Sandra Regina Torres

Clinical aspects of Candida species carriage in saliva of xerotomic subjects.

In order to investigate the clinical factors that might influence the diversity and the degree of Candida species carriage in saliva, we conducted a cross-sectional study with 133 patients with complaints of xerostomia. Anamnesis, oral examination and collection of chewing-stimulated whole saliva were performed. The samples of saliva were kept refrigerated until they were plated onto CHROMagar Candida; cfu were counted and Candida species were identified by standard methods. There was a high prevalence of mixed Candida colonization. No relationship was found between total Candida cfu counts and variables like gender, age, place of origin, underlying diseases, exposure to medications (except antibiotics), daily habits and salivary flow rates. Oral candidiasis, antibiotic exposure and dental prosthesis wearing were associated with relatively high Candida counts in saliva. Low salivary flow rates predisposed to intense colonization by C. albicans and C. parapsilosis.

A prospective randomized trial to reduce oral Candida spp. colonization in patients with hyposalivation

Low salivary flow rates are associated with higher oral Candida spp. counts, which may predispose to oral candidiasis. The aim of this study was to compare the effect of stimulating salivary flow rates with that of a regimen of chlorhexidine mouth rinse on the intensity of Candida colonization in patients with reduced salivary flow rates. Thirty-one outpatients were randomized to stimulate salivary output (group 1) or to receive chlorhexidine mouth rinses (group 2). Evaluations were performed at baseline (T0), at end of treatment (T1), and 15 days after last day of treatment (T2). Chewing-stimulated whole saliva samples were collected at each visit. Group 1 showed a constant reduction in median cfu counts, although the difference was significant only between T0 and T2 (p = 0.004). Group 2 showed a reduction in median Candida cfu counts between T0 and T1 (p = 0.01), but the counts increased at T2 (p = 0.01), and the difference between T0 and T2 was not significant (p = 0.8). In conclusion, patients who received salivary stimulation showed reductions of Candida cfu counts in saliva and a trend for increasing salivary flow rates between baseline and end of study evaluations. The use of chlorhexidine mouth rinses dramatically reduced Candida cfu counts, but when patients discontinued treatment, intensity of colonization rose again.

Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw.

OBJECTIVES The objective of this study was to develop a technique for detecting cortical bone dimensional changes in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). STUDY DESIGN Subjects with BRONJ who had cone-beam computed tomography imaging were selected, with age- and gender-matched controls. Mandibular cortical bone measurements to detect bisphosphonate-related cortical bone changes were made inferior to mental foramen, in 3 different ways: within a fixed sized rectangle, in a rectangle varying with the cortical height, and a ratio between area and height. RESULTS Twelve BRONJ cases and 66 controls were evaluated. The cortical bone measurements were significantly higher in cases than controls for all 3 techniques. The bone measurements were strongly associated with BRONJ case status (odds ratio 3.36-7.84). The inter-rater reliability coefficients were high for all techniques (0.71-0.90). CONCLUSIONS Mandibular cortical bone measurement is a potentially useful tool in the detection of bone dimensional changes caused by bisphosphonates.

Low-power laser to prevent oral mucositis in autologous hematopoietic stem cell transplantation

To the Editor, Oral mucositis is a frequent complication of hematopoietic stem cell transplantation (HSCT) (1, 2). Low power laser (LPL) has been tested in the prophylaxis and treatment of oral mucositis with promising results (1, 3, 4). In this study, the prophylactic effect of LPL was tested in a double-blind randomized placebo-controlled trial. Adult patients undergoing autologous HSCT from January 2005 to July 2006 were eligible, provided they had integrity of the oral mucosa, and good oral hygiene and dental status on admission. The protocol was approved by the Institution Ethics Committee and patients signed an informed consent. Patients received LPL or placebo with daily applications from D-7 to D0. LPL was applied bilaterally in the following anatomic sites: posterior wall of the oropharynx; buccal mucosa; hard and soft palate; dorsal, ventral and lateral sides of the tongue; floor of the mouth; upper and lower labial mucosa; and vermillion border. A diode laser (Laser Solution Ltda, Niterói, Brazil) of 50 mW AsGaAl was applied emitting continuous light at 660 nm. Patients in the control group received the same form of treatment simulated by a light spot from a simple led. The dentist who applied the laser was not blind for randomization group. Evaluation was performed daily from D-2 until discharge by trained physicians, using the Tardieu’s scale (5). The primary endpoint was the number of days with oral mucositis grade zero and secondary endpoints were the proportion of patients with any grade of mucositis different from zero and the cumulative probability of developing mucositis. Routine prophylactic acyclovir was applied to all patients, but antifungal prophylaxis was not given routinely. Low power laser was given to 17 patients and 17 received placebo. The groups were comparable regarding baseline characteristics. The median duration of hospitalization of patients receiving LPL and placebo were similar (21 d, range 17–30 vs. 20 d, range 15–42, P = 0.52). Low power laser was well tolerated and no toxicity was recorded. There was a trend for a lower proportion of patients with fever of unknown origin in the laser group (35% vs. 65%, P = 0.09), suggesting that preventing mucositis may reduce the frequency of infection (6, 7). Oral mucositis was observed in eight patients in LPL group (47%) and 12 in the control group (71%, P = 0.16). The median number of days with oral mucositis grade zero (primary endpoint) was 14 in the laser group and eight in the placebo group (P = 0.01). There were no differences in the grade of oral mucositis between the two groups (P = 0.34). The cumulative probability to develop oral mucositis was 47% in the laser group and 69% in the placebo group (P = 0.27). Comparison of studies evaluating LPL in HSCT is difficult because of differences in the types of transplant, conditioning regimens, protocols of LPL application and evaluation of mucositis (1, 3, 4). Nevertheless, all studies showed a reduction in the duration and ⁄or severity of oral mucositis, suggesting that LPL should perhaps be incorporated into the general care of HSCT recipients. However, future studies need to evaluate different parameters of LPL application and the timing of intervention.

Oral sustained release nystatin tablets for the treatment of oral candidiasis: formulation development and validation of UV spectrophotometric analytical methodology for content determination

Objective: In this study, oral sustained release mucoadhesive nystatin tablets were developed to increase nystatin contact time with the oral cavity and mask its unpleasant taste. Methods. The best formulation studied included sustained release agents and it was submitted to physical-mechanical characterization, taste assessment and clinical test in twelve patients. The ultraviolet-visible nystatin methodology was also developed and validated in parallel as an alternative to the pharmacopoeial microbiological dosage method. Results. The best formulation developed in this study included sustained release agents. The efficacy of this formulation was verified through a clinical assessment, showing that this formulation is more effective (100%) than the commercial oral nystatin suspension used traditionally (50%). Moreover, the UV absorption spectrophotometry method developed to validate the methodology for nystatin content analysis for new oral tablets was shown to be specific, linear, exact and reproducible, as recommended by the ICH regulations. Conclusion. The oral nystatin tablets developed showed to present faster therapeutic response than the oral aqueous solution through the preliminary clinical assays. The UV absorption spectrophotometry method showed to be an attractive test for the usual routine in the pharmaceutical industry.

Oral events related to low-dose methotrexate in rheumatoid arthritis patients

Low-dose methotrexate (MTX) is frequently used for patients with rheumatoid arthritis (RA). High doses of MTX frequently produce side effects. The aim of this study was to explore oral complications of low-dose MTX therapy in a population of RA patients. This is a cross-sectional study in which oral examination was performed on a population of RA patients. Patients undergoing MTX therapy (5-20 mg weekly) for at least six months were included in the study group, and RA patients being treated under another regimen were used as controls. The frequency of oral lesions was compared between groups. The chi-square test was used to compare frequencies. Relative risk (RR) and its confidence interval (CI) were established. Significance level was set at 0.05. Twenty-eight RA patients on a low-dose MTX regimen and 21 controls were enrolled in the study. Oral lesions were found in 22 patients (78.6%) undergoing MTX therapy, and in 5 patients (23.8%) undergoing other therapies (p < 0.001). There were no significant differences regarding age, gender or dosage. The most common oral events observed in patients in the MTX group were ulcerative/erosive lesions (60.7%) and candidiasis (10.7%). Patients in the control group presented lower prevalence of the same lesions (p < 0.001). The RR for developing oral lesions was 11.73 (CI 2.57 - 58.98), with low-dose MTX therapy. In conclusion, the prevalence of oral mucosa lesions in RA patients receiving low doses of MTX therapy is higher than in RA patients not receiving the drug.

Orthodontic treatment of patients with sickle-cell anemia.

Sickle-cell anemia is a genetic blood disease characterized by a hemoglobin gene mutation. The genetic failure is basically constituted by replacement of the hemoglobin beta chain in the sixth position so that the amino acid valine is encoded instead of glutamic acid. As a result, the erythrocytes have their normal biconcave discoid shape distorted, generally presenting a sicklelike shape, which reduces both their plasticity and lifetime. Because a complete blood supply is so important during application of both intraoral and extraoral forces, this article addresses the general and oral aspects associated with sickle-cell anemia. This will guide the clinician regarding such patients who seek orthodontic treatment by making references to literature on multidisciplinary management.

The Association Between Detectable Plasmatic Human Immunodeficiency Virus (HIV) Viral Load and Different Subgingival Microorganisms in Brazilian Adults With HIV: A Multilevel Analysis

BACKGROUND This study investigates the association between detectable plasmatic human immunodeficiency virus (HIV) viral load (HVL) and high levels of periodontal- and non-periodontal-related microorganisms in the subgingival microbiota of individuals with HIV. METHODS Thirty-seven individuals with HIV were divided into two groups: 1) detectable HVL (n = 15); and 2) undetectable HVL (n = 22). Subgingival biofilm samples were obtained, and the levels of 35 microbial species were determined by the checkerboard DNA-DNA hybridization method. Periodontal clinical measures and laboratory and sociodemographic data were also registered. χ(2) test, Fisher exact test, and Mann-Whitney U test were used to compare groups. Multilevel ordinal regression models were used to test the association between HVL and the levels of 35 microbial species in subgingival biofilm, adjusted for confounders. RESULTS Of the 35 species studied, 11 (31.4%) showed higher mean levels in the detectable HVL group than undetectable HVL group (P <0.001). These species included Actinomyces naeslundii II, Actinomyces israelii, Actinomyces odontolyticus, Veillonella parvula, Capnocytophaga gingivalis, Eikenella corrodens, Campylobacter concisus, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Candida albicans. Significant associations between detectable HVL and high levels of microorganisms, adjusted for confounders, were observed for A. naeslundii I, Actinomyces gerencseriae, C. gingivalis, E. corrodens, C. concisus, Prevotella nigrescens, T. forsythia, and Dialister pneumosintes. CONCLUSION Detectable plasmatic HVL in individuals with HIV was associated with elevated levels of known periodontal pathogens, such as P. nigrescens, T. forsythia, and E. corrodens, as well as C. concisus, C. gingivalis, and D. pneumosintes in the subgingival biofilm.

Recurrent bilateral gingival peripheral calcifying epithelial odontogenic tumor (Pindborg tumor): A case report

Calcifying epithelial odontogenic tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similar to their intraosseous counterparts. We report an unusual case of multifocal peripheral CEOT. A 40-year-old female presented with bilateral soft, painful, erythematous, gingival swellings localized in premolar areas of the mandibular gingiva. The presumptive diagnosis was bilateral pyogenic granuloma. The masses were surgically excised under local anesthesia without bone curettage and both recurred 12 months later. Morphologic features, and histochemical and immunohistochemical tests revealed bilateral peripheral calcifying odontogenic epithelial tumor. There is no clinical or radiographic evidence of recurrence 3.5 years after excision. This multifocal phenomenon has been reported previously only for intraosseous CEOT. Gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia.

Variations of salivary flow rates in Brazilian school children

The salivary flow rate (SFR) in healthy individuals may vary according to different factors. There is a scarcity of studies from different geographical areas that analyze SFR variations in children. The aim of this study was to verify stimulated salivary flow rate (SFR) variations in 6 to 12-year-old children, from four different public schools of Rio de Janeiro and correlate these data to gender, age, type of dentition, and health status. Clinical data were taken from the childrens medical records that were kept at those schools. Oral examination and sialometry were performed in every child. Salivary flow rate was obtained by chewing-stimulated whole saliva under standard conditions. There were significant differences in SFR according to age (p = 0.0003). Six and 12-year-old children showed the lowest SFR, and when they were excluded from the analysis, no significant differences were found (p = 0.21). There were also significant differences in SFR among children from different public schools (p = 0.0009). The gender did not show any correlation to SFR, even when children were stratified by age (p = 0.36). Correlation between SFR and deciduous, mixed or permanent dentition was not found as well. These results show that the analyzed clinical variables did not seem to influence SFR in this children population.