A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Maxillary Surgical Ciliated Cyst After Orthognathic Surgery.

Surgical ciliated cysts, also known as implantation cysts or postoperative maxillary cysts, are uncommon cystic formations predominantly arising in the posterior maxillary region after radical maxillary sinus surgery. Herein, we present the case of a 28-year-old male patient who had previously undergone orthognathic surgery and later experienced a minor car accident without major consequences. Approximately four years after surgery, the patient sought dental care due to the presence of a painless swelling in the maxillary region. Upon intraoral examination, the swelling extended from the area around the right canine to the upper left molar, covered by red mucosa. Image studies revealed an extensive well-defined osteolytic lesion causing thinning, erosion, buccal cortical plate perforation, and root resorption. An incisional biopsy was performed, and microscopic examination revealed a cystic lesion lined by ciliated respiratory-type epithelium and capsule variably fibrotic with sparse chronic inflammation. The final diagnosis was surgical ciliated cysts. The treatment approach involved decompression followed by enucleation and curettage, with the addition of bone grafting and the application of Leukocyte-Platelet Rich Fibrin (L-PRF). The patient has been under clinical follow-up for approximately 17 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach. In conclusion, this case highlights the importance of accurate diagnosis and appropriate treatment approaches for surgical ciliated cysts to ensure favorable patient outcomes.

Basal cell adenocarcinoma of the soft palate: A closer look for an exceedingly rare salivary gland tumor.

Basal cell adenocarcinoma (BCAd) is an extremely rare primary biphasic carcinoma of the salivary glands with few well-documented cases reported in the literature. Herein, we report a rare case of a 44-year-old male patient who presented an oral medicine service with an erythematous nodular lesion on the soft palate, measuring 1.5 cm in its largest diameter, with a 5-year duration. The clinical diagnosis was pleomorphic adenoma, and an excisional biopsy was performed. Histopathological analysis revealed a biphasic infiltrative tumor composed of a mixture of central ductal cells and abluminal basal cells with slight atypia arranged in solid, trabecular, tubular and cribriform growth patterns in a loose stroma. The peripheral cells show a palisading arrangement with round hyperchromatic nuclei and scanty cytoplasm. Occasional mitotic figures were seen. Few spindle-shaped cells suggestive of myoepithelial cells were present in the stroma surrounding the basaloid tumor nests. The diagnosis was BCAd. The patient was referred to a head and neck service and has been followed up for 8 months with no signs of recurrence. In conclusion, although the diagnosis of BCAd can be challenging due to its rarity and morphological overlap with other salivary gland lesions, a meticulous morphological assessment is key for accurate diagnosis, especially in cases originating from minor salivary glands. Surgical excision with a wide safety margin is the treatment of choice and long-term follow-up is recommended to monitor possible recurrences.

Salivary gland tumors: A 13-year clinicopathologic retrospective study in a Brazilian northeast population.

Background: The present study aimed to evaluate the clinicopathologic features of salivary gland tumors (SGTs) in a Brazillian northeast population. Material and Methods: A retrospective descriptive cross-sectional study was performed (1995-2009). All cases of SGTs diagnosed in a private surgical pathology service in Brazil were reviewed, and clinicopathological data were collected. Results: A total of 23.258 histopathological records of biopsies were analyzed, and 174 cases were diagnosed as SGTs (0.7%). Of these, 117 (67.2%) were classified as benign, and 57 (32.8%) were malignant. The series comprised 89 females (51.1%) and 85 males (48.9%), with a mean age of 50.2 years (range: 3-96 years) and a roughly equal female-to-male ratio (1:1). Most tumors occurred in the parotid gland (n = 82, 47.1%), followed by the palate (n = 45, 25.9%), submandibular gland (n = 15, 8.6%). Pleomorphic adenoma (n = 83; 70.9%) and mucoepidermoid carcinoma (n = 19, 33.3%) were the most frequent benign and malignant tumors, respectively. After reevaluation of morphology and immunohistochemical analysis, seven tumors (4.0%) were reclassified following the current WHO Classification of the Head and Neck Tumors. Conclusions: The general features of SGT from the studied Brazilian population were similar to previously published reports in other countries. However, SGTs do not show any sex predilection. Although careful morphological analysis is the key to the correct diagnosis of these tumors, immunohistochemical analysis is essential to establish an accurate diagnosis in the face of challenging cases. Key words:Salivary gland tumors, epidemiology, head and neck pathology.

Immunoexpression of CXCL12 and CXCR4 in Radicular Cysts, Dentigerous Cysts, and Odontogenic Keratocysts.

The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs ( P <0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs ( P <0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs ( P <0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs ( P <0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs ( P >0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups ( P <0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.

A retrospective multicenter study of oral and maxillofacial lesions in older people

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Immunoexpression of CXCL12 and CXCR4 in sporadic and Gorlin-Goltz syndrome-related odontogenic keratocysts.

Background: Differences in the pathogenesis and biological behavior of sporadic and Gorlin-Goltz syndrome-related odontogenic keratocysts (OKCs) have been reported, but the underlying mechanisms are not fully elucidated. Chemokine CXCL12 and its main receptor CXCR4 regulate important events in the pathogenesis of several lesions. Material and Methods: This study evaluated the immunoexpression of CXCL12 and CXCR4 in sporadic and syndromic OKCs. Twenty-two sporadic OKCs and 22 syndromic OKCs were subjected to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. The results were analyzed statistically using the nonparametric Mann-Whitney test and Spearman correlation test (p<0.05). Results: Higher cytoplasmic expression of CXCL12 was observed in the epithelial lining and fibrous capsule of sporadic OKCs compared to syndromic OKCs (p<0.001). No statistically significant differences in the cytoplasmic expression of CXCR4 were observed between syndromic OKCs and sporadic OKCs (p>0.05). Compared to syndromic OKCs, sporadic OKCs exhibited higher nuclear expression of CXCR4 in the epithelial lining and lower immunoexpression in the fibrous capsule (p<0.05). In the epithelial lining of syndromic OKCs, positive correlation was observed between cytoplasmic and nuclear expressions of CXCR4 (p=0.003). In the fibrous capsule of syndromic OKCs and sporadic OKCs, cytoplasmic and nuclear expressions of CXCR4 were positively correlated (p<0.001). Conclusions: The results suggest a potential participation of CXCL12 and CXCR4 in the development of OKCs. The heterogeneous expression of these proteins in syndromic and sporadic OKCs may reflect differences in their pathogenesis and biological behavior. Key words:Odontogenic keratocyst, CXCL12, CXCR4, Immunohistochemistry.

Myofibroblasts and increased angiogenesis contribute to periapical cystic injury containment and repair

BACKGROUND: Myofibroblasts (MF) and angiogenesis are important factors in the development and expansion of cystic lesions, where these cells secrete growth factors and proteases, stimulating angiogenesis, matrix deposition and cell migration, affecting the growth of these periapicopathies. The present study aimed to evaluate the immunohistochemical expression of CD34 and Alpha-SMA in radicular cysts (RC) and residual radicular cysts (RRC), with the purpose of contributing to a better understanding of the expansion and progression of these periapical lesions. MATERIAL AND METHODS: The present study os a descriptive, quantitative and comparative analysis of positive CD34 and Alpha-SMA immunohistochemical expressions in 30 RC and 30 RRC specimens. Alpha-SMA expression was evaluated in the fibrous capsule of the lesions, at 100x magnification below the epithelial lining. A total of 10 higher immunostaining fields were selected and subsequently, positive cells were quantified at 400x magnification, averaged per field. Regarding the angiogenic index, immuno-labeled microvessel counts for the anti-CD34 antibody were performed in 10 fields at 200x magnification. RESULTS: Statistically significant differences regarding Alpha-SMA immunostaining were observed (p = 0.035), as well as a correlation between Alpha-SMA versus CD34 (p = 0.004) in RRC. However, the angiogenic index obtained by immunostaining for CD34 indicated no statistical difference between lesions. Intense inflammatory infiltrates were predominant in RC, while mild and moderate degrees were more commonly observed in RRC (p < 0.001). Intense inflammatory infiltrates were also more often noted in larger RRC (p = 0.041). Inflammatory infiltrates showed no significant correlation with α-SMA and CD34 immunostaining. CONCLUSIONS: The results indicate that the significant correlation found between the presence of MF and the angiogenic index are related to the repair process in RRC

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FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients.

Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients

Abstract Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma.

The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Tumores metastáticos para os maxilares: uma revisão integrativa / Metastatic tumors to the jaws: an integrative review

Introdução: Tumores metastáticos na região oral e perioral são extremamente raros. Objetivo: realizar uma revisão integrativa dos casos de metástases nos maxilares e sua relação com os tumores primários, os tipos histológicos e as principais localizações topográficas de ambos. Metodologia: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report e classical articles sobre o tema, utilizando os seguintes descritores: maxilares, mandíbula, maxila, metástases, incidência e seus mesh terms. Resultados: Foram incluídos um total de 35 artigos que cumpriam com todos os critérios. Foram ao todo 452 pacientes com metástases, dos quais 53.1% eram homens. A idade dos pacientes variou dos 4 meses a 90 anos. A mandíbula foi acometida em 55.7% dos casos, e a principal localização primária foi a mama, seguida pelo pulmão com 90 e 87 casos, respectivamente. Em 39% da amostra, os tumores primários eram desconhecidos. O adenocarcinoma foi o principal padrão histopatológico sendo encontrado em 30.3% da amostra. Conclusão: Os tumores metastáticos dos maxilares estão relacionados com um diagnóstico desafiador e tardio com prognóstico sombrio de curta sobrevida. Acometem mais comumente a região posterior mandibular entre a quinta e oitava décadas de vida, em ambos os sexos. O cirurgião dentista tem grande papel no diagnóstico precoce destas lesões. (AU)

Introduction: Metastatic tumors in the oral and perioral region are extremely rare. Objective: To aimed at performing an integrative review of the cases of metastases in the jaws and their relation to primary tumors, histological types and the topographic locations of both. Methods: A search was carried out in the MEDLINE, Google academic and LILACS databases using the following criteria: full articles published, from 2000 to 2016, in English, Portuguese and Spanish, case report and classical articles about the topic, using the following descriptors: jaws, mandible, maxilla, metastasis, incidence and their mesh terms. Results: 35 articles that fulfilled all the criteria were included. There were 452 patients with metastases, of which 53.1% were men. Patient's ages ranged from 4 months to 90 years. The mandible was affected in 55.7% of the cases, and the main primary sites were the breast and lung with 90 and 87 cases each, respectively. In 39% of the sample, the primary tumors were unknown. Adenocarcinoma was the main histopathological pattern found in 30.3% of the sample. Conclusion: Metastatic tumors of the jaws are related to a challenging and late diagnosis with gloomy prognosis of short survival. They most commonly affect the posterior mandibular region between the fifth and eighth decades of life, in both sexes. The dentist practitioner has a great role in the early diagnosis of these lesions. (AU)

Intraoral findings in newborns: prevalence and associated factors

Aim: To investigate the prevalence of intraoral characteristics and associated factors with neonatal and parent variables in a group of Brazilian newborns. Methods: This cross-sectional study with a descriptive and inferential approach, whose data was obtained through clinical examination, interview and the collection of medical record information. The sample was selected from babies up to three days old, of both sexes, and born between January and December 2013 in the Ana Bezerra University Hospital, in the city of Santa Cruz-RN, Brazil. The exposure variables included neonatal (sex, weight, gestational age, type of delivery and Apgar score) and parent (presence of systemic disease(s), drug use and consanguinity between the parents) variables. Descriptive analysis and Poisson regression were performed to estimate the ratio of gross and adjusted prevalence of intraoral findings (Epstein pearls, Bohn's nodule, dental lamina cyst and ankyloglossia) with the neonatal and parent variables (p<0.05). Results: Of a total of 168 examined newborns, 56.5% (n=95) were male. The most prevalent intraoral feature was the fibrous cord of Magitot, 62.5% (n=105), and the most frequent alteration was Epstein pearls, 44.6% (n=75). Female gender was a factor for Bohn's nodule (OR=0.90; 95%CI:0.82-0.99), and no tobacco use by the father was a protective factor for Epstein pearls (OR=0.73;95%CI:0.55-0.97). Additionally, lower mother's age, between 20-34 years of age (OR=1.58;95%CI:1.07-2.35) and under 19 years of age (OR=1.61; 95%CI:1.03-2.52) increases the chance of having Epstein pearls. Conclusion: There was a high prevalence of alterations in the newborns' oral cavities and there were associations between neonatal and parent variables

Riscos e complicações do uso de piercing oral: uma revisão sistemática / Risks and complications of the use of oral piercing: a systematic review

Introdução: O uso de piercing oral tem despertado o interesse dos profissionais da Odontologia devido à associação com diversas complicações locais e sistêmicas. Objetivo: Este trabalho objetivou realizar uma revisão sistemática da literatura sobre riscos e complicações associadas ao uso de piercings orais e periorais. Métodos: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando-se os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report, classical articles e reviews sobre o tema utilizando os seguintes descritores: body piercing, risks management, complications, risk e seus mesh terms. Resultados: Foram incluídos um total de 39 artigos relevantes que cumpriam com todos os critérios. Foi observado que os locais mais frequentemente utilizados para a colocação de piercing oral são os lábios e a língua. As complicações incluem inflamação, infecções locais e sistêmicas, lesões mucocutâneas, lesões vasculares, trauma dental, problemas periodontais, reações de hipersensibilidade, disfonia, deglutição e aspiração do piercing, e até morte etc. Conclusão: Conclui-se que o cirurgião dentista deve exercer um papel importante na orientação da população em geral sobre os riscos e as complicações associadas ao uso de piercing oral, visando evitar tal prática ou minimizar ao máximo os riscos e as complicações naqueles indivíduos que os possuem. (AU)

Introduction: The use of oral piercing has aroused the interest of dental professionals because of its association with various local and systemic complications. Objective: This study aimed to perform a systematic review on risks and complications associated with the use of oral and perioral piercings. Methods: We searched the MEDLINE, Google Scholar and LILACS databases using the following criteria: articles published in full text, from 2000 to 2016 in English, Portuguese and Spanish, case reports, classic articles and reviews about the topic using the following descriptors: body piercing, risk management, complications, risk and their mesh terms. Results: 39 relevant articles that fulfilled all the criteria were included. It has been observed that the most frequently used sites for an oral piercing placement are the lip followed by the tongue. The complications included inflammation, local and systemic infections, mucocutaneous lesions, vascular lesions, dental trauma, periodontal problems, hypersensitivity reactions, dysphonia, swallowing and aspiration of the piercing, and even death etc. Conclusion: Its was conclude that the dentist can play an important role in guiding the population about the risks and complications associated with the use of oral piercing, aiming to avoid such practice or minimizing the maximum the risk and complications in those individuals who possess them. (AU)

Multinucleated giant cell reaction in lower lip squamous cell carcinoma: a clinical, morphological, and immunohistochemical study.

BACKGROUND: Multinucleated giant cell (MGC) reactions have been identified in several malignancies, but their frequency and significance in lower lip squamous cell carcinoma (SCC) are not established. This study evaluated the MGC reactions and their association with clinicopathological parameters in lower lip SCCs. The polarization profile of these cells (M1 or M2 macrophages) was also assessed. METHODS: The presence and distribution of MGC reactions in high-power fields (400×) were evaluated in hematoxylin/eosin-stained histological sections of 91 lower lip SCCs. The histopathological grade of malignancy was evaluated using two grading systems (World Health Organization [WHO] and Malignancy Grading of the Deep Invasive Margins). The histiocytic nature (CD68) and polarization profile (M1-HLA-DR+ or M2-CD163+) of MGCs were evaluated by immunohistochemistry. RESULTS: Multinucleated giant cell reaction was identified in 36 (39.6%) cases, and its frequency was 3.3 times higher in well/moderately differentiated tumors than in poorly differentiated tumors (WHO grading system) (P = 0.006). For Malignancy Grading of the Deep Invasive Margins, the frequency was 2.03 times higher in highly/moderately keratinized tumors than in tumors with minimal/no keratinization (P = 0.012). No significant associations were observed between the presence/distribution of MGCs and clinical parameters (tumor size, lymph node metastasis, distant metastasis, and clinical stage) (P > 0.05). All MGCs were positive for CD68 and there was a predominance of HLA-DR+ over CD163+ MGCs (P = 0.031). CONCLUSIONS: Multinucleated giant cell reactions may not be involved in tumor progression in lower lip SCCs. In this microenvironment, MGCs tend to exhibit a predominantly M1 phenotype and may represent a foreign body reaction to SCC keratin pearls.

Perception of dental care among children

Children that arrive at dental offices with fear and anxiety usually tend to resist conditioning mechanisms. The aim this study was to evaluate children's perception about dental treatment and to identify factors that influence this perception. Material and Methods: A random sample of 100 children of both genders aged 3 to 12, who were treated at the Department of Dentistry of a University (group I) and at a Children's Hospital (group II), was selected. A structured questionnaire about the child's perception about dental care was applied and the children were asked to draw a picture of this topic. Most of children expressed a positive perception in the questionnaire and in the drawings (93.8%). This positive perception was more pronounced in group I (94%) and in children aged 3 to 5 years (100%), particularly in girls (78%). The main cause of fear was the use of needles (42.4%). Many children (24.2%) reported to prefer the noninvasive procedures. A positive perception of dental treatment was observed in the majority of the sample. Therefore, dental pediatricians must be aware of the perception of children for better conditioning (Au)

Association of immunoexpression of the galectins-3 and -7 with histopathological and clinical parameters in oral squamous cell carcinoma in young patients.

An increasing incidence of oral squamous cell carcinoma (OSCC) in individuals younger than 45 years has been observed in recent years. OSCC in younger patients differs in terms of biological behavior and prognosis with the disease being more aggressive than in older patients. The aim of this study was to analyze the immunohistochemical expression of galectins-3 and -7 in 32 cases of OSCC in young patients and to correlate this expression with clinical and morphological parameters. All cases of OSCC of the sample were diagnosed at oncology referral hospitals in Paraíba, Brazil, between 2002 and 2012. Clinical data were obtained from the patient records. Histological malignancy grading systems proposed by Bryne et al. (J Pathol 166:375-381, 1992) and the World Health Organization (In: Pathology and genetics of head and neck tumours: Word Health Organization classification of tumours, 2005) were used for morphological analysis. Immunohistochemistry was performed by the streptavidin-biotin technique using anti-galectin-3 and -7 antibodies. The results were analyzed statistically by the Chi-squared and Fisher exact tests (p < 0.05). Immunoexpression of galectin-3 was observed in 65.6 % of the cases analyzed, but showed no significant association with any of the variables studied (clinical staging; histological malignancy grading systems). Immunoexpression of galectin-7 was observed in 96.9 % of cases and was significantly associated with histological malignancy grading systems (p < 0.05). In conclusion, the results suggest the use of galectin-7 as marker of biological behavior and tumor progression in OSCC in young patients.

Primary adenocarcinoma of the colon with metastases to the mandible and liver: a case report / Adenocarcinoma primario de colon con metástasis en mandíbula e hígado: reporte de un caso

Metastatic lesions to the mandible may be originated from primary tumors elsewhere in the body. However, metastatic colonic carcinomas to this bone have been described infrequently. We report the case of a 71-year-old man with an adenocarcinoma in the sigmoid colon with liver metastasis. The patient underwent chemotherapy with indication of sigmoidectomy and retroperitoneal lymphadenectomy. One year and four months after the first metastatic diagnosis, the patient presented a tumor mass in the body and branch of the right mandible. Histopathological and immunohistochemical analysis with monoclonal antibodies specific for CEA, CK20, CDX-2, and vilin were compatible with the diagnosis of moderately differentiated metastatic adenocarcinoma with colonic origin. However, due to the wide spread of the disease, the patient died four months later. Tumor markers have been applied in clinical practice to assist in the diagnosis and to help guide prognosis, staging and treatment of cancer. The management of metastatic lesions remains a controversial issue and the development of new and more specific markers of gastrointestinal differentiation that may promote early diagnosis, are of continuous interest.

Las lesiones metastásicas de la mandíbula pueden surgir de los tumores primarios en cualquier partes del cuerpo. Sin embargo, el carcinoma metastásico de colon de este hueso se han reportado con poca frecuencia. Presentamos el caso de un hombre de 71 años de edad, con un adenocarcinoma de colon sigmoide con metástasis en el hígado. El paciente fue sometido a quimioterapia con indicación de sigmoidectomía y linfadenectomía retroperitoneal. Un año y cuatro meses después de la emisión del primer diagnóstico de la metástasis, el paciente presentaba una masa tumoral en el cuerpo y rama de la mandíbula derecha. El análisis histopatológico e inmunohistoquímico con anticuerpos monoclonales específicos para CEA, CK20, CDX-2, y vilin fueron compatibles con el diagnóstico de adenocarcinoma moderadamente diferenciado metastásico originario en el colon. Sin embargo, debido a la amplia propagación de la enfermedad, el paciente murió cuatro meses más tarde. Los marcadores tumorales se han aplicado en la práctica clínica para ayudar en el diagnóstico y ayudar a orientar el pronóstico, la estadificación y tratamiento del cáncer. Gestión de las lesiones metastásicas sigue siendo un tema controvertido, y el desarrollo de marcadores nuevos y específicos que promueven la diferenciación del diagnóstico precoz gastrointestinal, son de interés continuo.

Recurrent Oral Manifestations of Paracoccidioidomycosis without Pulmonary Involvement: Case Report and Review of Literature / Manifestación Oral Recurrente de Paracoccidioidomcosis sin Compromiso Pulmonar: Reporte de Caso y Revisión de la Literatura

This article describes a case of recurrence of chronic paracoccidioidomycosis (PCM) 11 years following the initial diagnosis. The patient was a 51-year-old white Brazilian female, which had been previously diagnosed with PCM. The physical examination revealed the presence of a single crusted lesion in the upper lip and an elevated lesion with fibrous scar appearance on right buccal mucosa. Although the diagnosis of PCM, the absence of pulmonary involvement led to the biopsy of the lesion localized on the buccal mucosa and the histopathological analysis in H&E and PAS stains revealed no morphological changes suggestive of any lesion. However, the exfoliative cytology stained with Grocott-Gomori showed the presence of Paracoccidioides brasiliensis and the infection caused by this fungus was proven. Of this way, we emphasize the importance of stomatologic evaluation to the diagnosis of diseases that usually manifestssystemically. So, the correct diagnosis of oral manifestations of PCM, is essential to ensure early and safe intervention.

En este artículo se describe un caso de paracoccidioidomicosis crónica (PCM) recurrente 11 años después del diagnóstico inicial. La paciente una mujer blanca de Brasil de 51 años de edad, que había sido diagnosticada previamente con PCM. El examen físico reveló la presencia de una lesión única en el labio superior y una lesión elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnóstico de PCM, la ausencia de compromiso pulmonar llevó a la biopsia de la lesión localizada en la mucosa bucal y el análisis histopatológico no demostró cambios morfológicos indicativos de cualquier lesión. Sin embargo, la citología exfoliativa teñida con Grocott-Gomori mostró la presencia de Paracoccidioides brasiliensis y la infección causada por este hongo fue probado. De esta manera, hacemos hincapié en la importancia de la evaluación odontológica para el diagnóstico de enfermedades que se manifiestan generalmente por vía sistémica. Por lo tanto, el diagnóstico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervención temprana y segura.