Differential Diagnosis of Oral Metastases / Diagnóstico Diferencial de las Metástasis Orales

Metastatic lesions in the mouth can resemble common inflammatory lesions. Therefore, we set out to investigate oral metastases whose clinical and imaging characteristics mimicked those of harmless lesions, confusing and delaying the diagnosis. For this, a systematic review was carried out from case reports, case series, and cross-sectional studies in the PubMed/Medline, Scopus, Embase-via Elsevier, Virtual Health Library, Web of Science, and gray literature, using PICO strategy without period restriction. We assessed the quality of studies using the Joanna Briggs Institute assessment tool. A narrative synthesis of the data was carried out. Association analyses using chi-square and Fisher's exact tests were performed, with statistical significance at p<0.05. Most of the lesions came from the lung, breast, kidneys, liver, and thyroid. They affected mainly the mandibles of men, between the fifth and seventh decades of life, causing osteolysis. In soft tissue, there were firm swellings, associated with bleeding. Limitations regarding the heterogeneity of the included studies and the absence of clinic pathological descriptions of the tumors substantially reduced the chance of statistical analysis of the data. Knowing the different possibilities of clinical presentation of oral and maxillofacial metastases is important for the diagnost ic suspicion to occur and diagnostic errors to be avoided. Thus, treatment is instituted and survival can be extended. Protocol registration: PROSPERO CRD42020200696.

Las lesiones metastásicas en la cavidad oral pueden parecer similares a lesiones inflamatorias comunes. Por ello, nos propusimos investigar metástasis orales cuyas características clínicas e imagenológicas simularan las de lesiones inofensivas, confundiendo y retrasando el diagnóstico. Para ello, se realizó una revisión sistemática a partir de reportes de casos, series de casos y estudios transversales en PubMed/Medline, Scopus, Embase-vía Elsevier, Virtual Health Library, Web of Science y literatura gris, utilizando la estrategia PICO sin restricción de periodo. La calidad de los estudios se evaluó mediante la herramienta de evaluación del Instituto Joanna Briggs. Se realizó una síntesis narrativa de los datos. Se realizaron análisis de asociación mediante chi-cuadrado y prueba exacta de Fisher, con significancia estadística en p<0,05. La mayoría de las lesiones procedían de pulmón, mama, riñones, hígado y tiroides. Afectan principalmente a las mandíbulas de los hombres, entre la quinta y la séptima década de la vida, provocando osteólisis. En los tejidos blandos, había hinchazones firmes, asociadas con sangrado. Las limitaciones con respecto a la heterogeneidad de los estudios incluidos y la ausencia de descripciones clinicopatológicas de los tumores redujeron sustancialmente la posibilidad de realizar un análisis estadístico de los datos. Conocer las diferentes posibilidades de presentación clínica de las metástasis orales y maxilofaciales es importante para que se produzca la sospecha diagnóstica y se eviten errores diagnósticos. Por lo tanto, se instituye el tratamiento y se puede prolongar la supervivencia. Registro de protocolo: PROSPERO CRD42020200696.

Hybrid Verrucous Carcinoma: A Wolf in Sheep's Clothing Case Report and Integrative Review of 280 Cases

ABSTRACT: Hybrid verrucous carcinoma (HVC) is defined as a rare neoplasm in which there is histopathological evidence of verrucous carcinoma and microscopic foci of squamous cell carcinoma, synchronously in the same site, affecting behavior and prognosis. This study aimed to present a new case of HVC in the mouth, and critically and comparatively analyze the cases reported in literature, to better understand the biological behavior and contribute to diagnostic precision. A review was performed using six databases, and the gray literature. Twenty-two articles were selected, with a total of 280 cases. The most frequent clinical appearance was verrucous carcinoma which included benign lesions. This implies that the potential for aggressive behavior can be detected microscopically, in the form of a ruptured basement membrane, which visualization can be facilitated by the use of some immunohistochemical markers discussed here. This is important for the diagnosis of HVC and adequate treatment. Hybrid verrucous carcinoma is what can be thought of as "a wolf in sheep's clothing." When analyzing cases with clinical suspicion of verrucous carcinoma microscopically, great attention is recommended, since they may be HVC and can recur, metastasize, and lead to death.

RESUMEN: El carcinoma verrugoso híbrido (CVH) se define como una neoplasia poco frecuente en la que existe evidencia histopatológica de carcinoma verrugoso y focos microscópicos de carcinoma de células escamosas, sincrónicamente en el mismo sitio, que afectan el comportamiento y el pronóstico. Este estudio tuvo como objetivo presentar un nuevo caso de CVH en la cavidad oral, y analizar crítica y comparativamente los casos reportados en la literatura, para comprender mejor el comportamiento biológico y contribuir a la precisión diagnóstica. Se realizó una revisión utilizando seis bases de datos y la literatura gris. Se seleccionaron veintidós artículos, con un total de 280 casos. La aparición clínica más frecuente fue el carcinoma verrugoso que incluyó lesiones benignas. Esto implica que el potencial de comportamiento agresivo puede detectarse microscópicamente, en forma de una membrana basal rota, cuya visualización puede ser facilitada por el uso de algunos marcadores inmunohistoquímicos discutidos aquí. Esto es importante para el diagnóstico de CVH y el tratamiento adecuado. El CVH es lo que se puede considerar como "un lobo con piel de oveja". Al analizar microscópicamente casos con sospecha clínica de carcinoma verrugoso, se recomienda una atención inmediata debido a que pueden ser CVH y pueden recurrir, metastatizar y conducir a la muerte.

Oral metastasis as the first indication of undiscovered malignancy at a distant site: A systematic review of 413 cases.

This systematic review is the first to provide evidence regarding demographic, clinical, and imaging characteristics, as well as information related to survival, of patients with oral and maxillofacial metastases of occult primary tumors. Case reports, case series, and cross-sectional studies were included. Ten databases were searched. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Overall, 353 articles (413 patients) were included. Statistically significant associations between survival and multiplicity of metastatic foci, and between each of the main primary sites and some features of the oral lesions were observed. Some clinical and imaging characteristics can help dentists in raising diagnostic suspicions and also in relating to plausible primary sites. Early diagnosis of oral and maxillofacial metastases can positively affect the survival rate when they are the only focus of dissemination, conferring an important role on the dentist.

Hyaline ring granuloma of the mouth-A foreign-body reaction that dentists should be aware of: Critical review of literature and histochemical/immunohistochemical study of a new case.

Hyaline ring granuloma (HRG) is a rare and atypical foreign-body granulomatous chronic inflammatory condition. Our aim was to make a critical review of the literature cases and also to illustrate histochemical and immunohistochemical findings of a new case. A modified PICO strategy was used. Inclusion criteria were met by case reports and case series with a histologically confirmed diagnosis of HRG, necessarily in mouth or maxillary bones. Exclusion criteria were no access to the full-text paper. The search was done up to 2019, totalizing 231 selected cases in 54 papers. The new case was analyzed through PAS, Azan-Mallory's trichrome, and CD34 and CD68 reactions. HRG is found mainly in the mandible of men, edentulous and prosthesis users, between 51 and 60 years of age, with 0.5-120 months of duration, usually causing edema and pain or discomfort. Endogenous and exogenous theories may be complementary in HRG. Eosinophilic areas could represent particles of vegetal origin, while the hyaline material could be the result of collagen degradation. Considering the material is not always present or even is ring-shaped, we suggest the change from "hyaline ring granuloma" to "granuloma induced by vegetal inoculation."

Unusual intraoral cancer with unexpected outcome in a patient with xeroderma pigmentosum: An alert for antineoplastic treatment.

Xeroderma pigmentosum (XP) is a rare autosomal disorder characterized by extreme sensitivity to ultraviolet radiation. DNA repair mechanisms are impaired, and minimal sun exposure can lead to the development of cutaneous neoplasms in very young patients. Intraoral carcinomas are uncommon and, when present, are located mainly at the tongue tip. We report an unprecedented case of squamous cell carcinoma (SCC) in the floor of mouth of a 23-year-old woman with XP. The patient was referred to the oncologist, and 2 months after surgical resection, she underwent a single session of chemotherapy plus radiotherapy. However, she died 73 hours after undergoing her first chemotherapy session. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments (especially cisplatin-based chemotherapy) in patients with XP and reviewed the main characteristics of the disease, especially cases with oral manifestations reported in the literature.

Can non-collagenous proteins be employed for the differential diagnosis among fibrous dysplasia, cemento-osseous dysplasia and cemento-ossifying fibroma?

Differential diagnosis among fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias is difficult, since there is considerable overlap of histologic features, but also extremely important, since they differ greatly in etiology, clinical behaviour, prognosis and terapeuthic approach. There is no data about the use of immunohistochemistry, a viable and accessible technique, for this purpose. The objective of this study was to investigate, comparatively, the immunohistochemical expression of major non-collagenous proteins (osteonectin [ON], osteopontin [OP], bone sialoprotein [BSP] and osteocalcin [OC]) of mineralized tissue extracellular matrix in 22 cases of fibrous dysplasias, 16 of cemento-ossifying fibromas and 16 of cemento-osseous dysplasias. ON maintained the same expression profile in all cases; the staining for OP was negative in fusiform cells producing cementoid globules and weak, as well as heterogeneous, in high mineralized matrixes; there was negativity for BSP in cementoid globules and in the fusiform cells that produce them, differently from the strong positive expression found in the majority of bone trabeculae and their peripheral cuboidal osteoblasts; and finally, the immuno-reactivity for OC was weak, except in cuboidal osteoblasts and osteocytes. We can conclude that the nature of mineralized structure and the cellular phenotype are much more responsible for variability in immunohistochemical profile than the type of lesion (fibrous dysplasias, cemento-ossifying fibromas and cemento-osseous dysplasias) which makes difficult, at least for a while, the use of these proteins with diagnosis purpose.

Delayed Diagnosis of Gorlin-Goltz Syndrome: The Importance of the Multidisciplinary Approach.

Gorlin-Goltz syndrome (GGS), also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder with high penetrance and variable expressivity. The classic triad originally described by Gorlin and Goltz in 1960 is composed of multiple nevoid basal cell carcinomas (NBCCs), odontogenic keratocysts (OKCs) in the jaws and bifid ribs. in 1977, this triad was modified by Rayner et al, and to GGS diagnosis, the OKCs had to appear in combination with calcification of the cerebellar falx or palmar and plantar pits. It may occur that although GGS syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed in an always complex clinical panel. The authors introduce an example in this report. In the present case, the patient had NBCCs, OKCs, and probably other signs of GGS since 1998, and has been treated for this conditions separated, without a diagnosis of a syndromic condition. A 54-year-old white woman was referred to the oral medicine service due to cyst located in the right mandibular body. She had history of skin cancer and undergone surgeries and radiotherapies for the lesions treatment, scars on the skin face due to the lesions removed, and a new ulcerated lesion on the back of was diagnosed. In addition, the patient presented frontal and parietal bossing leading to increased cranial circumference, hypertelorism, strabismus, broad base, and mandibular prognathism. To the image examination, skull radiography revealed calcification of the falx cerebri; on chest X-ray bifid rib was observed and spine radiography showed vertebral osteophytes. Panoramic radiograph showed a well-defined bilocular radiolucent image located in posterior and anterior mandibular region. The whole elements induced us to investigate the patient's past medical history, which revealed that since 1998 had the diagnosis of NBCC and OKC. A multidisciplinary approach becomes necessary for the diagnosis and follow-up of patients with GGS, considering the complexity of the clinical manifestations. Therefore, it is of primary importance for dental surgeons and dermatologists to know the signs and symptoms of GGS to perform early diagnosis and to avoid progression of the oral cysts or metastasis of the skin lesions.

Photodynamic therapy in oral potentially malignant disorders-Critical literature review of existing protocols.

INTRODUCTION: Oral cancer is a serious public health issue. Apart from its high rate of prevalence, incidence and mortality, it can often result in more complex and expensive treatment when diagnosed late. Potentially malignant disorders (PMDs) can precede oral cancer, and are usually treated by surgical excision. However, in many cases patients are elderly and multiple interventions may be required. Photodynamic therapy (PDT) is a simple alternative, which has been successfully used in the treatment of oral PMDs. OBJECTIVE: Due to the lack of standardization regarding photosensitizers (PTSs), types of irradiation, and methods of application, the objective of this study was to analyze existing PDT protocols in an attempt to identify the one that demonstrates greater efficiency, reliability and feasibility in the treatment of oral PMDs for both researchers and clinicians. METHODS: Original clinical studies published only in English between 1993 and 2016 were searched in Pubmed/Medline database using the following keywords: photodynamic therapy; oral potentially malignant disorder; oral premalignant lesions. Review articles; experimental studies; case-reports; commentaries; and letters to the Editor were excluded from the selection. RESULTS AND CONCLUSION: Based on the 16 studies selected, the topical 5-ALA-20% PTS, associated to a LED light applied for 15min with a 7-day interval between sessions emerged as the most frequently used PDT protocol, with satisfactory results. Due to its low rate of side effects, this PDT protocol presents good potential for the treatment of oral PMDs. Further clinical studies are required to ascertain its long-term validity in preventing oral cancer.

Associated aneurysmal bone cyst and cemento-osseous dysplasia: a case report and review of the literature.

The purpose of this case report is to describe a previously unpublished association between focal cemento-osseous dysplasia (FCOD) and an aneurysmal bone cyst (ABC) and review the literature with regard to associated benign fibro-osseous lesions and cysts. A 41-year-old woman without a history of trauma presented with asymptomatic swelling in the right side of the mandible. Radiographs of the region revealed a unilocular radiolucent area with radiopaque foci. After aspiration of the lesion was positive for serosanguineous fluid, complete excision of the lesion was performed. Microscopic examination revealed a hybrid ABC and FCOD. The 12-month follow-up showed significant bone repair and no signs of recurrence. A review of the English-language literature from 1980 to 2012 revealed 1 retrospective study, 4 case series, and 18 single-case reports on the topic of cemento-osseous dysplasias, fibro-osseous lesions, and aneurysmal bone cysts. Of 59 cases, none reported an association between an ABC and FCOD. Although fibro-osseous lesions do not require intervention, surgical excision is recommended when they are associated with cysts. This case, in which an ABC and FCOD were associated, reinforces the need for a careful diagnostic process in radiographically mixed lesions that respond positively to aspiration biopsy.

Association between oral lichen planus and hepatitis C: retrospective study and case report / Associação entre líquen plano oral e hepatite C: estudo retrospectivo e relato de caso

Oral Lichen Planus (OLP), a chronic inflammatory disease of unknown etiology, which affects the skin and/or mucosal tissues, is an autoimmune disease (pathology) of special interest to dentists due to its oral manifestations and its possible association with Hepatitis C virus (HCV). Although a possible association has been extensively discussed in the literature, the results have been controversial. So that the relationship between Oral Lichen Planus (OLP) and infection by HCV (OLP-HCV) may be investigated, current study conducted an epidemiological survey of all OLP cases diagnosed in two reference projects, with regard to diagnosis, treatment and epidemiology of oral lesions in Maringá, Paraná, Brazil. In addition, the clinical case of a patient with HCV and the clinical manifestation of severe OLP will be provided. A total of 3,488 clinical records of biopsies performed between 1994 and 2014 and 85 cases of OLP were selected for the present study. The reticular type of OLP showed significant prevalence but only 2.3% of OLP cases revealed any association with HCV.

Líquen Plano (LP) é uma doença inflamatória crônica de etiologia desconhecida, que acomete pele e/ou mucosas. Esta doença autoimune é de especial interesse para o cirurgião-dentista pelo fato de apresentar manifestações bucais e pode estar associado ao vírus da hepatite C (VHC). Esta possível associação tem sido muito discutida na literatura, apresentando resultados controversos. Com o intuito de investigar a relação entre o Líquen Plano Oral (LPO) e a infecção pelo VHC (LPO-VHC), o presente trabalho objetivou conduzir um levantamento de todos os casos de LPO diagnosticados em dois projetos de referência quanto a diagnóstico, tratamento e epidemiologia de lesões bucais na cidade de Maringá, Paraná, Brasil. Adicionalmente, um caso clínico de um paciente portador do VHC com manifestação clínica severa de líquen plano será apresentado. Foram selecionados para o presente estudo um total de 3.488 prontuários de biópsias realizadas entre os anos de 1994 e 2014 e 85 casos de LPO. O LPO do tipo reticular apresentou prevalência estatisticamente significante e apenas 2.3% dos casos de LPO apresentaram associação com o VHC.

Inflammatory collateral cyst associated with a palatoradicular groove: report of a case and discussion of nomenclature.

The aims of this article are to present a case demonstrating the connection between palatoradicular grooves and inflammatory collateral cysts and to discuss the related nomenclature. Radiographs in a 21-year-old man revealed a radiolucent, unilocular, well-defined area near the vital maxillary right lateral incisor and canine. Palatal swelling was present, and a 6-mm-deep periodontal pocket was found at the palatal surface of the right lateral incisor. The differential diagnoses were keratocystic odontogenic tumor, developmental lateral periodontal cyst, and inflammatory lateral periodontal cyst. The area was explored surgically, and the lesion was excised. Surgical exploration revealed a palatoradicular groove, which was scaled and planed with the aid of manual curettes with the intention of creating a flat surface to promote insertion of the periodontal fibers. Histopathologic analysis revealed that the lesion was an inflammatory cyst. The presence of a palatoradicular groove can put the periodontium at risk because a resulting lack of fiber insertion makes oral hygiene difficult. This established inflammatory process can initiate development of an inflammatory collateral cyst that may be misdiagnosed, hindering successful management. In this case, bone grafting and placement of a resorbable membrane were used to promote bone formation and subsequent sealing of the periodontal space.

Histological evaluation of the rat dental pulp after indirect capping with sildenafil or L-NAME incorporated into a bioadhesive thermoresponsive system / Avaliação histológica da polpa dental do rato após capeamento pulpar indireto usando sildenafil ou L-NAME incorporados a um sistema bioadesivo termorresponsivo

We evaluated the histological dental pulp state in vivo after indirect pulp capping using sildenafil or LG-nitro-L-arginine (L-NAME), incorporated into a new bioadhesive thermoresponsive system (BTS). Male Wistar rats were subjected to an upper and lower first molar class I cavity preparation followed by indirect pulp capping with sildenafil or L-NAME. Calcium hydroxide (CaOH2) was used as a control. The teeth and surrounding bone were properly dissected and processed for Nissl's staining. Pulp state was evaluated considering the morphological aspects of the inflammatory response, type of inflammatory infiltrate, organization of the odontoblast layer, blood vessel condition, and presence of abscesses or necrosis. The results were expressed as average of observations. The most intense inflammatory response was observed 3 days after the cavity preparation. No identified changes were detected in the dental pulp response of the molars treated with L-NAME compared with those treated with CaOH2. A dual effect was observed in the teeth treated with sildenafil. While low sildenafil concentration (0.015% w w-1) promoted effects comparable to CaOH2, at a higher concentration (0.15% w w-1), sildenafil caused a severe inflammatory response and pulp necrosis. This pioneering suggest that NO pathway activity may be a determinant in the process of dental pulp healing.

Avaliou-se o estado histológico da polpa dental in vivo após capeamento pulpar indireto usando sildenafil ou LG-nitro-L-arginine (L-NAME), incorporados num novo sistema bioadesivo termorresponsivo (BTS). Ratos Wistar machos foram sujeitos ao preparo cavitário, classe I nos primeiros molares superiores e inferiores, seguido de capeamento pulpar indireto com sildenafil ou L-NAME incorporados em BTS. Hidróxido de cálcio (CaOH2) foi usado como controle positivo. Os dentes e tecidos adjacentes foram adequadamente dissecados e processados para a coloração de Nissl. O estado da polpa foi avaliado quanto aos aspectos morfológicos e tipo do infiltrado inflamatório, organização da camada de odontoblastos, condições dos vasos sanguíneos e presença de abcesso ou necrose. A reposta inflamatória mais intensa foi observada três dias após o preparo cavitário. Nenhuma alteração foi detectada na polpa dental dos molares tratados com L-NAME comparados com aqueles tratados com CaOH2. Um efeito dual foi observado nos dentes tratados com sildenafil. Enquanto baixas concentrações de sildenafil (0.015% v v-1) promoveram efeitos comparáveis com o CaOH2, altas concentrações (0.15% v v-1) causaram uma severa resposta inflamatória e necrose pulpar. Este estudo pioneiro sugere que a atividade da via do NO pode ser determinante no processo de cicatrização.

Potencial de transformación maligna del liquen plano oral: estudio retrospectivo / Potential malignant transformation of oral lichen planus: retrospective study

El liquen plano oral (LPO) es una enfermedad mucocutánea inflamatoria más común en las mujeres. Su etiología aún no es bien definida y esta condición puede estar relacionada, por ejemplo, a la ansiedad, estrés, diabetes, las enfermedades autoinmunes, infecciones y predisposición genética. El LPO se manifiesta en dos formas principales: reticular y erosivo. El objetivo de esta investigación es, a través de un estudio retrospectivo, analizar el posible potencial maligno del LPO. Se analizaron los registros de los pacientes atendidos en dos proyectos de lesiones bucales de dos diferentes instituciones en el período de 1995 a 2014. Se recogieron datos como género, edad, presencia de enfermedad sistémica, presencia de lesiones en la piel, tabaquismo, duración de la lesión, localización, síntomas, tratamiento, proservación y transformación maligna. Los resultados mostraron que, de los 3488 analizados, 85 (2,4%) tuvieron un diagnóstico confirmado de LPO, que afecta fundamentalmente a pacientes de sexo femenino (85%) siendo el LP reticular más común. En relación a la transformación maligna del LPO, 1 paciente (0,85%) tenía carcinoma de células escamosas 4 años después del diagnóstico inicial de LPO. Además, 3 pacientes mostraron atipia celular moderada en el diagnóstico. Los resultados refuerzan el potencial de transformación maligna del LPO. Aunque esta asociación es especulativa, la posibilidad debe ser considerada por los profesionales, que deben presentar estos pacientes a largos periodos de preservación.

Oral lichen planus (OLP) is an inflammatory mucocutaneous disease, more common in females. Its etiology is not yet well defined; this condition may be related, for example, to anxiety, stress, diabetes, autoimmune diseases, infections and genetic predisposition. The OLP manifests itself in two main forms: reticular and erosive. This work aims to perform a retrospective study analyzing the possible malignant potential of OLP. Records of the patients were analyzed in two projects of oral lesions in two different institutions in the period from 1995 to 2014. Data as gender, age, presence of systemic disease, presence of skin lesions, smoking, duration of the injury, location, symptoms, treatment, follow-up time and malignant transformation were collected. The results showed that, of the 3488 analyzed, 85 (2.4%) had a confirmed diagnosis of OLP, which mainly affected female patients (85%) being the most common the reticular LP. Regarding the malignant transformation of OLP, one patient (0.85%) had squamous cell carcinoma 4 years after the initial diagnosis of OLP. In addition, 3 patients showed moderate cellular atypia. The results reinforce the potential of malignant transformation of OLP. Although this association is speculative, this possibility must be considered by the dental practitioners, who must submit these patients to long periods of monitoring.

Carcinoma in situ in a patient with erythroleukoplakia: challenges in the diagnosis and in the therapeutic choice / Carcinoma in situ in erythroleukoplakia

A 41-year-old Caucasian male smoker presented a red and white plaque on the left jugal mucosa suggestive of oral erythroleukoplakia (OEL). Biopsy followed by microscopic examination revealed carcinoma in situ. Since OEL is considered a precancerous lesion with a high malignant transformation potential, the present case set out to discuss the challenges in diagnosing the condition and choosing the most appropriate treatment. The discussion deals with issues such as whether there is a limit for choosing either a radical or a more conservative approach to treatment and the importance of using a procedure that allows a microscopic examination of the entire lesion. Carcinoma in situ associated with OEL made the treatment planning even more complex in the present case. In order to avoid a mutilating approach, multiple excisions with safety margins were performed, and the patient was instructed not to smoke. A strict 12-month follow-up shows no signs of recurrence of the OEL... (AU)

Manifestações bucais em pacientes portadores de anemia: estudo clínico e radiográfico / Oral manifestations in patients with anemia: clinical and radiographic study

Manifestações bucais da anemia estão entre os diversos sinais e sintomas associados à doença, tornando a participação do cirurgião-dentista de fundamental importância no processo de diagnóstico e tratamento dos pacientes. Objetivo: avaliar pacientes diagnosticados com anemia e identificar possíveis manifestações bucais, buscando esclarecer o mecanismo causal por trás da relação entre a manifestação bucal encontrada e o tipo diagnosticado de anemia. Materiais e método: por meio da avaliação de pacientes portadores de anemia, este trabalho quer relacionar quadros clínicos de pacientes oriundos do Hemocentro do Hospital Universitário da Universidade Estadual de Maringá com eventuais manifestações bucais passíveis de reconhecimento por meio de exame clínico e/ou radiográfico. Resultados: dos 21 pacientes analisados, as alterações mais identificadas estão na palidez de mucosa (66,67 %), na doença periodontal (38,09 %), na atresia papilar lingual (38,09 %) e na pigmentação dentária (28,57 %). Conclusões: pacientes portadores de anemia falciforme e pacientes com ?-talassemia exibiram alterações extrabucais, ao passo que pacientes portadores de anemia por deficiência vitamínica foram os que mais apresentaram atresia papilar lingual (62,5 %).

Gravidarum granuloma associated to an osseointegrated implant: case report / Granuloma gravídico associado a implante osseointegrado: relato de caso

Introduction: Pyogenic granuloma, known as gravidarum granuloma or pregnancy granuloma, is a benign non-neoplastic reactive oral lesion that may occur in pregnant women. It is usually a highly vascularized mass, which has exophytic characteristics, and it may be sessile or pedunculated. Its surface has usually a smooth or lobular aspect, with its coloration ranging from red to pink. The pain sensitivity will depend on the degree of injury involving the traumatic lesion, but it is frequently painless. Adjacent areas to dental implants are rare for the appearance of this type of granuloma. Objective: The aim of this case report was to present a clinic case of gravidarum granuloma in the region of lower lingual gingiva, adjacent to an osseointegrated implant in a 33-year-old woman, with 3 months of gestation, who had the lesion since the beginning of her pregnancy. Conclusion: Gravidarum granuloma was diagnosed in association to a dental implant, and it highlights the necessity for improvements of oral hygiene in the peri-implant regions. Surgical treatment with excisional biopsy plus hygiene control were enough to settle the case. .

Introdução: O granuloma piogênico é uma lesão oral reativa, benigna não-neoplásica que pode ocorrer em mulheres grávidas, conhecido como granuloma gravídico ou granuloma da gravidez. Geralmente é uma massa altamente vascularizada, tem característica exofítica, podendo ser séssil ou pediculado e, sua superfície costuma ter aspecto liso ou lobular, com coloração que varia de vermelha a rósea. A sensibilidade dolorosa irá depender do grau de injúria traumática que envolve a lesão, mas esta é frequentemente indolor. áreas adjacentes a implantes são raras para o aparecimento de tal granuloma. Objetivo: O objetivo deste relato foi apresentar um caso clínico de granuloma piogênico, em região de gengiva lingual inferior, próximo a um implante osseointegrado, em uma paciente de 33 anos de idade, grávida de 3 meses, que possui a lesão desde o início da gestação. Conclusão: Granuloma gravídico foi diagnosticado em associação a um implante dentário. Isto evidencia a necessidade de reforço em higiene oral nas regiões peri-implantares. O tratamento cirúrgico com biópsia excisional e controle da higiene oral foram suficientes para resolução do caso. .

Expressão de TGFβ1 mRNA nas fases iniciais de expansão da sutura palatina mediana / The expression of TGFβ1 mRNA in the early stage of the midpalatal suture cartilage expansion

INTRODUÇÃO: a expansão da maxila induz a formação de novo osso na sutura palatina mediana por um processo de proliferação e diferenciação celular. A força de expansão pode estimular, nas células progenitoras, a produção de citocinas com atividade osteoindutiva, tais como o transforming growth factor β1(TGFβ1). OBJETIVOS: o principal objetivo deste estudo foi determinar a função dessa citocina nos estágios iniciais de expansão da sutura palatina mediana. MÉTODOS: um aparelho ortodôntico foi instalado entre os molares superiores direito e esquerdo de ratos com 4 semanas de idade. A força de expansão inicial foi de 50g. Os grupos controle e experimental foram sacrificados nos dias 0, 2 e 5. Cortes bucais de 6µm foram obtidos e sujeitos à técnica de hibridização in-situ. RESULTADOS: dois dias após a aplicação de força, as células osteocondroprogenitoras, distribuídas no lado interno do tecido cartilaginoso, exibiram altos níveis de transcrição de transforming growth factor β1. No dia 5, o nível de transcrição de TGFβ1 foi observado nos osteócitos e nas células osteoblásticas, na superfície do novo osso. A atividade osteoblástica foi confirmada por meio de um estudo imunohistoquímico utilizando-se Osteocalcina-Pro (OC-Pro). CONCLUSÕES: os dados sugerem que a expansão da sutura palatina induz a diferenciação de células osteocondroprogenitoras em osteoblastos, estimuladas pela produção de citocinas.

INTRODUCTION: The application of an orthodontic expansion force induces bone formation at the midpalatal suture because of cell proliferation and differentiation. Expansion forces may stimulate the production of osteoinductive cytokines, such as transforming growth factor β1 (TGFβ1), in the progenitor cells. OBJECTIVES: This study determined the role of TGFβ1 in the early stage of midpalatal suture cartilage expansion. METHODS: A rectangular orthodontic appliance was placed between the right and left upper molars of 4-week-old rats. The initial expansion force was 50 g. Animals in the control and experimental groups were sacrified on days 0, 2, and 5 and 6 µmm thick sections were prepared for an in situ hybridization technique. RESULTS: Two days after the application of force, prechondroblastic and undifferentiated mesenchymal cells distributed along the inner side of the cartilaginous tissue had high levels of TGFβ1 transcription. On day 5, the TGFβ1 transcription was found in osteocytes and osteoblastic cells on the surface of newly formed bone. Immunohistochemistry using Osteocalcin-Pro (OC-Pro) confirmed osteoblastic activity. Conclusions: Results suggest that the expansion of midpalatal suture cartilage induces differentiation of osteochondroprogenitor cells into osteoblasts after stimulation by cytokine production.

Estudo da expressäo imuno-histoquímica de proteínas da matriz extracelular em lesöes fibro-ósseas benignas dos maxilares / Estudo da expressäo imuno-histoquímica de proteínas da matriz extracelular em lesöes fibro-ósseas benignas dos maxilares

O diagnóstico diferencial entre as lesöes fibro-ósseas benignas dos maxilares é muito importante, visto que elas diferem quanto à etiologia, comportamento, prognóstico e, conseqüentemente, abordagem terapêutica. Este estudo teve como objetivo analisar, comparativamente, a expressäo imuno-histoquímica das principais proteínas näo-colágenas constituintes da matriz extracelular de tecidos mineralizados (osteonectina, osteopontina, sialoproteína óssea e osteocalcina) em 54 casos de lesöes fibro-ósseas benignas dos maxilares, sendo 22 displasias fibrosas, 16 fibromas cemento-ossificantes e 16 displasias cemento-ósseas. Os resultados mostraram que a osteonectina manteve o mesmo perfil de expressäo em todas as lesöes fibro-ósseas estudadas a marcaçäo para osteopontina foi negativa nas células fusiformes produtoras de glóbulos cementóides e fraca, bem como heterogênea, nas matrizes altamente mineralizadas houve negatividade para sialoproteína óssea nos glóbulos cementóides e nas células fusiformes que os produzem, diferentemente da expressäo fortemente positiva encontrada na maioria das trabéculas ósseas e seus osteoblastos cuboidais periféricos e, por fim, a imuno-reatividade para osteocalcina foi fraca, exceto em osteoblastos cuboidais e osteócitos. Concluiu-se que a natureza da estrutura mineralizada e o fenótipo celular se responsabilizam muito mais pelas variaçöes de expressäo encontradas do que, propriamente, o tipo de lesäo fibro-óssea, o que impossibilita, pelo menos por enquanto, a utilizaçäo dessas proteínas com finalidade diagnóstica

Evaluation of health questionnaires used in dentistry.

An evaluation of a patient's general health before dental treatment is necessary to identify any systemic conditions, which may influence treatment and allow the dentist to evaluate risks, and reduce possible complications. Of the 860 dentists contacted by mail, 112 provided health questionnaires used in their offices. The authors evaluated the information in these questionnaires by describing content and rating them according to the importance of each topic. Questions were divided into categories and compared against a standard list of health-related topics. The authors also assessed the questionnaires based on dentists' area of specialization and length of clinical experience. It was not possible to establish a statistically significant correlation between the quality of a health questionnaire and dentists' specialty or length of experience; however, the questionnaires used by periodontists were rated as more comprehensive than those adopted by pedodontists (p < 0.05). Overall, the topics asked about most frequently were allergies, diabetes, and patient drug use.