Proliferative verrucous leukoplakia mimicking oral lichen planus: case report and literature review

This report presents the clinical, microscopic and immunohistochemical aspects of a case of proliferative verrucous leukoplakia (PVL) mimicking oral lichen planus (OLP) in a 66-year-old woman. We also review the literature reporting cases of PVL mimicking OLP, where we found a higher prevalence in women who do not consume tobacco or alcohol. The initial manifestation of lichenoid areas was around the age of 59, with the diagnosis of PVL being established on average 6 years later, while malignant transformation occurred in 8 of the 22 cases at an average of 3.7 years after the final diagnosis of PVL. We emphasize the need for a close follow-up of any patient presenting white lesions of the oral mucosa. Lesions that are clinically and microscopically compatible with lichenoid reactions or OLP must be investigated and differentiated from PVL, which has a worse prognosis.

Este relato apresenta os aspectos clínicos, microscópicos e imuno-histoquímicos de um caso de leucoplasia verrucosa proliferativa (LPV) mimetizando líquen plano oral (LPO) em uma paciente do sexo feminino de 66 anos. Também revisamos a literatura relatando casos de LPV mimetizando LPO, onde encontramos maior prevalência em mulheres que não consomem tabaco ou álcool, com manifestação inicial de áreas liquenoides por volta dos 59 anos, sendo estabelecido o diagnóstico de LPV em média 6 anos depois, enquanto a transformação maligna ocorreu em 8 dos 22 casos em média 3,7 anos após o diagnóstico final de LPV. Ressaltamos a necessidade de acompanhamento rigoroso de qualquer paciente que apresente lesões brancas da mucosa oral, devendo ser investigadas lesões clinicamente e microscopicamente compatíveis com reações liquenóides ou LPO e diferenciadas da LPV, que tem pior prognóstico

Este reporte presenta los aspectos clínicos, microscópicos e inmunohistoquímicos de un caso de leucoplasia verrugosa proliferativa (LVP) simulando liquen plano oral (LPO) en una paciente de 66 años. También revisamos la literatura reportando casos de LVP simulando LPO, donde encontramos una mayor prevalencia en mujeres que no consumen tabaco ni alcohol, con una manifestación inicial de áreas liquenoides alrededor de los 59 años, estableciéndose el diagnóstico de LVP en promedio 6 años después, mientras que la transformación maligna ocurrió en 8 de los 22 casos en un promedio de 3,7 años después del diagnóstico final de LVP. Resaltamos la necesidad de un seguimiento estrecho de todo paciente que presente lesiones blanquecinas de la mucosa oral, que las lesiones clínica y microscópicamente compatibles con reacciones liquenoides o LPO deben ser investigadas y diferenciadas de la LVP, que tienen peor pronóstico.

Effect of radiotherapy on the differentiation and osteogenic activity of mesenchymal stem cells on dental implants / Efeito da radioterapia na diferenciação e atividade osteogênica de células-tronco mesenquimais em implantes dentários

Objective: to evaluate the differentiation and gene expression of transcripts related to osteogenesis in a primary culture of Mesenchymal Stem Cells (MSCs) derived from rat femurs submitted to radiotherapy and the installation of pure titanium implants. Material and Methods: fifty-four rats received titanium implants in both femurs and were divided into three groups: Control: implant surgery (C); Implant + immediate irradiation (IrI), and Implant + late irradiation (IrL). Euthanasia occurred 3, 14, and 49 days after surgery. The bone marrow MSCs from the femurs were isolated and cultivated. The cell viability, total protein content, alkaline phosphatase (ALP) activity, and the formation of mineralization nodules and cellular genotoxicity were analyzed. The gene expression of Alkaline Phosphatase (phoA), Collagen 1 (COL1), Runt-related transcription factor 2 (RUNX2), Osterix (OSX), Osteopontin (OPN), Integrin ß1(ITGB1), Bone Sialoprotein (BSP), Osteonectin (SPARC), Osteocalcin (Bglap), Transforming Growth Factor ß-type (TGF-ß), Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-6 (IL-6), Apolipoprotein E (APOE) and Prostaglandin E2 synthase (PGE2) were evaluated by qRT- PCR. Results: ionizing radiation suppresses the gene expression of essential transcripts for bone regeneration, as well as cellular viability, as observed in the IrI and IrL groups. Conclusion: although this can lead to the loss of osseointegration and failure of the implant, the MSCs showed more activity at 49 days than at 3 and 14 days. (AU)

Objetivo: avaliar a diferenciação e expressão gênica de transcritos relacionados à osteogênese em cultura primária de MSCs derivadas de fêmures de ratos submetidos à radioterapia e instalação de implantes de titânio puro. Material e Métodos: cinquenta e quatro ratos receberam implantes de titânio em ambos os fêmures e foram divididos em três grupos: Controle: cirurgia de implante (C); Implante + irradiação imediata (IrI) e Implante + irradiação tardia (IrL). A eutanásia ocorreu 3, 14 e 49 dias após a cirurgia. As MSCs de medula óssea dos fêmures foram isoladas e cultivadas. Foram analisadas a viabilidade celular, teor de proteína total, atividade da fosfatase alcalina (ALP), formação de nódulos de mineralização e genotoxicidade celular. A expressão gênica de Fosfatase Alcalina (phoA), Colágeno 1 (COL1), fator de transcrição relacionado a Runt 2 (RUNX2), Osterix (OSX), Osteopontina (OPN), Integrina ß1 (ITGB1), Sialoproteína Óssea (BSP), Osteonectina (SPARC), Osteocalcina (Bglap), Fator de Crescimento Transformador tipo ß (TGF-ß), Fator Estimulante de Colônia de Granulócitos-Macrófagos (GM-CSF), Interleucina-6 (IL-6), Apolipoproteína E (APOE) e Prostaglandina E2 sintase (PGE2) foram avaliados por qRT-PCR. Resultados: a radiação ionizante suprime a expressão gênica de transcritos essenciais para a regeneração óssea, bem como a viabilidade celular, como observado nos grupos IrI e IrL. Conclusão:embora isso possa levar à perda da osseointegração e falha do implante, as MSCs apresentaram maior atividade aos 49 dias do que aos 3 e 14 dias (AU)

Unveiling an oral hemangiolymphangioma

ABSTRACT Hemangiolymphangioma is a very rare vascular malformation that develops as a combination of dilated venous and lymphatic vessels. We describe an unusual case of hemangiolymphangioma of the tongue affecting an adult man who complained of an uncomfortable, slowly progressing exophytic irregular dark red-violaceous nodular mass on his tongue that impaired speech and swallowing for two weeks. The clinical differential diagnoses were Kaposi's sarcoma and a COVID-19-related lesion. A complete blood count and serology for HIV-1 and 2 and RT-PCR for COVID-19 were requested and results were negative. An incisional biopsy was performed. Microscopically, the lesion exhibited several dilated vessels lined by normal-appearing endothelial cells, some filled with prominent intravascular erythrocytes and others containing proteinaceous eosinophilic material resembling lymphatic vessels, in close association with hyperkeratosis, papillomatosis, and acanthosis. From immunohistochemical analysis, most vessels were found to be CD34 positive, some highlighted by α-SMA, whereas D2-40 was focal. Positive staining for some lymphatic and blood vessel markers, i.e., D2-40 and CD34, respectively, indicates a mixed derivation of the lesion. HHV-8 was negative. Clinical features, the congested blood vessels with ectasia in intimate association with hyperplastic epithelium, and the immunohistochemical profile supported the final diagnosis of oral hemangiolymphangioma. The patient underwent minimally invasive surgical excision with no intercurrences. After 18 months of follow-up, there were no signs of relapse.

Student profile of a brazilian public Dental school / O perfil do aluno de uma faculdade de Odontologia pública brasileira

Objetive: The aim of this study was to assess the profile of dental students at the ICT/CSJC-UNESP School of Dentistry and their preferred studying style. Material and methods: Data on age, sex, place of residence, first-choice course, secondary education background and study method preference were collected from an online questionnaire given in the second year dental materials course (first class) of the day and evening courses of the years 2016 to 2019. All data were tabulated and submitted to one-way ANOVA and to t test, both with α= 0.05. Pearson correlation test was performed between demographic data and study method preference (α = 0.05). Results: Most of the students were women living in São José dos Campos city who had chosen Dentistry as their first-choice course. Many were originally from other cities and lived in shared accommodation with friends. The majority stated that private high school was their main educational background. The students' age and place of living showed to correlate with study method preference. Conclusion: Although ICT/CSJC-UNESP students were from millennial and post-millennial generations, students with public secondary education preferred studying alone, while those from private education preferred studying in group (AU).

Objetivo: O objetivo do estudo foi o de assessar o perfil de alunos do curso de Odontologia do ICT/CSJC-UNESP e seu método de estudo de preferência. Material e Métodos: Dados de idade, sexo, local de residência, primeira escolha de curso, formação escolar prévia e método de estudo de preferência foram coletados a partir de um questionário online aplicado no primeiro dia de aula aos alunos do segundo ano na disciplina de materiais odontológicos dos cursos integral e noturno entre 2016 e 2019. Os dados foram tabulados e submetidos a ANOVA um fator e ao teste t, ambos com α = 0,05. O teste de correlação de Pearson foi realizado para os dados demográficos e métodos de estudo de preferência (α= 0,05). Resultados: A maioria dos estudantes eram mulheres que moravam em São José dos Campos, quem tinham a Odontologia como a primeira escolha de curso. Muitos eram originariamente de outras cidades e compartilhavam moradia com amigos. A maioria relatou ter a escola particular como maior parte no ensino fundamental e médio. A idade do aluno e o local de residência mostraram estar correlacionadas ao método de estudo de preferência. Conclusão: Embora os estudantes do ICT/CSJC-UNESP sejam da geração "millennial" e "pós-millennial", aqueles com formação em escola secundária pública preferiram estudar sozinhos, enquanto que aqueles com formação em escola particular preferiram estudar em grupo (AU).

The role of Osterix protein in the pathogenesis of peripheral ossifying fibroma

Abstract Peripheral ossifying fibroma (POF) is a reactive lesion of oral tissues, associated with local factors such as trauma or presence of dental biofilm. POF treatment consists of curettage of the lesion combined with root scaling of adjacent teeth and/or removal of other sources of irritants. This study aimed to analyze the clinical and pathological features of POF and to investigate the immunoexpression of Osterix and STRO-1 proteins. Data such as age, gender, and size were obtained from 30 cases of POF. Microscopic features were assessed by conventional light microscopy using hematoxylin-eosin staining and immunohistochemical markers, and by polarized light microscopy using Picrosirius red staining. The age range was 11-70 years and 70% of the patients were female. Moreover, the size of POF varied from 0.2 to 5.0 cm; in 43.33% of the cases, the mineralized content consisted exclusively of bony trabeculae. The immunohistochemical analysis showed nuclear staining for Osterix in 63% and for STRO-1 in 20% of the cases. Mature collagen fibers were observed in mineralized tissue in 76.67% of the cases. The clinical and microscopic features observed were in agreement with those described in the literature. Osterix was overexpressed, while STRO-1 was poorly expressed. Osterix was expressed particularly in cells entrapped in and around mineralized tissue, indicating the presence of a stimulus that triggers the differentiation of these cells into osteoblasts or cementoblasts, i.e., cells that produce mineralized tissue. Based on our results, Osterix may play a role in the pathogenesis of POF.

How to improve the early diagnosis of oral cancer? / Como melhorar o diagnóstico precoce do câncer bucal?

Objective: Oral squamous cell carcinoma (OSCC) is one of the most common malignant neoplasms, with 300,000 new cases annually diagnosed in the world. Although it appears in the fifth position among men in Brazil, late diagnosis continues to be a leading cause of poor prognosis. We reviewed the literature to evaluate factors that contribute to diagnostic delay in oral cancer considering aspects related to the patient, health team and public health system. Material and Methods: The Medline (PubMed), Scopus, Web of Science and Embase databases were searched in the last 5 years using the following MeSH descriptors: carcinoma, squamous cell; mouth neoplasms; delayed diagnosis. The articles should contain in their objectives factors contributing to the delayed diagnosis of OSCC related to the patient, healthcare professionals and public health system in general. Results: One hundred twenty articles were retrieved and 27 on the delayed diagnosis of oral cancer were eligible. Conclusion: The literature showed that the delay in the diagnosis and treatment of patients with oral cancer could be minimized by providing health information, particularly about risk factors, by improving the training and retraining of physicians and dentists and by improving access to the health system. The communication technologies such as telemedicine, can play a key role in the early diagnosis of oral cancer. (AU)

Objetivo: o carcinoma de células escamosas de cavidade bucal (CCECB) é uma das neoplasias malignas mais comuns, com cerca de 300 mil novos casos diagnosticados anualmente no mundo. Embora esteja na quinta posição entre os mais frequentes em homens no Brasil, o diagnóstico tardio continua a ser a principal causa de mau prognóstico. Revisamos a literatura para avaliar fatores que possam contribuir para o atraso de diagnóstico no câncer bucal considerando aspectos relacionados ao paciente, equipe de saúde e o Sistema de Saúde Pública. Material e Métodos: Foram pesquisados os bancos de dados Medline (PubMed), Scopus, Web of Science e Embase nos últimos 5 anos utilizando os seguintes descritores MeSH: carcinoma de células escamosas, neoplasias de boca e atraso diagnóstico. Os artigos deveriam conter em seus objetivos fatores que possam ter contribuído para o diagnóstico tardio do CCECB relacionado ao paciente, aos profissionais de saúde e ao Sistema de Saúde Pública em geral. Resultados: Cento e vinte artigos foram recuperados, sendo elegíveis, vinte e sete relacionados ao diagnóstico tardio de câncer bucal. Conclusão: a literatura mostrou que o atraso no diagnóstico e tratamento de pacientes com câncer bucal poderia ser minimizado, fornecendo informações sobre saúde, particularmente sobre fatores de risco a população, melhorando o treinamento e reciclagem de médicos e dentistas e melhorando o acesso ao sistema de saúde. As tecnologias de comunicação, dentre elas a telemedicina, pode desempenhar um papel fundamental no diagnóstico precoce de câncer bucal. (AU)

Challenges to be overcome: Current situation involving smoking cessation in Dental setting / Desafios a serem superados: situação atual envolvendo cessação do tabagismo no cenário odontológico

Objetivo: O uso do tabaco é a principal causa de doenças evitáveis no mundo. A consulta odontológica representa uma oportunidade de abordar os fumantes no controle do uso do tabaco. Embora esta conclusão seja bem conhecida, a intervenção para cessação tabágica entre dentistas permanece menos explorada do que o esperado. Este estudo avaliou artigos publicados sobre intervenções entre dentistas e profissionais de saúde dentária na cessação do tabagismo e discute as barreiras a serem superadas para atingir esse objetivo. Material e Métodos: As bases de dados Medline (PubMed), Scopus, Web of Science, Cochrane Reviews, LILACS e Google Scholar foram pesquisadas por artigos publicados em inglês entre janeiro de 2010 e dezembro de 2016 usando os seguintes termos MeSH: tobacco use cessation, smoking cessation, tobacco use disorder and dentistry. A busca manual complementar para potenciais artigos foi feita verificando-se referências bibliográficas. Resultados: setenta e duas publicações foram elegíveis e os resultados foram divididos em oito categorias: 1) o papel dos dentistas no controle do uso do tabaco; 2) conhecimento sobre tratamento e intervenções sobre uso do tabaco; 3) características da abordagem do dentista aos fumantes; 4) barreiras e facilitadores; 5) intervenções futuras para cessação do tabagismo, 6) reembolso de intervenções de tabaco, 7) pesquisas e 8) revisões sistemáticas e diretrizes. Conclusão: Os dentistas desempenham um papel importante na prevenção e controle do tabagismo. O treinamento na cessação do uso do tabaco tem aumentado nas últimas décadas. Ensinar a lidar com o tabagismo em cursos de graduação deve ser uma prioridade para os próximos anos, de modo que uma nova geração de dentistas incorpore em suas atividades habituais uma abordagem natural e eficiente para os fumantes.(AU)

Objective: Tobacco use is the leading cause of preventable illness in the world. The dental office represents an opportunity to smokers approach tobacco use control. Despite this well-known statement tobacco use cessation intervention delivered by dentists remain less explored than expected. This study evaluated published articles about interventions delivered by dentists and dental healthcare professionals on smoking cessation and discusses the barriers to be overcome to achieve this goal. Material and Methods: The Medline (PubMed), Scopus, Web of Science, Cochrane Reviews, LILACS and Google Scholar databases were searched for articles published in English between January 2010 and December 2016 using the following MeSH terms keywords: tobacco use cessation, smoking cessation, tobacco use disorder and dentistry. Complementary hand searching was done checking bibliographic references for potentially articles. Results: Seventy-two publications were eligible and the results were divided into eight categories: 1) the role of dentists in tobacco use control; 2) knowledge about tobacco use treatment and interventions; 3) characteristics of the dentist's approach to smokers; 4) barriers and facilitators; 5) future interventions for smoking cessation, 6) reimbursement for tobacco interventions, 7) surveys and 8) systematic reviews or guidelines Conclusion: Dentists play an important role in the prevention and control of smoking. Training in tobacco use cessation has been increased in the past few decades. Teaching how to deal with smoking in undergraduate courses should be a priority for the next few years, so that a new generation of dentists will incorporate into their habitual activities a natural and efficient approach to smokers.(AU)

Anticoagulant-induced oral bleeding / O uso de anticoagulante induzindo o sangramento bucal

A varfarina é um anticoagulante usado para prevenir a trombose, arritmias cardíacas, fibrilação atrial e a recorrências de embolia pulmonar. Um paciente do sexo masculino de 69 anos de idade relatou quatro episódios de ataques cardíacos, um acidente vascular cerebral, enfisema pulmonar, varizes, disfunção da tireoide e histórico de angioplastia. O paciente utilizava uma dose diária de 5 mg de warfarina. O exame clínico intraoral revelou uma lesão nodular hemorrágica de cor púrpura com bordas irregulares e uma superfície lisa. O tempo de protrombina foi de 68,9 segundos, a atividade foi de 10%, e a proporção normalizada internacional (INR) foi de 8,26. Com base nestes resultados, o paciente recebeu uma dose única de 2,5 mg de vitamina K por via subcutânea. O diagnóstico final foi de lesões hemorrágicas bucais induzidas pelo uso de anticoagulantes. Profissionais clínicos devem estar familiarizados com os efeitos colaterais causados pelo uso de anticoagulantes, que são raros na cavidade bucal, mas podem ser fatais se diagnosticados tardiamente ou de forma imprecisa, principalmente em pacientes idosos que costumam fazer uso de muitos outros medicamentos.(AU)

Warfarin is an anticoagulant used to prevent thrombosis, cardiac arrhythmias, atrial fibrillation, and recurrence of pulmonary embolism. A 69-year-old male patient reported episodes of four heart attacks, stroke, pulmonary emphysema, varicose veins, thyroid dysfunction, and a history of angioplasty. They use daily dose of 5 mg. Intraoral clinical examination revealed a bleeding nodular lesion of purple color with irregular borders and a smooth surface. The prothrombin time was 68.9 seconds, activity was 10%, and the international normalized ratio (INR) was 8.26. Based on these results, the patient received a single dose of 2.5 mg vitamin K via subcutaneous route. The final diagnosis was oral anticoagulant-induced lesions. Clinicians should be familiar with the side effects of anticoagulants, which are rare in the oral cavity, but can be life-threatening if diagnosed late or inaccurately, especially in older patients that often use many drugs.(AU)

Prevalence and microscopic features of enamel pearls from permanent human molars

Enamel pearls are ectopic structures observed mainly on the roots of permanent teeth and couldbe related to periodontal diseases. Aim: To evaluate the prevalence of enamel pearls in extractedhuman molars and characterize their structures using light and scanning electron microscopy.Methods: The study comprised 2,201 extracted human permanent molars. The teeth wereanalyzed and classified according to morphological features. The presence, location and shapeof enamel pearls were investigated. Fifteen human molars with enamel pearls were embeddedin acrylic resin and observed by light microscopy. Results: Seventy-one enamel pearls wereidentified on third molar root. Microscopically, most pearls were composed of prismatic irregularenamel and normal dentin. The dentinoenamel junction presented an irregular course. Thenumber of dentinal tubules was normal and they presented curvature to continue within the rootdentin of the carrier tooth. Dentinal tubules below the enamel pearls were closer to each other.Conclusions: Scanning electron microscopic analysis revealed that the enamel pearls weresimilar to coronal enamel.

Multiple supernumerary teeth in non-syndromic patients: report of 5 clinical cases

A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. They have been described in both primary and permanent dentition. Multiple supernumerary teeth are rare in non-syndromic patients. The purpose of this study was to evaluate non-syndromic patients with five or more supernumerary teeth, by general and local clinical examinations, periapical, occlusal and panoramic radiographs. The patientsÆ data were collected regarding to the number of supernumerary teeth, location, shape, position and association to pathological lesion. Thirty-five supernumerary teeth were found, 17 in the mandible and 18 in the maxilla. In the lower arch, 16 supernumerary teeth were localized in the premolar region and 1 in a disto molar region. However, in the upper arch, there were 7 in the premaxilla, 6 in the premolar and 5 in the disto molar region. From the total, 28 were supplemental and 7were found in a rudimentary shape. Completing the observations, 29included teeth were detected and one showed a radiolucent area that suggested a dentigerous cyst. Six other teeth showed a widened follicular space. One of the upper molar from the normal series was related to an odontoma. We could conclude that mandible and maxilla were equally affected and most of the teeth morphology was similar in size and shape to normal tooth (supplemental). Twenty-nine teeth were impacted; however few have caused pathologies.

Tumor odontogênico adenomatóide: relato de caso / Adenomaitoid odontogenic tumpr: case report

O tumor odontogênico adenomatóide (TOA)é uma lesão odontogênica incomum, não invasiva, de crescimento lento, porém progressivo. Apresneta três variantes: folicular, extra-folicular e periférico, sendo que cerca de 75% dos casos está associado com dente incluso. O propósito deste trabalho é relatar um caso de TOA, enfocando os aspectos clínicos, radiográficos, histopatológicos e seu diagnóstico diferencial