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OBJECTIVE: The purpose of this scoping review is to evaluate the oral manifestations (OM) of heart transplant (HT) patients undergoing immunosuppressive therapy (IT). MATERIAL AND METHODS: A literature search was performed using keywords and MeSH terms related to OM and HT in the Medline/PubMed, Web of Science, Cochrane Library, Scopus, LILACS/BBO databases and in gray literature without language or date restrictions until June 2023. Studies that evaluated HT individuals who used any IT and who reported the occurrence of OM were considered eligible. The results from the search were imported to EndNote Web, and duplicates were removed followed by title/abstract and full-text analysis. RESULTS: A total of 402 nonduplicated studies were found and 13 fulfilled the criteria and were included in the present review: 10 cross-sectional, 2 cohorts, and 1 clinical trial. The most reported OM were periodontal diseases, including drug-induced gingival enlargement (DIGE), gingival bleeding, gingivitis, and periodontitis. Reported in a minority of studies are oral cancer, opportunistic infections (oral hairy leukoplakia and erythematous candidiasis), enamel defects, and burning mouth. CONCLUSION: Considering the methodological heterogeneity of the studies analyzed, DIGE is the most commonly observed oral manifestation in HT individuals.
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AIM: To discuss the diagnosis and treatment of an exuberant oral pyogenic granuloma (OPG) in the palatal region in a systemically compromised patient. METHODS AND RESULTS: A 50-year-old woman presented with extensive and painless nodular mass that extended throughout the palatal region, with difficulty speaking, swallowing and spontaneous bleeding for 6 months. Her medical history showed poorly controlled type II diabetes mellitus and hypertension. The intraoral physical examination also revealed poor oral hygiene and periodontal disease. After clinical and radiographic evaluation, the presumptive diagnosis of OPG was made and complete excision of the lesion was performed. Local hemostatic measures were employed to control bleeding. Microscopic evaluation showed a lobulated lesion composed of many blood capillaries confirming the diagnostic hypothesis. CONCLUSIONS: In summary, individuals with severe periodontal disease and systemic disorders may present exacerbated clinical presentations of OPG.
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A 56-year-old Brazilian woman sought dental care, presenting with multiple asymptomatic papillomatous lesions with a coalescent pattern and intermingled cobblestone-like clefts along the alveolar ridge and marginal and attached gingivae. Multiple whitish papules were also observed on the face, neck, and limbs. Incisional biopsies of these lesions were performed. Microscopically, the skin lesion revealed epithelial clear cells and intraepithelial keratinization with areas of orthokeratosis, while the gingival lesions showed a parakeratinized stratified squamous epithelium with collagenous connective tissue. These features were consistent with those of a trichilemmoma and fibroepithelial hyperplasia, respectively. This article illustrates a case of Cowden syndrome (CS), a rare multisystem genetic condition in which both cutaneous and mucosal tissues were affected. Fewer than 40 cases of CS with oral involvement affecting middle-aged adults have been documented hitherto.
