What are the main oral manifestations in heart transplant patients? A scoping review.

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.

Lymphomas affecting the submandibular glands / Linfomas que afectan las glándulas submandibulares

Background: Lymphomas affecting the submandibular glands are very uncommon and few reports are currentlyavailable in the literature. Therefore, the aim of the current study is to describe the clinical and microscopic fea-tures of an original series of lymphomas affecting the submandibular glands.Material and Methods: The pathology files of two institutions were searched for lymphoma cases affecting thesubmandibular glands. The original hematoxylin and eosin, and immunohistochemical slides were revised by apathologist for diagnosis confirmation following the revised 4th edition of the World Health Organization classification of tumours of haematopoietic and lymphoid tissues. Clinical data regarding age, sex, clinical manifestation,treatment, follow-up and status at last appointment were retrieved from the patients’ medical charts.Results: During the period investigated, 16 cases were included in the study. Females predominated (10:6) with amean age of 57.8 years-old. Tumors usually presented as asymptomatic swellings. MALT lymphoma representedthe most common subtype, followed by diffuse large B cell lymphoma and follicular lymphoma. Three patientsdied, one of them affected by plasmablastic lymphoma, one by DLBCL and one by MALT lymphoma.Conclusions: Low-grade B cell lymphomas predominate in the submandibular glands, but DLBCL and other sub-types may also be rarely diagnosed in this salivary gland.(AU)

A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil.

This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Diagnosis and management of exuberant palatal pyogenic granuloma in a systemically compromised patient - Case report.

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.

Lesions in the oral mucosa associated with the use of checkpoint inhibitors: A bibliometric and critical review.

AIMS: Immune-related adverse events (irAEs) linked to the use of immune checkpoint inhibitors (ICIs) have become increasingly frequent. To perform a bibliometric and critical review of the general panorama of publications on oral mucosal lesions (OML) associated with ICIs. METHODS AND RESULTS: Systematized searches were performed in four databases. The included studies were organized and bibliometric and clinical data were extracted and analyzed using VantagePoint and Microsoft Excel. Most of the 35 included studies were reports or case series (n = 33/94.2%). The American authors stood out (n = 17/48.5%), with the majority presenting only one publication. Independent groups carried out most of the publications (n = 31/88.5%). Over the years, publications have increased for users of nivolumab and pembrolizumab. In 21 studies (60%), OML were more common in men, between the 6th and 9th decades of life and who had lung carcinoma (n = 13/37.1%). Pembrolizumab (n = 17/48.5%) was the most used ICI. The patients were affected by one or more OML, including: ulcers (n = 28/80%) and erythema (n = 11/31.4%). Systemic corticosteroids (n = 24/68.5%) and the discontinuation of ICI use (n = 18/51.4%) were the main approaches used. CONCLUSION: OML related to the use of ICIs have become increasingly common. More accurate data need to be published.

Diagnóstico e tratamento de extenso cisto dentígero mandibular em um paciente pediátrico / Diagnosis and treatment of extensive mandibular dentigerous cyst in a pediatric patient

Introdução: lesões gnáticas pediátricas são comumente assintomáticas e diagnosticadas em exames de imagem de rotina. Entretanto, algumas podem cursar com dor, assimetria facial, destruição óssea e rápida evolução, requerendo diagnóstico preciso e precoce. Objetivo: o objetivo desse estudo é reportar o processo de diagnóstico e tratamento de um extenso cisto dentígero (CD) em um paciente pediátrico. Relato do caso: um menino de 5 anos idade apresentou queixa de aumento de volume doloroso na região posterior de mandíbula com tempo de evolução de 4 meses. A tomografia computadorizada demonstrou uma imagem hipodensa, bem delimitada, envolvendo a coroa do dente 37, causando a expansão da cortical vestibular e erosão da cortical lingual, com aproximadamente 3cm. Com as hipóteses diagnósticas de fibroma ameloblástico ou CD, a lesão foi enucleada totalmente. Microscopicamente, observou-se uma lesão cística com revestimento epitelial odontogênico, áreas de hiperplasia e exocitose, além de cápsula de tecido conjuntivo densamente colagenizado, com áreas de hemorragia e infiltrado inflamatório linfoplasmocitário. Resultados: baseado nas características clínicas, imagenológicas e histopatológicas, o diagnóstico final foi de CD inflamado. O paciente continua em acompanhamento clínico e radiográfico, com ausência de recidiva. Conclusão: CD inflamados em pacientes pediátricos podem apresentar comportamento peculiar e mimetizar outras lesões de natureza odontogênica. O diagnóstico precoce permite uma menor morbidade associada aos tratamentos cirúrgicos.

Introduction: pediatric gnathic lesions are commonly asymptomatic and diagnosed in routine imaging exams. However, some of them may cause pain, facial asymmetry, bone destruction and rapid evolution, requiring accurate and early diagnosis. Objective: the aim of this study is to report the diagnosis and treatment of an extensive dentigerous cyst (DC) in a pediatric patient. Case report: a 5-year-old boy complained of painful swelling in the posterior region of the mandible with an evolution time of 4 months. Computed tomography showed a hypodense, well-delimited image involving the crown of tooth 37, causing buccal cortical expansion and lingual cortical erosion, measuring approximately 3cm. With the diagnostic hypotheses of ameloblastic fibroma or DC, the lesion was completely enucleated. Microscopically, a cystic lesion with an odontogenic epithelial lining with areas of hyperplasia and exocytosis was observed, in addition to a densely collagenous connective tissue capsule, with areas of hemorrhage and lymphoplasmacytic inflammatory infiltrate. Results: based on clinical, imaging and histopathological characteristics, the final diagnosis was inflamed DC. The patient remains under clinical and radiographic follow-up, with no recurrence. Conclusion: inflamed DC in pediatric patients may show a peculiar behavior and mimic other odontogenic lesions. Early diagnosis allows for lower morbidity associated with surgical treatments.

Epithelial salivary gland tumors in pediatric patients: An international collaborative study.

OBJECTIVE: Salivary gland tumors (SGT) are a diverse group of uncommon neoplasms that are rare in pediatric patients. This study aimed to characterize the clinicopathological profile of pediatric patients affected by SGT from a large case series derived from an international group of academic centers. STUDY DESIGN: A retrospective analysis of pediatric patients with SGT (0-19 years old) diagnosed between 2000 and 2021 from Brazil, South Africa, and the United Kingdom was performed. SPSS Statistics for Windows was used for a quantitative analysis of the data, with a descriptive analysis of the clinicopathological characteristics and the association between clinical variables and diagnoses. RESULTS: A total of 203 cases of epithelial SGT were included. Females were slightly more commonly (56.5%), with a mean age of 14.1 years. The palate was the most common site (43.5%), followed by the parotid gland (29%), lip (10%), and submandibular gland (7.5%). The predominant clinical presentation was a flesh-colored, smooth, and painless nodule. Pleomorphic adenoma (PA) was the most frequently diagnosed SGT (58.6%), followed by mucoepidermoid carcinoma (MEC) (26.6%). Surgery (90.8%) was the favored treatment option. CONCLUSIONS: Benign SGT in pediatric patients are more commonly benign than malignant tumors. Clinicians should keep PA and MEC in mind when assessing nodular lesions of possible salivary gland origin in pediatric patients.

Oral paracoccidioidomycosis: a retrospective study of 95 cases from a single center and literature review

Background: The ecoepidemiological panorama of paracoccidioidomycosis (PCM) is dynamic and still ongoing in Brazil. In particular, data about the oral lesions of PCM are barely explored. The aim of this study was to report the clinicopathological features of individuals diagnosed with oral PCM lesions at an oral and maxillofacial pathology service in Rio de Janeiro, Brazil, in the light of a literature review. Material and methods: A retrospective study was conducted on oral biopsies obtained from 1958 to 2021. Additionally, electronic searches were conducted in PubMed, Embase, Scopus, Web of Science, Latin American and Caribbean Center on Health Sciences Information, and Brazilian Library of Dentistry to gather information from large case series of oral PCM. Results: Ninety-five cases of oral PCM were surveyed. The manifestations were more frequent among males (n=86/90.5%), middle-aged/older adults (n=54/58.7%), and white individuals (n=40/51.9%). The most commonly affected sites were the gingiva/alveolar ridge (n=40/23.4%) and lip/labial commissure (n=33/19.3%); however, one (n=40/42.1%) or multiple sites (n=55/57.9%) could also be affected. In 90 (94.7%) patients, "mulberry-like" ulcerations/moriform appearance were observed. Data from 21 studies (1,333 cases), mostly Brazilian (90.5%), revealed that men (92.4%; male/female: 11.8:1) and individuals in the fifth and sixth decades of life were the most affected (range: 7-89 years), with the gingiva/alveolar ridge, palate, and lips/labial commissure being the sites most frequently affected. Conclusions: The features of oral PCM lesions are similar to those reported in previous studies from Latin America. Clinicians should be aware of the oral manifestations of PCM, with emphasis on the clinicodemographic aspects and differential diagnoses, especially considering the phenomenon of the emergence of reported cases in rural and/or urban areas of Brazil. (AU)

Oral follicular lymphoma: a clinicopathologic and molecular study.

Follicular lymphoma is a hematolymphoid neoplasm that originates from germinal center B cells. It is made up of a combination of small cleaved centrocytes and a varying quantity of larger non-cleaved centroblasts to describe the clinical, microscopic, immunohistochemical, and molecular features of oral follicular lymphomas. Follicular lymphomas affecting the oral cavity were retrieved from pathology files. Immunohistochemistry was performed to confirm the diagnosis, and fluorescence in situ hybridization (FISH) was employed to detect rearrangements in BCL2, BCL6, and MYC genes. Clinical and follow-up data were obtained from the patient's medical and pathology files. Twenty cases were obtained. There was an equal sex distribution (10 males: 10 females) and a mean age of 60.9 years (range: 10-83 years-old). Lesions presented as asymptomatic swellings, usually in the palate (10 cases) and the buccal mucosa (7 cases). Five patients presented with concomitant nodal involvement. Microscopic evaluation depicted the follicular growth pattern with diffuse areas in six cases. Grades 1 and 2 follicular lymphomas represented 12 cases, while grade 3A neoplasms accounted for other 8 cases. Two cases showed rearrangements in MYC, BCL2, and BCL6 genes, while single BCL2 translocation was found in eight cases. Two cases had no translocation. Three patients deceased and the 2-year overall survival achieved 88%. Follicular lymphoma affecting the oral cavity is uncommon, usually affects the palate as a non-ulcerated swelling and the presence of a systemic disease most always be ruled out.

A retrospective multicenter study of oral and maxillofacial lesions in older people

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study

Abstract Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Lúpus eritematoso sistêmico: complicações sistêmicas que afetam o manejo odontológico - revisão narrativa / Systemic lupus erythematosus: systemic complications that suffered from dental management - narrative review

Introdução: o lúpus eritematoso sistêmico (LES) é uma doença autoimune, crônica, multissistêmica, de etiologia desconhecida e com acometimento variado. Objetivo: revisar narrativamente a literatura quanto às principais complicações sistêmicas encontradas em indivíduos com LES e suas repercussões no manejo odontológico. Fonte dos dados: a busca foi realizada no PubMed/MEDLINE, utilizando vocabulário controlado (MeSH terms), termos livres e operadores booleanos (AND e OR). Foram incluídos artigos dos últimos 10 anos, sem restrição de idioma ou região geográfica, os quais tratavam das principais doenças crônicas que afetam pessoas com LES e artigos que mencionaram o tratamento odontológico nesses indivíduos. Síntese dos dados: as manifestações clínicas mais referidas foram as cardiovasculares, hematológicas, cutâneas, pulmonares, renais e neuropsiquiátricas, além das alterações decorrentes do uso crônico de medicamentos utilizados no controle e tratamento da doença, como a osteoporose e o diabetes melito. Apesar das manifestações sistêmicas encontradas em indivíduos portadores de LES influenciarem diretamente na conduta do cirurgião dentista, não há trabalhos robustos quanto ao tratamento odontológico desses pacientes. As consultas odontológicas devem ser individualizadas e adaptadas de acordo com as necessidades individuais e os protocolos existentes para cada uma das complicações apresentadas. Conclusão: o atendimento odontológico de pessoas com LES é desafiador por causa das múltiplas complicações sistêmicas, dos medicamentos de uso contínuo e da falta de protocolos odontológicos específicos para essa população.

Introduction: systemic lupus erythematosus (SLE) is an autoimmune, chronic, multisystemic disease of unknown etiology and with great variability of clinical manifestations. Objective: to critically review the literature regarding the main systemic complications found in individuals with SLE and their repercussions on dental management. Sources of data: the search was performed on PubMed/ MEDLINE, using controlled vocabulary (MeSH terms), free terms and Boolean operators (AND/OR). Articles from the last 10 years were included, without language or geographic region restriction, which discussed the main chronic diseases that affect people with SLE and articles that mentioned dental treatment in these individuals. Synthesis of data: the most mentioned clinical manifestations were cardiovascular, hematological, cutaneous, pulmonary, renal and neuropsychiatric, in addition to alterations associated with the chronic use of medication, such as osteoporosis and diabetes mellitus. Although the systemic complications found in individuals with SLE directly influence the dentist's clinical decision, there are no robust studies regarding the dental treatment of these patients. Dental consultations must be individualized and adapted according to the existing protocols for each of the presented complications. Conclusion: dental care for people with SLE is challenging because of the multiple systemic complications, the continuous use of medications and the lack of specific dental protocols for this population.

Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases.

Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.

Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases

Abstract Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.

Resumo A mucocele oral (MO) é a lesão mais comum das glândulas salivares menores. O presente estudo teve como objetivo relatar as características clínicas e demográficas de uma grande série de MOs e identificar possíveis variáveis preditivas associadas à taxa de recorrência dessas lesões. Foi realizado um estudo transversal descritivo retrospectivo. Foram analisados 43.754 registros de biópsias de quatro serviços de patologia no Brasil. Todos os casos diagnosticados como MOs foram revisados e dados clínicos e demográficos foram coletados. Participaram do estudo 1.002 mulheres (56,2%) e 782 homens (43,8%), com média de idade de 19,8 ± 16,4 anos (variação: 01-87 anos) e proporção de mulheres para homens de 1,3:1. O lábio inferior (n=1.160; 67,4%) e assoalho da boca (n=172; 10,0%), foram os locais mais acometidos, apresentando-se clinicamente como nódulos (n=978; 79,4%) de superfície lisa (n =428; 77,5%) e coloração normal (n=768, 46,7%). A biópsia excisional foi o tratamento na maioria dos casos (n=1.392; 78,0%). As MOs recorrentes representaram 6,2% de todos os casos diagnosticados (n = 117). As recorrências recorreram mais comumente em pacientes mais jovens (idade < 20 anos) (p < 0,0001), em lesões maiores que 2 cm de diâmetro (p < 0,0001) e naquelas localizadas na superfície ventral da língua (p = 0,0351). Além disso, as taxas de recorrência foram significativamente maiores nos casos tratados com cirurgia a laser do que aqueles com cirurgia convencional utilizando bisturi (p = 0,0005). Pacientes com mucoceles devem ser informados sobre uma possível recorrência, principalmente quando encontrados no lábio ou assoalho bucal de pacientes jovens.

Peripheral ossifying fibroma: A 20-year retrospective studywith focus on clinical and morphological features

Background: Peripheral Ossifying Fibroma (POF) is a reactive hyperplastic lesion that exclusively occurs in thegingiva and is characterized by the deposition of dystrophic calcification, cementum-like tissue, and immatureand mature bone within the connective tissue. The objective of the present study was to perform a retrospectiveanalysis of clinicopathologic features of POF.Material and Methods: Clinical and histopathological data were obtained from biopsy records and histopathological reports from a Brazilian reference service in Oral Pathology (1999 - 2020). Morphological analysis wasperformed to evaluate features related to the mesenchymal component, inflammatory infiltrate, ulceration, andmineralized tissue.Results: A total of 270 POFs were diagnosed during the study period. A higher frequency was observed in females(71.9%) between the third (22.9%) and fourth (23.3%) decades of life. The anterior upper gingiva (29.1%) wasthe most affected region. Mature (86.7%) and immature (52.6%) bone tissue were the most frequent. There was asignificant association between immature bone deposition and lesions with size ≤ 1.7 cm (p = 0.041); immaturebone and cement-like tissue deposition with an evolution time ≤ 16 months (p < 0.001); deposition of immaturebone and mesenchymal hypercellularization (p < 0.001); deposition of dystrophic calcification and the presenceof ulceration (p < 0.001).Conclusions: The clinical characteristics corroborate the findings in the literature. The heterogeneous distributionand quantity of mineralized tissues found in the analyzed cases support the theory that the different mineralizedtissues constitute a spectrum of clinical maturation of POF. (AU)

Tratamento de ceratocistos na síndrome de Gorlin Goltz / Diagnosis and treatment of oral keratocysts in Gorlin Goltz Syndrome / Tratamento de ceratocistos na Síndrome de Gorlin Goltz

A Síndrome de Gorlin Goltz apresenta características com comprometimento craniofaciais que incluem carcinomas basocelulares, ceratocístos odontogênicos e fenda labial e/ou palatina. Ceratocísticos odontogênico aparecem durante as primeiras décadas de vida, mais comumente na mandíbula, associados a dentes impactados. O diagnóstico precoce possibilita a cura da lesão, minimiza as deformidades ósseas e pode ser concluído com exames como radiográfico e histopatológico. Relato de caso: Com o objetivo descrever o diagnóstico e analisar as possibilidades de tratamento das manifestações faciais da Síndrome de Gorlin Goltz será relatado um caso clínico de uma paciente infantil. A paciente tem um acompanhamento clínico multidisciplinar com geneticista, oncologista e cirurgião-dentista de 6 anos. Apresentou 5 ceratocisticos odontogênicos, carcinomas basocelulares na região do pescoço, calcificação da foice cerebral, ceratose palmo-plantar e macrocefalia. O tratamento para as lesões císticas foi a enucleação, seguida de osteotomia periférica. O defeito ósseo produzido pela enucleação de cisto mandibular foi enxertado com bloco de osso alógeno do banco de tecidos do INTO-RJ. Conclusão: Constata-se que o Cirurgião-dentista é capacitado para fazer o diagnóstico desta síndrome e encaminhar para o tratamento multidisciplinar. O enxerto alógeno é uma opção adequada de reconstrução de cavidades císticas, beneficiando pacientes do Sistema Único de Saúde... (AU)

Gorlin Goltz Syndrome has features with craniofacial involvement that include basal cell carcinomas, odontogenic keratocysts, and cleft lip and/or palate. Odontogenic keratocysts appear during the first decades of life, most commonly in the mandible, associated with impacted teeth. Early diagnosis enables healing of the lesion, minimizes bone deformities and can be completed with exams such as radiographic and histopathological exams. Case report: In order to describe the diagnosis and analyze the treatment possibilities of the facial manifestations of Gorlin Goltz Syndrome, a clinical case of a child patient will be reported.The patient has a multidisciplinary clinical follow-up with a 6-year geneticist, oncologist and dental surgeon. She had 5 odontogenic keratocystic keratocysts, basal cell carcinomas in the neck region, sickle cerebral calcification, palmoplantar keratosis and macrocephaly. The treatment for cystic lesions was enucleation, followed by peripheral osteotomy. The bone defect produced by the enucleation of a mandibular cyst was grafted with an allogeneic bone block from the tissue bank of INTO-RJ. Conclusion: It is concluded that the dentist is trained to make the diagnosis of this syndrome and refer to multidisciplinary treatment. Allogeneic graft is an appropriate option for the reconstruction of cystic cavities, benefiting patients from the Unified Health System... (AU)

El Síndrome de Gorlin Goltz tiene características con compromiso craneofacial que incluyen carcinomas de células basales, queratoquistes odontogénicos y labio leporino o paladar hendido. Los queratoquistes odontogénicos aparecen durante las primeras décadas de vida, más comúnmente en la mandíbula, asociados con dientes retenidos. El diagnóstico precoz permite la curación de la lesión, minimiza las deformidades óseas y se puede concluir con exámenes como exámenes radiográficos e histopatológicos. Reporte de caso: Con el fin de describir el diagnóstico y analizar las posibilidades de tratamiento de las manifestaciones faciales del Síndrome de Gorlin Goltz, se reportará un caso clínico de un paciente infantil. El paciente tiene un seguimiento clínico multidisciplinario con un genetista, oncólogo y cirujano dentista de 6 años. Presentó 5 queratocísticos odontogénicos, carcinomas basocelulares en la región del cuello, calcificación de la hoz cerebral, queratosis palmoplantar y macrocefalia. El tratamiento de las lesiones quísticas fue la enucleación, seguida de una osteotomía periférica. El defecto óseo producido por la enucleación de un quiste mandibular se injertó con un bloque óseo alogénico del banco de tejidos de INTO-RJ. Conclusión: Parece que el odontólogo está capacitado para realizar el diagnóstico de este síndrome y derivar al tratamiento multidisciplinario. El injerto alogénico es una opción adecuada para la reconstrucción de cavidades quísticas, beneficiando a los pacientes del Sistema Único de Salud... (AU)

Psammomatoid juvenile ossifying fibroma of frontal sinus - surgical and reconstructive approach

ABSTRACT Psammomatoid juvenile ossifying fibroma (PJOF) is a benign fibro-osseous lesion that mainly affects the paranasal sinuses and periorbital bones. It may cause significant esthetic and functional impairment. Herein, we describe the diagnosis and surgical approach of an extensive PJOF arising in the frontal sinus of a young male. After complete lesion removal and histopathological confirmation, the bone defect was repaired with a customized polymethylmethacrylate implant. PJOF may present aggressive clinical behavior. The excision of extensive PJOF in the orbitofrontal area can result in significant esthetic defects. Polymethacrylate implants restore functionally and esthetically the involved area.