CREST syndrome diagnosed by oral lesions: A case report and review of the literature.

BACKGROUND: Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is an acronym for the clinical features that are seen. Its etiology is unknown, affecting women three times more than men. CREST syndrome is often diagnosed by systemic symptoms. However, oral manifestations could be helpful in the early diagnosis of the disease. Less than 20 cases of CREST syndrome with oral symptoms were described. OBJECTIVE: To report a case of a 26-year-old female, who was diagnosed with CREST syndrome based on findings of the oral mucosa. CASE REPORT: Clinical examination revealed sclerodactyly and nail alterations. Oral findings were associated with hypochromic and paleness mucosa. The tongue was strongly rigid and reddish areas compatible with telangiectasias were found. The mouth opening was particularly compromised. Histological findings were suggestive of systemic sclerosis in the context of CREST syndrome. Considering the available diagnosis criteria, this case was diagnosed as CREST syndrome based on oral manifestations. CONCLUSIONS: Oral manifestations of CREST syndrome could help in early clinical diagnosis, preventing a delay in the onset of an aggressive form of the disease. Accurate referrals of patients to specialists are needed for a multidisciplinary approach.

[Therapeutic alternatives for drug-associated maxillary osteonecrosis (MRONJ): reports of two clinical cases and review of the literature]. / Alternativas terapéuticas de osteonecrosis maxilar asociada a medicamentos (ONMAM): reportes de dos casos clínicos y revisión de la literatura.

Introduction: Drug-associated Maxillary Osteonecrosis is one of the most relevant adverse effects in treatment with antiresorptive drugs such as bisphosphonates and denosumab. Oncological conditions such as multiple myeloma, breast cancer, prostate, and bone-metabolic disorders such as osteoporosis lead the indications for these antiresorptive therapies. Treatment is complex because the disease is often refractory. Pharmacological, conservative and surgical treatments are described. Objective: The aim of this study is to report two clinical cases of MRONJ treated with two different therapeutic protocols and the analysis of the available literature on these aspects based on the clinical classification defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusion: Patients who develop clinical signs of great morbidity associated with MRONJ, may see their quality of life conditioned and suffer a worsening of their underlying pathology. MRONJ treatment is conditioned by the stage of the disease, its success depends on interdisciplinary management and strict medical and dental clinical follow-up, as well as rigorous monitoring to prevent or detect future recurrences early.

Introducción: La Osteonecrosis Maxilar asociada a Medicamentos (ONMAM) constituye uno de los efectos adversos más relevantes en el tratamiento con drogas antirresortivas como bifosfonatos y denosumab. Patologías oncológicas como mieloma múltiple, cáncer de mama, próstata, y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. El tratamiento es complejo debido a que muchas veces, la enfermedad es refractaria a la terapéutica aplicada. Se describen tratamientos farmacológicos, conservadores y quirúrgicos. Objetivo: El objetivo de este trabajo es reportar dos casos clínicos de ONMAM tratados con dos protocolos terapéuticos diferentes y el análisis de la literatura disponible en la actualidad sobre estos aspectos en base a la clasificación clínica definida por la American Association of Oral and Maxillofacial Surgeons (AAOMS). Conclusión: Los pacientes que desarrollan cuadros clínicos bucales de gran morbilidad como lo es ONMAM, pueden ver condicionada su calidad de vida y sufrir un agravamiento de su patología de base. El tratamiento de ONMAM está condicionado al estadio de la enfermedad, el éxito del mismo depende del manejo interdisciplinario y de un estricto seguimiento clínico médico y odontológico, así como también un riguroso monitoreo para evitar o detectar precozmente futuras recurrencias.

False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis.

BACKGROUND: Syphilis is the oldest sexually transmitted infectious disease in humanity. In the last decades, it was noted the re-emergence of the disease, and actually it remains an important public health problem. Oral mucosa could be affected by the infection. Oral manifestations are commonly associated with secondary syphilis. It was described that the labial commissure could be involved as a split papule, also known as false cheilitis (FC). However, this clinical manifestation is poorly described in current literature. AIM: This brief report aims to determine the frequency of FC in patients diagnosed with secondary syphilis in our institution during the period 2009-2019. MATERIAL & METHODS: A cross-sectional retrospective study was conducted using the medical records of the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. The cases included were patients with provisional diagnosis of secondary syphilis with oral manifestations, confirmed by laboratory tests. Collection of clinical and serological data was performed. Absolute and relative values were obtained. RESULTS: In this study, 58 patients (26 males and 32 females) with an average age of 34.70 years old were included. The frequency of false cheilitis in these patients was 13% (8/58). All these patients with false cheilitis and secondary syphilis were young females with an average age of 25.12 years old. These lesions presented as angular cheilitis with an unilateral pattern with painful fissured papules associated with other oral lesions such as fissures, intraoral papules, tongue depapillation, white or red plaques, and the evidence of submandibular lymphadenopathies when examining the head and neck region. CONCLUSION: Our findings suggest that when angular cheilitis presents in young females as a painful, unilateral lesion, in the clinical context of other lesions and lymphadenopathies in the head and neck region, it could represent a suspicious clinical sign of syphilis. Considering the global re-emergence of sexually transmitted diseases, dentists should be aware of the oral clinical manifestations of syphilis as they play a significant role in the early detection of these conditions.

Clinical management of alveolar osteitis. A systematic review / Manejo clínico de la osteítis alveolar. Una revisión sistemática

Background: Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several thera-peutic interventions have been described for the treatment of AO, however, there are no treatment standardizedprotocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the differenttreatments for AO. The feasibility of the application of these interventions is also discussed.Material and Methods: A structured electronic and hand search strategy was applied to PubMed, Scopus, Co-chrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies accordingto PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients’ percentages. Thosetreatments that reach VAS ≤ 4 on day 2 or before; or ≥ 85% of patients with absence of pain symptoms at day 7 orbefore were considered acceptable for their recommendation.Results: The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AOtreatments. 53,8% of the treatments fulfill the proposed parameters for pain control.Conclusions: Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management ofAO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCeptPatch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected accordingto their availability and advantages or disadvantages.(AU)

Lichenoid proliferative leukoplakia, lichenoid lesions with evolution to proliferative leukoplakia or a continuum of the same precancerous condition? A revised hypothesis.

BACKGROUND: Multiple white plaques of the oral mucosa are usually associated with potentially malignant disorders such as oral lichen planus, oral lichenoid lesions and proliferative verrucous leukoplakia. Previous studies in the current literature describe a potential clinical overlap in these entities. The aim of this study is to review clinicopathological and evolutive features of these Oral Potentially Malignant Disorders highlighting the dynamic changes of diagnoses. DISCUSSION: It was previously hypothesized that a subset of patients with oral lichen planus or oral lichenoid diagnosis, could develop multiple white plaques during the natural history of the disease, fulfilling diagnostic criteria for proliferative verrucous leukoplakia. Consequently, these entities could, under certain conditions, obey a continuum of the same precancerous condition in the context of the field cancerization theory, increasing the risk of malignant transformation. Nevertheless, there is limited scientific evidence concerning this issue. CONCLUSION: Further studies are needed to understand the biological and evolutive features of the link between these oral potentially malignant disorders. Regardless of its diagnosis, these patients with multifocal white lesions must be carefully monitored to detect early malignant transformation.

[Myelodysplastic syndrome, osteoporosis and medication-related osteonecrosis of the jaw: a case report]. / Síndrome mielodisplásico, osteoporosis y osteonecrosis maxilar asociada a medicamentos antirresortivos: reporte de un caso.

Introduction: Medication-related osteonecrosis of the jaw is a frequent collateral effect found in patients under antiresorptive treatments. Malignancies such as multiple myeloma, breast and prostate cancer as well as bone-metabolic disorders such as osteoporosis, lead the indications for these antiresorptive therapies. Even with a low frequency, myelodysplastic syndromes are also entities that have previously been associated with the development of jaw osteonecrosis. Objective: the aim of this study is to present a case of a 78-year-old male patient with myelodysplastic syndrome and secondary osteoporosis, treated with high-dose Zoledronic Acid and who developed a clinical scenario compatible with medication-related osteonecrosis of the jaw during its evolution. Methodology: : the case was recorded and treated in the Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, during a two-years period with a partial resolution, which recurred fourteen months later, where finally therapeutic success was achieved through a conservative management. Conclusion: Due to the increasingly use of antiresorptive drugs, the development of jaw osteonecrosis is possible associated with less frequent pathologies, such as myelodysplastic syndrome. Treatment success in these patients depends on interdisciplinary management and a rigorous clinical, medical and dental follow-up.

Introducción: La osteonecrosis maxilar asociada a medicamentos es una complicación encontrada en pacientes bajo tratamiento con drogas antirresortivas. Patologías oncológicas como mieloma múltiple, cáncer de mama y próstata y alteraciones óseas-metabólicas como la osteoporosis lideran las indicaciones para estas terapias antirresortivas. Aún con una baja frecuencia, los síndromes mielodisplásicos también son entidades que previamente han sido vinculadas al desarrollo de osteonecrosis. Objetivo: el objetivo de este trabajo es presentar un caso de un paciente masculino de 78 años con síndrome mielodisplásico y osteoporosis secundaria, tratado con Ácido Zoledrónico a altas dosis y que en su evolución desarrolló un cuadro clínico compatible con osteonecrosis maxilar asociada a medicamentos. Metodología: el caso fue registrado y tratado en la Cátedra de Estomatología "A" de la Facultad de Odontología, Universidad Nacional de Córdoba, durante un periodo de dos años con una resolución parcial del cuadro, el cual recurrió a los catorce meses, donde finalmente se llegó al éxito terapéutico mediante terapéuticas conservadoras. Conclusión: debido al uso cada vez más extendido de fármacos antirresortivos, es posible el desarrollo de osteonecrosis maxilar asociada a patologías menos frecuentes, como el síndrome mielodisplásico. El éxito del tratamiento en estos pacientes depende del manejo interdisciplinario y de un riguroso seguimiento clínico médico y odontológico.

Oral Squamous Cell Carcinoma Associated with Arsenic Exposure: A Case Series from Argentina / Carcinoma Oral de Células Escamosas Asociado con la Exposición al Arsénico: Una Serie de Casos de Argentina

ABSTRACT: Many areas of South America are directly affected by Arsenic (As) contaminated groundwater. A high percentage of the water samples taken in multiple areas of Argentina had As concentrations above the WHO level recommended guidelines. This condition was previously associated with an increased risk of chronic diseases, including different cancers. Long-term As exposure was proposed as a risk factor for Oral Squamous Cell Carcinoma (OSCC). The aim of this study is to present a series cases of Argentine patients diagnosed with OSCC who have consumed water contaminated with As for more than 10 years. Clinical data were obtained from the archive of Clinical Records Histories of the Oral Medicine Department of the Dentistry School, Universidad Nacional de Córdoba and Universidad Católica de Córdoba, Argentina. 15 cases of OSCC were included. The male: female sex ratio was 2:1. The average age was 66 years (31-89 years). Regarding location, the gum or edentulous alveolar ridge was the most prevalent site (6/15; 40 %), followed by the tongue margin. The average years of exposure to arsenical waters were 24 years (13 - 40 years of exposure). The majority of the presented cases were non drinkers non smokers. 60 % of the tumors were diagnosed at advanced stages. the epidemiological studies carried out in As-contaminated areas that address oral cancer should always incorporate the record of variables related to As exposure. Patients who live or lived at As-contaminated areas must be regularly followed up for early diagnosis of potentially malignant or malignant lesions. The high frequency of gum cancer among these cases, should raise awareness of periodontic specialists to perform a careful and thorough periodontal examination.

RESUMEN: Muchas regiones de América del Sur están directamente afectadas por aguas subterráneas contaminadas con arsénico (As). Un alto porcentaje de las muestras de agua tomadas en múltiples áreas de Argentina tenían concentraciones de As superiores al nivel aprobado por la OMS. Esta condición se asociaba previamente con un mayor riesgo de enfermedades crónicas, incluidos diferentes tipos de cáncer. La exposición a largo plazo se propuso como un factor de riesgo para el carcinoma oral de células escamosas (OSCC). El objetivo de este estudio es presentar una serie de casos de pacientes diagnosticados con OSCC que han consumido agua contaminada con As durante más de 10 años. Se obtuvieron datos clínicos del archivo de Historias de registros clínicos del Departamento de Medicina Oral de la Facultad de Odontología, Universidad Nacional de Córdoba y Universidad Católica de Córdoba, Argentina. Se incluyeron 15 casos de OSCC. La relación de género masculino: femenino fue de 2: 1. La edad promedio fue de 66 años (31-89 años). En cuanto a la ubicación, la encía o la cresta alveolar edéntula fue el sitio más frecuente (6/15; 40 %), seguido del borde de la lengua. El promedio de años de exposición a las aguas arsenicales fue de 24 años (13 - 40 años de exposición). La mayoría de los casos presentados fueron de pacientes no bebedores y no fumadores. El 60 % de los tumores fueron diagnosticados en etapas avanzadas. Los estudios epidemiológicos realizados en áreas contaminadas con As que abordan el cáncer oral siempre deben incorporar el registro de variables relacionadas con la exposición a As. Se debe hacer un seguimiento continuo de los pacientes que viven o que vivieron en áreas contaminadas con As para el diagnóstico temprano de lesiones potencialmente malignas. La alta frecuencia de cáncer de encías en estos casos, debe concienciar a los especialistas en periodoncia para que realicen un examen periodontal cuidadoso y completo.

Oseointegración, aspectos que determinan su éxito. Revisión de la literatura / Osseointegration, aspects that determine its success. Literature review

El éxito del implante dental depende en gran medida de las características químicas, físicas, mecánicas y topográficas de su superficie; ya que determinan la actividad de las células que se adhieren a la superficie del implante. Por lo tanto, la humectabilidad, geometría, topografía, rugosidad, energía superficial, nanoestructuras y el recubrimiento con materiales bioactivos tienen un impacto sustancial en el éxito y calidad del proceso de oseointegración. Metodología: Se realizó una revisión de la literatura mediante la base de datos de MedLine con el motor de búsqueda Pubmed. Se seleccionaron, una vez aplicados los criterios de inclusión y exclusión, un total de 69 artículos. Resultados: La combinación de estas propiedades determinan la calidad y grado de oseointegración. Valores moderados de hidrofilia (30◦-60◦) y rugosidad (Sa=1-2µm) favorecen la oseointegración, pero aún se desconocen los mecanismos biológicos subyacentes. La investigación actual sigue los enfoques biomiméticos: imitar la configuración 3D de la superficie ósea.

Liquen plano oral. Reporte de un caso y revisión de la literatura / Oral lichen planus. Case report and literature review

El liquen plano oral (LPO) es una enfermedad mucocutánea crónica, de carácter inflamatorio, etiología desconocida y naturaleza autoinmune, en la que se produce una agresión por parte de los linfocitos T dirigida frente a las células basales del epitelio de la mucosa oral. El diagnóstico del LPO debe basarse en la observación clínica y confirmarse con la descripción de las características histopatológicas. Se presenta caso clínico de paciente femenina de 39 años de edad que acudió a consulta odontológica al Servicio de Estomatología de la Escuela de Odontología, de la Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, por presentar múltiples lesiones blancas en la cavidad bucal de 1 año de evolución. La paciente manifiesta episodios de stress. Se realizó biopsia de tipo incisional y se envió a anatomía patológica donde se confirmó el diagnóstico de Liquen Plano Oral. (AU)

Oral lichen planus (LPO) is a chronic mucocutaneous disease, of an inflammatory nature, unknown etiology and autoimmune nature, in which aggression by T lymphocytes directed against the basal cells of the oral mucosa epithelium occurs. The diagnosis of LPO should be based on clinical observation and confirmed with the description of histopathological characteristics. There is a clinical case of a 39-year-old female patient who attended a dental office at the Stomatology Service of the School of Dentistry, Faculty of Health Sciences, Catholic University of Córdoba for presenting multiple white lesions in the oral cavity of 1 year of evolution. The patient manifests episodes of stress. An incisional type biopsy was performed and sent to a pathological anatomy where the diagnosis of Oral Lichen Planus was confirmed. (AU)

Osteosarcoma mandibular osteogénico / Mandibular osteogenic sarcoma

El osteosarcoma es una neoplasia maligna, poco frecuente, que se presenta de forma agresiva y sepuede originar en el hueso de la cavidad oral. Se caracteriza por la producción de osteoide tumoral(trabéculas óseas inmaduras) por parte de las células neoplásicas. Estos tumores suelen formarse en la región metafisiaria de los huesos largos de los miembros, en especial en el fémur y en la tibia. Se presenta el caso clínico de un paciente que concurre al servicio de Estomatología de la Escuela deOdontología, de la facultad de Ciencias de la Salud, Universidad Católica de Córdoba; masculino de 26 años de edad de nacionalidad peruana con diagnóstico clínico de osteosarcoma mandibular, el cual fue tratado con hemisección, quimioterapia y radioterapia en la zona mandibular sector posterior de lado izquierdo con colocación de una placa de titanio en la región.

Osteosarcoma is a malignant, rare and aggressive neoplasm that originates in the bone of the oralcavity. It is characterized by the production of tumor osteoid (immature bone trabeculae) by neoplasticcells. These tumors usually originate in metaphyseal region of long limb bones, especially in femurand tibia.Case report: 26-year-old peruvian male patient attending the Stomatology service at the School ofDentistry, Faculty of Health Sciences, Catholic University of Cordoba. The patient was clinically diagnosedwith mandibular osteosarcoma, treated with hemisection, chemotherapy, radiotherapy onmandibular zone posterior sector of left side and fixation of a titanium bone plate.