Oral manifestations of leukemia as part of early diagnosis

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

La adenopatía como clave diagnóstica para la sífilis primaria. Informe de casos / Adenopathy as diagnostic key for primary syphilis. Case reports

Objetivo: Describir tres situaciones clínicas en las que se presentan distintas manifestaciones bucales para una misma entidad patológica. En los tres casos la sospe- cha diagnóstica de sífilis primaria se basó en la presencia de una adenopatía. Los estudios de laboratorio permitieron confirmar el diagnóstico de sífilis. Por su polimorfismo y variabilidad clínica en sus diferentes etapas evolutivas, la sífilis es descripta clásicamente como "la gran simuladora". Este artículo propone que la presencia de adenomegalias características puede ser una clave para orientar el diagnós- tico de la patología, lo cual no ha sido aún reportado en la literatura. Casos clínicos: Se presentan tres casos clínicos de pa- cientes que acudieron a una consulta estomatológica privada y al Servicio de Estomatología del Hospital Alemán de Bue- nos Aires. Los tres acuden con signos y síntomas diferentes, pero compartiendo la presencia de adenopatías múltiples, en las que se destaca un elemento ganglionar más voluminoso (AU)

Aim: To describe three clinical cases that present dif- ferent oral manifestations for the same pathological entity. In all three cases, the suspected diagnosis of primary syph- ilis was based on the presence of an adenopathy. Labora- tory studies confirmed the diagnosis of syphilis. Due to its polymorphism and clinical variability in the different evo- lutionary stages, syphilis is classically described as "the great simulator". This article proposes that the presence of characteristic adenomegalies can be a key to guide the di- agnosis, which has not yet been reported in the literature. Clinical reports: Three clinical cases of patients who attended a private stomatology consultation and the Stoma- tology Service of the Hospital Alemán de Buenos Aires are presented. The three patients showed different signs and symptoms but shared the presence of multiple adenopathies with a more voluminous ganglial element (AU)

Manifestaciones bucales en pacientes con medicación antihipertensiva / Oral manifestations in patients with antihypertensive medication

Objetivo: caracterizar las manifestaciones bucales en pacientes con medicación anti- hipertensiva que acuden al servicio estomatológico sur del municipio Morón, Ciego de Ávila, Cuba. Métodos: se realizó un estudio observacional, descriptivo, transversal, en el período enero 2019 a enero 2020. Se trabajó con la totalidad del universo, constituido por 162 pacientes. La información se recopiló de las historias clínicas estomatológicas individuales y de una ficha de recolección de datos creada por los autores de la investigación. Se estudiaron las variables grupo de edad, sexo, grupo de medicamentos antihipertensivos, dosis del medicamento, signos y síntomas clínicos, así como enfermedades bucales. Se utilizó estadística descriptiva (frecuencias absolutas y relativas porcentuales). Resultados: el 42,6 % representó el grupo de edad 35 a 59 años y el 53,7% al sexo femenino. Se observó que 88 pacientes (54,3 %) se encontraban medicados con inhibidores de la enzima convertidora de angiotensina; de ellos, 38 en su dosis mínima. La xerostomía estuvo presente en el 59,9 % de los casos. El 63,6 % presentó caries dental como enfermedad estomatológica. Conclusiones: existió predominio de la xerostomía y la caries dental en la mayoría de los pacientes.

Objective: To characterize the oral manifestations in patients with antihypertensive medication who attend the southern dental service of the Moron municipality, Ciego de Avila, Cuba. Method: An observational, descriptive, cross-sectional study was carried out in the period from January 2019 to January 2020. We worked with the entire universe which was made up of 162 patients. The information was collected from individual dental medical records and from a data collection form created by the authors of the research. The variables age group, sex, antihypertensive drug group, dose of antihypertensive drug, clinical signs and symptoms, and oral diseases were studied. Descriptive statistics were used (absolute and relative percentage frequencies). Results: 42,6 % represented the age group 35 to 59 years and 53,7 % the female sex. It was observed that 88 (54,3 %) patients were medicated with angiotensin converting enzyme inhibitors, 38 of them at their minimum dose. Xerostomia was present in 59,9% of the cases. 63,6 % presented dental caries as a dental disease. Conclusions: There was a predominance of xerostomia and dental caries in most of the patients.

Norma técnica de salud para el uso del odontograma: NTS N° 188-MINSA/DGIESP-2022 / Technical health norm for the use of the odontogram: NTS N° 188-MINSA/DGIESP-2022

La publicación describe los criterios para el registro de datos de las características, anomalías patológicas de las piezas dentarias, así como el registro de procedimientos estomatológicos realizados para el uso y manejo del odontograma en las diferentes UPS, pudiendo ser utilizados en aspectos clínicos, legales, forenses, estadísticos, de investigación o docencia. Asimismo las pautas para estandarizar el gráfico y la nomenclatura básica para el registro de hallazgos clínicos en el odontograma, permitiendo a la comunidad de cirujanos dentistas manejar la misma información

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)

Manifestações bucais em portadores de epidermólise bolhosa residentes em um município baiano / Oral manifestations of epidermolysis bullosa in a municipality of the state of Bahia

Introdução: a Epidermólise Bolhosa hereditária (EB) é uma doença rara, caracterizada por formações de bolhas na pele e nas mucosas que sofrem mínimos traumas ou aparecem espontaneamente. As principais divisões de EB são Epidermólise Bolhosa Simples, Epidermólise Bolhosa Juncional, Epidermólise Bolhosa Distrófica e a Síndrome de Kindler. As manifestações bucais geralmente encontradas nos pacientes com EB são as bolhas no epitélio oral, microstomia, anquiloglossia, doença periondontal, hipoplasia do esmalte, cárie dentária, atrofia da maxila e prognatismo mandibular, variando para cada tipo da doença. Objetivo: relatar as manifestações bucais dos portadores de Epidermólise Bolhosa residentes no município de Barra da Estiva. Metodologia: trata-se de um estudo transversal, quantitativo e descritivo que foi desenvolvido no município de Barra da Estiva ­ BA com a população de portadores de Epidermólise Bolhosa, através da realização de anamnese e exame clínico. Estatística descritiva foi utilizada para tabular os dados coletados. Resultados: foram analisados 5 portadores de Epidermólise Bolhosa, a maioria do sexo masculino (60%), com média de idade de 5,6 anos. As manifestações bucais encontradas foram bolhas orais (100%), anquiloglossia (100%), língua despapilada (100%), hipoplasia de esmalte (80%), cárie (40%) e abertura de boca limitada em média de 28,6 mm. Conclusão: os portadores de Epidermólise Bolhosa apresentaram manifestações orais características da doença, tendo como consequências maiores dificuldades para realizar higienização bucal e tratamento odontológico, sendo necessário conhecimento prévio dos cirurgiões-dentistas para o atendimento desses pacientes.

Introduction: inherited Epidermolysis Bullosa (EB) is a rare disease, characterized by blistering of the skin and mucous membranes that suffer minimal trauma or appear spontaneously. The main divisions of EB are Simple Epidermolysis Bullosa, Junctional Epidermolysis Bullosa, Dystrophic Epidermolysis Bullosa and Kindler Syndrome. The oral manifestations usually found in patients with EB are blisters in the oral epithelium, microstomy, ankyloglossia, periodontal disease, enamel hypoplasia, dental caries, atrophy of the jaw and mandibular prognathism, varying for each type of disease. Objective: to report the oral manifestations of Epidermolysis Bullosa patients living in the municipality of Barra da Estiva. Methods: cross-sectional study, quantitative and descriptive that was developed in the municipality of Barra da Estiva-BA with the population of people with Epidermolysis Bullosa, through anamnesis and clinical examination. Descriptive statistics was used to tabulate the data collected. Results: 5 children with Epidermolysis Bullosa were analyzed, most male (60%), with an average age of 5,6 years. Oral manifestations found were oral blisters (100%), anquiloglossia (100%), loss of papillae of the tongue (100%), enamel hypoplasia (80%), tooth decay (40%) and mouth opening limited to the average of 28.6 mm. Conclusion: epidermolysis Bullosa children presented oral manifestations common to the disease, leading to difficulties in performing oral hygiene and dental treatment, requiring prior knowledge of dental surgeons for the care of these patients.

Oral manifestations of systemic fungal infections: 25-year experience in an endemic region

Some mycoses are endemic. They develop through hematogenous spread, causing a generalized infection, usually with secondary mucosal involvement.The aim of this observational and retrospective study was to report the prevalence and characteristics of oral lesions in patients diagnosed with systemic fungal infections (SFI) over a 25-year period in southern Brazil. Demographic (age, sex, ethnicity, occupation) and clinical (anatomical location, symptoms,histopathological diagnosis and management) data from the medical records of patients with SFI were collected from 1995 to 2019. 34 cases of SFI were found, of which 31 (91.18%) were diagnosed as paracoccidioidomycosis (PCM) and 3 (8.82%) as histoplasmosis. Men were much more affected (n = 31; 91.18%), with an average age of 46.9 years. Most patients (n = 18; 58.06%) were Caucasian; 48% (n = 15) were farm/rural workers and the most affected region was the jugal mucosa (n = 13; 25.49%) followed by the alveolar ridge (n = 12; 23.52%). All patients with histoplasmosis were immunocompetent men (mean age: 52.67 years), and the palate was the most affected. All patients underwent incisional biopsy and were referred to an infectologist. The dentist has an essential role in the recognition of SFI, whose oral manifestations may be the first sign. SFI should be included in differential diagnosis in patients from endemic areas. In addition, the inevitable human mobility and globalization make knowledge of these mycosesnecessary worldwide, especially since advanced cases in immunocompromised patients can be fatal.

Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series

Abstract Objective: To describe systemic manifestations, the characteristics related to tooth eruption, and the occurrence of enamel defects in children with Congenital Zika Virus Syndrome (CZS). Material and Methods: Prospective case series based on nine children with confirmed CZS diagnosis assisted at a reference center in a municipality in the Northeast Region of Brazil. Through a structured interview directed to mothers, information related to prenatal, delivery, and postpartum periods was collected. Tooth eruption was monitored through clinical examinations for 36 months. The modified developmental defect of enamel index (DDE) was used to identify opacities and hypoplasia. Data were presented using descriptive statistics. Results: A high proportion (77.8%) had microcephaly, and 55.5% had low birth weight. Musculoskeletal disorders, swallowing difficulty, and self-injury practices were present in all children. Among the systemic findings, visual impairment (77.8%) and seizures (77.8%) were widely reported. Concerning disorders related to the stomatognathic system, bruxism (66.7%) and difficulty in sucking (33.3%) were present. For most children (77.8%), the deciduous right lower central incisor was the first tooth to erupt (minimum 8 months and maximum 17 months). Enamel defects were diagnosed in only two children (22.2%). Conclusion: A wide range of systemic manifestations was observed in children with CZS, including visual impairment and musculoskeletal disorders. Delayed eruption of the first deciduous tooth was also observed. Enamel defects were present in a small proportion of children.

Disfunções orofaciais em pacientes infantojuvenis com leucemia aguda / Orofacial dysfunctions in infants and young children with acute leukemia

RESUMO Objetivo Identificar a ocorrência de disfunções orofaciais em pacientes infantojuvenis com leucemia aguda, submetidos à quimioterapia de remissão. Métodos Em um período de 16 meses, 40 pacientes com leucemias agudas, entre 3 e 18 anos de idade, foram admitidos em um hemocentro no estado do Amazonas. Destes, 23 foram incluídos neste estudo transversal e submetidos à avaliação das funções orofaciais, por meio do Nordic Orofacial Test-Screening (NOT-S), entre o trigésimo (D30) e o trigésimo terceiro dia (D33) da fase de indução da remissão. A presença de manifestações orais também foi avaliada por meio de exame clínico. Resultados Disfunção orofacial foi observada em, aproximadamente, metade dos casos avaliados (n=11). Destes pacientes, todos tiveram o domínio Secura de Boca (VI) alterado e 81,8% (n=9) apresentaram alteração no domínio Mastigação e Deglutição (IV). Mucosites em lábios, língua, soalho e orofaringe foram as lesões orais mais encontradas após a fase de indução. Houve associação entre a ocorrência de lesões orais nos pacientes avaliados e a presença de disfunção orofacial, segundo o NOT-S (IC 95%, p-valor = 0,027). Conclusão Sugere-se que a disfunção orofacial seja frequente na fase de indução da remissão em pacientes infantojuvenis com leucemias agudas. Estudos sobre as disfunções orofaciais nessa população, bem como sua relação com as lesões orais são necessários para melhor esclarecimento e compreensão dos impactos funcionais.

ABSTRACT Purpose To Identify the occurrence of orofacial dysfunctions in young children and adolescents with acute leukemia who are undergoing remission chemotherapy. Methods Over a period of 16 months, 40 three to eighteen year -old patients with acute leukemia were admitted to the Amazonas State Hemocenter. Of these, 23 were included in the cross-sectional study and submitted to the evaluation of orofacial functions using the Nordic Orofacial Test-Screening, between D30 and D33 of the remission induction phase. The presence of oral manifestations was also evaluated via clinical examination. Results Orofacial dysfunction was observed in approximately half of the evaluated cases (n=11). Of these patients, all had alterations in the Dryness of the Mouth (VI) domain and 81.8% (n=9) showed alterations in the Chewing and Swallowing (IV) domain. Mucosites on lips, tongue, floor of the mouth and the oropharynx were the most commonly found oral lesions after the remission induction phase. According to the NOT-S, there was an association between the occurrence of oral lesions in the evaluated patients and the presence of orofacial dysfunction (95% CI, p-value = 0.027). Conclusion It is suggested that orofacial dysfunction is frequent in the remission induction phase in children and adolescents with acute leukemia. Studies regarding these orofacial dysfunctions in this population, as well as their relationship with oral lesions, are needed in order to fully understand their functional impact.

Molusco contagioso: actualización y casos clínicos / Molluscum contagiosum: an update and clinical cases

El molusco contagioso es una patología viral benigna muy frecuente, exclusiva del ser humano, y causada por un virus no clasificado del grupo de los Poxvirus. Las manifestaciones clínicas de la enfermedad inclu-yen lesiones en la piel, que pueden variar desde una pequeña pápula a un nódulo de mayor tamaño, pre-sentándose en forma solitaria o múltiple, dependien-do del estado inmunitario del paciente y del tiempo de evolución del proceso morboso. El estudio histo-patológico es importante para el diagnóstico, aunque en numerosas ocasiones éste se define clínicamen-te. Además del patrón histológico tradicional, y más frecuente, que exhibe hiperplasia e hipertrofia de la epidermis, se han descripto variantes poco usuales, cuyas características dependen, entre otros factores, de la sobreinfección y de la respuesta inmunitaria del paciente. En este trabajo se describen los rasgos ge-nerales del molusco contagioso y luego se presentan varios casos clínicos, uno de los cuales exhibe ma-nifestación inusual en la semimucosa del labio. Por último, se realizan comentarios referentes a la im-portancia que tiene para el odontólogo conocer esta patología y estar capacitado para detectarla, de modo de evitar sus complicaciones y su diseminación (AU)

Molluscum contagiosum is a very common benign viral pathologythat affects exclusively humans and is caused by an unclassified virus of the Poxvirus family. Clinical manifestations include skin lesions such as papule or nodule, which may range from a small papule to a larger nodule, presenting either solitary or multiple, depending on the immune status of the patient and the time of evolution of the morbid process. Histopathological study is important for the diagnosis, although in numerous occasions it is defined clinically. Classical and more frequent histology pattern exhibits hyperplasia and hypertrophy of the epidermis; however, distinct characteristics may occur depending on factors like superinfection and immune response of patients. This article describes general aspects of molluscum contagiosum and exposes several clinical cases, one of which exhibits an unusual manifestation in the semimucosa of the lip. Finally, comments are made regarding the importance for dentists to learn about the existence of this pathology and be able to recognize it in order to avoid its complications and spread (AU)

Manifestaciones orales y manejo estomatológico de paciente pediátrico con secuelas por COVID-19 / Manifestações orais e gestão estomatológica do paciente pediátrico com sequelas devido ao COVID-19 / Oral manifestations and stomatological management of pediatric patients with sequelae due to COVID-19

Introducción: Desde diciembre de 2019, la nueva cepa del coronavirus 2, causante del síndrome respiratorio agudo severo (SARS-CoV-2), ha provocado una pandemia mundial. Los niños y los adolescentes infectados generalmente son asintomáticos y solo experimentan síntomas respiratorios leves. Sin embargo, se ha reportado, una nueva tendencia alarmante en las infecciones pediátricas por COVID-19, en las cuales los pacientes han llegado a presentar manifestaciones agravantes que han requerido de hospitalización, dejando secuelas importantes. Objetivo: Dar a conocer las manifestaciones orales asociadas al caso clínico de un paciente pediátrico contagiado por SARS-CoV-2, así como la rehabilitación estomatológica de mínima invasión. Presentación de caso clínico: Paciente masculino de 5 años, con antecedente de COVID-19, quien, en su estancia hospitalaria en el Instituto Nacional de Pediatría de México, presentó choque séptico refractario secundario SARS-COV-2 y falla orgánica múltiple. Se observaron lesiones en dorso lingual secundarias a la infección por COVID-19 las cuales eran asintomáticas. El paciente presentaba caries, y fue rehabilitado exitosamente cumpliendo medidas de bioseguridad, con materiales bioactivos y convencionales, estableciendo un excelenterapport. Conclusiones: El odontólogo pediatra debe diagnosticar las manifestaciones bucales del COVID-19, estableciendo protocolos adecuados de atención. El presente caso fue tratado exitosamente con una estrategia de rehabilitación oral efectiva y parámetros de prevención. Es importante reportar las manifestaciones orales por lo que se sugiere realizar seguimiento de estos hallazgos.

Introdução: Desde dezembro de 2019, a nova cepa do Coronavírus 2, que causa a síndrome respiratória aguda grave (SARS-CoV-2), causou uma pandemia global. Crianças e adolescentes infectados são geralmente assintomáticos ou apresentam apenas sintomas respiratórios leves. Entretanto, uma nova tendência de alarme tem sido relatada nas infecções pediátricas por COVID-19, nas quais os pacientes passaram a apresentar manifestações agravantes que precisaram de hospitalização, deixando sequelas significativas. Objetivos: Apresentar as manifestações orais associadas ao caso clínico de um paciente pediátrico infectado pela SRA-CoV-2, bem como a reabilitação estomatológica minimamente invasiva. Apresentação do caso clínico: Paciente do sexo masculino com 5 anos, com história de COVID-19, que durante sua internação hospitalar no Instituto Nacional de Pediatria do México, apresentou choque séptico refratário secundário ao SARS-COV2 e falha orgânica múltipla. Foram observadas lesões no dorso da língua secundárias à infecção por COVID-19, assintomáticas. Foi reabilitado com materiais bioativos e convencionais, estabelecendo um excelente relacionamento com o paciente. Conclusões: O estomatologista pediátrica deve diagnosticar as manifestações orais da COVID-19, estabelecendo protocolos de cuidados apropriados. O presente caso foi tratado com sucesso com uma estratégia eficaz de reabilitação oral e parâmetros de prevenção. É relevante mencionar as manifestações orais, por isso sugere-se o acompanhamento desses achados.

Introduction: Since December 2019, the new strain of coronavirus 2, which causes severe acute respiratory syndrome (SARS-CoV-2), has caused a global pandemic. Infected children and adolescents are generally asymptomatic and experience only mild respiratory symptoms. However, an alarming new trend has been reported in pediatric COVID-19 infections, in which patients have even presented aggravating manifestations that have required hospitalization, leaving significant sequelae. Objectives: To present the various oral manifestations associated with this case of a pediatric patient infected by SARS-CoV-2, as well as minimally invasive stomatological rehabilitation. Case presentation: A 5-year-old male patient, with a history of COVID-19, who during his hospital stay at the National Institute of Pediatrics of Mexico, presented refractory septic shock secondary to SARS-COV-2 and multiple organ failure. Lesions on the dorsum of the tongue were observed secondary to COVID-19 infection, which were asymptomatic. The patient presented caries, and was rehabilitated following biosafety measures, with bioactive and conventional materials, establishing an excellent rapport. Conclusions: The pediatric stomatologist's should diagnose the oral manifestations of COVID-19, establishing adequate care protocols. The present case was successfully treated with an effective oral rehabilitation strategy and prevention parameters. It is important to report oral manifestations, so it is suggested to follow up on these findings.

Recurring oral erythema multiforme-like lesions elicited by COVID-19 infection: a case report / Lesões semelhantes a eritema multiforme oral recorrente induzidas por infecção por COVID-19: relato de caso

Oral mucosa could be the first site infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ­the causative agent of coronavirus disease 2019 (COVID-19). Indeed, different oral and paraoral lesions, conditions and symptoms have been reported in patients with COVID-19. Experts thought that such oral lesions could be secondary to the COVID-19-associated deterioration of systemic health or due to treatments of COVID-19. We present here a case of a 24-year-old male presented with painful multiple ulcers involving the labial and buccal mucosae bilaterally after a while of feeling very mild symptoms that laboratory-confirmed by reverse-transcription polymerase chain reaction to be COVID-19. Involvement of eyes was also reported. The above clinical presentation was consistent with minor erythema multiform. Many topical preparations were prescribed but with limited improvement. Hence, oral prednisolone was prescribed with a 40-mg loading dose that was tapered by 10 mg every 3 days. Complete healing of oral mucosa was observed on the 10 day. Strikingly, the patient got affected with the second episode of similar oral lesions 5 months later without any apparent triggering factors, suggestive a long term effects of COVID-19 in a subset of patients. The present case report provides dentists with useful information and increases their awareness regarding possible involvement of oral cavity with multiple ulcerative lesions associated with COVID-19 (AU)

A mucosa oral pode ser o primeiro local infectado com a síndrome respiratória aguda grave coronavírus 2 (SARS- CoV-2) ­ o agente causador da doença por coronavírus 2019 (COVID-19). De fato, diferentes lesões, condições e sintomas orais e paraorais foram relatados em pacientes com COVID-19. Os especialistas pensavam que essas lesões orais poderiam ser secundárias à deterioração da saúde sistêmica associada ao COVID-19 ou devido a tratamentos do COVID-19. Apresentamos aqui um caso de um homem de 24 anos que apresentou múltiplas úlceras dolorosas envolvendo bilateralmente as mucosas labial e bucal após um tempo sentindo sintomas muito leves que foram confirmados laboratorialmente pela reação em cadeia da polimerase de transcrição reversa como COVID-19. O envolvimento dos olhos também foi relatado. A apresentação clínica acima foi compatível com eritema multiforme menor. Muitas preparações tópicas foram prescritas, mas com melhora limitada. Assim, foi prescrito prednisolona oral com uma dose inicial de 40 mg que foi reduzida em 10 mg a cada 3 dias. A cicatrização completa da mucosa oral foi observada no 10º dia. Surpreendentemente, o paciente foi afetado com o segundo episódio de lesões orais semelhantes 5 meses depois, sem nenhum fator desencadeante aparente, sugerindo efeitos de longo prazo do COVID-19 em um subconjunto de pacientes. O presente relato de caso fornece aos dentistas informações úteis e aumenta sua conscientização sobre o possível envolvimento da cavidade oral com múltiplas lesões ulcerativas associadas ao COVID-19 (AU)

Qualidade de Vida e Saúde Bucal em Crianças submetidas à Terapia Antineoplásica / Quality of Life and Oral Health in Children undergoing Antineoplastic Therapy / Calidad de Vida y salud Oral de los Niños sometidos a Terapia Antineoplásica

Introdução: O câncer é uma doença grave cujo protocolo de tratamento pode produzir severos efeitos colaterais de ordem psicossocial e física. Os principais efeitos do tratamento antineoplásico podem acometer a cavidade oral, especialmente em crianças, comprometendo a sua qualidade de vida e a do núcleo familiar. Objetivo: Identificar e descrever as lesões bucais relacionadas aos efeitos colaterais produzidos pelo tratamento antineoplásico e avaliar seu impacto sobre a qualidade de vida da criança e da sua família. Método: Estudo qualitativo e transversal, com a participação de 117 crianças pré-escolares atendidas em hospital de referência (Paraíba), por meio do questionário B-ECOHIS, de exames clínicos odontológicos e de prontuários médicos. O tratamento estatístico fundamentou-se na análise descritiva e regressão de Poisson com variância robusta no método (p<0,05). Resultados: As manifestações mais observadas foram mucosite e xerostomia (66,7% e 54,7%, respectivamente). Relativo ao impacto na qualidade de vida da criança, o domínio de maior média foi limitação funcional 3,0 (±1,8) e, na família, função familiar 1,0 (±1,0). Conclusão: O impacto na qualidade de vida das crianças se revelou fraco e, no núcleo familiar, não foi significativo

Introduction: Cancer is a burdensome disease whose treatment protocol can produce severe psychosocial and physical side effects. The main effects of antineoplastic treatment may affect the oral cavity, especially in children, compromising theirs and their family quality-of-life. Objective: To identify and describe side effects-related antineoplastic treatment and to assess its impact on the children's and their families' quality-of-life. Method: Qualitative and cross-sectional study, with the participation of 117 children, preschoolers, consulted at a referral hospital in the State of Paraíba, through the B-Ecohis questionnaire, dental clinical exams and medical records. The statistical treatment was based on descriptive analysis and Poisson Regression with robust variance in the Stepwise method (p<0.05). Results: The most common manifestations were mucositis and xerostomia (66.7% and 54.7% respectively). The impact on the children's quality-of-life affected mostly the domain of functional limitation with mean of 3.0 (±1.8) and 1.0 (±1.0) for the family function in the family. Conclusion: The impact on the quality-of life in children was weak and not significant in the family

Introducción: El cáncer es una enfermedad grave cuyo protocolo de tratamiento puede producir efectos secundarios psicosociales y físicos graves. Entre los principales efectos del tratamiento antineoplásico, algunos afectan la cavidad bucal, especialmente en los niños, comprometiendo su calidad de vida y el núcleo familiar. Objetivo: Identificar los efectos secundarios producidos por el tratamiento antineoplásico y evaluar su impacto en la calidad de vida del niño y su familia. Método: Estudio cualitativo y transversal, con la participación de 117 niños, preescolares, atendidos en un hospital de referencia (Paraíba), mediante el cuestionario B-Ecohis, exámenes clínicos dentales y registros médicos. El tratamiento estadístico se basó en análisis descriptivo y Regresión de Poisson con varianza robusta en el método Stepwise (p<0,05). Resultados: Las manifestaciones más observadas fueron mucositis y xerostomía (66,7% y 54,7% respectivamente). En cuanto al impacto en la calidad de vida del niño, el dominio con mayor promedio fue la limitación funcional 3,0 (±1,8) y la función familiar 1,0 (±1,0) en la familia. Conclusión: El impacto en la calidad de vida de los niños fue débil y en la familia no significativo

Síndrome de Gardner: informe de un caso y revisión de la literatura / Gardner syndrome: case report and literature review

El síndrome de Gardner es una enfermedad genética de herencia autosómica dominante, presenta múltiples manifestaciones craneofaciales caracterizadas por hipercrecimientos óseos conocidos como osteomas, riesgo de desarrollo de pólipos gastrointestinales con alto potencial de malignidad y de tumores o quistes en piel, así como alteraciones dentales, entre las que destacan la presencia de dientes supernumerarios, retenciones dentarias, permanencia de dientes deciduos y odontomas, estas últimas de gran importancia para el odontólogo. Se trata de una enfermedad que afecta a mujeres y hombres de forma indistinta, no obstante, su prevalencia es mayor en el sexo femenino. El objetivo del presente artículo es explicar las manifestaciones clínicas y radiográficas dentales y craneofaciales del síndrome de Gardner mediante la presentación de un caso clínico y revisión de la literatura (AU)

Gardner syndrome is a genetic disease of autosomal dominant inheritance, it presents multiple craniofacial manifestations characterized by bone overgrowths known as osteomas, risk of development of gastrointestinal polyps with high potencial of malignancy, and skin tumors or cysts, as well as dental alterations, among the characteristics of the presence of supernumerary teeth, dental retention, permanence of deciduous teeth and odontomas, the latter of great importance for the dentist. It is a disease that affects women and men indistinctly, however, its prevalence is higher in the female sex. The aim of this article is to explain the dental and craniofacial clinical and radiographic manifestations of Gardner syndrome by presenting a clinical case and a review of the literature (AU)

Manifestações orais do Covid-19: uma breve revisão da literatura / Oral manifestations of Covid-19: a brief review of the literature

A pandemia gerada pelo SARS-CoV-2 gerou uma série de estudos sobre essa nova doença. Este cenário proporcionou mudanças na odontologia, modificando a forma de atendimento e a rotina do consultório. O conhecimento sobre as implicações desse vírus no sistema estomatognático pode fornecer informações valiosas no conhecimento sobre o mecanismo dessa doença na cavidade oral. Dessa forma, foi realizada uma revisão de literatura, a fim de discutir os efeitos do COVID-19 na cavidade oral. No entanto, há poucas evidências na literatura sobre a correlação da COVID-19 e manifestações orais. Pode-se concluir que o vírus possui reflexo na cavidade oral, apresentando diferentes alterações, tais como: úlceras, periodontite, alterações do paladar, infecções oportunistas, dentre outras. Ainda se faz necessária a realização de mais estudos, para compreensão dos mecanismos fisiopatológicos da doença. Além disso, o trabalho ressalta a importância do cirurgião-dentista no ambiente hospitalar, para diagnóstico e conduta no tratamento dessas manifestações na cavidade oral(AU)

The SARS-CoV-2 pandemic has spawned several studies on this new disease. This scenario provided changes in Dentistry by modifying the form of care and the routine of the office. The knowledge about the implications of this virus in the stomatognathic system can provide valuable information in the knowledge about the mechanism of this disease in the oral cavity. Thus, a literature review was carried out to discuss the effects of COVID-19 on the oral cavity. However, there is little evidence in the literature about the correlation between COVID-19 and oral manifestations. It can be concluded that the virus is reflected in the oral cavity, such as ulcers, periodontitis, changes in taste, opportunistic infections, among others. Further studies are still needed to understand the pathophysiological mechanisms of the disease. Besides, the work highlights the importance of the Dental Surgeon in the hospital environment for diagnosis and management in the treatment of these manifestations in the oral cavity(AU)

Papel de los tejidos orales durante la infección por SARS-CoV-2 / Role of oral tissues in SARS-CoV-2 infection

La actual pandemia de COVID-19 provocada por el virus SARS-CoV-2 es un problema de salud que afecta a la población globalmente. Su desarrollo puede ser asintomático o exhibir manifestaciones clínicas moderadas o severas dependiendo en gran medida de la respuesta inmune de quien la padece. Esta enfermedad afecta principalmente a los pulmones a través del desarrollo del síndrome respiratorio agudo severo (SRAS), tanto como por la «tormenta de citocinas¼, una respuesta inflamatoria exacerbada que podría provocar una falla multisistémica y, en casos severos, la muerte. Se conoce que la enzima convertidora de angiotensina 2 (ECA-2), presente en diversos tejidos del cuerpo, actúa como receptor funcional del virus SARS-CoV-2 facilitando la entrada de éste a las células. Se ha demostrado la presencia de dicho receptor en varios tejidos orales, por lo que se puede considerar a la cavidad bucal como una vía latente de infección por dicho coronavirus, ya que su mecanismo de transmisión es a través de la inhalación de partículas virales, ya sea por vía nasal u oral. Así mismo, la presencia de carga vírica en la saliva y algunos de los síntomas de la COVID-19, por ejemplo la ageusia, pueden indicar la presencia de contagio viral en etapas tempranas. La presente revisión muestra evidencia que sugiere que diversos tejidos en la cavidad oral podrían ser considerados sitios potenciales de contagio por el SARS-CoV-2, teniendo un papel importante en el mecanismo de transmisión y en el desarrollo de coinfecciones (AU)

The COVID-19 pandemic caused by the SARS-CoV-2 virus is currently a global healthcare problem. The onset of this disease can exhibit several clinical manifestations ranging from mild to severe symptoms, depending on the individual's immune response. COVID-19 primarily affects the lungs by developing the Severe Acute Respiratory Syndrome (SARS) and the «cytokine storm¼, an exacerbated inflammatory reaction that can lead to multiorgan failure and consequently death. The angiotensin-converting enzyme 2 (ACE-2), present in several tissues in the human body, is known to act as the functional receptor of the SARS-CoV-2 germ facilitating its entrance into the cells. Such receptor is also present in diverse oral cavity tissues, indicating a latent route of infection due to its influence in the transmission mechanism by inhalation, either oral or nasal, of virus particles. Also, viral load in saliva and taste disorder symptoms like ageusia could indicate a viral infection in its early stages. This article presents evidence suggesting that several tissues in the oral cavity can be considered potential sites of SARS-CoV-2 infection, thus playing an essential role in the transmission mechanism and development of co-infections (AU)

O impacto do uso de substâncias psicoativas e suas repercussões na cavidade bucal: revisão integrativa / The impact of the use of psychoactive substances and their manifesta-tions on the oral cavity: integrative review / El impacto del uso de sustancias psicoactivas y sus manifestacionesen la cavidad oral: revisíon integradora

Introdução:O consumo de drogas pode promover consequências para o organismo, sobretudo a cavidade bucal. Objetivo:Verificar quais são as substâncias psicoativas mais utilizadas e suasmanifestações na cavidade bucal. Metodologia:Trata-se de uma revisão integrativa, realizadana base de dados Medical Publications (PubMed) com os descritores "Transtornos Relacionados ao Uso de Substâncias (Substance-Related Disor-ders)" e "Odontologia (Dentistry)" com o operador booleano "And".Foram seleciona-dos artigos primeiramente por meio de leituras exploratórias dos seus títulos e resumos, seguida da leitura dos artigos na íntegra, levando em consideração os critérios de inclusão, que consistiam em textos completos, publicados nos idiomas Português e Inglês, do tipo estudo transversal indexados na base de dados referida, no período de 2015 a 2020 e que associassem o uso das substâncias psicoativas com as manifestaçõesna cavidade bucal, e os critérios de exclusão, que foram artigos de opinião, relatos de caso, revisões de literatura e os estudos que não abordassem sobre a temática da pesquisa. Resultados:A amostra foi composta por 5 artigos seleciona-dos, em que 4 deles realizaram a pesquisa com homens e mulheres e apenas 1 com homens, em ambos os trabalhos a idade dos participantes foram superiores a 18 anos e as substâncias psicoativas analisadasvariaram entre ópio, crack, cocaína, heroína, maconha, álcool e tabaco. Como consequência ao uso dessas substânciasa perda den-tária, presença de cárie dentária e doença periodontal foram as principais manifesta-çõesbucais. Conclusões:O consumo de substâncias psicoativas aumenta o limiar de dor, podendo mascarar a sintomatologia dolorosa das manifestações bucais e postergar a busca por tratamento odontológico, agravando, por vezes, a condição bucal do indivíduo. Sendo portanto, de extrema importância o conhecimento e atuação do cirurgião dentista frente ao usuário de drogas, desde a prevenção, diagnóstico etratamento do caso (AU).

Introduction:Drug use can have consequences for the body, especially the oral cavity.Objective:To investigate the most used psychoactive substances and their manifesta-tions in the oral cavity. Methodology:This is an integrative review, carried out in the Medical Publications database (PubMed) with the descriptors "Substance-Related Dis-orders (Substance-Related Disorders)" and "Dentistry (Dentistry)" with the Boolean operator "And". Articles were selected first through exploratory readings of their titles and abstracts, followed by reading the articles in full, taking into account the inclusion criteria, which consisted of full texts, published in Portuguese and English, of the cross-sectional type indexed in the referred database, in the period from 2015 to 2020 and that associated the use of psychoactive substances with the manifestations in the oral cavity, and the exclusion criteria, which were opinion articles, case reports, litera-ture reviews and studies that did not address the research theme.Results:The sample consisted of 5 selected articles, of which 4 of them researched with men and women and only 1 with men. In both studies, the participants' age was over 18 years, and the psychoactive substances analyzed varied between opium, crack, cocaine, heroin, ma-rijuana, alcohol, and tobacco. As a consequence of using these substances, tooth loss, dental caries, and periodontaldisease were the main oral manifestations.Conclusions:The consumption of psychoactive substances increases the pain threshold, masks the painful symptoms of oral manifestations and postpones the search for dental treat-ment, sometimes worsening the individual's oral condition. Therefore, the knowledge and performance of the dental surgeon concerning the drug user is essential, from pre-vention, diagnosis, and treatment of the case (AU).

Introducción:El consumo de drogas puede tener consecuencias en el organismo, es-pecialmente en la cavidad oral.Objetivo:Investigar las sustancias psicoactivas más utilizadas y sus manifestaciones en la cavidad oral.Metodología: Revisión integra-dora, realizada en la base de datos de publicaciones médicas (PubMed) con los des-criptores "Substance-Related Disorders (Trastornos relacionados con sustancias)" y "Dentistry (Odontología)" con el operador booleano "And". Los artículos fueron selec-cionados primero a través de la lectura exploratoria de sus títulos y resúmenes, se-guida de la lectura de los artículos en su totalidad, teniendo en cuenta los criterios de inclusión, que consistieron en textos completos, publicados en portugués e inglés, de tipo transversal indexados en la referida base de datos, en el período de 2015 a 2020 y que asociaran el uso de sustancias psicoactivas con las manifestaciones en la cavidad oral, y los criterios de exclusión, que fueron los artículos de opinión, los informes de casos, las revisiones bibliográficas y los estudios que no abordaron el tema de investi-gación. Resultados:Consistió en 5 artículos seleccionados, de los cuales 4 investigaron con hombres y mujeres y sólo 1 con hombres. En ambos estudios, la edad de los parti-cipantes era superior a 18 años y las sustancias psicoactivas analizadas variaban entre opio, crack, cocaína, heroína, marihuana, alcohol y tabaco. Como consecuencia del consumo de estas sustancias, la pérdida de dientes, la caries dental y la enfermedad periodontal fueron las principales manifestaciones orales.Conclusiones: El consumo de sustancias psicoactivas aumenta el umbral del dolor, enmascara los síntomas dolo-rosos de las manifestaciones orales y pospone la búsqueda de tratamiento odontoló-gico, empeorando en ocasiones la condición oral del individuo. Por lo tanto, el conoci-miento y la actuación del cirujano dentista en relación con el consumidor de drogas es esencial, desde la prevención, el diagnóstico y el tratamiento del caso (AU).

Manifestaciones bucales de pacientes con mucopolisacaridosis / Oral manifestations in patients with mucopolysaccharidosis

Objetivo: Describir las características bucales prevalentes de pacientes argentinos con mucopolisacaridosis (MPS) atendidos en el Servicio de Odontología del Hospital Nacional "Prof. Alejandro Posadas". Materiales y métodos: Se consideraron las historias clínicas de 19 pacientes con diagnóstico de MPS. Se registraron la edad, el sexo, el lugar de residencia, el tipo de MPS y la presencia de retraso madurativo. La muestra estuvo constituida por 13 niños (6,7±3 años) y 6 adultos (26±9 años): 2 eran mujeres (1 con MPS tipo I; 1 con MPS tipo IV A) y 17 eran hombres (15 con MPS tipo 2; 1 con MPS tipo 1; 1 con MPS tipo III); 13 de los pacientes presentaban discapacidad intelectual. Se evaluaron: tipo de dentición, oclusión, macroglosia, hipoplasias del esmalte, tipo de respiración predominante, clase molar y tratamiento realizado. Resultados: Ambos casos con MPS I presentaban mordida abierta anterior y giroversión dental, y solo uno de estos, diastemas, microdoncia, hipoplasias del esmalte, macroglosia y respiración bucal. De los 15 pacientes con MPS II, 11 presentaban mordida abierta anterior (73%), 3 mordida cruzada posterior (20%), 5 giroversión dental (33%), 11 diastemas (73%), 3 retraso en la erupción (20%), 4 hiperplasia gingival (26%), 13 macroglosia (87%), 7 hipoplasias del esmalte (47%), 2 microdoncia (13%), 9 respiración bucal (60%). Se registraron 5 pacientes con clase molar I (33%), 3 con clase molar II (20%), 3 con clase molar III (20%) y en 3 casos no se pudo evaluar (20%). En el paciente con MPS tipo III se halló mordida abierta anterior, diastemas, retraso en la erupción, macroglosia, respiración bucal y clase molar II; y en el caso de MPS tipo IV A, mordida abierta anterior, diastemas, hiperplasia gingival, macroglosia y clase molar II. El 90% de los pacientes requirió tratamiento odontológico (AU)

Aim: To identify the most prevalent oral manifestations of 19 Argentine patients with mucopolysaccharidos (MPS) attending the Dentistry Service of the National Posadas Hospital. Materials and methods: The medical records of 19 patients diagnosed with MPS were considered. Age, sex, place of residence, type of MPS, and presence of maturational delay were recorded. The sample consisted of 13 children (6.7 ± 3 years) and 6 adults (26 ± 9 years): 2 were women (1 with MPS type I; 1 with MPS type IV A) and 17 were men (15 with MPS type 2; 1 with MPS type 1; 1 with MPS type III); 13 of the patients had intellectual disabilities. The following were evaluated: type of dentition, occlusion, macroglossia, enamel hypoplasia, predominant type of respiration, molar class and treatment performed Results: Both cases with MPS I presented anterior open bite and dental gyroversion, and only one of these, diastemas, microdontia, enamel hypoplasia, macroglossia and mouth respiration. Of the 15 patients with MPS II, 11 presented anterior open bite (73%), 3 posterior crossbite (20%), 5 dental gyroversion (33%), 11 diastemas (73%), 3 delayed eruption (20%), 4 gingival hyperplasia (26%), 13 macroglossia (87%), 7 enamel hypoplasia (47%), 2 microdontia (13%), 9 mouth breathing (60%). 5 patients with molar class I (33%), 3 with molar class II (20%), 3 with molar class III (20%) and in 3 cases it could not be evaluated (20%). In the patient with type III MPS, anterior open bite, diastemas, delayed eruption, macroglossia, mouth breathing and molar class II were found; and in the case of type IV A MPS, anterior open bite, diastemas, gingival hyperplasia, macroglossia and molar class II. 90% of the patients required dental treatment. Conclusion: The most observed oral manifestations were macroglossia (84.2%) and anterior open bite (73%) (AU)

Histoplasmosis: informe de un caso / Histoplasmosis: a case report

Objetivo: Describir el diagnóstico y el tratamiento interdisciplinario de un caso clínico de histoplasmosis. Caso clínico: Un paciente masculino de 39 años, con antecedentes de consumo de drogas, alcohol, tabaquismo crónico y VIH+ sin adherencia al tratamiento, acudió al Servicio de Odontología por una interconsulta del Servicio de Clínica Médica para la evaluación de lesiones erosivas en paladar duro y blando, reborde alveolar anterior, dorso lingual y lesión tumoral en encía anterosuperior. El diagnóstico definitivo se obtuvo por medio del análisis de muestras de biopsia transbronquial, lavado broncoalveolar y biopsia de lesión en piel. El paciente recibió tratamiento sistémico con antimicóticos (anfotericina B e itraconazol según esquema) y tratamiento local con colutorio de clorhexidina al 0,12% y 100.000 UI de nistatina en suspensión. Al momento del alta, presentaba una considerable mejoría de su estado general y de las lesiones orales, con disminución de sintomatología dolorosa. Se indicó turno para control a los 7 días de forma ambulatoria, al cual el paciente no asistió. El abordaje interdisciplinario y el análisis de los diferentes aspectos socioeconómicos, culturales, ambientales y sistémicos del paciente facilitaron el diagnóstico temprano de la enfermedad (AU)

Aim: To describe the diagnosis and interdisciplinary treatment of a clinical case of histoplasmosis. Clinical case: 39-year-old male patient with a history of drug abuse, alcohol, and chronic smoking, HIV+ without treatment compliance, attends the dental department referred by the medical department for the diagnosis of erosive lesions in the hard and soft palate, anterior alveolar ridge, lingual dorsum and tumor lesion in the anterosuperior gingiva. The definitive diagnosis was obtained by the analysis of transbronchial biopsy, bronchoalveolar lavage and skin lesion biopsy. The patient received systemic treatment with antifungals (amphotericin b, itraconazole according to protocol), and local treatment with 0.12% chlorhexidine mouthwash and 100,000 IU nystatin suspension. At the time of medical discharge, the patient presented a considerable improvement in his general condition and of the oral lesions with a reduced pain. A 7 days recall was prescribed, however the patient failed to attend. The interdisciplinary approach to the patient and the analysis of the different socio-economic, cultural, environmental and systemic aspects of the patient facilitates the early diagnosis of the disease (AU)