Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

OBJECTIVES:The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease.METHOD:Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures.RESULTS:Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci.CONCLUSION:The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients’ quality of life, which is critical to provide oral care and prevent future oral problems.

Pemphigus vulgaris (PV) is a rare and potentially lethal autoimmune disease that affects the skin and mucous membranes. Injuries caused by the disease cause pain, risk of infection, and other complications that result in a high mortality rate. Frequently, management of the PV requires intensive care and a multidisciplinary approach. Oral lesions of PV are usually the first clinical signs of the disease and the last lesions to heal, requiring treatment by a specialized dental team. The aim of this study was to report two clinical cases of PV with involvement of the oral mucosa. The patients were admitted to an intensive care unit, and underwent multidisciplinary management of their condition along with low-level laser therapy. Both cases demonstrated the importance of specialized dental care in improving the quality of life of patients with PV.

<strong>Objective</strong>: The aim of this study was to evaluate the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms. <strong>Material and methods: </strong>This cross-sectional study assessed thirty-one patients, median age 14.2 years (range 5 - 25), who were off therapy for at least one year, comparatively with a control group of thirty-one healthy patients matched for age with the study group. Tooth abnormalities were evaluated by panoramic radiographs. <strong>Results: </strong>There was no statistical significant evidence that patients of the study group (age range 5 - 25 years) have more frequency of tooth abnormalities comparatively with controls.   However, in children who were diagnosed before 5 years of age, microdontia was the most common abnormality with statistically significant difference (<em>P=</em>0.037). Root shortening grade III was observed in patients over 10 years of age at the time of radiographic examination, also with statistical significance (<em>P=</em>0.046). <strong>Conclusions: </strong>Tooth abnormalities frequency in patients treated for central nervous system neoplasms is directly related to the age of diagnosis and stage of odontogenesis. Microdontia and reduced root surface areas, the most common abnormalities observed, can lead to future oral health impairment due to malocclusion and less periodontal support. It is important to give parents and patients early orientation about maintenance of good oral hygiene and proper treatment by orthodontics or dentofacial orthopedics.

Carrillo CM. Need of oral palliative care in children with chronic illness. Sample characterization [Dissertation]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2011. INTRODUCTION: Epidermolysis bullosa is a genetic chronic disease that affects the quality of life deeply, whose oral symptoms compromised the daily living activities as chewing, swallowing and teeth brushing.. Children with cancer may also have oral manifestations, but transient and usually do not affect the teeth. This study assessed the oral health and the need of oral care in children in palliative care with epidermolysis bullosa compared to children with cancer. METHODS: Twenty-four patients with epidermolysis bullosa (Group A) and 18 cancer patients (Group B) followed up at the Pain and Palliative Care Outpatient Clinic were studied. Clinical assessment included: clinical characteristics, assessment of orofacial pain, oral health, quality of life according to the activities of daily living and general health status. RESULTS: Face numbness, tooth mobility, taste disturbance and speech difficulties were observed only in group B. Difficult chewing, disfagia, gagging, dry lips, oral lesions were more frequent in group A compared to group B, with significant difference, p<0,0001, p<0,0001, p=0,002, p<0,0001 and p<0,0001, respectively. Group A had a greater difficulty opening mouth, number of decay teeth, prevalence of caries and disability regarding the CHAQ eating (III) and reach (VII) domains than group B, with significant difference, p< 0,0001, p=0,0004, p< 0,001, p<0,001, p=0,005 and p<0,0001, respectively. Both groups showed a significant general health impairment. CONCLUSIONS: Epidermolysis bullosa patients in palliative care had chronic oral blistering and ulcerations, due to disease, more frequently than cancer patients, which had oral mucositis as a side effect of the antineoplasic treatment. They also showed greater oral symptoms, poor oral health, greater open mouth limitation and poor quality of life than cancer patients.

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The oral cavity is highly susceptible to pathological changes due to the deleterious effects of radiation (RI) on tissues exposed during radiotherapy (RT). The aim of this study was to evaluate the feasibility of using pulse oximeter (PO) as a diagnostic instrument for assessing the pulp oxygenation level (%SpO2) of immature teeth previously exposure to IR. Pulp oxygenation saturation was evaluated in fifteen children or adolescent patients (Group RT) that received previous IR, 6.01 years ago (SD 4.08 years), and fifteen patients without a history of neoplasms or previous chemotherapy or radiotherapy (CO group). As result, the mean %SpO2 measured in Group RT and Group CO was 86.06% (SD 1.61%) and 91.11% (SD 0.87%), respectively. Conclusions: The use of the pulse oximeter adapted for dentistry for pulpal vitality evaluation in patients who received radiotherapy is feasible showing lower level of SpO2 than that of the control group (p<0.05).