Referência , Fatores de RiscoRESUMO
O câncer bucal é prioridade do Ministério da Saúde e o cirurgião-dentista (CD) deve comprometer-se efetivamente com sua prevenção e diagnóstico. Objetivos: Estabelecer e comparar o conhecimento dos acadêmicos de Odontologia da PUCRS sobre fatores de risco e condutas vinculadas ao câncer bucal e verificar o grau de interesse na educação continuada sobre o tema. Materiais e Métodos: Foram aplicados questionários a 289 acadêmicos dos 5 anos da graduação. Os resultados foram analisados pelo software SPSS versão 10.0 e considerados significativos quando p ? 0,05. Resultados: 100% dos formandos identificaram o carcinoma como a neoplasia maligna bucal mais prevalente. Independente do ano em curso, demostraram adequado conhecimento sobre câncer bucal e alto índice de acerto na identificação dos fatores de risco. O conhecimento aumentou com o avanço no curso, sendo o melhor desempenho obtido no 2º e 5º anos, quando cursaram respectivamente as disciplinas de Patologia Bucodental, Saúde Coletiva II e Estomatologia. Constatou-se que existem diferenças significativas para o total de acertos entre os semestres, demonstrando que o avanço no curso reflete em um maior número de respostas corretas. A maioria dos acadêmicos não participou de cursos temáticos de educação continuada, entretanto identificaram a importância do CD na prevenção e diagnóstico do câncer bucal.
Oral cancer is a priority of the Ministry of health and dentists should be able to adhere to the available programs providing adequate prevention and diagnosis. Objectives: To assess level of knowledge of PUCRS?s dentistry students about risk factors and behaviors linked to oral cancer and verify the amount of interest in continuing education on the topic. Materials and methods: Questionnaires were applied to 289 students of 5 years of graduation. Results were analyzed using SPSS version 10.0 and considered significant when p ? 0.05. Results: 100% of students identified carcinoma as the most prevalent malignant oral disease. They demonstrated adequate knowledge about oral cancer and high rate of accuracy in identification of risk factors, regardless of the year of graduation. Knowledge increased with the advancement in the course, being the best performance obtained in 2nd and 5th years, when taking classes of Oral Pathology, Public Health II and Oral Medicine, respectively. Conclusions: There were significant differences of correctness amongst semesters, demonstrating that the advance in course reflects in a higher education in this . Most students did not attend thematic courses in continuing education, however identified the importance of dentist in the prevention and diagnosis of oral cancer.
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BACKGROUND: Lupus erythematosus is a serious autoimmune disease, which can cause oral mucosal lesions, manifesting as white striae and erythematous, atrophic and hyperkeratotic areas, as well as erosions and ulcerations. Sometimes, these signs can be misdiagnosed as other oral diseases such as lichen planus. Also, on histopathological examination with haematoxylin-eosin staining (HE), the features of these diseases can overlap. MATERIALS AND METHODS: The authors report here two cases of oral lesions of lupus erythematosus, with a discussion of their clinical features and the process of differential diagnosis. CONCLUSIONS: It is crucial to consider in the diagnostic process for lupus erythematosus the whole clinical information as well as haematological tests, histopathological features in HE and direct immunofluorescence, not only at first evaluation but also during patient follow-up.
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Doenças Labiais/diagnóstico , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Técnica Direta de Fluorescência para Anticorpo/métodos , Seguimentos , Humanos , Doenças da Boca/diagnóstico , Mucosa Bucal/patologia , Palato/patologiaRESUMO
BACKGROUND: This study aimed to analyze the oral lesions of chronic paracoccidioidomycosis concerning their histomorphometric, immunohistochemical, and clinical features in a standardized sample. METHODS: Fifty biopsy specimens of oral lesions of chronic paracoccidioidomycosis were submitted to hematoxylin and eosin (H&E), Grocott-Gomori and immunohistochemical staining. Data regarding disease duration and size and number of oral lesions, as well as erythrocytes, leukocytes, lymphocytes, hematocrit, hemoglobin, and erythrocyte sedimentation rate, were collected from medical charts. Granuloma density and number and diameter of buds and fungal cells, and IL-2, TNF-alpha and IFN-gamma expression, as well as clinical and hematological features, were quantified and correlated. RESULTS: Bud diameter was significantly greater in intermediate density granulomas compared to higher density granulomas. The other variables (number of buds, number and diameter of fungi, expression of IL-2, TNF-alpha and IFN-gamma, and clinical and hematological features) did not significantly change with the density of granulomas. There was a positive correlation between bud number and fungal cell number (r = 0.834), bud diameter and fungal cell diameter (r = 0.496), erythrocytes and number of fungi (r = 0.420), erythrocytes and bud number (r = 0.408), and leukocytes and bud number (r = 0.396). Negative correlation occurred between number and diameter of fungi (r = -0.419), bud diameter and granuloma density (r = -0.367), TNF-alpha expression and number of fungi (r = -0.372), and TNF-alpha expression and bud number (r = -0.300). CONCLUSION: The histological, immunological, and clinical features of oral lesions evaluated did not differ significantly between patients in our sample of chronic paracoccidioidomycosis. TNF-alpha levels were inversely correlated with intensity of infection.
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Doenças da Boca/microbiologia , Paracoccidioidomicose/patologia , Adulto , Idoso , Biópsia , Sedimentação Sanguínea , Doença Crônica , Contagem de Colônia Microbiana , Eritrócitos/patologia , Feminino , Granuloma/microbiologia , Hematócrito , Hemoglobinas/análise , Humanos , Hifas/citologia , Imuno-Histoquímica , Interferon gama/análise , Interleucina-2/análise , Leucócitos/patologia , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/sangue , Paracoccidioides/citologia , Paracoccidioidomicose/sangue , Fator de Necrose Tumoral alfa/análiseRESUMO
BACKGROUND: The aim of this study was to compare clodronate and zoledronic acid regarding their influence on the repair of surgical wounds in maxillae (soft tissue wound and tooth extraction) and their relation to osteonecrosis. MATERIAL AND METHODS: Thirty-four Wistar rats were allocated into three groups according to the treatment received: (i) 12 animals treated with zoledronic acid, (ii) 12 animals treated with clodronate and (iii) 10 animals that were given saline solution. All animals were subjected to tooth extractions and surgically induced soft tissue injury. Histological analysis of the wound sites was performed by means of hematoxylin-eosin (H&E) staining and immunohistochemical staining for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), von Willebrand factor, and caspase-3. RESULTS: The zoledronic acid group showed higher incidence of non-vital bone than did the clodronate group at the tooth extraction site. At the soft tissue wound site, there were no significant differences in non-vital bone between the test groups. RANKL, OPG, von Willebrand factor, and caspase-3 did not show significant differences between the groups for both sites of surgical procedures. CONCLUSION: Both of the bisphosphonates zoledronic acid and clodronate are capable of inducing maxillary osteonecrosis. Immunohistochemical analysis suggests that the involvement of soft tissues as the initiator of osteonecrosis development is less probable than has been pointed out.
Assuntos
Conservadores da Densidade Óssea/farmacologia , Ácido Clodrônico/farmacologia , Difosfonatos/farmacologia , Imidazóis/farmacologia , Maxila/cirurgia , Animais , Carga Bacteriana , Caspase 3/análise , Tecido Conjuntivo/efeitos dos fármacos , Tecido Conjuntivo/patologia , Epitélio/efeitos dos fármacos , Epitélio/patologia , Feminino , Maxila/efeitos dos fármacos , Maxila/microbiologia , Maxila/patologia , Doenças Maxilares/induzido quimicamente , Doenças Maxilares/patologia , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/lesões , Osteonecrose/induzido quimicamente , Osteonecrose/patologia , Osteoprotegerina/análise , Ligante RANK/análise , Ratos , Ratos Wistar , Extração Dentária , Alvéolo Dental/efeitos dos fármacos , Alvéolo Dental/microbiologia , Alvéolo Dental/patologia , Cicatrização/efeitos dos fármacos , Ácido Zoledrônico , Fator de von Willebrand/análiseRESUMO
BACKGROUND: This work aimed at determining whether bisphosphonate therapy produces a sufficient condition for jaw osteonecrosis after tooth extraction. METHODS: Rats were allocated into 3 groups: (1) 11 rats treated with alendronate, (2) 10 rats treated with zoledronic acid, and (3) 10 control rats. The animals were subjected to tooth extractions, and at the end of bisphosphonate therapy, they were humanely killed. Histologic sections of the surgical site were processed and analyzed. RESULTS: The zoledronic acid group showed higher incidences of osteonecrosis, inflammatory infiltrate, and microorganisms. There was no significant difference for epithelial or connective tissue, root fragments, vital bone, and positive staining for vascular endothelial growth factor (VEGF) among the groups. CONCLUSION: Zoledronic acid is associated with jaw osteonecrosis, whereas alendronate did not produce a condition sufficient for osteonecrosis after tooth extraction. Neither zoledronic acid nor alendronate was associated with a reduced immunohistochemical expression of VEGF in vital bone at the tooth extraction site.