Manifestações orais e Covid-19: Revisão Sistemática da literatura / Oral Manifestations and Covid-19: Systematic literature review

A doença COVID-19, que se tornou uma pandemia em pouco espaço de tempo, apresenta uma ameaça grave para a saúde global. As condições bucais de pacientes com COVID-19 foram analisadas em vários estudos. Diante disso, observou-se que diversas manifestações bucais foram encontradas nesses pacientes. O objetivo deste trabalho foi realizar uma revisão de literatura sistemática sobre as manifestações bucais que podem estar associadas à doença COVID-19. A pesquisa foi realizada por meio de uma revisão sistemática nas bases de dados Bireme, PubMed e SciELO, no período de 30 de abril de 2021 a 11 de maio de 2023. A busca utilizou os descritores "COVID-19", "coronavirus" e "oral manifestations". Foram utilizados como critério de inclusão a presença do artigo completo disponível na íntegra e publicado nos anos de 2020 a 2023 e excluídos aqueles que não relatavam alguma manifestação da COVID-19 ou que não abordavam formas de tratamento. Foram incluídos 19 artigos. As informações foram compiladas de forma a compreender a importância de se investigar as manifestações orais em decorrência dessa doença, devido a sua importância internacional dadas às suas circunstâncias devastadoras. Concluiu-se que é notável a importância da anamnese e o exame intraoral para diagnosticar as manifestações orais nos pacientes sob suspeita ou confirmados com a COVID-19, e o diagnóstico precoce das alterações é fundamental para assegurar um suporte adequado ao paciente acometido. Mais estudos são necessários para comprovar a associação direta entre a COVID-19 e as manifestações orais relatadas.

COVID-19, which has become a pandemic in a short time, poses a serious threat to global health. The oral conditions of patients with COVID-19 have been analyzed in several studies. Therefore, it was observed that several manifestations were found in these patients. The objective of the work is to carry out a systematic literature review on the oral manifestations that may be associated with the disease COVID-19. The research was carried out through a systematic review in the databases Bireme, PubMed and SciELO, from April 30, 2021 o May 11, 2023. The search using the descriptors "COVID-19", "coronavirus" and "Oral manifestations". Inclusion criteria were the presence of the full article available in full and published in 2020 and 2023. Articles that did not report any manifestation of COVID-19 or those that did not address forms of treatment were excluded. 19 articles were included. The information was compiled in order to understand the importance of investigating oral manifestations as a result of this disease, due to its international importance given to its devastating entities. It was concluded that the importance of anamnesis and intraoral examination for the diagnosis of oral manifestations in patients suspected or confirmed with COVID-19 is remarkable, and the early diagnosis of alterations is essential to ensure adequate support for the affected patient. Further studies are needed to prove the direct association between COVID-19 and the reported oral manifestations.

Concordância entre agravos bucais autorreferidos durante e após a COVID-19 e condições clínicas de pacientes de um município do Sul do Brasil / Agreement between self-reported oral disorders during and after COVID-19 and clinical conditions of patients in municiplity in Southerm Brazil

O objetivo do presente estudo foi identificar a concordância entre agravos bucais autorreferidos durante e após a COVID-19 e condições clínicas de pacientes do município de Palhoça-SC. Materiais e Método: Estudo exploratório, transversal de base quantitativa descritiva com 30 participantes que possuíram testagem positiva para COVID-19 no município de Palhoça-SC. Cada paciente participou de uma avaliação clínica, identificando os agravos bucais, nessa mesma oportunidade, foram registrados dados sociodemográficos e condições bucais autorreferidas. Todas as análises foram conduzidas pelo Software Stata® versão 13. Análises descritivas, inferenciais pelo teste de Qui-quadrado de Pearson (α=5%). Concordância entre presença dos agravos bucais autorreferidos e presença do agravo avaliado clinicamente, pelo coeficiente Kappa e classificadas como: fraca 0 a 0,20; razoável 0,41 a 0,60; boa 0,61 a 0,80; muito boa 0,81 a 0,92; e excelente 0,93 a 1,00. Resultados: A maioria da amostra foram de mulheres (70%), com idade entre 36-59 anos (56,6%) e de baixa renda (70%). Houve concordância boa entre presença de cárie e relato de dor (Kappa=0,70), e para o diagnóstico clínico de sangramento gengival e autopercepção ruim/péssima a classificação também foi boa (Kappa=0,72). Todavia, a concordância entre o relato de sintomas de boca seca e baixo fluxo salivar foi considerada razoável (Kappa=0,57), assim como, para a presença de bolsa periodontal e o relato de autopercepção ruim/péssima (Kappa=0,41). Conclusão: A autopercepção das condições de saúde bucal durante a pandemia foi concordante com determinadas condições clínicas que necessitam de atendimento odontológico, corrobando com as preocupações sobre o agravamento das condições bucais durante a pandemia.(AU)

Aim: To identify the concordance between self-reported oral health problems during and after COVID-19 and clinical conditions of patients in the city of Palhoça-SC. Materials and Method: Exploratory, cross-sectional study with a descriptive quantitative base, formatted by 30 patients who tested positive for COVID-19 in the municipality of Palhoça-SC. Each patient participated in a clinical evaluation, identifying oral health problems. At the same time, sociodemographic data and self-reported oral conditions were recorded. All analyzes were performed using the Stata® Software, version 13. Descriptive and inferential analyzes were performed using Pearson's chi-square test (α=5%). Agreement between the presence of self-reported oral health problems and the presence of the clinically evaluated disease, by the Kappa coefficient and classified as: weak 0 to 0.20; take 0.21 to 0.40; reasonable 0.41 to 0.60; good 0.61 to 0.80; very good 0.81 to 0.92; and excellent 0.93 to 1.00. Results: Most of the sample were women (70%), aged between 36-59 years (56.6%) and low-income (70%). There was good agreement between the presence of caries and reported pain (Kappa=0.70), and for the clinical diagnosis of gingival bleeding and bad/very poor self-perception, the classification was also good (Kappa=0.72). However, the agreement between the report of symptoms of dry mouth and low salivary flow was considered reasonable (Kappa=0.57), as well as the presence of periodontal pockets and the report of poor/terrible self-perception (Kappa=0.41). Conclusion: The self-perception of oral health conditions during the pandemic was consistent with certain clinical conditions that require dental care, corroborating concerns about the worsening of oral conditions during the pandemic.(AU)

Defectos bucodentales en personas con síndrome de Down: una prioridad en salud bucal / Oral-dental defects in people with Down's syndrome: a priority in oral health

RESUMEN El síndrome de Down con frecuencia se acompaña de defectos bucodentales que comprometen la función masticatoria y fonatoria del paciente. Las acciones de prevención y promoción de salud bucal, el diagnóstico precoz y seguimiento de estas enfermedades, contribuyen al logro del verdadero enfoque interdisciplinario que demandan estos pacientes, para lograr una plena inclusión social. Se realizó una búsqueda bibliográfica sobre el tema, con el objetivo de estructurar los referentes teóricos relacionados con los principales defectos bucodentales -congénitos y adquiridos- que afectan a la población con síndrome de Down, para lograr la prevención de estos defectos y el incremento de la calidad de vida de los pacientes. Los defectos bucodentales congénitos más frecuentes encontrados en la trisomía 21, fueron la microdoncia, la macroglosia y la erupción dental tardía. La enfermedad periodontal fue el defecto adquirido de mayor presentación, al que se asocian diversos factores de riesgo, muchos modificables. Las intervenciones tempranas en salud bucal pueden incrementar la calidad de vida de los niños y adultos que padecen este trastorno, ayudándolos a lograr un pleno desarrollo como seres humanos (AU).

ABSTRACT Down's syndrome is frequently accompanied by oral-dental defects compromising the masticatory and phonatory function of the patients. Oral health promotion and prevention actions, precocious diagnosis and follow-up of these diseases contribute to achieving the true interdisciplinary approach these patients demand to reach their full social inclusion. A bibliographic search on the theme was carried out, with the objective of structuring the theoretical referents related to the main oral-dental defects -congenital and acquired-, affecting the population with Down's syndrome to reach these defects prevention and increasing these patients' life quality. The congenital oral-dental defects more commonly found in trisomy 21 were microdontia, macroglossia, and delayed tooth eruption. Periodontal disease was more frequently found acquired defect, to which several risk factors are associated, many of them modifiable. Early interventions in oral health may improve the life quality of these children and adults, helping them to achieve a full development as human beings (AU).

Sensibilidad y especificidad de pruebas moleculares en odontología / Sensitivity and specificity of molecular tests in dentistry

La biología molecular tiene mayor afinidad en las áreas de la salud, en odontología su principal aplicación ha sido en la identificación de microorganismos orales patógenos mediante el uso de secuencias genéticas específicas (ácido desoxirribonucleico [DNA], ácido ribonucleico [RNA] y proteínas). Las pruebas a nivel molecular se caracterizan por su rapidez, reproductibilidad, sensibilidad y especificidad de los microorganismos diana. El presente artículo de revisión bibliográfica servirá como herramienta para comprender los principios de las técnicas más destacadas como son: PCR estándar y RT-PCR en tiempo real, PCR con transcriptasa inversa, microarreglos y ensayo por inmunoabsorción ligado a enzimas (ELISA), además de sus ventajas y desventajas respecto a las pruebas convencionales (AU)

Molecular biology has a greater affinity in the areas of health. In dentistry, its main application has been the identification of pathogenic oral microorganisms, through the use of specific genetic sequences (deoxyribonucleic acid [DNA], ribonucleic acid [RNA] and proteins). Molecular tests are characterized by their rapidity, reproducibility, sensitivity and specificity of target microorganisms. This literature review article will serve as a tool to understand the principles of the most prominent techniques such as: Standard PCR, Real-time RT-PCR, Reverse transcriptase PCR, microarrays and Enzyme-linked immunosorbent assay (ELISA), in addition to their advantages and disadvantages with respect to conventional tests (AU)

Intervención comunitaria en salud bucal en la población de San Pablo de Pillao, Perú, 2018 / Community oral health intervention in the population of San Pablo de Pillao, Peru, 2018

RESUMEN Introducción. Las intervenciones comunitarias permiten promover la salud y prevenir enfermedades en el poblador. Objetivo. Describir los diagnósticos y tratamientos realizados por estudiantes de odontología en el Campamento Universitario Multidisciplinario de Investigación y Servicio. Métodos. Se diseñó un estudio epidemiológico, con el enfoque cuantitativo en el distrito de San Pablo de Pillao, provincia Huánuco, Perú. Participaron docentes y estudiantes de la Facultad de Medicina, Humana, Odontología, Nutrición y Psicología. De un total de 250 asistentes a las sesiones, 95 adultos fueron atendidos en la consulta odontológica. Se realizaron sesiones educativas referidas a "anemia y desnutrición", "enfermedades diarreicas", "infecciones respiratorias", "alcoholismo y violencia", "crecimiento y desarrollo", "lactancia materna" y "salud bucal", así como una campaña de diagnóstico y tratamiento de efecciones bucodentales. Se utilizó el programa Excel para el análisis de datos. Resultados. Se atendieron 95 pobladores adultos. El 6,3 por ciento correspondió a edéntulos totales y el 40 por ciento a edéntulos parciales. De los dentados, el 97,3 por ciento presentó caries dental con un promedio de índice CPOD (suma de los dientes cariados + dientes perdidos + dientes obturados, en la dentición pemanente) de 2,08 ± 1,56. Con respecto al estado periodontal, el 38,9 por ciento presentó inflamación gingival severa. En los adultos se realizó 35 restauraciones, 28 exodoncia y 8 ajustes de prótesis. En adultos y niños se realizaron fluorizaciones y cinco actividades educativas de promoción de la salud. Conclusiones. La presencia de caries y enfermedad gingival fue altamente prevalente; las principales actividades terapéuticas realizadas en el campamento fueron las restauraciones y exodoncia(AU)

ABSTRACT Introduction: Community interventions make it possible to promote health and prevent disease in the population. Objective: Describe the diagnoses and treatments made by dental students at the Multidisciplinary Research and Service University Camp. Methods: A qualitative epidemiological study was designed for the district of San Pablo de Pillao, Huánuco province, Peru. The participants were teachers and students from the School of Human Medicine, Dentistry, Nutrition and Psychology. Of the total 250 subjects attending the sessions, 95 adults were cared for at the dental service. The educational sessions conducted dealt with the topics of "anemia and malnutrition", "diarrheal diseases", "respiratory infections", "alcoholism and violence", "growth and development", "breastfeeding" and "oral health", as well as a campaign about diagnosis and treatment of oral disorders. Data analysis was performed on Microsoft Excel. Results: Of the total 95 adult residents cared for, 6.3 percent were totally edentulous and 40 percent were partially edentulous. Of the dentate subjects, 97.3 percent had dental caries with a mean DLRP index (sum total of decayed + lost + restored permanent teeth) of 2.08 ± 1.56. As to periodontal status, 38.9 percent had severe gingival inflammation. A total 35 restorations, 28 exodontias and 8 prosthesis adjustments were performed on adult patients. Adults and children alike received fluoridation and attended five educational health promotion sessions. Conclusions: Dental caries and gingival disease were highly prevalent. The main therapeutic actions performed in the camp were restorations and exodontia(AU)

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center / Diagnosticando sífilis adquirida através de lesões orais: a experiência de 12 anos de um Centro de Medicina Oral

Abstract Introduction: A resurgence of syphilis in Brazil has been reported in recent years. Objective: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. Methods: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. Results: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). Conclusion: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Resumo Introdução: Um ressurgimento da sífilis no Brasil tem sido relatado nos últimos anos. Objetivo: Investigar a frequência, as características demográficas e clínicas dos pacientes com sífilis adquirida com envolvimento oral que receberam atendimento médico em um centro de referência em medicina oral em um hospital público brasileiro. Método: Estudo retrospectivo, abrangeu 12 anos, feito para identificar tendências de mudança na sífilis. Registros médicos de todos os pacientes diagnosticados com sífilis adquirida que receberam atendimento médico na clínica de medicina oral do hospital de 2005 a 2016 foram revisados e os dados demográficos e clínicos foram coletados. Resultados: Foram diagnosticas 85 pacientes com sífilis adquirida, com um aumento significativo no número de casos nos últimos 5 anos. A idade dos pacientes variou de 16 a 76 anos, com pico na terceira e quarta décadas; 48 casos eram do sexo masculino (56,5%) e 37 do sexo feminino (43,5%). A maioria das lesões orais apareceu como úlceras ou placas únicas, os lábios e a língua representaram os locais mais afetados. Todos os casos foram positivos para Venereal Disease Research Laboratory e Fluorescent Treponemal Antibody Absorption Test e o tratamento foi feito com penicilina G benzatina na maioria dos casos (84,7%). Conclusão: A frequência da sífilis oral tem aumentado com o tempo e as lesões orais podem representar uma pista diagnóstica; portanto, os profissionais de saúde bucal devem ser conscientizados e devidamente treinados na tentativa de desenvolver um alto grau de suspeição clínica no diagnóstico da sífilis.

Biomarcadores salivares no diagnóstico e no monitoramento de patologias orais e sistêmicas / Biomarcadores salivares en el diagnóstico y monitoreo de enfermedades bucales y sistémicas / Salivary biomarkers for the diagnosis and monitoring of oral and systemic diseases

RESUMO Introdução: A saliva humana é constituída de um vasto arsenal de produtos secretórios com imenso potencial informativo e útil para detecção de determinadas patologias. A facilidade de obtenção e a especificidade dos biomarcadores, faz desta uma importante ferramenta clínica como método diagnóstico. Objetivo: Verificar, através de uma revisão de literatura, a utilização da saliva como método diagnóstico para doenças orais e sistêmicas. Métodos: Foram selecionados artigos publicados em inglês, no banco de dados online PubMed com descritores "saliva", "biomarkers" e "diagnosis", entre o período de 2013 a setembro 2018. Foram incluídos artigos no idioma inglês, dos últimos 5 anos. Foram obtidos 245 artigos. O estudo se conteve em 17 destes. Análise e integração da informação: Foi notória a aplicabilidade da saliva como método diagnóstico para uma variedade de doenças, entre as quais se podem citar: doenças bacterianas como a cárie dentária, pela detecção do Streptococcus mutans e Lactobacillus spp.; doenças autoimunes como a Síndrome de Sjögren, indicada não apenas pela redução do fluxo salivar, como também pelo aumento na concentração de sódio, cloro, Imunoglobulina A (IgA), Imunoglobulina G (IgG), e Prostaglandina E2 (PGE2); doenças virais como no diagnóstico auxiliar do HIV 1 e 2 pela expressão de IgG e também no diagnóstico precoce de enfermidades malignas como o carcinoma de células escamosas e o câncer de mama, pela detecção de anticorpos frente à proteína p53 e pela presença de marcadores tumorais como o c-erbB-2. Conclusão: O diagnóstico molecular na cavidade oral por meio da saliva mostra ser um método simples, não invasivo e muito promissor para o diagnóstico e monitoramento de inúmeras patologias(AU)

RESUMEN Introducción: La saliva humana está constituida de un considerable arsenal de productos secretorios con inmenso potencial informativo y útil para la detección de determinadas enfermedades. La facilidad de obtención y la especificidad de los biomarcadores, hace de esta una importante herramienta clínica como método diagnóstico. Objetivo: Verificar, por medio de una revisión bibliográfica, la utilización de la saliva como método diagnóstico para enfermedades bucales y sistémicas. Métodos: Se seleccionaron artículos publicados en inglés, en la base de datos online PubMed con descriptores "saliva", "biomarkers" y "diagnosis", entre el período de 2013 a septiembre de 2018. Se incluyeron artículos en idioma inglés, de los últimos 5 años. Se obtuvieron 245 artículos. El estudio se circunscribió a 17. Análisis e integración de la información: Se observó la aplicabilidad de la saliva como método diagnóstico para una variedad de enfermedades, entre las que cabe citar: enfermedades bacterianas como la caries, por la detección del Streptococcus mutans y Lactobacillus spp.; las enfermedades autoinmunes como el síndrome de Sjögren, indicado no solo por la reducción del flujo salivar, sino también por el aumento en la concentración de sodio, cloro, Inmunoglobulina A (IgA), Inmunoglobulina G (IgG), y Prostaglandina E2 (PGE2); las enfermedades virales como el diagnóstico auxiliar del VIH 1 y 2 por la expresión de IgG y también el diagnóstico precoz de enfermedades malignas como el carcinoma de células escamosas y el cáncer de mama, por la detección de anticuerpos contra la proteína p53 y por la presencia de marcadores tumorales como el c-erbB-2. Conclusiones: El diagnóstico molecular en la cavidad bucal por medio de la saliva muestra ser un método simple, no invasivo y muy prometedor para el diagnóstico y monitoreo de innumerables enfermedades(AU)

ABSTRACT Introduction: Human saliva consists of a vast arsenal of secretory products with huge information potential useful for the detection of certain diseases. The easy availability and the specificity of biomarkers make them an important clinical tool as a diagnostic method. Objective: By means of a bibliographic review, verify the use of saliva as a diagnostic method for oral and systemic diseases. Methods: A bibliographic search was conducted in the online database PubMed for papers published in English from 2013 to September 2018, using the search terms "saliva", "biomarkers" and "diagnosis". Papers written in English in the last five years were selected. Of the 245 papers obtained, the study considered 17. Data analysis and integration: It was found that saliva may be used as a diagnostic method for a variety of diseases. These include bacterial diseases such as dental caries, by detection of Streptococcus mutans and Lactobacillus spp.; autoimmune diseases such as Sjögren's syndrome, indicated not only by the decrease in salivary flow, but also by the increase in the concentration of sodium, chlorine, immunoglobulin A (IgA), immunoglobulin G (IgG), and prostaglandin E2 (PGE2); viral diseases as in the auxiliary diagnosis of HIV 1 and 2 by IgG expression and also in the early diagnosis of malignant diseases such as squamous cell carcinoma and breast cancer by detection of antibodies against p53 protein and the presence of tumor markers such as c-erbB-2. Conclusions: Molecular diagnostic examination of the oral cavity using saliva has shown to be a simple, non-invasive and very promising method for the diagnosis and monitoring of numberless diseases(AU)

Leishmaniasis mucocutánea con manifestacion oral: reporte de un caso / Mucocutaneous leishmaniasis with oral manifestation: case report

La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.

Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina, Brazil / Incidência de lesões hiperplásicas reativas na cavidade bucal: estudo retrospectivo de 10 anos em Santa Catarina, Brasil

Abstract Introduction Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions. Objective The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined. Methods A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients' files. Results A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5-2 cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%). Conclusion Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.

Resumo Introdução As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes. Objetivo A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados. Método Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes. Resultados Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2 cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%). Conclusão As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo.

Paraneoplastic pemphigus: a clinical, laboratorial, and therapeutic overview

Abstract: Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.

Salivary Transferrin Levels in Patients with Oral Lichen Planus

Objective: To compare salivary transferrin levels between patients with oral lichen planus (OLP) and healthy subjects. Material and Methods: In this descriptive, analytical, crosssectional study, 11 patients with OLP and 22 healthy subjects were selected after matching in terms of age and gender. OLP was confirmed by two oral medicine specialists based on clinical and histopathological criteria. Salivary samples were collected by spitting. The patients were asked to collect their saliva in their oral cavity and then evacuate it into sterilized Falcon tubes. The procedure was repeated every 60 seconds for 5-15 minutes. A total of 5 mL of saliva was collected using this method. The samples were collected from 8 to 9 in the morning in a fasting state to avoid circadian changes. The collected salivary samples were immediately placed next to ice and transferred to the laboratory to be centrifuged at 4°C at 800 g to isolate squamous cells and cellular debris. Then the samples were frozen at -80°C until the samples were prepared. An ELISA kit was used to determine salivary transferrin levels. Data were analyzed with descriptive statistics (means and standard deviations) and t-test for independent groups using SPSS 17. Statistical significance was set at p<0.05. Results: The mean salivary transferrin concentrations in patients with OLP and healthy subjects were 0.9055±0.28229 and 1.5932±0.80041 mg/dL, respectively (p<0.05). Conclusion: The salivary transferrin levels in patients with OLP were significantly lower than those in healthy subjects.

Efectos negativos de la ansiedad al tratamiento estomatológico / Negative effects of anxiety to dental treatment

Introducción: La ansiedad al tratamiento estomatológico es un fenómeno psicológico cuyos efectos negativos en el paciente adulto tienen gran impacto desde el punto de vista psicológico y de salud bucal. Objetivo: Realizar una revisión bibliográfica de los efectos negativos de la ansiedad al tratamiento estomatológico en el paciente adulto. Métodos: Se efectuó un estudio de revisión bibliográfica sobre ansiedad al tratamiento estomatológico y sus efectos en el individuo, tomando en consideración la bibliografía publicada en Google académico, SciELO y Medline en el período comprendido de enero del 2013 a diciembre de 2017. Se obtuvo como resultado un total de 50 artículos, 46 de ellos en revistas internacionales, uno en revista nacional y tres libros, de los cuales fueron utilizados 33 una vez aplicado los criterios de exclusión establecidos. Análisis e integración de la información: La no adherencia al tratamiento estomatológico como consecuencia de la ansiedad está relacionada con la última visita realizada a la consulta y la frecuencia con que habitualmente acuden a recibir la atención, aspectos estos considerados fundamentales para abordar este fenómeno. Específicamente los efectos sobre el órgano dentario y los de sostén, son las consecuencias bucales que se informan en investigaciones actuales, para referirse al deterioro de la salud bucal en relación con este fenómeno psicológico. Los pacientes ansiosos ante el tratamiento estomatológico no sufren solamente consecuencias sobre su salud bucal, también es posible apreciar consecuencias psicológicas, relacionadas fundamentalmente con emociones negativas y un aislamiento social del individuo como resultado de su deterioro bucal. Conclusiones: La ansiedad al tratamiento estomatológico es el resultado histórico de las creencias y actitudes de las personas, que las llevan a rechazar o evitar la Estomatología como especialidad médica. Sus efectos son el resultado de la no adherencia al tratamiento, lo cual trae consigo problemas de salud bucal; además se nota un efecto psicológico considerable(AU)

Introduction: Anxiety to dental treatment is a psychological phenomenon whose negative effects in the adult patient have great impact from the points of view of psychology and oral health. Objective: To carry out a bibliographic review about the negative effects of anxiety on dental treatment in adult patients. Methods: A bibliographic review study on anxiety to dental treatment and its effects on the individual was carried out, taking into consideration the bibliography published in Google Academic, SciELO and Medline in the period from January 2013 to December 2017. As a result, we obtained a total amount of 50 articles, 46 of them in international journals, one in a national journal and three books, of which 33 were used once the established exclusion criteria were applied. Analysis and integration of the information: Non-adherence to dental treatment as a consequence of this anxiety is associated with the last visit made to the dental office and the frequency with which they usually attend to receive dental care, being the fundamental aspects considered to address this phenomenon. Specifically, the effects on the dental organ and those of support are the oral consequences reported in the current research, for referring to the deterioration of oral health in relation to this psychological phenomenon. Patients anxious about dental treatment do not only suffer consequences on their oral health, it is also possible to appreciate psychological consequences, mainly associated with negative emotions and social isolation of the individual as a result of their oral deterioration. Conclusions: Anxiety to dental treatment is the historical result of the beliefs and attitudes of the people, leading them to reject or avoid dental medicine as a medical specialty. Its effects are the result of non-adherence to treatment, bringing about oral-health problems. Also, a considerable psychological effect is noticed(AU)

Lesões vasculares orais: avaliações clínicas, diagnósticas e terapêuticas / Lesiones vasculares bucales: evaluaciones clínicas, diagnósticas y terapéuticas / Oral vascular lesions: clinical, diagnostic and therapeutic evaluations

Introdução: As patologias vasculares acometem com alta incidência as regiões de cabeça e pescoço. Quando essas acometem a região oral, nota-se predileção por lábios, língua e comissura bucal, com predominância no sexo feminino. Objetivo: Analisar sobre as lesões vasculares orais, enfatizando as características clínicas, métodos de diagnósticos e abordagem terapêutica. Métodos: Trata-se de uma revisão literária, com busca bibliográfica, realizada nas bases de dados eletrônicos PubMED/Medline, Lilacs, Science Direct e SciELO (Scientific Eletronic Library), utilizando os descritores: Hemangioma, Malformações vasculares, escleroterapia e fotocoagulação, em português, inglês e espanhol, obtendo 262 artigos completos, dos quais 18 foram utilizados como base científica apropriada para tal tema, obedecendo aos critérios de inclusão e exclusão. Resultados: As lesões vasculares orais caracterizam-se clinicamente como lesões únicas do tipo nódular ou mancha, cuja coloração varia do vermelho intenso ao roxo e de tamanho variável. Para diagnosticar essas lesões, utilizam-se comumente exames clínicos associados à diascopia, sem na maioria dos casos necessitarem de exames complementares. A intervenção terapêutica justifica-se devido às deformidades estéticas, possíveis sangramentos, ulcerações e infecções. Para tais alterações, existem diversas modalidades terapêuticas, incluindo escleroterapia, crioterapia, remoção cirúrgica e terapia de fotocoagulação a laser. Conclusão: As lesões vasculares orais exibem caracteristicas clinicas peculiares, apresentando-se como nódulos ou manchas, cuja coloração varia do vermelho intenso ao roxo. A diascopia é a manobra semiotécnica mais utilizada e confiável para o estabelecimento do diagnóstico clínico dessas lesões. A utilização de soluções esclerosantes apresenta-se como o tratamento mais descrito na literatura, seguido da fotocoagulação a laser(AU)

Introducción: Las enfermedades vasculares afectan con alta incidencia las regiones de cabeza y cuello. Cuando estas afectan la región bucal, se nota predilección por labios, lengua y comisura bucal, con predominio en el sexo femenino. Objetivo: Analizar sobre las lesiones vasculares bucales, enfatizando en las características clínicas, los métodos de diagnóstico y el enfoque terapéutico. Métodos: Se realizó una revisión bibliográfica en las bases de datos PubMED/Medline, Lilacs, Science Direct e SciELO. Se utilizaron los descriptores hemangioma, malformaciones vasculares, escleroterapia y fotocoagulación, en portugués, inglés y español. Se obtuvieron 262 artículos completos, de los cuales 18 fueron utilizados como base científica apropiada para tal tema, según los criterios de inclusión y exclusión. Resultados: Las lesiones vasculares bucales se caracterizan clínicamente como lesiones únicas del tipo nódular o mancha, cuya coloración varía del rojo intenso al púrpura y de tamaño variable. Para diagnosticar estas lesiones, se utilizan comúnmente exámenes clínicos asociados a la diascopia, sin que en la mayoría de los casos necesiten exámenes complementarios. La intervención terapéutica se justifica debido a las deformidades estéticas, posibles sangrados, ulceraciones e infecciones. Para estas alteraciones existen diversas modalidades terapéuticas, incluyendo escleroterapia, crioterapia, remoción quirúrgica y terapia de fotocoagulación láser. Conclusiones: Las lesiones vasculares bucales muestran características clínicas peculiares, presentándose como nódulos o manchas, cuya coloración varía del rojo intenso al púrpura. La diacopia es la maniobra semiotécnica más utilizada y confiable para el establecimiento del diagnóstico clínico de estas lesiones. El uso de soluciones claras se presenta como el tratamiento más descrito en la literatura, seguido de la fotocoagulación láser(AU)

Introduction: Vascular disorders affect the head and neck regions with high incidence. When they affect the oral region, there is a predilection for lips, tongue and mouth commissure, predominantly in the female. Objective: To analyze oral vascular lesions, emphasizing the clinical characteristics, diagnostic methods and therapeutic approach. Methods: A bibliographic review was carried out in the databases PubMED/Medline, Lilacs, Science Direct andSciELO (Scientific Electronic Library). We used the descriptors hemangioma, vascular malformations, sclerotherapy and photocoagulation, in Portuguese, English and Spanish. We obtained 262 complete articles, of which 18 were used as appropriate scientific basis for this topic, based on the inclusion and exclusion criteria. Results: Oral vascular lesions are clinically characterized as single lesions of the nodes or blotches, whose color varies from deep red to purple and are of variable size. In order to diagnose these lesions, clinical examinations associated with the periodontal disease are commonly used, although in most cases they do not require complementary examinations. The therapeutic intervention is justified due to aesthetic deformities, possible bleeding, ulcerations and infections. For such changes, there are several therapeutic modalities, including sclerotherapy, cryotherapy, surgical removal and laser photocoagulation therapy. Conclusions: Oral vascular lesions show peculiar clinical characteristics, presenting as nodules or spots, whose coloration varies from intense red to purple. Diascopy is the most used and reliable semi-technical method for establishing the clinical diagnosis of these lesions. The use of sclerosing solutions is the most described treatment in the literature, followed by laser photocoagulation(AU)

Oral mucosa lesions as atypical manifestation of adult-onset Still´s disease

Abstract: Adult-onset Still's disease is a systemic inflammatory disorder of unknown etiology, characterized by skin rash, spiking fever, arthralgias or arthritis, and leukocytosis. The typical skin rash is evanescent, salmon-pink, nonpruritic and maculopapular, predominantly on the extremities. It is considered one of the major Yamaguchi's criteria in adult-onset Still's disease. However, atypical skin lesions are also described. Here, a 61-year-old woman with sore throat, spiking fever, polyarthritis and evanescent salmon-pink nonpruritic maculopapular skin rash on the extremities was diagnosed with adult-onset Still's disease. In addition, atypical brown macules on oral mucosa, localized on the inner lips and tongue were also observed. Biopsy revealed a neutrophilic infiltrate. Despite treatment and improvement of the adult-onset Still's disease, the atypical oral mucosal lesions persisted.

Maxillary Osteomyelitis by Actinomyces in a Child / Osteomielitis Maxilar por Actinomyces en un Niño

ABSTRACT: Actinomycosis is a bacterial infection caused by Actinomyces species, which usually affect the soft tissues of the cervicofacial region of adult males. Clinically, it's characterized by a slow-growing indurated mass, especially in the submandibular area. However, in a few cases, the jaws bones can be affected developing osteomyelitis characteristics. The aim of this paper is to report a rare clinical case of Actinomycotic Osteomyelitis affecting the maxilla of a child, involving the maxillary sinus, orbital and zygomatic areas that was treated by the association of antibiotic therapy and surgical debridement. The patient's 2 years follow-up was uneventful and no signs of the lesion recurrence.

RESUMEN: La actinomicosis es una infección bacteriana causada por la especie Actinomyces, que generalmente afecta los tejidos blandos de la región cervicofacial de los hombres adultos. Clínicamente, se caracteriza por una masa endurecida de crecimiento lento, especialmente en la zona submandibular. Sin embargo, en algunos casos, los huesos de las mandíbulas pueden ser afectados desarrollando características de osteomielitis. El objetivo de este trabajo es reportar un caso clínico poco frecuente de osteomielitis actinomicótica que afecta el maxilar de un niño, envolviendo el área del seno maxilar, y zonas orbitales y cigomáticas que fueron tratadas con la asociación de terapia con antibióticos y desbridamiento quirúrgico. El seguimiento del paciente por 2 años ocurrió sin incidentes y sin signos de recidiva de las lesiones.

Clinical Assessment of Frenum Morphology and Attachment in Malaysian Children

Objective: To determine the prevalence of various types and attachment level of maxillary frenum in Malaysian children. Material and Methods: A cross-sectional study was conducted in a total of 200 children of age ranging from 2 to 15 years. Photographs of maxillary frenum were taken and their types and level of attachment were recorded by using Placek's classification and modified Sewerin typology. Children were divided into 3 groups based on age: between 2-5, 6-11 and 12-15 years. Descriptive analysis was carried out to determine the frequency of frenum types and level of attachment. The relationship of frenal attachment with gender, and age were studied. Data collected was analyzed using descriptive statistics (frequencies, percentages, means and standard deviation). Statistical Package for Social Sciences (SPSS) version 19.0 was used to analyze the data. Results: The most common type was mucosal type of attachment (75%) and the least common was papillary penetrating (4.5%) based on Placek's classification whereas for modified Sewerin's typology, simple frenum (73%) was the most prevalent, followed by simple with nodule frenum (11.5%). There was no significant difference in the frenum attachment between the two genders. Mucosal and gingival attachment was significantly higher in older age group whereas papillary and papillary penetrating was higher in younger age group. Conclusion: This study showed that attachment of frenum in children changes according to age and whereas gender plays no role in portraying the difference. Hence, clinicians must be able to identify the different types of MMLF during dental examination to avoid any unnecessary surgical interventions particularly during the period of development.

Estado de salud oral y calidad de vida en pacientes dependientes moderados y severos, CESFAM Boca Sur, Chile / Oral health status and quality of life in moderate and severe dependent patients, CESFAM Boca Sur, Chile

Introducción: los adultos mayores dependientes presentan una mayor prevalencia y severidad de patologías bucales que el resto de la población, estas pueden influir negativamente en su calidad de vida. Objetivo: caracterizar el estado de salud oral y la calidad de vida relacionada en pacientes adultos mayores dependientes moderados y severos inscritos en el CESFAM Boca Sur, Chile. Materiales y Métodos: se realizó un estudio de corte transversal, la población en estudio fueron adultos mayores dependientes moderados y severos usuarios del CESFAM Boca Sur, Chile. Previo consentimiento informado de los pacientes y sus cuidadores, se les aplicó un cuestionario con variable sociodemográficas a pacientes y cuidadores. Se registraron enfermedad principal, índice COPD, estado periodontal, índice de higiene oral, portador o necesidad de prótesis removible y calidad de vida asociada a salud oral a través del cuestionario OHIP-14Sp validado en población adulta mayor chilena. La tabulación se realizó en Microsoft Excel y el análisis estadístico se hizo en STATA/MP 13.0. Resultados: se incluyeron 47 pacientes, 91,5% de los pacientes requerían algún tipo de tratamiento odontológico. 24 pacientes presentaron estado cognitivo normal. El OHIP-14Sp fue de 11,3±11,7 en pacientes con dependencia moderada, 12,1±9,9 en severa y 11,8±10,4 para la muestra total, las correlaciones del OHIP-14Sp con dientes cariados, perdidos e higiene oral fueron todas menores a 0,2. Conclusiones: la mayoría de los pacientes dependientes moderados y severos inscritos en el CASFAM Boca Sur presentan un mal estado de salud oral y mala calidad de vida relacionada a esta (AU).

Introduction: dependent older adults have a higher prevalence and severity of oral diseases that other populations, they can adversely affect their quality of life Objective: to characterize the state of oral health and related quality of life in moderate and severe dependents elderly patients enrolled in the CESFAM Boca Sur, Chile. Materials and Methods: a cross-sectional study was conducted, the study population were moderate and severe dependents elderly patients enrolled in the CESFAM Boca Sur, Chile. After the informed consent of patients and their caregivers was obtained, were applied a sociodemographic questionnaire. Chief disease, COPD index, periodontal status, oral hygiene index, carrier or need removable prosthesis and quality of life associated with oral health through OHIP-14Sp questionnaire validated in Chilean adult population were registered. Tabulation was done in Microsoft Excel and statistical analysis was done in STATA / MP 13.0. Results: forty-seven patients were included, 91.5% of patients required some type of dental treatment. Twenty-four patients had normal cognitive status. The OHIP-14Sp was 11.3 ± 11.7 in patients with moderate dependence, 12.1 ± 9.9 in severe dependence and 11.8 ± 10.4 for the total sample, the correlations of OHIP-14Sp with decayed teeth , lost and oral hygiene were all less than 0.2. Conclusions: most of the moderate and severe dependent patients enrolled in the CASFAM Boca Sur have a poor oral health and poor quality of life related to it (AU).

Calidad de vida relacionada con salud oral: impacto de diversas situaciones clínicas odontológicas y factores socio-demográficos: revisión de la literatura / Quality of life related to oral health: impact of various socio-demographic factors and dental clinical situations: review of literature

La calidad de vida relacionada con salud oral es un concepto relativamente nuevo que considera la autopercepción del individuo acerca de su salud, como un componente a ser considerado además del examen clínico odontológico. Se planteó una revisión de la literatura, con el objetivo de buscar evidencia científica sobre el impacto que tienen en la vida diaria diversas patologías orales y diversos factores socio-demográficos, en estudios que utilizaron el cuestionario Perfil de Impacto de Salud Oral, en los últimos 5 años (2009-2013). Se concluye que dicho instrumento es válido para el diagnóstico, plan de tratamiento y pronóstico del paciente, sirviendo como guía en el conocimiento de la percepción del paciente acerca de la afectación en su vida diaria, pudiendo de esta manera prever la adherencia del mismo.

The quality of life related to oral health is a relatively new concept that considers the self-perception of the individual about their health as a component to be further considered the dental clinical examination. A narrative review was proposed with the aim of seeking scientific evidence of the impact on daily life various oral pathologies and various socio-demographic factors in studies using Impact Profile Questionnaire Oral Health in the last 5 years (2009-2013). We conclude that the instrument is valid for the diagnosis, treatment plan and prognosis of the patient, serving as a guide in understanding the patient's perception about the effect on their daily lives, and can thus provide the same grip.