Virtual learning object about oral ulcerative lesions: controlled educational intervention study

Abstract The aim of this study was to develop a virtual learning object (VLO) to teach undergraduate dental students about the diagnostic and therapeutic approaches to oral ulcerative lesions. The VLO was developed with information on the diagnostic process, lesion classification, and clinical-surgical management of oral ulcerative lesions. The VLO content was initially validated by a group of specialists. Learning was evaluated in a sample of 58 undergraduate dental students, divided into control group (conventional theoretical class, n = 29) and intervention group (interaction with VLO, n = 29). All students answered a pre-test and post-test questionnaire. The VLO group also answered a specific questionnaire on the evaluation of the VLO. Both quantitative and qualitative descriptive analyses were performed. The validation showed that professors and students considered the VLO adequate. The use of the VLO was recommended by 100% of professors and 86.6% of students. In the intervention group, the results showed a significantly higher number of correct answers in the post-test (p < 0.01). In conclusion, the VLO proved to be a useful tool for teaching oral medicine, contributing significantly to the knowledge of ulcerated lesions in the mouth.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Online search interest in the use of antibiotics for dental pain: an infodemiology study / Interesse em pesquisas online sobre o uso de antibióticos para dor dentária: um estudo infodemiológico

Objective: The objective of this study was to evaluate the online search interest pertaining to queries regarding antibiotics for dental pain. Material and Methods : Google Trends™ was used to identify the online search interest. Previously, a literature search was performed on the most frequently used antibiotics in dentistry in Brazil. Accordingly, the search terms used were Amoxicillin (AM), Clindamycin (CD), Azithromycin (AZ) and Metronidazole (MD), with the phrase "for toothache" in Portuguese and English. A time-series covered the last 240 weeks (from 2015 to 2020), and the results of each term were compared to their respective annual value. Geographic regions were also evaluated. To obtain a relative search volume (RSV), the resulting Google Trends™ numbers were then scaled to a range from 0 to 100 based on the ratio of searches on a topic to searches across all topics. Results : We observed an upward trend in all antibiotics search terms over the 5 years analyzed, with a peak of greater interest in 2019. The antibiotic of most interest related to toothache was 'AM', followed by 'AZ', 'MD', and 'CD'. The annual RSV of toothache searches rose steadily from 2015 to 2020. Variations were observed between Brazilian geographic regions, and the Northeast region presented with the greatest interest in the topic. Conclusion : Although there were variations in annual and regional trends, an expressive and persistent increase in collective interest regarding the use of antibiotics related to toothache, mainly amoxicillin, was observed. Our findings provide insights for public health promotion programs. (AU)

Objetivo: O objetivo deste estudo foi avaliar o interesse da pesquisa online em consultas sobre antibióticos para dor de dente. Material e métodos : o Google Trends™ foi usado para identificar o interesse de pesquisa online. Anteriormente, foi realizada uma pesquisa bibliográfica sobre os antibióticos mais utilizados em odontologia no Brasil. A partir daí, os termos de busca utilizados foram Amoxicilina (AM), Clindamicina (CD), Azitromicina (AZ) e Metronidazol (MD) com os termos "para dor de dente" em português e inglês. Uma série histórica abrangeu as últimas 240 semanas (abril de 2015 a abril de 2020), e os resultados de cada período foram comparados com seus respectivos valores anuais. Regiões geográficas também foram avaliadas. Os números resultantes do Google Trends ™ são dimensionados para um intervalo de 0 a 100 com base na proporção de um tópico para todas as pesquisas em todos os tópicos de busca. Isso é chamado de volume relativo de pesquisa (RSV). Resultados : Foi observada uma tendência crescente para todos os termos de antibióticos ao longo dos 5 anos analisados, com um pico de maior interesse em 2019. O antibiótico de maior interesse na dor de dente foi 'AM', seguido por 'AZ', 'MD' e 'CD'. O RSV anual das buscas de dor de dente cresceu continuamente de 2015 a 2020. Variações foram observadas entre as regiões geográficas brasileiras, sendo que a Região Nordeste apresentou o maior interesse pelo tema. Conclusão : Embora tenha havido variação nas tendências anuais e regionais, observou-se um aumento expressivo e persistente do interesse coletivo pelo uso de antibióticos relacionados à dor de dente, principalmente a amoxicilina. Nossas descobertas fornecem insights para programas de promoção pública.(AU)

Prognostic factors from squamous cell carcinoma of the hard palate, gingiva and upper alveolar ridge

Abstract: The purpose of this study was to evaluate the clinicodemographic characteristics and treatment protocol as prognostic factors in patients with oral squamous cell carcinoma (OSCC) of the hard palate, upper gingiva, and alveolar ridge (HPUGAR). This retrospective cohort study collected data of patients treated in two head and neck surgery departments in southern Brazil between 1999 and 2021. Information on clinicodemographic data, habits, site, size, clinical aspect, clinical staging, cervical metastasis, treatment, and survival was collected. Associations between independent variables and outcomes were assessed using Pearson's chi-square test and binary regression. Kaplan-Meier test was employed to compare the survival between the neck approaches. Forty-one patients were included; most were male (61%), with a mean age of 68.8 (± 13.9) years. The consumption of tobacco (p = 0.003) and alcohol (p = 0.02) was significantly higher in male than in female patients. The main clinical features observed in the study sample were lesions larger than 2 cm (48.7%), no cervical (90.2%), or distant metastasis (90.2%). Surgery alone was the main treatment approach (48.8%). The watch-and-wait strategy was adopted in 34 cases (83.0%), while elective neck dissection was applied in five (12.2%). Only two patients with cN0 disease (4.9%) presented with cervical metastasis at follow-up. Eight patients (12.2%) died of the disease. Clinicodemographic variables, habits, surgical margins, and histological subtype were not significantly associated with cervical metastasis or survival. Cervical metastasis (p = 0.004) was associated with poor survival. No difference was detected in survival between different neck approaches (p = 0.28). Cervical metastasis and local recurrence are negative prognostic factors for HPUGAR OSCC.

Distance learning course improves primary care dentists' diagnosis and self-efficacy in the management of oral lesions

Abstract Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

An analysis of the completeness of referral forms and cases evaluated by an oral medicine specialized service

Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases. The primary aim of this study was to assess the completeness of referral forms of the patients referred by dentists from the primary care basic health units to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist. Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral's completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant's information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients' diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment. Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. Regarding the need of referral, 40,6% of the cases (n = 50) could be settle at the primary care. Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services. (AU)

Synchronous teleconsultation in the management of temporomandibular disorder

ABSTRACT Purpose: to analyze synchronous teleconsultation as a support tool in the management of temporomandibular disorders in primary health care and to identify which factors have an impact on decisions about teleconsultation. Methods: retrospective study perfomed in TelessaúdeRS, between May 2018 to May 2020. This study used primary data from synchronous teleconsultation, requested by primary health care professionals and carried out by multiprofessional teleconsultants. The data collected were the information reported by the requester, the teleconsultant's suggestions and if there was referral of the patient for specialized care after teleconsultation. The statistical association was investigated between patient characteristics and decision of teleconsultation; and teleconsultation conduct suggestions and decision of teleconsultation, using Fisher's exact test and modeling was performed using binary logistic regression considering 5% of significance (p≤0.05). Results: during the period, 56 teleconsultations had a temporomandibular diagnostic hypothesis, these 79.2% patients were female and the average age was 43.7 years. In 59.1% of teleconsultations, primary care management was suggested, with 72.4% of patients being managed. An association was found between the decision of teleconsultation and referral to specialized care (p <000.1). The trauma report (p = 0.004) was associated with a greater chance of being referred for special care and suggestions for pharmacological (p <0.001) and non-pharmacological (p = 0.007) treatments were introduced among the teleconsultation managed in primary care. Conclusion: teleconsultation helped to manage the majority of temporomandibular disorder, streamlining care and having the potential to avoid unnecessary referrals to special care.

Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study

Abstract This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients' profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment.

BMI-1 expression increases in oral leukoplakias and correlates with cell proliferation

Abstract Oral leukoplakia (OL) is a white lesion of an indeterminate risk not related to any excluded (other) known diseases or disorders that carry no increased risk for cancer. Many biological markers have been used in an attempt to predict malignant transformation; however, no reliable markers have been established so far. Objective To evaluate cell proliferation and immortalization in OL, comparing non-dysplastic (Non-dys OL) and dysplastic OL (Dys OL). Methodology This is a cross-sectional observational study. Paraffin-embedded tissue blocks of 28 specimens of Non-dys OL, 33 of Dys OL, 9 of normal oral mucosa (NOM), 17 of inflammatory hyperplasia (IH), and 19 of oral squamous cell carcinomas (OSCC) were stained for Ki-67 and BMI-1 using immunohistochemistry. Results A gradual increase in BMI-1 and K-i67 expression was found in oral carcinogenesis. The immunolabeling for those markers was higher in OSCC when compared with the other groups (Kruskal-Wallis, p<0.05). Ki-67 expression percentage was higher in OL and in IH when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). Increased expression of BMI-1 was also observed in OL when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). No differences were observed in expression of both markers when non-dysplastic and dysplastic leukoplakias were compared. A significant positive correlation between Ki-67 and BMI-1 was found (Spearman correlation coefficient, R=0.26, p=0.01). High-grade epithelial dysplasia was associated with malignant transformation (Chi-squared, p=0.03). Conclusions These findings indicate that BMI-1 expression increases in early oral carcinogenesis and is possibly associated with the occurrence of dysplastic changes. Furthermore, our findings indicate that both Ki-67 and BMI-1 are directly correlated and play a role in initiation and progression of OSCC.

Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial

Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Effect of different presentations of resveratrol on cell proliferation and epitelial thickness of the oral mucosa of wistar rats

Introduction: Grape is one of the most important fruit crops across the world and can be consumed in different ways. There has been a growing interest in the role of antioxidants such as resveratrol, which can be found in grape skin, in oral and dental tissues. Thus, the objective of this study was to analyze the effect of different presentations of resveratrol on cell proliferation and epithelial thickness of the oral mucosa of Wistar rats. Methods: Fifty male Wistar rats were randomly divided into five groups: water/control, red wine, grape juice, 12% alcoholic solution/ethanol and aqueous solution of resveratrol. Samples of palatal and tongue mucosa were collected for a histomorphometric analysis using hematoxylin-eosin staining and the argyrophilic nucleolar organizer region (AgNOR) technique for quantification of cell proliferation. Results: As to epithelial thickness, both the tongue and the palate showed a statistically significant difference between the control group and the other groups, with greater decrease in the resveratrol and the wine groups. In the suprabasal layer of both the tongue and the palate epithelium, red wine reduced the rate of cell proliferation, while ethanol increased it. In the basal layer of the tongue epithelium, there was a statistically significant difference between the control, the grape juice and the resveratrol groups and the ethanol group, with increased cell proliferation in the ethanol group. Conclusions: Wine does not interfere in the physiological renewal of the basal layer of the buccal epithelium and exerts a protective action by reducing the cell proliferation rate of the suprabasal layer (AU)

Effect of 15% Alcohol Dependence on Alveolar Bone Loss and TNF-α Secretion in Wistar Rats

Abstract The aim of the present study was to evaluate the effect of 15% alcohol dependence on ligature-induced alveolar bone loss and TNF- secretion in Wistar rats. Thirty-three male Wistar rats aged 45-60 days (mean weight=253 g) were randomly allocated test or control groups. Test group (n=18) received 15% alcohol as liquid intake and control group (n=15) received water during the experimental period. TNF-α was analyzed by ELISA assay in 11 animals per group. After 14 days of alcohol/water intake, alcohol dependency was assessed and silk ligatures were placed around the left second upper molars. Ligature presence and body weight were checked weekly. After 40 days, animals were sacrificed and the maxillae were defleshed for morphometric analysis using standardized images. All animals in the test group displayed signs of alcohol dependency at day 14. No statistically significant differences in final body weight (334.83±21.38 vs. 322.48±30.65 g, p=0.20) were observed between groups. In relation to alveolar bone loss, no statistically significant difference was observed among test and control groups both for ligated teeth (0.76±0.06 vs. 0.74±0.10 mm, p=0.60) and unligated teeth (0.41±0.16 vs. 0.35±0.05 mm, p=0.22). The TNF-α secretion also did not display statistically significant differences between test and control groups (10.78±1.84 vs. 12.13±2.11 pg/mL, p=0.12). It may be concluded that 15% alcohol dependency was not capable to alter alveolar bone loss and TNF-α secretion in Wistar rats.

Resumo O objetivo do presente estudo foi avaliar o efeito da dependência de álcool a 15% sobre a perda óssea alveolar induzida e secreção de TNF-α em ratos Wistar. Trinta e três ratos wistar com idade entre 45 e 60 dias (peso médio=253 g) foram alocados aleatoriamente para o grupo teste ou controle. O grupo teste (n=18) recebeu álcool a 15% como ingestão líquida e o grupo controle (n=15) recebeu água durante o período experimental. TNF-α foi analisado por meio de ELISA em 11 animais por grupo. Após 14 dias de ingestão de álcool/água a dependência do álcool foi determinada e ligaduras de seda foram colocadas ao redor dos segundos molares superiores esquerdos. A presença das ligaduras e o peso corporal foram verificadas semanalmente. Depois de 40 dias os animais foram sacrificados e as maxilas foram preparadas para análise morfométrica em fotografias estandardizadas. Todos os animais do grupo teste apresentaram sinais de dependência de álcool no dia 14. Não foram observadas diferenças estatisticamente significativas no peso corporal final entre os grupos (334,83±21,38 vs. 322,48±30,65 gramas, p=0,20) Em relação a perda óssea alveolar, não foram observadas diferenças estatisticamente significativas entre os grupos teste e controle tanto para dentes com (0,76±0,06 vs. 0,74±0,10 mm, p=0,60) como para dentes sem ligadura (0,41±0,16 vs. 0,35±0,05 mm, p=0,22). A secreção de TNF-α também não demonstrou diferenças estatisticamente significativas entre os grupos teste e controle (10,78±1,84 vs. 12,13±2,11 pg/mL, p=0,12). Pode-se concluir que a dependência de álcool a 15% não foi capaz de alterar a perda óssea alveolar e a secreção de TNF-α em ratos Wistar.

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

Abstract The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.

Oral mucosal lesions and their association with sociodemographic, behavioral, and health status factors

The aim of this study was to evaluate the frequency of oral mucosal lesions and their associations with sociodemographic, health, and behavioral factors in a southern Brazilian population. Information was collected from participants (n = 801) using a structured questionnaire during an oral cancer screening campaign held at an agribusiness show in southern Brazil in 2009. Data were described using frequency distributions or means and standard deviations. Associations between independent variables and outcomes were assessed using the Chi-squared test. A total of 465 lesions were detected (actinic cheilitis: n = 204, 25.5%; candidiasis: n = 50, 6.2%; fibrous inflammatory hyperplasia: n = 42, 5.2%; ulceration, n = 33, 4.1%; hemangioma: n = 14, 1.7%; leukoplakia: n = 11, 1.4%). Candidiasis, actinic cheilitis, and fibrous inflammatory hyperplasia were associated significantly with literacy. Actinic cheilitis was also associated significantly with sun exposure and hat use, and leukoplakia was associated with smoking. The high frequency of oral mucosal lesions observed highlights the importance of education about risk factors. Additionally, training of health professionals, mainly those from public health services, in the use of preventive and community education strategies is needed.

A 10-year analysis of the oral squamous cell carcinoma profile in patients from public health centers in Uruguay

The aim of this study was to evaluate the demographic, clinical, and therapeutic characteristics and predictive factors of poor prognosis in patients with primary oral squamous cell carcinoma (OSCC) in Uruguay. Medical records of patients with the diagnosis of primary OSCC treated between 2000 and 2010 in Uruguayan public hospitals were selected. Data on demographic characteristics, risk factors, clinical features, treatment, and outcome were collected. Associations of independent variables with outcomes were assessed using Pearson chi-squared and Fisher's tests. Of 200 patients with OSCC, 79.4% were men (3.8:1 male:female ratio), with a mean age of 60.75 ± 11.26 years. Tobacco and alcohol consumption were reported by 85.3% and 63.5% of patients, respectively. The most commonly affected location was the tongue (42.5%), with lesions exhibiting ulcerous aspects in 87.9% of cases and pain at the time of diagnosis in 70.4% of cases. One hundred sixty-one (82.1%) patients had advanced-stage (III/IV) OSCC. Surgery was the most common treatment option, and the overall 5-year survival rate was 58.5%. Univariate analysis showed that the predictors of poor prognosis were clinical aspect, size, regional metastasis, clinical stage, and treatment. In Uruguay, OSCC is diagnosed late, which is associated with a low survival rate. Educational and preventive measures and investment to improve early diagnosis should be undertaken.

Atrasos nos encaminhamentos de pacientes com câncer bucal: avaliação qualitativa da percepção dos cirurgiões-dentistas / Delayed referrals of oral cancer patients: the perception of dental surgeons

O objetivo deste estudo é verificar, na percepção dos cirurgiões-dentistas atuantes em Atenção Primária em Saúde (APS) em Porto Alegre (RS), quais as possíveis razões que justifiquem o atraso da chegada do paciente com câncer bucal aos setores de atenção em saúde de maior complexidade. O presente estudo teve como público-alvo cirurgiões-dentistas atuantes em cinco diferentes realidades laborais em APS em Porto Alegre. Foram utilizados como critérios de inclusão profissionais com formação em APS e que estivessem atuando na Atenção Básica. O instrumento para coleta de dados foi a técnica de grupo focal com aplicação de questionário estruturado. Uma vez coletados os dados, foi realizada análise interpretativa e categorização das informações em quatro eixos centrais: profissional, equipe, comunidade e rede de serviços. Os resultados sugerem que os seguintes fatores estão associados ao atraso da chegada do paciente com câncer bucal aos setores de atenção em saúde de maior complexidade: falha na identificação precoce, ausência de trabalho multidisciplinar, desvalorização da necessidade de corresponsabilização pela própria saúde por parte da comunidade e a deficiência da rede de atenção no que tange a qualidade da comunicação entre profissionais de diferentes níveis de atenção.

The scope of this study was to verify the possible reasons to justify the delay in the referral of oral cancer patients to specialized health care sectors from the standpoint of the dental surgeons involved in Primary Health Care (PHC) in Porto Alegre, state of Rio Grande do Sul. This target public of this study was dental surgeons working in five different labor environments in PHC in Porto Alegre. Criteria for inclusion was dental surgeons graduated in and working in PHC. The data collection instrument was the focus group technique and application of a structured questionnaire. After data collection, interpretative analysis was conducted with classification of the information under four main headings: professional, team, community and services network. The results suggest that there are several factors associated with delayed in referral of patients with oral cancer to specialized health care sectors. These include omission of early diagnosis, lack of multidisciplinary work and insufficient attention to the need for joint community responsibility with patients for their own health status. It is also due to deficiencies in the health service network, specifically regarding the quality of communication between professionals at different levels of the health services. .

Differential diagnosis between oral fibroma and inflammatory hyperplasia: a proposal for histopathological criteria / Diagnóstico diferencial entre fibroma oral e hiperplasia fibrosa inflamatória: uma proposta para critério histopatológico

Aim: The present study proposed histopathological criteria for thedifferential diagnosis between those pathological entities. Materialsand methods: Histological sections of lesions histopathologicallydiagnosed as Oral Fibroma (n=61) and Inflammatory Hyperplasia(n=75) and were submitted to different techniques (HematoxylinEosin;Masson Trichrome and Phosphomolybdic acid - Picrosirius red)to allow quantitative and qualitative analysis. The qualitative analysisof collagen density was based on sections stained by HematoxylinEosinand focused in the center and periphery of each lesion.Results: Wound and collagen fibers were more frequent and higher inOral Fibroma, while parallel fibers were more frequent in InflammatoryHyperplasia (Fisher’s exact test, p<0.05). The percentage of parallelcollagen fibers beneath the epithelium was 72.22% and 92.3% in OralFibroma and Inflammatory Hyperplasia, respectively (Mann Whitney Utest, p<0.05). The parallel collagen fibers in the center of the lesionwas found in 84.6% of Inflammatory Hyperplasia cases and wasabsent in 88.88% of Oral Fibroma. The central portion of Oral Fibromahad characteristically a dense and wound arrangement of collagenfibers. Conclusion: Oral Fibroma and Inflammatory Hyperplasia havedistinctive features that may be useful in routine histopathologicalanalysis, supporting the differential diagnosis.

Objetivos: O presente estudo propôs critérios histopatológicos para odiagnóstico diferencial entre as entidades patológicas. Materiais emétodos: Cortes histológicos de lesões diagnosticadasmicroscopicamente como Fibroma Oral (n=61) e Hiperplasia FibrosaInflamatória (n=75) foram submetidos a diferentes técnicas decoloração (Hematoxilina-eosina, Tricrômio de Masson e ÁcidoFosfomolibidico- Vermelho de Picrosírius) para permitir análisesquantitativa e qualitativa. A análise qualitativa da densidade docolágeno foi baseada nas lâminas coradas em Hematoxilina- eosinae observada no centro e periferia de cada lesão. Resultados: Fibrascolágenas enoveladas eram mais frequentes e mais densas noFibroma Oral, enquanto as fibras paralelas e ram observadas naHiperplasia Fibrosa Inflamatória (teste exato de Fisher, p<0,05). Nocentro da lesão, fibras colágenas paralelas foram encontradas em84,6% dos casos de Hiperplasias Fibrosas Inflamatórias e ausentesem 88,88% dos Fibromas Orais. A porção central do Fibroma Oral eracaracterizado por um arranjo denso e frouxo das fibras colágenas.Conclusão: o Fibroma Oral e a Hiperplasia Fibrosa Inflamatóriapossuem características bem distintas que pode ser útil na rotina daanálise histopatológica, auxiliando no diagnóstico diferencial.

Resilon and Gutta-percha cones: an evaluation of biocompatibility in the connective tissue of rats / Avaliação da biocompatibilidade de cones de Resilon e de gutapercha em tecido conjuntivo de ratos

Objective: This study tested tissue response to gutta-percha or Resilon cones at 7, 14, 30, 60 and 90 days. Methods: Thirty Wistar rats each received three subcutaneous implants of polyethylene tubes containing: GP (gutta-percha); R (Resilon); CG (control group ? empty tube). After histological processing, sections were analyzed by a calibrated examiner, using a light microscope to identify the presence of neutrophils, lymphocytes and plasma cells, eosinophils, macrophages and giant cells, fibrous capsule and abscesses, by an examiner using a light microscope. Kruskal-Wallis and multiple comparison tests were used for the statistical analysis. Results: There were no differences for the macrophages and giant cells, lymphocyte and plasma cell infiltrate, eosinophils, fibrosis or abscesses. Higher neutrophil infiltrate scores were observed at 7 days for groups R and CG (p? 0.05). In group R, the number of neutrophils decreased with time (p= 0.017). Conclusion: The results of the present study demonstrate that Resilon cones are well tolerated by tissues and have acceptable biocompatibility, in the same way as gutta-percha cones.

Objetivo: Avaliar a biocompatibilidade de cones de guta-percha e Resilon em tecido conjuntivo de ratos nos períodos de 7, 14, 30, 60 e 90 dias.Métodos: Trinta ratos Wistar receberam três implantes de tubos de polietileno contendo: GP (guta-percha), R (Resilon), CG (grupo controle - tubo vazio). Após cada período experimental, foi realizado o processamento histológico e os cortes foram analisados por um examinador calibrado, com auxílio de microscópio de luz para identificar a presença de neutrófilos; linfócitos e células plasmáticas; eosinófilos, macrófagos e células gigantes; cápsula fibrosa e abscessos. Para a análise estatística foram utilizados os testes de Kruskal-Wallis e de comparações múltiplas. Resultados: Não houve diferença para os macrófagos e células gigantes, linfócitos e células plasmáticas; eosinófilos, fibrose ou abscesso. Foram observadas altas taxas de infiltrado neutrofílico aos sete dias nos grupos R e GC (p ? 0,05). No grupo R, o número de neutrófilos diminuiu com o tempo (p = 0,017).Conclusão: Os resultados do estudo demonstram que os cones de Resilon são bem tolerados pelos tecidos e possuem biocompatibilidade aceitável, como cones de guta-percha.

A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features

The purpose of the present paper was to describe the range of lesions histologically diagnosed in an oral pathology laboratory in southern Brazil. A retrospective study of 8,168 specimen analyses recorded between 1995 and 2004 was conducted. The records were retrieved from the Oral Pathology Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, RS, Brazil. A total of 6,831 valid cases (83.63%) were examined. Of these, inflammatory lesions were the most common occurrences (n = 4,320; 63.24%). Benign and malignant tumors accounted for 7.66% (n = 523) and 1.9% (n = 130) of the occurrences, respectively. Significant associations were observed between nonneoplastic proliferative disorders and benign mesenchymal tumors in females, and between squamous cell carcinoma and leukoplakia in males. Most diagnoses were benign in nature and had an inflammatory etiology. The association of some demographic characteristics with the occurrence of lesions suggests that these characteristics should be considered in performing differential diagnoses.