Orofacial Manifestations in a Middle-Aged Woman with Cowden Syndrome: A Case Image.

A 56-year-old Brazilian woman sought dental care, presenting with multiple asymptomatic papillomatous lesions with a coalescent pattern and intermingled cobblestone-like clefts along the alveolar ridge and marginal and attached gingivae. Multiple whitish papules were also observed on the face, neck, and limbs. Incisional biopsies of these lesions were performed. Microscopically, the skin lesion revealed epithelial clear cells and intraepithelial keratinization with areas of orthokeratosis, while the gingival lesions showed a parakeratinized stratified squamous epithelium with collagenous connective tissue. These features were consistent with those of a trichilemmoma and fibroepithelial hyperplasia, respectively. This article illustrates a case of Cowden syndrome (CS), a rare multisystem genetic condition in which both cutaneous and mucosal tissues were affected. Fewer than 40 cases of CS with oral involvement affecting middle-aged adults have been documented hitherto.

Oral manifestations of sporotrichosis: A neglected disease.

Sporotrichosis is an uncommon subacute or chronic infection caused by Sporothrix spp. In some urban areas of Latin America, sporotrichosis has been considered an emergent cosmopolitan disease of zoonotic transmission by domestic cats. There are four different clinical forms of the disease: fixed cutaneous, lymphocutaneous, multifocal or disseminated cutaneous, and extracutaneous. The oral mucosa is rarely involved, usually as unspecified chronic ulcers in the context of multifocal or disseminated cutaneous form of systemic sporotrichosis. Microscopical features include chronic granulomatous inflammation containing microabscesses and fungal hyphae positive for Periodic acid Schiff and silver-based stains. The diagnosis of sporotrichosis is usually based on culture detection and strict correlation of clinical, microscopical and laboratorial data. We herein contribute with two additional illustrative cases of oral manifestation of sporotrichosis in immunocompromised patients from an endemic urban area from Rio de Janeiro-Brazil. Key words:Sporotrichosis, ulcer, oral cavity, immunosuppression.

The frequency of oral conditions detected in hematology inpatients

ABSTRACT Background: Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. Objective: To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. Methods: Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. Results: Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. Conclusion: This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.

The frequency of oral conditions detected in hematology inpatients.

BACKGROUND: Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. OBJECTIVE: To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. METHODS: Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. RESULTS: Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. CONCLUSION: This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association.

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection.

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection. .

Gender differences in oral manifestations among HIV-infected Brazilian adults.

AIM: The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. METHODOLOGY: A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearing house criteria. RESULTS: A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39-13.36)]. CONCLUSION: These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.

Necrotizing periodontal diseases in HIV-infected Brazilian patients: a clinical and microbiologic descriptive study.

OBJECTIVE: Nowadays, necrotizing periodontal diseases have a low prevalence; however, a better understanding of the etiopathogenesis of these diseases is necessary for determining more adequate preventive and therapeutic strategies. METHOD AND MATERIALS: From a pool of 1,232 HIV-infected patients, 15 presented with necrotizing periodontal diseases, which were evaluated by full-mouth periodontal clinical measurements. Subgingival biofilm samples were collected from necrotizing lesions of six of these individuals. The presence and levels of 47 bacterial species were determined by checkerboard DNA-DNA hybridization. RESULTS: All 15 patients (10 had severe immunodeficiency) had been infected sexually. Thirteen patients were taking antiretroviral medication (66.7% undergoing highly active antiretroviral therapy). Regarding necrotizing periodontal diseases, necrotizing ulcerative gingivitis (60%) was more prevalent than necrotizing ulcerative periodontitis (40%). The frequency of supragingival biofilm and bleeding on probing ranged from 11.5% to 59.2% and 3.0% to 54.0%, respectively, whereas the mean probing depth and clinical attachment level were between 1.48 and 2.61 mm and 1.30 and 2.62 mm, respectively. Species detected in high prevalence and/or counts in necrotizing lesions included Treponema denticola, Eikenella corrodens, Dialister pneumosintes, Enterococcus faecalis, Streptococcus intermedius, Aggregatibacter actinomycetemcomitans, and Campylobacter rectus. In contrast, Parvimonas micra, Prevotella melaninogenica, Fusobacterium nucleatum, Eubacterium nodatum, and Helicobacter pylori were observed in the lowest mean prevalence and/or counts. CONCLUSION: Necrotizing periodontal disease lesions in HIV-infected patients present a microbiota with high prevalence and/or counts of classical periodontal pathogens, in particular T denticola, as well as species not commonly considered as periodontal pathogens, such as E faecalis and D pneumosintes. In addition, these individuals with necrotizing periodontal disease frequently display severe immunodeficiency and AIDS-defining diseases such as tuberculosis.

Tongue hyperpigmentation resulting from peginterferon alfa and ribavirin combination therapy: a case report.

BACKGROUND: Tongue hyperpigmentation is a rare side effect in patients with hepatitis C virus infection who are receiving peginterferon alfa and ribavirin combination therapy. Tongue hyperpigmentation usually occurs after the patient has undergone several months of treatment, and it resolves after the patient discontinues therapy. CASE DESCRIPTION: A 66-year-old dark-skinned woman with hepatitis C virus infection was referred to the Oral Diseases Treatment Center of São Leopoldo Mandic Dental School, Campinas, Brazil, for evaluation of tongue pigmentation after receiving peginterferon alfa and ribavirin combination therapy for 32 weeks. A physical examination showed dark brown, asymptomatic pigmentation in the dorsum of the tongue. Six months after the patient discontinued therapy, the authors observed a marked reduction in the pigmentation's intensity. CASE IMPLICATIONS: Dentists should be aware that hyperpigmentation of the tongue can result from peginterferon alfa and ribavirin combination therapy. A biopsy should be performed if no firm diagnosis can be obtained from clinical findings and the patient's medical history.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004.

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5%. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5 percent. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Sialotomografia: revisão de literatura e relato de caso clínico / CT Sialography: a review of the literature and case report

A sialotomografia é um excelente modelo para observação e estudo de tumores das glândulas salivares. O objetivo deste estudo é revisar a literatura sobre sialotomografia, descrever seu protocolo de aquisição através de relato de um caso clínico e e discutir suas vantagens e contra-indicações. Paciente do gênero masculino, 33 anos, com aumento de volume indolor, bem definido, em região de glândula parótida esquerda. A associação do uso de meio de contraste à técnica tomográfica permitiu uma avaliação mais precisa dos limites da lesão. Entretanto, a administração de meios de contraste deve ser cautelosa devido às possíveis reações adversas.

Cisto odontogênico calcificante associado a odontoma composto: relato de caso / Calcifying odontogenic cyst associated to compound odontoma: report of a case

O cisto odontogênico calcificante (COe) é um tumor odontogênico, que comumente pode apresentar-se associado a um odontoma. O diagnóstico radiográfico de odontoma faz muitos cirurgiões não enviarem a peça cirúrgica para exame anatomopatológico. Tal conduta pode levar o profissional a ignorar o devido diagnóstico e realizar procedimento inadequado. Neste trabalho relata-se um caso de paciente de 16 anos, onde a única manifestação clínica era a ausência do dente 33. Em exame radiográfico foi detectada lesão radiolúcida, com imagens radiopacas no seu interior. Após a hipótese clínico-radiográfica de odontoma composto, foi realizada a biópsia excisional com preservação do dente 33. O resultado histopatológico foi de COC associado à odontoma composto. O paciente está sendo tratado por ortodontia, sem recidiva da lesão. Será enfatizada ainda a importância da associação de um exame clínico-radiográfico criterioso ao exame histopatológico, para obtenção de um diagnóstico final preciso.

The calcifying odontogenic cyst (COC) is an odontogenic tumor, which is commonly associated to odontomas. However, the radiographic diagnosis of an odontoma might lead the dentist not to send the surgical specimen to microscopic analysis. Such behavior might lead the dentists to ignore a proper post-surgical follow-up in cases of COC. In this paper, a case of a calcifying odontogenic cyst associated to an odontoma in a 16 years-old male patient whose only clinical manifestation was the absence of the tooth 33 is reported. In the radiographic examination a radiolucence was detected with radiopaque signs inside. With clinical and radiographic hypothesis of compound odontoma, an excisional biopsy was performed with preservation of the tooth 33. The histopathological result was COC associated to compound odontoma. The patient has been submitted to orthodontic treatment without recurrence. In this paper, it will be emphasized the importance of an association of a proper clinical and radiographic examinations to the histopatological analysis to obtain an accurate definitive diagnosis.

Prevalência de lesões orais na infecção por HIV em adultos e crianças / Prevalence of HIV related oral lesions in adults and children

Manifestações clínicas orais da Aids são comuns e podem ser o primeiro sinal da infecção por HIV. Elas constituem importante fator prognóstico, pois eu aparecimento indica evolução da doença. Após a introdução da terapia anti-retroviral combinada, foi observada uma redução da frequência dessas manifestações. Este estudo objetivou avaliar a prevalência de lesões orais associadas ao HIV/Aids em adultos e crianças atendidos em um serviço de referência (HUAP/UFF). Nossos dados mostram que, apesar da redução na prevalência, essas lesões ainda são frequentes, evidenciando a necessidade de um exame intra-oral regular e criterioso para melhor acompanhar a infecção pelo HIV nesses pacientes