Maria Paula Siqueira De Melo Peres

Efficacy of low-level laser therapy and aluminum hydroxide in patients with chemotherapy and radiotherapy-induced oral mucositis

This study evaluated the efficacy of low-level laser therapy (LLLT) and aluminum hydroxide (AH) in the prevention of oral mucositis (OM). A prospective, comparative and non-randomized study was conducted with 25 patients with head and neck cancer subjected to radiotherapy (RT) or radiochemotherapy (RCT). Twelve patients received LLLT (830 nm, 15 mW, 12 J/cm²) daily from the 1st day until the end of RT before each sessions during 5 consecutive days, and the other 13 patients received AH 310 mg/5 mL, 4 times/day, also throughout the duration of RT, including weekends. OM was measured using an oral toxicity scale (OTS) and pain was measured using the visual analogue scale (VAS). EORTC questionnaires were administered to the evaluate impact of OM on quality of life. The LLLT group showed lower mean OTS and VAS scores during the course of RT. A significant difference was observed in pain evaluation in the 13th RT session (p=0.036). In both groups, no interruption of RT was needed. The prophylactic use of both treatments proposed in this study seems to reduce the incidence of severe OM lesions. However, the LLLT was more effective in delaying the appearance of severe OM.

A prospective study of dentoalveolar trauma at the Hospital das Clínicas, São Paulo University Medical School

PURPOSE This prospective study evaluated the profile of patients with dentoalveolar trauma assisted at the emergency room of the Oral and Maxillofacial Trauma and Surgery Service at the Hospital das Clínicas, São Paulo University Medical School (Brazil). METHODS A prospective study by a questionnaire applied during the first attendance of those patients, in a period of eight months. RESULTS The collected data were statistically analyzed. It was observed that 4.7% of the patients that sought treatment at the Service had sustained dentoalveolar trauma and among these 74% were male. The most affected individuals were children aged 0 to 5 years and fall was the most prevalent etiologic factor. Avulsion and coronal/crown-root fractures were the most common types of dentoalveolar traumatic injures. As the age increases, the most common etiologic factors are traffic accidents and physical assault. CONCLUSION The incidence of dentoalveolar trauma decreased with age and the main etiologic factors in adult patients were traffic accidents and physical assault.

Analgesic and adjuvant anesthetic effect of submucosal tramadol after mandibular third molar surgery

OBJECTIVE The aim of this study was to assess analgesic and adjuvant anesthetic effects of submucosal tramadol after third molar extraction. STUDY DESIGN In this double-blind, split-mouth, placebo-controlled, single-dose, crossover investigation, 52 patients underwent mandibular third molar extraction under local anesthesia. Surgical side was randomly assigned to submucosal 2 mL 100 mg tramadol injection (group T) or normal saline solution (group P) immediately after surgery. Anesthetic blockade duration, time of intake and amount of analgesic rescue drug, and postoperative pain intensity were recorded immediately after anesthesia cessation and 4, 8, 24, 48, and 72 hours after surgery. Data were submitted to analysis of variance and Wilcoxon tests. RESULTS Anesthetic blockade duration between groups was similar. Group T took significantly less rescue drug after 72 hours (P = .008). Time elapsed before first intake of rescue drug was longer (P = .006), and pain intensity was significantly lower (P = .001) in group T. CONCLUSIONS Submucosal tramadol injection after oral surgery improved postoperative analgesia, but did not extend anesthetic action duration.

Treatment of drooling with scopolamine in pediatric ICU: A case series report: FRANCO et al.

Drooling is a condition that affects patients with difficulties in swallowing, being common in patients with mental, neurological or dysphagic deficiency. This condition is difficult to diagnose, as it is often confused with sialorrhea, and in many cases we have a hyposalivation scenario. Its diagnosis is subjective, which is why scales should be used for the standardization of the evaluation of the degree of drooling before and after the proposed treatment, as the Thomas-Stonell and Greenberg scale. It causes problems such as perioral infections, rashes, wet clothing, leading to social embarrassment, and may be a risk factor for respiratory infections caused by asymptomatic aspiration of saliva. It presents several treatments, among them the pharmacological one, that is dependent of the clinical picture of each patient that must be evaluated daily. This article refers to a series of reports of cases of children in mechanical ventilation by tracheostomy, hospitalized, with clinical diagnosis of drooling, and clinical improvement with the use of scopolamine by gastrostomy, without intercurrences during its use. The objective of this study is to show other professionals the importance of drooling management, and to expose the adopted behavior in the described cases, providing reduction of respiratory infections and improvement of the clinical and social complications resulting from drooling.

Assistência bucal na prevenção de pneumonia associada à ventilação mecânica em unidade de terapia intensiva neonatal e pediátrica: proposta de protocolo

Objective: to review the literature on ventilator-associated pneumonia in a neonatal and pediatric intensive care unit, the main substances and vehicles used for oral hygiene, and to propose an oral care protocol for the prevention of ventilator-associated pneumonia, prioritizing the oral comfort and providing a better quality of life. Material and Methods: search in databases from 2000 to 2018, with focus on oral care in neonatal and pediatric intensive care units, using the following descriptors: Ventilator-associated pneumonia; Aspiration pneumonia; Neonatal intensive care unit; Pediatric intensive care unit; Oral hygiene. Results: we selected 26 articles with neonatal and pediatric approach for preparation of the protocol proposal, which must be planned according to the availability of material and human resources, hospital profile, and must be based on scientific evidence. Conclusion: oral care protocols contribute for reducing the risk of infections in intensive care units, reducing the length of stay and hospital costs. Each hospital must develop its own protocol based on available scientific literature and on clinical experience of professionals involved.