Oral Lesions as the Primary Manifestations of Behçet's Disease: The Importance of Interdisciplinary Diagnostics-A Case Report.

BACKGROUND: Behçet's disease (BD) is a rare chronic auto-inflammatory systemic disease with non-specific oral manifestations, categorised as generalised variable vessel vasculitis that requires an interdisciplinary approach to diagnose due to its phenotypic heterogeneity. Whilst the oral lesions that reoccur in BD underpin the complex diagnostic process, the crucial role of dental professionals is highlighted in a case report summarised herein. We present a case of a 47-year-old male referred to the Oral Medicine Department by a rheumatologist after previous hospitalization for thrombosis of the iliac vein and inferior vena cava. He had elevated inflammatory C-reactive protein biomarker and an increased erythrocyte sedimentation rate. Recurrent episodes of folliculitis, oral and genital ulcers were reported. Clinical examination revealed multiple ulcerations in the oral mucosa. The complementary, histopathological analysis performed to rule out other disorders, based on excisional biopsy, showed non-keratinised stratified squamous epithelium with areas of exocytosis and ulceration. The connective tissue presented an intense mixed inflammatory infiltrate, congested blood vessels, haemorrhage, vasculitis, and HLA-B genotyping identified the expression of HLA-B15, further supporting the BD diagnosis. Treatment was initiated with colchicine, prednisolone, and weekly subcutaneous administration of methotrexate and resulted in the complete remission of oral lesions and no recurrence of other manifestations. CONCLUSIONS: This BD case report emphasizes the importance of a multidisciplinary approach in diagnosing BD, including the use of histopathological assessment and genetic profiling. It highlights the significance of thorough intraoral assessment and referral to a multidisciplinary team for diagnosis. The oral manifestations of BD as the primary symptoms often indicate underlying major systemic pathologies. The authors stress the need for a structured diagnostic algorithm to facilitate timely and effective management of BD.

Contribuição topográfica do forame e língula mandibular em procedimentos cirúrgicos no ramo da mandíbula / Topographic contribution of the foramen and mandibular lingula in mandibular ramus surgeries

Objetivo: analisar a topografia e biometria do forame mandibular e da lingula mandibular em crânios secos para verificar sua variabilidade e determinar suas posições topográficas. Material e Método: Para analisar as distâncias, foram realizadas medições utilizando um paquímetro digital Mitutoyo® devidamente calibrado para coletar a distância em milímetros, do centro do forame até as quatro margens (anterior, posterior, superior e inferior) do ramo mandibular (N = 176). Realizamos as medidas do forame mandibular em milímetros para determinar sua geometria externa. A lingula mandibular (N = 76) foi estudada quanto à sua localização topográfica e forma quando sua estrutura é preservada. Todos os dados foram documentados em um protocolo de coleta de dados com o objetivo de desenhar diagramas esquemáticos e arquivar as fotografias dos casos e a análise dos resultados. Resultados: em relação à frequência, o forame estava presente em todos os casos (100%), em ambos os lados da superfície medial do nervo mandibular. O número de forames de cada lado é único: foram observados 175 casos (99,5%). Apenas um forame (0,5%) era o dobro do lado direito. Em relação à sua posição em relação às margens da mandíbula, na maioria delas, está localizada próxima à margem inferior, variando entre 9,6 mm e 39,1 mm, com média de 26,0 mm. A margem posterior da mandíbula variou entre 6,8 mm e 24,0 mm, com média de 12,30 mm. A lingula mandibular dos maxilares foi analisada em 32 maxilares (64 casos), com formato triangular (55%), presente na maioria dos casos (86%) e posição ântero-superior em 43% deles. Conclusões: o forame mandibular é um elemento anatômico importante para o sucesso da técnica de bloqueio do nervo alveolar inferior. Sua estrutura acessória, a lingula mandibular, é uma posição de referência em cirurgia ortognática; devido à sua localização e aspecto, serve como um escudo protetor para o feixe neurovascular alveolar inferior

Objective: to analyze the topography and biometrics of the mandibular foramen and mandibular lingula in dry skulls to verify their variability and to determine their topographic positions. Material and method: to analyze the distances, measurements were made using a properly calibrated Mitutoyo® digital caliper to collect the distance in millimeters, from the center of the foramen to the four margins (anterior, posterior, superior and inferior) of the mandibular ramus (N=176). We performed the measurements of the mandibular foramen in millimeters to determine its external geometry. The mandibular lingula (N=76) was studied regarding its topographical location and shape when its structure was preserved. All data were documented in a data collection protocol aimed at drawing schematic diagrams and archiving the photographs of the cases and the analysis of the results. Results: in relation to the frequency, the foramen was present in all cases (100%), on both sides on the medial surface of the mandibular ramus. The number of foramen on each side is unique: 175 cases (99.5%) were observed. Only one foramen (0.5%) was double on the right side. Regarding its position in relation to the margins of the jaw, in most of them, it is located near the inferior margin, having varied between 9.6mm and 39.1mm, with an average of 26.0mm. The posterior margin of the jaw varied between 6.8mm and 24.0mm, with an average of 12.30mm. The mandibular lingula of the jaws were analyzed in 32 jaws (64 cases), having triangular shape (55%), present in most cases (86%) and in anterosuperior position in 43% of them. Conclusions: the mandibular foramen is an important anatomical element for the success of the inferior alveolar nerve block technique. Its accessory structure, the mandibular lingula, is a reference position in orthognathic surgery; due to its location and aspect, it serves as a protective shield for the inferior alveolar neurovascular bundle

Prevalência e caracterização das lesões orais na Clínica de Estomatologia da Policlínica Piquet Carneiro ­ Estudo Retrospectivo de 12 anos / Prevalence and characterization of oral lesions in the Stomatology Clinics of the Piquet Carneiro Polyclinics 12-Year Retrospective Study

Objetivo: avaliar a prevalência dos principais tipos de lesões submetidas à biópsia e identificar o perfil dos pacientes atendidos no ambulatório de Estomatologia da Policlínica Piquet Carneiro (PPC/UERJ, Rio de Janeiro) no período compreendido entre 2000 e 2012. Material e Métodos: estudo transversal e retrospectivo em que prontuários de 2078 pacientes foram avaliados e dados referentes às doenças, idade, gênero, cor da pele e localização anatômica das lesões foram coletados e analisados de forma descritiva. Resultados: 69% dos pacientes (1441 casos) obtiveram o diagnóstico conclusivo através de exame histopatológico, ao passo que 31% (637 casos) obtiveram um laudo histopatológico descritivo. Dos casos com diagnóstico histopatológico conclusivo, 58% eram mulheres, 31% homens e em 11% o sexo não foi informado. A média de idade da população estudada foi de 50,63 anos e em 58% dos casos os pacientes eram leucodermas. O maior número de lesões foram as do grupo dos processos proliferativos não-neoplásicos, sendo a hiperplasia fibrosa inflamatória (30,1%) a mais prevalente. Conclusão: o perfil epidemiológico do paciente atendido no período estudado foi composto predominantemente por mulheres com mais de 50 anos de idade e a lesão oral mais prevalente foi a hiperplasia fibrosa inflamatória. Este estudo reforça a importância do papel da análise histopatológica como método auxiliar de diagnóstico e que possibilita a elaboração de estratégias específicas para prevenção e detecção precoce das doenças orais mais frequentes na população

Objective: to evaluate the prevalence of the main types of lesions submitted to biopsy and to identify the profile of patients attended at the Stomatology Clinics of the Piquet Carneiro Polyclinics (PPC/UERJ, Rio de Janeiro) between 2000 and 2012. Material and methods: this is a cross-sectional and retrospective study in which medical records of 2,078 patients were evaluated and data referring to diseases, age, sex, skin color and anatomical location of the lesions were collected and analyzed descriptively. Results: A total of 69% of patients (1,441 cases) obtained the conclusive diagnosis by histopathological examination, whereas 31% (637 cases) obtained a descriptive histopathologic report. Of the cases with conclusive histopathological diagnosis, 58% were women, 31% were men and 11% did not inform their sex. The mean age of the studied population was 50.63 years and in 58% of the cases the patients had light skin. The largest number of lesions were from non-neoplastic proliferative processes, and the inflammatory fibrous hyperplasia (30.1%) was the most prevalent. Conclusion: the epidemiologic profile of patients attended during the study period consisted predominantly of women over 50 years of age and the most prevalent oral injury was inflammatory fibrous hyperplasia. This study reinforces the importance of the histopathological analysis as a diagnostic auxiliary method that enables the elaboration of specific strategies for prevention and early detection of the most frequent oral diseases in the population

Manifestações orais da doença do enxerto contra o hospedeiro crônica: revisão sistemática de literatura / Oral manifestations of chronic graft vs host disease: systematic literature review

Objetivo:Identificar a frequência das manifestações orais da DECHc em pacientes submetidos ao TCTH, através de uma revisão sistemática da literatura. Material e Métodos: Realizou-se uma revisão sistemática da literatura utilizando-se as bases de dados PubMed, Cochrane e Dentistry & Oral Sciences Source para realização da busca bibliográfica (setembro/2015), que resultou em um total de 212 publicações, entre as quais 40 foram incluídas no estudo. Resultados: As lesões liquenoides foram relatadas em 82,5% dos estudos, sendo as alterações mais frequentes entre diversas outras, como úlceras, relatadas em 57,1% dos estudos, atrofia da mucosa em 45,7%, mucocele em 37,1% e pseudomembranas em 17,1%. Entre os sintomas, a xerostomia foi relatada em 80% dos estudos, superando a dor (48,5%), sensibilidade/ queimação (34,2%) disgeusia/ageusia (17,1%), disfagia (14,2%), entre outras. Conclusão: Observou-se assim, na literatura, uma alta ocorrência de diversas manifestações orais associadas à DECHc.

Objective: To identify the frequency of oral manifestations of cGVHD in patients undergoing HSCT, through a systematic review of the literature. Material and Methods: It was performed a systematic review of the literature using the databases PubMed, Cochrane and Dentistry & Oral Sciences Source to perform the literature search (september/ 2015), which resulted in a total of 212 publications, among which 40 were included in the study. Results: The lichenoid lesions were reported in 82.5% of the studies, the most frequent changes among many others found, such as ulcers, reported in 57,1% of the studies, mucosal atrophy in 45,7%, mucocele in 37,1% pseudomembranes in 17.1%. Among the symptoms, dry mouth was reported in 80% of studies, overcoming the pain (48,5%), sensitivity/burning (34,2%) dysgeusia/ageusia (17,1%), dysphagia (14,2%), among others. Conclusion: There was, in the literature, a high occurrence of various oral manifestations associated with cGVHD.

Tratamento das manifestações orais da doença enxerto contra hospedeiro crônica: revisão sistemática da literatura / Treatment of oral manifestations of chronic graft versus host disease: systematic literature review

Objetivo: Sintetizar as principais modalidades terapêuticas utilizadas no tratamento das manifestações orais da doença enxerto contra hospedeiro crônica (DECHc), através de uma revisão sistemática da literatura. Material e Métodos: Foi realizada uma busca nas bases de dados Cochrane Library,Dentistry & Oral Sciences e Pubmed, com descritores para o tratamento da DECHc com envolvimento oral, entre os meses de Junho e Outubro de 2015. Definiu-se uma metodologia de seleção a partir da leitura dos títulos, resumos e artigos disponíveis. Resultados: Foram encontradas 32 publicações, que apresentaram um total de 13 fármacos imunossupressores, sendo 07 dos quais foram empregados por meio de terapia local e 06 via sistêmica. Dois artigos tratavam de terapias auxiliares para o alívio da hipossalivação. Conclusão: As medicações encontradas podem servir de parâmetros para futuros fármacos a serem empregados na prática clínica. O tratamento da DECHc oral ainda apresenta eficácia limitada, todavia, sugere-se o uso de medicação tópica para reduzir efeitos sistêmicos. São necessários estudos prospectivos, randomizados e controlados para comprovar a eficácia de certas medicações.

Objective: To summarize the main therapeutic modalities used in the treatment of oral manifestations of graft versus host disease (GVHD), through a systematic review of the literature. Material and Methods: A search was conducted in the databases Cochrane Library, Dentistry & Oral Sciences and Pubmed, with descriptors for the treatment of chronic GVHD with oral involvement, between June and October 2015. The methodology was defined from reading the titles, abstracts and articles available. Results: Founded 32 publications that presented a total of 13 immunosuppressant drugs, and 07 which were employed by local therapy and systemically 06. Two articles treated auxiliary therapies to relieve hyposalivation. Conclusion: Drugs found may serve as parameters for future drugs to be used in clinical practice. The treatment of oral GVHD still has limited effectiveness, however, suggests the use of topical medications to reduce systemic effects. Prospective studies are needed, randomized controlled trials to prove the effectiveness of these medications.

Evaluation of cephalometric landmark identification on CBCT multiplanar and 3D reconstructions.

OBJECTIVE: To evaluate the reliability of three-dimensional (3D) landmark identification in cone-beam computed tomography (CBCT) using two different visualization techniques. MATERIALS AND METHODS: Twelve CBCT images were randomly selected. Three observers independently repeated three times the identification of 30 landmarks using 3D reconstructions and 28 landmarks using multiplanar views. The values of the coordinates X, Y, and Z of each point were obtained and the intraclass correlation coefficient (ICC) was calculated. RESULTS: The ICC of the 3D visualization was rated >0.90 in 67.76% and 45.56%, and ≤0.45 in 13.33% and 14.46% of the intraobserver and interobserver assessments, respectively. The ICC of the multiplanar visualization was rated >0.90 in 82.16% and 78.56% and ≤0.45 in only 16.7% and 8.33% of the intraobserver and interobserver assessments, respectively. An individual landmark classification was done according to ICC values. CONCLUSIONS: The frequency of highly reliable values was greater for multiplanar than 3D reconstructions. Overall, lower reliability was found for points on the condyle and higher reliability for those on the midsagittal plane. Depending on the anatomic region, the observer must choose the most reliable type of image visualization.