Symptomatic subgemmal neurogenous plaque in patients with COVID-19: Is there an association?

BACKGROUND: Subgemmal neurogenous plaques (SNP) are composed of neural structures found in the posterolateral portion of the tongue, rarely biopsied as most of them are asymptomatic or eventually only clinically managed. We aimed to investigate a case series of possible correlation of symptomatic subgemmal neurogenous plaque (SNP) with coronavirus disease 2019 (COVID-19). METHODS: Eleven formalin-fixed paraffin-embedded cases from patients with previous confirmed COVID-19 (by RT-PCR) were retrieved from two pathology files. Histological sections were morphologically studied, and then submitted to immunohistochemical reactions against S-100 and neurofilament proteins, neuron-specific enolase, Glial fibrillary acidic protein (GFAP), synaptophysin, CD56, Ki67, cytokeratins (7, 8-18, 19, 20), nucleocapsid and spike proteins (SARS-CoV-1; and -2) and epithelial membrane antigen (EMA) antibodies. Clinical data were retrieved from the patients' medical files, including the symptoms and the complete history of the progression of the disease. RESULTS: The patients who had COVID-19 included in this study experienced painful lesions in the tongue that corresponded to prominent or altered SNP. Microscopically, neural structures were positive for S-100, GFAP and neurofilament protein. And the cellular proliferative index (by Ki-67) was very low. CONCLUSION: Thus, based on the current results, we hypothesize that symptomatic SNP may be a late manifestation of COVID-19 infection.

Salivary Gland Tumors: A Retrospective Study of 164 Cases from a Single Private Practice Service in Mexico and Literature Review.

Salivary gland tumors (SGT) represent an uncommon heterogeneous group of tumors with complex clinical and pathological characteristics. The prevalence of these lesions varies between studies but has been estimated between 3 and 6% of all tumors in the head and neck region. The present study aimed to evaluate the distribution and demographic findings of salivary gland tumors diagnosed in an oral pathology service in Mexico. A retrospective descriptive cross-sectional study was performed. A total of 164 cases of SGT from a private oral pathology service were diagnosed between 2000 and 2019 in Mexico City. All cases were reviewed histologically, and demographic data and histopathological diagnoses were collected. A total of 110 (67.1%) tumors were benign, and 54 (32.9%) were malignant. The majority of patients were female (n = 100, 61.0%) with an overall female:male ratio of 1.6:1. The minor salivary glands were affected more than the major salivary glands (68.9% vs. 25.6%). The palate (n = 67, 40.9%) was the most commonly affected site, followed by the parotid gland (n = 37, 22.6%), lips (n = 16, 9.8%), and buccal mucosa (n = 14, 8.5%). Pleomorphic adenoma (n = 88; 80.0%) and mucoepidermoid carcinoma (n = 16, 29.6%) were the most frequent benign and malignant tumors, respectively. The general features of SGT from the studied Mexican population shared some similarities and differences compared to previously reported series from various parts of the world.

Oral Amelanotic Melanomas: Clinicopathologic Features of 8 Cases and Review of the Literature.

Mucosal melanomas are aggressive tumors, rarely observed in the oral cavity. The diagnosis is based on the clinical and microscopical features. Often these tumors had variable amounts of melanin pigmentation. However, when melanin is absent, the tumors are denominated amelanotic, presenting a tendency to misdiagnosis and delayed treatment. The aim of this study was to describe the clinicopathologic features of a series of oral amelanotic melanomas (OAM). Records of all cases of OAM were retrospectively retrieved from oral pathology services from January 2002 to January 2019. Data regarding the clinical features, morphological aspects, immunohistochemical reactions, treatment, and follow-up status were collected. Eight cases of OAM were included, 6 in men and 2 in women (ratio of 3:1) ranging in age from 33 to 77 years (mean 53.6 years). Clinically, the tumors presented as masses or ulcerated swellings. The most common intraoral locations of the tumors were gingiva and palate. Cervical lymph node metastasis was detected in 3 patients at the first examination. All but one patient died from complications of the tumors after a mean follow-up period of 8.5 months. In conclusion, OAM is a very aggressive malignant tumor, and when melanin is absent, an immunohistochemical panel comprising S100, melan A, HMB45, and SOX10 should be performed.

Idiopathic osteosclerosis in the maxillomandibular area.

OBJECTIVES: To test a more complete set of morphometric radiographic parameters to evaluate the idiopathic osteosclerosis (IO) lesions located in the maxillomandibular area and to know their features during routine radiographic evaluation. MATERIALS AND METHODS: Radiographs from patients attending the oral diagnosis clinic of our institution were reviewed. Evaluated parameters were gender and age of the patients, size, side, homogeneity, morphology, radiodensity, mineralization, borders, relation to roots, affected tooth or teeth and location of the analyzed lesions. RESULTS: Of the 6340 assessed patients, 354 (5.6%) harbored 362 lesions. IOs were more common during 2nd to 4th decades (mean age = 39 years). IO frequency rose from 1st to 3rd decades and then decreased. Size varied from 0.1 to 5.8 cm, and its frequency increased from 7 to 30 years age and then decreased too. The mandible and molar region were more commonly affected. Radiopaque image, radicular location, round shape, homogeneous core and well-defined boundaries were the more frequent IO features. CONCLUSIONS: Our method allows to analyze IO lesions with precise parameters. Analysis of the results does not support the previously suggested theories to explain their origin, and these figures suggest that the so-called IOs are developmental alterations of the bone.

Squamous cell carcinoma of the tongue in patients older than 45 years.

This study aims to evaluate the clinicopathological features, TNM status, AJCC staging and behavior of squamous cell carcinoma of the tongue (SCCT) in patients older than 45 years. The files of the Department of Pathology of the Hospital General de México were reviewed and all cases of SCCT in patients older than 45 years were selected. Clinicopathological features, treatment, follow-up, microscopic diagnosis, and IJCC and TNM staging were retrieved. Complete data from 60 cases were evaluated. They were more common in males (mean age = 63.9 years). Unexpectedly a high rate of tumors (38.3%) were in the base of the tongue (BT). Moderately and poorly differentiated SCCT were the most common. 16.7% presented lymph node invasion, 15% were recurrent tumors and BT carcinomas recurred more frequently. A high rate (81.7%) were stage II and 48.3% were low-risk patients. SCCTs in the studied population displayed different clinico-pathological and behavioral features compared with worldwide data. Our results suggest that BT tumors should be treated more aggressively than those in the mobile tongue. BT located tumors were more frequent than previously published. Additional frequency studies will define outcomes in age cohorts with a consensus cut-off for young and elderly populations. More population-based studies should be performed in Latin American regions to acquire accurate data on SCC incidence in elder subpopulations and to identify precisely the etiological factors in these patients.

Frequency of dilaceration in a mexican school-based population.

BACKGROUND: The aim of this study was to record the frequency of dilaceration in patients attending our institution and to analyze the possible associated factors. MATERIAL AND METHODS: Orthopantomograms from all patients attended in our institution were reviewed and those cases of dilaceration were selected. Documented data were age, gender, diagnosis, location and involved teeth. Data on possible etiological factors was also recorded. RESULTS: 125 dilacerated teeth in 99 patients were found. Dilacerations were more commonly detected in females and in maxillary teeth. Maxillary 2nd bicuspids and lateral incisors were the more commonly affected teeth and were more common in teeth with predecessors (anterior teeth and bicuspids). Traumatic episodes and caries of the predecessor teeth was mentioned but never were related with affected teeth. CONCLUSIONS: Data from the studied population are different compared to previously published studies. Our results support the point of view that the occurrence of dilacerated teeth could be related to limited availability of space to allocate the erupting teeth in the dental arch and perhaps to the possibility of the tooth to rotate, preventing eruption. Key words:Developmental alterations, dental developmental alterations, root dilaceration.

Length of the ossified stylohyoid complex and Eagle syndrome.

PURPOSE: To assess radiographically the presence of an ossified stylohyoid complex (OSHC) with signs and symptoms of Eagle syndrome or other oro-facial painful diseases in patients attending our institution and to confirm that the important issue for study is to know the length of the ossificated portion of the stylohyoid complex only. METHODS: We separated 1000 consecutive files, and after selection, 922 panoramic radiographs were evaluated. Assessed parameters were gender and age of the patients, size, and location of the analyzed OSHCs. In addition, the length parameters of the studied OSHCs were also determined in 100 extra radiographs. RESULTS: Normal length of OSHCs was between 2.83 and 4.16 cm and OSHCs measuring more than 4.17 cm long comprising 23.2% of the sample. Any of the patients with OSHC presented signs or symptoms of the Eagle syndrome or any other orofacial painful disease. CONCLUSIONS: This is the first study on OSHCs using the mandatory parameters of normal, short and elongated length in the studied population. Our results suggest that the presence of an OSHC is not an important feature for pain detection in the Eagle syndrome and is not an important risk factor for development of throat pain in this and other painful orofacial diseases. Our results are different from those previously published in other populations and suggest that the widely used lengths of 2 to 4 cm for measuring the OSHCs are not adequate parameter. It is desirable to define first the short, normal and abnormal parameters of OSHCs in each studied population.

Maxillomandibular giant osteosclerotic lesions.

INTRODUCTION: Giant Osteosclerotic Lesions (GOLs) are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. OBJECTIVE: This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs) detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque) appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs) were assessed. RESULTS: Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs). The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. CONCLUSIONS: GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the osseous breakdown process.

Maxillomandibular giant osteosclerotic lesions

Abstract Giant Osteosclerotic Lesions (GOLs) are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. Objective This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs) detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque) appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs) were assessed. Results Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs). The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. Conclusions GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the osseous breakdown process.

Squamous cell carcinoma of the tongue in patients older than 45 years

Abstract: This study aims to evaluate the clinicopathological features, TNM status, AJCC staging and behavior of squamous cell carcinoma of the tongue (SCCT) in patients older than 45 years. The files of the Department of Pathology of the Hospital General de México were reviewed and all cases of SCCT in patients older than 45 years were selected. Clinicopathological features, treatment, follow-up, microscopic diagnosis, and IJCC and TNM staging were retrieved. Complete data from 60 cases were evaluated. They were more common in males (mean age = 63.9 years). Unexpectedly a high rate of tumors (38.3%) were in the base of the tongue (BT). Moderately and poorly differentiated SCCT were the most common. 16.7% presented lymph node invasion, 15% were recurrent tumors and BT carcinomas recurred more frequently. A high rate (81.7%) were stage II and 48.3% were low-risk patients. SCCTs in the studied population displayed different clinico-pathological and behavioral features compared with worldwide data. Our results suggest that BT tumors should be treated more aggressively than those in the mobile tongue. BT located tumors were more frequent than previously published. Additional frequency studies will define outcomes in age cohorts with a consensus cut-off for young and elderly populations. More population-based studies should be performed in Latin American regions to acquire accurate data on SCC incidence in elder subpopulations and to identify precisely the etiological factors in these patients.

[Preventive and remineralization effect over incipient lesions of caries decay by phosphopeptide-amorphous calcium phosphate]. / Efecto preventivo y de remineralizacion de caries incipientes del fosfopeptido de caseina fosfato de calcio amorfo.

INTRODUCTION. Dental caries continues to affect a large percentage of Mexican children and currently advises that if diagnosed at an early stage can be reversed with minimally invasive treatments. The casein phosphopeptide amorphous calcium phosphate known as CPP-ACP is a phosphoprotein capable of releasing calcium and phosphate ions in the oral environment promoting remineralization. OBJECTIVE. To evaluate the effect of CPP-ACP with fluoride added in a scholar preventive program. MATERIAL AND METHODS. A cuasi- experimental study was conducted in 104 schools of six years old. The children were classified into three groups and received six months biweekly applications of different treatments: casein phosphopeptide amorphous calcium phosphate added fluoride (CPP-ACPF), sodium fluoride (NaF) and a control group. Clinical evaluation was performed with the laser fluorescence technique (Diagnodent model 2095). 1340 teeth were included: 294 teeth with incipient lesions and 1,046 healthy teeth. Statistical tests of χ2 y Mc Nemar were used. RESULTS. In the group that received the application of CPP-ACPF, 38% of incipient carious lesions were remineralizing compared with 21% in the group receiving the NaF (p < 0.001) and 15% in the control group (p < 0.0001) The percentage of teeth free of caries were preserved in the therapy group phosphoprotein was the biggest. This group also showed the lower proportion of deep carious lesion development (p < 0.0001). CONCLUSION. The application biweekly for six months of CPP-ACPF showed a protective and remineralizing effect on incipient carious lesions. His action was better than the application of NaF. However, to reduce the impact from dental caries in schoolchildren is important to have a comprehensive preventive approach that includes promoting self-care, as well as the application of sealants.

In-office study to evaluate the effects of a stabilized stannous fluoride dentifrice and an advanced manual toothbrush regimen on gingival health and plaque accumulation in Mexican adults.

PURPOSE: This office-based study was conducted to investigate the influence of an oral hygiene regimen, consisting of a stabilized stannous fluoride dentifrice and an advanced manual toothbrush, on gingival health and plaque accumulation in Mexican adults after 4 weeks of use. METHODS: This was an unsupervised, open-label, single-treatment, 4-week study conducted in Mexico. At Baseline, gingival health and plaque coverage were assessed for each participant by dentists using categorical scales. Participants were given 0.454% stabilized stannous fluoride dentifrice (Crest Pro-Salud Limpieza Profunda) and an advanced manual toothbrush with a CrissCross bristle design (Oral-B Pro-Salud 7 Beneficios), and were instructed to follow the manufacturer's usage instructions for the products, which state to brush after every meal, at least three times daily, or as indicated by their dentists. At the end of Week 4, plaque and gingivitis were reassessed using the same scales. RESULTS: 200 participants (age range 18 - 49 years) completed the 4-week study and were considered evaluable. The mean age of the study group was 29.9 ± 8.8 years, with 125 females and 75 males. After 4 weeks of product use, 172 participants (86%) showed noticeable improvement in their gingival health and 93% showed noticeable improvements in their overnight plaque coverage.

Prevalence trends of oral squamous cell carcinoma. Mexico City's General Hospital experience.

OBJECTIVE: Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. The aim of this study was to analyze the trend in gender, age, anatomic zone and OSCC stage from Mexico City's General Hospital patients from 1990 to 2008. STUDY DESIGN: A retrospective review of all OSCC cases diagnosed by the Pathology Department of the Mexico City General Hospital was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. RESULTS: A total of 531 patients were diagnosed with OSCC; 58.4% were men, giving a male:female ratio of 1.4:1, and the mean age was 62.5 ± 14.9 years. The predominant anatomic zone was the tongue (44.7%), followed by the lips (21.2%) and gums (20.5%). The most frequent histological degree was moderately differentiated in 325 cases (61.2%). The rates of OSCC prevalence showed similar patterns in terms across time. A significant correlation (P = 0.007) between anatomic zone and age was observed. CONCLUSION: According to our results, the prevalence of OSCC does not show important variations; however, a relationship between age and anatomic zone was observed. These data could be used as parameters for the diagnosis of OSCC as well as for the development and dissemination of preventive programs for the early detection of oral cancer.

erbB expression changes in ethanol and 7,12- dimethylbenz (a)anthracene-induced oral carcinogenesis.

OBJECTIVE: [corrected] The aim of this study was to determine erbB expression in normal mucosa, oral dysplasia, and invasive carcinomas developed in the hamster's buccal pouch chemical carcinogenesis model. STUDY DESIGN: Fifty Syrian golden hamsters were equally divided in five groups (A-E); two controls and three experimental group exposed to alcohol, DMBA, or both for 14 weeks. Number of tumors per cheek, volume, histological condition, erbB expression were determined and results were analyzed by the Mann-Whitney U and Dunn's test. RESULTS: Control groups and those exposed to alcohol (A, B and C respectively) only presented clinical and histological normal mucosa; while those exposed to DMBA or DMBA plus alcohol (D and E groups) developed dysplasia and invasive carcinomas. erbB2, erbB3, and erbB4 increased their expression in alcohol-exposed mucosa, dysplasia, and invasive carcinomas. We observed a similar expression level for erbB2 in dysplasia and carcinomas; while, erbB3 and erbB4 were similar only in carcinomas. CONCLUSION: The DMBA and alcohol can be considered as carcinogen and promoter for oral carcinogenesis. The erbB expression is different according to their histological condition, suggesting differential participation of the erbB family in oral carcinogenesis induced by alcohol and DMBA.

Fluoride consumption and its impact on oral health.

OBJECTIVE: The purpose of this study was to evaluate caries and dental fluorosis among Mexican preschoolers and school-aged children in a non-endemic zone for fluorosis and to measure its biological indicators. METHODS: DMFT, DMFS, dmft, dmfs, and CDI indexes were applied. Fluoride urinary excretion and fluoride concentrations in home water, table salt, bottled water, bottled drinks, and toothpaste were determined. RESULTS: Schoolchildren presented fluorosis (CDI = 0.96) and dental caries (DMFT = 2.64 and DMFS = 3.97). Preschoolers presented dmft = 4.85 and dmfs = 8.80. DMFT and DMFS were lower in children with mild to moderate dental fluorosis (DF). Variable fluoride concentrations were found in the analyzed products (home water = 0.18-0.44 ppm F, table salt = 0-485 ppm F, bottled water = 0.18-0.47 ppm F, juices = 0.08-1.42 ppm F, nectars = 0.07-1.30 ppm F, bottled drinks = 0.10-1.70 ppm F, toothpaste = 0-2,053 ppm F). Mean daily fluoride excretion was 422 ± 176 µg/24 h for schoolchildren and 367 ± 150 µg/24 h for preschoolers. CONCLUSIONS: Data from our study show that, despite values of excretion within an optimal fluoride intake range, the prevalence of caries was significant in both groups, and 60% of the 11- to 12-year-old children presented with dental fluorosis. In addition, variable fluoride concentrations in products frequently consumed by children were found.

[Fluoride urinary excretion in Mexico City's preschool children]. / Excreción urinaria de flúor por preescolares en la ciudad de México.

OBJECTIVE: The assessment of urinary fluoride excretion during dental developing stage has been reported for different countries with community fluoride programs. Also, one of the factors that could influence on retention and excretion of fluoride is the deficient nutrition so the aim of this study was to determine fluoride urinary excretion by a group of preschool children with and without malnutrition. MATERIALS AND METHODS: Urinary samples from 24 hours were collected from 60 preschool children selected by convenience from Iztapalapa area of Mexico City, 30 with malnutrition and 30 with standard nutritrional status by weight for age. The samples were analyzed by fluoride especific electrode. Orion 720A. RESULTS: The average concentration of fluoride in urine from preschool children with and without malnutrition were 0.89 +/- 0.4 mg/L and 0.80 +/- 0.3 mg/L, respectively. The mean of 24 hours total fluoride excreted were 367 +/- 150 microg/24 hrs. in malnutrition children and 355 +/- 169 microg/24 hrs. for those with standard nutritional status. There were no differences statistically significant between groups. CONCLUSION: The urinary fluoride excretion for children with and without malnutrition were in the optimal range of fluoridation for the prevention of caries decay. Malnutrition was no associated with changes on fluoride orine concentration and excretion rates.

Fluoride content in table salt distributed in Mexico City, Mexico.

OBJECTIVE: The aim of this study was to analyze table salt available in Mexico City's market to identify the fluoride concentrations and to compare these with the Mexican regulations. METHODS: We analyzed 44 different brands of table salt. All samples were purchased at random in different stores, supermarkets, and groceries from Mexico City's metropolitan area and analyzed in triplicate in three different laboratories (nine determinations per sample) with an Orion 720 A potentiometer and an Orion 9609 BN ion-specific electrode. RESULTS: Fluoride concentration in the samples varied from 0 ppm to 485 ppm. It was found that fluoride concentration varied widely among the analyzed brands. Also, we found that fluoride concentration in 92 percent of the analyzed samples did not match with that printed on the label. Only 6.8 percent of the analyzed samples contained fluoride concentrations that meet Mexican and WHO regulations. CONCLUSIONS: The broad variation in the analyzed samples suggests that Mexican Public Health authorities must implement more stringent regulation guidelines and procedures for controlling the distribution of salt and its fluoride concentration for human consumption.

Clinicopathological and immunocytochemical study of multifocal epithelial hyperplasia.

PURPOSE: We present the clinicopathological findings after reviewing 52 patients affected by multifocal epithelial hyperplasia (MEH), previously known as focal epithelial hyperplasia and the results of an immunocytochemical study. PATIENTS AND METHODS: We reviewed the clinical files and microscopic slides from 52 MEH-affected patients and new slides were immunostained with a polyclonal antibody against high molecular weight cytokeratins. RESULTS: More than 95% of the patients were in poverty (<200 dollars monthly family income). Females comprised 71.1% of the MEH patients, 69.3% were in the first and second decades and buccal mucosa, lips, and tongue were more frequently affected. Ninety-two percent of the patients had a direct relative with similar lesions. In hematoxylin and eosin-stained slides, prominent multiple nucleoli were observed. Immunocytochemical study showed differences in immunostaining between lesional and normal cells. Cells with strongly immunostained cytoplasm were seen in the prickle layer of the lesional epithelium as well as in the clinically normal neighboring epithelial tissue. Cytokeratin-negative mitosis-like cells and koilocytes were identified within the lesions. CONCLUSIONS: The name "multifocal epithelial hyperplasia" is more accurate than those previously proposed designations, because it is more precise to describe the clinical and microscopic features of the disease. Also, our results suggest that mitosis-like cells and koilocytes are degenerated cells unable to synthesize cytokeratins and that cells with strongly immunostained cytoplasm represent epithelial cells showing an altered cytokeratin metabolic profile.