Orthopantomography Versus Cone Beam Computed Tomography for the Assessment of the Proximity of Posterior Maxillary Apexes with the Maxillary Sinus: A Cross-sectional Study.

BACKGROUND: The lack of knowledge of the relation of the maxillary sinus with the apexes of maxillary posterior teeth can lead to important complications during common dental procedures. This can be avoided using different imaging techniques, such as orthopantomography (OPG) and cone beam computed tomography (CBCT). The present study aims to compare the performance of OPG with CBCT in measuring the vertical distance of the apexes of posterior-superior teeth to the maxillary sinus. METHODS: This study corresponded to a cross-sectional study. OPGs and CBCT scans were obtained from the same individuals, and the qualitative and quantitative vertical distance of the apexes in relation to the maxillary sinus was categorized and measured in mm. RESULTS: A total of 28 pairs of OPGs and CBCT scans from the same patients were obtained. About 381 roots were analysed, which included 89 upper first premolars, 51 upper second premolars, 115 upper first molars, and 126 upper second molars. Projection/protrusion was observed with more frequency in molars, specially 1º molars in both OPG (n= 75, 65.2%) and CBCT (n= 31, 27%); however, 106 more cases (27.9%) were classified as projected in the OPG compared to CBCT (p < 0.05). When comparing the performance of the OPG and CBTC for analysing all roots qualitatively, there was a 57.8% agreement between both techniques. This difference was statistically significant (p <0.0001). Statistically significant differences were also observed when comparing the millimetric differences. CONCLUSION: This study showed that OPG is not an accurate technique to observe the relationship between the maxillary sinus and the apexes of the upper posterior teeth. In those cases where precision is required when performing dental procedures in this area, CBCT should be used. When not available, the clinicians should be aware of the limitations of the OPG and add other complementary techniques.

Cowden's syndrome diagnosed through oral lesions: A case report.

Cowden's syndrome (CS), also known as multiple hamartoma syndrome, is a rare autosomal dominant genodermatosis first described in 1963. It has a high penetrance in both sexes and variable phenotypes. Its origin is a PTEN (phosphatase and tensin homologue) gene mutation and affects multiple organs of endodermal, ectodermal, and mesodermal origin, resulting in the development of hamartomatous mucocutaneus lesions and an increased risk for malignancies in breast, thyroid, endometrium, kidney, colon, rectum, among other organs. The diagnosis of CS is based mainly on clinical findings and oral cavity manifestations are frequent, occurring in 80-90% of patients. This include oral and labial papillomatous papules that usually precede the development of malignant tumours. Here, we report a case of a 58-years-old male with a presumptive diagnosis of multiple "pseudofibromas" in the oral cavity that was diagnosed with CS by a dental surgeon through the identification of extra and intraoral lesions, demonstrating the importance of awareness of this entity in the dental community to improve its early diagnosis, which is vital for the early detection and treatment of malignancies. Key words:Cowden's Syndrome, Multiple Hamartoma Syndrome, PTEN Hamartoma Tumor Syndrome, Papillomatous papules.

Impact of 1% malic acid spray on the oral health-related quality of life of patients with xerostomia.

Dry mouth sensation, also known as xerostomia, is a common clinical problem with an increasing prevalence. Although recent studies have reported promissory results of malic acid, none have evaluated the impact of malic acid on the oral health-related quality of life (OHRQoL) of patients with xerostomia. Thus, this study aimed to evaluate the impact of 1% malic acid, combined with fluoride and xylitol, on the OHRQoL of patients with xerostomia. We enrolled 70 patients and randomly allocated them into two groups: the intervention group (applied topical sialogogue with 1% malic acid) and the control group (applied a placebo). We assessed the OHRQoL and severity of xerostomia before and after treatment with the Spanish version of the Oral Health Impact Profile-14 questionnaire (OHIP-14sp) and a visual analogue scale (VAS), respectively. In addition, stimulated and non-stimulated salivary flow rates before and after treatments were also measured. In total, 60 patients completed the study. According to the VAS, both sprays significantly improved dry mouth sensation (P < 0.001). However, OHIP-14sp total scores decreased significantly in the intervention group from 20.8 ± 10.4 to 16.5 ± 9.5 (P < 0.001), indicating an improvement in the OHRQoL. No significant differences were observed in the control group (P > 0.05). Furthermore, non-stimulated salivary flow rates significantly increased in the intervention group from 0.25 ± 0.22 to 0.33 ± 0.33 mL/min (P < 0.001). Overall, this study demonstrated that malic acid improves the OHRQoL and dry mouth sensation in patients with xerostomia.

Difference in EGFR expression and mean vascular density in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma

To evaluate the expression of the epidermal growth factor receptor (EGFR) and mean vascular density (MVD) in normal oral mucosa (NOM), oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Material and methods: Descriptive case study. Nineteen histological samples diagnosed with NOM, 18 diagnosed with OED, and 19 with OSCC, were analyzed with immunohistochemistry against EGFR and CD31. EGFR expression was evaluated by extent and intensity of its expression in normal, dysplastic and neoplastic epithelium. MVD was determined through the detection of blood vessels by antibodies against CD31. Results: Extension of EGFR expression was highest in OSCC followed by OED and lowest in NOM, resulting in significant different between the degrees of extension (p<0.001). Intensity of EGFR was similar in NOM, OED and OSCC, without differences in its expression (p=0.533). Differences in MVD were found between NOM and OSCC groups (p<0.01), and between OED and OSCC groups (p<0.01), with no differences between NOM and OED groups (p=0.91). MVD was 21.17 +/- 4.98 in NOM, 23.40 +/- 5.77 in OED and 33.92 +/- 8.39 in OSCC. Conclusion: EGFR is expressed in normal, dysplastic or neoplastic oral epithelium. However, the extent of its expression is greater as malignancy increases. MVD varies according to the diagnosis.

Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life.

To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.

Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life

Abstract To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.

Cáncer oromaxilofacial en niños: Parte II tumores odontogénicos y de glándulas salivales malignos / Maxillofacial cancer in children: Part II malignant odontogenic and salivary gland tumors

A nivel mundial, la información acerca de tumores malignos del territorio maxilofacial que afectan a niños es limitada. La mayoría de los resportes consiste principalmente en datos de la población adulta. Las neoplasias malignas originadas del aparato odontogénicos y glándulas salivales son lesiones que con cierta frecuencia pueden afectar a la población infantil. Los tumores odontogénicos malignos son entidades sumamente raras que, correspondiendo a menos del 5 % del total de tumores odontogénicos. Los sarcomas odontogénicos, si bien son poco frecuentes, corresponden a los tumores odontogénicos malignos más comunes en la infancia. Las neoplasias malignas de glándulas salivales corresponden al 35­60 % de los tumores de gándulas salivales en la infancia, siendo el más común de ellos el carcinoma mucoepidermoide. En general, el pronóstico de estas entidades es positivo sobre todo si es acompañado de un diagnóstico oportuno. A pesar de la baja frecuencia que presenta este grupo de patologías, no es menos cierto que es necesario saber con precisión cuales son los tejidos orales desde los cuales se pueden originar neoplasias malignas en los niños y tener una breve referencia diferencial entre ellos.

Globally, information about the maxillofacial malignant tumors affecting children is limited. Most reported data consists mainly of studies in the adult population. Malignant neoplasms arising from odontogenic apparatus and salivary glands are lesions that frequently can affect children. Malignant odontogenic tumors are extremely rare entities, corresponding to less than 5 % of all odontogenic tumors. Odontogenic sarcomas, although they are rare, correspond to the most common malignant odontogenic tumors in childhood. Malignant salivary gland neoplasms correspond to 35­60 % of tumors of salivary glands during childhood and the most common of these is mucoepidermoid carcinoma. In general, the prognosis of these entities is positive especially when there is a timely diagnosis. Despite the low frequency presented by this group of diseases, the fact remains that it is necessary to know precisely what the originating oral tissues are which can cause malignancies in children and have a brief reference differential between them.

Incidence and prevalence of salivary gland tumours in Valparaiso, Chile

BACKGROUND: To determine the incidence and prevalence of salivary gland tumours in the province of Valparaíso, Chile. MATERIAL AND METHODS: Retrospective review of salivary gland tumours diagnosed between the years 2000 and 2011 from four local pathology services. Information on demographics and histopathology were retrieved from the medical records. RESULTS: The study sample consisted of 279 salivary gland tumours. Prevalence and incidence rates per 100.000 persons were 15.4 and 2.51, respectively. Most of the neoplasms corresponded to benign tumours (70.3%). The most affected gland was the parotid gland. Pleomorphic adenoma was the most common benign tumour (53.8%) and mucoepidermoid carcinoma was the most common malignant tumour (7.2%). CONCLUSIONS: Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomor- : Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumours reported in this series

Cáncer oromaxilofacial en niños: Parte I tumores malignos de tejido duro / Oromaxillofacial cancer in children: Part I hard tissue malignant tumors

Las enfermedades malignas de cabeza y cuello en la población pediátrica son poco frecuentes. Considerando todos los tumores de cabeza y cuello, tanto benignos como malignos, éstos están representados por una frecuencia entre un 2% a 5% de todos los tumores pediátricos. A nivel de los maxilares, los tumores malignos en niños está representado por un rango que varía entre un 7% a 51%. En Chile, se estiman menos de 500 casos nuevos por año y en el rango entre los 5 y 15 años constituyen la segunda causa de muerte, precedida por los accidentes, traumatismos y violencias. Es importante considerar, al estudiar este grupo de enfermedades, que existen diferencias con los tumores de adultos, tanto en su incidencia, biología, comportamiento, histología y manejo. Es por esta razón que nos parece necesario realizar una revisión de la literatura científica para obtener un perfil del cáncer bucomaxilofacial infantil, que aporte en el entendimiento y aplicación de programas adecuados en el contexto de la salud bucomaxilofacial. Adicionalmente, buscamos actualizar el conocimiento de estas patologías, caracterizándolas en relación a su epidemiología, etiopatogenia y tratamiento, de manera que contribuya a los cirujanos dentistas para realizar diagnósticos y la pronta derivación a un centro especializado de patología oral. Para un estudio preciso, esta revisión constará de tres partes: la primera es sobre "tumores malignos de tejido óseo", mencionando, entre ellos, al osteosarcoma, sarcoma de Ewing, linfomas tanto Hodgkin como No Hodgkin, fibrosarcoma e histiocitosis de células de Langerhans.

Malignant head and neck disease in the pediatric population are rare. Considering all head and neck tumors, both benign and malignant, they represent between 2% to 5% of all pediatric tumors. At the level of the jaws, malignant tumors in children present in a range that varies from 7% to 51%. In Chile, fewer than 500 new cases are reported each year and in the 5 to 15 year-range are estimated to constitute the second cause of death, preceded by accidents, injuries and violence. When studying this group of diseases it is important to consider the differences with adult tumors, both in incidence, biology, behavior, histology and management. Therefore we believe it necessary to conduct a review of scientific literature to obtain a profile of child oral maxillofacial cancer, contributing to the understanding and implementation of appropriate programs in the context of maxillofacial health. In addition, we seek to update knowledge of these pathologies, characterizing their epidemiology, pathogenesis and treatment, so as to contribute to dental surgeons for diagnosis and early referrals to specialized centers for oral pathology. For a detailed study, this review will consist of three parts: the first is on "malignant bone tumors", included among these are: osteosarcoma, Ewing's sarcoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, Langerhans cell histiocytosis and fibrosarcoma.

Incidence and prevalence of salivary gland tumours in Valparaiso, Chile.

BACKGROUND: To determine the incidence and prevalence of salivary gland tumours in the province of Valparaíso, Chile. MATERIAL AND METHODS: Retrospective review of salivary gland tumours diagnosed between the years 2000 and 2011 from four local pathology services. Information on demographics and histopathology were retrieved from the medical records. RESULTS: The study sample consisted of 279 salivary gland tumours. Prevalence and incidence rates per 100.000 persons were 15.4 and 2.51, respectively. Most of the neoplasms corresponded to benign tumours (70.3%). The most affected gland was the parotid gland. Pleomorphic adenoma was the most common benign tumour (53.8%) and mucoepidermoid carcinoma was the most common malignant tumour (7.2%). CONCLUSIONS: Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumours reported in this series.

Human papilloma virus and oral cancer: narrative review of the literature / Virus papiloma humano y cáncer oral: revisión narrativa de la literatura

The Human Papilloma Virus (HPV) infection is now more common sexually transmitted diseases, with an incidence of 5.5 million worldwide, with 85 percent of the carrier of this virus adult population. Their oncogenic potential and increased oral lesions associated with oral HPV infection have led us to make a narrative of the literature on the role of HPV in oral cancer, especially types 16 and 18. Here we refer to the possible routes of infection, oncogenic mechanisms, both benign and potentially malignant oral lesions associated with the infection, different methods used for detection, prediction and prevention of infection. We stress the importance of the role of the dentist to identify individuals considered high risk and ease of performing detection in the oral cavity, through a quick and easy method as exfoliative cytology.

El Virus Papiloma Humano (VPH) en la actualidad constituye la infección por transmisión sexual más frecuente, presentando una incidencia de 5,5 millones en el mundo, siendo un 85 por ciento de la población adulta portadora de este virus. Su potencial oncogénico y el aumento de lesiones orales asociadas a infección oral por VPH nos han llevado a realizar una narración de la literatura referente al rol del VPH en el cáncer oral, especialmente de los subtipos 16 y 18. Nos referiremos a sus posibles vías de contagio, mecanismos oncogénicos, lesiones orales tanto benignas como potencialmente malignas asociadas a su infección, diferentes métodos utilizados para su detección, pronóstico y prevención de contagio. Destacamos la importancia del rol del odontólogo para identificar individuos considerados de alto riesgo y la facilidad de realizar su detección en la cavidad oral, a través de un método rápido y sencillo como es la citología exfoliativa.

Leucoplasia verrucosa proliferativa: a propósito de un caso clínico / Proliferative verrucous leukoplakia: a clinical case

La Leucoplasia Verrucosa Proliferativa (LVP) es una placa blanca, verrucosa, exofítica, de crecimiento lento, que no se desprende al raspado y que tiende a comprometer diversos sitios de la mucosa oral. Es resistente al tratamiento independiente de la terapia adoptada y presenta una alta tasa de recidiva posterior al tratamiento quirúrgico. Desde 1985, cuando fue descrita por primera vez por Hansen, hasta le fecha, se ha mantenido como una entidad patológica compleja. Reportamos un caso de una paciente de sexo femenino de 72 años de edad que consulta por una lesión blanca, verrucosa, asintomática, que no se desprende al raspado, en el borde y vientre lingual y piso de boca. Se realizaron 2 biopsias incisionales del borde lateral de la lengua. Al examen microscópico se observó en ambas biopsias un grueso revestimiento epitelial acantósico, con marcada hiperparaqueratosis, una membrana basal nítida y cambios displásicos mínimos. Al mes de realizadas las biopsias la lesión presentó recidiva, manteniendo las mismas características clínicas encontradas inicialmente. Considerando la evolución, comportamiento biológico y las características histopatológicas, la lesión se diagnosticó como una LVP. Hasta la fecha, no hay protocolo de tratamiento establecido para estas lesiones. En este caso en particular, tomando en cuenta la extensión de la lesión, los sitios comprometidos, las escasas atipias presentes al examen histopatológico, la edad y escaso nivel socioeconómico de la paciente, se decidió no realizar la remoción quirúrgica de la lesión y mantenerla en control clínico cada 3 meses. Después de varios controles realizados durante un periodo de 3 años, se observó que la lesión mantuvo sus características clínicas iniciales. Esto confirma que haber optado por un tratamiento conservador, en este caso en particular de LVP, fue la decisión correcta...

The proliferative verrucous leukoplakia (PVL) is a white plate, wart-like, exophytic , slow growth , which does not follow the scaling that tends to compromise various oral mucosal sites . It is resistent to independent therapy and has a high rate of recurrence after surgical treatment. Since 1985, when it was first described by Hansen, and to date it has remained a complex pathological disorder. We report a case of a 72-year-old female patient who complains of a white, verrucous and asymptomatic lesion. The lesion does not detach by scraping the edge, lingual belly or mouth floor. Two Incisional biopsies were performed on lateral border of the tongue. Upon microscopic examination of both biopsies, thick epithelial lining, with marked hyperparakeratosis, a basement membrane, and minimal dysplasia alterations were observed. One month following biopsies of the lesion were performed, lesion relapsed and maintained the same clinical features found initially. Considering the evolution, biological behavior and histopathological features, the lesion is diagnosed as an PVL. To date, there is no established treatment protocol for these injuries. In this particular case, taking into account the extent of the injury, compromised sites, the few atypia present histopathological examination, age and low socioeconomic level of the patient, it was decided not to perform surgical removal of the lesion and maintain clinical monitoring every 3 months. Following several examinations carried out over a three-year period, it was observed that the injury kept initial clinical features. This confirms that having opted for conservative treatment, in this particular case of PVL, was the right decision...

Solitary intraosseous neurofibroma of the mandible. Apropos of a case

Neurofibroma is a benign neoplasm derived from peripheral nerves. Most of these are associated with Neurofibromatosisbut may also occur as solitary lesions. When found on the head and neck they are generally located inthe soft tissue. Intraosseous location is very rare.The following report describes a case of an intraosseous neurofibroma located in the left mandibular ramus of a14-year-old child. The patient did not had clinical evidence of the lesion and it was found on a routine radiographicexamination. Surgical excision of the lesion was scheduled and the sample was submitted to histopathologicalstudy. Representative sample cuts were studied using conventional techniques of hematoxylin-eosin and immunohistochemistryusing primary antibodies anti S-100 protein, vimentin, and neuroespecific enolase.A review of clinical, radiographic, histologic and immunohistochemical features of other cases of intraosseuosneurofibromas located in the jaws together with the possible differential diagnosis of the lesion are discussed.Our case corresponds to a intraosseous neurofibroma of controveltial diagnosis because even though it presentstypical neurofibroma histomorphological features it has immunophenotype different from usual (AU)

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Solitary intraosseous neurofibroma of the mandible. Apropos of a case.

Neurofibroma is a benign neoplasm derived from peripheral nerves. Most of these are associated with Neurofibromatosis but may also occur as solitary lesions. When found on the head and neck they are generally located in the soft tissue. Intraosseous location is very rare. The following report describes a case of an intraosseous neurofibroma located in the left mandibular ramus of a 14-year-old child. The patient did not had clinical evidence of the lesion and it was found on a routine radiographic examination. Surgical excision of the lesion was scheduled and the sample was submitted to histopathological study. Representative sample cuts were studied using conventional techniques of hematoxylin-eosin and immunohistochemistry using primary antibodies anti S-100 protein, vimentin, and neuroespecific enolase. A review of clinical, radiographic, histologic and immunohistochemical features of other cases of intraosseuos neurofibromas located in the jaws together with the possible differential diagnosis of the lesion are discussed. Our case corresponds to a intraosseous neurofibroma of controveltial diagnosis because even though it presents typical neurofibroma histomorphological features it has immunophenotype different from usual.

Suicide prevention and community-level indictors.

This study sought to develop a set of easily obtainable, relevant measures of a community's condition that could be used to guide its suicide prevention efforts. Existing data were gathered across 159 Georgia counties for nine potential social indicators (rates of net migration, divorce, unemployment, violent crimes reported, driving under the influence of alcohol or drugs [DUI] crashes, high school dropouts, Temporary Assistance for Needy Families [TANF], percentage of population aged 65 or older, and percentage of population who are white males) that had been chosen by the communities. Data on the social indicators from 1995 through 1999 were averaged and analyzed to determine their correlation with aggregated 5-year county suicide rates. Results of multivariate modeling procedures showed number of DUI crashes and percentage of the population aged 65 or older to be significant correlates of the suicide rate, controlling for other potential indicators. These preliminary data may provide a useful model of a county's 5-year suicide rate among counties reporting 20 or more suicides. Research with additional indicators and in other states will help determine the generalizability of these findings to other communities.