Sclerotherapy as an esthetic indication in oral vascular malformations: a case series

Abstract Background The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. Objectives To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. Methods A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. Results A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. Study limitation Small sample size. Conclusions Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n = 16).

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.

Mucosal vitiligo in angles of the mouth: clinical and fluorescence aspects

SUMMARY Vitiligo is the most common depigmenting, chronic acquired disease of the skin and mucosa. However, vitiligo of an unclassified type and mucosal subtype affecting only one area of the mucosa is considered quite uncommon. The diagnosis of vitiligo, regardless of its type, is clinical. Nonetheless, a device that allows the visualization of the tissue fluorescence may be useful for confirming the diagnosis. We present the use of wide-field optical fluorescence device for complementary examination and diagnosis of unusual cases of mucosal vitiligo located only in angles of the mouth.

RESUMO O vitiligo é a doença crônica adquirida despigmentante mais comum da pele e/ou da mucosa. Entretanto, o vitiligo do tipo não classificado e subtipo de mucosa afetando apenas uma área da mucosa é considerado bastante incomum. O diagnóstico de vitiligo, independentemente do seu tipo, é clínico. No entanto, o uso de um dispositivo que permite a visualização da fluorescência tecidual pode ser útil para a confirmação do diagnóstico de vitiligo. Apresentamos o uso do dispositivo de exame complementar de fluorescência óptica de campo amplo para o diagnóstico de um caso incomum de vitiligo de mucosa localizado apenas em ângulos da boca.

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.

A multicenter study of biopsied oral and maxillofacial lesions in a Brazilian pediatric population

Abstract The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among children from representative regions of Brazil. A retrospective descriptive study was conducted. Biopsy records comprising the period from 2000 to 2015 were obtained from the archives of three Brazilian oral pathology referral centers. A total of 32,506 biopsy specimens were analyzed, and specimens from 1,706 children aged 0-12 years were selected. Gender, age, anatomical location and histopathological diagnosis were evaluated. Descriptive statistics was carried out. Likelihood ratio tests were used to evaluate the association between the categorical variables. The level of significance was set at 0.05. The post-hoc test was used to identify the subgroups that significantly differed from one another, and the Bonferroni correction was applied. A total of 1,706 oral and maxillofacial lesions were diagnosed in pediatric patients, including 51.9% girls. Oral mucocele was the most prevalent reactive/inflammatory lesion (64%). The most commonly affected sites were the lips (34.5%) and mandible (19.9%). A significant association was observed between age and the group of lesions of the oral cavity (p < 0.001), and between age and anatomical location (p < 0.001). Pediatric oral and maxillofacial lesions were frequent and showed wide diversity, with the prevalence of mucocele. Knowledge of oral lesions is important for pediatric dentists worldwide, since it provides accurate data for the diagnosis and oral health of children.

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).

Oral Nodular Lesions in Patients with Sjögren's Syndrome: Unusual Oral Implications of a Systemic Disorder

Abstract Sjögren's syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient's quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient's quality of life.

Resumo A síndrome de Sjögren (SS) é uma doença autoimune crônica sistêmica que afeta as glândulas lacrimal e salivar. A SS pode se manifestar como SS primária (SSp) ou SS secundária (SSs), a última ocorrendo em conjunto com outra desordem autoimune. Em ambos os casos, os olhos secos e a boca seca afetam a qualidade de vida do paciente. As complicações tardias podem incluir cegueira, destruição dos tecidos dentários, candidíase oral e linfoma. Este artigo relata dois casos de SS, cada um apresentando lesão nodular oral incomum diagnosticada como linfoma MALT reincidente e mucocele. A importância do diagnóstico, tratamento e manejo das lesões orais por um cirurgião-dentista durante o atendimento de pacientes com SS é enfatizada, pois as manifestações orais da SS podem comprometer a qualidade de vida do paciente.

High prevalence of human papillomavirus (HPV) in oral mucosal lesions of patients at the Ambulatory of Oral Diagnosis of the Federal University of Sergipe, Northeastern Brazil

Abstract The role of human papillomavirus (HPV) in oral carcinogenesis is still controversial as detection rates of the virus in oral cavity reported in the literature varies greatly. Objective The aim of this study was to evaluate the frequency of HPV infection and its genotypes in patients with oral lesions at the Ambulatory of Oral Diagnosis of the Federal University of Sergipe, Brazil. Material and Methods We conducted a molecular study with 21 patients (15 females) aged from two to 83 years with clinically detectable oral lesions. Samples were collected through exfoliation of lesions and HPV-DNA was identified using MY09/11 and GP5+/6+ primers. Genotyping was performed by multiplex PCR. Results Benign, premalignant and malignant lesions were diagnosed by histopathology. HPV was detected in 17 samples. Of these, HPV-6 was detected in 10 samples, HPV-18 in four and HPV-16 in one sample. When samples were categorized by lesion types, HPV was detected in two papilloma cases (2/3), five carcinomas (5/6), one hyperplasia (1/1) and nine dysplasia cases (9/11). Conclusion Unlike other studies in the literature, we reported high occurrence of HPV in oral lesions. Further studies are required to enhance the comprehension of natural history of oral lesions.

Diet and Squamous Cell Carcinoma of the Oral Cavity and Pharynx: A Case-Control Study

Objective: To investigate if an association exists between diet and oral squamous cell carcinoma (OSCC) in a Brazilian population. Material and Methods: This populationbased study investigated food groups intaken by means of a quantitative food frequency questionnaire (QFFQ) validated for use in Brazil. It was included 665 individuals, being 133 cases of OSCC, selected from reference hospitals for cancer in Paraíba and 532 being part of a control group, paired by age, gender, place and smoking habit took part in the study. Food consumption related to cases and control groups were evaluated by QFFQ. The Chi-square test was carried out in order to verify if there was association between the categorical variables. The level of significance was 5%. Conditional logistic regression was performed by the Enter method in order to verify the odds ratio of independent variables that predict OSCC. Results: It was found statistical association between OSCC and: processed and variety meats (p=0.048), dairy products (p<0.001), oils and fats (p<0.001) and alcoholic beverages (p<0.001). The high consumption of cereals and tubers (OR=0.53; CI95%: 0.29-0.96; p=0.0039) acted as protection factor for OSCC. Conclusion: Data of the present research suggest that the ingestion of animal fat, food rich in salt and refined carbohydrates were associated with OSCC cases.

The use of tools to support oral lesion description in oral medicine referrals

Abstract: Poor description of oral lesions jeopardize the prioritization of appointments in Oral Medicine. The present study investigated whether the use of support tools changes the quality of descriptions focusing on health care prioritization. Two oral lesions (A and B) were described by 64 dental students and 48 dentists using three methods: (a) without support tools (free); (b) using the oral examination form from the Specialties Manual in Oral Health/Brazilian Ministry of Health (SMOH form); and (c) using the OralDESC guideline. The descriptions were compared with a gold standard and percentage of agreement was analyzed by the Kruskal-Wallis and Dunn's tests (p<0.05). Descriptions with the OralDESC presented higher information quality. Considering items essential for prioritization, the OralDESC demonstrated better performance for lesion A; for lesion B, free descriptions and descriptions using the OralDESC were of higher quality than those using SMOH form. Therefore, the OralDESC offered greater support for the description of oral lesions for health care prioritization in Oral Medicine.

Ashy dermatosis with involvement of mucous membranes

Abstract: Ashy dermatosis is a rare condition, of unknown aetiology, in which mucous membranes are typically spared. The authors report the case of a 57-year-old female with a history of asymptomatic gray-bluish macules located on the trunk and oral mucosa. There were no relief changes on examination. Skin biopsies from the oral mucosa and trunk were performed and both were compatible with ashy dermatosis. The patient started treatment with oral clofazimine but due to the absence of clinical improvement the drug was discontinued three months later. This case report illustrates an atypical case of ashy dermatosis owing to the involvement of mucous membranes, which is rarely described in the literature.

Oral mucosal diseases in children - casuistics from the Department of Dermatology - University of São Paulo - Brazil

Abstract There are no studies about pediatric oral mucosal diseases performed by dermatologists in Brazil. This study presents the casuistics of oral mucosal diseases in children examined at the Oral Diseases Clinic at the Department of Dermatology - University of São Paulo - Brazil. Cases were retrospectively studied from the hospital records from 2003 to 2015. A hundredsix children have been examined. Commoner lesions examined included mucoceles and aphthae. Rare and difficult cases were also seen and have been published; this clinic is based in a tertiary hospital center that deals mostly with complex cases.

Manifestações Orais e Sistêmicas de carcinoma epidermóide de orofaringe em estádio avançado / Oral and systemic manifestations of advanced oropharyngeal squamous cell carcinoma

Racional ­ Tumor maligno pode comprometer a cavidade oral e promover alterações sistêmicas muito graves que podem levar à morte. Objetivo ­ Descrever como um tumor pode atingir a cavidade oral de um indivíduo de forma a modificar sua qualidade de vida até culminar com seu óbito. Material e Métodos ­ Adulto do sexo masculino, desempregado, usuário de drogas como: maconha, cocaína, crack, álcool e tabaco, apresentou, durante a fase aguda, pequeno nódulo em região de hemiarco superior esquerdo, na altura dos pré-molares. No exame físico, apresentava dor à palpação com pequeno nódulo não flutuante, localizada em região cervical esquerda. A biópsia evidenciou células tumorais malignas. Resultados ­ Observado progressão rápida, com debilidade adstrita do paciente; resultando em óbito. Conclusão ­ Conclui-se com base no caso acima relatado e tendo a literatura como aliada, que os tumores avançados de orofaringe podem progredir de forma rápida e devastadora, sendo sua taxa de sobrevida muito baixa, além de causar ao paciente constrangimento sócio emocional.(AU)

Lesiones orales asociadas con la enfermedad del virus de inmunodeficiencia humana en pacientes adultos, una perspectiva clínica / Oral lesions associated with human immunodeficiency virus disease in adult patients, a clinical perspective

Among the clinical manifestations which may occur in HIV/AIDS patients, oral lesions are relevant because there are easily accessible and usually the diagnosis is made through clinical features. Some oral manifestations are strongly related with HIV/AIDS patients indicating infection and progression to AIDS and also allow monitoring the success or failure of using antiretroviral therapy. The massive introduction of antiretroviral therapy has changed the morbidity and mortality, frequency, type of clinical manifestation and the timing of the classic opportunistic complications. The aim of this review is to provide an updated of the classical clinical features of the most frequent and relevant HIV/AIDS oral manifestations, considering the fundamental clinical features for their diagnosis.

Dentro de las manifestaciones que pueden aparecer en los pacientes con infección por VIH/SIDA, las lesiones de la cavidad oral tienen gran relevancia debido a que son fácilmente accesibles y por lo general su diagnóstico se efectúa a través de signos clínicos. Además, algunas manifestaciones orales están fuertemente relacionadas con el síndrome por lo que indican sospecha de infección y progresión a etapa SIDA y permiten monitorizar el éxito o fracaso de la terapia anti-retroviral empleada. La introducción masiva de la terapia anti-retroviral ha modificado la morbi-mortalidad, la frecuencia, el tipo de manifestación clínica y el momento de aparición de las clásicas complicaciones oportunistas. El objetivo de esta revisión es entregar las características clínicas clásicas actualizadas de aquellas manifestaciones orales asociadas a la infección por VIH/SIDA que son más frecuentes y que tienen mayor relevancia clínica, considerando las características fundamentales para su diagnóstico.

Síndrome de Laugier-Hunziker / Laugier-Hunziker syndrome

El síndrome de Laugier-Hunziker es un trastorno pigmentario adquirido poco frecuente, caracterizado por presentar lesiones hiperpigmentadas cutaneomucosas idiopáticas que pueden asociarse a melanoniquia longitudinal. A pesar de ser considerado una enfermedad benigna sin manifestaciones sistémicas ni potencial maligno, es clave realizar el diagnóstico diferencial con otros trastornos pigmentarios, en especial con el síndrome de Peutz-Jeghers. Se presenta aquí el caso de un paciente con este síndrome poco frecuente. (AU)

Laugier-Hunziker syndrome is a rare acquired pigmentary disorder that is characterized by idiopathic mucocutaneous pigmentation that may be associated with longitudinal melanonychia. Although this syndrome is considered a benign disease with no systemic manifestations or malignant potential, it is important to rule out other mucocutaneous pigmentary disorders, especially Peutz-Jeghers syndrome. We report the case of a patient with this unusual syndrome. (AU)

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

Abstract The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.

Sífilis: aspectos clínicos, transmissão, manifestações orais, diagnóstico e tratamento / Syphilis: clinical aspects, transmission, oral manifestations, diagnosis and treatment

A sífilis é uma doença que pode ser transmitida de diversas maneiras, mas as mais frequentes são por contato sexual desprotegido ou verticalmente pela mãe contaminada para o seu feto. Todas as suas fases podem apresentar manifestações orais, sendo uma doença de grande importância para o cirurgião-dentista, visto que essas manifestações são de atribuição diagnóstica e podem ser confundidas com outras enfermidades. Quanto mais rápido o diagnóstico, seja pelo cirurgião-dentista ou pelo médico, melhor é o prognóstico do paciente. As alterações mais frequentemente observadas em boca são o cancro duro, as placas mucosas e as gomas, além dos incisivos de Hutchinson e molares em amora no caso de sífilis congênita. O melhor fármaco disponível hoje para o tratamento da sífilis é a penicilina benzatina, sendo as suas doses e intervalos definidos pela fase em que se encontra o paciente. A prevenção da doença e o controle do paciente devem ser feitos com aconselhamento sobre práticas sexuais seguras, e o profissional de saúde que for examiná-lo deve estar atento às normas de biossegurança, pois as lesões das primeiras fases são altamente contagiosas. Uma atenção especial tem que ser dada às gestantes, visto que pode ocorrer a transmissão vertical da doença, a é totalmente passível de tratamento. A sífilis é uma doença curável, e por isso, é dever dos profissionais de saúde conhecerem suas manifestações, como fazer seu diagnóstico e como deve ser o tratamento adequado.(AU)

Syphilis is a disease that can be transmitted in several ways, but the most common are by unprotected sex or vertical transmission from infected mother to her fetus. All the disease stages present oral manifestations, which characterizes it as being of a great relevance to a dentist, since the disease are manifested in oral cavity the dentist is able to give an early diagnosis, but it can be confused with other illnesses. The quicker the diagnosis made either by a dentist or a physician, the better the prognosis. The most frequently observed oral alterations are: chancre, mucous plaques, and gummas; in congenital syphilis cases Hutchinson and Mulberry's molar have been reported as signs of this disease. Benzathine penicillin is the best available drug for syphilis' treatment nowadays, and the drug posology is defined by the patient's disease stage of evolution. The prevention and control of the disease are made through counseling regard safe sex habits and the professional treating an infected patient should be aware of biosecurity protocols, especially if this patient is on the first stages of the disease, which are the most contagious. Furthermore, special attention should to be given to pregnant women due to the fact of vertical transmission of the disease to the fetus, although the disease's transmission can be treated in this case. Therefore, syphilis is a curable disease, and health professionals's responsibility to know the disease's manifestations, how to make its diagnosis, and how the treatment should be approached.(AU)

Plasma cell granuloma in oral cavity: a case report / Granuloma de células plasmáticas en cavidad oral: informe de un caso

Plasma cell granuloma is a rare benign tumor lesion that is classified and described under the pseudo inflammatory tumor category. Its occurrence in the oral cavity is rare, making diagnosis and treatment really difficult, as it bears some clinical similarity with malignant tumor diseases. Proper diagnosis and treatment of PCG requires performing biopsy and a histopathological/immunohistochemicalstudy to rule out possible plasma and neoplastic cell dyscrasias. Consequently, the use of these auxiliary diagnostic devices will enable us to provide the appropriate treatment for the patient. In this study, we present the case of a 63-year-old female patient with a tumor/ulcerative lesion of the left buccal mucosa of a month of evolution and a tumor/ulcerative lesion on the right buccal mucosa of 15 days of evolution after the onset of the first lesion. The patient was treated successfully for a period of one year with immunosuppressive drugs, and to date the disease is inactive. The purpose of this paper is to show one of the most unusual locations in the oral cavity affected by this pathological entity, its clinical and histological features, and establish the differential diagnosis correctly with other malignant or benign disease entities, suggesting the most suitable treatment for this type of condition...

El Granuloma de Células Plasmáticas es una rara lesión tumoral benigna descrita dentro de la clasificación de tumores pseudoinflamatorios, es rara su aparición dentro de la cavidad oral, haciendo realmente complicado su diagnóstico y tratamiento, ya que presenta similitud clínica con patologías tumorales malignas. Para el adecuado diagnóstico y tratamiento del GCP, se requiere de la realización de biopsia y estudio histopatológico/inmunohistoquímico, para descartar posibles discrasias de las células plasmáticas y neoplásicas, de tal forma que el uso de estos auxiliares de diagnóstico nos permitirá sustentar de manera adecuada el tratamiento otorgado al paciente. Se presenta el caso de paciente femenino de 63 años de edad, con una lesión tumoral/ulcerativa de la mucosa yugal izquierda de un mes de evolución y lesión tumoral/ulcerativa de la mucosa yugal derecha de 15 días de evolución posterior a la aparición de la primera lesión, tratada por un periodo de un año con inmunosupresores de forma exitosa ya que a la fecha la paciente presenta inactiva la enfermedad. El propósito de este manuscrito es mostrar una de las localizaciones más extrañas de esta entidad patológica en la cavidad oral, sus características clínicas e histológicas, establecer de forma correcta el diagnóstico diferencial con otras entidades patológicas malignas ó benignas y así emplear el tratamiento requerido para la forma en que se presente la misma...