Foreign Body in Jugal Mucosa

Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.(AU)

cGVHD-Related Caries and Its Shared Features with Other 'Dry-Mouth'-Related Caries

Several systemic diseases and their medical treatment may predispose the development of aggressive dental caries. Head and neck radiotherapy, chemotherapy, Sjögren's syndrome and long-standing treatment with drugs that induce hyposalivation are some of these conditions. The aim of this article is to describe the clinical features of five patients who developed chronic graft-versus-host-disease (cGVHD) as a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and, in spite of close dental follow-up, subsequently developed rampant caries. In these cases, the restorations showed early failure and the caries still progressed until generalized teeth destruction. The majority of the teeth therefore had to be extracted due to advanced dental caries and rapid clinical progression. Herein the term "cGVHD-related caries" is proposed to describe this under-recognized complication of cancer treatment that may evolve in allo-HSCT recipients that develop cGVHD. This condition is poorly recognized in the literature and may represent the final result of the clustering of oral complications in cGVHD patients, including mucositis, oral pain, hyposalivation, taste loss and oral infections, leading to rampant caries due to impaired oral hygiene and increased intake of highly cariogenic food. Consequently, the knowledge of this oral complication should improve the medical and dental management of cGVHD oral manifestations and improve the quality of life of patients with this post allo-HSCT complication.

Diversas doenças sistêmicas e seus tratamentos podem predispor ao desenvolvimento de cáries dentárias agressivas. A radioterapia de cabeça e pescoço, quimioterapia, síndrome de Sjögren e tratamentos prolongados com as drogas que induzem a hipossalivação são algumas destas condições. O objetivo deste artigo é descrever as características clínicas de cinco pacientes que desenvolveram doença do enxerto contra hospedeiro crônica (DECHc) como uma complicação do transplante alogênico de células-tronco hematopoiéticas (aloTCTH) e, apesar do acompanhamento periódico com dentistas, desenvolveram cáries rampantes. Nestes casos relatados, as restaurações mostraram falhas precoces e as cáries continuaram progredindo até a destruição generalizada dos dentes. A maioria dos dentes, portanto, foi extraída devido à cárie avançada e rápida progressão clínica. Neste artigo, o termo "cáries relacionadas à DECHc" é proposto para descrever esta complicação pouco conhecida do tratamento do câncer, que se manifesta em receptores de TCTH que desenvolvem DECHc. Esta condição é pouco reconhecida na literatura e pode representar o resultado final do agrupamento das complicações bucais em pacientes com DECHc, incluindo mucosite, dor oral, hipossalivação, perda de paladar e infecções orais, levando à cárie rampante devido à dificuldade de higiene oral e aumento da ingestão de alimentos altamente cariogênicos. Por consequência, o conhecimento desta complicação oral deve melhorar os tratamentos médico e odontológico das manifestações bucais da DECHc e melhorar a qualidade de vida dos pacientes com esta complicação após o TCTH.

Early and late oral features of chronic graft-versus-host disease

Background: Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective: The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods: This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results: Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion: Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation. .

Brazilian workshop model to train investigators in chronic graft-versus-host disease clinical trials according to the 2005-2006 National Institutes of Health recommendations

BACKGROUND: The lack of standardization of clinical diagnostic criteria, classification and severity scores of chronic graft-versus-host disease led the National Institutes of Health to propose consensus criteria for the purpose of clinical trials. METHODS: Here we describe a one-day workshop model conducted by the Chronic Graft-versus-Host Disease Brazil-Seattle Consortium Study Group to train investigators interested in participating in multicenter clinical trials in Brazil. Workshop participants included eight transplant physicians, one dermatologist, two dentists, three physical therapists and one psychologist from five institutions. Workshop participants evaluated nine patients with varying degrees of severity of mucocutaneous lesions and other manifestations of the disease followed by a training session to review and discuss the issues encountered with the evaluation and scoring of patients and in the methods used to evaluate grip strength and the 2-minute walk test. RESULTS: Most participants had difficulties in rating the percentage of each type of mucocutaneous lesion and thought 20 minutes was insufficient to evaluate and record the scores of each patient using the National Institutes of Health criteria and other cutaneous assessments. Several specific areas of difficulties encountered by the evaluators were: 1) determining the percentage of erythema in movable and non-movable sclerosis, 2) whether to score all cutaneous findings in a particular area or just the dominant lesion; 3) clarification of the definition of poikiloderma in chronic graft-versus-host disease; 4) discrepant interpretation of the mouth score and 5) clarification on the methodology used for the evaluation of grip strength and the 2-minute walk tests. CONCLUSIONS: Results of this workshop support the need to train investigators participating in clinical trials on chronic graft-versus-host disease.

A multicenter feasibility study of chronic graft-versus-host disease according to the National Institute of Health criteria: efforts to establish a Brazil-Seattle consortium as a platform for future collaboration in clinical trials

BACKGROUND: New criteria for the diagnosis and classification of chronic graft-versus-host disease were developed in 2005 for the purpose of clinical trials with a consensus sponsored by the National Institute of Health. OBJECTIVES: The aim of this study is to present the results of a multicenter pilot study performed by the Brazil-Seattle chronic graft-versus-host disease consortium to determine the feasibility of using these criteria in five Brazilian centers. METHODS: The study was performed after translation of the consensus criteria into Portuguese and training. A total of 34 patients with National Institute of Health chronic graft-versus-host disease were enrolled in the pilot study between June 2006 and May 2009. RESULTS: Of the 34 patients, 26 (76 percent) met the criteria of overlap syndrome and eight (24 percent) the classic subcategory. The overall severity of disease was moderate in 21 (62 percent) and severe in 13 (38 percent) patients. The median time from transplant to onset of chronic graft-versus-host disease was 5.9 months (Range: 3 - 16 months); the median time for the overlap syndrome subcategory was 5.9 months (Range: 3 - 10 months) and for the classic subcategory, it was 7.3 months (Range: 3 - 16 months). At a median follow up of 16.5 months (Range: 4 - 39 months), overall survival was 75 percent. CONCLUSIONS: It was feasible to use the National Institute of Health consensus criteria for the diagnosis and scoring of chronic graft-versus-host disease in a Brazilian prospective multicenter study. More importantly, a collaborative hematopoietic cell transplantation network was established in Brazil offering new opportunities for future clinical trials in chronic graft-versus-host disease and in other areas of research involving hematopoietic stem cell transplantation.

Efeitos tardios do transplante de medula óssea alogênico: estudo retrospectivo em 98 pacientes receptores / Late complication of allogeneic bone marrow transplantation: retrospective study of 98 receptor patients

Objetivo - A Doença do Enxerto contra o Hospedeiro crônica (DECHc) é uma das mais frequentes complicações tardias do transplante de medula óssea alogênico. A cavidade bucal é o local de maior acometimento desta patologia. Métodos - Este estudo visa investigar a incidência de DECHc, os locais de acometimento, assim como o tipo de lesão em cavidade bucal. Foram avaliados, retrospectivamente, através de prontuários médicos, 98 pacientes que foram submetidos a transplante de medula óssea alogênico no Hemocentro/Unicamp, em um período de um ano. Foram analisadas a presença ou ausência da DECH crônica, os sítios de maior acometimento das lesões e, quando em cavidade bucal, os locais e aspecto clínico mais importantes. Resultados e Conclusões - Dos 98 pacientes, 64 apresentavam DECHc. Destes, 51 apresentavam envolvimento bucal. Em boca, 27 foram em mucosa bucal e a forma clinica mais frequente foi a liquenóide. Nenhum fator encontrado pode contribuir com a severidade da DECHc em cavidade bucal assim como suas manifestações clínicas.

Objective - Chronic graft versus host disease (cGVHD) is the most common late complication of allogeneic bone marrow transplantation. Oral cavity is the most common site of involvement of cGVHD. Methods - This study sought to investigate the incidence of cGVHD, the site of involvement, as well as the kind of oral lesions that resulted. They had been evaluated through medical handbooks, 98 patients who had been submitted the blood marrow alogenic transplant in the Hemocentro/Unicamp, in a period of one year. The presence or absence of the chronic GVHD had been analyzed, the side of the body injuries and, when in oral cavity, the more important places and clinical aspect. Results and Conclusions - Of ninety eight patients, sixty four were cGVHD. Fifty one patients presented oral involvement. On the oral cavity, twenty seven were on buccal mucosa and the clinic features most prevalent was the lichenoid type. No factor that could contribute to the severity of cGVHD oral lesions was found.

Candida in saliva of Brazilian hemophilic patients

Hemofilia é uma alteração hemorrágica hereditária comum, entretanto pouco se sabe a respeito da microbiota oral destes indivíduos. O objetivo deste estudo foi quantificar a presença de Candida e identificar as suas espécies na saliva de hemofílicos, correlacionando os resultados com fatores clínicos que possam influenciar a presença deste fungo. Foram avaliados 86 hemofílicos do Hemocentro/UNICAMP e 43 indivíduos saudáveis. Todos os pacientes foram submetidos a anamnese, exame clínico intra-oral e coleta de saliva de forma não estimulada. A quantificação e identificação das espécies de Candida foram realizadas nas amostras de saliva. Candida estava presente em 64% dos hemofílicos e em 44% dos indivíduos saudáveis. C. albicans representou 65% e 68% das espécies identificadas, nos hemofílicos e grupo controle respectivamente, e C. tropicalis foi a segunda espécie mais comum. Estes resultados sugerem que pacientes hemofílicos albergam mais freqüentemente Candida na cavidade bucal e em maiores quantidades que os indivíduos do grupo controle, independentemente dos parâmetros clínicos analisados, como infecção viral, próteses dentárias, transfusões de hemoderivados e fluxo salivar.

Telangectasia hemorrágica hereditária: relato de caso clínico / Hereditary hemorrhagic telangectasia: repórt of case

Telangectasia Hemorrágica Hereditária, também conhecida como síndrome de Rendu-Osler-Weber, é uma alteração caracterizada por uma displasia fibrovascular associada com a presença de telangectasias e malformações arteriovenosas. Acomete preferencialmente a pele, mucosas, pulmão e cérebro. No passado, era considerada uma doença rara, sem grandes conseqüências na vida dos indivíduos afetados. Entretanto, nos dias atuais, é reconhecida como uma entidade não tão incomum, e quando envolve o cérebro e os pulmões, está associada a altas taxas de mortalidade e morbidade destes pacientes. O objetivo deste estudo foi relatar um caso de telangectasia hemorrágica hereditária no qual a suspeita do diagnóstico foi feita pela detecção de telangectasias intrabucais

Infecçöes bucais e doenças sistêmicas / Oral infections and systemic diseases

Bactérias da placa dental alcançam a corrente sangüínea nas doenças periodontais, nas interveçöes odontológicas e mesmo durante a mastigaçäo e escovaçäo dos dentes.Muitas doenças sistêmicas eram atribuídas às batérias da boca e, comumente, era sugerido a extraçäo de dentes como prevençäo e tratamento destas doenças.Posteriormente, apenas a endocardite continuou sendo associada a bactérias da boca, e pacientes com problemas valvulares rececbem antibiocoterapia antes de intervençöes odontológicas invasivas. recentemente a importância das infecçöes bucais em doenças sistêmicas voltou a ser intensivamente discutida. Trabalhos epidemiológicos indicam que as bactérias da boca podem ser importantes näo apenas na endocardite, mas em várias outras doenças como diabetes, ,ateroesclerose, infarto e partos prematuros. Embora as evidências ainda näo sejam conclusivas, uma perspectiva nova e ampla está abrindo-se para odontologia e medicina, ou seja,de que a saúde bucal é imoprtante na prevençäo de doenças sistêmicas graves e freqüentes. Se atéo momento o objetivo da Odontologia foi a preservaçäo dos dentes, atualmente os horizontes säo mais amplos, ,objetivando a manutençäo da saúde bucal e sistêmica. Esta afirmativa é válida näo apenas para os indivíduos com deficiências dos mecanismos ded dedfesa, como idosos e imunocomprometidos, mas para toda populaçäo. Esta filosofia vai permitir também uma melhor integraçäo entre a dontologia e a Medicina. Esta integraçäo já é evidenete em pacientes portadores de doenças mucocutâneas, discrasias sagüineas, transplantados, diabéticos e doenças infecciosas como a Aids.

Levando o sangue em conta / Taking blood in count

O atendimento odontológico ao portador de alterações no sangue exige que o CD esteja atento aos riscos, converse com o paciente, busque a integração com outros profissionais e conheça os recursos disponíveis, como o selante de fibrina

Cuidado no tratamento odontológico em paciente com anemia aplástica: relato de dois casos clínicos / Dental care in a aplastic anemia patient: report of two cases

Relato de casos de dois pacientes com anemia aplástica (ou aplasia de medula) que receberam cuidados odontológicos antes de ir para transplante de medula óssea (TMO). Ao início do tratamento a paciente do caso 1 apresentava sangramento gengival espontâneo devido a trombocitopenia associado à doença periodontal, grande acúmulo de placa bacteriana, agravada pela ausência de higiene bucal. Foi realizado a orientaçäo de higiene bucal, procedimentos periodontais básicos e exodontia do dente 45. Ao final do tratamento a condiçäo bucal satisfatória, näo havendo episódios hemorrágicos. No caso 2 o paciente apresentava raízes residuais que foram extraídas com anestesia local e posterior sutura, não havendo também nenhuma intercorrência hemorrágica. Os pacientes foram submetidos ao TMO em condiçöes bucais satisfatórias e com controle de higiene bucal