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.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Histopathological parameters reported in microinvasive oral squamous cell carcinoma: a systematic review

Background: Microinvasive oral squamous cell carcinoma (OSCCmi) is an incipient stage of oral cancer. Through this systematic review, we aim to assess patterns of histopathological outcomes reported in OSCCmi cases. Material and methods: An online search in major databases was performed without period restriction, and 2,024 publications in English, Spanish and Portuguese were obtained. After screening and eligibility, 4 studies were selected. The risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist. A descriptive synthesis was conducted. Results: All 4 publications included were retrospective, reporting a total of 116 OSCCmi patients, with a male predominance (1.6:1) and a mean age of 55.9 years. The main parameters considered for microinvasion were tumor thickness (TT) (range 4-10mm) and depth of invasion (DOI) (range 0,02-5mm). Definition, cut-off values, and assessment of microscopic features were not standardized. Other relevant measures such as perineural or lymphovascular invasion and pattern of invasive front were barely described, and cytological/architectural characteristics were not discussed. Conclusions: TT and DOI are currently the primary histopathological criteria used to define OSCCmi. Nonetheless, the outcomes of this systematic review showed the absence of standardized quantitative parameters to render the diagnosis of microinvasive OSCC. Therefore, additional studies aiming to standardize histopathological features to diagnose OSCCmi are paramount. (AU)

[Impact of acute lymphoblastic leukemia on the microbiome and oral lesions: scoping review]. / Impacto de la leucemia linfoblástica aguda en el microbioma y lesiones bucales: revisión de alcance.

Objective: To describe the existing knowledge about the alterations of the MBO oral microbiome and the presence of OL Oral Lesions in patients with Acute Lymphoblastic Leukemia ALL. Materials and Methods: An electronic search was carried out in the PubMed, SciELO, and academic Google databases, and descriptive, analytical, observational articles on MBO, OL, and ALL were included, following the PRISMA criteria. 642 were evaluated, duplicate articles, case reports, and those where only changes were reported during or after chemotherapy treatment were eliminated. Results: 10 articles were evaluated, published between 1997 and 2021, 4 articles agreed that the MBO of patients with ALL is in dysbiosis showing a significant increase in firmicutes 0.1%, bacillus 0.05%, and opportunistic bacteria such as Moraxella spp, Klebsiella spp 5.66%, Pseudomonas spp 3.77%, Enterobacter spp 1.88%, Acinetobacter spp 1.88% and E. coli 1.08%, the most frequent OL reported in 5 articles were spontaneous gingival bleeding 3.5%, gingivitis 25% and ulcers 9.4%. Conclusions: The oral cavity of patients with ALL is in dysbiosis and associated OL is identified. It is necessary to establish preventive strategies with a niche-ecological approach to restore the MBO, to reduce the risk of opportunistic infections and other OL during chemotherapy treatment.

Estomatitis Asociada a Metotrexato: Un Reto Diagnóstico / Methotrexate Associated Stomatitis: A Diagnostic Challenge

RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.

ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.

Atención estomatológica a pacientes en protocolo para trasplante de órgano / Stomatological care for patients with organ transplantation protocol

El trasplante es el reemplazo con propósitos terapéuticos de órganos, tejidos, material celular para un humano, donado usualmente de otro humano vivo o muerto. En recientes años, el trasplante de órganos se ha desarrollado por la tecnología quirúrgica médica y los medicamentos inmunosupresores. Debido a la frecuencia de trasplantes que se realizan, es común atender a pacientes trasplantados en el consultorio dental para recibir tratamiento estomatológico. Objetivo: Revisión de literatura con respecto a las manifestaciones bucales en pacientes trasplantados y el tratamiento estomatológico antes y después del trasplante. Material y métodos: Se revisaron artículos de la literatura que se obtuvieron de la base de datos de PubMed y MedLine. Resultados y conclusión: Describimos las manifestaciones bucales más comunes debido a los medicamentos en pacientes trasplantados (infecciones virales, bacterianas, fúngicas, alteraciones gingivales y xerostomía); además del tratamiento estomatológico que deben recibir los pacientes trasplantados antes y después de ser trasplantado (AU)

Transplantation is the replacement for therapeutic purposes of organs, tissues, cellular material for a human, usually donated from another living or dead human. In recent years organ transplantation has been developed by medical surgical technology and immunosuppressive drugs. Due to the frequency of transplants that are performed it is common to treat transplant patients in the dental office to receive stomatological treatment. Objective: Review of literature regarding oral manifestations in transplant patients and stomatological treatment before and after transplantation. Material and methods: Literature articles that were obtained from the PubMed and MedLine databases were reviewed. Results and conclusion: We describe the most common oral manifestations due to drugs in transplant patients (viral, bacterial, fungal infections, gingival alterations, xerostomia, and the stomatological treatment that transplant patients should receive before and after being transplanted (AU)

Oral presentation of 10 patients with Cowden syndrome.

Cowden syndrome (CS) is an autosomal dominant genodermatosis that frequently affects several tissues with hamartomatous growth. The oral cavity is quite commonly involved with papillomatous lesions, which can be crucial to early diagnosis of this disease. In this series, 10 patients with a great diversity of manifestations associated with CS are presented, in whom oral papillomatosis was a constant and relevant finding to establish the diagnosis of CS. The role of the dentist in recognizing the oral lesions, the other diagnostic criteria, the risk for the development of malignancies, and the importance of lifetime follow-up are discussed.