A call for further research on the relation between type 2 diabetes and oral candidiasis.

OBJECTIVE: This study aimed to evaluate the relationship between oral candidiasis with salivary features, neutrophil function, and glycemic control in type 2 diabetes (T2D). DESIGN: Twenty-nine individuals were included, 16 with T2D and 13 without the disease. The participants underwent clinical examination, neutrophilic function tests, fasting glycemia and glycated hemoglobin (A1c), stimulated and unstimulated saliva collection, and swab and exfoliative cytology. Salivary flow, pH, and total fungi count were evaluated on saliva, and identification of the Candida species was performed in saliva and swab samples. RESULTS: There was no difference in unstimulated salivary flow and pH of the stimulated and unstimulated saliva for participants with T2D and controls (P > .05). Individuals from both groups presented no candidal lesions. The salivary fungal growth in the T2D group was higher than that in controls (P < .05). Only individuals with T2D presented alterations in the neutrophilic functions (14/16; 87.5%; P < .05). There was no relationship between high A1c values and neutrophil dysfunction with the presence of Candida spp. in both saliva and mucosa (P > .05). CONCLUSIONS: High A1c level, reduction in neutrophil activity, salivary flow and pH, and increase in total salivary Candida spp. counts were not related to oral candidiasis in patients with T2D.

Atendimento odontológico de paciente submetido à radioterapia em região de cabeça e pescoço: relato de caso clínico / Dental care of patient submitted to radiotherapy in the head and neck region: a case report

O tratamento do câncer de cabeça e pescoço depende da idade do paciente, presença de comorbidades, tamanho do tumor, localização, grau, estágio, presença de linfonodos afetados e de metástases, e inclui cirurgia, radioterapia e quimioterapia, combinadas ou separadamente. As complicações bucais da radioterapia em região de cabeça e pescoço são amplamente conhecidas, tais como, mucosite, xerostomia, disgeusia, trismo, cárie de radiação e osteorradionecrose. A prevenção ou redução da incidência e severidade dessas complicações são fundamentais para a manutenção da saúde bucal, tendo o dentista um papel primordial antes, durante e após a radioterapia. Dessa forma, este relato de caso visa discutir o atendi¬mento odontológico de uma paciente irradiada em região de cabeça e pescoço, salientando as principais complicações bucais, manejo odontológico e a importância da Odontologia na equipe multidisciplinar no tratamento do câncer bucal

The head and neck cancer treatment depend on age, comorbidities, tumor size, site, stage, grade, lymph nodes status and metastases, and include surgery, radiotherapy and chemotherapy, combined or separately. Oral complications of radiotherapy in the head and neck region are widely known, such as mucositis, xerostomia, dysgeusia, trismus, radiation caries and osteoradionecrosis. The prevention or reduction of incidence and severity of oral complications are essential in the maintenance of oral health, and the dentist having a primary role before, during and after radiotherapy. Thus, this case report aims to discuss the dental care of a patient irradiated in the head and neck region, highlighting the main oral complications, dental management and the importance of Dentistry in the multidisciplinary team in the treatment of oral cancer

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia.

Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10-year-old female patient presented with a 1-month history of an asymptomatic, firm, and pinkish-red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.

Salivary Immunoglobulins in Individuals with Common Variable Immunodeficiency

Abstract Oral manifestations of common variable immunodeficiency (CVID) are rare, have rarely been studied and have given controversial results. There are few data about IgA, IgG, and IgM antibody salivary levels in the literature, and there are few papers about the clinical impact of antibody deficiencies and CVID on the oral health of such patients. The aim of this study was to measure serum and salivary IgA, IgG, and IgM levels in CVID participants and controls, and to associate immunoglobulin levels with caries and periodontal disease. This was a case-control study involving 51 CVID individuals and 50 healthy controls. All participants underwent examination for dental caries and periodontal disease. Blood and whole saliva samples were collected on the same day of the oral examination. Serum IgA, IgM, and IgG levels were measured by turbidimetry and salivary IgA, IgM, and IgG titers were assessed by enzyme-linked immunosorbent assay. Incidences of caries and gingivitis were significantly higher in the CVID group than in the control group (p<0.05). Salivary and blood IgA and IgM titers were significantly reduced in the CVID group, but there was no association of salivary immunoglobulin levels with periodontal disease or with caries incidence (p>0.05 for both). Although CVID was associated with increased susceptibility to caries and gingivitis, it was not associated with low salivary levels of IgA and IgM.

Resumo As manifestações orais em pacientes com imunodeficiência comum variável (ICV) têm sido pouco estudadas e com resultados variados. Há escassos dados na literatura sobre os níveis de IgA, IgG e IgM na saliva, e pouco se sabe sobre o impacto clínico da deficiência destes anticorpos sobre a saúde bucal de pacientes com ICV. O objetivo deste estudo foi medir os níveis séricos e salivares de IgA, IgG e IgM em indivíduos com ICV e controles, e associar os níveis de imunoglobulinas com cárie e doença periodontal. Este foi um estudo de caso-controle, envolvendo 51 indivíduos ICV e 50 controles saudáveis. Todos os participantes foram examinados para cárie e doença periodontal. As amostras de sangue e saliva foram coletadas no mesmo dia do exame intraoral. Os níveis de IgA, IgM e IgG foram medidos por turbidimetria, e os títulos salivares de IgA, IgM e IgG foram avaliados através método imunoenzimático (ELISA). As incidências de cáries e gengivite foram significativamente maiores no grupo ICV do que no grupo controle (p<0,05). Os níveis de IgA e IgM salivares e no sangue foram significativamente reduzidos no grupo ICV, porém não houve associação dos níveis de imunoglobulina salivar com doença periodontal ou com a incidência de cárie (p>0,05 para ambos). Embora ICV foi associado com um aumento da susceptibilidade à cárie e gengivite, não estava associado com baixos níveis salivares de IgA e IgM.

Kostmann syndrome: oral aspects and 10-year follow-up case report.

Kostmann syndrome (KS) is an autosomal recessive disorder characterized by a low neutrophil count and recurrent bacterial infections, including periodontal disease. This report describes the case of a 5-year-old female KS patient treated with regular infusions of granulocyte stimulating factor (granulokine), with primary complaint of gingival bleeding and tooth mobility, and followed up for 10 years. Conventional periodontal treatment and some extractions were performed, after neutrophil function tests using flow cytometry. The invasive procedures were carried out at an outpatient clinic under antibiotic prophylaxis due to a low neutrophil count and an impaired neutrophil function presented. During the 10-year follow-up period, despite episodes of recurrent gingivitis and periodontitis the present report describes the positive outcome of dental treatment of a patient with KS.

Association between immunologic parameters, glycemic control, and postextraction complications in patients with type 2 diabetes.

BACKGROUND: The purpose of this study was to assess the association between metabolic control and immune dysfunction, and postoperative complications and wound healing after dental extractions in people with type 2 diabetes and control participants. METHODS: The authors performed a prospective, case-control study enrolling 53 participants with type 2 diabetes and 29 participants who did not have type 2 diabetes. Exclusion criteria included being a smoker and having teeth with periodontal pockets deeper than 4 millimeters, among others. All participants underwent an extraction of 1 erupted tooth. The investigators assessed patients' signs and symptoms at 3, 7, 21, and 60 days after surgery. The investigators measured glycemic control and immunologic profile at the time of the extraction. They compared the pattern of healing and the incidence of postextraction complications between the 2 groups. RESULTS: Even in the presence of impaired neutrophil function and poor glycemic control, we found no increase in the number of postoperative complications. There was no association between delayed wound epithelialization on postoperative day 21 and level of glycemic control, and reduced neutrophil function. On postoperative day 60, all alveolar sockets were epithelialized completely and showed no signs of infection. CONCLUSIONS: The study results suggest that type 2 diabetes per se or glycemic control is not a risk factor for experiencing postoperative complications in people undergoing dental extractions. Although people with type 2 diabetes may have impaired neutrophil function, the study results revealed that having this condition was not associated with an increased risk of experiencing postoperative complications. Additional research studies with larger sample sizes of patients who have diabetes are needed to confirm this study's findings. PRACTICAL IMPLICATIONS: The results allow clinicians to infer that people with type 2 diabetes undergoing dental extractions of erupted teeth that do not have an acute odontogenic infection should not receive antibiotic prophylaxis simply because of their diabetic status or level of glycemic control.

Manifestações bucais associadas à imunossupressão em pacientes submetidos a transplante de coração / Oral manifestations associated with immunosupression in patients undergoing heart transplant

A condição de imunossupressão de pacientes transplantadoscardíacos possibilita o surgimento de manifestações bucaisimportantes que representam risco para o sucesso dotransplante cardíaco. A avaliação e o acompanhamentoodontológico desses pacientes são fundamentais na prevençãodessas manifestações bucais e infecções sistêmicas. Por meiodo relato dos casos clínicos de três pacientes transplantadoscardíacos, apresentamos e discutimos as condições clínicas eas opções terapêuticas das manifestações bucais mais comunsneste grupo de pacientes...

The condition of immunosuppression in heart transplant patientsenables emergence of oral manifestations that represent significantrisk to the success of heart transplantation. The oral and dentalevaluation and the follow up of these patients are critical in preventingthese oral manifestations and systemic infections. Through thereports files of three patients who underwent cardiac transplantation,we present and discuss the clinical and therapeutic options of themost common oral manifestations in this group of patients...

Clinical and Histological Features of Multifocal Canalicular Adenomas of the Upper Lip

Canalicular adenoma (CA) is an uncommon benign salivary gland tumor that mostly occurs in the upper lip. Despite its benign nature, some patients may present multiple nodules and also microscopic growth that can be multifocal with foci of tumor within the adjacent gland. Microscopically, CA can be mistaken for a polymorphous low-grade adenocarcinoma (PLGA) or basal cell adenoma (BCA), and immunohistochemistry can be helpful in differentiating them. Two cases of canalicular adenoma showing tumor foci within the adjacent gland are described. Both cases occurred in the upper lip of white females aged 72 and 79 years. In addition to the histological multifocal aspect, one of the patients presented bi-lateral nodules. Histological examination of both lesions revealed interconnecting and branching canal-like structures composed by uniform columnar and sometimes cuboidal cells, partially encapsulated. Immunohistochemical analysis showed intense expression of cytokeratins (CK) 7, a weak reaction to CK14 and a negative reaction to vimentin. Upon the diagnosis of CA the lesions were excised. In conclusion, it is important to properly diagnose CA and differentiate its multifocal aspect from a malignant behavior.

O adenoma canalicular (AC) é uma rara neoplasia benigna de glândula salivar que ocorre com maior frequência em lábio superior. Apesar de sua natureza benigna, alguns pacientes podem apresentar múltiplos nódulos, além de apresentar microscopicamente um crescimento multifocal com focos de neoplasia na glândula adjacente. Microscopicamente, AC pode ser confundido com adenocarcinoma polimorfo de baixo grau ou adenoma de células basais, sendo a imunohistoquímica útil na diferenciação entre eles. Dois casos de AC com focos de neoplasia dentro da glândula são descritos. Ambos os casos ocorreram em lábio superior de dois indivíduos do sexo feminino com 72 e 79 anos de idade. Além do aspecto histológico multifocal, um dos pacientes apresentou nódulos bilaterais. A análise histológica dos dois casos revelou estruturas canaliculares interligadas, compostas por células colunares uniformes e cuboidais, parcialmente encapsuladas. A análise imunohistoquímica mostrou intensa marcação de citoqueratina (CK) 7, uma fraca expressão para CK14, e reação negativa para vmentina. Após o diagnóstico as lesões foram excisionadas. Conclusão: É importante o correto diagnóstico do AC e a diferenciação do aspecto multifocal de um comportamento maligno.

Clinical and histological features of multifocal canalicular adenomas of the upper lip.

Canalicular adenoma (CA) is an uncommon benign salivary gland tumor that mostly occurs in the upper lip. Despite its benign nature, some patients may present multiple nodules and also microscopic growth that can be multifocal with foci of tumor within the adjacent gland. Microscopically, CA can be mistaken for a polymorphous low-grade adenocarcinoma (PLGA) or basal cell adenoma (BCA), and immunohistochemistry can be helpful in differentiating them. Two cases of canalicular adenoma showing tumor foci within the adjacent gland are described. Both cases occurred in the upper lip of white females aged 72 and 79 years. In addition to the histological multifocal aspect, one of the patients presented bi-lateral nodules. Histological examination of both lesions revealed interconnecting and branching canal-like structures composed by uniform columnar and sometimes cuboidal cells, partially encapsulated. Immunohistochemical analysis showed intense expression of cytokeratins (CK) 7, a weak reaction to CK14 and a negative reaction to vimentin. Upon the diagnosis of CA the lesions were excised. In conclusion, it is important to properly diagnose CA and differentiate its multifocal aspect from a malignant behavior.

Reparação pós-exodôntica em pacientes com diabetes tipo 2 / Post-extraction wound healing in patients with type 2 diabetes

A hiperglicemia, bem como o diabetes, é reconhecida como fator de risco para infecções pós-cirúrgicas, assim manter o controle glicêmico perioperatório tem sido padrão de cuidado em saúde. Entretanto há poucos estudos sobre o impacto do controle glicêmico no processo de reparação de cirurgias de extração dentária. Apesar da escassez de estudos e de evidências clínicas e científicas que investiguem o risco de infecções pós-exodônticas em pessoas com diabetes, existem livros, artigos e guias que recomendam aos dentistas o uso de antibióticos profiláticos nesses indivíduos, especialmente para aqueles descompensados. O objetivo deste estudo foi avaliar clinicamente a cicatrização pós-exodôntica, em relação à cronologia dos eventos reparacionais e em relação à ocorrência de complicações pós-operatórias, em indivíduos com diabetes tipo 2 comparados a um grupo controle. Além disso, procuramos relacionar os eventos pós-cirúrgicos com o controle metabólico e com o perfil imunológico dos pacientes. Este estudo prospectivo longitudinal caso controle incluiu 53 indivíduos com diabetes tipo 2 (grupo de estudo=GE) e 29 indivíduos sem diabetes (grupo controle=GC). Foi aplicado questionário sobre a história médica, realizados exames clínicos intraoral e extraoral e exames laboratoriais para conhecimento do controle glicêmico e do perfil imunológico do indivíduo, tais como, hemograma completo, hemoglobina glicada (A1C), glicemia de jejum, IgA, IgG, IgM, C3, C4, linfócitos T CD3+, CD4+, CD8+, quimiotaxia de neutrófilos, oxidação de neutrófilos, fagocitose de neutrófilos e monócitos. Todos os participantes foram submetidos a extrações padronizadas de dentes erupcionados...

Hyperglycemia and diabetes are recognized as a risk factor for postoperative infections. Thus, maintaining perioperative glucose control has become the standard of care. However, there are scarce data on the appropriate glucose control during minor dental surgery. Despite the paucity of studies investigating the risk of postsurgical oral infections in persons with diabetes, there are text books, papers and guidelines recommending to dentists the use of prophylactic antibiotics for patients with poorly controlled diabetes undergoing invasive oral procedures. The aim of this study was to clinically evaluate the post extraction healing regarding to the chronology and to the occurrence of postoperative complications in patients with type 2 diabetes compared to a control group. Additionally, we associated the postoperative events with metabolic control and the immunological profile of the participants. This prospective case-control study included 53 subjects with type 2 diabetes (SG) and 29 controls without diabetes (CG). A questionnaire on medical history was applied, intraoral and extraoral clinical examinations were conducted and laboratory tests for glycemic control and immunological profile of the individual, such as complete blood count, glycated hemoglobin (A1C), fasting glucose, IgA, IgG, IgM, C3, C4, lymphocytes T CD3+, CD4+, CD8+, neutrophil chemotaxis, oxidation of neutrophil phagocytosis by neutrophils and monocytes, were obtained at the time of the extraction. All participants underwent standardized extractions of erupted teeth and clinical assessments were performed 3, 7, 21 and 60 days after surgery...

Oral manifestations in patients with hypogammaglobulinemia.

OBJECTIVE: The overall objective of this study was to assess the oral manifestations and their association with immunologic status and health history, of individuals with hypogammaglobulinemia. STUDY DESIGN: A case-controlled study of 100 subjects with hypogammaglobulinemia and 93 control individuals was performed. All participants were examined for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Decayed, missing, filled teeth and community periodontal index were recorded. Complete blood count, serum immunoglobulins, and lymphocyte immunophenotyping were measured on the same day of the oral health assessment. RESULTS: Individuals with hypogammaglobulinemia showed higher prevalence of enamel hypoplasia and complaints of dry mouth, and lower prevalence of dental caries and periodontal disease. CONCLUSIONS: The systemic conditions associated with hypogammaglobulinemia were not associated with enhanced susceptibility to caries, gingivitis, or periodontitis; however, individuals with hypogammaglobulinemia were more likely to report more episodes of recurrent aphthous ulcers compared with control individuals.

Assessment and management of oral health in liver transplant candidates

Liver transplantation has become a standard treatment for end-stage liver disease and the number of recipients has grown rapidly in the last few years. Dental care during pre-transplant workup is important to reduce potential sources of infection in the drug-induced immunosuppression phase of liver transplantation. Objectives: The objectives of this study were to document the prevalence of oral abnormalities in patients on a liver transplant waiting list presenting to an urban dental school clinic, discuss the appropriate dental treatment according their systemic conditions and compare their oral manifestations with those of healthy individuals. Material and Methods: A pilot study was conducted involving 16 end-stage liver disease individuals (study group- SG) attending the Special Care Dentistry Center of the University of São Paulo and 16 control individuals (control group- CG) with no liver diseases, receiving dental care at the Dental School of the University of São Paulo. These individuals were assessed for their dental status (presence of oral disease or abnormalities), coagulation status, and dental treatment indications. Results: The patients from SG exhibited a greater incidence of oral manifestations compared with CG (p=0.0327) and were diagnosed with at least one oral disease or condition that required treatment. Coagulation abnormalities reflecting an increased risk of bleeding were found in 93.75% of the patients. However, no bleeding complications occurred after dental treatment. Conclusions: The patients with chronic liver diseases evaluated in this study exhibited a higher incidence of oral manifestations compared with the control group and had at least one oral disease or abnormality which required dental treatment prior to liver transplantation. Careful oral examination and evaluation of the patient, including laboratory tests, will ensure correct oral preparation and control of oral disease prior to liver transplantation.

Osler-Weber-Rendu syndrome--dental implications.

Osler-Weber-Rendu syndrome (OWRS) is a rare hereditary, autosomal dominant disease characterized by a local angiodysplasia. Its clinical characteristics are vascular hamartomas of the skin and oral mucosa, arteriovenous malformations in the lungs, liver, kidney and brain, and episodes of epistaxis. The oral lesions, which become apparent through hemorrhagic telangiectasia, may be the first sign of the disease. This is a case report of a 74-year-old woman whose diagnosis of OWRS was established by her dentist based on the presence of telangiectasia in the skin and oral mucosa, reports of frequent nosebleeds of unknown etiology and a family history of telangiectasia. Amputation of a lower limb and comorbidities, such as cardiopathy, nephropathy and rheumatic disorders, completed the profile. OWRS causes major vascular changes that can be diagnosed initially by a dentist. In this article, we describe the skills and knowledge that dentists need to monitor patients with OWRS properly.

Comorbidades e manifestações bucais em pacientes idosos HIV positivos / Comorbidities and bucal manifestations in HIV-positive older patients

A epidemia do HIV/AIDS vive o final de sua terceira década seguida por importantes avanços terapêuticos e uma considerável expectativa de vida dos pacientes infectados. Diversas comorbidades têm sido frequentemente observadas, relacionadas com o próprio envelhecimento e/ou com o uso de terapia antiretroviral por tempo prolongado. As manifestações bucais oportunistas tornam-se mais raras, e outras alterações estão se tornando mais prevalentes e merecem atenção do cirurgião-dentista. O objetivo deste trabalho foi verificar a prevalência de comorbidades e de manifestações bucais em pacientes idosos portadores de HIV atendidos no CAPE-FOUSP, e analisa-las de acordo com dados demográficos e estado imunológico dos pacientes. Foram avaliados prontuários de 61 pacientes, de onde foram coletados dados demográficos e relativos à infecção pelo HIV. Todos os pacientes exibiam alguma comorbidade. Quarenta e um (70,5%) pacientes apresentaram ao menos uma manifestação bucal relacionada ao HIV, sendo as mais freqüentes a candidíase oral e a xerostomia. É importante que o cirurgião-dentista conheça o perfil do paciente HIV positivo idoso, as condições bucais mais observadas e as comorbidades mais frequentes, especialmente as que apresentem repercussões no manejo odontológico.

HIV/AIDS epidemic lives the end of its third decade followed by important advances in the therapy and life expectancy of the infect patients, with a growing number of HIV-positive older patients. Some comorbidities are becoming more common, related with aging and the long-term use of some antiretroviral medications. Some buccal manifestations are still considered important markers of HIV progression. Although, some lesions are becoming more frequent. All of them deserve attention by the dentist. Based on this, this article purpose is to verify the prevalence of comorbidities and HIV-related buccal manifestations on older patients attended on HIV-positive patients of Special Care Dentistry Center of Sao Paulo University (CAPE-FOUSP), and analyze them according to demographic data and immunologic status of the patients. Sixty-one patients were evaluated retrospectively and information about HIV infection and demographic data were collected. All patients comorbidities. Forty-three patients (75,5%) exhibited at least one buccal manifestation and the frequent are oral candidiasis and xerostomia. Is important for the oral health provider know the current profile of HIV-positive older patient, witch includes associated oral conditions and the most frequent comorbidities, especially those that demand changes in the dental management.