Prevalence of Oral Lesions Diagnosed at a Pathology Institute: A Four-year Analysis

Abstract Objective: To identify the most prevalent oral lesions based on reports from a pathology institute's reports and associations between malignant and oral potentially malignant disorders with patient's demographic variables and the anatomical location. Material and Methods: All 1,298 histopathological reports of oral lesions recorded in the database were reviewed. Demographic variables, anatomical location of the lesion, histopathological diagnosis of the lesions, and their biological behavior were analyzed. Results: Regarding the biological behavior of the identified lesions, benign lesions were predominant (70%), followed by lesions of undetermined behavior (14.3%), malignant lesions (14.2%), absence of histological alteration (1.2%), and finally, oral potentially malignant disorders (0.5%). The anatomical locations of the most prevalent oral lesions potentially malignant disorders and malignant were in the following structures of the oral cavity: gums, buccal mucosa, floor of the mouth and hard palate (p=49.2%), and tongue (p=48.7%). Conclusion: The probability of malignant and premalignant lesions was higher among males (PR= 4.21; 95% CI 2.08-6.22), the increase in age (PR = 1.06; 95% CI 1.05-1.08), and in the tongue region (PR = 5.48; 95% CI 1.67; 17.92). Identification of malignant and potentially malignant oral conditions is higher in older men and in tongue specimens.

Síndrome de Laugier-Hunziker, reporte de un caso y revisión de la literatura / Laugier-Hunziker syndrome, case report and literature review

El síndrome de Laugier-Hunziker (SLH) es un trastorno de hiperpigmentación macular benigno adquirido que se caracteriza por la presencia de máculas hiperpigmentadas policrómicas, de superficie plana, con morfología lenticular oval, de márgenes definidos; parte importante de éste es el desarrollo de melanoniquia longitudinal. Su principal diagnóstico diferencial es el síndrome de Peutz-Jeghers, ya que este último tiende a desarrollar neoplasias malignas en el tracto digestivo. Es importante que el estomatólogo conozca el SLH, con la finalidad de poder diagnosticarlo y diferenciarlo de otras entidades, particularmente de aquellas de carácter maligno (AU)

Laugier-Hunziker syndrome (LHS) is an acquired benign macular hyperpigmentation disorder, characterized by the presence of polychromic hyperpigmented macules, with a smooth surface, with oval lenticular morphology, with defined margins; An important part of this is the development of longitudinal melanonychia. Its main differential diagnosis is Peutz-Jeghers syndrome, since it tends to develop malignant neoplasms in the digestive tract. It is important that the Stomatologist knows the LHS, in order to be able to diagnose it and differentiate it from other entities, even those of a malignant nature (AU)

Análise da imunoexpressão de BAX e MMP-9 no líquen plano oral / Analysis of BAX and MMP-9 immunoexpression in oral lichen planus

Introdução: O líquen plano oral é uma doença crônica imunologicamente mediada relativamente comum, que acomete a mucosa oral. Clinicamente, o LPO é classificado em seis padrões bem identificados: placa, reticular, bolhoso, atrófico, papular e erosivo.Sendo os mais comuns oos tipos reticulares e erosivos. A ativação dos linfócitos TCD4+ no LPO, pode induzir os ceratinócitos ao processo de apoptose através da respostaimunológica citotóxica. A proteína Bax desempenha uma função relevante para o processo apoptótico. Deste modo, a presente pesquisa consistiu em um estudo transversal retrospectivo, descritivo, quantitativo e comparativo. Objetivo: Avaliar a expressão imuno-histoquímica das proteínas MMP9 e Bax no LPO. Método: Foram utilizados 43 casos de LPO para análise da imunoexpressão de Bax e MMP-9. Os resultados foram analisados através dos testes estatísticos apropriados e serão considerados significativos, valores onde p<0,05. Resultado: A imunoexpressão de MMP9 foi significativamente maior nos ceratinócitos e quando analisados os subtipos de líquen plano oral, não foram observados diferenças estatísticas entre os tipos reticulares e erosivos para as proteínas analisadas. Conclusões: Com essas observações, infere-se que a alteração na expressão das proteínas estudadas sugere um distúrbio nos mecanismos apoptóticos, os quais estão associados às lesões de LPO, e podemos concluir também que as imunoexpressões dessas proteínas não apresentaram diferença, quando relacionada ao tipo clínico reticular ou erosivo. Com esse resultado pode-se contribuir para um maior entendimento sobre os possíveis mecanismos celulares envolvidos na etiopatogenia dessa lesão (AU).

Background: Oral lichen planus is a relatively common immune-mediated chronic disease that affects the oral mucosa. Clinically, OLP is classified into six well-identified patterns: plaque, reticular, bullous, atrophic, papular, and erosive. The most common being the reticular and erosive types. The activation of TCD4+ lymphocytes in the OLP can induce keratinocytes to the process of apoptosis through the cytotoxic immune response. Thus, the present research consisted of a retrospective, descriptive, quantitative and comparative crosssectional study. Objective: to evaluate the immunohistochemical expression of MMP-9 and Bax proteins in OLP. Methods: We used 20 cases of Inflammatory Fibrous Hyperplasia as control. The results were analyzed through the appropriate statistical tests and will be considered significant, values where p<0.05. Results: The immunoexpression of MMP-9 was significantly higher in keratinocytes and when the subtypes of oral lichen planus were analyzed, no statistical differences were observed between the reticular and erosive types for the proteins analyzed. Conclusions: With these observations, it is inferred that the alteration in the expression of the studied proteins suggests a disturbance in the proliferative and apoptotic mechanisms, which are associated with a pathological behavior of the oral mucosa, and consequently with a repercussion on the lesions of OLP, and we can also conclude that the immunoexpression of these proteins had no difference, when related to the reticular or erosive clinical type. This research aims to contribute to a greater understanding of the possible cellular mechanisms involved in the etiopathogenesis of this lesion, thus enabling the understanding of the clinical aspects of the pathology (AU).

Manifestações bucais em pacientes internados na UTI de um hospital público / Oral manifestations in patients admitted to the ICU of a Public Hospital

Introdução: durante a permanência em Unidades de Terapia Intensiva (UTIs), os pacientes internados apresentam maior vulnerabilidade a alterações na cavidade oral decorrentes do uso de equipamentos de respiração artificial e do estado imunocomprometido em que se encontram. Objetivo: identificar as principais manifestações bucais em pacientes internados em uma UTI bem como verificar o conhecimento dos profissionais responsáveis pela higienização bucal. Metodologia: trata-se de um estudo quantitativo descritivo com delineamento transversal. Os dados foram obtidos nos prontuários médicos dos pacientes e através de um exame clínico intraoral. Para os profissionais responsáveis pela higiene bucal, foi utilizado um questionário. As análises foram realizadas no programa SPSS versão 21.0 de forma descritiva. Resultados: as manifestações bucais com maior incidência foram saburra lingual, biofilme dentário, candidíase, devido a qualidade da higiene bucal prestada e a baixa imunidade. Os achados bucais e sistêmicos relacionados aos pacientes com maior tempo de internação foram ressecamento labial, queilite angular, língua despapilada, candidíase e pneumonia. Todos os profissionais responsáveis pela higienização bucal dos pacientes tinham formação técnica em enfermagem e desconheciam alterações importantes como biofilme dentário e pneumonia nosocomial. Conclusão: os dados deste estudo permitem concluir que apesar da constância com que é realizada a higienização bucal, verifica-se alta frequência de lesões bucais nos pacientes críticos da UTI. Evidenciando o papel da assistência da higienização bucal de qualidade, destacando a importância da atuação do cirurgião dentista em equipes multiprofissionais, visto que o risco de focos infecciosos bucais pode contribuir para o agravo e piora do quadro clínico dos pacientes.

Introduction: during the stay in Intensive Care Units (ICUs), hospitalized patients are more vulnerable to changes in the oral cavity resulting from the use of artificial respiration equipment and the immunocompromised state in which they are found. Objective: to identify the main oral manifestations in patients admitted to an ICU, as well as to verify the knowledge of professionals responsible for oral hygiene. Methodology: this is a descriptive quantitative study with cross-sectional design. Data were obtained from the patient's medical records and through an intraoral clinical examination. For professionals responsible for oral hygiene, a questionnaire was used. The analyses were performed in the SPSS version 21.0 program in a descriptive way. Results: the oral manifestations with the highest incidence were tongue coating, dental biofilm, candidiasis, due to the quality of oral hygiene provided and low immunity. Oral and systemic findings related to patients with longer hospital stays were lip dryness, angular cheilitis, depapilated tongue, candidiasis and pneumonia. All professionals responsible for oral hygiene of patients had technical training in nursing and were unaware of important alterations such as dental biofilm and nosocomial pneumonia. Conclusion: the data from this study allow us to conclude that despite the constancy with which oral hygiene is performed, there is a high frequency of oral lesions in critical ICU patients. Evidencing the role of quality oral hygiene assistance, highlighting the importance of the dentist's role in multidisciplinary teams, since the risk of oral infectious foci can contribute to the aggravation and worsening of the clinical condition of patients.

A novel interlamellar oral mucosa graft surgery technique using fibrin glue for the treatment of trichiasis / Nova técnica cirúrgica de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase

ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>

RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.

Prevalence of oral injuries and salivary changes in patients with chronic renal failure on hemodialysis: systematic review and meta-analysis

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes.

Effects of honey-lemon spray on recurrent aphthous stomatitis comparing to Triamcinolone ointment: a randomized controlled clinical trial

Recurrent aphthous stomatitis (RAS) is recurrent and painful diseases of the oral mucosa that can be very painful and annoying despite their small size. There is no definitive cure for this disease and the usual treatments are mainly based on pain control. The aim of this study was to investigate the effect of honey-lemon spray (mucotin) in the treatment of recurrent aphthous stomatitis. Methods: This study is a randomized controlled clinical trial conducted in 2020 at Zahedan University of Medical Sciences on 46 RAS patients. The participants were randomly assigned to the intervention (mucotin) or control groups (Triamcinolone ointment) equally (23 patients in each group). Patients were evaluated for the severity of pain and ulcer size. Evaluations were performed on days 0, 2, 7 of the treatment using VAS. Data were analyzed using ANOVA statistical test. Results: The inner aspect of the lower lip was the most common site of RAS in the participants (48.8%) and the lowest site went for hard palate (2.4%). Four items including pain, burning sensation, necrosis area, and erythematous area were evaluated in both groups. There was no significant difference in all parameters before the treatment period (day 0). The mean pain score, burning sensation, necrosis, erythematous areas were not different in days 0, 2 and 7 between groups respectively (p=0.849, p=0.105, p=0.917, p=0.442). Conclusion: Honey-lemon spray (Mucotin) and topical corticosteroid have similar effects in RAS treating, So Mucotin can be used as the first line of treatment for RAS lesions. This herbal medicine has no side effects

Enfrentamiento de lesiones de cavidad oral: clasificación y diagnóstico diferencial / Assessment of oral cavity lesions: classification and differential diagnosis

Las lesiones de la cavidad oral corresponden a un hallazgo frecuente y muchas veces difíciles de diagnosticar. Su correcto reconocimiento podría ser clave en detectar patologías que podrían cambiar el pronóstico del paciente. El objetivo de esta revisión es describir una clasificación de las lesiones de la cavidad oral que permita ayudar al diagnóstico en la práctica clínica. Para esto, se detallan y se describen las lesiones, orientando al diagnóstico y a la necesidad de biopsiar. Para simplificar la orientación diagnóstica, las lesiones se clasifican en 2 grandes grupos: tumorales y no tumorales. Las lesiones no tumorales se subdividen en lesiones de la mucosa oral y lesiones de la lengua.

Lesions of the oral cavity are frequent and often difficult to diagnose. However, correct recognition could change the patient's prognosis. This review aims to describe a classification of oral mucosa lesions, to help the diagnosis in clinical practice. The lesions are described for this, guiding the diagnosis and the need for biopsy. To simplify the diagnostic orientation, the lesions are classified into two groups: tumor and non-tumor lesions. Non-tumor lesions are subdivided into lesions of the oral mucosa and lesions of the tongue.

Protocolos de atendimento odontológico em UTI Covid / Dental care protocols in Covid

O presente estudo aborda os protocolos odontológicos instituídos na Unidade de Terapia Intensiva COVID de um Hospital do Extremo Sul Catarinense. A cavidade oral, considerada uma abertura para a entrada de microrganismos, possui características favoráveis ao seu crescimento, com temperatura e umidade ideais para sua sobrevivência em longo prazo. A odontologia, por manipular diretamente mucosa oral, fica exposta e vulnerável ao contágio do COVID-19, assim como a equipe multiprofissional que manipula o paciente nas diversas áreas de atenção à saúde, no ambiente hospitalar. A COVID-19 é uma infecção respiratória aguda causada pelo coronavírus SARS-CoV-2, potencialmente grave, de elevada transmissibilidade e de distribuição global. A maioria das pessoas (cerca de 80%) se recupera da doença sem precisar de tratamento hospitalar. Uma em cada seis pessoas infectadas por COVID-19 fica gravemente doente e desenvolve dificuldade de respirar. As pessoas idosas e as que têm outras condições de saúde, como pressão alta, problemas cardíacos e do pulmão, diabetes ou câncer, têm maior risco de ficarem gravemente doentes. No entanto, qualquer pessoa pode pegar a COVID-19 e ficar gravemente doente. Constatou-se que a aplicação de protocolos odontológicos na Unidade de Terapia Intensiva apresenta uma série de vantagens em relação à prevenção da contaminação dos profissionais de saúde, à manutenção da saúde bucal do paciente, aos benefícios gerais para a saúde, à prevenção e ao tratamento de infecções oportunistas, que podem reduzir o tempo de internação do paciente, pois infecção generalizada e pneumonia são doenças nosocomiais também causadas por distúrbios na microbiota oral. Os resultados mostraram que não há cirurgiões dentistas atuando na Unidade de Terapia Intensiva, os protocolos não são específicos para área de odontologia e os equipamentos de proteção individuais são utilizados, porém, não em todos atendimentos(AU)

The present study addresses the dental protocols established in the COVID Intensive Care Unit of a Hospital in Extremo Sul Santa Catarina. The oral cavity, considered an opening for the entry of microorganisms, has characteristics favorable to its growth, with ideal temperature and humidity for its long-term survival. Dentistry, by directly manipulating the oral mucosa, is exposed and vulnerable to COVID-19 contagion, as well as the multidisciplinary team that handles the patient in the different areas of health care, in the hospital environment. COVID-19 is a potentially serious acute respiratory infection caused by the SARS-CoV-2 coronavirus, with high transmissibility and global distribution. Most people (about 80%) recover from the disease without needing hospital treatment. One in six people infected with COVID-19 becomes seriously ill and develops difficulty breathing. Elderly people and those with other health conditions, such as high blood pressure, heart and lung problems, diabetes or cancer, are at increased risk of becoming seriously ill. However, anyone can take COVID-19 and become seriously ill. It was found that the application of dental protocols in the Intensive Care Unit has a number of advantages in relation to the prevention of contamination of health professionals, the maintenance of the patient's oral health, the general benefits for health, prevention and treatment of opportunistic infections, which can reduce the patient's hospital stay, as generalized infection and pneumonia are nosocomial diseases also caused by disorders in the oral microbiota. The results showed that there are no dentists working in the Intensive Care Unit, the protocols are not specific to the field of dentistry and individual protective equipment is used, however, not in all cases(AU)

Mutagenicity in oral cells of individuals exposed to radiofrequency generated by different smartphones

Aim: This study aimed to investigate whether non-ionizing radiation emitted by smartphones is likely to cause genotoxic effects on oral epithelial cells. Methods: Thirty adults were distributed into two groups according to the mobile phone brand used, namely Samsung (Samsung, Seoul, South Korea) and Apple (Apple, California, USA). The material was collected with gentle swabbing of the right and left buccal mucosa using a cervical brush, then the micronucleus test was performed. Results: The Mann-Whitney test with a 5% significance level did not reveal statistically significant differences in micronuclei frequency between the exposed and non-exposed sides (p=0.251). The different brands do not seem to cause risks of inducing genetic damage because there were no statistically significant differences between them (p=0.47). Conclusion: Therefore, our results suggest no correlations of micronuclei frequency in the exposed buccal cells of mobile phone users at the exposure standard levels observed

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

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

Does systemic anticancer gemcitabine compromise oral soft tissue wound healing? / ¿La gemcitabina anticancerígena sistémica compromete la cicatrización de heridas en tejidos blandos orales?

Background: Numerous types of cancer are of substantial medical and social concern, posing a major challenge to modern medicine. Chemotherapeutic drugs include the use of nucleosides, which are composed of nucleic acid and sugar. Objective: This study aims to assess the impact of systemic chemotherapeutic drugs at a therapeutic dose on the wound healing process of the oral mucosa. Material and Methods: 30 healthy rats were randomly divided into two main groups based on the study material, 15 rats in each group. Group A (control) was given a single dose of normal saline (1ml/kg, intraperitoneal), and Group B (study) a single injection of gemcitabine (50 mg /Kg, intraperitoneal). After anesthesia, a full-thickness soft tissue incision (0.5 cm length) on the right side of the buccal mucosa was made in the animals of both groups. Each group was subdivided according to the time of sacrifice into 3, 7, 14 days after surgery, at the end of the experimental periods, specimens were collected for histopathological study, and samples of blood were obtained from retro-orbital venous plexus and collected in microfuge tubes and levels of antioxidant enzymes were measured by ELISA. The data were analyzed statistically at a 0.05 level of significance. Results: Gemcitabine delayed the onset of wound cascade (inflammation and re-epithelization) which lead to worsening healing of the oral tissue; it also resulted in a decrease of the antioxidant activity of glutathione peroxidase and catalase, as well as activated caspase 3, which induces cell apoptosis. Conclusion: Gemcitabine showed negative feedback on oral tissue wound healing through delayed wound healing cascade and by inducing apoptosis.

Antecedentes: numerosos tipos de cáncer son motivo de gran preocupación médica y social, lo que representa un gran desafío para la medicina moderna. Los fármacos quimioterapéuticos incluyen el uso de nucleósidos, que están compuestos de ácido nucleico y azúcar. Objetivo: Este estudio tiene como objetivo evaluar el impacto de los fármacos quimioterapéuticos sistémicos a una dosis terapéutica en el proceso de cicatrización de heridas de la mucosa oral. Material y Métodos: 30 ratas sanas se dividieron aleatoriamente en dos grupos principales según el material de estudio, 15 ratas en cada grupo. Al grupo A (control) se le administró una dosis única de solución salina normal (1 ml/kg, intraperitoneal) y al grupo B (estudio) una inyección única de gemcitabina (50 mg/kg, intraperitoneal). Después de la anestesia, se realizó una incisión de tejido blando de espesor total (0,5 cm de longitud) en el lado derecho de la mucosa bucal en los animales de ambos grupos. Cada grupo se subdividió de acuerdo al tiempo de sacrificio en 3, 7, 14 días después de la cirugía, al final de los períodos experimentales se colectaron especímenes para estudio histopatológico, se obtuvieron muestras de sangre del plexo venoso retroorbitario y se recolectaron en tubos de microcentrífuga y los niveles de enzimas antioxidantes se midieron por ELISA. Los datos se analizaron estadísticamente a un nivel de significación de 0,05. Resultados: La gemcitabina retrasó el inicio de la cascada de heridas (inflamación y reepitelización) que condujo a un empeoramiento de la cicatrización del tejido oral; también resultó en una disminución de la actividad antioxidante de la glutatión peroxidasa y la catalasa, así como de la caspasa 3 activada, que induce la apoptosis celular. Conclusión: La gemcitabina mostró retroalimentación negativa sobre la cicatrización de heridas del tejido oral a través de una cascada de cicatrización retardada y mediante la inducción de apoptosis.

Hemangioma capilar lobular: granuloma piógeno en lengua / Lobular capillary hemangioma: pyogenic granuloma of tongue

El granuloma piógeno es una lesión benigna, reactiva y multifactorial que resulta de le- siones repetitivas, microtraumatismos e irritación local en piel o mucosas y cambio hormonal. Cuando aparece en la cavidad oral tiene predilección por la encía vestibular, pero es importante que el odontólogo esté consciente y familiarizado con el hecho de que puede estar localizado en otras áreas anatómicas. Clínicamente se presenta como lesión hiperplásica altamente vascularizada, de tamaño generalmente no mayor a 2 cm, pediculada en la base o sésil y de lento crecimiento. Sin mostrar preferencia por edad o sexo, tiende a aparecer principalmente en encías, labios y mucosa oral, siendo muy pocos los casos reportados en el área lingual. Es por ello que, en este artículo, nos referimos a un caso de ubicación inusual, en conjunto con una revisión de la literatura (AU)

Pyogenic granuloma is a benign, reactive, and multifactorial lesion caused by repetitive injuries, microtrauma and local irritation on the skin or mucous membranes, and hormonal change. When it appears in the oral cavity, it has a predilection for the vestibular gingiva, but the dentist must be aware and familiar with the fact that it can be present in other anatomi- cal areas. Clinically, it is presented as a hyperplasic injury highly vascular-related, with a size generally no bigger than 2 cm, pedunculated in base or sessile, and slow in growth. Without showing any preference in age or gender, it tends to appear mainly on the gums, lips, and oral mucosae, with very few, reported cases in the lingual area. Therefore, in this study, we refer to a case of unusual localization with a literature review (AU)

Hiperplasia sebácea ectópica en mucosa oral de neonatos: reporte de tres casos / Ectopic sebaceous gland hyperplasia in neonates oral mucosa: 3 case studies / Hiperplasia sebácea ectópica na mucosa oral de recém-nascidos: relato de 3 casos

La hiperplasia de glándulas sebáceas es un hallazgo benigno y transitorio, común en el período neonatal. Secundariamente al estímulo hormonal androgénico se produce un hipercrecimiento de las glándulas, con mayor frecuencia en nariz y mejillas, donde existen en mayor densidad. La hiperplasia de glándulas en una localización ectópica, llamada gránulos de Fordyce (GF), es excepcional en el período neonatal. Se han reportado en aproximadamente 1% de los recién nacidos, y con frecuencia se localizan en la mucosa oral. Los GF se describen como lesiones papulares de aspecto vesiculoso blanco amarillentas de 1-3 mm2, que podrían confundir al neonatólogo o al pediatra con entidades infecciosas, dando lugar a pruebas invasivas y tratamientos innecesarios. Se describen tres casos clínicos de neonatos con diagnóstico de hiperplasia sebácea ectópica localizada en mucosa oral, con el objetivo de revisar la etiología, las características clínicas, los diagnósticos diferenciales y la evolución de esta entidad benigna. Conclusiones: la hiperplasia sebácea ectópica en mucosa oral de neonatos es un hallazgo benigno autolimitado que se presenta con baja frecuencia. El reconocimiento clínico de esta entidad es importante para evitar diagnósticos incorrectos y tratamientos innecesarios.

Sebaceous gland hyperplasia is a common transient and benign finding in neonates. After androgenic hormonal stimulation, there is a gland overgrowth mainly in the nose and cheeks where there is a greater density of glands. Ectopic sebaceous gland hyperplasia, called Fordyce's Granules (FG), is exceptional in neonates and it is reported in approximately 1% of newborns and frequently located in the oral mucosa. FGs are described as 1-3mm2 yellowish-white papular and vesicular lesions. Neonatologists or pediatricians may confuse these clinical features with infectious diseases, leading to invasive tests and unnecessary treatment. We describe three clinical cases of neonates with diagnosis of ectopic sebaceous gland hyperplasia located in the oral mucosa, with the aim of reviewing the etiology, clinical characteristics, differential diagnoses and evolution of this benign entity. Conclusions: ectopic sebaceous gland hyperplasia of the lips is a self-limited benign finding occurring infrequently in newborns. The clinical recognition of this entity is important to avoid inaccurate diagnoses or unnecessary treatment.

A hiperplasia das glândulas sebáceas é um achado benigno e transitório comum nos neonatos. Secundário ao estímulo hormonal androgênico, há um hipercrescimento das glândulas com mais frequência no nariz e nas bochechas onde há uma maior densidade das glândulas. A hiperplasia das glândulas num local ectópico, chamado Fordyce Granules (FG), é excepcional no período neonatal, e ela é relatada em aproximadamente 1% dos recém-nascidos e muitas vezes está localizada na mucosa oral. Os FGs são descritos como lesões vesiculares brancas amareladas de 1-3mm2, o que poderia confundir o neonatologista ou pediatra com entidades infecciosas, levando a testes invasivos e tratamentos desnecessários. Descrevemos três relatos clínicos de recém-nascidos com diagnóstico de hiperplasia sebácea ectópica localizada na mucosa oral, com o objetivo de rever a etiologia, características clínicas, diagnósticos diferenciais e evolução desta entidade benigna. Conclusões: hiperplasia sebácea ectópica na mucosa oral de recém-nascidos é um achado benigno autolimitante que ocorre com baixa frequência. O reconhecimento clínico desta entidade é importante para evitar diagnósticos incorretos e tratamentos desnecessários.

Lesiones bucales, factores de riesgo de cáncer bucal y autopercepción de irritación mecánica crónica en una campaña de prevención en la Ciudad de Buenos Aires / Oral lesions, oral cancer risk factors and self-perception of chronic mechanical irritation in a prevention campaign in Buenos Aires City

Objetivos: i) Describir las características poblaciona- les, la frecuencia de patologías de mucosa bucal y de factores de riesgo asociados al cáncer bucal en una Campaña de Pre- vención y Diagnóstico Precoz de Cáncer Bucal (CPDPCB) en la Ciudad de Buenos Aires; ii) establecer concordancia entre diagnóstico clínico profesional de irritación mecánica crónica (IMC) y autopercepción de trauma. Materiales y métodos: Se realizó un estudio descrip- tivo retrospectivo, en el que se utilizaron encuestas de 640 pa- cientes que participaron en las CPDPCB del Servicio de Odon- tología del Hospital Alemán entre los años 2016, 2017 y 2018. Se describen las variables demográficas, clínicas y cognitivas, y se analizan empleando chi cuadrado para variables cualitativas y ANOVA para variables cuantitativas comparando los años de campaña. Se realizó un estudio de concordancia entre el diag- nóstico clínico profesional de IMC y el trauma autopercibido mediante test Kappa, sensibilidad y especificidad. Resultados: Los sujetos participantes fueron predomi- nantemente mayores de edad, con bajo consumo de tabaco y alcohol. El porcentaje de pacientes con desórdenes potencial- mente malignos y cáncer bucal fue de 17,2%. La cartelería del hospital y la radio fueron las principales vías de información a los pacientes. El trauma autopercibido no presentó concor- dancia con el diagnóstico clínico profesional de IMC, y mos- tró sensibilidad de 0,41 y especificidad de 0,72. Conclusiones: El nivel de participación de los grupos de mayor riesgo de CBCE en la CPDPCB es bajo, y el perfil epidemiológico de los participantes no coincide generalmente con el perfil de los pacientes con CBCE. La autopercepción de trauma no sería una herramienta confiable para el diagnóstico de IMC (AU)

Aims: i) To describe population characteristics, frequency of oral mucosa pathologies, and risk factors for oral squamous cell carcinoma (OSCC) in a Campaign for the Prevention and Early Diagnosis of Oral Cancer (CPEDOC), and ii) to establish concordance between professional clinical diagnosis of chronic mechanical irritation (CMI) and self-perception of trauma. Materials and methods: A retrospective descriptive study was performed using surveys of 640 patients who had participated in the CPEDOC conducted by the Dentistry Ser- vice at the Hospital Alemán during 2016, 2017 and 2018. De- mographic, clinical and cognitive variables were described and analyzed, using chi-square for qualitative variables and ANOVA for quantitative variables, to compare campaign years. Concordance was studied between the professional clinical diagnosis of CMI and self-perceived trauma using the Kappa test, sensitivity and specificity. Results: Participants were predominantly older, with low consumption of tobacco and alcohol. The percentage of patients with potentially malignant disorders and oral cancer was 17.2%. Hospital posters and radio broadcasting were the main channels of information to patients. Self-perceived trauma did not agree with the professional clinical diagnosis of CMI. Self-perceived trauma sensitivity and specificity were 0.41 and 0.72, respectively. Conclusions: The level of participation in the CPEDOC by the groups at higher risk of OSCC was low, and the epide- miological profile of the participants did not generally coincide with the profile of patients with OSCC. Self-perception of trau- ma does not seem to be a reliable tool for the diagnosis of CMI (AU)

Epidemiología y frecuencia de enfermedades de transmisión sexual y su repercusión en la mucosa bucal: una revisión narrativa / Epidemiology and frequency of sexually transmitted diseases and their impact on oral mucosa: a narrative review

El objetivo de la presente revisión fue analizar y compa- rar las publicaciones sobre la prevalencia de manifestaciones bucales de pacientes infectados por el Virus de la Inmuno- deficiencia Humana, Virus del Papiloma Humano y sífilis. Se seleccionaron los artículos más relevantes y se abordó la incidencia según sexo, edad, distribución geográfica y locali- zaciones anatómicas frecuentes. Se encontró que las lesiones orales más prevalentes producidas por el Virus de la Inmu- nodeficiencia Humana son la candidiasis oral, la leucoplasia vellosa y enfermedades periodontales, entre otras. La sífilis presentó una frecuencia de 7,5% de manifestaciones orales en la etapa primaria, 92,5% en la secundaria y rara vez lesio- nes en la terciaria. Las formas más prevalentes fueron parches mucosos, pápulas y úlceras. Las lesiones orales benignas rela- cionadas con el Virus del Papiloma Humano halladas fueron la verruga vulgar, el papiloma plano, el condiloma acuminado y la hiperplasia epitelial focal. La prevalencia de carcinomas orofaríngeos y orales fue del 33,6% y del 22,2% respectiva- mente. Se encontraron similitudes en el comportamiento se- xual y las vías de transmisión de las enfermedades analizadas, y se observó que son más prevalentes en adultos jóvenes de sexo masculino y en países en vías de desarrollo (AU)

The aim of this review was to analyze and compare pub- lications on the prevalence of oral manifestations in patients infected with Human Immunodeficiency Virus, Human Pap- illoma Virus and syphilis. The most reliable studies were se- lected, and incidence was evaluated according to gender, age, geographic location and frequent anatomic sites. It was found that the most prevalent Human Immunodeficiency Virus oral lesions were oral candidiasis, hairy leukoplakia and perio- dontal diseases, among others. Syphilis had a 7.5% preva- lence of oral manifestations in the primary stage, 92.5% in the secondary, and rarely lesions in the tertiary. The most prevalent forms were mucous patches, papules and ulcers. The benign oral lesions related to the Human Papilloma Vi- rus were verruca vulgaris, squamous papilloma, condyloma acuminatum and multifocal epithelial hyperplasia. The preva- lence of oropharyngeal and oral carcinomas were 33.6% and 22.2%, respectively. Similarities were found in sexual behavior and transmis- sion routes of the diseases analyzed, which were more preva- lent among young adult males, and in developing countries (AU)

Variaciones celulares de la mucosa bucal en pacientes portadores de prótesis dental completa / Cellular variations of the oral mucous in patients with complete dental prosthesis i: en

Introducción: La prótesis dental completa genera una reacción tisular en el medio bucal, cuyo diagnóstico puede ser confirmado mediante el estudio citológico, que constituye una herramienta imprescindible para identificar cambios displásicos tempranos de la mucosa subprótesis. Objetivo: Identificar las posibles variaciones celulares de la mucosa bucal en pacientes portadores de prótesis completa. Métodos: Se realizó un estudio descriptivo y transversal en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, de junio de 2014 a enero de 2019, de 100 pacientes atendidos en la consulta de Prótesis Estomatológica, a los cuales se les realizó el raspado citológico de la mucosa del paladar y los rebordes para su posterior análisis microscópico según variables de interés. Para el procesamiento estadístico se empleó el porcentaje como medida de resumen y el estadígrafo de la Χ2, con un nivel de significación de 0,05. Resultados: En la serie predominaron las displasias leves (66,7 %), que resultaron más frecuentes en las edades de 20 a 39 años (12,5 %), en tanto, las moderadas y las graves figuraron principalmente en el grupo etario de 60 y más años (9,3 y 27,7 %, respectivamente). Todos los tipos de displasia primaron en los pacientes que habían portado la prótesis por más de 5 años y afectaron mayormente la queratina; de igual modo, entre las lesiones observadas, la estomatitis afectaba a un mayor porcentaje (31,2), sobre todo en el paladar (82,3 %), mientras que 8,3 % correspondió a la leucoplasia. Conclusión: Las pruebas citológicas son imprescindibles para la confirmación diagnóstica de cambios displásicos y posibilitan la prevención temprana del cáncer bucal.

Introduction: The complete dental prosthesis generates a tisular reaction in the oral cavity which diagnosis can be confirmed by means of citological study that constitutes an indispensable tool to identify early dysplastic changes of the subprosthesis mucous. Objective: To identify the oral possible cellular variations of the oral mucous in patients with complete prosthesis. Methods: A descriptive and cross sectional study was carried out in Mártires del Moncada Provincial Stomatological Clinic of Santiago de Cuba, from June, 2014 to January, 2019, with 100 patients, assisted in the Stomatological Prosthesis Department to whom the cytological scrapings of the palate and the edges were carried out for their later microscopic analysis according to variables of interest. For the statistical procedures, the percentage was used as summary measure and the Chi squared statistician, with a significance level of 0,05. Results: In the series the mild dysplasias prevailed (66,7%) that were more frequent in the 20 to 39 age group (12,5%), while the moderate and the serious dysplasias figured mainly in the age group of 60 and over (9,3 and 27,7%, respectively). All the dysplasia types prevailed in the patients that had carried the prosthesis for more than 5 years and they mostly affected the keratin; in a same way, among the observed lesions, the stomatitis affected a higher percentage (31,2), mainly in the palate (82,3%), while 8,3% corresponded to the leukoplakia. Conclusion: The cytological checkups are indispensable for the diagnostic confirmation of dysplasic changes and they allow to prevent early oral cancer.

Endoscopic Holmium Laser harvesting of bladder mucosal graft for substitution urethroplasty

ABSTRACT Introduction: Tissue transfer has been used in urethral reconstruction for decades, and several grafts have been described (1, 2). The ideal graft would have optimal tissue characteristics and lead to minimal morbidity at the donor site. Urethroplasty using bladder mucosa was first described by Memmelaar in 1947 (3). The main limitation in using bladder mucosal grafts has been the invasiveness of open harvesting (4). We describe an endoscopic technique using Holmium: YAG laser to harvest bladder mucosal graft for substitution urethroplasty. Methodology: A 33-year-old male with no history of urethral instrumentation, trauma, or infection presented with obstructive lower urinary tract symptoms. On retrograde urethrogram a 6cm bulbar urethral stricture was identified. Several options were discussed, and the patient opted for a one-sided onlay dorsal urethroplasty (5) using a bladder mucosal graft. Equipment used to harvest the graft included an 18.5Fr continuous flow laser endoscope with a Kuntz working element (RZ) and a 60W Holmium Laser (Quanta) with 550μm laser fiber. The procedure was started by making a perineal incision, urethral mobilization and incision of the stricture segment. The laser endoscope was then introduced via the perineum. Settings of 0.5J, 30 Hz, and long pulse were used and a 7 x 2.5cm graft was harvested from the posterior bladder wall. Hemostasis of the harvest site was performed. The bladder mucosal graft was thinned in similar fashion to a buccal mucosal graft and sutured as per previously described techniques. Conclusion: Endoscopic Holmium Laser harvesting of bladder mucosal graft is feasible and may allow this graft to become an alternative to buccal mucosa. Further studies are required to define its role in urethral reconstruction.

Síndrome da ardência bucal: relato de caso clínico / Oral burning syndrome: a clinical case report

O presente estudo teve como objetivo principal descrever por meio de um relato de caso clínico o diagnóstico e a conduta clínica de uma paciente portadora da Síndrome da Ardência Bucal (SAB). A SAB é definida como uma dor crônica e de difícil diagnóstico e difícil tratamento. O local mais acometido pela SAB é a língua, lábios e mucosa jugal, mas pode estar presente em qualquer parte da mucosa oral, causando desconforto e interferindo na qualidade de vida do paciente. Paciente do sexo feminino, leucoderma, 39 anos, sem histórico de doenças sistêmicas, saúde geral em bom estado, procurou atendimento no Centro Universitário da Serra Gaúcha ­ FSG por apresentar sensação de ardência recorrente na língua e na mucosa, que aumentava em momentos de estresse ou durante a ingestão de alimentos cítricos, picantes ou quentes. A paciente realizou exames complementares (hemograma completo, glicemia de jejum, exame de vitamina B12) e primeiramente, iniciou-se o tratamento com antifúngico tópico para remoção de uma camada esbranquiçada presente no dorso da língua. Após a remissão desta, foi utilizado AD-Muc tópico 2 vezes ao dia, durante 2 semanas e relatou ter reduzido seus sintomas em torno de 70%. A paciente ainda apresentava xerostomia e, então foi prescrita saliva artificial. A paciente teve a regressão total de seus sintomas. Pode-se concluir que diversos fatores etiológicos estão relacionados com a SAB, porém sua causa específica permanece desconhecida. O tratamento é paliativo, entretanto, o Ad-muc tópico se mostrou eficaz na redução da sintomatologia da SAB juntamente com o uso da saliva artificial(AU)

The present study aimed to describe, through a clinical case report, the diagnosis and clinical conduct of a patient with Burning Mouth Syndrome (BMS). BMSis defined as chronic pain that is difficult to diagnose and difficult to treat. The site most affected by BMS is the tongue, lips, and cheek mucosa, but it can be present in any part of the oral mucosa, causing discomfort and interfering with the patient's quality of life. Female patient, leucoderma, 39 years old, with no history of systemic diseases, general health in good condition, sought care at the Centro Universitário da Serra Gaúcha - FSG for presenting a recurrent burning sensation in the tongue and mucosa, which increased in times of stress or while eating citrus, spicy or hot foods. The patient underwent complementary tests (complete blood count, fasting blood glucose, vitamin B12 test) and first, treatment with topical antifungal was started to remove a whitish layer present on the back of the tongue. After remission, topical AD-Muc was used twice a day for 2 weeks and reported to have reduced his symptoms by around 70%. The patient still had xerostomia and then artificial saliva was prescribed. The patient had a total regression of her symptoms. It can be concluded that several etiological factors are related to SAB, but its specific cause remains unknown. Treatment is palliative, however, topical Ad-muc is effective in reducing the symptomsof BMS also with the use of artificial saliva(AU)

Urgencia odontopediátrica asociada a Bola Adiposa de Bichat: informe de un caso / Pediatric dental emergency associated with Bichat ́s fat pad: a case report

Objetivo: Presentar la resolución quirúrgica de un caso clínico poco frecuente en un paciente pediátrico luego de ha- ber sufrido la herniación traumática de la Bola Adiposa de Bichat. Caso clínico: Un paciente de 3 años concurre a la guar- dia del Hospital Interzonal Especializado Materno Infantil "Don Victorio Tetamanti" de Mar del Plata, luego de haber sufrido un traumatismo que le provocó el desplazamiento par- cial de la Bola Adiposa de Bichat. Si bien este tipo de urgencias es poco frecuente, es impor- tante tener los conocimientos para un correcto diagnóstico y tratamiento (AU))

Aim: To present the surgical resolution of an infrequent clinical case in a pediatric patient who suffered traumatic herniation of Bichat's fat pad. Clinical case: A 3-year-old patient who visited the Emergency Service at the "Don Victorio Tetamanti" Hospital in Mar del Plata after suffering a trauma which caused the partial displacement of Bichat's fat pad. Although this type of emergency is quite rare, it is important to know how to per- form proper diagnosis and treatment (AU)