Oral health status of patients in intensive care unit: a cross-sectional study

Introduction: Patients in intensive care unit (ICU) may present oral alterations asa result of patients' systemic conditions, the use of medications, intubation orpoor oral hygiene. Oral alterations should be detected and treated because theymay aggravate patients' condition. The objective of this study was to evaluate thetypes and frequencies of clinically detected oral alterations in inpatients of an ICU.Methods: This is a cross-sectional study in which an oral evaluation of patientshospitalized in an ICU of a public hospital was performed. Demographic, socialand clinical characteristics were collected from medical records. Oral examswere performed by two trained dentists, with reliability checked by intra-classcorrelation coefficient, while patients were lying in the hospital bed, using a frontalheadlamp, tongue depressor and sterile gauze. All data were recorded in studyprotocol forms and transferred to a data base for analysis. Results: Thirty-sevenpatients, with similar distribution between genders, withmedian age of 62 yearswere evaluated. The most frequent causes for hospitalization were postoperativecare (51.35%) and respiratory problems (29.72%). About 90% of the inpatientspresented some type of oral alterations during the hospitalization period. Themost common clinical alterations were dry lips (86.5%); coated tongue (61.1%);paleness of the oral mucosa (54.1%); oral foci of infection (37.8%) and candidiasis(13.5%). Conclusion: The majority of inpatients of the ICU presented some type oforal alteration, and the most frequent were dry lips and coated tongue. Dataobserved in this study reinforce the need of the dental team support during theperiod of hospitalization.

Introdução: Pacientes em unidade de terapia intensiva (UTI) podem apresentaralterações orais como resultado das condições sistêmicas dos pacientes, uso demedicamentos, intubação ou falta de higiene bucal. Alterações orais devem serdetectadas e tratadas, pois podem agravar a condição do paciente. O objetivodeste estudo foi avaliar os tipos e frequências de alterações orais clinicamentedetectadas em pacientes internados em uma UTI. Métodos: Estudo transversalem que foi realizada avaliação oral de pacientes internados em uma UTI de umhospital público. Características demográficas, sociais e clínicas foram coletadasdos prontuários médicos. Os exames orais foram realizados por dois dentistastreinados, com confiabilidade verificada pelo coeficiente de correlação intra-classe, enquanto os pacientes estavam deitados na cama do hospital, utilizandofrontal, abaixador de língua e gaze estéril. Todos os dados foram registrados emformulários de protocolo do estudo e transferidos para uma base de dados paraanálise. Resultados: Foram avaliados 37 pacientes, com distribuição semelhanteentre os sexos, com mediana de idade de 62 anos. As causas mais frequentes deinternação foram cuidados pós-operatórios (51,35%) e problemas respiratórios(29,72%). Cerca de 90% dos pacientes internados apresentaram algum tipo dealteração bucal durante o período de internação. As alterações clínicas maiscomuns foram lábios secos (86,5%); língua (61,1%); palidez da mucosa oral (54,1%);focos orais de infecção (37,8%) e candidíase (13,5%). Conclusão: A maioria dospacientes internados em UTI apresentou algum tipo de alteração oral, sendo osmais frequentes lábios secos e língua. Os dados observados neste estudo reforçama necessidade do apoio da equipe odontológica durante o período de internação.

The frequency of oral conditions detected in hematology inpatients

ABSTRACT Background: Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. Objective: To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. Methods: Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. Results: Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. Conclusion: This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.

Desafios na distinção de lesões de Líquen Plano Oral e Reação Liquenóide / Challenges to distinct Oral Lichen Planus and Lichenoid Reactional lesions

Objetivo: Realizar uma revisão de literatura apresentando características clínicas e histopatológicas que possam ajudar o profissional a caracterizar e diferenciar o líquen plano oral da reação liquenoide. Material e Métodos: Foram selecionados artigos em português e inglês, em humanos, de 2000 até os dias atuais, nos bancos de dados da PubMed / MEDLINE e BVS. Resultados: Foram obtidos 404 artigos e foram selecionados 16, sendo 11 com ênfase nas características clínicas e histopatológicas simultaneamente; três com características clínicas; três com características histopatológicas. Conclusão: As características clínicas e histopatológicas do LPO e da RLO são bastante semelhantes, existindo apenas pequenas diferenças que podem auxiliar na sua diferenciação

Objective: To perform a literature review focus on clinical and histopathologic features that can help professionals to characterize and differentiate OLP from OLR. Material and Methods: Scientific papers were selected in Portuguese and English languages, which were performed in humans, since 2013 until the present day, in the databases of the Medical Literature Analysis (PubMed / MEDLINE) and in Health Virtual Library (HVL). Results: It was obtained 404 published papers and 16 were selected, 11 were focused on clinical and histopathologic features simultaneously; two on clinical features; and three on histopathologic features. Conclusion: Clinical and histopathological features of OLP and OLR are quite similar but minor differences can help professionals to differentiate them.

Drugs or disease: evaluating salivary function in RA patients

Abstract Oral complications of RA may include temporomandibular joint disorders, mucosa alterations and symptoms of dry mouth. The aim of this study was to evaluate the salivary gland function of subjects with rheumatoid arthritis (RA) comparing it to healthy controls. Subjects with other systemic conditions known to affect salivary functions were excluded. A questionnaire was applied for the evaluation of xerostomia. Resting and chewing-stimulated salivary flow rates (SFR) were obtained under standard conditions. There were 145 subjects included of the study (104 RA and 38 controls). About 66.7% of the RA subjects and 2.4% in control group presented xerostomia. The median resting SFR were 0.24 ml/min for RA subjects and 0.40 mL/min for controls (p = 0.04). The median stimulated SFR were 1.31 mL/min for RA subjects and 1.52 ml/min for controls (p = 0.33). No significant differences were found between resting and stimulated SFR of RA subjects not using xerogenic medications and controls. There was significantly higher number of subjects presenting hyposalivation in the RA group than among controls, even when subjects using xerogenic medications were eliminated from the analysis. In conclusion, hyposalivation and xerostomia were more frequent among RA subjects not using xerogenic medication than among controls, although there were no significant differences in the median SFR between groups.

Diagnosis of secondary syphilis through oral lesionsin two patients with negative serology: case reports / Diagnóstico de sífilis secundária através daslesões orais em dois pacientes com sorologia negativa: relatos de caso

Syphilis is a sexually transmitted infection, and oral lesion can be the first manifestation. The serology test, such as Venereal Disease Research Laboratory test, is accepted as an effective testing strategy for detecting syphilis, although false-negative reaction can occur, and oral lesions may be pivotal to achievethe diagnosis. We report two cases of seronegative secondary syphilis, a human immunodeficiency virus positive patient and a no HIV positive patient,whose histopathological exams were pivotal to achieve the diagnosis of syphilis. The serology may be negative in secondary syphilis and the oral lesionsmay represent the unique method to diagnostic

A sífilis é uma doença sexualmente transmissível, e a lesão oral pode representar sua primeira manifestação. Testes sorológicos, como Venereal Disease Research Laboratory, são rotineiramente utilizados para detecção de sífilis, entretanto, em alguns casos, podem ocorrer resultados falso-negativos. Nesses casos, as lesões orais são essenciais para o diagnóstico. Relatamos dois casos de sífilis secundária com sorologia negativa, em um paciente HIV positivo e um paciente HIV negativo, que obtiveram o diagnóstico de sífilis a partir do exame histopatológico das lesões orais. Os testes sorológicos podem ser negativos na sífilis secundária, e as lesões orais podem representar o único método diagnóstico.

Oral lichen planus: study of 21 cases

Abstract BACKGROUND: Lichen planus is considered to be the most common dermatological disease involving the oral mucosa. OBJECTIVE: To investigate the profile, clinical features, and the presence of dysplasia and candidiasis in patients with oral lichen planus. METHODS: A total of 21 patients were selected from 258 patients at risk for oral cancer development. RESULTS: Most of the patients were white (76,2%), female (66,6%), with mean age of 58.8 years. Eight were smokers and seven were alcohol consumers. The buccal mucosa was the most affected site, followed by the tongue and the gingiva. The reticular pattern was the most common appearance. Histopathology depicted dysplasia in nine cases and cytopathology was positive for Candida in eight cases in the first appointment. CONCLUSION: Our data are similar to the literature. Cytopathology was important for the diagnosis of candidiasis. Although the presence of dysplasia was verified, further studies are necessary to clarify the importance of this finding. .

Comparative analysis of Gram’s method and PAS for the identification of Candida spp. samples from the oral mucosa / Análise comparativa entre o método de Gram e PAS para a identificação de Candida spp. em amostras da mucosa oral

Introduction: Candida species are part of the normal microbiota of healthy subjects, living as commensals. However, they can become pathogenic when changes in the mechanisms of host defense or disruption of anatomic barriers occur. Candidiasis is the most common fungal infection in the oral cavity, mainly caused by Candida albicans. The diagnosis is based on symptoms and clinical aspects, in association with laboratory methods. Objective: To evaluate the sensitivity and specificity of Gram’s method for Candida spp. identification in scrapes from the buccal mucosa and evaluate the degree of concordance between clinical and cytological methods in the diagnosis of oral candidiasis. Material and methods: A blind study was performed in 170 smears from patients of Hospital Universitário Antônio Pedro of Universidade Federal Fluminense (HUAP/UFF), stained by Gram (n = 57), periodic acid-Schiff (PAS) (n = 57) and Papanicolaou (Pap) (n = 57) methods. Results: The comparative analysis of the methods demonstrated a higher prevalence of Candida spp. (12%) in PAS than in Gram staining, without statistic significance. The cytology method was positive in 93% of the clinical diagnosis of candidiasis. Conclusion: Gram was an adequate method; however more intensive professional training would be necessary to identify the fungus morphological structures. Although Pap test is the most common method of routine cytopathologic examination, for candidiasis diagnosis PAS staining is also recommended. Thus, it is suggested that candidiasis diagnosis should be accomplished by clinical evaluation in association with cytopathological analysis based on the identification of hyphae and/or pseudohyphae. .

Introdução: Espécies de Candida fazem parte da microbiota normal de indivíduos sadios, residindo como comensais. Entretanto, podem tornar-se patogênicas caso ocorram alterações nos mecanismos de defesa do hospedeiro ou comprometimento das barreiras anatômicas. A candidíase é a infecção fúngica mais frequente na mucosa oral, causada principalmente pela Candida albicans. O diagnóstico baseia-se nos aspectos clínicos e nos sintomas, em conjunto com os métodos laboratoriais. Objetivos: Avaliar a sensibilidade e a especificidade do método de Gram na identificação da Candida spp. em raspados de mucosa oral e avaliar o grau de concordância entre os métodos clínico e citopatológico no diagnóstico de candidíase oral. Material e métodos: Teste cego de 171 esfregaços, provenientes dos pacientes atendidos no Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (HUAP/UFF), corados pelas colorações de Gram (n = 57), ácido periódico de Schiff (PAS) (n = 57) e Papanicolaou (n = 57). Resultados: A análise comparativa entre os métodos revelou que no PAS há maior prevalência de Candida spp. (12%) em relação ao Gram; todavia, não há diferença significativa entre os resultados. Dos casos com diagnóstico clínico de candidíase, 93% foram confirmados pela citopatologia. Conclusão: A coloração pelo Gram mostrou-se adequada, sendo necessário intensificar o treinamento do profissional para a identificação das estruturas morfológicas do fungo. Apesar de o Papanicolaou representar o método mais utilizado na rotina citopatológica para diagnóstico da candidíase, também se indica a utilização do PAS concomitantemente. Desse modo, sugere-se que o diagnóstico ...

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection. .

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

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

Utilização do teste com o azul de toluidina como método auxiliar no diagnóstico de lesões orais / Toluidine blue test as an auxiliar method for the diagnosis of oral lesions

A avaliação clínica nem sempre é suficiente para garaA avaliação clínica nem sempre é suficiente para garantir o diagnóstico das lesões orais. O objetivo deste artigo é avaliar a validade do teste com o azul de toluidina como método auxiliar no diagnóstico de lesões orais. A amostra constituiu-se de 110 pacientes com lesões orais. Seguindo o protocolo estabelecido para este trabalho, todas as lesões foram submetidas ao teste do azul de toluidina. Um total de 105 lesões foram biopsiadas e a histopatologia considerada padrão-ouro diagnóstico. O teste do azul de toluidina foi positivo em 31 das 110 lesões, com 20 marcações focais e 11 difusas. Concluiu-se que, o teste do azul de toluidina é um recurso útil como método auxiliar no diagnóstico de lesões orais.

Prevalência da leucoplasia pilosa oral: identificação citopatológica das formas clínica e subclínica / Prevalence od oral hairy leukoplakia: cytopathologic identification of the clinical and subclinical forms

Introdução - Vários estudos apontam para a importância do diagnóstico da leucoplasia pilosa oral (OHL) no diagnóstico e prognóstico da AIDS. Raros estudos utilizam a citopatologia como recurso da OHL, particularmente após a descrição de sua forma subclínica. O objetivo deste trabalho foi investigar a prevalência da leucoplasia pilosa oral em indivíduos soropositivos para o HIV. material e métodos - Realizou-se a oroscopia e raspagem bilateral das bordas laterais da língua, em 676 pacientes HIV+. O critério diagnóstico foi a a identificação das alterações nucleares (inclusão Cowdry A e núcleos em vidro fosco e em colar) representativas do efeito citopático do Vírus epstein-Barr (EBV). Resultados - Identificou-se OHL em 179 (27 por cento) dos 676 pacientes, sendo em 65 (10 por cento) OHL clínica e em 114 (17 por cento) OHL subclínica...

Introduction - Accurate diagnosis of oral hayry leukoplakia (OHL) is important because it many be an early indicator of undiagnosed HIV infection and AIDS's prognostic. Few studies tested cytopathology as a method for diagnosis of OHL, particularly after the description of it subclinical stage. Our purpose was to investigated the lateral borders of tongues of 676 patients. OHLwas considered as a diagnosis only when nuclear changes caused by Epstein-Barr Virus (Cowdry tupe A inclusion, ground glass and nuclear beading) were presents. Results - We identified OHL in 179 (27 percent) of the 676 patients, that 65 (10 percent) were clinica OHL and 114 (17 percent) were OHL in subclinical stage...

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5 percent. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Prevalence of oral hairy leukoplakia in 120 pediatric patients infected with HIV-1

A leucoplasia pilosa oral (OHL) é uma infecção oportunista causada pelo Vírus Epstein-Barr (EBV) encontrada em pacientes infectados pelo HIV. É uma lesão assintomática que tem um importante valor prognóstico na AIDS. Diferentemente de pacientes adultos, a OHL tem sido descrita na literatura como tendo uma prevalência muito pequena em pacientes pediátricos. Logo, o objetivo deste estudo foi investigar a prevalência da OHL em pacientes pediátricos positivos para o HIV através do uso da citopatologia. A amostra consistiu-se de 120 pacientes, que foram submetidos a exame oral e coleta de material de ambos os lados da língua. O critério diagnóstico foi baseado na identificação de alterações nucleares. A OHL clínica foi identificada em dois (1,67%) pacientes. A citopatologia revelou vinte casos (16,7%) de OHL subclínica. Nossos resultados mostram que a prevalência de OHL em pacientes pediátricos infectados pelo HIV deve ser maior que a relatada na literatura.

Leucoplasia pilosa oral em uma criança com Aids: relato de caso e revisão da literatura / Oral hairy leukoplakia in a child with Aids: case report and review of the literature

A leucoplasia pilosa oral (OHL) é uma lesão causada pelo vírus Epstein-Barr (EBV), ocorrendo com maior frequência em pacientes adultos infectados pelo vírus da imunodeficiência humana (HIV). No entanto, em pacientes pediátricos infectados pelo vírus, a leucoplasia pilosa era é considerada uma lesão bastante rara. Logo, este trabalho tem como objetivo relatar mais um caso de OHL em paciente pediátrico.

Carcinoma adenóide cístico: revisão da literatura e relato de caso clínico / Adenoid cystic carcinoma: review of the literature and case report

O carcinoma adenóide cístico (CAC) é neoplasia maligna de glândula salivar que acomete principalmente as glândulas parótidas, as submandibulares e as salivares acessórias, sendo raro nas glândulas sublinguais. Com crescimento lento e natureza infiltrativa, clinicamente apresenta-se como nódulo de consistência endurecida. O presente trabalho teve como objetivo revisar a literatura atual sobre o tema em relação aos aspectos clínicos e histopatológicos, bem como relatar um caso de CAC na região submandibular.

Leucoplasia pilosa oral: aspectos histopatológicos da fase subclínica / Oral hairy leukoplakia: histopathologic features of the subclinical stage

A leucoplasia pilosa oral (LPO) é uma das manifestaçöes orais mais comuns na AIDS, com valor diagnóstico e prognóstico. A LPO está relacionada ao Epstein-Barr vírus (EBV), com características clínicas e histopatológicas definidas. Já existem relatos de uma fase subclínica da LPO, porém sem caracterizaçäo histopatológica. O presente trabalho teve por objetivo descrever os aspectos histopatológicos desta fase, bem como realizar uma análise comparativa entre a LPO subclínica e clínica, com a finalidade de verificar a suficiência diagnóstica dos critérios histopatológicos. Trata-se de uma estudo retrospectivo de 11 casos, obtidos a partir de cinco biópsias realizadas em pacientes com lesäo e da borda de seis línguas sem lesäo macroscopicamente detectável, provenientes de necropsias. Foram utilizados os seguintes métodos: histopatologia, imuno-histoquímica e hibridizaçäo in situ. Os aspectos histopatológicos que caracterizaram a fase subclínica da LPO foram: ausência de paraceratose e papilomatose, acantose leve, presença de células claras e alteraçöes nucleares (inclusäo tipo Cowdry A, núcleo em "vidro fosco" e núcleo "em colar"). Houve identificaçäo do EBV através da hibridizaçäo in situ e da imuno-histoquímica nas alteraçöes nucleares observadas na histopatologia. Concluiu-se, com fundamentos na identificaçäo do EBV nas alteraçöes nucleares, que a LPO em sua fase subclínica, da mesma forma que na lesäo clínica, apresenta características histopatológicas específicas específicas e suficientes para um diagnóstico definitivo, independentemente da identificaçäo do EBV

Diagnóstico citopatológico da leucoplastia pilosa / Citopathology diagnosis of hairy leukoplakia

A leucoplasia pilosa (LP) é uma lesäo branca, descrita inicialmente na língua de pacientes com aids. Alteraçöes nucleares indicativas do efeito citopático do vírus Epstein-Barr (EBV) permitem o diagnóstico histopatológico e citopatológico, embora alguns autores só o consideram definitivo com a identificaçäo do EBV. Avaliou-se a eficácia da citopatologia em 30 esfregos de lesöes compatíveis com LP. Foram investigadas a disposiçäo celular e as presenças de celulas orangeofílicas, de alteraçöes nucleares e de Candida sp. As células agrupadas foram associadas a Candida sp., e as orengeofílicas, numerosas. Identificaram-se alteraçöes nucleares nos 30 casos. A citopatologia foi diagnóstica em 100 por cento dos casos, baseada na presença de núcleos " em vidro fosco" e "em colar". Como o diagnóstico de LP é indicativo de realizaçäo de sorologia para o HIV e fator prognóstico na AIDS, concluímos que é necessária uma ampla divulgaçäo da citopatologia como método de escolha para o diagnóstico de lesöes suspeitas de leucoplasia pilosa

AIDS: manual sobre manifestaçöes bucais e controle de infecçäo / AIDS: handbook of oral diseases and infection control

Manual de prática cotidiana relativo às principais manifestaçöes bucais da AIDS e do controle de infecçöes na clínica odontológica (FHS)