Distinguishing bowenoid papulosis from Bowen disease in the mouth: A case report.

Bowenoid papulosis (BPap) is an uncommon skin disorder linked to human papillomavirus (HPV) infection and characterized clinically by the presence of scattered papules or small plaques, multiple and pigmented, that involve the stratified squamous epithelium. Bowen disease (BD) is recognized as the main differential diagnosis of BPap. An 80-year old white woman was referred for the evaluation of multiple, brown verrucous papules measuring 3 to 4 mm in diameter on the right maxillary gingiva. Histopathological analysis revealed disturbed epithelial maturation with papillary stratified squamous epithelium, koilocytic dysplasia, parakeratosis, acanthosis, basal double-layer, loss of cellular polarity, nuclear hyperchromatism and pleomorphism, scattered mitosoid bodies, and a high degree of cytologic atypia. An immunohistochemical investigation for p53 and Ki67 showed staining of the basal and suprabasal layer, while p16 was strongly expressed in the nuclei of epithelial cells and Bcl-2 was positive only in mitosoid bodies and the lymphocytic inflammatory infiltrate. In situ DNA hybridization was negative for HPV. Oral BPap is an uncommon lesion in which the diagnostic process includes clinical, histopathological, and molecular correlations due to the similarity to aggressive behavior lesions such as BD.

Leiomyomatous Hamartomas of the Oral Cavity: Clinicopathological and Immunohistochemical Features of 4 Cases and Literature Review.

Objective. To present 4 new cases of oral leiomyomatous hamartomas (OLH), describing its clinical, microscopical, and immunohistochemical features, and a literature review. Methods. The OLH cases were retrieved from the files of 2 Brazilian and 1 Peruvian oral pathology services. Clinical data were obtained from the pathology reports. Microscopical features were reviewed, and immunohistochemical reactions were performed. A review of the English-language literature about OLH was done. Results. The sample was composed of 3 females (4-, 10-, and 15-year-old) and 1 male (3-year-old). Three cases affected the dorsum of the tongue and one the incisive papilla, and all presented sessile or pedunculated smooth nodules. Microscopically, the lesions were composed of varying-size fascicles of smooth muscle fibers in a fibrous connective tissue background. Immunohistochemistry revealed positivity of the smooth muscle bundles for myogenic markers. The English-language literature review revealed 38 OLH cases reported, most were congenital or diagnosed up to 5 years old. The main locations were tongue and anterior maxilla. Conclusions. Although OLH is a rare lesion, it must be considered in the differential diagnosis of midline tongue or maxillary masses in newborns, infants, and youngsters.

Distribution of biopsied non plaque-induced gingival lesions in a Chilean population according to the classification of periodontal diseases.

BACKGROUND: Many gingival lesions are not induced by plaque. The aim of this study was to analyze the frequency of biopsied non-plaque-induced gingival lesions (NPIGL) in a Chilean population. METHODS: One thousand twelve cases of biopsied gingival lesions with confirmed anatomopathologic diagnosis were included, from the records of the Oral Pathology Referral Institute (OPRI), Faculty of Dentistry, University of Chile, between years 1990 and 2009. RESULTS: The most frequent non plaque-induced gingival lesions categories from biopsied cases included hyperplastic lesions, malignancies and benign neoplasms. The most frequent diagnoses in each category were fibrous hyperplasia (35.47%), squamous cell carcinoma (3.85%) and giant cell fibroma (2.08%), respectively. From all lesions, only 8.3% fitted in the specified categories of the current classification of periodontal diseases. CONCLUSIONS: The most frequent biopsied NPIGL were hyperplastic lesions and neoplasms. These categories represent relevant lesions to be included in a future periodontal classification system to improve the care needs of the patients, as well as early diagnosis and treatment.

Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease.

Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.

Estado gingival de dientes temporales con y sin restauración de coronas de acero en niños de 3 a 9 años / Gingival Condition around the Temporary Teeth with and without Steel Crown Restorations in 3-to-9 Year-Old Children

Antecedentes: Con las coronas de acero es posible conservar los dientes temporales hasta su exfoliación fisiológica; sin embargo, en la literatura existe controversia con respecto al comportamiento del tejido gingival de los dientes restaurados con coronas de acero. Propósito: /Analizar el estado gingival de dientes temporales con restauración de coronas de acero y sin esta en niños de 3 a 9 años de edad atendidos en las clínicas odontológicas de la Pontificia Universidad Javeriana, en Bogotá, entre 2013 y 2014. Métodos: Se realizó un estudio descriptivo de corte transversal. Se observaron 110 dientes temporales restaurados con corona de acero y sus antagonistas sin corona de acero. Se analizaron los índices gingival y de biopelíeula, la adaptación clínica de las coronas de acero y la presencia o ausencia de exceso de cemento en todas las superficies de los dientes. Resultados: No hubo diferencias estadísticamente significativas entre la adaptación de las coronas de acero y el estado gingival. El único indicador relevante fixe la superficie vestibular (p = 0,018). Por otra parte, el estado gingival y la biopelíeula presentaron una baja correlación (¡9 %). Conclusiones: El índice gingival de dientes restaurados con coronas de acero y sin estas presentó una correlación positiva entre la inflamación gingival y la edad de la población pediátrica, aun cuando la retención de biopelíeula no fue significativa.

Bideground: Ihc use of steel crowns enables to preserve the temporary teeth until their physiological changeover; however, in the literature there is a controversy regarding the behavior of the gingival tissue around teeth restored with steel crowns. Purpose: To analyze the gingival condition around the temporary teeth that have been restored with and without steel crowns in children from 3 to 9 years old who attended to the dental clinic at the Pontificia Universidad de Colombia in Bogotá between 2013 and 2014. Methods: A cross-sectional descriptive study was carried out and 110 temporary teeth restored with steel crown were observed and compared to the teeth restored without it. Biofilm and gingival indexes were analyzed as well as the steel crown clinical adaptation and the presence of cement excess in any of the dental surfaces. Results: No significant statistical difference was found bccwccn the steel crown adaptation and the gingival condition. 'Ihc only relevant indicator was the vestibular surface (p = 0.018). On the other hand, both the biofilm and the gingival condition showed a poor correlation (19%). Conclusions: Ihc gingival index in teeth restored with and without steel crown showed a positive correlation between gingival inflammation and the children populación age, even chough the biofilm retention was not significant.

Periodontal disease detection in primary and mixed dentitions.

AIM: This was to compare the periodontal status of children with primary and mixed dentition at the time of their first consultation. METHODS: Children (200), aged 0-12 years (156 with mixed and 44 with primary dentition), were examined by assessing their simplified plaque index (PI) and simplified periodontal record (PSR). Statistical analysis (Chi-square test) was performed with appropriate software to find any significant associations between sex, type of dentition and PI with the PSR codes (0, 1, 2, 3 and 4). RESULTS: There was no statistically significant difference with regard to gender (p = 0.82). Generalised PI was associated more significantly with mixed dentition (p = 0.025 and higher PSR scores (p < 0.001). There was no significant relationship between sex and PSR codes (p = 0.82). CONCLUSION: Children presenting with a mixed dentition had worse PI values and PSR scores. It is important to perform periodontal examination in children to diagnose and prevent future periodontal disease and maintain their dentition as well as to identify any associated systemic conditions.

Conditions for oral health in patients with autism / Condiciones de salud oral en pacientes con autismo

Autism is characterized as a behavioral disorder. The autistic patient has some difficulties with common life routines, such as oral hygiene and also improper diet. As a consequence the refusal of physical contact, the implementation of brushing and flossing by caregivers is difficult. The present study aimed to conduct an epidemiological study of autistic patients in treatment at the Rehabilitation Center and Neurological Organization in North of Brazil, adopting the CPO-D and ceo-d. The clinical examination has been performed with the patient sitting in chairs, at the Rehabilitation Centre itself, under artificial fluorescent light intended for room lighting. From 26 patients included in the study, 76.9 % of subjects were male with a mean age of 13 years. Fifty percent had caries, and 11.5% had lesions on the gums. The mean ceo-d of children 2­8 years was 0.67. In patients 10­15 years and 20­40 years, the mean CPO-D was 0.70, and 3.00, respectively. From the study, the most significant data, seen was that half of autistic patients had carious lesions. It is vital to improve oral health conditions in these patients and by using preventive dentistry, analyze their susceptibility to oral diseases.

El autismo se caracteriza como un trastorno conductual. El paciente autista tiene algunas dificultades en las rutinas ordinarias de la vida, tales como la higiene oral. Como consecuencia, la negativa al contacto físico, la implementación del cepillado y uso de hilo dental es difícil para los cuidadores. Este estudio tuvo como objetivo llevar a cabo un estudio epidemiológico de los pacientes autistas en el Centro de Rehabilitación y la organización neurológica en el norte de Brasil, adoptando el CPOD y ceod. El examen clínico se realizó con el paciente sentado en una silla en el propio Centro de Rehabilitación, bajo una luz fluorescente artificial para la iluminación de la habitación. Veintiseis pacientes fueron incluidos en el estudio, el 76,9 % de los sujetos eran varones con una edad media de 13 años con un 50 % de caries, y en un 11,5 % se observaron lesiones gingivales. La media ceod de los niños de 2 a 8 años fue de 0,67. En los pacientes de 10­15 años y 20­40 años, el promedio CPOD fue de 0,70 y 3,00, respectivamente. A partir del estudio se pudo determinar que la mitad de los pacientes autistas tienen caries. Es importante la educación de estos pacientes para mejorar la salud oral y la aplicación de la odontología preventiva.

Hallazgos citológicos de la enfermedad gingivo-periodontal pre y post-tratamiento en pacientes atendidos en la Cátedra de Periodoncia de la FOUNNE / Pre- and post-treatment findings of gingivo-periodontal disease in patients who attended the Department of Periodontics, FOUNNE

Describir y comparar las alteraciones citológicas encontradas en la pared blanda de la bolsa periodontal y margen gingival vestibular de pacientescon enfermedad gíngivo-periodontal en el pre y post tratamiento. Material y métodos: Se estudiaron 38 pacientesmayores de 24 años y menores de 61 años, de ambos sexos, quienes acudieron a la Cátedra de Periodoncia de la Facultad de Odontología de la UNNE. Las muestras citológicas fueron tomadas con cureta de Gracey, se fijaron en alcohol de 96 grados y se colorearon con la técnica de Papanicolaou. En la evaluación citológica se consideró: tipos celulares, grado de queratinización y otros elementos acompañantes del fondo. Resultados: Se observó un mayor porcentaje deperiodontitis moderada (63 por ciento), predominando en el sexo masculino (56 por ciento) y el promedio de edad fuede 49 y 61 años (53 por ciento). Los extendidos pre- tratamiento presentaron mayor celularidad con células superficiales de núcleos picnóticos, células reactivas y abundantes células inflamatorias. En los posttratamiento predominó la mayor queratinización con escamas epiteliales y células con características reparativas (metaplásicas) y menor porcentaje decélulas inflamatorias y hematíes. Conclusiones: la citología exfoliativa gingival constituye un método diagnóstico complementario sencillo en la evaluación y seguimiento del tratamiento y evolución de pacientes con periodontitis...

Gingival Cysts of Adults: Retrospective Analysis from Two Centers in South Brazil and a Review of the Literature.

Gingival cysts of adults are rare developmental cysts, with an incidence of 0.3% among all odontogenic cysts. They are benign, well-defined nodules located on the attached gingiva with a fluid-filled appearance. The aim of the present study was to perform an analysis of gingival cysts in adults diagnosed at an oral pathology laboratory and a hospital pathology service in order to determine the frequency of occurrence of this lesion, and to perform a literature review to correlate the present findings with those described in the literature. This study emphasizes the low frequency of gingival cysts in adults and the importance of gathering clinical, radiographic and histopathological information to define the final diagnosis.

Presentación de una paciente con granuloma periférico de células gigantes / Presentation of a Patient with Peripheral Giant Cell Granuloma

Se presentó una paciente femenina de 37 años de edad, sin antecedentes generales de interés, con hábito de onicofagia desde la niñez, que presentaba aumento de volumen localizado en la papila interdentaria entre incisivo lateral y canino maxilar derecho, de aproximadamente dos años de evolución, que le ocasionaba molestias y sangramiento durante el cepillado dentogingival. La lesión se presentó con aspecto de una pieza dentaria, de coloración rosa a rojo, superficie lisa, base sésil, no doloroso a la palpación, rebasaba el borde incisal, sin interferir con la oclusión y sobrepasaba el ancho vestíbulo lingual de los dientes contiguos en aproximadamente dos milímetros. Radiográficamente se observó reabsorción superficial de la cresta del tabique interdentario entre ambos dientes y espaciamiento del trabeculado óseo. Se realizó la escisión quirúrgica y posterior examen anatomopatológico, el cual confirmó la presencia de granuloma periférico gigante celular completamente resecado, lo cual corroboró el diagnóstico presuntivo. Se apreció una satisfactoria evolución postquirúrgica.(AU)

A female patient of 37 years old with no history of general interest, nail biting habit from childhood, which had increased volume within the interdental papilla between lateral incisor and maxillary right canine about two years of evolution was presented, which caused discomfort and bleeding during dentogingival brushing. The lesion appeared with appearance of a tooth, pink color to red, smooth, sessile base, not painful on palpation, exceeded the incisal margin, without interfering with the occlusion and surpassing the broad lingual hall of the contiguous teeth in approximately two millimeters. The radiographic exam evidenced superficial reabsorption of the crest of the interdental partition between both teeth and bone-like spacing of the trabeculate. The lesion was eliminated by surgical excision. The histologic test confirmed the presence of peripheral giant cell granuloma completely eliminated. A satisfactory post-surgical evolution was observed.(AU)

Manejo del espacio biológico: revisión de literatura / Management of biological width: Literature review

Dentro de los diagnósticos de las patologías Periodontales, la clasificación número VIII según el último workshop de la Academia Americana de Periodoncia incluye a factores localizados y relacionados con un diente que predisponen a enfermedades gingivales inducidas por la biopelícula o la periodontitis; muchos de estos diagnósticos involucran directamente al espacio biológico. El espacio biológico es una zona variable, ya sea por la edad, el sexo, la pieza dentaria, la posición dentro de la arcada, etc. Sin embargo su función siempre es la misma, servir de soporte y de ser una zona fisiológicamente activa frente a la agresión bacteriana y mecánica. El presente artículo resume las múltiples fuentes de información de la literatura científica para abordar al detalle los aspectos a considerar al momento de diagnosticar las alteraciones del espacio biológico así como los protocolos para el tratamiento que permita su restauración...

Within the diagnoses of periodontal diseases, the classification number VIII according to the last workshop of the American Academy of Periodontology includes tooth localized factors and related that predisposing plaque-induced gingival diseases or Periodontitis, many of these diagnoses involve directly the biological width. Biological width is a variable area, either due to age, sex, the tooth, the position within the arcade, etc. However, its function is always the same, provide support and be a physiologically active zone against bacterial aggression and mechanics. This article summarizes the multiple sources of information in the scientific literature to address in detail the aspects to consider when diagnosing disorders of the biological width and the protocols for the treatment to its restoration or alteration...

Peripheral odontogenic fibroma: an uncommonly overviewed lesion.

Peripheral odontogenic fibroma is considered a gingival tumor characterized by a proliferation of relatively cellular fibrous or fibromyxomatous connective tissue which exhibits variable amounts of odontogenic epithelium and sometimes foci of calcification in the form of dentinoid, cementicles, or bone. It is considered the extraosseous counterpart of central odontogenic fibroma. This lesion usually is presented as a focal swelling in the gingiva, occurring in a wide age range, and the anterior region of the gingiva is the most frequent anatomic site. Conservative local excision is the treatment frequently adopted and its recurrence rate varies widely, and its biologic behavior is still unknown. In this study, the authors discuss 3 cases of peripheral odontogenic fibroma, and present their clinical and histopathological features and management.

A rare case of iatrogenic gingival Kaposi's sarcoma.

Kaposi's sarcoma is an angioproliferative tumour rarely found in the oral cavity. We present the 3rd case of iatrogenic gingival Kaposi's sarcoma reported in the English-language literature which developed in a young patient 5 years after a renal transplant and discuss their histological features and differential diagnosis.

Interdental papillary house: a new concept and guide for clinicians.

Surgical and nonsurgical techniques have been proposed to regenerate interdental papillae. The results are influenced by the morphology of the interdental space, which is the housing for the papilla. The concept of the interdental papillary "house" has been established not only to allow diagnosis of the causes of papillary loss, but also to manage and predict reconstruction of the interdental gingival tissue. The adjacent teeth in contact, involving the proximal contact, contour and shape of the teeth, course of the cementoenamel junction, interdental distance, and underlying bone crest, determine the outline of the house. Since the components are combined, an understanding of each allows adequate treatment planning involving interdisciplinary procedures. This new concept serves as a guide and teaching aid for the practitioner.

Extensive amalgam tattoo on the alveolar-gingival mucosa.

Amalgam tattoos are common exogenous pigmented lesions of the oral mucosa occurring mainly by inadvertent placement of amalgam particles into soft tissues. The diagnosis of amalgam tattoo is simple, usually based on clinical findings associated with presence or history of amalgam fillings removal. Intraoral X-rays may be helpful in detecting amalgam-related radiopacity. In cases where amalgam tattoo cannot be differentiated from other causes of oral pigmentation, a biopsy should be performed. This article deals with an extensive amalgam tattoo lesion which required a biopsy for a definitive diagnosis.

Tatuagem extensa por amálgama em mucosa gêngivo-alveolar / Extensive amalgam tattoo on the alveolar-gingival mucosa

Tatuagens por amálgama são lesões pigmentadas, exógenas, de frequente ocorrência na mucosa bucal, que resultam da introdução acidental de partículas de amálgama nos tecidos moles. O diagnóstico da tatuagem por amálgama é simples, geralmente, baseado em achados clínicos, complementado pela história recente ou pregressa de remoção de restauração por amálgama. Radiografias intraorais podem ser úteis na detecção de radiopacidade, associadas à partícula de amálgama. Nos casos em que as tatuagens por amálgama não permitem diferenciação de outras lesões melanocíticas, o exame histopatológico deve ser realizado. Os autores relatam à ocorrência de lesão extensa por tatuagem de amálgama com confirmação histopatológica.

Amalgam tattoos are common exogenous pigmented lesions of the oral mucosa occurring mainly by inadvertent placement of amalgam particles into soft tissues. The diagnosis of amalgam tattoo is simple, usually based on clinical findings associated with presence or history of amalgam fillings removal. Intraoral X-rays may be helpful in detecting amalgam-related radiopacity. In cases where amalgam tattoo cannot be differentiated from other causes of oral pigmentation, a biopsy should be performed. This article deals with an extensive amalgam tattoo lesion which required a biopsy for a definitive diagnosis.

Fibromatous Epulis in a Captive Lion (Panthera leo)

An epulis in the oral cavity of an aged captive lion in Brasilia, Brazil, is reported. Oral inspection of the animal revealed a pale blunt and irregular multilobulated mass involving the upper left caninum tooth. Microscopic features of the mass included a fibrous stroma (mesenchyme) interspaced with a few blood vessels, suggesting a periodontal ligament origin. The dense collagen fiber background had a moderate cellularity composed of regularly orientated fibroblasts and it surrounded foci of osteoid or mineralized material. Mild overlying gingival epithelial hyperplasia with some irregular cellular cords was also observed. Based on the location of the lesion as well as the gross and microscopic features, the lesion was classified as fibromatous epulis and is believed to be the first report in this species.(AU)

Principais tumores não odontogênicos que acometem a cavidade bucal de crianças: [revisão] / The most relevant non odontogenic tumors found in children oral cavity: [review]

O objetivo deste trabalho é descrever as características clínicas, radiográficas e histológicas, assim como aspectos relacionados ao tratamento e prognóstico das patologias tumoriformes não odontogênicas mais comumente encontradas na cavidade bucal de crianças. Dentre elas estão o papiloma, o hemangioma, o linfangioma, a epúlide congênita do recém-nascido, o granuloma piogênico, as lesões periféricas e centrais de células gigantes e o fibroma ossificante periférico.

The aim of this review is to relate the clinical, radiographical and histological aspects, the treatment andprognostic of non odontogenic tumors commonly found in the oral cavity of children. Beside these tumors are the papilloma, hemangioma, lymphangioma, neonatal congenital epulis, pyogenic granuloma, peripheral and central giant cell lesions, and peripheral ossifying fibroma.