PATOLOGIAS E SUAS CONSEQUÊNCIAS NO EQUILÍBRIO DA SAÚDE ORAL
PATOLOGÍAS Y SUS CONSECUENCIAS EN EL EQUILIBRIO DE LA SALUD BUCODENTAL
REGISTRO DOI: 10.69849/revistaft/cs10202409071332
Pedro Guimarães Sampaio Trajano dos Santos1; Rosana Maria Coelho Travassos2; Adriana da Costa Ribeiro3; Francisco Braga da Paz Júnior4; Eliana Santos Lyra da Paz5; Carlos Fernando Rodrigues Guaraná6; Maria Regina Almeida de Menezes7; Heloisa Helena Pinho Veloso8; Advisor: Luciano Barreto Silva9
Abstract
Objective: To address pathologies that affect oral health, discuss them, and point out the negative effects these conditions trigger on the oral structure, showing how the disease manifests itself in the mouth and what symptoms the patient presents. Methodology: Since this is a narrative literature review, it was necessary to acquire a range of articles, books, monographs, and other research that could provide maximum information on the subject. Thus, searches were carried out in the following databases and websites: DeCs, PUBMED Central, Scielo, PROSPERO, Science Direct, Web of Science, The Brazilian Journal of Health Review, BVS/BIREME, CAPES Periodicals Portal, The Cochrane Library, Research, Society and Development, Redalyc.org, ResearchGate in conjunction with Google Academy. In addition, in order to obtain the maximum amount of rich content to compose the article, searches were strategically designed using the following descriptors: Mucocele; Ranula; Herpetic Stomatitis; Oral Candidiasis; Chickenpox. Results: A total of 49 studies were used to compose this study. Conclusion: The conclusion reached was that the pathologies addressed have a great impact not only on oral health, but also in a systematic way, and it is extremely important that society stops dissociating oral health from the rest of the body, since it is something that complements each other and if it is not treated in such a way, more and more people may end up acquiring these pathologies. It was also seen that these conditions cause several harms to the oral structure, causing an extremely negative impact.
Keywords: Mucocele; Ranula; Herpetic Stomatitis; Oral Candidiasis; Chickenpox.
Resumo
Objetivo: Abordar sobre patologias que afetam a saúde oral, discutir sobre elas, apontando quais efeitos negativos esses acometimentos desencadeiam na estrutura bucal, mostrando de que forma a doença se manifesta na boca e quais sintomas o paciente apresenta. Metodologia: Por se tratar de uma revisão de literatura narrativa, foi necessário se adquirir uma gama de artigos, livros, monografias, e entre outras pesquisas que pudessem fornecer o máximo de informação sobre o tema. Dessa forma, foram realizadas pesquisas nas seguintes bases de dados e sites: DeCs, PUBMED Central, Scielo, PROSPERO, Science Direct, Web of Science, The Brazilian Journal of Health Review, BVS/BIREME, Portal de Periódicos da CAPES, The Cochrane Library, Research, Society and Development, Redalyc.org, ResearchGate em conjunto com o Google Academy. Além disso, com o objetivo de se obter o máximo de conteúdo rico para compor o artigo, buscas foram traçadas de forma estratégica utilizando dos seguintes descritores: Mucocele; Rânula; Estomatite Herpética; Candidíase Bucal; Varicela. Resultados: Foi utilizado um total de 49 trabalhos para compor este trabalho. Conclusão: Foi obtido como conclusão de que as patologias abordadas possuem grande impacto não só na saúde oral, mas de maneira sistêmica, sendo de extrema importância que a sociedade pare de desassociar a saúde da boca com o resto do corpo, se tratando de algo que se completa e que se não for tratado de tal maneira, mais e mais pessoas podem acabar adquirindo essas patologias. Também foi visto que esses acometimentos provocam diversos malefícios à estrutura oral, causando um impacto extremamente negativo.
Palavras-chave: Mucocele; Rânula; Estomatite Herpética; Candidíase Bucal; Varicela.
Resumen
Objetivo: Abordar patologías que afectan la salud bucal, discutirlas, señalando qué efectos negativos tienen estos trastornos en la estructura bucal, mostrando cómo se manifiesta la enfermedad en la boca y qué síntomas presenta el paciente. Metodología: Cómo se trata de una revisión de literatura narrativa, fue necesario adquirir una variedad de artículos, libros, monografías y otras investigaciones que pudieran proporcionar la máxima información sobre el tema. Por lo tanto, se realizaron búsquedas en las siguientes bases de datos y sitios web: DeCs, PUBMED Central, Scielo, PROSPERO, Science Direct, Web of Science, The Brazilian Journal of Health Review, BVS/BIREME, Portal Periódico CAPES, The Cochrane Library, Research, Sociedad y Desarrollo, Redalyc.org, ResearchGate en conjunto con Google Academy. Además, con el objetivo de obtener el mayor contenido rico posible para componer el artículo, se diseñaron estratégicamente búsquedas utilizando los siguientes descriptores: Mucocele; Ránula; Estomatitis herpética; Candidiasis oral; Varicela. Resultados: Para la composición de este trabajo se utilizaron un total de 49 obras. Conclusión: Se concluyó que las patologías abordadas tienen un gran impacto no solo en la salud bucal, sino de manera sistémica, y es de suma importancia que la sociedad deje de desvincular la salud de la boca con la del resto del cuerpo, ya que esto es algo que sea completo y que si no se trata de esa forma cada vez más personas pueden acabar adquiriendo estas patologías. También se ha observado que estos trastornos provocan diversos daños en la estructura bucal, provocando un impacto extremadamente negativo.
Palabras clave: Mucocele; Ránula; Estomatitis herpética; Candidiasis oral; Varicela.
1. Introduction
Nowadays, we live in an era in which more and more new bacteria, fungi, viruses, protozoa and other microorganisms are causing negative impacts on human health, whether they are beings that have existed for centuries, recent species or even mutations of existing organisms. The microbiota is basically a set of pathogenic or commensal microorganisms that live inside the human body, with our body being composed of a set of varied microorganisms that have come into contact with the intestine, skin and oral cavity of every individual after birth, creating a symbiotic relationship with it, enabling the development and life of both. The balanced human microbiota is of great importance in the large and small processes of health and disease, being an active participant in the body’s defenses against pathogens through: vitamin synthesis, development and maturation of the nervous system, digestion and regulation of immunity (Thomas et al., 2017; Chimenos-Küstner et al., 2007; Sampaio-Maia et al., 2016).
Within the oral cavity, there is a group of microorganisms that make up the oral microbiota, beings such as: several different species of archaea, viruses, protozoa, fungi and bacteria that are mostly commensal beings, that is, they do not play any negative role in the host, being beings that actually prevent the development of other pathogenic microorganisms, beings that, unlike those that make up the healthy microbiota, will play many negative aspects and impacts on the health and maintenance of the oral cavity. However, certain microorganisms that are present in the oral microbiota can end up causing problems in the oral cavity, if they change their colonization size and composition, based on changes in the host’s immune system or by taking advantage of possible diseases and infections that may be affecting the individual (Sampaio-Maia et al., 2016; Avila et al., 2009).
Thus, it is seen that certain microorganisms can perform pathogenic functions, which may be microorganisms that already make up the oral cavity or other invaders. Thus, the objective of this narrative literature review is to address pathologies that affect oral health, discuss them, and point out the negative effects these conditions trigger on the oral structure, showing how the disease manifests itself in the mouth and what symptoms the patient presents.
2. Methodology
Given that this work is a narrative literature review, Rother’s study (2007) was used as a basis for structuring the methodology and the work in general. It was necessary to acquire a range of articles, books, monographs, and other research that could provide the maximum amount of information on the topic. Thus, searches were carried out in the following databases and websites: Web of Science, DeCs, Scielo, Science Direct, The Brazilian Journal of Health Review, The Cochrane Library, BVS/BIREME, CAPES Periodicals Portal, PROSPERO, PUBMED Central, Research, Society and Development in conjunction with Google Academy. In addition, in order to obtain the maximum amount of rich content to compose the article, searches were strategically designed using the following descriptors: Mucocele; Ranula; Herpetic Stomatitis; Oral Candidiasis; Chickenpox.
3. Results
3.1 Ranula
Ranula is a serious problem in society, affecting the oral health of many patients, and is divided into two different types: plunging and simple ranula. The one classified as “simple” occurs in the area where the sublingual salivary gland is located, above the mylohyoid muscle, and is an increase in volume in the floor of the oral cavity. In addition, an invasion of the submandibular space may occur if the fibers of the mylohyoid muscle dissect, a dissection that will be triggered by an increase in volume caused by the ranula (Miloro & Schow, 2005). However, ranula may occur in other ways other than an increase in volume in the floor of the mouth; it may occur as a swelling in the neck, and is classified as dissecting, plunging or penetrating ranula (Neville et al., 2004; Sampaio et al., 2004). From a clinical perspective, simple ranula presents as a bluish, dome-shaped lesion, resembling a frog’s belly, and is a condition that usually develops on the lateral portion of the mouth floor (Loney et al., 2006; Sampaio et al., 2004). The deeper lesions are normally colored (Miloro & Schow, 2005), while the larger lesions mostly cause deviation of the midline of the tongue (Chidzonga & Mahomva, 2007).
Over the years, the treatment of ranula has been seen as a major challenge due to its high recurrence rate in modern society. The available forms of treatment are varied, but they depend on the size and location of the lesion, in addition to the preferred surgical technique of each respective dentist. Treatment options include: surgery, botulinum toxin, carbon dioxide laser, enucleation with or without removal of the sublingual gland, silver nitrate, cryosurgery, marsupialization, micromarsupialization, and sclerotherapy with OK-432 (Coloma et al., 2011; Samant et al., 2011; Sheikhi et al., 2011). The technique known as “marsupialization” is a conservative alternative, with a lower chance of causing injury to adjacent structures because it is minimally invasive. However, research shows that patients had a recurrence rate of approximately 61% to 89% between six months and one year. This technique is performed by removing part of the lesion, suturing its margins with the adjacent mucosa, allowing the elimination of mucus to the external environment of the tissues, making the floor of the mouth and the floor of the lesion at the same level, thus compressing the opening that was recently created, through the natural apposition of the belly of the tongue against the floor of the mouth (Alves et al., 2013; Sigismund et al., 2013).
3.2 Mucocele
Mucocele is an uncommon alteration located in the oral mucosa, with a prevalence of approximately 2.4 cases in every 1,000 individuals. This condition develops mostly in young people, with 70% of cases appearing in young people under the age of 20. In children, ranulas and superficial mucocele are found in people over 30 years of age, while in the elderly, it can appear in the form of mucus retention cysts (Senthilkumar & Mahabob, 2012).
Through pathogenesis and histopathological characteristics, mucoceles can be divided into two different types, classified as: “mucus extravasation phenomenon”, where there is a cavity filled with mucus, lined by a thin membrane or a capsule of granulation tissue in different stages of evolution; the other type is called “mucus retention cyst”, which occurs when the cavity is lined by glandular ductal epithelium and there is mucoid material inside it (Nico et al., 2008; Jimbu et al., 2003). Mucocele is a lesion that has a relatively easy microscopic diagnosis; however, certain rare histopathological characteristics can end up making this process difficult, signs such as synovial-like metaplasia and myxoglobulosis, which only appear in certain cases, making the diagnosis made by the dentist very difficult (Chi et al., 2010). The treatment for mucocele is basically through surgical excision followed by careful dissection of the adjacent minor salivary glands, with the aim of avoiding possible future recurrences (Neville et al., 2009; Yamasoba et al., 1990).
3.3 Candidiasis
Candida is seen within the scientific world as an opportunistic microorganism that is normally found in the microbiota of the gastrointestinal tract, urogenital tract and mainly in the oral cavity of human beings. In most cases, it does not trigger infectious processes when it affects healthy individuals, however, it can cause serious problems in patients who are undergoing antimicrobial therapy for a long period of time, immunocompromised people (Suzuki, 2009; Matos et al., 2009). Among the factors that favor the development of this pathology are: people who have a lack of saliva or dry mouth, the use of dental prostheses or orthodontic appliances, patients with endocrine alterations or who use steroid medications (Costa & Candido, 2007).
Candida belongs to the Fungi kingdom, with around 350 species of the genus, some examples being: Candida parapisilosis, Candida albicans, Candida krusei, Candida tropicalis and Candida glabrata, which are the types that are of greatest interest from a clinical perspective, with the other types being analyzed in isolation in certain cases of infection. Ten species of this pathogen are found in the oral cavity, with yeasts being part of the oral microbiota, which colonize 30% to 35% of the adult population and which, for the most part, do not cause infections in the individual’s body (Dalazem, 2010; Kemmelmeier et al., 2008; Dalazem, 2010). Candida is present in the oral microbiota of the human body in a way that does not cause harm, however, it can become a pathogen if the body of a given patient favors its development (Costa & Candido, 2007).
When it comes to candidiasis, it is seen that the pseudomembranous and atrophic types are extremely common within society. According to studies, pseudomembranous candidiasis is one of the most common forms of the disease, which presents itself acutely, affecting people of different ages, but mainly affects people who have chronic diseases, are debilitated or who are infants (Shafer et al., 1987). From a clinical perspective, this form of candidiasis presents itself as white-yellowish plaques or nodules (Araújo, 1994), with a soft to gelatinous consistency, with centrifugal growth and confluence (Regezi & Sciubba, 2000). These plaques can be easily removed using gauze compresses or cotton swabs (Regezi & Sciubba, 2000), which, after removal, leave the surface with an eroded or ulcerated, erythematous characteristic and, in certain cases, leave a certain sensitivity in the region (Shafer et al, 1987).
Atrophic candidiasis, also known as erythematous candidiasis (Tommasi, 2000), may be the result of pseudomembranous candidiasis after its persistence in the body (Shafer et al, 1987; Tommasi, 2000), but which loses the pseudomembrane and presents a more generalized red lesion (Shafer et al, 1987). Erythematous candidiasis may occur in the human body together with pseudomembranous candidiasis or independently of it, with erythematous candidiasis being a condition that is somewhat difficult to identify as candidiasis, due to the absence of the classic appearance that exists in pseudomembranous candidiasis (Tommasi, 2000). Atrophic candidiasis is a symptomatic lesion that triggers intense sensitivity caused by its numerous erosions spread throughout the mucosa (Pindborg, 1981).
3.4 Herpetic Gingivostomatitis
‘’GEHA’’, better known as ‘’acute herpetic gingivostomatitis’’, is a type of infection triggered by the herpes simplex virus (HSV), serotype 1 (Chiarelli et al., 2008). It is a symptomatic primary herpes infection that is most common in society and is most commonly found in children aged one to five years (Santos et al., 2012; Lawall et al., 2005). This infection presents prodromal symptoms such as general malaise, headache, anorexia, chills, odynophagia, erythema, bleeding gums, tachycardia, drowsiness, fever, irritability, sialorrhea diarrhea, general malaise and inflammation in the oral mucosa region (Neville et al., 2004).
From a clinical perspective, oral lesions begin as numerous vesicles measuring approximately 1 to 2 mm, which, after rupture, give rise to ulcers. These ulcers, which originate from the vesicles, increase in size and may eventually coalesce until they give rise to shallow ulcers covered by a fibrin membrane. These ulcers cause a high level of pain to the patient, but take 7 to 14 days to heal spontaneously without leaving marks such as scars. The affected areas cover the mucosa in general, as well as the perioral region and the lips, resulting in many different lesions, with the gingival area being present in all cases. The gums become erythematous with symptoms of pain in the region and very swollen, and may or may not have punctiform erosive zones distributed throughout the gingival margin together with swelling of the lymph nodes located in the areas close to the affected area (Regezi et al., 1991; Neville et al., 2004). Research states that tissue culture inoculated with gallbladder fluid is a definitive procedure when compared to others, and is the test that indicates the respective etiological agent (Neville et al., 2004).
3.5 AIDS
Nowadays, people who acquired immunodeficiency syndrome (AIDS) can live peacefully and with a certain positive quality of life in relation to their oral health, and have relatively good oral health, being able to tolerate most dental surgical procedures. In addition to these facts, other studies carried out by a range of researchers state that patients with HIV are no more likely to have complications, in a way that does not vary independently of the CD4 cell count (Zhang et al., 2009).
It is common for HIV to trigger several oral manifestations and these normally present as the first clinical signs of the disease (Coulter et al., 2000). HIV causes a very broad spectrum of oral manifestations in people with this infection, depending on factors such as the degree to which the immune system is compromised, oral hygiene status, use of antiretrovirals, and other aspects (Marcenes & Pankhurst, 1998; Aguirre, 1999; Birnbaum et al., 2002; Dobalian et al., 2003). These can be developed through bacterial, fungal, and viral infections, as well as lesions of idiopathic cause or through neoplastic processes (Souza et al., 2000; Brasil, 2000).
3.6 Measles
Measles is an acute, easily transmitted, febrile, exanthematous disease caused by a virus belonging to the Paramyxoviridae family of the Morbillivirus genus. This disease is one of the most common childhood infections, distributed globally, and has no predisposition to a particular race or gender. The virus that causes measles has eight different classes (from A to H), distributed in 24 genotypes in a continuous and geographically modeled manner (Pan American Health Organization, 2019). This health problem is transmitted from person to person through nasopharyngeal secretions expelled during speech, coughing, breathing, or sneezing. This virus can be transmitted between four and six days before or four days after the appearance of the rash. Measles can affect newborns of mothers who have some predisposition, however, it rarely affects children in their first six months of life, due to the presence of maternal antibodies that were transferred transplacentally (Brazil, 2017; Brazil, 2014).
There is a sign that can be considered as “pathognomonic”, which means “specific” when it comes to measles, a characteristic called “Koplik’s” spots (Battegay et al., 2012). This particular sign presents as raised lesions, measuring approximately 2 to 3 mm, with a reddish base and appearing bluish-white in color (Schoini et al., 2019). However, research indicates that there is a variation in relation to the time it takes for their appearance to occur, their duration and the location of the Koplik’s spots within the oral cavity. In most cases, the spots appear on the oral mucosa, opposite the upper molars, later spreading throughout the oral mucosa. Other studies show that the spots are also found on the inner mucosa of the lips, vagina and gastrointestinal tract. The time of appearance of these spots is generally associated with the prodromal stage of measles, when the disease is occurring during its initial stage or within the days before the rash occurs. Research shows results that report that Koplik spots last for about several days on the oral mucosa, persisting until the onset of the rash for up to 3 days (Battegay et al., 2012; Katz et al., 2023).
3.7 Chickenpox
Chickenpox, or Varicella, is a benign, self-limiting disease that mainly infects children between the ages of three and six, and is caused by the herpes zoster virus, which is part of the herpes family. It is a disease that usually affects children, however, approximately 10% of individuals over the age of fifteen are within a group susceptible to acquiring this pathology. Primary chickenpox infection is highly contagious, resulting from exposure of individuals who have a certain predisposition to the virus. The main symptoms of this disease are skin rashes and generalized exanthema. This virus is generally considered to be “endemic”, however, it has a prevalence of appearing in seasonal periods from early spring to late winter. One form of chickenpox manifestation is shingles, better known as herpes zoster, which is the result of the reactivation of the latent virus in people who have already been exposed to the virus at some point in the past. It is a problem that occurs at different ages, especially in the elderly. Herpes zoster is a sporadic condition, in which its reactivation is related to the balance between host and viral factors (Soman & Madan, 2013).
The forms in which this pathology manifests itself in the oral and perioral regions are extremely common and may precede skin lesions, with the vermilion border of the lips and the palate being the sites most often involved, together with the buccal mucosa. Gingival lesions are rare, and they usually resemble those triggered by primary HSV infections. The lesions begin as opaque white vesicles measuring 3 to 4 mm, which later rupture, giving rise to ulcers measuring 1 to 3 mm (Groves & State, 2016; Neville, 2009; Tyring, 1992).
Regarding the forms of treatment associated with this pathology, research recommends the use of ‘’Acyclovir’’ as an option for treating chickenpox, since newborns of mothers who have had contact with this virus will be treated with immunoglobulin for the herpes-zoster virus within a period of 48 hours after birth (White et al, 2012). Within the treatment of chickenpox, supportive measures for treating symptoms together with antiviral therapy are necessary measures to avoid possible complications. For the treatment of children, acyclovir is not an indicated option when it comes to treating healthy children, however, it is recommended for premature children, children with a history of cardiovascular disease, chronic skin disease and in children who use inhaled or oral steroids (Soman & Madan, 2013).
4. Discussion
The oral microbiota is essential for the balance and proper functioning of the entire human organism. However, when there is an imbalance in the microbiota, the occurrence of oral and systemic diseases is favored, and pathologies may develop in the body. The dentist has a great responsibility in diagnosing pathologies in general, since most of them present lesions in the oral cavity. Therefore, it is extremely important that the dentist is able to analyze the oral structure, identifying the characteristics of the symptoms presented by each respective pathology, so that each disease can be recognized and the best form of treatment can be outlined, aiming to restore the health and balance of the oral microbiota.
Another aspect that should be linked to the dentist is the recommendations that should be passed on to people with certain pathologies, taking into account that a large part of society, even after receiving the diagnosis, ends up not knowing what they should do to treat themselves and what things they should not do so that the disease does not get worse, in addition to what measures they should take to not transmit these pathologies, taking into account that a large part of them end up being transmissible, and can be transmitted to people with low immunity or predisposed by other factors. Thus, the patient with a certain pathology should be instructed by the dentist, so that he or she can have his or her health restored as quickly as possible and so that third parties do not end up acquiring the disease.
A factor linked to most pathologies is the low immunity presented by patients affected by these diseases, who presented this deficiency even before being affected by a certain pathology, with low immunity being a factor that makes it easier for the development and establishment of various oral pathologies. Another factor that favors the development of these problems is poor oral hygiene, which increases the amount of microorganisms in the oral cavity, leaving the “normal” and balanced amount, serving as a source for bacteria, fungi, viruses and other beings to use to benefit themselves, increasing their development within the cavity, bringing these impacts to health in general. Therefore, it is seen that it is extremely important for people to have good oral hygiene, brushing their teeth correctly so that the number of microorganisms is controlled and balanced so as not to cause harm, together with vitamin D that must be acquired through sunlight or by ingestion from food or supplementation, thus achieving oral health that is less prone to the development of pathologies.
Considering that most of the pathologies that develop in the mouth are related to the body in general and vice versa, it is extremely important that there is this interprofessional relationship within the health area, where dentists together with doctors, nutritionists and psychologists work together, aiming to bring balance to the entire body since both the mouth and the other organs of the body interact and are interconnected with each other, so that people can obtain the best quality and health support possible.
5. Conclusion
Over the years, more viruses, bacteria, fungi, parasites and other pathologies have emerged, causing a range of harm to people’s health within society. These health problems cause many problems in oral health, being responsible for causing impacts on the salivary glands, dental structure, tongue, gums and all the soft tissue that lines the oral cavity. Therefore, it is extremely important to stop dissociating the mouth from the rest of the body, at a time when most of the pathologies that arise in the mouth have their entry point in other areas of the body and vice versa, having a negative effect on the entire organism.
Pathologies such as: Chickenpox, Measles, AIDS, Herpetic Gingivostomatitis, Candidiasis, Mucocele and Ranula are part of the large part of the pathologies that affect the body in general, with the oral cavity as one of the components, being the main causes of problems such as: gum infections and lesions, gingival eruptions, spots on the mucosa, ulcerations, edema, gum bleeding and among other effects caused by these pathologies. Thus, this group of pathologies is the main responsible for negative effects on the entire oral structure derived from diseases and other problems.
Therefore, it is extremely important that more research be done with the aim of developing new treatment possibilities for this pathology, which would be disseminated in the scientific community through scientific articles, so that more dental surgeons have access to these alternative forms of treatment. In order for more dentists to know how these pathologies manifest themselves, it is necessary that case reports be made, demonstrating real cases of patients who were affected by these problems, demonstrating what happens to the oral structure of someone with one of these specific pathologies and what impacts should be analyzed at the time the oral evaluation is being carried out.
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1ORCID: https://orcid.org/0009-0001-5720-603X – Faculdade de Odontologia do Recife, Brazil. E-mail: pedroguimaraessampaio@gmail.com
2ORCID: https://orcid.org/0000-0003-4148-1288 – Universidade de Pernambuco, Brazil. E-mail: rosana.travassos@upe.br.
3ORCID:https://orcid.org/0009-0005-8337-8096 – Universidade de Pernambuco, Brazil. E-mail: adriana.costaribeiro@upe.br.
4ORCID: https://orcid.org/0000-0003-1810-4011, Instituto Federal de Pernambuco, Brasil. E-mail: franciscobraga@recife.ifpe.edu.br
5ORCID: https: orcid.org/0000-0003-4486-142X – Universidade de Pernambuco,Brasil. E-mail: eliana.lyra@upe.br
6Orcid: https:ORCID.org/0000-0003-1312-3312 – Universidade Federal Rural de Pernambuco, Brasil. E-mail: carlos.guarana@ufrpe.br
7ORCID: http://orcid.org/0000-0003-3012-3979 .- Universidade de Pernambuco-Brasil. E-mail: regina.menezes@upe.br
8ORCID http://orcid.org/0000-0002-8988-2462 – Universidade Federal da Paraíba.E-mail : heloisa.veloso@academico.ufpb.br
9ORCID: https://orcid.org/0000-0002-1508-4812 – Universidade de Pernambuco, Brazil. E-mail: lucianobarreto63@gmail.com