Impact of PI and NNRTI HAART-based therapy on oral lesions of Brazilian HIV-infected patients.

BACKGROUND: The incidence of oral lesions related to human immunodeficiency virus (HIV) infection have been investigated after treatment with highly active antiretroviral therapy (HAART) including protease inhibitors (PI) but no data are available on the effect of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy on incidence of acquired immunodeficiency syndrome (AIDS) oral manifestations or impact of HAART on oral manifestations of HIV infection in Brazil. The aim of this study was to describe the effects of anti-HIV therapy on the incidence of oral lesions during 17 years of AIDS epidemics in a Brazilian population. METHODS: From 1989 to 2006, we collected data from 1595 consecutive HIV patients at the Special Care Dentistry Center, São Paulo, Brazil. We compared the effect of PI- and NNRTI-based antiretroviral therapy (ARVT) on the annual incidence of Kaposi sarcoma (KS), oral candidiasis (OC) and hairy leukoplakia (HL). The chi-squared test was used to test the association between oral lesions and therapeutic regimen (P < 0.05). RESULTS: None of patients on ARVT presented with KS. Patients who used (nucleoside reverse transcriptase inhibitors) NRTI + PI were 0.9 times as likely to present with HL as those who used NRTI + NNRTI. This finding, however, was not statistically significant (P = 0.5). The relative risk for OC was 0.8 in patients with PI-based HAART. The increased risk among those on PIs was statistically significant (P = 0.004). CONCLUSIONS: The superiority of NNRTI regimens in decreasing OC incidence is consistent with current therapeutic guidelines which recommend NNRTI-based therapy as the treatment of choice for initial ARVT.

Clinical and imaging correlations of Treacher Collins syndrome: report of two cases.

Mandibulofacial dysostosis (Treacher Collins Syndrome) is an autosomal dominant genetic disorder that probably derives from inhibition of the facial structures from the first and second branchial arches. The facial pattern of the syndrome is a convex facial profile with a prominent nose above a retruded chin. The eyes are deformed by antimongoloid slant of the palpebral fissures and facial bones are hypoplastic. The alterations are caused by mutation in gene 5q32-33.1, which encodes the nucleolar phosphoprotein treacle. Computed tomography images are able to demonstrate craniofacial bones, allowing the morphological analysis of these bones in individuals with complex deformities. The purpose of this paper is to present the results of a clinical and computed tomography investigation of two patients with Treacher Collins syndrome.

Condylar hemangioma: report of a case and review of the literature.

According to the World Health Organization, hemangiomas are benign vasoformative neoplasms or developmental conditions of endothelial origin. The body region is the most commonly affected part of the mandible, and only 4 cases of condylar tumors have been reported in the literature to date. The differential diagnosis between high and low flow vascular lesions is crucial for successful treatment, decreasing the occurrence of serious intraoperative hemorrhage. The clinical, radiographic, and pathological features of an intraosseous vascular lesion in the mandibular condyle in a 22-year-old male are presented, and the differential diagnostic aspects between hemangioma, vascular malformation, and high or low flow lesions are discussed.

Detection of Epstein-Barr virus (EBV) in the oral mucosa of renal transplant patients.

The purpose of this study was to determine the prevalence of Epstein-Barr virus (EBV)-DNA in the oral mucosa of renal transplant patients and observe the efficacy of mouth rinses with phosphate-buffered saline (PBS) to eliminate EBV present in the saliva. Lingual, gingival, and buccal cytobrushings were obtained from normal oral mucosa of 10 renal transplant patients and 10 normal subjects, and were examined through polymerase chain reaction (PCR), before and after rinses with PBS. EBV-DNA was detected in 86.6% of renal transplant recipients and in 46.6% of healthy subjects. No significant difference was observed between oral scrapes obtained before and after rinses with PBS with regard to detection of EBV-DNA. Our results suggest that the use of PCR to detect the presence of EBV-DNA in oral mucosa in the absence of specific lesions gives rise to the problem of identifying the viral replication sites. In addition, PBS was not effective at minimizing contamination by saliva.

Manejo clínico ambulatorial do paciente portador de hepatite viral / Clinical management of patients with viral hepatitis

O fígado pode ser afetado por agentes químicos, físicos ou biológicos. Atualmente, aceita-se a existência de 9 vírus hepatotrópicos capazes de causar hepatites virais. Independentemente do tipo de hepatite viral, as alterações hepáticas podem estar presentes no paciente e representar distúrbios funcionais importantes. O cirurgião-dentista deve estar apto a tratar o paciente hepatopata, sendo capaz de avaliar as alterações sistêmicas relacionadas ao mau funcionamento do órgão.

Primary malignant melanoma of the oral cavity: a case report.

A 43-year-old white man was referred to the Special Care Dentistry Center of the School of Dentistry, University of Sao Paulo, Brazil, for the diagnosis of an extensive nodular lesion of the maxillary gingiva. The patient complained that his left maxilla had swollen over the last 4 months, with some exudation from the gingival crevice, sporadic bleeding, and slight tooth mobility, but no pain. An extra-oral examination confirmed expressive swelling of the left side of the face (Fig. 1A). Palpation disclosed bilateral enlargement of the submandibular lymph nodes. An intra-oral examination showed an extensive, reddish, nodular mass (around 11 cm in diameter) that extended from the last left maxillary molar to the right maxillary incisor, covered by a mucosa that was ulcerated in some areas (Fig. 1B,C). Palpation revealed a painless, soft, bleeding tissue that seemed to arise in the periodontal ligaments, extending to the palate and vestibular area. A small pigmented spot was found in the palatal mass. Histopathologically, the biopsy revealed a proliferation of neoplastic cells that exhibited a wide variety of shapes, including spindle, plasmacytoid, and epithelioid forms. The atypical cells showed enlarged and pleomorphic nuclei. Mitotic activity and pigmented areas were observed (Fig. 2A,B). Immunohistochemistry was used to establish the final diagnosis. The tumor cells strongly expressed S100 protein, gp100 (HMB-45), melan A, and tyrosine antibodies (Fig. 2C,D). With the diagnosis of malignant melanoma, the patient was referred to an oncologist for treatment. As computed tomography revealed that the lesion was deeply inserted into the skull surface (Fig. 1D), surgical intervention was not possible. The patient underwent radiotherapy, but died 14 months later.

Management of a large dentigerous cyst occurring in a six-year-old boy.

A case of dentigerous cyst in a six-year-old healthy Brazilian boy, who had a diagnostic hypothesis of ameloblastoma and keratocyst because of the extension and radiographic appearance is presented. The importance of a previous incisional biopsy and consequent conservative treatment is discussed.

Secondary syphilis in an HIV positive patient.

The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso of skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.

Sífilis secundaria en un paciente VIH positivo / Secondary syphilis in an HIV positive patient

La incidencia de afecciones orales, antes infrecuentes en pacientes infectados por VIH, se está incrementando y es posible que se subestime. Las lesiones orales resultantes de la sífilis secundaria son raras; sin embargo, ocurren, y el odontólogo debería ser capaz de realizar un correcto diagnóstico. En algunos casos la anamnesis y los signos clínicos de las lesiones son insuficientes para permitir el diagnóstico de la enfermedad. El conocimiento de sus características histológicas y las pruebas de laboratorio relevantes, así como su aplicabilidad y limitaciones son necesarios para el correcto diagnóstico de la sífilis secundaria (AU)

Solitary fibrous tumor of the oral mucosa--morphological and immunohistochemical profile in the differential diagnosis with hemangiopericytoma.

The objective was to investigate two cases of solitary fibrous tumor (SFT) of oral mucosa, emphasizing the differential diagnosis with one case of oral hemangiopericytoma (HPC), in terms of their morphological and immunohistochemical features. Solitary fibrous tumors showed cellularity and collagenization varying from area to area, focal perivascular hyalinization, scattered giant nuclei cells and abundant mast cells throughout the tumor. The hemangiopericytoma case exhibited thin-walled and dilated vessels lined with flat endothelial cells, identified by "staghorn appearance". Tumoral cells of solitary fibrous tumor exhibited immunohistochemical positivity for CD34, as well as endothelial cells. The hemangiopericytoma was positive only in endothelial cells. In solitary fibrous tumor, alpha-smooth muscle actin, h-caldesmon and laminin stained the wall vessels. In hemangiopericytoma, on the other hand, the wall vessels were positive only for laminin, which staining was also observed in perivascular tumoral cells. The morphological and immunohistochemical differences observed allowed us to infer these lesions constitute distinct entities.

General and oral characteristics in Rett syndrome.

Rett syndrome (RS) is a neurodegenerative disorder characterized by developmental arrest of parts of the brain. It is an X chromosome-linked condition which affects females almost exclusively. Recent reports have been generated concerning the multidisciplinary management of individuals exhibiting Rett syndrome. The aim of the present report was to provide an update on the oral manifestations of the disorder. We evaluated the general and oral characteristics of RS in 13 female patients. The most frequent manifestations were stereotyped hand movements and bruxism. The treatment we carried out included the use of biteplanes and acupuncture.