Association of anxiety, depression, and stress with burning mouth syndrome: a case-control study.

Burning mouth syndrome (BMS) is a painful disorder characterized by severe burning in the oral cavity in the absence of clinical signs. In this case-control study, 60 patients were allocated to 3 groups: patients with BMS, patients with benign changes in the oral cavity (anxiety [positive] control group), or healthy patients (negative control group). A visual analog scale (VAS), Beck Anxiety and Depression inventories, Lipp Stress Symptoms Inventory, Xerostomia Inventory-Dutch Version, and a BMS questionnaire were used. Statistical analyses (P < 0.05) were performed using the Kruskal-Wallis with Dunn post hoc, Pearson chi-square, Fisher exact, and multinomial logistic regression tests. Most of the patients were female. The BMS group had more patients who were older than 60 years (P = 0.008), more patients with high VAS scores (P < 0.001), and more patients with moderate or severe anxiety (P < 0.001) and depression (P < 0.001) than the 2 control groups. Patients in the BMS group also had higher rates of stress during the alarm (P = 0.003), resistance (P < 0.001), and exhaustion phases (P < 0.001). All patients with BMS reported burning and xerostomia, 90% reported a feeling of dry mouth, and 80% reported a change in taste; these values were significantly higher than those in the control groups (P < 0.001). Anxiety was independently associated with a 123.80 times greater risk of having BMS (P = 0.004). Psychological factors are directly associated with BMS, and anxiety is the most important of these factor.

Photobiomodulation and antimicrobial photodynamic therapy as adjunct in the treatment and prevention of osteoradionecrosis of the jaws: A case report.

CASE REPORT: We report on a patient with a history of radiotherapy to the head and neck region exhibiting necrotic bone exposure associated with fistula and purulent exudation in the mandible, with the diagnosis of stage 3 osteoradionecrosis, in addition to a periapical cyst in the maxillary anterior region and multiple root remnants. An antibiotic coverage protocol with amoxicillin and metronidazole was prescribed for subsequent necrotic bone removal. The surgical procedure was performed along with the aPDT using methylene blue and red light, followed by coaptation of the edges of the surgical wound and the healing protocol with LLLT. The extraction of non-rehabilitated teeth was performed two per session using antibiotic coverage, aPDT, and LLLT and mouthwash with 0.12 % chlorhexidine was prescribed until the complete closure of the surgical wound was achieved. Additionally, two aPDT sessions and four LLLT protocols were performed for complete healing of the surgical sites. Extra and intraoral examinations and panoramic and periapical radiographs were performed. No emergence or recurrence of osteonecrosis was observed after 12 months of follow-up.

Mast Cells and Blood Vessels Profile in Oral Carcinogenesis: An Immunohistochemistry Study.

BACKGROUND: The objectives of the present study were to evaluate angiogenesis and mast cell density in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: This was an observational, retrospective and quantitative study. The samples consisted of 60 tissue specimens from patients with squamous cell carcinoma, epithelial dysplasia and controls (n=20/group). Immunohistochemistry was performed using an anti-tryptase antibody to mast cells and anti-CD31 and anti-CD34 for blood vessels and we count the number of mast cells and determine the percentage of CD31 and CD34 antibody staining (vascular density). RESULTS: The mast cells had lower density in OSCC compared to control and dysplasia (p = 0.009). In angiogenesis, the expression of CD31 showed a higher percentage of blood vessels in OSCC (p < 0.001), however, CD34 showed no difference between groups (p=0.092). The CD31 antibody presented as a high immunostaining in oral mucosa than CD34. CONCLUSIONS: The increased vascularity in squamous cell carcinoma suggests that angiogenesis begins when malignant transformation starts that seems to be inversely associated with the number of mast cells.

Dental care in patients with antiphospholipid syndrome: two case reports.

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease that may be classified as primary or secondary. Treatment consists of oral anticoagulant, antiplatelet, and/or immunosuppressant drugs. This report describes the dental treatment of 2 women with APS and multiple dental concerns, including periodontal disease, caries, and missing teeth. The invasive dental procedures were performed in an outpatient setting with hematologic monitoring and use of local hemostatic measures. Neither interruption of anticoagulant medications nor administration of blood products was necessary. All of the procedures were performed without complications. To date, no recommendations for the dental care of patients with APS have been established, demonstrating a need to investigate the risks for bleeding and infection, among other concerns, during dental treatment of these patients.

Effect of different doses of zoledronic acid in establishing of bisphosphonate-related osteonecrosis.

OBJECTIVES: To establish osteonecrosis of the jaws in rats treated with different doses of zoledronic acid (ZA). METHODS: Male Wistar rats (n=6-7) received three consecutive weekly intravenous ZA infusions at doses of 0.04, 0.20 or 1.00mg/kg ZA or saline (control). Four weeks after the last administration, the animals were submitted to simple extraction of the lower left first molar. An additional dose of ZA was administered seven days later, and the animals were sacrificed 28 days after exodontia. Weight was measured and blood was collected weekly for analysis. The jaw was radiographically and microscopically examined along with the liver, spleen, kidney and stomach. RESULTS: All ZA doses showed a higher radiolucent area than the control (p<0.0001), but the dose of 0.04mg/kg did not show BRONJ. Doses of 0.20 and 1.00mg/kg ZA showed histological evidence of bone necrosis (p=0.0004). Anaemia (p<0.0001, r(2)=0.8073) and leucocytosis (p<0.0001, r(2)=0.9699) are seen with an increase of lymphocytes (p<0.0001, r(2)=0.6431) and neutrophils and monocytes (p=0.0218, r(2)=0.8724) in all the animals treated with an increasing dose of ZA. Haemorrhage and ectasia were observed in the spleen (p=0.0004) and stomach (p=0.0168) in a dose-dependent manner, and the animals treated with ZA showed a lower rate of weight gain (p<0.0001). CONCLUSIONS: We designed a bisphosphonate-related osteonecrosis of the jaw model that reproduces radiographic and histological parameters and mimics clinical alterations such as leucocytosis, anaemia and idiosyncratic inflammatory post infusion reactions.

Expression of S-100, EMA, CD34 and presence of mast cells in eight oral neurofibromas, and a review of 127 cases of the literature / Expressão de S-100, EMA, CD34 e presença de mastócitos em oito neurofibromas orais e revisão de 127 casos da literatura

INTRODUCTION: The rarity of oral neurofibromas (ONs) generates problems regarding their epidemiological and immunohistochemical characterization. OBJECTIVES: The aim of this study was to evaluate the expression of different markers in ONs and review epidemiologic data reported in the literature. MATERIAL AND METHODS: Clinicopathologic, immunohistochemical (markers S-100, epithelial membrane antigen [EMA], CD34) and histochemical (modified-Ziehl-Neelsen-method) studies were performed in eight cases of ON diagnosed in the Department of Pathology and Legal Medicine (DPML), Universidade Federal do Ceará (UFC), Ceará, Brazil, between 1994 and 2010. RESULTS: Oral neurofibromas represented 0.2% of the oral lesions diagnosed by our service in 16 years, and the buccal mucosa was the most frequent oral site (71.4%). Seven (87.5%) and 8 (100.0%) cases were positive for S-100 and CD34, respectively, and none for EMA. Mast cells were identified in seven cases (87.5%). The literature search indicated that solitary ONs are more common and occur preferentially in females, affecting patients between 30 and 40 years old. The alveolar ridge is the most commonly involved site. CONCLUSION: S-100- and CD34 markers proved to be of great value as a diagnostic tool, unlike EMA staining. Identification of mast cells in most cases suggests their involvement in this tumor pathogenesis. The clinicopathologic data retrieved from the literature enabled the establishment of a more consistent epidemiological profile.

INTRODUÇÃO: A rara ocorrência de neurofibromas orais (NO) gera problemas com relação à caracterização epidemiológica e imuno-histoquímica dessas lesões. OBJETIVOS: Avaliar a expressão celular de diferentes marcadores em NO e revisar dados epidemiológicos reportados na literatura. MATERIAL E MÉTODOS: Estudos clinicopatológico, imuno-histoquímico (marcadores S-100, epithelial membrane antigen [EMA] e CD-34) e histoquímico (método Ziehl-Neelsen modificado) foram realizados em oito casos de NO diagnosticados no Departamento de Patologia e Medicina Legal (DPML) da Universidade Federal do Ceará (UFC), Ceará, Brasil, entre 1994 e 2010. RESULTADOS: Os NO representaram 0,2% das lesões bucais diagnosticadas pelo serviço em 16 anos; mucosa jugal foi a localização mais frequente (71,4%); sete (87,5%) e oito (100%) casos apresentaram positividade para S-100 e CD-34, respectivamente, e nenhum para EMA. Adicionalmente, mastócitos foram identificados em sete casos (87,5%). A revisão de literatura indicou que NO solitários são mais comuns e ocorrem preferencialmente em mulheres, afetando pacientes entre 30 e 40 anos. O rebordo alveolar é a localização intraoral mais comum. CONCLUSÃO: Os marcadores S-100 e CD34 provaram ser de grande valor como ferramentas diagnósticas, diferente da coloração EMA. A identificação de mastócitos na maioria dos casos sugere seu envolvimento na patogênese desse tumor. Os dados clinicopatológicos da revisão de literatura ajudaram no estabelecimento de um perfil epidemiológico mais consistente.