Oral health and quality of life of people living with human T-cell leukemia virus-1 in Salvador, Brazil: a cross-sectional study.

OBJECTIVE: To compare the oral health status and oral health-related quality of life (OHRQoL) in symptomatic and asymptomatic patients with human T-cell leukemia virus-1 (HTLV-1). MATERIAL AND METHODS: This cross-sectional study included 204 seropositive patients, classified into two groups, symptomatic and asymptomatic. The first group included patients with neurological symptoms associated with HTLV-1 (n = 69), and the second group, asymptomatic HTLV-1 carriers (n = 135). We evaluated the total unstimulated saliva flow, oral mucosa, the Decayed, Missing, Filled Teeth (DMFT) index, and Periodontal Screening and Recording (PSR). The Oral Health Impact Profile (OHIP14) measured the oral health-related quality of life. General health-related quality of life was measured by the 36-Item Short-Form Health Survey (SF-36). Variables with a value of p < 0.25 in bivariate analysis were selected, together with SF-36 summaries' scores and total OHIP-14, for composing a logistic regression model that had symptomatology as the dependent variable. RESULTS: The OHIP-14 total score was poor in symptomatic and asymptomatic groups, but with no marked difference between them. Symptomatic patients showed significantly lower SF-36 scores (P ≤ 0.05) compared to asymptomatic ones, except for mental component summary (MCS). Family income (1-2.99 minimal wages), reduced salivary flow, flossing, and lower physical component summary (PCS) were associated (P ≤ 0.05) with symptomatology. CONCLUSIONS: Symptomatic individuals living with HTLV-1 showed lower HRQoL and poorer OHRQoL compared to asymptomatic ones. Family income, flossing, reduced salivary flow, and lower PCS were associated with symptomatic HTLV-1 individuals. CLINICAL RELEVANCE: In the present study, symptomatic individuals with HTLV-1 showed higher family income, poorer oral health status, lower salivary flow, poorer OHRQoL, and lower HRQoL compared to asymptomatic ones.

Obesity in young women is positively associated with periodontitis.

OBJECTIVE: This cross-sectional study was performed to investigate the association between excess body weight and periodontitis in adults, stratified by sex and age, and using different criteria for obesity. MATERIAL AND METHODS: Enrolled in the study were 345 individuals with a minimum age of 18 years who had attended the Public Health Service in the city of Salvador, Bahia, Brazil. All individuals underwent a complete periodontal examination and anthropometric measurements and answered a questionnaire regarding their socioeconomic, demographic, health, and lifestyle conditions. Excess body weight (exposure factor) was defined using body mass index (BMI) and waist circumference (WC). Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were obtained by Poisson regression analysis with robust variance. RESULTS: Periodontitis was found in 74.2% of study participants, with the disease being more prevalent among those individuals with increased WC. The occurrence of overweight was 44.4% and that of obesity ranged from 29.9 to 70.8%, dependent upon the specific definition of obesity that was used. There was a positive association between obesity (WC > 88 cm) and periodontitis only among women, after adjustment for age, smoking habit, education level, diabetes, and family income (PRadjusted: 1.20; 95%CI: [1.01-1.44]). The magnitude of this positive association was higher among women aged 18 to 49 years when the outcome was severe periodontitis, and the exposure was obesity defined by WC. CONCLUSIONS: The findings draw attention to the high frequency of the diseases investigated: overweight, obesity and periodontitis. Moreover, obesity was positively associated with periodontitis in women and younger individuals, demonstrating that among those with obesity, there is a higher probability of having periodontitis. The smaller number study of men in the may have influenced the non-statistically significant association found in that group. CLINICAL RELEVANCE: Obese females and younger people are more likely to also have periodontitis. Periodontal evaluation and clinical management of individuals with obesity is recommended.

A Comparative Study of Multidetector Computed Tomography, Cone Beam Computed Tomography, and Computed Microtomography on Trabecular Bone Structures in the Human Mandible: An Ex Vivo Study.

OBJECTIVE: The aim of this study was to evaluate the accuracy of multislice computed tomography (MSCT) and cone beam computed tomography (CBCT) scanners in the assessment of trabecular bone microarchitecture by radiomorphometric analysis. METHODS: Eight dry human hemimandibles were selected and scanned by 4- and 128-MSCT, CBCT with different voxel sizes, and a computed microtomography (micro-CT). The images were spatially aligned, the axial slices were segmented using CTAn software (Skyscan, Konitch, Belgium), and 10 bone morphometric parameters were quantified. The micro-CT images were the criterion standard. RESULTS: The results show the superiority of CBCT images with 0.2-mm voxel size and 128-MSCT. CONCLUSIONS: We can conclude that the CBCT scanner with 0.2-mm voxel size and 128-MSCT had better performance on reproducibility of the distribution and organization of trabecular bone and marrow spaces evaluated in this study.

Oral health and health-related quality of life in HIV patients.

BACKGROUND: Oral health care may improve the health-related quality of life (HRQoL) of HIV/AIDS patients. We aimed to evaluate oral health and HRQoL of HIV/AIDS patients using antiretroviral therapy. METHODS: A cross-sectional study included 120 HIV-infected patients, aged ≥18 years, from February, 2016 to September, 2017. The 36-Item Short Form Health Survey (SF-36) was used to evaluate the HRQoL. We assessed dental caries status using the Decayed, Missing and Filled Teeth (DMFT) index. Information about demographic, socioeconomic status, depression, and other comorbidities were collected. All patients with depression had a medical diagnosis. Comorbidities were defined as medical diagnoses of arterial hypertension, type-2 diabetes, tuberculosis, syphilis, cardiopathy, chronic renal failure, lymphoma, HCV infection, HBV infection and fatty liver disease. Independent t-tests were used to compare differences between mean levels of HRQoL, age, and DMFT and its components according to groups of sex, comorbidities and depression. Simple linear regression was used to analyze the relationship between the Mental Component Summary (MCS) and DMFT, and a multiple regression equation investigated depression, age, MCS, and comorbidities as predictors of DMFT. RESULTS: The mean DMFT index was 12.4 ± 8.2. A linear regression equation estimated a significant (p = 0.022) decrease of 0.25 unit (%) in MCS for each unit increase in DMFT. Among depressed patients, a significant (p = 0.008) decrease of 0.67% in MCS for each unity increase in DMFT was estimated. Depressed patients showed worse oral health indicators (DFMT index; p ≤ 0.001; and mean Missing Teeth; p ≤ 0.052) and lower HRQoL domains than non-depressed patients. DMFT remained associated with depression (P < 0.005) after controlling for age, MCS, and comorbidities. CONCLUSIONS: We found association between poorer oral health (higher DMFT index) and lower Mental Health Component Summary in HIV-infected patients with depression. Patients with depression deserve especial attention to their HRQoL and oral care.

Comparison of two visual methods for detecting caries among obese and non-obese children.

OBJECTIVE: The study aimed to compare two visual methods for detecting caries among obese and non-obese children in Salvador, Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted from 2011-2012, which evaluated 180 paediatric patients, 6-14 years old, girls and boys, categorized into two groups: obese and non-obese (healthy weight), according to the body mass index. For the evaluation of dental caries, the decayed, missing or filled teeth index (DMFT/dmft) and International Caries Detection and Assessment System II (ICDAS II) visual criteria were used. RESULTS: The mean DMFT value was 0.98 in obese children and 0.57 in the non-obese children, without significant differences between groups (p = 0.206). The mean dmft value in the non-obese children (1.66) was higher than in obese children (0.95), with significant differences between groups (p = 0.021). According to ICDAS II criteria, there was a higher prevalence of non-cavitated enamel lesions (D1-3) in obese children (n = 156, 10.5%) compared to the non-obese children (n = 55, 1.9%), with significant differences between the groups (p < 0.001). CONCLUSIONS: The inclusion of non-cavitated lesions during the caries evaluation represents a challenge in diagnosis, which allows for control of this process before the evolution of these lesions to cavitation.

Mandibular ramus length as an indicator of chronological age and sex.

Age and sex estimation is crucial in forensic investigations, whether in legal situations that involve living people or to identify mortal remains. The aim of this study was to establish reference values in a Brazilian population to estimate age and sex by measuring the length of the mandibular ramus on lateral cephalometric radiographs, and to determine the probability that an individual being is 18 years or older, based on the results that were obtained. Two hundred and eighteen scanned lateral cephalograms of individuals between 6 and 20 years of age (101 males and 117 females) were measured with reference to mandibular ramus length (the distance between Condylion superior (Cs) and Gonion (Go)) using ImageJ 1.41 software (NIH, Bethesda, MA, USA). The results showed that sexual dimorphism was not observed until 16 years and, based on the ramus length measurements in this sample, it is possible to predict sex with an accuracy of only 54 %. There was a positive correlation between age and ramus length (r = 0.90; p < 0.001). From the linear regression analysis, one formula was derived; therefore, it was possible to calculate the individual's age, given his or her ramus length. The results showed that if an individual's ramus length is 7.0 cm or more, then there is an 81.25 % chance that the individual is 18 years old or older. In conclusion, the mandibular ramus length was not effective in discriminating sex. Mandibular length is strongly related to chronological age and can be used to predict whether an individual is 18 years or older with high degree of expected accuracy.

LED and laser photobiomodulation in the prevention and treatment of oral mucositis: experimental study in hamsters.

PURPOSE: This paper aims to evaluate the effects of laser (660 nm) and light-emitting diode (LED) (670 nm) irradiation in the cheek pouch mucosa of hamsters with oral mucositis (OM) induced by chemotherapy (Che) with 5-fluorouracil (5-FU). MATERIALS AND METHODS: In the preventive groups, the photobiomodulation was started 1 day before the drug administration and was performed every 48 h (Ia, IIa, Ib, and IIb). In the therapeutic groups (IIIa, IIIb, IVa, and IVb), the irradiations were started on the third day after the Che d(0) and was performed every 48 h. In both groups, animals were sacrificed 7 or 14 days after Che. In the positive control groups, the hamsters were subjected to Che but did not receive irradiation, and they were sacrificed in 7 days (Va) or 14 days (Vb). In the negative control groups, no procedures were done and the animals were sacrificed 7 days (Vc) or 14 days (Vd) after the experiment started. RESULTS: The results indicated loss of body mass, xerostomia, and alopecia in the animals subjected to Che and the healing of OM to different degrees after the photobiomodulation treatment. Histologically, the positive control and experimental groups showed inflammation, predominately with lymphocytes and plasma cells, which tended to diminish with time. Epithelial atrophy, hyperemia, fibroblast proliferation, and vascular congestion were also observed at those intervals. CONCLUSIONS: The best results were obtained from the preventive laser and LED photobiomodulation groups; both treatments were effective in diminishing the OM lesions. CLINICAL RELEVANCE: A noninvasive and effective method with sparse side effects of OM would be desirable for use in cancer centers around the world.

Evaluation of Mandibular Bone Microstructure in CT Scans of People with Sickle Cell Disease.

OBJECTIVE: Sickle cell disease (SCD) is a common inherited disease, and is characterized by a genetic modification that determines the production of a hemoglobin with altered morphology. This anatomical change of hemoglobin leads to vaso-occlusive disorders and premature hemolysis of the cell, causing chronic anemia and bone marrow hyperplasia due to increased hematopoietic demand. As a consequence, several skeletal changes are reported in the skull, spine, ribs, pelvis, femur, and metatarsals. In the craniofacial region, dentofacial deformities are described, especially maxillary protrusion. However, studies evaluating bone microarchitecture are scarce. The aim of this study is to evaluate the mandibular bone microstructure of people with SCD on computed tomography (CT) scans. MATERIALS AND METHODS: Morphometric parameters were analyzed on CT scans of the mandible of people with SCD and people without this disease or any other disease affecting bone metabolism, matched for sex and age. STATISTICAL ANALYSIS: The results were compared by Student's t-test for paired samples and for an error probability of 5%. RESULTS: This study demonstrated that the mandibular bone of people with SCD presents significantly less number, connectivity and thickness of bone trabeculae, as well as having a lower fractal dimension and greater porosity. CONCLUSION: Mandibular bone of people with SCD has lower bone density and more widely spaced trabeculae.

Evaluation of the quality of different endodontic obturation techniques by digital radiography.

OBJECTIVES: This study was aimed to evaluate different endodontic obturation techniques (Thermafil, lateral condensation, and Tagger's hybrid technique) regarding the homogeneity of the obturation radiopacity. MATERIALS AND METHODS: Seventy roots of human upper central incisors were filled using the Thermafil system, lateral condensation. and Tagger's hybrid technique. Radiopacity of the filling was evaluated based on mean of grey levels, and its homogeneity was assessed by the coefficient of variation (CV), analyzing the histograms obtained of digitized and digital radiographs. RESULTS: The increase in mean grey levels (p < 0.001) and reduction in the CV (p < 0.05) were higher for Tagger's hybrid technique compared with other methods. CONCLUSIONS: Tagger's hybrid technique provided better homogeneity of the obturation radiopacity and better apical sealing compared with lateral condensation technique. CLINICAL RELEVANCE: The results suggest that Tagger's hybrid technique provided the best compaction of the root canal filling material, an important factor for the sealing of obturations and, consequently, for the effectiveness of treatment.

Application of two segmentation protocols during the processing of virtual images in rapid prototyping: ex vivo study with human dry mandibles.

OBJECTIVES: The aim of this study was to evaluate the accuracy of virtual three-dimensional (3D) reconstructions of human dry mandibles, produced from two segmentation protocols ("outline only" and "all-boundary lines"). MATERIALS AND METHODS: Twenty virtual three-dimensional (3D) images were built from computed tomography exam (CT) of 10 dry mandibles, in which linear measurements between anatomical landmarks were obtained and compared to an error probability of 5 %. RESULTS: The results showed no statistically significant difference among the dry mandibles and the virtual 3D reconstructions produced from segmentation protocols tested (p = 0,24). CONCLUSIONS: During the designing of a virtual 3D reconstruction, both "outline only" and "all-boundary lines" segmentation protocols can be used. CLINICAL RELEVANCE: Virtual processing of CT images is the most complex stage during the manufacture of the biomodel. Establishing a better protocol during this phase allows the construction of a biomodel with characteristics that are closer to the original anatomical structures. This is essential to ensure a correct preoperative planning and a suitable treatment.

Impact of Anxiety on Health-Related Quality of Life and Symptoms of Burnout in Multi-Professional Residents in Brazil During the COVID-19 Pandemic.

We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

Work ability and associated factors in people living with human T-cell leukemia virus type 1.

BACKGROUND: Infection with the human T-lymphotropic virus type 1 (HTLV-1) affects an estimated 10-15 million people worldwide. However, knowledge of the impact of HTLV-1 infection on work ability is lacking. This study aimed to measure the frequency and identify factors associated with poor work ability in patients living with HTLV-1. METHODS: This cross-sectional study included 207 individuals infected with HTLV-1 who attended the University Hospital in Salvador, Bahia, Brazil. HTLV-1 antibodies were detected in the participants' blood by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blotting. Participants answered a questionnaire on sociodemographic data, personal habits, clinical data, health-related quality of life, and work ability, evaluated using the work ability index questionnaire. A Poisson regression model with a robust variance estimate was used to identify the factors associated with the prevalence of poor work ability. RESULTS: Patients mean age was 55.2, ranging from 19 to 84 years, 73.0% were females, 100% had monthly family income less than US$ 394, and 33.8% presented HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). No individual was classified as having excellent work ability. Poor work ability prevalence was strongly associated (prevalence ratio; 95% confidence interval [CI]) with sedentarism (1.30; 1.03-1.65), neurological symptoms (1.25; 1.02-1.52), and low physical (0.95; 0.94-0.96) and mental (0.98; 0.97-0.99) component summaries of health-related quality of life. CONCLUSIONS: Poor work ability among people living with HTLV-1 is associated with sedentarism, neurologic symptoms, and low health-related quality of life.

Gene expression profile of chronic oral graft-versus-host disease.

Among the complications observed after allogeneic hematopoietic stem cell transplantation, graft-versus-host disease (GVHD) is the primary cause of post-transplant mortality. The oral cavity is the second most affected organ target in chronic GVHD. Tissue damage results from the upregulation of inflammatory mediators, which play a critical role in the immunopathogenesis of the disease. This case series observational study aims to evaluate the participation of cytokines, chemokines, transcription factors, and heat shock proteins in the pathogenesis of oral GVHD (oGVHD), describing the mRNA expression of 28 genes selected. Peripheral blood mononuclear cells were isolated from six participants with oGVHD and two without GVHD, and relative expression of transcripts with established roles as inflammatory mediators was determined in triplicate using the human RT2 Profiler™ PCR Array. The gene expression levels in the group with oGVHD were mainly up-regulated compared to those without GVHD. PBMC from oGVDH expressed consistently higher IFN-γ, TNF, IL-1ß, CCL2, HSP60 (HSPD1) and HSP90 (HSP90B1). These results can provide a basis for developing new molecular diagnostics and targets therapies for the clinical management of oGVHD.

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles.

INTRODUCTION: Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce. OBJECTIVES: The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT). METHODS: Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard. RESULTS: There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size. CONCLUSIONS: The linear measurements on reformatted panoramic views are reliable.

Clinical and Laboratory Profile of People Living with HIV/AIDS with Oral Kaposi Sarcoma.

The aim of this article was to evaluate the clinical and laboratory profile of people with oral Kaposi's sarcoma (KS) associated with AIDS (KS-AIDS), followed-up at a public university hospital in Salvador, Bahia, Brazil, in the past 10 years. We identified patients diagnosed with KS-AIDS, presenting oral manifestation from January 2007 to December 2017. We searched, in the hospital information systems, the patient demographics, diagnostic data, treatment, image studies, and oral photographic records. Of the 39 cases of KS-AIDS identified at the institution, 14 (22.8%) presented oral lesions. There was a predominance of black men, with a mean age of 32.5 years. Most cases (85.1%) manifested signs of KS simultaneously with the diagnosis of HIV infection, with extremely low initial CD4 T cell counts (average of 52.6 cells/mm2) and visceral involvement (64.3%). The palate (32.1%) and gingiva (21.4%) were the most affected oral sites. Histologically, the tumors exhibited proliferation of spindle cells between vascular clefts and extravasated erythrocytes. Oral KS-AIDS was frequent in young black adult men, with severe immunosuppression and high viral load counting, mostly with lesions manifested in the same period of diagnosis of infection by the HIV.

Corticosteroid Use and Periodontal Disease: A Systematic Review.

Periodontitis affects the teeth supporting structures, such as periodontal tissues. We aimed to evaluate the association between periodontal disease and corticosteroid use. We searched in MEDLINE, Web of Sciences, SCOPUS, LILACS, and Cochrane databases, using the descriptors "Periodontal diseases" AND ("adrenal cortex hormones" OR "adrenal cortex hormones" OR ("adrenal" AND "cortex" AND "hormones") OR "adrenal cortex hormones" OR "corticosteroid"). We selected the summaries of observational studies, addressing periodontal disease in patients using corticosteroids. The search resulted in 403 articles. After applying the selection criteria, eight studies remained; being two retrospective cohorts and six cross-sectional studies. There are few studies with appropriate methodology to produce sound evidence about the causal relationship between the use of corticosteroids and periodontitis. However, two retrospective cohorts confirmed that chronic corticosteroid use is associated with the incidence of periodontal disease. Dental staff must be aware of this association for better management of periodontal disease therapy in patients using corticosteroids.

Oral health-related quality of life in individuals with severe asthma.

OBJECTIVE: To evaluate oral health-related quality of life (OHRQoL) among individuals with severe asthma, comparing it with that observed among individuals with mild-to-moderate asthma and individuals without asthma. METHODS: We conducted a cross-sectional study of 125 individuals: 40 with severe asthma; 35 with mild-to-moderate asthma; and 50 without asthma. We calculated the decayed, missing, and filled teeth (DMFT) index, as well as the Periodontal Screening and Recording index, and determined the stimulated salivary flow rate. We applied three structured questionnaires: the 14-item Oral Health Impact Profile (OHIP-14); the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2); and the Work Ability Index (WAI). RESULTS: Periodontitis and reduced salivary flow were both more common in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups. In addition, the WAI scores were lower in the severe asthma group than in the mild-to-moderate asthma and no-asthma groups, as were the scores for all SF-36v2 domains. The individuals with severe asthma also scored lower for the OHIP-14 domains than did those without asthma. Although the mean DMFT index did not differ significantly among the groups, the mean number of missing teeth was highest in the severe asthma group. Strong correlations between the SF-36v2 Component Summaries and poorer OHRQoL were only observed in the severe asthma group. CONCLUSIONS: Severe asthma appears to be associated with poorer oral health, poorer OHRQoL, a lower WAI, and lower scores for SF-36v2 domains.

Orofacial manifestations of mucocutaneous leishmaniasis: a case series from Brazil.

The dental surgeon plays a fundamental role in the early diagnosis of oral leishmaniasis, since oral mucosa may be the primary site of the disease manifestation. This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had mucocutaneous leishmaniasis with oropharyngeal involvement confirmed by laboratory tests. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dental surgeon. In two reported cases, there were unspecific biopsy results. The multidisciplinary approach plays an important role in orofacial leishmaniasis diagnosis and treatment. Leishmaniasis should be investigated in case of atypical and persistent lesions in patients from endemic regions. This recommendation may avoid diagnosis delays and decrease dissemination of the disease.

Expression of Ki-67, p53 and p63 proteins in keratocyst odontogenic tumours: an immunohistochemical study.

AIM: To investigate the immunohistochemical expression of Ki-67, p53 and p63 in Keratocyst Odontogenic Tumours (KOTs) in order to contribute to the biological profile of this tumor. METHODS: Immunohistochemical technique was performed using the EnVision System in 37 cases of KOTs. RESULTS: Ki-67- and p53-immunostained cells were mainly located in the suprabasal layers. p63-positive cells were found throughout the lining cystic epithelium. No difference in the immunostaining for these proteins was observed between primary and recurrent KOTs (Ki-67: P = 0.5591; p53: P = 0.9847; p63: P = 0.9127), or between KOTs associated with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) and sporadic KOTs (Ki-67: P = 0.7013; p53: P = 0.3197; p63: P = 0.2427). CONCLUSIONS: It is possible that biological behavior of KOTs may be related to suprabasal proliferative compartment in the cystic epithelium as observed by high levels of Ki-67, p53 and p63. In addition, p63 immunostaining may represent immaturity of keratinocytes in KOTs, and suggests that this protein may participate in the regulation of epithelial cell differentiation. Taken together, these data may favor tumorigenesis on KOTs.

Evaluation of Antibiotic Prophylaxis Prescriptions for Infectious Endocarditis Before Oral Procedures Between Cardiologists and Dentists

Abstract Background Infective endocarditis (IE) is a serious disease with a high mortality rate. Antibiotic prophylaxis for bacterial endocarditis before invasive procedures has been recommended in patients with predisposing cardiac conditions since 1960, but contemporary guidelines worldwide have proposed changes. Objective To evaluate the knowledge and pattern of prescription by cardiologists and dentists regarding antibiotic prophylaxis for bacterial endocarditis before risky oral procedures. Methods This is an observational and cross-sectional study. Data were obtained from an online questionnaire, sent to cardiologists and dentists linked to specialty societies, in the first semester of 2021. Data analysis was performed using descriptive statistics, and comparisons between variables were done in an exploratory approach. The significance level adopted was 5%. Results From 613 responders, 82.5% of cardiologists and 79.5% of dentists reported prescribing antibiotic prophylaxis for patients at high and moderate risk for IE. Of dental procedures capable of generating bacteremia, all were correctly identified by more than 50.0% of the sample. As for the habits of daily living, flossing and toothbrushing had almost 50.0% of correct answers, chewing had only 17.3%, and 40.9% reported that none of the actions presented a risk of bacteremia. When comparing variables, the correct prescription of amoxicillin (2 g, 30-60 minutes before the procedure) was more prevalent among cardiologists and in responders with less than 20 years of graduation (p<0.01). Conclusion In the present study, the prescription of antibiotic prophylaxis for IE were frequent for high- and moderate-risk patients, before oral/dental procedures. Partial knowledge was found about endocarditis, which highlights the need for continuous medical/dental education.