Craniofacial Morphology in Patients With Opitz G/BBB Syndrome.

OBJECTIVE: To compare the cephalometric characteristics of patients with and without Opitz G/BBB syndrome type I. DESIGN: Cross-sectional, case-control study. SETTING: Tertiary cleft center in Brazil. PARTICIPANTS: Eighteen individuals with Opitz G/BBB syndrome with complete bilateral cleft lip and palate (BCLP), compared to 18 individuals with nonsyndromic complete cleft lip and palate and 18 individuals without malformations, matched for gender and age. INTERVENTIONS: Pretreatment lateral cephalograms of all patients were manually traced and digitized for achievement of linear and angular measurements. MAIN OUTCOME MEASURES: Analysis of variance or Kruskal-Wallis followed by Tukey tests were used for intergroup comparisons at a significance level of P < .05. RESULTS: Individuals with Opitz G/BBB syndrome exhibited alterations in SNGn, P-Co, and N'-Pr/Po-Or that were not attributable to BCLP. Co-Go, Sella-Nasion-Supramentale, ANB (maxillo-mandibular relationship), and anterior nasal spine-posterior nasal spine (ANS-PNS)/U1A-U1T were significantly different in both G/BBB and BCLP groups compared to control, but not different between G/BBB and BCLP groups. Anterior nasal spine-posterior nasal spine/Go-Gn, ANS-PNS, V-Upper pharyngeal wall, and U-lower pharyngeal wall were different in nonsyndromic BLCP compared to nonsyndromic controls and Opitz G/BBB group. CONCLUSION: Patients with Opitz G/BBB syndrome exhibited some unique cephalometric alterations compared to patients with nonsyndromic complete BCLP and controls.

Vascular leiomyoma in the oral cavity.

The aim of this study was to examine a case report of vascular leiomyoma located in the oral mucosa of the oral cavity. Vascular leiomyoma is a benign tumor arising from smooth muscle. One factor that makes vascular leiomyomas in the oral cavity rare is that there is little smooth muscle in the mouth. The most common histological subtype in the oral cavity is the vascular subtype. The greatest difficulty in histological diagnosis of this entity is the similarity in morphology with other malignancies, particularly of neural or fibroblastic lineage. Wide surgical resection is the only treatment reported in the literature with good results. The recurrence rate is very low if complete resection is achieved. The study of rare or unusual lesions is very important for the clinical diagnosis of vascular leiomyoma.

Craniofacial morphology in patients with velocardiofacial syndrome.

OBJECTIVE: To compare cephalometric measurements of patients with and without velocardiofacial syndrome. DESIGN: Cross-sectional. SETTING: Public tertiary craniofacial center. SUBJECTS: Lateral cephalograms of 18 patients with velocardiofacial syndrome and 18 controls without morphofunctional alterations, matched for gender and age; all cephalograms were obtained before orthodontic intervention. MAIN OUTCOME MEASURES: The cephalograms were manually traced and digitized for the achievement of linear and angular measurements. RESULTS: Individuals with velocardiofacial syndrome presented a reduced length of the skull base, retrusion of nasal bones, reduced posterior height of the maxilla, increased gonial angle, increased interincisal angle, greater lingual inclination of the mandibular incisors, reduced nasolabial angle, and reduced nasal depth compared with the control group. CONCLUSIONS: Patients with velocardiofacial syndrome presented morphological differences compared with individuals without morphofunctional alterations, which might be considered in the evaluation of patients with suspected diagnosis of the syndrome, as well as for the establishment of treatment protocols adequate to their needs. The present findings did not support the hypothesis of differences in pharyngeal dimensions mentioned by other authors, suggesting that the velopharyngeal insufficiency in these patients may be caused by functional alterations rather than by anatomical differences.

Quantitative analysis of Langerhans' cells in oral chronic graft-vs.-host disease.

BACKGROUND: The Langerhans cells (LCs) are scattered throughout the epithelium of skin and mucosa and have been associated with the graft-vs.-host disease (GVHD), which is the highest cause of morbidity and mortality in patients who underwent bone marrow transplant (BMT). This study aims at quantifying the LCs in the oral chronic GVHD (cGVHD). METHODS: Microscopic sections from biopsies carried out in the buccal mucosa of 40 patients who underwent allogenic BMT and developed (20) or not (20) oral cGVHD (Groups 1 and 2, respectively) were utilised. For the control group, free surgical margins of 20 biopsies of non-inflammatory lesions in the buccal mucosa (Group 3) were used. The sections were studied in routine colouration and immunostained for CD1a. RESULTS: Group 1 (with cGVHD) presented a greater number of Langerhans' cells/mm(2) (50.6 +/- 37.2) when compared with the other groups (Group 2, 23.11 +/- 19.7; Group 3, 16.6 +/- 17.3). CONCLUSION: Our results suggest a greater recruitment of LCs in patients transplanted with cGVHD, probably as a result of cytokines secreted by the inflammatory cells.

Darier disease: case report with oral manifestations.

Darier disease, also known as keratosis follicularis or dyskeratosis follicularis, is a rare autosomal dominant genodermatosis. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas on the head, neck and thorax, with less frequent involvement of the oral mucosa. When oral manifestations are present, they primarily affect the palatal and alveolar mucosa, are usually asymptomatic, and are discovered in routine dental examination. Histologically, the lesions present suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells represented by corps ronds and corps grains. This paper reports a case of an adult male patient presenting clinical signs of Darier disease in the palatal mucosa and skin on the neck and upper limbs. Intraoral biopsy of the affected area, analysis of family history and evaluation by a multidisciplinary team led to the diagnosis of Darier disease. Dental professionals and pathologists should be aware of these lesions to allow correct diagnosis and proper management of this disease.

Expression of betacatenin in carcinoma in pleomorphic adenoma, pleomorphic adenoma and normal salivary gland: an immunohistochemical study.

OBJECTIVES: Pleomorphic adenomas are the most frequent type of epithelial salivary gland neoplasms, and their malignant counterpart, the carcinoma in pleomorphic adenomas, is much less common. Beta-catenin is a cell adhesion molecule associated with the invasion and metastasis of carcinomas of the head and neck, esophagus. The objective of this study was to detect the expression of beta-catenin in pleomorphic adenomas, carcinomas in pleomorphic adenomas and normal salivary glands to discuss its role in the development of these two lesions. STUDY DESIGN: The expression of beta-catenin (BD Transduction Laboratories) was analyzed by immunohistochemistry in formalin-fixed, paraffin embedded specimens by the avidin-biotin-peroxidase complex method in 16 pleomorphic adenomas (12 from minor salivary glands), 3 carcinomas in pleomorphic adenomas (all from palate) and 10 normal salivary glands as control group (5 from major and 5 from minor salivary glands). RESULTS: All cases of glands, adenomas and carcinomas in pleomorphic adenomas have membranous and cytoplasmic immunostaining. Nuclear beta-catenin immunostaining was not observed. The antibody presented a fine granular arrangement in the cytoplasm and cellular membrane of duct and acinic cells. Higher beta-catenin index rates were seen mainly in salivary gland ducts and in ductal structures in the adenomas and carcinomas in pleomorphic adenomas. There was protein loss in pleomorphic adenomas and cytoplasmic accumulation in carcinoma in pleomorphic adenomas. CONCLUSIONS: The present study showed participation of the loss of beta-catenin adhesion molecule in the development of pleomorphic adenoma, and that the cytoplasmic accumulation of the molecule takes part in the malignant transformation of the pleomorphic adenoma into carcinoma in pleomorphic adenoma.

Immunohistochemical expression of Bcl-2 and Ki-67 in oral lichen planus and leukoplakia with different degrees of dysplasia.

OBJECTIVES: Oral lichen planus (OLP) is a chronic inflammatory disease of unknown cause. Malignant transformation in OLP lesions may be favored by changes in the expression of proteins that regulate cell proliferation and apoptosis. This study aimed to investigate these issues by immunohistochemical staining for Bcl-2 and Ki-67 and by correlating histopathological findings in samples from lesions of OLP and leukoplakia with epithelial dysplasia. METHODS: Data for patients with OLP or leukoplakia with moderate or severe epithelial dysplasia recorded during 2006-2011 were retrospectively reviewed. The study samples represented 37 subjects with OLP (n = 14), leukoplakia with moderate (n = 8) or severe (n = 6) epithelial dysplasia, and normal buccal mucosa (controls, n = 9). New sections were subjected to histological examination and immunohistochemistry for Bcl-2 and Ki-67 in the basal layer, suprabasal layer, and inflammatory infiltrate, respectively. RESULTS: All basal layer sections stained either negative or positive in <10% of cells for Bcl-2 in OLP (92.9% and 7.1%, respectively) and control (77.8% and 22.2%, respectively) samples. In leukoplakia, 85.7% of sections indicated positivity in <10% of cells, and 14.3% indicated positivity in 10-26% of cells. Most OLP (42.9%) and leukoplakia (64.3%) sections stained positive for Ki-67 in >50% of cells. All suprabasal sections stained either negative or positive in <10% of cells for Bcl-2 in OLP (92.9% and 7.1%, respectively), leukoplakia (42.9% and 57.1%, respectively), and control (88.9% and 11.1%, respectively) samples. Suprabasal staining for Ki-67 was negative or positive in <10% of cells in OLP (14.3% and 85.7%, respectively), leukoplakia (7.1% and 92.9%, respectively), and controls (88.9% and 11.1%, respectively). Staining for Bcl-2 in inflammatory infiltrate in OLP was positive in 92.9% of sections. CONCLUSIONS: Expression of Bcl-2 may play a dual role in tumor development and progression. Increased cell proliferation in the epithelium may present a predisposition to cancer in OLP. The expression of Ki-67 can be considered as an adjunct marker for proliferative activity in lesions with malignant potential. The prognostic value of these immunomarkers in the evaluation of precancerous oral lesions requires further investigation.

Increased levels of Porphyromonas gingivalis are associated with ischemic and hemorrhagic cerebrovascular disease in humans: an in vivo study.

OBJECTIVE: This study investigated the role of periodontal disease in the development of stroke or cerebral infarction in patients by evaluating the clinical periodontal conditions and the subgingival levels of periodontopathogens. MATERIAL AND METHODS: Twenty patients with ischemic (I-CVA) or hemorrhagic (H-CVA) cerebrovascular episodes (test group) and 60 systemically healthy patients (control group) were evaluated for: probing depth, clinical attachment level, bleeding on probing and plaque index. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were both identified and quantified in subgingival plaque samples by conventional and real-time PCR, respectively. RESULTS: The test group showed a significant increase in each of the following parameters: pocket depth, clinical attachment loss, bleeding on probing, plaque index and number of missing teeth when compared to control values (p<0.05, unpaired t-test). Likewise, the test group had increased numbers of sites that were contaminated with P. gingivalis (60%x10%; p<0.001; chi-squared test) and displayed greater prevalence of periodontal disease, with an odds ratio of 48.06 (95% CI: 5.96-387.72; p<0.001). Notably, a positive correlation between probing depth and the levels of P. gingivalis in ischemic stroke was found (r=0.60; p=0.03; Spearman's rank correlation coefficient test). A. actinomycetemcomitans DNA was not detected in any of the groups by conventional or real-time PCR. CONCLUSIONS: Stroke patients had deeper pockets, more severe attachment loss, increased bleeding on probing, increased plaque indexes, and in their pockets harbored increased levels of P. gingivalis. These findings suggest that periodontal disease is a risk factor for the development of cerebral hemorrhage or infarction. Early treatment of periodontitis may counteract the development of cerebrovascular episodes.

Pyogenic granuloma on the upper lip: an unusual location.

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion. It is a reactional response to constant minor trauma and might be related to hormonal changes. In the mouth, PG is manifested as a sessile or pedunculated, resilient, erythematous, exophytic and painful papule or nodule with a smooth or lobulated surface that bleeds easily. PG preferentially affects the gingiva, but may also occur on the lips, tongue, oral mucosa and palate. The most common treatment is surgical excision. This paper describes a mucocutaneous PG on the upper lip, analyzing the clinical characteristics and discussing the features that distinguish this lesion from other similar oral mucosa lesions. The diagnosis of oral lesions is complex and leads the dentist to consider distinct lesions with different diagnostic methods. This case report with a 4 year-follow-up calls the attention to the uncommon mucocutaneous labial location of PG and to the fact that surgical excision is the safest method for diagnosis and treatment of PG of the lip, even when involving the mucosa and skin.

Epidemiological and oral manifestations of HIV-positive patients in a specialized service in Brazil.

The purpose of this study was to evaluate the prevalence of oral lesions in HIV-positive patients attending the Specialized Service for Infectious-contagious Diseases and Parasitoses of the Health Secretariat of the State of Pará (URE-DIPE/SESPA), in the city of Belém, PA, Brazil. A total of 79 HIV-positive patients (53 males and 26 females) were examined. Clinical and epidemiological evaluations were done by correlating the lesions with gender, race, chronological age, risk behavior and prevailing immune status (CD4+ cells count). Lesion location and the presence of associated factors, such as alcohol use, smoking and denture wearing, were quantified individually for each type of lesion using a diagnostic pattern based on the clinical aspects. Approximately 47% of the patients (n=37) presented some type of oral lesion. Candidiasis (28%) and periodontal disease (28%) were the most common, followed by cervical-facial lymphadenopathy (17.5%). Other lesions observed were hairy leukoplakia, melanin hyperpigmentation, ulcerative stomatitis (aphthous), herpes simplex, frictional keratosis and pyogenic granuloma. This analysis presented some relevance as to the statistical data. Concerning CD4+ cells, most lesions manifested with the reduction of the CD count. There were a larger number of HIV-positive female heterosexual patients. Alcohol and/or smoking were strongly associated with the occurrence of hairy leukoplakia in these patients. Candidiasis and periodontal disease were the most common oro-regional clinical manifestations in the patients.

Radiographic study of dental anomalies in Brazilian patients with neuropsychomotor disorders.

The purposes of this study were to investigate radiographically the dental and maxillomandibular in patients with neuropsychomotor disorders and determine the role of panoramic radiographs for quantitative and qualitative analyses of dental alterations. A total of 322 panoramic radiographs from 190 males and 132 females aged 4 to 57 years were obtained from the files of the Center for Care to Patients with Special Needs (CAPE; Dental School, University of São Paulo) and subdivided into syndromes, special needs, neurological, neuromuscular or cerebral disorders, and sequels of diseases. 32% of dental alterations were in tooth position, with 69% of this group associated with tooth rotation. The mandible accounted for 54.62% of alterations. The male gender (55.85%) and the permanent dentition (78.7%) were most affected. Panoramic radiographs were proved to be well suited for quantitative evaluation of dental anomalies of epidemiological nature. Panoramic radiographs are important diagnostic resources when applied to patients with special needs because of the difficulty to place intraoral films and held them correctly positioned during the radiographic technique.

Incidência de lesões bucais na Universidade do Sul de Santa Catarina (Unisul) / Incidence of oral lesions in University of Southern Santa Catarina (Unisul)

Um dos maiores dilemas que o clínico encontra com respeito ao diagnóstico de lesões bucais é a variedade de possíveis condições que podem ocorrer, visto que se depara com um número extenso de diagnósticos diferenciais. Os objetivos deste estudo foram avaliar a incidência de lesões bucais encontradas na clínica de Estomatologia da Unisul, Tubarão - SC; analisar prontuários, observando sexo, idade, hábito de tabagismo ou não e alterações sistêmicas dos pacientes, correlacionando com o tipo de lesão que apresentarem; definir as lesões intrabucais mais frequentes no estudo e relatar suas características clínicas. As informações clínicas dos pacientes e as informações dos resultados foram obtidas por meio de consulta aos respectivos prontuários arquivados no serviço da disciplina, tendo sido pesquisados 64 laudos anatomopatológicos. As lesões mais frequentes foram a hiperplasia fibrosa inflamatória, a leucoplasia e o cisto periodontal apical.

Increased levels of Porphyromonas gingivalis are associated with ischemic and hemorrhagic cerebrovascular disease in humans: an in vivo study

OBJECTIVE: This study investigated the role of periodontal disease in the development of stroke or cerebral infarction in patients by evaluating the clinical periodontal conditions and the subgingival levels of periodontopathogens. MATERIAL AND METHODS: Twenty patients with ischemic (I-CVA) or hemorrhagic (H-CVA) cerebrovascular episodes (test group) and 60 systemically healthy patients (control group) were evaluated for: probing depth, clinical attachment level, bleeding on probing and plaque index. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were both identified and quantified in subgingival plaque samples by conventional and real-time PCR, respectively. RESULTS: The test group showed a significant increase in each of the following parameters: pocket depth, clinical attachment loss, bleeding on probing, plaque index and number of missing teeth when compared to control values (p<0.05, unpaired t-test). Likewise, the test group had increased numbers of sites that were contaminated with P. gingivalis (60 percentx10 percent; p<0.001; chi-squared test) and displayed greater prevalence of periodontal disease, with an odds ratio of 48.06 (95 percent CI: 5.96-387.72; p<0.001). Notably, a positive correlation between probing depth and the levels of P. gingivalis in ischemic stroke was found (r=0.60; p=0.03; Spearman's rank correlation coefficient test). A. actinomycetemcomitans DNA was not detected in any of the groups by conventional or real-time PCR. CONCLUSIONS: Stroke patients had deeper pockets, more severe attachment loss, increased bleeding on probing, increased plaque indexes, and in their pockets harbored increased levels of P. gingivalis. These findings suggest that periodontal disease is a risk factor for the development of cerebral hemorrhage or infarction. Early treatment of periodontitis may counteract the development of cerebrovascular episodes.

Lesão periférica de células gigantes recorrente: relato de caso / Recurrent peripheral giant cell lesion: case report

Lesão periférica de células gigantes é um processo proliferativo não neoplásico reativo à irritaçãolocal ou trauma. Apresenta-se como uma lesão bem circunscrita, que acomete a mucosa alveolar egengiva, podendo comprometer os tecidos ósseos adjacentes, causando mobilidade dentária. O examemicroscópico dessa lesão revela uma massa não encapsulada de tecido, contendo um grande númerode células do tecido conjuntivo e de células gigantes multinucleadas em um padrão estrutural,constituído de nódulos focais de células gigantes, separados por septos fibrosos. Tecido hemorrágico,hemossiderina, células inflamatórias e osso neoformado ou material calcificado também podem serencontrados ao longo do tecido conjuntivo. A associação de extensas lesões periféricas de célulasgigantes a fatores bucais ou sistêmicos ainda não é claramente estabelecida. O objetivo deste trabalhoé o de relatar um caso de lesão periférica de células gigantes recorrente. O correto diagnóstico eo adequado tratamento culminaram em resultados satisfatórios e completa resolução do caso, semindícios de recidivas. Este trabalho apresenta uma revisão atual sobre essa entidade, além de discutir sobre os fatores relacionados à sua etiologia.

Peripheral giant cell lesion is a non-neoplastic proliferative process reactive to the local that has anirritation or a trauma. Presents as well-circumscribed lesion confined to the alveolar and gingivalmucosa, may compromise the bone tissue adjacent causing tooth mobility. On histologic evaluation,the lesion is a noncapsulated mass of tissue containing a large number of young connective tissuecells and multinucleated giant cells in an architectural pattern of giant cells? focal nodules, separatedby fibrous septa. Hemorrhage, hemosiderin, inflammatory cells, and newly formed bone or calcifiedmaterial may also be seen throughout the cellular connective tissue. The association of large peripheralgiant cell?s lesions to oral or systemic factors is also unclear. The purpose of this work is to presenta case of peripheral giant cell?s lesion recurrence. The correct diagnosis and treatment culminatedin a totally satisfactory result and complete resolution of the case, without recurrences. This paperpresents a review on the current entity, and discusses the factors related to its etiology.

Macroscopic and microscopic study of tissue response to oral antiseptics and its influence on carcinigenesis.

Studies have related the action of alcohol on the oral mucosa as a promoter of carcinogenesis, once most oral antiseptics contain alcohol. Its utilization for mouthrinses from 30 to 60 seconds, as indicated on the labels, yields a longer-lasting topical action when compared to the intake of alcoholic beverages. This study aimed at conducting a macroscopic and microscopic analysis of the tissue response of tongue mucosa of hamsters to daily topical applications of antiseptics (Anapyon, Listerine, Oral B) during 13 and 20 weeks, following the methodology for carcinogenesis investigation developed by the Discipline of Pathology of Bauru Dental School, University of São Paulo. After sacrificing the animals, their tongues were removed and fixed on 10% formalin. Macroscopic examination did not reveal significant alterations, and the specimens were processed by routine histotechnical procedures for HE staining. Three serial sections of each tongue were evaluated, and characteristics related to epithelial hyperkeratinization, atrophy, hyperplasia and dysplasia were organized in tables. Despite the observation for moderate dysplasia in one case in the Anapyon 20 week group, the further results were very similar to the control group (saline solution), eliminating the need of comparative statistical tests. By means of such methodology for testing the carcinogenesis-initiating action, it was concluded that oral antiseptics are unable to trigger the development of neoplasms.

Pyogenic granuloma on the upper lip: an unusual location

Pyogenic granuloma (PG) is a benign non-neoplastic mucocutaneous lesion. It is a reactional response to constant minor trauma and might be related to hormonal changes. In the mouth, PG is manifested as a sessile or pedunculated, resilient, erythematous, exophytic and painful papule or nodule with a smooth or lobulated surface that bleeds easily. PG preferentially affects the gingiva, but may also occur on the lips, tongue, oral mucosa and palate. The most common treatment is surgical excision. This paper describes a mucocutaneous PG on the upper lip, analyzing the clinical characteristics and discussing the features that distinguish this lesion from other similar oral mucosa lesions. The diagnosis of oral lesions is complex and leads the dentist to consider distinct lesions with different diagnostic methods. This case report with a 4 year-follow-up calls the attention to the uncommon mucocutaneous labial location of PG and to the fact that surgical excision is the safest method for diagnosis and treatment of PG of the lip, even when involving the mucosa and skin.

Manifestações bucais da paracoccidioidomicose: considerações gerais e relato de caso / Oral manifestations of paracoccidioidomycosis: general considerations and case report

A paracoccidioidomicose é uma doença sistêmica que envolve primariamente, os pulmões e, posteriormente, dissemina-se para outros órgãos e sistemas. Lesões secundárias aparecem frequentemente nas membranas mucosas, linfonodos e pele. Tanto a apresentação clínica dessa micose quanto o curso da doença variam para cada paciente. Infecções subclínicas tem sido documentadas em pessoas saudáveis residentes em áreas endêmicas. Essas áreas estão confinadas a alguns países da América Latina. A paracoccidioidomicose é frequentemende diagnosticada no Brasil, Venezuela, Colômbia, Equador e Argentina. No Brasil a doença constitui um importante problema de saúde pública. O agente etiológico da doença é um fungo dismórfico, o Paracoccidioides brasiliensis. A abordagem clínica de pacientes portadores de lesões ulceradas crônicas na boca deve considerar a paracoccidioidomicose como possibilidade diagnóstica. Este trabalho apresenta uma revisão de literatura sobre essa doença, abordando aspectos clínicos, epidemiologia, métodos diagnósticos e de tratamento, além de relatar um caso diagnosticado após avaliação clínica, citologia esfoliativa e biópsia incisional

Abordagem cirúrgica de hemangioma intra-oral / Surgical approach of intraoral hemangioma

Hemangioma é um termo clínico que designa uma neoplasia vascular benigna ou malformação vascular de origem endotelial. Não é incomum na região de cabeça e pescoço, portanto, o cirurgião-dentista deve conhecer seu aspecto clínico, manobras de diagnóstico e saber conduzir o caso. É mais comum acometerem os tecidos moles e geralmente se apresentam clinicamente como pápulas ou nódulos avermelhados assintomáticos. Existem várias formas de abordagem terapêutica descritas na literatura. Alguns fatores do próprio paciente e características da lesão devem ser considerados para o melhor tratamento. Este artigo relata um caso de um hemangioma em mucosa jugal, optando-se por uma abordagem cirúrgica da lesão.

Hemangioma is clinical term for designate a benign vascular neoplasm or vascular malformation of endothelial origin. Isn't unusual occurs into head and neck region, therefore, surgeon dentis must to know your clinical aspect, diagnosis measures and how follow-up the case. The most common locations are the soft tissues and it presents as asymptomatic papule or nodule red. There are some therapeutic alternatives in the literature. Treatment of hemangioma depends of factors of the patient and characteristic of the lesion. The aim of this paper is to report a hemangioma into cheek in which the treatment was the excision of the lesion.