Anti-inflammatory and wound healing effect of Copaiba oleoresin on the oral cavity: A systematic review.

Copaiba oleoresin has been related to properties including healing and anti-inflammatory effects, making it a potential candidate to treat oral lesions. We aimed to define the benefits related to the anti-inflammatory and healing capacity of Copaiba-based formulations on the oral cavity. This is a systematic review, conducted in PubMed, Web of Science, Scopus, Embase, Scielo, Cochrane Library, BVS, and Google Scholar databases selecting full articles in English, Portuguese, or Spanish, until March 3rd, 2021. Pre-clinical, clinical, or randomized clinical trials, cohort and case-control in vivo studies were included; studies with other designs, in vitro, and those that did not match the PICO question were excluded (PROSPERO: CRD42021244938). Data was collected and synthesized descriptively through a specific form. The risk of bias was evaluated by SYRCLE's RoB Tool. So, five studies were included. Two reported beneficial wound healing effects, such as early reduction in the wound area and greater immature bone formation in the rats' mandibles; and two related benefic anti-inflammatory effects, like reduced acute inflammatory reaction and more advanced tissue repair stage, early formation of collagen fibrils, with greater quantity, thickness and better organization, and more expressive anti-inflammatory activity, reduction of the edema intensity and the CD68 + macrophages concentration. Based on the articles, benefits related to the wound healing and anti-inflammatory effects in the oral cavity of rats treated with Copaiba oleoresin were suggested. However, due to the limited data, future studies are necessary, especially clinical ones.

Successful GaAlAs low-level laser therapy of self-inflicted thermal burns of the palate.

Thermal burns of the oral cavity usually arise from ingestion of hot foods or beverages. A 38-year-old female patient presented with two painful ulcerative erythematous patches of the palate. The patient was consulted on the same day lesions appeared. Medical history was unremarkable. Clinically significant self-inflicted injuries may result in wide ulcers in the mouth and usually do not take less than 2 weeks to heal, whereas our patient, treated with low-level laser therapy, had a complete response in day 4, after 2 days of treatment. The fact that multiple lesions were present signaled against the World Health Organization exclusion diagnosis of erythroplakia for red patches. A traumatic ulcer, regardless of its cause of origin, usually heals within 2 weeks, after the source of injury is resolved. A thermal burn in the oral cavity usually takes longer than that to heal, but whenever this time frame is not respected, the suspicion of a potentially malignant disorder should always arise, and a biopsy should be performed. The present case showed two painful thermal burns with great results in terms of speeding up the relieve of symptoms and healing time with soft laser as opposed to the traditional treatment with oral topical corticosteroid.

Epidemiology of uveal melanoma in Brazil.

PURPOSE: To report the prevalence of uveal melanoma in a Hospital database in Brazil over the period of 16 years (2000 to 2016). DESIGN: Descriptive epidemiological study evaluating the Brazilian Hospital Based Cancer Registries. PARTICIPANTS/METHODS: Uveal melanomas were identified based on ICD-O-3 codes C69.3 [choroid], C69.4 [ciliary body and iris], and C69.2 [retina]) derived from the Integrator Registry database. Kolmogorov-Smirnov Test was used for evaluation of normality of data, t-test and Chi square were used for categorical and continuous variables respectively using SPSS Software. MAIN OUTCOME MEASURES: Age, sex, education, regional distribution, clinical staging at the diagnosis, time from diagnosis to treatment (≤ 60 days versus > 60 days) and first-course therapy (surgery, chemotherapy, radiotherapy or a combination of such). RESULTS: There were 2166 cases of uveal melanoma representing 5.4% of all cases of melanoma. Histological confirmation of uveal melanoma was available in all cases. Higher prevalence of 1139 cases (52.6%) in women than 1027 cases (47.4%) in men was observed. Age distribution revealed 1411 cases (65.1%) in the group between 41 and 69 years old. A total of 429 (19.8%) patients were classified as initial disease and 334 (15.4%) as advanced (regional or distant metastases). Staging as initial disease was more frequent (113-24.8%) in patients with > 8 school years than in patients with < 8 school years (179-17.6%) reflecting disparities in healthcare access between those two populations. No difference was noticed in terms of diagnosis, staging and treatment after the Brazilian "60 days law" (Federal Law 12.732/12) came into effect in 2013 regulating the maximum period that a patient with cancer has to wait until start the treatment. CONCLUSION: Epidemiological data is critical for planning early treatment strategies and allocating medical resources. This study intended to understand the characteristics of uveal melanoma in Brazil.

Panorama Atual dos Programas de Residência Multiprofissional em Oncologia para Cirurgiões-Dentistas do Brasil / Current Portrait of Multiprofessional Residency Programs in Oncology for Dentist in Brazil / Panorama Actual de los Programas de Residencia Multiprofesional en Oncología para Cirujanos-Dentistas en Brasil

Introdução: Os Programas de Residência Multiprofissional constituem-se uma estratégia fundamental para a ampliação da capacidade para o enfrentamento do câncer. Objetivo: Analisar o panorama atual dos Programas de Residência Multiprofissional em Oncologia para cirurgiões- -dentistas no Brasil, bem como o número de profissionais egressos desses cursos, a partir de dados informados pelo Ministério da Educação (MEC). Método: Trata-se de um estudo quantitativo, exploratório. A primeira fase consistiu na solicitação à Equipe Técnica da Residência Multiprofissional do MEC do Brasil da relação de todos os Programas de Residência Multiprofissional em Oncologia que incluíssem a categoria profissional da odontologia. Adicionalmente, foi realizada busca manual. Na segunda fase, realizaram-se contato por e-mail e busca pelos editais disponíveis na Internet dos casos em que não houve resposta. Os dados investigados foram a presença de Programa ativo, inclusão da categoria profissional da odontologia, número de vagas ofertadas e de egressos para cada ano entre 2010 e 2020, que foram analisados descritivamente. Resultados:Foram identificados 13 Programas de Residência Multiprofissional em Oncologia para cirurgiões-dentistas, distribuídos em 12 centros, situados em dez cidades de oito Estados brasileiros, sobretudo, na Região Sudeste. Seis Programas foram implementados em 2010, seis em 2016 e um em 2020. No cenário Brasileiro, entre 2010 e 2020, foram ofertadas 216 vagas e formados pouco mais de 114 profissionais especializados nessa área. Conclusão: Ressalta-se a necessidade do incremento de centros, Programas e vagas para Residências Multiprofissionais em Oncologia para cirurgiões-dentistas no Brasil, bem como do reconhecimento da Oncologia como uma especialidade odontológica.

Introduction: Multiprofessional Residency programs represent a fundamental strategy to increase the capacity of cancer management. Objective: To analyze the current portrait of Multiprofessional Residency programs in oncology for dental surgeons in Brazil, as well as the number of professionals graduating from these courses, based on data reported by the Ministry of Education (MEC). Method: Quantitative, exploratory study. The first phase consisted in requesting to the Brazilian MEC Technical Team of Multiprofessional Residency to list all the Multiprofessional Residency Programs in Oncology that included the professional category of dentistry. Additionally, a manual search was performed. In the second phase, a contact was made by e-mail and a search in the available Internet public notices of the unanswered cases was conducted. The data searched and analyzed descriptively consisted in the existence of an active program, inclusion of the professional dentistry category, number of vacancies offered and graduates for each year between 2010 and 2020. Results: Thirteen Multiprofessional Residency programs in oncology for dental surgeons were identified, distributed in 12 centers, located in ten cities in eigtht Brazilian states, mainly in the Southeast region. Six programs were implemented in 2010, six in 2016 and one in 2020. In the Brazilian scenario, between 2010 and 2020, a total of 216 vacancies were offered and just over 114 professionals specialized in this area completed the academic formation. Conclusion: It is emphasized the necessity to increase the quantity of centers, programs and vacancies for Multiprofessional Residencies in Oncology for dental surgeons in Brazil, as well as the recognition of oncology as a dental specialty

Introducción: Los Programas de Residencia Multiprofesional constituyen una estrategia fundamental para expandir la capacidad de enfrentar el cáncer. Objetivo:Analizar el panorama actual de los Programas de Residencia Multiprofesional en oncología para cirujanos-dentistas en Brasil, así como el número de profesionales que concluyeron estos cursos, con base en datos reportados por el Ministerio de Educación (MEC). Método: Este es un estudio cuantitativo exploratorio. La primera fase consistió en pedirle al Equipo Técnico de Residencia Multiprofesional del MEC del Brasil que enumerara todos los Programas de Residencia Multiprofesional en Oncología que incluían la categoría profesional de odontología. Además, se realizó una búsqueda manual. En la segunda fase, se contactó por correo electrónico y se buscaron los avisos disponibles en Internet de los casos en que no hubo respuesta. Los datos investigados fueron la presencia de Programa activo, inclusión de la categoría profesional odontología, número de vacantes ofrecidas y número de graduados para cada año entre 2010 y 2020, que fueron analizados descriptivamente. Resultados: Se identificaron 13 Programas de residencia multiprofesional en oncología para cirujanos dentistas, distribuidos en 12 centros, ubicados en diez ciudades de ocho estados brasileños, principalmente en la región Sudeste. Se implementaron seis Programas en 2010, seis en 2016 y uno en 2020. En el escenario brasileño, entre 2010 y 2020, se ofrecieron 216 vacantes y se capacitaron poco más de 114 profesionales especializados en esta área. Conclusión: Se enfatiza la necesidad de aumentar el número de centros, Programas y vacantes para residencias multiprofesionales en oncología para dentistas en Brasil, así como del reconocimiento de la oncología como especialidad odontológica

Manejo Terapêutico das Lesões Cariosas em Pacientes com a Doença do Enxerto contra o Hospedeiro Crônica: Relato de Caso / Therapeutic Management of Carious Injuries in Chronic Graft-Versus-Host Disease Patients: Case Report / Manejo Terapéutico de Lesiones Cariosas en Pacientes con Enfermedad del Huésped Injerto contra Huésped Crónica: Reporte de un Caso

Introdução: A doença do enxerto contra o hospedeiro crônica (DECHc) é a principal causa de morbimortalidade após o transplante alogênico de células-tronco hematopoiéticas (TCTH-alo). Relato do Caso: Acompanhamento odontológico de paciente do sexo masculino, 59 anos, com diagnóstico inicial de leucemia mieloide aguda, submetido ao TCTH-alo em maio de 2017. No D+ 224, o paciente evoluiu para um quadro de DECHc acometendo a pele, a cavidade oral e o trato gastrointestinal, porém com dentes ainda hígidos. No D+ 392, o paciente queixou-se de boca seca, e foram observadas lesões orais, sialometria de 0,024 mL/min e evolução de lesões cariosas nos dentes 17, 15, 22, 25, 27, 38, 45 e 46. No D+ 560, o paciente ainda estava com DECHc oral e houve progressão das cáries em inúmeros dentes. Tratamento e Resultados: O manejo terapêutico adotado consistiu na utilização de diamino fluoreto de prata pela propriedade cariostática com redução da odontalgia e, posteriormente, foram realizadas as restaurações dentárias. Além disso, o paciente foi orientado em relação à dieta, à manutenção da higiene oral e ao uso de lubrificante oral na tentativa de amenizar a xerostomia. Conclusão: Observou-se, neste caso clínico, que o diamino fluoreto de prata foi eficaz no controle da evolução da cárie e redução da odontalgia no paciente adulto. É evidente a importância da capacitação dos cirurgiões-dentistas no que diz respeito ao conhecimento sobre a utilização de cariostáticos em pacientes com alterações na qualidade e quantidade de saliva como os pacientes com DECHc oral. Palavras-chave: Cariostáticos;Doença Enxerto-Hospedeiro; Manifestações Bucais; Relatos de Casos

Introduction: Chronic graft-versus-host disease (cGVHD) is the main cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT-alo). Case Report: Dental follow-up of a 59-year-old male patient, with initial diagnosis of acute myeloid leukemia, who underwent HSCT-alo in May 2017. At D+ 224, the patient developed a condition of GVHD affecting the skin, oral cavity and gastrointestinal tract, but with still healthy teeth. On D+ 392, the patient complained of dry mouth, oral lesions were observed, and sialometry was 0.024mL/min, with evolution of carious lesions on teeth 17, 15, 22, 25, 27, 38, 45 and 46. At D+ 560, the patient still had oral GVHD and the progression of caries was observed in numerous teeth. Treatment and Results: The therapeutic management adopted consisted of the use of silver diamine fluoride due to its cariostatic property with reduced tooth pain and later dental restorations were performed. In addition, the patient received guidance about diet, maintenance of oral hygiene and - use of oral lubricant to ease xerostomia. Conclusion: It was observed in this clinical case that silver diamine fluoride was effective in controlling the evolution of caries and reducing tooth pain in adult patients. It is evident the importance of training dentists on the knowledge about the use of cariostatic resources in patients with changes in the quality and quantity of saliva, such as patients with oral GVHD

Introducción: La enfermedad crónica del huésped versus el injerto (cGVHD) es la principal causa de morbilidad y mortalidad después del trasplante alogénico de células madre hematopoyéticas (HSCT-alo). Relato del Caso: Seguimiento dental de un paciente masculino de 59 años, con diagnóstico inicial de leucemia mieloide aguda, que se sometió a un HSCT-alo en mayo de 2017. En D+ 224, el paciente desarrolló una condición de EICH que afecta la piel, la cavidad oral y el tracto gastrointestinal, pero con dientes aún sanos. En D+ 392, el paciente se quejó de sequedad en la boca y se observaron lesiones orales y con sialometría de 0,024 ml/min. También presentó evolución de lesiones cariosas en los dientes 17, 15, 22, 25, 27, 38, 45 y 46. En D+ 560, el paciente todavía tenía EICH oral y se observó la progresión de la caries en numerosos dientes. Tratamiento y Resultados: El tratamiento terapéutico adoptado consistió en el uso de diamino fluoruro de plata debido a su propiedad cariostática con reducción del dolor dental y posteriormente se realizaron restauraciones dentales. Además, el paciente recibió instrucciones sobre la dieta, el mantenimiento de la higiene bucal y el uso de lubricante oral en un intento por aliviar la xerostomía. Conclusión: Se observó en este caso clínico que el diamino fluoruro de plata fue efectivo para controlar la evolución de la caries y reducir el dolor dental en pacientes adultos. Es evidente la importancia de capacitar a los dentistas con respecto al conocimiento sobre el uso de recursos cariostáticos en pacientes con cambios en la calidad y cantidad de saliva, como los pacientes con EICH oral

An Update on Mucosal Melanoma: Future Directions.

By definition, mucosal melanomas are malignant primary tumors originating from melanocytes located in the mucosal membranes of the nasal cavity and accessory sinuses, oral cavity, lips and pharynx, and vulvar, vaginal or uterus, anorectal, or basically any other part of the mucosal surface lining. These malignant melanomas usually occur in occult sites, which in combination with the lack of early specific signs contributes to the delay in diagnosis and poor prognosis of the disease. Given the rarity of mucosal melanomas, knowledge about their pathogenesis and risk factors is insufficient and when compared with cutaneous and ocular melanoma, they have the lowest five-year survival rate. Surgical resection is frequently the first approach to primary tumors, even though the utility of lymph node surgery and radiation therapy is not well established. Novel molecular techniques such as whole exome sequencing have become routine in order to aid patient care. They show great promise in the treatment of rare and usually fatal diseases such as mucosal melanomas. Target therapy against c-KIT activating mutations, frequently seen in mucosal melanomas, and the immunotherapy have emerged as a promising treatment modality for these aggressive tumors.

The role of dental surgeons on patient care with regards to potentially malignant disorders and oral cancer

In order to understand how dentists should act when approaching patients that can present with cancer or precancer of the oral cavity, it is adamant that the professionals familiarize themselves with the current trends of oral cancer and potentially malignant disorders. A study conducted only three years ago pinpointed that squamous cell carcinoma of the head and neck has a five-year survival rate of only 40 to 60% in fifty years, despite advances in surgical techniques, radiotherapy, chemotherapy and combined therapies.1 In order to avoid these terrible statistics, a great effort must be made by medical professionals, especially those that constantly examine the oral cavity, also known as: dentists.

Erysipelatoid Carcinoma.

Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Erysipelatoid Carcinoma

SUMMARY Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Geographic stomatitis: an oral manifestation of psoriasis?

BACKGROUND: Geographic stomatitis is an uncommon oral lesion that presents similar clinical, histopathological and genetic features as those of psoriasis. These findings suggest that this lesion may actually represent an oral manifestation of psoriasis. We report one case of geographic stomatitis and discuss a possible connection between this condition and psoriasis. MAIN OBSERVATIONS: A 37-year-old woman presented with red patches, surrounded by a white border on the labial mucosa and a positive family history of psoriasis. Histopathological examination, immunohistochemical analysis with antibodies against CD4, CD8, CD20, CD68, CD31, and Ki-67 and HLA-A*, -B*, -C*, -DRB1*, -DQA1* and -DQB1* genotyping were performed. Histopathological examination revealed parakeratosis, marked elongation of rete ridges with acanthosis and clubbing, exocytosis, Munro microabscesses, pustule of Kogoj, dilated tortuous vessels at the tip of dermal papillae, and predominant superficial and perivascular lymphocytic chronic inflammatory cell infiltrate. Immunohistochemistry analysis revealed a predominant T-cell subepithelial infiltrate. Based on the referred clinicopathological findings and in the absence of cutaneous lesions, the diagnosis of geographic stomatitiswas confirmed. CONCLUSIONS: This case and theoretical data indicate that geographic stomatitis may be an oral manifestation of psoriasis. Moreover, to improve our understanding, psoriatic patients should routinely undergo a detailed oral examination and patients with geographic stomatitis should routinely be submitted to a cutaneous routine examination.