Syphilis Diagnosis Based on Oral Manifestations: a Case Series / Diagnóstico de Sífilis a Partir de Lesões Orais: uma Série de Casos

Syphilis is a sexually transmitted bacterial disease that has shown a significant increase in its incidence in recent years, both in Brazil and around the world. The disease can be transmitted sexually (acquired) or congenitally. The main route of transmission of the disease is sexual. When not treated initially, the infection becomes systemic and, in many cases, exhibits manifestations in the oral mucosa, allowing the establishment of the diagnosis through confirmation by laboratory tests. The great variability of clinical presentations of its oral lesions may make its identification difficult, so it is essential to know the characteristics of syphilis for a correct diagnosis. The identification of oral manifestations can help in the early diagnosis, which is of great importance for the correct treatment of this infection, as if it is not treated in time, it can result in morbidity and even mortality. In this study, five cases of secondary syphilis with different clinical manifestations in the buccal region are presented. The etiopathogenesis, the evolution of the disease, the useful tests for diagnosis and treatment are discussed. The role of the dental surgeon is increasingly evident as part of a multidisciplinary healthcare team. Therefore, it is necessary to prepare for orientation, reception, early identification of the lesions, and targeting a day of treatment of this infection. (AU)

A sífilis é uma doença bacteriana sexualmente transmissível que tem apresentado aumento significativo em sua incidência nos últimos anos, tanto no Brasil quanto no mundo. Pode ser transmitida sexualmente (adquirida) ou de forma congênita. A principal via de transmissão da doença é sexual. Quando não tratada inicialmente, a infecção torna-se sistêmica e, em muitos casos, apresenta manifestações na mucosa oral, permitindo o estabelecimento do diagnóstico por meio da confirmação por exames laboratoriais. A grande variabilidade de apresentações clínicas de suas lesões bucais pode dificultar sua identificação, por isso é fundamental conhecer as características da sífilis para um diagnóstico correto. A identificação das manifestações bucais pode auxiliar no diagnóstico precoce, o que é de grande importância para o correto tratamento desta infecção, pois se não for tratada a tempo, pode resultar em morbidade e até mortalidade. Neste estudo, são apresentados cinco casos de sífilis secundária com diferentes manifestações clínicas na região bucal. A etiopatogenia, a evolução da doença, os testes úteis para o diagnóstico e tratamento são discutidos. O papel do cirurgião-dentista é cada vez mais evidente como parte de uma equipe multidisciplinar de saúde. Portanto, é preciso se preparar para orientação, acolhimento, identificação precoce das lesões e direcionamento de um dia de tratamento dessa infecção. (AU)

Clinical and demographic features of minor salivary gland tumors: A collaborative study of 480 cases.

OBJECTIVE: To describe the frequency, clinical, and demographic features of minor salivary gland tumors and possible associated factors. MATERIALS AND METHODS: A cross-sectional study was conducted. Clinical and demographic data were collected from biopsy records of two oral pathology services. Chi-square test, Fisher's exact test, and descriptive statistical analysis were performed. RESULTS: A total of 480 (0.89%) minor salivary gland tumors were retrieved, 272 (56.7%) benign and 147 (30.7%) malignant. Sixty-one (12.6%) had no subtype specification. Most patients were women (307/64.0%), in sixth decade of life (80/16.7%), with a mean age of 45.32 years. Palate was the most common site (336/70.1%). Pleomorphic adenoma (PA; 245/51.1%), mucoepidermoid carcinoma (MEC; 70/14.6%), and adenoid cystic carcinoma (ACC; 43/8.9%) were the most frequent tumors. Symptomatic case, recurrence, and tobacco use were associated with malignancy (p < 0.05). PA and MEC were more frequent in palate (p < 0.05). No association between the three most frequent histological types and gender or age group was observed (p > 0.05). CONCLUSIONS: This represents one of the largest exclusive series of minor salivary gland tumors in Brazil and worldwide. PA, MEC, and ACC were the most frequent tumors. Clinical and demographic data are similar from Brazilian studies or from other countries.

A survey on brazilian dentists' awareness, perception, and knowledge of bisphosphonates

Aim: The purpose of the study was to analyze the knowledge of dentists in Belo Horizonte, Brazil, about bisphosphonates and their clinical implications. Methods: A cross-sectional questionnaire-based study was conducted with a convenience sample of dentists in Belo Horizonte, in a period of 8 weeks. The questionnaire was self-applied and was structured with 10 items about the dentists' demographic characteristics, professional profile, and knowledge about bisphosphonates. Associations in the data were analyzed by with the Fischer's exact test with a significance level of 5%. Results: Of the 214 participating dentists, 163 (76.17%) were women, and 51 (23.83%) were men, with age ranged for 21 to 73 years (mean of 30 years) and mean of 6 years of professional activity. Nearly half (106/49.53%) reported having knowledge about bisphosphonates, and undergraduate courses were the primary source of such information (73/34.11%). Osteoporosis was the most identified indication for use (75/35.04%), although no participants correctly identified all indications. Regarding the drugs' side effects, only three dentists (1.40%) could correctly identify all responses, with bone necrosis being recognized by the majority (88/41.12%). Sodium alendronate (54/25.23%) and sodium ibandronate (15/7.01%) were the most identified examples of bisphosphonates. Last, only nine dentists (4.20%) could identify all examples of the drugs, and their capacity was associated with self-reported knowledge (p<0.05). Conclusions: More information about bisphosphonates should be disseminated in Belo Horizonte, ideally via better approaches in local undergraduate and postgraduate courses. Until then, knowledge of the basic aspects of bisphosphonates will remain limited

Assessment of screening programs as a strategy for early detection of oral cancer: a systematic review.

The present study is a systematic review of the evaluation of screening programs as a strategy for early detection of oral cancer. The aim of this study was to assess whether screening through visual inspection is able to identify injuries in early stages, to increase survival, and to decrease the incidence and mortality of oral cancer. Studies using visual inspection to screen for oral cancer and potentially malignant lesions in apparently healthy individuals over 18 years without previous diagnosis of the disease were included. The MEDLINE/PubMed, Cochrane databases Library, EMBASE, and LILACS, including manual search and gray literature, were searched through January 2021 with no language or date restrictions. The risk of bias and the methodological quality were evaluated according to the appropriate tool for each study design. The analysis of the results was narrative. Seventeen studies were reviewed that included cohort, accuracy, and randomized clinical trial studies. The tracking type performed was opportunistic and organized in a variety of environments. The age of participants ranged between 18 and 60 years old and, in some programs, only people with risk habits for oral cancer were included. The screeners were healthcare professionals, physicians, and dentists. Two studies reported data on the incidence rate of severe cases and mortality and showed a reduction when patients were at risk for the disease and participated in the program more than once. A limitation of this review was the great variability observed in the estimates of the screening effectiveness among the studies, which made comparisons difficult. If a screening program is continuous and able to ensure the inclusion of high-risk individuals, it can contribute to improvement in survival rates with a change of stage and can have a significant impact on incidence and mortality due to the disease. Registration in the Open Science Framebook (OSF) with the osf.io/zg8nr link.

Lip carcinoma mimicking keratoacanthoma: case reports / Carcinoma de lábio mimetizando queratoacantoma: relato de casos

ABSTRACT Oral amyloidosis is a disease characterized by extracellular and irreversible deposition of amorphous and fibrillar proteins in the oral cavity, being strongly associated with Multiple Myeloma. The objective of this study is to report a case of a 62-year-old woman diagnosed with Multiple Myeloma who, approximately 2 years after starting treatment for the underlying disease, presented a lesion on the lateral border of the tongue with exophytic growth, pinkish color, vascularized, painless, measuring 3cm in its largest diameter. After histopathological analysis through incisional biopsy, a final diagnosis of amyloidosis was obtained. As a local treatment, we opted for complete excision of the lesion. The patient evolved to death due to Multiple Myeloma influenced by the diagnosis of systemic amyloidosis. Oral amyloidosis is usually associated with the systemic presentation of the disease, making it necessary to conduct a thorough investigation of other organs. Its diagnosis is important since the prognosis is directly related and can negatively influence survival rates and treatment of the underlying disease.

RESUMO A amiloidose oral é uma doença caracterizada pela deposição extracelular e irreversível de proteínas amorfas e fibrilares na cavidade bucal, sendo fortemente associada com Mieloma Múltiplo. O objetivo deste trabalho é relatar o caso de uma mulher com 62 anos de idade diagnosticada com Mieloma Múltiplo que, aproximadamente 2 anos após o início do tratamento para a doença de base, apresentou lesão em borda lateral de língua com crescimento exofítico, de coloração rósea, vascularizada, indolor, medindo 3 cm em seu maior diâmetro. Após análise histopatológica através de biópsia incisional, obteve-se diagnóstico final de amiloidose. Como tratamento local, optou-se pela exérese completa da lesão. A paciente evoluiu para óbito por consequência do Mieloma Múltiplo com complicações associadas à amiloidose sistêmica. A amiloidose oral geralmente está associada com a apresentação sistêmica da doença, tornando necessária uma investigação aprofundada nos demais órgãos. Seu diagnóstico é importante uma vez que pode influenciar diretamente no prognóstico e, consequentemente, negativamente nas taxas de sobrevida e no tratamento da doença de base.

Juvenile Spongiotic Gingival Hyperplasia: Clinicopathological Features of Eight Cases and a Literature Review.

BACKGROUND: Juvenile spongiotic gingival hyperplasia (JSGH) is a benign proliferation of non-keratinised stratified squamous epithelium with evident spongiosis, exocytosis leukocytes and dilated vessels with varying numbers of inflammatory cells. Although uncertain, it has been suggested that the epithelial proliferation is probably related to trauma and local irritants. It emerges as a painless erythematous patch or papule with an irregular surface. CASE REPORTS: We present a series of eight cases and a literature review of the clinical presentation and treatment approaches for JSGH. This series includes four females and four males with a mean age of 11.6 years, all complaining of injury to the gums. All lesions were painless and not bleeding. One patient associated the lesion with the onset of trauma and another with a previous history of an eruption cyst. Periapical radiographs of the adjacent area did not show any alteration of bone or teeth. Based on these findings, the diagnostic hypotheses were a non-neoplastic proliferative process or a factitious injury. Incisional biopsy was performed and histopathologic diagnosis was conclusive for JSGH. Surgical excision was conducted in three cases, and the other five cases were supported by clinical observation and plaque control in order to prevent gingival recession defects. After a follow-up period of 11 months (mean), no recurrence was observed for surgically treated cases and mild improvement was achieved with periodontal treatment. CONCLUSION: This case series illustrates the importance of diagnosis and follow-up of patients with JSGH. A conservative approach consisting of basic periodontal support instead of surgical excision may be indicated because of the risk of aesthetic defects at the involved areas.

Experience with 5% ethanolamine oleate for sclerotherapy of oral vascular anomalies: A cohort of 15 consecutive patients.

PURPOSE: To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing. MATERIALS AND METHODS: We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed. RESULTS: Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly. CONCLUSION: The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

The use of social networks in scientific research with questionnaires

Aim: The aim of this study was to determine the response rate of the SF-36 quality of life questionnaire sent and received by mail and over a social network to caregivers of individuals with epidermolysis bullosa (EB) in Brazil. Methods: All volunteers were first-degree relatives of patients with EB that directly spent time helping them with their basic activities of daily living. A maximum of two caregivers per patient could answer the questionnaire. Volunteers were divided into two groups: for group 1, questionnaires were sent to 53 members of a support association for the disease by mail, and for group 2, 798 members of the Facebook™ page of friends and relatives of patients with EB were invited to participate using an access link to Google Drive™ to gain access to the questionnaire. The data from both groups were analyzed 150 days after the start the study. Descriptive analysis was performed by EpiInfo8 and the return of questionnaires was evaluated according to age, sex, and time of return using the Chi-squared and Fisher's exact test. Results: After 150 days, 30 questionnaires were returned, 17 (56.7%) of which from group 1 and 13 (43.3%) from group 2. Approximately 12 questionnaires were returned by mail and 11 over the social network. Conclusions: The data collection of the SF-36 quality of life questionnaire from caregivers of individuals with EB over a social network seems to be efficient mainly when it is necessary to collect results within a short timeframe, highlighting the importance of social networks as a means for conducting this type of research. However, in our study, the most efficient method was distributing the questionnaires by mail

Multiple oral radiopaque masses leading to Gardner's syndrome diagnosis.

Gardner's syndrome, an autosomal dominant syndrome, is linked to familial adenomatosis polyposis (FAP), which is known mainly as a colorectal disease. FAP also presents extracolonically as intestinal polyposis, multiple osteomas, cutaneous cysts, or fibromas. This article reports the case of a 66-year-old white woman who was referred to the Oral Medicine Clinic, School of Dentistry, Universidade Vale do Rio Verde, Brazil, for evaluation of multiple sclerotic, asymptomatic masses in the jaws that were observed in a routine periapical radiographic exam by a dentist. The patient presented with intestinal poliposis, periosteal osteoma in the face, and fibromas and multiple endosteal osteomas in the maxilla, which are indications of Gardner's syndrome. The clinical differential diagnosis included multiple buccal exostoses, idiopathic osteosclerosis, cemento-osseous dysplasias, multiple odontomas, osteomas, and Gardner's syndrome. Patients with a suspected diagnosis of Gardner's syndrome should be referred to a dermatologist, have a colonoscopy performed, and be followed up by a dentist.

Desmoplastic fibroblastoma (collagenous fibroma): a case identified in the buccal mucosa.

Desmoplastic fibroblastoma is a rare, benign, soft tissue tumor affecting mainly the subcutaneous and muscle tissue. Only five cases identified in the oral cavity have been reported in prior literature. This article presents a case report of a 56-year-old man, with no previous history of trauma, who presented a slow-growing mass in the buccal mucosa. Histopathology and immunohistochemistry staining studies were performed, and a diagnosis of the desmoplastic fibroblastoma was made. The patient has been disease-free for one year.

Oral mucosal conditions in chronic hepatitis C Brazilian patients: a cross-sectional study.

OBJECTIVE: Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. METHODS: A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. RESULTS: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant (P = 0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). CONCLUSION: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.

Hepatite C: uma revisão para dentistas / Hepatitis C: a review for dentists

Neste trabalho, os autores fazem uma revisão de literatura sobre a hepatite C ressaltando aspectos importantes da doença, tais como a epidemiologia, a virologia, a transmissão, o diagnóstico, a história natural, as manifestações extra-hepáticas, o tratamento e as manifestações bucais e sistêmicas relevantes para os cirurgiões-dentistas.

Risk factors for oral hairy leukoplakia in HIV-infected adults of Brazil.

BACKGROUND: Oral hairy leukoplakia (OHL) may be an indicator of the progression of Human Immunodeficiency Virus (HIV)-induced immuno-depression, and the evaluation of risk factors leading to OHL is important in the management of these HIV-infected patients. However, there are few studies that analyze risk factors leading to OHL in the Brazilian population. The aim of this case-control study is to present data about prevalence rates and risk factors leading to OHL in a sample of HIV-infected adults in Brazil. METHODS: This case-control study included 111 HIV-infected patients treated at a clinic for sexually transmitted diseases and HIV. In the initial examinations with dentists, variables were collected from all patients. Diagnosis of OHL was performed in accordance with the International Classification System and cytological features. The Fisher and the chi-squared tests were used for statistical analysis. The proportional prevalence and odds ratio were estimated. RESULTS: Outcome presented a positive, statistically significant association among the presence of OHL and viral load of 3000 copies/mul or greater (P = 0.0001; odds ratio (OR) = 5.8), presence of oral candidiasis (P = 0.0000; OR = 11.1), previous use of fluconazole (P = 0.0000; OR = 24.6), and use of systemic acyclovir (P = 0.032; OR = 4.3). Antiretroviral medication presented a negative, statistically significant association with the presence of OHL (P = 0.002; OR = 8.4). CONCLUSIONS: Prevalence of OHL was 28.8%. Viral load, oral candidiasis, previous use of fluconazole, and systemic acyclovir were determined to be risk factors for OHL. Antiretroviral medication proved to be protective against the development of OHL.

Líquen plano bucal e hepatite C / Oral lichen planus and hepatitis C

O Líquen Plano bucal tem sido relacionado com o vírus da Hepatite C, com achados ainda inconclusivos, não estando, ainda estabelecida, se essa associação é real ou ocasional. Esse trabalho tem por objetivo revisar a literatura atual sobre a prevalência da relação entre o Líquen Plano bucal e a Hepatite C, com levantamento de dados e discussão crítica dos achados. Embora estudos surgiram uma asociação loco regional, a relação entre o Líquen Plano bucal e hepatite C não está, ainda totalmente estabelecida, sendo necessárias maiores investigações.

Estudo epidemiológico de lesöes bucais de líquen plano do laboratório de patologia bucal da Faculdade de Odontologia da Universidade Federal de Minas Gerais / Epidemiologic study of oral lichen planus from Oral Pathology Laboratory, School of Dentistry of Minas Gerais Federal University

O líquen plano (LP) é uma doença inflamatória mucocutânea crônica de aparecimento comum na populaçäo e provavelmente mediado por linfócitos T. Pode apresentar-se sob várias formas clínicas, o que dificulta o seu reconhecimento. Existem controvérsias na literatura sobre a possível associaçäo do LP com várias alteraçöes sistêmicas, e com o carcinoma epidermóide de boca. Objetivou-se, com esse trabalho, o levantamento retrospectivo dos dados epidemiológicos referentes aos casos de líquen plano bucal da Faculdade de Odontologia da UFMG, e a avaliaçäo da correlaçäo entre os diagnósticos clínicos e histopatológicos. O trabalho discute a necessidade de melhor conhecimento, pelo cirurgiäo-dentista, sobre as várias formas de apresentaçäo clínica desta alteraçäo, assim como a necessidade de estabelecimento do diagnóstico diferencial com outras lesöes que podem ser confundidas clinicamente com o LP