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.

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.

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.

ABSTRACT Objective: The objective of this study was to evaluate the oral health condition and dental treatments performed in patients in pre-allogeneic HCT. Method: The records of patients treated during 2018 at a Brazilian HCT service were reviewed. The following oral health data were obtained: 1. Decayed, missing and filled teeth / correlated index for primary dentition (DMFT/dmft); 2. Quality of oral hygiene and 3. Dental pathologies: 3.1 Periodontal infectious focus, 3.2 Endodontic infectious focus and 3.3 Carie incidence. All dental procedures performed were surveyed. Results: Thirty-three patients were included, with a mean age of 28.42 (±16.37), 20 male (60%) and 13 female. The average DMFT/dmft found in this study was 10.24 (± 8.37), similar to the index found in the population in southeastern Brazil. The younger study population presented a DMFT/dmft considered high, when compared to the general population. A total of 27.2% of the patients had active caries lesions, 33.3%, foci of periodontal infection, 15.1%, endodontic infectious focus and 40%, poor oral hygiene. Almost half of the patients (48.4%) had to undergo dental intervention, 24.2% needing periodontal scaling, 21.2%, fillings and 12.1%, tooth extractions. Conclusion: We conclude that the studied population had an important incidence of dental pathologies and infectious conditions that could complicate throughout HCT, especially in younger patients, therefore presenting a high demand for dental treatment in the pre-HCT. Studies that assess the impact of dental conditioning on the outcomes of HCT with an emphasis on dental infectious complications, days of hospitalization and survival are necessary.”

Abstract Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Este estudo comparou os níveis de biofilme em próteses totais maxilares e mandibulares, e analisou o número de unidades formadoras de colônias de leveduras, após o uso de agentes auxiliares da escovação e saliva artificial. Vinte e três usuários de próteses totais com hipossalivação e xerostomia foram orientados a escovar as dentaduras 3 vezes ao dia durante 3 semanas com os seguintes produtos: Corega Brite (dentifrício para prótese), sabonete líquido neutro, Corega Brite associado com o uso do Oral Balance (saliva artificial) ou água de torneira. Para a quantificação do biofilme, as superfícies internas das próteses totais foram evidenciadas, fotografadas e o biofilme quantificado com o auxílio de um software. Para a análise microbiológica, o biofilme foi removido por escovação, coletado, diluído, semeado em meio seletivo CHROMagar™ Candida e incubado a 37°C por 48 h. A análise de variância para dois fatores (p<0,05%) mostrou que as próteses mandibulares apresentaram uma média de porcentagem de biofilme (µ=26,90±21,10) maior que as maxilares (µ=18±15). O teste complementar de Tukey (0,46; p<5%) mostrou que a escovação com Corega Brite e Oral Balance (µ=15,87 ± 18,47) foi mais efetiva que o dentifrício (µ=19,47 ± 17,24), sabonete neutro (µ=23,90 ± 18,63), ou água de torneira (controle; µ=32,50 ± 20,68). Em relação á análise microbiológica, o teste de Qui-Quadrado não indicou diferença entre os produtos de higiene, para ambas as próteses. As espécies de leveduras mais comumente isoladas foram C. albicans, C. tropicalis e C. glabrata. Em conclusão, as próteses mandibulares apresentaram mais biofilme do que as maxilares. Além disso, a escovação das próteses com o Corega Brite associado ao uso do Oralbalance foi o método mais efetivo na redução dos níveis de biofilme, entretanto o uso dos produtos não demonstrou diferença no número de ufc de leveduras.

This study compared the levels of biofilm in maxillary and mandibular complete dentures and evaluated the number of colony-forming units (cfu) of yeasts, after using auxiliary brushing agents and artificial saliva. Twenty-three denture wearers with hyposalivation and xerostomia were instructed to brush the dentures 3 times a day during 3 weeks with the following products: Corega Brite denture dentifrice, neutral liquid soap, Corega Brite combined with Oral Balance (artificial saliva) or tap water. For biofilm quantification, the internal surfaces of the dentures were disclosed, photographed and measured using a software. For microbiological analysis, the biofilm was scrapped off, and the harvested material was diluted, sown in CHROMagar™ Candida and incubated at 37°C for 48 h. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05). Mandibular dentures presented a mean biofilm percentage (µ=26.90 ± 21.10) significantly greater than the maxillary ones (µ=18.0 ± 15.0) (p<0.05). Brushing using Corega Brite combined with Oral Balance (µ=15.87 ± 18.47) was more effective (p<0.05) than using the denture dentifrice (µ=19.47 ± 17.24), neutral soap (µ=23.90 ± 18.63) or tap water (control; µ=32.50 ± 20.68). For the microbiological analysis, the chi-square test did not indicate significant difference between the hygiene products for either type of denture. The more frequently isolated species of yeasts were C. albicans, C. tropicalis and C. glabrata. In conclusion, mandibular dentures had more biofilm formation than maxillary ones. Denture brushing with Corega Brite dentifrice combined with the use of Oral Balance was the most effective method for reduction of biofilm levels, but the use of products did not show difference in yeast cfu counts.

OBJETIVO: avaliar radiograficamente a qualidade óssea no local da distração osteogênica. METODOLOGIA: vinte ratos foram divididos em 2 grupos: Distração Osteogênica (DO) e Controle (C). Os animais do grupo DO foram submetidos à osteotomia da mandíbula, fixação de um aparelho distrator e aplicação de força de distração osteogênica. Os animais do grupo C serviram como controle para a avaliação do tecido ósseo produzido pela técnica da distração osteogênica. As mandíbulas desses animais foram segmentadas transversalmente, tiveram seus segmentos separados em 2,5mm de forma aguda no ato cirúrgico e fixados nessa posição. Nos 2 grupos, os animais foram sacrificados com 2 e 6 semanas após o término da DO (5 animais em cada período). As mandíbulas foram radiografadas simultaneamente, sobre o mesmo filme radiográfico. As imagens obtidas foram digitalizadas e submetidas à análise de densitometria óssea. RESULTADOS E CONCLUSÕES: os grupos DO e C não apresentaram diferenças estatísticas na neoformação óssea nos períodos analisados. As mandíbulas dos dois grupos apresentaram consolidação incompleta na segunda semana e consolidação completa 6 semanas após a distração osteogênica e estabilização. As diferenças encontradas entre esses dois períodos foram significativas apenas para o grupo DO.

AIM: radiograph evaluation of osteogeneous distraction sites. METHODS: twenty rats were divided in 2 groups: Osteogeneous Distraction (OD) and Control (C). The animals of the OD group were subjected to mandibular osteotomy, fixation of a distractor device and application of osteogenic distraction force. Rats of the C groups were used as control on the evaluation of the osseous tissue formed from the osteogeneous distraction technique. These animals mandible (C group) were transversely segmented, the segments were acurately separeted one from other in 2,5mm and then fixed in position. The animals of both groups were sacrificed after 2 and 6 weeks of the end of the OD (5 animals in each period for both groups). All of the mandible were simultaneously radiographied over the same radiographic film. Images obtained from X-ray were scanned and the osseous densitometry performed. RESULTS AND CONCLUSIONS: there were found no significant difference between 2 groups in nome of the periods evaluated. Mandible of both groups showed incomplete osseous consolidation after 2 weeks while after 6 weeks it was found complete consolidation. It was found significant difference in ossoeus densitometry between the periods of evaluation (2 and 6 weeks) only to OD group.

Foram comparadas duas pastas, específica para prótese total e convencional para dentes naturais, quanto à habilidade de remoção de biofilme e cura de lesões do palato em pacientes com Candidíase Atrófica Crônica. Avaliou-se também o grau de correlação entre biofilme e grau de eritema. Vinte e quatro pacientes (45-80 anos) foram distribuídos em: a) pasta específica (produto experimental); b) pasta convencional (pasta dental Sorriso). Para ambos os grupos foram fornecidas escovas dentais de cerdas macias. Assuperfícies internas (próteses superiores) foram evidenciadas (fluoresceína 1%) e fotografadas (45º) em 4 visitas (0, 15, 30 e 60 dias). Os slides foram escaneados e as áreas (total e biofilme) foram medidas (software Image Tool). Sobre slides avaliou-se o grau de eritema empregando-se o Índice Tecidual de Prótese. Houve redução significativa (1%) dos níveis de biofilme (análise de variância) entre as primeiras (0 e 15 dias) e últimas visitas (45 e 60 dias) e dos escores de eritema (Kruskal-Wallis) da primeira para quarta vistita para ambas pastas. O teste de Mann-Whitney mostrou diferença estatística entre as pastas para os níveis de biofilme e igualdade estatística para os escores de eritema. Os valores de correlação entre níveis de biofilme e grau de eritema foram de 0,3801 (pasta específica) e 0,3678 (pasta convencional). A pasta específica mostrou-se efetiva, mostrando que é possível a manutenção da higiene de próteses totais com o uso regular de higienizador em forma de pasta.

The efficacy of 2 oral hygiene products, an experimental toothpaste specific for complete denture cleansing and a regular standard toothpaste, was compared in terms of denture biofilm removal and cure of palatal lesions in patients with atrophic chronic candidiasis. The degree of correlation between presence of biofilm and mucosa erythema was also evaluated. Twenty-four complete denture wearers (45-80 years old) were divided into 2 groups: experimental paste and standard toothpaste (Sorriso-Kolynos, Brazil). Both groups received soft toothbrushes. The internal surfaces of upper dentures were stained using 1% sodium fluorescein and photographed at a 45º angle at 0, 15, 30 and 60 days. The slides were scanned and the areas of interest (denture total area and biofilm area) were measured (Image Tool software). The degree of erythema was evaluated on slides according to the Prosthesis Tissue Index. There was a significant reduction (1%) in the degree of biofilm (ANOVA/Tukey) between the two initial visits (0 and 15 days) and the two final visits (30 and 60 days), and in the average erythema scores (Kruskal-Wallis) between 0 and 60 days, in both groups. The Mann-Whitney test showed a significant difference (1%) between pastes in terms of biofilm degree, but no difference was found for the erythema score. Correlation values between biofilm and erythema degree were 0.3801 (experimental paste) and (0.3678 (standard toothpaste). We may therefore conclude that the experimental product was efficient for the removal of denture plaque biofilm.