Which devices can be used to decompress odontogenic cystic lesions in the oral cavity? A systematic review.

Odontogenic cysts are bony lesions in the jaws that can reach large sizes. Decompression, a technique that helps in their surgical treatment, aims to reduce their size. We aimed to conduct a systematic review of the main types of device used for the decompression of odontogenic cysts and to analyse the indications, types, advantages, and disadvantages of the devices used. We searched PubMed, Science Direct, LILACS, EMBASE, and Web of Science until February 2023, with no time restriction. We considered studies with a minimum of 10 patients published only in English, those that reported cases and case series, randomised clinical trials of the decompression of odontogenic cysts, and the types of devices used during the decompression period. All reported odontogenic cysts had to have been confirmed by biopsy in their respective publications. We found 713 articles in the selected databases. After removing duplicates, 499 remained. After reading the titles and abstracts, we excluded 461 articles so 38 remained. Nine studies were selected for the review, totalling 244 patients. A total of 206 lesions were identified and confirmed by anatomopathological examination: 123 keratocysts, 40 dentigerous cysts, 34 radicular cysts, one cyst of epithelial origin but without specification, and eight unicystic ameloblastomas. Although we did not find out which device is best for the decompression of odontogenic cysts, our findings show that those that are most effective should be as comfortable as possible and should remain in place. They should have stability in the oral cavity and be easy for the patient to clean.

Glandular Odontogenic Cyst in the Anterior Mandible: A Case Report of a Conservative Approach and a Recurrence Detection.

PURPOSE: The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. METHODS: In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient's medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. RESULTS: Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. CONCLUSIONS: Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable.

Oral cancer analysis in a Brazilian city: interval between diagnosis and treatment.

In Brazil, there are 15,500 incident cases of oral cancer (OC) yearly, and early diagnosis is the main factor for a better prognosis. The objective of this study was to analyze the interval between the first symptoms, diagnosis, and treatment commencement in patients with malignant neoplasms in the oral cavity, lips, and oropharynx diagnosed between 2012-2018. Epidemiological data, duration, history of lesion, biopsy, and diagnosis were obtained from the medical records of these patients, who were then contacted via phone and interviewed about their oncological treatment. The results were analyzed and expressed as mean, median, and SD. Of 184 patients, most were men, white, 50-69 years old, smokers, and alcoholics. The longest interval was between the first symptoms and first evaluation (a mean of 275 days). The interval between the first appointment and the result of the biopsy was shorter (13 days). Among the 85 patients interviewed, the interval between the diagnosis, the first appointment at the oncological clinic and treatment commencement was 55 days (mean) for patients using private-sector health care, and 96 days (mean) for patients using public health care. The interval was twice as long in the public health system compared with the private sector, which highlights the inequality of access to health care in Brazil. Delay in seeking health care after the appearance of the first symptoms remains a major problem.

Pilomatrixoma in the cheek: a clinical case report.

Pilomatrixoma is a follicular benign tumor of unknown etiology that originates in the matrix of a hair follicle. It develops more frequently in children and young adults, with a slight predominance in female patients. It is a slow-growing tumor that presents as a mobile nodule, firm, and with well-defined borders. The present study aimed to report the clinical, histopathologic, and radiographic aspects of pilomatrixoma in the cheek area of a 20-year-old female patient as the established treatment at an oral maxillofacial department. Pilomatrixoma is rarely included in the differential diagnosis of masses and nodules in the skin, and it is often confused with other nodular lesions, such as epidermoid cysts. The diagnostic method to identify this entity is an incisional biopsy. Because of its high incidence in the head and neck region, oral surgeons should be well-acquainted with this type of tumor so that it can be included as a diagnostic hypothesis of masses and nodules of the head and neck.

Oral medicine (stomatology) in Brazil: the first 50 years and counting.

This review outlines the historical perspective, status, and future challenges of oral medicine (stomatology) in Brazil based on the records of the Brazilian Society of Stomatology and Oral Pathology (SOBEP) and the Brazilian Federal Dental Council as well as expert evidence input from academic leaders from 3 different generations of Brazilian oral medicine specialists. The beginning of oral medicine in Brazil dates to 1969, followed by the organization of SOBEP in 1974; however, official recognition as an independent specialty was achieved more recently within the Brazilian Federal Dental Council in 1992. After a 50-year maturation period of oral medicine in Brazil in terms of specialty crystallization across dentistry, medicine, and research, it is now time to follow the historical trends of the specialty internationally and establish a standard curriculum at a post-graduate level that will lead to uniformity of training for oral medicine in Brazil.

Treatment of oral leukoplakia with CO2 laser (10,600 nm): analysis of 37 cases.

Oral leukoplakia is a potentially malignant disorder, defined as a white plaque that cannot be diagnosed as another known disease or disorder, and has an increased risk of malignancy. The aim of the present study was to evaluate the results of CO2 laser treatment in a well-defined cohort of patients with oral leukoplakia in order to identify the occurrence of clinical outcomes of relapse, resolution, or malignancy after treatment. The study group comprised 37 patients. Before treatment, clinical photographs and incisional biopsies were obtained in all cases. In addition, the post-treatment results were documented using photographs. Evaluation of treatment results was performed by an independent researcher who had not performed the surgery. The minimum, maximum, and mean values of continuous variables were calculated. Statistically significant relationships were tested using the Cox regression analysis. A survival curve was constructed according to the Kaplan-Meier method to analyze the malignant transformation and recurrence of oral leukoplakia. The clinical outcomes analyzed were resolution, recurrence, and malignancy. The mean follow-up period was 36 months (range, 6-239 months). In 13/37 patients, leukoplakia recurred between 6 and 93 months (mean, 38.2 months). In 8/37 patients, a malignant transformation occurred (mean, 50.6 months). In 16/37 patients, lesion resolution occurred. No risk factor was statistically significant for malignancy or recurrence of lesions. The treatment of the lesions by CO2 laser was efficient in the removal of the lesions; however, it did not avoid the clinical outcomes of recurrence or malignancy.

Telediagnosis of oral lesions using smartphone photography.

OBJECTIVE: The objective of this observational study was to evaluate telediagnosis of oral lesions using smartphone photography. MATERIALS AND METHODS: Individuals with visible oral lesions composed a convenience sample. The lesions were photographed using a smartphone camera and emailed along with clinical information to three evaluators, who formulated up to two diagnostic hypotheses for each case. A total of 235 photographs from 113 clinical cases were obtained. The evaluators answered questions regarding referral decisions, requests for additional tests, diagnostic difficulties, and image quality. The diagnostic hypotheses were compared to the gold standard by means of percent agreement and kappa coefficient. Consensual face-to-face diagnoses of three specialists-when only a clinical diagnosis was necessary-or histopathological results-when a biopsy was necessary-were considered the gold standard. RESULTS: The telediagnosis was similar to the gold standard in 76% of the cases, and kappa coefficients showed almost perfect agreement (k = 0.817-0.903). The evaluators considered that referrals could have been avoided on an average of 35,4% of the cases. CONCLUSION: Diagnosis of oral lesions using images taken with a smartphone showed almost perfect agreement and diagnostic accuracy comparable to face-to-face diagnosis.

Oral cancer analysis in a Brazilian city: interval between diagnosis and treatment

Abstract: In Brazil, there are 15,500 incident cases of oral cancer (OC) yearly, and early diagnosis is the main factor for a better prognosis. The objective of this study was to analyze the interval between the first symptoms, diagnosis, and treatment commencement in patients with malignant neoplasms in the oral cavity, lips, and oropharynx diagnosed between 2012-2018. Epidemiological data, duration, history of lesion, biopsy, and diagnosis were obtained from the medical records of these patients, who were then contacted via phone and interviewed about their oncological treatment. The results were analyzed and expressed as mean, median, and SD. Of 184 patients, most were men, white, 50-69 years old, smokers, and alcoholics. The longest interval was between the first symptoms and first evaluation (a mean of 275 days). The interval between the first appointment and the result of the biopsy was shorter (13 days). Among the 85 patients interviewed, the interval between the diagnosis, the first appointment at the oncological clinic and treatment commencement was 55 days (mean) for patients using private-sector health care, and 96 days (mean) for patients using public health care. The interval was twice as long in the public health system compared with the private sector, which highlights the inequality of access to health care in Brazil. Delay in seeking health care after the appearance of the first symptoms remains a major problem.

Pilomatrixoma in the cheek: a clinical case report

ABSTRACT Pilomatrixoma is a follicular benign tumor of unknown etiology that originates in the matrix of a hair follicle. It develops more frequently in children and young adults, with a slight predominance in female patients. It is a slow-growing tumor that presents as a mobile nodule, firm, and with well-defined borders. The present study aimed to report the clinical, histopathologic, and radiographic aspects of pilomatrixoma in the cheek area of a 20-year-old female patient as the established treatment at an oral maxillofacial department. Pilomatrixoma is rarely included in the differential diagnosis of masses and nodules in the skin, and it is often confused with other nodular lesions, such as epidermoid cysts. The diagnostic method to identify this entity is an incisional biopsy. Because of its high incidence in the head and neck region, oral surgeons should be well-acquainted with this type of tumor so that it can be included as a diagnostic hypothesis of masses and nodules of the head and neck.

Treatment of oral leukoplakia with CO2 laser (10,600 nm): analysis of 37 cases

Abstract Oral leukoplakia is a potentially malignant disorder, defined as a white plaque that cannot be diagnosed as another known disease or disorder, and has an increased risk of malignancy. The aim of the present study was to evaluate the results of CO2 laser treatment in a well-defined cohort of patients with oral leukoplakia in order to identify the occurrence of clinical outcomes of relapse, resolution, or malignancy after treatment. The study group comprised 37 patients. Before treatment, clinical photographs and incisional biopsies were obtained in all cases. In addition, the post-treatment results were documented using photographs. Evaluation of treatment results was performed by an independent researcher who had not performed the surgery. The minimum, maximum, and mean values of continuous variables were calculated. Statistically significant relationships were tested using the Cox regression analysis. A survival curve was constructed according to the Kaplan-Meier method to analyze the malignant transformation and recurrence of oral leukoplakia. The clinical outcomes analyzed were resolution, recurrence, and malignancy. The mean follow-up period was 36 months (range, 6-239 months). In 13/37 patients, leukoplakia recurred between 6 and 93 months (mean, 38.2 months). In 8/37 patients, a malignant transformation occurred (mean, 50.6 months). In 16/37 patients, lesion resolution occurred. No risk factor was statistically significant for malignancy or recurrence of lesions. The treatment of the lesions by CO2 laser was efficient in the removal of the lesions; however, it did not avoid the clinical outcomes of recurrence or malignancy.

Juvenile Spongiotic Gingival Hyperplasia: Clinicopathological Features of Eight Cases and a Literature Review.

BACKGROUND: Juvenile spongiotic gingival hyperplasia (JSGH) is a benign proliferation of non-keratinised stratified squamous epithelium with evident spongiosis, exocytosis leukocytes and dilated vessels with varying numbers of inflammatory cells. Although uncertain, it has been suggested that the epithelial proliferation is probably related to trauma and local irritants. It emerges as a painless erythematous patch or papule with an irregular surface. CASE REPORTS: We present a series of eight cases and a literature review of the clinical presentation and treatment approaches for JSGH. This series includes four females and four males with a mean age of 11.6 years, all complaining of injury to the gums. All lesions were painless and not bleeding. One patient associated the lesion with the onset of trauma and another with a previous history of an eruption cyst. Periapical radiographs of the adjacent area did not show any alteration of bone or teeth. Based on these findings, the diagnostic hypotheses were a non-neoplastic proliferative process or a factitious injury. Incisional biopsy was performed and histopathologic diagnosis was conclusive for JSGH. Surgical excision was conducted in three cases, and the other five cases were supported by clinical observation and plaque control in order to prevent gingival recession defects. After a follow-up period of 11 months (mean), no recurrence was observed for surgically treated cases and mild improvement was achieved with periodontal treatment. CONCLUSION: This case series illustrates the importance of diagnosis and follow-up of patients with JSGH. A conservative approach consisting of basic periodontal support instead of surgical excision may be indicated because of the risk of aesthetic defects at the involved areas.

Oral yeast colonization in patients with eating disorders: commensal acquisition or due to purgative habits?

Oral problems are common in patients diagnosed with Eating Disorders (ED) and still require better elucidation. We aimed to analyze the prevalence of oral Candida spp in individuals with ED. The sample of the study was comprised of 30 women with purgative habits and 15 without purgative habits. Samples of the oral cavity were collected by sterile cotton swab rubbed on soft tissues and teeth. Yeasts were isolated on Sabouraud dextrose agar. Yeasts were isolated from the oral cavity of 53% of the patients yielding 75 yeast isolates; of these, 43 were identified by conventional mycological methods: C. parapsilosis (n=19), C. glabrata (n=16), Rhodotorula sp (n= 6), C. famata (n=2). The remaining 32 isolates were presumptively identified as C. albicans or C. dubliniensis and required mass spectrometry for the final differentiation: 28 isolates were confirmed as C. albicans and four as C. dubliniensis. Among the control group, only four subjects (26.7%) were found to harbor C. albicans. The four C. dubliniensis isolates were from two patients, one that was only colonized and the other, with severe ED, was diagnosed with an oral candidiasis as demonstrated by the presence of pseudohyphae on the direct mycological exam from different sites. The increased rate of isolation of non-albicans species, such as C. glabrata, C. parapsilosis, and C. dubliniensis in the oral cavity from ED patients with nutritional deficiency may suggest that purgative habits of these patients can lead to changes in normal flora and predispose to oral candidiasis.

Oral leishmaniasis: Report of two cases.

Leishmaniasis is a chronic inflammatory disease caused by several species of the parasite Leishmania that is transmitted by insects of the genus Phlebotomus spp. or Lutzomyia spp. This disease can affect skin, mucous membranes and viscera being classified as cutaneous, mucocutaneous and visceral leishmaniasis, depending on the spectrum of clinical manifestations. Diagnosis can be achieved through biopsy, microscopical analysis, Montenegro intradermoreaction and/or ELISA. The dentist plays an important role in the diagnosis of this disease due to frequent involvement of oral mucosa. This article reports two clinical cases of leishmaniasis with oral mucosa involvement, their diagnosis workup and treatment.

Proteomic profile of saliva collected directly from ducts: a systematic review.

OBJECTIVE: To present a systematic review that provides updated information about proteins found in salivary fluid extracted strictly from ducts. METHODS: The systematic review probing strategy was based on electronic databases word search (PubMed, EMBASE, LILACS, Web of Science, and Scopus). Risk of bias was assessed based on Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS: After 2 rounds of scrutiny, 12 articles were included, totaling 231 individuals (125 were healthy, 41 were elder individuals with radicular caries, 56 had primary Sjögren's syndrome, and 9 were patients who had received radiotherapy for head and neck cancer). The selected studies had no similarities among proteins found, demonstrating the need of standard reference in experimental methodology to obtain a thorough coverage of proteins. CONCLUSION: Further studies are required to better determine the relative amount of proteins described in this study. It is essential to increase the number of samples, to perform similar collection techniques, to include other analyses methods such as mass spectrometry, and to perform the validation of some proteins using immunoassay techniques such as Elisa and Western blot. CLINICAL RELEVANCE: Proteomic profile of saliva collected from ducts is essential to better understand the disease process, enabling the identification of biomarkers for specific clinical situations.

Oral profile of eating disorders patients: Case series.

Oral alterations in patients diagnosed with eating disorders (ED) are reported in the literature, but few articles demonstrate these changes in a specific population. This study aims to summarize the findings of 26 patients with ED in a Brazilian dental clinic, through analyzing the body mass index and oral conditions (decayed, missing and filled teeth-DMFT, dental wear, salivary flux, xerostomia, oral hygiene-OHI-S, oral lesions, and the prevalence of candidiasis), in order to facilitate recognition and enable accurate diagnosis for the general dentist. Probably, the premature diagnosis of ED resulted in lower DMFT and oral lesions.

Successful Management of a Gigantic Ameloblastic Fibroma: A 12-Year Follow-up.

An ameloblastic fibroma (AF) is a benign mixed odontogenic tumor that mainly affects patients in the first and second decades of life. It is usually associated with an impacted tooth, commonly the first or second permanent molar. We present a case of an 11-year-old male patient diagnosed with AF, showing well-defined borders almost completely affecting the body and inferior alveolar nerve (IAN) branch on the right side of the mandible and displacing teeth 46 and 47 associated with the lesion. The treatment included conservative surgery, with oral rehabilitation, including IAN lateralization, implant placement without sensorial alteration, and posterior rehabilitation, performed after 10 years of follow-up. Rehabilitation with implants is a safe and effective procedure for the prosthetic rehabilitation of the posterior atrophic mandible. However, sensorial alteration of the IAN occurs in 100% of cases and tends to regress with time or may be permanent in few cases.

Fatal case of oral metastatic hepatocellular carcinoma in a patient unaware of his disease.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Metastases to the soft tissues of the oral cavity are extremely uncommon. This report describes a rare case of an oral metastatic HCC, located completely within the oral mucosa overlying the alveolar ridge, in a patient who was unware of his primary disease. A 64-year-old man was referred for evaluation of a nodular mass on the edentulous mandibular ridge underneath an implant-supported overdenture. According to the patient, he was successfully treated for hepatitis C infection 7 years previously, and he reported that his α-fetoprotein levels were monitored at semiannual intervals. The results of his current blood tests were within the reference range. A biopsy was performed, and analysis of the specimen revealed a malignant neoplasm suggestive of metastatic HCC. Because the patient was unaware of any underlying disease, he was referred to an oncologist for further evaluation. However, signs of hepatic decompensation appeared immediately after the biopsy results were obtained, and the patient was hospitalized. The overall medical examination disclosed an HCC with metastases to the lungs and oral cavity, and the patient died 8 days after hospitalization. This case reinforces the important potential for dentists to identify neoplastic diseases that are unknown to their patients.

The relevance of clinical and radiographic features of jaw lesions: A prospective study.

The study was carried out in a Brazilian population and the aim was to describe the prevalence and the clinic-radiographical features of jaw lesions. In addition, a comparison between the main diagnosis hypothesis and final diagnosis was accessed. A prospective study which evaluated all patients with jaw lesions diagnosed in an Oral Diagnosis Center, between August 2013 and October 2014. A total of 450 patients were observed for the first time, and 130 had some type of jaw lesion. The mean age of the patients was 35.2 years ± 17.86. Among these, 71 were women (54.62%) and 87 were Caucasian (66.92%). The mandible was affected more frequently (71.43%) than the maxilla (28.57%). Swelling and pain were the most frequent clinical signs and symptoms and were observed in 60 (42.85%) and 38 (27.14%) cases, respectively. The panoramic x-ray was the main radiographic exam utilized (88.57%). Radiolucent lesions accounted for 89 cases (63.57%) and the unilocular form was present in 114 cases (81.43%). A total of 93 cases had histopathological analyses and the periapical cyst was the most frequent lesion. In the other 47 lesions, the diagnosis was conducted by clinical and radiographic management. Bone lesions were frequent, being noted on first visit in approximately 30% of patients; in 1/3 of the cases, the diagnoses were completed with a combination of clinical and radiographic exams.