Abstract Background: In this experimental protocol, we evaluated the immediate and delayed repair of the buccal branch of the facial nerve (BBFN) with heterologous fibrin biopolymer (HFB) as a coaptation medium and the use of photobiomodulation (PBM), performing functional and histomorphometric analysis of the BBFN and perioral muscles. Methods: Twenty-eight rats were divided into eight groups using the BBFN bilaterally (the left nerve was used for PBM), namely: G1 - control group, right BBFN (without injury); G2 - control group, left BBFN (without injury + PBM); G3 - Denervated right BBFN (neurotmesis); G4 - Denervated left BBFN (neurotmesis + PBM); G5 - Immediate repair of right BBFN (neurotmesis + HFB); G6 - Immediate repair of left BBFN (neurotmesis + HFB + PBM); G7 - Delayed repair of right BBFN (neurotmesis + HFB); G8 - Delayed repair of left BBFN (neurotmesis + HFB + PBM). Delayed repair occurred after two weeks of denervation. All animals were sacrificed after six weeks postoperatively. Results: In the parameters of the BBFN, we observed inferior results in the groups with delayed repair, in relation to the groups with immediate repair, with a significant difference (p < 0.05) in the diameter of the nerve fiber, the axon, and the thickness of the myelin sheath of the group with immediate repair with PBM compared to the other experimental groups. In measuring the muscle fiber area, groups G7 (826.4 ± 69.90) and G8 (836.7 ± 96.44) were similar to G5 (882.8 ± 70.51). In the functional analysis, the G7 (4.10 ± 0.07) and G8 (4.12 ± 0.08) groups presented normal parameters. Conclusion: We demonstrated that delayed repair of BBFN is possible with HFB, but with worse results compared to immediate repair, and that PBM has a positive influence on nerve regeneration results in immediate repair. Background protocol (BBFN (HFB PBM, , (PBM) muscles Methods Twentyeight Twenty PBM) namely G without injury) neurotmesis (neurotmesis) HFB) PBM. . denervation postoperatively Results p 0.05 005 0 05 axon area 826.4 8264 826 4 (826. 69.90 6990 69 90 836.7 8367 836 7 (836. 96.44 9644 96 44 882.8 8828 882 8 (882. 70.51. 7051 70.51 70 51 70.51) 4.10 410 10 (4.1 0.07 007 07 4.12 412 12 0.08 008 08 Conclusion (PBM 0.0 00 826. 82 (826 69.9 699 6 9 836. 83 (836 96.4 964 882. 88 (882 705 70.5 5 4.1 41 1 (4. 0. (82 69. (83 96. (88 70. 4. (4 (8 (

Resumen: Las discusiones sobre la política presupuestaria discrecional han destacado su potencial impacto negativo en el desarrollo económico. Este estudio examina cómo la política presupuestaria discrecional, como consecuencia de prácticas de rent-seeking, afecta los gastos en el área de la salud de los municipios de Mato Grosso, durante el escándalo de la “Mafia de las Ambulancias” (2001 a 2006). Nuestros hallazgos revelan un aumento significativo en la aplicación de políticas presupuestarias discrecionales durante este caso de corrupción, particularmente entre los municipios involucrados, indicando una mayor agresividad en la asignación de presupuesto en salud. Además, encontramos que el uso excesivo de esta política no solo perjudica la economía actual, sino que también tiene efectos negativos en los indicadores de desarrollo social. En resumen, nuestros resultados sugieren que un aumento en los gastos públicos por encima de un nivel óptimo puede dañar la salud de la población local. Esta relación entre la política presupuestaria discrecional y el IFDM-Salud fue claramente observado en el contexto de la “Mafia de las Ambulancias”. Resumen económico rentseeking, rentseeking rent seeking, seeking rent-seeking Grosso Mafia Ambulancias 2001 (200 2006. 2006 . 2006) corrupción involucrados Además actual social resumen local IFDMSalud IFDM Salud Ambulancias. 200 (20 20 (2 2 (

Abstract: Discussions on discretionary fiscal policy often underscore its potential negative impacts on economic development. This study examines the consequences of such policies in the context of rent-seeking practices, particularly focusing on healthcare expenditures by municipalities in Mato Grosso during the “Ambulance Mafia” scandal (2001 to 2006). Our empirical analysis reveals a significant increase in discretionary fiscal measures during the corruption case, particularly among implicated municipalities, indicating heightened budget execution for healthcare expenses. Importantly, our findings underscore that excessive use of this policy not only harms the economy but also adversely affects social development indicators. In summary, excessive public spending beyond an optimal threshold correlates with detrimental effects on local population health. This relationship between discretionary budgetary policy and IFDM-Health was evident in the context of the “Ambulance Mafia.” Abstract rentseeking rent seeking practices Ambulance Mafia 2001 (200 2006. 2006 . 2006) case expenses Importantly indicators summary health IFDMHealth IFDM Health Mafia. 200 (20 20 (2 2 (

Resumo: As discussões em torno da política orçamentária discricionária têm evidenciado que seu uso agressivo pode acarretar impactos negativos no desenvolvimento econômico. Neste estudo, investigamos essa política como uma consequência de práticas rent-seeking, examinando empiricamente seu efeito sobre o orçamento público, maiormente na dimensão dos gastos na área da saúde realizados pelos municípios de Mato Grosso, durante o escândalo da “Máfia das Ambulâncias” (2001 a 2006). Nossos resultados apontam para um aumento significativo nas medidas de política orçamentária discricionária durante o caso de corrupção, principalmente entre os municípios envolvidos, sugerindo uma maior agressividade na execução do orçamento das despesas na função de saúde. Além disso, nossas descobertas destacam que o uso excessivo dessa política pode não apenas prejudicar o estado atual da economia, mas também ter impactos negativos nos indicadores de desenvolvimento social. Em suma, quanto mais os gastos públicos ultrapassam um nível ótimo, mais danos tendem a causar à saúde da população local. Essa relação entre a política orçamentária discricionária e o IFDM-Saúde foi claramente observado no contexto da “Máfia das Ambulâncias”. Resumo econômico estudo rentseeking, rentseeking rent seeking, seeking rent-seeking público Grosso Máfia Ambulâncias 2001 (200 2006. 2006 . 2006) corrupção envolvidos disso economia social suma ótimo local IFDMSaúde IFDM Saúde Ambulâncias. 200 (20 20 (2 2 (

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT. acutechronic chronic effects preHSCT, preHSCT pre 201 202 groups Committees s members necessary characteristics (SBTMO Specialties settingspecific setting specific 20 2

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations. , (HSCT) cavity conditions patients s mucositis infections bleeding microbiota taste aspects control intake nutrition sepsis morbidity recommendations (HSCT

ABSTRACT Patients undergoing hematopoietic stem cell transplantation (HSCT) might present acute and late toxicities and the oral tissues are frequently affected. With the survival increasing, patients show late and long-term morbidities, and there is an important association between the general and the oral health. The first and second parts of this Consensus have showed the importance of the adequacy of oral health in the pre-HSCT, and the main alterations and oral care during the period of admission for HSCT. This third part aims to review specific themes of post-HSCT dental care, such as graft-versus-host disease (GVHD) and the pediatric patient. It also aims to review pertinent subjects, both during the HSCT period and post-HSCT, concerning quality of life, pain, cost-effectiveness, and remote care. Based on this review, it is evident the importance of the work of the dental surgeon (DS) in the follow-up and treatment of the HSCT patient, always collaborating with the whole multidisciplinary team. (HSCT affected increasing longterm long term morbidities preHSCT, preHSCT pre HSCT, pre-HSCT postHSCT post graftversushost graft versus host GVHD (GVHD patient subjects postHSCT, life pain costeffectiveness, costeffectiveness cost effectiveness, effectiveness cost-effectiveness DS (DS followup follow up team

ABSTRACT: This study aimed to carry out an integrative review of the use of diode lasers in the treatment of oral fibrous hyperplasia in order to observe surgical efficacy, healing process, and main microscopic findings. The following databases-PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science, and gray literature-were searched without regard to the time of year or language. Diode laser treatment cases described in case reports and case series were included, but those who did not undergo microscopic analysis to confirm the diagnosis or who did not provide postoperative information were excluded. Twelve studies (64 patients) were included. Prevalence was observed for females (68.75 %, n=44). In view of the diagnosis, there was a prevalence of focal fibrous hyperplasia (79.68 %, n=51), followed by inflammatory fibrous hyperplasia (20.31 %, n=13). For surgical removal, a diode laser was used with a wavelength ranging from 808 to 960 nm, in continuous mode, and an average power of 2830 mW. In general, there were no intercurrences in the trans and postoperative periods and wound healing occurred by second intention, with excellent evolution. High-powered diode lasers can be an excellent therapeutic option for oral hyperplastic lesions. Long-term clinical trials should be conducted to determine laser setting parameters in various oral lesions.

RESUMEN: El objetivo de este estudio fue realizar una revisión integradora sobre el uso del láser de diodo en el tratamiento de la hiperplasia fibrosa oral, con el fin de visualizar la eficacia quirúrgica, el patrón de cicatrización y el análisis de los principales resultados microscópicos. Se realizó una búsqueda sin restricciones de año e idioma en PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science y literatura gris. Se incluyeron reportes de casos y series de casos que brindaron información sobre pacientes diagnosticados con lesiones hiperplásicas orales tratados con láser de diodo, excluyendo aquellos a los que no se les había realizado análisis microscópico para confirmar el diagnóstico, así como aquellos que no brindaron información postoperatoria. Se incluyeron doce estudios (64 pacientes). Se observó prevalencia en el sexo femenino (68,75 %, n=44). Ante el diagnóstico, predominó la hyperplasia fibrosa focal (79,68 %, n=51), seguida de la hiperplasia fibrosa inflamatoria (20,31 %, n=13). Para la remoción quirúrgica se utilizó un láser de diodo con una longitud de onda de 808 a 960 nm, en modo continuo, y una potencia promedio de 2830 mW. En general, no hubo intercurrencias en el trans y postoperatorio y la cicatrización de la herida ocurrió por segunda intención, con excelente evolución. El uso de láseres de diodo de alta potencia puede ser una excelente alternativa terapéutica para las lesiones hiperplásicas orales. Se deben realizar más estudios clínicos a largo plazo para determinar los parámetros de ajuste del láser en diferentes lesiones orales.

Abstract Objective: To identify oral characteristics found in children with liver disease in programming for liver transplantation. Data source: The methodology was written according to PRISMA-ScR. We adopted the methodological framework and recommendations for this type of review by Arksey and O’Malley and the Joanna Briggs Institute. The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). A systematic search (Medline/PubMed, Scopus, Web of Science, and ProQuest) was conducted to identify studies that met the inclusion criteria: systematic reviews; prospective clinical trials (parallel or crossover group designs); observational studies (cohort, case-control, and cross-sectional studies); clinical case series; and case reports evaluating children with liver disease in preparation for transplantation. The last search was conducted in July 2021, and no restrictions were imposed as to language or year of publication. Studies presenting mixed data with post-transplant evaluation, and studies evaluating not only liver transplantation but also other solid organs were excluded. Screening, inclusion, and data extraction were performed by two reviewers independently. A narrative synthesis was conducted to describe the findings of the study. Data synthesis: The bibliographic search identified 830 references. A total of 21 articles were read in their entirety after the inclusion criteria assessment. Finally, after evaluating the exclusion criteria, only 3 studies were considered for the qualitative analysis. Conclusions: Children with liver disease in preparation for transplantation may present enamel defects, tooth pigmentation, caries, gingivitis, and opportunistic infections such as candidiasis. Objective source PRISMAScR. PRISMAScR PRISMA ScR. ScR PRISMA-ScR OMalley O Malley Institute https//doi.org/10.17605/OSF.IO/QCU4W. httpsdoiorg1017605OSFIOQCU4W httpsdoiorgOSFIOQCUW https //doi.org/10.17605/OSF.IO/QCU4W . doi org 10 17605 OSF IO QCU4W QCU W (https://doi.org/10.17605/OSF.IO/QCU4W) Medline/PubMed, MedlinePubMed Medline PubMed (Medline/PubMed Scopus ProQuest reviews parallel designs designs) cohort, cohort (cohort casecontrol, casecontrol control, control case-control crosssectional cross sectional studies) series 2021 publication posttransplant post transplant evaluation excluded Screening independently study 83 references 2 assessment Finally analysis Conclusions defects pigmentation caries gingivitis candidiasis https//doi.org/10.17605/OSF.IO/QCU4W httpsdoiorg OSFIOQCU doiorg1017605OSFIOQCU4W doiorgOSFIOQCUW 1 1760 QCUW (https://doi.org/10.17605/OSF.IO/QCU4W Medline/PubMed 202 8 doiorg 176 20 17

RESUMO Objetivo: Identificar características bucais em crianças hepatopatas em programação para o transplante hepático. Fontes de dados: A metodologia foi descrita de acordo com o PRISMA-ScR. Adotamos a estrutura metodológica e recomendações para este tipo de revisão por Arksey e O’Malley e o Instituto Joanna Briggs. O protocolo foi registrado no Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). Uma pesquisa sistemática (Medline/PubMed, Scopus, Web of Science e ProQuest) foi conduzida para identificar estudos que preenchessem os critérios de inclusão: revisões sistemáticas; ensaios clínicos prospectivos (desenhos de grupos paralelos ou cruzados); estudos observacionais (coorte, caso-controle e estudos transversais); séries de casos clínicos; e relatos de casos que avaliam crianças com doenças hepáticas em preparação para o transplante. A última busca foi conduzida em julho de 2021, e não foram impostas restrições quanto ao idioma ou ano de publicação. Foram excluídos estudos que apresentavam dados mistos com avaliação pós-transplante e estudos que avaliavam não só o transplante de fígado, mas também de outros órgãos sólidos. O rastreio, inclusão e extração de dados foram realizados por dois revisores independentemente. Foi conduzida uma síntese narrativa para identificar os resultados do estudo. Síntese dos dados: A pesquisa bibliográfica identificou 830 referências. Foram lidos 21 artigos na íntegra após avaliação dos critérios de inclusão. Finalmente, após a avaliação dos critérios de exclusão, apenas três estudos foram considerados para análise. Conclusões Crianças com doença hepática em preparação para o transplante podem apresentar defeitos de esmalte, pigmentação dentária, cárie, gengivite além de infecções oportunistas como a candidíase. Objetivo hepático PRISMAScR. PRISMAScR PRISMA ScR. ScR PRISMA-ScR OMalley Malley Briggs https//doi.org/10.17605/OSF.IO/QCU4W. httpsdoiorg1017605OSFIOQCU4W httpsdoiorgOSFIOQCUW https //doi.org/10.17605/OSF.IO/QCU4W . doi org 10 17605 OSF IO QCU4W QCU W (https://doi.org/10.17605/OSF.IO/QCU4W) Medline/PubMed, MedlinePubMed Medline PubMed (Medline/PubMed Scopus ProQuest sistemáticas desenhos cruzados cruzados) coorte, coorte (coorte casocontrole caso controle transversais transversais) 2021 publicação póstransplante pós fígado sólidos rastreio independentemente estudo 83 referências 2 Finalmente exclusão análise esmalte dentária cárie candidíase https//doi.org/10.17605/OSF.IO/QCU4W httpsdoiorg OSFIOQCU doiorg1017605OSFIOQCU4W doiorgOSFIOQCUW 1 1760 QCUW (https://doi.org/10.17605/OSF.IO/QCU4W Medline/PubMed 202 8 doiorg 176 20 17

RESUMO Objetivo: Revisar casos de malignidades da cavidade oral disponíveis na literatura em receptores de transplantes renais. Métodos: Foi realizada uma pesquisa no banco de dados PubMed usando os termos “oral cancer”, “mouth neoplasms”, “renal transplantation” e “kidney transplantation”. Independentemente da data de publicação, as publicações foram escolhidas por dois pesquisadores após considerarem cuidadosamente os títulos e resumos e lerem cada artigo em sua totalidade. Resultados: Foram encontrados 12 artigos com casos de malignidades orais em receptores de transplantes renais. No total, 31 neoplasias malignas foram diagnosticadas na cavidade oral, das quais 64,5% (20/31) eram carcinomas espinocelulares; o sarcoma de Kaposi representou 12,9% (4/31) dos casos. Lábios e língua foram os locais mais afetados mencionados mais frequentemente nos artigos avaliados. O tempo pós-transplante variou de 8 meses a 23 anos, e vários imunossupressores foram utilizados. Conclusão: Os receptores de transplante renal devem ser encaminhados regularmente a dentistas e outros profissionais médicos que trabalham no diagnóstico de lesões malignas da cavidade oral a serem avaliadas, e novos casos de câncer oral poderão ser reconhecidos precocemente para tratamento. Esta estratégia poderá melhorar a sobrevivência dos pacientes com esta doença ameaçadora. Objetivo renais Métodos cancer, cancer , cancer” mouth neoplasms, neoplasms neoplasms” transplantation kidney transplantation. . publicação totalidade Resultados 1 total 3 645 64 5 64,5 20/31 2031 20 (20/31 espinocelulares 129 9 12,9 4/31 431 4 (4/31 avaliados póstransplante pós 2 anos utilizados Conclusão avaliadas tratamento ameaçadora 6 64, 20/3 203 (20/3 12, 4/3 43 (4/3 20/ (20/ 4/ (4/ (20 (4 (2 (

ABSTRACT Objective: To review cases of oral cavity malignancies available in the literature in kidney transplant recipients. Methods: A search was carried out in the PubMed database using the terms “oral cancer,” “mouth neoplasms,” “renal transplantation,” and “kidney transplantation.” Regardless of the publication date, the publications were chosen by two researchers after they carefully considered the titles and abstracts and read each article in its entirety. Results: Twelve articles were found with cases of oral malignancies in kidney transplant recipients. In all, 31 malignant neoplasms were diagnosed in the oral cavity, of which 64.5% (20/31) were squamous cell carcinomas; Kaposi's sarcoma represented 12.9% (4/31) of the cases. Lips and tongue were the most affected sites mentioned most frequently in the articles evaluated. Post-transplantation time ranged from 8 months to 23 years, and several immunosuppressants were used. Conclusion: Kidney transplant recipients should be regularly forwarded to dentists and other medical professionals who work in diagnosing malignant lesions of the oral cavity to be evaluated, and new cases of oral cancer can be recognized early to treatment. This strategy could improve the survival of patients with this threatening disease. Objective Methods cancer, mouth neoplasms, renal transplantation, transplantation transplantation. date entirety Results all 3 645 64 5 64.5 20/31 2031 20 (20/31 carcinomas Kaposis Kaposi s 129 12 9 12.9 4/31 431 4 (4/31 evaluated Posttransplantation Post 2 years used Conclusion treatment disease 6 64. 20/3 203 (20/3 1 12. 4/3 43 (4/3 20/ (20/ 4/ (4/ (20 (4 (2 (

ABSTRACT: The objective of this study was to analyze the inflammation index, edema, bacterial plaque presence and postoperative discomfort, with the use of chlorhexidine gel. This is a randomized double-blinded pilot study, with 21 unilateral cleft lip and palate individuals, randomized into 2 groups: Test Group (TG), with 7 individuals who used 0.2 % chlorhexidine bioadhesive gel in the surgical wound after the bone graft; and Control Group (CG) with 14 individuals who used a placebo gel as the same way. The gel was applied on the surgical wound suture after alveolar bone graft. The evaluation criteria of the gel application effectiveness were the visual analogue scale (VAS) for pain control and/or discomfor t and clinical evaluation of inflammatory condition and/or wound infection. The study showed promising results for postoperativel y use of the chlorhexidine gel, although there was no statistically significant difference between the groups.

RESUMEN: El objetivo de este estudio fue analizar el índice de inflamación, edema, presencia de placa bacteriana y molestias postoperatorias, con el uso del gel de clorhexidina. Se trata de un estudio piloto aleatorizado, doble ciego, con 21 individuos con fisura labial y palatina unilateral, aleatorizados en 2 grupos: Grupo Test (GT), con 7 individuos que utilizaron gel bioadhesivo de clorhexidina al 0,2 % en la herida quirúrgica posterior al injerto óseo; y Grupo Control (GC) con 14 individuos que usaron un gel placebo de la misma forma. El gel se aplicó sobre la sutura de la herida quirúrgica después del injerto óseo alveolar. Los criterios de evaluación de la efectividad de la aplicación del gel fueron la escala analógica visual (EVA) para el control del dolor y/o malestar y la evaluación clínica del estado inflamatorio y/o infección de la herida. El estudio mostró resultados positivos para el uso posoperatorio del gel de clorhexidina, aunque no hubo diferencias estadísticamente significativas entre los grupos.

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

ABSTRACT BACKGROUND: There is a need for studies that correlate the severity of oral mucositis (OM) with chemotherapy protocols, transient myelosuppression and oral health. OBJECTIVE: To analyze the severity of OM among individuals with solid tumors during hospitalization and its correlation with the type of chemotherapy, myelosuppression and oral health condition. DESIGN AND SETTING: Retrospective study at a public hospital in Bauru, state of São Paulo, Brazil, that is a regional referral center. METHODS: Individuals diagnosed with solid malignant tumors who received chemotherapy during hospitalization for completion of the antineoplastic treatment cycle or who presented complications resulting from this were assessed. RESULTS: Twenty-eight individuals (24.3%) manifested some degree of OM. The most prevalent degrees of OM according to the World Health Organization (WHO) and modified WHO classification were grades 2 (11.3%) and 5 (4.3%), respectively. It was observed that the higher the OM-WHO (P < 0.001; r = 0.306) and modified OM-WHO (P < 0.001; r = 0.295) classifications were, the greater the oral pain reported by the individuals was. Presence of mucositis in the upper lip and buccal mucosa contributed to increased severity of OM and worsening of swallowing during hospitalization. Thus, severe OM was associated with use of the FOLFIRI protocol (folinic acid, fluorouracil and irinotecan). CONCLUSION: Individuals with tumors who presented severe OM had greater severity of oral pain and worse oral health. Use of the FOLFIRI protocol was associated with higher prevalence of severe OM, while use of 5-fluorouracil (5-FU) was correlated with worse oral condition.

ABSTRACT: To report a rare case of erythema multiforme (EM) associated with methotrexate (MTX) with cutaneous and oral manifestations and to compare it to existing cases in which MTX was not used for cancer treatment. A 56-years- old female, in physical examination skin lesions and multiple oral ulcers associated with pain during manipulation were observed, and underwent treatment for rheumatoid arthritis with Methotrexate 2.5mg. During examination patient-reported that 15 days ago she had undergone a rheumatoid factor examination, doubling the MTX dosage (10mg / day) without doctor's consent. The diagnostic hypothesis of EM. The medical conduct consisted of the suspension of MTX and prescription of a vitamin complex with folinic acid. Local dental therapy for to control oral lesions, pain control and lip hydration was performed using low-level laser therapy (Twin Laser, P: 40mW, T: 50s, DE: 50J / cm), benzydamine hydrochloride spray, purified lanolin for lip dryness, and toothpaste without sodium lauryl sulfate to prevent burning. After 12 days, there was significant remission of oral and skin signs and symptoms, which confirmed the diagnosis was EM due to MTX intoxication. Thorough clinical evaluation and anamnesis favored diagnosis and early multi-professional management provided remission of oral and skin lesions, prevented systemic complications.

RESUMEN: El objetivo de este trabajo fue informar un caso raro de eritema multiforme (EM) asociado a metotrexato (MTX) con manifestaciones cutáneas y orales y compararlo con casos existentes en los que no se utilizó MTX para el tratamiento del cáncer. Caso clínico: Mujer de 56 años, en el examen físico se observaron lesiones cutáneas y múltiples úlceras de la cavidad oral asociadas a dolor durante la manipulación.Se sometió a tratamiento para la artritis reumatoide con metotrexato 2,5 mg. Durante el examen, la paciente informó que hacía 15 días se había sometido a un examen de factor reumatoide, duplicando la dosis de MTX (10 mg / día) sin el consentimiento del médico. La hipótesis diagnóstica de EM. La conducta médica consistió en la suspensión de MTX y prescripción de un complejo vitamínico con ácido folínico. La terapia dental local para el control de las lesiones orales, el control del dolor y la hidratación de los labios se realizó mediante terapia con láser de bajo nivel (Twin Laser, P: 40mW, T: 50s, DE: 50J / cm), aerosol de clorhidrato de bencidamina, lanolina purificada para la sequedad de labios y pasta de dientes sin lauril sulfato de sodio para evitar quemaduras. Después de 12 días, hubo una remisión significativa de los signos y síntomas orales y cutáneos, lo que confirmó el diagnóstico de ME por intoxicación por MTX. La evaluación clínica exhaustiva y la anamnesis favorecieron el diagnóstico y el manejo multiprofesional precoz proporcionó la remisión de las lesiones orales y cutáneas, evitando además complicaciones sistémicas.

ABSTRACT: Pazopanib, an antiangiogenic agent, has shown promising results in controlling tumor growth and metastasis in patients with renal cell carcinoma. The use of pazopanib in the management of malignancies has increased over recent years, with more patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ). This paper presents the first case report of MRONJ associated with pazopanib monotherapy. A 59-year-old man was referred to the dental clinic with complaints of dysphagia and dysgeusia. The patient was prescribed pazopanib (400 mg) daily following surgical treatment and chemotherapy for metastatic renal cell carcinoma. He had undergone extraction of the maxillary left second premolar nine weeks previously. Intraoral examination revealed exposed necrotic bone, which was treated effectively with leukocyte and platelet-rich fibrin (LPRF). The patient was followed up for 150 days after dental treatment with no signs of relapse.

RESUMEN: Pazopanib, un agente antiangiogénico, ha mostrado resultados prometedores en el control del crecimiento tumoral y las metástasis en pacientes con carcinoma de células renales. El uso de pazopanib en el tratamiento de las neoplasias malignas ha aumentado en los últimos años, con más pacientes en riesgo de desarrollar osteonecrosis de la mandíbula relacionada con la medicación (MRONJ). Este artículo presenta el primer reporte de caso de MRONJ asociado con la monoterapia con pazopanib. Un hombre de 59 años fue remitido a la clínica dental con quejas de disfagia y disgeusia. Al paciente se le prescribió pazopanib (400 mg) al día tras tratamiento quirúrgico y quimioterapia por carcinoma metastásico de células renales. Había sido sometido a extracción del segundo premolar superior izquierdo nueve semanas antes. El examen intraoral reveló hueso necrótico expuesto, que fue tratado eficazmente con leucocitos y fibrina rica en plaquetas (LPRF). El paciente fue seguido durante 150 días después del tratamiento dental sin signos de recidiva.

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.