Central Odontogenic Fibroma with the Presence of Large Fibroblasts of Varying Morphology.

A patient with an odontogenic fibroma (OF) with the presence of fibroblasts of varying morphology is presented, and the main microscopic differential diagnosis is discussed. Case report: a 51-year-old man complained of a swelling in the anterior region of the mandible. The panoramic radiograph showed a radiolucent, well-defined multilocular image, with displacement of the roots of the left mandibular incisors and canine. A cone beam computed tomography examination revealed a hypodense image, with delicate bone spicules inside, divergence of the tooth roots and destruction of the buccal cortical bone. Under the differential diagnosis of a desmoplastic ameloblastoma or a squamous odontogenic tumor, an incisional biopsy was made. Microscopically, deeply collagenized tissue with scarce odontogenic epithelium islands, large fibroblasts of varying morphology and calcified material was observed. A diagnosis of OF was made. Surgical removal was carried out, and the specimen was examined. Identical aspects were found, and the immunohistochemical reaction for pan-cytokeratin was carried out to identify the odontogenic epithelial cells. The definitive diagnosis of OF was confirmed, and we emphasize the importance of the correlation of all characteristics for a definitive diagnosis.

Bilateral mandibular buccal bifurcation cyst: a case report emphasizing the role of imaging examination in the diagnosis.

A mandibular buccal bifurcation cyst is an inflammatory cyst that usually occurs on the buccal aspect of the permanent mandibular first molar of children. This lesion is diagnosed by an association of radiographic, clinical, and histological features. We report a bilateral case of mandibular buccal bifurcation cyst and discuss the main findings of this entity. A 7-year-old girl presented pain and delayed dental eruption in the posterior mandibular region. A cone beam computed tomography was performed and revealed hypodense lesions involving the crown and root of the mandibular first molars, with expansion of the buccal cortical and lingual tilting of the molar roots. A biopsy was carried out, and the common features of an inflammatory odontogenic cyst were histologically observed. The final diagnosis was bilateral mandibular buccal bifurcation cyst. Clinicians need to be aware of this diagnostic possibility in cases of mandibular cysts in children-especially when bilateral-to perform the correct treatment, which should not involve the extraction of the affected tooth.

Vascular leiomyoma in the oral cavity - Report of two cases.

Vascular leiomyomas (VL) are benign lesions of perivascular origin. We report two new cases and discuss their clinical, histological and immunohistochemical characteristics, in order to facilitate the diagnosis and treatment of such lesions. The patients, both male, presented asymptomatic nodules located in the bottom of the labial sulcus and buccal mucosa. In the second case, color doppler ultrasonography was performed, which showed no change in blood flow. After excisional biopsies, a limited lesion was observed histologically, with multiple tortuous vessels of varying sizes and calibers, and among them, spindle cells bundles, positive for smooth muscle actin. Oral VLs have clinical features similar to those of other more common lesions, making preoperative diagnosis difficult. Imaging examination, such as color doppler ultrasonography, may help in diagnosis. In general, excisional biopsy is performed, due to the ease of removal of the lesion during surgery. The treatment of choice is the complete excision of the lesion, which has an excellent prognosis and a low rate of recurrence. Key words:Vascular leiomyoma, spindle cells, thrombus, Doppler.

Bilateral mandibular buccal bifurcation cyst: a case report emphasizing the role of imaging examination in the diagnosis

A mandibular buccal bifurcation cyst is an inflammatory cyst that usually occurs on the buccal aspect of the permanent mandibular first molar of children. This lesion is diagnosed by an association of radiographic, clinical, and histological features. We report a bilateral case of mandibular buccal bifurcation cyst and discuss the main findings of this entity. A 7-year-old girl presented pain and delayed dental eruption in the posterior mandibular region. A cone beam computed tomography was performed and revealed hypodense lesions involving the crown and root of the mandibular first molars, with expansion of the buccal cortical and lingual tilting of the molar roots. A biopsy was carried out, and the common features of an inflammatory odontogenic cyst were histologically observed. The final diagnosis was bilateral mandibular buccal bifurcation cyst. Clinicians need to be aware of this diagnostic possibility in cases of mandibular cysts in children­especially when bilateral­to perform the correct treatment, which should not involve the extraction of the affected tooth.

Optical diagnosis of actinic cheilitis by infrared spectroscopy.

Actinic cheilitis (AC) is considered a potentially malignant disorder of the lip. Biomolecular markers study is important to understand malignant transformation into squamous cell carcinoma. Fourier transform infra red (FT-IR) spectroscopy was used to analyze AC in this study. OBJECTIVES: The aim of the study was to evaluate if FT-IR spectral regions of nucleic acids and collagen can help in early diagnosis of malignant transformation. METHODS: Tissues biopsies of 14 patients diagnosed with AC and 14 normal tissues were obtained. FT-IR spectra were measured at five different points resulting in 70 spectra of each. Analysis of Principal components analysis (PCA) and linear discrimination analysis (LDA) model were also used. In order to verify the statistical difference in the spectra, Mann-Whitney U test was performed in each variable (wavenumber) with p-value <0.05. RESULTS: After the Mann-Whitney U test the vibrational modes of CO (Collagen 1), PO2 (Nucleic Acids) and CO asymmetric (Triglycerides/Lipids) were observed as a possible spectral biomarker. These bands were chosen because they represent the vibrational modes related to collagen and DNA, which are supposed to be changed in AC samples. Based on the PCA-LDA results, the predictive model corresponding to the area under the curve was 0.91 for the fingerprint region and 0.83 for the high wavenumber region, showing the greater accuracy of the test. CONCLUSIONS: FT-IR changes in collagen and nucleic acids could be used as molecular biomarkers for malignant transformation.

Spindle Cell Lipoma Occurring in the Buccal Mucosa: An Unusual Location of This Benign Lipomatous Neoplasm.

Spindle cell lipoma is a benign lipomatous neoplasm, which rarely occurs in the oral cavity. The aims of this paper are to report a case of spindle cell lipoma located in buccal mucosa and discuss the main clinical, histological, and immunohistochemical findings of this entity. Thus, we report a 4-year history of an asymptomatic smooth surface nodule in an elderly Caucasian man with clinical hypothesis of fibroma. The histopathological examination showed spindle cells, mature adipose tissue, and many mast cells in a stroma of connective tissue presenting ropey collagen fibers bundles. After immunohistochemical analysis, the final diagnosis was spindle cell lipoma.

An Isolated Phlebolith on the Lip: An Unusual Case and Review of the Literature.

Background. Calcified thrombi are a common finding, especially in the pelvic veins. There are generally multiple thrombi, and they are generally associated with vascular malformations. Design. Herein we report a rare case of a single labial phlebolith, not associated with any other vascular lesion. We aim to alert clinicians to the possibility of the occurrence of vascular thrombi in the mouth and to describe the clinical and histological characteristics of such lesions in order to simplify the diagnosis and treatment. Furthermore, we have reviewed the English-language literature published since 1970 reporting oral (including masticatory muscles) phleboliths. Results. Twenty-nine cases of phleboliths have been reported in the literature since 1970. Only three of the reported phleboliths were solitary and not associated with other vascular lesions, as in the case presented here. Conclusion. Although phleboliths not associated with other vascular lesions are not common, clinicians should be aware of the existence of this pathology and include it as differential diagnosis of oral lesions.

Study of MDM2 and SUMO-1 expression in actinic cheilitis and lip cancer.

Actinic cheilitis exhibits a potential of malignant transformation in 10-20 % of cases. The objective of this study was to compare the expression of MDM2 and SUMO-1 proteins between actinic cheilitis (AC) and squamous cell carcinoma (SCC) of the lip. The sample consisted of lower lip mucosa specimens obtained from cases with a clinical and histopathological diagnosis of AC (n = 26) and SCC (n = 25) and specimens of labial semi-mucosa (n = 15) without clinical alterations or inflammation. The tissue samples were stained with hematoxylin-eosin and anti-MDM2 and anti-SUMO-1 antibodies. Data were analyzed by the Kruskal-Wallis and Dunn's tests (5 %). The median expression of MDM2 (kW = 36.8565; df = 3-1 = 2; p = 0.0001) and SUMO-1 (kW = 32.7080; df = 3-1 = 2; p = 0.0001) was similar in cases of AC and SCC of the lip, but differed significantly from that observed for normal labial semi-mucosa. Despite the limitations of the present study, immunohistochemistry demonstrated the overexpression of important proteins (MDM2 and SUMO-1) related to regulatory mechanisms of apoptosis in AC and SCC of the lip, but further studies are needed.

Análisis del perfil clínico del paciente portador de queilitis actínica: importancia para el diagnóstico / Analysis of the clinical profile of the patient with actinic cheilitis: diagnostic importance

La queilitis actínica es una lesión inflamatoria crónica del labio causada por la acción de los rayos solares. Debido a su lenta progresión, el paciente relaciona el proceso con una consecuencia del envejecimiento, ignorando su naturaleza evolutiva y cancerígena. El objetivo de este trabajo fue presentar el perfil clínico de los pacientes para realizar el diagnóstico. Fueron investigados 47 casos de queilitis actínica; la alteración de la línea de transición de la seni-mucosa de los labios con la piel se destacó por estar presente en 45 pacientes (96%). Concluimos que clínicamente todas las lesiones de queilitis actínica tenían aspecto multifocal; la presencia clínica de casi 100% de la alteración de la línea de transición de la seni-mucosa de los labios y la piel fue debida a la cronicidad de la afección; la resequedad labial fue disminuyendo porcentualmente por el hecho de realizar controles periódicos de los pacientes

Ulceration of the oral mucosa induced by antidepressant medication: a case report.

INTRODUCTION: Ulcers are frequent lesions of the oral mucosa. Generally, they are circumscribed round or elliptical lesions surrounded by an erythematous halo and covered with an inflammatory exudate in their central portion, and are accompanied by painful symptoms. Oral ulcers affect 20% of the population, especially adolescents and young adults. The etiopathogenesis includes immunological alterations, infections, nutritional deficiency, trauma, food and contact allergies, autoimmune diseases, neoplasms, and psychosomatic, genetic and environmental factors. CASE PRESENTATION: A 78-year-old Caucasian woman was referred by her dentist to our outpatient clinic with a 4-week history of an oral ulceration after using an antidepressant (sertraline hydrochloride). On the basis of the clinical findings and anamnesis, the occurrence of the lesion was attributed to the use of the drug. Exfoliative cytology was performed, to reassure the patient that it was not oral cancer, which revealed the presence of a nonspecific inflammatory reaction. The drug was replaced and resolution of symptoms was observed. CONCLUSION: Exfoliative cytology should be the complementary examination of choice in cases of oral ulcers with a suspicion of drug interaction. Although this is a rare event in dental practice, dentists should be aware of the diagnostic possibility of drug-induced ulcers and should cooperate with the clinician to adjust the prescribed medication to resolve the symptoms.

Ameloblastic fibro-odontoma: a case report.

Ameloblastic fibro-odontoma (AFO) is a rare, benign, slow-growing odontogenic tumor, generally asymptomatic and more prevalent in children and adolescents. We report a case of AFO in the mandible of an eight-year-old Caucasian male patient, and review the literature . Intraoral examination revealed a swelling extending from the deciduous second molar to the retromolar triangle, covered with normal mucosa. A panoramic radiograph showed a large, well-demarcated radiolucency with radiopaque areas. The provisional diagnosis was of AFO, and so an incisional biopsy was performed. Histologically, the lesion was composed of connective tissue resembling the dental papilla, with epithelial strands or islands, as well as denticles and amorphous masses of enamel and dentin consistent with a diagnosis of AFO. Surgical excision and curettage of the lesion were performed. The patient has been monitored for eight years and the lesion has not recurred.

Congenital ranula: a case report.

The purpose of this study was to report a case of bilateral swelling on the floor of the mouth of a 7-month-old patient. The lesion was congenital and had started to cause feeding problems. After the clinical diagnosis of ranula was made, the lesion was marsupialized. The obtained specimen was submitted for histopathological examination, which revealed an epithelial-lined cystic lesion. These results led to the final diagnosis of mucus retention cyst. After an 8-year follow-up period, the patient is in good general health with no recurrences.

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident.

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.

Florid cemento-osseous dysplasia: a report of three cases.

Florid cemento-osseous dysplasia (FCOD) is a non-neoplastic condition of the jaws that is not associated with inflammation of the pulp or periodontal tissue. This article reports on three cases that were diagnosed as FCOD, demonstrating the importance of both clinical and radiographic diagnosis and the clinical management of these lesions.

Actinic cheilitis: clinical and histological features.

PURPOSE: The purpose of this study was to analyze the clinical and histological features of actinic cheilitis (AC). PATIENTS AND METHODS: A total of 29 patients with AC were clinically evaluated, and incisional biopsies were performed to confirm the clinical diagnosis. Histological features were analyzed, and dysplasia was classified as mild, moderate, or severe. The chi(2) test was used for the following variables: gender, age, race, and smoking habits. The degree of dysplasia was related to these variables (Fisher's test) to test for independence between them (P < .05). RESULTS: Of the patient group, 72.41% were male, 75.86% were over age 40 years, 93.10% were white, and 72.41% were nonsmokers. Clinically, all patients presented with multifocal lesions. The following manifestations were seen: dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor. Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia were found in the epithelial tissue; elastosis, inflammatory infiltrate, and vasodilatation were found in the connective tissue. Dysplasia was mild in 10.34% of the patients, moderate in 27.59%, and severe in 62.07%. Absence of sample homogeneity was observed in regard to gender, age, race, and smoking habits. It was not possible to reject the hypothesis of independence between mild, moderate, or severe dysplasia and gender, age, race, and smoking habits. CONCLUSIONS: Dryness, atrophy, and scaly lesions were the most common clinical findings observed. Dysplasia, inflammatory infiltrate, and vasodilatation, as well as elastosis, were the most common histological findings observed. Gender, age, race, or smoking habits were not related to the degree of dysplasia in the sample.

Candidíase bucal: aspectos de interesse ao cirurgião-dentista / Oral candidiasis: aspects of interest for the dentist

Fungos do gênero Candida fazem parte da microbiota bucal nos seres humanos caracterizados pelo oportunismo. Podem tornar-se patológicos quando os mecanismos de defesa do hospedeiro estão comprometidos, como nos indivíduos imunossuprimidos, portadores de endocrinopatias (principalmente diabete melito) e estressados. Condições sistêmicas como má nutrição, antibioticoterapia, quimioterapia e corticoterapia, também predispõem o organismo a esta infecção. A alcalinização do pH bucal e uso de medicamentos antifúngicos são condutas efetivas, freqüentemente adotadas no tratamento e controle da afecção.

Fungi of the genus Candida are part of the human oral microbiota and are opportunistic microorganisms. These fungi can become pathologic when the defense mechanisms of the host are compromised as occurs in immunosuppressed individuals, patients with endocrinopathies (mainly diabetes mellitus) and individuals who are under stress. Systemic conditions such as malnutrition, antibiotic therapy, chemotherapy and corticosteroid therapy also predispose the organism to this infection. Alkalinization of oral pH and antifungal drugs are effective therapeutic approaches that are frequently adopted in the treatment and control of this disease.

Conhecimento da população quanto à atuação do dentista estomatologista nas doenças da boca / Aqcuaintance level regarding dentist role in oral diseases

Neste estudo avaliamos o nível de conhecimento da população de classe média quanto à atuação do cirurgião- dentista na sociedade. Por meio de questionário foram abordadas questões relativas ao campo de atuação desses profissionais, à sua formação técnico-científica, ao grau de informação da sociedade quanto à Estomatologia e sua inter-relação com outras especialidades da área. Os resultados obtidos foram relevantes, evidenciando a falta de conhecimento da população a respeito da Odontologia voltada para a saúde bucal, bem como a qualificação dos profissionais para diagnosticar e tratar doenças da boca, revelando a pouca ênfase dada à Estomatologia no País, o que demonstra a necessidade da divulgação estimulada e reconhecida da área de atuação do cirurgião-dentista. Para tanto, a educação é a saída em direção a uma sociedade mais bem informada

Leucemia no paciente pediátrico: atuação odontológica / Pediatric patients with leukaemia: dental care

O objetivo deste trabalho foi verificar as principais manifestações clínicas gerais e bucais da leucemia em crianças e adolescentes, antes do diagnóstico da doença e durante a terapêutica adotada, além de enfatizar a participação do Cirurgião-Dentista no diagnóstico de leucemia que estavam em tratamento ou acompanhamento de manutenção no Grupo de Pediatria Oncológica de São José dos Campos. Utilizou-se uma ficha criada especialmente para este trabalho, com o objetivo de facilitar o levantamento de dados como idade, sexo, tipo de leucemia e sintomatologia. Antes do diagnóstico de leucemia, as manifestações gerais mais relatadas foram febre, fraqueza, cansaço e palidez e as manifestações bucais foram palidez de mucosa, sangramento gengival, candidíase, ulcerações e hiperplasia gengival. Durante a terapêutica adotada, náuseas e vômitos foram as manifestações gerais mais relatadas e ulcerações, candidíase, sangramento gengival e xerostomia, as manifestações bucais. A leucemia pode ter suas primeiras manifestações na boca, o que reafirma a participação do Cirurgião-Dentista no diagnóstico precoce da doença e na equipe multidisciplinar de atendimento a esse tipo de paciente. Após o diagnóstico, a presença desse profissional na equipe de tratamento oncológico pode diminuir a morbidade e a mortalidade relacionadas às complicações bucais, assim como aumentar o conforto e a qualidade de vida dos pacientes durante a terapia.

Avaliaçäo clínica e radiográfica das condiçöes dentárias de 500 pacientes / Clinical and radiographic evaluation of dental conditions in 500 patients

O objetivo do presente trabalho é avaliar, através dos exames clínico e radiográfico, as alteraçöes ocorridas na cavidade bucal de 500 indivíduos. Para tanto, analisaram-se os prontuários de 500 pacientes que procuraram atendimento odontológico nas clínicas da Faculdade de Odontologia de Bauru-USP. Foram analisados dados relativos à cárie, patologias periapicais, periodontais, tratamento odontológico já realizado e alteraçöes de desenvolvimento. Examinaram-se 12293 dentes (média de 24,59 dentes remanescentes por pessoa), dos quais 4671 possuíam restauraçöes (9,34 dentes restaurados por pessoa), valor que superava tanto a quantidade de dentes extraídos (3630) como a de dentescariados (2991). Apresentavam tratamento endodôntico 717 dentes, sendo que 51,04 por cento destes possuíam canais parcialmente obturados ou com sobreobturaçäo. Dos dentes examinados, 6,08 por cento apresentavam alteraçöes periapicais. Cálculo supra ou infragengival foi encontrado em 55 por cento dos pacientes, e reabsorçäo da crista alveolar, em 63 por cento. As alteraçöes de desenvolvimento mais encontradas foram: dilaceraçäo radicular e bifurcaçäo do conduto radicular. Apesar de grande parte da mostra analisada já ter tido contacto com algum tipo de tratamento odontológico, a demanda para atendimento ainda é grande. Há, portanto, necessidade de melhoria técnica nos tratamentos e cuidado na atitude de informaçäo ao paciente, em especial quanto à prevençäo

Estudo da morfologia da prata metálica, formada em filmes periapicais, por açäo de soluçöes de processamento convencional e monobanho / Study on the morphology of metal silver, formed in periapical films by action of conventional and monobath processing solutions

A observaçäo da morfologia da prata metálica formada na emulsäo dos filmes radiográficos periapicais (Agfa M2 e Ektaspeed EP 21), processados nos líquidos convencional Kodak e monobanho Inodon, foi o objetivo deste estudo. Após a avaliaçäo microscópica da morfologia da prata metálica, passamos às medidas das leituras de densidade óptica e à confecçäo das curvas características. Pelos resultados alcançados pudemos concluir que: os grânulos de prata metálica formados no filme Ektaspeed processado nas soluçöes Kodak e Inodon säo sempre maiores do que os do filme Agfa; os resultados das curvas características, nas combinaçöes filme/processamento utilizadas, comprovam os dados fornecidos pelos fabricantes dos filmes e das soluçöes de processamento quanto ao contraste e à latitude, que säo semelhantes. O filme Agfa apresentou ainda densidade base e velamento, densidade média e densidade máxima maiores que os mesmos parâmetros do Ektaspeed. Observamos ainda que nos dois processamentos o filme Agfa é mais sensível que o Ektaspeed, o que näo era esperado