Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10, 381 cases and literature review

Abstract The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.

Análise epidemiológica e imunológica em indígenas das etnias Sateré Mawé e Tikuna portadores de infecções endodônticas / Epidemiological and immunological analysis in indigenous people of the Sateré Mawé and Tikuna ethnic groups with endodontic infections

Os povos indígenas compõem 305 etnias, distribuídas por todas as unidades federativas do Brasil. Esta diversidade cultural consiste em uma das maiores riquezas do país, mas, ao mesmo tempo, é também um grande desafio para a elaboração e implementação de políticas públicas específicas e diferenciadas. O objetivo deste estudo foi analisar o perfil epidemiológico de saúde bucal e a necessidade de tratamento endodôntico de indígenas das etnias SATERÉ MAWÉ, que vivem em Barreirinha-AM, e TIKUNA, residentes na zona urbana de MANAUS-AM. Após determinar a necessidade de tratamento endodôntico, este estudo comparou as respostas perirradiculares de infecções endodônticas entre membros de uma civilização ocidental, residentes em Belo Horizonte MG, e indígenas não miscigenados da etnia TIKUNA. Para a análise epidemiológica participaram do estudo 138 indivíduos, sendo 98 pertencentes à etnia TIKUNA e 40 SATERÉ-MAWE; distribuídos nos grupos etários de 7 a 50 anos ou mais. Para a analise imunológica das alterações perirradiculares das populações selecionas, coletaram-se as amostras clínicas em dentes portadores de necrose pulpar. Os indígenas da etnia Tikuna foram atendidos na Clínica de Endodontia da UNIP (Universidade Paulista), campus Manaus. Os membros da população ocidental foram atendidos nas clínicas da Faculdade de Odontologia da UFMG. As amostras foram coletadas imediatamente após a instrumentação do SCR, introduzindo-se cones absorventes nos SCR, 1 mm além do ápice radicular. Subsequentemente, as amostras foram transferidas para um tubo estéril, e mantidas na temperatura de - 70 º C até a sua análise. Utilizando-se o PCR em tempo real, avaliou-se a expressão das citocinas e quimiocinas TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR-4, CCL-2/MCP-1 e CCR-6. Os resultados demonstram que, em relação à etnia SATERÉ-MAWÉ, na faixa etária de 7 a 12 anos, o CPO-d apresentou valor médio de 3.17. Comparando-se o índice CPO-d e a necessidade de tratamento endodôntico em cada uma das etnias, verificou-se que estas variáveis estão correlacionadas, uma vez que, à medida que o CPO-d aumentou, verificou-se um aumento na necessidade de tratamento endodôntico. Os molares prevaleceram dentre os os dentes mais acometidos por cárie e com necessidade de tratamento endodôntico. Quanto à análise imunológica, observou-se um aumento significativo na expressão gênica de TNF, CCL-2/MCP-1, CXCR4, e CCR6, após os procedimentos de limpeza e formatação dos SCR apenas na população ocidental. Os níveis de INF- aumentaram na 2a coleta na população indigena, enquanto, em ambas as populações, houve um aumento significativo na expressão de IL-10 e IL-17 após os procedimentos de limpeza e formataçao. Não observaram-se diferenças significativas entre as expressões de IL-1 , IL-9, e CCL4, entre a 1ª e 2ª coleta, em ambas as populações. Conclui-se que as populações indígenas encontram-se desasistidas, visto que o CPO-d de ambas as etnias se encontram acima dos padrões recomendados pela OMS, principalmente na faixa etária de 07 a 12anos. Ademais, o nível de escolaridade ainda é muito baixo nas populações indígenas analisadas, mesmo na comunidade Tikuna, situada na zona urbana de Manaus/AM. Finalmente, observaram-se padrões imunes distintos quando se comparou as respostas das comunidades ocidentais e Tikuna, sugerindo que os determinantes genéticos e ambientais devem ser mais bem avaliados no futuro.

The indigenous peoples comprise 305 ethnic groups, distributed by all the federative units of Brazil. This cultural diversity is one of the most significant assets of the country, but at the same time, it is also a great challenge for the elaboration and implementation of specific and differentiated public policies. The objective of this study was to analyse the epidemiological profile of oral health and the need for endodontic treatment of SATERÉ MAWÉ indigenous people living in Barreirinha-AM, and TIKUNA, living in the urban area of MANAUS-AM. After determining the need for endodontic treatment, this study compared the perirradicular responses of endodontic infections among members of western civilisation, living in Belo Horizonte - MG, and no - mixed indigenous TIKUNA. For the epidemiological analysis, the study consisted of 138 individuals, of whom 98 were TIKUNA ethnicity, and 40 were SATERÉ-MAWE ethnics; aged between 7 and 50 years or more. For the immunological analysis of the perirradicular alterations of the selected populations, the clinical samples were collected in teeth with pulp necrosis. The Tikuna Indians were treated at the Endodontics Clinic of UNIP (Universidade Paulista), Manaus campus. The members of the western population were attended in the clinics of the Faculty of Dentistry of UFMG. Samples were collected immediately after SCR instrumentation, introducing absorbent cones in the SCR, 1 mm beyond the root apex. Subsequently, the samples were transferred to a sterile tube and maintained at -70 ° C until analysed. Using the real-time PCR, the expression of cytokines and chemokines TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR- 2 / MCP-1 and CCR-6. The results show that, concerning the ethnicity SATERÉ-MAWÉ, in the age group of 7 to 12 years, the CPO-d presented a mean value of 3.17. Comparing the CPO-d index and the need for endodontic treatment in each of the ethnicities, these variables were correlated, since, as CPO-d increased, there was an increase in the demand for endodontic treatment. The molars prevailed among the teeth most affected by caries and in need of endodontic treatment. As for the immunological analysis, a significant increase in the gene expression of TNF, CCL-2 / MCP-1, CXCR4, and CCR6 was observed after the SCR cleaning and formatting procedures only in the western population. INF- levels increased in the second collection in the Indian community, while in both people, there was a significant increase in the expression of IL-10 and IL-17 after the cleaning and shaping procedures. There were no significant differences between IL-1, IL-9, and CCL4, between the 1st and 2nd collection, in both populations. It is concluded that the indigenous people are disassociated, since the CPO-d of both ethnic groups is above the standards recommended by the WHO, especially in the age group from 07 to 12 years. Besides, the educational level is still shallow in the indigenous populations analysed, even in the Tikuna community, located in the urban area of Manaus / AM. Finally, distinct immune patterns were observed when comparing Western societies and Tikuna responses, suggesting that genetic and environmental determinants should be better evaluated in the future. Keywords: endodontic treatment, epidemiology, indigenous, cytokines, chemokines, periapical lesion.

Enfermedades pulpares y periapicales en estructuras dentales permanentes en pacientes con edades de seis-catorce años / Pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years

Introducción: cuando las estructuras dentales permanentes tienen pulpas jóvenes e inmaduras, son más grandes y las paredes del canal radicular muy delgadas. Si estas son afectadas por alguna enfermedad pulpar o periapical, la integridad de la pulpa se ve dañada y consecuentemente el desarrollo radicular. Objetivo: identificar las enfermedades pulpares y periapicales en estructuras dentales permanentes y su grado de desarrollo según la clasificación de Patterson, de pacientes con edades de seis a catorce años. Métodos: estudio observacional descriptivo y transversal. De 357 pequeños que acudieron a la Unidad Universitaria de Inserción Social de la Universidad Autónoma de Yucatán, México, 2013, por afectaciones pulpar o periapical, 56 infantes presentaron estas, en estructuras dentales inmaduras permanentes. Los criterios de inclusión fueron: edad, estructura dentaria, enfermedades pulpares y periapicales, clasificación de Patterson para observar radiográficamente el grado de desarrollo radicular. Se proporcionó a los padres una carta de consentimiento informado, realizándoles un cuestionario con datos demográficos del niño. Al niño, se le preguntó su historia de dolor, se realizaron pruebas, exámenes clínicos y toma radiográfica. Con pruebas Ji-cuadrada se comparó la proporción de pacientes según: 1) estructura dentaria; 2) edad; 3) clasificación de Patterson; 4) enfermedad pulpar y periapical. Resultados: el 57 por ciento fueron niñas y 43 por ciento niños. El 15,69 por ciento de los infantes tuvo enfermedad pulpar y/o periapical en estructuras dentales permanentes presentándose con mayor frecuencia en el estadio 1, 2 y 3 de Patterson. Difirió significativamente (X2= 22,6429; p= 0,0004; g.l.= 5) la estructura dentaria afectada. La proporción de pacientes con enfermedad pulpar o periapical según edad difirió significativamente (X2= 30,75; p< 0,0001; g.l.= 6). La proporción de pacientes con alguna estructura dentaria permanente afectada según la clasificación de Patterson, difirió significativamente (X2= 7,75; p= 0,0208; g.l.= 2). Hubo diferencias estadísticas entre los tipos de enfermedades pulpares (X 2= 7,2; p= 0,0273; g.l.= 2), no difirió significativamente entre los tipos de enfermedades periapicales (X2= 1,4615; p=0,4815; g.l.= 2). Conclusiones: desde muy temprana edad los niños y niñas, están presentando mayor cantidad de enfermedades pulpares que periapicales en estructuras dentales permanentes aún sin terminar su desarrollo radicular, lo que pone en riesgo la conservación de sus dientes en la edad adulta, y afecta severamente el sistema estomatognático con probabilidad de padecer maloclusiones a temprana edad(AU)

Introduction: when permanent dental structures have young, immature pulps, they are bigger and their root canal walls are very thin. If they are affected by some pulp or periapical disease, damage is caused to pulp integrity and consequently to root development as well. Objective: identify pulp and periapical diseases in permanent dental structures of patients aged six to fourteen years, and their degree of development according to Patterson's classification. Methods: a cross-sectional observational descriptive study was conducted. Of the 357 children attending the Social Service University Unit at the Autonomous University of Yucatán, Mexico, in the year 2013, for pulp or periapical diseases, 56 presented them in immature permanent dental structures. The following inclusion criteria were applied: age, dental structure, pulp and periapical diseases, and Patterson's classification, to radiographically observe the degree of root development. Parents provided their informed consent in writing, and answered a questionnaire with personal details of the child. Children were asked about the antecedents of their pain, and underwent tests and clinical and radiographic examination. Chi-square tests were used to sort out the patients according to: 1) dental structure, 2) age, 3) Patterson's classification, 4) pulp and periapical disease. Results: 57 percent of the sample were girls and 43 percent were boys. 15.69 percent had pulp and/or periapical disease in permanent dental structures, with a higher prevalence of Patterson's stages 1, 2 and 3. The dental structure affected varied significantly (X2= 22.6429; p= 0.0004; g.l.= 5). The proportion of patients with pulp or periapical disease varied significantly with age (X2= 30.75; p< 0.0001; g.l.= 6). The proportion of patients with some permanent dental structure affected varied significantly according to Patterson's classification (X2= 7.75; p= 0.0208; g.l.= 2). Significant statistical differences were found between the types of pulp diseases (X2= 7.2; p= 0.0273; g.l.= 2), not between the types of periapical diseases (X2= 1.4615; p=0.4815; g.l.= 2). Conclusions: incidence of pulp diseases is higher than that of periapical diseases in very young children. These affect permanent dental structures with incomplete root development, jeopardizing tooth preservation in adult age and severely affecting the stomatognathic system with a potential for causing malocclusion at an early age(AU)

Prevalencia de enfermedades pulpares y periapicales en pacientes geriátricos: Mérida, Yucatán, México / Prevalence of pulpal and periapical disease among geriatric patients in Mérida, Yucatán, Mexico

Introducción: las consideraciones médicas, psicológicas y biológicas en la población de personas mayores es una responsabilidad social que todo profesional deberá atender con sumo cuidado, ya que este grupo etario es más susceptible a presentar diversas enfermedades, entre las que se encuentran las pulpares y las periapicales. Objetivo: determinar la prevalencia de enfermedades pulpares y periapicales en pacientes de 60 y más años de edad en pacientes geriátricos de la Facultad de Odontología de la Universidad Autónoma de Yucatán, México. Métodos: estudio descriptivo, prospectivo, transversal y observacional. El universo estuvo constituido por los pacientes que acudieron a la Clínica de Admisión de la Facultad de Odontología de la Universidad Autónoma de Yucatán, México durante el periodo comprendido de agosto a diciembre de 2012. La muestra fue de 74 paciente de 60 y más años de edad, con alguna afección pulpar o periapical, que aceptaron participar en el estudio. Se les realizó: entrevista por medio de un formulario de historia odontológica que permitió al paciente describir su experiencia de dolor de un modo organizado, breve y descriptivo; examen clínico y pruebas pulpares: térmicas, percusión y palpación; estudio radiográfico. Se utilizó estadística descriptiva y pruebas chi cuadrado. Resultados: se revisaron 108 órganos dentarios. El 41,67 pr ciento (n= 45) presentó patologías pulpares: 22,22 por ciento (n= 10) pulpitis reversible, 57,78 por ciento (n= 26) pulpitis irreversible y 20 por ciento (n= 9) necrosis pulpar. El 58,33 por ciento (n= 63) patologías periapicales: 42,85 por ciento (n= 27) periodontitis apical aguda, 15,87 por ciento (n= 10) periodontitis apical crónica, 1,58 por ciento (n= 1) quiste apical, 27 por ciento (n= 17) absceso apical agudo y 12,70 por ciento (n= 8) absceso apical crónico. Conclusión: no se obtuvo diferencias significativas entre el número de dientes que presentaron enfermedades pulpares y el número de dientes que presentaron enfermedades periapicales en este grupo etario(AU)

Introduction: medical, psychological and biological factors should be carefully considered by health professionals when dealing with elderly patients, for this age group is more prone to a number of conditions, among them pulpal and periapical disease. Objective: determine the prevalence of pulpal and periapical disease among patients aged 60 and over attending the School of Dentistry of the Autonomous University of Yucatán, Mexico. Methods: a descriptive cross-sectional observational prospective study was conducted. The study universe was composed of the patients attending the Outpatient Clinic at the School of Dentistry of the Autonomous University of Yucatán, Mexico, from August to December 2012. The sample was 74 patients aged 60 and over with some pulpal or periapical condition who accepted to participate in the study. An interview was conducted based on a dental history form allowing patients to describe their pain experience in a brief, descriptive, organized manner. Clinical examination was performed, as well as pulpal tests: thermal, percussion and palpation, and a radiographic study. Analysis was based on descriptive statistics and chi square tests. Results: 108 dental organs were examined. 41.67 percent (n= 45) presented the following pulpal pathologies: reversible pulpitis 22.22 percent (n= 10), irreversible pulpitis 57.78 percent (n= 26) and pulp necrosis 20 percent (n= 9). 58.33 percent (n= 63) presented the following periapical pathologies: acute apical periodontitis 42.85 percent (n= 27), chronic apical periodontitis 15.87 percent (n= 10), apical cyst 1.58 percent (n= 1), acute apical abscess 27 percent (n= 17) and chronic apical abscess 12.70 percent (n= 8). Conclusion: no significant differences were found between the number of teeth with pulpal disease and the number of teeth with periapical disease in this age group(AU)

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. .

Referred dental pain, an analysis of their prevalence and clinical implication / Dolor dental referido, análisis de su prevalencia e implicancias clínicas

The study objective was to evaluate the prevalence of referred dental pain (RDP) in a group of Brazilians subjects and identify possible partnerships with sex, age and the presence of periodontal or periapical lesions. A descriptive cross-sectional study was designed, 98 patients between 14 and 64 years old (59 women and 39 men), who consulted by dental pain were evaluated clinically and radiographically in order to determine the cause and partnership with periapical and periodontal lesions and its possible territories projection other than their origin. The prevalence of RDP was 31.6 percent, higher in women (67.74 percent) though without statistical significance. The RDP was presented at a 45.16 percent together with periapical lesion and a 25.8 percent along with periodontal lesion. There was no relationship between age and RDP presence. The high prevalence of RDP found reinforces the need for a diagnosis of orofacial pain.

El objetivo de este estudio fue analizar la prevalencia de dolor referido dental (DRD) en un grupo de sujetos brasileros y determinar las posibles asociaciones con sexo, edad y la presencia de lesión periapical o periodontal. Se diseñó un estudio descriptivo de corte transversal, con 98 pacientes, de entre 14 y 64 años (59 mujeres y 39 hombres), que consultaron por dolor dental, ellos fueron evaluados clínica y radiográficamente con el fin de determinar la causa y la asociación con lesión periapical y periodontal y su posible proyección a territorios distintos de su origen. La prevalencia del DRD fue de 31,6 por ciento, mayor en mujeres (67,74 por ciento) aunque sin significancia estadística. El DRD se presentó en un 45,16 por ciento junto con lesión periapical y un 25,8 por ciento junto a lesión periodontal. No se encontró asociación entre la edad y la presencia de DRD. La alta prevalencia de DRD encontrada refuerza la necesidad de un diagnóstico etiológico del dolor orofacial.

Análise epidemiológica, microbiológica e resposta imune periapical em pacientes HIV positivos e negativos portadores de infecções endodônticas / Epidemiologival, microbiological and immunological analysis of endodontic infections in HIV positive and HIV negative patients

As patologias pulpo-periapicais abrangem muitas áreas do conhecimento, tais como a epidemiologia, microbiologia e imunologia. Muito estudadas em humanos e animais, pouco foi pesquisado sobre a interferência da síndrome da imunodeficiência adquirida humana sobre essas alterações. Este estudo analisou a necessidade de tratamento endodôntico em uma população HIV-positiva, e correlacionou esse achado com os dados pessoais e sistêmicos desses indivíduos. Aqueles que apresentavam necessidade de tratamento endodôntico tiveram seus canais radiculares analisados quanto ao perfil microbiológico e imunológico. Pacientes HIV negativos foram também avaliados para que se confrontassem os dados...

A survey of oral and maxillofacial biopsies in children: a single-center retrospective study of 20 years in Pelotas-Brazil

Despite the large number of published cases about oral and maxillofacial pediatric lesions, the literature is scarce on epidemiological studies regarding the prevalence of these entities. This study retrieved oral and maxillofacial pediatric lesions from the Center of Diagnosis of Oral Diseases (CDDB) at the Dental School of the Federal University of Pelotas (UFPEL), comprising a 20-year period (1983-2002). From the total of 9,465 biopsies received in this period, 625 (6.6%) were from children aged 0 to 14 years. Regardless of the histopathological diagnosis, patient data referring to lesion location, sex and age were collected. Diagnoses were grouped in 13 categories. As much as 89 percent of the cases occurred in patients aged 7 to 14 years (53% in females and 47 percent in males). Mucocele (17.2%) was the most common type of lesion, followed by dentigerous cyst (8.6%). In the category of odontogenic tumors, odontoma was the most frequent lesion (64.2%). Malignant lesions were observed in a small section of the sample (1.2%). Generally, the results of the present study are in line with those reported in the literature concerning the most prevalent lesions in the pediatric population. Most lesions were benign, and malignant lesions were diagnosed in a very small part of the sample.

Avaliaçäo de achados radiográficos em pacientes encaminhados para tratamento ortodôntico e/ou ortopédico facial / Radiographic findings evaluation in orthodontic patients going through orthodontic and/or orthopedic treatment

O objetivo deta pesquisa foi fazer o levantamento de anomalias dentárias e de lesöes periapicais assintomáticas descobertas através do exame radiográfico de rotina e relevantes para o diagnóstico e planejamento ortodôntico/ortopédico facial. Foram inspecionadas, aleatoriamente, num Centro Radiológico na cidade de Varginha - MG, 500 radiografias panorâmicas de pacientes de ambos os sexos, na faixa etária dos 6 aos 50 anos, que iriam se submeter ao tratamento ortodôntico/ortopédico facial. A avaliaçäo radiográfica constou da detecçäo das seguintes alteraçöes: anodontias, dentes supranumerários, dilaceraçöes radiculares, lesöes periapicais e dentes retidos/impactados. Os resultados mostraram que 178 radiografias (35,6 por cento) apresentaram-se com anomalias e/ou alteraçöes periapicais, sendo 136 dentes retidos/impactados, 29 anodontias, 21 com dilaceraçöes radiculares, 70 lesöes periapicais e 31 supranumerários. Concluímos que a radiografia panorâmica deve ser rotina nas fases de pré, trans e pós-tratamento ortodôntico/ortopédico facial, e que o sucesso desse tratamento está diretamente associado ao diagnóstico radiográfico