Oral lesions of systemic lupus erythematosus: A collaborative Latin American study.

BACKGROUND: Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America. METHODS: This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions. RESULTS: Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11-77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases. CONCLUSION: Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment.

Squamous Odontogenic Tumor in the Posterior Region of Maxilla.

Squamous odontogenic tumor (SOT) is a rare benign but locally infiltrative tumor often misdiagnosed as other entities, such as ameloblastoma and squamous cell carcinoma, due to overlapping morphological findings. We document here the clinicopathological and imaging findings of an aggressive intraosseous SOT in the posterior left region of the maxilla in a 25-year-old male patient. On intraoral examination, the tumor extended from the region of the left lateral incisor to the upper left premolar and was covered by reddish mucosa, with discrete areas of ulceration. Imaging exams revealed an osteolytic lesion causing thinning, erosion, and buccal and lingual cortical plate perforation associated with an impacted canine. Microscopically, the tumor showed a proliferation of islands of well-differentiated squamous epithelium in a variably collagenized background. The peripheral cells of the islands were flat or slightly cuboidal and did not exhibit nuclei with peripheral palisade and reverse polarization. The diagnosis of SOT was rendered. The patient underwent surgical resection and has been under clinical follow-up for approximately 12 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach.

Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review.

Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.

Acquired oral syphilis: A multicenter study of 339 patients from South America.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

Mature T/NK-Cell lymphomas of the oral and maxillofacial region: A multi-institutional collaborative study.

BACKGROUND: The diagnosis of oral and maxillofacial mature T/NK-cell neoplasms is challenging because of their rarity, morphological heterogeneity and complex immunophenotype with scarce available data describing their clinical and microscopic aspects. Therefore, in this study, we investigated a series of mature T/NK-cell neoplasms affecting this anatomical region and provided an updated literature review. METHODS: Cases diagnosed as mature T/NK-cell lymphomas affecting the oral and maxillofacial region were retrospectively retrieved from six pathology files and their diagnoses were confirmed using haematoxylin and eosin-stained slides, immunohistochemical reactions and in situ hybridization for Epstein-Barr virus (EBV) detection. Patients' clinical data were collected from their pathology forms. RESULTS: A total of 22 cases were included in this study. Eleven (50%) consisted of extranodal NK/T-cell lymphomas, nasal type; eight (36.4%) were peripheral T-cell lymphomas, NOS; two (9.1%) were adult T-cell leukaemia/lymphomas, and one (4.5%) was an ALK-positive anaplastic large cell lymphoma. Overall, males predominated, with a mean age of 55.7 years. The palate was the most affected site (50%), and tumours usually presented as destructive and painful ulcers. EBV was present in all cases of extranodal NK/T-cell lymphoma nasal type but was absent in the other subtypes. CONCLUSION: Among mature T/NK-cell lymphomas of the oral and maxillofacial region, extranodal NK/T-cell lymphoma, nasal type and peripheral T-cell lymphoma, NOS predominated. Older men were the most affected patients, and this heterogeneous group of neoplasms has a very aggressive clinical behaviour.

Nasolabial cyst in an elderly patient: A case report.

INTRODUCTION: Nasolabial Cyst (NC) or Klestadt's cyst is a relatively rare soft tissue developmental lesion of nasal alar region accounting for 0.7% of all non-odontogenic cysts. NC usually presents as an asymptomatic swelling located in the anterior region of the maxilla lateral to midline-resulting in obliteration of nasolabial sulcus, nasal vestibule and maxillary labial sulcus and facial asymmetry-often observed on early stages by most patients due to cosmetics issues. CASE REPORT: A 76-year-old woman was referred for evaluation of an asymptomatic facial swelling in the left upper lip region lasting 20 years. Extraoral clinical examination showed a left-sided swelling lateral to midline near to the alar base resulting in facial asymmetry. Intraoral clinical examination revealed the presence of a single painless well-defined nodular, sessile, non-tender swelling covered by normal oral mucosa, and located in the upper labial mucosa in the left incisor's region. An excisional biopsy was performed, and microscopic examination revealed a cystic cavity lined by cuboidal to columnar epithelium with mucous cells. The underlying connective tissue showed chronic inflammatory infiltrate close to muscular tissue. Patient recovery was uneventful, and there are no signs of local recurrence in a 2-year clinical follow-up. CONCLUSION: Clinicians should consider NC when evaluating an upper lip swelling extending to the nasolabial region of the elders.

Peripheral odontogenic keratocyst: Report of two new cases and review of the literature.

Peripheral odontogenic keratocyst (POKC) is a rare soft tissue entity showing the same histological characteristics of odontogenic keratocyst. Herein, we report two cases of POKC affecting the gingiva/alveolar mucosa. Case 1. A 43-year-old female was referred for evaluation of a painless well-defined nodular, sessile, non-tender swelling in the right maxillary buccal gingiva. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. There were no signs of local recurrence after a 4-year follow-up. Case 2. A 63-year-old female was referred for evaluation of a painless well-defined nodular, sessile, yellowish swelling in the anterior mandibular alveolar mucosa. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. Patient recovery was uneventful but she did not return for follow-up. POKC should be considered in the differential diagnosis of gingival cystic swellings and can be managed through conservative surgery. Key words:Odontogenic keratocyst, peripheral, gingiva, alveolar mucosa.

Avaliação clínica e histopatológica da eficácia do tratamento utilizando terapia fotodinâmica associada ao laser de baixa potência em pacientes portadores de queilite actínica - Um acompanhamento de 6 meses / Clinical and Histopathological Evaluation of Photodynamic Therapy Associated with The Low-Level Laser Therapy on Patients with Actinic Cheilitis - A Six-Month Follow-Up Trial

O objetivo do presente estudo foi avaliar a eficácia clínica e histopatológica da terapia fotodinâmica (TFD) associada à terapia a laser de baixa potência no tratamento de pacientes com queilite actínica (QA) após seis meses de acompanhamento. Material e Métodos: pacientes com QA ativa foram submetidos a duas sessões de TFD associadas à laserterapia de baixa potência, utilizando o 5-aminolevulinato de metila como droga fotossensibilizadora. Após seis meses de acompanhamento, uma nova biópsia incisional foi realizada para avaliar a resposta ao tratamento. Resultados: excelentes taxas de eficácia foram observadas na melhora dos sintomas neste estudo, no entanto, a análise histopatológica não foi tão promissora e apenas a melhora do grau de displasia só pode ser observada em 20% da amostra. Conclusão: de acordo com os resultados do presente estudo, pode-se concluir que a terapia fotodinâmica associada à laserterapia de baixa potência parece ser uma opção a ser considerada no tratamento da Queilite Actínica. No entanto, os pacientes devem ser acompanhados de perto clinicamente e, eventualmente, histopatologicamente

Objective: the aim of the present study was to evaluate the clinical and histopathological efficacy of photodynamic therapy (PDT) associated with the low-level laser therapy (LLLT) in the treatment of patients with Actinic Cheilitis (AC) after a six-month follow-up. Material and Methods: patients with active AC undergone through two sessions of PDT, associated with the low-level laser therapy using the Methyl 5-aminolevulinate as a photosensybilizer drug. After a six-month follow-up, a new incisional biopsy was performed in order to evaluate the response to treatment. Results: excellent efficacy rates were observed in the improvement of symptoms in this study, however, histopathological analysis was not so promising and the improvement of dysplasia degree could only be seen in 20% of the sample. Conclusion: according to the results of the present study, we concluded that the photodynamic therapy associated with low-level laser therapy is an option to be considered when treating Actinic Cheilits. However, patients should be clinically followed-up in a severing agenda and eventually, histopathologically

Eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/Aids / Antimicrobial efficacy of photodynamic therapy on the treatment of oral candidiasis in people living with HIV/Aids / Eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas viviendo con VIH/Sida

Objetivo: avaliar a eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/aids. Método: estudo experimental, qualitativo e descritivo com 18 pessoas vivendo com HIV/aids que manifestavam a candidíase oral, maiores de 18 anos, que estavam em tratamento no Hospital Universitário Gaffrée e Guinle. Este grupo subdividiu-se em um grupo controle, composto por sete pessoas, que recebeu tratamento com a terapia fotodinâmica e antifúngicos, e um grupo experimental, com 11, que recebeu apenas a terapia fotodinâmica. A evolução do tratamento de cada participante foi acompanhada por registros fotográficos em duas consultas, inicial e final. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do hospital, parecer número 2.431.107. Resultados: a maioria dos participantes apresentou melhora clínica, ainda que discreta, e em apenas um houve piora clínica. Conclusão: a terapia fotodinâmica antimicrobiana pode ser eficaz no tratamento da candidíase oral em pessoas vivendo com HIV/Aids

Objective: evaluate the antimicrobial efficacy of photodynamic therapy in the treatment of oral candidiasis in people living with HIV/ aids. Method: experimental, qualitative and descriptive study with 18 people living with HIV/aids who presented oral candidiasis, over 18 years of age, who were being treated at the Gaffrée and Guinle University Hospital. This group was subdivided into a control group, composed of seven people, who received treatment with photodynamic and antifungal therapy, and an experimental group, with 11, who received only the photodynamic therapy. The evolution of the treatment of each participant was followed by photographic registers in two appointments, initial and final. This research was approved by the Research Ethics Committee from the hospital, dictum number 2.431.107. Results: most of the participants showed clinical improvement, albeit discrete, and in only one there was clinical worsening. Conclusion: antimicrobial photodynamic therapy may be effective in the treatment of oral candidiasis in people living with HIV/Aids

Objetivo: evaluar la eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas que viven con VIH/sida. Método: estudio experimental, cualitativo y descriptivo con 18 personas viviendo con VIH/sida que manifestaban la candidiasis bucal, mayores de 18 años, que estaban en tratamiento en el Hospital Universitario Gaffrée y Guinle. Este grupo se subdividió en grupo control, compuesto por siete personas, que recibió tratamiento con la terapia fotodinámica y antifúngicos, y un grupo experimental, con 11, que recibió sólo la terapia fotodinámica. La evolución del tratamiento de cada participante fue acompañada por registros fotográficos en dos consultas, inicial y final. La investigación fue aprobada por el Comité de Ética en Investigación del lugar, dictamen número 2.431.107. Resultados: la mayoría de los participantes presentó mejoría clínica, aunque discreta, y en apenas uno hubo empeoramiento clínico. Conclusión: la terapia fotodinámica antimicrobiana puede ser eficaz en el tratamiento de la candidiasis bucal en personas que viven con el VIH/Sida

Oral Juvenile Xanthogranuloma: Report of Two Cases.

Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually occurs in the skin of children. Extracutaneous involvement is rare, and few cases affecting the oral cavity have been reported. The purpose of the present study was to report two cases of oral juvenile xanthogranuloma affecting the lower lip of a 14-year-old girl and the soft palate of a second 14-month-old girl, both present as yellowish papules. The lesions were surgically excised, and histological and immunohistochemical analysis showed a proliferation of non-Langerhans cells histiocytes and foamy cells, fulfilling the morphologic features of juvenile xanthogranuloma. The patients have been followed up, respectively, for 36 and 49 months with no signs of recurrence. Based on these results, juvenile xanthogranuloma should be included in the differential diagnosis of oral yellowish soft-tissue swellings in children and adolescents and should be managed through conservative surgical excision.

Intraoral nerve sheath myxoma: case report and systematic review of the literature.

BACKGROUND: Oral nerve sheath myxoma (NSM) is an uncommon benign neoplasm with Schwann-cell origin, which is frequently mistaken for neurothekeoma. We report a case of NSM on the buccal mucosa in a 42-year-old woman. This case is compared with previously reported cases and a systematic review is performed. METHODS AND RESULTS: We conducted a case report and systematic review of oral cases considered true NSMs. A literature search was performed using PubMed, Lilacs, Scielo, Cochrane, SciVerse Scopus, Web of Science, and Embase electronic database. Twenty-five cases of oral NSM were included in the systematic review. CONCLUSION: Oral NSM is rare and may represent a diagnostic challenge for pathologists. To confirm the diagnosis of NSM, the evaluation of S-100 protein expression or other neural marker is essential. The use of the terms NSM and neurothekeoma as synonymous or as variants of the same tumor should be avoided, because they are clearly distinct lesions.

Difficulties in the diagnosis of plexiform ameloblastoma.

BACKGROUND: Plexiform ameloblastoma is a rare and benign odontogenic tumor which may reach grotesque proportions affecting over a region of lower molars. The correct diagnosis is essential to reduce this risk of local recurrences and obtain an effective treatment. CASE REPORT: A 10-year-old female patient, Caucasian, presented a complaint of painless facial asymmetry. The clinical and imaginological examinations showed an increase in volume in the left mandibular body related to radiolucent unilocular injury near the apex of the first molar, expansion of the vestibular cortical bone, and tooth root resorption ipsilaterally. The former intraosseous biopsy suggested an aneurysmal bone cyst. In reopening the previous marsupialization, a new biopsy was performed with histopathologic findings compatible with plexiform ameloblastoma associated with acute inflammation. Curettage was performed in the region associated with cryotherapy. At the last biopsy, the diagnosis of plexiform ameloblastoma was confirmed with multiple cystic formations and areas of foreign body reaction. The patient is being followed for 2 years and yet remains clinically and radiographically stable with no recurrence. DISCUSSION: This case reports the importance of selecting the correct area of biopsy of an intraosseous extended lesion to contribute to the diagnosis and treatment of plexiform ameloblastoma.

Controvérsias no diagnóstico da displasia cemento-óssea periapical / Controversies in the diagnosis of periapical cemental displasia

A displasia cemento-óssea periapical é uma lesão não neoplásica que pode estar associada ao ápice de um dente vital e quando o seu diagnóstico não é correto, pode levar ao tratamento endodôntico desnecessário. O objetivo deste trabalho é adicionar um caso de displasia cemento-óssea periapical à literatura e mostrar a importância do conhecimento do seu aspecto radiográfico.

The periapical cemental dysplasia can be found involving the apical area of a tooth with pulp vitality and the failure to recognize the nature of the lesion may often result in unnecessary endodontic treatment. The purpose of this study is to add a case of periapical cemental dysplasia on the literature and shows the importance of the knowledge of it´s radiographic aspects.

Bilateral adenomatoid odontogenic hamartoma.

We report the first case of bilateral odontogenic lesions consistent with several cases of unifocal adenomatoid odontogenic hamartoma in the literature. The lesions were well circumscribed, unilocular, radiolucent, and located in the region of the third mandibular molar region in a 12-year-old female patient. The lesions were composed of odontogenic hard and soft tissues, dental papilla, dentin, enamel matrix, and adenomatoidlike odontogenic epithelium. The lesions were enucleated with no recurrence at 6 months.

Hiperplasia fibrosa inflamatoria por cámara de succión: tratamiento quirúrgico: relato de caso clínico / Inflamatory fibrous hyperplasia caused by suction chamber surgical treatment: case report

La hiperplasia fibrosa inflamatoria por cámara de succión es una lesión reacional asociada a la cámara de succión, artefacto antiguamente utilizado para aumentar la retención estabilidad de la prótesis total superior. El objetivo de este trabajo es relatar un caso de hiperplasia fibrosa inflamatoria por cámara de succión en una mujer, 76 años, cuya opción ha sido la remoción quirugica

Inflammatory fibrous hyperplasia caused by upper dentures with suction-chamber, an old-fashioned maneuver to achieve retention and stability of upper dentures. The aim of this study is to report a case of inflammatory fibrous hyperplasia caused by upper dentures on a female patient, 76 years old, that was treated by surgery

Atypical location of pyogenic granuloma in two pediatric patients.

Pyogenic granuloma is a reactional lesion that is associated with dental calculi or trauma. It occurs most frequently in children and young adults, where the gingiva is affected most commonly. Its differential diagnosis is based on histopathological findings and treatment consists of surgical removal and elimination of the irritating factor. This article presents two cases of pyogenic granuloma in pediatric patients and explains the treatment methods used in each case.

Cisto ósseo simples em pacientes sob tratamento ortodôntico: relato de dois casos / Simple bone cyst in orthodontic treated patients: report of two cases

INTRODUÇÃO: o cisto ósseo simples (cisto ósseo traumático, cisto ósseo hemorrágico, cisto ósseo solitário) é uma lesão não-neoplásica que representa aproximadamente 1 por cento de todos os cistos maxilares, acometendo as regiões de corpo e sínfise de mandíbula com maior freqüência. Trata-se de uma cavidade intra-óssea delimitada por fina camada de tecido conjuntivo frouxo, sem revestimento epitelial. É uma lesão assintomática comumente identificada em exames radiográficos de rotina, apresentando imagem radiolúcida unilocular bem definida. Sua etiopatogênese não está bem esclarecida, mas acredita-se que o trauma local seja um fator relacionado ao seu desenvolvimento. OBJETIVO: este trabalho relata dois casos de cisto ósseo simples descobertos em exames radiográficos de rotina de pacientes que estavam sob tratamento ortodôntico. RELATO DOS CASOS E DISCUSSÃO: em ambos os casos a hipótese diagnóstica foi confirmada através de biópsia incisional e exame histopatológico. O tratamento escolhido foi a curetagem óssea, radiografias panorâmicas de controle pós-operatório mostraram reparo ósseo no local. Nestes casos, discute-se se há relação do trauma associado ao tratamento ortodôntico com o surgimento do cisto ósseo simples, ou se representa apenas um achado radiográfico, que é mais freqüente nestes pacientes devido ao maior controle radiográfico a que são submetidos.

INTRODUCTION: simple bone cyst (traumatic bone cyst, hemorrhagic bone cyst, solitary bone cyst) is a non-neoplastic lesion which represents about 1 percent of all maxillary cysts, found mainly in mandibular body and symphysis. It is an intraosseous cavity covered by thin, loose fibrous connective tissue, without epithelial lining. Simple bone cysts are asymptomatic and are commonly found in routine radiographic examination as a well defined unilocular radiolucent lesion. Its etiopathogenesis remains obscure, but the local trauma is frequently related to its occurrence. OBJECTIVE: this article reports two cases of simple bone cyst found in routine radiographic examination of orthodontic treated patients. CASE REPORT AND DISCUSSION: in both cases, the clinical diagnosis was confirmed by biopsy and histological examination. The patients underwent surgical exploration and a radiographic follow up showed evidence of local healing. This study discuss if there is a relationship between the orthodontic trauma and the occurrence of simple bone cyst in these patients, or if it represents an incidental finding, since they are most frequently submitted to radiographic examination.

Estomatite protética versus candidíase: diagnóstico e tratamento / Denture stomatitis associated with candidiasis: diagnosis and treatment

A estomatite protética consiste em uma lesão eritematosa observada no palato duro sob uma prótese total, que tem causa multifatorial, sendo a candidíase o fator mais importante no seu surgimento. O objetivo deste trabalho é discutir os métodos diagnósticos e opções terapêuticas da estomatite protética associada à candidíase.

Denture stomatitis is a multifatorial lesion which occurs on the palate under a complete denture. The main factor associated with denture stomatitis is oral candidiasis. The aim of this study is to describe diagnostic methods and the best treatment for denture stomatitis associated with oral candidiasis.

Carcinoma mucoepidermóide: revisão de literatura / Mucoepidermoid carcinoma: review of the literature

O objetivo deste estudo é promover uma revisão de literatura sobre o carcinoma mucoepidermóide, um tumor raro de glândula salivar e ressaltar a importância do diagnóstico histopatológico prévio à cirurgia definitiva, mesmo quando há características de benignidade.

Piercing oral: fator de risco para o câncer? / Oral piercing: risk factor for cancer?

O presente estudo tem como objetivo discutir, através da realização de uma revisão da literatura, o uso do piercing oral, dando ênfase às conseqüências e complicações de seu uso contínuo. A prática de perfuração de estruturas da cavidade bucal e da face para colocação de jóias tem sido realizada por várias civilizações, com objetivos estéticos, culturais, políticos e religiosos. Na atualidade, essa prática tem grande popularidade e está fortemente associada à juventude, simbolizando atração sexual, provocação social, rebeldia e estética. A colocação e o uso do piercing oral envolvem possíveis complicações, que podem ser de origem infecciosa ou não, como lesões inflamatórias e pré-malignas. Dessa forma, o cirurgião-dentista, como profissional da área de saúde, deve estar preparado para instruir os usuários sobre os riscos e cuidados envolvidos, bem como propor políticas públicas que visem à regulamentação e fiscalização dos profissionais que realizam a perfuração para colocação do piercing e de seus estabelecimentos.