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Katz J, Ensz OS, Rotstein I. Prevalence of acute periapical abscesses in head and neck cancer patients receiving radiotherapy. SPECIAL CARE IN DENTISTRY 2024; 44:946-951. [PMID: 38183165 DOI: 10.1111/scd.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
AIMS Head and neck cancer is a serious condition affecting the life of patients. Radiotherapy is commonly used to treat such conditions. The aim of this study was to assess the prevalence of acute periapical abscesses (PAs) in patients who received radiotherapy for head and neck cancer. METHODS AND RESULTS Data on acute PAs and oropharyngeal cancer (OPC) diagnosis with or without a history of radiation therapy (RAD) was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with a history of OPC with or without RAD were then calculated. Adjustment for comorbidities such as diabetes, smoking and gingival and periodontal diseases was also done. The prevalence of acute PAs in patients with a history of OPC was significantly higher as compared to the general hospital patient population (OR 2.92, 95%CI, p < .0001). Males were more affected than females and whites were more affected than African Americans and other ethnicities. The prevalence for PAs in patients with a history of OPC and RAD was higher and the difference in prevalence was statistically significant (OR 3.61, 95%CI, p < .0001). Whites were more affected than African Americans by more than 3.5-fold. Adjustment for diabetes comorbidly affected mainly the OPC + RAD group, however, the difference remained statistically significant. Adjustment for smoking and gingival and periodontal disease reduced the OR but the difference remained statistically different. CONCLUSIONS The high prevalence of acute PAs in patients with a history of OPC and RAD may suggest an association between these conditions warranting a meticulous medical and dental examination.
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Affiliation(s)
- Joseph Katz
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Olga S Ensz
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Ilan Rotstein
- Department of Endodontics and Periodontics, University of Southern California, Los Angeles, California, USA
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Kasper RH, Coelho MR, Miguens-Jr SAQ, Grazziotin-Soares R, Barletta FB. Pulse oximetry as a dental pulp test: A scoping review to identify barriers hindering the use of oximeters in clinical practice. Saudi Dent J 2024; 36:262-269. [PMID: 38419999 PMCID: PMC10897589 DOI: 10.1016/j.sdentj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/27/2023] [Accepted: 11/05/2023] [Indexed: 03/02/2024] Open
Abstract
Background and Objective Although medical pulse oximeters are considered effective for endodontic diagnoses, the method remains uncommon in current dental practice. The aim of the present scoping review was to investigate clinical factors that exert a negative impact on the use of pulse oximeters in dental practice. Methods This study followed the PRISMA-ScR guidelines and the protocol was prospectively registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/3GQCE). A comprehensive search of the MEDLINE (via PubMed), Cochrane Library, and Web of Science databases was performed in December 2022 for articles published in English or Spanish. All types of clinical studies were included, except comments, letters to the editor, and abstracts. Two independent investigators analyzed 45 full-text articles. Data extraction included general characteristics, oxygen saturation levels, and limiting factors/barriers to the use of oximeters as pulp testers. Results The search of the databases yielded 1,300 records and 38 were included (quantitative data extraction was performed for 35 and three articles were systematic reviews). Publications were highest in number between 2016 and 2017, with an evident reduction occurring after 2021. The oxygen saturation level for sound/vital maxillary anterior teeth was 84.99% (overall mean). The main limiting factors/barriers were i) the difficulty in maintaining the two light-emitting diodes parallel during pulp tests, ii) infrared light diffraction by enamel/dentin/gingiva, and iii) the diversity of patient ages in studies. Conclusion This scoping review encountered noteworthy findings associated with the impracticability of using medical pulse oximeters as dental pulp testers. The recent decrease in the frequency of published studies compared to approximately seven years ago may imply a negative trend in the use of the method.
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Sankar V, Xu Y. Oral Complications from Oropharyngeal Cancer Therapy. Cancers (Basel) 2023; 15:4548. [PMID: 37760517 PMCID: PMC10526346 DOI: 10.3390/cancers15184548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Post-oropharyngeal cancer treatment complications include a multitude of oral side effects that impact overall survival and quality of life. These include acute and chronic conditions affecting the oral cavity and head and neck, such as mucositis, infection, xerostomia, dysgeusia, radiation caries, osteonecrosis, and trismus. This review will summarize the most common oral complications from oropharyngeal cancer therapy. The authors would like to point out that the literature cited frequently combines oropharyngeal and head and neck cancer results. If recommendations are made strictly related to oropharyngeal cancers, this will be highlighted.
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Affiliation(s)
- Vidya Sankar
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
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Santana MLL, Ribeiro TE, Silva JA, de Alencar AHG, Novais VR, Estrela C, Decurcio DDA. Does irradiation of the tooth structure interfere with oxygen saturation measured by pulse oximetry?-An ex vivo laboratorial study. AUST ENDOD J 2023; 49 Suppl 1:419-425. [PMID: 37036185 DOI: 10.1111/aej.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
The effect of tooth structure subjected to ionising radiation on oxygen saturation levels (SpO2 ) measured by pulse oximetry was investigated. Fifty-four extracted human third molars were sectioned mesiodistally. Pulse oximeter diodes were placed in prefabricated silicone moulds, secured on a vise with tooth surfaces placed between the diodes and the participant's finger, and SpO2 levels were measured. After that, the tooth surfaces were subjected to ionising radiation in fractionated doses of up to 70 Gy, and SpO2 was measured according to the protocol described. The Kolmogorov-Smirnov test was used for the analysis of normality of the quantitative variables, and Student's t-test compared mean SpO2 levels before and after irradiation. Mean SpO2 after irradiation was 94.6 ± 0.9%, without a statistically significant difference from SpO2 before irradiation, which was 94.7 ± 0.6%. Irradiation of the tooth structure did not interfere with SpO2 levels measured by pulse oximetry.
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Affiliation(s)
| | | | | | | | | | - Carlos Estrela
- Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Brazil
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Ribeiro TE, Novais VR, Estrela C, Santana MLL, Rossi-Fedele G, Decurcio DDA. Does radiotherapy treatment alter the pulp condition in patients with head and neck cancer? A systematic review. Braz Oral Res 2023; 37:e079. [PMID: 37531515 DOI: 10.1590/1807-3107bor-2023.vol37.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/06/2023] [Indexed: 08/04/2023] Open
Abstract
The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head and neck region?" Clinical observational studies in adults with head and neck cancer undergoing treatment with ionizing radiation, longitudinal or cross-sectional follow-up to measure oxygen saturation (SpO2), and/or pulp sensitivity test to cold stimulation, were considered eligible. A systematic literature search was performed in six different databases, including the gray literature, and in article references. Two independent evaluators selected the studies, extracted the data, recorded the data on electronic spreadsheets, and then evaluated the methodological quality using the Checklist for Quasi-Experimental Studies tool devised by JBI. The data were assessed qualitatively using the Synthesis Without Metanalysis (SWiM) guidelines. After removing the duplicate articles, carefully analyzing the titles and abstracts, and reading the papers in full, seven studies were included. Four of the studies evaluated applied the cold sensitivity test, two associated pulse oximetry and cold sensitivity, and only one used just pulse oximetry. Evaluation using the cold sensitivity test and pulse oximetry in the initial periods before radiotherapy showed a decrease in the sensitive response and in SpO2 levels during a maximum period of 1 year. However, analyses thereafter indicated a normal response in both tests from 5 to 6 years after the end of radiotherapy treatment. Radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to average values occurs after long periods.
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Affiliation(s)
- Thalles Eduardo Ribeiro
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Veridiana Resende Novais
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Dentistry and Dental Materials, Uberlândia, MG, Brazil
| | - Carlos Estrela
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Maria Luiza Lima Santana
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
| | - Giampiero Rossi-Fedele
- University of Adelaide, Adelaide Dental School, Department of Endodontics, Adelaide, South Australia, Australia
| | - Daniel de Almeida Decurcio
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Science, Goiânia, GO, Brazil
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Age-Related Variation of Pulpal Oxygen Saturation in Healthy Primary and Permanent Teeth in Children: A Clinical Study. J Clin Med 2022; 12:jcm12010170. [PMID: 36614971 PMCID: PMC9821562 DOI: 10.3390/jcm12010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Pulse oximetry (PO) is an effective method of dental pulp status monitorization but still lacks practical implementation in dentistry, as well as clear reference values for different tooth types. The study’s aim was to investigate the age-related variation of blood oxygen saturation (SpO2) from the dental pulp during different stages of tooth development in all types of primary and permanent teeth of children. (2) Methods: The pulps of 600 healthy primary and permanent teeth (incisors, canines, premolars, and molars) of patients aged 2−15 years were tested with an adapted PO device, and the results were statistically analyzed; (3) Results: Statistically significant differences (p < 0.05) were found between open-apex and closed-apex teeth and between the canines and other tooth types in both primary and permanent dentitions. (4) Conclusions: Values of SpO2 tended to decrease with age progression in both primary and permanent dentitions. Enamel and dentine thickness and their optical properties and the shape and volume of coronal pulp, which differed among tooth types, seemed to have some influence on the reading as well. The study indicates that factors such as the root development and the tooth type must be taken into account when establishing reference SpO2 values for the dental pulp.
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Wali R, Sacco R, Singh G, Patel V. The clinical effect of radiotherapy on pulpal microvasculature: a systematic review. Br Dent J 2022:10.1038/s41415-022-5301-8. [PMID: 36473977 DOI: 10.1038/s41415-022-5301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.
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Affiliation(s)
- Rana Wali
- Oral Surgery Registrar, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK
| | - Roberto Sacco
- Clinical Lecturer, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, University of Manchester, Manchester, UK; 3Clinical Teacher, Oral Surgery Department, King´s College Hospital, London, UK
| | - Gurpreet Singh
- Managed Clinical Network Chair, Restorative Dentistry, NHS England and NHS Improvement East of England, UK
| | - Vinod Patel
- Oral Surgery Consultant, Oral Surgery Department, Guy´s and St Thomas´ Hospital, London, UK.
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Antic S, Markovic-Vasiljkovic B, Dzeletovic B, Jelovac DB, Kuzmanovic-Pficer J. Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study. J Appl Oral Sci 2022; 30:e20220329. [PMID: 36477557 PMCID: PMC9724493 DOI: 10.1590/1678-7757-2022-0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. METHODOLOGY A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. RESULTS Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. CONCLUSIONS RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.
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Affiliation(s)
- Svetlana Antic
- University of BelgradeSchool of Dental MedicineCenter for Radiological DiagnosticsBelgradeSerbiaUniversity of Belgrade, School of Dental Medicine, Center for Radiological Diagnostics, Belgrade, Serbia.,Corresponding address: University of Belgrade - School of Dental Medicine - Center for Radiological diagnostics - Svetlana Antic - dr Subotica 8,11000 - Belgrade - Serbia. Phone: +381113440841/ tel:+381642175834, e-mail:
| | - Biljana Markovic-Vasiljkovic
- University of BelgradeSchool of Dental MedicineDepartment of Restorative Odontology and EndodonticsBelgradeSerbiaUniversity of Belgrade, School of Dental Medicine, Department of Restorative Odontology and Endodontics, DentalNet Research Group, Belgrade, Serbia.
| | - Bojan Dzeletovic
- University of BelgradeSchool of Dental MedicineClinic for Maxillofacial SurgeryBelgradeSerbiaUniversity of Belgrade, School of Dental Medicine, Clinic for Maxillofacial Surgery, Belgrade, Serbia.
| | - Drago B. Jelovac
- University of BelgradeSchool of Dental MedicineClinic for Maxillofacial SurgeryBelgradeSerbiaUniversity of Belgrade, School of Dental Medicine, Clinic for Maxillofacial Surgery, Belgrade, Serbia.
| | - Jovana Kuzmanovic-Pficer
- University of BelgradeSchool of Dental MedicineDepartment for Medical Statistics and InformaticsBelgradeSerbiaUniversity of Belgrade, School of Dental Medicine, Department for Medical Statistics and Informatics, Belgrade, Serbia.
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Pedroso CM, Migliorati CA, Epstein JB, Ribeiro ACP, Brandão TB, Lopes MA, de Goes MF, Santos-Silva AR. Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror. FRONTIERS IN ORAL HEALTH 2022; 3:961594. [PMID: 35911379 PMCID: PMC9330023 DOI: 10.3389/froh.2022.961594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).
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Affiliation(s)
- Caique Mariano Pedroso
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Joel B. Epstein
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Thaís Bianca Brandão
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mário Fernando de Goes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: Alan Roger Santos-Silva
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Weissheimer T, Só BB, Pradebon MC, de Figueiredo JAP, Martins MD, Só MVR. Head and neck radiotherapy effects on the dental pulp vitality and response to sensitivity tests. A systematic review with meta-analysis. Int Endod J 2022; 55:563-578. [PMID: 35298027 DOI: 10.1111/iej.13726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no consensus whether radiotherapy for head and neck cancer (HNC) could induce pulp necrosis. Therefore, a systematic review of clinical studies is necessary. OBJECTIVES To evaluate the evidences on radiotherapy for HNC and pulp status. METHODS A systematic search of articles published until November 2021 was performed in the MEDLINE/PubMed, Cochrane Library, Web of Science (All Databases), Scopus, EMBASE and Open Grey databases. The eligibility criteria were based on the PICOS strategy, as follows: (P) vital teeth of adult patients with intraoral and/or oropharyngeal cancer; (I) radiotherapy; (C) control group or values of the same tooth before radiotherapy (basal values); (O) pulpal status after radiotherapy; (S) clinical studies. The Cochrane Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess the quality of the included studies. Meta-analyses were performed using fixed and random effects. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS Six studies were included for qualitative analysis. Five were classified as serious risk of bias and one as moderate risk of bias. Four studies reported altered pulp responses to cold thermal test after radiotherapy initiation. Meta-analyses were performed using three included studies. From these, all were included in the meta-analysis for pulp response values to cold sensitivity test immediately after radiotherapy initiation (risk ratio: 0.00[CI:0.00, 0.02], P < 0.00001; I2 = 0%); and two in the meta-analysis for pulp response values to cold sensitivity test after 4-5 months of radiotherapy (risk ratio: 0.01[CI: 0.00. 0.06], P < 0.00001; I2 = 0%). Two reported progressively higher readings to pulp response in the electrical test after radiotherapy initiation (mean difference: -11.46[-13.09, -9.84], P < 0.00001; I2 = 68%) and at all periods evaluated. Two studies demonstrated a pulp oxygen saturation (SpO2 ) decrease at the end of radiotherapy; and increase after 4-6 months of radiotherapy beginning. And other demonstrated normal dental pulp SpO2 4 to 6 years after treatment. GRADE analysis presented a moderate certainty of evidence. DISCUSSION This review verified that radiotherapy for HNC causes significant alterations on the dental pulp responses, but does not seem to induce pulp necrosis. Significant limitations regarding controlling for confounding factors, classification of interventions and measurement of outcomes were verified, evidencing the need for well-designed studies. CONCLUSIONS This systematic review demonstrated that radiotherapy for HNC induced significant changes in the pulp response with moderate quality of evidence. Such altered responses cannot determine pulp status accurately.
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Affiliation(s)
- Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marieli Chitolina Pradebon
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | | | - Manoela Domingues Martins
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
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A Clinical Study Determining Pulp Vitality in Oropharyngeal Cancer Patients Undergoing Radiotherapy Using Diagnostic Tool-Pulse Oximetry. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:5-9. [PMID: 34211740 PMCID: PMC8200620 DOI: 10.12865/chsj.47.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
Abstract
Pulse oximetry is an equipment that evaluates pulp vitality for concrete endodontic diagnosis and treatment plan. One of the treatment methods of oropharyngeal cancer is radiotherapy. Radiotherapy has some harmful effects on dental pulp that affects pulp vitality. The objective of study was to assess pulp vitality before, at the end of radiotherapy and six months after radiotherapy (RT) in oropharyngeal cancer patients undergoing radiotherapy. 25 patients who were diagnosed with oropharyngeal cancer having asymptomatic intact crowns were selected for the study. Pulp vitality was checked before the commencement of radiotherapy (PV1), immediately after radiotherapy (PV 2) and six months post radiotherapy (PV 3). Pulp vitality of first posterior tooth was selected of each patient and was checked with pulse oximetry. Paired t-test was used as statistical analysis. Statistically significant difference was observed when PV 1 and PV 2, PV 1 and PV 3 and PV 2 and PV 3 were compared amongst each other. There was reduction noted in mean SpO2 value when groups PV 2 and PV1 were compared. This was statistically significant. Statistically significant increase in mean SpO2 value was observed six months post radiotherapy (PV 3). Thus, it can be concluded that statistically significant reduction in mean SpO2 level post radiotherapy recovers after six months.
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Pulse Oximetry as a Diagnostic Tool to Determine Pulp Vitality: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11062747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulse oximetry (PO) can be used as a technique to assess vascularization. Although it is commonly used in the field of medicine, it still has limited use in dentistry. The aim of this study is to evaluate, by means of a systematic review, if pulse oximetry is a viable and effective system to determine pulp vitality and assess the clinical criteria for its use. A literature search was performed in Medline, Scopus, Embase, and Web of Science databases. Clinical studies using pulse oximetry as a tool to determine pulp vitality in permanent teeth were eligible. Quality assessment of the included studies was performed following the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2) guidelines. A total of 24 articles were included in the review. The subjective test most compared to PO was the cold test. PO has shown a good sensibility and specificity, and it has been used in different clinical situations. Pulse oximetry has a high potential as a tool for the diagnosis of pulp vitality. However, the absence of a specific pulse oximeter for a dental practice, among other limitations, added to the lack of evidence on how different systemic and oral pathologies may affect the pulp’s oxygen saturation levels, which hinders its clinical use.
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Lambert P, Miguens SAQ, Solda C, Sganzerla JT, Reichert LA, Estrela C, Barletta FB. Reference values for pulp oxygen saturation as a diagnostic tool in endodontics: a systematic review and meta-analysis. Restor Dent Endod 2020; 45:e48. [PMID: 33294413 PMCID: PMC7691259 DOI: 10.5395/rde.2020.45.e48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives This systematic review aimed to identify mean oxygen saturation values (SpO2) using pulse oximetry in permanent maxillary anterior teeth. Materials and Methods The MEDLINE, Scientific Electronic Library Online, Cochrane Central Register of Controlled Trials, EMBASE, and Literatura Latino Americana em Ciências da Saúde electronic databases were searched. Combinations and variations of “oximetry” AND “dental pulp test” were used as search terms. Studies reporting means and standard deviations of SpO2 values were included. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Heterogeneity was assessed using the I2 statistic, and all analyses were performed using R software. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale. Results Of the 251 studies identified, 19 met the eligibility criteria and were included (total sample, 4,541 teeth). In the meta-analysis, the mean SpO2 values were 84.94% (95% confidence interval [CI], 84.85%–85.04%) for the central incisors, 89.29% (95% CI, 89.22%–89.35%) for the lateral incisors, and 89.20% (95% CI, 89.05%–89.34%) for the canines. The studies were predominantly low-quality due to the high risk of bias associated with the index test, unclear risk regarding patient selection, and concerns about outcome assessment. Conclusions Although most studies were low-quality, the oxygen saturation levels in normal pulp could be established (minimum saturation, 77.52%). Despite the risk of bias of the included studies, the reference values reported herein are clinically relevant for assessments of changes in pulp status. Trial Registration International Prospective Register of Systematic Reviews Identifier: CRD42018085598
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Affiliation(s)
- Paula Lambert
- Department of Endodontics, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | | | - Caroline Solda
- Department of Endodontics, Faculdade Meridional (IMED) School of Dentistry, Passo Fundo, RS, Brazil
| | - Juliana Tomaz Sganzerla
- Department of Oral Diagnostic, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Leandro Azambuja Reichert
- Department of Operative Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS) School of Dentistry, Porto Alegre, RS, Brazil
| | - Carlos Estrela
- Department of Endodontics, Graduate Program in Dentistry, Universidade Federal de Goiás (UFG), Goiania, GO, Brazil
| | - Fernando Branco Barletta
- Department of Endodontics, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
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14
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Radiation-related caries: current diagnostic, prognostic, and management paradigms. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:52-62. [DOI: 10.1016/j.oooo.2020.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/02/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
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15
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Fonsêca JM, Palmier NR, Silva WG, Faria KM, Vargas PA, Lopes MA, Salvajoli JV, Brandão TB, Ribeiro ACP, Almeida JFA, De Goes MF, Santos-Silva AR. Dentin-pulp complex reactions in conventional and radiation-related caries: A comparative study. J Clin Exp Dent 2019; 11:e236-e243. [PMID: 31001393 PMCID: PMC6461726 DOI: 10.4317/jced.55370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/17/2018] [Indexed: 11/05/2022] Open
Abstract
Background Radiation-related caries (RRC) is one of the most significant oral toxicities of head and neck radiotherapy (HNRT); however, the potential of radiation to directly cause harmful dentin and pulpal effects and impair response to caries progression is controversial. Material and Methods Therefore, the aim of this study was to characterize the reactions of the dentin-pulp complex in teeth affected by RRC. Patients and methods: Twenty-two carious teeth extracted from 22 head and neck cancer (HNC) patients were divided into control (conventional caries; n=11) and irradiated (RRC; n=11) groups and paired matched by dental homology, clinical patterns of caries progression following the Post-Radiation Dental Index (PRDI) and microscopic depth of carious invasion. Histopathological characteristics based on morphological hierarchy, cell populations of dental pulp, blood vessels, neural elements, extracellular matrix components, inflammation, patterns of carious invasion and reactionary dentin presence were evaluated by optical light microscopy and histomorphometry. Results Mean PRDI scores were 3.2 for the control group and 3.8 for the irradiated group. Dentin demineralization patterns were also similar between the groups and the mean depths of demineralization were 1,158.58µm and 1,056.89µm for the control and irradiated groups, respectively. Conclusions Pulp histopathological changes and dentin reaction patterns were similar between groups and varied according to the PRDI scores and carious lesions depth. Dentin and pulp reactions are highly preserved in RRC teeth. Key words:Cancer, radiotherapy, radiation-related caries, teeth, pulp.
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Affiliation(s)
- Jéssica-Montenegro Fonsêca
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - Natália-Rangel Palmier
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - Wagner-Gomes Silva
- Serviços de Odontologia e Radioterapia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Karina-Morais Faria
- Serviços de Odontologia e Radioterapia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Pablo-Agustin Vargas
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - Marcio-Ajudarte Lopes
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - João-Victor Salvajoli
- Serviços de Odontologia e Radioterapia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Thais-Bianca Brandão
- Serviços de Odontologia e Radioterapia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Ana-Carolina-Prado Ribeiro
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil.,Serviços de Odontologia e Radioterapia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - José-Flávio-Affonso Almeida
- Departamento de Odontologia Restauradora, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - Mario-Fernando De Goes
- Departamento de Odontologia Restauradora, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
| | - Alan-Roger Santos-Silva
- Departamento de Diagnóstico Oral, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brasil
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16
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Lorena Ferreira L, Ana Helena Gonçalves de A, Decurcio DDA, Silva JA, Favarão IN, Loureiro MAZ, Barletta FB, Estrela C. Effect of dental bleaching on pulp oxygen saturation in maxillary central incisors - a randomized clinical trial. J Appl Oral Sci 2019; 27:e20180442. [PMID: 30994776 PMCID: PMC6459226 DOI: 10.1590/1678-7757-2018-0442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess pulp oxygen saturation levels (SaO2) in maxillary central incisors after dental bleaching. MATERIALS AND METHODS 80 participants (160 teeth) were randomly allocated to four groups: G1 In-office bleaching with two applications of 35% hydrogen peroxide (HP) (20 minutes), followed by at-home bleaching with 10% carbamide peroxide (CP) (2 hours/day for 16 days); G2 - Same protocol as G1, plus desensitizing toothpaste; G3 - In-office bleaching with 35% HP and one application of placebo gel (20 minutes), followed by at-home bleaching with 10% CP (2 hours/day for 16 days); and G4 - Same protocol as G3, plus desensitizing toothpaste. Pulp SaO2 levels were measured before (T0) and immediately after (T1) in-office bleaching; on the 5th (T2), 8th (T3), 12th (T4), and 16th days of at-home bleaching (T5); and on the 7th (T6) and 30th (T7) days. Mean (SD) pulp SaO2 levels were compared within groups by generalized estimating equations (GEE) and Student's t-test (P<0.05). RESULTS Mean pulp SaO2 at T0 was 84.29% in G1, 84.38% in G2, 84.79% in G3, and 85.83% in G4. At T1, these values decreased to 81.96%, 82.06%, 82.19%, and 81.15% in G1, G2, G3, and G4 respectively, with significant difference in G4 (P<0.05). During home bleaching, pulp SaO2 levels varied in all groups, with 86.55%, 86.60%, 85.71%, and 87.15% means at T7 for G1, G2, G3, and G4, respectively; G2 presented significant difference (P<0.05). CONCLUSIONS Pulp SaO2 level in maxillary central incisors was similar at baseline, reducing immediately after in-office bleaching, regardless of using desensitizing toothpaste and increasing at 30 days after dental bleaching.
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Affiliation(s)
- Lima Lorena Ferreira
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
| | | | - Daniel de Almeida Decurcio
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
| | - Julio Almeida Silva
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
| | - Isabella Negro Favarão
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
| | - Marco Antônio Zaiden Loureiro
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
| | - Fernando Branco Barletta
- Universidade Luterana do Brasil, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Canoas, Rio Grande do Sul, Brazil
| | - Carlos Estrela
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil
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17
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Solda C, Barletta FB, Vanni JR, Lambert P, Só MVR, Estrela C. Effect of At-Home Bleaching on Oxygen Saturation Levels in the Dental Pulp of Maxillary Central Incisors. Braz Dent J 2018; 29:541-546. [PMID: 30517476 DOI: 10.1590/0103-6440201802170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023] Open
Abstract
The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.
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Affiliation(s)
| | | | | | - Paula Lambert
- ULBRA - Universidade Luterana do Brasil, Canoas, RS, Brazil
| | | | - Carlos Estrela
- Department of Stomatology, UFG - Universidade Federal de Goiás, Goiânia, GO, Brazil
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18
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Fregnani ER, Parahyba CJ, Morais-Faria K, Fonseca FP, Ramos PAM, de Moraes FY, da Conceição Vasconcelos KGM, Menegussi G, Santos-Silva AR, Brandão TB. IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients. Radiat Oncol 2016; 11:116. [PMID: 27604995 PMCID: PMC5015339 DOI: 10.1186/s13014-016-0694-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient's morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). MATERIAL AND METHODS Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients' treatment plans. Clinicopathological data were retrieved from patients' medical files. RESULTS The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p < 0.001), whereas no significant difference was found for the other dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p < 0.001). CONCLUSION IMRT delivered lower radiation doses to teeth than 3DRT, but only for some groups of patients and teeth, suggesting that this decrease was more likely due to the protection of other high risk organs, and was not enough to remove teeth from the zone of high risk for radiogenic disturbance (>30Gy).
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Affiliation(s)
| | | | - Karina Morais-Faria
- Department of Oral Diagnosis (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Av. Limeira, 901 CEP 13414-903, Piracicaba, São Paulo, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Av. Limeira, 901 CEP 13414-903, Piracicaba, São Paulo, Brazil
| | | | - Fábio Yone de Moraes
- Departments of Radiation Oncology and Oral Medicine, Sírio-Libanês Hospital, São Paulo, Brazil.,Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Gisela Menegussi
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicinada Universidade de São Paulo, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis (Pathology and Semiology), Piracicaba Dental School, University of Campinas, Av. Limeira, 901 CEP 13414-903, Piracicaba, São Paulo, Brazil.
| | - Thais B Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicinada Universidade de São Paulo, São Paulo, Brazil
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