EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity

Abstract This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

Resumo Lipomas são as neoplasias mesenquimais benignas mais comuns, no entanto sua etiopatogenia ainda permanece desconhecida. Dessa forma, essa pesquisa teve como objetivo detectar, quantificar e comparar a expressão imunoistoquímica do EGFR, VEGF e contagem microvascular (MVC) dos lipomas orais, relacionando-os com as características clínicas e morfológicas dos casos estudados. A amostra foi composta por 54 lipomas orais (33 clássicos e 21 não clássicos) e 23 casos de tecido adiposo normal. A análise da expressão imunoistoquímica de EGFR e VEGF foi fundamentada na marcação citoplasmática e/ou nuclear. O índice angiogênico foi avaliado por meio da MVC. A contagem de células foi realizada utilizando software IMAGE J®. Os dados obtidos foram analisados no software Statistical Package for Social Science. O nível se significância de 5% foi adotado para os testes estatístico. A análise da imunoexpressão das proteínas revelou para o EGFR diferença estatisticamente significativa (p=0,041) entre o lipoma clássico e o tecido adiposo normal. Houve diferença significativa na MVC entre lipomas não clássicos e tecido adiposo normal (p=0,022). Nos lipomas não clássicos, apenas a imunoexpressão de VEGF apresentou correlação do tipo moderada, positiva e significativa (r=0,607; p=0,010) em relação a MVC. Ademais, nos lipomas clássicos foi percebido que os adipócitos imunomarcados para EGFR estiveram diretamente proporcionais a imunoexpressão de VEGF, apresentando correlação do tipo moderada, positiva e estatisticamente significativa (r=0,566; p = 0,005). Com base nos resultados, pode-se sugerir que o EGFR, VEGFR e MCV participam do desenvolvimento nos lipomas orais, contudo, não estão primariamente envolvidos no crescimento tumoral dessas neoplasias.

Higher immunoexpression of CK14 from the Wnt-1/β-catenin pathway in the development of odontomas

Abstract Tooth development depends on a series of reciprocal signaling interactions between the oral epithelium and ectomesenchyme. This study aimed to investigate the role of CK14, a protein involved in Wnt-1/β-catenin signaling, in odontogenesis and the development of odontomas. This cross-sectional, retrospective, immunohistochemical study analyzed 30 compound odontomas, 30 complex odontomas, and 17 tooth germs. Higher immunoexpression of CK14 was observed in odontogenic epithelial cells of tooth germs (p < 0.001) and odontogenic epithelial cells of odontomas (p < 0.001). There was higher immunoexpression of Wnt-1 and β-catenin proteins in epithelial cells of tooth germs (p = 0.002 and p < 0.001, respectively), as well as in the ectomesenchyme of odontomas (p = 0.003 and p < 0.001, respectively). β-Catenin was moderately and significantly correlated with CK14 in the membrane of reduced enamel epithelial cells in odontomas (p = 0.007). Higher immunoexpression of CK14 was observed in the odontogenic epithelium during the bud and cap stages and lower immunoexpression in the internal enamel epithelium during the bell stage. In odontomas, lower expression of Wnt-1/β-catenin and higher immunoexpression of CK14 were found in odontogenic epithelial cells, especially adjacent to the mineralized material resembling the tooth formed in these lesions.

Resumo O desenvolvimento dentário depende de uma série de interações de sinalização recíproca entre o epitélio oral e o ectomesênquima. O objetivo deste estudo foi investigar o papel da CK14 das vias WNT-1/β-catenina na odontogênese e no desenvolvimento de odontomas. Este estudo transversal, retrospectivo, imuno-histoquímico analisou 30 odontomas compostos, 30 odontomas complexos e 17 germes dentários. A CK14 apresentou maior imunoexpressão em células epiteliais odontogênicas de germes dentários (p<0,001) e em células epiteliais odontogênicas de odontomas (p<0,001). A Wnt-1 e a β-catenina apresentaram maior imunoexpressão de proteínas nas células epiteliais dos germes dentários (p = 0,002 e p<0,001, respectivamente), bem como no ectomesênquima dos odontomas (p = 0,003 e p < 0,001, respectivamente). A β-catenina correlacionou-se moderada e significativamente com a CK14 na membrana de células epiteliais reduzidas do esmalte em odontomas (p = 0,007). Maior imunoexpressão da CK14 foi observada no epitélio odontogênico nos estágios de botão e capuz com menor imunoexpressão no epitélio interno do órgão do esmalte no estágio de sino. Nos odontomas, foi observado menor expressão de Wnt-1/β-catenina e maior imunoexpressão da CK14 presente nas células epiteliais odontogênicas, especialmente, vizinhas ao material mineralizado semelhante ao dente formado nessas lesões.

Verruciform xanthoma associated with lichen planus

Verruciform xanthoma (VX) is a rare benign lesion of unknown etiology, with a rough or papillary aspect, painless, sessile, well-defined, most lesions do not exceed 2 cm in their largest diameter, the degree of keratinization of the surface influences color, varying white to red, affecting mainly the gingiva and alveolar mucosa, and can also be seen in skin and genital. Herein, we present a report a clinical case of oral verruciform xanthoma in the buccal mucosa associated with the lichen planus lesion, as well as the morphological and immunohistochemical characteristics of the lesion. The clinical diagnostic hypothesis of oral lichen planus of the white reticular lesions on the buccal mucosa and on the tongue was confirmed by histopathology before a subepithelial connective tissue exhibiting intense inflammatory infiltrate in a predominantly lymphocytic band. In contrast, the hypothesis of the verrucous lesion in the left buccal mucosa was leukoplakia, with histopathological evidence showing exophytic and digitiform proliferations with parakeratin plugs between the papillary projections. Subepithelial connective tissue was characterized by macrophages with foamy cytoplasm (xanthoma cells). An immunohistochemical examination was performed, showing positivity for CD68, a macrophage marker, in addition to testing by Schiff's periodic acid (PAS) with diastasis, which was detected the presence of lipids inside these macrophages. The patient is free of recurrences of verruciform xanthoma and is being monitored due to the presence of lesions of oral lichen planus.

Involvement of tryptase-positive mast cells and angiogenesis in the growth of inflammatory odontogenic cysts

Abstract: Inflammatory periapical lesions are characterized by infiltration of different immune cell types, the functions of which depend on an effective vascular network. This study aimed to evaluate the mast cells density (MCD) in inflamatory odontogenic cysts capsules concerning microvascular density (MVD), microvascular area (MVA), and microvascular perimeter (MVP), and correlate such findings with the type of lesion, intensity of the inflammatory infiltrate, and thickness of the epithelial lining. Twenty inflamatory dentigerous cysts (IDCs), twenty radicular cysts (RCs), and twenty residual radicular cysts (RRCs) were submitted to immunohistochemical analysis using anti-tryptase and anti-CD34 antibodies. RCs exhibited the highest MCD, MVD, MVA, and MVP indexes (p = < 0.001, p = 0.008, p = 0.003 and p = < 0.001, respectively), and lesions with inflammatory infiltrate grade III showed the highest MVD (p = 0.044). Considering epithelial thickness, a higher MVP index was identified in lesions with hyperplastic epithelium (p = 0.018). In IDCs, RCs, and RRCs, a strong positive correlation was observed between MVA and MVP (r = 0.950 and p = < 0.001; r = 0.914 and p = < 0.001; r = 0.713 and p = < 0.001, respectively). In IDCs, a moderate correlation was observed between MCD and both MVA and MVP (r = 0.660 and p = 0.002; r = 0.634 and p = 0.003, respectively). These results suggest that tryptase-positive mast cells might play an important role in the angiogenic activity of IDCs, while RCs had the highest indexes. Our findings also confirmed that the intensity of the inflammatory infiltrate and epithelial thickness influence angiogenesis.

Macrophages subpopulations in chronic periapical lesions according to clinical and morphological aspects

Abstract: The aim of this study was to evaluate macrophage M1 and M2 subpopulations in radicular cysts (RCs) and periapical granulomas (PGs) and relate them to clinical and morphological aspects. M1 macrophages were evaluated by the percentage of CD68 immunostaining associated with the inflammatory cytokine TNF-α, and M2 macrophages, by its specific CD163 antibody. The CD68+/CD163+ ratio was adopted to distinguish between the two macrophage subpopulations. Clinical, radiographic, symptomatology, treatment, and morphological parameters of lesions were collected and a significance level of p = 0.05 was adopted for statistical analysis. The results showed that the CD68+/CD163+ ratio was higher in the RCs (median = 1.22, p = 0.002), and the highest TNF-α immunostaining scores were found in RCs (p = 0.018); in PGs, the CD68+/CD163+ ratio was lower and associated with a greater CD163+ immunostaining (median = 1.02, p <0.001). The TNF-α in cyst epithelium had a score of 3 in 10 cases and predominance of M1 macrophages by CD68+/CD163+ (median = 2.23). In addition, CD68+ cells had higher percentage of immunostaining in smaller RCs (p = 0.034). Our findings suggest that increased CD68 immunostaining associated with TNF-α cytokine in RCs results in a greater differentiation of the M1 phenotype. The higher CD163 immunostaining in PGs results in greater differentiation of the M2 phenotype. Therefore, the inflammatory state promoted by M1 macrophages is related to growth and progression of RCs; on the other hand, the immunomodulatory state of M2 macrophages is related to maintenance of PGs.

Incidental Discovery of Acinic Cell Carcinoma of the Oral Mucosa with Metachronous Adenoid Cystic Carcinoma of the Upper Lip / Hallazgo Incidental de Carcinoma de Células Acinares de la Mucosa Oral con Carcinoma Adenoide Quístico Metacrónico del Labio Superior

ABSTRACT: Multiple salivary gland tumors represent an unusual event characterized by the development of composite lesions originated from minor or major salivary glands. These neoplasms can be categorized into three perspectives: Histologic type, time of appearance and topographic distribution. We report an unusual case of a 73-year-old black man with an acinic cell carcinoma (ACC) of the oral mucosa discovered incidentally during surgical removal of an adjacent mucocele. Approximately one year after the first consultation, the patient was seen at the local cancer reference center with a third lesion that was diagnosed as an adenoid cystic carcinoma (AdCC) of the upper lip. The patient underwent surgical reconstruction of the treated areas and has been free of the disease for the past year. To our knowledge, the combination of ACC and AdCC in intraoral sites has not been reported in the literature.

RESUMEN: Los tumores de glándulas salivales múltiples representan un evento inusual caracterizado por el desarrollo de lesiones compuestas, originadas en glándulas salivales menores o mayores. Estos neoplasmas se pueden categorizar en tres perspectivas: tipo histológico, tiempo de aparición y distribución topográfica. Reportamos un caso inusual de un hombre negro de 73 años con un carcinoma de célula acínica (ACC) de la mucosa oral descubierta incidentalmente durante la extirpación quirúrgica de un mucocele adyacente. Aproximadamente un año después de la primera consulta, el paciente se presentó en el centro de referencia del cáncer local con una tercera lesión que fue diagnosticada como carcinoma adenoide quístico (AdCC) del labio superior. El paciente se sometió a la reconstrucción quirúrgica de las áreas tratadas y durante el último año no ha presentado recurrencia de la enfermedad. De acuerdo a nuestro conocimiento la combinación de ACC y AdCC en sitios intraorales no se ha informado en la literatura.

Influência dos herpes-vírus na patogênese da doença periodontal / Influence of herpesvirus in pathogenesis of disease periodontal – a review of literature

A etiologia da doença periodontal está estreitamente relacionada à presença de microrganismos patogênicos, principalmente bactérias anaeróbias gram-negativas. Estudos recentes sugerem que os herpes-vírus (HHV) podem estar associados à ocorrência e progressão de diferentes formas da doença periodontal. Diante disso, este trabalho fez uma investigação na literatura em relação à presença dos vírus Epstein-Barr (EBV), Citomegalovírus (HCMV) e Herpes simples (HSV) em pacientes com doença periodontal. A análise dos estudos mostra que estes herpes-vírus podem contribuir para a destruição periodontal através da infecção e replicação viral, liberação de mediadores pró-inflamatórios e citotoxinas, ou como resultado de uma alteração na defesa do hospedeiro. Um número crescente de pesquisas sugere que, dentre os HHVs, o EBV e o HCMV são os que estão mais comumente envolvidos no desenvolvimento da doença periodontal. De acordo com a literatura revisada, embora ainda não tenha sido estabelecida uma relação causal entre a infecção por herpes-vírus e o desenvolvimento da doença periodontal, tem sido destacada uma associação positiva entre ambas.

Manifestações periodontais associadas às doenças auto-imunes: uma revisão de literatura / Periodontal manifestations associated with autoimmune diseases: a literature review

As doenças auto-imunes envolvem a formação de auto-anticorpos direcionados contra alguns elementos teciduais, particularmente os da pele ou superfícies das mucosas, como forma sistêmica. Dentre estas doenças podemos destacar o pênfigo vulgar, o lúpus eritematoso sistêmico e o penfigóide das membranas mucosas. Estas estão, muitas vezes, associadas com sintomas bucais, podendo apresentar em diversos sítios orais a presença de lesões vesículo-bolhosas e gengivite descamativa. Baseado nisto, este artigo realizou uma revisão de literatura que teve como objetivo associar as manifestações periodontais ao pênfigo vulgar, lúpus eritematoso sistêmico e penfigóide das membranas mucosas com o intuito fornecer aos profissionais um melhor entendimento sobre essas doenças, de modo que eles sejam capazes de oferecer um atendimento clínico mais adequado para estes pacientes. Os resultados puderam mostrar que há uma associação dessas doenças auto-imunes a manifestações periodontais, especialmente a gengivite descamativa. Além disso, a literatura as associa à perda óssea alveolar, ao aumento do sangramento gengival, a perda de inserção e a outras desordens periodontais.

Primary adenocarcinoma of the colon with metastases to the mandible and liver: a case report / Adenocarcinoma primario de colon con metástasis en mandíbula e hígado: reporte de un caso

Metastatic lesions to the mandible may be originated from primary tumors elsewhere in the body. However, metastatic colonic carcinomas to this bone have been described infrequently. We report the case of a 71-year-old man with an adenocarcinoma in the sigmoid colon with liver metastasis. The patient underwent chemotherapy with indication of sigmoidectomy and retroperitoneal lymphadenectomy. One year and four months after the first metastatic diagnosis, the patient presented a tumor mass in the body and branch of the right mandible. Histopathological and immunohistochemical analysis with monoclonal antibodies specific for CEA, CK20, CDX-2, and vilin were compatible with the diagnosis of moderately differentiated metastatic adenocarcinoma with colonic origin. However, due to the wide spread of the disease, the patient died four months later. Tumor markers have been applied in clinical practice to assist in the diagnosis and to help guide prognosis, staging and treatment of cancer. The management of metastatic lesions remains a controversial issue and the development of new and more specific markers of gastrointestinal differentiation that may promote early diagnosis, are of continuous interest.

Las lesiones metastásicas de la mandíbula pueden surgir de los tumores primarios en cualquier partes del cuerpo. Sin embargo, el carcinoma metastásico de colon de este hueso se han reportado con poca frecuencia. Presentamos el caso de un hombre de 71 años de edad, con un adenocarcinoma de colon sigmoide con metástasis en el hígado. El paciente fue sometido a quimioterapia con indicación de sigmoidectomía y linfadenectomía retroperitoneal. Un año y cuatro meses después de la emisión del primer diagnóstico de la metástasis, el paciente presentaba una masa tumoral en el cuerpo y rama de la mandíbula derecha. El análisis histopatológico e inmunohistoquímico con anticuerpos monoclonales específicos para CEA, CK20, CDX-2, y vilin fueron compatibles con el diagnóstico de adenocarcinoma moderadamente diferenciado metastásico originario en el colon. Sin embargo, debido a la amplia propagación de la enfermedad, el paciente murió cuatro meses más tarde. Los marcadores tumorales se han aplicado en la práctica clínica para ayudar en el diagnóstico y ayudar a orientar el pronóstico, la estadificación y tratamiento del cáncer. Gestión de las lesiones metastásicas sigue siendo un tema controvertido, y el desarrollo de marcadores nuevos y específicos que promueven la diferenciación del diagnóstico precoz gastrointestinal, son de interés continuo.

Dens invaginatus: case report / Dente invaginado: caso clínico atípico

Dens invaginatus is one of the most frequent malformations in dental elements. It can affect all teeth, even primary and supernumerary ones. It consists of an invagination of the crown surface, which happens during odontogenesis and penetrates the interior of the pulp chamber of the dental elements involved. In some cases, it can reach the apical tooth area. The maxillary lateral incisor is the most common site of occurrence. Due to its complex and variable anatomy, the tooth may present pulp necrosis and open apex, making it difficult to salvage. Oehlers classified them into types I, II, and III according to their complexity. This article reviews the literature and describes the treatment of a maxillary central incisor with type II invagination. The invaginated structure in this case detached due to various instrumentations during the change of dressing phase, facilitating root canal filling. In conclusion, this case shows that many methods are capable of removing the invaginated area of a dens invaginatus type II.

O dente invaginado é uma das alterações de desenvolvimento que mais incide sobre os elementos dentários, podendo acometer qualquer dente existente na cavidade oral, inclusive decíduos e supranumerários. Consiste em uma invaginação da superfície da coroa, que ocorre na odontogênese, que penetra no interior da cavidade pulpar dos elementos dentários envolvidos, podendo chegar, em algumas situações, à região apical. O incisivo lateral superior permanente é o que apresenta maior envolvimento. Por apresentar uma anatomia complexa e variável, quando diagnosticado, o dente pode apresentar necrose pulpar e rizogênese incompleta, o que torna a sua manutenção muitas vezes de difícil solução. Em 1957, Oehlers classificou-os, conforme sua complexidade, em tipos I, II e III. Foi realizada uma revisão da literatura e descrito o tratamento de um incisivo medial superior com invaginação tipo II, cuja estrutura invaginada se desprendeu devido às várias instrumentações durante as trocas de curativo, o que facilitou sua obturação. Pudemos concluir com este caso a viabilidade, através de diversos métodos, da remoção da porção invaginada no tratamento de dentes invaginados tipo II.

Caracterização da pressão da língua em idosos / Characterization of tongue pressure in the elderly

Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso. .

Purpose To characterize tongue pressure in elderly individuals. Methods This was a cross-sectional study involving 45 individuals aged between 61 and 96 years old (34 [75.6%] women; 11 [24.4%] men) with no neurological or cognitive disorders, no history of head or neck cancer, and no history of radiotherapy. The subjects were surveyed with a questionnaire that recorded the presence or absence of complaints about swallowing problems and an orofacial myofunctional evaluation, which examined the movement and tension of the tongue. The Iowa Oral Performance Instrument (IOPI) was used to measure tongue pressure. The data analysis was descriptive, with significance set at the 5% level. Results The mean pressure peak was 44.6 kPa (±16), with minimum and maximum values of 9 and 88 kPa, respectively. Pressure peak and age were moderately and negatively correlated. The oldest subject had the lowest average pressure peak, which was less than the normal range. The mean pressure peak differed according to the use of dentures, tongue pressure, and tongue mobility during clicking. Conclusion The pressure peak and the pressure of the tongue decreased moderately with increasing age, decreasing tongue tension, and mobility during clicking. In contrast, the pressure peak values were higher in the elderly who used dentures than those who did not. .

Recurrent Oral Manifestations of Paracoccidioidomycosis without Pulmonary Involvement: Case Report and Review of Literature / Manifestación Oral Recurrente de Paracoccidioidomcosis sin Compromiso Pulmonar: Reporte de Caso y Revisión de la Literatura

This article describes a case of recurrence of chronic paracoccidioidomycosis (PCM) 11 years following the initial diagnosis. The patient was a 51-year-old white Brazilian female, which had been previously diagnosed with PCM. The physical examination revealed the presence of a single crusted lesion in the upper lip and an elevated lesion with fibrous scar appearance on right buccal mucosa. Although the diagnosis of PCM, the absence of pulmonary involvement led to the biopsy of the lesion localized on the buccal mucosa and the histopathological analysis in H&E and PAS stains revealed no morphological changes suggestive of any lesion. However, the exfoliative cytology stained with Grocott-Gomori showed the presence of Paracoccidioides brasiliensis and the infection caused by this fungus was proven. Of this way, we emphasize the importance of stomatologic evaluation to the diagnosis of diseases that usually manifestssystemically. So, the correct diagnosis of oral manifestations of PCM, is essential to ensure early and safe intervention.

En este artículo se describe un caso de paracoccidioidomicosis crónica (PCM) recurrente 11 años después del diagnóstico inicial. La paciente una mujer blanca de Brasil de 51 años de edad, que había sido diagnosticada previamente con PCM. El examen físico reveló la presencia de una lesión única en el labio superior y una lesión elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnóstico de PCM, la ausencia de compromiso pulmonar llevó a la biopsia de la lesión localizada en la mucosa bucal y el análisis histopatológico no demostró cambios morfológicos indicativos de cualquier lesión. Sin embargo, la citología exfoliativa teñida con Grocott-Gomori mostró la presencia de Paracoccidioides brasiliensis y la infección causada por este hongo fue probado. De esta manera, hacemos hincapié en la importancia de la evaluación odontológica para el diagnóstico de enfermedades que se manifiestan generalmente por vía sistémica. Por lo tanto, el diagnóstico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervención temprana y segura.

Maxillary brown tumor associated with chronic kidney failure: a case report / Tumor marrom na maxila associado à insuficiência renal crônica: relato de caso

The brown tumor is a bone lesion that may affect the entire skeleton, including the maxillary bones. These tumors are characterized as focal giant cell lesions that may be associated with primary or secondary hyperparathyroidism (HPT). Brown tumors are invasive in some cases and an association with chronic renal failure (CRF) has been reported. With the aim to facilitate the differential diagnosis of bone lesions that may affect dialysis patients, this paper describes a case of brown tumor in a 36- year old patient with CRF, secondary HPT carrier, who had a lesion on the right maxilla for approximately five months.

O tumor marrom é uma lesão óssea que pode acometer todo o esqueleto, inclusive os ossos maxilares. Apresenta-se como uma lesão focal de células gigantes associada ao hiperparatireoidismo (HPT) primário ou secundário; é invasiva em alguns casos e pode associar-se à insuficiência renal crônica (IRC). O presente trabalho descreve um caso de tumor marrom em uma paciente de 36 anos com insuficiência renal crônica (IRC), portadora de HPT secundário, que apresentava lesão, com duração de aproximadamente cinco meses, localizada na maxila direita, com o objetivo de auxiliar o diagnóstico diferencial das lesões ósseas que podem afetar pacientes dialíticos.

Influence of dialysis duration and parathyroid hormone on the clinical and radiographic oral conditions of pre-transplant patients with chronic kidney disease

Aim: To evaluate the oral conditions of patients with chronic kidney disease undergoing dialysisand to determine the influence of dialysis duration and bone metabolism on the prevalence andseverity of the alterations found. Methods: The simplified oral hygiene index (OHI-S), prevalenceof dental caries (decayed, missing filled teeth index, DMFT), and the periodontal screening andrecording (PSR) index were evaluated in 154 patients. Parathyroid hormone (PTH), calcium,phosphorus and urea measurements, as well as panoramic radiographs, were obtained from allpatients. To evaluate the effect of duration of dialysis treatment on oral health, the patients weredivided into two groups: (1) <5 years and (2) > 5 years. Regarding blood levels of PTH, patientswere divided into three groups: (1) 0-149 pg/mL, (2) 150-584 pg/mL, and (3) >585 pg/mL. TheOHI-S identified the accumulation of biofilm and calculus around the teeth. Results: Gingivalinflammation was found in 100% of dentate patients, with 2 being the predominant PSR score(72.3%). The DMFT index was high (17.52). Dental calculus was the most common radiographicfinding (70.8%). No significant correlation was observed between dialysis duration, biochemicalalterations, and oral health. Conclusions: Most patients undergoing dialysis presented precariousoral hygiene, periodontal inflammation, and bone alterations. However, these manifestationswere not influenced by the duration of dialysis or bone metabolism.

Immunohistochemical expression of protein 53, murine double minute 2, B-cell lymphoma 2, and proliferating cell nuclear antigen in odontogenic cysts and keratocystic odontogenic tumor.

Introduction: Even though odontogenic cysts share a similar histogenesis, they show different growth and differentiation profile due to differences in the proliferative cellular activity. Aims: We perform an immunohistochemical assessment of protein 53 (p53), proliferating cell nuclear antigen (PCNA), B-cell lymphoma 2 (bcl-2), and murine double minute 2 (MDM2) expression in odontogenic cysts and keratocystic odontogenic tumor analyzing their correlation with the biological behavior of these lesions. Materials and Methods: By the streptavidin-biotin-peroxidase method with antibodies against p53, PCNA, bcl-2, and MDM2 proteins, 11 radicular cysts, 11 dentigerous cysts, and 11 keratocystic odontogenic tumor were analyzed. The non-parametric Mann-Whitney U-test and Kruskall-Wallis test (P ≤ 0.05) were used to analyze the data. Results: Immunopositivity for PCNA was observed in all cases appraised, predominantly in the suprabasal layer of keratocystic odontogenic tumor epithelial lining (SD ± 19.44), but no significant differences were found among the groups of lesions. Bcl-2 immunoexpression was observed especially in the basal layer of keratocystic odontogenic tumor. PCNA LI was significantly higher than bcl-2 LI in keratocystic odontogenic tumor. MDM2 and p53 immunoexpression were not detected in the lesions studied. Among the evaluated lesions, the keratocystic odontogenic tumor showed different immunoexpression of the proliferation and apoptosis markers. Conclusion: The results of this study suggest that the keratocystic odontogenic tumor presents distinct biological behavior of the odontogenic cysts, as for the processes of proliferation, apoptosis, and differentiation, reinforcing the information in favor of the neoplastic nature of this lesion.

Qualidade de vida e experiência em saúde bucal de crianças com e sem infecção pelo HIV / Quality of life and oral health experience in HIV-infected andnon-infected children

Objective: Identify and compare quality of life indicators with oral health experience of HIV-infected and non-infected children. Methods: The study was of the descriptive, exploratory and quantitative type, which was used the modified Autoquestionnaire Qualité de Vie Enfant Imagé, consisting of 26 questions with four possible answers and total scores ranging from 0 to 78. The cut-off score was 48, with same or higher scores indicative of satisfaction with quality of life indicators and lower, prejudiced quality of life indicators. To evaluate oral health experience, six questions were added, which used the same score scale as Autoquestionnaire Qualité de Vie Enfant Imagé, but that were considered separately. Eighty children from 6 to 13 years old participated in the research. They were divided in two groups: 20 HIV+ (Group 1) and 60 HIV- (Group 2). Results: The mean scores were 50.45 and 50.8 for Groups 1 and 2, respectively. In relation to the oral health experience, the mean score was 7.0 for Group 1 and 8.6 for Group 2, showing significant differences (p = 0.0018). When the subdivision by age (children from 6 to 10 years and from 11 to 13) was considered, significant differences were also observed only for the oral health experience (p = 0.0165). Conclusion: The children interviewed had satisfactory quality of life indicators indicators, while the oral health of HIV-infected children was considered impaired when compared with that of non-infected children.

Objetivo: Identificar e comparar os indicadores de qualidade de vida com a experiência em saúde bucal de crianças infectadas ou não pelo HIV.Métodos: O estudo foi do tipo descritivo, exploratório e com abordagem quantitativa, no qual foi utilizado o Autoquestionnaire Qualité de Vie Enfant Imagé modificado, composto por 26 questões com quatro possibilidades de resposta e pontuação total variando de 0 a 78 escores. A nota de corte foi de 48, sendo os escores iguais ou superiores à mesma indicativos de qualidade de vida satisfatória e os inferiores, de prejudicada. Para avaliar a experiência em saúde bucal, foram adicionadas seis questões que utilizavam a mesma escala de pontuação do Autoquestionnaire Qualité de Vie Enfant Imagé, mas que foram consideradas separadamente. Participaram da pesquisa 80 crianças dos 6 aos 13 anos que foram divididas em dois grupos: 20 HIV+ (grupo 1) e 60 HIV- (grupo 2). Resultados: A média geral dos escores foi de 50,45 e de 50,8 para os grupos 1 e 2, respectivamente. Em relação à experiência em saúde bucal, a média dos escores foi de 7,0 para o grupo 1 e de 8,6 para o grupo 2, verificando-se diferenças estatisticamente significantes (p=0,0018). Ao se considerar as crianças de acordo com a subdivisão por idades (6 a 10 anos e 11 a 13) também foram observadas diferenças significativas apenas quanto à experiência em saúde bucal (p=0,0165).Conclusão: As crianças entrevistadas apresentaram padrões de qualidade de vida satisfatórios, enquanto que em relação à saúde bucal, as com HIV foram consideradas prejudicadas quando comparadas com as não infectadas.

Perfil de acadêmicos de Odontologia sobre biossegurança / Profile of dental students about biosafety

Objetivo: A formação do profissional da Odontologia requer preparo e esclarecimento quanto ao uso das medidas universais de biossegurança em virtude da exposição a agentes infectocontagiosos. Este estudo descritivo teve como objetivo avaliar o nível de conhecimento de uma população de acadêmicos de Odontologia a respeito de biossegurança, além de identificar as dúvidas mais frequentes sobre medidas preventivas no ambiente odontológico e avaliar o interesse desses acadêmicos em relação ao tema biossegurança. Materiais e métodos: A amostra foi constituída por 358 alunos de três universidades. Foi aplicado um questionário contendo perguntas objetivas e subjetivas em alunos dos 1º, 5º e últimos períodos. Resultados: Observou-se que 92.6% dos alunos conheciam o significado de biossegurança e 92.3% relatou o uso de EPI pelo seu CD e para o paciente. Frente a um atendimento na clínica, 291 (82.7%) alunos responderam que saberiam se cuidar e 59 (16.8%) que não, sendo 94.9% destes últimos, alunos do primeiro período. Entre os alunos do primeiro período, 38.4% responderam não ser importante considerar o paciente como potencial portador de doença. Conclusões: Conclui-se que, é importante ministrar conteúdos básicos sobre biossegurança nos períodos pré-clínicos, visando a entrada dos alunos às atividades clínicas com maior segurança. Ressalta-se ainda a importância da fiscalização e atualização periódicas de práticas, e conhecimentos das medidas preventivas adequadas que permitam o exercício de atividades acadêmicas em segurança em todos os períodos do curso.

Aim: The professional formation in Dentistry requires preparation andknowledge regarding the use of universal biosafety measures againstexposure to infectious agents. This descriptive study aimed to evaluate the level of knowledge of dentistry students about biosafety, and identify the most frequent doubt about preventive measures in dental care environment, also assess the student’s interest bybiosafety. Material and methods:The sample consisted of 358 students from three universities. A questionnaire with subjective and objective questionswas applied to students at 1st, 5th and last periods. Results: It was observed that 92.6% of students knew themeaning of biosafety and 92.3% reported the use of PPE for their dentist and for the patient. When as ked if theywould know to take care in clinicalenvironment, 291 (82.7%) students answered that they would know how to care and 59 (16.8%) not, 94.9% of the latter were students of the first period, in this group, 38.4% of students responded not be important to consider the patient as a potential transmitter ofdisease. In the total sample, 98.6% considered to be important the topic of the research. Conclusions: It was concluded that it is important introduce basic content on biosafety in the pre-clinical periods, aimin g at the entry of students to the clinical activities moresafely. It is emphasized the importance of supervision and periodic update of practices and knowledge about preventive measures facilitating the exercise of academic activities in safety at all course periods.

Complicaciones estomatológicas en pacientes VIH positivos: correlaciones clínico demográficas y de laboratorio / Dental complications in HIV positive patients: clinical correlations demographic and laboratory

Las complicaciones estomatológicas (CE) en pacientes VIH+ muchas veces constituyen los primeros signos clínicos de la enfermedad, pudiendo funcionar como señalizadores del curso y progresión de la infección por el VIH y el SIDA. Este estudio evaluó la prevalencia de lesiones orales en pacientes VIH+ del Hospital de Enfermedades Infectocontagiosas Gizelda Trigueiro, en Natal-RN, Brasil y correlacionarlas con factores socio-demográficos como el sexo, edad, forma de contagio y status inmunológico. De acuerdo con los criterios de la EC-CLEARINGHOUSE/WHO, a través de examen clínico oral y conteo de células T CD4+ fueron evaluados 121 pacientes VIH+. Las lesiones más frecuentes fueron candidiasis (45.2%), leucoplasia vellosa (16.1%), eritema gingival linear (16.1%), herpes labial (12.9%), periodontitis necrosante (6.5%) y gingivitis necrosante (3.2%), ocurriendo con mayor frecuencia en hombres entre las edades de 30 a 44 años, que adquirieron el VIH a través de contacto sexual. Basado en los resultados de este estudio concluyese que hubo una prevalencia del perfil de complicaciones estomatológicas comúnmente relatado en la literatura. Las lesiones estuvieron asociadas a la reducción del número de células TCD4+, representando, por lo tanto marcadores de la progresión de la infección por el virus y/o de falla de la HAART, siendo así, un exhaustivo examen oral es importante en la evaluación clínica y acompañamiento de pacientes con VIH.

The stomatologic complications due to VIH infection are, a lot of times, the first clinical signs of the disease. These injuries may also function as beepers and sentries of the curse and progression of the VIH infection and SIDA. The objective of this work was to evaluate the prevalence of the oral injuries in VIH positive patients from the Hospital of Infected contagious Gizelda Trigueiro in Natal-RN, Brazil, and correlate them with demographic factors such as gender, age, form of VIH infection and immune status (T CD4+ cells). According to the criteria of EC-CLEARINGHOUSE/WHO, through clinical oral examination and T CD4+ cell count 121 patients were evaluated. The oral candidiasis was the most common lesion (45.2%), followed by oral hairy leukoplakia (16.1%), linear gingival erythema (16.1%), lips herpes (12.9%), necrotizing periodontitis (6.5%) and necrotizing gingivitis (3.2%), occurring predominantly in men between the ages 30 to 44 years, who acquired VIH infection through sexual contact. Based on the results of this study, concluded that there was a prevalence of the stomatologic complications profile that is commonly reported in the literature. These changes were associated with a decrease in the number of CD4+ T cells, representing markers of the infection progression and / or failure of HAART, so a thorough oral examination is important in clinical evaluation and follow up of patients with VIH.

Mucosite oral induzida por radiação: uso de fatores de crescimento e de laser / Radiation-induced oral mucositis: the use of growth factors and laser

Dosagens de radiação em torno de 50 a 70 Gy são consideradas de risco para o desenvolvimento de mucosite oral. Foi realizado um levantamento da literatura relacionada com a mucosite oral induzida por radiação em humanos na base de dados MEDLINE, tendo como critério inicial a seleção de artigos completos publicados em inglês de 1995 a 2005. Foram identificados 40 trabalhos relevantes, dos quais apenas 17 apresentavam evidências científicas sobre o uso local de fatores de crescimento e do laser de baixa potência como modalidades terapêuticas para a mucosite oral. A maioria dos autores considerava o sistema de gradação em escores preconizado pela Organização Mundial da Saúde como o mais adequado para a classificação do grau de evolução desta complicação oral. Observou-se, a partir da análise realizada, que o uso local de fatores de crescimento e do laser de baixa potência pode reduzir a severidade da mucosite oral induzida por radiação, favorecendo a proliferação celular e, consequentemente, a indução do reparo da mucosa e contribuindo para melhorar a qualidade de vida dos pacientes.

Radiation doses of 50 to 70 Gy may cause oral mucositis. The MEDLINE database was searched for full articles published in English from 1995 to 2005 on radiation-induced oral mucositis in humans. Forty relevant articles were found and of these, only 17 presented scientific evidence of the use of growth factors and low-power laser administered locally as treatment options for oral mucositis. Most authors considered the World Health Organization's grading system the most appropriate for classifying the grade of this oral complication. Review of these articles revealed that growth factors and low-power laser used locally can reduce the severity of radiation-induced oral mucositis, stimulating cell proliferation and consequently, promote healing. This helps to better the quality of life of these patients.