Telediagnosis of oral lesions using smartphone photography.

OBJECTIVE: The objective of this observational study was to evaluate telediagnosis of oral lesions using smartphone photography. MATERIALS AND METHODS: Individuals with visible oral lesions composed a convenience sample. The lesions were photographed using a smartphone camera and emailed along with clinical information to three evaluators, who formulated up to two diagnostic hypotheses for each case. A total of 235 photographs from 113 clinical cases were obtained. The evaluators answered questions regarding referral decisions, requests for additional tests, diagnostic difficulties, and image quality. The diagnostic hypotheses were compared to the gold standard by means of percent agreement and kappa coefficient. Consensual face-to-face diagnoses of three specialists-when only a clinical diagnosis was necessary-or histopathological results-when a biopsy was necessary-were considered the gold standard. RESULTS: The telediagnosis was similar to the gold standard in 76% of the cases, and kappa coefficients showed almost perfect agreement (k = 0.817-0.903). The evaluators considered that referrals could have been avoided on an average of 35,4% of the cases. CONCLUSION: Diagnosis of oral lesions using images taken with a smartphone showed almost perfect agreement and diagnostic accuracy comparable to face-to-face diagnosis.

A case series of medication-related fibrovascular hyperplasia following hematopoietic stem cell transplantation for Fanconi anemia.

Systemic medications categorized as diphenylhydantoin, calcineurin inhibitor and calcium channel blocker may have effects on the oral cavity by modifying the inflammatory and immune response and causing undesired tissue proliferative reactions. Calcineurin inhibitors are medications commonly used for long periods in patients undergoing allogeneic hematopoietic stem cell transplant (HSCT) and solid organ transplantation. Medication-related fibrovascular hyperplasia (MRFH) is an extra gingival hyperplastic nodular growth associated with medications use. This study reports five cases of pediatric patients (6 to 12-years-old) diagnosed with Fanconi anemia (FA) after HSCT who presented similar oral mucosal lesions associated with the use of cyclosporine, phenobarbital and amlodipine. After excision of the lesions, histopathological analysis described them as pyogenic granuloma (PG). As the aetiology of the lesions manifested by the patients was associated with the use of medications, the final diagnosis was MRFH. Despite the clinical and histopathological similarity between PG and MRFH, it is fundamental to know the aetiological agent for achieving definitive diagnosis and correct management. Considering the etiologic agent (medication) and histopathological findings, it is suggested that the most appropriate term for this manifestation should be "medication-related fibrovascular hyperplasia". The correct nomenclature related to extra gingival hyperplastic lesions identified in patients on medications with potential to induce hyperplastic reactions should be adopted to facilitate scientific communication and improve the treatment.

Quality of life in cancer patients with or without medication-related osteonecrosis of the jaw.

PURPOSE: Cancer and its therapies can have a significant impact on general and oral health and, therefore, cause a reduction in patients' quality of life (QoL). The study aimed to evaluate the QoL of cancer patients who use antiresorptive and anti-angiogenic medications with or without the development of medication-related osteonecrosis of the jaws (MRONJ). METHODS: Sixty-two patients diagnosed with cancer under antiresorptive therapy answered three instruments from the European Organization for Cancer Research and Treatment (EORTC). The first questionnaire (QLQ-C30) aimed to measure the overall QoL, the second (QLQ-ELD14) is a complementary module for elderly patients, and the third (QLQ-OH15) aimed to assess oral health related to QoL. RESULTS: The mean age of the patients was 62.19 years, and 12.9% developed MRONJ. There was no significant difference between sex and MRONJ. Among the QLQ-C30 scales, the item "role functioning (RF2)" presented a significant result (p = 0.019). Those patients without MRONJ had a better function performance both in their daily chores and in their free time. Age was not associated to MRONJ, although some concerns are common to the elderly and cancer patients. QoL related to oral health presented a significant result (p = 0.048) showing that MRONJ has a negative impact on patients' QoL. CONCLUSION: Our results showed that MRONJ has a significant impact on the general and oral QoL of cancer patients, and therefore prevention and awareness must be a priority.

Immunohistochemical analysis of BRAF V600E mutation in ameloblastomas.

OBJECTIVE: This study aimed to investigate the presence of BRAF V600E mutation in mandible ameloblastomas by correlating clinical and imaging data on the cases studied. METHODS: Eighty-four cases diagnosed as mandibular ameloblastoma were selected for analysis. The specimens were submitted to immunohistochemistry for detection of BRAF V600E mutated protein. Clinical-pathological data such as age, gender, tumour size, mandibular location, radiographic aspects, histological type and sub-type, and tumour status were collected. The clinical-pathological parameters were categorised and analysed according to BRAF V600E detection. RESULTS: Of the 84 patients, 78.6% (66 cases) demonstrated positivity for anti-BRAF V600E antibody, whereas 18 were negative (21.4%). The correlation between BRAF expression and variables showed statistical significances for mandibular location (P = 0.0353) and tumour size (P = 0.008), whereas no statistical significance was observed for gender, age, radiographic aspect, histological pattern, histological sub-type and tumour status. Multivariate logistic regression revealed a significant risk for BRAF positivity in tumours with posterior mandibular location (OR = 7.23, P = 0.0451) and size > 4 cm (OR = 7.29, P = 0.0150). CONCLUSION: BRAF V600E mutation is common in mandibular ameloblastomas, especially in cases of tumours larger than 4 cm and in the posterior region of the mandible. In addition, this mutation can occur regardless of histological type of the tumour, age, gender, radiographic aspect and tumour status. CLINICAL SIGNIFICANCE: The association between clinical-pathologic features and BRAF V600E mutation in ameloblastomas may provide directions for the treatment of this neoplasia. The use of BRAF inhibitors for targeted therapy could lead to an establishment of an alternative compared to the resective surgery.

Effect of short-term mechanical stimulation on the salivary concentrations of vitamin C, vitamin E, total antioxidant capacity and total oxidant status.

Oxidative stress biomarkers of oral and systemic diseases can be found in saliva. However, there is no uniformity for the saliva collection time in these kinds of analyses and saliva composition may change because of mechanical stimulation. Therefore, the aim of this work was to determine the effect of mechanical stimulation for 10 min on the concentrations of vitamin C, vitamin E, total antioxidants and total oxidants in saliva. Saliva samples from individuals of both sexes, aged between 18 and 38 years, were collected for 10 min at 2 minintervals. Saliva flow rate in each 2 min period was measured, as well the total oxidant state, the total antioxidant capacity, vitamin C and vitamin E concentrations. All analyses were performed in triplicate and were determined using colorimetric tests. The results were analysed using t-test, Friedman's test and analysis of variance (ANOVA) for repeated measures. Mauchly's sphericity test was applied and, if necessary, technical corrections were made using the Greenhouse-Geisser test. We found no significant difference between the amounts of saliva produced across the collection times. Total oxidant status, total antioxidant capacity, vitamin C and vitamin E concentrations remained stable. Based on our findings, saliva can be collected for 10 min or less with masticatory stimulation without any variations in the concentration of the variables analysed. However, we suggest using saliva samples after two minutes of mechanical stimulation.

Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face.

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.

Oral lesions as an important marker for HIV progression.

BACKGROUND: Oral hairy leukoplakia (OHL) is a benign lesion caused by Epstein-Barr virus (EBV) replication in the oral epithelium affecting the borders of the tongue. It is strongly associated with immunosuppression, especially in HIV+ adults but is uncommon in pediatric population. The aim of the study is to show the importance of the correct diagnosis of OHL and its influence on HIV treatment.We report two cases of HIV+ adolescent patients that presented with leukoplakic lesions on the border of the tongue, suggestive of OHL. OHL diagnosis was confirmed in only one case through EBV in situ hybridization. After confirmation of the diagnosis, the patient with OHL was referred to an infectious disease specialist with the decision to start antiretroviral therapy. CONCLUSION: OHL definitive diagnosis can help clinical management of pediatric HIV+ patients.

Simultaneous Occurrence of Central Giant Cell Granuloma and Odontogenic Keratocyst in Mandible.

Odontogenic keratocysts and central giant cell granulomas are distinct entities of separate origin that may appear simultaneously in the jaw, making them difficult to differentiate. The objectives of this paper are to report a case of a 54-year-old man presenting with a large lesion in the right mandible and to describe the histological characteristics of that lesion. Imaging revealed tumefaction and multilobulation. The case was surgically managed. Histopathological examination revealed that the lesion was a hybrid of an odontogenic keratocyst and a central giant cell granuloma. It remains unclear as to whether this lesion represented a coincidental or related injury. Since both types of lesion involved have a high rate of recurrence, however, long-term follow-up is scheduled.

Core needle biopsy in the diagnosis of head and neck lesions: a retrospective study of 3 years.

The management of head and neck tumors is guided by its nature, location and extension. Despite CNB accuracy and efficiency being widely described in the literature, there are few studies that evaluate the diagnostic utility of the technique performed in an outpatient setting, in the diagnosis of head and neck tumors. The aim of this study is to present the experience, sensitivity, specificity and accuracy of the CNB performed in an outpatient setting, free handed, in an important oncology school-hospital. A total of 2007 patients with tumors in the head and neck treated for a period of 3 years were evaluated. A retrospective chart review was performed in 36 of these patients, who underwent core needle biopsy for diagnosis. All samples collected were subjected to histopathological analysis. Values of accuracy, sensitivity and specificity were 94, 92 and 100 %, respectively. In our service, held in an outpatient setting and without the aid of imaging tests, the core needle biopsy proved to be a test with high accuracy values, sensitivity and specificity, easy of application, low morbidity and high predictability, with great use in diagnosing tumors in head and neck.

Immunohistochemical biomarkers in ameloblastomas.

Ameloblastoma is an aggressive odontogenic tumour, which is locally invasive and highly recurrent. Studies show that ameloblastoma is a benign odontogenic neoplasia, being relatively rare and occasionally presenting behaviour of malignant lesions. In addition to these particularities, the histological diagnosis of ameloblastoma can be challenging when the tumour shows high rates of mitosis, absence of nuclear pleomorphism, basilar hyperplasia and neural invasion. In order to help in the diagnosis, prognosis and treatment of this neoplasia, some immunohistochemical markers were shown to be associated with tumoural epithelium. The identification of these markers as well as of their association with clinical signs can be useful to elaborate more efficient treatment strategies and to control this pathology, including improvement of the quality of life of patients affected by this neoplasia. This article aims to review some markers associated with specific molecular pathways, bone remodelling, cell proliferation, apoptosis, cell signalling and tumour suppression.

Effect of radiotherapy on osseointegration of dental implants immediately placed in postextraction sites of minipigs mandibles.

INTRODUCTION: The aim of this study was to compare the osseointegration and the survival of dental implants (DIs) immediately placed in postextraction sites, in mandibles of minipigs that underwent radiotherapy (RT). MATERIALS AND METHODS: Twelve Brazilian minipigs were divided into the following groups: A, control; B, implants placement 15 days before RT; C, implants placement 3 months after RT. Implant loss rate (ILR), fibrointegration rate (FIR), bone-implant contact (BIC), and bone density inside the threads (BDIT) were determined in each group 90 days after implantation. RESULTS: ILR was higher in group C (68.7%) than in groups B (28.1%) and A (21.9%), (P = 0.001). FIR was more frequent in group C (30%) than in groups B (21.7%) and A (4%), although not statistically significant. The averages of BIC and BDIT were, respectively, 33.1 and 41.5 in group C; 18.5 and 26.6 in group B; and 11.5 and 16.3 in group A (P = 0.003 for both variables). CONCLUSIONS: RT showed a negative effect in periimplant bone regeneration. The implants placement before RT showed better results compared with the implants performed after RT, suggesting that DIs in head and neck cancer patients must be placed before RT or simultaneously during ablative tumor surgery.

Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic acid-case-control study.

INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is a complication that develops in patients who use or have used antiresorptive or antiangiogenic medications for the treatment of bone metabolic disease and bone metastases. Clinically, MRONJ is characterized by the appearance of an inflammation in soft tissues and exposure of necrotic bone tissue in mandible or maxilla, for a period of 8 weeks, in patients with no history of head and neck radiotherapy that were being or are being treated with antiresorptive and/or antiangiogenic agents. The fibrin-rich platelets and leukocytes (L-PRF) membrane has been used as an alternative for MRONJ prevention. The aim of this study was to evaluate the use of L-PRF in prevention and treatment of bone necrosis. MATERIAL AND METHODS: The patients included had MRONJ diagnosis confirmed after clinical and radiographic examination and patients whose only therapeutic option was dental extraction. RESULTS: Twenty patients were included in the study and were divided in three groups. Two patients were removed from the study due to previous history of pentoxifylline and tocopherol use. The result of surgical treatment was successful in 57% in group 1 (control/MRONJ prevention), 100% in group 2 (MRONJ prevention), and 80% in group 3 (MRONJ treatment). CONCLUSION: L-PRF is an autologous biomaterial that allows the release of growth factors for a prolonged time, resulting in a better healing, reducing the risk contamination, edema, and postoperative pain, being a great ally in the prevention and treatment of MRONJ because it returns to these patients, mainly quality of life, reducing pain, and recurrent infections commonly seen in the processes of bone necrosis of the jaws.

Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series.

Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.

IL17A and IL17RA gene polymorphisms in Fanconi anemia.

Fanconi anemia is a rare autosomal recessive disease. In this disease, cytokine pathways can induce the bone marrow failure that is observed in individuals with Fanconi anemia. Interleukin IL-17 exhibits a protective effect in organisms because it induces neutrophil recruitment and shows a pathological role in several models of autoimmune diseases, periodontal disease, cancer, allograft rejection, and graft versus host disease. Polymorphisms in the IL17A and IL17RA genes were evaluated from DNA in saliva, comparing individuals with or without Fanconi anemia, using models of genotypic transmission (additive, dominant, and recessive). Polymorphisms in the IL17A and IL17RA genes (rs2241044 [C allele], rs879577 [C allele], rs9606615 [T allele], and rs2241043 [C allele]) were risk factors for developing Fanconi anemia. We also performed an analysis of gene markers with clinical variables in the Fanconi group. Polymorphisms in the IL17A gene (rs3819025 [A allele] and rs2275913 [G allele], respectively) were associated with an age of less than 20 years (p = 0.026; RP 0.65) and the female sex (p = 0.043; RP 0.88). The IL17RA gene was also associated with age and the presence of leukoplakia (a potentially malignant oral disorder). An age of less than 20 years was associated with rs917864 (T allele; p = 0.036; RP 0.67). The presence of leukoplakia was associated with rs17606615 (T allele; p = 0.042; RP 0.47). To our knowledge, this is the first study that associates IL17A and IL17RA gene polymorphisms with Fanconi anemia and examines rs2241044 polymorphisms in scientific literature thus far.

Lymphoepithelial cysts of oral mucosa: two cases in different regions.

Lymphoepithelial cyst of the oral cavity is a rare cystic lesion that presents as an asymptomatic, well-circumscribed, yellowish small submucosal nodule covered by normal overlying mucosa, usually located in the floor of the mouth or in the ventral or posterolateral surface of the tongue. Histopathological examination reveals a cyst lined by a stratified squamous epithelium surrounded by lymphoid tissue. In this paper, we report two cases of oral lymphoepithelial cyst, one on the anterior floor of the mouth and another on the posterior lateral tongue. In both cases, the patients were women aged approximately 50 years and the lesions were treated by local surgical excision, with no evidence of recurrence after 2 years of follow-up.

Challenge of Brazilian health researchers in the COVID-19 pandemic scenario.

Advances in Brazilian science made the country reach the 13th position in the world scientific production, and, in 2020, o Brazil was responsible for 2.39% of the world scientific production, reaching the 11th position among the countries that most published about COVID-19. The aim of this study was to contribute to and reflect on the issue of health researchers and graduate students in the scenario of COVID-19 pandemic. This pandemic highlighted the importance of science in the outcome of public policies and the fragility of the research system in Brazil, where the workforce is mainly composed of graduate students, who often do not have ideal working conditions and are not included in the response plans to global public health emergencies. This text brings a reflection and a questioning on the role of health researchers and graduate students and reinforces the importance of discussing the work of researchers/scientists in a period of great uncertainty in society.

Os avanços na ciência brasileira alcançaram a 13ª posição na produção científica mundial, e, em 2020, o Brasil foi responsável por 2,39% da produção científica mundial, alcançando a 11a posição entre os países que mais publicaram sobre a COVID-19. O objetivo deste trabalho foi contribuir e refletir sobre o debate dos pesquisadores e pós-graduandos da área de saúde no cenário pandêmico da COVID-19. A pandemia da COVID-19 evidenciou a importância da ciência no desfecho de políticas públicas e a fragilidade do sistema de pesquisa no Brasil, em que a maior força de trabalho se concentra em pós-graduandos, que muitas vezes não possuem condições ideais de trabalho e não estão inseridos nos planos de resposta às emergências globais de saúde pública. Este texto traz uma reflexão e problematização sobre o papel dos pesquisadores e pós-graduandos em saúde e reforça a importância de discutir a atuação de pesquisadores/cientistas em um período de grandes incertezas na sociedade.

Antimicrobial Photodynamic Therapy as a treatment option for inoperable cases of medication-related Osteonecrosis of the jaws.

The present study aims to report conservative treatment of an extreme case of MRONJ in a patient illegible for surgical treatment. A 69-year-old female patient, diagnosed with Multiple Myeloma underwent treatment with bisphosphonate. After a turbinectomy, she was referred to a dental clinic with painful oral symptoms, presence of necrotic and suppurative bone exposures in maxilla compatible with MRONJ. As surgery was not indicated, the treatment of option was to control infection and pain. PENTO protocol, antibiotic therapy and photodynamic therapy were instituted. The patient has been under dental follow-up for more than 1 year, with an important reduction in the areas of bone exposure, absence of active infection and painful symptoms, characterizing a significant improvement in the oral condition. The conservative approach achieved satisfactory results for the case, where the patient is ineligible for a surgery due to local and general conditions, and quality of life being prioritized.

Demineralized human dentin matrix for alveolar ridge preservation using a volumetric and histologic analyses in rats.

The aim of this study was to evaluate a Demineralized Human Dentine Matrix (DHDM) as viable biomaterial for alveolar ridge preservation in a rat model. Wistar rats were submitted to the extraction of maxillary first molars bilaterally. Sockets were filled with biomaterials and divided into 4 experimental groups (n=5): blood clot, autogenous bone, bovine-derived xenograft (BDX) and DHDM. Animals were sacrificed at 7, 14 e 28 days. Microtomography (uCT) volumetric evaluation and qualitative histological analyses were performed. Results obtained through the uCT showed similar values between the DHDM and the other experimental groups. The histological evaluation demonstrated DHDM with an unspecific inflammatory process and bone neoformation with slow reabsorption of the material. This result indicates that DHDM implanted in rat sockets is biocompatible and reduces the alveolar ridge volume loss after tooth extraction.

Innovative reflection on oral cancer research priorities: the contribution of social network analysis.

The objective of this study is to present a tool to help understand how variables associated with oral cancer prevention relate to each other in a social network. A search of the Scopus database was performed using terms related to oral cancer and prevention from 2000 to 2020. The keywords were used as nodes and were analyzed using NodeXL, which produced the network graphic analysis. From the 1004 publications available, 4038 different keywords were obtained and then grouped into 75 constructs based on conceptual similarity. The most influential nodes were risk factors, comorbidities, epidemiology, and treatment. However, topics such as technology, telemedicine, self-examination, and diagnostic delay remain far removed from central relations. Network analysis enabled us to observe the bias of biological and basic science in the field and identify a need for studies concerning primary prevention, behavioral interventions, and inequalities in oral cancer.

Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients.

INTRODUCTION: Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient's quality pf life. OBJECTIVE: The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. METHODS: Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. RESULTS: As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923). CONCLUSION: A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.