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Introduction: Aesthetic applications of botulinum toxin type A (BoNT-A) may lead to some complications, including unwanted muscle paralysis. Moreover, BoNT-A effects may last several months, and there is no medical intervention so far to accelerate muscle function recovery. Case Report: A female patient with a movement disorder of the mimic muscles resulting from BoNT-A injections received daily sessions of photobiomodulation therapy (PBMT). A fast improvement in both facial asymmetry and muscle function was noted within a few weeks. After nine weeks, almost complete recovery was achieved. Conclusion: According to the current case, PMBT seems to be an effective intervention to accelerate muscle function recovery following BoNT-A use.

To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: "Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?".MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs - version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented.Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible.In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn.

To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ.Electronic databases were searched to identify peer-reviewed studies, followed by reference list search and further hand-searching. Randomized clinical trials and controlled studies were considered for inclusion when comparing at least two anesthetic approaches. The risk of bias was assessed using the Cochrane risk of bias tool.Of a total of 506 potentially eligible studies, only a randomized controlled clinical trial and an observational study were included. The former compared some outcomes of arthrocentesis under local and general anesthesia and the latter under sedation and general anesthesia. Moreover, both studies were judged as "high risk of bias."In general, there appears to be a slight trend toward better outcomes of arthrocentesis for internal TMJ derangements (Wilkes grades I to III) when performed under general anesthesia; however, given that the available evidence is remarkably limited and a high risk of bias was detected within the included studies, a definitive statement cannot be made.

Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1ml of 10μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P0.001), specifically between the first 25 ml and 200 ml (P=0.014), 225 ml (P=0.001), 250 ml (P0.001), and 275 ml (P=0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.

To assess the efficacy of silver diamine fluoride (SDF) and sodium fluoride (NaF) in inhibiting enamel erosion in primary teeth. 80 primary canine teeth were immersed for 24 h in 2% NaF, 10% SDF, or distilled water. Afterward, some of them underwent a 10-min acid challenge using either 1% or 10% citric acid while others did not. Specimens selected for negative controls were immersed in distilled water but not exposed to the acids, whereas those selected for positive controls were not only immersed in distilled water, but also exposed to the acids. Following, 3-mL samples were collected for calcium and phosphorus analysis by an atomic emission spectrometer. 1% acid caused higher phosphorus loss in the positive control group than in the others (no differences between them). Regarding 10% acid, the SDF group showed lower phosphorus loss compared to the positive control and NaF groups. From calcium loss analysis, SDF and NaF groups presented no significant difference when compared to the positive control groups after both acidic challenges. Considering phosphorus loss values, 10% SDF seems to be effective in inhibiting enamel erosion after 1% and 10% citric acid challenges, whereas 2% NaF only after 1% citric acid challenge. Regarding calcium loss values, both fluoride agents seem to have no impact on inhibiting enamel erosion after 1% and 10% citric acid challenges.

Purpose The purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs. Materials and methods Thirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region. Results Statistically significant decreases were observed in the mean pixel intensity (P=0.0368) and fractal dimension (P=0.0495) values after radiotherapy. Conclusion The results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

Introduction: Thrombocytopenia is usually seen after allogeneic hematopoietic stem cell transplantation (HSCT) and may favor the development of oral bleeding, infections, and ulcerations. Case Report: A patient with chronic myelomonocytic leukemia had been submitted to allogeneic HSCT. Within a few days, she developed severe thrombocytopenia and an extensive ulcerative area comprising both lips, which bled spontaneously, as well as smaller ulcers on the tongue mucosa. The lesions were managed using a combination of phototherapies (photobiomodulation and antimicrobial photodynamic therapies), totalizing 4 laser sessions. After 4 days, there was an important reduction in the severity of the lesions, with spontaneous disappearance of the crusts and reepithelization. Conclusion: The proposed combination of phototherapies would be a suitable therapeutic modality for the management of oral lesions related to platelet disorders induced by oncologic treatments.

Although phototherapies have been used to manage nipple lesions and pain in breastfeeding women, there is no information on alternative therapies treating puerperal mastitis-associated breast abscess. The current study aimed to present a case in which adjuvant photobiomodulation therapy was used for a breast abscess developed as a complication of puerperal mastitis. Despite receiving antibiotic therapy, exudate drainage, surgical cleaning, and drain placement, after 11 days, the patient was still experiencing pain and there were marked inflammation signs on the region. Fifteen sessions of photobiomodulation therapy were then proposed. Pain relief was achieved after 3 laser sessions and wound healing after 15 laser sessions. According to the current case, photobiomodulation therapy seems to be a valuable adjuvant therapeutic modality for puerperal mastitis-associated breast abscess. A pesar de que las fototerapias han sido utilizadas para controlar lesiones mamilares y como analgésicos en mujeres que amamantan, no hay información sobre terapias alternativas para el control de abscesos mamarios asociados a mastitis puerperal. El presente estudio tuvo como objetivo presentar un caso en que la terapia de biofotomodulación fue propuesta como terapia adyuvante en el control de un absceso mamario asociado a mastitis puerperal. A pesar de que la paceinte recibió fototerapia terapia antibiótica, drenaje del exudado, limpieza quirúrgica y colocación de un drenaje, después de 11 días, todavía presentaba dolor y tenía señales inflamatorias acentuadas en la región. Entonces fueron propuestas quince sesiones de terapia de biofotomodulación. Una analgesia completa fue relatada después de 3 sesiones de laser y, después de 15 sesiones, el reparo completo de la lesión fue observado. De acuerdo con el presente caso, la terapia de fotobiomodulación parece ser una valiosa modalidad terapéutica adyuvante para el control del absceso mamario asociado a una mastitis puerperal. Embora as fototerapias tenham sido utilizadas para o manejo de lesões mamilares e analgesia em mulheres que amamentam, não há informações sobre terapias alternativas para o manejo de abscesso mamário associado a mastite puerperal. O presente estudo teve como objetivo apresentar um caso em que a terapia de fotobiomodulação foi proposta como terapia coadjuvante no manejo de um abscesso mamário associado à mastite puerperal. Apesar de ter recebido antibioticoterapia, drenagem de exsudato, limpeza cirúrgica e colocação de dreno, após 11 dias a paciente ainda apresentava dor e a inflamação na região persistia. Foram então propostas quinze sessões de terapia de fotobiomodulação. A completa analgesia foi referida após 3 sessões de laser e, após 15 sessões, o reparo completo da lesão foi observado. De acordo com o presente caso, a terapia de fotobiomodulação parece ser uma valiosa modalidade terapêutica adjuvante para o manejo do abscesso mamário associado à mastite puerperal.

Introduction: Fixed drug eruption (FDE), a very specific adverse drug reaction and one of the most common types of drug eruption, generally resolves spontaneously within 7-10 days upon withdrawal of the causative agent; however, extensive and severe cases may also require systemic drug therapy. The present study aimed to report a case in which a broad spectrum of severe, painful lesions of FDE was managed with photobiomodulation therapy (PBMT). Case Report:A 31-year-old Caucasian woman presented with many extremely painful mucocutaneous lesions of FDE which had arisen 8 days before, following a long period of hospitalization. The lesions were not responsive to either corticosteroids or analgesics within 5 days, and then seven daily sessions of PBMT were proposed. Pain alleviation was achieved on the 1st day of PBMT, and the lesions showed an advanced course of healing on the 3rd day. Within 7 days of PBMT, the lesions were almost completely repaired. In a 3-month follow-up period, no relapse of any FDE lesion was reported. Conclusion: PBMT may be a promising strategy for the management of painful lesions of FDE refractory to conventional medication therapy. However, further studies are needed to confirm this hypothesis.

O objetivo deste estudo foi propor um novo Sistema de Identificação Odonto-legal para a Polícia Militar do Estado de São Paulo (PMESP) baseado no protocolo DVI (Disaster Victim Identification) da INTERPOL (International Criminal Police Organization). Para comparar a percepção sobre o preenchimento e interpretação dos dados, 10 oficiais dentistas preencheram a ficha odonto-legal (FOL) em uso atualmente na PMESP e a nova ficha baseada na da INTERPOL. Também, um questionário estruturado sobre a nova FOL foi respondido por um perito criminal cirurgião-dentista do Núcleo de Odontologia Legal do Instituto Médico-Legal (IML) da Superintendência da Polícia Técnico Científica (SPTC) do Estado de São Paulo. Após a análise dos dados, constatou-se que a nova FOL proposta com base no protocolo da INTERPOL parece ser de preenchimento simples e interpretação mais fácil que a atualmente utilizada, além de ser mais rápida e precisa, atendendo a parâmetros aceitos internacionalmente. Ademais, o exame imaginológico (radiografia do tipo panorâmica) foi citado como sendo muito importante na elaboração da FOL. This study aimed to propose a new Dental Forensic Identification System for the Military Police of the State of São Paulo (PMESP) based on the DVI (Identification of Victims of Disasters) protocol of INTERPOL (International Criminal Police Organization). In order to compare the perception about the filling and interpretation, 10 dental officers completed the dental-legal form (FOL) in use currently at the PMESP and the new form based on the INTERPOL’s protocol. A structured questionnaire about the new FOL was also answered by a criminal expert dentist of the Forensic Dentistry Nucleus of the Legal Medicine Institute (IML) of the Superintendence of the Scientific Technical Police (SPTC) of the State of São Paulo. After analyzing the data collected, it was suggested that the new form proposed based on the INTERPOL’s protocol is simpler to complete and easier to interpret than the form currently used, besides being faster and more accurate, meeting internationally accepted parameters. Furthermore, the imaging exam (panoramic radiography) was mentioned as a very important tool in the elaboration of the FOL. El objetivo de este estudio fue proponer un nuevo Sistema de Identificación Odontológico-Forense a la Policía Militar del Estado de São Paulo (PMESP) basado en el protocolo DVI (Disaster Victim Identification) de la INTERPOL (Organización Internacional de Policía Criminal). Con el fin de comparar la percepción sobre el llenado e interpretación de datos, 10 odontólogos completaron el formulario odontologico-legal (FOL) actualmente en uso en el PMESP y el nuevo formulario basado en la INTERPOL. Además, un cuestionario estructurado sobre el nuevo FOL fue contestado por un odontólogo especialista en criminalística del Núcleo de Odontología Forense del Instituto de Medicina Legal (IML) de la Superintendencia de la Policía Técnica Científica (SPTC) del Estado de São Paulo. Luego de analizar los datos recolectados por la investigación, se encontró que el nuevo FOL propuesto en base al protocolo de la INTERPOL parece ser sencillo de llenar y más fácil de interpretar que lo que se usa actualmente, además de ser más rápido y preciso, cumpliendo con parámetros aceptados internacionalmente. Lo examen de imagen (radiografía panorámica) fue mencionado también como muy importante en la elaboración de la FOL.

Olfactory dysfunction is commonly seen in COVID-19 patients; however, little is known about the pathophysiology and management. The present study aimed to report a series of cases in which three protocols of intranasal photobiomodulation therapy (PBMT) were used for COVID-19-related olfactory dysfunction. Irrespective of the PBMT protocol, olfaction recovery was noted in all cases but with varying degrees of improvement. Although intranasal PBMT seems to be a promising therapeutic modality, more research is demanded to identify the most suitable protocol.

This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.

Hypoplastic left heart syndrome consists of several structural abnormalities in the left side of the heart and may be associated with a hereditary genetic cause, possibly related to the connexin gene GJA1; however, only a few studies have investigated it. The present study aimed to analyse the expression of connexin-43 in the cardiac muscle of hypoplastic left heart syndrome children by Western blot method and confocal laser scanning microscopy. For that, tissue samples were taken during corrective surgery to treat heart defects. Patients of control group (8) presented any type of heart defect not related to hypoplastic left heart syndrome, connexin-43, or its gene and those of hypoplastic left heart syndrome group (9) presented this disease singly, without any other associated congenital diseases. By means of confocal laser scanning microscopy, it was noticed no connexin-43 qualitative differences in positioning and location pattern between both groups. From Western blot analysis, the connexin-43 expression did not show a statistically significant difference (p = 0.0571) as well. Within the limits of this study, it is suggested that cardiomyocytes of hypoplastic left heart syndrome children are similar in connexin-43 location, distribution, and structural and conformational patterns to those of children with heart defects not related to this protein and its genes.

Localizado no terço médio da face, o corpo adiposo da bochecha é uma estrutura adiposa arredondada, biconvexa e delimitada por uma cápsula fina. Indivíduos com volume excessivo do corpo adiposo da bochecha podem apresentar uma aparência infantil ou de que estão em sobrepeso, porém a excisão cirúrgica é capaz de esculpir os ângulos faciais e melhorar a estética da face como um todo. Apesar deste procedimento (também conhecido como “bichectomia”) ter se tornado muito popular nos dias de hoje, as evidências e os estudos que fornecem detalhes técnicos são bastante limitados. Desta forma, a presente revisão narrativa da literatura teve como objetivo compilar o máximo de informações relativas à excisão do corpo adiposo da bochecha com finalidade de recontorno estético da face. De acordo com os estudos levantados, o manejo cirúrgico do corpo adiposo da bochecha pode ser considerado um procedimento relativamente simples e que apresenta ótimos resultados estéticos quando bem indicado e realizado por profissional experiente na técnica. Entretanto, considerando a carência de evidências científicas de alto nível principalmente relacionadas aos efeitos em longo prazo, estudos bem delineados e com seguimento apropriado são ainda necessários para maiores esclarecimentos e fundamentação da técnica no cotidiano clínico.

The treatment of rheumatoid arthritis (RA), an inflammatory autoimmune disease of chronic nature, consists of medications, exercises, patient education on the disease, and rest. Unfortunately, many drugs used for RA have been recently recognized to induce oral manifestations due to either immunosuppression or antiproliferative effects. Thus, the present study reports a case of a patient who was receiving multiple medications (methotrexate, leflunomide, and sodium risedronate) for RA and developed an extensive lip ulcerative lesion not responsive to previous treatments. The lesion management was performed using only a combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT), totalizing three laser sessions. Within 4 days, the patient no longer complained of pain and the lesion presented an advanced healing aspect. According to the current case, the combination of PBMT and aPDT seems to be a suitable alternative for the management of oral lesions in patients taking medications for RA. La artritis reumatoide (AR) es una enfermedad inflamatoria autoinmune de naturaleza crónica, cuyo tratamiento consiste en medicamentos, ejercicios y en educar al paciente sobre la enfermedad y el reposo necesario. Sin embargo, se ha reconocido recientemente que muchos fármacos utilizados para tratar la AR ocasionan manifestaciones orales debido a sus efectos inmunosupresores o antiproliferativos. El presente estudio reporta el caso de un paciente que estaba recibiendo múltiples medicamentos (metotrexato, leflunomida y risedronato de sodio) para la AR y desarrolló una lesión ulcerosa labial extensa que no respondió a tratamientos previos. Se optó por una combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana, totalizando tres sesiones de láser. A los 4 días, el paciente ya no se quejaba de dolor y la lesión presentaba aspecto de cicatrización avanzado. Los resultados sugieren que la combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana parece ser una alternativa adecuada para el manejo de lesiones orales en pacientes que utilizan medicamentos para tratar la AR. O tratamento da artrite reumatoide (AR), uma doença inflamatória autoimune de natureza crônica, consiste em medicamentos, exercícios, instrução ao paciente sobre a doença e repouso. Infelizmente, muitos medicamentos utilizados para AR recentemente foram associados a manifestações orais por imunossupressão ou efeitos antiproliferativos. Assim, o presente estudo relata o caso de um paciente que estava recebendo vários medicamentos (metotrexato, leflunomida e risedronato de sódio) para AR e desenvolveu uma lesão ulcerativa labial extensa não responsiva a tratamentos prévios. O manejo da lesão foi realizado apenas com a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana, totalizando três sessões de laser. Em 4 dias, a paciente não se queixava mais de dor e a lesão apresentava aspecto de cicatrização avançado. De acordo com o caso atual, a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana parece ser uma alternativa adequada para o manejo de lesões orais em pacientes em uso de medicamentos para AR.

Many oral signs and symptoms related to the novel coronavirus disease (COVID-19) have been reported; however, both prevalence and etiology are still undetermined. Since the clinical features of the oral lesions seen in COVID-19 are highly heterogeneous and the treatments differ considerably in the literature, the present study aimed to report a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for extensive lip lesions in a patient suffering from COVID-19. Within 4 days and without any systemic drug administration, after two sessions of aPDT and one session of PBMT, the lip lesions were completely healed, and the patient recovered her orofacial functions satisfactorily. According to the current case report and taking into consideration the evident lack of information about many aspects of COVID-19 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related lip lesions; however, more studies are necessary.

In hematopoietic cell transplants (HCT) patients, opportunistic fungal infections – especially candidiasis - are typical and, due to the immunosuppressed condition, severe and fatal clinical conditions may occur. Many antifungal agents are used for treating candidiasis; however, there are non-responsive, drug-resistant cases in which alternative antimicrobial therapies are strongly needed. The present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) was used for extensive oral pseudomembranous candidiasis not responsive to micafungin in a patient undergoing HCT. Thus, 0.01 % methylene blue solution was applied for 3 min onto the infected area, followed by 660-nm laser irradiation. Within 72 h, there was neither a symptom nor a sign of the fungal infection. According to the current case report, aPDT seems to be highly effective for HCT patients presenting oral candidiasis not responsive to micafungin; however, further studies are necessary.

Osteoradionecrosis (ORN) is considered one of the most severe complications of radiotherapy (RT). Treatment modalities for ORN may vary considerably, including conservative or surgical procedures. Recently, alternative managements such as the combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT) have also yielded promising results in patients presenting ORN or delayed healing post-RT. Herein, it is reported a case of ORN manifested as an oral fistula on the mandibular alveolar mucosa in which a combination of PBMT and aPDT was used every 15 days for six weeks. A laser device with an optical fiber was introduced into the fistula for light delivery. Seven days after the first laser session, it was noted complete resolution of both edema and erythema; after six weeks, the ORN fistula was no longer present. According to the current case, the combination of PBMT and aPDT with an optical fiber to deliver the laser light seems to be a suitable alternative for restricted areas such as fistula paths.

To evaluate the technical success of conventional TMJ arthrocentesis in cadavers, using the tragal-lateral canthus line as an anatomical reference for the puncture points. Ten formalin-treated and 8 fresh cadavers were submitted to the arthrocentesis. A point located 10 mm anteriorly and 2 mm inferiorly to the beginning of the tragal-lateral canthus line (A) and another point 20 mm anteriorly and 10 mm inferiorly (B) were demarked on the cadavers’ skin. Following, 1 mL of methylene blue solution was injected through the needle at point A, and then another needle was placed at point B. Saline solution was injected through the first needle, identifying a free flow of bluish solution. Concerning the formalin-treated cadavers, TMJ arthrocentesis was not successfully performed in any case (0%). In the fresh cadavers, the procedure was properly conducted bilaterally in only one case (12.5%) and unilaterally in 3 cases (37.5%), 2 on the left side (25.0%) and one on the right (12.5%). The traditional points related to the tragal-lateral canthus line seemed not to be accurate references for the insertion of the needles in conventional TMJ arthrocentesis when 1 mL of solution is used initially and the maximum mouth opening is not achieved.

O absenteísmo por doenças é reconhecido como um problema de saúde pública mundial, tendo grandes impactos econômicos e sociais. Ademais, informações a respeito destas condições em bombeiros, políciais e outros profissionais de serviços armados são muito escassas. Desta forma, o presente estudo teve como objetivo analisar os afastamentos odontológicos do quadro de servidores da Polícia Militar do Estado de São Paulo em 2017. Para isso, foram coletados os dados demográficos, funcionais e relacionados ao tipo de afastamento (plataforma logística SIGs – Saúde) para cálculo das razões de chances entre as variáveis sócio-demográficas e funcionais e convalescença (afastamentos de até 10 dias). Foi calculado também o índice de gravidade, de frequência e de duração média das ausências odontológicas, bem como o comparativo com os afastamentos por motivos médicos no mesmo período. Foram identificados 80.928 afastamentos relacionados a condições bucais. As características funcionais, sócio-demográficas e da doença odontológica estiveram associadas a convalescença, ou seja, policiais acima de 50 anos, do interior de SP e afastados por lesões de cárie, condições pulpares ou doença periodontal estiveram associados à presença de afastamento de até 10 dias. Na Polícia Militar, em 2017, houve uma média de perda de serviço de 2h/pessoa/ano exclusivamente por motivo odontológico. A duração média das ausências foi de 2,21 dias. Assim, parece que quanto maior a idade e mais distante da capital paulista, maior o número de dias de absenteísmo. Ademais, o envelhecimento no contexto ocupacional é um forte fator para o absenteísmo. Cárie e doença periodontal também estão altamente relacionadas ao absenteísmo quando comparadas às demais doenças odontológicas.

Among the most common symptoms of COVID-19 is taste dysfunction, which has a ranging clinical presentation. As well as its pathophysiology remains to be unclear, there is not enough information about the efficacy and safety of the available treatments. This study aims to report a series of cases using PBMT for the management of COVID-19-related taste impairment.8 female and 2 male patients sought medical help for taste impairment (either partially or completely) after COVID-19 infection. Photobiomodulation therapy (PBMT) on the tongue mucosa was then proposed but with 3 different protocols. Taste perception at baseline and before every laser session was evaluated using a visual analog scale. Irrespective of the PBMT protocol, taste recovery was noted in all cases but with varying degrees of improvement.given the high prevalence rates of taste dysfunction in COVID-19 patients and the lack of information about the available treatments, PBMT seems to be a promising therapeutic modality but not dependent on the total number of laser sessions and the interval between them. The choice of the most suitable laser protocol as well as the knowledge of the exact photonic mechanisms, however, need to be better studied.

Objective: To carry out morphometric, topographic, incidence analysis of retromolar foramina in dry adult human mandibles, and relate the findings to Dental practice. Methods: 265 mandibles were evaluated simultaneously by two researchers. With the aid of metal wires, each retromolar foramen was classified regarding diameter. Foramina with a diameter smaller than 0.5mm were not taken into account. Results: Retromolar foramina were observed in 23.4% of cases, with a higher bilateral incidence (with distinction of both antimeres), and up to 4 of them located in the same mandible. Furthermore, most foramina had a diameter between 0.5 and 1mm. Conclusion: The retromolar foramina are clinically relevant findings and should never be underestimated by clinicians. RESUMO Objetivo: Realizar análises morfométrica, topográfica e de incidência de forames retromolares em mandíbulas humanas maceradas de adultos, correlacionando os achados com a prática clínica odontológica. Métodos: 265 mandíbulas foram avaliadas simultaneamente por dois observadores. Com o auxílio de fios de metal, cada forame retromolar foi classificado quanto ao diâmetro. Forames inferiores a 0.5mm não foram contabilizados. Resultados: Observaram-se forames retromolares em 23.4% dos casos, com maior incidência bilateral (com distinção dos antímeros) e podendo ocorrer em número de até 4 em uma mesma peça anatômica. Além do mais, a grande maioria apresentou diâmetro entre 0.5 e 1mm. Conclusão: Os forames retromolares são achados consistentes e clinicamente relevantes, não devendo ser subestimados pelos clínicos.

Although the treatment and management options for perianal abscess vary considerably, most cases require incision and drainage. Whatever the clinical approach selected, it is imperative to monitor patients to identify postoperative signs and symptoms which suggest treatment failure or further complications, such as sepsis, recurrent abscess, and fistula formation. Considering the debate on the role of postoperative antibiotic therapy for patients with perianal abscess and the significant discomfort caused by the infection, the present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were used after incision and drainage of a simple perianal abscess. Within 5 days, there was no sign or symptom of both infection and inflammation, and after 3 months, no fistulous pathways or perianal collections were present. According to the current case report, the combination of aPDT and PBMT following incision and drainage of perianal abscess may be a smart strategy for infection resolution and prevention of late complications.

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm2, 30 mW, illuminated area 0.04 cm2, 7.5 J/cm2, 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p

Background Patients with Down syndrome (DS) present functional and anatomical alterations that may negatively impact their health and quality of life. Down syndrome patients have been shown to have a high prevalence of temporomandibular disorder (TMD), but little is known about the diagnosis, treatment and prevention in these individuals. Objective To evaluate the impact of a home-based multidisciplinary programme on muscular TMD in DS adults. Methods After being diagnosed with TMD-related masticatory muscle disorder, 20 adult men and 20 adult women with DS received an educational material with instructions on how to perform daily home facial self-massage and exercises for orofacial and masticatory muscles. Participants were also provided with educational information on TMD. Those who failed to perform at least 50% of the programme (23 days) were considered non-adherent. Oral parafunctional behaviours, facial pressure-pain threshold and maximum mouth opening were assessed at baseline and after the intervention. Results Twenty-five patients adhered to the programme as opposed to 15 non-adherent patients. Statistically significant improvements in all parameters were observed among adherent patients, except for the number of parafunctions. Conclusion The proposed home-based multidisciplinary programme seemed to be effective in improving some aspects related to muscular TMD in DS adults.

Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words:Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.

Purpose of review The current review summarizes recent evidence on the impact of type-2 diabetes mellitus (T2DM) on implant dentistry, highlighting the behavior of peri-implant bone. Recent findings There is no definitive information on the development and course of peri-implant bone loss associated with T2DM; however, poorly controlled T2DM patients present worse outcomes. Nevertheless, dental implants may be a successful therapy for these patients in a manner similar to healthy individuals, when glycemic levels and oral hygiene are strictly maintained. Summary The most recent literature on the impact of T2DM on peri-implant bone loss was reviewed to evaluate the feasibility of dental implant therapy over the time for these patients.

Oral lesions related to the novel Coronavirus Disease 2019 (COVID-19) have been increasingly described; however, clinical and epidemiological information is still scant. Although a diversity of therapeutic strategies for the management of these lesions are present in the literature, one can note a lack of standardization and doubtful effectiveness. Thus, the present study aimed to report a series of cases in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for orofacial lesions in patients suffering from COVID-19. It was noted, in all cases, a marked improvement in tissue repair and pain relief within a few days; moreover, the patients recovered their orofacial functions satisfactorily. Based on the present series of cases and having in mind the conspicuous lack of information on the different aspects of COVID-19, the protocol which combined aPDT with PMBT seemed to be effective in the management of COVID-19-related orofacial lesions.

The present study aimed to assess the impact of low-level laser (LLL) on low salivary flow rate in patients undergoing radiochemotherapy (RT-CT) for head and neck cancer.LLL has shown efficiency in preventing hyposalivation in patients under different pathological conditions, including those undergoing RT-CT.During all RT-CT, 17 patients received laser therapy and 10 received clinical care only. An Indium-Gallium-Aluminum-Phosphorus diode laser was punctually used for intraoral (660 nm, 40 mW, 10 J/cm(2), illuminated area 0.04 cm(2), 10 sec) and extraoral irradiation (780 nm, 15 mW, 3.8 J/cm(2), illuminated area 0.04 cm(2), 10 sec), three times a week and on alternate days, for a total of 21 sessions. Unstimulated salivary flow rate was assessed before the first RT session (N0), at the 15th RT session (N15), at the last RT session (Nf), and at 30 (N30) and 90 days after the end of the oncologic treatment (N90).At N15, Nf, and N30, patients treated with LLL showed significantly higher averages of salivary flow rate when compared with patients receiving clinical care only.LLL seems to be an efficient tool for mitigation of salivary hypofunction in patients undergoing RT for head and neck cancer.

Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer. Resumo Objetivo: Avaliar o impacto do laser de baixa potência na prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. Materiais e Métodos: Treze pacientes receberam laserterapia e dez receberam cuidados clínicos. Utilizou-se um InGaAlP laser diodo para aplicação intraoral (comprimento de onda de 660 nm, 40 mW de potência e dose média de 10 J/cm2) e extraoral (comprimento de onda de 780 nm, 15 mW de potência e dose média de 3,7 J/cm2), três vezes por semana, em dias alternados. Sialometrias estimulada e não estimulada foram realizadas antes da primeira sessão de radioterapia e quimioterapia (N0) e 30 dias após o final do tratamento (N30). Resultados: Em N30, os pacientes submetidos à laserterapia apresentaram médias estatisticamente maiores de fluxo salivar estimulado (p = 0,0131) e não estimulado (p = 0,0143), em comparação com os pacientes que receberam apenas cuidados clínicos. Conclusão: A laserterapia de baixa potência realizada concomitantemente a radioterapia e quimioterapia foi capaz de mitigar a hipofunção das glândulas salivares em pacientes portadores de câncer de cabeça e pescoço após o tratamento oncológico.

One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT.A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction.Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%).The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.

The relationship between cytomegalovirus (CMV), a severe complication in immunocompromised patients, and graft-versus-host disease (GVHD) has already been reported but remains without complete elucidation, especially concerning oral lesions. Considering that antimicrobial photodynamic therapy (aPDT) has an antimicrobial effect and photobiomodulation therapy (PBM) provides analgesia and modulation of inflammatory processes, the present study aimed to report a clinical case in which oral CMV reactivation following acute GVHD was treated by a combination of aPDT and PBMT concomitantly with conventional drug treatment. Intense and uninterrupted oral pain and consequent impairment of the patient's oral functions were present due to ulcerated lesions in the tongue, soft palate, and labial mucosa. After 72 hours from the first laser session, a marked decrease in the severity of the lesions and pain relief was observed. All oral lesions were repaired within 30 days. Based on this case report, when used concomitantly with conventional drug treatment, the combination of aPDT and PBMT seems to play a crucial role in treating CMV associated with GVHD.

O objetivo do presente estudo foi relatar um caso clínico de abordagem multimodal para a reabilitação oral de paciente do sexo masculino, 69 anos, irradiado em cabeça e pescoço (radioterapia conformacional 3D, dose total de radiação de 70Gy), após metástase em laringe de câncer de intestino. Na consulta inicial, o paciente queixava-se de ausências dentárias e sensação de boca seca. Além do mais, foram observadas lesões de cárie de radiação na maior parte dos dentes, os quais também exibiam grande destruição coronária. O plano de tratamento consistiu na exodontia do dente 27 com auxílio de terapia fotodinâmica antimicrobiana para cicatrização do alvéolo, seguida da realização de tratamento endodôntico com subsequente sepultamento de raízes residuais, restaurações e reabilitação com próteses parciais removíveis. O manejo odontológico de pacientes pós-irradiados em cabeça e pescoço deve ser cuidadosamente planejado e conduzido por uma equipe odontológica interdisciplinar, considerando as sérias consequências resultantes dos efeitos deletérios da radioterapia na cavidade oral. Desta forma, pode-se mitigar o impacto negativo da radioterapia na qualidade de vida destes pacientes.

The present study aimed to compare the conventional scalpel technique and the use of a high-power diode laser for second-stage implant surgery. For that, fifteen patients were randomly assigned to receive either the conventional scalpel technique (Control Group, n = 7) or a diode laser-assisted technique (Laser Group, n = 8) for second-stage surgery of submerged dental implants placed at bone level. The local anesthetic amount required, and the total surgical time was determined just after surgery. Local pain, peri-implant mucosa status, and bleeding were assessed at the end of the surgery and after 7 and 15 days. Information on the need for postoperative pain medication on the first day and during the next two weeks was also gathered. The surgical time was significantly shorter in the Laser Group (P = 0.001) and only the Control Group presented bleeding at the end of surgery and on the seventh day (P =

Avaliar retrospectivamente a prevalência de infecções orais oportunistas em pacientes portadores de neoplasias malignas de cabeça e pescoço submetidos a radioterapia (RT), associada ou não a quimioterapia e/ou cirurgia. Levantamento de dados foi realizado por meio de revisão dos prontuários eletrônicos dos pacientes submetidos à RT conformacional 3D de cabeça e pescoço que constavam no Livro de Registro da Física Médica do Setor de Radioterapia da Universidade Federal de São Paulo (Hospital São Paulo), considerando informações individuais e clínicas. Dos 79 pacientes avaliados, 38 desenvolveram alguma infecção oral oportunista. Entre estes, observou-se prevalência de leucodermas do sexo masculino, com idade inferior a 60 anos e história de tabagismo, etilismo e tratamento odontológico pré-RT. Houve predomínio do carcinoma espinocelular como tipo histológico, da laringe como sítio anatômico, do estádio IV e do tratamento oncológico realizado com combinação de radioterapia, quimioterapia e cirurgia. Com relação às infecções orais oportunistas, a candidose foi a mais representativa. Pacientes portadores de neoplasias malignas de cabeça e pescoço em estádio avançado parecem apresentar a candidose oral com mais frequência, provavelmente em decorrência do tratamento multimodal.

Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.