The need for communication between clinicians and pathologists in the context of oral and maxillofacial diseases

Abstract Good communication between clinicians and pathologists is a vital element in the diagnostic process, and poor communication can adversely affect patient care. There is a lack of research about communication in diagnostic oral and maxillofacial pathology. This narrative review explores different aspects of the quality of communication between clinicians and oral pathologists, with a focus on the diagnosis of oral and maxillofacial diseases. An electronic search was carried out in MEDLINE through the PubMed, Scopus, and Embase databases up to April 2021. No studies reporting communication, its adequacy or the required skills between clinicians and pathologists in oral diagnosis were found. According to studies published in medicine, strategies for improving communication skills include clinician-pathologist collaboration; a well-formatted, clear and thorough report; training in communication skills; and patient-centered care. Further studies evaluating the current practices and quality in oral and maxillofacial pathology are required to identify barriers and encourage optimal communication to facilitate diagnosis, as well as patient safety.

Cytokines, cortisol, and nitric oxide as salivary biomarkers in oral lichen planus: a systematic review

Abstract The etiopathogenesis of oral lichen planus (OLP) is still not fully elucidated, and it is believed that its development could involve a neuro-immune-endocrine profile. This systematic review investigated the relationship between cytokines, cortisol, and nitric oxide (NO) in the saliva of OLP patients. An electronic search was conducted in Pubmed/Medline, Scopus, LIVIVO, and Web of Science databases with no restriction of language to identify studies published up to December 2017. Data extraction was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 140 articles were retrieved, and 32 articles fulfilled the inclusion criteria (cytokines = 17; cortisol = 9; NO = 6). The most studied cytokines in the saliva of OLP patients were interleukins IL-4, IL-6, IL-8, IFN-ү, and TNF-α, which were higher in OLP patients than in healthy controls (HC). Salivary cortisol was found to be higher in OLP than in HC in most (55.5%) of the selected studies, and all studies related to NO found higher levels of this marker in OLP than in HC. Despite controversial results, our review suggests that OLP patients have an increased inflammatory response, as indicated by the proinflammatory profile of salivary cytokines. In addition, we conclude that salivary cytokine and NO measurements may have significant diagnostic and prognostic potential for monitoring disease activity and therapeutic responses in OLP.

Oral Nodular Lesions in Patients with Sjögren's Syndrome: Unusual Oral Implications of a Systemic Disorder

Abstract Sjögren's syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient's quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient's quality of life.

Resumo A síndrome de Sjögren (SS) é uma doença autoimune crônica sistêmica que afeta as glândulas lacrimal e salivar. A SS pode se manifestar como SS primária (SSp) ou SS secundária (SSs), a última ocorrendo em conjunto com outra desordem autoimune. Em ambos os casos, os olhos secos e a boca seca afetam a qualidade de vida do paciente. As complicações tardias podem incluir cegueira, destruição dos tecidos dentários, candidíase oral e linfoma. Este artigo relata dois casos de SS, cada um apresentando lesão nodular oral incomum diagnosticada como linfoma MALT reincidente e mucocele. A importância do diagnóstico, tratamento e manejo das lesões orais por um cirurgião-dentista durante o atendimento de pacientes com SS é enfatizada, pois as manifestações orais da SS podem comprometer a qualidade de vida do paciente.

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil

ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS:Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

Can fasting plasma glucose and glycated hemoglobin levels predict oral complications following invasive dental procedures in patients with type 2 diabetes mellitus? A preliminary case-control study

OBJECTIVE: To evaluate the effects of the levels of glycemic control on the frequency of clinical complications following invasive dental treatments in type 2 diabetic patients and suggest appropriate levels of fasting blood glucose and glycated hemoglobin considered to be safe to avoid these complications. METHOD: Type 2 diabetic patients and non-diabetic patients were selected and divided into three groups. Group I consisted of 13 type 2 diabetic patients with adequate glycemic control (fasting blood glucose levels <140 mg/dl and glycated hemoglobin (HbA1c) levels <7%). Group II consisted of 15 type 2 diabetic patients with inadequate glycemic control (fasting blood glucose levels >140 mg/dl and HbA1c levels >7%). Group III consisted of 18 non-diabetic patients (no symptoms and fasting blood glucose levels <100 mg/dl). The levels of fasting blood glucose, glycated HbA1c, and fingerstick capillary glycemia were evaluated in diabetic patients prior to performing dental procedures. Seven days after the dental procedure, the frequency of clinical complications (surgery site infections and systemic infections) was examined and compared between the three study groups. In addition, correlations between the occurrence of these outcomes and the glycemic control of diabetes mellitus were evaluated. RESULTS: The frequency of clinical outcomes was low (4/43; 8.6%), and no significant differences between the outcome frequencies of the various study groups were observed (p>0.05). However, a significant association was observed between clinical complications and dental extractions (p = 0.02). CONCLUSIONS: Because of the low frequency of clinical outcomes, it was not possible to determine whether fasting blood glucose or glycated HbA1c levels are important for these clinical outcomes.

Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries

Leprosy is an ancient disease that remains endemic and continues to be a major public health problem in some tropical countries, where it has been internationally recognized as being linked to the underdevelopment conditions. The natural course of the disease covers a wide variety of clinical conditions with systemic involvement. In this paper, we review the findings obtained in studies of the pathological mechanisms of leprosy, including a survey of the literature and of our own work. The understanding and control of the wide variety of clinical conditions should help improve patient care and thus prevent the onset of physical impairment and the stigma of the disease.

Could leprosy reaction episodes be exacerbated by oral infections? / Episódios reacionais da hanseníase podem ser exacerbados por infecções orais?

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.

INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05 percent clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

O objetivo deste estudo foi avaliar a eficácia do propionato de clobetasol a 0,05 por cento administrada com moldeiras em 22 pacientes com gengivite descamativa por meio de estudo duplo-cego, cruzado, placebo-controlado. Pacientes receberam bisnaga número 1 e foram instruídos a aplicar a pomada 3 vezes ao dia por um período de 2 semanas, e reduzir a aplicação para 1 vez ao dia na terceira semana. Os pacientes foram instruídos a suspender o tratamento por 2 semanas, e então receberam a bisnaga 2, usando-a da mesma maneira que o container 1. Com relação aos sinais, 17 pacientes apresentaram alguma melhora, enquanto 5 apresentaram piora com o propionato de clobetasol. Com o uso do placebo, 14 pacientes apresentaram alguma melhora, e 8 pacientes apresentaram piora do seu quadro clínico. Com relação aos sintomas, houve completa melhora em 2 pacientes, melhora parcial em 12, ausência de resposta em 7, e piora em 1 pacientes durante o uso do propionato de clobetasol. Com o uso do placebo, houve melhora parcial em 8 pacientes, ausência de resposta em 12 e piora dos sintomas em 2 pacientes. Não foi verificada diferença estatisticamente significante em nenhum dos parâmetros entre o uso do clobetasol e placebo; p>0,05. Baseado no protocolo utilizado neste grupo de pacientes, o propionato de clobetasol não demonstrou efetividade significante quando comparado ao placebo.

A brief review of the enamel defects in children with coeliac disease / Uma breve revisão dos defeitos de esmalte em crianças portadoras de doença celíaca

The purpose of this review is to describe the principal effects of coeliac disease (CD) upon development and mineralization of children teeth. The authors point out that an inspection of dental enamel could be a useful tool for screening for CD especially in an asymptomatic population.

A proposta desta revisão é descrever os principais efeitos da doença celíaca (DC) no desenvolvimento e mineralização dos dentes decíduos. Os autores ressaltam que o exame do esmalte dentário pode auxiliar a investigação da DC principalmente em uma população assintomática.

Corticosteróide tópico oclusivo no tratamento de manifestações gengivais de doenças vesicobolhosas auto-imunes / Topical occlusive corticosteroid for the treatment of gingival manifestations of vesicobullous autoimmune diseases

O tratamento das lesões gengivais de doenças vesicobolhosas auto-imunes constitui grande desafio na estomatologia, principalmente pela natureza crônica das lesões. O tratamento sistêmico é necessário no controle das apresentações mais graves; entretanto, quando possível, o tratamento tópico é preferível. Este artigo descreve uma técnica oclusiva para aplicação de corticosteróide tópico que tem demonstrado ser eficaz no controle dessas lesões, sobretudo em pacientes com manifestações exclusivamente gengivais.

The carcinogenic potential of cadmium in the palatal and gingival epithelium of rats: a morphologic and morphometric analysis

Cádmio (Cd) é um metal pesado que exerce uma variedade de efeitos tóxicos, crônicos e agudos, em organismos expostos. O objetivo deste estudo foi investigar o potencial carcinogênico do Cd no epitélio do palato e da gengiva de ratos Wistar. Dois grupos de animais foram estudados: grupo 1 que consistiu de 5 ratos expostos a cloreto de cádmio (CdCl2) em água de bebedouro (300 mg/L) por um período de 6 meses; grupo 2 que também consistiu de 5 ratos submetidos às mesmas condições dos animais do grupo 1, mas permaneceu livre de Cd por um período adicional de 6 meses. Dois outros grupos (C1 and C2) com o mesmo número de animais, entretanto não expostos ao CdCl2, foram usados como controle para o grupo 1 e 2, respectivamente. Todos os animais foram pesados antes e após o período experimental. Após terem sido sacrificados, os tecidos de interesse para o estudo foram fixados em formalina a 10 por cento, processados por meio de técnica histopatológica padrão, corados em HE, e analisados sob microscopia de luz, utilizando parâmetros cariométricos e estereológicos. Perda de peso, atrofia do epitélio da gengiva e do palato mole foram os principais achados deste estudo, e verificados apenas no grupo 1 (p < 0.05). Em conclusão, Cd não produziu efeito carcinogênico nos tecidos orais, nas condições experimentais empregadas neste estudo.

Technical assessment of WHO-621 periodontal probe made in Brazil

O presente estudo objetivou verificar, tecnicamente a sonda periodontal OMS-621, de fabricação brasileira, bem como sua estabilidade dimensional e de peso após esterilização. Cem (100) sondas novas foram triplamente medidas nas seguintes características: diâmetro e área linear da esfera da ponta, assim como referência inicial e final da faixa colorida, através de método morfométrico indireto, e peso, com auxílio de balança de precisão em 0,01 mm. Cinqüenta (50) sondas foram submetidas a cem (100) ciclos de esterilização por meio de método úmido ou seco. A sonda OMS-621 Trinity apresentou valores médios de 0,66 mm para o diâmetro longitudinal, 0,54 mm no diâmetro transversal e 0,40 mm² na área linear de sua esfera; 3,56 mm e 5,76 mm no início e no final de sua faixa colorida, respectivamente. O peso médio foi de 10,12 g com pequena variação. Alguns parâmetros variaram significativamente frente aos dois processos de esterilização. Nenhum método de esterilização mostrou-se superior (teste t-Student, p=0,05).

Periodontal disease associated with Langerhans cell histiocytosis: case report / Doença periodontal associada à histiocitose de células de Langerhans: relato de um caso clínico

Apresenta-se um caso clínico de histiocitose de células de Langerhans tipo granuloma eosinofílico em um jovem paciente adulto. Tendo em vista a ocorrência de manifestações orais no estágio inicial da doença faz-se necessário o seu diagnóstico diferencial, especialmente com a periodonite de ínicio precoce