Biosafety in Dental Health Care During the COVID-19 Pandemic: A Longitudinal Study.

Background: The coronavirus disease 2019 (COVID-19) pandemic had quite an impact on dental health care. Concerns about the risk of SARS-CoV-2 transmission through contaminant fluids and droplet formation during several dental procedures highly impacted dental health care, drastically reducing the number of dental practices worldwide. To monitor SARS-CoV-2 contamination in dental clinics, a longitudinal study was carried out during the return of dental practice at university. Methods: Dental health care professionals [(DHCPs); teachers, undergraduate dental students, and dental assistants] and patients were screened for SARS-CoV-2 RNA in a dental school clinic environment from 11th January to 12th March 2021 (9 weeks). Serological testing was performed on DHCPs in two-time points. Additionally, samples with low Ct values were sequenced to identify the circulating SARS-CoV-2 variant and possible transmission clusters. Results: We found a low number of dental staff (5.8%), patients (0.9%), and environment sites (0.8%) positive for SARS-CoV-2. Most positive cases had asymptomatic to mild symptoms, and two asymptomatic DHCPs presented prolonged infection. In the first week after previous exposure to COVID-19, 16.2% of DHCPs had IgM or IgG antibodies against SARS-CoV-2, and 1/3 of them had undetected antibodies in the last weeks. The variant zeta (P.2) could be detected. No cross-infection was observed between participants. Conclusion: Our study suggests that dental practice can be safely executed when adequate control measures and biosafety protocols are applied. DHCP and patient testing, patient telemonitoring, proper use of personal protection equipment, and sanitization of surfaces are essential to avoid SARS-CoV-2 cross-infection in dental practice.

Unveiling metabolic changes in marsupialized odontogenic keratocyst: A pilot study.

OBJECTIVE: We aimed to assess which metabolic pathways would be implicated in the phenotypic changes of the epithelial lining of odontogenic keratocyst after marsupialization, comparing pre- and post-marsupialized lesions with adjacent oral mucosa. MATERIALS AND METHODS: Eighteen formalin-fixed and paraffin-embedded tissues from six subjects were divided into three paired groups: odontogenic keratocyst pre- (n = 6) and post-marsupialization (n = 6), and adjacent oral mucosa (n = 6). The metabolic pathways found in these groups were obtained by high-performance liquid chromatography-mass spectrometry-based untargeted metabolomics performed. RESULTS: Through putative metabolite annotation followed by pathway enrichment and predictive analysis with automated algorithms (Mummichog and Gene Set Enrichment Analysis), we found differences in many cellular processes that may be involved in inflammation, oxidative stress response, keratinocyte-basal membrane attachment, differentiation, and proliferation functions, all relevant to odontogenic keratocyst pathobiology and the phenotype acquired after marsupialization. CONCLUSION: Our study was able to identify several metabolic pathways potentially involved in the metaplastic changes induced by marsupialization of odontogenic keratocysts. An improved comprehension of this process could pave the way for the development of targeted therapies.

Aplicação do laser de baixa intensidade no tratamento do eritema multiforme: relato de caso / Low intensity laser application in the treatment of erythema multiforme: case report

Objetivo: Este trabalho tem como objetivo relatar um caso de Eritema Multiforme (EM) menor desencadeado por amoxicilina oral, tratado a partir de aplicação de laser de baixa intensidade na região afetada pela doença. Relato de caso: Paciente de 12 anos, atendido no Hospital Metropolitano Odilon Behrens (HMOB), apresentando úlceras em mucosa jugal, lábios e língua, disfagia, dislalia e febre, recebeu diagnóstico clínico de EM e tratamento com aplicação de laser vermelho de baixa intensidade, emitindo em 660nm, com potência de 100mW, sendo aplicado uma dose de 33 J/cm², em pontos com distância aproximada de 1 cm entre eles. Houve resolução das lesões em 7 dias após instituição do tratamento. Conclusão: O presente trabalho mostrou que a Terapia de Fotobiomodulação (TF) com laser de baixa intensidade associado à substituição do medicamento detectado como causa foram fundamentais para a resolução do EM, evidenciando as propriedades bioestimulantes do laser nas lesões ulceradas de mucosa bucal.

Aim: This paper aims to report a case of minor Erythema Multiforme (EM) triggered by oral amoxicillin, treated with low-level laser applications in the region affected by the disease. Case report: A 12-year-old patient, treated at the Metropolitan Hospital Odilon Behrens, presenting ulcers in the buccal mucosa, lips, tongue, dysphagia, dyslalia, and fever, received a clinical diagnosis of EM and treatment with low-intensity red laser applications, emitted at 660 nm, with a power of 100 mW, with a dose of 33 J/cm² being applied, in points with an approximate distance of 1 cm between them. The lesions resolved within 7 days after treatment were instituted. Conclusion: This present paper shows a successful therapeutic, non-pharmacological alternative for the management of EM, showing the bio stimulating properties of laser in ulcerated lesions of the oral mucosa.

Dental Implants in Patients with Oral Lichen Planus: A Systematic Review.

Background and Objectives: To integrate the available published data on patients with oral lichen planus (OLP) rehabilitated with dental implants, as well as to review the recommendations for OLP patients receiving implants. Materials and Methods: An electronic search was undertaken in February 2019 using five databases. Publications reporting cases of patients with OLP and rehabilitated with implant-supported oral prosthesis were included. Results: Twenty-two publications were included (230 patients, 615 implants). The overall implant failure rate was 13.9% (85/610). In patients with oral squamous cell carcinoma (OSCC) the failure rate was 90.6% (29/32), but none of these implants lost osseointegration; instead, the implants were removed together with the tumor. One study presented a very high implant failure rate, 76.4% (42/55), in patients with "active lichen planus", with all implants failing between 7-16 weeks after implant placement, and its conflicting and incongruent results are discussed in detail. There was a statistically significant difference between the failure rates in implants installed in different jaws (maxilla/mandible) and when implants of different surfaces were used (turned/moderately rough), but not between patients with reticular or erosive OLP types, or between male and female patients. If OSCC patients and the cases of the latter study are not considered, then the failure rate becomes very low (2.7%, 14/523). The time between implant placement and failure was 25.4 ± 32.6 months (range 1-112). The mean ± SD follow-up was 58.9 ± 26.7 months (1-180). Conclusions: When the results of the one study with a very high failure rate and of the cases that developed OSCC are not considered, the dental implant failure rate in OLP patients was 2.7% after a follow-up of approximately five years. Recommendations are given when treating OLP patients with dental implants.

Low-level laser as a complementary therapy in orofacial granulomatosis management: a case report.

Orofacial granulomatosis (OFG) is a chronic inflammatory disease that typically affects the soft tissues of the orofacial region. The most common clinical manifestation of OFG is lip swelling, which may be associated with intrabuccal ulcerations and increased growth of the gingiva and mucosa, as well as cutaneous erythema and facial edema. The treatment for OFG is challenging, and sometimes considered unsatisfactory. Thus, this study presents a case report of OFG and the therapeutic regimen applied. A 47-year-old man presented with increased lip volume which had started 10 months earlier. His lips were thick with a fibroelastic consistency, which were painless upon palpation. Incisional biopsy and histopathological analysis of the upper lip revealed non-specific granulomatous inflammation and the diagnosis of OFG was subsequently made. Low-level laser therapy was successfully used to treat OFG in this case, and appears to be an efficient treatment for OFG when corticosteroid therapy is not enough.

Reticular and erosive oral lichen planus have a distinct metabolomic profile: A preliminary study using gas chromatography-mass spectrometry.

BACKGROUND: Oral Lichen Planus is a chronic inflammatory disorder that affects the oral mucosa, with the reticular and erosive forms representing the primary clinical variants of the disease. Previous studies have shown that metabolic alterations may well be involved in the pathogenesis of the disease; however, the molecular mechanisms related to the clinicopathological differences between erosive and reticular forms remain unknown. METHODS: A comparative metabolomic analysis was performed on formalin-fixed and paraffin-embedded tissue samples of erosive (n = 6) and reticular (n = 10) oral lichen planus using gas chromatography-mass spectrometry. RESULTS: The metabolomic analysis showed a distinct profile between the two clinical variants. Five metabolites (cyclohexanamine, glycine, mannitol/sorbitol, methyl palmitate and trehalose) were significantly diminished in erosive oral lichen planus as compared to the reticular form. CONCLUSIONS: Reticular and erosive forms of oral lichen planus have a distinct metabolic profile. However, further studies using a large number of fresh tissue samples are necessary to confirm this data.

DNA methylation patterns of genes related to immune response in the different clinical forms of oral lichen planus.

BACKGROUND: The oral lichen planus is a chronic inflammatory disease. Although its aetiology is not well understood, the role of T lymphocytes in its inflammatory events is recognised. Identifying the epigenetic mechanisms involved in the pathogenesis of this immune-mediated condition is fundamental for understanding the inflammatory reaction that occurs in the disease. The purpose of this work was to evaluate the methylation pattern of 21 immune response-related genes in the different clinical forms of oral lichen planus. METHODS: A cross-sectional study was performed to analyse the DNA methylation patterns in three distinct groups of oral lichen planus: (i) reticular/plaque lesions; (ii) erosive lesions; (iii) normal oral mucosa (control group). After DNA extraction from biopsies, the samples were submitted to digestions by methylation-sensitive and methylation-dependent enzymes and double digestion. The relative percentage of methylated DNA for each gene was provided using real-time polymerase chain reaction arrays. RESULTS: Hypermethylation of the STAT5A gene was observed only in the control group (59.0%). A higher hypermethylation of the ELANE gene was found in reticular/plaque lesions (72.1%) compared to the erosive lesions (50.0%). CONCLUSION: Our results show variations in the methylation profile of immune response-related genes, according to the clinical type of oral lichen planus after comparing with the normal oral mucosa. Further studies are necessary to validate these findings using gene expression analysis.

Mucosal leishmaniasis in Brazilian patients: two case reports with similar clinical presentation and different approaches.

Mucosal leishmaniasis is a chronic infection that affects the upper respiratory tract and/or the oral mucosa caused by Leishmania protozoan parasites. We present two cases of oral leishmaniasis and discuss the different diagnostic strategies and treatment. In both cases, the patients were male, 60 and 94 years of age, and presented with lesions on the soft palate. In the first patient, the final diagnosis was made on the basis of histopathologic examination. In the second case, polymerase chain reaction and Montenegro skin test were necessary to confirm the diagnosis. The first patient was treated with meglumine antimoniate (Glucantime), and the lesions healed after 2 months. In the second case, the patient received treatment with liposomal amphotericin B but later died as a result of generalized infection. Mucosal leishmaniasis is a highly disfiguring disease. Early diagnosis is important to prevent a lethal outcome.

Análise da prevalência de carcinoma de células escamosas da cavidade bucal no Serviço de Estomatologia do Hospital Metropolitano Odilon Behrens em Belo Horizonte, Minas Gerais / Analysis of the prevalence of squamous cell carcinoma of the oral cavity in the Stomatology Service of Hospital Metropolitano Odilon Behrens in Belo Horizonte, Minas Gerais, Brazil

O objetivo desse trabalho foi determinar a prevalência de carcinoma de células escamosas (CCE) em pacientes atendidos no serviço de Estomatologia do Hospital Metropolitano Odilon Behrens (HMOB) de Belo Horizonte (BH) no período de maio de 2012 a maio de 2014. Métodos: Trata-se de um estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva de prontuários de pacientes atendidos no serviço de Estomatologia do HMOB, com abordagem quantitativa dos dados. Resultados: Foram avaliados 139 prontuários de pacientes diagnosticados com CCE. Quanto à faixa etária dos pacientes diagnosticados, houve maior prevalência em torno da 5ª e 6ª década de vida. Em relação ao gênero, o sexo masculino foi o mais atingido em todas as faixas etárias. Com relação aos principais fatores de risco, 60 pacientes (75,94%) relataram ser tabagistas e etilistas. Quanto à classificação dos pacientes em relação ao consumo diário de tabaco, 33 (50%) foram considerados tabagista grave (mais de 20 cigarros/ dia). Em relação ao tamanho das lesões, uma larga parcela dos pacientes (48,51%) diagnosticados com CCE de cavidade bucal, apresentaram lesão medindo de 30 a 60 mm. Na distribuição dos pacientes segundo a localização anatômica e sexo, a língua foi o sítio mais acometido (32,82%), seguido do assoalho bucal (29,95%), em ambos os gêneros. Conclusão: Este estudo mostrou, de forma pioneira, o perfil epidemiológico dos pacientes diagnosticados com câncer da cavidade bucal no Serviço de Estomatologia do HMOB, referência na região de Belo Horizonte. Percebe-se que houve uma preponderância de pacientes do sexo masculino, faixa etária acima dos 50 anos e que faz uso frequente de tabaco e\ou álcool.(AU)

Objective: This study aimed to determine the prevalence of squamous cell carcinoma (SCC) in patients who received dental care at the Stomatology Service of Hospital Metropolitano Odilon Behrens (HMOB) in Belo Horizonte, MG, Brazil, from May 2012 to May 2014. Methods: This is a cross-sectional, epidemiological study based on the retrospective and descriptive analysis of the medical records of patients who received dental care at the HMOB Stomatology Service, using a quantitative data approach. Results: This study evaluated 139 medical records of patients diagnosed with SCC. Regarding the age of the diagnosed patients, a higher incidence was observed around the fifth and sixth decades of life. Regarding gender, males were the most affected in all age groups. Regarding the main risk factors, 60 patients (75.94%) reported being smokers and drinkers. The classification of patients in relation to daily tobacco consumption, 33 (50%) were considered severe smokers (more than 20 cigarettes/day). Regarding the size of the lesions, a large portion of the patient (49 patients = 48.51%) diagnosed with oral cavity SCC presented lesions measuring 30 to 60 mm. In the distribution of patients according to gender and anatomical location, the tongue was the most commonly affected site (43 patients = 32.82 %), followed by the floor of the mouth (34 patients = 29.95%) in both genders. Conclusion: This unprecedented study showed the epidemiological profile of patients diagnosed with oral cavity cancer in the HMOB Stomatology Service, a reference hospital in the Belo Horizonte region. It was observed that there was a preponderance of male patients, who are 50 years of age or older and who frequently use of tobacco and/ or alcohol.(AU)

Análise do perfil de encaminhamentos realizados pela Atenção Básica/Saúde da Família do município de Belo Horizonte ao serviço de Estomatologia do Hospital Municipal Odilon Behrens / Profile analysis of referrals made by primary care/family health program to the stomatology service of the Odilon Behrens Municipal Hospital

Objetivo: Avaliar o tipo e a relevância dos encaminhamentos feitos pela Atenção Básica/ Saúde da Família, do município de Belo Horizonte (BH), ao serviço de Estomatologia do Hospital Municipal Odilon Behrens (HOB) e analisar os critérios do Protocolo de Regulação da Saúde Bucal de BH. Material e Métodos: Para isso, realizou-se estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva dos livros de registro do HOB e das listagens de marcação de consulta especializada de todos os pacientes encaminhados ao serviço de Estomatologia do HOB do período de janeiro de 2013 a junho de 2014. Resultados: Foram avaliados os encaminhamentos de 1992 pacientes, dos quais 71% (1414) compareceram às consultas agendadas. Houve predominância feminina entre os participantes e idade média de 54 anos. Quanto à prioridade dos encaminhamentos, foram encontrados: 513 (37%) prioridades alta, 422 (30%) prioridades média e 231 (16%) prioridades baixa. 75 (5%) dos encaminhamentos recebidos apresentavam alterações cujas características não estão descritas nos critérios do protocolo. 62 (4%) foram encaminhados erroneamente e 105 (8%) não possuíam alterações no momento da consulta. Assim, os encaminhamentos realizados pela atenção básica estão em conformidade com os critérios estabelecidos pelo Protocolo de Regulação. Mas, ao se comparar as alterações encontradas com o protocolo, observou-se critérios pouco objetivos, ocasionando discrepância entre a orientação do Ministério da Saúde e os atendimentos realizados pelo serviço de Estomatologia no município de BH. Conclusão: Sendo assim, ainda há a necessidade de revisão do protocolo atual, além da necessidade de instituir uma política de educação permanente na atenção básica.(AU)

Aim: This study aimed to evaluate the type and relevance of referrals by Primary Care / Family Health Program to the Stomatology Department of Odilon Behrens Municipal Hospital (HOB) and analyzed the criteria of the Belo Horizonte Oral Health Regulation Protocol. Methods: The authors conducted a cross-sectional epidemiological study, based on retrospective and descriptive analysis of the HOB's logs and specialized consultation appointment listings of all patients referred to the HOB's Stomatology Department from January 2013 to June 2014. Results: This study evaluated 1,992 patient referrals, of which 71% (1414) attended the scheduled visits. There was a predominance of female participants and the average age was 54 years. Regarding the prioritization of referrals, the following data were found: 513 (37%) high priorities, 422 (30%) average priorities, and 231 (16%) low priorities; 75 (5 %) of the received referrals presented changes, whose characteristics are not described in the protocol criteria; 62 (4%) were wrongly referred to the stomatology department, and 105 (8%) presented no change at the time of the doctor's appointment. Thus, the referrals made by primary care are in accordance with the criteria established by the oral health regulation protocol. However, upon comparing the changes found through the protocol, what could be observed was that the criteria presented little objectivity, resulting in adiscrepancy between the advice provided by the Ministério da Saúde and the services performed by the stomatology services in Belo Horizonte. Conclusion: Therefore, the results indicate the need to revise the current protocol and reveal the need to establish a permanent education policy in primary care.(AU)