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Bernardo da Fonseca Orcina,1 Fabiano Vieira Vilhena,2 Rodrigo Cardoso de Oliveira,1 Lucas Marques da Costa Alves,3 Koiti Araki,4 Sérgio Hiroshi Toma,4 Mariana Schutzer Ragghianti Zangrando,1 Paulo Sérgio da Silva Santos1 1University of Sao Paulo, Faculty of Dentistry of Bauru, Department of Surgery, Stomatology, Pathology and Radiology, Bauru, SP, Brazil; 2TRIALS – Oral Health & Technologies, Bauru, SP, Brazil; 3Hospital Estadual de Bauru, Bauru, SP, Brazil; 4University of Sao Paulo, Department of Fundamental Chemistry, Institute of Chemistry, Sao Paulo, SP, BrazilCorrespondence: Paulo Sérgio da Silva SantosDepartment of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of Sao Paulo, Al. Dr. Octávio Pinheiro Brisolla, 9 -75, Bauru, CEP 17012-901, São PauloTel +55 14 99670 – 0921Email paulosss@fob.usp.brAim: This case series demonstrated that phthalocyanine derivate mouthwash is a promising alternative for reducing the viral load of SARS-CoV-2 and for clinical improvement of infected patients who presented mild and moderate symptoms.Purpose: The aim of this study was to report a case series of patients diagnosed with COVID-19 that used the phthalocyanine derivate mouthwash to reduce clinical symptoms.Patients and Methods: Eight patients used 5mL of phthalocyanine derivate mouthwash gargling/rinsing for one minute, five times daily, over a fourteen day period. Two measurement scales were applied for each patient in different periods to verify sore throat – VAS – Visual Analogue Scale for Pain and the clinical conditions – PS – Performance Status.Results: All patients presented a significant reduction in clinical symptoms with the use of the mouthwash for gargling/rinsing after few days of use, without hospitalization.Conclusion: The phthalocyanine derivate mouthwash protocol appears as a potential alternative for clinical improvement of COVID-19 infected patients. Daily use of this mouthwash rapidly reduced clinical symptoms such as sore throats, cough and mouth ulcers. Large, high-quality randomized controlled trials with larger sample size are necessary to confirm the effectiveness of this mouthwash protocol against COVID-19.Keywords: mouthwash, sore throats, mouth ulcers, coronavirus infections

Objective: Self-etching dental adhesives bond with dentin through chemical reactions with calcium. This study assessed bond strength (BS) using microtensile (µTBS) and microshear (µSBS) tests on sound and post-radiotherapy dentin, with dental adhesives containing different functional monomers., Methods: Sound dentin (SD) and post-radiotherapy irradiated dentin (ID) were tested with two adhesive systems: Clearfil SE Bond (SE, 10-MDP-based) and FL Bond II (FL, containing carboxylic and phosphonic monomers with S-PRG bioactive particles). The tests occurred initially (24 h) and six months later; fracture mode was also analyzed (40x). Ninety-six human molars were randomly assigned (n = 12), and half were irradiated with a 70 Gy radiation dose. For µTBS test, teeth were bonded, restored and sectioned them into beams (0.64 mm 2 ). The µSBS test used filled transparent cylindrical matrices with resin composite and light-cured them after dental adhesive applications. Three-way ANOVA and Tukey's test (p < 0.05) analyzed the data., Results: µTBS showed a significant substrate x adhesive interaction (p < 0.001), while µSBS was significant for all factors (p = 0.006). SE and FL performed better on SD and ID, respectively, in the µTBS test. As for µSBS, SE showed higher values on ID (p < 0.05). Lower BS values occurred for SD-FL and ID-SE after six months., Conclusion: Dental adhesive performance varied based on substrate type and test method. FL was more stable for ID in µTBS, while SE excelled in µSBS., Clinical Relevance: As post-radiotherapy irradiated dentin becomes more vulnerable, self-etching systems based on functional monomer and bioactive ingredients may exhibit appropriate bonding to this altered substrate., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: The purpose of this brief report is to discuss the impact of an oral rinse and spray containing an iron phthalocyanine derivative as an additional therapy in hospitalized COVID-19 patients., Methods: In the first study by this group of authors published on this topic, the clinical status of 22 patients with COVID-19 who were hospitalized and receiving PDMS (phthalocyanine derivative mouth spray) was assessed using the Karnofsky scale (KS) for thtree days (D0, D2, and D4). In another study, the laboratory data (CBC, D-dimer, Ferritin, and C-reactive protein [CRP]) of 41 patients hospitalized with COVID-19 who took part in a randomized clinical trial with an MIPD (mouthwash with iron phthalocyanine derivative) were evaluated retrospectively on the first day of intervention (D1) and 48 hours later (D2). The present study used these data to determine a correlation between clinical symptoms and laboratory data., Results: In individuals receiving PDMS and evaluated using the KS, a statistically significant intra-group difference (p=0.03, Friedman's test) was identified. The Durbin-Conover test found a significant difference between D0 and D2 (p=0.008). Laboratory data from only 9 patients in the experimental group and 13 patients in the control group were found in the retrospective analysis. There were no statistically significant confounders in the survival analysis using the Cox regression model. In the descriptive analysis, the intervention group's CRP was lower than that of the control group., Conclusion: PDMS demonstrated considerable clinical improvement in patients, whereas MIPD appears to lower CRP, an inflammatory marker, in descriptive analysis., Competing Interests: Dr. F. V. Vilhena has a patent. The other authors declare that they have no conflict of interest., (Copyright © 2024 da Fonseca Orcina et al.)

The aim of this study was to assess whether toothbrushing with a dentifrice containing an antimicrobial phthalocyanine derivative (APD) can reduce the intraoral viral load of SARS-CoV-2. Twenty COVID-19-positive dentate patients aged ≥18 years were selected instructed to brush their teeth for 2 min with a dentifrice containing APD. Self-collected samples of unstimulated saliva were carried out three times: T0 (baseline), T5 (5 min after toothbrushing), and T30 (30 min after toothbrushing). The analysis of viral RNA was performed by RT-qPCR for detection of three viral genes (ORF1ab, N and S genes). Results were statistically tested using Friedman's test and pairwise comparison with Bonferroni corrections, with a significance level of 5%. There was an increase in the cycle threshold (Ct) value from T0 to T5 in 13 patients (72.2%), and from T0 to T30 in 14 patients (77.8%). In two patients (11.1%) no SARS-CoV-2 was detected at T5 and five patients (27.8%) at T30. The Ct values were statistically significantly higher (p=0.020) at T30 in comparison to T0 and T5. This pilot study suggests that toothbrushing with a dentifrice containing APD could reduce the SARS-CoV-2 viral load in the oral cavity. However, further studies are needed to confirm this possible beneficial effect against SARS-CoV-2., Competing Interests: Dr. Vilhena has a patent pending. The other authors declare that they have no competing interests., (Copyright © 2024 Poleti et al.)

Aim: The purpose of this study is to undertake an integrative literature review in order to determine the prevalence, etiology, and reactivation of oral HSV infection in patients receiving chemotherapy (CT)., Methods: The study was carried out in the PubMed/MEDLINE, Embase, Virtual Health Library, and Scopus databases, using the descriptors "Herpes Simplex", "Viral Diseases", "Mouth", and "Antineoplastic Agents"., Results: The findings suggest that HSV infection is widespread in this group of patients and can be severe. HSV infection is frequent in CT patients, and treatment should begin as soon as it is feasible, utilizing antivirals to avoid future difficulties, as patients are immunocompromised., Conclusion: It is critical for health professionals to be fully informed on the dangers and treatment choices available, with the most appropriate therapy for each circumstance. Furthermore, more recent research with acceptable methodological rigor is required to better quantify the prevalence of HSV in these patients., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Carvalho et al.)

Aim: In a population profile corrected for sociodemographic factors, the aim of this study was to examine sociodemographic the protective effect of a phthalocyanine-derived mouthwash (APD) before infection with SARS-CoV-2, in addition to analyzing the survival of the at-risk population and the confirmed diagnosis of COVID-19., Methods: For individuals from the Uru municipality, a structured questionnaire consisting of two parts was completed before the distribution of APD. Subsequently, subjects received two bottles containing 600 mL of APD and were instructed to rinse/gargle with 3 mL of the solution 3 to 5 times per day for 1 min for 2 months. Data were obtained from the electronic system of the municipal health center, organized in a spreadsheet, and analyzed using multiple linear regression and Cox regression analysis., Results: The study included 995 participants with the following sociodemographic data: 98/995 individuals (p<0.002) who did not complete high school used the APD 66.30 times more than did individuals with higher education. The results in terms of survival were meaningful in relation to the duration of APD use. The protective factor for COVID-19 was 14.1%., Conclusion: Daily use of a solution containing phthalocyanine derivatives provided a higher protection factor against COVID-19 infection, predominantly in individuals without a school-completion certificate., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Brito Reia et al.)

Purpose: The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer., Methods: An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%., Results: There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878)., Conclusion: In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Immunosuppression and critical illnesses in combination with ecological imbalance open the door for novel opportunistic fungal infections, as in case of Candida (C). auris . C. auris has emerged globally as a multidrug-resistant yeast, causing infections and outbreaks in health care facilities. This narrative review discusses the properties of the yeast, the development of the epidemiological situation, the nosocomial spread and causes for nosocomial outbreaks triggered by C. auris in the hospital environment, and summarizes international recommendations for infection control, supplemented by suggestions on diagnostic, screening and antibiotic stewardship., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Caliman Sato et al.)

Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon and severe condition in patients who are receiving treatment with antiresorptive and/or antiangiogenic drugs, which are frequently used to treat or prevent cancer metastases. The treatment of MRONJ is challenging because the choice of a specific dental treatment depends on several factors, including the systemic condition of the patient, type and dosage of medications, and clinical and radiographic characteristics of the dental lesions. This case report describes the conservative endodontic treatment of an odontogenic infection in a patient at risk of developing MRONJ owing to bisphosphonate treatment. Endodontic retreatment was performed to control the odontogenic infection and avoid tooth extraction. Certain factors favor the use of a conservative approach, such as a localized and small infection, the absence of systemic factors (such as metabolic disorders or medications) that can impair bone healing, and good oral hygiene., Competing Interests: No conflicts of interest reported.

Background: In individuals with coronavirus disease (COVID-19), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load (VL) plays an important role in infectivity., Objectives: This study aimed to evaluate the reduction in the VL and infectivity induced by phthalocyanine mouthwash and nasal spray in patients with COVID-19., Methods: Patients with mild COVID-19 were recruited to participate in a triple-blinded randomized controlled trial. Participants were assigned to one of three groups: Group 1, non-active mouthwash and saline nasal spray (SNS); Group 2, phthalocyanine mouthwash and SNS; and Group 3 phthalocyanine mouthwash and phthalocyanine nasal spray. VL was assessed in nasopharyngeal and oropharyngeal swabs collected at the time of clinical diagnosis at baseline as well as 24 and 72 hours after starting the rinsing protocols., Findings: Forty-six participants were included in the analysis: 15, 16, and 15 in Groups 1, 2, and 3, respectively. After 72 hours, the reduction in VL was significantly higher in Group 3 (mean cycle threshold (Ct) decrease: 11.21) than in Group 1 (mean Ct decrease: 5.53). Additionally, only the mean VL in Group 3 was reduced to a non-contagious level after 72 hours., Main Conclusions: Use of phthalocyanine mouthwash and nasal spray is effective at reducing SARS-CoV-2 infectivity., Competing Interests: Dr. Vilhena has a patent classification pending. Prof. Dr. da Silva Santos reports grants from CNPq process nº 309525/2018-7. The other authors declare that they have no competing interests., (Copyright © 2023 Colado Simão et al.)

The study aimed to evaluate the relation between microcirculation of the genian region using laser Doppler flowmetry and oral mucositis (OM) and pain in individuals undergoing antineoplastic therapy. A case-control clinical study was conducted with the participants divided into three groups: chemotherapy (CTG), radiation therapy and chemotherapy group (RCTG), and control group (CG). Pain was assessed by visual analog scale; OM was classified by oral mucositis assessment and WHO scales. The blood flow was assessed by laser Doppler flowmetry. Kruskal-Wallis statistical test, Friedman test, and Spearman test were used for statistical analysis of this study. CTG (7 individuals/25.93%) showed the worst manifestations of OM between 2nd and 4th evaluations (OM-WHO: T2, p = 0.006; T3, p = 0.006; T4, p = 0.003; OM-OMAS: T2, p = 0.004; T3, p = 0.000; T4, p = 0.011), and increased blood flow over time, with the exception of the 3rd evaluation (p = 0.138). The RCTG (9 individuals/33.33%) showed the worst manifestations of oral mucositis on the 4th week (OM-WHO and OM-OMAS: p = 0.000) with a decrease in blood flow (p = 0.068). The decreased blood flow is associated with greater severity of oral mucositis and greater pain intensity., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objectives: To assess halitosis parameters using OralChroma™ and the correlation with salivary flow, oral hygiene index, radiation dose, and tongue-coating index among irradiated head and neck cancer patients compared to patients without cancer., Materials and Methods: This cross-sectional study enrolled irradiated and non-irradiated patients divided into two groups. Hydrogen sulfide, methyl mercaptan, and dimethyl sulfide (DMS) levels were measured using a gas chromatograph, and sialometry was performed. The tongue-coating index and simplified oral hygiene index were also assessed., Results: Thirty-eight patients were allocated to each group. Volatile sulfur compound levels were above the thresholds in both groups. Non-irradiated individuals showed higher levels of hydrogen sulfide and dimethyl sulfide. Patients with asialia had an inexpressive tongue-coating index and increased dimethyl sulfide levels. A decrease in salivary flow rate was followed by a significant increase in volatile sulfur compound levels. Higher doses of radiation to the submandibular salivary glands were associated with higher concentrations of sulfide and methyl mercaptan., Conclusions: Head and neck radiotherapy may be important in the development of halitosis. Irradiated patients with asialia presented insignificant lingual biofilm. Consequently, lower levels of volatile sulfur compounds were detected in this group. Asialia, a severe radiation-induced hyposalivation, impacted the levels of DMS (extraoral origin)., (© 2022 Wiley Periodicals LLC.)

Extending the range of use of the heterologous fibrin biopolymer, this pre-clinical study showed a new proportionality of its components directed to the formation of scaffold with a lower density of the resulting mesh to facilitate the infiltration of bone cells, and combined with therapy by laser photobiomodulation, in order to accelerate the repair process and decrease the morphofunctional recovery time. Thus, a transoperative protocol of laser photobiomodulation (L) was evaluated in critical bone defects filled with deproteinized bovine bone particles (P) associated with heterologous fibrin biopolymer (HF). The groups were: BC L (blood clot + laser); HF; HF L ; PHF (P+HF); PHF L (P+HF+L). Microtomographically, bone volume (BV) at 14 days, was higher in the PHF and PHF L groups (10.45 ± 3.31 mm 3 and 9.94 ± 1.51 mm 3 ), significantly increasing in the BC L , HF L and PHF L groups. Histologically, in all experimental groups, the defects were not reestablished either in the external cortical bone or in the epidural, occurring only in partial bone repair. At 42 days, the bone area (BA) increased in all groups, being significantly higher in the laser-treated groups. The quantification of bone collagen fibers showed that the percentage of collagen fibers in the bone tissue was similar between the groups for each experimental period, but significantly higher at 42 days (35.71 ± 6.89%) compared to 14 days (18.94 ± 6.86%). It can be concluded that the results of the present study denote potential effects of laser radiation capable of inducing functional bone regeneration, through the synergistic combination of biomaterials and the new ratio of heterologous fibrin biopolymer components (1:1:1) was able to make the resulting fibrin mesh less dense and susceptible to cellular permeability. Thus, the best fibrinogen concentration should be evaluated to find the ideal heterologous fibrin scaffold.

Objectives: The aim of this study is to investigate the long-term effects on jaw and femur bone induced by oncologic doses of zoledronic acid in a young rat model., Material and Methods: Six 12-week-old male Wistar rats received zoledronic acid (0.6 mg/kg) and six control rats received saline solution in the same volume. Compounds were administered intraperitoneally in five doses every 28 days. Euthanasia was performed 150 days after therapy onset. After animal sacrifice, their mandibles and femurs were scanned ex vivo using a high-resolution (14 μm) micro-computed tomography. Morphometric bone parameters were calculated using CT-Analyzer (Bruker, Belgium) between the first and second mandibular molars and in the distal femur metaphysis and epiphysis., Results: The treatment group as compared to the controls showed a significantly (p < .05) increased bone quantity (↑BV/TV, ↓Po[Tot], ↑Tb.Th), bone density (↑TMD, ↑BMD), and osteosclerosis of the trabecular bone (↓Tb.Sp, ↓Conn.Dn, ↓Tb.Pf, ↓SMI) in all anatomical sites. Bone remodeling suppression due to zoledronic acid treatment was more pronounced (p < .05) in the femoral metaphysis relative to the mandible and epiphysis. The exploratory linear discriminant analysis showed that for the mandible, it was mainly the bone quantity-related morphometric indices (BV/TV and Tb.Th), while for the femoral epiphysis and metaphysis, it was bone structure-related (Tb.Pf and Tb.N), which are of primary importance to study the treatment effect., Conclusion: High doses of bisphosphonates can differently affect the bone quantity, density, and structure in long bones and jawbones. In the metaphysis, bone changes were primarily concentrated in the region of the growth plate. Future studies may consider the use of bone morphometric indices to evaluate the effect of bisphosphonates., (© 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Purpose: This study identifies the impact of the absence of dental support for patients with cancer whose clinical dental care was interrupted by the coronavirus disease 2019 (COVID-19) pandemic., Methods: Individuals with oncologic diseases were selected from a telephone list of a Clinical Research Center (CRC) that specialized in the care of patients with cancer at the Bauru School of Dentistry, University of São Paulo (FOB/USP). The convenience sample comprised 280 patients (aged > 18 years) with a history of cancer that underwent dental treatment at the FOB/USP CRC in 2019 and did not receive care in 2020 owing to the pandemic. The participants completed a questionnaire sent via email or a text messaging application. Individuals receiving treatment or who were already treated for cancer were divided into two groups for data tabulation. Statistical analyses were performed using Fisher's and chi-square tests., Results: Of the 280 patients, 104 answered the questionnaire, and 75 (72.1%) were women. Among the women, 45 (60.0%) were receiving antineoplastic treatment, and 30 (40.0%) had already been treated. Among the men, 15 (51.7%) were receiving antineoplastic treatment, and 14 (48.3%) had already been treated. Regarding oral problems that arose during the pandemic, dental pain when eating hot or cold food or drinks (57.0%), muscle pain (53.8%), and difficulties when chewing (51.0%) were the most common reported among patients. Furthermore, most individuals reported not having received any type of remote dental follow-up, before being contacted by our team, which could contribute to reducing these oral problems., Conclusion: It is impossible to say whether the absence of dental support in cancer patients during the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on oral issue rates., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Vilhena reports personal fees from TRIALS Inc. while conducting the study. In addition, Dr. Vilhena has a patent pending. Dr. da Silva Santos reports grants from CNPq process nº. 309525/2018-7. The other authors claim no conflicts of interest.

Objectives: Salivary glands are affected during radiotherapy in the head and neck region, leading to a reduction in salivary flow and changes its composition. Besides negatively affecting the oral soft tissues, this can also lead to dental impairment. Thus, we evaluated the effect of radiotherapy in the proteomic profile of the saliva in patients with head and neck cancer (HNC)., Materials and Methods: HNC patients had their saliva collected before (BRT), during (2-5 weeks; DRT), and after (3-4 months; ART) radiotherapy. Saliva was also collected from healthy volunteers (control; C). Samples were processed for proteomic analysis., Results: In total, 1055 proteins were identified, among which 46 were common to all groups, while 86, 86, 286, and 395 were exclusively found in C, BRT, DRT, and ART, respectively. Remarkably, alpha-enolase was increased 35-fold DRT compared with BRT, while proline-rich proteins were decreased. ART there was a 16-fold increase in scaffold attachment factor-B1 and a 3-fold decrease in alpha-enolase and several cystatins. When compared with C, salivary proteins of BRT patients showed increases cystatin-C, lysozyme C, histatin-1, and proline-rich proteins CONCLUSION/CLINICAL REVELANCE: Both HNC and radiotherapy remarkably change the salivary protein composition. Altogether, our results, for the first time, suggest investigating alpha-enolase levels in saliva DRT in future studies as a possible biomarker and strategy to predict the efficiency of the treatment. Moreover, our data provide important insights for designing dental products that are more effective for these patients and contribute to a better understanding of the progressive changes in salivary proteins induced by radiotherapy. Graphical abstract., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To investigate the association of oral health condition with the occurrence of medication-related osteonecrosis of the jaw (MRONJ) in a cancer population., Methods: A multicenter cross-sectional study was conducted with cancer patients exposed to bisphosphonates for at least 7 months. Dental and periodontal conditions were assessed by epidemiological indices., Results: The sample consisted of 80 patients under bisphosphonate therapy, nine of which were allocated to group 1 (with MRONJ) and 71 to group 2 (without MRONJ). Osteonecrosis cases presented 19 decayed, missing, and filled teeth on average. Moderate gingival inflammation was noted in both groups and together with severe inflammation exceeded 50% of the groups. The presence of dental calculus was detected in about half of the individuals in both groups. Shallow periodontal pockets were detected in about 25% of both groups. Deep periodontal pockets were more prevalent among patients with osteonecrosis. Regular oral hygiene was detected in approximately 25% of individuals in both groups. There was a strong positive correlation between the clinical staging of osteonecrosis and decayed, missing, and filled teeth index (DMFTI)., Conclusions: Patients had a poor oral health condition. All but one osteonecrosis case had no previous history of tooth extraction; oral infections seemed to play a major role in the development of bone necrosis. Advanced osteonecrosis stages were associated with a higher DMFTI., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Determine the relationship between swallowing function, nutritional status, and salivary flow in patients after head and neck cancer treatment. This pilot study included 17 patients. Swallowing was assessed through videofluoroscopy and surface electromyography (sEMG), nutritional status through anthropometry and dietary assessment, and salivary flow both with and without mechanical stimulation. Test analysis showed that 66.7% of patients had functional limitations in swallowing in 58.3%, 66.7%, and 58.3% residue scale with an average of a line of barium on a structure for pudding, honey, and liquid consistencies, respectively. Laryngeal penetration was found in 8.3% during the swallowing of liquid. Surface electromyography (sEMG) showed above normal values for muscle activity time during the swallowing of pudding. Anthropometric assessment and muscle and adipose tissue indicated eutrophy. Salivary flow test with mechanical stimulus showed that 82.3% of patients' salivary production was well below the appropriate level. There was a significant correlation between muscle tissue reserve and muscle activity time during swallowing in the studied muscles (left masseter p = 0.003, right masseter p = 0.001, suprahyoid p = 0.001, orbicularis oris = 0.020), all in pudding consistency. This pilot study confirmed the relationship between swallowing and nutritional status for its participants, showing that appropriate protein intake influences muscle activity during swallowing in head and neck cancer survivors., (© 2021. The Author(s).)

The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n = 20) or nonactive mouthwash (control group NAM/n = 21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p = 0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p = 0.0207). This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period.Trial registration: The clinical study was registered at REBEC-Brazilian Clinical Trial Register (RBR-58ftdj)., (© 2021. The Author(s).)

Competing Interests: All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Vilhena reports personal fees from TRIALS Inc while conducting the study. In addition, Dr. Vilhena has a patent pending. Dr. DA Silva Santos reports grants from CNPq process nº. 309525/2018-7. The other authors claim no conflicts of interest

The objectives are to identify volatile sulphur compounds (VSCs) in individuals with Chronic Kidney Disease (CKD) and to relate quality of life and oral health. A case-control study with 32 individuals with CKD in haemodialysis in the study group (SG) and 32 healthy individuals in the control group (CG) was performed. The VSCs were identified by gas chromatograph before (BC) and after cysteine (AC) mouthwash and an organoleptic test. For oral health assessment, oral health index was used. For quality of life, the Oral Health Impact Profile (OHIP-14) and Medical Outcomes Study 36-Item Short Form Health Survery (SF-36) were used. The hydrogen sulphide AC, methyl mercaptan AC, tongue coating, dry mouth, plaque index, and DMFT were significantly higher in the SG. VSCs did not negatively affected the impact of oral health on the quality of life in the SG but did in the CG. As for the impact of general health on quality of life, methyl mercaptan BC and AC worsened overall health in vitality and mental health, respectively. Individuals with CKD have more halitosis than healthy individuals, and it is more related to methyl mercaptan. The halitosis worsened the general quality of life of individuals with CKD. The diagnosis and identification of the origin of halitosis is important to prevent one more factor that it worsened the global quality of life of patients with CKD.

Aim: This research suggested an in vitro virucidal action of a dental gel and a mouthwash with phthalocyanine derivative., Purpose: The aim of this study was to report an in vitro study evaluating the virucidal capacity of mouthwash and dental gel containing anionic phthalocyanine derivate (APD)., Methods: The research followed the recommendations of the National Health Surveillance Agency (ANVISA) and adapted methodology, described in the standards EN14776: 2015; ASTM E1053-11 and the Robert Koch Institute - RKI, in addition to good laboratory practices (GLP). The determination of the percentage of inactivation of the SARS-CoV-2 virus particles was carried out by imposing the viral solution in contact with the respective tested products, with intervals of 30 seconds, 1 and 5 minutes, with subsequent submission of the aliquots, recovered in cell culture microplates following virus titration using the TCID50 (50% Median Tissue Culture Infectious Dose)., Results: The Mouthwash APD presented 90% of viral inactivation percentage, while the dental gel APD demonstrated 99.99% of viral inactivation., Conclusion: In vitro analyses showed that mouthwash and dental gel APD can reduce the viability of SARS-CoV-2 virus particles., Competing Interests: Dr Vilhena reports personal fees from TRIALS Inc, during the conduct of the study; in addition, Dr Vilhena has a patent classified pending. Dr da Silva Santos reports grants from CNPq process nº. 309525/2018-7. The other authors claim there are no conflicts of interest., (© 2021 Santos et al.)

Objective: To evaluate the impact of oral alterations on the quality of life (QoL) of individuals with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)., Methods: A case-control study in 32 individuals with RA, 28 with SLE, and 29 in the control group (CG). The questionnaire SF-36 (Medical Outcomes Study Short-Form 36) was used to evaluate the health-related quality of life (HRQoL), and OHIP-14 (Oral Health Impact Profile-14) was used to evaluate the oral health-related quality of life (OHRQoL). The severity of xerostomia was evaluated by the Xerostomia Inventory (XI). In the clinical examination, decayed (D-T), missing(M-T), and filled teeth (F-T) (DMF-T), periodontal status, plaque index (PI), gingival index (GI), unstimulated whole salivary flow rate (UWSFR), and stimulated whole salivary flow rate (SWSFR) were also assessed. Data were analyzed by Student's t tests, chi-square test, Kruskal-Wallis test, ANOVA, Pearson's correlation, and Spearman's correlation., Results: Individuals with RA had a higher caries index (D-T/p = 0.004) and more frequent periodontal disease (PI/p = 0.017). In the SLE group, there was a significant lower salivary flow (SFR/p = 0.016, SFMS/p = 0.004) and severe xerostomia (p = 0.002). The impact of ORHQoL in individuals with RA occurred due to oral candidiasis, halitosis, and xerostomia, compromising the HRQoL. Overall, OHRQoL and HRQoL were more compromised in individuals with SLE, with xerostomia being the main oral problem., Conclusion: Individuals with RA and SLE present oral diseases with negative impact on their QoL., Clinical Relevance: This study shows the main oral manifestations in rheumatic autoimmune diseases, with mainly xerostomia compromising the quality of life.

This in vitro study evaluated the protective effect of titanium tetrafluoride (TiF 4 ) varnish and silver diamine fluoride (SDF) solution on the radiation-induced dentin caries. Bovine root dentin samples were irradiated (70 Gy) and treated as follows: (6 h): 4% TiF 4 varnish; 5.42% NaF varnish; 30% SDF solution; placebo varnish; or untreated (negative control). Microcosm biofilm was produced from human dental biofilm (from patients with head-neck cancer) mixed with McBain saliva for the first 8 h. After 16 h and from day 2 to day 5, McBain saliva (0.2% sucrose) was replaced daily (37 °C, 5% CO 2 ) (biological triplicate). Demineralization was quantified by transverse microradiography (TMR), while biofilm was analyzed by using viability, colony-forming units (CFU) counting and lactic acid production assays. The data were statistically analyzed by ANOVA (p < 0.05). TiF 4 and SDF were able to reduce mineral loss compared to placebo and the negative control. TiF 4 and SDF significantly reduced the biofilm viability compared to negative control. TiF 4 significantly reduced the CFU count of total microorganism, while only SDF affected total streptococci and mutans streptococci counts. The varnishes induced a reduction in lactic acid production compared to the negative control. TiF 4 and SDF may be good alternatives to control the development of radiation-induced dentin caries.

Objectives: Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are chronic inflammatory diseases whose symptoms can impair patient's quality of life (QoL). Psychological factors seem to play an important role in these diseases. This study aimed to determine the impact of oral health and anxiety levels on the QoL of patients with OLP and OLL., Patients and Methods: This was a cross-sectional study composed of OLP and OLL patients and a control group matched by age and sex with no autoimmune/inflammatory or malignant oral lesions. Anxiety levels and oral health impact on QoL were assessed using the Hamilton Anxiety Scale (HAM-A) and the Oral Health Impact Profile-14 (OHIP-14), respectively. The instruments were filled through personal interview before starting the treatment for oral lesions., Results: A total of 87 patients diagnosed with OLP (n = 45) and OLL (n = 42), and 87 controls were included in the study. Statistical differences were observed for the psychic and somatic anxiety dimensions between severities of diseases. Patients with OLP or OLL had higher scores for the OHIP-14 dimensions physiological discomfort and social limitation compared with controls. In addition, higher scores for physical pain, physical disability, social disability, and handicap were detected among patients with greater severity., Conclusion: Greater severity of OLP and OLL seems to be associated with increased levels of anxiety, higher scores of oral health impact profile, and decreased QoL., Clinical Relevance: Patients with severe OLP/OLL may benefit from additional therapeutic treatments, such as psychological and/or psychiatric management, concomitant to treatment specific to oral lesions.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is characterized by the development of bone necrosis in the jaws of patients receiving antiresorptive and/or antiangiogenic medications. No scientific reports have been published yet on bevacizumab-related osteonecrosis of the jaw (BeRONJ) when associated with dental implant placement and adjuvant ozone therapy., Case Presentation: A 54-year-old female patient with a history of metastatic breast cancer and bevacizumab use presented with a dental infection. Dental extraction followed immediately by dental implant placement was planned after suspension of the bevacizumab treatment. The patient presented with pain, drainage of purulent secretion, and bone exposure 5 weeks post-surgery. Complete healing was achieved at postoperative 7 months., Conclusions: The combination of adjuvant ozone therapy and surgical debridement was effective for the treatment of MRONJ; however, the risk of MRONJ may persist after the suspension of bevacizumab for 28 days.

Dosimetry for low-level laser therapy (LLLT) depends on several parameters, such as target tissue type, lesion type and laser equipment used. This study aimed to determine the most used LLLT dosimetry for the treatment and prevention of oral mucositis (OM) resulting from radiation therapy (RT) in head and neck cancer patients (HNCP). This research was conducted according to the PRISMA guidelines using the PICO framework. After extensively searching PubMed, Web of Science, Embase, Scopus, BVS and Cochrane Library databases, we found 130 records and selected 7 studies, involving 363 HNCP with an average age of 60.6 years who received RT. Briefly, sites affected by tumors were the following: oral cavity (170), oropharynx (91), throat (42), larynx (32), nasopharynx (11), hypopharynx (9), and in 8 cases, sites were not reported. These studies used several classifications for OM (RTOG/EORTC, WHO, NCI-CTC) and pain (NRS, VAS and modified VAS). These various researchers performed the LLLT punctual application of different forms using several protocols making analysis difficult. However, LLLT was effective regardless of the parameters used (632.8 nm to 685 nm, 1.8 J/cm 2 to 3.0 J/cm 2 , 10 mW to 60 Mw, 0.8 J to 3.0 J). The meta-analysis showed a better results with preventive LLLT 660 nm, 3.8 J/cm 2 , 15 mW; 0.15 J compared to preventive LLLT 660 nm, 1.3 J/cm 2 , 5 mW; 0.05 J (OMS: p = 0.03; NCI-CTC: p = 0.027). We conclude that there is, as of yet, no evidence of better laser dosimetry being more effective. Thus, randomized clinical trials to determine which doses of LLLT are most appropriate for treating and preventing OM due to RT are lacking and should be further investigated., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Post-radiation dental lesions affect mainly the cervical area of the tooth. Until now, there are quite few evidences regarding the effects of radiation exposure on root dentin breakdown. To better understand this effect, we used human root dentin specimens obtained from third molars from similarly aged individuals., Materials and Methods: Twenty specimens were analyzed by the surface hardness (SH), energy-dispersive X-ray spectroscopy (EDX), and X-ray diffraction (XRD) to evaluate the baseline properties of their root dentin. Other six human teeth were prepared and analyzed by scanning electron microscopy (SEM). Then the specimens were randomly distributed between two groups (n = 13 per group) and irradiated with a total dose of 55 or 70 Gy in a linear accelerator. The percentage of EDX and surface hardness loss (%SHL) were determined based on measurements before and after irradiation. The specimens were also analyzed after irradiation by SEM and XRD. The Ca/P weight ratio was calculated., Results: Based on SEM analysis, radiation exposure induced dehydration of the dentin. The Ca/P weight ratio decreased (p = 0.0045). The %SHL of specimens irradiated with 70 Gy was higher than that of the 55-Gy group (p < 0.05), although even the lower dose induced root dentin breakdown., Conclusions: Overall, we can state that radiation exposure changes the composition and structure of human root dentin, which detrimentally affect its hardness., Clinical Relevance: The changes reported herein might influence the selection of the dental materials and will bring new knowledge in this field to prevent radiation-related caries in root dentin.

Purpose: The aim was to assess the effect of a relevant regimen of zoledronic acid (ZA) treatment for the study of bisphosphonate-related osteonecrosis of the jaw on alveolar bone microstructure and vasculature. A sub-objective was to use 3-dimensional imaging to describe site-specific changes induced by ZA in the alveolar bone., Materials and Methods: Five Wistar rats received ZA (0.6 mg/kg) and five (controls) received saline solution in the same volume. The compounds were administered intraperitoneally in 5 doses every 28 days. The rats were euthanized 150 days after therapy onset. The mandibles were scanned using high-resolution (14-μm) micro-computed tomography (micro-CT), decalcified, cut into slices for histologic analysis (5 μm), and stained with hematoxylin-eosin. Bone quality parameters were calculated using CT-Analyser software (Bruker, Kontich, Belgium) in 2 different volumes of interest (VOIs): the region between the first molar roots (VOI-1) and the periapical region under the first and second molars' apex (VOI-2). Blood vessel density and bone histomorphometric parameters were calculated only for the region between the roots of the first molar using AxioVision Imaging software (version 4.8; Carl Zeiss, Gottingen, Germany)., Results: ZA-treated rats showed a significant increase in percentage of bone volume and density (P < .05), with thicker and more connected trabeculae. Furthermore, the ZA group showed a significant decrease in the size of the marrow spaces and nutritive canals and in blood vessel density (P < .05). In the micro-CT evaluation, VOI-2 showed better outcomes in measuring the effect of ZA on alveolar bone., Conclusions: ZA treatment induced bone corticalization and decreased alveolar bone vascularization. VOI-2 should be preferred for micro-CT evaluation of the effect of bisphosphonates on alveolar bone. This analysis allowed the effect of ZA on alveolar bone and its vascularization to be characterized. The results of this analysis may add further knowledge to the understanding of the physiopathology of osteonecrosis of the jaw., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Due to the low incidence of the Ewing's Sarcoma (ES) family tumors, the available epidemiology is likely to be unreliable, and at present, there are no standard diagnostic or clinical guidelines outlining their management. This report describes a case of peripheral primitive neuroectodermal tumor (ES/pPNET) which initially mimicked cystic lesions, and describes a comparison between ES and ES/pPNET in the jaws by the World Health Organization classification. This review addressed 63 cases published in the English literature between 1950 and 2016. The majority of cases were ES. Both ES and ES/pPNET mimicked other benign entities such as traumatic, cystic and inflammatory lesions. The patients who died of their disease had a history of metastatic tumors, and primary tumor located in the mandible and maxilla for ES and ES/pPNET, respectively. The differentiation of the ES family tumors from other small blue-cell tumors may be difficult and requires familiarity with histological and immunohistochemical features., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Kostmann syndrome (KS) is an autosomal recessive disorder characterized by a low neutrophil count and recurrent bacterial infections, including periodontal disease. This report describes the case of a 5-year-old female KS patient treated with regular infusions of granulocyte stimulating factor (granulokine), with primary complaint of gingival bleeding and tooth mobility, and followed up for 10 years. Conventional periodontal treatment and some extractions were performed, after neutrophil function tests using flow cytometry. The invasive procedures were carried out at an outpatient clinic under antibiotic prophylaxis due to a low neutrophil count and an impaired neutrophil function presented. During the 10-year follow-up period, despite episodes of recurrent gingivitis and periodontitis the present report describes the positive outcome of dental treatment of a patient with KS., (© 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Leukemia is the most common neoplastic disease of the white blood cells which is important as a pediatric malignancy. Oral manifestations occur frequently in leukemic patients and may present as initial evidence of the disease or its relapse. The symptoms include gingival enlargement and bleeding, oral ulceration, petechia, mucosal pallor, noma, trismus and oral infections. Oral lesions arise in both acute and chronic forms of all types of leukemia. These oral manifestations either may be the result of direct infiltration of leukemic cells (primary) or secondary to underlying thrombocytopenia, neutropenia, or impaired granulocyte function. Despite the fact that leukemia has long been known to be associated with oral lesions, the available literature on this topic consists mostly of case reports, without data summarizing the main oral changes for each type of leukemia. Therefore, the present review aimed at describing oral manifestations of all leukemia types and their dental management. This might be useful in early diagnosis, improving patient outcomes.