Inflammatory Fibrous Hyperplasia Associated with Chondroid Metaplasia - Report and Morphological Analysis of Five Cases

Inflammatory fibrous hyperplasia (IFH) is a common reactive lesion in dental prostheses users that may be associated with chondroid metaplasia (CM). Metaplasia is an adaptive cellular process that may be caused by trauma. We reported here five cases of IFH associated with CM and analyzed morphologically the deposition of collagen in these lesions. Patients had a mean age of 58.8 years-old and were ill-fitting dental prostheses users. They presented nodular lesions located in the anterior maxilla. Microscopically, it was observed hyperplastic fibrous connective tissue with chronic inflammatory infiltrate and hyaline cartilage. No morphological differences were observed in collagen deposition under light microscopy, but quantitative analysis revealed a significantly higher collagen deposition at the connective tissue near CM (p = 0.015). IFH associated with CM affects ill-fitting dental prostheses users. The presence of CM is not significant to the lesion prognosis. However, its formation and the higher collagen deposition near it reinforces the IFH reactive origin.

La hiperplasia fibrosa inflamatoria (HFI) es una lesión reactiva común en los usuarios de prótesis dentales que puede estar asociada con la metaplasia cartilaginosa (MC). La metaplasia es un proceso celular adaptativo que puede ser causado por un trauma. El presente informe analizó cinco casos de HFI asociados a MC y se analizaron morfológicamente la deposición de colágeno en estas lesiones. Los pacientes tenían una edad media de 58,8 años y eran usuarios de prótesis dentales mal adaptadas. Se observaron lesiones nodulares localizadas en el la parte anterior del maxilar Microscópicamente se observó tejido conectivo fibroso hiperplásico con infiltrado inflamatorio crónico y cartílago hialino. No se observaron diferencias morfológicas en la deposición de colágeno bajo microscopía óptica, pero el análisis cuantitativo reveló una deposición de colágeno significativamente mayor en el tejido conectivo cerca de MC (p = 0,015). La HFI asociada con la MC afecta a los usuarios de prótesis dentales mal adaptadas. La presencia de MC no es significativa para el pronóstico de la lesión. Sin embargo, su formación y la mayor deposición de colágeno cerca de MC refuerza el origen reactivo de HFI.

A Case of Doxycycline-induced Melanin in the Gingiva Tissue: Case Report.

BACKGROUND: Gingival pigmentation is a discoloration of the gingiva due to a variety of lesions and conditions associated with several endogenous and exogenous etiologic features. OBJECTIVE: The purpose of this study is to describe a report of gingival pigmentation in a patient who used doxycycline. CASE REPORT: A 21-year-old Caucasian female was under dermatological treatment and antibiotic therapy with doxycycline 100 mg (one time a day) for 90 days. She presented brown pigmentation at the gingival margin on the facial surfaces of the upper and lower anterior incisors and premolars. The patient was evaluated by immunohistochemical (S-100, Melan-A, and HMB-45) and histopathologic analyses, and clinical history. Blood levels of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) were analyzed by UV/Vis spectroscopy. The adrenaline, noradrenaline, and dopamine in blood were analyzed by high-performance liquid chromatography (HPLC); dehidroepiandrosterone (DHEA) in serum by radioimmunoassay; and luteinizing hormone (LH) and 25-Hydroxyvitamin D by chemiluminescence. Hematoxylin-eosin stained sections revealed keratinocytes with pigment compatible with melanin. The Fontana-Masson staining was positive in melanophages and in some basal keratinocytes. S-100, Melan A and HMB-45 were confirmed as positive markers of melanocytic differentiation in gingival tissue. We observed a significant increase in malondialdehyde (p˂0.05) and a decrease in superoxide dismutase levels (p˂0.05). The dopamine value was found to be 15 pg/ml (reference value ≤ 10 pg/ml). CONCLUSION: The use of doxycycline is associated with an increase in oxidative stress and of dopamine with melanin pigments in the gingival tissue. This case report showed a cause-effect relationship between exposure to doxycycline and pigmentation of the marginal gingiva.

Evaluation of Microbial Contamination in the Inner Surface of Titanium Implants Before Healing Abutment Connection: A Prospective Clinical Trial.

PURPOSE: The objective of this investigation was to assess the microbiologic contamination in the inner surface of titanium implants prior to prosthetic abutment placement. MATERIALS AND METHODS: The study population consisted of partially edentulous individuals who had previously received at least one internal hexagon titanium dental implant. A bacterial sample of the inner surface of the individual dental implant was taken after surgical reopening for healing abutment placement. The samples were allocated in order to evaluate three distinctive variables as follows: (1) location (mandible vs maxilla), (2) early exposure of implants to the oral cavity (cover screw) throughout the healing stage (exposed vs not exposed), and (3) existence or lack of keratinized mucosa (KM). The microorganism species detected were examined by checkerboard DNA-DNA hybridization. RESULTS: A total of 32 partially edentulous patients with 78 implants placed in both the maxilla and mandible were enrolled: 8 men and 24 women, ranging in age from 27 to 64 years (mean age: 47.7 years). Bacteria were detected in 20 patients, distributed in 41 implants. Spontaneous early implant exposure and absence of KM did not increase bacterial contamination in the inner surface of implants. A significant increase in the detection of 22 bacterial species was found in the mandible when compared with the maxilla. CONCLUSION: Microbial biofilm accumulation in the implant's internal surface might happen before healing abutment placement. Exposure of implants to the oral cavity and absence of KM were not directly related to a greater microbial biofilm count. The results suggested that submerged healing does not protect implants against bacterial colonization.

Quality of life of patients with cleft lip and / or cleft palate: perspective of parents/guardians

To evaluate the quality of life of children with oral cleft.Material and Methods:The ECOHIS questionnaire was used to assess the quality of life of 31 patients aged 02-05 years from the perception of their parents. Study's variables were divided into impact on children subscale, through the domain of symptoms, limitations, psychological and self-image; and impact on the family subscale, through the domain anguish of parents and family function. Descriptive analysis tests were used in Statistical Software Program -SPSS® version 18.0.Results:71% of sample subjects were male.There was prevalence of cleft lip -palate (38.7%), followed by cleft lip (32.3%) and cleft palate (29%). Cleft transforamen incisive (38.7%) was predominantand the most frequent location was unilateral left (58.3%) and the complete type was the most significant (75%). All participants mentioned some impact of the problem on the child's quality of life. In the impact on children subscale, limitations domain had the highest average (mean: 5.16; SD2.87) and in the impact on family subscale, family function domain was the most significant (mean: 2.29; SD: 1.82). As for difficulties faced by children, question on "difficulty in pronouncing words" was the most significant (61.3%). Conclusion:The presence of clefts impacts the quality of life of children and their families, thus requiring strategies for the reestablishment of aesthetics, function and psychological support for such individuals...

Perfil odontológico de pacientes com necessidades especiais assistidos em hospital pediátrico de uma universidade pública brasileira / Dental Profile of Special Needs Patients in a Pediatric Hospital of a Brazilian Public University

Objetivo: Traçar o perfil odontológico dos pacientes com necessidades especiais que são assistidos no ambulatório odontológico em um hospital pediátrico de uma universidade pública. Método: Foi realizado estudo descritivo e retrospectivo, pela análise de 186 prontuários odontológicos dos pacientes com Necessidades Especiais, provenientes do Hospital de Pediatria Professor Heriberto Ferreira Bezerra, Natal/RN. Coletaram-se os dados relativos ao sexo, faixa etária, hábitos parafuncionais, forma de higiene oral, presença de cárie, mancha branca ativa, doença periodontal, e uso de medicação. Os dados foram analisados no programa SPSS por meio da estatística descritiva e analítica. Resultados: Observou-se maior prevalência do sexo masculino (55,9%) e da faixa etária de nove a 11 anos (26,9%). Das necessidades especiais, as mais registradas foram as anomalias congênitas (54,3%) e doenças sistêmicas crônicas (45,7%). Dentre eles, 53,8% usam medicamentos, sendo hormônio 15,6%, vitaminas 12,4%, antibiótico 9,1%, anti-hipertensivo 9,1% e anticonvulsivante 9,1%. Entre os hábitos deletérios, destacaram-se a respiração bucal (41,4%) e a onicofagia (31,2%). A higiene oral é realizada com escova e dentifrício em 96,8% dos pacientes, sendo que o dentifrício com flúor é usado por 78,5% da amostra. O uso do fio dental foi identificado em apenas 12,4% e a condição de higiene oral foi insatisfatória em 86% das PNEs. Constatou-se presença de mancha branca ativa (14%), necessidade de selamento dentário (31,7%) e exodontia (57%). 87,1% dos pacientes apresentam lesões cariosas, 35,5% gengivite, e 29,6% cálculo dentário.Conclusões: As necessidades especiais mais comuns foram fenda labial e/ou palatina, síndrome de Down, diabetes, epilepsia, doença renal crônica e cardiopatia. A respiração bucal é um hábito deletério recorrente. Apesar da utilização de escova dental regularmente e dentifrício fluoretado, a higiene oral é insatisfatória e há alta incidência de cárie, presença de gengivite e necessidade de exodontias múltiplas.

Objective: To outline the dental profile of special needs patients treated in the dental outpatient clinic in a pediatric hospital of a Brazilian public university.Method: A descriptive retrospective study of 186 dental charts of special needs patients referred from the Prof. Heriberto Ferreira Bezerra Pediatric Hospital in Natal, RN, Brazil. Data were collected on sex, age group, parafunctional habits, oral hygiene method, caries, active white spots, periodontal disease and use of medication. The collected data were analyzed by descriptive and analytical statistics using the SPSS software.Results: There was prevalence of males (55.9%) and the 9-11 year-old (26.9%) age group. Among the special needs, the most frequent were congenital anomalies (54.3%) and chronic systemic diseases (45.7%). Medication was used by 53.8% of the sample; 15.6% were hormones, 12.4% vitamins, 9.1% antibiotics, 9.1% anti-hypertensive drugs and 9.1% were anticonvulsant drugs. The main deleterious habits were mouth breathing (41.4%) and nail biting (31.2%). Oral hygiene was performed with dentifrice and toothbrushing by 96.8% of the patients and fluoridated dentifrice is used by 78.5% of the subjects. Dental floss was used only by 12.4% and poor oral hygiene conditions were observed in 86% of the special needs patients. The analyses also revealed active white spots (14%), need of restoration by 31.7% and extraction by 57%. As much as 87.1% presented carious lesions, 35.5% presented gingivitis, and 29.6% had dental calculi.Conclusions: The most common special needs were cleft lip/palate, Down syndrome, diabetes, epilepsy, chronic renal disease and cardiopathy. Mouth breathing was a recurrent deleterious habit. Despite regular toothbrushing and use of fluoridated dentifrice, poor oral hygiene was observed and there was a high incidence of caries, presence of gingivitis and need of multiple extractions.

Elastofibromatous change of the oral mucosa: case report and literature review.

Elastofibroma is an uncommon fibrous pseudotumor that usually occurs in the subscapular region of middle-aged and older adults. Since its seminal description, cases of elastofibroma or elastofibroma-like proliferations have been identified at several anatomic locations, including the foot, hand, thigh, olecranon, gastrointestinal tract, trachea, dorsal spine and eye. Involvement of the oral cavity is rare, with only four cases reported to date. Herein, we report a case of elastofibromatous change in the soft palate of a 55-year-old man and review the literature regarding pathogenesis, clinicopathologic features, differential diagnosis and management.

Absence of periodontitis in acromegalic patients.

Acromegaly is a metabolic disorder caused by increased growth hormone (GH) secretion. Common oral features are prognatism, increased interdental spaces, macroglosia, and dental mobility. However, not much is known about the periodontal status of acromegalics. The periodontal status of 16 acromegalic subjects was investigated and compared with 20 controls (similar socioeconomic profile and age). Periodontal probing, followed by the assessment of gingival overgrowth, tooth loss and mobility, and malocclusion was performed. Acromegalic patients' did not present periodontitis and all of them had complete absence of periodontal pockets, while 50% of the control group presented periodontitis. All acromegalic patients presented dental mobility degree 1, mainly in the anterior inferior teeth. Malocclusion (100%) and diastemas (93.75%) were also present in these patients. It was concluded that acromegalic patients may be less prone to periodontal diseases than control subjects.

[Scientific output trends in oral health in Brazil]. / Tendências da produção científica em odontologia no Brasil.

OBJECTIVE: To describe dental research trends in Brazil (especially population-based oral health) in the early Twenty-first Century. METHODS: The abstracts of studies presented at meetings of the Brazilian Society for Dental Medicine Research (Sociedade Brasileira de Pesquisa Odontológica) from 2001- 2006 were assessed in terms of methodological design (aggregate or population-based and individual-based studies, observational and intervention studies, cross-sectional and longitudinal studies); general type (literature review, studies with human subjects, and laboratory studies); and classification into one of the 19 specialty categories recognized by the Brazilian Federal Dentistry Council. Of the 10 406 abstracts presented in this period, 5 203 (50%) were reviewed. RESULTS: Concerning methodological design, 87.5% of the abstracts referred to individual-based studies, whereas 12.5% were of aggregate studies. Concerning the general category, 41.7% referred to studies with human subjects. The remaining abstracts (58.3%) described in vitro (31.1%) or in vivo (23.6%) laboratory research and literature reviews (3.6%). Concerning the Council's specialty categories, only five had a frequency higher than 10.0%: esthetic dentistry, periodontics, endodontics, pediatric dentistry, and population-based oral health. CONCLUSIONS: Brazil's scientific output in the field of oral health for the period 2001- 2006 was balanced, with increasing interest in the area of population-based oral health.

Tendências da produção científica em odontologia no Brasil / Scientific output trends in oral health in Brazil

OBJETIVO: Descrever a tendência da produção científica odontológica no Brasil, destacando-se a área de saúde bucal coletiva, nos primeiros anos do século XXI. MÉTODOS: Os resumos de trabalhos apresentados nas reuniões da Sociedade Brasileira de Pesquisa Odontológica (SBPqO) de 2001 a 2006 foram avaliados em termos do seu desenho metodológico (estudo agregado ou individuado; estudo observacional ou de intervenção; estudo transversal ou longitudinal), natureza geral (revisões bibliográficas, estudos com seres humanos ou pesquisas laboratoriais) e enquadramento em uma das 19 especialidades reconhecidas pelo Conselho Federal de Odontologia (CFO). Dos 10 406 trabalhos apresentados nesse período, foram lidos 5 203 (50,0 por cento do total). RESULTADOS: Quanto ao desenho metodológico, 87,5 por cento dos resumos eram do tipo operativo individuado e 12,5 por cento do tipo agregado. Na classificação da natureza geral da pesquisa, 41,7 por cento dos resumos tratavam de estudos com seres humanos. Os resumos restantes (58,3 por cento) tratavam de pesquisas laboratoriais in vitro (31,1 por cento), pesquisas laboratoriais in vivo (23,6 por cento) e revisões bibliográficas (3,6 por cento). Com relação às áreas de conhecimento do CFO, apenas cinco atingiram percentuais de ocorrência superiores a 10,0 por cento: dentística, periodontia, endodontia, odontopediatria e saúde coletiva. CONCLUSÕES: A produção científica odontológica brasileira no período de 2001 a 2006 foi equilibrada, com crescente interesse na área de saúde bucal coletiva.

OBJECTIVE: To describe dental research trends in Brazil (especially population-based oral health) in the early Twenty-first Century. METHODS: The abstracts of studies presented at meetings of the Brazilian Society for Dental Medicine Research (Sociedade Brasileira de Pesquisa Odontológica) from 2001-2006 were assessed in terms of methodological design (aggregate or population-based and individual-based studies, observational and intervention studies, cross-sectional and longitudinal studies); general type (literature review, studies with human subjects, and laboratory studies); and classification into one of the 19 specialty categories recognized by the Brazilian Federal Dentistry Council. Of the 10 406 abstracts presented in this period, 5 203 (50 percent) were reviewed. RESULTS: Concerning methodological design, 87.5 percent of the abstracts referred to individual-based studies, whereas 12.5 percent were of aggregate studies. Concerning the general category, 41.7 percent referred to studies with human subjects. The remaining abstracts (58.3 percent) described in vitro (31.1 percent) or in vivo (23.6 percent) laboratory research and literature reviews (3.6 percent). Concerning the Council's specialty categories, only five had a frequency higher than 10.0 percent: esthetic dentistry, periodontics, endodontics, pediatric dentistry, and population-based oral health. CONCLUSIONS: Brazil's scientific output in the field of oral health for the period 2001-2006 was balanced, with increasing interest in the area of population-based oral health.

Perfil periodontal de pacientes com hiperprolactinemia / Periodontal status of patients with hyperprolactinemia

Nos últimos quinze anos um considerável número de estudos tem sido focado nas relações entre as periodontopatias e as alterações hormonais importantes, como a hiperprolactinemia (HPL), não têm sua situação periodontal investigada e descrita na literatura. Trinta pacientes do sexo feminino, portadoras de HPL, foram selecionadas aleatoriamente no Serviço de Endocrinologia do Hospital Universitário Walter Cantídio, da Universidade Federal do Ceará (UFC). Um número similar de pacientes (n+30), sem doenças sistêmicas, foi selecionada como grupo controle. Profundidade de sondagem (OS) e Índice de Sangramento Gengival (ISG) foram avaliados nos dois grupos para definir a situação da saúde periodontal dos pacientes. O grupo experimental mostrou que três pacientes (10%) apresentavam periodontite crônica avançada, três tinham periodontite crônica leve/moderada (10%) e 24 foram consideradas saudáveis (80%). Na análise do ISG, as pacientes com HPL pertenciam, em sua maioria, ao grupo com ISG elevado podendo ser reflexo da alteração na microcirculação gengival. Novos estudos devem ser realizados para esclarecer a relação entre a doença periodontal e a hiperprolactinemia.

The influence of a gummy smile on lip seal.

OBJECTIVE: The purpose of this study was to verify the influence of excessive gingival display on lip seal. METHODS: Eighteen individuals with gummy smiles and poor lip seal were submitted to orofacial myofunctional assessment and surface electromyography in order to verify the action potential amplitude of mentalis muscle action generated during muscular exertion. Periodontal surgery was performed to remove excessive gingival tissue and bone volume from the pre-maxilla, and after 6 months, the patients were re-evaluated. RESULTS: Decreased contraction and tensing of the mentalis muscle (chin dimpling) was clinically observed when attempting lip seal and electromyographical analysis revealed a statistically significant difference among action potential values during muscular exertion to achieve lip contact. CONCLUSION: It was concluded that lip seal is influenced by gingival bone volume and that surgical removal contributed to a smoother contact between the lips.

Dental and periodontal alterations in Berardinelli-Seip syndrome.

BACKGROUND: Congenital generalized lipodystrophy (CGL), or Berardinelli-Seip congenital lipodystrophy (BSCL), is a rare disorder characterized by the absence of body fat and resistance to insulin. Other manifestations, such as acanthosis nigricans, hepatomegaly, hyperandrogenism, muscular hypertrophy, and diabetes mellitus may be seen. Although the general clinical picture of this disease has already been characterized, there has yet been no description of the dental manifestations of individuals with this disease. METHODS: Eight patients with BSCL were assessed (4 adults and 4 children/adolescents), with ages ranging between 4 and 35 years, of which 6 had diabetes mellitus. Gingival bleeding index (GBI) was measured and periodontal probing, caries detection and visual examination of gingival volume were performed. RESULTS: GBI was variable and was related to poor oral hygiene. There was a marked presence of caries and no alteration in gum tissue growth was observed. Important anomalies were detected in the periodontal examination. The patients over the age of 30 years had an aggressive and generalized form of periodontal disease, uncommon for this age. The etiology of these alterations may be the diabetes mellitus present in these patients since childhood. CONCLUSION: We concluded that a predisposition to caries must be reviewed and periodontal disease must be systematically investigated in individuals with BSCL, since periodontitis may be seen along with the numerous systemic complications.

Emprego de miniparafusos na sutura palatina mediana como ancoragem ortodôntica: relato de caso / Midpalatal miniscrew implants as orthodontic anchorage: a case report

A sutura palatina mediana com uma fina espessura de tecido mole ceratinizado e suficiente cortical óssea é um ótimo local para o implante de miniparafusos. Apesar das limitações anatômicas da sutura palatina mediana, ela vem sendo usada com extensões, a partir dos miniparafusos. Essa técnica de implantes também pode ser usada para intrusão de molares superiores com redução no tempo de tratamento e aumento do conforto do paciente.

Avaliação da margem gengival dos dentes anteriores superiores como guia para cirurgias estéticas periodontais / Evaluation of the Gingival Margin in Upper Anterior Teeth as a Guide for Periodontal Esthetics Surgery

Os últimos anos mostraram muitos avanços a respeito das novas técnicas para procedimentos cirúrgicos estéticos periodontais em pacientes com problemas muco-gengivais. Recessões e crescimentos gengivais são os problemas mais freqüentes que requerem a intervenção do periodontista. Com o auxílio da microscopia tomou-se necessário o estabelecimento de padrões estéticos para a execução de cirurgias plásticas periodontais. Cem pacientes foram avaliados em dois aspectos: posição do zênite gengiva I dos seis dentes anteriores superiores - localizado no centro da coroa ou na posição distal - e posição da margem gengival dos incisivos laterais comparada com a dos incisivos centrais e caninos - mais alta, mais baixa ou no mesmo nível. Pacientes em tratamento ortodôntico, com contenções, dentes em má posição ou com anomalias de forma, recessões gengivais, hiperplasia ou com inftamação foram excluídos desta investigação. Obtivemos como resultado uma maior prevalência da posição centralizada do zênite gengival nos incisivos laterais e caninos e distalizada nos incisivos centrais. A altura da margem gengival dos incisivos laterais estava mais baixa em relação aos incisivos centrais e caninos em 67% dos pacientes. Embora a literatura reporte que o zênite gengiva I dos incisivos centrais e caninos esteja distalizado, esta investigação observou o zênite dos caninos mais centralizado.