Amígdalas y adenoides: defensa ante agentes patógenos y su implicancia estomatológica / Tonsils and adenoids: defend to pathogenic agents and their stomatological involvement

La función de las amígdalas siempre ha sido discutida, desde afirmar que no tenían funcionalidad, hasta la actualidad que se plantea un papel inmunológico, con actividad linfocitaria de defensa, debido a la localización de linfocitos en el tejido de las amígdalas. Este artículo de actualización pretende describir desde la embriología, histología, fisiología, patología y estomatología, el rol que desempeñan las mismas en su papel inmunológico ante la acción de agentes patógenos. Se destaca la acción conjunta de las amígdalas palatinas, amígdalas faríngeas o adenoides, amígdalas peritubarias, amígdalas linguales y todo el resto de tejido linfático que conforman el anillo linfático faríngeo o anillo de Waldeyer, ya que cumplen un rol determinante en la defensa del organismo (AU)

The function of the tonsils has always been debated, from stating that they had no functionality, to the present day that an immunological role is proposed, with lymphocyte defense activity, due to the location of lymphocytes in the tissue of the tonsils. This update article aims to describe from embryology, histology, physiology, pathology and stomatology, the role they play in their immunological role against the action of pathogens. The joint action of the palatine tonsils, pharyngeal or adenoid tonsils, peritubal tonsils, lingual tonsils and all the rest of the lymphatic tissue that make up the pharyngeal lymphatic ring or Waldeyer's ring is highlighted, since they play a decisive role in the defense of the organism (AU)

La saliva: una mirada hacia el diagnóstico / Saliva: a look on diagnosis

La saliva juega un importante rol en la prevención y mantenimiento de la salud oral. La alteración del flujo salival es un factor clave en el desarrollo de diversas patologías e infecciones oportunistas en lacavidad bucal. Existen diversos caminos por los que algunos elementosque no son constituyentes y habituales de la saliva pueden llegar a ella, a través de rutas intracelulares y extracelulares; gracias a esta posibilidad, se abre una perspectiva para su aplicación en el diagnósticode determinadas patologías. El conocimiento de su composición y funciones ayudará a promoveren los profesionales una mayor conciencia del papel de la saliva en la prevención de patologías y mantenimiento de la salud oral.

Saliva plays an important role in the preventionand maintenance of oral health. Alterationof salivary flow is a key factor in the developmentof various diseases and opportunistic infectionsin the oral cavity.There are various way by which some elementsthat are not common constituents of saliva canreach it through intracellular and extracellularroutes; thanks to this possibility, a prospectfor application in the diagnosis of certainpathologies opens. The knowledge of itscomposition and functions, help promoteprofessionals, greater awareness of the roleof saliva in the prevention of diseasesand maintenance of oral health.

Complicaciones estomatológicas en pacientes VIH positivos: correlaciones clínico demográficas y de laboratorio / Dental complications in HIV positive patients: clinical correlations demographic and laboratory

Las complicaciones estomatológicas (CE) en pacientes VIH+ muchas veces constituyen los primeros signos clínicos de la enfermedad, pudiendo funcionar como señalizadores del curso y progresión de la infección por el VIH y el SIDA. Este estudio evaluó la prevalencia de lesiones orales en pacientes VIH+ del Hospital de Enfermedades Infectocontagiosas Gizelda Trigueiro, en Natal-RN, Brasil y correlacionarlas con factores socio-demográficos como el sexo, edad, forma de contagio y status inmunológico. De acuerdo con los criterios de la EC-CLEARINGHOUSE/WHO, a través de examen clínico oral y conteo de células T CD4+ fueron evaluados 121 pacientes VIH+. Las lesiones más frecuentes fueron candidiasis (45.2%), leucoplasia vellosa (16.1%), eritema gingival linear (16.1%), herpes labial (12.9%), periodontitis necrosante (6.5%) y gingivitis necrosante (3.2%), ocurriendo con mayor frecuencia en hombres entre las edades de 30 a 44 años, que adquirieron el VIH a través de contacto sexual. Basado en los resultados de este estudio concluyese que hubo una prevalencia del perfil de complicaciones estomatológicas comúnmente relatado en la literatura. Las lesiones estuvieron asociadas a la reducción del número de células TCD4+, representando, por lo tanto marcadores de la progresión de la infección por el virus y/o de falla de la HAART, siendo así, un exhaustivo examen oral es importante en la evaluación clínica y acompañamiento de pacientes con VIH.

The stomatologic complications due to VIH infection are, a lot of times, the first clinical signs of the disease. These injuries may also function as beepers and sentries of the curse and progression of the VIH infection and SIDA. The objective of this work was to evaluate the prevalence of the oral injuries in VIH positive patients from the Hospital of Infected contagious Gizelda Trigueiro in Natal-RN, Brazil, and correlate them with demographic factors such as gender, age, form of VIH infection and immune status (T CD4+ cells). According to the criteria of EC-CLEARINGHOUSE/WHO, through clinical oral examination and T CD4+ cell count 121 patients were evaluated. The oral candidiasis was the most common lesion (45.2%), followed by oral hairy leukoplakia (16.1%), linear gingival erythema (16.1%), lips herpes (12.9%), necrotizing periodontitis (6.5%) and necrotizing gingivitis (3.2%), occurring predominantly in men between the ages 30 to 44 years, who acquired VIH infection through sexual contact. Based on the results of this study, concluded that there was a prevalence of the stomatologic complications profile that is commonly reported in the literature. These changes were associated with a decrease in the number of CD4+ T cells, representing markers of the infection progression and / or failure of HAART, so a thorough oral examination is important in clinical evaluation and follow up of patients with VIH.

Comparison of oral manifestations with CD4 count in HIV-infected patients.

Aim and Objective: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. Materials and Methods: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student's " t" test, was applied and objective conclusions were drawn. Result: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count <200 (group A), 10 patients were in group, B (CD4 count 200-500 cell/mm 3 ) and 2 patients in group C(CD4 >500 cell/mm 3 ). Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. Conclusion: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.

Emprego do óleo de Melaleuca alternifolia Cheel (Myrtaceae) na odontologia: perspectivas quanto à utilização como antimicrobiano alternativo às doenças infecciosas de origem bucal / Use of Melaleuca alternifolia Cheel (Myrtaceae) oil in dentistry: perspectives on its use as alternative antimicrobial to infectious diseases of oral origin

O interesse por medicamentos alternativos, principalmente daqueles provenientes de extratos naturais, tem aumentado nas últimas décadas. A Melaleuca alternifolia é um arbusto pertencente ao gênero Melaleuca, popularmente conhecida como "árvore de chá", cujo principal produto é o óleo essencial (TTO - tea tree oil), de grande importância medicinal por possuir comprovada ação bactericida e antifúngica contra diversos patógenos humanos. Em virtude da atividade terapêutica em diversas especialidades médicas, o TTO passou a ser empregado na área odontológica. Esta revisão de literatura foi realizada com o objetivo de discutir os ensaios já realizados com o TTO contra microrganismos relacionados à doença cárie, doença periodontal e problemas pulpares. O óleo de Melaleuca tem demonstrado boa ação antibacteriana in vitro contra microrganismos bucais, porém, pesquisas envolvendo o estudo do mecanismo de ação sobre as células microbianas ou estudos in vivo ainda são escassos e precisam ser realizados, já que esse produto pode ser útil na odontologia, seja na manutenção química da higiene ou prevenção de doenças bucais.

The interest in alternative medicines, especially those from natural extracts, has increased in recent decades. Melaleuca alternifolia is a shrub belonging to the genus Melaleuca, popularly known as "tea tree", the main product of which is its essential oil (TTO - tea tree oil), of great medicinal importance for its proven bactericidal and antifungal activity against several human pathogens. By virtue of its therapeutic activity in various medical specialties, TTO is now used in dentistry. This literature review was conducted in order to discuss the tests already carried out with TTO against microorganisms related to dental caries, periodontal disease and pulpal problems. Melaleuca oil has shown good in vitro antibacterial activity against oral microorganisms; however, research involving the study of its mechanism of action on the microbial cells or in vivo studies are still scarce and need to be done since this product may be useful in dentistry, either in the chemical maintenance of hygiene or in the prevention of oral diseases.

Mucinas salivales: estructura química, mecanismos de liberación y participación en la defensa no inmunológica de la cavidad bucal / Salivary mucins: chemical structure, release mechanisms and participation in the non-immunological defense of the oral cavity

En este artículo se describen: 1) las características físico-químicas de las mucinas salivales, denominadas MG1 y MG2. 2) El mecanismo de secreción por estimulación simpática y parasimpática. 3) La distinta participación de MG1 y MG2 tanto en la actividad deglutoria como en los mecanismos de defensa de la cavidad bucal, en relación con sus propiedades físico-químicas. 4) El rol de las mucinas salivales en la protección de la mucosa del tracto gastrointestinal. 5) La relación entre las mucinas saliales y las patologías de la cavidad bucal.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5 percent. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Failure of nitric oxide production by macrophages and decrease in CD4+ T cells in oral paracoccidioidomycosis: possible mechanisms that permit local fungal multiplication

A paracoccidioidomicose é uma doença granulomatosa crônica que induz resposta inflamatória e imune específica. A participação do óxido nítrico (NO), produto da enzima óxido nítrico sintase induzível (iNOS), como uma importante molécula fungicida contra o fungo Paracoccidioides brasiliensis tem sido demonstrada. Com o objetivo de melhor caracterizar as lesões orais da paracoccidioidomicose (OP), propusemos estudo imunohistoquímico das células iNOS+ e das células CD45RO+, CD3+, CD8+, CD20+, CD68+ e mastócitos. As amostras foram distribuídas em grupos de acordo com o número de fungos viáveis por mm2. Nossos resultados demonstraram leve imunomarcação para iNOS nas células gigantes multinucleadas (MNGC) e na maioria das células mononucleares (MN), e a proporção de células MN/MNGC iNOS+ na OP foi comparável a do grupo Controle (tecido bucal clinicamente saudável). Adicionalmente, nossa análise revelou similaridade no número de células CD4+ entre o Controle e o grupo de OP com elevado número de fungos. Estes achados sugerem que a baixa expressão de iNOS e a diminuição de células CD4+ na OP podem representar possíveis mecanismos que permitiram a multiplicação local do fungo e a manutenção das lesões bucais ativas.

Proteínas que intervienen en la homeostasis bucal / Proteins that intervene in bucal homoestasis

Se presentan algunos aspectos generales de un grupo de proteínas que recientemente han sido descritas y cuya función es determinante para el mantenimiento de la homeostasis de la cavidad bucal. Estas proteínas son las histatinas, antibióticos naturales; las cistatinas, que inhiben la acción de las proteasas bacterianas en la enfermedad periodontal; y la estaterina, que regula la precipitación del dosfato de calcio en la saliva. Las histatinas, cistatinas y estaterina han sido aisladas, caracterizadas y secuenciadas. Se piensa que en un futuro no muy lejano estas moléculas podrán ser utilizadas para dar una mejor calidad de vida a pacientes con infecciones bucales causadas por hongos o con otras enfermedades relacionadas

Fatores de prognóstico da queilite actínica analisados por imuno-histoquímica e citometria estática: estudo comparativo com leucoplasias associadas a displasias, e carcinomas espinocelulares / Prognostic parameters of actinic cheilitis analysed by immunohistochemical and estatic cytometry: comparative study with leukoplakia combined with dysplasia and squamous cell carcinoma

As lesöes cancerizáveis podem manter-se estáveis, regredir ou sofrer transformaçöes neoplásica. Nos fatores de prognóstico, classicamente estabelecidos, repousam dogmas e elevado grau de subjetividade. Para caracterizar a expressäo imuno-histoquímica de p53, CD31, TGFx e PCNA e avaliar o conteúdo de DNA nuclear pela citometria estática foram selecionados 13 casos de queilite actínicas. Nove casos de hiperplasias, 12 casos de leucoplasias e 13 casos de neoplasias, situados no lábio, foram submetidos aos mesmos exames. Os resultados indicaram as alteraçöes da proteína p53 como as mais significativas nas queilites actínicas. Em lesöes positivas para p53, 50 por cento apresentaram um conteúdo aneuplóide, indicando a precocidade destas alteraçöes e assimilando sua propensäo para malignidade. Nas queilites actínicas, a marcaçäo do TGFx exibiu um padräo intermediário entre lesöes hiperplásicas e neoplásicas. Os índices de proliferaçäo, obtidos pela expressäo de PCNA, foram crescentes a partir das lesöes hiperplásicas até os carcinomas. A densidade vascular, aferida pela contagem de vasos marcados com CD31, apresentou padräo similar. Na análise de citometria de imagem, todas as lesöes hiperplásicas mostraram conteúdo diplóide. As queilites actínicas e leucoplasias, em nove casos, apresentaram histogramas aneuplóides. Os carcinomas exibiram padräo aneuplóide em dez casos. A expressäo dos marcadores p53, CD31, PCNA e TGFx e a mensuraçäo da ploidia, foram caracterizadas em lesöes de queilites actínicas, podendo ser utilizadas como indicadores de prognóstico nas lesöes cancerizáveis

Moléculas de adhesión y su importancia en odontología: revisión de la literatura / Adhesion molecules and its importance in dentistry

En la actualidad se reconoce que las interacciones que se suceden entre las células entre sí y de éstas con los componentes de la matriz extracelular se producen por la intervención de las Moléculas de Adhesión. Las Moléculas de adhesión son glucoproteínas distribuidas en gran cantidad de células que le permiten al organismo realizar funciones tanto fisiológicas, como la adhesión entre las células epiteliales, como fisiopatológicas, por ejemplo la inflamación. Es por ello que se hace imperativo conocer estas familias, para así entender los procesos que se desarrollan en las diversas actividades, normales o patológicas, de la cavidad bucal