Oral pigmented lesions: a retrospective analysis from Brazil.

BACKGROUND: Pigmented lesions are uncommon in the oral mucosa, and studies investigating the incidence and types of these lesions are desired to improve the diagnostic knowledge of clinicians. The aim of this study was to analyze the distribution of oral pigmented lesions in a Brazilian population. MATERIAL AND METHODS: A retrospective descriptive cross-sectional study was performed. Oral pigmented lesions were retrieved from the files of two oral and maxillofacial pathology services from Brazil over a 45-year period (1974-2019). The clinical data and the diagnoses of each case were retrieved and included in a Microsoft Excel® database. RESULTS: From 77.074 lesions diagnosed in this period, 761 (0.99%) represented pigmented lesions of the oral mucosa, including 351 (46.1%) melanocytic and 410 (53.9%) non-melanocytic lesions, with a higher incidence in females (73.2%) between the fourth and seventh decades of life. Amalgam tattoo (53.6%) represented the most common lesion, followed by melanotic macule (18.3%) and racial pigmentation (10.8%). Other pigmented lesions included nevus (9.9%), post-inflammatory pigmentation (3%), melanoma (2.1%), melanoacanthoma (1.4%), smoker's melanosis (0.4%), drug-induced pigmentation (0.3%), and melanotic neuroectodermal tumor of infancy (0.1%). The buccal mucosa was the most commonly affected site (25.2%), followed by the alveolar ridge (14.5%), and gingiva (11.8%). CONCLUSIONS: The current findings were similar to previous studies with minor differences due methodology and characteristics of the services from where lesions were retrieved. The knowledge of these data may contribute to a better understanding of oral pigmented lesions and assist clinicians to better recognize and manage them.

Radiographic estimation of the growth rate of initially underdiagnosed ameloblastomas.

BACKGROUND: To evaluate the specific growth rate (SGR) of ameloblastoma. MATERIAL AND METHODS: cases of ameloblastoma initially underdiagnosed (e.g. cases overlooked or diagnosed as reactive lesions) which had adequate radiographic documentation to evaluate their progression were retrospectively selected. Two panoramic radiographs were analyzed to determine the specific growth rate (SGR) of each tumor, defined as the logarithm of the ratio of final tumor area (when the diagnosis of ameloblastoma was made) to the initial tumor area (when the lesion was underdiagnosed), divided by the time interval between the radiographic images. The tumor area was measured using the software ImageJ. RESULTS: Twelve patients with mandibular ameloblastomas were selected, including 5 males and 7 females, with a mean age of 24.9 years (range: 14-61 years). In four cases, the lesion was associated with the crown of an impacted third molar. In three cases, it was initially diagnosed as a periapical lesion. Three cases were extrafollicular and were not noticed in the initial radiographs. Two cases were initially diagnosed as ameloblastoma, but the surgery was delayed for personal reasons. The mean interval of time between the two radiographic images was 4.3 years (range: 0.4-9 years). Based on our analysis, ameloblastoma grows in average 40.4% per year (range: 14.9-88.7%). CONCLUSIONS: Ameloblastoma is a progressively growing tumor, but its growth rate seems to be smaller than initially reported in the literature. Better understanding the radiographic progression of ameloblastoma might improve its early diagnosis, management, and prognosis.

Chikungunya fever: General and oral healthcare implications.

Chikungunya virus (CHIKV) was first isolated in humans in 1952, following an epidemic in Tanzania. The origin of the name means "to bend forward or become contorted," in reference to the posture adopted by patients due to the joint pain that occurs during the infection. Epidemiology data suggest that by the end of 2015, about 1.6 million people had been infected with CHIKV. The acute period of the disease is characterized by high fever, myalgia, joint pain, and severe and disabling polyarthritis, sometimes accompanied by headache, backache, and maculopapular rash, predominantly on the thorax. Around half of the patients will progress to the subacute and chronic phases, that is manifested by persistent polyarthritis/polyarthralgia, accompanied by morning stiffness and fatigue, which could remain for years. Oral features may include gingivitis possibly as a consequence of arthralgia of the hands leading to limited oral health measures as well as burning sensation and oral mucosal ulceration. Treatment in the acute phase includes acetaminophen, and weak opioids (tramadol or codeine) should be used in cases of severe or refractory pain. For patients who have progressed to the subacute stage and who have not had notable benefit from common analgesics or opioids, NSAIDs, or adjunctive pain medications (anticonvulsants or antidepressants) may be of benefit. In patients with moderate-to-severe musculoskeletal pain or in those who cannot be given or tolerate NSIADs or opiates, prednisolone should be prescribed.

Malignant odontogenic tumors: a multicentric Latin American study of 25 cases.

OBJECTIVE: The aim of this study was to show the epidemiological features of 25 malignant odontogenic tumors (MOT) in Latin America. MATERIALS AND METHODS: We retrieved 25 cases of MOT out of 2142 odontogenic tumors, from four oral diagnostic centers in Latin America, and described the main clinical and pathological characteristics. RESULTS: A total of 19 cases were carcinomas, including eight ameloblastic carcinomas, five primary intra-osseous squamous cell carcinomas, three clear cell odontogenic carcinomas and three ghost cell odontogenic carcinomas. All six sarcomas corresponded to ameloblastic fibrosarcoma. Thirteen cases occurred in men and 12 in women, age ranged from 7 to 77 years old, with a mean of 41.4 years. The average age of patients with carcinomas and sarcomas were 48.53 and 19 years old, respectively. CONCLUSION: As malignant odontogenic tumors are very rare, this series helps to better clarify their relative frequency, predominant subtypes, and clinical characteristics in Latin America.

Cleidocranial dysplasia: oral features and genetic analysis of 11 patients.

BACKGROUND: Cleidocranial dysplasia (CCD) is a dominantly inherited autosomal disease characterized by typical bone defects including short stature, persistently open or delayed closure of the cranial sutures, and hypoplastic or aplastic clavicles. Oral features are frequent and include supernumerary teeth, delayed eruption or impaction of the permanent teeth, and malocclusion. Heterozygous mutations in RUNX2 gene, which encodes a transcription factor essential for osteoblast differentiation, were identified as the etiological cause of CCD. OBJECTIVE AND METHODS: Herein, we performed physical and radiographic examination and screening for RUNX2 mutations in 11 patients from five families with CCD. RESULTS: All patients demonstrated the classical phenotypes related to CCD. Families whose affected members had several dental alterations such as multiple impacted and supernumerary teeth demonstrated heterozygous missense mutations (R190Q and R225Q) that impair the runt domain of RUNX2. On the other hand, CCD patients from families with low frequency of dental abnormalities showed no mutation in RUNX2 or mutation outside of the runt domain (Q292fs→X299). CONCLUSION: The current findings suggest a correlation between dental alterations and mutations in the runt domain of RUNX2 in CCD patients. Further clinical and genetic studies are needed to clarify the relationship between phenotypes and genotypes in CCD and to identify other factors that might influence the clinical features of this uncommon disease.

Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease.

Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.

Lymphoepithelial infiltrate of palatal minor salivary glands: implications for diagnostic work-up.

Benign lymphoepithelial lesions (BLLs) usually affect the parotid glands, resulting in their asymmetrical enlargement. The condition can be associated with Sjögren's syndrome (SS), which in turn may predispose the affected patient to the development of malignant lymphoma. BLLs arising in the intraoral minor salivary glands are rare; such a lesion should prompt the work-up for SS. In some instances, a BLL of a minor salivary gland could represent the initial stage of a mucosa-associated lymphoid tissue (MALT) lymphoma. A case of BLL arising in the palatal minor salivary glands is reported here. The importance of an appropriate diagnostic work-up is emphasized and the relationship of BLL with SS is reinforced.

Salivary gland tumors in a Brazilian population: a retrospective study of 496 cases.

Salivary gland tumors are uncommon and the microscopical features can be complex. Epidemiological data of these tumors in the various parts of the world can be helpful for a better understanding of its biology and clinical characteristics. In this study, 496 epithelial and mesenchymal tumors of major and minor salivary glands diagnosed at Londrina Cancer Institute during the period from 1972 to 2001 were reviewed. Out of all cases, 335 (67.5%) were classified as benign and 161 (32.5%) as malignant. The majority of the cases occurred in the parotid gland (67.7%), followed by the minor salivary glands (22.8%) and submandibular gland (9.5%). Among the minor salivary gland tumors, the palate was the most frequent location (67%). The tumors affected more commonly adult patients with peak incidence between 40 and 50 years of age and with a slightly predominance in females. Pleomorphic adenoma was the most frequent tumor representing 54.2% of all cases, followed by mucoepidermoid carcinoma (13.5%), Warthin's tumor (8.5%) and adenoid cystic carcinoma (7.9%).

Pulpal lesions in normal and cyclosporin A treated rats.

The objective of this study was to examine the development of pulpal lesions in the lower molar of control and cyclosporin A (CyA) treated rats. The pulps of the first lower molars of 20 normal and 20 CyA treated rats were exposed and left open into the oral cavity. Five animals of each group were killed at 7, 14, 21, and 28 days after the pulp exposure. The specimens were sectioned sagittally at a thickness of 7 microns and stained with hematoxylin and eosin. The pulpal lesions were similar for both normal and CyA treated rats in all studied periods and the differences between both groups were not statistically significant by the Student t test at the 5% (0.05) level of significance, indicating that the immunosuppression did not alter the evolution of the inflammatory process.

Herpes zoster infection as a differential diagnosis of acute pulpitis.

Many diseases can cause orofacial pain, and the diagnosis must be established before final treatment. This case report presents a patient with orofacial pain that was diagnosed as an acute pulpitis. However, there was no evidence of this problem on examination. After 4 days, the patient showed multiples vesicles on the face, and a herpes zoster viral infection was diagnosed. The patient was treated with acyclovir and, after 2 yr, she still complains of facial sensitivity.

The effect of cyclosporin A on the activity of matrix metalloproteinases during the healing of rat molar extraction wounds.

Cyclosporin A (CyA) is a cyclic peptide used as an immunosuppressive agent because it can block the synthesis of interleukin-2 and other cytokines produced by CD4+ lymphocytes. It is widely used for the prevention of allograft rejection and treatment of autoimmune diseases. Several side-effects of CyA treatment have been reported, among which are chronic nephrotoxicity, hepatotoxicity and neurotoxicity, lymphoproliferative neoplasms, hypertension, thromboembolic complications and gingival overgrowth. Here, using a rat molar model, it is demonstrated that CyA immunosuppression inhibits the activity of matrix metalloproteinases 2 and 9 in the early phase of granulation tissue in the healing dental socket. These observations suggest that CyA may interfere with the wound healing following dental extractions.

Hepatitis B vaccination and infection control in Brazilian dental practice, 1990.

The aims of the study were to examine the knowledge of occupational hazards from blood-borne viruses, and practices related to cross-infection control in Brazil, by a survey of 947 Brazilian dental practitioners at a National Dental Congress in January 1990. Over 80% were aware that hepatitis B virus can be present in the oral cavity and constitutes an occupational hazard but their perceptions as to the hazards from other agents were at variance with the published evidence. Over 75% were aware of the existence of vaccines against hepatitis B virus but less than 60% appreciated the possible long-term hepatic sequelae of hepatitis B virus infection and, less than 40% were aware of the oncogenic potential. Less than 10% had been immunized against hepatitis B and only a further 30% intended to be vaccinated. Autoclaves were used by less than 10%: most appeared to use chemical means for disinfection of dental instruments. These results indicate the urgent need for a campaign to improve infection control procedures in Brazilian dental practice.

Oral mucosal health and disease in institutionalized elderly in Brazil.

During the last decade, many studies in Europe and North America have evaluated oral conditions and dental needs in the elderly. Similar information does not exist in Brazil. The aim of this study was to determine the prevalence of oral health and disease in elderly persons living in an institution in the city of Piracicaba, State of São Paulo, Brazil. Of 350 elderly persons, 134 males and 136 females were interviewed and clinically examined. Less than one half had healthy mouths. 58.9% of the examined individuals showed one or more lesions in the oral mucosa, the most frequent being denture-induced stomatitis (20.0%). Fibrous hyperplasias (11.8%) and angular cheilitis (9.3%) were fairly common. Gender, use and degree of hygiene of the denture were factors statistically significantly contributing to prevalence of denture stomatitis. Precancerous lesions such as leukoplakia (3.0%), actinic cheilitis (2.6%) were uncommon but three cases of squamous carcinoma (1.1%) were revealed. This study emphasizes the need for regular oral examinations of the elderly by personnel trained in oral diagnosis.

Ultrastructural aspects of connective tissue in hereditary gingival fibromatosis.

OBJECTIVE: The purpose of this study was to analyze the ultrastructure of gingival connective tissue from patients in one family affected by hereditary gingival fibromatosis (HGF). STUDY DESIGN: Electron microscopic examination was performed with gingival tissue from 10 patients from a Brazilian family with 132 members. Fifty of 96 persons at risk for this disorder were affected, which is consistent with an autosomal dominant pattern of inheritance. RESULTS: The extracellular matrix showed flocculent material and collagen fibrils with structural abnormalities and variation in diameter. Increased numbers of oxytalan fibers were identified; however, elastic fibers were rare in the analyzed areas. CONCLUSIONS: The structural alterations found in HGF appear similar to those described in certain other heritable collagen disorders, suggesting that HGF should be included in the group of hereditary diseases in which connective tissue alterations have a distinct pattern, in contrast to reactive fibrotic gingival enlargements with no genetic component.

HIV prevalence in dental outpatients in Brazil.

A series of dental outpatients in Brazil was anonymously screened for HIV antibodies in whole unstimulated saliva with an immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Salivary HIV antibodies were detected in 40 patients in the control group who were known to be HIV-seropositive but were not detected in any of a series of 40 known HIV-seronegative patients in the control group, confirming the very high sensitivity and specificity of the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Only one patient from 84 consecutive dental outpatients of unknown HIV serostatus who were examined anonymously for HIV by immunoglobulin G antibody-capture enzyme linked immunosorbent assay showed HIV positivity (1.2% of the population).

PIP: Dental outpatients in Sao Paulo, Brazil, were anonymously screened for HIV through use of a salivary immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. The ages of the 84 consecutive emergency dental patients ranged from 16 to 52 years. Pretesting of the saliva test in 40 patients confirmed to be HIV-positive through two serum assays, and 40 known HIV-seronegatives indicated this method is 100% accurate. Only 1 salivary test (1.2%) among the dental outpatients was positive for HIV antibodies. Salivary antibody testing has the advantages of absence of needlestick injuries, simplicity, ease of collection, lack of need for trained staff, greater compliance in high-risk groups, and better acceptability by children. Moreover, because of the lower titer of HIV in saliva than in blood and the HIV inhibitory action of saliva, this diagnostic method is associated with a reduced risk of occupational hazard during sample collection.

Regional odontodysplasia. Report of two cases.

Two cases of regional odontodysplasia in girls are reported; one affected the lower incisors, and the other the left maxilla. The first case was radiographically followed over a 6-year period, during which time the ghost teeth exhibited significant dentin formation, along with a resultant decrease in pulp size and relative normalization of the radicular anatomy. The second case involved the deciduous molars and the first permanent molar. In addition to tooth alterations, both cases exhibited many odontogenic epithelial islands and extensive areas of calcification in the mucosa. Diagnosis, causes, and treatment are discussed in the light of recent data.

Radiation safety: what can happen in an accident.

Radiation hazards in dental practice have long been recognized, and the dangers from ionising radiation during dental radiography are discussed elsewhere. Continuing legislation will undoubtedly help reduce the risk of over-exposure and accidents. Nevertheless, it is of some concern that radiation safety is still ignored by some: for example, one recent survey in the UK showed that not all radiography sets conformed to modern safety standards. However, the profession also has reason to be concerned about more public radiation hazards that may affect them, and their families and others, and may, without denying the importance of dental radiation protection, have far greater effects on health. Well-known examples of domestic radon exposure occurred in the UK, particularly in the Lake District and the South West, and the nuclear reactor accidents--notably at Chernobyl in 1986.

An unusual alteration in the shape of a tooth.

Dental anomalies are an important issue and dentists should be able to manage these conditions. Often, treatment is not necessary; however, some abnormalities may affect the esthetics or function of teeth and can lead to other problems. This case report presents an unusual case of alteration in shape affecting the left lower canine in a 34-year-old woman.

Oral changes associated with biliary atresia and liver transplantation.

A child is reported with green hypoplastic teeth in both dentitions, resulting from hyperbilirubinemia biliary atresia. Following liver transplantation, labial hirsutism, gingival hyperplasia and herpes labial, were seen as a consequence of cyclosporin therapy and iatrogenic immunosuppression. The oral manifestations and management in biliary atresia and after liver transplantation are reviewed.

Hereditary gingival fibromatosis: report of three cases.

Three cases of generalized and severe HGF in young patients of the same family without other features are reported. The purpose of this article is to present documented cases and discuss the identification, treatment, and control of the disease. The histopathological characteristics of HGF are emphasized.