Clinical diagnostic approach for oral lymphomas: a multi-institutional, observational study based on 107 cases.

OBJECTIVE: To evaluate oral lymphomas' clinical manifestations and investigate whether clinical features are associated with lymphoma subtypes. STUDY DESIGN: Oral lymphomas with at least 1 representative clinical image were evaluated. They were classified according to their microscopic grade (high vs low), predominant cell size (small vs medium/large), and cellular lineage (B cell vs T cell). Clinical images were described according to tumor location, number, swelling, ulcer, necrosis, telangiectasia, predominant color, and lobulation. Lymphomas affecting the palate were compared with salivary gland tumors (SGTs) affecting this location. RESULTS: Data from 107 cases were included. High-grade subtypes (80.4%), with medium/large-sized cells (52.3%), and diagnosed as diffuse large B cell lymphomas (29%) predominated. High-grade lymphomas often presented as painful, ulcerative, and osteolytic diseases (P < .05). Tumors predominantly composed of medium/large-sized cells were associated with painful lesions, ulcerated, with necrosis and bone destruction (P < .05). When only palate tumors were considered, multiple and bilateral lesions, the presence of pain, ulceration, and necrosis were significantly more associated with a diagnosis of lymphoma than SGT (P < .001). CONCLUSION: High-grade oral lymphomas are more associated with destructive presentation than low-grade subtypes, and bilateral lesions in the palate are more associated with a lymphoma diagnosis than SGT.

Central giant cell granulomas of the jaws stromal cells harbour mutations and have osteogenic differentiation capacity, in vivo and in vitro.

BACKGROUND: Central giant cell granulomas (CGCG) of the jaws are osteolytic lesions that may behave aggressively and respond poorly to surgery. Microscopically, in addition to giant cells, there is a mononuclear cell population composed of macrophage/monocytic cells and spindle-shaped cells of mesenchymal origin. Seventy two percent of these tumours harbour mutually exclusive TRPV4, KRAS and FGFR1 mutations. We aimed to assess the mutational status of mononuclear and giant cells and the osteogenic potential of stromal cells in vitro and in vivo. METHODS AND RESULTS: We screened CGCG for signature mutations and used laser-capture microdissection to demonstrate that the mutations are restricted to the mononuclear cells. Additionally, we established CGCG primary cell culture and observed that the cells retained the mutations throughout passages. By flow cytometry, we observed predominance of CD14- CD51- CD61- cells, consistent with the expected profile for stromal cells. Considering the mesenchymal origin of stromal cells, we assessed the osteogenic differentiation potential of CGCG cells in culture by cytochemistry (von Kossa and alizarin red staining), alkaline phosphatase (ALP) activity assay and gene expression of osteogenic markers. CGCG cells presented self-capacity to increase ALP levels in a time-dependent manner and under osteogenic induction presented increasing number of calcium deposits, and overall higher expression of osteocalcin, RUNX2, ALPL and osteopontin than cells without osteogenic induction. A patient-derived xenograft model for CGCG was established, and osteoid material deposition was observed. CONCLUSION: Collectively, the results confirm that the signature mutations are restricted to stromal cells in CGCG, and the in vitro and in vivo results support that these cells have the capacity to differentiate into osteoblasts, in line with the bone formation often observed in the stroma of these lesions.

Unveiling metabolic changes in marsupialized odontogenic keratocyst: A pilot study.

OBJECTIVE: We aimed to assess which metabolic pathways would be implicated in the phenotypic changes of the epithelial lining of odontogenic keratocyst after marsupialization, comparing pre- and post-marsupialized lesions with adjacent oral mucosa. MATERIALS AND METHODS: Eighteen formalin-fixed and paraffin-embedded tissues from six subjects were divided into three paired groups: odontogenic keratocyst pre- (n = 6) and post-marsupialization (n = 6), and adjacent oral mucosa (n = 6). The metabolic pathways found in these groups were obtained by high-performance liquid chromatography-mass spectrometry-based untargeted metabolomics performed. RESULTS: Through putative metabolite annotation followed by pathway enrichment and predictive analysis with automated algorithms (Mummichog and Gene Set Enrichment Analysis), we found differences in many cellular processes that may be involved in inflammation, oxidative stress response, keratinocyte-basal membrane attachment, differentiation, and proliferation functions, all relevant to odontogenic keratocyst pathobiology and the phenotype acquired after marsupialization. CONCLUSION: Our study was able to identify several metabolic pathways potentially involved in the metaplastic changes induced by marsupialization of odontogenic keratocysts. An improved comprehension of this process could pave the way for the development of targeted therapies.

Unicystic ameloblastoma with stromal giant cells: A case series of a rare entity.

Ameloblastoma is a locally aggressive, benign epithelial odontogenic neoplasm currently classified to include conventional, unicystic, and extraosseous/peripheral subtypes. Giant cells have been reported in various malignancies but rarely in odontogenic neoplasms. To date, only a single case of unicystic ameloblastoma with stromal giant cells has been reported in the literature. We report two new cases with histologic features compatible with unicystic ameloblastoma with stromal giant cells. CD68 immunohistochemical staining of the giant cells supported a histiocytic origin. Further research is needed to better understand the origin and nature of these giant cells.

Aplicação do laser de baixa intensidade no tratamento do eritema multiforme: relato de caso / Low intensity laser application in the treatment of erythema multiforme: case report

Objetivo: Este trabalho tem como objetivo relatar um caso de Eritema Multiforme (EM) menor desencadeado por amoxicilina oral, tratado a partir de aplicação de laser de baixa intensidade na região afetada pela doença. Relato de caso: Paciente de 12 anos, atendido no Hospital Metropolitano Odilon Behrens (HMOB), apresentando úlceras em mucosa jugal, lábios e língua, disfagia, dislalia e febre, recebeu diagnóstico clínico de EM e tratamento com aplicação de laser vermelho de baixa intensidade, emitindo em 660nm, com potência de 100mW, sendo aplicado uma dose de 33 J/cm², em pontos com distância aproximada de 1 cm entre eles. Houve resolução das lesões em 7 dias após instituição do tratamento. Conclusão: O presente trabalho mostrou que a Terapia de Fotobiomodulação (TF) com laser de baixa intensidade associado à substituição do medicamento detectado como causa foram fundamentais para a resolução do EM, evidenciando as propriedades bioestimulantes do laser nas lesões ulceradas de mucosa bucal.

Aim: This paper aims to report a case of minor Erythema Multiforme (EM) triggered by oral amoxicillin, treated with low-level laser applications in the region affected by the disease. Case report: A 12-year-old patient, treated at the Metropolitan Hospital Odilon Behrens, presenting ulcers in the buccal mucosa, lips, tongue, dysphagia, dyslalia, and fever, received a clinical diagnosis of EM and treatment with low-intensity red laser applications, emitted at 660 nm, with a power of 100 mW, with a dose of 33 J/cm² being applied, in points with an approximate distance of 1 cm between them. The lesions resolved within 7 days after treatment were instituted. Conclusion: This present paper shows a successful therapeutic, non-pharmacological alternative for the management of EM, showing the bio stimulating properties of laser in ulcerated lesions of the oral mucosa.

KRAS mutations in brown tumor of the jaws in hyperparathyroidism.

BACKGROUND: Brown tumors are giant cell-rich lesions that result from abnormal bone metabolism in hyperparathyroidism, one of the most common endocrine disorders worldwide. Brown tumors occasionally affect the jaws and, despite well-known clinical and microscopic features, their molecular pathogenesis remains unclear. We investigated the presence of pathogenic activating mutations in TRPV4, FGFR1, and KRAS in a cohort of brown tumors since these have recently been reported in giant-cell lesions of the jaws and non-ossifying fibromas of the bones (FGFR1 and KRAS), which are histologic mimics of brown tumors. METHODS: We target sequenced 13 brown tumors of the jaws associated with primary or secondary hyperparathyroidism. As mutations in these genes are known to activate the MAPK/ERK signaling pathway, we also assessed the immunostaining of the phosphorylated form of ERK1/2 (pERK1/2) in these lesions. RESULTS: KRAS pathogenic mutations were detected in seven cases (p.G12V n = 4, p.G12D n = 1, p.G13D n = 1, p.A146T n = 1). KRAS variants of unknown significance (VUS), p.A134T and p.E37K, were also detected. All samples showed wild-type sequences for FGFR1 and TRPV4 genes. The activation of the MAPK/ERK signaling pathway was demonstrated by pERK1/2 immunohistochemical positivity of the brown tumors´ mononuclear cells. CONCLUSION: Mutations in KRAS and activation of the MAPK/ERK signaling pathway were detected in brown tumors of hyperparathyroidism of the jaws, expanding the spectrum of giant cell lesions whose molecular pathogenesis involve RAS signaling.

Odontologia hospitalar no Brasil: onde estamos? Uma análise do cenário dos últimos anos / Hospital dentistry in Brazil: where are we? An analysis of the scenario of the past few years

A Odontologia Hospitalar visa à manutenção e aos cuidados prestados a pacientes sob internação hospitalar. O cirur-gião-dentista é um profissional devidamente capacitado para identificação, prevenção e tratamento de alterações na cavidade bucal. A inserção do CD em ambiente hos-pitalar tem sido instituída mediante resoluções e leis para beneficiar quem carece desse atendimento. Sendo assim, o objetivo deste trabalho é apresentar trajetória da Odontologia Hospitalar no Brasil, verificar seu panorama atual e mostrar sobre a importância desse profissional na equipe multidisciplinar dos hospitais. As buscas foram realizadas, entre os anos de 2001 e 2019, em bases de dados bibliográficos nacionais e como complemento no manual de odontologia hospitalar, em matérias publicadas pela Agência Nacional de Vigilância Sanitária e em leis publi-cadas nos diários oficiais dos municípios, estados e união. Os dados mostram que muitos estados já se adequaram, do ponto de vista legal, no sentido de tornar a Odontologia Hospitalar uma realidade. No entanto, ainda falta fiscaliza-ção e profissionais ocupando todos os postos de trabalho. Logo, percebe-se que a última década foi decisiva em prol da Odontologia Hospitalar, mas ainda há muito o que se fazer para que novos avanços aconteçam.

Hospital Dentistry aims at the maintenance and care provided to patients under hospitalization. The dental surgeon is a professional duly trained to identify, pre-vent and treat changes in the oral cavity. The insertion of the DS in a hospital environment has been instituted through resolutions and laws to benefit those who need this service. Therefore, the objective of this work is to present the trajectory of OH in Brazil, to verify its cur-rent panorama and to show about the importance of this professional in the multidisciplinary team of hospitals. The searches were carried out between 2001 and 2019 in national bibliographic databases and as a complement to the hospital dentistry manual, in articles published by the National Health Surveillance Agency and in laws published in the official diaries of the municipalities, states and union. The data show that many states have already adapted, from the legal point of view, to make hospital dentistry a reality. However, inspection and professionals are still lacking in all jobs. Therefore, the last decade has been decisive in favor of hospital dentistry, but there is still a lot to be done for new advances to happen.

Adenoid ameloblastoma in the posterior maxilla: a case report and review of the literature.

INTRODUCTION: Adenoid ameloblastoma is a rare benign odontogenic tumor that favors a slight predilection for male patients, fourth and fifth decades of life, and posterior regions of the jaws. To date, less than 40 cases have been reported in the English language literature. The radiographic aspects of adenoid ameloblastoma vary from unilocular and well-defined lesions to diffuse and multilocular lesions. Most of the lesions exhibit a radiolucent image and are usually large, with a mean size of 3.5 cm. Microscopically, pseudoductal structures composed of columnar cells in a palisaded arrangement formed from the parenchyma of the tumor were observed. CASE PRESENTATION: We describe a case of adenoid ameloblastoma in a 54-year-old woman, who presented with no symptoms. Panoramic radiography showed a well-circumscribed, unilocular radiolucency in the left posterior maxilla. CONCLUSION: As odontogenic tumors are rare, some entities are infrequently encountered, making the diagnosis more difficult. Clinicians, oral and maxillofacial surgeons and oral pathologists should be familiar with the adenoid ameloblastoma and its differential diagnosis for accurate diagnosis and management.

DNA methylation patterns of genes related to immune response in the different clinical forms of oral lichen planus.

BACKGROUND: The oral lichen planus is a chronic inflammatory disease. Although its aetiology is not well understood, the role of T lymphocytes in its inflammatory events is recognised. Identifying the epigenetic mechanisms involved in the pathogenesis of this immune-mediated condition is fundamental for understanding the inflammatory reaction that occurs in the disease. The purpose of this work was to evaluate the methylation pattern of 21 immune response-related genes in the different clinical forms of oral lichen planus. METHODS: A cross-sectional study was performed to analyse the DNA methylation patterns in three distinct groups of oral lichen planus: (i) reticular/plaque lesions; (ii) erosive lesions; (iii) normal oral mucosa (control group). After DNA extraction from biopsies, the samples were submitted to digestions by methylation-sensitive and methylation-dependent enzymes and double digestion. The relative percentage of methylated DNA for each gene was provided using real-time polymerase chain reaction arrays. RESULTS: Hypermethylation of the STAT5A gene was observed only in the control group (59.0%). A higher hypermethylation of the ELANE gene was found in reticular/plaque lesions (72.1%) compared to the erosive lesions (50.0%). CONCLUSION: Our results show variations in the methylation profile of immune response-related genes, according to the clinical type of oral lichen planus after comparing with the normal oral mucosa. Further studies are necessary to validate these findings using gene expression analysis.

MicroRNA profiling reveals dysregulated microRNAs and their target gene regulatory networks in cemento-ossifying fibroma.

BACKGROUND: Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm of uncertain pathogenesis, and its treatment results in morbidity. MicroRNAs (miRNA) are small non-coding RNAs that regulate gene expression and may represent therapeutic targets. The purpose of the study was to generate a comprehensive miRNA profile of COF compared to normal bone. Additionally, the most relevant pathways and target genes of differentially expressed miRNA were investigated by in silico analysis. METHODS: Nine COF and ten normal bone samples were included in the study. miRNA profiling was carried out by using TaqMan® OpenArray® Human microRNA panel containing 754 validated human miRNAs. We identified the most relevant miRNAs target genes through the leader gene approach, using STRING and Cytoscape software. Pathways enrichment analysis was performed using DIANA-miRPath. RESULTS: Eleven miRNAs were downregulated (hsa-miR-95-3p, hsa-miR-141-3p, hsa-miR-205-5p, hsa-miR-223-3p, hsa-miR-31-5p, hsa-miR-944, hsa-miR-200b-3p, hsa-miR-135b-5p, hsa-miR-31-3p, hsa-miR-223-5p and hsa-miR-200c-3p), and five were upregulated (hsa-miR-181a-5p, hsa-miR-181c-5p, hsa-miR-149-5p, hsa-miR-138-5p and hsa-miR-199a-3p) in COF compared to normal bone. Eighteen common target genes were predicted, and the leader genes approach identified the following genes involved in human COF: EZH2, XIAP, MET and TGFBR1. According to the biology of bone and COF, the most relevant KEGG pathways revealed by enrichment analysis were proteoglycans in cancer, miRNAs in cancer, pathways in cancer, p53-, PI3K-Akt-, FoxO- and TGF-beta signalling pathways, which were previously found to be differentially regulated in bone neoplasms, odontogenic tumours and osteogenesis. CONCLUSION: miRNA dysregulation occurs in COF, and EZH2, XIAP, MET and TGFBR1 are potential targets for functional analysis validation.

Osteonecrose dos Maxilares Associada ao uso de Bisfosfonatos / Osteonecrosis of the Jaws Associated with the use of Bisphosphonates

Os bifosfonatos são uma classe de medicamentos, que têm por função a inibição da atividade dos osteoclastos, interferindo na remodelação e no turnover ósseo. São indicados para retardar a metástase óssea em algumas condições malignas, como em mielomas múltiplos, câncer de mama e próstata, e outras condições benignas, como no tratamento da doença de Paget e da osteoporose. Desde 2003, estudos têm associado a osteonecrose avascular dos ossos maxilares ao uso dos bifosfonatos. Dentre os mecanismos de ação dos bifosfonatos, podemos citar a sua atividade antiosteoclástica e antiangiogênica, que altera o metabolismo ósseo, inibindo a reabsorção óssea e diminuindo o turnover ósseo. As exposições ósseas maxilo-mandibulares ocorrem após procedimentos cirúrgicos odontológicos ou, menos comumente, após o uso de próteses apoiadas na fina mucosa de revestimento ósseo da cavidade bucal. O tratamento da osteonecrose associada aos bifosfonatos (OAB) é bastante variado, controverso e desafiador, visto que nenhum tratamento efetivo tem sido proposto até o momento. O objetivo desse relato de caso é descrever a ocorrência de áreas de exposição óssea mandibular em um paciente que fez uso do ácido zolendrônico (Zometa®) bem como apresentar a abordagem terapêutica realizada que resultou em completo recobrimento mucoso das áreas ósseas expostas... (AU)

Biphosphonates are a class of drugs whose function is the inhibition of osteoclast activity, interfering in remodeling and bone turnover. They are indicated to delay bone metastases in some malignancies such as multiple myeloma, prostate cancer and other benign conditions such as in the treatment of Paget's disease and osteoporosis. Since 2003, studies associate avascular osteonecrosis of the jaws to the use of bisphosphonates, especially intra venous. Among the mechanisms of action of bisphosphonates are their osteoclastic and antiangionenic activity which alters bone metabolism, inhibiting bone resorption and reducing bone turnover. Maxillo-mandibular bone exposures occur after surgical dental procedures or less commonly after the use of prostheses supported on thin bone lining mucosa of the buccal cavity. The treatment of osteonecrosis associated with biphosphonates (OAB) is quite varied, controversial and challenging, since no effective treatment has been proposed until this moment. The purpose of this case report is to describe the occurrence of areas of mandibular bone exposure in a patient with history of use of Zolendronic Acid (Zometa) and present the therapeutic approach undertaken which resulted in full mucous covering of the exposed bony áreas... (AU)

Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients.

Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease.

Mucosal leishmaniasis in Brazilian patients: two case reports with similar clinical presentation and different approaches.

Mucosal leishmaniasis is a chronic infection that affects the upper respiratory tract and/or the oral mucosa caused by Leishmania protozoan parasites. We present two cases of oral leishmaniasis and discuss the different diagnostic strategies and treatment. In both cases, the patients were male, 60 and 94 years of age, and presented with lesions on the soft palate. In the first patient, the final diagnosis was made on the basis of histopathologic examination. In the second case, polymerase chain reaction and Montenegro skin test were necessary to confirm the diagnosis. The first patient was treated with meglumine antimoniate (Glucantime), and the lesions healed after 2 months. In the second case, the patient received treatment with liposomal amphotericin B but later died as a result of generalized infection. Mucosal leishmaniasis is a highly disfiguring disease. Early diagnosis is important to prevent a lethal outcome.

Desmoplastic fibroblastoma (collagenous fibroma) of the oral cavity.

UNLABELLED: Desmoplastic fibroblastoma is benign soft tissue tumor, with fibroblastic or myofibroblastic origin, that rarely occurs in oral cavity. We reported the case of a 56-year-old man who presented a tumor in the left mandibular alveolar ridge, with slow and asymptomatic growth, with no osseous involvement. The tumor was sessile with lobulated surface, covered by healthy mucosa with erythematous areas. The lesion was excised and specimens sent to histopathology and immunohistochemistry. Histopathological exam showed a non-encapsulated fibroblastic proliferation, characterized by myofibroblasts, spindle and stellate fibroblasts with large or oval nuclei and bi or tri nucleation, immersed in an abundant hypocellular dense collagen stroma. Tumor cells were positive for vimentin, HHF35, α-smooth muscle actin and factor XIIIa. The diagnosis of desmoplastic fibroblastoma was based in the clinical history of absence of trauma related to the growth in the alveolar ridge, associated with macroscopic, microscopic and immunohistochemical features. The patient is free-diseases by eight months. KEY WORDS: Collagenous fibroma, desmoplastic fibroblastoma, neoplasm of connective and soft tissue.

Análise da prevalência de carcinoma de células escamosas da cavidade bucal no Serviço de Estomatologia do Hospital Metropolitano Odilon Behrens em Belo Horizonte, Minas Gerais / Analysis of the prevalence of squamous cell carcinoma of the oral cavity in the Stomatology Service of Hospital Metropolitano Odilon Behrens in Belo Horizonte, Minas Gerais, Brazil

O objetivo desse trabalho foi determinar a prevalência de carcinoma de células escamosas (CCE) em pacientes atendidos no serviço de Estomatologia do Hospital Metropolitano Odilon Behrens (HMOB) de Belo Horizonte (BH) no período de maio de 2012 a maio de 2014. Métodos: Trata-se de um estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva de prontuários de pacientes atendidos no serviço de Estomatologia do HMOB, com abordagem quantitativa dos dados. Resultados: Foram avaliados 139 prontuários de pacientes diagnosticados com CCE. Quanto à faixa etária dos pacientes diagnosticados, houve maior prevalência em torno da 5ª e 6ª década de vida. Em relação ao gênero, o sexo masculino foi o mais atingido em todas as faixas etárias. Com relação aos principais fatores de risco, 60 pacientes (75,94%) relataram ser tabagistas e etilistas. Quanto à classificação dos pacientes em relação ao consumo diário de tabaco, 33 (50%) foram considerados tabagista grave (mais de 20 cigarros/ dia). Em relação ao tamanho das lesões, uma larga parcela dos pacientes (48,51%) diagnosticados com CCE de cavidade bucal, apresentaram lesão medindo de 30 a 60 mm. Na distribuição dos pacientes segundo a localização anatômica e sexo, a língua foi o sítio mais acometido (32,82%), seguido do assoalho bucal (29,95%), em ambos os gêneros. Conclusão: Este estudo mostrou, de forma pioneira, o perfil epidemiológico dos pacientes diagnosticados com câncer da cavidade bucal no Serviço de Estomatologia do HMOB, referência na região de Belo Horizonte. Percebe-se que houve uma preponderância de pacientes do sexo masculino, faixa etária acima dos 50 anos e que faz uso frequente de tabaco e\ou álcool.(AU)

Objective: This study aimed to determine the prevalence of squamous cell carcinoma (SCC) in patients who received dental care at the Stomatology Service of Hospital Metropolitano Odilon Behrens (HMOB) in Belo Horizonte, MG, Brazil, from May 2012 to May 2014. Methods: This is a cross-sectional, epidemiological study based on the retrospective and descriptive analysis of the medical records of patients who received dental care at the HMOB Stomatology Service, using a quantitative data approach. Results: This study evaluated 139 medical records of patients diagnosed with SCC. Regarding the age of the diagnosed patients, a higher incidence was observed around the fifth and sixth decades of life. Regarding gender, males were the most affected in all age groups. Regarding the main risk factors, 60 patients (75.94%) reported being smokers and drinkers. The classification of patients in relation to daily tobacco consumption, 33 (50%) were considered severe smokers (more than 20 cigarettes/day). Regarding the size of the lesions, a large portion of the patient (49 patients = 48.51%) diagnosed with oral cavity SCC presented lesions measuring 30 to 60 mm. In the distribution of patients according to gender and anatomical location, the tongue was the most commonly affected site (43 patients = 32.82 %), followed by the floor of the mouth (34 patients = 29.95%) in both genders. Conclusion: This unprecedented study showed the epidemiological profile of patients diagnosed with oral cavity cancer in the HMOB Stomatology Service, a reference hospital in the Belo Horizonte region. It was observed that there was a preponderance of male patients, who are 50 years of age or older and who frequently use of tobacco and/ or alcohol.(AU)

Análise do perfil de encaminhamentos realizados pela Atenção Básica/Saúde da Família do município de Belo Horizonte ao serviço de Estomatologia do Hospital Municipal Odilon Behrens / Profile analysis of referrals made by primary care/family health program to the stomatology service of the Odilon Behrens Municipal Hospital

Objetivo: Avaliar o tipo e a relevância dos encaminhamentos feitos pela Atenção Básica/ Saúde da Família, do município de Belo Horizonte (BH), ao serviço de Estomatologia do Hospital Municipal Odilon Behrens (HOB) e analisar os critérios do Protocolo de Regulação da Saúde Bucal de BH. Material e Métodos: Para isso, realizou-se estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva dos livros de registro do HOB e das listagens de marcação de consulta especializada de todos os pacientes encaminhados ao serviço de Estomatologia do HOB do período de janeiro de 2013 a junho de 2014. Resultados: Foram avaliados os encaminhamentos de 1992 pacientes, dos quais 71% (1414) compareceram às consultas agendadas. Houve predominância feminina entre os participantes e idade média de 54 anos. Quanto à prioridade dos encaminhamentos, foram encontrados: 513 (37%) prioridades alta, 422 (30%) prioridades média e 231 (16%) prioridades baixa. 75 (5%) dos encaminhamentos recebidos apresentavam alterações cujas características não estão descritas nos critérios do protocolo. 62 (4%) foram encaminhados erroneamente e 105 (8%) não possuíam alterações no momento da consulta. Assim, os encaminhamentos realizados pela atenção básica estão em conformidade com os critérios estabelecidos pelo Protocolo de Regulação. Mas, ao se comparar as alterações encontradas com o protocolo, observou-se critérios pouco objetivos, ocasionando discrepância entre a orientação do Ministério da Saúde e os atendimentos realizados pelo serviço de Estomatologia no município de BH. Conclusão: Sendo assim, ainda há a necessidade de revisão do protocolo atual, além da necessidade de instituir uma política de educação permanente na atenção básica.(AU)

Aim: This study aimed to evaluate the type and relevance of referrals by Primary Care / Family Health Program to the Stomatology Department of Odilon Behrens Municipal Hospital (HOB) and analyzed the criteria of the Belo Horizonte Oral Health Regulation Protocol. Methods: The authors conducted a cross-sectional epidemiological study, based on retrospective and descriptive analysis of the HOB's logs and specialized consultation appointment listings of all patients referred to the HOB's Stomatology Department from January 2013 to June 2014. Results: This study evaluated 1,992 patient referrals, of which 71% (1414) attended the scheduled visits. There was a predominance of female participants and the average age was 54 years. Regarding the prioritization of referrals, the following data were found: 513 (37%) high priorities, 422 (30%) average priorities, and 231 (16%) low priorities; 75 (5 %) of the received referrals presented changes, whose characteristics are not described in the protocol criteria; 62 (4%) were wrongly referred to the stomatology department, and 105 (8%) presented no change at the time of the doctor's appointment. Thus, the referrals made by primary care are in accordance with the criteria established by the oral health regulation protocol. However, upon comparing the changes found through the protocol, what could be observed was that the criteria presented little objectivity, resulting in adiscrepancy between the advice provided by the Ministério da Saúde and the services performed by the stomatology services in Belo Horizonte. Conclusion: Therefore, the results indicate the need to revise the current protocol and reveal the need to establish a permanent education policy in primary care.(AU)

Assessment of BRAFV600E and SMOF412E mutations in epithelial odontogenic tumours.

The classification of ameloblastoma in multicystic or unicystic variants is associated with its clinical behaviour. Recently, BRAF and SMO mutations have been reported in ameloblastomas. However, it is not clear if such mutations are shared by the multi- and unicystic variants of ameloblastoma or by odontogenic carcinomas. We assessed BRAFV600E and SMOF412E in multicystic, unicystic and desmoplastic ameloblastomas. In addition, we investigated whether the BRAFV600E mutation occurs in odontogenic carcinomas. A total of 28 formalin-fixed paraffin-embedded samples, comprising 17 ameloblastomas and 11 odontogenic carcinomas, were included. The BRAFV600E mutation was assessed by real-time PCR with a specific TaqMan probe and confirmed by Sanger sequencing. The SMOF412E mutation was assessed by Sanger sequencing. Fourteen out of 17 (82 %) ameloblastomas showed the BRAFV600E mutation, specifically, 5/6 (83 %) unicystic, 7/9 (78 %) multicystic and 2/2 desmoplastic ameloblastomas. BRAFV600E mutation was detected in 4/11 (36 %) malignant tumours, specifically, 3/8 (38 %) ameloblastic carcinomas and 1/1 clear cell odontogenic carcinoma, while the two ghost cell odontogenic carcinomas did not harbour this mutation. The SMOF412E mutation was not detected in ameloblastoma. The BRAFV600E-activating mutation is a common event in ameloblastomas, occurring regardless of site or histological type. This mutation is also detected in odontogenic carcinomas. SMO somatic mutation is a secondary genetic event in the ameloblastoma pathogenesis. Our findings support the possibility for personalised, molecular-targeted therapy for ameloblastomas and odontogenic carcinomas harbouring the BRAFV600E mutation.

Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery.

Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up features of this lesion are also discussed. To our knowledge, this is the second report of SC of the TMJ in Brazil.

Epigenetic regulation of matrix metalloproteinase expression in ameloblastoma.

BACKGROUND: An ameloblastoma is a benign odontogenic neoplasm with aggressive behaviour and high recurrence rates. The increased expression of matrix metalloproteinases (MMPs) has been reported in ameloblastomas. In the present study, we hypothesised that epigenetic alterations may regulate MMP expression in ameloblastomas. METHODS: We investigated the methylation status of the genes MMP-2 and MMP-9 in addition to mRNA transcription and protein expression in ameloblastomas. Methylation analysis was performed by both methylation-specific polymerase chain reaction (MSP-PCR) and restriction enzyme digestion to evaluate the methylation profile of MMP-2 and MMP-9 in 12 ameloblastoma samples and 12 healthy gingiva fragments, which were included as controls. Furthermore, we investigated the transcription levels of the genes by quantitative reverse-transcription PCR (qRT-PCR). Zymography was performed to verify protein expression in ameloblastomas. RESULTS: The ameloblastomas showed a high frequency of unmethylated MMP-2 and MMP-9, whereas the healthy gingival samples presented a sharp prevalence of methylated MMPs. Higher expression levels of MMP-9 were found in ameloblastomas compared to healthy gingiva. However, no significant differences in the MMP-2 mRNA expression between groups was found. All ameloblastomas showed positive expression of MMP-2 and MMP-9 proteins. CONCLUSIONS: Our findings suggest that expression of MMP-9 is increased in ameloblastomas and is possibly modulated by unmethylation of the gene.