Oxidative stress markers in the saliva of patients with oral lichen planus.

OBJECTIVE: To evaluate the levels of oxidative stress markers in the saliva of patients with oral lichen planus (OLP). METHODS: A cross-sectional study was conducted with 22 patients diagnosed both clinically and histologically with OLP (reticular or erosive) and 12 individuals without OLP. Non-stimulated sialometry was performed and oxidative stress (myeloperoxidase - MPO and malondialdehyde - MDA) and antioxidant (superoxide dismutase - SOD and glutathione - GSH) markers were determined in the saliva. RESULTS: Among the patients with OLP, most were women (n = 19; 86.4%) and reported to have experienced menopause (63.2%). Patients with OLP were mostly in the active stage of the disease (n = 17; 77.3%) and the reticular form was predominant (n = 15; 68.2%). No statistically significant differences were observed when comparing SOD, GSH, MPO and MDA values between individuals with and without OLP, as well as between erosive and reticular forms of OLP (p > 0.05). Patients with inactive OLP presented higher SOD when compared to those with active disease (p = 0.031). CONCLUSION: Oxidative stress markers in the saliva of patients with OLP were similar to those found in people without OLP, which can be related to the high exposure of the oral cavity environment to several physical, chemical and microbiological stimuli, important generators of the oxidative stress.

Co-existence of cheilitis glandularis and actinic cheilitis-an update.

Cheilitis Glandularis (CG) is a chronic inflammatory disorder with no specific etiology that affects the minor salivary glands of the lips. The main characteristic of this condition consists of the exit of thick saliva or mucopurulent secretion through the dilated ducts present in the vermilion border of the lip, associated to varying degrees of macrocheilia. In this article we report the case of a male patient, leucoderma, 48 years old, that exhibited actinic cheilitis and glandular cheilitis. We emphasized the clinical management, diagnosis criteria and treatment, taking into consideration that GC is a rare condition and makes a differential diagnosis with other entities that may occur on lips. Although a diagnosis of CG is not difficult, its treatment is a challenge, considering the unknown etiology that hinders the development of more specific and effective treatments.

Expression profile of DNA repair proteins and histone H3 lys-9 acetylation in cutaneous and oral lichen planus.

OBJECTIVES: To analyze the expression profile of DNA repair proteins (XRCC1 and APE1) and histone acetylation (H3K9) in oral and cutaneous lichen planus, in order to investigate potential biological markers that can clarify pathogenesis of these lesions. DESIGN AND RESULTS: The total sample consisted of 89 lichen planus cases (66 oral and 23 cutaneous). Analysis of APE1 and XRCC1 expression was performed by immunohistochemistry in 44 oral and 20 cutaneous lichen planus, whereas the analysis of H3K9 acetylation was performed by immunofluorescence in 42 oral and 11 cutaneous lichen planus. RESULTS: Immunoreactivity for APE1 and XRCC1 was significantly higher in cutaneous lichen planus than in oral lichen planus (P = 0.003 and P = 0.034, respectively). There was a significant and moderate positive correlation between APE1 and XRCC1 in the oral group (Rho = 0.544; P < 0.0001). In oral cases, there were no statistically significant results comparing APE1 and XRCC1 expression between reticular and erosive cases (P > 0.05). Evaluation of H9K3 histone acetylation levels did not reveal significant results comparing oral to cutaneous lichen planus, neither comparing erosive to reticular (P > 0.05). CONCLUSIONS: Changes in the expression profile of the DNA repair proteins exerted greater influence in pathogenesis of cutaneous lichen planus than oral lichen planus, in addition, H3K9 histone acetylation is an epigenetic event found in both lesions.

Radiographic evaluation of the prevalence of Stafne bone defect / Evaluación radiográfica de prevalencia de defecto óseo de Stafne

Stafne bone defect (SBD) is a bone cavity in the lingual surface of the mandible normally filled by salivary gland tissue. In conventional radiographs, SBD typically resembles a radiolucent unilocular lesion with welldefined margins, localized under the inferior alveolar canal. The diagnosis of SBD is often incidental due to the asymptomatic nature. The aim of this study was to investigate the prevalence of SBDs in a Brazilian population and to describe the radiographic features of the cases reported. This retrospective study evaluated 17,180 digital panoramic radiographs of patients with an indication of radiography for dental treatment seen at three centers located in the three Brazilian states. In each center, two researchers evaluated the images for establishment of the consensual diagnosis of SBD. In the case of disagreement, a third researcher was consulted to reach a final consensus. To assess the prevalence of SBDs, sex and age of patients were considered, and SBDs were classified according to their form and location. Data were submitted to descriptive analysis. Among the 17.180 patients, only 15 (0.08 %) had SDB, including 3 women and 12 men. The age range of the patients with SDB was 30-69 years (mean: 49.2). Fourteen cases were located in the posterior region of the mandibular body and one case in the ascending ramus. Stafne bone defect is a rare developmental anomaly that more commonly affects middle-aged men. The condition has a typical radiographic appearance and panoramic radiography is a valuable tool for its diagnosis.

El defecto óseo de Stafne (DOS) es una cavidad ósea en la superficie lingual de la mandíbula, normalmente llena de tejido glandular salival. En las radiografías convencionales, el DOS generalmente se asemeja a una lesión unilocular radiotransparente con bordes bien definidos, ubicada debajo del canal alveolar inferior. El diagnóstico de DOS a menudo es accidental debido a su naturaleza asintomática. El objetivo de este estudio fue investigar la prevalencia de DOS en una población brasileña y describir las características radiográficas de los casos reportados. Este estudio retrospectivo evaluó 17.180 radiografías panorámicas digitales de pacientes con indicación radiográfica para tratamiento dental atendidos en tres centros ubicados en tres estados brasileños. En cada centro, dos investigadores evaluaron las imágenes para establecer un diagnóstico consensuado de DOS. En caso de desacuerdo, se consultó a un tercer investigador para llegar a un consenso final. Para evaluar la prevalencia de DOS, se consideraron el sexo y la edad de los pacientes, y se clasificaron según su forma y ubicación. Los datos fueron sometidos a análisis descriptivo. Entre los 17.180 pacientes, solo 15 (0,08 %) tenían DOS, incluidos 3 mujeres y 12 hombres. El rango de edad de los pacientes con DOS fue de 30 a 69 años (media: 49,2). Catorce casos se ubicaron en la región posterior del cuerpo mandibular y un caso en la rama ascendente. Los defectos óseos de Stafne son una anomalía rara del desarrollo que afecta más comúnmente a los hombres de mediana edad. La condición tiene una apariencia radiográfica típica y la radiografía panorámica es una herramienta valiosa para su diagnóstico.

Fludroxycortide cream as an alternative therapy for actinic cheilitis.

OBJECTIVES: The objective of the study is to assess, by clinical follow-up, the efficacy of the dermatological cream Fludroxycortide 0.125 mg/g (Drenison®) in the treatment of actinic cheilitis (AC). MATERIAL AND METHODS: Twenty-three patients diagnosed with AC participated in the study. Fifteen were submitted to corticotherapy with Fludroxycortide, applied three times a day for up to 6 weeks, associated with lip sunscreen (LS) before sun exposure. In the control group of eight patients, only the use of LS was established. At each weekly return, a photographic record was made of the lesion. After treatment, images were evaluated and scores were assigned to verify clinical evolution. Also, patients treated with Fludroxycortide responded to a questionnaire, to assess drug tolerability and treatment satisfaction. RESULTS: In the group treated with Fludroxycortide (n = 15), five patients showed total improvement, seven presented partial improvement, and three showed no clinical change. Concerning the patients treated with LS (n = 8), one presented total remission of the clinical lesion characteristics, four exhibited partial improvement, and three exhibited no clinical lip alteration. No case presented symptom worsening. Of the 15 patients undergoing corticotherapy, 12 were satisfied and reported that the product was not irritating and contributed to lesion improvement. CONCLUSIONS: Conventional treatment with LS was effective in the remission of some AC lesions, but treatment responses were improved when associated with Fludroxycortide, especially in the more severe cases. CLINICAL RELEVANCE: As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, Fludroxycortide can be considered an effective alternative treatment for AC.

Neoplasms and non-neoplastic pathologies in the oral and maxillofacial regions in children and adolescents of a Brazilian population.

BACKGROUND: Few studies regarding the distribution of pediatric oral diseases are available. Thus, the aim of this study was to investigate the incidence and demographic profile of neoplasms and non-neoplastic lesions among children and adolescents (0-19 years old). METHODS: A retrospective descriptive cross-sectional study was performed and data regarding gender, age, anatomical location, and histopathological diagnosis were collected and categorized. Biopsy records were obtained from the archives of a Brazilian referral center between 1980 and 2016. RESULTS: A total of 2.114 pediatric patient biopsy records were analyzed, where most cases were diagnosed in patients aged 10 to 19 years old (80.7%). Females were more affected (n = 1180) and the lip (n = 507) was the most common anatomical site. Reactive and inflammatory lesions (n = 942) were the most prevalent non-neoplastic pathologies, followed by cysts (n = 308). Benign neoplasms were the most frequent among neoplasms (n = 346) and malignant cases were very rare (n = 11). CONCLUSIONS: An increase in the prevalence of lesions in the second decade of life was observed, where reactive and inflammatory lesions, cysts, and benign neoplasms were most frequent. CLINICAL RELEVANCE: Biopsy data allows for the real characterization of the incidence of oral and maxillofacial lesions and, thus, permits Brazilian dentists and pediatricians to diagnose these diseases.

Evaluation of laser therapy and alpha-lipoic acid for the treatment of burning mouth syndrome: a randomized clinical trial.

The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) and alpha-lipoic acid (ALA) in the treatment of burning mouth syndrome (BMS) and secondary oral burning (SOB) by unstimulated sialometry, symptom assessment, and measurement of salivary TNF-α levels. Forty-four patients were randomized into four treatment groups: BMS/laser (n = 10), BMS/ALA (n = 5), SOB/laser (n = 15), and SOB/ALA (n = 14). The control group consisted of eight healthy female subjects. Unstimulated salivary flow was measured before and after treatment, and the collected saliva was stored at - 20 °C for the analysis of TNF-α. Symptoms were evaluated before and after treatment using a pain visual analog scale. Most patients were women (81.8%) during menopause (72.2%). LLLT and ALA were efficient in increasing salivary flow only in BMS but provided symptom relief in both conditions. TNF-α levels did not differ between patients with BMS and SOB or between those patients and the control group. No differences were observed in posttreatment TNF-α levels in either condition. The results of this study suggest that LLLT and ALA are efficient therapies in reducing burning mouth symptoms, with LLLT being more efficient than ALA.

Diclofenac sodium gel therapy as an alternative to actinic cheilitis.

OBJECTIVE: Actinic cheilitis (AC) is a potentially malignant lesion caused by prolonged exposure to ultraviolet light. The aim of this research was to analyze the efficacy of diclofenac sodium 3% gel in the treatment of this condition, through clinical follow-up. METHODS: Thirty-one patients diagnosed with AC were instructed to perform a topical application of the gel three times a day for a period of 90 days. In each visit, a digital photography was obtained for verified progress and response to treatment. Two researchers evaluated all images after treatment was completed and assigned the following scores regarding clinical aspect of the lip: 1, complete improvement; 2, partial improvement; 3, no changes; 4, worsening of the clinical condition. In addition, the patients' tolerability to the drug and their satisfaction after treatment were evaluated. RESULTS: Twelve cases abandoned the treatment for reasons unrelated to the study. Ten participants showed total remission of all clinical features of the lesion and three had partial improvement of the characteristics. One participant presented worsening of clinical condition, and in five cases, treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding satisfaction analyses and tolerability to the drug, from 14 patients who completed treatment without adverse effects or complications, most agreed fully that they were satisfied with the therapy (n = 11) and that the drug was not irritating to the mouth (n = 9). Patients are being monitored without clinical signs of recurrence and/or progression of the lesions. CONCLUSION: Topical application of the drug has provided a convenient and well tolerated in most cases. CLINICAL RELEVANCE: Diclofenac sodium gel (3%) may be a promising alternative for treatment of actinic cheilitis.

Potentially malignant oral lesions: clinicopathological correlations.

OBJECTIVE: To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. METHODS: The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). RESULTS: Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). CONCLUSION: In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.

Granular cell tumor in two oral anatomic sites.

Granular cell tumor (GCT) is an uncommon benign soft tissue neoplasm, which usually presents as a solitary nodule, appearing especially in the tongue. There are few cases of multiple oral GCT in the English-language literature, with only three cases reported in the last 20 years. This report describes a case of two oral GCT in a young patient and provides a literature review from 1995 to 2015. Clinical characteristics of the reviewed cases were retrieved and compared with the present case. Exceptionally, the current case was the only one that occurred in an adolescent and solely affected the oral cavity. Besides the oral cavity, the other cases also observed GCT lesions in the skin. Although rare, it is important to know multiple oral GCT clinical and histopathological characteristics so they can be correctly diagnosed, treated and followed up.

Comparative Analysis of Psychological, Hormonal, and Genetic Factors Between Burning Mouth Syndrome and Secondary Oral Burning.

OBJECTIVE: The objective of this study was to evaluate the association between psychological, hormonal, and genetic factors with the development of burning mouth syndrome (BMS) and secondary oral burning (SOB) in order to provide a better characterization and classification of these conditions. DESIGN: Cross sectional study. SETTING: Patients with complaints of mouth burning registered at the Oral Diagnostic Service of the Federal University of Rio Grande do Norte between 2000 and 2013. SUBJECTS: The sample consisted of 163 subjects divided into a group of patients with BMS (n = 64) and a group of subjects with SOB (n = 99). METHODS: The following variables were analyzed: passive and stimulated saliva flow, stress levels and phase, depression, anxiety, serum cortisol and dehydroepiandrosterone (DHEA) levels, and the presence of polymorphisms in the interleukin 6 (IL-6) gene. RESULTS: The results showed significant differences in the presence of xerostomia (p = 0.01), hyposalivation at rest (p < 0.001) and symptoms of depression (p = 0.033) between the two groups, which were more prevalent in the BMS group. DHEA levels were lower in the BMS group (p = 0.003) and were sensitive and specific for the diagnosis of this condition. Genetic analysis revealed no significant association between the polymorphisms analyzed and the development of BMS. CONCLUSION: These results suggest a possible role of depression, as well as of reduced DHEA levels, as associated factors for development of BMS.

Study of the etiopathogenesis and differential diagnosis of oral vascular lesions by immunoexpression of GLUT-1 and HIF-1α.

BACKGROUND: To investigate whether the immunohistochemical expression of GLUT-1 and HIF-1α is related to the diagnosis and pathogenesis of oral vascular lesions. STUDY METHODS: Thirty cases each of pyogenic granuloma (PG) and hemangioma were studied. Antibodies against GLUT-1 and HIF-1α were detected by immunoperoxidase staining in 3-µm histological sections, and the results were analyzed qualitatively and quantitatively, respectively. Positive and negative cells were counted, and the mean number of positive cells was calculated for each case. RESULTS: The initial diagnosis of hemangioma was maintained in only 7 (23%) of the 30 cases studied, which were positive for GLUT-1. The remaining 23 cases were reclassified as vascular malformation (VM) (n = 13) and PG (n = 10) due to the absence of staining. The endothelium of blood vessels was negative for GLUT-1 in all cases initially diagnosed as PG (n = 30). The percentage of HIF-1α-positive cells was higher in cases of PG, followed by hemangiomas and VMs (P = 0.005). CONCLUSIONS: Histological features are not sufficient to establish the correct diagnosis of oral hemangiomas, and an accurate anamnesis is essential in these cases. In addition, these findings demonstrate that vascular lesions express mediators of angiogenesis, HIF-1α, and suggest that his process may play a role in the pathogenesis of vascular.

Peripheral ameloblastoma in the maxillary gingiva: a case report.

Peripheral ameloblastoma is an uncommon, extraosseous counterpart of solid ameloblastoma, which occurs in the soft tissues overlying tooth-bearing areas or the alveolar mucosa of the mandible and maxilla. In this paper, the authors report a case of peripheral ameloblastoma located in the maxillary gingiva of a 54-year-old woman and review the literature regarding clinicopathological features, differential diagnosis and therapeutic management of peripheral ameloblastomas.

Severe florid cemento-osseous dysplasia: a case report treated conservatively and literature review.

BACKGROUND: Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. FCOD is usually asymptomatic. In severe cases, focal expansion may occur due to infection. Management of the symptomatic patient is more difficult due to the avascular nature of the lesion which contributes to susceptibility severe infection, bone sequestration, and osteomyelitis when surgery is performed. CASE REPORT: This paper presents a rare case of severe FCOD; the black woman patient was diagnosed based on clinical and radiographic findings and treated conservatively. The examination of panoramic radiographs revealed a multiple sclerotic masses with radiolucent borders, found in the mandible and maxilla which were symmetrical at presentation. The patient continuous with the follow-up. DISCUSSION: This report confirms that a diagnosis can be made with accurate clinical and radiographic assessment. The correct selection of treatment for FCOD depends on this information.

Exfoliative cytology of the oral mucosa in burning mouth syndrome: a cytomorphological and cytomorphometric analysis.

OBJECTIVE: The aim of this study was to evaluate oral epithelial cells by exfoliative cytology in burning mouth syndrome (BMS). MATERIAL AND METHODS: Oral smears were collected from clinically normal-appearing mucosa by liquid-based exfoliative cytology in 40 individuals (20 BMS patients and 20 healthy controls matched for age and gender) and analysed for cytological and cytomorphometric techniques. RESULTS: Mean values of nuclear area (NA) for experimental and control groups were, respectively, 67.52 and 55.64 µm² (p < 0.05). Cytoplasmic area (CA) showed the following mean values: 1258.0 (experimental) and 2069.0 µm² (control). Nucleus-to-cytoplasm area ratio for the experimental group was 0.07, besides the control group was 0.03 (p < 0.05). Morphologically, oral smears exhibited normal epithelial cells in both experimental and control groups. There was a significant predominance of nucleated cells of the superficial layer in the smears of BMS patients (p = 0.00001). CONCLUSION: This study revealed that oral mucosa of BMS patients exhibited significant cytomorphometric changes in the oral epithelial cells. These changes probably are associated with epithelial atrophy and a deregulated maturation process that may contribute to the oral symptoms of pain and discomfort in BMS.

Sialolipoma in minor salivary gland: case report and review of the literature.

Sialolipoma is a rare benign neoplasm characterized by a well-circumscribed mass composed of neoplastic mature adipose tissue and non-neoplastic salivary gland elements. A 72-year-old woman presented with a painless swelling located in the hard palate, which had been identified 15 days earlier. Microscopically, the tumor was well-circumscribed consisting of lobular proliferation of the lipomatous tissue with thin fibrous tissue septa containing clustered salivary gland elements. Both the glandular and adipose components were found in almost equal proportion. No atypia in the adipose tissue was observed. The definitive diagnosis was sialolipoma. The patient showed no signs of recurrence 8 months after surgical excision. Including the present case, 35 cases of sialolipoma have been reported in the English literature. Of these 35 cases, 16 cases were located in minor salivary glands. Gender was identified in 14 of these cases with 4 males (28.5%) and 10 females (71.5%). The age distribution was from 27 to 84 years (mean, 61.6 years) and the tumor size ranged from 0.9 to 4 cm (mean, 1.7 cm). The most frequently reported clinical presentation was of a painless swelling (56.3%).

Expression of extracellular matrix proteins in ameloblastomas and adenomatoid odontogenic tumors.

This study evaluated the expression of fibronectin, tenascin and type I collagen in ameloblastomas and adenomatoid odontogenic tumors (AOTs) aiming to contribute with the comprehension of the differences in the biological behavior of these tumors. Immunohistochemical technique was performed in 20 cases of ameloblastoma (16 solid and 4 desmoplastic) and in 10 cases of AOT. All tumors presented moderate fibronectin expression in the stroma. Solid ameloblastomas showed intense expression of fibronectin at the epithelial-mesenchymal interface, whereas desmoplastic ameloblastomas revealed no immunoexpression of fibronectin at this site. Ameloblastomas presented stronger immunoreactivity to tenascin than AOTs, especially at the epithelial-mesenchymal interface. AOTs and desmoplastic ameloblastomas showed intense labeling for type I collagen. The patterns of expression of the proteins studied agree with the locally more invasive behavior of ameloblastomas in comparison to AOTs. Our results might suggest a less invasive behavior of desmoplastic ameloblastoma in comparison to solid ameloblastoma.