Aim To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended.

Resumo A síndrome de Stevens-Johnson é relatada como uma reação incomum de hipersensibilidade tardia associada principalmente ao uso de medicamentos, e que se manifesta prioritariamente através de erupções cutâneas e ulcerações nas membranas mucosas que revestem a boca, o órgão genital e os olhos. O dimaleato de afatinibe é uma medicação inibidora da tirosina quinase que tem como alvo o recetor do fator de crescimento epidérmico, sendo indicada como monoterapia para o tratamento de carcinoma pulmonar de células não pequenas. A síndrome de Stevens-Johnson é um efeito adverso raro dessa medicação. O presente relato tem por objetivo apresentar um caso clínico de manifestação da Síndrome de Stevens-Johnson em um paciente jovem do sexo masculino após uso de dimaleato de afatinibe para tratamento de um adenocarcinoma pulmonar, com ênfase na perspetiva terapêutica odontológica em relação às manifestações orais de tal condição.

Abstract Stevens-Johnson syndrome is an uncommon delayed hypersensitivity reaction primarily associated with drug use, manifested primarily through rashes, ulcerations of the mucous membranes lining the mouth, genitals, and eyes. Afatinib dimaleate is a tyrosine kinase inhibitor that targets the epidermal growth factor receptor and is indicated as a monotherapy for the treatment of non-small-cell lung carcinoma. The Stevens-Johnson syndrome is a rare adverse effect of that medication. The present report aims to present a unique case of Stevens-Johnson syndrome in a young male patient after afatinib dimaleate treatment for pulmonary adenocarcinoma, emphasizing the dental therapeutic perspective concerning this condition’s oral manifestations.

This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

RESUMO Objetivo: Conhecer, compreender e descrever a experiência do tratamento oncológico radioterápico na perspectiva da mulher com câncer de boca. Métodos: Trata-se de um estudo qualitativo, exploratório, descritivo, com referencial teórico da antropologia médica e método do estudo de caso instrumental. A coleta de dados foi realizada no setor de oncologia de um hospital público universitário da região Sudeste do Brasil, estado de Minas Gerais e na residência da participante, durante o período de março a agosto de 2016. O caso selecionado foi de uma paciente, gênero feminino, com diagnóstico de Carcinoma Espinocelular em cavidade oral, submetida à radioterapia. Foram realizadas e áudio-gravadas 5 entrevistas semiestruturadas e observação participante. Resultados: São apresentadas três unidades temáticas: a trajetória da radioterapia, redes de apoio e importância da equipe multiprofissional. Das reações adversas, a odinofagia, a disgeusia e a perda de peso foram as que mais se destacaram, sendo causas do isolamento social da participante. O sentido atribuído à radioterapia foi “otimismo e esperança, apesar do isolamento social”. Conclusão: A metodologia qualitativa permitiu acompanhar toda a trajetória da radioterapia, o que oportunizou conhecer a experiência do tratamento na perspectiva da participante. Apesar das reações adversas, não foi verificada construção negativa da experiência com a radioterapia. Sugerimos novos estudos utilizando a metodologia qualitativa, com grupos que tenham características semelhantes às da participante, proporcionando assim maior compreensão da temática abordada, além da identificação e adoção de estratégias que objetivem aprimoramento do atendimento e melhora da qualidade de vida desta população.

Abstract Objective: The aim of this manuscript was to understand and describe the experience of radiotherapy on the perspective of a woman with oral cancer. Methods: This is a qualitative, exploratory, descriptive study, with theoretical reference of medical anthropology and instrumental case study methodology. Data collection was performed in the oncology sector of a public university hospital in the Southeast region of Brazil, State of Minas Gerais, Brazil and at the participant’s residence, during from March to August, 2016. The case selected was of a female patient, diagnosed with Spinocellular Carcinoma in oral cavity, submitted to radiotherapy. Five semi-structured interviews and participant observation were performed and audio-taped. Results: Three thematic units are presented: the radiotherapy trajectory, family support and refuge in God and the importance of the multiprofessional team. The adverse reactions such as odynophagia, dysgeugia and weight loss were the ones that stood out the most, being causes of the social isolation of the participant, nonetheless the patient showed optimism and hope, despite the social isolation. Conclusion: The qualitative methodology allowed the whole trajectory of radiotherapy follow-up which made it possible to understand the treatment experience from the perspective of the participant. Despite the adverse reactions, no negative experience with radiotherapy was found. New studies using the qualitative methodology are suggested with groups presenting similar characteristics of the participant, thus providing a better understanding of the topic addressed, as well as the identification and adoption of strategies that aim at improving care and the quality of life of this population, as well.