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BACKGROUND: Pemphigus vulgaris (PV) is a potentially life-threatening mucocutaneous autoimmune disease that affects desmoglein-1 and desmoglein-3, leading to intraepithelial vesiculobullous lesions. In the oral mucosa, PV lesions can mimic other diseases such as mucous membrane pemphigoid, other forms of pemphigus, recurrent aphthous stomatitis, erythema multiforme, Stevens-Johnson syndrome, and virus-induced ulcers like herpes simplex virus (HSV), making diagnosis challenging. The co-occurrence of PV with Crohn's disease is rare and predominantly seen in younger patients. The therapeutic mainstay for both PV and Crohn's disease usually involves systemic corticosteroids combined with immunosuppressants and immunobiological drugs. Literature indicates that the use of these drugs, particularly TNF-alpha inhibitors, for managing autoimmune diseases like Crohn's can potentially induce other autoimmune diseases known as autoimmune-like syndromes, which include episodes of lupus-like syndrome and inflammatory neuropathies. There are few cases in the literature reporting the development of PV in individuals with CD undergoing infliximab therapy. CASE REPORT: A young female with severe Crohn's disease, treated with the TNF-alpha inhibitor infliximab, developed friable pseudomembranous oral ulcerations. Histopathological and immunofluorescence analyses confirmed these as PV. The treatment included clobetasol propionate and low-level photobiomodulation, which resulted in partial improvement. The patient later experienced severe intestinal bleeding, requiring intravenous hydrocortisone therapy, which improved both her systemic condition and oral lesions. Weeks later, new ulcerations caused by herpes virus and candidiasis were identified, leading to treatment with oral acyclovir, a 21-day regimen of oral nystatin rinse, and photodynamic therapy, ultimately healing the oral infections. To manage her condition, the gastroenterologists included methotrexate (25 mg) in her regimen to reduce the immunogenicity of infliximab and minimize corticosteroid use, as the patient was in remission for Crohn's disease, and the oral PV lesions were under control. CONCLUSION: Young patients with Crohn's disease should be referred to an oral medicine specialist for comorbidity investigation, as oral PV and opportunistic infections can arise during immunosuppressive therapy. The use of TNF-alpha inhibitors in patients treated for inflammatory bowel disease, such as Crohn's, should be carefully evaluated for potential side effects, including oral PV.
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Doença de Crohn , Herpes Simples , Fatores Imunológicos , Infliximab , Pênfigo , Humanos , Pênfigo/tratamento farmacológico , Pênfigo/complicações , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Feminino , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Infliximab/uso terapêutico , Infliximab/efeitos adversos , Adulto , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Doenças da Boca/tratamento farmacológico , Doenças da Boca/complicaçõesRESUMO
OBJECTIVE: To evaluate the prevalence and clinical aspects of oral candidiasis in patients hospitalised in the intensive care unit. METHODS: This is a longitudinal and prospective study that included 48 participants hospitalised in the intensive care unit. Sociodemographic data, presence of systemic disorders, use of medications, laboratory tests, cause of hospital admission, type of breathing, and length of hospital stay were obtained from medical records. Oral clinical inspection and cytopathological examinations were performed on all participants. The diagnosis of clinical candidiasis was based on the presence of clinical alterations together with positive cytopathological examination results. The diagnosis of subclinical candidiasis was based on the absence of clinical lesions and a positive cytopathological examination. The absence of oral candidiasis was considered when the participant did not present oral lesions and had a negative cytopathological examination. RESULTS: Clinical candidiasis was present in 18.8% of the 48 participants, and 45.8% of them had the subclinical form. Levels of urea (P = 0.005), creatinine (P = 0.009), haemoglobin (P = 0.009), haematocrit (P = 0.011), bands (P = 0.024), international normalised ratio (INR; P = 0.034), types of breathing (P = 0.017), length of hospital stay (P = 0.037), and outcome (P = 0.014) demonstrated statistically significant differences between the groups with and without oral candidiasis. CONCLUSIONS: Clinical and subclinical forms of oral candidiasis are frequent in intensive care unit patients. Levels of urea, creatinine, haemoglobin, haematocrit, bands, INR, type of breathing, length of hospital stay, and outcome can be associated with the presence of candidiasis.
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Candidíase Bucal , Candidíase , Humanos , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Estudos Prospectivos , Creatinina , Candidíase/diagnóstico , Candidíase/epidemiologia , Unidades de Terapia IntensivaRESUMO
ABSTRACT: Lichen planus (LP) is a mucocutaneous immune-mediated disease of unknown etiology. It is more prevalent in women and usually occurs between the third and sixth decades of life. Oral lesions may or may not be associated with skin and genital lesions. Although the role of genetic factors is still undetermined, reports of LP in more than one family member are not uncommon. However, the occurrence of LP in monozygotic twins is rare. We report a rare case of 42-year-old female monozygotic twins presenting oral LP. This report is even rarer because one of the patients had cutaneous lesions of an unusual variant of LP (LP pigmentosus) and the other had an uncommon association with lichen sclerosus. The etiology and pathogenesis of LP are still uncertain. However, despite being rare, its occurrence in family members and monozygotic twins suggests that genetic factors are involved in its development.
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Líquen Plano Bucal/patologia , Líquen Plano/patologia , Líquen Escleroso Vulvar/patologia , Adulto , Feminino , Humanos , Hiperpigmentação/patologia , Gêmeos MonozigóticosRESUMO
Background: Assessment of oral epithelial dysplasia is the gold standard for investigating the risk of malignant progression. The World Health Organization (WHO) methods and the binary system have limitations. This study assess the inter- and intra-observer variability of the architectural and cytological criteria and the classification of the presence and degree of epithelial dysplasia in oral lichen planus (OLP) and oral lichenoid lesion (OLL), using both the 2017 WHO criteria and the binary system. Material and Methods: The sample consisted of 65 biopsies from lesions classified as OLP and OLL according to the American Academy of Oral and Maxillofacial Pathology (AAOMP) criteria. The histological slides were reevaluated by two oral pathologists. Results: The individual alterations with most inter-observer disagreement were atypical mitotic figures (43.1%), loss of cohesion between epithelial cells (38.5%) and drop shape rete ridges ridges (38.5%). Inter-observer agreement analysis did not show statistically significant agreement regarding the classification of epithelial dysplasia grade by WHO criteria, only regarding the binary system classification (k=0.257; p=0.035). Intra-observer agreement analysis by evaluator 1 showed that the classification of epithelial dysplasia grade according to both methods had statistically significant agreement (k=0.546; p=0.004, k=0.861; p<0.001). Considering evaluator 2, only the evaluation of the WHO system classification showed statistically significant agreement (k=0.593; p=0.010). Conclusions: The evaluation of epithelial dysplasia is subjective and focal changes and inflammatory infiltrate, characteristic of OLP and OLL, can increase the degree of disagreement among evaluators. The binary system presents better inter-observer agreement, while the WHO system presents better intra-observer agreement. Key words:Oral lichen planus, oral lichenoid lesion, oral lichenoid disease, dysplasia, inter-observer variation.
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Cheilitis is a term given to the inflammation that occurs in the vermillion of the lips. The exfoliative type is an uncommon form of cheilitis, which is characterized by inflammation and desquamation of the lip. It can cause aesthetic problems and compromise daily eating and phonation. The aim of this paper is to describe two cases of exfoliative cheilitis in young persons under periods of emotional stress and parafunctional habits. A 22-year-old white male and an 18-year-old black female presenting edema, intense dryness, and slight desquamation on the vermilion of the lips. In the second case, fissures with bleeding were also observed. Oral lesions were associated with intense emotional stress. The diagnosis of both was made based on the clinical presentation and the exclusion of other conditions. Although the patients have presented a significant improvement after the corticosteroid treatment, they still have a recurrence in stressful episodes. Detailed clinical examination and complementary exams are fundamental for determining associated factors and correctly diagnosing exfoliative cheilitis. Treatment can be challenging, especially in the face of relapses. Key words:Cheilitis, exfoliative cheilitis, oral lesions, stress psychological.
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We conducted an integrative review on oral manifestations in patients with COVID-19 based on the current available literature evidence. A bibliographic search was carried out on March 11, 2021, among published studies in the years 2019-2021 in the PubMed database and based on the search strategy ("COVID-19" AND "oral lesions" OR "oral mucositis" OR "oral manifestation"). After applying the inclusion and exclusion criteria, 29 articles were considered suitable for this review. A total of 110 cases of patients with COVID-19 who had oral manifestations were reported. The presence of ulcerated lesions was the most common finding, having a herpetiform and aphthous clinical pattern observed in most cases. Macules, petechiae, hemorrhagic blisters, pustular enanthem, mucositis, and halitosis were also among the most frequently described oral manifestations. The tongue was the most commonly affected site, followed by the palate and lip. Most of the reported cases were diagnosed only by the clinical aspect of the lesion associated with a positive SARS-CoV-2 test or the presence of other COVID-19 symptoms. Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID-19 are related to the virus's direct or indirect action on the oral mucosa. To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions.
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COVID-19 , Úlceras Orais , Humanos , Mucosa Bucal , Úlceras Orais/etiologia , Estudos Prospectivos , SARS-CoV-2RESUMO
Dentinogenic ghost cell tumor (DGCT) represents a rare benign odontogenic neoplasm that can appear in a central or peripheral form and may rarely undergo malignant transformation to ghost cell odontogenic carcinoma (GCOC). We aim to report a case of a central DGCT with focal cytological malignant aspects. A 24-year-old woman exhibited a painful enlargement and dental mobility in the left posterior maxilla for about one year, which appeared as an expansive well-defined hypodense maxillary image with hyperdense foci invading ipsilateral maxillary sinus. Incisional biopsy showed a predominantly solid hyperchromatic basaloid epithelium presenting cellular pleomorphism and mitotic activity, admixed with abundant ghost cell aggregates and dentinoid material. The lesion was immunopositive for p53 and had 21% of Ki-67 proliferation index (PI). These microscopic features suggested initially a GCOC diagnosis. Partial left maxillectomy was performed without complications. The surgical specimen presented an exuberant variation of the epithelial parenchyma, including ameloblastomatous, fusiform, and cribriform areas, with numerous ghost cells and dentinoid material, lacking any signs of malignancy. The final diagnosis was DGCT. The patient is in a strict regular follow-up for over two years, and there are no signs of recurrence.
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Ameloblastoma , Carcinoma , Neoplasias Maxilomandibulares , Tumores Odontogênicos , Adulto , Feminino , Humanos , Neoplasias Maxilomandibulares/patologia , Maxila/patologia , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos/patologia , Tumores Odontogênicos/cirurgia , Adulto JovemRESUMO
The most common oral choristomas are consisted of thyroid tissue and bone. The presence of sebaceous glands in the oral mucosa, especially in the buccal mucosa and labial mucosa, is often considered a normal anatomical variation since they are observed in about 80% of the population and are called ectopic sebaceous glands or Fordyce's granules. However, the presence of these glands on the tongue is rare, with only 11 cases in the dorsum of the tongue reported in the English literature, and it is considered a choristoma. This paper aims to report the third case in the literature of a congenital sebaceous choristoma on the tongue. An 11-year-old white male patient presented a firm sessile papule, without color alteration, measuring 0.4 cm x 0.3 cm in diameter, in the middle third of the dorsum of the tongue with a slight increased size in the last months. Histopathological examination showed an invagination of the epithelium into the connective tissue, forming a ductal structure covered by stratified squamous epithelium. The deeper areas had normal well-differentiated sebaceous glands, with ducts connected to the central duct. Considering clinical and histopathological findings the diagnosis was sebaceous choristoma. Despite being rare, sebaceous choristomas should also be considered in the differential diagnosis of tongue abnormalities or lesions. Although the pathogenesis is not well understood, the present report, as a congenital choristoma case in the midline, reinforces the hypothesis of a disorder with embryological origin and a possible relationship with thyroglossal duct remnants. Key words:Choristoma, Oral Mucosa, Tongue.
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BACKGROUND: The diagnosis of oral lichenoid lesions (OLL) remains a challenge for clinicians and pathologists. Although, in many cases, OLL cannot be clinically and histopathologically distinguishable from oral lichen planus (OLP), one important difference between these lesions is that OLL has an identifiable etiological factor, e.g. medication, restorative material, and food allergy. The list of drugs that can cause OLL is extensive and includes anti-inflammatory drugs, anticonvulsants, antihypertensives, antivirals, antibiotics, chemotherapeutics, among others. This work aimed to perform a literature review of OLL related to chemotherapy drugs and to report two cases of possible OLL in patients with B-cell and T-cell non-Hodgkin lymphomas in use of chemotherapy and adjuvant medications. We also discuss the challenge to clinically and histopathologically differentiate OLL and OLP. CASE PRESENTATION: In both cases, oral lesions presented reticular, atrophic, erosive/ulcerated, and plaque patterns. The diagnosis of OLL was initially established in both cases by the association of histopathology and history of onset of lesions after the use of medications. Although the patients have presented a significant improvement in the oral clinical picture for more than 2 years of follow-up, they still have some lesions. CONCLUSION: A well-detailed anamnesis associated with the drug history, temporal relationship of the appearance of the lesions, and follow-up of patients are fundamental for the diagnosis of OLL related to drugs. Nevertheless, its differentiation from OLP is still a challenge.
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Líquen Plano Bucal , Erupções Liquenoides , Linfoma não Hodgkin , Humanos , Líquen Plano Bucal/induzido quimicamente , Líquen Plano Bucal/diagnóstico , Líquen Plano Bucal/tratamento farmacológico , Erupções Liquenoides/induzido quimicamente , Erupções Liquenoides/diagnóstico , Erupções Liquenoides/patologiaRESUMO
Dentinogenic ghost cell tumor (DGCT) and ghost cell odontogenic carcinoma (GCOC) form a spectrum of rare benign and malignant odontogenic neoplasms, respectively. The aim of this study was to perform a comparative systematic review of the clinicopathological, genetic, therapeutic, and prognostic features of DGCT and GCOC. The electronic search was performed until December 2020 on seven electronic databases. Case reports, series, and research studies with enough histopathological criteria for diagnosis and all genomic studies were included. Both DGCT and GCOC showed a male prevalence (p = 0.043), with mandibular and maxillary predilections, respectively (p = 0.008). Peripheral DGCT (DGCTp) affected most elderly people (p < 0.001), and central DGCT (DGCTc) and GCOC occurred mainly in younger individuals. Unilateral enlargement of maxilla or mandible was the most common clinical sign associated with a radiolucent or mixed image. Ameloblastomatous epithelium was often present in both neoplasms. Basaloid and large cells with vesicular nuclei were also frequently seen in GCOC. ß-catenin expression and mutations (CTNNB1 gene) were found in DGCT and GCOC. Conservative surgery was mostly used for DGCTp, while radical resection was chosen for DGCTc and GCOC. High recurrence rates were found in DGCTc and GCOC. Metastasis occurred in 16.7% of GCOC cases and the 5-year survival rate was 72.6%. DGCT and GCOC share numerous clinicopathological features and demand a careful histopathological evaluation, considering the overlap features with other odontogenic tumors and the possibility of malignant transformation of DGCT. A strict regular post-operative follow-up is mandatory due to high recurrence rates and metastatic capacity in GCOC.
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Neoplasias Maxilomandibulares/patologia , Tumores Odontogênicos/patologia , Fatores Etários , Variações do Número de Cópias de DNA , Humanos , Neoplasias Maxilomandibulares/genética , Queratinas/metabolismo , Antígeno Ki-67/metabolismo , Mutação , Recidiva Local de Neoplasia , Tumores Odontogênicos/genética , Fatores Sexuais , Proteína Supressora de Tumor p53/metabolismo , beta Catenina/genéticaRESUMO
Evaluation and comparison of odontogenic keratocysts and detigerous cysts immunoexpression and immunostaining intensities of Ki-67 antigen by assessing the whole extent of the epithelium (all epithelium layers in combination) and each layer individually. Ki-67 immunoexpression was evaluated in 15 odontogenic keratocysts and 6 dentigerous cysts using automated methods and the Aperio Technologies Inc. computer system. No statistically significant differences were observed in immunoexpression nor in immunostaining intensities between both lesions. Also, no statistically significant differences were found between odontogenic keratocysts from maxilla versus mandible nor primary versus recurrent. However, odontogenic keratocyst showed a significantly higher cellular proliferation index in the suprabasal layers compared to the basal layer. Assessment of the cellular proliferation index through a computerized system enabled the evaluation of all epithelial tissue without field selection. The increased Ki-67 immunoexpression in suprabasal layers of odontogenic keratocyst suggests a different biological behavior and more aggressive proliferation potential when compared to dentigerous cyst. The same result was found in recurrent odontogenic keratocysts when compared with primary ones. The odontogenic keratocysts of the maxilla and mandible have similar Ki-67 immunoexpression. The evaluation of cellular proliferation only by immunohistochemical analysis with Ki-67 antigen does not provide enough data to elucidate the biological behavior of odontogenic keratocyst.
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Interpretação de Imagem Assistida por Computador/métodos , Antígeno Ki-67/análise , Cistos Odontogênicos/patologia , Proliferação de Células , HumanosRESUMO
Primordial odontogenic tumor (POT) was recently recognized in the 2017 World Health Organization (WHO) Classification as a distinct mixed odontogenic tumor most commonly observed in the posterior mandible of young patients. POT appears as an expansile radiolucency associated to an unerupted tooth. The aim of the present study was to perform a retrospective microscopic evaluation of pediatric odontogenic tumors diagnosed in an Oral Pathology Laboratory from Rio de Janeiro-Brazil, in order to reclassify potential cases as POT. From 150 cases of odontogenic tumors in children diagnosed in the last 50 years, one case filled the criteria for POT, being therefore better diagnosed as such. The patient was in the first decade of life and presented a well-defined expansile tumor in the posterior mandible, which had been initially diagnosed as immature complex odontoma. To the best of our knowledge, only 12 cases of POT have been reported in the English-language literature. We herein present an additional case of POT and review of its clinicopathological findings is offered.
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Neoplasias Mandibulares/patologia , Tumores Odontogênicos/patologia , Pré-Escolar , Humanos , MasculinoRESUMO
Objetivo: sistematizar a produção bibliográfica sobre as recomendações para o manejo e a mitigação do aerossol produzidos por instrumentos rotatórios de alta velocidade em tempos de epidemia pela COVID-19. Método: foi realizada uma busca bibliográfica no em bases bibliográficas eletrônicas brasileiras e internacionais (Lilacs, SciELO, MEDLINE e PubMed). Após aplicados critérios de inclusão e exclusão dos documentos, 21 estudos foram selecionados para a realização da revisão. Resultado: foi construída uma proposta com recomendações para reduzir a contaminação durante procedimentos geradores de aerossol provenientes de instrumentos rotatórios de alta velocidade. Conclusão: recomenda-se a utilização de equipamentos de proteção individual completo, incluindo respiradores N95, PFF2, PFF3 ou similar, o emprego de barreiras mecânicas, a aspiração através de bomba de alta eficiência, a constante renovação do ar ambiente através de sistemas de exaustão ou pressurização da sala de trabalho e a limpeza e desinfecção criteriosa do ambiente de trabalho após cada atendimento
Objective: To systematize the bibliographic production on the recommendations for management and mitigation of aerosol generated by high-speed rotary instruments in times of COVID-19 epidemic. Material and Methods: A bibliographic search was carried out on Brazilian and international electronic bibliographic databases (Lilacs, SciELO, MEDLINE and PubMed). After applying criteria for inclusion and exclusion of articles, 21 studies were selected to carry out the review. Results: A proposal was designed with recommendations to reduce contamination during aerosol-generating procedures with high-speed rotary instruments. Conclusion: It is recommended to use complete personal protective equipment, including N95, FFP2, FFP3 or similar respirators, mechanical barriers, suction through high volume evacuator, constant renewal of the ambient air through exhaust systems or workroom pressurization, and careful cleaning and disinfection of the work environment after each patient
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Cirurgia Bucal , Infecções por Coronavirus , AerossóisRESUMO
Objetivo: sistematizar a produção bibliográfica sobre as recomendações, práticas e cuidados adotados no atendimento odontológico em tempos de COVID-19, assim como, propor um protocolo de atendimento odontológico nas unidades de saúde bucal da Polícia Militar do Estado do Rio de Janeiro a partir das evidências encontradas na literatura. Material e Métodos: foi realizada uma busca bibliográfica no dia 11 de abril de 2020 em bases bibliográficas eletrônicas brasileiras e internacionais (Portal Regional da Biblioteca Virtual em Saúde, Web of Science e Pubmed), a partir da estratégia de busca ("COVID-19" AND "dentistry"), entre estudos publicadas nos anos de 2019 e 2020. Após aplicados os critérios de inclusão e exclusão dos documentos, 18 estudos foram considerados elegíveis para a realização da revisão. Resultados: a partir das evidências científicas encontradas nos estudos, foi construída uma proposta de protocolo para o atendimento odontológico nas unidades de saúde da Polícia Militar do Estado do Rio de Janeiro, assim como em qualquer outra unidade de saúde bucal. Conclusão: durante o período de surto epidêmico os atendimentos devem restringir-se às urgências e emergências odontológicas. O Cirurgião-Dentista deve redobrar a atenção à rotina de biossegurança como: lavagem rigorosa das mãos com água e sabão e/ou 'álcool gel a 70%', uso correto de todo equipamento de proteção individual e sua troca a cada paciente. Recomenda-se o tempo de 3 horas entre os atendimentos quando houver produção de aerossol, a higienização de todas as superfícies do consultório com hipoclorito de sódio a 0,1% ou 'álcool 70%', esterilização de todo instrumental e o descarte adequado dos resíduos.
Objective: to collate the literature that contains recommendations, best practices, and infection control measures for dental health care during the COVID-19 pandemic and, based on this evidence, to propose a protocol for use at the Rio de Janeiro State Military Police dental health care units. Materials and Methods: search of the regional VHL Network Portal, Web of Science, and Pubmed databases using the search query ("covid19" AND "dentistry") to retrieve studies published in 2019 and 2020. After applying the inclusion and exclusion criteria, 18 were found to be eligible for the review. Results: from the scientific evidence reported in the retrieved documents, an infection control protocol was proposed for use at the Rio de Janeiro State Military Police dental care units, which could be applied to any dental health setting. Conclusion: while the epidemic continues, only urgent and emergency dental care should be provided. The dental surgeon should adopt enhanced biosecurity measures, namely: rigorous hand sanitizing with soap and water and/or 70% alcohol hand sanitizer; correct use of complete personal protective equipment (PPE), and discarding of PPE after each patient; allowing three hours to elapse between patients after aerosol-generating procedures; cleaning of all surfaces with 0.1% sodium hypochlorite or 70% ethanol; sterilization of all instruments; and adequate disposal of all waste.
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Infecções por Coronavirus , Infecções por Coronavirus/prevenção & controle , Contenção de Riscos Biológicos/métodosRESUMO
Objetivo: sistematizar a produção bibliográfica sobre as recomendações para uso, uso prolongado, reuso e descontaminação de equipamentos de proteção individual (EPI) no atendimento odontológico em período de surto epidêmico da COVID-19 a partir das evidências encontradas na literatura. Material e Métodos: foi realizada uma busca bibliográfica no dia 1 de maio de 2020 em bases bibliográficas eletrônicas brasileiras e internacionais (Portal Regional da Biblioteca Virtual em Saúde, Web of Science e Pubmed), a partir da estratégia de busca ("individual protective equipment" AND "covid-19"), entre estudos publicados nos anos de 2015 a 2020. Foram também analisados documentos de órgãos de vigilância sanitária de diferentes países e recomendações da Associação Americana de Odontologia. Após aplicados os critérios de inclusão e exclusão dos documentos, 20 estudos foram considerados elegíveis para a realização da revisão. Resultados: Há uma escassez de publicações que relacionem a odontologia e o uso de EPI durante a pandemia. O uso prolongado/reuso limitado de respiradores (N95, PFF2, PFF3) pode ser recomendado em períodos de grave desabastecimento de EPIs desde que a sua integridade e capacidade de vedação estejam mantidas. Os aventais de tecido não tecido, máscaras cirúrgicas, luvas e gorros são considerados equipamentos de uso único. Os protetores oculares podem ser reusados após limpeza e desinfecção. Conclusão: Em períodos de surtos epidêmicos da SARS-CoV-2 recomendamos para atendimento odontológico com geração de aerossol o uso de respiradores do tipo N95, PFF2, PFF3 ou equivalente, protetor facial que pode ser reusado após limpeza e desinfecção e o uso de avental impermeável, luvas e gorro que devem ser descartados a cada paciente
Objective: to collate the recommendations on the use, extended use, reuse, and decontamination of personal protective equipment (PPE) in dental care during the COVID-19 outbreak, based on evidence found in the literature. Materials and Methods: searches were made of the following Brazilian and international databases on May 1, 2020: the Virtual Health Library Regional Portal, the Web of Science, and PubMed. The search strategy was based on the query ("individual protective equipment" AND "COVID-19") and retrieved publications from 2015 to 2020. Oficial infection prevention and control documents from different countries were also analyzed, as well as the recommendations of the American Dental Association. After applying the inclusion and exclusion criteria, a total of 20 studies were found to be eligible for the review. Results: there is a dearth of publications relating dentistry and PPE use during the pandemic. The extended use and reuse of respirators (N95, FFP2, FFP3) may be recommended during severe shortages, provided they are not damaged and they seal adequately. Nonwoven fabric gowns, surgical masks, gloves, and caps are singleuse PPE. Eye protection may be reused after cleaning and disinfection. Conclusion: during the epidemic of SARS-CoV-2 we recommend wearing a N95, FFP2, FFP3 or equivalent respirator during aerosol-generating procedures, a face shield, which may be reused after cleaning and disinfection, and an impermeable gown, gloves, and cap, which should be discarded between patients
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Infecções por Coronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Contenção de Riscos Biológicos , OdontologiaRESUMO
Objetivo: analisar artigos científicos sobre o índice de proliferação celular usando o anticorpo anti-Ki-67 em ceratocistos odontogênicos e comparar esses trabalhos para estimar um índice médio para essa lesão. Material e Métodos: dois pesquisadores realizaram a busca literária de forma independente na base de dados MEDLINE/PubMed e 28 artigos contendo dados relevantes foram selecionados. Resultados: a análise imuno-histoquímica utilizada nos artigos avaliados mostrou-se muito variável, não apresentando metodologias claras e unificadas, tornando a comparação entre os diferentes resultados difícil. Conclusão: Considerando o ceratocisto odontogênico uma lesão de comportamento clínico incomum, uma classificação adequada é necessária, assim como um tratamento apropriado com um bom prognostico deve ser estabelecido para o paciente de acordo com sua natureza. Dessa forma, um protocolo de análise imuno-histoquímica deve ser estabelecido para que possamos obter dados confiáveis sobre essa lesão
Objective: this review aims to analyze scientific articles about cell proliferation index using Ki-67 in odontogenic keratocyst and compare these papers to estimate the average index of this lesion. Material and Methods: two researchers performed a literature search independently in the MEDLINE/PubMed database and 28 articles containing relevant data were selected. Results: the immunohistochemical analysis methodology showed great variability among all the papers, with unclear and unified methodologies, making the comparison among different studies difficult. Conclusion: considering odontogenic keratocyst as a lesion with an uncommon clinical behavior, an adequate classification for it is necessary, so an appropriate treatment with a good prognosis for the patient can be established according to its nature. A standardization is needed so immunohistochemical analyses will find reliable data to classify properly this lesion
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Patologia Bucal , Cistos Odontogênicos , Tumores Odontogênicos , Proliferação de Células , AntígenosRESUMO
OBJECTIVE: To compare the findings of the clinical examination of the oral cavity with and without theaid of an intraoral video camera (videoroscopy) with the purpose of diagnosing epithelial precursorlesions (leukoplakia, erythroplakia and actinic cheilitis) and precancerous conditions (lichen planus).MATERIALS AND METHODS: Both forms of examination were performed in 100 patients withincreased risk of oral cancer. All patients were examined without the aid of any enlargement apparatusbefore the intraoral video camera was used. After each of the exams, the presence or absence of epithelialprecursor lesions or lichen planus was recorded. In the event a lesion was found, a digital picture was takena toluidine blue staining test was performed and then a biopsy was done. RESULTS: Of the patients withepithelial precursor lesions or lichen planus, 80% of the lesions had been observed in both of the examinationswhile 7% only had been diagnosed the after the videoroscopy. The results of the histopathological analysisand the toluidine blue staining tests are also presented. CONCLUSIONS: In this study videoroscopy issuggested for use on a regular basis in patients with an increased risk of oral cancer in an attempt to diagnoseearly lesions, select of the best area to be biopsied and during the following up of these lesions.
OBJETIVO: Comparar os achados do exame clínico da boca com e sem auxílio da vídeo-câmeraintrabucal (videoroscopia) com o propósito de diagnosticar lesões epiteliais precursoras(leucoplasia, eritroplasia, eritroleucoplasia e queilite actínica) e condições pré-cancerosas (líquen plano). MATERIAL E MÉTODOS: Os exames foram realizados em 100 pacientes com riscoaumentado para câncer oral. Todos os pacientes foram examinados sem o auxílio de qualqueraparelho de aumento antes que a vídeo-câmera intrabucal fosse usada. Após cada exame, a presençaou ausência de lesões epiteliais precursoras ou líquen plano foram anotadas. Nos casos em quelesões foram diagnosticadas, fotografaram-se as lesões, bem como o teste do azul de toluidina ea biópsia. RESULTADOS: Dos pacientes com lesão epitelial precursora ou líquen plano, 80%das lesões foram observadas em ambos os exames, enquanto 7% foram somente diagnosticadasapós a videoroscopia. Os resultados histopatológicos e dos testes com azul de toluidina foramtambém discutidos. CONCLUSÕES: Sugere-se a utilização regular da videoroscopia nos pacientescom risco aumentado para o câncer de boca, para auxiliar o diagnóstico de lesões precoces, naseleção da melhor área para a biópsia e acompanhamento dessas lesões.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Diagnóstico Bucal/instrumentação , Diagnóstico por Imagem/instrumentação , Neoplasias Bucais/diagnóstico , Diagnóstico por Imagem/métodos , Diagnóstico Precoce , Fatores EpidemiológicosRESUMO
Oral squamous cell carcinoma represents approximately 90% of all oral malignancies and in some cases can be preceded by lesions considered epithelial precursor lesions. Early diagnosis of these lesions and intervention at an early stage constitute keys to reduce mortality, morbity and expenses with oral cancer treatment. The objective of this paper is to present the prevalence of epithelial precursor lesions and oral squamous cell carcinoma at the Anatomic Pathology Service of Antônio Pedro University Hospital, Fluminense Federal University in the last ten years. Considered data were sex, age, race, location, addictions, clinical and histological aspects. A total of 3,752 oral lesions were found and evaluated. The epithelial precursor lesions represented 4.23% of the oral biopsies, while the squamous cell carcinoma represented 4.21%. Leukoplakia was the most prevalent clinical aspect among the epithelial precursor lesions. The white women in their sixties were the mostaffected and the buccal mucosa was the most common anatomic localization. The most frequent histological finding was the epithelial hyperplasia without dysplasia. The squamous cell carcinoma showed up clinically as an ulceration in 80.3% of the cases. The white men in their sixties were the most affected. The tongue was the most affected area. In relation to the histological classification, the most frequent type was the moderately differentiated squamous cell carcinoma. The patientswith epithelial precursor lesions and with squamous cell carcinoma were smokers in its majority.