Periodontitis in individuals with few remaining teeth and a high gingival bleeding index increases the probability of dyslipidemia.

BACKGROUND: Dyslipidemia, a silent multifactorial condition, is characterized by changes in blood lipid levels, affecting all socioeconomic strata, increasing the risk for atherosclerotic diseases. This study investigated whether there is an association between dyslipidemia and the combined exposure of periodontitis plus the number of remaining teeth, gingival bleeding, or caries. METHODS: A two-center cross-sectional study was conducted involving 1270 individuals, with a minimum age of 18 years. Socioeconomic and demographic data, health conditions, lifestyle parameters, and anthropometric, biochemical, and oral clinical examinations were performed. The exposures considered were the presence of periodontitis, dental caries, number of remaining teeth, and gingival bleeding. The outcome was dyslipidemia as defined by the Brazilian Guidelines on Dyslipidemia and Prevention of Atherosclerosis. The combined associations between periodontitis plus other oral health conditions and dyslipidemia were estimated using confounder-adjusted prevalence ratios (PRsingle , PRmultiple , for single and multiple covariable adjustments) with 95% confidence intervals (95% CIs), in a Poisson regression model with robust variance. RESULTS: The occurrence of dyslipidemia was 70.1% and periodontitis was 84.1%. A positive association between periodontitis and dyslipidemia existed: PRsingle  = 1.13; 95% CI: 1.01-1.26. Combined exposure of periodontitis plus <11 remaining teeth (PRmultiple  = 1.23; 95% CI: 1.05-1.43), as well as combined exposure of periodontitis plus ≥10% gingival bleeding and <11 remaining teeth (PRmultiple  = 1.22; 95% CI: 1.03-1.44), represented greater probabilities of 23% and 22% of individuals having a diagnosis of dyslipidemia. CONCLUSION: Periodontitis combined with fewer than 11 teeth doubled the likelihood of being diagnosed with dyslipidemia.

Periodontitis is a factor associated with dyslipidemia.

OBJECTIVE: To investigate the association between the severity of periodontitis (exposure) and dyslipidemia (outcome). METHODS: This was a cross-sectional study of users of public health services. Periodontitis was defined using the Center for Disease Prevention and Control and the American Academy of Periodontology criteria. Lipid evaluation used data on systemic biomarkers. Dyslipidemia diagnosis was based on the Guidelines of total cardiovascular risk of the World Health Organization. Weight, height, waist circumference, and blood pressure were measured, and socioeconomic-demographic, lifestyle behavior factors, general and oral health conditions of the participants were collected. Hierarchical and logistic regression analyzes were used to determine the association between the exposures and the outcome. Odds Ratios, unadjusted and adjusted, and 95% confidence intervals were estimated. RESULTS: Of 1,011 individuals examined, 75.17% had dyslipidemia, and 84.17% had periodontitis, 0.2% with mild, 48.56% moderate, and 35.41% severe disease. The association between periodontitis and dyslipidemia was maintained through hierarchical analysis and in the multiple regression modeling, showing that the occurrences of dyslipidemia in the group with periodontitis, and its moderate and severe levels, were, respectively, 14%, 30%, and 16% higher compared with those without periodontitis. CONCLUSIONS: The results showed a positive association between moderate and severe periodontitis and dyslipidemia.

Panoramic imaged carotid atheromas are associated with increased neutrophil count: both validated, independent predictors of near-term myocardial infarction.

OBJECTIVES: Panoramic images (PXs) demonstrating calcified carotid artery atheromas (CCAAs) are associated with heightened risk of near-term myocardial infarction (MI). Elevated neutrophil counts (NC) within normal range 2,500-6,000 per mm3 are likewise associated with future MI signaling the role neutrophils play in the chronic inflammation process underlying coronary artery atherogenesis. We determined if CCAAs on PXs are associated with increased NC. METHODS: Investigators implemented a retrospective study of PXs and accompanying medical records of white males ≥ 65 years treated by a VA dental service. Two groups (N = 60 each) were constituted, one with atheromas (CCAA+) and one without (CCAA-). Predictor variable was CCAA + and outcome variable was NC. Bootstrapping analysis determined the difference in mean NCs between two groups, significance set at ≤0.05. RESULTS: The study group of (CCAA+) (mean age 75.9; range 69-91 years) demonstrated a mean NC of 4,843 per mm3 and control group (CCAA-) (mean age 75.3; range; 66-94) a mean NC of 4,108 per mm3. The difference between the groups was significant (p = 0.0008) (95% CI of difference of mean: -432, 431; observed effect size 736). CONCLUSIONS: CCAAs on PXs of elderly white males are associated with elevated NC; amplifying need for medical consultation prior to invasive dental procedures.

Inflammatory cytologic alterations in the oral epithelium associated with HIV pre-exposure prophylaxis: a preliminary study.

OBJECTIVE: The objective of this study was to assess inflammatory cytologic alterations in the oral epithelium of patients on human immunodeficiency virus pre-exposure prophylaxis (PrEP). MATERIAL AND METHODS: Epithelial cells from the buccal mucosa of 30 patients were collected by exfoliative cytology and were evaluated according to inflammatory cellular alterations: karyomegaly, bi- or multinucleation, karyopyknosis, karyorrhexis, perinuclear halo formation, metachromasia, cytoplasmic vacuolization, indistinct cytoplasmic border, keratinization, and atrophy. Epithelial cells were collected initially before PrEP onset (T1) and then after 30 days of PrEP use (T2). Two experienced cytopathologists independently analyzed the slides. RESULTS: The nonparametric Wilcoxon test showed that there was a statistically significant increase in the number of cells with karyomegaly at T2 compared to T1 (P = .033). The other cellular alterations did not present with statistically significant differences between the 2 moments of evaluation (P > .05). CONCLUSION: The increased number of oral epithelial cells with karyomegaly after 30 days of using PrEP suggests the presence of inflammatory alterations at this site.

Salivary protein candidates for biomarkers of oral disorders in alcohol and tobacco dependents.

OBJECTIVES: To evaluate the oral condition of alcohol and tobacco dependents and identify salivary protein candidates for biomarkers of oral disorders. SUBJECTS AND METHODS: Thirty-three male volunteers were evaluated for alcohol abuse rehabilitation; nine were selected for proteomic analysis. Intraoral examination was performed, and non-stimulated saliva was collected. Salivary proteins were extracted and processed for analysis. A list of proteins identified in saliva was generated from the database and manually revised, obtaining the total number of candidate biomarkers for oral disorders. RESULTS: The mean age (n = 33) was 42.94 ± 8.61 years. Fourteen (42.4%) subjects presented with 23 oral mucosa changes, and 31 (94%) had dental plaque. A total of 282 proteins were found in saliva (n = 9), of which 26 were identified as candidates for biomarkers of oral disorders. After manual review, 21 proteins were selected. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n = 10), nasopharyngeal carcinoma (n = 6), and periodontal disease (n = 6). CONCLUSION: Alcohol and tobacco dependents showed gingival inflammation, and less than half of them showed oral mucosa changes. Twenty-one protein candidates for biomarkers of oral disorders were identified in saliva. The two major oral disorders in number of candidates for biomarkers were head and neck cancer and periodontal disease.

Marsupialization of a Large Radicular Cyst with Extensive Maxillary Tooth Displacement: Eight-Year Follow-Up.

Radicular cysts arising from primary teeth are uncommon and, when present as large lesions, may adversely affect the underlying permanent teeth. The purpose of this paper is to describe the management of a very large atypical radicular cyst involving the primary dentition of a nine-year-old boy and causing extensive tooth displacement with transposition of the permanent maxillary left canine between the bicuspids. The root apex of the canine was close to the median level of the lateral border of the nasal cavity and showed incomplete root formation and signs of dilacerations in its apical third. Marsupialization was successfully performed, followed by long-term orthodontic treatment. This interdisciplinary management facilitated the lesion resolution for repositioning of the canine into functional occlusion. (J Dent Child 2019;86(1):64-8)
Received October 23, 2018; Last Revision January 10, 2019; Accepted January 11, 2019.

Association of calcified carotid artery plaque in panoramic images and diagonal earlobe crease.

OBJECTIVES:: Brazilians who are free of traditional atherogenic risk factors frequently suffer myocardial infarctions (MI). Calcified carotid artery plaque (CCAP) on panoramic images (PIs) has been shown to be a validated "risk indicator" of future MIs. The diagonal earlobe crease (DELC) is likewise a validated "risk indicator" of future MI. We sought to determine the prevalence of DELC+ among patients having CCAP+ on their PIs. METHODS:: In a masked cross-sectional study, three dentists evaluated PIs of patients (N = 481) over age 55 for presence of CCAP+. Among the CCAP+ cohort, the presence of DELC+ was determined by two additional dentists masked to the presence of CCAP+ on PIs. A control group (CCAP-) comprised of individuals with PIs devoid of plaque was similarly evaluated for evidence of DELC+. RESULTS:: A mixed-gender group (8.6%) of patients (N = 41; mean age 67.5 ± 6.8) evidenced CCAP+ on their PIs and approximately 88% of these individuals (N = 36) had concomitant DELC+. Among members of the control group (N = 41), 17 patients were DELC+. Our results demonstrated that among the full mixed-gender cohort (N = 82), the association between CCAP+ and DELC+ was statistically significant (p = 0.0001). However, when adjusting for gender, only the CCAP+ men were significantly (p = 0.00011) more likely to evidence DELC+ on clinical examination. CONCLUSIONS:: Males with atherosclerosis of their carotid arteries as evidenced by PIs displaying calcified atheromas are significantly more likely to evidence a DELC+ than those without an imaged atheroma.

Massive Submandibular Sialolith: Complete Radiographic Registration and Biochemical Analysis through X-Ray Diffraction.

Sialolithiasis is a pathologic condition that affects 60 million people per year, which is caused by the presence of calcified structures, named sialoliths, inside the salivary glands and their salivary ducts. Despite the large incidence of sialolithiasis, its etiology is still unknown. In the present case report, a 47-year-old female patient, presenting with local pain and hampered mouth opening, underwent a surgical approach for the removal of a 20 mm sialolith, which was further analyzed through X-ray diffraction. In parallel, a radiographic registration of 8 years, covering all the period for sialolith formation, is presented along the case report.

Gingival Anaplastic Large-Cell Lymphoma Mimicking Hyperplastic Benignancy as the First Clinical Manifestation of AIDS: A Case Report and Review of the Literature.

This paper presents an unusual case of gingival ALCL, which mimicked a benign hyperplastic lesion that occurred in a 57-year-old white man representing the first clinical manifestation of acquired immunodeficiency syndrome (AIDS). The patient was referred to the Dental Clinic of PUCPR complaining of a lobulated nodule on the gingiva of his upper central incisors. The presence of advanced chronic periodontitis and dental plaque raised suspicion for a benignancy. An excisional biopsy was performed, and large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli and "Hallmark" cells, were observed through hematoxylin and eosin staining. The tumor cells showed strong CD30 expression, EMA, Ki-67, and LCA, and negative stain for p80(NPM/ALK), CKAE1/AE3, CD20, CD3, CD56, and CD15. The final diagnosis was ALCL (ALK-negative). Further laboratory tests revealed positivity for human immunodeficiency virus (HIV). The patient was submitted to chemotherapy, but four months after diagnosis, the patient died due to pneumonia and respiratory failure. Oral anaplastic large-cell lymphoma (ALCL) is a rare disorder. Only 5 cases involving the gingiva have been reported, and to our knowledge, this is the first case reported of the ALCL, which mimicked a hyperplastic benignancy as the first clinical manifestation of AIDS.

Radiographic analysis of pixel intensity with aluminum step-wedgeand different spatial resolutions / Análise radiográfica da intensidade de pixel com a utilização de penetrômetro de alumínio e diferentes resoluções espaciais

Objective: To evaluate the pixel intensity and to compare it with different spatial resolutions, using an aluminum step-wedge. Methods: The sample consisted of three bone chips of two dry pig mandibles. Then, each bone chip and the aluminum step-wedge were placed on periapical radiographs in order to take the images with Ekta Speed film, with an exposure time of 0.2 seconds and focal length of 25 cm. All radiographs were scanned with spatial resolutions of 150 and 300 dpi and saved as JPEG files. The images were measured using the histogram tool provided by the Image Tool program (UTHSCSA, Texas, USA) selecting specific areas on the bone chips and on the aluminum step-wedge. Results: The data were analyzed by ANOVA and Tukey statistical tests which showed that there was no significant difference in pixel intensity between bone chips and step 3 (3.6 mmEq/Al) of the aluminum step-wedge (p>0.05). It was also observed that there were no significant differences in pixel intensity value measured on step-wedges 2 (3.3 mmEq/Al), 3 (3.6 mmEq/Al), 4 (3.9 mmEq/Al) and on the bone chips, between spatial resolutions of 150 and 300 dpi. Conclusion: Small differences in spatial resolution did not interfere with the evaluation of pixel intensity. It is recommended to measure pixel intensity on digitalized radiographs using an aluminum step-wedge as a reference density value.

Objetivo: Avaliar a intensidade de pixels de fragmentos de tecido ósseo mandibular, bem como compará-la em diferentes resoluções espaciais, utilizando um penetrômetro de alumínio. Métodos: A amostra consistiu de 3 fragmentos ósseos, provenientes de 2 mandíbulas secas de suínos. Em seguida, cada fragmento ósseo, juntamente com o penetrômetro de alumínio, foram posicionados sobre filmes radiográficos periapicais. As radiografias foram realizadas com filme Ekta Speed, tempo de exposição de 0,20 segundos e distância focal de 25 cm. Todas as radiografias foram digitalizadas com resoluções espaciais de 150 e 300 dpi e, em seguida, arquivadas em JPEG. As imagens foram medidas por meio da ferramenta histograma do programa Image Tool (UTHSCSA, Texas, USA) selecionando-se áreas nos fragmentos ósseos e no penetrômetro de alumínio. Resultados: A análise dos resultados pelos testes estatísticos ANOVA e Tukey mostrou que não houve diferença significativa de intensidade de pixel entre os fragmentos ósseos e o degrau 3 do penetrômetro de alumínio (3,6 mmEq/Al) (p>0,05). Observou-se ainda que não houve diferenças significativas dos valores da intensidade de pixel dos degraus 2 (3,3 mmEq/Al), 3 (3,6 mmEq/Al) e 4 (3,9 mmEq/Al) e os fragmentos ósseos, entre as resoluções espaciais avaliadas nesse estudo. Conclusão: Pequenas diferenças de resolução espacial não interferiram nos valores de intensidade de pixel. É recomendável medir esta intensidade com a utilização de penetrômetro de alumínio como referência para valor de densidade.

Clinical diagnosis of hyposalivation in hospitalized patients.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheeks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05). CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Clinical diagnosis of hyposalivation in hospitalized patients

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05). CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

Histological diagnosis of oral lesions with cutting needle biopsy: a pilot study.

OBJECTIVES: The aim of this pilot study was to evaluate the effectiveness of cutting needle biopsy in the diagnosis of solid oral lesions. MATERIAL AND METHODS: The biopsies were carried out on seven patients who presented with solid oral lesions with sizes ranging from 2 to 6 cm. Specimens were obtained from each lesion before conventional biopsies using a cutting needle with 18-gauge x 9 cm (MD TECH, Gainesville, FL, USA). A total of 64 specimens processed by hematoxylin-eosin staining method, were obtained. Afterwards, the analysis was performed by an oral pathologist, in two different stages, with and without the clinical history of each lesion. Then, these answers were compared with the final histological diagnosis. RESULTS: Results presented by the descriptive analysis showed that the correct diagnosis using cutting needle biopsy without the clinical history of lesions was registered in 37.5% of cases, while with the clinical history in 76.6%. CONCLUSIONS: Despite the promising results as a potential technique for biopsies and histological diagnosis of oral lesions, the cutting needle biopsy should be analyzed carefully in those cases.

Spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst.

A dentigerous cyst is the most common developmental odontogenic cyst. It is a benign and asymptomatic intraosseous lesion that affects the bones of the maxillofacial complex, interfering with tooth eruption. This article reports the spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst and extraction of the deciduous teeth. A radiograph showed a large cyst with a radiolucent area involving the mandibular left deciduous canine and first molar, and the permanent canine and first premolar. Although enucleation is the treatment of choice, marsupialization is the best option for large cysts involving an unerupted permanent tooth, as in this case. The patient was followed for 1 year, and eruption of the permanent canine and first premolar and gradual reduction of the radiolucent area were observed.