Fernanda de Paula Eduardo

Stem Cell Proliferation Under Low Intensity Laser Irradiation: A Preliminary Study

Phototherapy with low intensity laser irradiation has shown to be effective in promoting the proliferation of different cells. The aim of this in vitro study was to evaluate the potential effect of laser phototherapy (660 nm) on human dental pulp stem cell (hDPSC) proliferation.

LASER PHOTOTHERAPY AS TOPICAL PROPHYLAXIS AGAINST HEAD AND NECK CANCER RADIOTHERAPY-INDUCED ORAL MUCOSITIS: COMPARISON BETWEEN LOW AND HIGH/LOW POWER LASERS

Oral mucositis is a dose‐limiting and painful side effect of radiotherapy (RT) and/or chemotherapy in cancer patients. The purpose of the present study was to analyze the effect of different protocols of laser phototherapy (LPT) on the grade of mucositis and degree of pain in patients under RT.

LED Phototherapy to Prevent Mucositis: A Case Report

OBJECTIVE The purpose of this case report was to evaluate the efficacy of phototherapy using light-emitting diodes (LEDs) to prevent oral mucositis in a Hodgkins disease patient treated with the ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine) chemotherapy regimen. BACKGROUND DATA Mucositis is a common dose-limiting complication of cancer treatment, and if severe it can lead to alterations in treatment planning or suspension of cancer therapy, with serious consequences for tumor response and survival. Therefore, low-power lasers and more recently LEDs, have been used for oral mucositis prevention and management, with good results. MATERIALS AND METHODS In this study, a 34-year-old man received intraoral irradiation with an infrared LED array (880 nm, 3.6 J/cm2, 74 mW) for five consecutive days, starting on chemotherapy day 1. In each chemotherapy cycle, he received the ABVD protocol on days 1 and 15, and received LED treatment for 5 d during each cycle. To analyze the results, the World Health Organization (WHO) scale was used to grade his mucositis, and a visual analogue scale (VAS) was used for pain evaluation, on days 1, 3, 7, 10, and 13 post-chemotherapy. RESULTS The results showed that the patient did not develop oral mucositis during the five chemotherapy cycles, and he had no pain symptoms. CONCLUSION LED therapy was a safe and effective method for preventing oral mucositis in this case report. However, further randomized studies with more patients are needed to prove the efficacy of this method.

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost‐effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval −5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs. Copyright

Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: Clinical outcomes in a context of specialized oral care using low‐level laser therapy

OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM‐related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA‐haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patients oral hygiene routine must be adopted with help from parents/companions and clinical staff.

Prevention of recurrent herpes labialis outbreaks through low-intensity laser therapy: a clinical protocol with 3-year follow-up

IntroductionThe recurrent herpes labialis (RHL) is a chronic lifelonginfection that affects a great part of the world’s population.It is caused by the herpes simplex virus type 1 (HSV 1) [1].The first virus contact causes the primary infection, whichis characterized by symptoms like multiple oral vesicles,fever, chills, fatigue, and muscle aches, lasting for 10 to14 days [2]. In general, primary infection is more severethan recurrences and is more commonly observed inchildren, teenagers, and young adults [3].After the primary infection and resolution of the lesions,the virus moves through the nerve endings and establishes alatent state at sensory ganglia, most commonly thetrigeminal ganglion. The exposition of the host to severalkinds of stress causes virus reactivation and migrationthrough sensory nerves to skin and mucosa, achieving thebasal epithelium of the lips and perioral area. Replication ofthe virus at these sites takes place and initiates a clinicalepisode of recurrent herpes labialis [4]. During theseepisodes, most of the clinical symptoms such as pain,redness, and swelling are consequences of the anti-inflammatory response generated by the immune systemof the host [5]. Thus, it is well known that patients withrecurrent herpes simplex infections have two concomitantmedical problems: virus multiplication and the overreactingimmune system [5].The virus reactivation may be triggered by fever, sunexposure, menstruation, psychological stress, or physicaltrauma. Afterwards, recurrent herpes labialis infection willmanifest clinically in different stages [6, 7]. The “coldsores” are the visible sign of RHL orofacial outbreaks andappear most frequently on the lips, at the juncture of themucous membrane, and perioral skin or inside the nose [8,9]. Up to 60% of the patients will experience a prodromicstage, after which the cold sores outbreaks develop through

Efficacy of cryotherapy associated with laser therapy for decreasing severity of melphalan-induced oral mucositis during hematological stem-cell transplantation: a prospective clinical study.

Melphalan followed by hematopoietic stem‐cell transplantation (HSCT) is the standard treatment for multiple myeloma and other hematopoietic neoplasms. However, high doses of melphalan cause severe oral mucositis (OM). The objective was to verify the efficacy of cryotherapy plus laser therapy on reduction of OM severity. HSCT patients undergoing melphalan chemotherapy (n = 71) were randomly divided into two groups according to OM treatment: oral cryotherapy performed with ice chips for 1 h 35 min followed by low‐level laser therapy (InGaAIP, 660 nm, 40 mW, 6 J/cm2) (n = 54) and laser therapy alone with the same protocol (n = 17). A control group (n = 33) was composed of HSCT patients treated with melphalan who received no specific treatment for OM. OM scores and clinical information were collected from D0 to D + 11. The cryotherapy/laser therapy group showed the lowest OM scores (maximum Grade I) and the lowest mean number of days (8 days) with OM in comparison with the other groups (p < 0.001). OM Grades III and IV were present with high frequency only in the control group. The association of cryotherapy with laser therapy was effective in reducing OM severity in HSCT patients who underwent melphalan conditioning. Copyright

Effect of irradiation with red and infrared laser in the treatment of oral mucositis

Oral mucositis (OM) is considered the cause of highmorbidity and one of the main side effects of chemotherapy for antineoplastic treatment. The impact of OM on the patient’s health ranges from worsening quality of life during chemotherapy through to increased treatment costs [1, 2]. OM refers to lesions of the oral mucosa that vary from erythematous to ulcerative, and may result in various degrees of signs and symptoms, such as burning and pain when swallowing and speaking. These symptoms predispose the patient to nutritional disturbances and ulcerations may increase the risk of opportunist infections [2]. The drug 5-fluorouracil (5-FU) is an antimetabolite that works on the S-phase of the cell cycle, promoting DNA damage. It is used as a chemotherapeutic agent in the therapy of control and remission of various solid tumors, such as those of the gastrointestinal tract, breast and cervix. Its adverse effects are conditioned to the form of administration and dose, and involve hematologic, dermatologic and gastrointestinal tract alterations. In the latter, OM is one of the first and most severe complications generated by 5-FU therapy, followed by diarrhea, which may be considered a clinical manifestation of intestinal mucositis. In 5-FU therapy, patients of the female gender [3] and advanced age have been associated with greater risk for the occurrence of OM, which is manifested in a larger number of patients between the third and seventh weeks after infusion of the drug, and can persist up to the 24th week in patients with gastrointestinal tract tumors [4]. Various treatment modalities have been used for chemotherapy-inducedOM, among them therapy with growth factors for keratinocytes, anti-inflammatory drugs with benzidamin, natural agents such as aloe vera and camomile, and physical agents as cryotherapy and laser therapy [5, 6]. There is evidence in the literature that low level laser therapy in OM lesions results in significant reduction of its severity [7, 8], and promotes an important preventive effect on the appearance of lesions [9]. The beneficial effects of laser irradiation on conditions of mucositis involve both aspects of injury repair and analgesia. In the latter case, frequently the reduction in painful symptomatology in the oral cavity, even where there are ulcerations, facilitates chewing and ingestion of foods, which helps to maintain the patient’s nutritional levels and quality of life. In general, the majority of present irradiation protocols involve the use of red laser in the selected wavelength of 660 nm, ranging between 632.8 and 685 nm [10]. These types of lasers are mainly characterized by their reparative C. B. Cunha Aristides Maltez Hospital, Salvador, BA, Brazil

The influence of dental care associated with laser therapy on oral mucositis during allogeneic hematopoietic cell transplant: retrospective study

OBJECTIVE To verify decrease in frequency and severity of oral mucositis in patients submitted to dental care and laser therapy during allogeneic hematopoietic cell transplant. METHODS Medical records of patients submitted or not to dental care associated with laser therapy during allogeneic transplant were reviewed. The following data were collected: sex, age, underlying disease, myeloablative conditioning regimens, prophylaxis for graft versus host disease, extension and severity of oral mucositis, pain in the oral cavity and when swallowing, diarrhea, need of peripheral parenteral nutrition and presence of acute graft versus host disease. RESULTS Significant reduction in extension and severity of oral mucositis, as well as in frequency of oral cavity pain, was observed in patients with dental care/laser therapy (p < 0.01). There were no statistically significant differences regarding frequency of diarrhea, pain when swallowing, and need of parenteral nutrition among the groups. Significant association was found between acute graft versus host disease and pain when swallowing (p < 0.01). Acute graft versus host disease was not associated with oral mucositis severity, oral cavity pain, and diarrhea. CONCLUSION Dental care associated with laser therapy reduces the extension and severity of oral mucositis in patients with allogeneic hematopoietic transplant. Further studies are necessary to clarify the isolate efficacy of laser therapy in these conditions, mainly regarding the influence of reduced oral mucositis on the graft versus host disease.

Oral care in Brazilian bone marrow transplant centers

BACKGROUND Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. OBJECTIVE The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. METHODS A questionnaire was mailed to 36 Brazilian transplant centers with questions about basic oral care protocols, the indication of specific mouthwashes, antibiotic therapy regimens, laser therapy, and treatment of oral mucositis and graft-versus-host disease. All the respondent centers (n = 12) have dentists as members of the HSCT medical staff. RESULTS The majority indicate non-alcoholic chlorhexidine (n = 9; 75.0%) and sodium bicarbonate (n = 5; 41.7%) as routine mouthwashes. Laser therapy was frequently indicated (n= 9; 75.0%), mainly in the prevention of oral mucositis and in oral pain control. In the post-transplant period, antibiotic therapy was only indicated for invasive dental treatments (n= 8; 66.7%). Several treatments for graft-versus-host disease were mentioned without a trend towards establishing a standard protocol. CONCLUSION Basic oral care constitutes regular assessment in the routine treatment of hematopoietic stem cell transplantation patients in Brazilian centers.