Oral pathology and oral medicine in Latin American countries: current stage.

BACKGROUND: Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. MATERIAL AND METHODS: A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. RESULTS: OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). CONCLUSIONS: Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.

Frequency of BRAF V600E immunoexpression in ameloblastomas: a multi-institutional analysis of 86 cases in Latin America and comprehensive review of the literature.

BACKGROUND: The initiation of odontogenic tumorigenesis often involves the activation of the MAP-kinase pathway, with a pivotal role played by the BRAF V600E mutation. This study aimed to investigate the frequency of BRAF V600E immunoexpresion in ameloblastomas diagnosed in four Latin American centers and correlate this finding with the histological types and subtypes of the analyzed cases. MATERIAL AND METHODS: A total of 86 samples of ameloblastomas were examined for immunohistochemistry using anti-BRAF V600E antibody. The histopathological features of each case were analyzed. RESULTS:  Positivity for anti-BRAF V600E antibody was detected in 65/86 cases (75.6%). BRAF V600E was positive in 38/56 cases (67.9%) of conventional ameloblastomas and in 27/30 cases (90.0%) of unicystic ameloblastomas. A statistically significant difference in BRAF V600E positivity was observed when comparing unicystic ameloblastomas to conventional ameloblastomas (p=0.03). No statistically significant difference in BRAF V600E positivity was observed when comparing histological variants, both for conventional ameloblastomas and unicystic ameloblastomas. CONCLUSIONS: This study highlights a high frequency of BRAF V600E immunoreactivity in ameloblastomas among Latin American cases. The prevalence of the BRAF V600E immunoexpresion may suggest the feasibility of utilizing BRAF-targeted therapy for ameloblastomas with this mutation.

Hallazgos bucales en pacientes COVID-19 / Oral Findings in Patients With COVID-19

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 varones (54,5%), con edades comprendidas entre uno y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en 2 pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60, 27,3 y 36,4%, respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron los síntomas comunes en estos pacientes (AU)

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms (AU)

[Translated article] Oral Findings in Patients With COVID-19 / Hallazgos bucales en pacientes COVID-19

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms (AU)

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 varones (54,5%), con edades comprendidas entre uno y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en 2 pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60, 27,3 y 36,4%, respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron los síntomas comunes en estos pacientes (AU)

[Oral Findings in Patients With COVID-19]. / Hallazgos bucales en pacientes COVID-19.

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms.

Oral Findings in Patients With COVID-19.

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms.

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 hombres (54,5%), con edades comprendidas entre 1 y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en dos pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60%, 27,3% y 36,4% respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron síntomas comunes en estos pacientes.

Expression of caveolin-1 in tooth germ, ameloblastoma and ameloblastic carcinoma.

BACKGROUND: The caveolin-1 protein (structural component of membrane caveolae) plays important roles in several biological functions, such as endocytosis, cell adhesion, and cell signaling. However, this protein has been associated with mechanisms of tumorigenesis in several neoplasms. The expression patterns and roles of caveolin-1 in the oral epithelium and in embryonic and odontogenic tumor tissues are still unclear. MATERIAL AND METHODS: The expression of caveolin-1 was evaluated in samples of the normal gingival epithelium (n=7), human tooth germ (TG) (n=12), ameloblastoma (AM) (n=83), and ameloblastic carcinoma (AC) (n=9) by immunohistochemistry. Additionally, AM samples were analyzed by qRT-PCR and Western blot. RESULTS: Most TG (91.7%), AM (73.5%) and AC (100%) samples showed diverse patterns of immunohistochemical positivity for caveolin-1, while only one gingival sample was positive. The transcript levels of cav-1 were significantly upregulated by 14.9-fold in AM tissue (P = 0.0014) compared to those in normal gingival epithelial tissue, as shown by qRT-PCR. Presence of caveolin-1 protein was confirmed by Western blot analysis. The caveolin-1 immunoexpression patterns throughout the stages of TG show its importance during odontogenesis. CONCLUSIONS: The overexpression of caveolin-1 in AM and AC compared to its expression in normal gingival epithelium (adult tissue) suggests a possible role of caveolin-1 in protumoral events, but due to the similar immunoexpression observed in AM and AC, caveolin-1 may not necessarily participate in the malignant transformation process. However, future studies are needed to clarify and confirm these hypotheses.

Caracterización de lesiones bucales de pacientes con enfermedad de Hansen / Characteristics of Oral Lesions in Patients With Hansen Disease

ANTECEDENTES Y OBJETIVO: La enfermedad de Hansen o lepra es una enfermedad causada por Mycobacterium leprae y Mycobacterium lepromatosis. Estas bacterias ingresan al organismo por las vías aéreas superiores, por lo que generan manifestaciones clínicas en la mucosa nasal y en la cavidad bucal. El objetivo del estudio es caracterizar las lesiones bucales de los pacientes con una enfermedad de Hansen. MATERIALES Y MÉTODOS: Se diseñó un estudio observacional, transversal, de 100 pacientes con diagnóstico de lepra. Se examinó la cavidad bucal y se registraron los hallazgos clínicos en una ficha epidemiológica. Además, se incluyó el estudio histopatológico de las lesiones que requirieron de una biopsia. Los casos sugestivos de lepra fueron teñidos y analizados con hematoxilina y eosina, Ziehl-Neelsen y Fite-Faraco. Las variables fueron analizadas y comparadas mediante las pruebas Chi2, correlación de Spearman y U de Mann-Whitney. RESULTADOS: El grupo de estudio estuvo conformado por 67 hombres y 33 mujeres, con una media (± desviación estándar) de 48,1±16,4 años de edad. Fueron observadas lesiones bucales en 34 pacientes. Las lesiones orales relacionadas con lepra, presentes en 9 pacientes, se ubicaron en el paladar duro y el labio superior. Estas fueron significativamente más frecuentes en la lepra lepromatosa, la borderline lepromatosa (p = 0,029) y en el eritema nudoso leproso (p = 0,031). CONCLUSIONES: Las lesiones bucales asociadas a lepra ocurren con una frecuencia baja, manifestándose como lepromas y placas leprosas en el paladar duro y el labio superior

BACKGROUND AND OBJECTIVE: Hansen disease, or leprosy, is caused by Mycobacterium leprae or Mycobacterium lepromatosis. Because these bacteria enter the body via the upper airways, they generate clinical manifestations in the nasal mucous membranes and the mouth. We aimed to describe the characteristics of oral lesions in patients with Hansen disease. MATERIAL AND METHODS: Cross-sectional observational study of 100 patients diagnosed with Hansen disease. We examined the oral cavity and recorded clinical findings on a disease reporting form for each patient. We also included the histopathologic findings for lesions that required a biopsy. Samples suggestive of Hansen disease were processed with hematoxylin-eosin, Ziehl-Neelsen, and Fite-Faraco staining. Variables were analyzed, as appropriate, with the χ2 test, the Mann-Whitney U test, or the Spearman correlation coefficient. RESULTS: Sixty-seven men and 33 women were included. The mean (SD) age was 48.1±16.4 years. Thirty-four patients had oral lesions. Lesions related to Hansen disease were found in 9 patients. The locations were the hard palate and upper lip. Oral lesions were significantly more frequent in patients with lepromatous leprosy, borderline lepromatous leprosy (P = .029), and erythema nodosum leprosum (P = .031). CONCLUSIONS: The frequency of oral lesions is low in Hansen disease. Such lesions present as lepromas and leprous plaques on the hard palate and upper lip

Characteristics of Oral Lesions in Patients With Hansen Disease. / Caracterización de lesiones bucales de pacientes con enfermedad de Hansen.

BACKGROUND AND OBJECTIVE: Hansen disease, or leprosy, is caused by Mycobacterium leprae or Mycobacterium lepromatosis. Because these bacteria enter the body via the upper airways, they generate clinical manifestations in the nasal mucous membranes and the mouth. We aimed to describe the characteristics of oral lesions in patients with Hansen disease. MATERIAL AND METHODS: Cross-sectional observational study of 100 patients diagnosed with Hansen disease. We examined the oral cavity and recorded clinical findings on a disease reporting form for each patient. We also included the histopathologic findings for lesions that required a biopsy. Samples suggestive of Hansen disease were processed with hematoxylin-eosin, Ziehl-Neelsen, and Fite-Faraco staining. Variables were analyzed, as appropriate, with the χ2 test, the Mann-Whitney U test, or the Spearman correlation coefficient. RESULTS: Sixty-seven men and 33 women were included. The mean (SD) age was 48.1±16.4 years. Thirty-four patients had oral lesions. Lesions related to Hansen disease were found in 9 patients. The locations were the hard palate and upper lip. Oral lesions were significantly more frequent in patients with lepromatous leprosy, borderline lepromatous leprosy (P = .029), and erythema nodosum leprosum (P = .031). CONCLUSIONS: The frequency of oral lesions is low in Hansen disease. Such lesions present as lepromas and leprous plaques on the hard palate and upper lip.

Salivary Factors Related to Caries in Children with Autism.

Many predisposing factors to caries are present in autism, however, it is unlikely that autistic patients exhibit higher caries indexes than the rest of the population. OBJECTIVE: To evaluate salivary factors related to caries in autistic patients. STUDY DESIGN: 34 autistics and 34 controls aged between 4-13 years old were included. Decayed, missing, and filled teeth (DMFT) index and oral hygiene simplified index (IHO-S) were assessed, as well as, pH, total proteins, phosphate, calcium and IgA in saliva. All data were analyzed by chi2 and Student t tests for independent samples. P values<0.05 were considered statistically significant. RESULTS: Autistic patients showed less caries than controls (p≤0.001), DMFT was 1±1 and 3±2 respectively (p≤0.001). In relation to IHO-S, values increased (p=0.008) in autistic patients (2.25±0.78) compared to controls (1.79±0.59), however Salivary ph means were similar (7.20±0.48 and 7.27±0.34 respectively). Decreased calcium levels (p=0.013) were observed in autistics (0.621±0.35 mmol/L) compared to controls (0.89±0.51 mmol/L), but phosphate levels were similar (6.17±4.22 M, 5.51±4.86 M respectively). When total proteins of saliva were assessed, autistics showed a slight increment (2.65±1.81 mg/mL) compared to controls (2.24±1.27 mg/mL) and zymography showed a higher proteolytic activity in autistic children. Finally, IgA concentration reached 116.55±90.97 µg/mL in autistics and 161.61 ± 193.37µg/mL (p=0.527) in the control group. CONCLUSIONS: Even though patients with autism exhibited a poorer oral hygiene, caries indexes were lower, calcium levels in saliva were found to be lesser and phosphate levels higher.

Cambios tisulares y celulares portabaquismo en mucosa bucal clínicamente sana: Estudio clínico transversal / Tissue and cellular changes related to smoking in clinically healthy oral mucosa: a cross sectional study

El presente estudio tuvo como propósito determinar los cambios tisulares y celulares que ocasiona el tabaquismo en la mucosa bucal de aspecto normal. Metodología: Se estudiaron 30 pacientes con edades comprendidas entre los 19 y los 29 años de edad, divididos en 3 grupos de acuerdo a su estatus tabáquico. De cada individuo se tomó una muestra de mucosa bucal aparentemente sana ubicada distal a la zona donde se realizó la incisión para la exodoncia de un tercer molar, la cual fue procesada y teñida con H&E. Las mucosas fueron evaluadas bajo microscopio de luz y los datos analizados estadísticamente. Resultados: El grupo de los individuos no fumadores presentó en un 100% epitelio paraqueratinizado a diferencia del grupo de individuos con tabaquismo que mostró en un 90% ortoqueratinización (p= 0,0001). El estrato basal se presentó intacto en el 100% del grupo de individuos no fumadores mientras que en el 60% de los fumadores se observó duplicado (p= 0,003). El infiltrado inflamatorio fue mayor en los fumadores pero no estadísticamente significativo, a diferencia de la vascularización que se observó estadísticamente disminuida en este grupo. Conclusión: La mucosa bucal en fumadores muestra numerosos cambios tisulares y celulares que pueden conllevar al desarrollo de lesiones malignas. La ausencia de cambios clínicos no implica que no exista el riesgo de transformación carcinogénica (AU)

The constant contact of cigarette smoke and its components with the oral mucosa leads to a series of microscopic architectural changes of the mucosa. The aim of the study was to determine tissue and cellular changes caused by smoking in the oral mucosa of normal appearance. Methods: 30 patients aged between 19 and 29 years of age were included in the study. Patients were divided into 3 groups according to their smoking status. A sample of oral mucosa was taken during extraction of third molar, and then processed and stained for H&E. Biopsies were evaluated under light microscope and the data analyzed statistically. Results: 100% of non-smokers showed parakeratinized epithelia and orthokeratin was observed in 90% of smoker cases (p= 0.0001). Basal layer was preserved in all healthy individuals, contrary to 60% of smokers showed basal hyperplasia (p= 0.003). Inflammatory infiltrated was observed augmented in smokers but difference was not statically significant. However, in this group number of blood vessels was statistically decreased. Conclusions: Oral mucosa of tobacco users shows tissue and cellular changes which may lead to malignant development. Carcinogenic risk may be present although absence of clinical changes (AU)

Cambios histopatológicos de la mucosa bucal de ratas expuestas al humo de cigarrillos / Histopathological oral tissues changes of rats exposed to tobacco smoke

Introducción: El propósito de esta investigación fue evaluar el efecto del humo del tabaco en la mucosa bucal"in vivo" usando un modelo animal. Materiales y métodos: La población de estudio estuvo constituida por 20 ratas hembras Sprague Dawley, 10 expuestas al humo de 10 cigarrillos diarios por 16 semanas (GEC) y un grupo control no expuesto (GC). Las ratas fueron sacrificadas y se extrajo la lengua para su estudio histopatológico. Variables categóricas fueron comparadas mediante la prueba U de Mann-Whitney. Valores p<0,05 fueron considerados estadísticamente significativos. Resultados: La mucosa lingual del GEC mostró mayores cambios epiteliales proliferativos que el GC, como hiperplasia basal (p= 0,001), acantosis (p= 0,0001), hipercromatismo y picnosis nuclear (p= 0,010 y 0,014 respectivamente), y displasia epitelial (p= 0,0001). En el corion de la mucosa del GEC se observó un incremento del infiltrado inflamatorio crónico (p= 0,007); y aunque no hubo aumento en el número de vasos sanguíneos en el GEC, es importante resaltar que la ubicación de los mismos fue muy próxima al epitelio de revestimiento expuesto al tabaco. Discusión: El presente estudio, usando un modelo animal, demuestra que el humo del tabaco induce cambios precoces en la arquitectura tisular y morfología de células epiteliales de la mucosa bucal de aspecto macroscópicamente sano (AU)

Introduction: The purpose of this study was to evaluate the histopathological changes in oral tissues of rats exposed to tobacco smoke. Materials & methods: 20 female rats Sprague Dawley were included in the study and 10 rats exposed to environmental tobacco smoke of 10 cigarettes daily for 16 weeks. All animals were sacrificed and tissues extracted, died using H&E and finally evaluated under light microscope. Categorical variables were compared using U Mann-Whitney test. P values<0.05 were considered statistically significant. Results: Oral mucosa of rats exposed to tobacco showed augmented epithelial changes as basal hyperplasia basal (p= 0,001), acanthosis (p= 0,0001), nuclear hyperchromatism and picnosis (p= 0,010 y 0,014 respectively), and epithelial dysplasia (p= 0.0001). Increased chronic inflammatory infiltrate was also observed in this group (p= 0.007), as well as, a higher number of blood vessels although difference was not statistically significant. Discussion: Tobacco inhalation showed to produce tissue alterations of macroscopically healthy mucosa of rats. This study, using an animal model, demonstrated microscopical oral mucosa changes produced by tobacco smoke without clinical alterations (AU)

Chondroid lipoma of the tongue: a report of two cases.

BACKGROUND: Chondroid lipoma affecting the oral cavity is rare and usually presents as a polyp of benign clinical appearance which is easily excised. However, the histopathological features of chondroid lipoma resemble liposarcoma due to the presence of lipoblasts and lack of mature cartilage. CASE REPORTS: The clinicopathological features of two cases of chondroid lipoma of the dorsum of the tongue, one in a 66-year-old woman and the other in a 43-year-old man, are described. CONCLUSION: Once the diagnosis had been established, no treatment other than surgical excision was necessary and in neither case has there been recurrence in two years of follow-up.

Lesión híbrida conformada por una lesión central de células gigantes y un fibroma osificante central: reporte de un caso y revisión de la literatura / Hybrid lesión composes by a central giant cell lesion and central ossifying fibroma: a case report and review of literature

Las lesiones híbridas son entidades poco frecuentes conformadas por elementos histopatológicos de distintas lesiones, la asociación de un Fibroma Osificante Central (FOC) con una Lesión Central de Células Gigantes (LCCG) es un ejemplo de ellas y representa el tipo más frecuentemente reportado en la literatura con diez casos hasta la fecha. A continuación presentamos el caso de una paciente de 24 años de edad, quien es referida al servicio de clínica estomatológica de la Facultad de Odontología, por presentar un aumento de volumen en la zona mandibular derecha que ocasiona asimetría facial, al examen intrabucal se observó una lesión tumoral de aproximadamente 2,5 cms. de diámetro y recubierta por mucosa bucal sana, que se extendía desde el canino inferior derecho hasta el segundo premolar del mismo lado (de 43 al 45). La paciente refiere una evolución de 3 meses y aparición posterior a un trauma. Se indican pruebas hematológicas y de vitalidad pulpar de los dientes involucrados, tomografía computarizada y biopsia Incisional, la cual concluye: LCCG asociada a FOC. Se trata con recesión quirúrgica total previo tratamiento endodóntico de los dientes involucrados y después de dos años la paciente se mantiene libre de recidiva. El reporte de este tipo de lesiones híbridas permitirá entender mejor en el futuro su comportamiento y a su vez brindar el tratamiento más adecuado a estos pacientes.

Hybrid lesions are rare entities formed by histopathological elements of different lesions, the association of a Central Ossifying Fibroma (COF) with a Central Giant Cell Lesion (CGCL) is an example of them and represents the most frequently reported type in the literature, only ten cases to date. We present the case of a 24 years female patient, who is referred to the dental clinic service to present a swelling in the right mandibular region causing facial asymmetry, the intra oral examination revealed a 2,5 cm lesion covered with healthy oral mucosa which extended from the distal aspect of lower right canine to the right second bicuspid, with 3 months evolution and associated to a trauma. Haematological tests, pulp vitality of involved teeth, CT scan and incisional biopsy were indicated, concluding a diagnosis of COF associated to CGCL. The decision was made to go for the surgical approach of the lesion with previous endodontic treatment of involved teeth and after two years the patient remains free of recurrence. The report of this type of hybrid lesions helps to understand their behavior and guides to the best treatment for these patients.

Pigmentación inusual del paladar asociada a imatinib. Reporte de caso clínico / Unusual pigmentation of palate associated to imatinib. A case report

Existen diversos factores que pueden inducir pigmentaciones en la mucosa bucal, entre ellos algunos fármacos tienen la capacidad de estimular la producción de melanina en el epitelio oral. Recientemente se ha demostrado que el mesilato de imatinib (Glivec®) usado como droga antineoplásica es capaz de producir como efecto adverso pigmentación de la mucosa bucal muy especialmente la del paladar. Se reporta el caso de una paciente de 56 años de edad bajo terapia con imatinib desde hace 8 años por padecer de leucemia mieloide crónica. Al examen clínico se observó una hiperpigmentación color azul grisácea en la totalidad del paladar óseo que al estudio histopatológico mostró acúmulo de melanina principalmente en el corion. La paciente se ha mantenido con la lesión en paladar bajo observación, sin cambios clínicos ni histopatológicos. Para establecer la asociación de este fármaco con la pigmentación en la mucosa bucal es necesario descartar otros factores inductores de melanosis además de considerar las características clínicas como coloración y ubicación de la lesión (AU)

There are several factors related to oral mucosa pigmentations, among them; some drugs may be able to induce melanin production in oral epithelia. Recently, it has been demonstrated that imatinib metylate (Glivec®), used to stop tumor growth, may cause oral pigmentation especially on the hard palate. A case is reported regarding a 56 year old female under imatinib treated since 8 years for chronic myeloid leukemia. Oral evaluation showed a diffuse blue/grey hyperpigmentation covering completely hard palate. Histopathologycal analysis revealed melanin accumulation in corion. Patient is under clinical surveillance, with no clinical changes. In order to establish the association between imatinib and oral pigmentation is necessary to discard other factors that may induce melanin production (AU)

Melanosis bucal asociada a tabaquismo inhalado en un grupo de venezolanos: estudio clínico transversal / Oral melanosis related to smoking in a group of venezuelans: cross sectional clinical study

El objetivo del presente trabajo fue determinar la prevalencia de melanosis asociada a tabaquismo en un grupo de individuos venezolanos. Metodología: Fueron evaluados clínicamente 50 individuos fumadores (grupo fumadores) (GF) y 50 individuos no fumadores (grupo control) (GC) (n=100) que acudían a consulta odontológica de rutina. Después de firmado el correspondiente consentimiento informado, los datos epidemiológicos fueron recolectados así como la presencia de melanosis en la mucosa bucal. La prevalencia y el riesgo de melanosis por tabaquismo fueron determinados mediante SPSS versión 17.0 Resultados: El GF estuvo constituido por 18 mujeres (36%) y 32 hombres (64%) con una media de edad de 32.98±13.56 años. El GC fue conformado por 30 mujeres (60%) y 20 hombres (40%) con una media de edad de 34.4±13.88 años. 20 individuos del GF mostraron melanosis en la mucosa bucal (40%), principalmente localizadas en la encía y sólo 1 individuo (2%) del GC presentó pigmentaciones generalizadas. La presencia de melanosis fue estadísticamente mayor en el GF (p=0.0001), así como el riesgo a tener la entidad cuando se fuma (OR=32.67; 95%IC 26.36 a 38.97). Conclusiones: La melanosis o pigmentaciones bucales, principalmente de la encía, fueron una lesión frecuente observada en los individuos fumadores estudiados. Una persona con tabaquismo tiene un riesgo 30 veces mayor que una persona no fumadora de desarrollar melanosis de la mucosa bucal especialmente en la encía de la zona anterior

The aim of this study was to determine the prevalence of melanosis associated with smoking in a group of Venezuelans. Methodology: 50 smokers (smoking group) (GF) and 50 nonsmokers (control group) (GC) (n=100) were clinically evaluated during a routine dental appointment. After signing the corresponding informed consent, epidemiological data and the presence of melanosis in the oral mucosa were collected. The data were statistically analyzed by SPSS version 11.0. The prevalence and risk of melanosis by smoking were determined. Results: The GF was formed by 18 women (36%) and 32 men (64%) with a mean age of 32.98 ± 13.56 years. The GC was formed by 30 women (60%) and 20 men (40%) with a mean age of 34.4 ± 13.88 years. GF 20 individuals showed melanosis of the oral mucosa (40%), mainly located in the gums and only 1 patient had pigmentation GC (2%) of generalized type. The presence of melanosis was statistically higher in the GF (p = 0.0001), and the risk of getting that condition when smoked (OR = 32.67, 95% CI 26.36 to 38.97). Conclusions: The oral melanosis or pigmentation, especially the gum, was a common injury in smokers studied. A person who smokes has a risk 30 times greater than a nonsmoker to develop melanosis of the oral mucosa especially in the anterior gingiva

Factores que influyen en la prevalencia de patologías bucales de tejidos blandos y duros de niños y adolescentes: revisión de la literatura / Factors affecting the prevalence of oral soft tissue pathology and hard of children and teens: literature review

El objetivo de este trabajo es hacer una revisión bibliográfica del tema, con el fin de actualizar los conocimientos relativos al mismo, considerando las variables involucradas y presentar una propuesta de línea de investigación, ya que como señalan algunos autores la edad pediátrica es una etapa de crecimiento rápido, desarrollo, de múltiples aptitudes en los campos de las áreas motoras, de la inteligencia, del lenguaje, de la personalidad y de la emocionalidad, por lo que constituye una edad crucial que requiere ser atendida eficazmente en la prevención de sus múltiples aspectos. La Organización Mundial de la Salud, (OMS), ha incrementado las recomendaciones epidemiológicas en los últimos años a este grupo poblacional, además los signos y síntomas de la mucosa bucal de los infantes pueden cambiar con la edad y son a menudo diferentes a las del adulto. Metodología: Se revisaron 34 publicaciones en revistas especializadas, todas referidas a escolares con edades comprendidas entre 6 y 14 años, aunque algunos se refieren a edades puntuales. Resultados: las patologías de los adolescentes difieren de la de los adultos, aunque existen pocas referencias; no hay acción definida en los planes y proyectos nacionales ni regionales para esta población; la mayoría de las patologías que ocurren en la cavidad bucal de esta población, son relativamente inocuas, no necesitan tratamiento, presentándose de forma asintomática y limitándose al desarrollo cronológico del niño. Conclusión: definir una línea de investigación, e incorporar la población de niños, niñas y adolescentes, por cuanto en Venezuela y América Latina, la investigación en esta área es limitada

The goal is to make a literature review of the subject, in order to update the knowledge relating to the subject, considering the variables involved and submit a proposal for a line of research, as some authors point out the Pediatric is rapid growth, development of multiple skills in the fields of motor areas, intelligence, language, personality and emotionality, for what constitutes a crucial age requiring to be dealt with effectively in the prevention of its multiple aspects. The World Health Organization, (who), the epidemiological recommendations has increased in recent years to this population group, also the signs and symptoms of the buccal mucosa of infants can change with age and are often different from the adult. Methodology: We reviewed 34 publications in specialized magazines, all relating to school children aged between 6 and 14 years old, although some refer to specific ages. Results: pathologies of adolescents differ from that of adults, although there are few references; There is no action defined in the plans and national and regional projects for this population; the majority of diseases that occur in the oral cavity of this population, are relatively harmless, do not need treatment, presenting of asymptomatic form and limited to the chronological development of the child. Conclusion: define a line of research, and to incorporate the population of children and adolescents, as in Venezuela and Latin America, research in this area is limited

Expresión de p53 y Ki-76 en ameloblastomas acantosos / Expression of P53 and KI-67 in ameloblastomas acanthomatous

El Ameloblastoma Acantomatoso es una variante histopatológica donde la parte central de las células Epiteliales Odontogénicas sufren una metaplasia escamosa. Este cambio biológico podría darle a esta forma de ameloblastoma características de mayor agresividad y recidiva. El objetivo del presente trabajo fue determinar la expresión de las proteínas p53 y Ki-67 en ameloblastomas acantomatosos. Metodología: 12 especímenes diagnosticados histopatológicamente como ameloblastoma acantomatoso fueron examinados y la expresión de p53 y Ki-67 determinada inmunohistoquímicamente usando los anticuerpos anti-humanos clones DO-7 y MIB-1 respectivamente (DAKO®). La expresión de ambas proteínas fue evaluada mediante microscopio de luz y la intensidad y número de núcleos positivos semicuantificados y analizados mediante estadística descriptiva. Resultados: La expresión de p53 fue observada en el 50% de los casos tanto en las células basales como centrales de las islas tumorales. La expresión de Ki-67 fue observada en el 66,7% de los casos, en su mayoría tanto en las células basales como tumorales y en su totalidad de fuerte intensidad. Conclusiones: La expresión de p53 y Ki-67 en los ameloblastomas acantomatosos sugiere una proliferación celular acelerada y por ende una mayor capacidad de crecimiento. Estas proteínas podrían conformar una herramienta para la selección de tratamientos más radicales en ameloblastomas que las expresen

Acanthomatous Ameloblastoma is a histopathological variant where the central portions of odontogenic epithelial cells undergo squamous metaplasia. This biological change could confer more aggressive features and recurrence to the tumour. The aim of this study was to determine the expression of p53 and Ki-67 in acanthomatous ameloblastoma. Methods: 12 specimens histologically diagnosed as acanthomatous ameloblastomas were examined and the expression of p53 and Ki-67 determined immunohistochemically using anti-human antibody clone DO-7 and MIB-1 respectively (DAKO ®). The expression of both proteins was assessed by light microscopy and the intensity and number of positive cells semi-quantified and analyzed using descriptive statistics. Results: The expression of p53 was observed in 50% of the cases both in the basal cells as tumor central islands. The Ki-67 expression was observed in intensely in 66.7% of cases, mainly on basal cell as central. Conclusions: The expression of p53 and Ki-67 in acanthomatous ameloblastomas suggests accelerated cell proliferation and therefore increased capacity for growth. Expression of these proteins may constitute a tool for prognosis and treatment selection

Evaluación clínica del adaptado de retenedores directos de dentaduras parciales removibles a extensión distal / Clinical evaluation of direct retainer adaptation in distal extension removable partial dentures

Introducción: El propósito del presente estudio fue evaluar clínicamente el adaptado de los retenedores directos en Dentaduras Parciales Removibles (DPR) a extensión distal y determinar si el diseño del retenedor empleado impactaba sobre el adaptado de la misma. Materiales y métodos: Fueron evaluados 84 sujetos a los cuales le fueron instaladas DPR. La evaluación del adaptado incluyó la utilización de un material de silicona fluida como sustancia detectora de contacto y con el uso de un calibrador digital se determinó la distancia del tope sobre el descanso. Este espacio fue calculado en mm y la media ± desviación estándar determinada. La relación entre el adaptado de los elementos del retenedor directo y el tipo de retenedor empleado se comparó aplicando las pruebas de chi cuadrado y t de Student considerando diferencias estadísticamente significativas cuando p<0,05. Resultados: Se evaluaron 168 retenedores directos, observando que solo el 9% contactaba en el centro del tope. El espacio promedio fue de 0,1892 ± 0,25216 mm y no se observó diferencia (p= 0,261) según el tipo de retenedor directo empleado. En los elementos retentivos y estabilizadores se observó que el contacto ocurría mayormente en la parte terminal o extremo y adaptado de estos elementos varió según el tipo de retenedor directo empleado (p= 0,0001). Discusión: En las DPR evaluadas el adaptado del retenedor directo al diente fue deficiente y el ajuste de los elementos retentivos y estabilizadores fue directamente asociado al diseño del retenedor. El uso de DPR es una solución práctica y de bajo costo para la rehabilitación protésica de gran parte de la población, sin embargo su cuidadoso diseño y el correcto adaptado de los retenedores deben considerarse estrictamente para garantizar la salud bucal del individuo (AU)

Introduction: The purpose of this study was to clinically evaluate the adaptation of direct retainers used in distal extension Removable Partial Dentures (RPD) and to determine the relationship between the retainer design and the adjustment of this element. Materials & methods: 84 subjects recently rehabilitated with RPD were included in the study. The evaluation process included the use of a fluid silicone material as a detection substance in addition to a digital gauge to determinate the distance of the rest upon the abutment teeth. Space was calculated in mm and mean± standard deviation determined. Adjustment of the retainers was compared using chi2 and t Student tests. P values<0,05 were considered statistically significant. Results: A total of 168 direct retainers were evaluated and only 9% contact in the center of the rest was observed. Average of space was 0,1892 ± 0,25216 mm and no difference was observed when type of retainers was compared (p= 0,261). On retentive and stabilizing elements of the direct retainers it was noted that contact occurs mostly on its terminal part, however, adjustment of those elements varied depending on the design of direct retainer used (p= 0,0001). Discussion: Direct retainer adjustment of RPD evaluated was deficient and adaptation of retentive and stabilizing elements was directly dependant on direct retainer design. RPD are a low cost and practical solution for population dental rehabilitation, nonetheless, correct prosthetic plan and strict adaptation of the denture are required to warrant an oral healthy status (AU)

Squamous cell carcinoma on the palate in a patient with systemic lupus erythematosus: case report and review of literature.

Squamous cell carcinoma is a rare consequence of lupus erythematosus and it is generally associated with skin lesions rather than with oral mucosa. This paper reports a patient diagnosed with systemic lupus erythematosus who developed a squamous cell carcinoma on the palate as an outcome of a persistent ulcer, a frequent lesion in patients with this disease and, in fact, clinical criterion for its diagnosis. A 38-year-old female patient diagnosed with systemic lupus erythematosus 12 years previously, who attended the dental school for routine dental control. The patient was being treated with prednisone 10 mg per day and cyclophosphamide 750 mg per month until 10 months prior to her diagnostic biopsy. She had, however, been previously treated with chloroquine. Oral lesions started 6 months before consultation as symptomatic multiple ulcers on the palate. After topical treatment with steroids for 1 month, the lesions regressed except for the central lesion, from which an incisional biopsy was taken and a well differentiated squamous cell carcinoma was diagnosed. The oncological phase consisted of partial palatectomy. To date, 3 years after surgery, the patient is free from malignant lesions. Lupus erythematosus is considered a potentially malignant disorder, although the cause for neoplasic transformation in these patients is still not clear, but cyclophosphamide consumption may be implicated; the case emphasizes the importance of periodical oral evaluation of such patients. Repeated biopsies should be performed if there is failure to respond to conventional therapy.