Objective  To determine the influence of hormone therapy in periodontal disease through the intake assessment of antiestrogen tamoxifen in women with breast cancer.  To determine the prevalence and the different species of yeast in the evolution of patients with breast cancer treated with anti- estrogen therapy with Tamoxifen

Secondary objectives Diagnose and classify gingival disease - periodontal patients based on clinical parameters. Determine whether more time with tamoxifen therapy improves gingival periodontal status. Quantify the presence of yeast in the different stages of cancer treatment.

 CANCER: When dealing with cell proliferation, estrogen receptor (ER) and progesterone (PR) are directly involved and their functional integrity is essential for multiplication, normal growth and differentiation of these hormone- responsive cells. The malignant transformation of cells may be due to various causes not always identifiable. Estrogens have been linked to the onset of cancer in various tissues, such as prostate and mammary gland.  Tamoxifen: The main pharmacological effect of tamoxifen (Tx) derives from its ability to bind to the ER. Thus, moves and blocks the receptor from its union with the hormone. Acts as cytostatic and not cytotoxic.

 Periodontal disease: The presence of estrogen receptors in the gingival tissues has been confirmed in numerous studies. Fluctuating levels of estrogen / progesterone affects the periodontium. Progesterone cause modulation of interleukin 6 production in fibroblasts, thus reducing resistance to inflammatory changes produced by bacteria. Meanwhile, estrogen and progesterone induce a physiological phenomenon vascular redness of the gums and bleeding. These hormones also induce microbiological changes to alter the microenvironment and act as nutrients.

 What happen with patients receiving anti- estrogen therapies?

Hypothesis:  Tamoxifen intake positively affects the gingival periodontal status.  Tamoxifen intake positively affects the state of oral health decreasing Candida albicans in the oral cavity.

 Materials and Methods  Sample (n = 66): peri-menopausal diagnosed breast cancer patients for 2 to 5 years, average patient age 50 years.  A survey of patients and, after periodontal indices and mucosal swabs will be taken.  Healthy patients were classified as 0 (zero) with no bleeding on probing, probing depth <2 mm, insertion loss <2 mm, without mobility, plaque index <or = 1, gingival <or = 1 index.  The others were considered with periodontal disease were grouped into mild, moderate, severe or aggressive according to the latest ranking

MATERIALES AND METHODS:  Cross-sectional study of cases for the variables "Patient Cancer-Tamoxifen  Experimental group: Women with breast cancer receiving tamoxifen therapy drug. (n = 46).  Control group: Women with breast cancer who did not receive the drug tamoxifen therapy (sample = 20)

Exclusion criteria:  Men  Patients may receive antibiotics and / or antifungal three weeks prior to the study.  Patients who received periodontal treatment two months prior to the experience.  Patients suffering from autoimmune diseases, HIV (AIDS).  Patients could receive long-term corticosteroid.

 RESULTS What s microbiological findings showed that a greater variety of species of Candida were isolated from patients who used the drug during the first two years (C. albicans, C. tropicalis, C.parapsilosis, C.dubliniensis, C.glabrata) and were accompanied by isolation of P. gingivalis and P.intermedia.

 Only 2 species were isolated in those patients who used the drug for more than two years or those who have completed treatment. The length of the intake of Tamoxifen influenced the periodontal status.

 Patients who used the drug during the first two years show a high incidence of mild and severe periodontitis. Patients who used the drug more than two years and those who have completed treatment show a decreasing trend of moderate and severe periodontitis and a high incidence of mild periodontitis and gingival health.

DISCUSSION This work tried to investigate the presence of pathogenic microorganisms in the oral cavity (the same is found in the mouth in different ecological niches, periodontal pockets, mucus and others) in patients undergoing oncological therapy with Tamoxifen. Our study allowed us to observe the lower prevalence of periodontopathogens during the time of intake of Tamoxifen, as well as lesser count of Candida species. This work also showed that the longer time of drug use there is a growing tendency for periodontal health.

 Conclusions  Estrogen and progesterone induce changes microbiological acting as nutrients for microorganisms and generating altered homeostasis.  It is important epidemiological surveillance and monitoring of pathogens in particular clinical situations to demonstrate their participation in gingivoperiodontales diseases as well as health.  Seniority in the anti-estrogen therapy in women with breast cancer generates cumulative benefits.

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