Oral health conditions of institutionalized older adults and associated factors

Introduction: The growth of the Brazilian older adult population has influenced the increased demand for institutionalization for this public, which usually has poor oral health conditions such as edentulism. Objective: To characterize the oral health conditions and verify the variables related to the edentulism of institutionalized older adults and verify the relation of the time of institutionalization with oral health. Methods: It was a cross-sectional study conducted with 512 institutionalized older adults in which the sociodemographic profile, general health conditions, and oral health care and conditions were evaluated by clinical exams, consultations of medical records, and structured questionnaires. The data were analyzed in the Statistical Package for Social Sciences using the Pearson Chi-square and Fisher's Exact tests and a logistic regression model using a 95% confidence level. Results: A high DMFT (29.4), high prevalence of complete edentulism (61.3%), high need for maxillary (73.6%), and mandibular oral rehabilitation (56.8%) were observed. Edentulism was associated with older age (p<0.001), lower schooling (p<0.001) and non-retirement (p=0.031). It was found that longer institutionalization time remained associated with edentulism even when adjusted by sociodemographic and general health variables (p=0.013). It was also associated with the absence of brushing (p=0.024) and a lower frequency of tooth, gum, and prosthesis brushing (p<0.001). Conclusion: It is suggested to establish oral health care routines within long-term institutions for the effective maintenance of oral health throughout the institutionalization time.

Regulação do acesso ao tratamento do câncer de boca no estado do Rio de Janeiro / Study of the regulation system for access to oral cancer treatment in the state of Rio de Janeiro

Objetivos: Descrever o perfil das solicitações de vaga para tratamento do câncer de boca e analisar o tempo entre a solicitação e o agendamento. Métodos. Pesquisa com dados secundários do Sistema Estadual de Regulação do Estado do Rio de Janeiro, entre setembro de 2015 e junho de 2018. Incluiu-se as solicitações para "Oncologia Ambulatório de 1ª vez- Cirurgia de Cabeça e Pescoço" classificadas como câncer de boca e excluiu-se as com status "cancelada". Resultados. Foram exportados 5802 registros, sendo 1663 elegíveis. A idade média foi de 61 anos, com um desvio padrão de 12,3 anos. O tempo médio de espera foi de 19 dias com um desvio padrão de 16,6 dias. 19% dos agravos referiram-se as "Neoplasia maligna de outras partes e partes não especificadas da língua". Conclusão. O perfil dos pacientes corrobora o encontrado na literatura e o tempo de espera para o atendimento é considerado aceitável.

Objectives: To describe the profile of vacancy requests for treatment of oral cancer and to analyze the time between the request and the schedule. Methods. Research with secondary data from the State Regulation System of the State of Rio de Janeiro, between September 2015 and June 2018. Included were requests for "First-time Ambulatory Oncology - Head and Neck Surgery" classified as oral cancer and those with "canceled" status were excluded. Results. 5,802 records were exported, of which 1663 were eligible. The average age was 61 years, with a standard deviation of 12.3 years. The average waiting time was 19 days with a standard deviation of 16.6 days. 19% of the complaints referred to "Malignant neoplasm from other parts and unspecified parts of the tongue". Conclusion. The profile of patients corroborates that found in the literature and the waiting time for care is considered acceptable.

Dental treatment before surgery in a patient with cleft lip and palate: case report / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Introduction: orofacial clefts are common congenital malformations with an important social, psychological, and economic impact. The treatment of this condition may include different surgical procedures that previously require an adequate oral condition. Case report: we report a case of dental treatment before palatoplasty in a male patient of 17 years-old with bilateral cleft lip and palate and lesion in the jugal mucosa. Final considerations: the adequacy of the oral environment is a fundamental step in the treatment of patients with orofacial clefts and aims to restore oral health regardless of the degree of complexity of the dental treatment through the reduction of the pathogenic microbiota, elimination of retentive niches, instructions on diet and adequate oral hygiene and constant patient motivation.

Objetivos: as fissuras orofaciais são malformações congênitas comuns, com importante impacto social, psicológico e econômico. O tratamento dessa condição pode incluir vários procedimentos cirúrgicos que requerem previamente uma adequada condição bucal. Relato de caso: Relatamos o caso de tratamento odontológico prévio a palatoplastia em um paciente do gênero masculino de 17 anos de idade, com fissura transforame incisivo bilateral e lesão em mucosa jugal. Considerações finais: A adequação do meio bucal é uma etapa fundamental no tratamento de pacientes com fissuras orofaciais e visa restabelecer a saúde bucal independente do grau de complexidade do tratamento odontológico por meio da redução da microbiota patogênica, eliminação de nichos retentivos, orientações sobre dieta e higiene bucal adequada e motivação constante do paciente.

The assessment of periimplant soft tissue condition with morse taper abutment connection: a rapid review

Aim: This study aims to evaluate the clinical assessment results of periimplant soft tissue with morse taper (internal abutment connection). Methods: The study was conducted using a rapid review by searching the articles from PubMed NCBI and Cochrane by using keywords. All articles were selected by the year, duplication, title, abstract, full-text, and finally, all selected articles were processed for final review. Following clinical parameters were included; Periimplant Probing Pocket Depth (PPD), Plaque Score (PS), modified Plaque Index (mPI), Mucosal Thickness (MTh), Gingival Height (GH), periimplant mucosal zenith, Pink Esthetic Score (PES), Bleeding On Probing (BOP), Sulcus Bleeding Index (SBI), and modified Gingival Index (mGI). Results: 9 selected articles were obtained from the initial literature searching count of 70 articles. The overall samples included 326 morse taper implants. Based on the evaluation, 3 out of 4 articles reported pocket depth < 4 mm, no bleeding was reported in 2 out of 4 articles. 4 out of 4 articles reported low plaque accumulation, low soft tissue recession was reported in 3 out of 3 articles, and 4 out of 4 articles reported acceptable PES values. Conclusion: The evaluations indicate that the morse taper (internal abutment connection) has favorable assessment results based on various clinical parameters

Evaluation of oncological outcomes in patients with oral cavity cancer treated in a lowvolume hospital

Introduction: Oral cavity cancer (OCC) is one of the 10 most common types of tumors in the world. Surgical resection is the most indicated initial treatment, followed by adjuvant therapy, depending on tumor stage. A few studies have suggested that patients treated in high-volume hospitals present better oncologic outcomes; however, particularly in continental countries, some patients are treated in regional hospitals. Objective: To evaluate the results of OCC patients treated in low-volume regional hospitals. Methods: This is a retrospective longitudinal study conducted with patients diagnosed with OCC and operated on in a low-volume hospital between January 2003 and December 2018. Results: 174 patients with OCC were treated at the institution - an average of 11 patients/year. The most common tumor location was the tongue (48.2%), followed by the lip (18.2%). Squamous cell carcinomas were the most frequent (94.7% of patients). Adjuvant radiotherapy and chemotherapy were performed in 46.7 and 31.9% of patients, respectively. Almost 21% of patients had some postoperative complication. Specific survival of 62.6% and global survival of 58.2% after 3 years were similar to the results reported in high-volume centers. Disease-free survival was 45.8% in the same period. Conclusion: Low-volume hospitals qualified for oncological treatments can present outcomes similar to those of high-volume centers, and are thus a regional option for patients with OCC.

Oncologic outcomes of microscopic tumor cut-through in locally advanced oral squamous cell carcinoma

Introduction: The gold standard treatment of oral cavity squamous cell carcinoma (OCSCC) is surgical resection; however, standardization of the margins and the role of frozen section are still debatable. Microscopic tumor cut-thought (MTCT) occurs when the surgeon has an initial positive frozen section margin that is cleared with further resection to negative. Objective: This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods: A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results: We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR 2.205; 95% CI 1.243 ­ 3.914; p=0.007) and multivariate (HR 1.851; 95% CI 1.285 ­ 2.666; p=0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ 1.669; 95% CI 1.056 ­ 2.635; p=0.028) and multivariate (HZ 1.307; 95% CI 0.816 ­ 2.092; p=0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion: Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients.

Ventral onlay glanuloplasty for treatment of fossa navicularis strictures

ABSTRACT Purpose: Management of fossa navicularis (FN) strictures balances restoring urethral patency with adequate cosmesis. Historically, FN strictures are managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Ventral onlay glanuloplasty (VOG) is an easily reproducible technique that involves a single-stage augmentation with buccal mucosal graft. We have been applying this technique for several years and present early promising outcomes of this novel approach. Materials and Methods: We retrospectively reviewed all patients with FN strictures who underwent VOG at our institution. Treatment success was designated by the absence of extravasation on voiding cystourethrogram and no need for further urethral instrumentation on follow up. Glans cosmesis was assessed by patients providing binary (yes/no) response to the satisfaction in their appearance. We also noted stricture length, stricture etiology, demographic characteristics and any post-operative complications and reported median, interquartile range (IQR) and count, frequency (%), accordingly. Results: Ten patients underwent VOG and fit our inclusion criteria. Median stricture length was 2.0 cm (IQR 1.6 -2). Success rate was 90% (9/10) with a median follow up of 30 months (IQR 24.3 - 36.8). The one recurrence was treated by dilation combined with triamcinolone injection at 419 days post-op. Stricture etiology included primarily iatrogenic causes such as transurethral prostate resection (4/10), greenlight laser vaporization (2/10), cystolitholapaxy (1/10), and traumatic catheterization (3/10). All patients were satisfied with penile cosmesis. Conclusion: VOG is a simple technique for treating FN strictures. Based on our preliminary series, VOG provides sustained distal urethral patency and patients are pleased with the appearance.

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity / Retalho do músculo masseter para reconstrução de defeitos intraorais em pacientes com câncer inicial de partes póstero‐inferiores da cavidade oral

Abstract Introduction Early carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. Objective This study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. Methods A superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T < 4 cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. Results The flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean ± standard deviation of change in mouth opening at 1 week postoperatively was +1.917 ± 3.36 mm, which increased to +2.633 ± 2.95 mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p = 0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0-5 mm in 39 patients, 5-10 mm in 17 patients and more than 10 mm in 4 patients. There were no recurrences noted in the masseter flaps used. Conclusion The study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

Resumo Introdução Os carcinomas iniciais da cavidade oral nas regiões póstero‐inferiores representam um desafio para a reconstrução devido à falta de suporte muscular abaixo da região e ao espaço limitado disponível para o uso de alguns dos retalhos mais empregados. Objetivo Avaliar a eficácia do retalho do músculo masseter de base superior na reconstrução de defeitos intraorais pós‐ablação em pacientes com carcinoma oral inicial da parte póstero‐inferior da cavidade oral. Método Um retalho do músculo masseter de base superior foi usado para reconstruir o defeito intraoral pós‐cirúrgico em 60 pacientes com carcinoma espinocelular inicial (T < 4 cm) localizado na parte póstero‐inferior da cavidade oral. Os pacientes foram acompanhados após uma semana e um mês de pós‐operatório para verificação da viabilidade do retalho, complicações, alteração na abertura bucal e desvio da mandíbula na abertura bucal. Para descartar recidiva nos retalhos do masseter, os pacientes foram acompanhados por um ano. Resultados O retalho foi viável em todos os pacientes e foi submetido à mucolização; 7/60 pacientes tiveram infecções pós‐operatórias, enquanto 2/60 pacientes desenvolveram uma fístula orocutânea que exigiu um procedimento corretivo secundário. A média ± desvio‐padrão da alteração na abertura da boca em uma semana de pós‐operatório foi + 1,917 ± 3,36 mm, que aumentou para + 2,633 ± 2,95 mm em um mês de pós‐operatório. O teste de Friedman revelou que houve uma alteração estatisticamente significante na abertura da boca do período pré‐operatório para os períodos de uma semana e um mês de pós‐operatório (p = 0,000). Pacientes do sexo feminino apresentaram maior melhoria na abertura da boca no pós‐operatório. O desvio ipsilateral da mandíbula na abertura da boca ficou entre 0 a 5 mm em 39 pacientes, 5 a 10 mm em 17 pacientes e mais de 10 mm em 4 pacientes. Não foram observadas recidivas nos retalhos de masseter usados. Conclusão O retalho do músculo masseter com base superior é um método confiável para reconstrução em casos de câncer oral inicial, produz bons resultados funcionais e resultados cosméticos aceitáveis com complicações pós‐operatórias insignificantes.

Propuesta del curso optativo Protectores Bucales en el Deporte / Proposal of the optional course Mouth Guards in Sports

Introducción: La protección de las estructuras dentomaxilofaciales durante las actividades deportivas y el ejercicio físico se hace cada vez más necesaria, por lo que el Técnico Superior en Prótesis Estomatológica debe saber confeccionar protectores bucales y dominar el conocimiento en estos temas. Objetivo: Diseñar un curso optativo en primer año del Técnico Superior en Prótesis Estomatológica que contribuya a la formación de un profesional capaz de elaborar protectores bucales personalizados. Métodos: Se realizó un estudio cualitativo con carácter descriptivo. Se emplearon métodos del nivel teórico: (histórico-lógico, inductivo-deductivo, analítico-sintético, sistémico-estructural y la modelación) y empírico: (revisión documental, criterios de especialistas). Resultados: Se diseñó un curso optativo de 20 horas de duración, con carácter presencial y estructurado en tres temas. El curso optativo Protectores Bucales en el Deporte contribuye a potenciar actividades curriculares que tributen al desarrollo de una cultura para la protección bucodental. Conclusiones: El diseño del curso optativo se corresponde con las necesidades de aprendizaje de los Técnicos Superiores en Prótesis Estomatológica para confeccionar protectores bucales.

Introduction: The protection of the dentomaxillofacial structures during sports activities and physical exercise is increasingly necessary, so the Superior Technician in Stomatological Prosthesis must know how to make mouth guards, and develop knowledge on these topics. Objective: To design an optional course in the first year of the speciality Superior Technician in Stomatological Prosthesis that contributes to the training of a more qualified professional to make mouth guards. Methods: A qualitative descriptive study was carried out. Theoretical methods: (historical-logical, inductive-deductive, analytical-synthetic, systemic-structural and modeling), and empirical methods: (documentary review, specialist criteria) were used. Results: An optional face-to-face and structured in three topics course of 20 hours was designed. The optional course Mouth Guards in Sports contributes to promoting curricular activities which support the development of a culture on oral protection. Conclusions: The design of the optional course corresponds to the learning needs of the Superior Technician in Stomatological Prosthesis to make mouth guards.

Lesiones de la mucosa asociadas al uso de prótesis estomatológica en pacientes adultos mayores / Mucosal lesions associated with the use of dental prostheses in elderly patients

RESUMEN Fundamento: La calidad de la prótesis dental y su papel en la aparición de las lesiones bucales, sobre todo en el adulto mayor, resulta de especial interés para la comprensión de la etiología de estas enfermedades y la recomendación de estrategias preventivas. Objetivo: caracterizar la población geriátrica con lesiones en la mucosa bucal asociadas al uso de prótesis estomatológicas. Métodos: estudio descriptivo, que incluyó a todos los pacientes (N=48) portadores de prótesis dental que presentaron lesión de la mucosa, los cuales acudieron a la consulta de prótesis estomatológica, en la Clínica Estomatológica de Especialidades, de Cienfuegos, en el periodo de enero a junio de 2020. Se analizaron las variables: edad, sexo, lesiones bucales, tiempo de uso de la prótesis, hábito de uso y estado técnico. Resultados: predominaron las lesiones en mujeres, con un 70,9 %. El grupo etario más afectado, el de 65-69 años, con 45,4 %. La estomatitis subprótesis representó el 90,2 %, de todas las lesiones, seguida por el épulis fisurado (7,8 %). La presencia de lesión se asoció en un 54,5 % de los casos con el tiempo de uso de 5-9 años. El uso continuo y presencia de prótesis desajustada se evidenciaron en mayor frecuencia, representados en un 76,4 % y 70,9 %, respectivamente. Conclusión: c uestiones como el tiempo de uso prolongado, prótesis desajustada y uso continuo de estas, son características en este grupo poblacional, las cuales guardan una lógica relación con la presencia de lesiones de la mucosa.

ABSTRACT Background The quality of the dental prosthesis and its role in the appearance of oral lesions, especially in the elderly, is of special interest for the etiology understanding of these diseases and the preventive strategies recommendation. Objective to characterize the geriatric population with lesions in the oral mucosa associated with the use of dental prostheses. Methods descriptive study, which included all patients (N=48) with dental prostheses who presented mucosal lesions, who attended the dental prosthesis consultation, at the Specialty Stomatology Clinic, in Cienfuegos, from January to June 2020. The analyzed variables were: age, sex, oral lesions, time of use of the prosthesis, habit of use and technical status. Results lesions in women predominated, with 70.9%. The most affected age group, 65-69 years, with 45.4%. Subprosthesis stomatitis represented 90.2% of all lesions, followed by fissured epulis (7.8%). The presence of injury was associated in 54.5% of cases with a time of use of 5-9 years. The continuous use and presence of maladjusted prostheses were evidenced more frequently, represented in 76.4% and 70.9%, respectively. Conclusion issues such as prolonged use time, maladjusted prosthesis and continuous use of these are characteristic in this population group, which are logically related to the presence of mucosal lesions.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective

Abstract The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Resumo Os achados clinico-patológicos que caracterizam de forma precisa o líquen plano oral (LPO) e as lesões liquenoides orais (LLO) ainda representam um desafio. O objetivo do presente estudo foi analisar, pela perspectiva do patologista oral, os achados clínicos do LPO e das LLO. Espécimes preenchendo os critérios histológicos para o diagnóstico de LPO e LLO, e também aqueles compatíveis com LPO (LPO-C), foram selecionados e as informações clínicas foram obtidas a partir das requisições laboratoriais. A amostra final foi composta de 221 casos, incluindo 119 LPO (53.8%), 65 LPO-C (29.4%) e 37 LLO (16.7%). As mulheres foram mais acometidas nos três grupos, mas o número de homens acometidos foi maior nas LLO. A média de idade foi menor no LPO (52.3 anos) em comparação com as LLO (57.9 anos) (p=0.020). O envolvimento da mucosa jugal e da língua foi mais frequente no LPO; o envolvimento gingival foi incomum nas LLO. O padrão reticular foi mais frequentemente encontrado no LPO, enquanto a associação dos padrões reticular e atrófico/erosivo/ulcerado foi mais comum no LPO-C e nas LLO (p=0.025). Em conclusão, o gênero e a média de idade dos pacientes, assim como a localização anatômica e a manifestação clínica das LLO são diferentes do LPO, e podem ajudar a melhor caracterizar este grupo de condições. Espécimes diagnosticados como LPO-C mostraram parâmetros clínicos mais próximos ao LPO.

Oral manifestations of leukemia as part of early diagnosis

ABSTRACT Introduction: The oral cavity can present the first clinical manifestations of leukemia, therefore; it is important to recognize their principal characteristics. Objective: To identify oral manifestations as the first clinical signs of leukemia. Methods: This is an integrative review, that gathered data from articles with oral manifestations of leukemia as part of its first clinical features. The were included case reports, case series, clinical research, or reviews with case reports. The variables that were considered relevant: age, sex, sites of the oral lesions, characteristics of the oral lesions, medical history and physical examination, time of evolution, radiographic examination, blood test results, initial diagnosis, differential diagnosis and final diagnosis. Results: A total of 31 studies were included, with a total of 33 individuals identified. There were 19 (57.57%) males and 14 (42.42%) females. The age range was from 1.6 to 74 years. Acute myeloid leukemia (72.72%) and acute lymphoid leukemia (18.18%) presented more oral manifestations as the first clinical signs of the disease. All individuals with leukemia presented lesions, such as ulcer, erosion, bleeding, ecchymosis, color change of the bluish or pale mucous membranes and areas of tissue necrosis. Hard tissue lesions were less frequent, being 6 (18.18%). Conclusion: The first clinical manifestations of leukemia can be present in the oral cavity, mainly in acute myeloid leukemia. The principal oral tissues affected were gingival tissue, buccal mucosa and hard and/or soft palate. When hard tissues, such as the maxilla bone or mandible bone were affected, dental mobility was the principal clinical sign.

Epidemiological study on the lip and oral cavity cancer in Brazil: connecting science and clinical applicability

SUMMARY OBJECTIVE: The aim of this study was to describe and discuss the epidemiological indicators of lip and oral cavity cancer in Brazil, in 2017, according to data from the Global Burden of Disease data. METHODS: This is a descriptive study reported according to STROBE guidelines. We identified epidemiological indicators using the Global Burden of Disease results tool. Mortality/incidence rates were described per 100,000 population. Global Burden of Disease 2017 reviews were completed using Python version 2.7, Stata version 13.1, and R version 3.3. RESULTS: In 2017, there were 5,237 deaths from the lip or oral cavity cancer in Brazil, most of them were males aged between 50 and 69 years (2,730 cases, which was equivalent to 52% of the universe of deaths resulting from this cause). Regarding the burden of lip and oral cavity cancer, per 100,000 Brazilians, we observed an incidence of 3.99, prevalence of 15.46, and mortality of 2.29 (with higher indicators in the South and Southeast regions of the country). CONCLUSIONS: Epidemiological indicators of lip and oral cavity cancer were higher in men, with higher mortality indicators in individuals aged 50-69 years, and higher rates (incidence, prevalence, and mortality) in the South and Southeast regions of Brazil. From 2002-2015, there was a reduction in mortality; however, in the period from 2015-2017, there was a resumption in the growth of this indicator.

Afecciones bucales y factores de riesgo en adultos mayores portadores de prótesis dental / Oral conditions and risk factors in older adults with dental prostheses

RESUMEN Introducción: las afecciones bucales consecuentes al uso de prótesis dental en el adulto mayor son un problema de salud pública de alta prevalencia. Con el uso de dentaduras artificiales pueden aparecer factores de riesgo que condicionan las afecciones bucales, su frecuencia en este grupo poblacional motivó la realización del presente estudio. Objetivo: establecer el comportamiento de las afecciones bucales y factores de riesgo presentes en adultos mayores portadores de prótesis dental. Métodos: se realizó un estudio descriptivo, retrospectivo de corte transversal en el período 2018-2020. Universo: 3 884 pacientes portadores de prótesis dental, de 60 años o más, pertenecientes a la Clínica Estomatológica "Antonio Briones Montoto" de Pinar del Río. Muestra: 250 pacientes seleccionados por muestreo aleatorio simple. Se empleó estadística descriptiva mediante frecuencias absolutas y relativas. Resultados: predominaron pacientes femeninas (54 %) y el grupo de 80-84 años (38,8 %). Las lesiones más frecuentes fueron estomatitis subprótesis (40,4 %) y úlcera traumática (22,9 %) en portadores de prótesis totales. El hábito de fumar, la higiene bucal deficiente y la placa dentobacteriana incidieron en la ocurrencia de estas afecciones. Conclusiones: las afecciones bucales consecuentes al uso de prótesis dental y los factores de riesgo presentes en el adulto mayor, se asociaron con deficientes estilos de vida como la inadecuada higiene bucal, la ausencia de medidas preventivas, la mala calidad del aparato protésico y la necesidad de confeccionar y reinstalar nuevas prótesis.

ABSTRACT Introduction: oral diseases resulting from the wear of dental prostheses in older adults continue to be a highly prevalent public health problem. With the use of artificial dentures, risk factors can appear that condition oral diseases. The frequency of these conditions in this age group encouraged the present study. Objective: to establish the behavior of oral diseases and risk factors present in older adults who wear dental prostheses. Methods: a descriptive, retrospective, cross-sectional study was carried out in the period 2018-2020. Target group: 3884 patients with dental prostheses, 60 years or older, belonging to Antonio Briones Montoto dentistry clinic in Pinar del Rio. Sample: 250 patients chosen by simple random sampling. Descriptive statistics was applied by means of absolute and relative frequencies. Results: female patients predominated (54 %) and the age group 80-84 reaching a 38,8 %. The most frequent lesions were subprosthetic stomatitis (40,4%) and traumatic ulcer (22,9 %) in total prosthesis wearers. Smoking, poor oral hygiene and dentobacterial plaque had an impact on the occurrence of these conditions. Conclusions: the oral diseases resulting from the wear of dental prostheses and the risk factors present in older adults were associated with poor lifestyles such as inadequate oral hygiene, the absence of preventive measures, the poor quality of the prosthetic appliance and the need to make and reinstall new dental prostheses.

Prevalencia de la enfermedad periodontal en el embarazo / Prevalence of periodontal disease in pregnancy

RESUMEN Introducción: los cambios hormonales que experimentan las mujeres gestantes acentúa la respuesta gingival y causa un cuadro clínico diferente, se considera un factor modificador en la enfermedad periodontal. Objetivo: valorar la prevalencia de la enfermedad periodontal en gestantes atendidas en la Clínica Estomatológica José Martí en el período de septiembre 2018 a enero 2020. Métodos: se realizó un estudio observacional, descriptivo y transversal en 83 pacientes gestantes, en el período comprendido de septiembre del 2018 a enero 2020. La información de interés se obtuvo de las historias clínicas individuales de servicios básicos de estomatología y de periodoncia. Todos los pacientes dieron su consentimiento informado y los resultados se obtuvieron con la utilización del análisis estadístico que incluyó el porcentaje y la razón. Resultados: predominaron pacientes enfermas con un 82 % sobre las sanas con 18 %. La gingivitis fue la enfermedad más frecuente en el 35 % de las gestantes estudiadas. Las formas menos graves de la enfermedad se presentaron con mayor frecuencia en el grupo de 27 a 36 años para el 43,7 %, y las periodontitis fueron más frecuentes en las gestantes de 37 a 45 años para un 33,3 %. El nivel de conocimientos fue regular para un 37,3 % seguido del bueno para un 36,2 %. Conclusiones: la frecuencia de la enfermedad periodontal fue alta con predominio de la forma leve de esta.

ABSTRACT Introduction: the hormonal changes experienced by pregnant women accentuate the gingival response and cause a different clinical picture, being considered a modifying factor in periodontal disease. Objective: to assess the prevalence of periodontal disease in pregnant women attended at Jose Marti Dentistry Clinic in the period from September 2018 to January 2020. Methods: an observational, descriptive and cross-sectional study was conducted in 83 pregnant women, in the period from September 2018 to January 2020. The information of interest was collected from individual medical records of basic dentistry and Periodontics services. All patients provided an informed consent and the results were processed using statistical analysis including percentage and ratio. Results: sick patients predominated with 82 % over healthy patients with 18 %. Gingivitis was the most frequent disease in the 35 % of pregnant women studied. Less severe forms of the disease were more frequent in the age group 27 to 36 years for 43,7 %, and periodontitis was more frequent in pregnant women aged 37 to 45 years for 33,3 %. The level of knowledge was fair for 37,3 % followed by good for 36,2 %. Conclusions: the frequency of periodontal disease was high with a predominance of mild periodontal disease.

Riesgo a padecer cáncer bucal en adultos mayores de un consultorio médico / Oral Cancer Risk in Older Adults in a Medical Practice

RESUMEN Introducción: el cáncer bucal constituye un problema de salud no por su incidencia, sino por su mortalidad y está considerado como la sexta causa de muerte más común entre todos los cánceres del mundo. Objetivo: determinar el riesgo a padecer cáncer bucal en los adultos mayores del Consultorio Médico No. 3 del área Centro de Sancti Spíritus. Métodos: se realizó un estudio observacional descriptivo transversal en pacientes mayores de 60 años pertenecientes al consultorio ante mencionado en el período de septiembre de 2019 a febrero de 2020. El universo estuvo constituido por los 195 adultos mayores del consultorio y la muestra por 103 pacientes. Se estudiaron las variables: edad, sexo, factores de riesgo y riesgo a padecer cáncer bucal y de labio. Resultados: el sexo masculino (65,3 %) y el grupo de edad de 65 a 69 años (34,7%) fueron los predominantes. La higiene bucal deficiente resultó el factor de mayor aparición (57,9 %) seguido del tabaquismo (21,2 %). El 14,7 % de los adultos mayores tiene un riesgo elevado de padecer cáncer bucal, mientras que el 11,6 % de desarrollar cáncer de labio. Conclusiones: existió predominio del sexo masculino y el grupo de 65 a 69 años. Dentro de los factores de riesgo presentes en la población, la higiene bucal deficiente fue la de mayor prevalencia y existió un mayor riesgo de padecer cáncer bucal.

ABSTRACT Introduction: oral cancer is a health problem not because of its incidence but because of its mortality and is considered the sixth most common cause of death among all cancers in the world. Objective: to determine the risk of suffering oral cancer in older adults of the Medical Office No. 3 of the Sancti Spíritus Center area. Methods: a cross-sectional descriptive observational study was carried out in patients over 60 years of age belonging to the aforementioned clinic in the period from September 2019 to February 2020. The universe consisted of 195 older adults of the clinic and the sample consisted of 103 patients. The variables studied were: age, sex, risk factors and risk of oral and lip cancer. Results: the male sex (65,3 %) and the age group 65 to 69 years (34,7 %) were the predominant ones. Poor oral hygiene was the most common factor (57,9 %) followed by smoking (21,2 %). 14,7 % of older adults had a high risk of developing oral cancer, while 11,6 % had a high risk of developing lip cancer. Conclusions: there was a predominance of the male sex and the 65-69 years age group. Among the risk factors present in the population, poor oral hygiene was the most prevalent and there was a higher risk of developing oral cancer.

Fibrolipoma of the hard palate: an uncommon location. Case report / Fibrolipoma del paladar duro: una ubicación poco frecuente. Reporte de caso

Abstract Fibrolipoma, a benign soft tissue adipose tumor, is a histological variant of lipoma. Clinically, it presents as a painless slow-growing mass, indistinguishable from other benign soft tissue tumors. In the oral cavity, it is mainly encountered in the buccal mucosa. Involvement of the palate is very rare; it accounts for around 7-14% of all oral fibrolipomas. In this article, we describe a case of fibrolipoma in the hard palate of a 70-year-old female, who presented with an asymptomatic pedunculated mass, characterized by a normal-colored and smooth surface, which have been present for 20 years. The lesion was excised, and histopathological study revealed a fibrolipoma. To the best of our knowledge, only 17 cases occurring in the palate have been reported in the literature. Since fibrolipoma presents clinical similarities with other benign soft tissue neoplasms, a thorough clinical examination and histopathological analysis are essential for obtaining diagnosis.

Resumen El fibrolipoma es una neoplasia benigna de tejido adiposo, variante histológica del lipoma. Clínicamente se presenta como una tumoración de crecimiento lento, asintomática, indistinguible de otras neoplasias benignas de tejidos blandos. En cavidad oral se presenta principalmente en la mucosa yugal. El paladar es un sitio infrecuente, comprende del 7 al 14% de todos los fibrolipomas. En este reporte, describimos un caso de fibrolipoma de paladar duro en una mujer de 70 años de edad, que presentó una tumoración pediculada, asintomática, de superficie lisa, del mismo color de la mucosa adyacente, con un tiempo de evolución de 20 años. La lesión fue extirpada, y el estudio histopatológico reveló un fibrolipoma. En nuestro conocimiento, se han reportado en la literatura únicamente 17 casos de fibrolipoma de paladar. Siendo que el fibrolipoma presenta similitud clínica con otras neoplasias benignas de tejidos blandos, un examen clínico detallado, así como el estudio histopatológico son esenciales en la obtención del diagnóstico.

The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma / Impacto da biópsia do linfonodo sentinela na qualidade de vida em pacientes com carcinoma espinocelular da cavidade oral

Abstract Introduction Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. Objective The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. Methods Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. Results The evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy. Conclusion Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.

Resumo Introdução A biópsia de linfonodo sentinela é um método comprovado para estadiamento cervical em pacientes com carcinoma espinocelular inicial da cavidade oral, porque apresenta menor taxa de morbidade do que o método tradicional de esvaziamento cervical seletivo, com os mesmos resultados oncológicos. Porém, o verdadeiro efeito desse método na qualidade de vida desses pacientes permanece desconhecido. Objetivo Avaliar a qualidade de vida de pacientes com carcinoma espinocelular de cavidade oral T1/T2N0 submetidos a biópsia do linfonodo sentinela em comparação aos pacientes nos quais o esvaziamento cervical seletivo foi feito. Método Estudo transversal que incluiu 24 pacientes, após 36 meses de seguimento, dos quais 15 foram submetidos a biópsia do linfonodo sentinela e nove a esvaziamento cervical seletivo. Todos os pacientes responderam ao questionário de qualidade de vida da University of Washington. Resultados A avaliação dos questionários evidenciou pioria tardia dos domínios aparência (p = 0,035) e mastigação (p = 0,041), bem como diminuição de cerca de 10% da qualidade de vida geral (p = 0,025) nos pacientes submetidos a esvaziamento cervical seletivo em comparação com aqueles submetidos a biópsia do linfonodo sentinela. Conclusão Pacientes com carcinoma espinocelular de cavidade oral em estágio inicial submetidos a biópsia do linfonodo sentinela apresentaram melhores resultados tardios de qualidade de vida geral, principalmente quanto à aparência e à mastigação, quando comparados aos pacientes submetidos a esvaziamento cervical seletivo.

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis / Eficácia da quimioluminescência no diagnóstico e rastreamento de câncer oral e pré-câncer: uma revisão sistemática e metanálise

Abstract Introduction Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy. Objective This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions. Methods Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). Results Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I2 = 9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91). Conclusion Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.

Resumo Introdução A detecção precoce de distúrbios orais potencialmente malignos é fundamental para um bom prognóstico e não está claro se o uso da quimioluminescência como método auxiliar de triagem diagnóstica melhora a eficácia do diagnóstico. Objetivo Avaliar a precisão da quimioluminescência para o diagnóstico de câncer oral e pré-câncer. Método Foram revisados 16 estudos prospectivos e retrospectivos dos bancos de dados PubMed, Cochrane, Scopus, Web of Science, Embase e Google Scholar. Os distúrbios da mucosa oral detectados por quimioluminescência foram comparados com os distúrbios da mucosa oral detectados pelo azul de toluidina ou pelo exame visual. Taxas de resultados verdadeiro-positivos, verdadeiro-negativos, falso-positivos e falso-negativos foram extraídas de cada estudo. A qualidade metodológica foi avaliada com a ferramenta Quality Assessment of Diagnostic Accuracy Studies-versão 2 (QUADAS-2). Resultados Sensibilidade, especificidade, valor preditivo negativo e odds ratio diagnóstico do uso do azul de toluidina foram 0,832 (intervalo de confiança de 95%: 0,692-0,917), 0,429 (IC95%: 0,217-0,672), 0,747 (IC95%: 0,607-0,849) e 4,061 (intervalo de confiança 95%: 1,528-10,796; I2 = 9,128%), respectivamente. A área sob a curva SROC, do inglês summary receiver operating characteristic, foi de 0,743. Comparada ao azul de toluidina, como usado em 12 estudos, a quimioluminescência apresentou uma sensibilidade mais alta (0,831 vs. 0,694) e especificidade (0,415 vs. 0,734), valor preditivo negativo (0,674 vs. 0,729) e odds ratio diagnóstico (3,889 vs. 7,705) mais baixos. Comparado com o exame clínico, como usado em três estudos, a quimioluminescência apresentou menor odds ratio diagnóstico (4.576 vs. 5.499) e área sob a curva (0,818 vs. 0,91). Conclusão Embora a quimioluminescência em si tenha boa sensibilidade para o diagnóstico de câncer oral e pré-câncer, sua precisão diagnóstica é comparável ou pior do que o azul de toluidina e o exame clínico. A precisão do diagnóstico foi, portanto, insuficiente para o uso isolado confiável da quimioluminescência.

Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

Abstract Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.