Amiloidose com expressão em cavidade bucal: relato de caso

Objetivo: o objetivo deste trabalho é relatar um caso raro de amiloidose com expressão em cavidade bucal, discutindo a construção do método diagnóstico do caso com dados da literatura especializada, bem como alertar os profissionais de saúde do seu prognóstico desfavorável e da necessidade de diagnóstico precoce. Relato de caso: paciente do gênero masculino, 87 anos de idade, procurou a clínica-escola de cirurgia do Curso de Odontologia da Universidade Estadual de Feira de Santana (Uefs) no estado da Bahia, referindo como queixa principal um aumento de volume na lateral da língua. No exame físico intrabucal, notaram-se múltiplas lesões nodulares em língua (bilateralmente), moles à palpação, sésseis, de crescimento exofítico, superfície rugosa e coloração esbranquiçada. O diagnóstico histopatológico pela coloração hematoxilina-eosina foi inconclusivo, porém, o patologista bucal observou a presença de depósitos de proteínas. Foi, então, realizado o exame histoquímico vermelho congo, que confirmou a presença de depósitos de material amiloide. Dois meses após o diagnóstico, o paciente foi a óbito, não sendo possível determinar se tratava de uma doença local ou sistêmica. Considerações finais: ressalta-se a importância de o cirurgião-dentista conhecer as manifestações clínicas da amiloidose, assim como participar da equipe multiprofissional para diagnosticar as doenças sistêmicas com envolvimento da cavidade oral.

Pleomorphic adenoma in the oral mucosa of a young adult: a case report

Introduction: The pleomorphic adenoma (PA) is the most common benign neoplasia in salivary glands, affecting most commonly the parotid gland of females between the 4th and 6th decades of life. PA can less commonly affect the minor salivary glands; in these cases the main site of attack is the palate. Objective: This study aims are twofold: to report a clinical case of PA involving minor salivary glands in the oral mucosa, treated conservatively; and to emphasize the importance of pathologic examination in defining the correct diagnosis. Case report: A 22 year-old melanoderm male patient sought emergency room due to asymptomatic swelling in the right side of the face. After comprehensive clinical examination, it was decided to perform an incisional biopsy to confirm the diagnosis and further treatment. After confirming the diagnosis of pleomorphic adenoma, we opted for enucleation of the lesion to avoid possible complications such as scar retraction and salivary fistula. Conclusion: It is very important that the dentist early diagnoses the neoplasia to perform more conservative treatments and achieve a better prognosis for the patient, always following-up the case for a period from five to ten years to ensure the non-recurrence of this neoplasia.

Increased bone loss and amount of osteoclasts in kinin B1 receptor knockout mice.

AIM: The pathophysiology of periodontal diseases involves aspects of immunity and bone remodelling. Considering the role of the kinin B1 receptor (Bdkrb1) in inflammation and healing, the purpose of this study was to evaluate the contribution of Bdkrb1 to the pathogenesis of periodontitis. MATERIAL AND METHODS: We used a model of ligature-induced experimental periodontitis (LIEP) in mice lacking Bdkrb1 (Bdkrb1(-/-) ) to test the role of this receptor in bone loss and cytokine secretion by lymph nodes cells. Angiotensin-converting enzyme inhibitor (ACEi) was used as a pharmacological strategy to support the genetic model. Also, autonomous effect of Bdkrb1 deletion was evaluated in osteoclasts precursors from bone marrow. RESULTS: Bdkrb1(-/-) mice exhibit increased bone loss and IL-17 secretion in response to LIEP when compared to wild type. LIEP does not modify TNF-α, IFN-γ and IL-10 levels in Bdkrb1(-/-) mice after 21 days. Bone marrow cells from Bdkrb1(-/-) displayed increased differentiation into functional osteoclasts with consistent artificial calcium phosphate degradation. Furthermore, treatment of mice with ACEi prevented bone destruction. CONCLUSION: Bdkrb1 participates in the pathogenesis of LIEP bone loss possibly through mechanisms that involve modulation of the TH 17 response, thereby demonstrating its role in the development of periodontitis.

B-1 lymphocytes differentiate into functional osteoclast-like cells.

The existence of murine peritoneal osteoclast precursors has been already described. Also, recent reports evidenced an interplay between B lymphocytes and osteoclasts development. B-1 cells comprise a B-lymphocyte subset that resides mostly in pleural and peritoneal cavities. It has been demonstrated that B-1 cells can differentiate into mononuclear phagocytes and form multinucleated giant cells. Based on these findings, we investigated the role of B-1 lymphocytes in bone resorption and osteoclastogenesis. In vivo experimental periodontitis induced in B-1 deficient Xid mice demonstrated that bone resorption is impaired in these animals. However, reconstitution of Xid mice with B-1 cells increased bone resorption to near Balb/c values. B-1 cell derived phagocytes express the receptor activator of nuclear factor-κB (RANK) and the macrophage colony-stimulating factor receptor (M-CSFR). When cultured with RANK-ligand (RANKL) and M-CSF, B-1 cells became tartrate resistant acid phosphatase (TRAP) positive multinucleated cells, a typical osteoclast phenotype. Lacunae formation was observed when cells were cultivated onto a calcium phosphate analog, indicating functional differentiation of B1 cells into osteoclast-like cells. The dynamics of their IgM expression showed that this lymphoid marker was downregulated along the differentiation of B-1 lymphocytes into osteoclasts. Our results unveiled the first evidence that B-1 cells have a role in osteoclastogenesis and bone resorption and offer new insights in the relationship between bone and lymphoid cells.

Serum antibody levels against Porphyromonas gingivalis extract and its chromatographic fraction in chronic and aggressive periodontitis.

UNLABELLED: Periodontitis is an inflammatory oral disease caused by multifactorial intrinsic and extrinsic agents, including Gram-negative bacteria such as Porphyromonas gingivalis. OBJECTIVE: To evaluate if there is difference in the serum levels of IgA, IgG and IgG subclasses reactive to Porphyromonas gingivalis in subjects with different periodontal conditions. METHODS: The study included 89 patients divided into four groups: 29 subjects with moderate or severe chronic periodontitis (CP), 12 with aggressive periodontitis (AP), 22 with gingivitis or mild periodontitis (GP), and 26 healthy controls (HC). Humoral response was assayed by enzyme-linked immunosorbent assay (ELISA) to verify serum levels of IgG, IgG1, IgG2, IgG3, IgG4 and IgA serum levels reacting to crude P. gingivalis ATCC 33277 sonicate extract and fraction IV, an enrichment of the immunoreactive bands of the crude extract obtained by chromatography. RESULTS: IgA, IgG (p < 0.01), IgG2, IgG3 and IgG4 serum level reactions to fraction IV were higher in the CP group compared with the healthy control. The CP group had higher levels of IgG and IgG4 to both antigens than the GP group, and higher levels of IgG and IgG4 to sonicate extract than the AP group. There were statistically significant differences in serum levels of IgG to both antigens (p < 0.01), IgG2 to fraction IV (p < 0.01), IgG3 to fraction IV (p < 0.05) and IgG4 to both antigens (p < 0.05) between AP and HC groups. IgG1 titers to sonicate extract were significantly higher (p < 0.05) in the GP group in comparison to the AP group. CONCLUSIONS: The findings of this study suggest that there are differences in the serum levels of IgA, IgG and IgG subclasses in patients with different periodontal conditions.

Existe correlação entre níveis séricos de anticorpos reativos a porphyromonas gingivalis e a condição periodontal clínica? / Is there any correlation between serum antibody levels reactive to porphyromonas gingivalis and clinical periodontal status?

Porphyromonasgingivalis has been shown to be shown to be one of the most important pathogen in chronic periodontitis development. The aim of this study was to evaluate the correlation among IgA, IgG and IgC and IgG isotype serum levels reactive Porphyromonas gingivalis ATTCC33277 and the clinical periodontal status. Twenty nine periodontitis patients were evaluated according to clinical parameters: probing depth, bleeding on probing, and clinical attachment loss measurements. Humoral immune response was assayed by enzyme linked immunosorbent assay (ELISA). There was no correlation between bleeding on probing (criterion 1) and the evaluated antibodies. Significant positive correlations were found between IgA levels and percentual of sites with clinical attachment loss (CAL) >3mm (criterion 2), percentual of sites with CAL > 5 mm (criterion 3), and percentual of sites with CAL > 3mm associated to probing depth > 4mm and bleeding on probing at the same site (criterion 4) (r=0,311; r=0,336; r=0,358, respectively; p<0,05). There were significant positive correlations between IgG serum levels and criteria 3 and 4 (r=0,400 and r=0,372, respectively; p<0,05), and between IgG1 and criteria 2, 3 and 4 (r=0,333, r=0,323 and r=0,340, respectively; p<0,05). The findings indicate that the antibody response to Porphyromonas gingivalis depends on the periodontal status, determined by clinical parameters

A surface 75-kDa protein with acid phosphatase activity recognized by monoclonal antibodies that inhibit Paracoccidioides brasiliensis growth.

Paracoccidioides brasiliensis is a thermo-dimorphic fungus responsible for paracoccidioidomycosis (PCM), a systemic granulomatous mycosis prevalent in Latin America. The fungus releases many antigens which may be transiently bound to its cell surface. Some of them may show enzymatic functions essential for maintaining many cell processes and survival of the microorganism at different conditions. In this study, we report the characterization of a secreted 75kDa protein from P. brasiliensis with phosphatase activity. Biologic function of the molecule was demonstrated using two specific mAbs produced and characterized as IgM and IgG isotypes. Confocal microscopy and flow cytometry analysis demonstrated that both mAbs recognized the protein on the fungus surface, mainly in its budding sites. In vitro experiments showed that fungal growth was inhibited by blocking the protein with mAbs. In addition, opsonized yeast cells with both mAbs facilitated phagocytosis by murine peritoneal macrophages. Passive immunization using mAbs before P. brasiliensis mice infection reduced colony-forming units (CFU) in the lungs as compared with controls. Histopathology showed smaller inflammation, absence of yeast cells and no granuloma formation.

Prevalência de porphyromonas gingivalis. e leucometria, em mestiços brasileiros com periodontite crónica severa / Porphyromonas gingivalis prevalence and leukometry in Brazilians of mixed race with severe chronic periodontitis

Objetívos: Sendo a periodontite uma doença multifatorial que se inicia e é mantida pela agressão das bactérias periodontopatogênicas, este trabalho objetivou identificar a presença de Pgingvalis (Pg) no biofilme subgengival em indivíduos com periodontite crónica severa, bem como avaliar o leucograma respectivo.Material e métodos: Oitenta e quatro voluntários não-fumantes foram selecionados para o estudo: 43 pacientes com periodontite crónica severa (grupo caso - PCS) e 41 indivíduos sem periodontite (grupo controle - NP). Parâmetros clínicos periodontais e o leucograma foram avaliados. Amostras do biofilme subgengival foram coletadas para detecção de Pg pela técnica da reação em cadeia da polimerase (PCR). Para a análise estatística foram usados os testes t-student e Mann-Whitney (p<0.05). Resultados: Foi detectada a presença de Pg no biofilme subgengival de 29 pacientes (67,4%) do grupo PCS, não sendo observado este periodontopatógeno em nenhum dos indivíduos do grupo NP O grupo PCS apresentou significantemente valores mais elevados do que o NP no número de leucócitos totais e no número absoluto de neutrófilos. Conclusões: Os resultados mostraram que na maioria dos pacientes do grupo PCS foi detectada a presença de Porphyromonas gingivalis e que esta infecção bacteriana pode refletir-se na leucometria.

The influence of low-level laser therapy on biomodulation of collagen and elastic fibers

O estudo da terapia a laser de baixa densidade de energia sobre os diversos constituintes da matriz extracelular é crucial para o entendimento do processo cicatricial sob esse agente. Todavia, pouco se sabe sobre a interferência do laser em relação às fibras colágenas e elásticas. Realizaram-se ferimentos cutâneos padronizados no dorso de setenta e dois ratos Wistar e, em seguida, aplicação pontual do raio laser de baixa potência do tipo Arseneto de Gálio-Alumínio (Ga-Al-As) com diferentes densidades de energia. Os animais foram sacrificados com 24, 48 e 72 horas e aos 5, 7 e 14 dias. Procedeu-se à análise das secções teciduais coradas por hematoxilina-eosina, sírius vermelho e orceína. Observou-se, que nos grupos submetidos à terapia a laser, houve maior redução do edema e infiltrado inflamatório. Os animais tratados apresentaram uma maior expressão de fibras colágenas e elásticas, embora sem significância estatística (p > 0,05). No tratamento com a fluência de 4 J/cm² observaram-se melhores resultados do que naquele em que foi utilizada a fluência de 8 J/cm². Neste estudo, pôde-se concluir que o laser contribuiu para uma maior expressão de fibras colágenas e elásticas durante o processo cicatricial.

Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts.

BACKGROUND AND OBJECTIVE: In re-evaluating the effects of laser therapy in wound healing, the role of extracellular matrix elements and myofibroblasts, was analyzed. STUDY DESIGN/MATERIALS AND METHODS: Cutaneous wounds were inflicted on the back of 72 Wistar rats. Low level laser was locally applied with different energy densities. Lesions were analyzed after 24, 48, 72 hours and 5, 7, and 14 days. Tissues were studied by histology, immunohistochemistry, and electron microscopy. RESULTS: In treated animals, the extent of edema and the number of inflammatory cells were reduced (P < 0.05), but the amount of collagen and elastic fibers appeared slightly increased. Desmin/smooth muscle alpha-actin-phenotype myofibroblasts were statistically more prominent on the 3rd day after surgery (P < 0.05) in treated wounds than in controls. Treatment with a dosage of 4 J/cm(2) was superior to that with 8 J/cm(2). CONCLUSIONS: Laser therapy reduced the inflammatory reaction, induced increased collagen deposition and a greater proliferation of myofibroblasts in experimental cutaneous wounds.

The influence of low-level laser therapy on biomodulation of collagen and elastic fibers.

The study of low-level laser therapy upon extracellular matrix elements is important to understand the wound healing process under this agent. However, little is known about the interference of laser light in relation to collagen and elastic fibers. Cutaneous wounds were performed on the back of 72 Wistar rats and a Ga-Al-As low-level laser was punctually applied with different energy densities. The animals were killed after 24, 48, 72 hours and 5, 7 and 14 days. Tissues were stained with hematoxilin-eosin, sirius red fast green and orcein and then analyzed. It was observed that the treated group exhibited larger reduction of edema and inflammatory infiltrate. The treated animals presented a larger expression of collagen and elastic fibers, although without statistical significance (p > 0.05). Treatment with a dosage of 4 J/cm(2) exhibited more expressive results than that with 8 J/cm(2). In this study, the authors concluded that low-level laser therapy contributed to a larger expression of collagen and elastic fibers during the early phases of the wound healing process.

Contribuiçäo ao estudo da cárie dentária em crianças de 0-30 meses / Contribution to the study of dental caries in 0-30-month-old infants

Este estudo avaliou as condiçöes de sáude bucal de 340 crianças de 0-30 meses de idade (21,3 ñ 5,6), sendo 54,4 por cento meninos, 45,6 por cento meninas, de 20 creches de Salvador, considerando lesöes incipientes e relacionando-as a alguns fatores determinantes da cárie. Os exames foram realizados por um único examinador utilizando-se espelho, sonda e lanterna. Os dentes foram limpos, secos com gaze e as lesöes classificadas de acordo com grau de severidade em cinco níveis (CO-C4; ativa/inativa). Um questionário avaliou o conhecimento sobre a cárie, fatores de risco, instruçäo, renda familiar e uso de flúor. Foram incluídos 229 questionários (67,35 por cento). A análise dos dados foi realizada no Epi-info 6.02. Observou-se uma prevalência de cárie de 55,3 por cento quando todos os estágios da lesäo foram considerados: 25 por cento entre 0-12 meses; 51,18 por cento entre 13-24 meses; 71,03 por cento 25-30 meses (x²=25,31; p<0,01). Avaliando-se apenas manchas barncas ativas, 49,7 por cento das crianças mostraram-se afetadas e 17,6 por cento, apenas com lesöes cavitadas. Das crianças afetadas, 90,96 por cento apresentavam apenas dentes anteriores afetados: 80 por cento das lesöes eram incipientes e 20 por cento, cavitadas. Näo foi observada diferença significante entre sexos. O aumento da quantidade de biofilme dental motrou associaçäo positiva com a cárie nesta faixa etária (x²=67,61; p<0,01) e a por centagem de crianças afetadas mostrou-se maior na presença de aleitamento noturno (x²=0,24; p=0,62). Foi observado um aumento da prevalência de cárie com a idade (x²=25,31; p<0,01) e com o número de dentes irrompidos (x²=122,95; p 0,01). Sugere-se atençäo precoce à saúde bucal para o diagnóstico de lesöes incipientes e adoçäo de medidas educativas e preventivas, incentivando mudanças na higiene bucal e dieta