Association between epithelial-mesenchymal transition markers, proliferative index, and oral epithelial dysplasia: an immunohistochemical study.

OBJECTIVE: This study aimed to correlate the immunoexpression of epithelial-mesenchymal transition markers, vimentin and E-cadherin (E-CAD), and putative markers, podoplanin (PDPN) and osteopontin (OTPN), with the expression of interleukin (IL-6), P53, and Ki-67, and with clinical and histologic parameters of oral epithelial dysplasia (ED). STUDY DESIGN: Immunohistochemical reactions were performed in 61 cases of leukoplakia with ED, graded as low-risk (LRED = 38) and high-risk (HRED = 23) for malignant transformation. Odds ratios (OR) and 95% CI were calculated using logistic regression analysis. RESULTS: High-risk epithelial dysplasia was more frequently observed in non-homogeneous leukoplakia (OR:7.66; CI:1.43-41.04), lesions on the tongue/floor of the mouth (OR:3.37; 95% CI:1.14-9.94), and intense PDPN expression (OR:9.17; CI:1.0-83.77). High-risk epithelial dysplasia exhibited higher Ki-67 expression than LRED (P = .013). Non-continuous PDPN was more likely to exhibit extensive loss of E-CAD than continuous PDPN expression (OR:5.81; CI:1.18-28.55). Intense OTPN was more likely to exhibit intense IL-6 than mild/moderate OTPN expression (OR: 8.06, 95% CI: 1.33-48.85). P53 expression was higher in the intense IL-6 group than in the mild/moderate expression group (P = .021). CONCLUSIONS: Our data support the potential of PDPN as a biomarker for malignant transformation owing to its association with HRED and loss of E-CAD expression. Additionally, we demonstrated a possible shared regulatory mechanism between IL-6 and OTPN expression.

Oral health care of homebound older adults: multidimensional theoretical model / Cuidado à saúde bucal de idosos domiciliados: modelo teórico multidimensional

OBJECTIVES: To understand the dimensions of oral health care of homebound older adults and to develop a preliminary theoretical model that explains how these dimensions are interrelated in the provision of care. METHODS: Cross-sectional, qualitative study, based on Grounded Theory. Participants were 37 intentionally selected older adults registered at a Primary Health Care center, Florianópolis (SC), Brazil. Data collection was conducted at home, following an interview script. The interviews were audio-recorded, transcribed, and analyzed by constant comparison. Formulation of the model followed the Glaserian approach. RESULTS: The theoretical model presents the dimensions of oral health care of homebound older adults - who, why, when, how, and where oral health care is provided. Frailties were identified in all dimensions of oral health care, with emphasis on those related to older adults' living, health, and oral health conditions, compromising dental care provided at home, access to dental services, and presence of the dentist. In combination, these frailties constitute a rupture in the possibilities for oral health care. CONCLUSIONS: Strategies for provision of oral health care to homebound older adults should be implemented in each of the dimensions to overcome the frailties identified and promote better oral health conditions and access to dental services. (AU)

OBJETIVOS: Compreender quais as dimensões presentes no cuidado à saúde bucal de idosos domiciliados e elaborar um modelo teórico preliminar que explique de que modo essas dimensões estão inter-relacionadas na produção do cuidado. METODOLOGIA: Estudo transversal, qualitativo, com referencial da Teoria Fundamentada nos Dados. Participaram 37 idosos, intencionalmente selecionados, cadastrados na Atenção Primária à Saúde, Florianópolis (SC). A coleta de dados foi realizada no domicílio, seguindo roteiro de entrevista. As falas foram gravadas em áudio, transcritas e analisadas por comparação constante. A elaboração do modelo seguiu a vertente glaseriana do método. RESULTADOS: Identificaram-se fragilidades no processo de cuidado em todos os elementos de caracterização (quem, porque, quando, como e onde), destacando-se as relacionadas ao próprio idoso, a sua condição de saúde bucal, ao cuidado realizado no domicílio, ao acesso aos serviços odontológicos e à participação do cirurgião-dentista. O somatório dessas fragilidades promove uma ruptura nas possibilidades de cuidado à saúde bucal nas múltiplas dimensões: individual, familiar, profissional e institucional. CONCLUSÕES: Estratégias de cuidado à saúde bucal prestado aos idosos em domicílio devem ser implementadas em cada uma das dimensões identificadas a fim de superar as fragilidades e promover melhores condições de saúde bucal e acesso aos serviços odontológicos. (AU)

Differentiated Immunohistochemical Expression of Osteoclastogenic Markers in Radicular Cyst, Odontogenic Keratocyst, and Ameloblastoma.

The aim of this study was to investigate the osteoclastogenesis process by means of immunohistochemical markers for receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), interleukin-6 (IL-6), and cathepsin K (CTSK) antigens in osteolytic lesions of maxillary bones. The sample consisted of 23 radicular cysts (RC), 25 odontogenic keratocysts (OKC), and 25 ameloblastomas (AM). RANKL was statistically higher in RC (49.6±15.2/53.7±18) and OKC (48.6±15.1/51.4±16.8) when compared with AM (37.2±12.5/36.4±13) in the epithelium and connective tissue. OPG was lower in OKC (34.8±18.5) only in connective tissue when compared with RC (44.5±11.2). The expression of RANKL was statistically higher than OPG in RC (epithelium and connective tissue) and OKC (connective tissue). For IL-6, a statistical difference was observed only in the connective tissue between groups, with higher expression in RC (48.2±15) and lower in OKC (22±11.9). The expression of IL-6 was correlated with the intensity of the inflammatory infiltrate. CTSK was statistically higher in AM (34±19) and OKC (29±13.8) compared with RC (19±10.5). According to the results of the present research the bone resorption in cysts and odontogenic tumors occurs through different mechanisms. The ostoclastogenic process in lesions with aggressive clinical behavior, as AM and OKC, seems to be associated with the expression of CTSK. In contrast, lesions with inflammatory etiology, as RC, the expression of IL-6 seems to have an important role in the bone resorption process. The highest expression of RANKL under the expression of OPG also seems to contribute to the growth mechanism of RC and OKC.

Immunohistochemical Expression of MMP-9, TIMP-1, and Vimentin and its Correlation With Inflammatory Reaction and Clinical Parameters in Oral Epithelial Dysplasia.

The aim of this study was to investigate the immunoexpression of matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), and vimentin (VIM) and its association with the inflammatory reaction (IR) and clinical parameters in oral epithelial dysplasia (ED). The sample was composed of 66 cases of ED, 27 oral squamous cell carcinoma (OSCC), and 28 non-neoplastic epithelium (NNE). ED was graded according to the binary system as low-risk ED (n=42) and high-risk epithelial dysplasia (HRED: n=24). The IR was defined as the median number of inflammatory cells present on the connective tissue in 5 consecutive fields. Tissue sections of paraffin-embedded samples were immunohistochemically stained; MMP-9 and TIMP-1 expression was analyzed separately in the epithelium and the connective tissue; VIM was analyzed in the epithelium. Clinical parameters such as age, sex, lesion site and clinical presentation, alcohol/tobacco use, and malignant transformation of ED were retrospectively obtained from medical records. Nonhomogeneous leukoplakia presented higher odds (3.857; 95% confidence interval: 1.16-12.85) of being graded as HRED than did homogeneous lesions. The IR was higher in OSCC and ED than in NNE, and correlated with the epithelial expression of VIM. HRED and nonhomogeneous leukoplakias presented higher IR than did low-risk ED and homogeneous leukoplakias. Alcohol users had higher IR than nonalcohol users. Smokers had higher epithelial expression of MMP-9 and VIM. High IR in OSCC and HRED, and its positive correlation with VIM expression suggest a contribution of the IR in the progression of OSCC. Moreover, the high expression of MMP-9 and VIM in smokers implies its involvement in tobacco carcinogenesis.

Saúde bucal de pessoas idosas domiciliadas acompanhadas na atenção primária: estudo transversal / Oral health of homebound older adults followed by primary care: a cross sectional study

Resumo Objetivo caracterizar a condição de vida, saúde e saúde bucal das pessoas idosas domiciliadas cadastradas na atenção primária e os cuidados realizados em domicílio. Método estudo transversal, de base domiciliar com amostra de conveniência, em Florianópolis, sul do Brasil. A coleta de dados ocorreu por meio de questionário e exame clínico, os quais incluíram variáveis sociodemográficas, condição de dentes e mucosa, higiene bucal, acesso a atendimento odontológico e visita de cirurgião-dentista no domicílio. Procedeu-se análise de frequência absoluta e relativa e análise bivariada (qui-quadrado, IC=95%). Resultados participaram 123 idosos com idade média de 81,3 anos, 62,6% eram mulheres. Possuíam cuidador 87%, 60% encontravam-se domiciliados por até 5 anos e 89,4% eram frágeis. Quanto à presença de dentes, 56,1% eram edêntulos e 40,5% possuíam de 1 a 8 dentes. Restos radiculares foram observados em 12,8%, lesão de cárie não tratada em 25,2%, biofilme visível em 69,9%, e lesões na mucosa em 8,9%. Necessitavam de auxílio para higiene bucal 45,5% e não realizavam limpeza diária 24,4%. A dificuldade de acessar atendimento odontológico por estar domiciliado foi relatada por 32,5% e visita do cirurgião-dentista ocorreu em 16,3%. Sexo feminino e menor escolaridade estiveram associados à ausência de dentes e menor força física. Conclusão a saúde bucal das pessoas idosas estudadas é precária pela presença de problemas bucais que demandam intervenção. Há dependência de terceiros para cuidados bucais, que não são garantidos de modo consistente, no domicílio. O estudo aponta necessidade de atendimento odontológico no domicílio no âmbito dos serviços públicos de saúde.

Abstract Objective to characterize the life, health, and oral health conditions of homebound older people registered in the primary care teams and oral homecare provided. Method cross-sectional, household based study with a convenience sample, in Florianópolis, southern Brazil. Data collection through a questionnaire and clinical oral examination which included sociodemographic variables, condition of teeth and mucosa, oral hygiene, access to dental care and dentist providing homecare. Absolute and relative frequency analysis and bivariate analysis (chi-square, CI=95%) were performed. Results 123 older people participated with mean age of 81.3 years, 62.6% were women. Living with a caregiver were 87%, 60% were domiciled for up to 5 years, and 89.4% were frail. Regarding the presence of teeth, 56.1% were edentulous and 40.5% had from 1 to 8 teeth. Root remains were observed in 12.8%, untreated caries lesions in 25.2%, visible biofilm in 69.9%, tooth mobility in 57.7% and mucosal lesions in 8.9% of the elders; 45.5% needed help with oral hygiene and 24.4% did not perform daily mouth cleaning. The difficulty in accessing dental care due to homeboundness was reported by 32.5% and home visits provided by the dentist occurred in only 16.3%. Conclusion the oral health of the older adults studied is poor due to the presence of oral problems that require intervention. There is dependence on third parties for oral care, which is not consistently guaranteed at home. The study points to the need for dental homecare provided by public health services.

Evaluation of cell proliferation in cystic lesions associated with impacted third molars.

The purpose of this study was to evaluate the metabolism and epithelial cell proliferation of odontogenic keratocyst (OKC), dentigerous cyst (DC), and unicystic ameloblastoma (UA) by quantifying the nucleolar organizing regions (AgNORs) and Ki-67 protein immunoexpression. Forty-eight cases (16 OKC, 16 DC, and 16 UA) were evaluated retrospectively. The metabolism and epithelial cell proliferation was measured by the Ki-67 positive cell percentage index and by the mean AgNOR count in each group. The Ki-67 and AgNOR counts were significantly higher in OKC comparing to the DC and UA (p < .001). Ki-67 positive cells were observed higher in suprabasal cell layers of OKC with uniform distribution, a few of them were predominantly observed in basal cell layer in DC and UA. The AgNOR count was significantly higher in the OKC basal cell layers and observed throughout the lining epithelium of DC and UA. Ki-67 and AgNOR reinforced the aggressive character of OKC, presenting high metabolism and cellular proliferation compared to DC and UA, possibly due to its more aggressive clinical behavior and high recurrence rate. RESEARCH HIGHLIGHTS: We evidence higher metabolism and epithelial cell proliferation in OKC when compared to UA and DC, supporting its aggressive aspect and its high rate of recurrence. OKC had intense and predominant labeling of Ki-67 on the suprabasal layer unlike UA and DC.