Diagnóstico diferencial e opções de tratamento da úlcera aftosa recorrente: revisão narrativa da literatura / Differential diagnosis and treatment options of recurrent aphrhous ulcer: narrative literature review

Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.

Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments. MATERIALS AND METHODS: The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias. RESULTS: After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34). CONCLUSION: Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited. CLINICAL RELEVANCE: Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Oral Manifestation COVID-19 and the Rapid Resolution of Symptoms Post-Phtalox Treatment: a Case Series / Manifestación Oral de COVID-19 y la Rápida Resolución de los Síntomas Después del Tratamiento con Phtalox: una Serie de Casos

The mouth plays a critical role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to the fact that both the tongue and salivary glands are conducive environments for the storage and spread of the virus. This case series aimed to describe the oral manifestations of coronavirus disease (COVID-19) and report the rapid response to Phtalox® treatment in all patients who tested positive for the virus. The patients were grouped based on whether according to convenience as soon as they tested positive for COVID-19. All patients had mouth ulcers and were advised to use 5 mL of Phtalox® mouthwash for 1 min, five times daily, in addition to standard COVID-19 treatment. Complete healing of mouth ulcers occurred in all patients diagnosed with COVID-19, and the mean duration for complete healing was 2.37 days. General improvement of COVID-19 symptoms was also observed. Based on the rapid recovery of mouth ulcers observed, we suggest that Phtalox® is effective as a complementary oral treatment for ulcers associated with COVID-19.

La cavidad oral juega un papel fundamental en la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) debido al hecho de que tanto la lengua como las glándulas salivales son entornos propicios para el almacenamiento y la propagación del virus. Esta serie de casos tuvo como objetivo describir las manifestaciones orales de la enfermedad por coronavirus (COVID-19) e informar la rápida respuesta al tratamiento con Phtalox® en todos los pacientes que dieron positivo al virus. Los pacientes se agruparon en función de su conveniencia tan pronto como dieron positivo a COVID-19. Todos los pacientes tenían úlceras en la boca y se les recomendó utilizar 5 ml de enjuague oral Phtalox® durante 1 minuto, cinco veces al día, además del tratamiento estándar de COVID-19. La curación completa de las úlceras orales ocurrió en todos los pacientes diagnosticados con COVID-19, y la duración media para la curación completa fue de 2,37 días. También se observó una mejoría general de los síntomas de COVID-19. Con base en la rápida recuperación de las úlceras orales observadas, sugerimos que Phtalox® es eficaz como tratamiento oral complementario para las úlceras asociadas con COVID-19.

Estomatitis Asociada a Metotrexato: Un Reto Diagnóstico / Methotrexate Associated Stomatitis: A Diagnostic Challenge

RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.

ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.

Effects of a mucoadhesive formulation containing Curcuma longa L. on oral wound healing

Introduction: The aim of this study was to investigate the effects of a topical mucoadhesive formulation with Curcuma longa L. extract (MFC) on oral wound healing. Methods: Seventy-two Wistar rats were randomly assigned to 3 groups: Control, Vehicle, and MFC. Traumatic ulcers were made on the dorsum of the tongue with a 3-mm diameter punch. Vehicle and MFC groups received application of the products twice a day, while animals in the control group were cared for in identical conditions but received no product application. Six rats in each group were euthanized at days 3, 5, 10, and 14. Percentage of repair was calculated based on wound area. HE-stained histological sections were obtained for semi-quantitative analysis of re-epithelization and inflammation. Results: Clinical findings revealed that at days 3 and 5, animals from the MFC group exhibited a significantly higher percentage of wound repair. At day 5, animals from this group also demonstrated a significant increase in the degree of re-epithelization and inflammation. Conclusions: MFC is capable of accelerating oral wound repair in an in vivo model by modulating the inflammatory process and stimulating epithelial proliferation. (AU)

Utilidad del Oleozón® tópico en las úlceras orales del paciente con ventilación artificial mecánica, Guantánamo 2018 / Utilidade do Oleozón® tópico nas úlceras orais do paciente com ventilação artificial mecânica, Guantanamo 2018 / Usefulness of topical Oleozón® in the oral ulcers of the patient with mechanical artificial ventilation, Guantanamo 2018

Introducción: Las úlceras de la mucosa oral son comunes en los pacientes con ventilación artificial mecánica. Objetivo: Determinar la utilidad del Oleozón® tópico en el tratamiento de las úlceras de la mu cosa oral en pacientes tratados con ventilación artificial mecánica en la Unidad de Cuidados Intensivos (UCI) del Hospital General Docente Dr Agostinho Neto. Método: Se realizó un estudio tipo caso-control durante enero-julio de 2018. El universo lo conformaron 70 pacientes, de los que se seleccionó una muestra aleatoria y se agruparon en un grupo control (n=20) que se les realizó limpieza de la cavidad bucal con solución salina fisiológica 0,9 por ciento y un grupo estudio (n=20) que se les realizó cura de la úlcera con Oleozón® tópico. Se analizó la localización, área, forma de presentación y magnitud de la úlcera y la evolución clínica de acuerdo al tratamiento que se aplicó. Resultados: La evolución satisfactoria de este tipo de úlcera se precisó en el 40,0 por ciento de los pacientes que conformaron el grupo control y el 90,0 por ciento de los que integraron el grupo estudio (p < 0,01). En este último grupo la ventana entre el inicio del tratamiento y control de la úlcera oral fue de 4,5 ± 1,1 días y para el primero fue 8,1 ± 2,7 días (p < 0,01). Conclusión: Se revela la conveniencia de la aplicación de Oleozón® tópico al tratamiento de las úlceras de la mucosa oral que se presentan en los pacientes tratados con ventilación artificial mecánica(AU)

Introduction: Ulcers of the oral mucosa are common in patients with mechanical artificial ventilation. Objective: To determine the usefulness of topical Oleozón® in the treatment of oral mucosal ulcers in patients treated with mechanical artificial ventilation in the Intensive Care Unit (ICU) of the General Teaching Hospital "Dr. Agostinho Neto". Method: A case-control study was carried out during January-July 2018. The universe was made up of 70 patients, from which a random sample was selected and grouped in a control group (n=20) who were cleaned the oral cavity with 0.9per cent physiological saline solution and a study group (n=20) who were cured of the ulcer with topical Oleozón®. The location, area, form of presentation and magnitude of the ulcer and the clinical evolution were analyzed according to the treatment that was applied. Results: The satisfactory evolution of this type of ulcer was required in 40.0por cento of the patients that formed the control group and 90.0per cent of those who made up the study group (p<0.01). In this last group, the window between the start of treatment and control of the oral ulcer was 4.5 ± 1.1 days and for the first one it was 8.1 ± 2.7 days (p<0.01). Conclusion: The convenience of the application of topical Oleozón® to the treatment of oral mucosal ulcers that occur in patients treated with mechanical artificial ventilation is revealed(AU)

Introdução: Úlceras da mucosa oral são comuns em pacientes com ventilação artificial mecânica. Objetivo: Determinar a utilidade do Oleozón® tópico no tratamento de úlceras na mucosa oral em pacientes tratados com ventilação artificial mecânica na Unidade de Terapia Intensiva (UTI) do Hospital Geral de Ensino "Dr. Agostinho Neto". Método: Foi realizado um estudo de caso-controle no período de janeiro a julho de 2018. O universo foi constituído por 70 pacientes, dos quais uma amostra aleatória foi selecionada e agrupada em um grupo controle (n=20) que foi limpo de cavidade oral com solução salina fisiológica a 0,9por cento e um grupo de estudo (n=20) curado da úlcera com Oleozón® tópico. A localização, área, forma de apresentação e magnitude da úlcera e a evolução clínica foram analisadas de acordo com o tratamento aplicado. Resultados: A evolução satisfatória desse tipo de úlcera foi necessária em 40,0por cento dos pacientes que formaram o grupo controle e em 90,0por cento daqueles que fizeram parte do grupo de estudo (p<0,01). Neste último grupo, a janela entre o início do tratamento e o controle da úlcera oral foi de 4,5 ± 1,1 dias e no primeiro foi de 8,1 ± 2,7 dias (p<0,01). Conclusão: É revelada a conveniência da aplicação tópica de Oleozón® no tratamento de úlceras na mucosa bucal que ocorrem em pacientes tratados com ventilação artificial mecânica(AU)

Oral manifestations of Langerhans cell histiocytosis: A case series.

AIM: Langerhans cell histiocytosis (LCH) is an unusual proliferative disorder of bone marrow-derived histiocytes (Langerhans cells) that can produce focal or systemic manifestations. Oral manifestations of LCH can present as single or multiple lesions and can be a challenge in clinical practice. The aim of this paper is to present the clinicopathological features of a series of nine patients with oral involvement. METHODS AND RESULTS: The patient's age ranged from 2 to 63 years being five males and four females. The most common oral site involvement was the hard-palate mucosa. Ulceration was the main clinical feature. Only two patients showed clearly jawbone involvement. In eight out of nine patients, the diagnosis of LCH was established because of the oral manifestations. CONCLUSION: The recognition of the clinical features of LCH oral manifestation is important to avoid misdiagnosis and to the establishment of the correct treatment. Thus, dentists can play a vital role in the diagnosis of LCH since oral lesions may be the earliest manifestation and sometimes the only sign of the disease. Furthermore, oral lesions may be the early signs of disease reactivation or a multisystem disease indication.

Aplicación del Láser de Baja Potencia (LLLT) en Pacientes Pediátricos: Revisión de Literatura a Propósito de una Serie de Casos / Application of Low Power Laser (LLLT) in Pediatric Patients: Review of the Literature in a Series of Cases

RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.

ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.

Palatal perforation and chemical ulcers of the tongue in a blind patient.

We report a unique case of a potassium aluminum sulfate oral dissolution leading to palatal chemical necrosis and extensive chemical ulcers on the tongue. The patient, a 47-year-old white, blind male, denied using cocaine or other illegal drugs that could cause such lesions. His self-medication started as a treatment for a traumatic ulcerative lesion on the hard palate. After palatal perforation, he started another self-medication routine, mixing corticoid cream and tandrilax tablets with a gauze obturator. Our treatment comprised the removal of all chemical factors, a surgical debridement, and a prosthetic obturator to resolve the communication. The 1-year follow-up showed no complications.

Resolución de úlcera sublingual en paciente con parálisis cerebral: informe de un caso / Resolution of sublingual ulcer in cerebral palsy patient: case report

Male patient, 19 years old, diagnosed with severe mixed tetraparesis, predominantly spastic, secondary to severe perinatal asphyxia, West syndrome and intellectual disability, GMFCS V. october 2012 presents a 1 cm white-colored and painless ulcer on the ventral surface of the tongue, showing indurated borders, and no signs of palpable lymph nodes, compatible with Riga-Fede disease. the patient is referred to the commune hospital. August 2013 attends a dental control presenting the ulcer with similar conditions, awaiting treatment from the hospital. April 2014 he returns for a health control in the same conditions. this time a non invasive intervention is performed, covering the incisal edges of teeth 3.1 and 4.1 with composite resin. A two weeks later control shows a smaller ulceration. By June 2015 the ulcer has healed completely, and stayed healed until january 2016. the mother reports decreased tongue protrusion in frequency and intensity since January 2015. Conclusion: Sublingual traumatic ulcer can be healed by eliminating the cause of the trauma, using a non invasive technique.

Paciente de sexo masculino, 19 años de edad con diagnóstico de tetraparesia mixta severa de predominio espástico, secundaria a asfixia perinatal, síndrome de West y discapacidad intelectual, GMFCS V. En octubre de 2012 presenta úlcera en cara ventral de la lengua, de 1 cm de diámetro aproximadamente, de bordes indurados, fondo de color blanquecino e indolora, sin ganglios palpables, compatible con diagnóstico de enfermedad de Riga Fede. Se deriva en esa oportunidad al hospital de su comuna. En agosto de 2013 asiste nuevamente a control presentando la úlcera con similares condiciones, en espera de tratamiento en el hospital. En abril de 2014 vuelve a control en iguales condiciones. En esta oportunidad se realiza intervención no invasiva, recubriendo superficies incisales de dientes 3,1 y 4,1 con resina compuesta. En control a las dos semanas se observa la úlcera más pequeña. En junio de 2014 se observa ausencia de úlcera, situación que persiste hasta control de enero de 2016. La madre manifiesta que protrusión lingual ha disminuido en frecuencia e intensidad desde enero de 2015. Conclusión: La úlcera sublingual de origen traumático puede ser resuelta eliminando la causa del trauma, de forma no invasiva.

Management of oromandibular dystonia on a chorea acanthocytosis: a brief review of the literature and a clinical case.

BACKGROUND: Chorea acanthocytosis is an extremely rare neurodegenerative condition characterized by neuropsychiatric disturbances, movement disorders, neuropathy, seizures, and acanthocytosis. In this case report, the authors will present the management of the oromandibular movement disorders associated with this disease. CASE DESCRIPTION: This case report describes the focal management of the severe orofacial manifestations associated with this condition. The therapeutic approach adopted to reduce the severe oromandibular movements, dysphagia, and the numerous oral ulcers was selective electromyography (EMG)-guided botulinum toxin application to the inferior head of the lateral pterygoid muscles and masseters. This would be applied to control severe and sudden oromandibular dystonia. RESULTS: Through this procedure, the authors were able to reduce these severe oral manifestations, which had a major impact on the patient's quality of life, and temporarily improve vital functions, such as mastication, deglutition, and speech articulation. CONCLUSIONS: Electromyography-guided botulinum toxin application may be a useful tool in the multimodal management of this condition.

Arnica montana does not affect mast cell populations in experimentally induced oral ulcers in rats / Arnica montana não afeta populações de mastócitos em úlceras orais induzidas experimentalmente em ratos

BACKGROUND: Studies have shown that Arnica montana shows anti-inflammatory and antioxidant activities. It has been used in traditional medicine for the treatment of several disorders. The aim of this study was to investigate the effect of Arnica montana on mast cells during the wound healing of oral ulcers. METHOD: An ulcerated lesion was chemically induced on the tongue of 75 male albino rats and, then, treated topically for seven days using saline solution (control), Arnica montana gel or tincture. The animals were killed after 2nd, 7th, 14th, 21th and 42th day of treatment. The tongues were removed and subjected to routine laboratory (0.2% toluidine blue staining). The numbers of mast cell were determined in two regions: superficial and submucosa. RESULTS: The numbers of mast cells were significantly increased for all groups in the region of the deeper tissue when compared to the superficial region. No statistical difference was observed in mast cell numbers for each group. CONCLUSION: This study revealed that Arnica montana tincture and gel were unable to change mast cell population during wound healing of oral ulcer of rats. According to these results, the anti-inflammatory effects of Arnica montana were not related to inhibition of mast cell degranulation.

OBJETIVO: Sabe-se que a Arnica montana mostra atividade anti-inflamatória e anti-oxidante e tem sido usada em medicina tradicional para o tratamento de vários distúrbios. O objetivo deste estudo foi investigar o efeito da Arnica montana em mastócitos durante a cicatrização de feridas de úlceras orais. MÉTODO: Uma úlcera foi quimicamente induzida na língua de 75 ratos albinos machos e, em seguida, tratada topicamente durante sete dias, utilizando solução salina (controle), gel ou tintura de Arnica montana. Os animais foram sacrificados após 2, 7, 14, 21 e 42º dia de tratamento. As línguas foram removidas e submetidas a rotina de laboratório (coloração com 0,2% de azul de toluidina). A densidade de mastócitos foi determinada em duas regiões: superficial e submucosa. RESULTADOS: O número de mastócitos aumentou nitidamente para todos os grupos na região mais profunda do tecido peri-ulceroso, quando comparada à região superficial. Nenhuma diferença estatística foi observada no número de mastócitos entre os grupos. CONCLUSÃO: Este estudo revelou que a tintura ou o gel de Arnica montana foram incapazes de interferir na população de mastócitos durante a cicatrização da úlcera oral de ratos. De acordo com estes resultados, os efeitos anti-inflamatórios de Arnica montana não foram relacionados à inibição da degranulação dos mastócitos.

Influence of different energy densities of laser phototherapy on oral wound healing.

The aim of the present prospective study was to evaluate the impact of laser phototherapy (LPT) on the healing of oral ulcers. Different power densities were used on oral wounds in Wistar rats (n=72) randomly divided into three groups: control (0 J/cm2), 4 J/cm2 laser, and 20 J/cm2 laser. Ulcers (3 mm in diameter) were made on the dorsum of the tongue with a punch. Irradiation with an indium-gallium-aluminum-phosphide laser (660 nm; output power: 40 mW; spot size: 0.04 cm2) was performed once a day in close contact with the ulcer for 14 consecutive days. A statistically significant acceleration in healing time was found with wounds treated with 4 J/cm2 LPT. Moreover, striking differences were found in the ulcer area, healing percentage, degree of reepithelialization, and collagen deposition. The most significant changes occurred after 5 days of irradiation. Based on the conditions employed in the present study, LPT is capable of accelerating the oral mucosa wound-healing process. Moreover, faster and more organized reepithelialization and tissue healing of the oral mucosa were achieved with an energy density of 4 J/cm2 in comparison to 20 J/cm2.

Etiologia e tratamento da estomatite aftosa recorrente: revisão de literatura / Etiology and treatment of recurrent aphthous stomatitis: literature review

Objetivos: Descrever as características e os principais achados relatados na literatura quanto à provável etiologia e tratamentos das lesões causadas pela Estomatite Aftosa Recorrente (EAR). Métodos: Realizou-se a revisão da literatura nas bases de dados PubMed, SciELO e LILACS, no período de tempo do ano de 2005 a 2012. Utilizaram-se, isoladamente e em combinação, os descritores a seguir: Stomatitis, Aphthous; Oral Ulcer; Risk Factors e Therapeutics. Resultados: A patogênese da estomatite aftosa recorrente ainda continua indefinida, havendo confirmação científica quanto à sua relação com fatores imunológicos e mutações genéticas. Os procedimentos realizados e recursos utilizados para o tratamento das lesões são paliativos, no intuito de aliviar a dor, não existindo uma terapêutica de cura. Conclusão: Por ser a etiologia da EAR ainda incerta, o tratamento atual das lesões é bastante variado,e baseia-se no alívio dos sintomas da doença, variando, desde o uso de produtos naturais, como a própolis, passando por anti-inflamatórios, até à aplicação do laser de baixa potência.

Objectives: To describe the characteristics and key findings reported in the literature about the possible etiology and treatment of lesions caused by Recurrent Aphthous Stomatitis (RAS). Methods: It was conducted a literature review in the databases PubMed, SciELO and LILACS, from 2005 to 2012. Were used singly or in combination, the following descriptors: Stomatitis, Aphthous; Oral Ulcer; Risk Factors and Therapeutics. Results: The pathogenesis of recurrent aphthous stomatitis still remains unclear, however, there is strong evidence regarding its relationship with immunological factors and genetic mutations. The procedures performed and resources used for the treatment of lesions are palliative in order to relieve pain, there is not a therapeutic healing. Conclusion: As the uncertain etiology of RAS, the current treatment of lesions is very wide, and relies on relieving symptoms of the disease, ranging from the use of natural products, such as propolis, to anti-inflammatories, until the implementation of low-power laser.

Sublingual traumatic ulcerative lesions caused by the eruption of first primary mandibular molars: a case report / Lesión ulcerativa traumática sublingual causada por la erupción del primer molar temporal: reporte de un caso

Traumatic ulceration of the ventral surface of the tongue is an uncommon condition in infants and toddlers, which is often associated with natal and neonatal teeth in newborns. The aim of this report is to present a case of bilateral ulcerative ulcers on the ventral surface of the tongue caused by the eruption of first primary mandibular molars in a 14-month-old male child. The child was able to point to the lesions and also refused to consume certain beverages and foods, which favored an early diagnosis. Clinical treatment consisted of manual smoothing of the sharp edges of both mandibular first molars and a home regimen of lidocaine hydrochloride solution (Xylocaine®, Astra) and a steroid solution of triamcinolone acetonide (Omcilon ­ A, Brystol-Myers) for symptoms relief and lesion healing, respectively. Complete healing of both lesions and normal feeding were both observed at a one-week follow-up exam. Early detection of the lesions and parental compliance with recommended home regimens were key factors for a successful treatment outcome, since untreated cases of tongue ulcerative lesions may evoke feeding difficulties and failure to thrive. Although there are several reports of ulcerative lesions on the tongue caused by dental eruption, they are usually associated with the eruption of mandibular primary incisors (Riga-Fede disease). However, there are no reports of ulcerative lesions caused by other primary teeth.

La ulceración traumática de la superficie ventral de la lengua es una condición poco común en bebés y niños pequeños, la cual se asocia a menudo con los dientes natales y neonatales en los recién nacidos. El objetivo de este reporte es presentar un caso de úlceras bilaterales en la superficie ventral de la lengua causada por la erupción de los primeros molares mandibulares temporales en un infante de sexo masculino de 14 meses de edad. En niño fue capaz de señalar las lesiones y se negó a consumir ciertas bebidas y alimentos, lo que favoreció un diagnóstico precoz. El tratamiento clínico consistió en el suavizado manual de los bordes afilados de los primeros molares inferiores y un régimen casero de solución de clorhidrato de lidocaína (Xilocaína®, Astra) junto a la solución esteroidal de acetónido de triamcinolona (Omcilon - A, Brystol-Myers) para el alivio de los síntomas y curación de la lesión respectivamente. La curación completa de ambas lesiones y la alimentación normal se observó en una semana del control de seguimiento. La detección temprana de las lesiones y el cumplimiento de los padres con los regímenes caseros recomendados, son factores claves para un resultado exitoso del tratamiento, ya que los casos no tratados de estas lesiones ulcerosas pueden provocar dificultades en la alimentación y una evolución inadecuada. Aunque existen varios informes de lesiones ulcerosas en la lengua causada por la erupción dental, que se asocian generalmente con la erupción de los incisivos mandibulares temporales (enfermedad de Riga-Fede). Sin embargo, no existen informes de lesiones ulcerosas causadas por otros dientes temporales.

Dentes natais e doença de Riga-Fede / Natal teeth and Riga-Fede disease

Dentes natais são aqueles presentes na cavidade oral ao nascimento de etiologia desconhecida. Um ou dois dentes aparecem comumente na mandíbula (região de incisivos inferiores) podendo causar a doença de Riga-Fede, caracterizada por uma úlcera no ventre da língua relacionada ao trauma devido à presença desses dentes precoces, interferindo na alimentação da criança. Paciente HNS, dois meses de idade, gênero feminino, foi levado pela mãe à clínica de Odontopediatria, pois não conseguia mais se alimentar (mamar no seio materno). Realizou-se uma completa anamnese, na qual a mãe relatou a presença de dentes na cavidade oral do lactente, desde o nascimento, e de uma úlcera na língua. Ao exame clínico, observaram-se dois dentes na região de incisivos inferiores e a úlcera de Riga-Fede. Ao exame radiográfico constatou-se que os mesmos não eram supranumerários, e sim os dentes 71 e 81. Optou-se por mantê-los, já que eram os decíduos e estavam bem implantados. O tratamento preconizado foi o desgaste das incisais dos dentes com disco de Soflex® (3M ESPE, St Paul, Mn, USA) seguido de aplicação de verniz de flúor; prescrição de V.A.S.A. na úlcera, antes das mamadas e Oncilon A® (B-MF, São Paulo, Brasil) em orabase três vezes ao dia, por quatro dias. Dez dias após, a criança retornou para acompanhamento, a úlcera desapareceu e a abordagem mostrou-se indicada e eficaz.

Natal teeth are those present in the oral cavity at birth with unknown etiology. Generally, one or two teeth can appear in the mandibular incisor region and lead to Riga-Fede disease, which is characterized by an ulcer on the ventral surface of the tongue caused by the trauma due to this early tooth, affecting the child´s ability to suckle. Patient HNS, a two-month-old female, was taken by her mother to a pediatric dental clinic because she could not suckle. A complete interview was done, in which mother reported the presence of teeth in the child´s oral cavity and an ulcer on the tongue. Clinical examination revealed two teeth in the mandibular central incisor region and Riga-Fede disease. Radiographs revealed that those teeth were not supranumerary, but teeth 71 and 81. It was decided that they would remain in the oral cavity since they were the deciduous teeth and were well implanted. Treatment consisted of rounding the incisal edges of the teeth with a Sof-Lex® (3M ESPE, St Paul, Mn, USA) disc, followed by application of a fluorine varnish. Additionally, V.A.S.A. should be applied on the ulceration before breastfeeding and Orabase Oncilon A® (B-MF, São Paulo, Brasil) given three times a day for four days. Ten days later, the child returned for a follow-up visit. The ulcer had disappeared and the approach proved to be indicated and efficient.

[Failure of sublingual immunotherapy to treat latex allergy. A report of a case]. / Fracaso de la inmunoterapia sublingual para tratar la alergia al látex. Comunicación de un caso.

Natural rubber latex has been in widespread use for over a century. Reports of immediate hypersensitivity to latex have increased dramatically since the first case was reported in 1979, specially in persons with cumulative latex exposure. A 13 year old male was referred to our office. He had been wearing orthodontic rubber bands for two years. The previous year he started having itchy, red and watery eyes, with sneezing and runny nose when he was exposed to rubber products. Then he developed oral edema and lip ulcers. Finally, he experienced cough, wheezing, chest tightness and dyspnea. The patient had no history of undergoing surgery, and his mother denied pacifier use. He had no history of fruit and vegetables allergy. Physical examination revealed conjunctival hyperemia, with fine papillary response in the upper tarsal plate, hyaline rhinorrhea, turbinate hypertrophy and perioral ulcers. Skin prick test were positive for latex and Quercus albus. Patch test with latex glove was negative, but positive with rubber tourniquet. Total IgE was 365 UI/mL. Latex-specific IgE testing confirmed the diagnosis. Spirometric values were normal. He started rush sublingual immunotherapy with latex extract. When he had finished, he traveled abroad. At immigration the inspectors examined him with latex gloves. Immediately he developed anaphylaxis, needing urgent medical attention. Although the efficacy and safety of sublingual immunotherapy for latex allergy has been demonstrated, the most effective strategy is complete avoidance of latex-containing products. World Public Health Services must promote the use of synthetic elastomer gloves in airports worldwide.

Clinical management for epidermolysis bullosa dystrophica.

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.