Frecuencia de lesiones de la mucosa oral en el servicio de urgencias y orientación de pacientes de la facultad de odontología de la Universidad de Buenos Aires / Frequency of oral mucosal lesions at the emergency service and patient orientation of the school of dentistry, University of Buenos Aires

Objetivo: estimar la frecuencia de lesiones que afectan la mucosa oral, en una muestra de pacientes que concurrieron por demanda espontánea al Servicio de Urgencias y Orientación de Pacientes (SUYOP) de la Facultad de Odontología de la Universidad de Buenos Aires, a fin de valorar las características de esta población y poder adoptar conductas preventivas adecuadas. Materiales y métodos: Un operador único perteneciente al SUYOP evaluó a todos los pacientes que ingresaron al estudio (n=503) yposteriormente un especialista único, perteneciente a la Cátedra de Estomatología, examinó a aquellos pacientes que presentaron lesiones(n=208) a fin de determinar el diagnóstico de certeza de las mismas. Todos los diagnósticos fueron confirmados mediante biopsia, estudiode cultivo, o seguimiento clínico de la enfermedad. Resultados: 41,35 por ciento (n=208) de los pacientes examinados presentaron al menos una lesión estomatológica en la mucosa oral. 89 por ciento (n=185) de los pacientes con lesiones desconocía la existencia de las mismas y solamente el 11 por ciento (n=23) se presentó a la consulta con una derivación u orientación estomatológica. 23 por ciento (n=48) de los pacientes que presentaron lesiones fueron considerados de gravedad diagnostica. Conclusión: Los datos obtenidos en el presente estudio revelan la importancia de las campañas para concientizar a la sociedad acerca de la necesidad de realizar consultas de rutina, pero también, y muy especialmente, concientizar a estudiantes y profesionales de la salud en el examen exhaustivo de la mucosa oral de todos los pacientes.

Objective: to estimate the frequency of lesions affecting the oral mucosa in a sample of patients seeking unscheduled care at theEmergency and Patient Referral Service (EPRS), School of Dentistry, University of Buenos Aires, with the aims to evaluate thecharacteristics of the studied population and thus adopt appropriate preventive measures. Materials and Methods: A single operatorfrom the EPRS assessed all the patients included in the study (n=503), after which a single specialist from the Oral MedicineDepartment examined patients presenting oral mucosal lesions (n=208) to establish definitive diagnosis. All diagnoses were confirmedby biopsy, culture studies, or clinical follow-up. Results: 41.35% of studied patients (n=208) had at least one oral mucosal lesion; 89%(n=185) of patients who had a lesion were unaware that they had a lesion, and only 11% (n=23) of patients knew they had a lesion.23% who had a lesion were considered as gravity diagnosis patients. Conclusion: All the obtained data show the importance of conducting campaigns in the community to increase the awareness of the need for regular routine dental visits, and particularly, to create an awarenessamong dental students and health care professionals of the importance of thoroughly examining the oral mucosa of all patients.

Molecular and phenotypic expression of decorin as modulator of angiogenesis in human potentially malignant oral lesions and oral squamous cell carcinomas.

Background: Decorin is an extracellular matrix, multifunctional small proteoglycan molecule in tumor stroma that has been shown to be modulator of angiogenesis. No clinical data is available so far on decorin expression and survival outcome of oral cancer. Aim: The aim of the present study was to examine molecular and phenotypic expression of two angiogenesis modulators viz. decorin and vascular endothelial growth factor-A (VEGF-A) in human potentially malignant oral lesions (PMOLs) and oral squamous cell carcinomas (OSCC) in relation to clinico-pathological variables and survival outcome. Materials and Methods: Tissue biopsies were obtained from 72 PMOLs, 108 OSCC and 52 healthy controls. The PMOLs included cases of leukoplakias and oral submucous fi brosis. Immunohistochemistry was performed using antibodies against decorin, VEGF-A and CD-31. Messenger-ribonucleic acid (mRNA) expression was analyzed by using real-time polymerase chain reaction. Results: Cytoplasmic staining of decorin was observed in the basal layer of epithelium in 53 (73.61%) cases of PMOLs and in peritumoral stroma in 55 (50.92%) cases of OSCC. None of the cases showed nuclear expression of decorin. Decorin expression both at phenotypic and molecular level was found to be down-regulated from PMOLs to OSCC. Lymph node metastasis and reduced decorin expression independently correlated with overall survival in OSCC. VEGF-A expression had no signifi cant impact on survival outcome. Conclusion: Micro vessel density and VEGF-A expression were signifi cantly associated with reduced decorin expression in tumor stroma suggesting, decorin as angiogenic modulator in OSCC. Down-regulation of decorin expression and the presence of lymph node metastasis were adverse factor independently affecting overall survival in OSCC.

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos / Potentially malignant oral lesions: clinical and morphological analysis of 205 cases

OBJETIVOS: O objetivo desta pesquisa foi realizar uma análise clínica e morfológica em lesões orais com potencial de malignização. MATERIAL E MÉTODO: Os dados clínicos e morfológicos referentes a tais lesões foram obtidos a partir das fichas clínicas e dos laudos histopatológicos, respectivamente. RESULTADOS: Dos 205 casos analisados, a lesão mais prevalente foi a leucoplasia (70,7 por cento), seguida da queilite actínica (16,1 por cento), eritroplasia (9,8 por cento) e eritroleucoplasia (3,4 por cento). Verificou-se uma associação significativa entre o sexo e as lesões (p < 0,001), sendo o sexo feminino mais prevalente nas leucoplasias e eritroplasias. A raça branca foi mais acometida em todas as lesões. Quanto à localização anatômica, o rebordo alveolar prevaleceu na leucoplasia (21 por cento), na eritroplasia e eritroleucoplasia, o palato foi mais acometido com 47,4 por cento e 57,1 por cento, respectivamente. Com relação à idade, não houve diferença significativa entre as lesões (p > 0,05), sendo mais frequentes nas quinta, sexta e sétima décadas de vida. Observou-se que, na maioria dos casos de eritroplasias e eritroleucoplasias, os diagnósticos clínicos foram incompatíveis com o morfológico. Verificou-se associação significativa entre transformação maligna e lesões (p < 0,001), pois a eritroplasia apresentou uma taxa de malignização de 20 por cento, enquanto na leucoplasia o índice foi de 2,1 por cento. CONCLUSÃO: A prevalência das lesões orais com potencial de malignização foi semelhante ao encontrado na literatura, mas com algumas diferenças em relação ao perfil epidemiológico das mesmas, ressaltando-se que estas entidades merecem uma atenção especial por parte do clínico, especialmente as eritroplasias, que apresentaram um elevado percentual de malignização e o maior índice de equívocos no diagnóstico clínico.

OBJECTIVE: The objective of this study was to perform a clinical and morphological analysis of potentially malignant oral lesions. MATERIAL AND METHOD: The clinical and morphological data related to these lesions were obtained from clinical and histopathological records, respectively. RESULTS: Out of 205 cases, the most prevalent lesion was oral leukoplakia (70.7 percent), followed by actinic cheilitis (16.1 percent), erythroplakia (9.8 percent) and erythroleukoplakia (3.4 percent). There was a significant association between the lesions and gender (p < 0.001). The female gender was the most affected in leukoplakias and erythroplakias. Caucasians were mostly affected in all conditions. As far as anatomical location is concerned, the alveolar ridge was the most prevalent site in oral leukoplakias (21 percent); the palate was the most affected in erythroplakia (47.4 percent) and erythroleukoplakia (57.1 percent). There was no significant difference among the lesions as to age (p > 0.05), although they were more frequent in the 5th, 6th and 7th decades of life. In most cases of erythroplakias and erythroleukoplakias, it was observed that clinical and morphological diagnoses were incompatible. There was a significant association between malignant transformation and lesions (p < 0.001) as the erythroplakia presented a malignization rate of 20 percent, whereas in leukoplakias the rate was 2.1 percent. CONCLUSION: The prevalence of potentially malignant oral lesions was similar to other findings in the medical literature, but with some differences in their epidemiological profile. It is important to highlight that these entities require further medical investigation, mainly erythroplakias, which showed high risk of malignization and the highest rate of clinical misdiagnosis.