Assembling a consensus on actinic cheilitis: A Delphi study.

AIMS: To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. METHODS: Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). RESULTS: A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC < 50). CONCLUSIONS: AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.

[OROPHARYS CANCER: THE SQUAMOUS CELL]. / CÁNCER OROFARINGEO: LA CÉLULA ESPINOSA.

The Diffuse Large B-Cell Lymphoma is the most frequent non Hodgkin Lymphoma. The role of CT/PET in this relatively homogeneous group of lymphomas is controversial. It rarely changes the management of the patients in the initial staging. Recents publications, clinical trials and experts consensus meetings have demonstrated its utility in the evaluation of the response at the end of the treatment. The interest of CT/PET in the evaluation of the response during the treatment, with the objective of implement a "Risk Adapted Therapy", in increasing.

Oral health status and dental care for individuals with visual impairment. A narrative review.

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals' skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.

Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary wall combined with bovine-derived hydroxyapatite: clinical and histologic observations.

OBJECTIVE: The aim of this study was to determine the clinical efficacy of a mixture of autologous bone harvested from the lateral wall of the maxilla using bone shavers and bovine-derived hydroxyapatite (HA) placed as a graft to elevate the maxillary sinus floor. The histological picture of tissue found in the sinus, the survival rate and the success of the implants were all evaluated. MATERIAL AND METHODS: A total of 90 titanium implants were placed in 34 patients. In all of them, the lateral maxillary wall was harvested as a particulate bone graft, subsequently mixed with bovine-derived HA and packed in the sinus cavity. The lateral access window was then covered with a bioresorbable porcine-derived collagen membrane. In 32 sinuses, a two-stage surgery was performed, while in the remaining 10 cases a one-stage surgery was carried out. In the two-stage approach, 14 randomly selected biopsies were obtained at the time of implant insertion after a healing period of 9 months. The histological specimens were histologically and histomorphometrically evaluated. RESULTS: One implant was lost, leading to a survival rate of 98.9%. The new bone consisted of lamellae of living bone contained osteocytes and in close contact with bovine bone particles that were partly infiltrated by newly formed bone. Bovine bone particle resorption could not be found. The histomorphometric analysis showed the following averages: 29% of newly formed bone and 21% of anorganic bovine bone. The marrow spaces made up the remaining 50% of the specimens. CONCLUSION: Sinus lift graft with autologous bone harvested from the maxillary lateral wall combined with demineralized bovine bone leads to a predictable outcome regarding the amount of bone formation in sinus floor augmentation.

Clinical and radiographic outcomes of allogeneic block grafts for maxillary lateral ridge augmentation: A randomized clinical trial.

BACKGROUND: A main drawback of bone block graft surgery is the resorption occurring in early stages of healing. To our knowledge, there are no studies comparing outcomes of freeze-dried bone allograft (FDBA) blocks with different architecture. PURPOSE: The aim of this work was to investigate different factors that can affect graft resorption and to compare the resorption rates of two different types of allogeneic blocks, corticocancellous and cancellous. MATERIALS AND METHODS: A randomized clinical trial was designed. Twenty-eight patients referred for onlay bone augmentation prior to implant placement were included in the study. Preoperative computerized tomography (CT) was taken for all patients. Patients received FDBA blocks of either cancellous or corticocancellous bone obtained from the iliac crest. After a 4-month follow-up, postoperative CT was taken. Then, another surgery was performed, with the purpose to place dental implants. The aforementioned groups were compared for bone resorption and implant outcome using analysis of covariance (ANCOVA) and repeated ANOVA measures, respectively. Demographic data, trabecular bone density, and graft sites were also analyzed. RESULTS: A total of 93 implants were placed in the augmented bone sites over 28 patients. A 100% survival rate was achieved during a mean follow-up period of 24 months in both groups. Higher bone resorption rate was found with cancellous bone grafts (29.2% ± 2.6) compared with corticocancellous grafts (19.3% ± 2.3). Moreover, higher resorption rates in patients with lower bone density (<185 Hounsfield Units) (31.7% ± 3.1) and smokers (26.39% ± 2.3) were observed when compared with patients with higher bone density (>185 Hounsfield Units) (16.8% ± 2.1) and nonsmokers (22.1% ± 2.3), respectively. CONCLUSION: Within the limitations of this study, these findings indicate that both corticocancellous and cancellous FDBA grafts constitute a clinical acceptable alternative for bone reconstruction, although cancellous grafts present higher resorption rates. Moreover, host factors such as patient's low bone density and smoking habits may also increase graft resorption rates.

Distinct Expression and Clinical Significance of Zinc Finger AN-1-Type Containing 4 in Oral Squamous Cell Carcinomas.

Zinc finger AN1-type containing 4 (ZFAND4) has emerged as a promising prognostic marker and predictor of metastasis for patients with oral squamous cell carcinoma (OSCC). However, further validation is fundamental before clinical implementation. Hence, this study evaluated the expression pattern of ZFAND4 protein expression by immunohistochemistry using an independent cohort of 125 patients with OSCC, and correlations with the clinicopathologic parameters and disease outcome. Remarkably, ZFAND4 expression, while negligible in normal epithelium, exhibited two distinct expression patterns in tumors that did not overlap. A gross granular staining was characteristic of the undifferentiated cells at the invasive front of tumors, whereas the most differentiated cells located at the center of the tumor nests showed diffuse non-granular staining. ZFAND4 staining was higher in undifferentiated than in differentiated areas of tumors. High ZFAND4 expression in differentiated cells was significantly associated to well-differentiated (p = 0.04) and non-recurrent tumors (p = 0.04), whereas ZFAND4 expression in undifferentiated cells correlated with tumor location (p = 0.005). No correlations between the ZFAND4 expression and patient survival were found. These data question the clinical relevance of ZFAND4 expression as a prognostic biomarker in OSCC, and also reveal distinct ZFAND4 expression patterns depending on the differentiation areas of tumors that should be evaluated separately.

Dental management in patients with antiplatelet therapy: A systematic review.

INTRODUCTION: Cardiovascular diseases are the most frequent cause of death in the Western world. Its treatment frequently needs therapy with antiplatelet agents, which increases the haemorrhage risk after oral surgical procedures. The aim of this study is to present a review on the dental management of the patients under antiplatelet treatment. MATERIAL AND METHODS: A systematic review was carried out following PRISMA recommendations including studies searched in Pubmed-Medline, Embase and Cochrane databases. RESULTS: The current trend is to maintain the treatment during the surgical procedure, assuring a good control of the haemorrhage with local haemostatic measures. However, new antiplatelet drugs protocols are not firmly established. CONCLUSIONS: In spite of the existing recommendations, it is always advisable to consult with the internist or cardiologist of every patient before any intervention. Key words:Antiplatelet, Oral Surgery, Exodontia, Dental Management.

The relationship between the levels of salivary cortisol and the presence of xerostomia in menopausal women. A preliminary study.

UNLABELLED: Xerostomia is a particularly frequent occurrence among menopausal women, and is often associated with depression. OBJECTIVES: To evaluate the relationship between unstimulated salivary flow rate and the presence of xerostomia, and to determine the levels of salivary cortisol and its relationship with xerostomia. STUDY DESIGN: Thirty women were selected from patients attending the Department of Medicine and Buccofacial surgery, and formed into two groups, study and control. Samples of unstimulated salivary flow were collected, and the amounts of salivary cortisol determined using the ELISA technique (enzyme-linked immunosorbent assay). RESULTS: The mean unstimulated salivary flow rates for the control and study group were 0.37 +/- 0.28 ml/min and 0.24 +/- 0.18 ml/min, respectively. The concentration of salivary cortisol was 3.47 +/- 1.64 ng/ml for the control group and 2.29 +/- 2.60 ng/ml for the study group. The statistical tests applied showed no significant differences for either variable between the two groups in the study. CONCLUSIONS: The results of the present study indicate that there is no relationship between variations in the rates of unstimulated salivary flow and the corresponding concentration of cortisol.

Quality of life and oral health in elderly.

BACKGROUND: We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia. MATERIAL AND METHODS: 30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked. RESULTS: The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects). CONCLUSIONS: Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth. Key words:Quality of life, oral health, elderly.

Expression and clinical significance of matrix metalloproteinase-2 and matrix metalloproteinase-9 in oral squamous cell carcinoma.

To successfully establish a metastasis from an invasive carcinoma, the first step involves the degradation of the underlying basement membrane, which is mainly made up of type IV collagen. Matrix metalloproteinases (MMPs)-2 and -9 are thought to play an important role in its degradation because of their ability to destroy this type of collagen. In order to evaluate the prognostic significance of these proteases, we studied the expression of MMP-2 and -9 in series of 68 OSCC by immunohistochemistry. Of the oral carcinomas, 28% (n = 19) expressed MMP-2, and 17.6% (n = 12) expressed MMP-9. MMP-2 immunoreactivity was significantly higher in patients with alcohol consumption (p = 0.028) (OR = 4), and in those younger than 60 years (p = 0.041). MMP-9 immunostaining showed statistically significant association with the tumor grade of differentiation (p = 0.019), the T-stage (p = 0.05), and also with the alcohol intake (p = 0.04) (OR = 7.67). In the present study, although not statistically significant, we observed that immunoexpression of MMP-2 and MMP-9 was stronger in patients with lymph node metastasis (OR = 1.65 and 2.29, respectively). In patients without regional lymph node metastasis, positive MMP-9 immunostaining was related to poor survival rates (p = 0.02; OR = 5.8). MMP-2 and -9 are involved in the invasion process of oral cancer, and MMP-9 is related to poor prognosis in the subset of patients without neck node metastasis. Ethanol could enhance the carcinogenetic process in oral cavity through its influence in the expression of MMP-2 and -9.

The prognostic role of claudins -1 and -4 in oral squamous cell carcinoma.

Claudin dysregulation has been described in various tumor types; however, its clinical relevance is poorly understood. We present a study in which we assessed the expression of claudin 1 (CLDN1) and CLDN4 in oral squamous cell carcinoma (OSCC), as well as their prognostic relevance. Immunohistochemical analysis of CLDN1 and CLDN4 expression was carried out on tissue sections from 65 OSCCs. The presence of CLDN1 in the invasive front of tumor islands was associated with neck node metastasis, and the expression of CLDN4 was associated with higher histological grade, and tumor recurrence. Membranous staining for CLDN4 in tumor cells, and weak intensity of CLDN4 immunoexpression were predictive for poorer survival. In a multivariate analysis for disease recurrence, CLDN1 immunostaining was statistically significant. Specifically, CDLN1 expression in the tumor invasive front was associated with tumor recurrence. Our results indicate that CLDN4 expression is correlated with poor prognosis, and CLDN1 expression may be an indicator of recurrence of OSCC.

Small cell undifferentiated carcinoma of the submandibular gland with neuroendocrine features.

This article reports the clinical, histopathologic, and immunohistochemical findings in a case of small cell undifferentiated carcinoma of the submandibular gland. The tumor was composed of anaplastic cells slightly larger than lymphocytes without ductal differentiation. On immunohistochemical analysis, the tumor contained cells that reacted positively with antibodies to cytokeratin, neuron-specific enolase, synaptophysin, and chromogranin. The present case supports the hypothesis that small cell undifferentiated carcinomas of the salivary glands arise from presumed multipotential ductal stem cells. When this tumor entity is located on the salivary glands, it appears to behave less aggressively than when it is a primary tumor of the bronchial tree.

Actualización en el manejo odontológico del paciente con patología hepática / Update on dental handling of the patient with liver disease

La enfermedad o disfunción hepática puede deberse a numerosas causas como infecciones adquiridas, patologías congénitas o el abuso de drogas. Cuando esta disfunción y el daño hepático se prolongan a lo largo del tiempo, puede desembocar en una cirrosis hepática, cuadro irreversible y de graves repercusiones para el enfermo. Las dos patologías hepáticas más frecuentes y principales causas de la cirrosis son la hepatitis o inflamación hepática, la cual se puede deber a numerosos factores siendo el más frecuente las infecciones por virus, y la enfermedad hepática alcohólica, provocada por el abuso de alcohol continuado durante un largo período de tiempo. El manejo odontológico de un paciente con alteraciones hepáticas supone un verdadero reto, ya que el hígado juega un papel vital en numerosas funciones metabólicas, como la secreción de bilis o la excreción de bilirrubina procedente del metabolismo de la hemoglobina. Un fallo en la función hepática puede suponer alteraciones en el metabolismo de aminoácidos, amoníaco, proteínas, hidratos de carbono y triglicéridos. Un paciente con patología hepática tendrá un metabolismo alterado de numerosos fármacos empleados habitualmente por el dentista, tendrá un mayor riesgo de hemorragia debido a anomalías en la síntesis de diferentes factores de coagulación, siendo además un paciente con mayor riesgo de infecciones. La gran repercusión de la enfermedad hepática, así como el notable desconocimiento de muchos profesionales odontólogos en su manejo, justifican este artículo donde se talla tanto las generalidades más importantes de esta entidad como sus principales manifestaciones orales y consideraciones en el manejo odontológico

Liver disease or dysfunction may be due to numerous causes such as acquired infections, congenital pathologies or drug abuse. When this dysfunction and liver damage are prolonged overtime, it can lead to hepatic cirrhosis, an irreversible condition and serious repercussions for the patient. The two most frequent liver diseases and major causes of cirrhosis are hepatitis or hepatic inflammation, which may be due to numerous factors being the most frequent virus infections, and alcoholic liver disease, caused by alcohol abuse continued during A long period of time. The dental management of a patient with liver disorders is a real challenge, since the liver plays a vital role in many metabolic functions, such as bile secretion or excretion of bilirubin from hemoglobin metabolism. A failure in liver function can lead to alterations in the metabolismof amino acids, ammonia, proteins, carbohydrates and triglycerides. A patient with liver disease will have an altered metabolism of numerous drugs commonly used by the dentist, will have a greater risk of hemorrhage due to abnormalities in the synthesis of different coagulation factors, being also a patient with a higher risk of infections. The great repercussion of liver disease, as well as the remarkable lack of knowledge of many dental professionals in its management, justify this article where it is detailed both the most important generalities of this entity as its main oral manifestations and considerations in dental management

Manifestaciones orales relacionadas con la artritis reumatoide. Revisión a propósito de un caso / Oral manifestations related to rheumatoid arthritis. Case report and literature review

Objetivo: Mostrar las manifestaciones orales cuya etiología está relacionada con la artritis reumatoide (AR), revisando la literatura más reciente, a propósito de un caso. Caso clínico: El tratamiento de la AR está basado principalmente en la terapia farmacológica, siendo esta responsable de manifestaciones a nivel de la cavidad oral. Se presenta el caso de una mujer de 65 años con AR en tratamiento bajo metotrexato y tocilizumab, que acude a consulta por presentar desde hace 40 días una úlcera en el borde lateral de la lengua. Conclusión: Las manifestaciones orales de la AR derivan principalmente de la terapia farmacológica, que se debe conocer para el correcto diagnóstico y tratamiento de la patología oral de estos pacientes

Objective: The aim of the present article was to describe the oral manifestations whose etiology is related to rheumatoid arthritis (RA), reviewing the most recent literature, in relation to a case. Clinical case: The treatment of RA is based mainly on pharmacological therapy, being responsible for the manifestations at the level of the oral cavity. We present the case of a 65-year-old woman with RA on treatment with methotrexate and tocilizumab, which occurs through 40 days on the lateral border of the tongue. Conclusion: The oral manifestations of RA are derived mainly from pharmacological therapy, which should know the correct diagnosis and treatment of the oral pathology of these patients

Manejo odontológico del paciente con EPOC / Dental management of the patient with COPD

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odotológicas y las manifestaciones orales que pueden presentar los pacientes con EPOC. Para ello se revisaron los artículos disponibles en Pubmed. De los resultados destacamos que los principales factores de riesgo de la EPOC son el tabaco y la edad. En España se prevé un aumento de pacientes con EPOC debido al envejecimiento paulatino de la población. En la práctica odontológica hay un promedio de 130 pacientes con EPOC de cada 2.000 pacientes que acuden a la consulta. El dentista debe llevar a cabo el tratamiento odontológico siguiendo las consideraciones pre, intra y postoperatorias propuestas para los pacientes con EPOC, e identificar aquellos que son inestables para posponer la cita o considerar su hospitalización. Las lesiones orales más frecuentes son la enfermedad periodontal, xerostomía, caries, y erosiones del esmalte. Conclusiones: Dada la alta prevalencia de la EPOC es necesario tener en cuenta ciertas precauciones a la hora de realizar el tratamiento dental y las contraindicaciones farmacológicas en estos pacientes. El dentista debe estar familiarizado con esta enfermedad y promover la salud oral en estos pacientes

The aim purpose of this work was to review the available scientific literature on the odontologic considerations and oral lesions that can present a patient with COPD. In order to do so, the available articles were checked in Pubmed. The principal risk factors for COPD include smoking and age. In Spain, an increase in the number of patients with COPD is expected due to the gradual aging of the population. In dental practice there is an average of 130 patients with COPD out of every 2000 patients who come to the dental clinic. The dentist must carry out the dental treatment following the considerations proposed for patients with COPD and identify the unstable patients to postpone the dental appointment or consider their hospitalization. The most frequent oral lesions are periodontal disease, xerostomia, caries and enamel erosions. Conclusions: Given the high prevalence of COPD, it is necessary to take into account certain precautions when performing dental treatment and pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Manejo y consideraciones clínicas de los pacientes asmáticos en la consulta dental / Management and clinical considerations of the asthmatic patients in the dental practice

El objetivo de este trabajo es revisar la literatura científica disponible sobre las consideraciones odontológicas y las manifestaciones orales que pueden presentar los pacientes asmáticos. Se han revisado 34 artículos publicados entre los años 2001 y 2018. En función de su fisiopatología hay 5 tipos de asma, y clínicamente se clasifica en leve, moderada y grave. Entre los factores de riesgo destacan el tabaco, obesidad, genética, factores socioeconómicos y exposición a ciertas sustancias. El tratamiento de elección se basa en los broncodilatadores y glucocorticoides inhalados. Esta medicación disminuye la cantidad de flujo y el pH salival. Por este motivo la cavidad oral es más susceptible de desarrollar patologías como caries, enfermedad periodontal y candidiasis oral. Concluimos que, dada la alta prevalencia del asma, es necesario que el odontólogo tenga en cuenta las consideraciones pre, intra y postoperatorias propuestas para los pacientes asmáticos, y evite los fármacos que puedan precipitar un ataque. El dentista debe estar familiarizado con esta enfermedad, y promover la salud oral en estos pacientes

The purpose of this work is to review the available scientific literature on the dental considerations and the oral manifestations that may present asthmatic patients. 34 articles published between 2001 and 2018 were reviewed. According to its pathophysiology, there are 5 types of asthma, and clinically, the asthma severity classification is divided into mild, moderate and severe. The principal risk factors for asthma include tobacco, obesity, genetics, socioeconomic factors and exposure to substances. The treatment of choice is based on inhaled bronchodilators and glucocorticoids. This medication decreases the amount of flow and salivary pH. For this reason, the oral cavity is more susceptible to developing pathologies such as caries, periodontal disease and oral candidiasis. Conclusions. Given the high prevalence of asthma, the dentist must carry out the dental treatment following the considerations proposed for patients with asthma and should know the pharmacological contraindications in these patients. The dentist should be familiar with this illness and promote the oral health in these patients

Manejo odontológico del paciente con trastornos de la alimentación / Dental management of the patient with eating disorders

El objetivo del presente trabajo es realizar una revisión narrativa acerca del manejo y las manifestaciones orales de los pacientes que presentan trastornos alimenticios, centrándose en la anorexia y la bulimia nerviosa. Ambos trastornos frecuentemente se manifiestan por primera vez de forma oral: caries, erosión de las caras linguales y oclusales de los dientes, mucosas atróficas y traumatizadas, agrandamiento de las glándulas parótida y submandibular, etc. Es importante detectar a este tipo de pacientes y advertir al paciente y/o a los padres de las posibles complicaciones que pueden desencadenarse, y consecuentemente derivar al paciente para su correcto diagnóstico y tratamiento. Desde punto de vista odontológico, el profesional debe instruir al paciente en técnicas de higiene oral e introducirlo en un programa de prevención individualizado

The objective of this paper is to perform a narrative review about the management and oral manifestations of patients who present eating disorders, focusing on anorexia and bulimia nervosa. Both disorders are often manifested orally for the first time: teeth decay, erosion of the lingual and occlusal surfaces of the teeth, atrophic and traumatized oral mucosa, parotid and submandibular enlargement, etc. It is important to detect these types of patients and remark the patient and/or their parents of the possible complications that may occur, and consequently refer the patient for a correct diagnosis and treatment. The professional must instruct the patient in oral hygiene techniques and introduce him into an individualized prevention program

Focal adhesion kinase overexpression: correlation with lymph node metastasis and shorter survival in oral squamous cell carcinoma.

BACKGROUND: Focal adhesion kinase (FAK) has been identified as a key mediator in tumor progression. The objective of this study was to determine the role of FAK as a predictor of neck node metastasis and poor prognosis in oral squamous cell carcinomas (OSCCs). METHODS: FAK expression in normal oral mucosa and in 69 OSCCs was examined by immunohistochemistry, and the percentage of stained cells was recorded. The correlation of these findings with clinicopathologic variables and survival was studied. RESULTS: FAK expression in OSCCs was heterogeneous: 33.3% of cases showed weak expression; 23.2%, moderate expression, and 33.3% cases showed high expression. FAK expression significantly correlated with tumor size (p = .010), neck node metastasis (p = .01), and local tumor recurrence (p = .01). FAK expression was an independent prognostic factor in the survival analysis (p = .017). CONCLUSIONS: Increased expression of FAK may play a role in invasiveness and metastasis of OSCCs, which contribute to poor prognosis and low survival.

Manifestaciones orales y manejo odontológico en el paciente con síndrome de Rendu-Osler-Weber. A propósito de un caso clínico / Oral manifestations and dental management int he patient with Rendu-Osler-Weber síndrome. A case report

El objetivo del trabajo es describir el caso clínico de un hombre de 67 años con el Síndrome de Rendu-Osler-Weber (SROW). A la exploración, se pueden apreciar múltiples telangiectasias en la región facial, algunas puntiformes en los lóbulos de ambos pabellones auriculares y otras lineales en el área nasogeniana. A nivel intraoral, se observan telangiectasias de pequeño tamaño en labio, lengua, paladar, encía, y mucosa yugal. Así mismo, presenta lesiones vasculares clínicamente identificadas como hemangiomas intraorales. Según la literatura, la epistaxis es el signo clínico más frecuente en los pacientes con el SROW y el principal motivo de consulta. También es frecuente la presencia de telangiectasias que se pueden observar principalmente en labios (34%), lengua (33%), mucosa yugal (17%), paladar (10%) y encía (6%). Los odontólogos pueden ser los primeros en sospechar el cuadro por la presencia de lesiones orales y ayudar a un diagnóstico precoz por lo que pueden desempeñar un papel clave en el manejo de estos pacientes que incluirá un control y tratamiento multidisciplinar debido a las diferentes manifestaciones de esta entidad

The aim of this study is to describe the clinical case of a 67-yeart-old man with SROW. At the exploration, multiple telangiectasias can be seen in the facial region, some punctiform in the lobes of both atrial and other linear in the nasogenian area. At the oral level, small telangiectasias are seen on the lip, tongue, palate, gums, and buccal mucosa. it also presents vascular lesions clinically identified as intraoral hemangiomas. According to the literature, epistaxis is the most frequent clinical sign in patients with SROW and the main reason for consultation. It is also frequent the presence of telangiectasias that can be seen mainly on lips (34%), tongue (33%), yugal mucosa (17%), palate (10%) and gums (6%). Dentists may be the first to suspect the condition due to the presence of oral lesions and to help early diagnosis, so they can play a key role in the management of these patients, including multidisciplinary treatment and control due to the different manifestations of this condition. Entity

Manejo y consideraciones clínicas de la enfermedad inflamatoria intestinal en la consulta dental / Management and clinical considerations of the inflammatory bowel disease in the dental office

El objetivo de este trabajo es realizar una revisión bibliográfica sobre la enfermedad inflamatoria intestinal (EII) y sus manifestaciones clínicas orales. La EII es un término que abarca dos enfermedades idiopáticas del tracto gastrointestinal: la colitis ulcerosa y la enfermedad de Crohn. Cuando un paciente que tiene una de estas condiciones se presenta para el tratamiento en nuestra consulta dental, es necesario ser consciente de la condición del paciente, controlar los síntomas indicativos de enfermedad inicial o recaída, y haber realizado una correcta historia clínica que incluya los fármacos que interactúan con medicamentos gastrointestinales o que pueden agravar la situación del paciente. Además, las manifestaciones orales de la enfermedad gastrointestinal no son infrecuentes, por lo que el dentista también debe estar familiarizado con los patrones orales de la enfermedad

The objective was to perform a literature review of the inflammatory bowel disease (IBD) and it's clinical oral manifestations. It is a term that encompasses two idiopathic diseases of the gastrointestinal tract: ulcerative colitis and Crohn’s disease. When a patient who has one of these conditions comes for treatment at our dental office, it is necessary to be aware of the patient's condition, to control the symptoms indicative of initial illness or relapse, and to have a correct medical history including the drugs which interact with gastrointestinal drugs or which may aggravate the patient's condition. In addition, oral manifestations of gastrointestinal disease are not infrequent, so the dentist should also be familiar with the oral patterns of the disease