A retrospective multicenter study of oral and maxillofacial lesions in older people

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients

Abstract Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Tumores metastáticos para os maxilares: uma revisão integrativa / Metastatic tumors to the jaws: an integrative review

Introdução: Tumores metastáticos na região oral e perioral são extremamente raros. Objetivo: realizar uma revisão integrativa dos casos de metástases nos maxilares e sua relação com os tumores primários, os tipos histológicos e as principais localizações topográficas de ambos. Metodologia: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report e classical articles sobre o tema, utilizando os seguintes descritores: maxilares, mandíbula, maxila, metástases, incidência e seus mesh terms. Resultados: Foram incluídos um total de 35 artigos que cumpriam com todos os critérios. Foram ao todo 452 pacientes com metástases, dos quais 53.1% eram homens. A idade dos pacientes variou dos 4 meses a 90 anos. A mandíbula foi acometida em 55.7% dos casos, e a principal localização primária foi a mama, seguida pelo pulmão com 90 e 87 casos, respectivamente. Em 39% da amostra, os tumores primários eram desconhecidos. O adenocarcinoma foi o principal padrão histopatológico sendo encontrado em 30.3% da amostra. Conclusão: Os tumores metastáticos dos maxilares estão relacionados com um diagnóstico desafiador e tardio com prognóstico sombrio de curta sobrevida. Acometem mais comumente a região posterior mandibular entre a quinta e oitava décadas de vida, em ambos os sexos. O cirurgião dentista tem grande papel no diagnóstico precoce destas lesões. (AU)

Introduction: Metastatic tumors in the oral and perioral region are extremely rare. Objective: To aimed at performing an integrative review of the cases of metastases in the jaws and their relation to primary tumors, histological types and the topographic locations of both. Methods: A search was carried out in the MEDLINE, Google academic and LILACS databases using the following criteria: full articles published, from 2000 to 2016, in English, Portuguese and Spanish, case report and classical articles about the topic, using the following descriptors: jaws, mandible, maxilla, metastasis, incidence and their mesh terms. Results: 35 articles that fulfilled all the criteria were included. There were 452 patients with metastases, of which 53.1% were men. Patient's ages ranged from 4 months to 90 years. The mandible was affected in 55.7% of the cases, and the main primary sites were the breast and lung with 90 and 87 cases each, respectively. In 39% of the sample, the primary tumors were unknown. Adenocarcinoma was the main histopathological pattern found in 30.3% of the sample. Conclusion: Metastatic tumors of the jaws are related to a challenging and late diagnosis with gloomy prognosis of short survival. They most commonly affect the posterior mandibular region between the fifth and eighth decades of life, in both sexes. The dentist practitioner has a great role in the early diagnosis of these lesions. (AU)

Intraoral findings in newborns: prevalence and associated factors

Aim: To investigate the prevalence of intraoral characteristics and associated factors with neonatal and parent variables in a group of Brazilian newborns. Methods: This cross-sectional study with a descriptive and inferential approach, whose data was obtained through clinical examination, interview and the collection of medical record information. The sample was selected from babies up to three days old, of both sexes, and born between January and December 2013 in the Ana Bezerra University Hospital, in the city of Santa Cruz-RN, Brazil. The exposure variables included neonatal (sex, weight, gestational age, type of delivery and Apgar score) and parent (presence of systemic disease(s), drug use and consanguinity between the parents) variables. Descriptive analysis and Poisson regression were performed to estimate the ratio of gross and adjusted prevalence of intraoral findings (Epstein pearls, Bohn's nodule, dental lamina cyst and ankyloglossia) with the neonatal and parent variables (p<0.05). Results: Of a total of 168 examined newborns, 56.5% (n=95) were male. The most prevalent intraoral feature was the fibrous cord of Magitot, 62.5% (n=105), and the most frequent alteration was Epstein pearls, 44.6% (n=75). Female gender was a factor for Bohn's nodule (OR=0.90; 95%CI:0.82-0.99), and no tobacco use by the father was a protective factor for Epstein pearls (OR=0.73;95%CI:0.55-0.97). Additionally, lower mother's age, between 20-34 years of age (OR=1.58;95%CI:1.07-2.35) and under 19 years of age (OR=1.61; 95%CI:1.03-2.52) increases the chance of having Epstein pearls. Conclusion: There was a high prevalence of alterations in the newborns' oral cavities and there were associations between neonatal and parent variables

Riscos e complicações do uso de piercing oral: uma revisão sistemática / Risks and complications of the use of oral piercing: a systematic review

Introdução: O uso de piercing oral tem despertado o interesse dos profissionais da Odontologia devido à associação com diversas complicações locais e sistêmicas. Objetivo: Este trabalho objetivou realizar uma revisão sistemática da literatura sobre riscos e complicações associadas ao uso de piercings orais e periorais. Métodos: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando-se os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report, classical articles e reviews sobre o tema utilizando os seguintes descritores: body piercing, risks management, complications, risk e seus mesh terms. Resultados: Foram incluídos um total de 39 artigos relevantes que cumpriam com todos os critérios. Foi observado que os locais mais frequentemente utilizados para a colocação de piercing oral são os lábios e a língua. As complicações incluem inflamação, infecções locais e sistêmicas, lesões mucocutâneas, lesões vasculares, trauma dental, problemas periodontais, reações de hipersensibilidade, disfonia, deglutição e aspiração do piercing, e até morte etc. Conclusão: Conclui-se que o cirurgião dentista deve exercer um papel importante na orientação da população em geral sobre os riscos e as complicações associadas ao uso de piercing oral, visando evitar tal prática ou minimizar ao máximo os riscos e as complicações naqueles indivíduos que os possuem. (AU)

Introduction: The use of oral piercing has aroused the interest of dental professionals because of its association with various local and systemic complications. Objective: This study aimed to perform a systematic review on risks and complications associated with the use of oral and perioral piercings. Methods: We searched the MEDLINE, Google Scholar and LILACS databases using the following criteria: articles published in full text, from 2000 to 2016 in English, Portuguese and Spanish, case reports, classic articles and reviews about the topic using the following descriptors: body piercing, risk management, complications, risk and their mesh terms. Results: 39 relevant articles that fulfilled all the criteria were included. It has been observed that the most frequently used sites for an oral piercing placement are the lip followed by the tongue. The complications included inflammation, local and systemic infections, mucocutaneous lesions, vascular lesions, dental trauma, periodontal problems, hypersensitivity reactions, dysphonia, swallowing and aspiration of the piercing, and even death etc. Conclusion: Its was conclude that the dentist can play an important role in guiding the population about the risks and complications associated with the use of oral piercing, aiming to avoid such practice or minimizing the maximum the risk and complications in those individuals who possess them. (AU)

Perception of dental care among children

Children that arrive at dental offices with fear and anxiety usually tend to resist conditioning mechanisms. The aim this study was to evaluate children's perception about dental treatment and to identify factors that influence this perception. Material and Methods: A random sample of 100 children of both genders aged 3 to 12, who were treated at the Department of Dentistry of a University (group I) and at a Children's Hospital (group II), was selected. A structured questionnaire about the child's perception about dental care was applied and the children were asked to draw a picture of this topic. Most of children expressed a positive perception in the questionnaire and in the drawings (93.8%). This positive perception was more pronounced in group I (94%) and in children aged 3 to 5 years (100%), particularly in girls (78%). The main cause of fear was the use of needles (42.4%). Many children (24.2%) reported to prefer the noninvasive procedures. A positive perception of dental treatment was observed in the majority of the sample. Therefore, dental pediatricians must be aware of the perception of children for better conditioning (Au)

Primary adenocarcinoma of the colon with metastases to the mandible and liver: a case report / Adenocarcinoma primario de colon con metástasis en mandíbula e hígado: reporte de un caso

Metastatic lesions to the mandible may be originated from primary tumors elsewhere in the body. However, metastatic colonic carcinomas to this bone have been described infrequently. We report the case of a 71-year-old man with an adenocarcinoma in the sigmoid colon with liver metastasis. The patient underwent chemotherapy with indication of sigmoidectomy and retroperitoneal lymphadenectomy. One year and four months after the first metastatic diagnosis, the patient presented a tumor mass in the body and branch of the right mandible. Histopathological and immunohistochemical analysis with monoclonal antibodies specific for CEA, CK20, CDX-2, and vilin were compatible with the diagnosis of moderately differentiated metastatic adenocarcinoma with colonic origin. However, due to the wide spread of the disease, the patient died four months later. Tumor markers have been applied in clinical practice to assist in the diagnosis and to help guide prognosis, staging and treatment of cancer. The management of metastatic lesions remains a controversial issue and the development of new and more specific markers of gastrointestinal differentiation that may promote early diagnosis, are of continuous interest.

Las lesiones metastásicas de la mandíbula pueden surgir de los tumores primarios en cualquier partes del cuerpo. Sin embargo, el carcinoma metastásico de colon de este hueso se han reportado con poca frecuencia. Presentamos el caso de un hombre de 71 años de edad, con un adenocarcinoma de colon sigmoide con metástasis en el hígado. El paciente fue sometido a quimioterapia con indicación de sigmoidectomía y linfadenectomía retroperitoneal. Un año y cuatro meses después de la emisión del primer diagnóstico de la metástasis, el paciente presentaba una masa tumoral en el cuerpo y rama de la mandíbula derecha. El análisis histopatológico e inmunohistoquímico con anticuerpos monoclonales específicos para CEA, CK20, CDX-2, y vilin fueron compatibles con el diagnóstico de adenocarcinoma moderadamente diferenciado metastásico originario en el colon. Sin embargo, debido a la amplia propagación de la enfermedad, el paciente murió cuatro meses más tarde. Los marcadores tumorales se han aplicado en la práctica clínica para ayudar en el diagnóstico y ayudar a orientar el pronóstico, la estadificación y tratamiento del cáncer. Gestión de las lesiones metastásicas sigue siendo un tema controvertido, y el desarrollo de marcadores nuevos y específicos que promueven la diferenciación del diagnóstico precoz gastrointestinal, son de interés continuo.

Recurrent Oral Manifestations of Paracoccidioidomycosis without Pulmonary Involvement: Case Report and Review of Literature / Manifestación Oral Recurrente de Paracoccidioidomcosis sin Compromiso Pulmonar: Reporte de Caso y Revisión de la Literatura

This article describes a case of recurrence of chronic paracoccidioidomycosis (PCM) 11 years following the initial diagnosis. The patient was a 51-year-old white Brazilian female, which had been previously diagnosed with PCM. The physical examination revealed the presence of a single crusted lesion in the upper lip and an elevated lesion with fibrous scar appearance on right buccal mucosa. Although the diagnosis of PCM, the absence of pulmonary involvement led to the biopsy of the lesion localized on the buccal mucosa and the histopathological analysis in H&E and PAS stains revealed no morphological changes suggestive of any lesion. However, the exfoliative cytology stained with Grocott-Gomori showed the presence of Paracoccidioides brasiliensis and the infection caused by this fungus was proven. Of this way, we emphasize the importance of stomatologic evaluation to the diagnosis of diseases that usually manifestssystemically. So, the correct diagnosis of oral manifestations of PCM, is essential to ensure early and safe intervention.

En este artículo se describe un caso de paracoccidioidomicosis crónica (PCM) recurrente 11 años después del diagnóstico inicial. La paciente una mujer blanca de Brasil de 51 años de edad, que había sido diagnosticada previamente con PCM. El examen físico reveló la presencia de una lesión única en el labio superior y una lesión elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnóstico de PCM, la ausencia de compromiso pulmonar llevó a la biopsia de la lesión localizada en la mucosa bucal y el análisis histopatológico no demostró cambios morfológicos indicativos de cualquier lesión. Sin embargo, la citología exfoliativa teñida con Grocott-Gomori mostró la presencia de Paracoccidioides brasiliensis y la infección causada por este hongo fue probado. De esta manera, hacemos hincapié en la importancia de la evaluación odontológica para el diagnóstico de enfermedades que se manifiestan generalmente por vía sistémica. Por lo tanto, el diagnóstico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervención temprana y segura.

Influence of dialysis duration and parathyroid hormone on the clinical and radiographic oral conditions of pre-transplant patients with chronic kidney disease

Aim: To evaluate the oral conditions of patients with chronic kidney disease undergoing dialysisand to determine the influence of dialysis duration and bone metabolism on the prevalence andseverity of the alterations found. Methods: The simplified oral hygiene index (OHI-S), prevalenceof dental caries (decayed, missing filled teeth index, DMFT), and the periodontal screening andrecording (PSR) index were evaluated in 154 patients. Parathyroid hormone (PTH), calcium,phosphorus and urea measurements, as well as panoramic radiographs, were obtained from allpatients. To evaluate the effect of duration of dialysis treatment on oral health, the patients weredivided into two groups: (1) <5 years and (2) > 5 years. Regarding blood levels of PTH, patientswere divided into three groups: (1) 0-149 pg/mL, (2) 150-584 pg/mL, and (3) >585 pg/mL. TheOHI-S identified the accumulation of biofilm and calculus around the teeth. Results: Gingivalinflammation was found in 100% of dentate patients, with 2 being the predominant PSR score(72.3%). The DMFT index was high (17.52). Dental calculus was the most common radiographicfinding (70.8%). No significant correlation was observed between dialysis duration, biochemicalalterations, and oral health. Conclusions: Most patients undergoing dialysis presented precariousoral hygiene, periodontal inflammation, and bone alterations. However, these manifestationswere not influenced by the duration of dialysis or bone metabolism.

Immunohistochemical expression of protein 53, murine double minute 2, B-cell lymphoma 2, and proliferating cell nuclear antigen in odontogenic cysts and keratocystic odontogenic tumor.

Introduction: Even though odontogenic cysts share a similar histogenesis, they show different growth and differentiation profile due to differences in the proliferative cellular activity. Aims: We perform an immunohistochemical assessment of protein 53 (p53), proliferating cell nuclear antigen (PCNA), B-cell lymphoma 2 (bcl-2), and murine double minute 2 (MDM2) expression in odontogenic cysts and keratocystic odontogenic tumor analyzing their correlation with the biological behavior of these lesions. Materials and Methods: By the streptavidin-biotin-peroxidase method with antibodies against p53, PCNA, bcl-2, and MDM2 proteins, 11 radicular cysts, 11 dentigerous cysts, and 11 keratocystic odontogenic tumor were analyzed. The non-parametric Mann-Whitney U-test and Kruskall-Wallis test (P ≤ 0.05) were used to analyze the data. Results: Immunopositivity for PCNA was observed in all cases appraised, predominantly in the suprabasal layer of keratocystic odontogenic tumor epithelial lining (SD ± 19.44), but no significant differences were found among the groups of lesions. Bcl-2 immunoexpression was observed especially in the basal layer of keratocystic odontogenic tumor. PCNA LI was significantly higher than bcl-2 LI in keratocystic odontogenic tumor. MDM2 and p53 immunoexpression were not detected in the lesions studied. Among the evaluated lesions, the keratocystic odontogenic tumor showed different immunoexpression of the proliferation and apoptosis markers. Conclusion: The results of this study suggest that the keratocystic odontogenic tumor presents distinct biological behavior of the odontogenic cysts, as for the processes of proliferation, apoptosis, and differentiation, reinforcing the information in favor of the neoplastic nature of this lesion.

Perfil de acadêmicos de Odontologia sobre biossegurança / Profile of dental students about biosafety

Objetivo: A formação do profissional da Odontologia requer preparo e esclarecimento quanto ao uso das medidas universais de biossegurança em virtude da exposição a agentes infectocontagiosos. Este estudo descritivo teve como objetivo avaliar o nível de conhecimento de uma população de acadêmicos de Odontologia a respeito de biossegurança, além de identificar as dúvidas mais frequentes sobre medidas preventivas no ambiente odontológico e avaliar o interesse desses acadêmicos em relação ao tema biossegurança. Materiais e métodos: A amostra foi constituída por 358 alunos de três universidades. Foi aplicado um questionário contendo perguntas objetivas e subjetivas em alunos dos 1º, 5º e últimos períodos. Resultados: Observou-se que 92.6% dos alunos conheciam o significado de biossegurança e 92.3% relatou o uso de EPI pelo seu CD e para o paciente. Frente a um atendimento na clínica, 291 (82.7%) alunos responderam que saberiam se cuidar e 59 (16.8%) que não, sendo 94.9% destes últimos, alunos do primeiro período. Entre os alunos do primeiro período, 38.4% responderam não ser importante considerar o paciente como potencial portador de doença. Conclusões: Conclui-se que, é importante ministrar conteúdos básicos sobre biossegurança nos períodos pré-clínicos, visando a entrada dos alunos às atividades clínicas com maior segurança. Ressalta-se ainda a importância da fiscalização e atualização periódicas de práticas, e conhecimentos das medidas preventivas adequadas que permitam o exercício de atividades acadêmicas em segurança em todos os períodos do curso.

Aim: The professional formation in Dentistry requires preparation andknowledge regarding the use of universal biosafety measures againstexposure to infectious agents. This descriptive study aimed to evaluate the level of knowledge of dentistry students about biosafety, and identify the most frequent doubt about preventive measures in dental care environment, also assess the student’s interest bybiosafety. Material and methods:The sample consisted of 358 students from three universities. A questionnaire with subjective and objective questionswas applied to students at 1st, 5th and last periods. Results: It was observed that 92.6% of students knew themeaning of biosafety and 92.3% reported the use of PPE for their dentist and for the patient. When as ked if theywould know to take care in clinicalenvironment, 291 (82.7%) students answered that they would know how to care and 59 (16.8%) not, 94.9% of the latter were students of the first period, in this group, 38.4% of students responded not be important to consider the patient as a potential transmitter ofdisease. In the total sample, 98.6% considered to be important the topic of the research. Conclusions: It was concluded that it is important introduce basic content on biosafety in the pre-clinical periods, aimin g at the entry of students to the clinical activities moresafely. It is emphasized the importance of supervision and periodic update of practices and knowledge about preventive measures facilitating the exercise of academic activities in safety at all course periods.

Prevalencia de accidentes ocupacionales en estudiantes de odontología de la Universidad Federal de Río Grande del Norte, Brasil / Prevalence of occupational accidents in dental students at the Rio Grande do Norte Federal University, Brazil

El objetivo de este estudio fue determinar la prevalencia de accidentes ocupacionales en estudiantes de Odontología de la Universidad Federal de Rio Grande del Norte (UFRN), Brasil y el nivel de conocimiento de estos sobre exposición ocupacional, medidas preventivas y manejo post exposición. Los datos fueron recogidos a través de un cuestionario, con información referente a edad, género y período cursado, además de la ocurrencia de accidentes ocupacionales, medidas pre y post exposición de 150 estudiantes. Los datos fueron registrados en un banco de datos del Statistical Package for the Social Science (SPSS) 17.0 y sometidos a análisis descriptivo. De los 150 estudiantes evaluados, 45.3% eran hombres y 54.7% mujeres. La prevalencia de accidentes fue de 45.3%, ocasionados por perforación durante el lavado y condicionamiento del instrumental (30.9%) o en procedimientos clínicos (21.8%), por salpicaduras en el ojo (11.8%), contacto directo con sangre (10.9%) y por otras causas (24.6%). De los 68 accidentados, solo 14.7% se realizó exámenes para detectar infección por HBV y/o VIH después del accidente, 86.8% de los estudiantes no recibió ningún tratamiento. De la muestra, 88.7% estaban vacunados contra la hepatitis B y de estos, 48.7% completaron el esquema de vacunación. A pesar de que los estudiantes de Odontología presentaron un adecuado conocimiento sobre medidas preventivas y manejo post exposición, hubo una considerable prevalencia de accidentes ocupacionales e inadecuadas conductas post exposición, reflejando la necesidad de la adopción y/o intensificación de programas preventivos, garantizado el egreso de profesionales con alto nivel de preparación en materia de riesgo laboral.

The aim of this study was to determine the prevalence of accidents in dental students at the Federal University of Rio Grande do Norte (UFRN), Brazil, and the knowledge level about their occupational exposure, preventive measures and post-exposure management. Were collected through a questionnaire, data on age, sex and academic semester, as well as the occurrence of accidents, pre and post-exposure. Were recorded in the database of the Statistical Package for the Social Sciences (SPSS) 17.0 and submitted to a descriptive analysis. Of the 150 students evaluated, 45.3% were men and 54.7% women. The prevalence of accidents was 45.3%, caused by drilling in the wash of instrumental (30.9%) or dental procedures (21.8%), due to splash in the eye secretion (11.8%), direct contact with blood (10.9%) and other causes (24.6%). Of the 68 victims, only 14.7% were tested for HBV infection and / or HIV and after the accident, 86.8% of students did not undergo any treatment. Of the sample, 88.7% were vaccinated against hepatitis B and of these 48.7% completed the vaccination schedule. Despite the dental students have an adequate knowledge of preventive measures and post-exposure management, there was a considerable prevalence of occupational accidents and inappropriate behavior after exposure, reflecting the need for adoption or intensification of preventive programs, ensuring the egress of professionals with a high level of preparedness in biohazard.

Prevalencia de anormalidades bucales y caries dental en portadores de Síndrome de Down / Prevalence of mouth anomalies and dentario caries in people with Down Syndrome

Este estudio epidemiológico evaluó la prevalencia de anormalidades bucales y caries dental en pacientes portadores de Síndrome de Down. La muestra fue compuesta por 48 pacientes con edades entre 2 y 18 años, siendo analizada las variables: sexo; edad, presencia y tipo de alteraciones bucales; frecuencia y forma de cepillado; visita al cirujano odontólogo y prevalencia de caries dental. Los datos fueron analizados descriptivamente con el Software Epi info 3.7 y presentados a través de estadística descriptiva. Análisis bivariado fue realizado a través del test Chi-cuadrado de Pearson (p<0,05). Del total examinado, 58.3% eran del sexo másculino, con predominio de las edades entre 2 a 10 años (66,7%). Fue verificado que 83.8% de la muestra tenía lengua fisurada y 35.4% poseía microdoncia. La frecuencia diaria de cepillado fue de dos veces al día (85,4%), siendo realizada bajo la supervisión de los padres (50,0%). Una única visita anual al cirujano odontólogo fue relatada por 85.7% de los evaluados. El valor medio del CPO-D fue de 5,3, con predominio de caries en el sexo femenino (75,0%) y entre las edades de 11 a 18 años (93,8%). Concluyese que la muestra estudiada presenta una alta prevalencia de caries y un conjunto de manifestaciones bucales peculiares al individuo portador del Síndrome de Down

This epidemiological study offered to evaluate the prevalence of mouth anomalies and dentario caries in patients with Down syndrome. The sample was composed of 48 patients aging from 2 to 18 years, being the following variables evaluated: sex, age, presence and types of mouth alterations; frequency and the way they brush; consult with the dentario surgeon and prevalence of dentario cavity. The data were organized with the aid of a 3.7 Epi info Software and presented by means of descriptive statistics. The bi-varied analysis was carried out through Pearson's Qui-square test (p<0.05). Out of the total examined, 58.3% were males, aging predominantly 2-10 years (66.7%). It was verified that 83.8% of the sample had fissured tongue, and 35.4% had microdonty. As to the brushing of the teeth, the daily frequency of twice a day prevailed (85.4%), being conducted under the parents' supervision (50.0%). A single annual consult with the dentario surgeon was stated by 85.7% of the subjects. The average value of DMF-T was 5.3, with predominance of dentario caries in females (75.0%) and in the patients aging 11-18 years (93.8%). It was concluded that the sample studied presents a high prevalence of dentario caries and an array of peculiar mouth manifestations to the person with Down syndrome

Complicaciones estomatológicas en pacientes VIH positivos: correlaciones clínico demográficas y de laboratorio / Dental complications in HIV positive patients: clinical correlations demographic and laboratory

Las complicaciones estomatológicas (CE) en pacientes VIH+ muchas veces constituyen los primeros signos clínicos de la enfermedad, pudiendo funcionar como señalizadores del curso y progresión de la infección por el VIH y el SIDA. Este estudio evaluó la prevalencia de lesiones orales en pacientes VIH+ del Hospital de Enfermedades Infectocontagiosas Gizelda Trigueiro, en Natal-RN, Brasil y correlacionarlas con factores socio-demográficos como el sexo, edad, forma de contagio y status inmunológico. De acuerdo con los criterios de la EC-CLEARINGHOUSE/WHO, a través de examen clínico oral y conteo de células T CD4+ fueron evaluados 121 pacientes VIH+. Las lesiones más frecuentes fueron candidiasis (45.2%), leucoplasia vellosa (16.1%), eritema gingival linear (16.1%), herpes labial (12.9%), periodontitis necrosante (6.5%) y gingivitis necrosante (3.2%), ocurriendo con mayor frecuencia en hombres entre las edades de 30 a 44 años, que adquirieron el VIH a través de contacto sexual. Basado en los resultados de este estudio concluyese que hubo una prevalencia del perfil de complicaciones estomatológicas comúnmente relatado en la literatura. Las lesiones estuvieron asociadas a la reducción del número de células TCD4+, representando, por lo tanto marcadores de la progresión de la infección por el virus y/o de falla de la HAART, siendo así, un exhaustivo examen oral es importante en la evaluación clínica y acompañamiento de pacientes con VIH.

The stomatologic complications due to VIH infection are, a lot of times, the first clinical signs of the disease. These injuries may also function as beepers and sentries of the curse and progression of the VIH infection and SIDA. The objective of this work was to evaluate the prevalence of the oral injuries in VIH positive patients from the Hospital of Infected contagious Gizelda Trigueiro in Natal-RN, Brazil, and correlate them with demographic factors such as gender, age, form of VIH infection and immune status (T CD4+ cells). According to the criteria of EC-CLEARINGHOUSE/WHO, through clinical oral examination and T CD4+ cell count 121 patients were evaluated. The oral candidiasis was the most common lesion (45.2%), followed by oral hairy leukoplakia (16.1%), linear gingival erythema (16.1%), lips herpes (12.9%), necrotizing periodontitis (6.5%) and necrotizing gingivitis (3.2%), occurring predominantly in men between the ages 30 to 44 years, who acquired VIH infection through sexual contact. Based on the results of this study, concluded that there was a prevalence of the stomatologic complications profile that is commonly reported in the literature. These changes were associated with a decrease in the number of CD4+ T cells, representing markers of the infection progression and / or failure of HAART, so a thorough oral examination is important in clinical evaluation and follow up of patients with VIH.

Mucosite oral induzida por radiação: uso de fatores de crescimento e de laser / Radiation-induced oral mucositis: the use of growth factors and laser

Dosagens de radiação em torno de 50 a 70 Gy são consideradas de risco para o desenvolvimento de mucosite oral. Foi realizado um levantamento da literatura relacionada com a mucosite oral induzida por radiação em humanos na base de dados MEDLINE, tendo como critério inicial a seleção de artigos completos publicados em inglês de 1995 a 2005. Foram identificados 40 trabalhos relevantes, dos quais apenas 17 apresentavam evidências científicas sobre o uso local de fatores de crescimento e do laser de baixa potência como modalidades terapêuticas para a mucosite oral. A maioria dos autores considerava o sistema de gradação em escores preconizado pela Organização Mundial da Saúde como o mais adequado para a classificação do grau de evolução desta complicação oral. Observou-se, a partir da análise realizada, que o uso local de fatores de crescimento e do laser de baixa potência pode reduzir a severidade da mucosite oral induzida por radiação, favorecendo a proliferação celular e, consequentemente, a indução do reparo da mucosa e contribuindo para melhorar a qualidade de vida dos pacientes.

Radiation doses of 50 to 70 Gy may cause oral mucositis. The MEDLINE database was searched for full articles published in English from 1995 to 2005 on radiation-induced oral mucositis in humans. Forty relevant articles were found and of these, only 17 presented scientific evidence of the use of growth factors and low-power laser administered locally as treatment options for oral mucositis. Most authors considered the World Health Organization's grading system the most appropriate for classifying the grade of this oral complication. Review of these articles revealed that growth factors and low-power laser used locally can reduce the severity of radiation-induced oral mucositis, stimulating cell proliferation and consequently, promote healing. This helps to better the quality of life of these patients.

La participación de las células tronco en la regeneración periodontal / The involvement of stem cells in periodontal regeneration

La enfermedad periodontal causa destrucción de los tejidos periodontales, incluyendo el ligamento periodontal, el hueso alveolar y el cemento, siendo considerada la mayor causa de pérdida dentaria en adultos. Una vez dañificado, el periodonto posee un limitado potencial de regeneración. La reconstrucción del complejo periodontal destruido por la periodontitis es la mayor meta de la terapia periodontal. Para eso varios tratamientos fueron propuestos, a pesar de basarse casi que completamente en la implantación de substitutos estructurales con pequeño o ningún potencial reparador. Los progresos recientes en la terapia con células-tronco y de nuevas técnicas basadas en la ingeniera tisular podrán ser utilizados en las prácticas regenerativas. Las células-tronco pueden ser encontradas en muchos tejidos dentários adultos como pulpa y ligamento periodontal, y podrán ser utilizadas para regenerar los tejidos del complejo periodontal. La reciente identificación de células-tronco dentro del ligamento periodontal representa un desenvolvimiento significativo de nuevas terapéuticas clínicas direccionadas a la regeneración periodontal de manera previsible. Siendo así, este abordaje literario explora los conceptos contemporáneos a cerca de la biología de las células-tronco, los recientes progresos en la identificación de estas, su potencial regenerador y sus implicaciones clínicas

Periodontal diseases lead to the destruction of periodontal tissues, including periodontal ligament, cementum and alveolar bone, are a major cause of adult teeth loss. Once damaged, the periodontium has limited regeneration potential. The reconstruction of the complex destroyed by periodontitis is the periodontal therapy top barrier. Aiming this, many treatments were proposed, almost all of them based on estructural substitute implantation with less on no repairing potential. The recent progress on stem-cells therapy and tissue enginnering based new technique will allow their use in regenerative practices. The stem-cells identification into the periodontal ligament and the cientific proofs of their applicability in periodontal complex regeneration on predictable methods represent the periodontics revolution, providing tissue reconstruction never found on any other technique satisfactorily. Thus, this literary approach explores the contemporary concepts concerning the biology of stem-cells, the recent progresses in their identification, regeneration potential and their clinical implications

Cisto radicular residual incomum: relato de caso / Unusual residual radicular cyst: case report

Cisto é definido como cavidade patológica totalmente revestida por epitélio com material líquido ou semissólido. Dentre os cistos de origem odontogênica, destaca-se o cisto inflamatório radicular residual, que se caracteriza pela localização em região de extração dentária prévia. Neste trabalho, os autores relatam um caso incomum de cisto radicular residual volumoso com invasão de estruturas adjacentes, como o seio maxilar. O paciente, masculino, procurou uma clínica particular com queixa de aumento de volume na maxila. Após exame clínico, realizou-se biópsiaincisional da lesão para determinar sua natureza, sendo levantadas duas hipóteses de diagnóstico com base nos aspectos clínicos e radiográficos: tumor odontogênico ceratocístico e cisto radicular residual. O exame histopatológico confirmou a hipótese de cisto radicular residual. Com base nesse diagnóstico, utilizou-se como tratamento a marsupialização da lesão, obtendo-se sucesso. Os autores concluíram que os cistos radiculares podem alcançar grandes proporções, embora este seja um comportamento incomum, cujas causas são desconhecidas. Além disso,a marsupialização constituiu uma forma viável de tratamento para esse tipo de lesão.

Cyst is defined as a pathological cavity entirely lined by epithelium and may contain liquid or semisolid material. Among cysts with odontogenic origin, the inflammatory residual radicular cyst stands out from the others: it?s mainly feature is its localization in previous dental extraction region. In this issue, the authors report an uncommon case of a residual radicular cyst with large proportions and invasion of adjacent structures, like the maxilar sinus. A male patient has searched for a treatment in a private clinic complaining of an increasing bulky mass in his maxilla. After clinical examination, an incisional biopsy was done to establish the nature of the lesion, two hypothesis of diagnosis were made based on clinical and radiographic aspects: keratocystic odontogenic tumor or residual radicular cyst. The histopathological exam confirmed the hypothesis of residual radicular cyst. Based on this diagnosis, a marsupializationof the lesion was performed and this treatment resulted in success. The authors concluded that the radicular cyst may achieve great proportions, although this behavior is uncommon and its causes are unknown. Besides,marsupialization was a viable form of treatment for this type of lesion.

Inmunohistochemical expression of PCNA, p53 and bcl-2 in pleomorphic adenomas / Expresión inmunohistoquímica de PCNA, p53 y bcl-2 en adenomas pleomórficos

The aim of the study was to determine the immunohistochemical expression of the PCNA, p53 and bcl-2 proteins in pleomorphic adenomas. Nineteen specimens of pleomorphic adenomas were selected for analysis by the streptavidin-biotin-peroxidase method with antibodies againstp53, PCNA and bcl-2 proteins. It was observed weak labeling for p53 in 12 cases (63.1 percent) andforPCNA in 8 (42.1 percent). With respect to the bcl-2 labeling index, o no expression of this protein was detected in 12 cases, corresponding to 63.1 percent of the sample. Based on these findings, it was concluded that p53 and PCNA can favour the proliferative activity of pleomorphic adenomas, whereas bcl-2 probably does not effectively participate in the pathogenesis of this tumor.

El objetivo del estudio fue determinar la expresión inmmunohistoquímica de las proteínas PCNA, p53 y bcl-2 en adenomas pleomórficos. Fueron seleccionados 19 especímenes de adenomas pleomórficos para análisis a través del método de la estreptavidina-biotina-peroxidasa con anticuerpos contra las proteínas p53, PCNA y bcl-2. Fue observada leve marcación para p53 en 12 casos (63,1 por ciento) y para PCNA en 8 (42,1 por ciento). Con relación al índice de marcación para bcl-2, ono fue detectada en 12 casos (63,1 por ciento) expresión de esta proteína. En base a los resultados, se concluyó que las proteínas p53 y PCNA pueden favorecer la actividad proliferativa de adenomas pleomórficos, y por otro lado, la bcl-2 probablemente ono participaría efectivamente de la patogenia de este tumor.

Análisis clínico e histomorfológico de la mucosa oral normal, hiperplasia fibroepitelial inflamatoria oral y displasia oral / Clinical and histomorphological analysis of normal oral mucosa, oral inflammatory hyperplasia and oral epithelial displasia

El desarrollo del cáncer oral puede darse a partir de una mucosa aparentemente normal o a partir de una lesión precursora inicial, las cuales pueden representar pasos diferentes del proceso de carcinogénesis epitelial oral. El objetivo de este estudio fue analizar morfológicamente, a través de la técnica de la hematoxilina / eosina, la mucosa oral normal, con hiperplasia fibroepitelial oral y displasia epitelial oral, con el propósito de obtener mayor información sobre las alteraciones epiteliales que pueden preceder al establecimiento y evolución de una neoplasia propiamente tal. Fue observado que muchas de las alteraciones morfológicas observadas en las hiperplasias fibroepiteliales orales probablemente eran asociadas al proceso inflamatorio, donde es conocida la acción de mediadores químicos con capacidad de promover modificaciones morfológicas celulares y en la estructura tisular y no necesariamente representan alteraciones comunes de lesiones potencialmente malignas. Correlacionando el aspecto clínico de las lesiones con el diagnóstico histopatológico de displasia epitelial oral, no fue observada diferencia expresiva; sin embargo, la mayoría de los especímenes tuvo diagnostico clínico de leucoplasia. Se concluyó que la simple observación de las características morfológicas de las alteraciones de la mucosa oral puede ayudar el establecimiento del diagnóstico de las lesiones sufridas por la mucosa; sin embargo, no ofrecen muchas información sobre cuáles serían los eventos que llevarían al establecimiento de una determinada lesión.

The oral cancer development can be from apparently normal mucosa, or from precursory lesions, that can represent different step of oral epithelial carcinogenesis process. This study aimed to analyze morphologically trough the hematoxilina/eosine technique normal oral mucosa, oral fibroepithelial inflammatory hyperplasia and oral epithelial dysplasia (OED) to get more informations about the epithelial alterations that can to precede the installation and evolution of oral cancer. Its was observed that some of the morphologic alterations in the oral fibroepitelial hyperplasia were provably associated to the inflammatory process, where exist the action of chemical mediators with capacity to promote cellular morphologic modifications and alterations of the tissue architecture but not to common alterations of lesions potentially malignant. Correlating the clinical aspect of the lesions with the histopatologic diagnosis of oral epithelial dysplasia its was not observed expressive difference, however the majority of the OED specimens had clinical diagnosis of leucoplasia. Its was concluded that the simple observation of the morphologic characteristics of epithelial alterations in the oral mucosa can to improve the diagnostic of the lesions suffered by this mucosa, however, its not offers much informations about which would be the events that would lead to the establishment of a determined lesion.