ABSTRACT
A doença pênfigo é uma enfermidade autoimune que dependendo do nível de acometimento epitelial, pode ser classificada em pênfigo vulgar, vegetante, eritematoso e foliáceo. Além desses, há também o denominado pênfigo paraneoplásico, que ocorre especialmente em casos que há vínculo a neoplasias malignas com destaque para os linfomas. Somente os tipos vulgar e vegetante podem afetar a mucosa oral, sendo o pênfigo vulgar o mais prevalente. O mecanismo fisiopatológico da doença é caracterizado pela ação de autoanticorpos contra as proteínas desmogleínas dos desmossomos encontrados nas células epiteliais, desencadeando assim, a formação de fendas intraepiteliais e bolhas. O manejo dos pacientes com pênfigo vulgar oral é bastante desafiador, especialmente em casos de indivíduos idosos e portadores de comorbidades. O presente trabalho objetiva discutir aspectos contemporâneos do pênfigo vulgar oral e elucidar o caso de uma idosa acometida pela doença, destacando toda a propedêutica utilizada no seu atendimento e o tratamento empregado, com o uso de corticoides sistêmicos e acompanhamento constante da condição da paciente, uma vez que o pênfigo vulgar é uma doença que não tem cura.
Pemphigus is an autoimmune disease that, depending on the level of epithelial involvement, can be classified into pemphigus vulgaris, vegetans, erythematosus and foliaceus. In addition to these, there is also the so-called paraneoplastic pemphigus, which occurs especially when there is a link to malignant neoplasms with emphasis on lymphomas. Only the vulgaris and vegetans types can affect the oral mucosa, with pemphigus vulgaris being the most prevalent one. The pathophysiological mechanism of the disease is characterized by the action of autoantibodies against the desmoglein proteins of the desmosomes found in the epithelial cells, thus triggering the formation of intraepithelial clefts and blisters. The management of patients with oral pemphigus vulgaris is quite challenging, especially in cases of older individuals and patients with comorbidities. This study discusses contemporary aspects of oral pemphigus vulgaris and elucidate the case of an old woman affected by the disease, highlighting all the propaedeutics used in her care and the treatment employed, with the use of systemic corticosteroids and constant follow-up of the patient's condition, since pemphigus vulgaris is a disease that has no cure.
ABSTRACT
INTRODUCTION: The purpose of this systematic review was to determine the possible risk factors related to pathophysiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and identify adequate treatment strategies available and success rates. EVIDENCE ACQUISITION: We performed a search for publications about the treatment of BRONJ, published between 2003 and 2018 in the PubMed/Medline data base using the key words: "Bisphosphonate-Associated Osteonecrosis of the Jaw" OR "Bisphosphonate Osteonecrosis" OR "BRONJ", based on the list of MeSH and DeCS. EVIDENCE SYNTHESIS: According to pre-established criteria for data collection concerning the treatment of BRONJ, we found 19 articles covering a total of 400 patients. Treatments that showed good outcomes were Ozone, PRF, PRP/Debridement/Laser bio-stimulation, Laser surgery and Laser surgery/Laser bio-stimulation. HBO did not achieve good results and was used in only 10 patients. BRONJ is a rare condition in patients with osteoporosis/other pathologies using BP orally. These patients had long exposure time and cumulative doses of BPs until onset of the lesion. The oncological patients were exposed to more potent intravenously administered BPs such as pamidronate and zoledronate. These patients had a shorter exposure time until onset of the lesion. CONCLUSIONS: The treatment of BRONJ is still under debate and there are promising treatments that need randomized trials with larger numbers of patients to confirm their results. Patients receiving BPs or those who will start treatment should be encouraged to perform preventive dental treatment and maintain good oral hygiene.
