Background: Radiation therapy used for head and neck cancer patients cause many side effects in the oral cavity and above all affects the salivary glands. Complaint of dry mouth (xerostomia) and hyposalivation are common as well as swallowing difficulty (dysphagia) even after the cancer is remitted.  Aim: The aim of the study is to examine the correlation between hyposalivation and xerostomia in patients undergoing radiotherapy.   Methods: Six patients undergoing radiotherapy for head and neck cancer at Norrlands University Hospital participated in the study. A questionnaire regarding xerostomia was answered and a collection of stimulated as well as unstimulated saliva was taken.  Results: Regarding the stimulated salivary flowrate, one out six patients was below the limit of hyposalivation. Three out of six patients were below the limit of hyposalivation with reference to the unstimulated salivary output. The questionnaire regarding xerostomia showed that all patients experienced dry mouth symptoms to varying degrees. The questions concerning the dryness of the tongue and the amount of saliva in the mouth had the highest rating.  Conclusion: Regarding the patients that participated in this study, a correlation is shown between xerostomia and unstimulated salivary output. However, due to the lack of participants in the study, no firm conclusion can be drawn.

A boca é local de frequentes complicações relacionadas ao transplante de células tronco hematopoiéticas (TCTH) tais como xerostomia, disgeusia, disfagia, mucosite, infecções oportunistas e doença do enxerto contra hospedeiro (DECH). Sabe-se que estas complicações podem comprometer a qualidade de vida do paciente e interferir na morbidade pós-TCTH. O dentista é o profissional da saúde que deverá intervir no momento correto para tratar e minimizar esses efeitos secundários do TCTH. Para tanto é importante conhecermos o momento em que cada complicação ocorre para que a intervenção seja pronta e eficiente. O objetivo principal deste estudo foi identificar e quantificar as alterações bucais em indivíduos submetidos ao TCTH em cinco momentos consecutivos desde antes do início do condicionamento pré-TCTH até o dia 100 pós-TCTH. Como objetivos secundários buscamos investigar possíveis relações entre a severidade da mucosite oral e a manifestação da DECH com dados demograficos (sexo, idade), com o status de saude bucal (por meio dos índices IHO-S, CPOD, número de dentes cariados) e com a realização de adequação bucal pré-TCTH, e ainda, somente para a DECH, também foi investigada a possível relação entre esta doença com infecção sistêmica por citomegalovírus e com a manifestação de mucosite oral severa. Foram incluídos no estudo 27 indivíduos com doenças hematológicas do Serviço de Transplante de Medula Óssea do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), com idade 12 anos que receberam TCTH alogênico. Os indivíduos foram examinados em cinco momentos consecutivos. No primeiro momento, pré-TCTH, foi realizada a coleta de índices de saúde bucal e aplicação de questionário sobre o histórico de tratamentos odontológico prévios. Nos momentos de 10, 20, 60 e 100 dias pós-TCTH foram avaliadas as manifestações bucais presentes. A incidência de mucosite oral foi de 82,6% considerando todos os momentos avaliados. Mucosite oral severa, ou seja, graus 3 e 4 (OMS) foi observada em 57,9% dos pacientes avaliados nos momentos 2 e 3. Dez (37%) pacientes apresentaram GVHD em algum órgão, e destes, 8 (80%) apresentaram GVHD de boca. Infecção sistêmica por CMV foi diagnosticada em 6 (22,2%) pacientes. Concluímos que entre as queixas levantadas, dor bucal e disfagia foram as mais referidas. O período de maior incidência das complicações bucais foi nos segundo e terceiro momentos, ou seja, D+10 e D+20, representando deste forma, o período de maior morbidade do tratamento. Não houve associação entre a severidade de mucosite oral e idade, sexo, fonte de células, regime de condicionamento, número de dentes cariados, IHO-S, CPOD e preparo bucal pré-TCTH. Para a DECH a única relação encontrada foi para fonte de células, tendo sido observada menor chance de ocorrer DECH quando a fonte de células foi o sangue periférico. / The mouth is a well-known site of complications of the hematopoietic stem cell transplantation (HSCT) such as dry mouth, dysgeusia, dysphagia, mucositis, opportunistic infections and graft versus host disease (GVDH). It is known that these complications can compromise the patients quality of life and morbidity post-HSCT. The dentist is the health professional who should interfere at the right time to treat and minimize these side effects of HSCT. Thus, it is important to know the time at which each complication occurs to be dynamic and efficient. The main objective of this study was to identify and quantify the oral complications in patients treated with HSCT in five consecutive moments starting before conditioning chemotherapy until day 100 post-HSTC. As secondary objectives we seek to investigate possible relationships between the severity of oral mucositis and the manifestation of GVHD with demographic data (gender, age), with the oral health status (IHO-S, CPOD, number of decayed teeth) and dental treatment previously HSCT, and, only for GVHD, was also investigated the possible relationship between this disease with systemic cytomegalovirus infection and the manifestation of severe oral mucositis. It was included in the study 27 patients with hematologic diseases who were admitted in the Unit of Bone Marrow Transplantation, Hospital of Clinics, Faculty of Medicine, University of Sao Paulo (HC-FMUSP), 12 years old whom received allogeneic HSCT. The subjects were examined in five consecutive moments. At the first moment, before HSCT, the oral health índex evaluation and a questionnaire about history of previous dental treatments were performed. Besides that, 10, 20, 60 and 100 days after HSCT they were evaluated for oral manifestations. Oral mucositis incidence was 82,6% and 57,9% of these patients presented severe mucositis. Ten (37%) patients had GVHD in any organ, and of these, 8 (80%) had oral GVHD. Infection by CMV was diagnosed in 6 (22.2%) patients. We conclude that among the complaints raised, mouth pain and dysphagia were the most mentioned. The period of increased incidence of oral complications was the second and third times (D +10 and +20), representing the increased morbidity period. There was no association between the severity of oral mucositis and age, sex, cell source, conditioning regimen, number of decayed teeth, IHO-S, CPOD and dental treatment pre-HSCT. For GVHD the only relation found was with source of cells, in which, GVHD was less likely to occur when the source of cells was peripheral blood.

A boca é local de frequentes complicações relacionadas ao transplante de células tronco hematopoiéticas (TCTH) tais como xerostomia, disgeusia, disfagia, mucosite, infecções oportunistas e doença do enxerto contra hospedeiro (DECH). Sabe-se que estas complicações podem comprometer a qualidade de vida do paciente e interferir na morbidade pós-TCTH. O dentista é o profissional da saúde que deverá intervir no momento correto para tratar e minimizar esses efeitos secundários do TCTH. Para tanto é importante conhecermos o momento em que cada complicação ocorre para que a intervenção seja pronta e eficiente. O objetivo principal deste estudo foi identificar e quantificar as alterações bucais em indivíduos submetidos ao TCTH em cinco momentos consecutivos desde antes do início do condicionamento pré-TCTH até o dia 100 pós-TCTH. Como objetivos secundários buscamos investigar possíveis relações entre a severidade da mucosite oral e a manifestação da DECH com dados demograficos (sexo, idade), com o status de saude bucal (por meio dos índices IHO-S, CPOD, número de dentes cariados) e com a realização de adequação bucal pré-TCTH, e ainda, somente para a DECH, também foi investigada a possível relação entre esta doença com infecção sistêmica por citomegalovírus e com a manifestação de mucosite oral severa. Foram incluídos no estudo 27 indivíduos com doenças hematológicas do Serviço de Transplante de Medula Óssea do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), com idade 12 anos que receberam TCTH alogênico. Os indivíduos foram examinados em cinco momentos consecutivos. No primeiro momento, pré-TCTH, foi realizada a coleta de índices de saúde bucal e aplicação de questionário sobre o histórico de tratamentos odontológico prévios. Nos momentos de 10, 20, 60 e 100 dias pós-TCTH foram avaliadas as manifestações bucais presentes. A incidência de mucosite oral foi de 82,6% considerando todos os momentos avaliados. Mucosite oral severa, ou seja, graus 3 e 4 (OMS) foi observada em 57,9% dos pacientes avaliados nos momentos 2 e 3. Dez (37%) pacientes apresentaram GVHD em algum órgão, e destes, 8 (80%) apresentaram GVHD de boca. Infecção sistêmica por CMV foi diagnosticada em 6 (22,2%) pacientes. Concluímos que entre as queixas levantadas, dor bucal e disfagia foram as mais referidas. O período de maior incidência das complicações bucais foi nos segundo e terceiro momentos, ou seja, D+10 e D+20, representando deste forma, o período de maior morbidade do tratamento. Não houve associação entre a severidade de mucosite oral e idade, sexo, fonte de células, regime de condicionamento, número de dentes cariados, IHO-S, CPOD e preparo bucal pré-TCTH. Para a DECH a única relação encontrada foi para fonte de células, tendo sido observada menor chance de ocorrer DECH quando a fonte de células foi o sangue periférico. / The mouth is a well-known site of complications of the hematopoietic stem cell transplantation (HSCT) such as dry mouth, dysgeusia, dysphagia, mucositis, opportunistic infections and graft versus host disease (GVDH). It is known that these complications can compromise the patients quality of life and morbidity post-HSCT. The dentist is the health professional who should interfere at the right time to treat and minimize these side effects of HSCT. Thus, it is important to know the time at which each complication occurs to be dynamic and efficient. The main objective of this study was to identify and quantify the oral complications in patients treated with HSCT in five consecutive moments starting before conditioning chemotherapy until day 100 post-HSTC. As secondary objectives we seek to investigate possible relationships between the severity of oral mucositis and the manifestation of GVHD with demographic data (gender, age), with the oral health status (IHO-S, CPOD, number of decayed teeth) and dental treatment previously HSCT, and, only for GVHD, was also investigated the possible relationship between this disease with systemic cytomegalovirus infection and the manifestation of severe oral mucositis. It was included in the study 27 patients with hematologic diseases who were admitted in the Unit of Bone Marrow Transplantation, Hospital of Clinics, Faculty of Medicine, University of Sao Paulo (HC-FMUSP), 12 years old whom received allogeneic HSCT. The subjects were examined in five consecutive moments. At the first moment, before HSCT, the oral health índex evaluation and a questionnaire about history of previous dental treatments were performed. Besides that, 10, 20, 60 and 100 days after HSCT they were evaluated for oral manifestations. Oral mucositis incidence was 82,6% and 57,9% of these patients presented severe mucositis. Ten (37%) patients had GVHD in any organ, and of these, 8 (80%) had oral GVHD. Infection by CMV was diagnosed in 6 (22.2%) patients. We conclude that among the complaints raised, mouth pain and dysphagia were the most mentioned. The period of increased incidence of oral complications was the second and third times (D +10 and +20), representing the increased morbidity period. There was no association between the severity of oral mucositis and age, sex, cell source, conditioning regimen, number of decayed teeth, IHO-S, CPOD and dental treatment pre-HSCT. For GVHD the only relation found was with source of cells, in which, GVHD was less likely to occur when the source of cells was peripheral blood.

A doença do enxerto contra o hospedeiro (DECH) é uma das maiores causas de mortalidade e morbidade pós-transplante de células-tronco hematopoiéticas. A DECH, em sua manifestação crônica (DECHc), ainda não tem sua fisiopatologia totalmente esclarecida; entretanto, o envolvimento do sistema imunológico, por meio de respostas imunes inatas e adaptativas é bem estabelecido na literatura. A DECHc afeta múltiplos órgãos, incluindo as glândulas salivares, o que tem, como causa imediata, a xerostomia. Essas alterações são largamente desconhecidas e sub-relatadas. Assim, esse estudo indagou se o sintoma de xerostomia na DECHc é decorrente de alterações morfológicas e funcionais das glândulas salivares. Para responder essa pergunta analisamos de forma qualitativa e por meio da morfometria, espécimes de biopsias de glândulas salivares labiais de pacientes com DECHc e com sintoma de xerostomia. Foram utilizados como controles, espécimes de biopsias de glândulas salivares de pacientes diagnosticados com Síndrome de Sjögren (SSp) (que é um modelo clássico de xerostomia) e de pacientes com líquen plano oral (LPO) (cujas manifestações clínicas orais podem se assemelhar às da DECHc) e queixa de xerostomia. Também foram analisadas, por meio de ensaio multiplex, as citocinas relacionadas à resposta imune Th17 (importante via imunológica na patogenia da DECHc) na saliva de 21 pacientes de DECHc, 27 de SSp, 10 de LPO e 15 voluntários saudáveis. Os principais achados morfológicos nas glândulas salivares dos pacientes de DECHc foram a extensa fibrose, fibroplasia periductal, atrofia ductal e acinar; alterações vasculares representadas pela congestão e formação de trombos hialinos; e infiltrado inflamatório intersticial difuso de aspecto leve a moderado. As glândulas salivares de SSp, entretanto, apresentaram um infiltrado inflamatório na forma de focos de linfócitos ao redor dos ductos excretores de intensidade moderada a severa; os ductos excretores apresentaram-se atróficos, ectásicos, exibindo metaplasia oncocítica e fibroplasia periductal; as alterações vasculares, por sua vez, se apresentaram em maior proporção na forma de vasculite. No LPO as alterações teciduais foram menos intensas. Quando analisadas as concentrações das citocinas, na DECHc, foram encontradas maiores concentrações de IL-17A, IL-4, IL-17F e IL-10, em relação aos grupos controles, essas citocinas estão envolvidas em mecanismos prófibróticos, o que permitiu a correlação dessa expressão aos eventos escleróticos nas glândulas salivares dos pacientes de DECHc. Entre elas, a IL-17F apresentou uma tendência de aumento em relação a proporção da área de fibrose nas glândulas salivares destes pacientes. A CD40L, que também esteve presente em maior concentração nos pacientes de DECHc, é uma molécula de ligação capaz de amplificar a resposta imunológica no mecanismo de rejeição do enxerto no hospedeiro, além de regular o mecanismo de apoptose e ativar o endotélio para a formação de trombos. As citocinas IL-31, IL-23 e IL-22, também apresentaram relevância na saliva dos pacientes de DECHc, sendo participantes do mecanismo das alterações liquenóides no LPO. Através das análises comparativas foi possível correlacionar a presença de citocinas envolvidas na resposta Th17 com as alterações glandulares e consequente xerostomia nos pacientes de DECHc. / The graft versus host disease (GVHD) is one of the biggest causes of mortality and morbidity after hematopoietic stem cells transplantation. The pathophysiology in the chronical manifestation of the disease (cGVHD), is not entirely elucidated, however the involvement of the immunological system, by means of the innate and adaptive responses are depicted in the literature concerning the disease development. The cGVHD affects multiple organs, including the salivary glands, leading to xerostomia. These alterations are under reported and mostly unknown. Therefore, this study investigated if the symptom of xerostomia in cGVHD is triggered by functional e morphological changes in minor salivary glands. To answer this inquiry specimens of biopsied labial salivary glands from patients of cGVHD and xerostomia were analyzed qualitatively and through morphometry. Specimens of biopsied salivary glands from patients with Sjögren\'s Syndrome (SS) (which is a classic model of xerostomia) and from patients with oral lichen planus (OLP) (whose clinical oral manifestations resemble the cGVHD lesions) were used as controls. Also, the cytokines related to the immunological response Th17 (important immune pathway in cGVHD pathophysiology) in the saliva of 21 cGVHD patients, 27 of SS, 10 patients of OLP and 165 healthy individuals were analyzed using the multiplex assay. The major morphological findings revealed on the salivary glands of cGVHD patients were the extensive fibrosis, periductal fibrosis, ductal and acinar atrophy. Congestion and hyaline thrombi formation were the most important vascular changes shown among these specimens. A diffuse interstitial inflammatory infiltrate was observed, with varied intensity. The SS salivary glands, however, portrayed a focal inflammatory infiltrate, with moderate to severe intensity around the excretory ducts. These ducts exhibited atrophy, ectasia, periductal fibrosis and oncocytic metaplasia. The main vascular change presented in these patients was the manifestation of vasculitis. The salivary glands from the OLP patients showed a lesser amount of alterations. The multiplex assay revealed a higher concentration of the cytokines IL-17A, IL-4, IL-17F and IL-10 in the cGVHD samples, when compared to the other groups. These cytokines are involved within the promotion of fibrosis, which endorsed the association of these secretions with the salivary glands sclerotic mechanisms. The secretion of CD40L was higher in cGVHD samples; this membrane protein is capable of amplifying the immunological response in graft rejection, besides the capacity to regulate apoptosis and activate the endothelium in thrombi formation. The cytokines IL-31, IL-23 and IL-22, also presented a higher concentration in cGHVD patients\' saliva, these secretions are actively involved in the mechanisms of lichenoid lesions in OLP, corroborating the perceived morphological changes. The comparative analysis of the morphological and salivary changes in cGVHD confirmed the correlation of Th17 immunological response within the minor salivary glands injuries and consequent xerostomia in these patients.

A doença do enxerto contra o hospedeiro (DECH) é uma das maiores causas de mortalidade e morbidade pós-transplante de células-tronco hematopoiéticas. A DECH, em sua manifestação crônica (DECHc), ainda não tem sua fisiopatologia totalmente esclarecida; entretanto, o envolvimento do sistema imunológico, por meio de respostas imunes inatas e adaptativas é bem estabelecido na literatura. A DECHc afeta múltiplos órgãos, incluindo as glândulas salivares, o que tem, como causa imediata, a xerostomia. Essas alterações são largamente desconhecidas e sub-relatadas. Assim, esse estudo indagou se o sintoma de xerostomia na DECHc é decorrente de alterações morfológicas e funcionais das glândulas salivares. Para responder essa pergunta analisamos de forma qualitativa e por meio da morfometria, espécimes de biopsias de glândulas salivares labiais de pacientes com DECHc e com sintoma de xerostomia. Foram utilizados como controles, espécimes de biopsias de glândulas salivares de pacientes diagnosticados com Síndrome de Sjögren (SSp) (que é um modelo clássico de xerostomia) e de pacientes com líquen plano oral (LPO) (cujas manifestações clínicas orais podem se assemelhar às da DECHc) e queixa de xerostomia. Também foram analisadas, por meio de ensaio multiplex, as citocinas relacionadas à resposta imune Th17 (importante via imunológica na patogenia da DECHc) na saliva de 21 pacientes de DECHc, 27 de SSp, 10 de LPO e 15 voluntários saudáveis. Os principais achados morfológicos nas glândulas salivares dos pacientes de DECHc foram a extensa fibrose, fibroplasia periductal, atrofia ductal e acinar; alterações vasculares representadas pela congestão e formação de trombos hialinos; e infiltrado inflamatório intersticial difuso de aspecto leve a moderado. As glândulas salivares de SSp, entretanto, apresentaram um infiltrado inflamatório na forma de focos de linfócitos ao redor dos ductos excretores de intensidade moderada a severa; os ductos excretores apresentaram-se atróficos, ectásicos, exibindo metaplasia oncocítica e fibroplasia periductal; as alterações vasculares, por sua vez, se apresentaram em maior proporção na forma de vasculite. No LPO as alterações teciduais foram menos intensas. Quando analisadas as concentrações das citocinas, na DECHc, foram encontradas maiores concentrações de IL-17A, IL-4, IL-17F e IL-10, em relação aos grupos controles, essas citocinas estão envolvidas em mecanismos prófibróticos, o que permitiu a correlação dessa expressão aos eventos escleróticos nas glândulas salivares dos pacientes de DECHc. Entre elas, a IL-17F apresentou uma tendência de aumento em relação a proporção da área de fibrose nas glândulas salivares destes pacientes. A CD40L, que também esteve presente em maior concentração nos pacientes de DECHc, é uma molécula de ligação capaz de amplificar a resposta imunológica no mecanismo de rejeição do enxerto no hospedeiro, além de regular o mecanismo de apoptose e ativar o endotélio para a formação de trombos. As citocinas IL-31, IL-23 e IL-22, também apresentaram relevância na saliva dos pacientes de DECHc, sendo participantes do mecanismo das alterações liquenóides no LPO. Através das análises comparativas foi possível correlacionar a presença de citocinas envolvidas na resposta Th17 com as alterações glandulares e consequente xerostomia nos pacientes de DECHc. / The graft versus host disease (GVHD) is one of the biggest causes of mortality and morbidity after hematopoietic stem cells transplantation. The pathophysiology in the chronical manifestation of the disease (cGVHD), is not entirely elucidated, however the involvement of the immunological system, by means of the innate and adaptive responses are depicted in the literature concerning the disease development. The cGVHD affects multiple organs, including the salivary glands, leading to xerostomia. These alterations are under reported and mostly unknown. Therefore, this study investigated if the symptom of xerostomia in cGVHD is triggered by functional e morphological changes in minor salivary glands. To answer this inquiry specimens of biopsied labial salivary glands from patients of cGVHD and xerostomia were analyzed qualitatively and through morphometry. Specimens of biopsied salivary glands from patients with Sjögren\'s Syndrome (SS) (which is a classic model of xerostomia) and from patients with oral lichen planus (OLP) (whose clinical oral manifestations resemble the cGVHD lesions) were used as controls. Also, the cytokines related to the immunological response Th17 (important immune pathway in cGVHD pathophysiology) in the saliva of 21 cGVHD patients, 27 of SS, 10 patients of OLP and 165 healthy individuals were analyzed using the multiplex assay. The major morphological findings revealed on the salivary glands of cGVHD patients were the extensive fibrosis, periductal fibrosis, ductal and acinar atrophy. Congestion and hyaline thrombi formation were the most important vascular changes shown among these specimens. A diffuse interstitial inflammatory infiltrate was observed, with varied intensity. The SS salivary glands, however, portrayed a focal inflammatory infiltrate, with moderate to severe intensity around the excretory ducts. These ducts exhibited atrophy, ectasia, periductal fibrosis and oncocytic metaplasia. The main vascular change presented in these patients was the manifestation of vasculitis. The salivary glands from the OLP patients showed a lesser amount of alterations. The multiplex assay revealed a higher concentration of the cytokines IL-17A, IL-4, IL-17F and IL-10 in the cGVHD samples, when compared to the other groups. These cytokines are involved within the promotion of fibrosis, which endorsed the association of these secretions with the salivary glands sclerotic mechanisms. The secretion of CD40L was higher in cGVHD samples; this membrane protein is capable of amplifying the immunological response in graft rejection, besides the capacity to regulate apoptosis and activate the endothelium in thrombi formation. The cytokines IL-31, IL-23 and IL-22, also presented a higher concentration in cGHVD patients\' saliva, these secretions are actively involved in the mechanisms of lichenoid lesions in OLP, corroborating the perceived morphological changes. The comparative analysis of the morphological and salivary changes in cGVHD confirmed the correlation of Th17 immunological response within the minor salivary glands injuries and consequent xerostomia in these patients.

Made available in DSpace on 2015-05-14T12:56:00Z (GMT). No. of bitstreams: 1 Arquivototal.pdf: 1022365 bytes, checksum: a34bf595e7b1cb1f78a6b3c35f2353bf (MD5) Previous issue date: 2011-12-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Radiotherapy is an important treatment available for malignant head and neck neoplasias. However, this therapeutic modality triggers a number of oral complications that compromise the quality of life of the oncological patient. The present study aimed at performing a comparative assessment of salivary flow, xerostomy, tongue coating and dysgeusia rates, before and after head and neck radiotherapy. Thirty-one patients referred for radiotherapy treatment were selected. These individuals were submitted to anamnesis, determination of stimulated and unstimulated (resting) salivary flow rate (SSF and USF) and dry weight of tongue coating, in addition to the occurrence of dysgeusias. Data obtained were analyzed with SPSS 13.0 statistical software. Wilcoxon, Spearman s correlation, chi-square and student t-tests were also applied, considering p<0.05. Mean age was 38±88 years. Mean USF rates were 0.49±0.27ml/min - 0.14±0.17ml/min, while mean SSF rates were 1.77±0.79ml/min. - 0.38±0.48ml/min, respectively before and after radiotherapy, both with p = 0.000. After radiotherapy, 84% of patients reported xerostomy, 54% hyposalivation for USF and 77% for SSF. Postoperative altered sense of taste was observed in 97% of cases, and of these, 61.2% (19) were grade IV ageusia; 29% (9) grade III hypogeusia, 6.4% (2) grade II hypogeusia and 10% (3) grade II hypergeusia. Mean dry weight of tongue coating ranged from 0.072±0.557g to 0.003±0.040g before and after radiotherapy, respectively, a statistically significant difference (p=0.001). The results of the study sample shows that radiotherapy provoked dysfunction in salivary glands and the sense of taste, as well as a reduction in tongue coating, which was influenced by the marked decrease in salivary flow. / A radioterapia é um importante tratamento disponível para as neoplasias malignas de cabeça e pescoço. Entretanto, essa modalidade terapêutica desencadeia várias complicações bucais que comprometem a qualidade de vida do paciente oncológico. O objetivo do estudo foi avaliar comparativamente as taxas de fluxo salivar, xerostomia, saburra lingual e disgeusias, antes e após radioterapia de cabeça e pescoço. Foram selecionados 31 pacientes com indicação de tratamento radioterápico, os quais foram submetidos à anamnese, determinação do FSR, FSE e peso seco da saburra lingual, além de avaliação quanto à ocorrência de disgeusias. Os dados obtidos foram analisados em programa estatístico SPSS 13.0, sendo aplicados testes de Wilcoxon, correlação de Spearman, qui-quadrado e t de Student, considerando p<0,05. A média de idade foi de 38±88 anos. As taxas médias do FSR foram: 0,49±0,27ml/min - 0,14±0,17ml/min e do FSE foram: 1,77±0,79ml/min. -0,38±0,48ml/min , respectivamente antes e após-radioterapia, ambas com p=0,000. Após-radioterapia, 84% dos pacientes referiram xerostomia, 54% tinham hipossalivação em relação ao FSR e 77% para o FSE. Foram observadas alterações do paladar em 97% dos casos após-radioterapia e entre estas, 61,2% (19) eram ageusia de grau 4; 29% (9) hipogeusia de grau 3 e 6,4% (2) hipogeusia de grau 2 e 10% (3) hipergeusia de grau 2. Os valores médios do peso seco saburra lingual variaram de 0,072±0,557g e 0,003±0,040g antes e após a radioterapia, respectivamente, sendo a diferença estatisticamente significativa (p=0,001). De acordo com os resultados da amostra estudada pode-se concluir que a radioterapia provocou disfunção das glândulas salivares e do paladar, bem como redução da saburra lingual, sendo esta influenciada pela diminuição acentuada do fluxo salivar.

Orientador: Denise Madalena Palomari Spolidorio / Banca: Elaine Maria Sgavioli Massucato / Banca: Antonio Olavo Cardoso Jorge / Resumo: O objetivo deste estudo foi avaliar os efeitos do tratamento periodontal em pacientes diabéticos do tipo 2 sobre alterações de fluxo salivar, xerostomia, Candida spp. na saliva e candidose bucal clínica. Foram selecionados 20 pacientes diabéticos tipo 2 e 17 pacientes não-diabéticos de ambos os gêneros, com idade média entre 37 e 55 anos, portadores de doença periodontal crônica. Após exame clínico para avaliação das condições clínicas periodontais, presença de xerostomia e presença clínica de candidose bucal, amostras de saliva foram coletadas para mensuração do fluxo salivar (mL/min), contagem das colônias de Candida spp. (UFC/mL) e identificação das espécies. Esse procedimento foi realizado antes da terapia periodontal (baseline), que consistiu em raspagem e alisamento radicular, instrução de higiene bucal e motivação do paciente, aos 30 e 90 dias após a mesma. Os resultados demonstraram que os pacientes diabéticos apresentaram maior ocorrência de xerostomia e de candidose bucal, sendo estes colonizados por várias espécies de Candida spp. com predominância de C. albicans, sem no entanto, implicar no desenvolvimento da candidose clinicamente. A terapia periodontal, a motivação do paciente e a instrução de higiene bucal foram importantes para melhorar as condições clínicas periodontais e evitar a formação de reservatórios intrabucais de infecção. / Abstract: In order to investigate the effect of periodontal therapy, in type 2 diabetes mellitus subjects about salivar flow rates, presence of xerostomia, presence of Candida species in the saliva and presence of buccal candidose, twenty type 2 diabetes mellitus subjects and seventeen no-diabetes mellitus subjects, with medium age among 33 to 55 years, presenting generalized chronic periodontal disease were selected. After initial clinical exam to analyze periodontal parameters, xerostomia and buccal candidose presence, saliva samples were assessed to quantify as millimeters of saliva generated per minute (mL/min), account yeasts by colony forming units per mL (CFU/mL) and identificated species. That procedure was accomplished before periodontal therapy (baseline) that it consisted in scaling and root planning, oral hygiene instructions and patient's motivation to the thirty and ninety days after these. Diabetics subjects showed to having hyposalivation in similar levels in no-diabetics groups and in all the analyzed periods, higher prevalence of xerostomia and higher occurrence of buccal candidose. Candida albicans were the prevalent yeast at all periods in both groups, but the presence of yeasts in saliva not implied in the development of buccal candidose. Concluded that the periodontal therapy, the patients' motivation and the buccal hygiene instructions improve periodontal conditions and avoid the formation of microbial reservoirs in mouth. / Mestre

nÃo hà / Um estudo prospectivo e duplo-cego foi conduzido para verificar os efeitos do uso da pilocarpina no tratamento da xerostomia induzida por radiaÃÃo em pacientes oncolÃgicos, testando duas via de administraÃÃo: sublingual e bochechos. Os voluntÃrios foram randomicamente alocados em dois grupos: grupo para uso da soluÃÃo sublingual e grupo para uso de bochechos. Cada grupo foi subdividido, totalizando quatro amostras de resultados: duas para soluÃÃo sublingual (placebo e pilocarpina) e duas para bochechos (placebo e pilocarpina). As soluÃÃes foram formuladas na mesma concentraÃÃo de pilocarpina a 4% e administradas na dose total de 15 mg por dia, durante trÃs semanas. A amostra compreendeu quarenta voluntÃrios, de ambos os sexos, que foram submetidos à radiaÃÃo de cabeÃa e ou pescoÃo no serviÃo do CRIO (Centro Regional Integrado de Oncologia). Assim a distribuiÃÃo foi de dez pacientes em cada grupo. NÃo houve restriÃÃes quanto à idade nem ao grupo Ãtnico. Uma sialometria antes do estudo foi realizada em cada voluntÃrio, sendo selecionados os pacientes com fluxo salivar menor ou igual a 1 mL/min. Os resultados da sialometria apÃs uso das formulaÃÃes foram realizados semanalmente e anotados no formulÃrio de relato de caso (CRF). NÃo houve aumento quantitativo do fluxo salivar e nem diferenÃa estatisticamente significante entre as formulaÃÃes testadas. Portanto a soluÃÃo de pilocarpina a 4%, administrada na forma de bochechos ou pela via sublingual, nÃo aumentou o fluxo salivar nos pacientes com xerostomia induzida por radiaÃÃo / A prospective and double-blind study was conducted to verify the effects of the use of pilocarpine in the treatment of xerostomy induced by irradiation in oncologic patients, testing two administration routes: sublingual and mouthful. The volunteers were randomly allocated in two groups: a group for use of mouthfuls and a group for use of sublingual solutions. Each group was subdivided, totaling four samples of results: two for sublingual solutions (placebo and pilocarpine) and two for mouthfuls (placebo and pilocarpine). The solutions were formulated in the same pilocarpine concentration to 4% and administered in the total dose of 15 mg a day, for three weeks. The total group was formed by forty (40) volunteers, of both sex, treated with head and neck radiation in CRIO (Oncologic Integrated Regional Center) .The final distribuition was ten (10) patients in each subgroup. There was not restriction to age or etnic group.The volunteers who had the salivary flow less or equal to 1mL/min were selected to the study. The sialometry was measured weekly and whrote down in an appropriated formulary (CRF). The was not quantitative increase of the salivary flow or significant statistic difference between the two tested solutions. Therefore the pilocarpine solution 4% administrated sublingual or mouthful, did not increase the salivary flow in patients with xerostomy induced by radiation

Abstract The most common mental disorder, depression, is internationally acknowledged as a considerable public health problem, major depression being one of the leading causes of premature mortality and disability in the world (Murray &amp; Lopez 1996). Besides its associations with disturbances in psychological and social functioning, depression is also associated with various biological alterations. Accordingly, extensive research has been conducted to link depression with several somatic diseases. The relationship between depression and oral health is still obscure, however. This study was carried out to investigate the relationship of depressive symptoms with oral health and related factors in 55-year-old inhabitants of Oulu, 780 of whom participated. Depressive symptoms were measured with the Zung Self-Rating Depression Scale (ZSDS). A high rate of depressive symptoms was associated with symptoms of temporomandibular disorders (TMD), the subjective sensation of dry mouth, and high counts of salivary lactobacilli. An uncertain association was demonstrated between depressive symptoms and abundant growth of salivary mutans streptococci and the presence of yeasts in saliva. Depressive symptoms were associated with edentulousness in a subgroup of men who had never smoked. The dentate women with high rates of depressive symptoms did not consider it equally important to preserve their natural teeth as did the dentate women with fewer depressive symptoms. They also consumed sweets, snacks, and soft drinks more often, and a longer time had elapsed since their last visit to a dentist. No associations between depressive symptoms and periodontal pocketing or dental caries could be demonstrated in this cross-sectional study. It is suggested that depression should be considered as a possible underlying factor when treating patients with TMD symptoms and complaints of oral dryness. Furthermore, considering the discovered association between depressive symptoms and microbial growth, the possibility of an increased risk for impaired oral health among depressed persons is emphasized.

Bakgrund: En stor andel individer drabbas årligen av cancer i Sverige. Vanliga behandlingsformer är cytostatika och strålning. Effekten av behandlingarna har många orala biverkningar, vilket kan påverka drabbade individers liv negativt. Syfte:Var att beskriva patienters upplevelse av munhälsa vid cytostatika- och strålbehandling mot cancer. Metod: Studien genomfördes som en allmän litteraturstudie och grundades på åtta resultatartiklar som bearbetats med hjälp av innehållsanalys där resultat har granskats, sammanställts och skapat kategorier.Resultat: Patienter upplevde orala komplikationer relaterat till cytostatika- och eller strålbehandling samt stor påverkan på det sociala livet. Det framkom även upplevelse av bristande information om hantering av orala biverkningar. Resultatet delas in i tre kategorier; Patienters upplevda munhälsa vid cytostatika- och strålbehandling, Information om vikten av munhygien vid cytostatika- och strålbehandling och Patienters upplevelse av utanförskap kopplat till nedsatt munhälsa. Konklusion: Att drabbas av orala komplikationer vid cancerbehandling påverkar patienters hela livssituation både fysiskt och psykiskt. För att tillgodose patienters välbefinnande är det av vikt att inte bara fokusera på att bota från sjukdom utan även lindra biverkningar under behandling. En ökad medvetenheten om hur orala biverkningar påverkar patienter som genomgått cancerbehandling är av stor vikt ur ett omvårdnadsperspektiv. / Background: Individuals suffer from cancer annually in Sweden. Common treatments are chemotherapy and radiation. The effect of the treatments has oral side effects, which can negatively affect the lives of individuals. Purpose: To describe patients' experience of oral health in chemotherapy and radiotherapy. Method: The study was conducted as a general literature study based on eight result articles. Content analysis were used. Results have been reviewed and compiled creating categories. Results: Patients experienced oral complications related to chemotherapy and radiotherapy as well as impact on social life. There was also experience of a lack of information on the management of oral side effects. The result is divided into three categories; Patients' perceived oral health during chemotherapy and radiotherapy, Information about the importance of oral hygiene during chemotherapy and radiotherapy and Patient's experience of exclusion linked to impaired oral health.Conclusion: Experiencing oral complications related to cancer treatment affects patients' life situation both physically and mentally. To ensure the well-being of patients, it is important not only to focus on curing from disease, but also to relieve side effects during treatment. Raising awareness of how oral side effects affect patients undergoing cancer treatment is of great importance from a nursing perspective.