Periodontal treatment of patients with hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is a rare condition in which fragile vascular walls lead to increased risks of bleeding, cerebral abscesses, arteriovenous malformations, anemia, and thrombosis. To date, no protocol has been established for optimizing the clinical outcomes of periodontal treatment in patients with this condition. The aim of this case report is to describe a safe clinical approach to periodontal treatment in a patient with HHT. A 39-year-old woman had a history of multiple macules on the oral mucosa, and a diagnosis of HHT was made based on the Curaçao diagnostic criteria (epistaxis, telangiectases, visceral lesions, and family history). Evaluation of the patient's periodontal clinical parameters and radiographs led to a diagnosis of generalized periodontitis, stage IV, grade C. The patient underwent nonsurgical periodontal therapy consisting of supragingival and subgingival scaling and root planing under a careful and specific protocol that included antibiotic prophylaxis before each session. Two months after therapy, the periodontal reevaluation showed improvement in the clinical parameters at most sites. Sites with remaining periodontal pockets were re-treated according to the same protocol, including the antibiotic prophylaxis. The patient was enrolled in a periodontal maintenance program, and her HHT was routinely monitored by her physician. Periodontal treatment may promote secondary complications in patients with HHT if appropriate systemic care is not provided, and the periodontal treatment plan should be designed individually for each patient. Establishing the correct HHT diagnosis and coordinating care with the patient's physician are essential to safe, effective treatment.

Gardner Syndrome With Unusual Maxillofacial Manifestation.

Gardner syndrome is a rare autosomal-dominant condition characterized by the presence of intestinal polyposis, multiple osteomas, and tumors of the hard and soft tissues. This paper describes a patient of Gardner syndrome with unusual maxillofacial manifestation with presence of fibromyxomatous injury in jaw, coronoid hyperplasia, and multiple osteomas diffusely distributed in the craniomaxillofacial skeleton. Imaging examinations have identified craniofacial manifestations and the patient was referred to the gastroenterologist who confirmed the diagnosis of Gardner syndrome. The early diagnosis of this syndrome is important since intestinal polyps have high potential for malignant transformation. It is therefore essential that dentists are familiar with the maxillofacial features of this condition, since they precede the intestinal polyposis and encourage early diagnosis. In addition to classic maxillofacial signs of this syndrome, one must consider that, although it is rare, other injuries may be present such as those described in this clinical patient.

Oral Intravascular Papillary Endothelial Hyperplasia Associated with an Organizing Thrombus: Case Report and Immunohistochemical Analysis.

Intravascular papillary endothelial hyperplasia (IPEH) is a benign lesion of the skin and mucosa of vascular origin characterized by reactive proliferation of endothelial cells. A 76-year-old woman was referred presenting a painless nodule on the lip. Intraoral examination revealed bluish submucosal nodular proliferation, measuring 10 × 5 × 5 mm, affecting the lower labial mucosa. The lesion had a firm consistency and it was not fixed to the adjacent tissues. The main differential diagnoses were mucocele/mucus retention cyst, sialolith, or salivary gland neoplasia. An incisional biopsy was performed and during the intraoperative procedure an encapsulated red-bluish nodular mass was observed. Microscopic analysis revealed papillary endothelial proliferation in the center of the lesion and fibrin admixed with inflammatory cells in organization peripherally. There was no nuclear atypia, mitotic figures, or necrosis. The endothelial cells were CD34 positive, with low Ki-67 proliferation index (4%). α-SMA highlighted the vessel walls, whereas negativity for D2-40 excluded lymphatic origin. Final diagnosis was IPEH associated with an organizing thrombus. Dentists should be aware about this rare benign vascular lesion, whose final diagnosis is achieved only after histopathology analysis. Surgical removal is the treatment of choice and no recurrence is expected.

Smear layer removal and collagen fiber exposure using tetracycline hydrochloride conditioning.

AIM: Smear layer removal and collagen fiber exposure may improve periodontal treatment and regeneration. This in vitro study assessed smear layer removal and collagen fiber exposure after tetracycline hydrochloride (TTC) application on root surfaces using scanning electron microscopy (SEM). METHODS AND MATERIALS: Root cementum was removed with diamond burs followed by scaling and root planning. Four hundred fifty samples were divided into ten groups: a control (saline application) and nine different TTC concentrations were applied at doses of 10, 25, 50, 75, 100, 125, 150, 200, and 250 mg/ml. The TTC application was performed in all groups in three different ways (passive, brushing, and burnishing) and at three different periods of conditioning (1, 2, and 3 minutes). A previously trained, calibrated, and blind examiner evaluated photomicrographs of the samples using Sampaio's index (2005). Statistical analysis was performed using the Kruskal-Wallis' and Dunn's tests. RESULTS: The concentrations of 50 mg/mL and 75 mg/mL applied by burnishing were the most effective in smear layer removal and collagen fiber exposure. Both the passive mode of application (p=0.0001) and 1 minute period of application (p=0.002) were the least effective. CONCLUSIONS: The concentrations of 50 mg/mL and 75 mg/mL applied by burnishing during 2 or 3 minutes were the most effective. CLINICAL SIGNIFICANCE: These parameters may be applied in periodontal procedures involving TTC root conditioning to optimize results.

Periodontal condition in patients with rheumatoid arthritis.

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fishers exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.

Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fisher’s exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.

Transformación de leucoplasia verrugosa proliferativa en carcinoma oral: diez años de seguimiento / Transformation of proliferative verrucous leukoplakia to oral carcinoma: a ten years follow-up

Los autores presentan un caso de leucoplasia verrugosa proliferativa (LVP) en varón de 78 años de edad. Fue inicialmente presentado como un caso de leucoplasia en lengua pero un estudio microscópico en 1991 reveló la presencia de displasia epitelial leve. Tras 5 años de seguimiento, la lesión sufrió cambios de tamaño y localización y tuvo comportamiento recidivante. En 1996, un área eritematosa granular e indurada que apareció en lengua resultó ser un carcinoma de células escamosas microinvasivo cuando se estudió microscópicamente. Tras una revisión del comportamiento clinicopatológico de esta entidad, los autores concluyeron que se trataba de una leucoplasia verrugosa proliferativa, cuyo diagnóstico es difícil y retrospectivo, como indicaban otros autores. Los autores enfatizan la importancia del examen periódico detallado clínico e histológico de este tipo de lesiones con el fin de detectar signos de malignidad precozmente (AU)

The authors present a case of proliferative verrucous leukoplakia (PVL) in a 78-year-old man. It was initially presented as leukoplakia on the tongue but a microscopic investigation in 1991 revealed it to be a mild epithelial dysplasia. After 5 years of follow-up, the lesion presented changes in size and location, and a recidivant behavior. In 1996, a red granular and indurated area that appeared on the tongue was found to be a microinvasive squamous cell carcinoma when microscopically investigated. After a review of the clinicopathologic behavior of this entity, the authors concluded that it was a typical PVL, whose diagnosis is difficult and retrospective, as indicated by others. The authors emphasize the importance of periodic detailed clinical and histological examination of this type of lesions in order to detect early signs of malignancy (AU)

Transformation of proliferative verrucous leukoplakia to oral carcinoma: a ten years follow-up.

The authors present a case of proliferative verrucous leukoplakia (PVL) in a 78-year-old man. It was initially presented as leukoplakia on the tongue but a microscopic investigation in 1991 revealed it to be a mild epithelial dysplasia. After 5 years of follow-up, the lesion presented changes in size and location, and a recidivant behavior. In 1996, a red granular and indurated area that appeared on the tongue was found to be a microinvasive squamous cell carcinoma when microscopically investigated. After a review of the clinicopathologic behavior of this entity, the authors concluded that it was a typical PVL, whose diagnosis is difficult and retrospective, as indicated by others. The authors emphasize the importance of periodic detailed clinical and histological examination of this type of lesions in order to detect early signs of malignancy.

Ultrastructural analysis of glands located in the wall of the congenital fistulae of the lower lip of patients with Van der Woude syndrome / Análise ultra-estrutural das glândulas localizadas na parede da fístula congênita de lábio inferior de pacientes com a Síndrome de Van Der Woude

O objetivo do presente estudo foi avaliar a ultraestrutura de glândulas da parede de fístula congênita de lábio inferior ao microscópio eletrônico de transmissão para caracterizar seu padrão microestrutural. Deste modo, as fístulas congênitas de 4 pacientes com a síndrome de Van der Woude do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de Sâo Paulo, Bauru, SP, foram processadas para inclusão em resina Araldite e os cortes finos foram analisados no microscópio eletrônico de transmissão. Os resultados mostraram que as glândulas estavam constituídas por ácinos mucosos típicos exibindo com certa freqüência células mioepiteliais ao seu redor. Em alguns lóbulos, foram observados em pequeno número, ácinos menores que o mucoso típico, exibindo células com grânulos de moderada eletron-densidade contendo um corpo denso ou uma pequena esférula densa no interior de um material predominante granular. Estes grânulos lembravam os descritos recentemente em glândulas salivares labiais humanas. Em vista dos resultados obtidos concluímos que as glândulas associadas com a fístula congênita de lábio inferior de pacientes com a síndrome de Van der Woude, apesar de estarem localizadas no vermelhão do lábio, mostraram ao microscópio eletrônico de transmissão características de glândula salivar labial, i.e., são predominantemente mucosos com poucas unidades seromucosas, mas semiluas seromucosas típicas não estão presentes.

Tratamento de rânula pela técnica da micromarsupialização / Micromarsupialization for treatment of oral ranula

Ranulas e mucoceles são as mais freqüentes patologias que ocorrem nas glândulas salivares. Muitas formas de tratamento são descritas para o manejo dessas patologias, sendo algumas destas muito traumáticas e de resultados clínicos pobres. O objetivo deste trabalho é destacar a técnica da micromarsupialização como opção viável para o tratamento de ranulas, através da revisão de litaratura e relato de um caso clínico

Ultrastructural analysis of glands located in the wall of the congenital fistulae of the lower lip of patients with Van der Woude syndrome.

The objective of the present study was to evaluate the glands of wall of congenital fistulae of the lower lip with the transmission electron microscope in order to characterize their microstructural pattern. Thin section of Araldite resin embedded congenital fistulae of the lower lip of four patients with Van der Woude syndrome from the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, Bauru, SP, were analyzed with a transmission electron microscope. The results showed that the glands were mostly made by typical mucous acini exhibiting, with certain frequency, myoepithelial cells surrounding them. In some of lobules, a few acini smaller than the typical mucous, showed granules of moderate electron density or containing a dense core or exhibiting small dense spherule and predominance granular material. These granules resemble to described recently by others in various human minor salivary glands. We concluded that glands associated with congenital fistula of lower lip of patients with Van der Woude syndrome, in spite of being located in vermilion border of the lip, showed at the transmission electron microscope characteristics of labial minor salivary gland, i.e, are mostly mucous with a few seromucous units, while typical seromucous demilunes are not present.

[Evaluation of the dental students' knowledge on HIV infection. Analysis before and after an informative lecture]. / Avaliação do conhecimento sobre a infecção HIV de estudantes de odontologia antes e após palestra informativa.

The knowledge about HIV infection and AIDS is essential to the dentist. So they should be prepared in the use of measures of cross infection control. The purpose of this research is to evaluate the general and specific knowledge about HIV infection, of the dental students before and after an informative lecture on the subject. In the first stage of the evaluation 160 questionnaires, were given to the students. In the second stage, 3 months later, they went to a 15 minutes lecture about the HIV infection, afterwards another 160 questionnaires were given to the same students. In the questionnaires filled before the lecture the total success index was of 49% and of mistakes was 45.9%. After the lecture those values were 54.4% and 40.8% respectively. We concluded that even after the informative lecture the students presented a high mistake index and little assimilation of the subject, indicating that just 15 minutes of lecture was insufficient for a subject of great importance. The graduation dental students need more information on the HIV infection as well as up to date informative aspects.

Coristoma osseo lingual / Lingual osseous choristoma

Um caso de coristoma ósseo lingual é relatado em uma paciente de 51 anos, leucoderma, com queixa de «verruga¼ na língua presente há dois anos, que dificultava a deglutição e a respiração. Ao exame clínico notou-se a presença de um nódulo séssil, de consistência firme à palpação, na região posterior da língua com diagnóstico presuntivo de fibroma. O tratamento proposto foi a remoção cirúrgica. A peça cirúrgica foi radiografada e observou-se uma imagem radiopaca arredondada, o que levou ao diagnóstico clínico de coristoma ósseo lingual ou fibroma ossificante. A microscopia confirmou o diagnóstico de coristoma ósseo lingual

Estomatite por prótese: orientaçäo ao C.D. quanto à prevençäo e terapêutica / Stomatitis by prosthesis: orientation to D.S. for prevention and therapeutics

Os autores indicam a terapêutica empregada nas estomatites por próteses e enfatizam a importância das orientaçöes aos pacientes portadores de próteses removíveis visando a prevençäo dessas lesöes

Ulceras bucais: diagnóstico diferencial e conduta clínica. Parte I: Ulceras superficiais / Oral ulcers: differential diagnosis and clinical management. Part I: Superficial ulcerations

O diagnóstico das úlceras superficiais da mucosa bucal muitas vezes é difícil e a eficácia do tratamento depende de um diagnóstico correto. O objetivo deste trabalho é orientar o cirurgião dentista no diagnóstico diferencial das úlceras bucais superficiais e na conduta clínica a ser adotada

Ultraestrutura da parede da fístula congênita de lábio inferior na Síndrome de Van Der Woude / Ultrastructure of the wall of congenital fistula of the lower lip in the Van Der Woude Syndrome

A parede mucosa de fístulas congênitas de lábio inferior de 4 pacientes do Hospital de Pesquisa e Reabilitaçäo de Lesöes Lábio-Palatais de Bauru-SP, foram analisadas ao microscópio eletrônico de transmissäo. A fístula de um dos pacientes, em sua porçäo proximal apresentou revestida por epitélio pavimentoso estratificado paraqueratinizado, nas porçöes média e do fundo, o epitélio foi sempre do tipo näo queratinizado. Nos demais pacientes, a parede das fístulas em toda sua profundidade estava constituída por epitélio näo queratinizado. As características ultraestruturais, de ambos os tipos de epitélio näo foram semelhantes às descritas na literatura, para a mucosa humana paraqueratinizada e näo queratinizada. A lâmina própria em todos os casos estava formada por tecido conjuntivo denso näo modelado constituído de densa rede de fibras colágenas

Avaliaçäo do controle da infecçäo cruzada nas clínicas de graduaçäo do curso de odontologia / Evaluation of cross-infection control in of graduate course in odontology

O controle da infecçäo cruzada é a utilizaçäo do conjunto de todas as medidas de prevençäo de barreiras contra a contaminaçäo. Esse trabalho baseou-se na observaçäo e análise das atitudes de prevençäo de infecçäo cruzada nas clínicas odontológicas desenvolvidas pelos alunos de curso de graduaçäo da Faculdade de Odontologia de Araraquara - UNESP (2º semestre de 1994 ao 1º semestre de 1995). Foram analisadas 40 duplas de alunos de graduaçäo da Faculdade de Odontologia de Araraquara em diferentes situaçöes de atendimento ao paciente (exame clínico e tratamento). Os resultados mostraram que 48,7 por cento dos alunos lavaram as mäos antes de colocarem as luvas e 97,5 por cento utilizaram a proteçäo das vias respiratórias, porém, o uso de óculos näo foi observado em 68,8 por cento da amostra. Concluímos que apesar das orientaçöes dadas aos alunos de graduaçäo, quanto à prevençäo de infecçäo cruzada, estas näo foram observadas na prática clínica e que além das informaçöes teóricas, devem ser tomadas medidas para reforçar a orientaçäo aos estudantes

Atendimento odontológico da paciente gestante: complicações e cuidados a serem adotados / Dental treatment of the pregnant patient: complications and management

A paciente gestante apresenta alterações bucais e complicações sistêmicas que interferem no tratamento odontológico. A proposta deste trabalho é informar e auxiliar o Cirurgião-Dentista quanto aos cuidados a serem adotados durante o atendimento odontológico das pacientes gestantes