Is vitamin D receptor (VDR) polymorphism associated with head and neck cancer risk? A systematic review and meta-analysis.

BACKGROUND: Head and neck cancer encompasses neoplasms affecting the oral cavity, pharynx, larynx, and thyroid. Identifying factors that modulate the carcinogenesis process can aid in identifying subgroups at higher risk of developing the disease, enabling implementation of prevention programs. Vitamin D receptor polymorphisms can affect the carcinogenesis of various tumors by altering vitamin D metabolism and cellular response. METHODS: To elucidate the role of vitamin D receptor polymorphisms in head and neck cancer, a systematic review was performed, searching the Embase, PubMed, Scopus, and Lilacs databases. A total of 19 articles met the inclusion criteria. The frequency of vitamin D receptors polymorphism alleles (FokI, ApaI, BsmI, TaqI, Cdx2, rs2107301, rs2238135) was recorded and pooled to calculate the odds ratio in a meta-analysis using the Review Manager software. RESULTS: Subgroup analysis demonstrated significant associations in the anatomical site of cancer (oral cancer in ApaI and BsmI, and unspecified subsites of head and neck cancer in TaqI), genotyping method (FokI and BsmI), and continent of the study (ApaI, FokI, and BsmI). CONCLUSION: Our findings were heterogeneous, as with other evidence available in the literature. Therefore, more clinical studies with larger sample sizes are needed to obtain more accurate results on the relationship between vitamin D receptor polymorphism and head and neck cancer.

Impact of dental imaging on pregnant women and recommendations for fetal radiation safety: A systematic review.

Purpose: This study was conducted to investigate the safety of dental imaging in pregnant women with respect to fetal health. Materials and Methods: Searches were conducted of the PubMed, Scopus, and Web of Science databases in May 2023. The inclusion criteria encompassed cross-sectional and longitudinal studies that focused on the analysis of diagnostic dental imaging in pregnant women, as well as studies utilizing phantoms to simulate imaging examinations. The exclusion criteria consisted of reviews, letters to the editor, book chapters, and abstracts from scientific conferences and seminars. Results: A total of 3,913 articles were identified. Based on a review of the titles and abstracts, 3,892 articles were excluded, leaving 21 articles remaining for full-text review. Of these, 18 were excluded, and 4 additional articles were included as cross-references. Ultimately, 7 articles underwent quantitative-qualitative analysis. Three retrospective studies were focused on pregnant women who underwent dental imaging procedures. The remaining 4 studies utilized female phantoms to simulate imaging examinations and represent the radiation doses absorbed by the uterus or thyroid. Conclusion: Few dental radiology studies have been conducted to determine the safe radiation threshold for pregnant women. Additionally, the reviewed articles did not provide numbers of dental examinations, by type, corresponding to this dose. Dental imaging examinations of pregnant women should not be restricted if clinically indicated. Ultimately, practitioners must be able to justify the examination and should adhere to the "as low as diagnostically acceptable, being indication-oriented and patient-specific" (ALADAIP) principle of radioprotection.

Comparison of different DNA preservation solutions for oral cytological samples.

OBJECTIVE: The objective of this study was to compare the DNA preservation capacity of buccal mucosa exfoliated cells when stored in different solutions under varying time and temperature conditions. DESIGN: DNA preservation solutions, including Dimethyl sulphoxide disodium-EDTA-saturated NaCl (DESS), Tris-EDTA-NaCl-Tween20 buffer (TENT), Nucleic Acid Preservation Buffer (NAP), and phosphate-buffered saline (PBS), were prepared. Buccal mucosa cells from a single patient were collected, dispensed into these solutions, and stored at room temperature (RT) and 4 °C for 24 h, 72 h, 30 days, 90 days, and 180 days. DNA was extracted using the salting-out method and the QIAamp DNA Mini Kit. DNA concentration and purity were determined using the QuBit device and NanoDrop, while DNA integrity was assessed using the Agilent 4200 TapeStation system. The ability to amplify the IFNA primer was also evaluated by PCR. RESULTS: The salting-out method yielded better concentration and purity results, with PBS, TENT, and DESS buffers demonstrating superior concentration values when stored at 4 °C, resulting in mean values exceeding 10 ng/µL for up to 30 days. DESS consistently exhibited the best integrity values over time for both temperature conditions. Amplification capacity was enhanced when samples were stored at 4 °C. When stored at RT, PBS achieved 100% amplification within 24 h. NAP yielded the poorest results. CONCLUSION: In the context of long-term preservation, the DESS buffer emerges as the most effective solution, maintaining requisite DNA quality and quantity standards for up to 30 days at RT and up to 3 months at 4 °C.

Is imiquimod a promising drug to treat oral mucosa diseases? A scoping review and new perspectives.

Imiquimod (IMQ) is a chemotherapeutic and immunostimulant drug that is applied topically, demonstrating antitumor and antiviral activities. The objective of this review was to compile data on the off-label use of IMQ in oral mucosal diseases. IMQ has exhibited effectiveness in the treatment of various oral mucosal conditions, including oral carcinogenic lesions, neoplasms, HPV-related lesions and autoimmune disorders. Although IMQ holds promise as a potential strategy for addressing oral mucosal lesions, it is important to note that significant side effects have been frequently reported. Nonetheless, it is crucial to develop and test new technological systems, such as the combination of nanotechnology with innovative drug delivery platforms. These advancements aim to minimize side effects and prolong the drug's contact time with the mucosa, preventing its removal by salivary flow.

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study.

Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

Oral cancer over six decades: a multivariable analysis of a clinicopathologic retrospective study.

Studies have reported changes in the epidemiological profile of patients with oral cancer in recent decades, especially regarding gender and age. This study aimed to evaluate a historical series of oral malignant lesions prevalence over six decades and define characteristics associated with the occurrence, mainly, of oral squamous cell carcinoma (OSCC). A retrospective review of histopathological records from 1953 to 2019 was conducted in three oral pathology laboratories in South Brazil about age, sex, anatomical site, clinical aspect, and histopathological diagnosis. Descriptive and analytical analyses were performed comparing the histopathological diagnoses with other variables. Multivariable logistic regression was applied to determine the associated predictors of OSCC. Of the 53,065 records available in the institutions, 986 were oral malignant tumors (including all malignant neoplasms), representing 1.86% of all diagnoses. The occurrence of OSCC in the 1960's was 80.0%, decreasing over time reaching the lowest percentage of cases in the 1990's (75.8%) and significantly increasing to 88.7% in the 2010s. Females had a lower chance than males of having OSCC independently of the decade (odds ratio=0.30, p<0.001). This was the same for older individuals compared to those younger than 40 years. No interactions between sex, age, and decade were observed. The number of diagnoses of oral malignant lesions increased over time, and the occurrence of OSCC varied. Older individuals and males had higher chances of having OSCC independently of the decade. Therefore, in this study sample, no changes were observed in the epidemiological profile over the years concerning these predictors.

Systemic non-steroidal immunomodulators for oral lichen planus treatment-a scoping review.

OBJECTIVE: The aim of this scoping review was to evaluate the efficacy and safety of the use of systemic nonsteroidal immunomodulators (SNSI) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS: This review was conducted according to PRISMA-ScR guidelines and registered at PROSPERO (CRD42021243524). Consulted databases were Pubmed, Embase, Scopus, and Web of Science. The inclusion criteria was as follows: clinical trials, case series, prospective, and retrospective studies conducted with participants presenting OLP of any sex and age. RESULTS: Thirty-two studies were selected, assessing 9 different SNSI: methotrexate, dapsone, levamisole, hydroxychloroquine, thalidomide, metronidazole, azathioprine, mycophenolate mofetil, and colchicine. Methotrexate and dapsone were the drugs with the best evidence among the options included, regarding number and quality of studies. Methotrexate resulted in significant improvement in the clinical condition and remission of symptoms, ranging between 63 and 93% of cases. Dapsone presented a similar effect to the use of topical corticosteroids and tacrolimus CONCLUSION: Among SNSI therapeutic options, methotrexate, and dapsone showed promising efficacy and safety. However, large-scale randomized clinical trials are still needed. CLINICAL RELEVANCE: SNSI have been used in the treatment of recalcitrant OLP; however, so far, it is not clear which are the best options. This scoping review highlights the potential use of methotrexate and dapsone.

Oral cancer over six decades: a multivariable analysis of a clinicopathologic retrospective study

Abstract Studies have reported changes in the epidemiological profile of patients with oral cancer in recent decades, especially regarding gender and age. This study aimed to evaluate a historical series of oral malignant lesions prevalence over six decades and define characteristics associated with the occurrence, mainly, of oral squamous cell carcinoma (OSCC). A retrospective review of histopathological records from 1953 to 2019 was conducted in three oral pathology laboratories in South Brazil about age, sex, anatomical site, clinical aspect, and histopathological diagnosis. Descriptive and analytical analyses were performed comparing the histopathological diagnoses with other variables. Multivariable logistic regression was applied to determine the associated predictors of OSCC. Of the 53,065 records available in the institutions, 986 were oral malignant tumors (including all malignant neoplasms), representing 1.86% of all diagnoses. The occurrence of OSCC in the 1960's was 80.0%, decreasing over time reaching the lowest percentage of cases in the 1990's (75.8%) and significantly increasing to 88.7% in the 2010s. Females had a lower chance than males of having OSCC independently of the decade (odds ratio=0.30, p<0.001). This was the same for older individuals compared to those younger than 40 years. No interactions between sex, age, and decade were observed. The number of diagnoses of oral malignant lesions increased over time, and the occurrence of OSCC varied. Older individuals and males had higher chances of having OSCC independently of the decade. Therefore, in this study sample, no changes were observed in the epidemiological profile over the years concerning these predictors.

Resumo Alguns estudos relataram mudanças no perfil epidemiológico dos pacientes com câncer bucal nas últimas décadas, principalmente quanto ao gênero e a idade. Este estudo teve como objetivo avaliar, em uma série histórica, a prevalência de todas as lesões malignas bucais ao longo de seis décadas e definir características associadas na ocorrência, principalmente, de carcinoma espinocelular (CEC). Um levantamento retrospectivo dos registros histopatológicos de 1953 a 2019 foi realizado em três laboratórios de Patologia Bucal no Sul do Brasil em relação à idade, gênero, sítio anatômico, aspecto clínico e diagnóstico histopatológico. Análises descritivas e analíticas foram realizadas comparando-se os diagnósticos histopatológicos com as outras variáveis. A regressão logística multivariada foi aplicada para determinar os possíveis preditores associados ao CEC. Dos 53.065 prontuários disponíveis nas instituições, 986 eram tumores malignos bucais (incluindo todas as neoplasias malignas), representando 1,86% de todos os diagnósticos. A ocorrência de CEC na década de 1960 foi de 80,0%, diminuindo ao longo do tempo, atingindo o menor percentual de casos na década de 1990 (75,8%) e aumentando significativamente para 88,7% na década de 2010. As mulheres tiveram menor risco de desenvolver CEC do que os homens, independentemente da década (OR=0,30, p<0,001). Este foi o mesmo para indivíduos com idade mais avançada em comparação com aqueles com menos de 40 anos de idade. Não foram observadas interações entre gênero, idade e década. O número de diagnósticos de lesões malignas bucais aumentou ao longo das décadas e a ocorrência de CEC variou. Indivíduos com mais de 40 anos e do sexo masculino tiveram maiores chances de ter CEC, independentemente da década analisada. Portanto, nessa amostra estudada, não foram observadas mudanças no perfil epidemiológico ao longo dos anos com relação a esses preditores.

Chemoprevention in oral leukoplakia: challenges and current landscape.

Oral potentially malignant disorders have the potential to transform into oral cancer. Oral leukoplakia is a prevalent OPMD with a 9.8% malignant transformation rate. The standard management for OL involves surgical excision, but its efficacy in preventing clinical recurrence and malignant transformation is limited. Therefore, alternative strategies such as chemoprevention modalities have emerged as a promising approach to inhibit the carcinogenesis process. The aim of this review was to identify human studies that investigated the effectiveness of chemopreventive agents in preventing the progression of oral leukoplakia and to provide guidance for future research. Several systemic and topical agents have been evaluated for their potential chemopreventive effects in oral leukoplakia. Systemic agents that have been investigated include vitamin A, lycopene, celecoxib, green tea extract, ZengShengPing, Bowman Birk inhibitor, beta-carotene, curcumin, erlotinib, and metformin. In addition, topical agents tested include bleomycin, isotretinoin, ONYX-015 mouthwash, ketorolac, and dried black raspberry. Despite numerous agents that have already been tested, evidence supporting their effectiveness is limited. To improve the search for an ideal chemopreventive agent for oral leukoplakia, we propose several strategies that can be implemented. Oral leukoplakia chemoprevention presents a promising opportunity for decreasing the incidence of oral cancer. Identifying new chemopreventive agents and biomarkers for predicting treatment response should be a focus of future research.

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

Abstract Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

Transmission electron microscopy in oral cytopathology: a pilot study / Microscopia eletrônica de transmissão em citopatologia bucal: um estudo piloto

Introduction: Cytopathology is a collection method that allows cell analysis through the different techniques. The oral mucosa exfoliated cells observation demonstrates morphological, biochemical and/or molecular aspects depending on the type of processing of the sample. Aim: This study tested the use of oral cytopathology associated with transmission electron microscopy (TEM) to observe the morphology of cells, mainly in relation to the cell nucleus, the cytoplasmic membrane, and cell junctions. Materials and Methods: Exfoliated epithelial cells from the oral mucosa were analyzed by TEM from individuals exposed to tobacco and alcohol, with leukoplakia or with a histopathological diagnosis of squamous cell carci-noma. Results: The cytoplasmic cell-cell junctions in the malignant samples lost the characteristic irregular pattern formed by the numerous interdigitations and the junctional process of normal cells and started to present a straight cytoplasmic surface. The nuclei of cells from leukoplakia and squamous cell carcinoma samples showed heterogeneous staining, while non-lesional cells were homogeneous. Discussion: The analysis of oral cytopathological smears by TEM contributes to the un-derstanding of the changes that occur during the process of malignancy of the oral mucosa, especially with regard to the cytoplasmic membrane and intercellular junctions. Conclusion: TEM may be a good analytical method to investigate morphological changes in exfoliated cells of the oral epithelium.

Introdução: A citopatologia é um método de coleta que permite a análise celular por meio de diferentes técnicas. A observação das células esfoliadas da mucosa bucal demonstra aspectos morfológicos, bioquímicos e/ou moleculares dependendo do tipo do processamento empregado. Objetivo: Este estudo testou o emprego da técnica de citopatologia bucal associada à microscopia eletrônica de transmissão (MET) para observar a morfologia das células, principalmente com relação à membrana citoplasmática, as junções celulares e ao núcleo da célula. Materiais eMétodos: Células epiteliais esfoliadas da mucosa bucal foram analisadas por MET de indivíduos expostos a tabaco e álcool, apresentando leucoplasia ou com diagnóstico de carcinoma espinocelular. Resultados:As junções citoplasmáticas célula-célula nas amostras malignas perderam o padrão irregular característico formado pelas inúmeras interdigitações e o processo juncional das células normais e passaram a apresentar uma superfície citoplasmática reta. O núcleo das células das amostras de leucoplasia e do carcinoma espinocelular apresentou coloração heterogênea, enquanto as células não lesionais foram homogêneas. Discussão: A análise de esfregaços citopatológicos bucais por MET contribui para o entendimento das alterações que ocorrem durante o processo de malignidade da mucosa bucal, principal-mente no que diz respeito à membrana citoplasmática e as junções intercelulares. Conclusão: A MET pode ser um bom método analítico para investigar alterações morfológicas em células esfoliadas do epitélio bucal.

Clinical and immunological features of chronic ulcerative stomatitis: A systematic review.

Chronic ulcerative stomatitis (CUS) is a rare disease of the mucous membranes with characteristics similar to other autoimmune diseases. The aim of this study was to conduct a systematic review of the literature to recover all reported cases of CUS in order to summarize what are the clinical, demographic, microscopic, immunological features of CUS and its therapeutic response to different drugs. A systematic review of the literature was carried out following the statements of preferred reporting items for systematic reviews and meta-analyses (PRISMA). The searches were performed in the electronic databases PubMed, Scopus, EMBASE, LILACS, Opengrey, and Google scholar. Inclusion criteria were articles or abstracts reporting at least one case with a final diagnosis of CUS. A total of 696 records were identified through databases, and 25 studies were selected reporting 81 cases. CUS affects more females (92%), and a greater number of cases are reported in Caucasian patients (53%). The age of patients ranged from 20 to 86 years with a mean age of 60 years (±13.86), and 15% of cases reported concomitantly skin lesions. The clinical and histopathological characteristics of CUS are very similar to those of oral lichen planus. The direct immunofluorescence (DIF) remains the gold-standard diagnostic resource and was performed in 69 cases, revealing a dotted pattern of deposition of stratified epithelium-specific antibodies (SES-ANA). The serum of 38 patients was collected for the performance of the indirect immunofluorescence (IIF), and the use of epithelial substrates such as monkey and guinea pig esophagus often resulted in positive SES-ANA IgG. Most patients were treated with antimalarials, and the treatment of choice that proved to be effective is hydroxychloroquine (HCQ). This entity must be considered in the differential diagnosis of other autoimmune diseases, as it may be underreported.

Sun protection as a protective factor for actinic cheilitis: Cross-sectional population-based study.

OBJECTIVE: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. MATERIALS AND METHODS: A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. RESULTS: Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. CONCLUSIONS: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.

The role of tumor acidification in aggressiveness, cell dissemination and treatment resistance of oral squamous cell carcinoma.

AIMS: To investigate the role of tumor acidification in cell behavior, migration, and treatment resistance of oral squamous cell carcinoma (OSCC). MAIN METHODS: The SCC4 and SCC25 cell lines were exposed to acidified (pH 6.8) cell culture medium for 7 days. Alternatively, a long-term acidosis was induced for 21 days. In addition, to mimic dynamic pH fluctuation of the tumor microenvironment, cells were reconditioned to neutral pH after experimental acidosis. This study assessed cell proliferation and viability by sulforhodamine B and flow cytometry. Individual and collective cell migration was analyzed by wound healing, time lapse, and transwell assays. Modifications of cell phenotype, EMT induction and stemness potential were investigated by qRT-PCR, western blot, and immunofluorescence. Finally, resistance to chemo- and radiotherapy of OSCC when exposed to acidified environmental conditions (pH 6.8) was determined. KEY FINDINGS: The exposure to an acidic microenvironment caused an initial reduction of OSCC cells viability, followed by an adaptation process. Acidic adapted cells acquired a mesenchymal-like phenotype along with increased migration and motility indexes. Moreover, tumoral extracellular acidity was capable to induce cellular stemness and to increase chemo- and radioresistance of oral cancer cells. SIGNIFICANCE: In summary, the results showed that the acidic microenvironment leads to a more aggressive and treatment resistant OSCC cell population.

Efficacy of topical non-steroidal immunomodulators in the treatment of oral lichen planus: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review was to assess the efficacy and safety of topical non-steroidal immunomodulators (TNSIs) for oral lichen planus (OLP) treatment. MATERIALS AND METHODS: A search strategy designed for this purpose retrieved 1156 references. After analysis of titles and abstracts, 75 studies were selected for full-text analysis. Only randomized controlled clinical trials were selected, resulting in 28 studies included for qualitative and quantitative analysis. RESULTS: The meta-analysis showed similar benefits in clinical response and symptom resolution between tacrolimus 0.1% and pimecrolimus 1% in comparison to topical steroids (TS). Pimecrolimus showed superior efficacy of clinical response but not for symptom resolution compared to placebo. Tacrolimus and pimecrolimus showed better performance preventing symptom relapse, while pimecrolimus also prevented clinical relapse better than TS. Cyclosporine was superior to placebo; however, TS showed better efficacy of clinical response. Thalidomide and retinoid were assessed in only one trial each, and both showed similar efficacy to TS. Rapamycin also presented similar clinical response to TS; however, the later showed greater reduction of symptoms. Mycophenolate mofetil 2% mucoadhesive was no better than placebo. No serious adverse effects have been reported. Cyclosporine showed a higher frequency and variety of adverse effects. CONCLUSIONS: Topical tacrolimus and pimecrolimus are safe and effective alternatives for OLP treatment. CLINICAL RELEVANCE: TS are usually the first choice for OLP treatment. Because some oral lesions may have a low response to treatment with TS, more topical therapeutic options, such as TNSIs, should be considered before systemic steroids are used.

Fibroma ossificante trabecular juvenil: um relato de caso / Juvenile ossifying fibroma: a case report

Objetivo: o fibroma ossificante trabecular juvenil (FOJT) é uma lesão fibro-óssea incomum, benigna, porém de comportamento agressivo. Ocorre, frequentemente, em crianças e adolescentes, com maior acometimento em maxila e mandíbula. O presente relato aborda os aspectos clínicos, imaginológicos, histopatológicos, imuno-histoquímicos e o tratamento de um caso de FOTJ. Além de discutir suas similaridades com o osteossarcoma de baixo grau e as alternativas para o seu diagnóstico. Relato de caso: paciente do sexo masculino, com 12 anos de idade, apresentando aumento de volume em mandíbula no lado esquerdo, perda de função mastigatória e de fala, com tempo de evolução de seis meses. Radiograficamente, a lesão apresentava aspecto unilocular, com limites definidos e de padrão misto. O tratamento consistiu em cirurgia de enucleação total da lesão, seguida de curetagem sob anestesia geral. A histopatologia e a ausência de marcação para MDM2 e CDK4 na imuno-histoquímica confirmaram o diagnóstico de FOTJ e excluíram o de osteossarcoma de baixo grau. No controle pós-operatório de 20 dias, o paciente relatou melhora da parestesia, da função mastigatória e da fala e ausência de dor. Não se observou recidiva no acompanhamento de 1 ano após a cirurgia. Considerações finais: a similaridade dos aspectos clínico, imaginológico e microscópico entre FOJT e osteossarcoma de baixo grau pressupõe o estudo imuno-histoquímico com os arcadores MDM2 e CDK4, minimizando equívocos no diagnóstico e orientando de forma mais eficiente o plano de tratamento adotado.(AU)

Objective: juvenile Trabecular Ossifying Fibromas (JTOF) are uncommon benign fibro-osseous lesions with a local aggressive behavior. They frequently occur in children and adolescents involving the jaw bones. This report addresses the clinical, imaging, histopathological, and immunohistochemical aspects and the treatment of a case of JTOF. In addition, it discusses similarities between JTOF and low-grade osteosarcomas and alternatives for their diagnosis. Case report: male patient, 12 years old, with a tumor in his left mandible, loss of masticatory function and speech, with a 6-month time course. Radiographically, the lesion had an unilocular aspect, with defined borders and a mixed image pattern. Treatment consisted surgical enucleation, followed by bone curettage, under general anesthesia. Histopathology presented fibrous stroma interspaced with bone trabeculae without signs of cellular malignancy. MDM2 and CDK4 markers in immunohistochemistry, confirmed the diagnosis of JTOF and excluded low-grade osteosarcoma. At the 20-day postoperative follow-up, the patient reported improvement in paresthesia, masticatory function and speech, and the absence of pain. Evaluation 1 year after surgery showed no signs of local recurrence. Final considerations: the similarity of clinical, imaging, and microscopic aspects between JTOF and low-grade osteosarcoma prompts an immunohistochemical study including MDM2 and CDK4 markers in order to improve final diagnosis and guide the treatment plan more efficiently.(AU)

The imaging role for diagnosis of idiopathic osteosclerosis: a retrospective approach based on records of 33,550 cases.

OBJECTIVE: The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions. MATERIALS AND METHODS: An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam computed tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student's t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review. RESULTS: After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations. CONCLUSIONS: A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis. CLINICAL RELEVANCE: Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal.

An analysis of the completeness of referral forms and cases evaluated by an oral medicine specialized service

Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases. The primary aim of this study was to assess the completeness of referral forms of the patients referred by dentists from the primary care basic health units to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist. Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral's completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant's information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients' diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment. Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. Regarding the need of referral, 40,6% of the cases (n = 50) could be settle at the primary care. Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services. (AU)

Osteonecrosis of the jaw as a late complication of herpes zoster infection: a case report.

Occurrences of rare oral complications following herpes zoster (HZ) infection have been reported. In the present case, a 57-year-old man was referred for periodontal evaluation due to gingival bleeding. His medical history included diagnoses of chronic lymphocytic leukemia and HZ infection. Intraoral examination revealed necrosis and alveolar bone exposure around the mandibular left lateral incisor, and the patient reported spontaneous exfoliation of the maxillary and mandibular left central incisors. Conservative surgical and antibiotic therapies were provided to the patient, and a diagnosis of osteonecrosis of the jaw following HZ infection was established. There were no signs of recurrence in 17 months of follow-up. Clinicians should be aware of unusual complications related to a previous HZ infection.