Relação entre a recorrência do herpes simples e o estresse durante a pandemia de covid-19 em estudantes de odontologia / Relation between the recurrence of herpes simplex and stress during the covid-19 pandemic in dental students

Introdução: A infecção viral causada pelo HSV-1 leva ao aparecimento das lesões do herpes simples e é caracterizada por períodos de infecção primária, latência e recorrência. Durante a vida do indivíduo esta infecção pode ser reativada por diversos fatores como o estresse. No contexto pandêmico de COVID-19, observa-se um aumento de efeitos psicológicos negativos derivados da exaustão emocional entre os estudantes universitários. Objetivo: Avaliar a relação entre o estresse e a recorrência de lesões do herpes simples bucal durante a pandemia de COVID-19 nos estudantes de graduação em odontologia. Materiais e Métodos: Este estudo observacional, descritivo, transversal e de abordagem quali-quantitativo, foi realizado com uma população constituída por 347 estudantes de odontologia, maiores de 18 anos independente de gênero e cor da pele, que já apresentaram episódios primários e/ou recorrentes de herpes simples bucal antes da pandemia de COVID-19. Foram excluídos os estudantes matriculados em odontologia que se recusaram a concordar com o termo de consentimento livre e esclarecido (TCLE). Resultados: A maioria dos participantes era do gênero feminino (81%) com idade entre 20 e 23 anos. Somente 8% apresentaram recorrência das lesões do herpes simples durante o período pandêmico. Entre eles, 78% apresentaram 1 vez, 11% indicaram 4 vezes e 11% revelaram 5 vezes. Analisou-se o nível de estresse, ansiedade e depressão dos participantes por meio da escala DASS-21 e observou-se que entre os colaboradores que apresentaram recorrência do herpes simples bucal, 44% apresentavam ansiedade grave. Ademais, 44% dos participantes manifestaram nível grave e outros 44% nível moderado de estresse. Conclusão: O estudo mostrou o impacto negativo que o período da pandemia de COVID-19 tem causado nos estudantes de odontologia. Notou-se que a parcela da população que apresentou a recorrência das manifestações do vírus em grande maioria indicou ansiedade no nível grave e estresse nos níveis moderado e grave.

Introduction: The viral infection caused by HSV-1 leads to manifestation of herpes simplex lesions and is characterized by periods of primary infection, latency and recurrence. During the individual's life, this infection can be reactivated by several factors such as stress. In the COVID-19 pandemic context, an increase in negative psychological effects derived from emotional exhaustion among university students is observed. Objective: To evaluate the relationship between stress and recurrence of oral herpes simplex lesions during the COVID-19 pandemic in undergraduate dentistry students. Materials and Methods: This observational, descriptive, cross-sectional study, with a quali-quantitative approach, was carried out with a population consisting of 347 dentistry students, over 18 years old, regardless of gender and skin color, who had already had primary episodes and/or recurrent oral herpes simplex before the COVID-19 pandemic. Students enrolled in Dentistry who refused to agree to the free and informed consent form (ICF) were excluded. Results: Most participants were female (81%), aged between 20 and 23 years. Only 8% had recurrence of herpes simplex lesions during the pandemic period. Among them, 78% presented 1 time, 11% indicated 4 times and 11% revealed 5 times. The level of stress, anxiety and depression of the participants was analyzed using the DASS-21 scale and it was observed that among the collaborators who presented recurrence of oral herpes simplex, 44% had severe anxiety. Besides, 44% of participants expressed a severe level and another 44% moderate level of stress. Conclusion: The study showed the negative impact that the period of the COVID-19 pandemic has caused in dentistry students. It was noted that the portion of thepopulation that presented the recurrence of the manifestations of the virus in the vast majority indicated severe level anxiety and stress at moderate and severe levels

Treatment Following Erythema Multiforme in the Oral Mucosa After qHPV Vaccine with Low-Level Laser Therapy: Case Report

ABSTRACT: Erythema multiforme (EM) is a mucocutaneous condition of uncertain etiology, although the hypersensitivity reaction to a wide variety of agents may be related to the onset of the lesions. In about half of the affected patients it is possible to identify a previous infection. This article aims to report a case of EM in the oralmucosa after qHPV vaccine (Gardasil®), to highlight the diagnostic process and the proposed treatment. Female patient, 16 years old, after 10 days of receiving the first dose of the qHPV vaccine. On physical examination, she presented multiple ulcers and hemorrhagic crusts to the touch, based on the clinical picture and the history of the disease, a diagnostic hypothesis was EM. Low-level laser therapy (LLLT) was chosen as an alternative treatment, since the exercises applied were not successful. The patient was followed up, reported decreased pain and burn and, after one year of treatment, there was no recurrence of the lesions. Laser treatment showed an effective treatment alternative, in addition to the low cost and ease of application.

RESUMEN: El eritema multiforme (EM) es una afección mucocutánea de etiología incierta, aunque la reacción de hipersensibilidad a una amplia variedad de agentes puede estar relacionada con la aparición de las lesiones. En aproximadamente la mitad de los pacientes afectados es posible identificar una infección previa. Este artículo tiene como objetivo informar un caso de EM en la mucosa oral después de la vacuna qHPV (Gardasil®), para resaltar el proceso de diagnóstico y el tratamiento propuesto. Paciente de 16 años, después de 10 días de recibir la primera dosis de la vacuna qHPV. En el examen físico, presentó múltiples úlceras y costras hemorrágicas al tacto, según el cuadro clínico y la historia de la enfermedad, una hipótesis diagnóstica fue EM. La terapia con láser de baja potencia (TLBP) se eligió como un tratamiento alternativo, ya que los ejercicios aplicados no tuvieron éxito. La paciente fue seguida, informó disminución del dolor y las quemaduras y, después de un año de tratamiento, no hubo recurrencia de las lesiones. El tratamiento con láser mostró una alternativa de tratamiento efectivo, además del bajo costo y la facilidad de aplicación.

Osteoradionecrosis in a Patient Submitted to Head and Neck Radiotherapy: A Case Report / Osteoradionecrosis en un Paciente Sometido a Radioterapia de Cabeza y Cuello: Reporte de un Caso

ABSTRACT: Radiotherapy applies ionizing radiation at predetermined doses for a limited period of time in order to destroy tumors. The oral cavity, which has a high rate of cell renewal, is affected by the side effects of radiotherapy including osteoradionecrosis (ORN). This condition occurs due to irradiated bone tissue that becomes devitalized and exposed in the oral cavity. Conservative therapies are recommended for ORN lesions that are not extensive or in an early stage. Surgical intervention is necessary for extensive areas affected by necrosis. This study reports a case of ORN in the left mandibular body which resulted in a pathological fracture. The treatment consisted of segmental mandibulectomy and the use of a reconstruction plate. Also, low-level laser therapy around bone exposure was performed. After surgery, the patient underwent 6 months of follow-up and was satisfied with the outcome. However, the patient died before control of ORN was achieved due to a heart attack.

RESUMEN: La radioterapia aplica radiación ionizante a dosis predeterminadas durante un período de tiempo limitado para destruir tumores. La cavidad oral, que tiene una alta tasa de renovación celular, se ve afectada por los efectos secundarios de la radioterapia, incluida la osteorradionecrosis (ORN). Esta condición se produce debido al tejido óseo irradiado que se desvitaliza y expone en la cavidad oral. Se recomiendan terapias conservadoras para las lesiones de ORN que no son extensas o en una etapa temprana. La intervención quirúrgica es necesaria para áreas extensas afectadas por necrosis. Este estudio reporta un caso de ORN en el cuerpo mandibular izquierdo que resultó en una fractura patológica. El tratamiento consistió en mandibulectomía segmentaria y el uso de una placa de reconstrucción. Además, se realizó una terapia con láser de bajo nivel alrededor de la exposición ósea. Después de la cirugía, el paciente se sometió a 6 meses de seguimiento y quedó satisfecho con el resultado. Sin embargo, el paciente falleció antes de que se lograra el control de ORN debido a un ataque cardíaco.

Tratamento conservador de hemangioma em lábio ­ relato de caso / Hemangioma on lip conservative treatment ­ case report

Hemangioma é uma neoplasia benigna de origem vascular comum, embora assintomática, pode causar compressão de estruturas vizinhas, ulcerações ou sangramentos. Na boca, os locais mais afetados por essa alteração patológica são a língua, os lábios e a mucosa jugal. O objetivo deste trabalho é relatar um caso clínico de hemangioma em lábio, ressaltar os aspectos clínicos e o tratamento de escolha. Paciente AJF, 59 anos, sexo masculino, apresentou-se à Clínica de Estomatologia da FAESA com um nódulo em lábio superior do lado esquerdo de superfície lisa e consistência amolecida. O exame de diascopia positivo evidenciou uma leve palidez na coloração arroxeada da lesão e a hipótese diagnóstica foi de hemangioma. Dentre as possíveis alternativas de tratamento, optou-se pelo uso de agente esclerosante devido ao seu baixo custo, sua eficiência e seu resultado clínico esteticamente favorável. O paciente segue em proservação sem necessidade de uma nova intervenção e satisfeito com o resultado estético (AU).

Hemangioma is a benign neoplasm of common vascular origin that, although asymptomatic, may cause compression of neighboring structures, ulcerations or bleeding. In the mouth, the sites most affected by this pathological alteration are the tongue, the lips, and the jugal mucosa. The objective of this paper is to report a clinical case of hemangioma, to highlight the clinical aspects and treatment of choice. Patient AJF, 59- year-old, male, came to the Stomatology Clinic of FAESA with a nodule on the left side of the upper lip of smooth surface and softened consistency. The positive diascopy showed a slight pallor in the lesion purple coloration and the diagnostic hypothesis was hemangioma. Among the possible treatment alternatives, the use of sclerosing agent was chosen due to its low cost, efficiency and aesthetically favorable clinical result. The patient is still in proservation without the need of a new intervention and satisfied with the aesthetic result (AU).

Oral Thrombus: Report of 122 cases with clinically descriptive data

BACKGROUND: The aim of the present study was to assess the frequency and characterize clinic-pathologic aspects of thrombus occurring as a single lesion or in association with other oral pathologies. MATERIAL AND METHODS: 122 cases of thrombus from the oral cavity were retrieved. Information regarding site of the lesion, age, sex and clinical diagnosis or hypothesis and associated lesions were collected from the patients' records. RESULTS: The lesions occurred in a wide age range but the 5th decade was the most prevalent and female patients were more affected. The most frequent site for the lesion was the lip, followed by tongue, buccal mucosa, alveolar ridge, gingiva, floor of the mouth and vestibule. Thirty-five cases were associated with other vascular anomalies or actinic cheilitis. Microscopically, typical thrombus morphology was present. Organized thrombus presented neovascularization and fibroblasts, associated with hemorrhagic areas. CONCLUSIONS: Only 4 cases of oral thrombus have been described in the oral cavity. Given the limited number of cases reported, the importance of a thrombus in the oral cavity is not well established. This study contributes to establishing the profile of patients presenting oral thrombus, a lesion not rare but not well documented

Extra-tongue oral granular cell tumor: Histological and immunohistochemical aspect

BACKGROUND: Granular cell tumor (GCT) is an uncommon benign tumor founded in any part of the body but mainly in the tongue. Extra-tongue oral granular cell tumor (ETOGCT) is rare with few cases reported. Here we describe seven cases of oral GCT located in sites other than the tongue and discuss histopathological and immunohistochemical differences between differential diagnoses. MATERIAL AND METHODS: We retrieved all cases diagnosed with oral granular cell tumor, from the Oral Pathology Service at the School of Dentistry/ University of Săo Paulo, and excluded the ones sited in the tongue. Immunohistochemical staining anti-S100 was also performed. RESULTS: The presented cases of Extra-tongue Oral Granular Cell Tumor (ETOGT) are composed by granular cells with intimately association with the adjacent tissue. Atypia and mitoses were not seen, and in most cases, the typical pseudoepitheliomatous hyperplasia was not observed. CONCLUSIONS: The importance of an adequate attention is to avoid misdiagnoses, since ETOGT is rare and the tricking histopathological findings could induce to it. All the cases can be differentiated from the tumors that has a granular cell proliferation through a morphological analysis and when needed, immunohistochemistry stain

Influence of melaleuca and copaiba oils on Candida albicans adhesion.

OBJECTIVE: To evaluate the efficacy of Melaleuca alternifolia and Copaifera officinalis in inhibiting the adhesion of Candida albicans biofilm. BACKGROUND: Over 65% of denture wearers suffer from denture stomatitis, which is one of the most prevalent forms of oral candidiasis. This disease is characterised by the inflammation of the oral mucosa in contact with the contaminated denture. The contaminated denture contributes to the switch of C. albicans from yeast to its pathogenic hyphal form. Candida albicans adheres and colonises the polymethylmethacrylate resin surfaces and thus contributes to the development of denture stomatitis. MATERIALS AND METHODS: The minimal inhibitory concentration (MIC) of M. alternifolia and Co. officinalis was assessed by the agar dilution method. Sixty-six thermopolymerised acrylic resin squares were used and treated with phosphate-buffered saline, sodium hypochlorite 1%, melaleuca 0.75%, melaleuca 0.375%, melaleuca 0.188% and copaiba 10%. For adherence and biofilm formation, the treated squares were placed in six-well tissue culture plates containing 1 × 10(7)  cells/ml of ATCC1023 or SC5314 in Roswell Park Memorial Institute (RPMI) medium, and after 12 h, the planktonic cells were counted. RESULTS: Copaiba oil did not inhibit C. albicans growth. However, melaleuca oil showed an MIC value of 0.375% (3.4 mg/ml) for ATCC10231 and 0.093% (0.84 mg/ml) for SC5314. CONCLUSIONS: Our results demonstrated that M. alternifolia oil inhibited the growth of C. albicans. Moreover, both oils promoted significant adhesion reduction in the tested strains. These findings suggest the possibility of using these oils in prophylaxes against candidiasis.

Immunohistochemical expression of Bcl-2 and Ki-67 in oral lichen planus and leukoplakia with different degrees of dysplasia.

OBJECTIVES: Oral lichen planus (OLP) is a chronic inflammatory disease of unknown cause. Malignant transformation in OLP lesions may be favored by changes in the expression of proteins that regulate cell proliferation and apoptosis. This study aimed to investigate these issues by immunohistochemical staining for Bcl-2 and Ki-67 and by correlating histopathological findings in samples from lesions of OLP and leukoplakia with epithelial dysplasia. METHODS: Data for patients with OLP or leukoplakia with moderate or severe epithelial dysplasia recorded during 2006-2011 were retrospectively reviewed. The study samples represented 37 subjects with OLP (n = 14), leukoplakia with moderate (n = 8) or severe (n = 6) epithelial dysplasia, and normal buccal mucosa (controls, n = 9). New sections were subjected to histological examination and immunohistochemistry for Bcl-2 and Ki-67 in the basal layer, suprabasal layer, and inflammatory infiltrate, respectively. RESULTS: All basal layer sections stained either negative or positive in <10% of cells for Bcl-2 in OLP (92.9% and 7.1%, respectively) and control (77.8% and 22.2%, respectively) samples. In leukoplakia, 85.7% of sections indicated positivity in <10% of cells, and 14.3% indicated positivity in 10-26% of cells. Most OLP (42.9%) and leukoplakia (64.3%) sections stained positive for Ki-67 in >50% of cells. All suprabasal sections stained either negative or positive in <10% of cells for Bcl-2 in OLP (92.9% and 7.1%, respectively), leukoplakia (42.9% and 57.1%, respectively), and control (88.9% and 11.1%, respectively) samples. Suprabasal staining for Ki-67 was negative or positive in <10% of cells in OLP (14.3% and 85.7%, respectively), leukoplakia (7.1% and 92.9%, respectively), and controls (88.9% and 11.1%, respectively). Staining for Bcl-2 in inflammatory infiltrate in OLP was positive in 92.9% of sections. CONCLUSIONS: Expression of Bcl-2 may play a dual role in tumor development and progression. Increased cell proliferation in the epithelium may present a predisposition to cancer in OLP. The expression of Ki-67 can be considered as an adjunct marker for proliferative activity in lesions with malignant potential. The prognostic value of these immunomarkers in the evaluation of precancerous oral lesions requires further investigation.

Tecidos musculoesqueléticos e pele de origem humana: aspectos éticos e legais da produção científica no Brasil / Musculoskeletal tissues and human skin: ethical and legal aspects scientific production of Brazil / Tejidos musculo esqueléticos y piel de origen humano: aspectos éticos y legales de la producción cienofica en Brasil

Este trabalho realizou análise crítica acerca dos padrões éticos e jurídicos de trabalhos envolvendo casos clínicos e pesquisas que utilizaram enxertos de órgãos ou tecidos musculoesqueléticos e cutâneos publicados em revistas nacionais e internacionais, incluindo ainda dissertaçães e teses de universidades brasileiras. Foram utilizadas três bases de dados de 2000 até 2010: Scielo, Medline e Bireme. Concluiu-se que muitas vezes os princípios bioéticos e as normas jurídicas não foram adotados quanto à aquisição, a utilização e o descarte de tecidos musculoesqueléticos e cutâneos utilizados em estudos científicos, demonstrando a necessidade de se evidenciar normas éticas e legais para aqueles profissionais que utilizarão esse tipo de material.

Este trabajo realizó el análisis crítico de los estándares é ticos y jurídicos de trabajos que involucren casos clínicos e investigaciones que utilizaron injertos de órganos o tejidos musculoesqueléticos y cutáneos publicados en revistas nacionales e internacionales, incluyendo también disertaciones y tesis de universidades brasi-leñas. Se utilizaron tres bases de datos desde el año 2000 hasta el 2010: SciELO, MEDLINE y BIREME. Se concluye que a menudo los principios de la bioética y las normas jurídicas no se han adoptado en la adquisición, uso y eliminación de los tejidos musculoesqueléticos y cutáneos utilizados en los estudios cienơficos, lo que demuestra la necesidad de evidenciar las normas éticas y legales para aquellos profesionales que utilizarán ese tipo de materiales.

This study performed a critical analysis about the ethical and legal standards of papers published in national and international journals involving clinical cases and research regarding musculoskeletal and cutaneous organs or tissue grafts, also including dissertations and thesis of Brazilian Universities. Three databases from 2000 to 2010 were used, which are SciELO, MEDLINE and BIREME. It was concluded that in many cases Bio-ethics principles and legal criteria were not adopted regarding acquistion, utilization and disposal of musculoskeletal and cutaneous tissues used in scientific trials, thus demonstrating the need of highlighting ethical and legal standards for those professionals who use this type of material.

Expressão imuno-histoquímica de Bcl-2, Ki-67 e caspase-3 ativa em líquen plano oral e leucoplasia com diferentes graus de displasia / Immunohistochemical expression of Bcl-2, Ki-67 and active caspase-3 in oral lichen planus and leukoplakia with different degrees of dysplasia

O líquen plano oral (LPO) é uma doença inflamatória crônica de causa desconhecida, e seu potencial de malignização é um tema bastante controverso. Diversos estudos têm sugerido que pacientes portadores de líquen plano apresentam um maior risco de desenvolver câncer. Contudo, muitos autores acreditam que não haja dados suficientes que provem uma associação entre líquen plano e câncer. Para esses autores, a maioria dos casos que sofreram transformação maligna é decorrente de falhas no diagnóstico inicial da lesão. Portanto, objetivou-se avaliar a expressão imuno-histoquímica das proteínas relacionadas à apoptose e proliferação celular, respectivamente caspase-3 ativa, Bcl-2 e Ki-67 no LPO e em displasias epiteliais na tentativa de explicar a polêmica em relação ao potencial de transformação maligna do LPO e enfatizar a importância de um acompanhamento de longo prazo dos pacientes com esta doença. Com esse propósito, foram selecionadas 14 amostras de LPO, 14 amostras de leucoplasia com displasia epitelial, além de 09 amostras de mucosa bucal normal como controle. A avaliação da expressão de caspase-3 ativa, Bcl-2 e Ki-67 foi conduzida de acordo com a técnica da imunoperoxidase. A contagem das células imunomarcadas nas amostras de LPO, de leucoplasia com displasia epitelial e de mucosa bucal normal resultou em número destas células por mm2 nas diferentes regiões (camada basal, camada suprabasal e infiltrado inflamatório) para cada imunomarcador. A expressão de Bcl-2 em células epiteliais, da camada basal, ocorreu mais frequentemente no grupo da leucoplasia com displasia epitelial, com diferença estatística entre o grupo do LPO e o grupo controle. Verificou-se também, uma alta expressão da proteína Bcl-2 em células inflamatórias de lesões de LPO e de leucoplasia com displasia epitelial. A expressão do marcador Ki-67 foi superior em todos os níveis teciduais analisados nas lesões de LPO e de leucoplasia com displasia epitelial quando comparados com o grupo...

The oral lichen planus (OLP) is a chronic inflammatory disease of unknown cause, and its malignant potential is a very controversial issue. Several studies have suggested that patients with lichen planus have a higher risk of developing cancer. However, many authors believe that there is insufficient evidence to prove an association between lichen planus and cancer. For these authors, most of the cases that had undergone malignant transformation is due to flaws in the lesion initial diagnosis. Therefore, the aim was to evaluate the immunohistochemical expression of proteins related to apoptosis and cell proliferation, respectively active caspase-3, Bcl-2 and Ki-67 in epithelial dysplasia and LPO in an attempt to explain the controversy regarding the potential malignant transformation of OLP and emphasize the importance of a long-term monitoring of patients with this disease. For this purpose, we selected 14 samples of OLP, 14 samples of leukoplakia with epithelial dysplasia, and 09 samples of normal oral mucosa as controls. The evaluation of the expression of active caspase-3, Bcl-2 and Ki-67 was conducted in accordance with the immunoperoxidase technique. The immunostained cells counting in samples of OLP, epithelial dysplasia in leukoplakia and normal oral mucosa resulted in a number of these cells per mm2 in the different regions (basal layer, suprabasal layer and inflammatory infiltrate) for each immunostained. The expression of Bcl-2 in epithelial cells, the basal layer, occurred more frequently in the group of leukoplakia with epithelial dysplasia, with statistical difference between the group of OLP and the control group. There was a high expression of Bcl-2 protein in inflammatory cells in OLP lesions and leukoplakia with epithelial dysplasia. The expression of the marker Ki-67 was superior in all analyzed tissue levels in OLP lesions and leukoplakia with epithelial dysplasia when compared to the control group. It was concluded that the highest...