Peripheral giant cell granuloma associated with a dental implant.

BACKGROUND: Peripheral giant cell granuloma (PGCG) is an uncommon pathology that affects gingival or alveolar mucosa. Although PGCG can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. This study sought to report a rare case of PGCG associated with dental implant, emphasizing its clinical and histopathological aspects. CASE PRESENTATION: A 53-year-old man had an exophytic, reddish lesion, around a crown attached to a dental implant located in the left mandible. Radiographically, there was bone loss around the implant. After excisional biopsy, histological examination revealed a submucosal proliferation of multinucleated giant cells rendering the diagnosis of peripheral giant cell granuloma. Patient has been under follow-up for 6 months with no recurrence. CONCLUSIONS: Peri-implant lesions must be completely removed to prevent recurrence of PGCG and implant failure, even in cases suspected to be reactive. Besides, histological examination must be performed on all peri-implant reactions to achieve the appropriate diagnosis and, consequently, the best treatment and follow up.

Oral Lesions as the Primary Manifestations of Behçet's Disease: The Importance of Interdisciplinary Diagnostics-A Case Report.

BACKGROUND: Behçet's disease (BD) is a rare chronic auto-inflammatory systemic disease with non-specific oral manifestations, categorised as generalised variable vessel vasculitis that requires an interdisciplinary approach to diagnose due to its phenotypic heterogeneity. Whilst the oral lesions that reoccur in BD underpin the complex diagnostic process, the crucial role of dental professionals is highlighted in a case report summarised herein. We present a case of a 47-year-old male referred to the Oral Medicine Department by a rheumatologist after previous hospitalization for thrombosis of the iliac vein and inferior vena cava. He had elevated inflammatory C-reactive protein biomarker and an increased erythrocyte sedimentation rate. Recurrent episodes of folliculitis, oral and genital ulcers were reported. Clinical examination revealed multiple ulcerations in the oral mucosa. The complementary, histopathological analysis performed to rule out other disorders, based on excisional biopsy, showed non-keratinised stratified squamous epithelium with areas of exocytosis and ulceration. The connective tissue presented an intense mixed inflammatory infiltrate, congested blood vessels, haemorrhage, vasculitis, and HLA-B genotyping identified the expression of HLA-B15, further supporting the BD diagnosis. Treatment was initiated with colchicine, prednisolone, and weekly subcutaneous administration of methotrexate and resulted in the complete remission of oral lesions and no recurrence of other manifestations. CONCLUSIONS: This BD case report emphasizes the importance of a multidisciplinary approach in diagnosing BD, including the use of histopathological assessment and genetic profiling. It highlights the significance of thorough intraoral assessment and referral to a multidisciplinary team for diagnosis. The oral manifestations of BD as the primary symptoms often indicate underlying major systemic pathologies. The authors stress the need for a structured diagnostic algorithm to facilitate timely and effective management of BD.

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services-A Retrospective, Comparative Study.

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. OBJECTIVE: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. METHODS: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. RESULTS: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). CONCLUSIONS: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care.

Applicability of the Geographic Tongue Area and Severity Index among Healthcare Professionals: A Cross-Sectional Clinical Validation of a Newly Developed Geographic Tongue Scoring System.

Geographic tongue (GT) is a chronic condition of unknown aetiology, with no defined parameters to establish the protocol for evidence-based management. Validation of a newly developed and proposed clinical index to assess the severity of GT could assist in its diagnosis, especially in cases associated with systemic dermatological diseases in the form of psoriasis. OBJECTIVE: To verify the applicability of the geographic tongue area and severity index (GTASI). This involved healthcare professionals from different specialties to evaluate the usefulness of the GTASI in supporting GT classification, as well as the follow-up process. METHODS: One hundred cases of previously diagnosed GT were initially evaluated by three independent, experienced researchers/clinicians to obtain a standardised classification baseline. Subsequently, nine cases of GT were selected, three cases for each category-mild, moderate and severe. These stages were professionally evaluated by 51 healthcare professionals from three groups: 17 dentists (33%), 22 oral medicine specialists (43%) and 12 specialist dermatologists (24%) during a cross-sectional survey. RESULTS: The quantitative and qualitative assessment based on experts' opinions in the cross-sectional survey demonstrated an acceptable, similar level of GT clinical diagnosis (p > 0.05), with coherence between the various groups of professionals critically appraising the GTASI. An apparent divergence was observed for the moderate GT category, as well as in the group of less experienced evaluators. CONCLUSION: Whilst the validation of GTASI applicability was successfully executed, the general dental practitioners, specialists in oral medicine and dermatologists were equally capable of correct GT diagnosis and appropriately rating its severity. These coherent results were especially replicated among the experienced clinicians. The validation of the newly proposed index confirmed its reliability as a feasible instrument in oral medicine, with the prospect of its wider implementation in clinical practice.

Contribution of benzodiazepines in dental care of patients with special needs.

BACKGROUND: Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. MATERIAL AND METHODS: The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. RESULTS: Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. CONCLUSIONS: The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated. Key words:Special patients, oral sedation, benzodiazepines, midazolam, dental care.

Prevalência das lesões orais em idosos atendidos no serviço de estomatologia do Instituto de Saúde de Nova Friburgo ­ UFF/RJ / Prevalence of oral lesions in the elderly treated at the stomatology service of the Instituto de Saúde de Nova Friburgo ­ UFF/RJ

Objetivo: realizar um levantamento epidemiológico acerca das alterações na mucosa oral dos pacientes acima de 60 anos, atendidos no serviço de Estomatologia do Instituto de Saúde de Nova Friburgo - UFF/RJ, no período de 2013 a 2018, e estabelecer as principais causas e formas de tratamento. Materiais e Métodos: estudo retrospectivo e observacional, com análise descritiva, através da coleta de dados nos prontuários: idade, sexo, cor da pele, ocupação, lesão e sua localização. Resultados: foram analisados 640 prontuários, destes, 395 (61,7%) apresentaram lesão, sendo 132 (20,6%) deles com mais de uma lesão. Dos 395 com lesão, 57,0% (225) eram do sexo feminino. A cor de pele branca representou 56,7% (224), porém 107 prontuários não apresentaram essa informação. A amostra contou com pacientes de 60 a 91 anos, com média de 65 anos. No total foram encontradas 613 lesões. Queilite actínica foi a mais prevalente 15,5% (95), seguida da estomatite protética 14,0% (86) e hiperplasia fibrosa 13,4% (82). Conclusão: os indivíduos idosos do presente estudo apresentaram alta frequência de lesões orais, sendo a queilite actínica, estomatite protética e hiperplasia fibrosa as mais comuns.

Objective: to carry out an epidemiological survey of oral mucosa lesions of patients aged over 60 years, attended at the Stomatology Service of the Nova Friburgo Health Institute - UFF/RJ, from 2013 to 2018, and to establish the main etiologies and forms of treatment. Materials and Methods: retrospective and observational study through data collection from medical records as: age, gender, skin color, occupation, lesion and its location. Results: 640 medical records were analyzed, of which 395 (61.7%) had lesions, 132 (20.6%) had more than one lesion. Of the 395 with injuries, 57.0% (225) were female. White skin color represented 56.7% (224), but 107 medical records did not present this information. The sample included patients aged 60 to 91 years, with a mean of 65 years. In total, 613 injuries were found. Actinic cheilitis was the most prevalent 15.5% (95), followed by prosthetic stomatitis 14.0% (86) and fibrous hyperplasia 13.4% (82). Conclusion: the elderly individuals in the present study had a high frequency of oral lesions, with actinic cheilitis, denture stomatitis and fibrous hyperplasia being the most common.

Evaluation of sclerotherapy with different dilutions of ethanolamine oleate in the treatment of oral varicose veins / Avaliação da escleroterapia com diferentes diluições de oleato de etanolamina no tratamento de varizes orais

ABSTRACT Objective: This study aim to evaluate the effectiveness of sclerotherapy protocols with different dilutions of ethanolamine oleate in the treatment of oral varicose veins. Methods: Clinical data and images of 14 cases treated with sclerotherapy were analyzed and descriptive analyses were performed. Results: Females (58%) and white skin color (83%) prevailed. Age varied between 14 and 79 years, with 47 years on mean (SD = 19 years). The most common anatomical locations were the buccal mucosa and lower lip. The final volume of the sclerosing agent (Ethamolin®) ranged from 0.4 to 4.3ml and the concentration ranged from 5% to 100%. The number of sessions ranged from 1 to 12 and the number of points per application was 1 to 7 points. Pain and edema were seen in 43% and 29% of patients, respectively. Conclusion: Sclerotherapy with monoethanolamine oleate diluted in anesthetic is a safe and effective option for the treatment of this lesion, regardless of concentration. However, edema and pain seem to be directly associated with increased drug concentration.

RESUMO Objetivos: Este estudo tem como objetivo avaliar a efetividade de protocolos de escleroterapia com diferentes diluições de oleato de etanolamina no tratamento de varizes orais. Métodos: Dados clínicos e imagens de 14 casos tratados com escleroterapia foram avaliados, sendo realizado análises descritivas. Resultados: As mulheres (58%) e a cor de pele branca (83%) prevaleceram na amostra. A idade variou entre 14 e 79 anos, com média de 47 anos (DP = 19 anos). As localizações anatômicas mais comuns foram a mucosa jugal e o lábio inferior. O volume final do agente esclerosante (Ethamolin®) variou de 0,4 a 4,3ml e a concentração variou de 5% a 100%. O número de sessões variou de 1 a 12 e o número de pontos por aplicação foi de 1 a 7 pontos. Dor e edema foram observados em 43% e 29% dos pacientes, respectivamente. Conclusão: A escleroterapia com oleato de monoetanolamina diluído em anestésico é uma opção segura e eficaz para o tratamento das varizes orais, independentemente da concentração. No entanto, edema e dor parecem estar diretamente associados ao aumento da concentração do medicamento.

Utilização da toxina botulínica no tratamento do bruxismo em pacientes portadores de paralisia cerebral: revisão de literatura / Use of botulinum toxin for the treatment of bruxism in patients with cerebral palsy: a literature review

A paralisia cerebral (PC) é caracterizada por lesão cerebral não progressiva, sendo a causa mais frequente de deficiência física infantil. Os problemas neuromusculares afetam a saúde bucal, sendo o bruxismo um achado frequente. Este é caracterizado pela aplicação de forças excessivas nos músculos mastigatórios, podendo causar disfunção da articulação temporomandibular, dores de cabeça e desgaste dentário. Recentemente a injeção local da toxina botulínica foi relatada como excelente opção terapêutica. O objetivo deste estudo foi realizar revisão de literatura sobre o tratamento do bruxismo com a utilização da toxina botulínica na PC.

Cerebral palsy (CP) is characterized by nonprogressive brain injury, the most common cause of child disability. Neuromuscular problems affecting oral health, being bruxism a frequent finding. This is characterized by the application of excessive forces in the masticatory muscles, may cause temporomandibular joint dysfunction, headaches and tooth wear. Recently, the local injection of botulinum toxin was reported as excellent therapeutic option. The aim of this study was to conduct a literature review on the treatment of bruxism with the use of botulinum toxin in the PC.

Prevalence of oral lesions caused by removable prosthetics / Chitosan/D. ambrosioides (mastruz) spheres to be applied as a biomaterial

(29%) had some type of associated injury. The lesions found included erythematous candidiasis, inflammatory fibrous hyperplasia, inflammatory papillary hyperplasia, traumatic ulcer, angular cheilitis, irritative keratosis, and denture stomatitis. Inflammatory fibrous hyperplasia was the most prevalent lesion, found in 88 patients (50%),followed by erythematous candidiasis in 75 patients (43%). Of the total number of injured patients, 141 (81%) were women and 34 (19%) were men, and 101 patients (58%) were Caucasian and 37 (21%) were black. Most lesions were located in the upper alveolar ridge and the hard palate. The most widely used type of prosthesis was full upperprosthesis with 84 users (48%). The average usage time for all prostheses was 17 years (SD ± 13). Average patient age was 62 years (SD ± 14). The prevalence of injuries caused by removable prostheses is high, and prolonged use of the device and the presence of oral lesions are strongly associated. Moreover, women represent the largest number of users of the prostheses and therefore carry the majority of the injuries.

Sedação inalatória com óxido nitroso/oxigênio: uma opção eficaz para pacientes odontofóbicos / Nitrous oxide/oxygen inhalation sedation: an effective option for odontophobic patients

O medo é o principal obstáculo para o atendimento odontológico seguro e de sucesso. A utilização da sedação inalatória vem se mostrando eficaz para o controle de comportamento destes pacientes. Entretanto, no Brasil, ainda poucos cirurgiões-dentistas são habilitados e lançam mão desta ferramenta. O objetivo deste relato é demonstrar um caso de paciente odontofóbico atendido com sucesso através da sedação inalatória. Esta técnica é eficaz para o tratamento odontológico de pacientes odontofóbicos, permitindo a colaboração do paciente e diminuindo os riscos de emergências médicas.

The fear is the main obstacle to a safe and successful dental care. The use of inhalation sedation has proved effective for controlling behavior of these patients. However, in Brazil, yet few dentists are enabled, and lay hold of this tool. The objective of this report is to demonstrate a case of odontophobia patient treated successfully by inhalation sedation. This technique is effective for dental treatment of odontophobic patients, allowing the patient’s collaboration and decreasing the risk of medical emergencies.

Utilização de corticosteroide tópico oclusivo para o tratamento da gengivite descamativa: uma opção eficaz / Use of occlusive corticosteroid for the treatment of desquamative gingivitis: an effective option

A gengivite descamativa é uma manifestação dolorosa de algumas desordens autoimunes. O tratamento requer a utilização de corticosteroides tópicos, havendo maior eficácia se for administrado por terapia oclusiva. O objetivo deste estudo é demonstrar a eficácia da terapia oclusiva com corticosteroides no tratamento da gengivite descamativa. Foram selecionados 10 pacientes com quadro clínico de gengivite descamativa com diagnóstico prévio da condição associada. Os pacientes foram instruídos a utilizar moldeiras de silicone com corticosteroide tópico, havendo regressão total em oito pacientes após 30 dias. A terapia oclusiva com corticosteroide tópico é uma opção eficaz para o tratamento da gengivite descamativa. Entretanto, nos casos mais graves, a associação com a medicação sistêmica poderá resultar em melhor controle da doença.

The desquamative gingivitis is a painful manifestation of some autoimmune disorders. Treatment requires the use of topical corticosteroids, with greater efficacy if administered by occlusive therapy. The aim of this study is to demonstrate the efficacy of occlusive therapy with corticosteroids in the treatment of desquamative gingivitis. We selected 10 patients with clinical desquamative gingivitis with a previous diagnosis of associated condition. Patients were instructed to use silicone trays with topical steroids, with complete regression in eight patients after 30 days. The occlusive therapy with topical steroids is an effective option for the treatment of desquamative gingivitis. However, in severe cases, the association with systemic medication may result in better disease control.

Lesões proliferativas não neoplásicas no periodonto: estudo epidemiológico / Non neoplastic proliferative lesions on the periodontum: an epidemiological study

Foi realizado um estudo epidemiológico com 212 casos de lesões proliferativas não neoplásicas localizadas no periodonto, obtidas a partir do arquivo do Laboratório de Histopatologia Bucal da UNIGRANRIO, no período de Janeiro de 1994 a Julho de 2006. A idade, o sexo, a raça, a localização anatômica e o diagnóstico histopatológico foram analisados em lesões de fibroma ossificante periférico, granuloma periférico de células gigantes, granulomapiogênico e hiperplasia fibrosa inflamatória. O granuloma piogênico foi a lesão mais frequente, sendo que 152 lesões (71,69%) do total das 212 estiveram na faixa etária entre 21 e 60 anos e apenas 19 (8,96%) estiveram acima dos 61 anos. A raça branca foi a mais prevalente com exceção dos casos de fibroma ossificante periférico. A maxila foi a localização anatômica predominante no granuloma piogênico e na hiperplasia fibrosa inflamatória e a mandíbula mais frequente no fibroma ossificante periférico e no granuloma periférico de células gigantes.

An epidemiological study was performed on 212 cases of non neoplastic proliferative lesions on the periodontumobtaine in the archives of the Oral Histology Laboratory from Unigranrio, in a period between january of 1994 - july of 2006. Age, sex, race, anatomic localization and histopatological diagnostics were analysed in lesions of peripheral ossifying fibroma, peripheral giant cell granuloma, pyogenic granuloma and inflamatory fibrous hyperplasy. Pyogenic granuloma was the most frequent lesion, and 152 from 212 lesions were from individuals between 21-60 years old and only 19 cases were > 61 years old. Lesions in Caucasians were more prevalent, except in cases of peripheral ossifying fibroma. The maxilla was the predominant anatomic localization in cases of pyogenic granuloma and inflammatory fibrous hiperplasy, and the mandibula was the predominant site in cases of peripheral ossifying fibroma and in peripheral giant cell granuloma.