Mucormycosis causing oral and nasal osteonecrosis in a case of acute myeloid leukemia.

AIMS: Mucormycosis is a rare and aggressive fungal infection with a high mortality rate because of its rapidly progressive and destructive nature. The oral cavity is often affected under opportunistic conditions. We report a 34-year-old woman diagnosed with acute myeloid leukemia complained of slight swelling on the right side of her face with toothache and gingival swelling. An incisional biopsy was performed, and the specimen analysis revealed broad aseptate hyphae with a ribbon-like appearance, which is characteristic of opportunistic Mucorales infection. METHODS AND RESULTS: The oral lesion worsened, and invasion of the fungal infection into the maxillary sinus, nasal cavity, ethmoidal air cells, and sphenoid and frontal sinuses was observed. Partial maxillectomy was performed concomitantly with the ongoing chemotherapy for leukemia. A maxillofacial prosthesis was used for functional rehabilitation. CONCLUSION: Successful management requires a multimodal approach. In this case, the patient required different systemic approaches for treating leukemia and the fungal infection as well as rehabilitation with an obturator prosthesis.

Diagnostic accuracy of a telediagnosis service of oral mucosal diseases: A multicentric survey.

OBJECTIVE: The aim of this multicentric study was to assess the diagnostic accuracy of a telediagnosis service for oral mucosal disorders. STUDY DESIGN: This study included 100 patients seen at the oral medicine outpatient clinic of 3 Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catrina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform. RESULTS: The sensitivity and specificity of telediagnosis were compared with those of the face-to-face approach and found to be 100% and 97.4%, respectively. The concordance between the examiners was 95%, and case management was relatively simple in approximately 60% of cases. CONCLUSIONS: Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.

Nível de conhecimento de estudantes do curso de graduação em Odontologia sobre cigarros eletrônicos / Level of knowledge of undergraduate dental students about electronic cigarettes

O cigarro eletrônico vem despontando como uma opção ao cigarro convencional, sendoconsiderado por alguns como uma alternativa para quem deseja parar de fumartabaco. Muitos jovens também têm usado o dispositivo em busca de novas experiências, sensações e diversão. O objetivo desse estudo foi avaliar o nível de conhecimento dos alunos do Curso de Graduação em Odontologia da UniversidadeFederal de Santa Catarinasobreos cigarros eletrônicos, com base em um questionário. Tambémforam coletadas informações sobre o interessepara experimentar o dispositivo, a abordagem do assunto durante o curso de graduação e a autopercepção sobre o preparo para orientar pacientes sobre este assunto.O questionário foi aplicadoem abril e maio de 2019a 209 estudantes maiores de 18 anos, que foram divididos em 3 grupos: ingressantes (1ª e 2ªfasesdo curso), intermediários (4ª e 5ª fases) e concluintes (9ª e 10ªfases).A análise descritiva foi realizada em todas as questões, e naestatística analíticaassumiu-se onível de significância de 95%. A análise dos resultados demonstrou que estudantes concluintes possuem mais conhecimento sobre o cigarro eletrônico que ingressantes ou intermediários. No entanto, o nível de conhecimento foi considerado insatisfatório, pois mesmo entre os concluintes apenas cerca de 40% alcançaram o conceito considerado satisfatório(e que corresponderia a pelo menos 60% de acertos). A maioria dos estudantes relatou não ter tido contato com o tema durante o Curso de Graduação. Da mesmaforma, a maioria dos concluintes declarou não se sentir preparada para orientar pacientes sobre cigarros eletrônicos. Os resultados deste estudo apontam para a necessidade de o currículo contemplar este conteúdo na formação dos futuros cirurgiões-dentistas, para capacitá-los a orientar seus pacientes sobre riscos e benefícios da utilização dos cigarros eletrônicos (AU).

The electronic cigarette has emerged as an alternative to the conventional cigarette, being considered by some as asmoking cessationaid. The device has attracted the interest of many young people in search of new experiences, sensations,and recreation. The aim of this study was to assess,using a questionnaire, the level of knowledge of undergraduate dental students fromthe Federal University of Santa Catarina(Florianópolis, Brazil)about electronic cigarettes. Information was also collected on the interest intryingthe device, theapproach ofthe subjectin the course,and the self-perceived abilityto informpatients aboutelectronic cigarettes. The questionnaire was applied in April and May 2019 to 209 students over 18 years old, who were divided into 3 groups: freshmen(1st and 2nd semestersof the course), junior(4th and 5th semesters),and senior(9th and 10th semesters). Thedescriptive and statistical analyses wereperformed, andthe significance level of 95% was adopted. The results showed that senior students hadhigherknowledge about electronic cigarettes than freshmenor juniorstudents. However, the level of knowledge was considered unsatisfactory, as about 40% of the senior students had adequatelevel of knowledge (at least 60% of correct answers). Most students reported not having had contact with the topic during the undergraduate course. Likewise, most senior studentsreported not feelingprepared to advise patients on electronic cigarettes. The results of this study indicate the dentalcurriculum shouldinclude this topicin the training of future dentists, enablingthem to informtheir patients about the risks and benefits of using electronic cigarettes (AU).

Diagnostic Challenge and Clinical Management of Juvenile Mandibular Chronic Osteomyelitis.

Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.

Fibrous dysplasia with secondary aneurysmal bone cyst-a rare case report and literature review.

INTRODUCTION: Fibrous dysplasia (FD) and aneurysmal bone cyst (ABC) are uncommon non-neoplastic intraosseous lesions, and the occurrence of concomitant FD and ABC is extremely rare. CASE REPORT: An 11-year-old boy presented with gradual progressive enlargement of his right zygomatic bone over 4 years prior to presentation. Computed tomography revealed a lesion with a central bony area showing a ground-glass appearance surrounded by a well-defined expansile lesion with internal septations. An incisional biopsy was performed and suggested a fibro-osseous lesion. Resection was performed, followed by immediate reconstruction using autogenous bone graft from the iliac crest. Histopathological examination revealed irregularly shaped trabeculae comprising immature woven bone in a fibroblastic cell-rich stroma. Blood-filled sinusoidal spaces lined by fibrous septa containing scattered multinucleated giant cells were observed peripherally. These findings were compatible with concomitant FD and ABC. The patient was disease-free at the time of his 10-month follow-up. CONCLUSIONS: Based on our literature search, this report is the first to describe concomitant monostotic FD and ABC in the zygomatic bone. Accurate diagnosis requires careful investigation and examination of clinical, radiographical, and histopathological features. The treatment of choice should provide an esthetic and functional improvement in the patient.

Intraoral Potentially Malignant Disorders in a Brazilian Oral Pathology Service: Epidemiological, Clinical, and Histopathological Findings.

The aim of this study was to investigate the characteristics of individuals with intraoral potentially malignant disorders (IOPMD) in an oral pathology service in Brazil. Cases were screened based on clinical diagnosis of leukoplakia (LKP), erythroleukoplakia (ELKP), and erythroplakia (EP). Clinical data and information regarding associated factors were gathered from biopsy reports. Histological diagnoses were collected from histopathological records. Among 208 IOPMD cases, 84.13% involved LKP; 11.1%, ELKP; and 4.8%, EP. The most affected sites were the gingiva and buccal mucosa. Histologically, epithelial dysplasia was present in 66.8% of the lesions, acanthosis and hyperkeratosis without epithelial dysplasia were present in 27.9%, and squamous cell carcinoma was present in 2.9%. Most patients were males, fair-skinned, with mean age of 53.4 years. Chronic smokers represented 73% of subjects, of which 30% also consumed alcohol. Smokers and drinkers were mostly males (p < 0.001). EP and ELKP represented histologically more severe degrees of epithelial dysplasia than LKP (p < 0.001). In conclusion, individuals with IOPMD were more frequently fair-skinned men in the sixth decade of life, with smoking habit. Special attention is required to clinical diagnoses of ELKP and EP since the prevalence of severe epithelial dysplasia, in situ carcinoma, and squamous cell carcinoma is higher than in LKP.

The use of tools to support oral lesion description in oral medicine referrals.

Poor description of oral lesions jeopardize the prioritization of appointments in Oral Medicine. The present study investigated whether the use of support tools changes the quality of descriptions focusing on health care prioritization. Two oral lesions (A and B) were described by 64 dental students and 48 dentists using three methods: (a) without support tools (free); (b) using the oral examination form from the Specialties Manual in Oral Health/Brazilian Ministry of Health (SMOH form); and (c) using the OralDESC guideline. The descriptions were compared with a gold standard and percentage of agreement was analyzed by the Kruskal-Wallis and Dunn's tests (p<0.05). Descriptions with the OralDESC presented higher information quality. Considering items essential for prioritization, the OralDESC demonstrated better performance for lesion A; for lesion B, free descriptions and descriptions using the OralDESC were of higher quality than those using SMOH form. Therefore, the OralDESC offered greater support for the description of oral lesions for health care prioritization in Oral Medicine.

Myositis Ossificans of the Temporalis Muscle.

Traumatic myositis ossificans (TMO) is a rare ossifying disease that occurs in the muscle or soft tissues. A case of TMO isolated in the temporalis muscle is reported. In the case described, calcification in the temporalis muscle was confirmed after computed tomography. Surgery, physiotherapy, and histopathological analysis were performed. One year after treatment, further ossification was present but without interference in function. The most accepted treatment for TMO in the maxillofacial region is excision followed by physiotherapy. The high rate of non-recurrence may be concealed due to the short follow-up period. TMO is a lesion that may frequently recur and long-term follow-up must be provided.

A Rare Case of Mucoepidermoid Carcinoma ex Pleomorphic Adenoma arising in Minor Salivary Gland: Histopathological and Immunohistochemical Analysis.

Mucoepidermoid carcinoma ex pleomorphic adenoma (MCxPA) is a rare salivary gland tumor predominantly found in major salivary glands. A case of MCxPA involving the soft tissue and bone of the retromolar region of a 26-year-old man is presented. The histopathological features revealed a neoplasm with predominance of pleomorphic adenoma (PA) elements, and presence of mucoepidermoid carcinoma malignant epithelial cells in several areas. Histochemical and immunohistochemical studies were positive for periodic acid Schiff, alcian blue, cytokeratins 7, 13, 14, and 19, Bcl-2, c-erbB-2, FGF-2 and maspin in the malignant areas. The patient underwent a partial resection of the left side of the mandible with neck dissection and MCxPA diagnosis was confirmed.

Dental treatment in patients with leukemia.

Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient.

Proposta de um roteiro de apoio à descrição de lesões bucais como instrumentalização para a comunicação profissional / Proposal for a guideline for the description of oral lesions as a support tool for professional communication in Oral Medicine

A boa comunicação escrita é uma habilidade essencial para a troca de informações entre profissionais da saúde. No contexto do SUS, essa troca ocorre por meio de documentos de referência e contrarreferência. Considerando as lesões bucais que necessitam de avaliação na atenção secundária, documentos de referência permitem avaliar a necessidade clínica e a urgência de cada caso, com impactos na priorização do acesso. A falta de detalhamento e concisão dos documentos de referência impacta na agilidade do fluxo do paciente entre os níveis de atenção à saúde e, consequentemente, na qualidade do cuidado a ele oferecido. Visando aprimorar o detalhamento dos documentos de referência em Estomatologia na região da Grande Florianópolis, Santa Catarina, foi desenvolvido o OralDESC - um roteiro de apoio à descrição de lesões bucais. O roteiro também vem sendo utilizado pelas disciplinas relacionadas ao Diagnóstico Bucal na Universidade Federal de Santa Catarina. Além de apresentar o roteiro, este trabalho procura ampliar a análise da questão, apresentando alguns desafios para a implantação dos complexos regulatórios no Brasil, bem como as dificuldades relatadas no país e em outras parte do mundo no que se refere à qualidade dos documentos de referência. Adicionalmente, apresenta a visão de alguns autores sobre o potencial educativo dos processos de referência e contrar-referência e a importância da formação para a comunicação escrita. São partilhadas, ainda, reflexões sobre a necessidade de inclusão, nos currículos acadêmicos, de atividades que permitam o desenvolvimento de habilidades de comunicação por estudantes de Odontologia, de forma a capacitá-los à atuação em redes de atenção que privilegiam a interação multiprofissional, interdisciplinar e transdisciplinar (AU).

Good written communication is an essential skill for the exchange of information between health professionals. In the context of Brazilian National Health Service, this exchange occurs via referral and reply letters. With regard to oral lesions that require evaluation in secondary care, referral letters allow the assessment of clinical need and the urgency for consultation with the oral health specialist. These factors determine the access priority in the secondary health system. The lack of details and conciseness of the referral letters impacts the patient flow throughout the healthcare levels and hence the quality of healthcare services. In order to improve the quality of information of the referral letters to specialists in Oral Medicine in the Greater Florianopolis city, Santa Catarina, Brazil, a guideline for supporting the description of oral lesions - the OralDESC ­ has been developed. The guideline is being used in the courses related to oral diagnosis consultations at the Federal University of Santa Catarina. This paper extends the analysis of the problem, discussing some challenges for the implementation of the referral procedures in Brazil as well as the difficulties reported in the country and in other countries regarding the quality of referral letters. Additionally, the paper provides views of some authors on the educational potential of referral and reply letters and the necessity of training health students for written communication. The authors share some thoughts about the need for inclusion of activities in the Brazilian Dentistry curricula aiming at developing communication skills in the students so as to prepare them to work in multidisciplinary, interdisciplinary and transdisciplinary teams (AU).

A experiência do SIG: diagnóstico bucal / The experience of the oral diagnosis Special Interest Group

A criação de Grupos de Interesse Especial (SIG, no acrônimo em inglês) nasceu de uma iniciativa da Rede Universitária de Telemedicina (RUTE), visando a colaboração remota entre profissionais da saúde. Nos SIGs, profissionais de saúde discutem temas específicos através de interação virtual. Este relato visa apresentar objetivos e modelos de funcionamento do SIG – Odontologia – Diagnóstico Bucal.

The Special Interest Groups (SIG) emerged from an initiative of Telemedicine University Network in Brazil, which aims remote collaboration between health professionals on the discussion of specific topics through virtual interaction. This report presents the objectives and operating model of SIG - Oral Diagnosis.

Plataforma colaborativa multimídia para apoio ao diagnóstico de lesões bucais em ambientes de teleodontologia / Collaborative multimedia platform to support oral diagnosis in teledentistry environments

Este artigo tem por objetivo apresentar uma solução tecnológica desenvolvida para permitir atividades colaborativas de diagnóstico de lesões bucais em ambientes de Teleodontologia. Trata-se de uma plataforma totalmente baseada na web e que permite o gerenciamento e compartilhamento de imagens clínicas, radiográficas e histopatológicas, dispensando a instalação de qualquer programa adicional no computador do usuário. Como suporte à colaboração através do navegador, as ações efetuadas por um usuário são replicadas e visíveis ao outro usuário conectado, sendo possível a discussão e troca de informações sobre o caso através de chat e/ou áudiovideoconferência. Ferramentas de Telessaúde podem ofereçe diferentes oportunidades para assistência e educação em Odontologia. Ao permitir a visualização de diferentes aspectos da doença do paciente, a solução aqui apresentada tem potencial para viabilizar: (1) a troca de informações entre profissionais de saúde atuantes em distintos níveis de assistência e (2) a tutoria, à distância, nos diferentes níveis de formação (graduação, pós-graduação e educação continuada) (AU).

This paper presents a technological solution developed to enabling collaborative activities in Teledentistry environments. This is a platform composed by a set of tools for the management and sharing of clinical, radio graphic and histopathologic images. The proposed solution is fully web-based, requiring only a web browser installed; it's not necessary to install any other software on the user's computer. As collaboration support, the actions performed by a user with mouse and keyboard are replicated and visible to the other connected user. This toolkit allows the discussion of disease via chat and/or videoconferen ing. Telehealth's tools offer opportunities for assistance and education in Dentistry. By allowing realtime viewing and discussion of different aspects of a disease this technological solution has potential to facilitate: (1) exchange of information between health professionals at different levels of assistance and (2) distance tutoring at different levels of training (undergraduate, postgraduate and continuing education) (AU).

Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.

Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions.

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.