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

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

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

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

Uso de laser de alta potência para remoção de granuloma piogênico em palato: relato de um caso / Use of high power laser to remove piogenic granuloma in the palate: a case report

A laserterapia na área odontológica oferece ao paciente e ao profissional uma alternativa terapêutica em relação a métodos convencionais. O uso do laser de alta potência em procedimentos cirúrgicos apresenta inúmeras vantagens, uma vez que reduz o sangramento durante a diérese, proporciona uma boa visão do campo operatório e torna mais curto e conveniente o tempo do procedimento. O objetivo deste trabalho é relatar um caso de remoção cirúrgica de granuloma piogênico em palato mole com Laser de diodo de alta potência. A paciente do sexo feminino com 75 anos foi encaminhada à Clínica Escola de Odontologia com lesão em palato, com hipótese diagnóstica de granuloma piogênico. O tratamento de escolha foi a exérese da lesão com o Laser de diodo Thera Lase surgery (DMC equipamentos, São Carlos/SP, Brasil) 808nm, meio ativo de Gallium-Indium-Arsenide (InGaAs), 3500mW, 4J e frequência contínua, a amostra foi encaminhada para o Laboratório de Histopatologia oral para análise histopatológica, sendo confirmado como granuloma piogênico fibrosado. O Laser cirúrgico utilizado foi eficaz na excisão da lesão, permitindo excelente hemostasia, acesso cirúrgico à lesão e fácil manuseio, não ocorrendo intercorrências trans- e/ou pós-operatórias. Após 3 anos de acompanhamento periódico, não houve recidiva da lesão... (AU)

Laser therapy in the dental field offers the patient and the professional an alternative to conventional methods. The use of high-powered laser in surgical procedures has numerous advantages, since it reduces bleeding during the incision, provides a good view of the operative field, the procedure time becomes shorter and more convenient. The objective of this work is to report a case of surgical removal of pyogenic granuloma in the soft palate with a high-power diode laser. The 75 year old female patient was referred to the Dental School Clinic with a palate lesion, with a diagnostic hypothesis of pyogenic granuloma. The treatment of choice was the excision of the lesion with the Thera Lase surgery diode laser (DMC equipment, São Carlos / SP, Brazil) 808 nm, active medium Gallium-Indium-Arsenide (InGaAs), 3500mW, 4J and continuous frequency, the sample was sent to the Oral Histopathology Laboratory for histopathological analysis, being confirmed as fibrous pyogenic granuloma. The surgical laser used was effective in excising the lesion, hemostasis was satisfactory, handling was practical, easy access to the area to be excised, there was no intraoperative complication and no postoperative complications were reported. The patient after about 3 years of periodic follow-up is healthy and has no recurrence of the lesion... (AU)

Analyses of VEGFC/VEGF-D expressions, density and endothelial lymphatic proliferation in salivary gland neoplasms.

OBJECTIVE: The aim of this study was to assess vascular endothelial growth factor C (VEGF-C) and VEGF-D expressions, tumor lymphatic density (D2-40) and endothelial lymphatic proliferation (D2-40/Ki-67 double labeling) in a series of salivary gland neoplasm cases. MATERIALS AND METHODS: Twenty pleomorphic adenomas (PA), 20 adenoid cystic carcinomas (ACC) and 20 mucoepidermoid carcinomas (MEC) were assessed, as well as 10 normal minor salivary gland (SG) tissues for comparison. RESULTS: All cases presented positive VEGF-C expression in the peritumoral and intratumoral regions, and no differences in immunoexpression were detected between groups. However, the ACC group presented a significant difference in VEGF-C immunoexpression according to the predominant histological pattern. Most cases presented poor VEGF-D labeling in the peritumoral and intratumoral regions. Concerning peritumoral, intratumoral and total lymphatic endothelial density, the assessed groups revealed an increasing gradient, with lower values for PA, followed by MEC and ACC. CONCLUSION: No correlation was detected between VEGF-C and VEGF-D immunoexpression in relation to lymphatic tumor density and endothelial lymphatic proliferation. Western blotting (WB) revealed no difference between VEGF-C and VEGF-D expression among the lesions, corroborating the immunohistochemistry findings.

Consideração sobre os aspectos histopatológicos do adenoma pleomórfico em glândula parótida: relato de caso / Consideration upon histopathological aspects of pheomorphic adenoma in parotid gland: study case

Introdução: o adenoma pleomórfico é a neoplasia salivar mais comum. É observado um aumento de volume, indolor, fixo, de crescimento lento e firme à palpação. Objetivo: relatar um caso clínico em paciente do gênero masculino, 53 anos de idade, com queixa de aumento de volume no lado direito da face, além de sintomatologia dolorosa. Metodologia: o paciente foi submetido à biopsia excisional, com resultado anatomopatológico de adenoma pleomórfico e estudo imuno-histoquímico que demonstrou expressão positiva para citoqueratinas, proteína S-100, proteína p63 e calponina. Conclusão: após dois anos de proservação, o paciente não apresentou recidiva.

Introduction: pleomorphic adenoma is the most common salivary neoplasia. A painless, steady, slow-growing, firmly growing swelling is seen on palpation. Objective: To report a case of a fifty-three (53) year-old male patient complaining of swelling on the right side of the face, in addition to painful symptoms. Methodology: the patient underwent excisional biopsy, with anatomopathological result of pleomorphic adenoma and immunohistochemical study that showed positive expression for cytokeratins, protein S-100, protein p63 and calponine. Conclusion: After two years of proservation, the patient did not relapse.

Desordens orais potencialmente malignas: um estudo de prevalência / Potentially malignant oral disorders: a prevalence study

Este estudo realizou a prevalência das desordens orais com potencial de transformação maligna diagnosticadas nos pacientes atendidos pela Clínica-Escola de Odontologia da Universídade Federal de Campina Grande. A pesquisa foi realizada nos prontuários arquivados dos pacientes atendidos na clínica-escola. Os pacientes diagnosticados com lesão foram convidadas a comparecerem novamente à clínica-escola para a realização do controle clínico. De um total de 2.706 prontuários, foram encontrados 131 pacientes com desordens orais, revelando uma prevalência de 4,84%. A queilite actínica foi a mais frequente com 68 (50,4%) casos, seguida da leucoplasia com 61 (45,2%). Homens corresponderam a 85 (64,9%) casos; o tipo de pele mais comum foi o feoderma com 64 (48,8%), e a média de idade dos pacientes foi de 45,11 anos. Também foi observado que 89 (68%) pacientes não realizaram o tratamento preconizado para a lesão e que o resultado histopatológico mais comum foi a hiperceratose com 11 (18%) casos, seguida da displasia epitelial leve com 5 (8,2%) ocorrências. Com relação ao controle clínico, apenas 33 (25,2%) pacientes retornaram, sendo 22 livres da doença. Diante do exposto, conclui-se que a prevalência das desordens encontradas foi semelhante à prevalência mundial e que existe uma grande evasão por parte dos pacientes no tratamento e no controle clínico... (AU)

This study evaluated the prevalence of oral disorders with potential malignant transformation diagnosed in the patients attended by the Clinical School of Dentistry of the Federal University of Campina Grande. The research was carried out from medical files of patients attended at the school-clinic. Patients diagnosed with an injury were called to attend the school clinic again for clinical control. From a total of 2,706 medical records, 131 patients with oral disorders were found, showing a prevalence of 4.84%. Actinic cheilitis was the most frequent with 68 (50.4%) cases, followed by leukoplakia with 61 (45.2%). Men corresponded to 85 (64.9%) cases, the most common skin type was feoderma with 64 (48.8%), and the mean age of the patients was 45.11 years. It was also observed that 89 (68%) patients did not perform the recommended treatment for the lesion, and that the most common histopathological result was hyperkeratosis with 11 (18%) cases, followed by mild epithelial dysplasia with 5 (8.2%) occurrences. Regarding the clinical control, only 33 (25.2%) patients returned, being 22 free of the disease. In view of the above, it is concluded that the prevalence of the disorders found was similar to the worldwide prevalence and that there is a great deal of evasion by the patients to the treatment and in the clinical control... (AU)

Immunohistochemical expression of myofibroblasts, TGF-ß1 and IFN-γ in oral fibrous lesions.

OBJECTIVE: Analyze the presence of myofibroblasts (MFBs) in oral fibrous lesions and investigate TGF-ß1 and IFN-γ expression by immunohistochemistry during their differentiation. DESIGN: Twenty giant cell fibromas (GCFs), 20 fibromas (FIBs), and 20 fibrous hyperplasias (FHs) were selected. To evaluate the presence of MFBs, anti-α-SMA-immunoreactive cells were quantified in connective tissue. TGF-ß1 and IFN-γ expressions were evaluated in epithelial and connective tissue by determining the percentage of immunoreactive cells. RESULTS: Higher MFBs concentrations were observed in GCFs (median of 20.00), followed by FHs (15.00) and FIBs (14.00) (P = 0.072). No significant correlation between TGF-ß1 or IFN-γ immunoexpression and the number of MFBs in oral fibrous lesions was observed (P > 0.05). CONCLUSIONS: The higher density of MFBs found in GCFs, followed by FHs and FIBs, reaffirms the fibrogenic role of these cells, while the higher concentrations detected in GCFs, including evidence of giant MFBs, also suggest a role in the neoplastic behavior of these lesions. No correlation was observed between TGF-ß1 and IFN-γ in the myofibroblastic transdifferentiation process of the analyzed lesions.

Pleomorphic adenomas of the salivary glands: retrospective multicentric study of 130 cases with emphasis on histopathological features.

Pleomorphic adenoma (PA) is the most frequent benign epithelial lesion of salivary gland origin, showing great histopathological diversity. The aim of this study was to perform a retrospective analysis, with emphasis on histopathologic features of PA of salivary glands. Clinical and histopathologic characteristics of 130 cases of minor and major salivary glands PAs from three Brazilian reference centers were studied. Higher frequency of PAs was observed in female (55.4 %) subjects, with mean age of 49.7 years. The most common affected site was palate (64.5 %) for the PAs of minor salivary glands and parotid for cases affecting major glands (86.2 %). Microscopically, most cases were classified as classic PAs (50 %). Incomplete capsule was observed in 36.2 % of the cases, while 47.2 % showed capsular infiltration. Rounded (66.9 %), angular (49.2 %), oval (46.2 %) and plasmacytoid (39.2 %) cells were widely observed, as well as fibrous (73.8 %) and myxoid (69.2 %) stroma, squamous metaplasia (25.4 %) and cystic degeneration (43.1 %). Crystalloids (3.1 %), increased mitotic activity (5.4 %) and vascular invasion (2.3 %) were rarely observed. PAs arising in minor salivary glands were associated with incomplete capsules, spindle, oval, angular, plasmacytoid and pleomorphic cells, fibrous and hyaline stroma, cystic degeneration, squamous metaplasia and pleomorphism (p < 0.05). No association between capsular features and histological subtype was noted (p ≥ 0.05). These results confirm the findings of previous studies regarding major clinicopathological features of pleomorphic adenomas; and highlighted some important morphologic characteristics like the capsule, vascular invasion, pleomorphism and increased mitotic activity, which can reflect the biological behavior of these tumors.

Immunoexpression of cell proliferation markers in oral squamous cell carcinoma / Inmunoexpresiones de marcadores de proliferación celular en carcinoma de células escamosas orales

This study aimed to assess the immunoexpression of cell proliferation markers (Ki-67 and Mcm-2) in oral tongue cancer, correlating it with patients' age and prognostic indicators. Sample was composed of 22 cases under 40 years and 22 over 50 years of age. Clinical staging and histological grade of malignancy were obtained. Cell proliferation was evaluated through labeling indices. Statistical analysis was performed (p<0.05 for statistical significance). Most young patients were stages III/IV (n=13/65 %) and most older patients were stages I/II (n=11/61.1 %) (p>0.05). Mean Ki-67-LI in young and older patients was 42.4 % and 44.15 %, respectively (p>0.05). Mean Mcm-2-LI was higher in older (63.6 %) than in young patients (55.75 %) (p<0.05). We found that young patients presented more aggressive lesions in comparison to older patients, however Mcm-2 expression was significantly higher in older than in young patients. SCC of tongue can be more aggressive in young patients, and this may not be related to cell proliferation. Our findings for Mcm-2 LI and Ki-67 LI suggests that Mcm-2 could be a more sensitive marker for cell proliferation.

Este estudio tuvo como objetivo evaluar la inmunoexpresión de marcadores de proliferación celular (Ki-67 y Mcm-2) en el cáncer de lengua oral, correlacionándolo con la edad de los pacientes y los indicadores pronósticos. La muestra estuvo compuesta por 22 personas menores de 40 años y 22 personas mayores de 50 años. Se identificaron los estadios clínicos y el grado histológico de malignidad. La proliferación celular se evaluó mediante índices de marcado. Se realizó análisis estadístico (p <0,05 para significación estadística). La mayoría de los pacientes jóvenes eran estadios III / IV (n = 13/65 %) y la mayoría de los pacientes mayores eran estadios I / II (n = 11 / 61,1 %) (p> 0,05). La media de Ki-67-LI en pacientes jóvenes y mayores fue 42,4% y 44,15%, respectivamente (p> 0,05). La media de Mcm-2-LI fue mayor en pacientes mayores (63,6 %) que en pacientes jóvenes (55,75 %) (p <0,05). Se encontró que los pacientes jóvenes presentaron lesiones más agresivas en comparación con los pacientes mayores, sin embargo la expresión de Mcm-2 fue significativamente mayor en pacientes mayores que en pacientes jóvenes. SCC de la lengua puede ser más agresivo en pacientes jóvenes, y esto no puede estar relacionado con la proliferación celular. Nuestros hallazgos para Mcm-2 LI y Ki-67 LI sugieren que Mcm-2 podría ser un marcador más sensible para la proliferación celular.

Expressão de VEGF-C, VEGF-D, mensuração da densidade linfática e da proliferação endotelial linfática em neoplasias de glândulas salivar / Expression of VEGF-C, VEGF-D density measurement of lymphatic and lymphatic endothelial proliferation in salivary gland neoplasms

As neoplasias de glândulas salivares exibem uma grande diversidade morfológica e comportamentos biológicos variados o que suscita o interesse na pesquisa destas lesões. A disseminação das células tumorais é um passo inicial para a progressão de neoplasias malignas e, dentro deste contexto, os vasos linfáticos neoformados são considerados essenciais para que ocorra essa disseminação. O papel do VEGF (fator de crescimento endotelial vascular) na formação dos vasos é fato conhecido mas, pouco se sabe a respeito de sua participação em tumores de glândula salivar. Desta forma, o objetivo deste estudo foi avaliar a expressão do VEGF-C e VEGF-D, a densidade linfática tumoral (D2-40) e a proliferação endotelial linfática (dupla marcação D2-40/Ki-67) em uma série de neoplasias de glândulas salivares. A amostra foi composta por 20 adenomas pleomórficos, 20 carcinomas adenóides císticos, 20 carcinomas mucoepidermóides e 10 casos de tecido glandular salivar com características de normalidade para efeito comparativo. Todos os casos estudados exibiram expressão positiva para VEGF-C em região peritumoral e intratumoral, não sendo encontrada diferenças de imunoexpressão entre os grupos. No entanto, o grupo dos carcinomas adenóides císticos demonstrou diferença significativa da imunoexpressão do VEGF-C segundo o padrão cribriforme e sólido (p = 0,004). A maioria dos casos constantes do presente estudo, apresentou fraca marcação para VEGF-D em região peritumoral e intratumoral...

Salivary gland neoplasms exhibit a great morphological diversity and varied biological behavior which raises the interest in the study of these lesions. The spread of tumor cells is an early step in the progression of malignancies and the neoformed lymphatic vessels are considered essential in tumor dissemination. Vascular endotelial growth fator (VEGF) is a family of proteins involved in angiogenesis e lymphangiogenesis. However, in salivar tumors we have limited information on the expression. The aim of this study was to assess the expression of VEGF-C and VEGF-D, lymphatic vessel density (single-staining D2-40) and lymphatic endothelial proliferation (double labeling D2-40/Ki-67) in a series of salivary glands neoplasms. We selected 20 cases of pleomorphic adenoma, 20 of mucoepidermoide carcinoma, 20 of adenoid cystic carcinoma and 10 tissue sample of normal salivary gland. All cases studied showed positive expression of VEGF-C in intratumoral and peritumoral region, no differences in immunoreactivity was found between the groups. However, the group of adenoid cystic carcinoma showed a significant difference in immunoreactivity of VEGF-C by the cribriform and solid pattern (p = 0.004). Most of the cases included in this study showed weak immunoreactivity for VEGF-D in intratumoral and peritumoral region. In the assessment of lymphatic endotelial density peritumoral, intratumoral and total, the groups showed an increasing gradient, with lower values for the group of pleomorphic adenomas followed by mucoepidermoid carcinoma and adenoid cystic carcinoma. Lymphatic endothelial cell density was higher in malignant than benign tumors. No correlation was observed between the immunoreactivity of VEGF-C and VEGF-D in relation to tumor lymphatic density and lymphatic endothelial proliferation.

Associação entre líquen plano bucal e infecção pelo vírus da hepatite C: [revisão] / Association between oral lichen planus and hepatitis C virus infeccion: [review]

Objetivo: apresentar uma revisão da literatura sobre as evidências de implicação do Vírus da Hepatite C (VHC) na etiologia do líquen plano bucal (LPB), abordando alguns aspectos deste controverso tema. Material e métodos: foi realizada uma pesquisa bibliográfica através da Biblioteca Virtual em Saúde (BVS), identificando-se artigos publicados nas revistas indexadas nas seguintes bases de dados: BBO, LILACS e MEDLINE. De forma combinada utilizaram-se como descritores: hepatite C, líquen plano bucal e leucoplasia, considerando o intervalo de tempo de 10 anos (entre 1998 e 2008) e os idiomas: Português, Inglês e Espanhol. Dessa forma, foram incluídas 30 publicações. Resultados: verificou-se que a associação entre a infecção do HCV e o LPB foi investigada, mas a maioria dos resultados foi inconsistente. Conclusão: considerando os resultados obtidos estudos adicionais são recomendados para provar as hipóteses atuais a respeito da associação e da patogênese do líquen plano bucal à infecção pelo HCV.

Objective: to present a literature review of the evidence of involvement of the Hepatitis C Virus (HCV) in the etiology of oral lichen planus (OLP), addressing some aspects of this controversial topic. Material and methods: we performed a literature search through the Virtual Health Library (VHL), identifying articles published in journals indexed in the following databases: BBO, LILACS and MEDLINE. In combination were used as descriptors: hepatitis C, lichen planus and leukoplakia, considering the time span of 10 years (between 1998 and 2008) and languages: Portuguese, English and Spanish. Thus, 30 publications were included. Results: it was found that the association between HCV infection and the LPB was investigated, but most results were inconsistent. Conclusion: the results, additional studies are recommended to prove the current hypotheses about the association and the pathogenesis of lichen planus with HCV infection.

Marcadores biológicos e etiopatogenia do Líquen plano bucal / Association of removable partial prothesis with the fixed prothesis: a literature rewiew

O Líquen Plano Bucal (LPB) é uma doença mucocutânea inflamatória crônica que clinicamente apresenta-se de variadas formas como reticular, atrófica ou eritematosa e erosiva. Sua etiologia é desconhecida, embora seja considerada como uma doença auto-imune. As citocinas produzidas e liberadas por células do infiltrado inflamatório presentes no LPB são importantes para o recrutamento de novos linfócitos para o local da lesão e são capazes de estimular e inibir produção de novas citocinas sendo essenciais para exacerbação e perpetuação do LPB. O objetivo deste trabalho é fazer uma revisão de literatura sobre os marcadores biológicos e a etiopatogenia do LPB.

The Oral Lichen Planus (OLP) is a chronic inflammatory mucocutaneous disease that clinically presents itself in many ways as reticular, atrophic or erythematous and erosive. Its etiology is unknown, although it is considered as an autoimmune disease. Cytokines produced and released by inflammatory cells present in the OLP are important for the recruitment of new cytokines are essential for the perpetuation and exacerbation of OLP. The objective of this study is to review the literature on biological markers and the pathogenesis of OLP.

Perfil da pesquisa científica em odontologia realizada no Brasil / The scientific dental research profile in Brazil

É inegável o avanço científico observado na odontologia brasileira. Nesse sentido, a reunião anual da Sociedade Brasileira de Pesquisa Odontológica (SBPqO) é o maior e o mais importante encontro de pesquisadores nacionais. Este estudo objetivou determinar o perfil da pesquisa em odontologia realizado nas instituições brasileiras. Realizou-seum estudo retrospectivo, por meio da documentação indireta,através da análise dos trabalhos apresentados na 20a reunião anual da SBPqO. Foram avaliados 1.905 estudos, os quais foram classificados quanto à área de conhecimento do CNPq, à região e estado do país, à instituição, ao tipo de estudo e ao recebimento de fomento. Pesquisas envolvendo materiais dentários foram as mais prevalentes, com 34,4 porcento do total. A região sudeste concentrou o maior número de trabalhos(76,4 porcento), sendo o Estado de São Paulo responsável por 59,4 por cento da produção científica nacional. As instituições estaduais centralizaram 55,5 por cento das pesquisas, enquanto as federais,19,7 por cento do total de trabalhos. Quanto ao tipo de estudo, 70,6 por cento foram trabalhos experimentais e 29,4 por cento, observacionais. Com relação à obtenção de fomento, apenas 18,3 por cento dos trabalhos mencionaram ter recebido apoio de órgãos governamentais defomento à pesquisa. Conclui-se que há uma discrepância interregional e interestadual na produção científica brasileira, sendo as instituições públicas, a despeito das dificuldades,responsáveis pela maioria das pesquisas odontológicas desenvolvidas no Brasil