Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study

Abstract Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective

Abstract The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Resumo Os achados clinico-patológicos que caracterizam de forma precisa o líquen plano oral (LPO) e as lesões liquenoides orais (LLO) ainda representam um desafio. O objetivo do presente estudo foi analisar, pela perspectiva do patologista oral, os achados clínicos do LPO e das LLO. Espécimes preenchendo os critérios histológicos para o diagnóstico de LPO e LLO, e também aqueles compatíveis com LPO (LPO-C), foram selecionados e as informações clínicas foram obtidas a partir das requisições laboratoriais. A amostra final foi composta de 221 casos, incluindo 119 LPO (53.8%), 65 LPO-C (29.4%) e 37 LLO (16.7%). As mulheres foram mais acometidas nos três grupos, mas o número de homens acometidos foi maior nas LLO. A média de idade foi menor no LPO (52.3 anos) em comparação com as LLO (57.9 anos) (p=0.020). O envolvimento da mucosa jugal e da língua foi mais frequente no LPO; o envolvimento gingival foi incomum nas LLO. O padrão reticular foi mais frequentemente encontrado no LPO, enquanto a associação dos padrões reticular e atrófico/erosivo/ulcerado foi mais comum no LPO-C e nas LLO (p=0.025). Em conclusão, o gênero e a média de idade dos pacientes, assim como a localização anatômica e a manifestação clínica das LLO são diferentes do LPO, e podem ajudar a melhor caracterizar este grupo de condições. Espécimes diagnosticados como LPO-C mostraram parâmetros clínicos mais próximos ao LPO.

Expression of epithelial growth factors and of apoptosis-regulating proteins, and presence of CD57+ cells in the development of inflammatory periapical lesions

Abstract The mechanisms that stimulate the proliferation of epithelial cells in inflammatory periapical lesions are not completely understood and the literature suggests that changes in the balance between apoptosis and immunity regulation appear to influence this process. Objective: To evaluate the expression of the epidermal growth factor (EGF), its receptor (EGFR) and of the keratinocyte growth factor (KGF), the presence of CD57+ cells, the epithelial cell proliferation index, and the expression of the Bcl-2 protein in inflammatory periapical lesions (IPL) at different stages of development. Methodology: Our sample was composed of 52 IPLs (22 periapical granulomas - PG - and 30 periapical cysts - PC), divided into three groups: PGs, small PCs, and large PCs. Specimens were processed for histopathologic and immunohistochemical analyses. Sections were evaluated according to the amount of positive staining for each antibody. Results: We found no significant differences among the groups regarding Bcl-2 (p=0.328) and Ki-67 (p>0.05) expression or the presence of CD57+ cells (p=0.748). EGF (p=0.0001) and KGF (p=0.0001) expression was more frequent in PCs than in PGs, and CD57+ cells were more frequent in IPLs with intense inflammatory infiltrates (p=0.0001). We found no significant differences in KGF (p=0.423), Bcl-2 (p=0.943), and EGF (p=0.53) expression in relation to inflammatory infiltrates or to the type of PC epithelial lining, but observed greater KGF expression (p=0.0001) in initial PCs. EGFR expression was similar among the groups (p>0.05). Conclusion: More frequent EGF and KGF expression in PCs and the greater presence of CD57+ cells in lesions with intense inflammatory infiltrates suggest that these factors influence IPL development. The greater KGF expression in initial PCs suggests its importance for the initial stages of PC formation.

Clinical and Research Activities of the Brazilian Productivity Fellows in Oral Medicine and Oral Pathology during the COVID-19 Era

ABSTRACT Objective To evaluate the effect of the COVID-19 impacts on the activities of researchers in the field of Oral Medicine (OM) and Oral Pathology (OP). To assess the research activities and training of human resources by Brazilian productivity fellows in research (BPFR) in OM and OP in the COVID-19 Era. Material and Methods Thirty-six BPFR in OM and OP areas, funded by National Council for Scientific and Technological Development (CNPq), received a virtual structured questionnaire by e-mail, on the Google Forms (Google®) platform, with questions regarding research activities and training of human resources (supervision of undergraduate and postgraduate students), during the COVID-19 pandemic. From the thirty-six BPFR in OM and OP, twenty-seven (75.0%) answered the questionnaire. Results Most of them were males (n=20; 74.1%) and were distributed in four Brazilian regions and ten states of the federation, including the Federal District. Twenty-four (88.9%) BPFR reported having suspended clinical activities, while sixteen (59.3%) answered that histopathology practices are suspended. Twenty-five (92.6%) BPFR mentioned difficulties in conducting research projects and 55.5% stated having no difficulties in the supervision of undergraduates, master's and PhD students. Conclusion The current scenario may significantly impact the diagnosis of oral diseases in Brazil. Moreover, a decrease in the scientific production of BPFR in OM and OP in the coming years is also considered.

Estado perirradicular e radicular de dentes tratados endodonticamente: estudo piloto utilizando a tomografia computadorizada de feixe cônico / Periapical and root status of endodontically treated teeth: a pilot study using cone-beam computed tomograph

As imagens radiográficas periapicais, essenciais para a realização e para o acompanhamento do sucesso do tratamento endodôntico, em virtude de limitações técnicas, não são capazes de oferecer visualização anatômica de toda a estrutura dos elementos dentários. Técnicas contemporâneas de obtenção de imagens, como a tomografia computadorizada realizada pela técnica de feixe cônico (TCFC) parecem ter o potencial de avaliar de forma mais adequada a qualidade da obturação e do remanescente radicular, e o estado perirradicular. O objetivo deste trabalho foi realizar uma avaliação descritiva das imagens obtidas pela técnica de TCFC de 100 elementos dentários tratados endodonticamente, buscando os achados referentes ao estado perirradicular, as lesões de furca, à presença de núcleos intrarradiculares e as fraturas radiculares. Nos 100 dentes analisados, 83 (83%) apresentavam áreas compatíveis com a presença de alteração perirradicular. Dos dentes multirradiculares, 51% apresentavam presença de lesão de furca e 91% apresentavam rarefação perirradicular. Vinte dos 83 dentes com alterações perirradiculares (24%) apresentavam imagem sugestiva de fratura radicular. A TCFC revelou a existência de diversas alterações radiculares e perirradiculares nos dentes tratados endonticamente estudados nesta amostra, sugerindo sua utilidade no acompanhamento imaginológico após o tratamento endodôntico.

Periapical radiographs are essential for endodontic treatment and for following the tooth response after finishing the treatment. Unfortunately, due to their technical limitations, they are not capable of offering a complete anatomical view of the dental structure. More recent image techniques, such as cone-beam computed tomograph (CBCT), seem to offer a more complete picture of the pulp chamber obturation and the remaining dental structure, as well as the periradicular status. The aim of our study was to analyze CBCT images obtained from 100 endodontically treated teeth, focusing on the obturation of the pulp chamber, periapical status, interadicular alterations and root fractures. From the 100 teeth, 83 (83%) presented periradicular alterations. From multiradicular teeth, 51% presented with alterations in the interadicular area and 91% showed periradicular alterations. Twenty out 83 teeth presenting periradicular alterations (24%) showed also root fractures. CBCT images revealed the presence of several root and periradicular alterations in the endodontically treated teeth studied in this sample, suggesting its utility as an adjunctive auxiliary in the follow-up of teeth after endodontic treatment.

Dental bleaching with and without LED/Laser association: a split-mouth controlled study

Objective: The aim of this study was to compare dental color changes after a one-session tooth bleaching procedure using 35% hydrogen peroxide with and without hybrid light (LED/diode laser) activation. Material and Methods: 20 volunteers were included in a split-mouth controlled clinical trial. A 35% hydrogen peroxide gel was applied directly on the buccal surface and adjacent areas of all upper anterior teeth. The six teeth were divided into two groups: the upper right incisors and canine were submitted to the tooth bleaching with the gel and the hybrid light (LED/diode laser) while the left incisors and canine were submitted to tooth bleaching with only the gel. Dental color was measured with a visual color scale and a spectrophotometer at five different moments: initial appointment, immediately after prophylaxis, and 14, 30 and 180 days after bleaching. Results: The comparison between the results of both treatments (with and without LED/laser) did not show any statistically significant differences (p > 0.05; Wilcoxon test) neither for objective (spectrophotometer) nor for subjective evaluations (visual color scale). Conclusion: The results of the present study showed that there are no differences in dental color changes between dental bleaching with gel and LED/Laser activation and dental bleaching with only gel.

Reação de corpo estranho a material de preenchimento estético: relato de quatro casos / Foreign body reaction due to aesthetic filling materials: report of four cases

Objetivo: o objetivo deste trabalho é relatar quatro casos de reações de corpo estranho a material de preenchimento estético acometendo a cavidade oral. Relato dos casos: quatro pacientes adultas do sexo feminino compareceram à consulta apresentando nódulos submucosos localizados nos lábios e sulcos nasogenianos com histórico prévio de injeção de materiais de preenchimento estético (ácido hialurônico em duas pacientes e polimetilmetacrilato em duas pacientes). O diagnóstico em três dos quatro casos foi baseado nos achados clínicos e histológicos e apenas nos achados clínicos em um caso. O tratamento consistiu de manejo cirúrgico em três pacientes e corticoterapia em uma paciente e todas se encontram bem e em acompanhamento clínico. Conclusão: os cirurgiões-dentistas devem estar atentos aos efeitos adversos provocados por materiais de preenchimento estético, considerando seus diagnósticos diferenciais e as formas mais adequadas de tratamento.

Objective: The aim of the present study is to report 4 cases of foreign body reactions to dermal fillers affecting the oral cavity. Cases report: Four adult females were referred for evaluation of submerse nodules on the lips and nasolabial folds with a previous history of injection of dermal fillers (hyaluronic acid in two cases and polymethylmethacrylate in two cases). Diagnosis was based on clinical and histological aspects in three cases and solely on clinical aspect in one case. Management consisted in surgical excision in three cases and corticosteroid therapy in one and all 4 patients are well, with no signs of recurrence and remain in clinical follow-up. Conclusion: Dental professionals should be aware of the side effects associated with the use of aesthetic fillers, considering their main differential diagnosis and the most adequate management strategy for each individual case.

Histologic and Tomographic Findings of Bone Block Allografts in a 4 Years Follow-up: A Case Series

Abstract The aim of this paper is to report histologic and tomographic findings of fresh frozen bone block allografts bearing dental implants in functional occlusion in a long-term follow-up. Four patients with implants functionally loaded for 4 years on augmented ridges requiring additional mucogingival surgery or implant placement were included in this case series. Cone-beam tomography scans were compared volumetrically between the baseline (first implant placement) and current images. Biopsies of the grafts were retrieved and sent to histological analysis. Volumetric reduction of the grafts varied from 2.1 to 7.7%. Histological evaluation demonstrated well-incorporated grafts with different degrees of remodeling. While data presented in this report are from a small sample size and do not allow definitive conclusions, the biopsies of the grafted sites were very similar to the host's native bone. Remodeling of the cortical portion of the allografts seems to take longer than the cancellous portion. The presence of unincorporated graft remains did not impair the implant success or the health of the surrounding tissues. This is the first time histologic and tomographic long term data of bone allograft have been made available in dentistry.

Resumo O objetivo deste artigo é relatar achados histológicos e tomográficos de aloenxertos ósseos em bloco com implantes dentários em oclusão funcional em um acompanhamento de longo prazo. Quatro pacientes com implantes funcionalmente carregados por 4 anos em rebordos alveolares enxertados, que necessitaram de cirurgia mucogengival ou instalação de implantes adicionais foram incluídos nesta série de casos. Imagens de tomografia cone-beam foram comparados volumetricamente entre o momento inicial (instalação do implante original) e imagens atuais. Biópsias dos enxertos foram coletadas e enviadas para análise histológica. A redução volumétrica dos enxertos variou entre 2,1-7,7%. A avaliação histológica demonstrou enxertos bem incorporados com diferentes graus de remodelação. Embora os dados apresentados neste relato sejam de uma amostra pequena e não permitam conclusões definitivas, as biópsias dos sítios enxertados apresentaram características muito similares ao osso nativo. A remodelação da porção cortical dos aloenxertos parece levar mais tempo do que a porção esponjosa. A presença de remanescentes do enxerto não incorporado não demonstrou impacto no sucesso dos implantes ou na saúde dos tecidos circunjacentes. Este é o primeiro relato com dados histológicos e tomográficos em longo prazo de enxertos ósseos alógenos disponível na odontologia.

Tratamento da assimetria facial causada por hiperplasia condilar: série de casos / Treatment of facial asymmetry caused by condylar hyperplasia: case series

Introdução: a hiperplasia do côndilo (HC) mandibular tem sido descrita como o crescimento excessivo de um dos côndilos sobre o contralateral, causando um crescimento desequilibrado, que resulta em assimetria facial. A classificação e o diagnóstico da HC, a atividade de crescimento dos côndilos, e as formas de tratamento foram abordados no presente estudo. Material e Métodos: foram descritas as formas de tratamento de três pacientes apresentando HC. As soluções cirúrgicas são representadas por condilectomia, cirurgia ortognática, e uma combinação de ambos. Resultados: após a realização do procedimento cirúrgico específico indicado para cada caso, houve melhora significativa na simetria facial e na função mastigatória. Conclusões: o diagnóstico da HC se baseia em achados clínicos e radiológicos, e esses avaliam as consequências do crescimento desproporcional. A cintilografia óssea funciona como um indicador da rapidez da progressão dessa condição, sendo essencial no planejamento cirúrgico do tratamento

Brazilian Oral pathology: a retrospective survey of 245 casesfrom a Surgical Pathology Hospital Laboratory / Patologia oral: uma pesquisa retrospectiva brasileira de 245 casos provenientes do Laboratório Hospitalar de Patologia Cirúrgica

The aim of this study was to determine the range of oral histopathological diagnoses in a Brazilian survey obtained from a surgical pathology hospital laboratory. Materials and Methods: A retrospective cross-sectional study was performed, and all histological slides from the oral and maxillofacial region during a 14-year period were reviewed. The diagnoses were grouped intofive major diagnostic categories, and age and sex were specified. Results: A total of 769 samples were collected and submitted for histopathological analysis. There were 245 oral cases, which were divided into 48 different diagnoses. There was no sex predilection, and the mean age was about 44 year sold. Proliferative non-neoplastic lesions (43.2%) and malignant neoplasms (26.5%) comprised the main two groups of diagnoses. Conclusion: The malignant neoplasms prevalence observed in this Brazilian sample may be due to the nature of the populationor, most probably, to the nature of the source, are ferral hospital center in the city...

O objetivo deste estudo foi determinar avariação de diagnósticos histopatológicos da cavidade oral em uma amostra brasileira obtida a partir de um laboratório hospitalar de patologia cirúrgica. Material e Métodos: Um estudo transversal retrospectivo foi realizado e todas as lâminas histopatológicas da região oral e maxilofacial durante um período de 14 anos foram revisadas. Os diagnósticos foram agrupados em cinco categorias principais de diagnóstico, sendo o sexo e a idade especificados. Resultados: Um total de 769 amostras foram coletadas e submetidas a análise histopatológica. Foram identificados 245 casos de lesões orais, que foram subdivididas em 48 diferentes diagnósticos. Não houve predileção por sexo, e idade média foi de 44 anos. Lesões proliferativas não-neoplásicas (43,2%) e neoplasias malignas (26,5%) representaram os dois principais grupos de diagnóstico. Conclusão: A prevalência de neoplasias malignas observada nesta amostra brasileira pode ser explicada devido a natureza da população ou, mais provavelmente, pela natureza da fonte, um hospital de referência na cidade...

Use of minimally invasive gingival biopsies in the study of inflammatory mediators expression and their correlation with gingival fluid in patients with chronic periodontitis.

Background: There are no studies comparing the gingival crevicular fluid (GCF) cytokines expression with its corresponding values from the same tissue’s sites. Such comparison might be of great value since most of the cytokine function is related to cell and/or tissue receptors. Aims: Our aim was to use minimally invasive biopsies to evaluate the expression of interferon‑gamma, interleukin 1 (IL‑1) β, IL‑6, IL‑17A, IL‑17F, and their correlation with the expression in gingival fluid in patients with chronic periodontitis. Materials and Methods: The collection of gingival fluid comprised 22 samples from 11 patients (mean age 46.73 ± 10.16 standard deviation years) with chronic periodontitis. The collection of biopsies comprised 22 samples from the same patients. Gingival fluid and biopsy were taken from the same site in one shallow and one deep site per patient. Gingival fluid samples were collected with periopaper® and analyzed using Luminex®. Biopsies were taken with a 2 mm diameter punch and analyzed for the same mediators using immunohistochemistry. Results: The gingival fluid showed higher amounts for IL‑1‑β in deep sites. Immunohistochemical markers were observed in the analyzed cells groups, both in deep and shallow sites, without significant differences between them. In the comparative analysis between immunohistochemical markers and GCF, IL‑1‑β showed high concordance in shallow and deep sites. Conclusions: The use of a standardized punch of 2 mm diameter for periodontal tissue biopsies seems to be suitable for immunohistochemistry analysis and showed that the GCF may not express all the markers in the same proportion at the corresponding tissue.

Expressão do interferon-γ em biópsias gengivais de pacientes com periodontite crônica severa / Expression of interferon-γ in gingival biopsies from patients with severe chronic periodontitis

O objetivo desse estudo foi analisar a expressão do interferon gama (INF-γ) em biópsias gengivais de sítios rasos e profundos de pacientes com periodontite crônica severa, e correlacionar a expressão do INF- γ no fluido gengival. Foram coletadas biópsias de 22 sítios profundos, 18 sítios rasos e 14 sítios controles. O fluido gengival foi coletado de 12 sítios profundos e 8 sítios rasos. Profundidade de bolsa à sondagem (PB); nível de inserção clínica (NIC); índice de placa visível (IPV) e índice de sangramento gengival (ISG) foram avaliados. As análises morfológica e imuno-histoquímica dos tecidos removidos foram realizadas. A intensidade da marcação do INF- γ nos tecidos foi avaliada semiquantitativamente. Houve uma tendência a um padrão de marcação similar nos sítios rasos e profundos, com predomínio de marcação fraca nos sítios profundos. Não houve diferenças estatisticamente significantes entre os três grupos. Não houve correlação significante (Spearman) com a expressão do INF- γ nos tecidos epiteliais e conjuntivos com os dados clínicos e o fluido gengival. Concluímos que não foi possível observar diferenças na expressão do INF- γ em biópsias gengivais nos sítios rasos e profundos de pacientes com periodontite quando comparados à indivíduos saudáveis, o que pode ser atribuído ao caráter bifásico do INF- γ.

The aim of this study was to analyze the expression of interferon-gamma (INF-γ) in gingival biopsies from shallow and deep sites in patients with severe chronic periodontitis and correlate the expression of INF-γ in the gingival crevicular fluid (GCF). Biopsies were collected from 22 deep sites, 18 shallow sites and 14 control sites. The GCF samples were collected from 12 deep and 8 shallow sites. Probing pocket in the epithelial and connective tissues with the clinical data and with the GCF. We conclude that there were no differences in the expression of INF-γ in gingival biopsies in shallow and deep sites of pacients with periodontitis compared to healthy subjects, which may be attributed to the biphasic character of INF-γ.

Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single Oral Pathology service during an 8-year period

Epidemiological data from oral squamous cell carcinoma (OSCC) is mostly derived from North American, European and East Asian populations. OBJECTIVE: The aim of this study was to report the demographic and clinicopathological features from OSCC diagnosed in an Oral Pathology service in southeastern Brazil in an 8-year period. MATERIAL AND METHODS: All OSCC diagnosed from 2005 to 2012 were reviewed, including histological analysis of all hematoxylin and eosin stained slides and review of all demographic and clinical information from the laboratory records. RESULTS: A total of 346 OSCC was retrieved and males represented 67% of the sample. Mean age of the patients was 62.3 years-old and females were affected a decade older than males (p<0.001). Mean time of complaint with the tumors was 10 months and site distribution showed that the border of the tongue (37%), alveolar mucosa/gingiva (20%) and floor of mouth/ventral tongue (19%) were the most common affected sites. Mean size of the tumors was 3.4 cm, with no differences for males and females (p=0.091) and males reported both tobacco and alcohol consumption more frequently than females. Histological grade of the tumors revealed that 27%, 40% and 21% of the tumors were, respectively, classified as well-, moderately- and poorly-differentiated OSCC, 26 cases (7.5%) were microinvasive OSCC and 17 cases were OSCC variants. OSCC in males mostly affected the border of tongue, floor of mouth/ventral tongue and alveolar mucosa/gingival, while they were more frequent on the border of tongue, alveolar mucosa/gingival and buccal mucosa/buccal sulcus in females (p=0.004). CONCLUSIONS: The present data reflect the epidemiological characteristics of OSCC diagnosed in a public Oral Pathology laboratory in southeastern Brazil and have highlighted several differences in clinicopathological features when comparing male and female OSCC-affected patients. .

Lingual Cortical Mandibular Bone Depression: Frequency and Clinical-Radiological Features in a Brazilian Population

The aim of this study was to report the frequency and clinical-radiological features of cases of lingual cortical mandibular bone depressions (LCMBD) diagnosed in consecutive panoramic radiographs and cone-beam computed tomography (CBCT) scans from a Brazilian population. The methods included a retrospective analysis of consecutive panoramic radiographs, charts from the Oral Medicine clinic and consecutive CBCT scans. All cases diagnosed as LCMBD were selected and clinical-radiological data were retrieved from the clinical charts and by the analysis of the image exams. Twenty LCMBD cases diagnosed in 18 patients were found, including 2 from 3,000 consecutive panoramic radiographs (0.07%), 6 from 2,421 Oral Medicine patients (0.25%) and 10 from 1,684 CBCT scans (0.59%). The 18 patients had a mean age of 51.5 years and 13 were males. Two patients presented bilateral lesions. Fourteen images (70%) were classified as well-defined. Eighteen affected the posterior area of the mandible and two affected the anterior mandible. Size of the lesions was larger in younger patients. In conclusion, there seemed to be a considerable radiological heterogeneity when comparing the LCMBD cases and it seemed that the images decreased in size with the increase of patient's age.

Resumo O objetivo deste estudo foi relatar a frequência e os achados clínico-radiográficos dos casos de depressão cortical mandibular lingual diagnosticados em radiografias panorâmicas e em tomografias computadorizadas realizadas pela técnica de feixe cônico consecutivas em uma população brasileira. A metodologia incluiu uma análise retrospectiva de radiografias panorâmicas consecutivas, dos registros dos pacientes da clínica de estomatologia e tomografias computadorizadas consecutivas realizadas pela técnica do feixe cônico. Todos os casos com diagnóstico de depressão cortical mandibular lingual foram selecionados e as informações clínico-radiográficas foram obtidas a partir dos prontuários dos pacientes e da análise dos exames imaginológicos. Um total de 20 casos de depressão cortical mandibular lingual foi diagnosticado em 18 pacientes, incluindo 2 casos em 3.000 radiografias panorâmicas (0,07%), 6 em 2.421 pacientes da clínica de Estomatologia (0,25%) e 10 em 1.684 pacientes do grupo submetido a tomografia computadorizada (0,59%). Os 18 pacientes mostraram uma média de idade de 51,5 anos e 13 eram do gênero masculino. Dois pacientes apresentaram imagens bilaterais. Quatorze imagens (70%) foram classificadas como bem definidas; dezoito acometeram a região posterior da mandíbula e dois casos acometeram a região anterior da mandíbula. O tamanho das lesões foi maior em pacientes mais jovens. Em conclusão, existe uma considerável heterogeneidade na expressão radiográfica das imagens e parece haver uma diminuição do tamanho das imagens com o aumento da idade dos pacientes. .

Fraturas coronárias com exposição pulpar: levantamento epidemiológico em um período de 8 anos / Coronal fractures with pulp exposure: epidemiological survey in an 8-year period

O objetivo deste estudo foi avaliar a frequência, a distribuição clínico-demográfica e a resposta ao tratamento das fraturas coronárias com exposição pulpar diagnosticadas em um ambulatório de trauma dentoalveolar em um período de 8 anos. As informações demográficas, clínicas, radiográficas e de tratamento foram obtidas dos prontuários dos pacientes. No período, 996 pacientes foram atendidos no ambulatório e 120 (12%) apresentaram fraturas coronárias com exposição pulpar. No total, 154 dentes foram diagnosticados com fraturas coronárias com exposição pulpar, incluindo principalmente os incisivos centrais superiores (70%). As causas mais comuns do trauma foram as quedas da própria altura (21%) e os acidentes automobilísticos (15,5%). O tratamento realizado mostrou ótimo resultado, reforçando o bom prognóstico dos dentes tratados adequadamente.

The aim of the present study was to evaluate the frequency, clinical and demographic distribution and response to treatment of the coronal fractures with pulp exposure diagnosed in a clinic for treatment of dentoalveolar trauma in an 8-year period. Demographic, clinical, radiological and treatment informatoin were obtained from the patients files. In the period, 996 patients attended the clinic and 120 (12%) presented with coronary fractures with pulp exposure. A total of 154 teeth were diagnosed with coronary fractures with pulp exposure, including mostly upper central incisors (70%). The most common causes for the fractures were falls (21%) and car/motorcycle accidents (15,5%). Treatment driven for the studied cases showed excellent results, reinforcing the overall good prognosis of the properly treated teeth.

Cisto do ducto nasopalatino: considerações microscópicas e de diagnóstico diferencial / Nasopalatine duct cyst: microscopic and differential diagnosis considerations

Os cistos do ducto nasopalatino são entidades incomuns dos maxilares, mas que podem assemelhar-se clínica e radiograficamente a outras lesões císticas e sólidas da região anterior mediana da maxila. O objetivo deste trabalho foi reportar 4 casos de cisto do ducto nasopalatino buscando discutir suas características microscópicas e de diagnóstico diferencial relevantes na prática clínica odontológica. As informações demográficas, clínicas e imaginológicas foram obtidas a partir dos registros laboratoriais dos pacientes e as lâminas histológicas coradas em hematoxilina e eosina dos 4 casos foram revisadas sob microscopia ótica. Os 4 casos acometeram homens com média de 53 anos de idade e todas as lesões eram assintomáticas. As imagens radiográficas eram radiolúcidas uniloculares, localizadas entre os incisivos centrais superiores e com tamanho médio de 2,0 cm (variando de 1,0 a 4,0 cm). Todos os casos foram tratados através de enucleação cirúrgica e a análise microscópica revelou que 3 dos 4 casos eram revestidos por mais de um tipo de epitélio, sendo o epitélio pavimentoso estratificado não queratinizado o mais comum. Conclui-se que os cistos do ducto nasopalatino acometem usualmente homens adultos, assemelhando-se aos cistos periapicais associados aos incisivos centrais superiores e que devem ser tratados através de procedimentos cirúrgicos conservadores com posterior avaliação microscópica minuciosa do espécime removido.

Nasopalatine duct cysts are uncommon maxillary lesions that can clinically and radiographically resemble other cystic and solid lesions from the maxillary midline area. The aim of this study was to report 4 additional cases of nasopalatine duct cyst focusing on the daily clinical importance of their microscopic and differential diagnosis characteristics. Demographic, clinical and radiographic information was obtained from the patient´s laboratory registries and hematoxilin and eosin stained histological slides from all cases were reviewed under light microscopy. The 4 cases affected males with a mean age of 53 years and all lesions were asymptomatic. Radiographic images were radiolucent and unilocular, between the roots of the upper central incisors measuring a mean of 2,0 cm (ranging from 1,0 to 4,0 cm). All cases were managed through surgical enucleation and microscopic analysis revealed that 3 of the 4 cases were lined by more than one epithelium type, the most common being stratified squamous epithelium. In conclusion, nasopalatine duct cyst usually affect adult males, are similar to periapical cysts associated to upper central incisors, and should be managed by conservative surgical approach followed by careful microscopic evaluation of the surgical specimen.

Pneumonia nosocomial: importância do microambiente oral / Nosocomial pneumonia: importance of the oral environment

A pneumonia nosocomial, em especial aquela associada à ventilação mecânica, é uma infecção frequente nas UTIs. Seus principais fatores etiológicos incluem bactérias colonizadoras e oportunistas da cavidade oral. Manobras de higiene oral, com o uso de antissépticos orais, como a clorexidina, têm se mostrado úteis na diminuição de sua incidência. O objetivo deste trabalho foi revisar a literatura sobre a importância do microambiente oral no desenvolvimento da pneumonia nosocomial.

Nosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.

Reações medicamentosas na cavidade oral: aspectos relevantes na estomatologia / Drug-induced oral reactions: relevant aspects to stomatology

Muitos medicamentos têm o potencial de induzir alterações e sequelas na cavidade oral, e no sistema muscular e esquelético. Por essa razão, torna-se crucial que todo profissional de saúde tenha conhecimento dos possíveis efeitos indesejáveis causados por drogas utilizadas com ou sem prescrição médica, possibilitando o correto diagnóstico e a conduta clínica adequada. O presente trabalho tem como objetivo revisar e listar medicamentos e suas reações adversas com enfoque na cavidade oral.

Cholesterol granuloma of the maxillary sinus

Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of CG in the maxillary sinus of a 22-year-old man, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography (CT) imaging showed complete opacification of the right maxillary sinus with cortical bone expansion and destruction. Incisional biopsy showed a solid mass filling the sinus and histological examination showed foreign body reaction to cholesterol crystals. The microscopic findings associated to tooth vitality, CT images and absence of a cavity during the surgical procedure were compatible with the diagnosis of CG of the maxillary sinus. Complete surgical excision of the mass under general anesthesia was suggested, but the patient did not return to conclude the treatment. CG must be included in differential diagnosis of diseases that cause opacification on the paranasal sinuses, especially sinusitis, and cystic and tumoral lesions.

Granuloma de colesterol (GC) é uma reação de corpo estranho a deposição de cristais de colesterol, usualmente encontrado em associação com doenças crônicas do ouvido médio, sendo bastante incomum nos seios paranasais. O objetivo deste artigo é relatar um caso de GC no seio maxilar de um homem de 22 anos de idade, manifestando-se como aumento de volume na maxila direita, associado a dor e obstrução nasal. Cortes de tomografia computadorizada (TC) mostraram opacificação completa do seio maxilar direito com expansão e destruição do osso cortical. A biópsia revelou uma massa sólida ocupando o seio maxilar e o exame histológico mostrou uma reação de corpo estranho aos cristais de colesterol. Os achados microscópicos associados à vitalidade dos dentes, imagens em TC e ausência de cavidade durante o procedimento cirúrgico foram compatíveis com o diagnóstico de GC do seio maxilar. A excisão cirúrgica completa da massa sob anestesia geral foi sugerida, mas o paciente não retornou para concluir o tratamento. O GC deve ser incluído no diagnóstico diferencial das doenças que causam opacificação dos seios paranasais, especialmente as sinusites e lesões císticas e tumorais.