Resumo Esta revisão integrativa da literatura tem por objetivo identificar as principais lesões bucais que afetam pacientes pediátricos com HIV, bem como descrever o efeito da terapia antirretroviral altamente ativa (HAART) sobre essas lesões, comparando-a com a terapia antirretroviral (ART). Foi feita uma busca nas bases de dados PubMed e Scielo, seguindo critérios de inclusão e exclusão pré-determinados. Foram selecionados dezenove artigos científicos e extraídas as informações principais sobre prevalência e a frequência das manifestações bucais em pacientes pediátricos HIV positivos e o efeito da terapêutica aplicada. As lesões mais frequentes foram candidíase oral, gengivite, aumento das parótidas e eritema gengival linear. O uso da HAART mostrou diminuir a prevalência das manifestações bucais nos pacientes pediátricos com HIV e ser mais eficaz que a ART. Os achados deste estudo sugerem que a manifestação bucal mais frequente em pacientes pediátricos com HIV é a candidíase oral, seguida de alterações como gengivite e aumento das glândulas parótidas. O uso de HAART parece reduzir a prevalência dessas lesões orais, apresentando resultados mais eficazes que os da ART.

Abstract This integrative literature review aims to identify the main oral lesions affecting pediatric patients with HIV, and describe the effect of highly active antiretroviral therapy (HAART) on these injuries, comparing it to antiretroviral therapy (ART). A search was conducted in PubMed and Scielo databases, following predetermined inclusion and exclusion criteria. 19 papers were selected and the main information on the prevalence and frequency of oral manifestations in HIV-positive pediatric patients and effect of therapy applied were extracted. The most frequent injuries were oral candidiasis, gingivitis, parotid gland enlargement and linear gingival erythema. The use of HAART shown to reduce the prevalence of oral manifestations in pediatric patients with HIV and be more effective than ART. The findings of this study suggest that the most frequent oral manifestation in HIV-infected children is oral candidiasis, followed by changes such as gingivitis and enlargement parotid glands. The use of HAART appears to reduce the prevalence of these oral lesions, showing more effective results than ART.

Resumo Esta revisão integrativa da literatura tem por objetivo identificar as principais lesões bucais que afetam pacientes pediátricos com HIV, bem como descrever o efeito da terapia antirretroviral altamente ativa (HAART) sobre essas lesões, comparando-a com a terapia antirretroviral (ART). Foi feita uma busca nas bases de dados PubMed e Scielo, seguindo critérios de inclusão e exclusão pré-determinados. Foram selecionados dezenove artigos científicos e extraídas as informações principais sobre prevalência e a frequência das manifestações bucais em pacientes pediátricos HIV positivos e o efeito da terapêutica aplicada. As lesões mais frequentes foram candidíase oral, gengivite, aumento das parótidas e eritema gengival linear. O uso da HAART mostrou diminuir a prevalência das manifestações bucais nos pacientes pediátricos com HIV e ser mais eficaz que a ART. Os achados deste estudo sugerem que a manifestação bucal mais frequente em pacientes pediátricos com HIV é a candidíase oral, seguida de alterações como gengivite e aumento das glândulas parótidas. O uso de HAART parece reduzir a prevalência dessas lesões orais, apresentando resultados mais eficazes que os da ART.

Abstract This integrative literature review aims to identify the main oral lesions affecting pediatric patients with HIV, and describe the effect of highly active antiretroviral therapy (HAART) on these injuries, comparing it to antiretroviral therapy (ART). A search was conducted in PubMed and Scielo databases, following predetermined inclusion and exclusion criteria. 19 papers were selected and the main information on the prevalence and frequency of oral manifestations in HIV-positive pediatric patients and effect of therapy applied were extracted. The most frequent injuries were oral candidiasis, gingivitis, parotid gland enlargement and linear gingival erythema. The use of HAART shown to reduce the prevalence of oral manifestations in pediatric patients with HIV and be more effective than ART. The findings of this study suggest that the most frequent oral manifestation in HIV-infected children is oral candidiasis, followed by changes such as gingivitis and enlargement parotid glands. The use of HAART appears to reduce the prevalence of these oral lesions, showing more effective results than ART.

Abstract: INTRODUCTION: Rhinosporidiosis is a chronic infection of the mucous membrane and is caused by Rhinosporidium seeberi, an aquatic mesomycetozoan. The mode of infection is probably transepithelial penetration. The large number of rivers and lakes and the strong presence of riparian populations in the State of Maranhão are strong predisposing factors for rhinosporidiosis. METHODS: A 5-year retrospective study was conducted in a tertiary medical center situated in Maranhão, Northeast Brazil. Twenty-five Maranhense patients diagnosed with rhinosporidiosis were analyzed. RESULTS: Most of the patients were children, adolescents and young adults (age range: 7-24 years, mean age: 14 years). The majority of the participants were male (84%), brown (76%), and students (92%). All lesions involved the entire nasal cavity and presented with a vascular polypoid mass. All patients were treated by surgical excision of the lesions. CONCLUSIONS: Rhinosporidiosis affects younger age groups, especially students from the countryside and the outskirts of urban areas. This study will aid and guide physicians in diagnosing and treating this infection in endemic areas.

The objective of this randomized clinical trial was to evaluate the clinical performance up to 18 months of restorations placed using ethanol-wet bonding technique (EWBT) compared with the three-step etch-and-rinse (TSER) and one-step self-etching (OSSE) approaches. Ninety-three non-carious cervical lesions (31 for each group) were restored by one experienced operator in 17 patients under relatively dry conditions using gingival retraction cord, cotton rolls and saliva ejector. Each adhesive system was randomly allocated to one of randomized cervical lesions until the three groups were present in the same subject in equal amounts. The restorations were evaluated at baseline, 6, 12 and 18 months by two blinded and calibrated examiners using the modified US Public Health Service guidelines (USPHS) for the following outcomes: retention (kappa= 1.00), staining and marginal adaptation (kappa=0.81) and analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups after 18 months for any of the assessed criteria (p>0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the time intervals baseline/18 months in marginal adaptation (p= 0.0117) and retention (p= 0.0101) for OSSE and in marginal staining for TSER (0.0051) and EWBT (p= 0.0277) groups. The survival analysis for retention criteria and the overall clinical success were performed using a log-rank test and did not show significant differences among groups (p> 0.05). All three adhesives protocols presented similar clinical performance up to 18 months.

El propósito de este ensayo clínico aleatorizado fue evaluar, durante 18 meses, el éxito clínico de las restauraciones realizadas por la técnica de adhesión húmeda en etanol (TAHE) en comparación con las técnicas de grabado independiente de tres pasos (GTP) y de autograbado de un paso (AUP). Un solo operador, especializado en odontología restaurativa, realizó sobre 17 pacientes 93 restauraciones en lesiones cervicales no cariosas (31 para cada grupo). Los diferentes protocolos adhesivos se distribuyeron aleatoriamente en las lesiones cervicales hasta que los tres grupos estuviesen presentes en el mismo paciente y en cantidades iguales. Las restauraciones fueron evaluadas a los 6, 12 y 18 meses, por dos examinadores calibrados y que no participaron del procedimiento restaurador. Las directrices modificadas del Servicio de Salud Pública de Estados Unidos (SSPEU) fueron la base para las evaluaciones de las siguientes variables: retención (kappa= 1,00), adaptación y decoloración marginal (kappa= 0,81). Estas variables fueron analizadas mediante la prueba exacta de Fisher y Kruskal-Wallis, respectivamente. No se observó diferencia significativa entre los grupos después de 18 meses en las tres variables evaluadas (p >0,05). El análisis intra-grupo hecho por la prueba de Cochran (para la retención) y la prueba de Wilcoxon (para la adaptación y decoloración marginal) revelaron diferencias significativas entre los intervalos de tiempo de la línea de base / 18 meses para la retención (p= 0,0101) y adaptación marginal en el grupo AUP (p= 0,0117), y para la decoloración marginal en los grupos GTP (p= 0,0051) e TAHE (p= 0,0277). El análisis de supervivencia para la retención, así como la comparación del éxito clínico de los protocolos adhesivos, fueron realizados con la prueba de log-rank, y no hubo diferencias significativas (p >0,05) entre los grupos. No hubo diferencia en el éxito clínico de los tres protocolos adhesivos después de 18 meses.

The ethanol wet-bonding technique (EWBT) was introduced in an attempt to overcome the problems caused by high hydrophilicity and/or incomplete penetration of most commercially available adhesive systems. This strategy provides better conditions for the inter-diffusion of hydrophobic dentin monomers. Today, there are many EWBT protocols, which yield bonding interfaces with minimal degradation and longer durability compared with commercial hydrophilic adhesive systems. The aim of this review is to discuss in greater detail the EWBT, focused on the following aspects: dentin saturation, hydrophobic primer preparation, inactivation of metalloproteinases (MMPs), dentin biomimetic remineralization and the clinical perspectives of this technique. The present review on the EWBT provides support for a better understanding of the behavior of dentin when exposed to dehydration and hydrophobic monomer interaction. Moreover, additional studies are suggested to investigate the long-term stability of this type of hybrid layer.

La técnica de la adhesión húmeda en etanol (TAHE) se introdujo en un intento de superar los problemas causados por la alta hidrofilicidad y/o la penetración incompleta de la mayoría de los sistemas adhesivos disponibles comercialmente. Esta estrategia ofrece mejores condiciones para la interdifusión de monómeros dentinarios hidrofóbicos. Hoy en día, hay muchos protocolos TAHE que producen las interfaces de unión con mínima degradación y mayor durabilidad en comparación con los sistemas adhesivos hidrofilicos comerciales. El objetivo de esta revisión es discutir con más detalle la TAHE, explicando los siguientes aspectos relacionados: la saturación de la dentina, la preparación del primer hidrofóbico, la inactivación de las metaloproteinasas (MMP's), remineralización biomimética de la dentina, y las perspectivas clínicas de esta técnica. La presente revisión sobre la TAHE proporciona soporte para una mejor comprensión del comportamiento de la dentina cuando es expuesto a la deshidratación y la interacción con monómero hidrófobo. Además, se sugieren estudios adicionales para investigar la estabilidad a largo plazo de este tipo de camada híbrida.