Clinical and radiographic characteristics of pycnodysostosis: A systematic review.

Purpose: Pycnodysostosis (PYCD), an autosomal recessive syndrome, is characterized by an imbalance in bone remodeling that produces various clinical and radiographic craniofacial manifestations. This review represents a systematic examination of these manifestations, as well as oral features associated with PYCD. Materials and Methods: A systematic review was conducted across 8 databases from February to March 2023. The search strategy focused on studies reporting cases of PYCD that examined the clinical and radiographic craniofacial and oral characteristics associated with this syndrome. Results: The review included 84 studies, encompassing a total of 179 cases of PYCD. More than half of the patients were female (55.3%), and the mean age was 14.7 years. Parental consanguinity was reported in 51.4% of the cases. The most common craniofacial clinical manifestation was a prominent nose, observed in 57.5% of cases. Radiographically, the most frequently reported craniofacial characteristics included the presence of an obtuse mandibular angle (84.3%) and frontal cranial bosses (82.1%). Clinical and radiographic examinations revealed oral alterations, with micrognathia present in 62.6% of patients and malocclusion in 59.2%. Among dental anomalies, tooth agenesis was the most commonly reported, affecting 15.6% of patients. Conclusion: Understanding the clinical and radiographic craniofacial features of PYCD is crucial for dental professionals. This knowledge enables these clinicians to devise effective treatment plans and improve patient quality of life.

Biological role of the bidirectional interaction between epithelial-mesenchymal transition and PD-L1 expression in head and neck squamous cell carcinomas: A systematic review

Background: Squamous cell carcinoma (SCC) is the most common head and neck malignant neoplasm. Despite progress in antineoplastic treatment for SCC, there are still high morbidity and mortality rates. Over the years, several tumor biomarkers have been suggested to predict the prognosis of patients with oral SCC. Studies point to a bidirectional association between the epithelial-mesenchymal transition (EMT) and the expression of PD-L1 with the aggressive biological behavior of the neoplastic cell. Thus, this systematic review aimed to explore the biological roles and mechanisms underlying the interaction between EMT and PD-L1 expression in head and neck SCC-derived cell lines. Material and methods: An electronic search was performed in the PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, and Cochrane Collaboration Library databases. Articles evaluating the in vitro relationship between EMT/PD-L1 interaction and the biological behavior of head and neck SCC cell lines were selected for this systematic review. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: After applying the previously established inclusion/exclusion criteria, 9 articles were included in the qualitative synthesis. The present systematic review suggests the existence of a bidirectional interaction between EMT and PD-L1 expression, which is related to alterations in the cell cycle, proliferation, apoptosis, and cell survival, affecting the migration and invasion ability of tumor cells. Conclusions: Combined targeting of the two pathways may be potentially effective for immunotherapy in head and neck SCC. (AU)

EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity.

This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

SNAIL1 is involved in the control of the epithelial-mesenchymal transition in oral tongue squamous cell carcinoma.

OBJECTIVE: The aim of the present study was to investigate the role of SNAIL1, E-cadherin, and N-cadherin immunoexpression in oral tongue carcinogenesis. In addition, we evaluated in vitro the impact of silencing of the nuclear transcription factor SNAIL1 on the viability, apoptosis, proliferation, migration, and invasion of SCC-9 and HSC-3 cells. STUDY DESIGN: Immunohistochemical analysis of SNAIL1, E-cadherin, and N-cadherin was carried out in 47 samples representing oral epithelial dysplasia (OED) and 41 oral tongue squamous cell carcinoma (OTSCC). The suppression of SNAIL1 expression was performed using shRNA-expression vectors in HSC-3 and SCC-9 cells to investigate in vitro the impact of SNAIL1 on proliferation, apoptosis, viability, migration, and invasion of SCC-9 and HSC-3 cells. RESULTS: Significant differences were observed in the expression of SNAIL1, E-cadherin, and N-Cadherin between OTSCC and OED. A low membrane expression of E-cadherin was strongly associated with poor overall survival in patients with OTSCC (P < .05), but the association did not withstand the Cox multivariate survival analysis. SNAIL1 silencing played a key role in the suppression of epithelial-mesenchymal transition and inhibited migration and invasion of HSC-3 cells (P < .0001, P < .01, respectively). In SCC-9 cells, SNAIL1 silencing promoted a significant reduction in the proliferation (P < .0001) and invasion (P < .0001). CONCLUSIONS: The epithelial-mesenchymal transition is present in different stages of oral tongue carcinogenesis, and SNAIL1 plays a key role in this process, although the underlying mechanisms still need to be elucidated. Thus, SNAIL1 might be a promising therapeutic target in OTSCC.

EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity

Abstract This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

Resumo Lipomas são as neoplasias mesenquimais benignas mais comuns, no entanto sua etiopatogenia ainda permanece desconhecida. Dessa forma, essa pesquisa teve como objetivo detectar, quantificar e comparar a expressão imunoistoquímica do EGFR, VEGF e contagem microvascular (MVC) dos lipomas orais, relacionando-os com as características clínicas e morfológicas dos casos estudados. A amostra foi composta por 54 lipomas orais (33 clássicos e 21 não clássicos) e 23 casos de tecido adiposo normal. A análise da expressão imunoistoquímica de EGFR e VEGF foi fundamentada na marcação citoplasmática e/ou nuclear. O índice angiogênico foi avaliado por meio da MVC. A contagem de células foi realizada utilizando software IMAGE J®. Os dados obtidos foram analisados no software Statistical Package for Social Science. O nível se significância de 5% foi adotado para os testes estatístico. A análise da imunoexpressão das proteínas revelou para o EGFR diferença estatisticamente significativa (p=0,041) entre o lipoma clássico e o tecido adiposo normal. Houve diferença significativa na MVC entre lipomas não clássicos e tecido adiposo normal (p=0,022). Nos lipomas não clássicos, apenas a imunoexpressão de VEGF apresentou correlação do tipo moderada, positiva e significativa (r=0,607; p=0,010) em relação a MVC. Ademais, nos lipomas clássicos foi percebido que os adipócitos imunomarcados para EGFR estiveram diretamente proporcionais a imunoexpressão de VEGF, apresentando correlação do tipo moderada, positiva e estatisticamente significativa (r=0,566; p = 0,005). Com base nos resultados, pode-se sugerir que o EGFR, VEGFR e MCV participam do desenvolvimento nos lipomas orais, contudo, não estão primariamente envolvidos no crescimento tumoral dessas neoplasias.

A 14-year retrospective study focusing on clinical and morphological features of oral cavity lipomas: A review of main topics.

BACKGROUND: Lipomas are benign soft tissue neoplasms frequently found in the human body. Head and neck lipomas are relatively uncommon, accounting for 1 to 4% of benign lesions at this location. This 14-year retrospective study analyzed the clinical-pathological features of cases of oral cavity lipomas and their histopathological variants seen at a single oral pathology referral center. MATERIAL AND METHODS: Data on age, sex, anatomical location, clinical diagnosis, and histological subtypes were collected from all cases microscopically diagnosed as lipoma. Three previously trained oral pathologists re-evaluated hematoxylin/eosin-stained slides of all selected cases. RESULTS: Among 7,861 oral and maxillofacial lesions diagnosed at the service, 95 (1.2%) were lipomas or their histopathological variants. There was a predominance of female patients (n = 65; 68%); the mean age at diagnosis was 58.8 years (±13.56). We found the following histological subtypes: conventional lipoma, fibrolipoma, spindle cell lipoma, sialolipoma, osteolipoma, chondrolipoma, and intramuscular lipoma. The buccal mucosa was the most affected site. Conventional lipoma and fibrolipoma were the most commonly diagnosed histological variants. Although most lipomas are asymptomatic, large lipomas can occur, reaching a diameter of 4 cm. CONCLUSION: The present study reinforces the importance of careful clinical and histopathological examination in order to obtain an accurate diagnosis and to ensure appropriate treatment.

Prognostic and clinicopathological significance of tumor-stroma ratio in head and neck squamous cell carcinoma: A systematic review

Background: Analysis of the tumor microenvironment has been proposed as a strategy for the treatment and prognosis of different neoplastic processes. A grading system based on the tumor-stroma ratio (TSR), which evaluates theproportion of stroma in relation to neoplastic parenchyma at the invasion front, has shown a strong prognostic valuein different neoplastic processes. The aim of the present systematic review was to understand the role of the TSR inhead and neck squamous cell carcinoma (HNSCC), evaluating its correlation with clinical and prognostic parameters.Material and Methods: An electronic search was performed in PubMed/Medline, Web of Science, Science Direct,Scopus, Embase, and the Cochrane Collaboration Library. Publications assessing the relationship between TSRand prognosis in cases of HNSCC were eligible. The quality of the studies was assessed independently by fourevaluators using the Newcastle-Ottawa scale.Results: After application of the previously es+lished inclusion/exclusion criteria, nine articles were included inthe qualitative synthesis. With regards to quality on the Newcastle-Ottawa scale, an overall value of 4.55 was obtained. This systematic review demonstrated a strong association between TSR and prognosis in esophageal andoral squamous cell carcinomas.Conclusions: Histopathological analysis of the TSR can optimize the analysis of the prognosis of cases diagnosedwith HNSSC. In addition, the TSR is a reliable and simple parameter that can be evaluated in hematoxylin/eosinstained slides during routine laboratory examinations, showing high inter- and intraobserver agreement. (AU)

Inequalities in the profile of using dental services in Brazil. / Desigualdades no perfil de utilização de serviços odontológicos no Brasil.

This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.

Este trabalho teve por objetivo analisar a influência de fatores socioeconômicos na desigualdade de utilização de serviços odontológicos na população brasileira. A metodologia baseou-se em um estudo seccional, com uso de dados secundários provenientes da Pesquisa Nacional de Saúde (PNS) 2013. O banco de dados utilizado contém informações sobre 60.202 indivíduos maiores de 18 anos. As variáveis dependentes avaliadas foram "frequência de consulta odontológica" e "tipo de tratamento odontológico realizado na última consulta. As variáveis independentes avaliadas foram sexo, faixa etária, escolaridade, classe social mensurada através do critério Brasil e região geográfica. Na análise multivariada, foram avaliadas as odds-ratio dos desfechos a partir de um modelo de regressão logística multinominal. Percebeu-se que a população de cor/raça negra, residente na região Norte/Nordeste, de menor classe social e escolaridade apresentou maior chance de realizar acompanhamento irregular e nunca ter ido ao dentista. Além disso, este estrato populacional também apresentou maior chance de realizar procedimentos odontológicos cirúrgicos ou de urgência na última consulta odontológica. Os dados da PNS 2013 demonstram um quadro de desigualdade social no acesso a serviços odontológicos no Brasil.

Desigualdades no perfil de utilização de serviços odontológicos no Brasil / Inequalities in the profile of using dental services in Brazil

Resumo Este trabalho teve por objetivo analisar a influência de fatores socioeconômicos na desigualdade de utilização de serviços odontológicos na população brasileira. A metodologia baseou-se em um estudo seccional, com uso de dados secundários provenientes da Pesquisa Nacional de Saúde (PNS) 2013. O banco de dados utilizado contém informações sobre 60.202 indivíduos maiores de 18 anos. As variáveis dependentes avaliadas foram "frequência de consulta odontológica" e "tipo de tratamento odontológico realizado na última consulta. As variáveis independentes avaliadas foram sexo, faixa etária, escolaridade, classe social mensurada através do critério Brasil e região geográfica. Na análise multivariada, foram avaliadas as odds-ratio dos desfechos a partir de um modelo de regressão logística multinominal. Percebeu-se que a população de cor/raça negra, residente na região Norte/Nordeste, de menor classe social e escolaridade apresentou maior chance de realizar acompanhamento irregular e nunca ter ido ao dentista. Além disso, este estrato populacional também apresentou maior chance de realizar procedimentos odontológicos cirúrgicos ou de urgência na última consulta odontológica. Os dados da PNS 2013 demonstram um quadro de desigualdade social no acesso a serviços odontológicos no Brasil.

Abstract This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.

Pindborg tumor associated with a supernumerary tooth: a case report.

The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

"A vida como ela é" e o desenvolvimento de competências e autonomia na integração ensino-serviço-comunidade / "Life as it is" and the development of skills and autonomy in the teaching-service-community integration

A formação em Odontologia alinhada às demandas atuais de saúde tem sido uma agenda importante. O objetivo desta pesquisa foi compreender os aprendizados a partir dos estágios supervisionados na perspectiva do desenvolvimento de competências e autonomia, a partir da voz de estudantes de Odontologia. Utilizou-se pesquisa qualitativa, com dois gruposfocais, com 13 estudantes, de ambos os sexos,de um curso de Odontologia, de uma instituição federal de ensino noNordeste do Brasil. Procedeu-se à análise temática de conteúdo. Os Estágios Supervisionados da Saúde Coletiva atuam como oportunidades de ensino-aprendizagemavaliação, permitindo vivência nos serviços públicos de saúdelocais e territórios, sensibilizando o estudante para o cuidado integral e para a compreensão ampliada do processo saúde-doença. As vivências partemsempre da premissa de que o aprendizado está vinculado aos serviços de saúde e a um percurso construído coletivamente por todos. Portanto, a compreensão dos estudantes sobre a integração entre o ensino, o serviço e a comunidade, permitiram a articulação entre a teoria e a prática da Saúde Coletiva e o desenvolvimento de competências "socio-lógicas" implicadas aos contextos do trabalho em saúde. Com esse entendimento, os participantes reconheceram o princípio da educação pelo/com o trabalho e a importância de todos para troca e produção de conhecimentos e de saberes em saúde (AU).

Dentistry education aligned with current health demands has been an important topic on the agenda. The objective of this research was to understand the acquired knowledge in supervised internships in terms of the development of skills and autonomy, from the point of view of dentistry students. Qualitative research was used, with two focus groups, with 13 students of both genders, from a dentistry course, from a Federal Educational Institution in Northeastern Brazil. A thematic content analysis was performed. The Collective Health Supervised Internships act as teaching-learning evaluation opportunities, allowing experience in local public health services and territories, creating student awareness of comprehensive care and a broader understanding of the health-disease process. The experiences are always based on the premise that learning is linked to health services and to a path built collectively by everyone. Therefore, the students' understanding of the integration between teaching, service and community allowed the articulation between theory and practice of Collective Health and the development of "socio-logical" competencies involved in the contexts of work in healthcare. With this understanding, the participants recognized the principle of education through/with work and the importance of everyone to exchange and produce knowledge and health education (AU).

Avaliação de um curso de Odontologia com base nas Diretrizes Curriculares Nacionais: um estudo seccional / Evaluation of a Dentistry course based on the National Curricular Guidelines: a sectional study

O estudo teve por objetivo avaliar, a partir da visão de professores e estudantes, um curso de graduação em Odontologia, com base nasDiretrizes Curriculares Nacionais(DCN). Trata-se de um estudo observacional e transversal, com metodologia exploratória, descritiva e de avaliação. A abordagem utilizada foi quantitativa, por meio da aplicação de questionário online, por meio de instrumento com critérios validados. A amostra de professores e estudantes do curso foi censitária. A Integração ensino-serviço obteve o melhor desempenho relativo entre as dimensões avaliadas tanto por estudantes quanto por professores. A maior parte dos estudantes considerou o curso adequado às DCN (50,2%), enquanto a maioria dos professores o consideraram parcialmente adequado (56,36%). Os estudantes mostraram-se mais satisfeitos com a formação ofertada no curso atribuindo maiores valores de média para todas as dimensões e subdimensões. Referente ao perfil do egresso, professores e estudantes atribuíram o pior desempenho à subdimensão "Autônomo", o melhor desempenho foi atribuído às subdimensões "Generalista" e "Capaz de compreender a realidade social". Na dimensão Orientação do cuidado em saúde professores e estudantes atribuíram melhor desempenho àsubdimensão "Tratamento odontológico", enquanto o pior desempenho foi atribuído à "Multiprofissionalidade" e "Enfoque epidemiológico". Na dimensão Abordagem pedagógica, o melhor desempenho foi atribuído às subdimensões "Papel do professor" e "Articulação ensino-pesquisa-extensão", o pior desempenho foi atribuído por professores e estudantes àsubdimensão "Flexibilização curricular". A dimensão Integração ensino-serviço e subdimensões relacionadas foram bem avaliadastanto por professores quanto por estudantes. As principais fragilidades encontradas estão relacionadas com dimensões que abordam as relações profissional/paciente e a as relações entre o cirurgião-dentista e a equipe de saúde durante a formação profissional. Faz-se necessária a criação de estratégias de reorientação da formação direcionadas a novos conceitos metodológicos de ensino e aprendizagem para a efetivação das DCN no curso de Odontologia avaliado (AU).

The study had the purpose of evaluating, from thepoint of view of teachers and students, an undergraduate course in Dentistry, based on the National Curriculum Guidelines (NCG). This is an observational and cross-sectional study, with exploratory, descriptive and evaluative methodology. The approach used was quantitative, through the application of an online survey, by means of an instrument with validated criteria. The sample of teachers and students was a census. The "Teaching-service Integration" dimension obtained the best relative performance amongthose evaluated by both students and professors. Most students considered the course adequate to the NCG (50.2%), while most professors considered it partially adequate (56.36%). Students showed themselves to be more satisfied with the training offered inthe course, assigning higher average ratings for all dimensions and subdimensions. Regarding the "Graduate Profile", professors and students gave the worst performance to the subdimension "Autonomous"; the best performance was attributed to the subdimensions "Generalist" and "Able to Understand the Social Reality". In the dimension "Healthcare Orientation", both teachers and students evaluated the best results in the subdimension "Dental Treatment", while the worst results were attributed to the subdimensions "Multiprofessionalism" and "Epidemiological Approach". In the "Pedagogical Approach" dimension, the best performance was attributed to thesubdimensions "Professor's Role" and "Teaching-research-extension Articulation", and the worst performance was attributed by professors and students to the subdimension "Curricular Flexibility". The "Teaching-service Integration" dimension and related subdimensions were well assessed by both professors and students.The main weaknesses found are related to dimensionsthat address the professional/patient relationships and the relationships between the dental surgeon and the healthcare team during professional qualification. It is necessary to develop strategies for the reorientation of training focused on new methodological concepts of teaching and learning for the implementation of the NCG in the evaluated Dentistry course (AU).

Pindborg tumor associated with a supernumerary tooth: a case report

The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

Imunoexpressão das proteínas E-caderina, α-SMA, TGF-ß e Snail em queilites actínicas e carcinoma epidermoide de lábio inferior / Immunoexpression of E-cadherin, α-SMA, TGF-ß and Snail proteins in actinic cheilitis and squamous cell carcinoma of the lower lip

A transição epitélio-mesenquimal (TEM) é um processo biológico que vem sendo amplamente estudado em carcinoma epidermoide oral (CEO), porém, ainda raramente avaliado na carcinogênese labial. O objetivo deste estudo foi de investigar a imunoexpressão das proteínas E-caderina, α-SMA, TGF-ß e Snail em queilites actínicas (QA) diagnosticadas histopatologicamente como displasias epiteliais, e em carcinomas epidermoides de lábio inferior (CELI). A imunoexpressão de E-caderina, α-SMA, TGF-ß e Snail foi analisada de forma semiquantitativa em 54 casos de QAs e em 49 CELIs. Visando a associação dos achados imunoistoquímicos com as variáveis clinicopatológicas e taxas de sobrevida global (SG) e livre de doença (SLD), os casos foram classificados nas categorias baixa expressão e alta expressão. Não foram observadas associações estatisticamente significativas com nenhuma das proteínas analisadas com o grau de severidade das displasias epiteliais em QAs (p > 0,05). A análise imunoistoquímica em CELIs revelou que uma baixa expressão membranar da E-caderina no front tumoral estava significativamente associada a CELIs com ≥5 buds (p = 0,005) e alto escore tanto para o modelo BD (p = 0,009), quando para o proposto por Dourado et al. (2020) (p = 0,038), entretanto, não foram observadas associações significativas entre a imunoexpressão desta proteína com parâmetros clínicos (p > 0,05). Constatou-se ainda associações significativas entre baixa expressão de α-SMA com CELIs em estágios clínicos TNM I/II (p = 0,05), baixa profundidade de invasão (p = 0,006), < 5 buds (p = 0,027) e escore de risco baixo/intermediário, ao passo que a alta expressão desta proteína foi associada com o desfecho óbito (p = 0,009). Também foram encontradas associações significativas entre o padrão de imunomarcação em rede/em fuso de α-SMA com CELIs em estágios TNM III/IV (p = 0,031), com alta profundidade de invasão (p = 0,002), ≥5 buds (p = 0,027), alto escore de risco BD (p = 0,001) e desfecho óbito (p = 0,015). Em relação à proteína TGF-ß, percebeu-se associações estatisticamente significativas entre sua baixa expressão em buds tumorais com ausências de metástase linfonodal (p = 0,047) e de recidiva locorregional (p = 0,042), contudo, não foram observadas significâncias com nenhum dos parâmetros morfológicos (p > 0,05). A análise imunoistoquímica da proteína Snail não revelou nenhuma associação significativa com os parâmetros clinicopatológicos (p > 0,05). A análise de associação das imunoexpressões das proteínas entre as lesões estudadas revelou resultados significativos para uma alta expressão citoplasmática da E-caderina e CELIs (p = 0,001), alta expressão de α-SMA e CELIs (p < 0,001), baixa expressão de TGF-ß e CELIs (p < 0,001) e alta expressão de Snail e QAs (p = 0,006). A análise de sobrevida revelou que uma alta expressão de α-SMA no estroma do front tumoral (p = 0,013), padrão de imunomarcação em rede desta proteína (p = 0,046) e alta expressão de TGF-ß em buds tumorais (p = 0,043) estavam significativamente associadas à pior SG, além de que CELIs com alta expressão de α-SMA também apresentavam maior risco de óbito (HR = 5,90, p = 0,030). Uma alta expressão citoplasmática de TGF-ß em buds tumorais estava significativamente associada tanto à pior SLD (p = 0,007), quanto a maiores riscos de desfechos negativos para a SLD (HR = 4,44; p = 0,014). Os resultados do presente estudo sugerem que apesar da imunoexpressão das proteínas avaliadas não indicarem diferenças no grau de severidade histopatológica em QAs, desregulações dessas proteínas foram identificadas entre as lesões estudadas. Ademais, foi constatado que CELI com comportamento mais agressivo estava associado a baixa expressão da E-caderina membranar, alta expressão de αSMA e seu padrão em rede e baixa expressão de TGF-ß em buds tumorais (AU).

Epithelial-mesenchymal transition (EMT) is a biological process that has been widely studied in oral squamous cell carcinoma (SCC), however, it is still rarely evaluated in lip carcinogenesis. The aim of this study was to investigate the immunoexpression of E-cadherin, α-SMA, TGF-ß and Snail proteins in actinic cheilitis (AC) histopathologically diagnosed as epithelial dysplasia, and in lower lip squamous cell carcinoma (LLSCC). The immunoexpression of E-cadherin, α-SMA, TGF-ß and Snail was semiquantitatively analyzed in 54 cases of ACs and 49 LLSCCs. Aiming at association of immunohistochemical findings with clinicopathological variables and overall (OS) and disease-free (DFS) survival rates, cases were classified into low expression and high expression categories. There were no statistically significant associations with any of the proteins analyzed with the degree of severity of epithelial dysplasia in ACs (p > 0.05). Immunohistochemical analysis in LLSCCs revealed that low membrane expression of E-cadherin in tumor front was significantly associated with LLSCCs with ≥5 buds (p = 0.005) and high score for both BD model (p = 0.009) and the proposed model by Dourado et al. (2020) (p = 0.038), however, no significant associations were observed between immunoexpression of this protein and clinical parameters (p > 0.05). Significant associations were also found between low expression of α-SMA with LLSCCs in clinical stages TNM I/II (p = 0.05), low depth of invasion (p = 0.006), < 5 buds (p = 0.027) and score of low/intermediate risk, while high expression of this protein was associated with the outcome of death (p = 0.009). Significant associations were also found between α-SMA network/spindle immunostaining pattern with LLSCCs in TNM stages III/IV (p = 0.031), with high depth of invasion (p = 0.002), ≥5 buds (p = 0.027), high BD risk score (p = 0.001) and death outcome (p = 0.015). Regarding the TGF-ß protein, statistically significant associations were noticed between its low expression in tumor buds with absence of lymph node metastasis (p = 0.047) and locoregional recurrence (p = 0.042), however, no significance was observed with any of morphological parameters (p > 0.05). Immunohistochemical analysis of Snail protein did not reveal any significant association with clinicopathological parameters (p > 0.05). The association analysis of protein immunoexpression between the lesions studied revealed significant results for a high cytoplasmic expression of E-cadherin and LLSCCs (p = 0.001), high expression of α-SMA and LLSCCs (p < 0.001), low expression of TGF -ß and LLSCCs (p < 0.001) and high expression of Snail and ACs (p = 0.006). Survival analysis revealed a high expression of α-SMA in tumor front stroma (p = 0.013), a network immunostaining pattern of this protein (p = 0.046) and high expression of TGF-ß in tumor buds (p = 0.043) were significantly associated with worse OS, and LLSCCs with high expression of α-SMA also had a higher risk of death (HR = 5.90, p = 0.030). High cytoplasmic expression of TGF-ß in tumor buds was significantly associated with both worse DFS (p = 0.007) and higher risks of negative outcomes for DFS (HR = 4.44; p = 0.014). The results of present study suggest that although the immunoexpression of evaluated proteins does not indicate differences in degree of histopathological severity in ACs, dysregulations of these proteins were identified among the lesions studied. Furthermore, it was found that LLSCC with more aggressive behavior was associated with low expression of membrane E-cadherin, high expression of α-SMA and its network pattern, and low expression of TGF-ß in tumor buds (AU).

BIOSAFETY KNOWLEDGE, ACTIONS AND MEASURES OF BRAZILIAN DENTISTS DURING THE COVID-19 PANDEMIC / CONHECIMENTOS, ATITUDES E PRÁTICAS DE BIOSSEGURANÇA POR CIRURGIÕES-DENTISTAS BRASILEIROS DURANTE A PANDEMIA DA COVID-19

Objective: To identify the level of knowledge, attitudes and practices related to biosafety measures, prevention and control by DCs during the pandemic. Methods: An online questionnaire consisting of 42 questions was disseminated to the CDs operating in Brazil through social networks and also to the 27 Regional Councils of Dentistry in the country via e-mail. The collection period was from June 26 to July 2, 2020. Results: 751 CDs answered the questionnaire, of these, 54.9% undertook training in preventing and controlling the spread of the virus and the scientific article was the main means of information (44.5%). Regarding biosafety in dental care, 95.9% reported having knowledge of ANVISA's rules on the subject, however, regarding attitudes and practices, there was a failure to comply with the recommendations. Link between professional performance and training or not, were factors associated with greater knowledge and correct biosafety attitudes and practices. Conclusion: Although the Brazilian CDs have good levels of knowledge about biosafety measures for the prevention of COVID-19, they still fail to comply with basic attitudes and recommended practices.

Objetivo: Identificar o nível de conhecimento, atitudes e práticas relacionadas às medidas de biossegurança, prevenção e controle por parte dos CDs durante a pandemia. Métodos: Um questionário online composto por 42 perguntas foi divulgado aos CDs atuantes no Brasil pelas redes sociais e também aos 27 Conselhos Regionais de Odontologia do país via e-mail. O período de coleta foi do dia 26 de junho a 2 de julho de 2020. Resultados: 751 CDs responderam ao questionário, destes, 54,9% realizaram capacitação para prevenção e controle de disseminação do vírus e artigo científico foi o principal meio de informação (44,5%).  Com relação à biossegurança nos atendimentos odontológicos, 95,9% relataram ter conhecimento das normas da ANVISA sobre o assunto, porém, com relação às atitudes e práticas, observou-se descumprimento das recomendações. Vínculo de atuação profissional e realização ou não de capacitação foram fatores associados a maior conhecimento e a atitudes e práticas corretas de biossegurança. Conclusão: Os CDs brasileiros embora apresentem bons níveis de conhecimento acerca das medidas de biossegurança para prevenção da COVID-19 ainda descumprem atitudes e práticas básicas recomendadas.

Saúde bucal no brasil: uma revisão integrativa do período de 1950 a 2019 / Oral health in brazil: an integrative review from 1950 to 2019 / Salud oral en brasil: una revisión integradora en el período de 1950 a 2019

A trajetória das políticas públicas de saúde bucal no Brasil foi historicamente caracterizada como um longo processo de rupturas e continuidades. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os modelos assistenciais e políticas públicas de saúde bucal no Brasil desenvolvidas ao longo do período de 1950 a 2019. Desenvolveu-se mediante o método qualitativo, consistindo em uma revisão integrativa da literatura. O tema abordado baseou-se em evidências bibliográficas e documentos públicos produzidos por setores estratégicos do governo. Os primeiros modelos assistenciais em saúde bucal implementados no Brasil se configuravam como excludentes, elitistas, mutiladores e pouco resolutivos. Apenas em 1994 o Ministério da Saúde criou o Programa Saúde da Família (PSF), incluindo, em 2001, as Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família (ESF). Diante da falta de uma política nacional efetiva para a saúde bucal, a Política Nacional de Saúde Bucal (PNSB), conhecida como Brasil Sorridente, foi criada em 2004, e em 2011, a Política Nacional de Atenção Básica (PNAB) foi aprovada. Ao ser revisada em 2017, a equipe de saúde bucal foi excluída da equipe multiprofissional mínima. O cenário histórico da saúde bucal no Brasil é caraterizado por dois momentos distintos, em que inicialmente houve evolução dos modelos assistenciais em saúde bucal, seguido pela exclusão da saúde bucal no contexto de saúde da família.

The trajectory of public oral health policies in Brazil has historically been characterized as a long rupture and continuities process. This study aimed at conducting an integrative literature review on care models and public oral health policies in Brazil from 1950 to 2019. It was developed through the qualitative method, consisting of an integrative literature review. The theme approached was based on bibliographic evidence and public documents produced by strategic sectors government. The first models of oral health care implemented in Brazil represented exclusionary, elitist, mutilating, and poorly resolving models. Only in 1994, the Brazilian Ministry of Health created the Family Health Program (FHP), including in 2001 the Oral Health Teams (OHT) in Family Health Strategy (FHS). In the absence of an effective national oral health policy, National Oral Health Policy (NOHP), known as Brasil Sorridente (Smiling Brazil), was created in 2004. In 2011, the National Primary Care Policy (NPCP) was approved. When revised in 2017, the oral health team was excluded from the minimum multi-professional team. The historical scenario of oral health in Brazil is characterized by two distinct moments. Initially, there was an evolution of care models in oral health, followed by exclusion of oral health in the context of family health.

La trayectoria de las políticas públicas de salud oral en Brasil se ha caracterizado históricamente como un largo proceso de rupturas y continuidades. Este estudio tuvo como objetivo realizar una revisión integradora de la literatura sobre modelos de atención y políticas públicas de salud oral desarrolladas en Brasil desde 1950 hasta 2019. Se utilizó el método cualitativo, que consiste en una revisión integradora de la literatura. El tema abordado se basó en evidencia bibliográfica y documentos públicos producidos por sectores estratégicos del gobierno. Los primeros modelos de atención de salud oral implementados en Brasil representaban modelos excluyentes, elitistas, mutiladores y de baja resolución. Solo en 1994 el Ministerio de Salud creó el Programa de Salud Familiar (PSF), que incluyó en 2001 los Equipos de Salud Oral (ESO) en la Estrategia de Salud Familiar (ESF). En ausencia de una política nacional efectiva de salud oral, la Política Nacional de Salud Oral (PNSB), conocida como Brasil Sorridente, se creó en 2004; y en 2011 se aprobó la Política Nacional de Atención Primaria (PNAB). Cuando se revisó en 2017, el equipo de salud oral fue excluido del equipo mínimo multiprofesional. El escenario histórico de la salud oral en Brasil se caracteriza por dos momentos distintos, inicialmente hubo una evolución de los modelos de atención en salud oral, seguido de la exclusión de la salud oral en el contexto de la salud familiar.

Integração ensino-serviço-comunidade em Odontologia: um estudo cultural / Integración enseñanza-trabajo-comunidad en Odontología: un estudio cultural / Teaching-service-community integration in Dentistry: a cultural study

O objetivo do estudo foi analisar a integração ensino-serviço-comunidade em um curso de Odontologia, a partir dos estágios curriculares vistos na perspectiva dos trabalhadores de saúde, estudantes, usuários, gestores e professores. Foram realizadas 27 entrevistas semiestruturadas, posteriormente transcritas e analisadas tematicamente. As representações culturais sobre a integração estudada são ressignificadas processualmente a partir das interações e colisões entre os seus diferentes agentes, possibilitando o deslizamento de sentidos expressos e compartilhados. As representações também operam de forma contingente, ora facilitando, ora dificultando um processo de formação odontológica efetivamente dialógico. A integração ensino-serviço-comunidade, estudada a partir de um dos seus dispositivos, os estágios supervisionados, é um lugar de "sair de si" para vivenciar a teoria na prática e a prática na teoria, com ações sociais e pedagógicas que produzem atualizações, corresponsabilizações e conhecimentos orientados coletiva e intencionalmente para o Sistema Único de Saúde (SUS).(AU)

El objetivo del estudio fue analizar la integración enseñanza-servicio-comunidad en un curso de Odontología, a partir de las pasantías curriculares vistas bajo la perspectiva de los trabajadores de la salud, estudiantes, usuarios, gestores y profesores. Se realizaron 27 entrevistas semiestructuradas, que posteriormente se transcribieron y analizaron temáticamente. Las representaciones culturales sobre la integración estudiada se resignifican procesalmente a partir de las interacciones y choques entre sus diferentes agentes, posibilitando el deslizamiento de sentidos expresados y compartidos. Las representaciones también operan de forma contingente, tanto facilitando, como dificultando un proceso de formación odontológica efectivamente dialógico. La integración enseñanza-trabajo-comunidad, estudiada a partir de uno de sus instrumentos, las pasantías supervisadas, es un lugar para "salir de sí" para vivir la teoría-en-la-práctica y la práctica-en-la-teoría, con acciones sociales y pedagógicas que producen actualización, corresponsabilidades y conocimiento orientados de forma colectiva e intencional hacia el Sistema Brasileño de Salud.(AU)

The aim of this study was to analyze teaching-service-community integration in a Dentistry course, based on curricular internships seen in the perspective of health workers, students, users, managers and teachers. Twenty-seven semi-structured interviews were conducted, transcribed and thematically analyzed. The cultural representations about the studied integration are procedurally re-signified from the interactions and clashes between their different agents, enabling the sliding of expressed and shared meanings. The representations also operate in a contingent way, sometimes facilitating, sometimes hindering an effectively dialogic dentistry education process. Teaching-service-community integration, studied from one of its devices, supervised internships, is a place to get out of the self to experience theory-in-practice and practice-in-theory, with social and pedagogical actions that produce modernizations, co-accountability and knowledge oriented collectively and intentionally to the Brazilian National Health System.(AU)

Olhar discente e a formação em Odontologia: interseções possíveis com a Estratégia Saúde da Família / The perspective of students and dental education: possible intersections with the Family Health Strategy / Mirada discente y la formación en Odontología: intersecciones posibles con la Estrategia Salud de la Familia

Objetivou-se compreender a percepção dos estudantes de Odontologia de uma instituição pública brasileira sobre a inserção desses na concretude do Sistema Único de Saúde (SUS), em particular nos territórios da Estratégia Saúde da Família (ESF), e as possíveis contribuições desse processo nas suas formações acadêmicas. É um estudo de caso analítico, de abordagem qualitativa, realizado com discentes, mediante grupos focais com roteiros semiestruturados e associados à análise de portfólios produzidos por esses sujeitos pela análise de conteúdo. A partir do olhar do graduando, ora protagonista, ora coadjuvante, observaram-se elementos importantes na perspectiva do fortalecimento do SUS e simultaneamente da sua própria formação, no diapasão da integração ensino-serviço-comunidade. Os discentes percebem o território da ESF como vivo e potente cenário de aprendizado que aproxima o estudante dos serviços de saúde e seus usuários.

The aim of this study was to understand the perception of dental school students at a public Brazilian institution about their practical insertion in the Brazilian National Health System (SUS), especially within the strategies of the Family Health System (FHS). Furthermore, the study gathered their impressions on how this experience contributed to their academic education. This was an analytical qualitative study conducted with focus groups of dental school students, using semi-structured scripts. Furthermore, the portfolios produced by the participants were submitted to content analysis. Based on the perspective of the graduating students, who sometimes took on leading roles and at others supporting roles, important elements were presented to strengthen SUS and simultaneously their own education, within the standard of integrating teaching/service/community. The students perceived the FHS territory as a living and powerful context for learning that brought them closer to health services and their users.

El objetivo fue comprender la percepción de los estudiantes de odontología de una institución pública brasileña sobre su inserción en lo concreto del Sistema Brasileño de Salud (SUS), en particular en los territorios de la Estrategia Salud de la Familia (ESF) y las posibles contribuciones de este proceso en sus formaciones académicas. Es un estudio de caso analítico, de abordaje cualitativo realizado con discentes, mediante grupos focales con guiones semi-estructurados, asociados al análisis de portafolios elaborados por dichos sujetos, por el análisis de contenido. A partir de la mirada del estudiante de graduación, que a veces ocupa un papel de protagonista y otras de coadyuvante, se observaron elementos importantes en la perspectiva del fortalecimiento del SUS y simultáneamente de su propia formación, en el diapasón de la integración enseñanza/servicio/comunidad. Los discentes perciben el territorio de la ESF como un escenario de aprendizaje vivo y potente que aproxima al estudiante de los servicios de salud y de sus usuarios.

Educação interprofissional e o programa de educação pelo trabalho para a saúde/Rede Cegonha: potencializando mudanças na formação acadêmica / Interprofessional education and the Education through Work for Health Program "Stork Network": leveraging changes in education / Educación interprofesional y Programa de Educación para el trabajo en Salud/Red Cigüeña: potencializando cambios en la formación académica

A educação interprofissional é uma possibilidade de capacitação de estudantes de diferentes cursos da área da saúde, na perspectiva do aprendizado colaborativo, bem como do trabalho em equipe e em rede, visando à integralidade do cuidado em saúde. Este trabalho tem por objetivo relatar as vivências e experiências no Programa de Educação pelo Trabalho para a Saúde/Rede Cegonha, com ênfase na educação interprofissional e nas práticas colaborativas em saúde para a promoção do cuidado integral materno-infantil, bem como na contribuição dessas vivências durante o processo de formação em saúde.

The interprofessional education is the opportunity to train students from different courses in the health area under the perspective of collaborative learning, as well as in teamwork and networking, aiming at the comprehensiveness of health care. This paper aims to report experiences in Education through Work for Health Program “Stork Network”, focusing on interprofessional education and collaborative practice in health to promote maternal and child comprehensive care, as well as the contribution of these experiences during the health education process.

La educación interprofesional es una posibilidad para la formación de estudiantes de diferentes cursos en el área de la salud, a partir de la perspectiva del aprendizaje colaborativo, trabajo en equipo y en red, dirigidos a la integridad del cuidado en salud. Este trabajo tiene como objetivo informar sobre las experiencias y vivencias en el programa PET Salud/Red Cigüeña, centrándose en la educación interprofesional y la práctica de colaboración en materia de salud para promover la atención integral materno-infantil, así como aportar material relativo a la contribución de estas experiencias durante el proceso de formación en salud.