Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies.

Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study.

The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study

Abstract The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies

Abstract Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Management of oral leukoplakia with an 808-nm high-power diode laser: a single-center experience.

PURPOSE: High-power diode laser emerges as a promising approach to the treatment of oral leukoplakia (OL); however, its short- and long-term effects have been barely explored. This study evaluated the postoperative endpoints and the recurrence rate of high-power diode laser treatment in a well-defined series of patients with OL. METHODS: A prospective analysis was performed on 22 individuals comprising 31 OL. The lesions were irradiated using the following protocol: Indium-Gallium-Arsenide diode laser, 808 nm, continuous-wave mode, 1.5-2.0 W, 780.0 ± 225.1 J, and 477.1 ± 131.8 s. Postoperative pain was assessed with a visual analog scale at three endpoints. Clinical follow-up was performed on all patients and the Kaplan-Meier test was used to analyze the probability of recurrence. RESULTS: The series consisted mostly of women (72.7%) with a mean age of 62.8 years. A single laser session was performed in 77.4% of cases. The median score on the scale that assessed pain on the 1st, 14th and 42nd postoperative day was 4, 1, and 0, respectively. The mean follow-up period per lesion was 28.6 months (range: 2-53 months). A complete response was observed in 93.5% of OL cases, while 6.5% had recurrence. The probability of recurrence at 39 months was 6.7%. No patient experienced malignant transformation. CONCLUSION: High-power diode laser for the treatment of OL is safe and effective during the trans- and postoperative period. These findings represent an alternative approach to the management of OL, mainly because a low recurrence rate was observed.

Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta-analyses.

AIMS: To synthesize the oral alterations observed in children with microcephaly associated with congenital Zika virus syndrome (CZS), and to compare the oral alterations of these children to a normotypic healthy controls. METHODS AND RESULTS: A search was performed in six electronic databases. Observational studies published that reported oral alterations in children with CZS were selected. Two authors independently extracted data, assessed study quality, using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-one studies were included in this systematic review and meta-analysis. The pooled crude occurrence showed 88% of increased salivation (95%CI: 82%-94%), 83% of biofilm (95%CI: 75%-91%), and 73% of bruxism (95%CI: 52%-95%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 12.92; 95%CI: 3.42-48.78), with very low certainty. CONCLUSION: There are several oral alterations found among children with CZS-associated microcephaly. They are more prone to present some of these alterations, such as difficulty in lip sealing, although with very low certainty of evidence.

Condição clínica e imunológica da cavidade bucal de crianças com síndrome congênita associada à infecção pelo vírus Zika / Clinical and immunologic condition of the oral cavity of children with congenital syndrome associated to Zika virus infection

O objetivo deste estudo foi comparar a condição bucal e parâmetros imunológicos de crianças com Síndrome Congênita associada à infecção pelo vírus Zika (SCZ), com microcefalia não associada à SCZ e normotípicas em um estudo transversal. Além disso, objetivou-se sintetizar, por meio de uma revisão sistemática da literatura, as alterações orais observadas em crianças com SCZ e comparar com crianças normotípicas. No artigo de revisão sistemática, buscas eletrônicas foram realizadas em cinco bases de dados, complementadas por escrutínio manual e pesquisas na literatura cinzenta. Os dados foram agrupados para análise quantitativa com intervalos de confiança de 95%. A qualidade metodológica dos estudos incluídos foi avaliada por meio das ferramentas de avaliação do Joanna Briggs Institute e a certeza da evidência, pela abordagem GRADE. Doze estudos observacionais foram incluídos. A prevalência bruta combinada mostrou 88% de aumento de salivação (IC 95%: 82%- 94%) e 52% de inserção anormal do freio labial superior (IC 95%: 43%-61%). Em comparação com controles normotípicos, crianças com SCZ tiveram maior chance de ter dificuldade de selamento labial (OR: 18,28; IC 95%: 1,42-235,91) e inadequada postura lingual em repouso (OR: 13,57; IC 95%: 4,24-43,44), com certeza muito baixa. Diversas alterações orais foram encontradas e as crianças com SCZ se mostraram mais propensas a desenvolver algumas delas, entretanto, entretanto, a certeza dessas evidências ainda é muito baixa. O estudo transversal foi desenvolvido com dois grupos de comparação, pareados por idade e sexo. Foram convidadas a participar da pesquisa mães e crianças com microcefalia, associada ou não à SCZ, e crianças normotípicas atendidas na Faculdade de Odontologia (FAO) da UFMG. Amostragem do tipo snowball foi utilizada para expandir a amostra inicial. Para a coleta de dados, as mães responderam a um questionário estruturado sobre informações sociodemográficas, história médica e odontológica das crianças. Também foi realizado um exame bucal para investigação das seguintes condições: experiência de cárie dentária, qualidade da higiene bucal, alterações de mucosa, presença de má oclusão, selamento labial, anomalias dentárias e defeitos de desenvolvimento de esmalte. A coleta de saliva para avaliação dos parâmetros imunológicos/inflamatórios da cavidade bucal das crianças foi realizada através do uso de um rolete de algodão. Os dados coletados foram armazenados e analisados pelo software Statistical Package for Social Science (SPSS®). Um total de 38 crianças (14 com SCZ, oito com microcefalia não associada à SCZ e 16 normotípicas) foram avaliadas. O sexo feminino foi o mais frequente (60,5%, n=23) e a média de idade entre eles foi de 4,9 (±1,4; 2-8) anos. Ausência de selamento labial e má oclusão foram os achados mais comuns nas crianças com SCZ, quando comparadas aos grupos controle. Em conjunto, os dados deste estudo contribuirão para a compreensão das condições bucais que crianças com SCZ possuem ou podem desenvolver, a fim de direcionar práticas clínicas e reforçar o incentivo aos cuidados de saúde bucal possibilitando uma melhora na qualidade de vida dessa população.

The objective of this study was to compare the oral condition and immunological parameters of children with congenital syndrome associated with Zika virus infection (CZS), with children with microcephaly non-CZS-associated and normotypic children in a cross-sectional study. In addition, it was intended to synthesize, through a systematic review of the literature, the oral alterations observed in children with CZS and compare with normotypic children. In the systematic review article, electronic searches were performed in five databases, complemented by manual scrutiny and research in gray literature. The data were grouped for quantitative analysis with 95%confidence intervals. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence was assessed using GRADE approach. Twelve observational studies were included. The pooled crude prevalence showed 88% of increased salivation (95%CI: 82%-94%), 52% of abnormal insertion of the upper labial frenum (95%CI: 43%-61%), and 50% of delayed tooth eruption (95%CI: 34%-66%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 9.37; 95%CI: 2.03-43.21) with very low certainty. Several oral alterations were found and children with CZS-associated microcephaly were more likely to develop some of them, however, the certainty of this evidence is still very low. The cross-sectional study was carried out with two comparison groups, matched for age and sex. Mothers and children with microcephaly, associated or not with CZS, and normotypic children attended at the School of Dentistry of the UFMG were invited to participate in the research. Snowball sampling was used to expand the initial sample. For data collection, mothers responded to a structured questionnaire on sociodemographic information, medical and dental history of children. An oral examination was also performed to investigate the following conditions: experience of dental caries (dmft/DMFT), quality of oral hygiene (simplified oral hygiene index-SOHI), mucosa alterations, lip sealing, presence of malocclusion, dental anomalies and developmental defects of dental enamel (DDE). Saliva collection to evaluate the immunological/inflammatory parameters of the children's oral cavity was performed using a cotton roller. The collected data will be stored and analyzed using the Statistical Package for Social Science software (SPSS®). A total of 38 children (14 with CZS, eight with non-CZS-associated microcephaly and 16 normotypic) were evaluated. The female was the most frequent (60.5%, n=23) and the average age among them was 4.9 (±1.4; 2-8) years. Absence of lip sealing and malocclusion were the most common findings in children with SCZ when compared to control groups. Together, the data in this study will contribute to the understanding of the oral conditions that children with CZS have or can develop, in order to direct clinical practices and reinforce the incentive to oral health care enabling an improvement in the quality of life of this population.

Phleboliths of the Head and Neck Region - A Case Report.

Rationale: Phleboliths are idiopathic calcifications resulting from mineralised structures inside veins, venules or blood vessels. Patient Concerns: A 48-year-old woman presented with multiple hard bodies on palpation. Diagnosis: Imaging studies revealed multiple, round, well-defined radiopaque lesions, extending from the coronoid process region down to the base of the mandible. The diagnosis was vascular malformation with multiple phleboliths. Treatment and Outcome: No treatment was proposed and the patient is under follow-up. Take-Away Lessons: Asymptomatic phleboliths of the head and neck region in an adult woman have been under surveillance.

Oral lymphatic malformations: A multicenter study of 208 cases and literature review.

BACKGROUND: To evaluate the frequency and analyze demographic and clinical characteristics of individuals with a histopathological diagnosis of oral lymphatic malformations (OLMs). METHODS: A multicenter study was performed, collecting biopsy record data from a consortium of Brazilian Oral and Maxillofacial Pathology Centers. A review was also conducted to compare this data with cases already available in the literature. RESULTS: This study retrieved 208 cases of OLM in the multicenter study and 1035 cases in the literature review. In both, OLMs affected male and female individuals equally, with the most affected site being the tongue. Individuals ≥60 years of age were uncommonly affected. Symptomatic and larger lesions were more commonly reported in the literature review. CONCLUSIONS: This study comprises the largest sample of OLMs to date. OLMs are rare conditions, without sex predilection. The elderly proved to be less frequently affected, and the tongue is the most commonly affected site.

Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020.

Myiasis is an infection caused by the deposition of fly larvae in tissues, and its involvement in the human oral cavity is uncommon. Herein, we have performed a data analysis of published cases of oral myiasis. A search was performed in PubMed, Ovid, Web of Science, Scopus, and LILACS. Geographic distribution, demographic data, associated factors, clinical features, fly types, treatment, and presence of sequelae were analyzed. A total of 122 articles reported the cases of 157 infected individuals. The most affected countries were India (41%) and Brazil (29.5%). Male predominance (67.5%) and a mean of 41.9 years of age were observed. The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%). There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing. The establishment of a standard treatment protocol, enabling comparison in future studies and providing uniformity in treatment strategies offered by health services is strongly recommended.

Lingual Lymphangioma Ablation With High Power Diode Laser: A Case Report.

Introduction: Lymphangioma is a rare vascular anomaly that affects the lymphatic vessels. Its etiology is not yet clear and it usually occurs in the head and neck region. This pathology is commonly diagnosed in childhood and there is no consensus about the most effective treatment of it. Case Report: We report a case of lymphangioma located on the dorsum of the tongue in a 9-year-old boy, with the clinical appearance of small transparent vesicles similar to "frog-eggs". The diagnosis was defined according to the clinical aspect and ultrasound images. The treatment performed consisted of two sessions of ablation with a high-power diode laser. Conclusion: High-intensity diode laser ablation was a safe and effective tool for the treatment of this lesion in the tongue, which provided the patient with a faster, efficient transoperative period and a more comfortable postoperative period.

Demographic and Clinicopathologic Features of Actinic Cheilitis and Lip Squamous Cell Carcinoma: a Brazilian Multicentre Study.

Data on the occurrence and clinicopathological characteristics of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) are well studied; however, they are based on studies limited to a single centre. Herein, we described the frequency of AC and LSCC submitted to microscopic examination from representative geographic regions of Brazil. A retrospective multicentre study was performed on biopsies obtained from 1953 to 2018 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,709 biopsy specimens were surveyed. Sociodemographic data and clinicopathologic characteristics were analysed. A total of 2017 cases of ACs (1.0%) and 850 cases of LSCCs (0.4%) were recorded. A strong fair-skinned (> 87%) male (> 70%) predilection was observed in both conditions. The mean age was 54.8 ± 18.7 for individuals with AC and 57.8 ± 19.0 for individuals with LSCC. The most commonly affected site was the lower lip (> 90%). This is a large multicentre study of AC and LSCC from Brazil. The frequency and clinicopathological features of AC and LSCC were similar to those described worldwide. This study provides robust and representative epidemiological data of these conditions for the scientific community.

Calcifying epithelial odontogenic tumours: Collaborative study of 32 cases and review of literature.

OBJECTIVES: To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. MATERIALS AND METHODS: A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. RESULTS: In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. CONCLUSIONS: Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.

Queilite actínica e carcinoma de células escamosas de lábio: um estudo multicêntrico / Actinic cheilitis and Lip squamous cell carcinoma: multicenter study

Este estudo investigou a frequência da queilite actínica (QA) e do carcinoma de células escamosas de lábio (CCEL) em diferentes regiões geográficas do Brasil realizando uma análise temporal dos casos por década. Também se estabeleceu o perfil dos pacientes e analisou os aspectos clínicos e histopatológicos. Em uma análise retrospectiva (1953-2018), arquivos de biópsias de 10 centros de Patologia Oral e Maxilofacial localizados em diferentes estados do Brasil: Pará, Rio Grande do Norte, Paraíba, Pernambuco, Rio Grande do Sul, Minas Gerais, Rio de Janeiro, São Paulo e Goiás foram analisados. O perfil da amostra, características clínicas e histopatológicas foram avaliados descritivamente e estatisticamente através dos testes qui-quadrado, ANOVA e t-Student utilizando o programa SPSS versão 23.0. Os laudos histopatológicos de QA e CCEL foram examinados de acordo com a classificação da Organização Mundial de Saúde (OMS) (2017). As análises estatísticas foram feitas utilizando o programa Dos 198.709 espécimes de biópsias, 2.017 casos de QA e 850 casos de CCEL foram avaliados, representando 1,0 e 0,4% das lesões orais, respectivamente. Em geral, indivíduos do sexo masculino (nQA=1.439, 71,4%; nCCEL=673, 79,3%), brancos (nQA=1.640, 87,3%; nCCEL=726, 91,3%), na sétima década de vida (nQA=570, 29,8%; nCCEL=222, 27,4%) com acometimento do lábio inferior (nQA=1.990, 98,7%; nCCEL=827, 97,3%) foram os mais afetados. Indivíduos fumantes e consumidores de álcool tiveram um maior grau de invasão nos casos de CCEL (p=0,004 e p=0,020) bem como indivíduos com história prévia de QA (p=0,018). A QA e o CCEL em estágios iniciais ainda são lesões subnotificadas no Brasil e negligenciadas por parte da população acometida. Novos dados sobre as características sociodemográficas e clinicopatológicas de 2.017 casos de QA e 850 casos de CCEL foram adicionados à literatura. Essa caracterização em um país tão grande e com tantas diferenças regionais como o Brasil fortalece evidências para clínicos, dermatologistas, estomatologistas e oncologistas e para o desenvolvimento de políticas públicas na prevenção dessas lesões na população brasileira.

This study investigated the frequency of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) in different geographic regions of Brazil, making a temporal analysis of the cases per decade. It also established the profile of the patients with this lesion and analyzed the clinical and histopathological aspects. In a retrospective analysis (1953-2018), biopsy files of 10 Oral and Maxillofacial Pathology centers located in different states of Brazil: Pará, Rio Grande do Norte, Paraíba, Pernambuco, Rio Grande do Sul, Minas Gerais, Rio de Janeiro , São Paulo and Goiás were analyzed. The sample profile, clinical and histopathological characteristics were descriptively and statistically evaluated by chi-square, ANOVA and t-Student tests using the SPSS program version 23.0. Histopathological data of AC and LSCC were examined according to the World Health Organization (WHO) classification (2017). Of 198,709 specimens of biopsies analyzed, 2,017 cases of AC and 850 cases of LSCC were surveyed, representing 1.0 and 0.4% of the oral lesions, respectively. Overall, male patients (nAC=1,439, 71.4%; nLSCC=673, 79.3%), white (nAC=1,640, 87.3%; nLSCC=726, 91.3%), in their seventh decade of life (nAC = 570, 29.8%, nLSCC = 222, 27.4%) with involvement of the lower lip (nAC = 1.990, 98.7%, nLSCC = 827, 97.3%) were the most affected. Individuals smokers and alcohol users had a higher invasion grade in cases of LSCC (p=0.004 and p=0.020) as well as individuals with previous history of AC (p=0.018). The AC and the LSCC in early stage are still very underreported lesions in Brazil and neglected by the affected population. Novel data on the sociodemographic and clinicopathological features of 2,017 cases of AC and 850 cases of LSCC have been added to the literature. This characterization in such a large country and with so many regional differences as Brazil strengthens evidence for clinicians, dermatologists, stomatologists and oncologists and for the development of public policies for the prevention of these lesions in the Brazilian population.

Immunohistochemical Analysis of Cyclooxygenase-2 and Tumor Necrosis Factor Alpha in Periapical Lesions.

INTRODUCTION: The purpose of this study was to evaluate the expression of cyclooxygenase-2 (COX-2) and tumor necrosis factor alpha (TNF-α) in periapical granuloma (PG) and radicular cyst (RC) samples and to correlate it with the type of lesion, the intensity of the inflammatory infiltrate, and the thickness of the epithelial lining. METHODS: A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to morphologic analysis and immunohistochemical study. The anti-COX-2 and anti-TNF-α antibodies were applied using the immunoperoxidase technique. Data were analyzed by the Mann-Whitney test, Pearson chi-square test, Fisher exact test, and Spearman correlation. RESULTS: Analysis of the inflammatory infiltrate revealed that 80% of PGs exhibited a grade III infiltrate as opposed to a 19% rate in RCs (P < .001). Morphologic evaluation of the epithelial thickness of RCs revealed the presence of atrophic epithelium in 73% of cases. The majority of PGs had a score of 1 for COX-2 immunoexpression (n = 14, 54%) and a score of 2 for TNF-α expression (n = 16, 64%), whereas in cases of RCs a score of 1 was more prevalent for COX-2 and TNF-α expression (n = 17, 65%). Significant differences in the expression scores of COX-2 and TNF-α were detected in periapical lesions (P < .001). CONCLUSIONS: Based on these findings, we emphasize that RCs and PGs have a similar expression of inflammatory mediators (COX-2 and TNF-α) although the secretion of TNF-α by macrophages and of COX-2 by several cells was higher in PGs, indicating a greater inflammatory response in these lesions.

Nonsyndromic cleft lip and/or palate: A multicenter study of the dental anomalies involved.

BACKGROUND: Nonsyndromic cleft lip and/or palate (NSCL/P) is the most common craniofacial malformation. Due to the anatomical defect present in the alveolar process, these patients tend to exhibit more dental anomalies. The aim of this study was to identify the prevalence of dental anomalies in patients with NSCL/P by obtaining orthodontic documentation from Brazilian Centers for cleft lip and palate treatment. MATERIAL AND METHODS: A retrospective analysis (2000-2014) was conducted on orthodontic archives, radiographs and medical records of NSCL/P of 524 patients under orthodontic treatment. Panoramic radiographs and intra-oral photographs were examined to identify these anomalies. Categorical variables were expressed in terms of frequencies and percentages and analyzed using the Chi-Square test. The level of significance was set at p≤0.05 in all analyses. RESULTS: Approximately 83.3% of the individuals had at least one dental anomaly. Tooth agenesis was the most common abnormality found in those patients (87.8%) (p<0.001). Also, the largest number of dental anomalies was detected in the group of unilateral left clefts. The prevalence of dental anomalies in the present sample of NSCL/P patients was high and reached the highest levels in patients with alveolar bone clefts. CONCLUSIONS: This study describes the most common dental anomalies observed in patients with NSCL/P. These abnormalities can cause significant problems that may be solved or minimized by early diagnosis and treatment. Key words:Cleft lip and/or palate, dental care for children, epidemiology, craniofacial abnormalities.

Odontogenic carcinosarcoma: A systematic review.

The aim of this study was to integrate the available data published on odontogenic carcinosarcoma into a comprehensive analysis of their features, treatment and recurrence. An electronic search with no publication date or language restriction was undertaken in March 2018 in the following databases: Medline Ovid, PubMed, Web of Science, Scopus and LILACS. Eligibility criteria included publications having enough clinical, imaginological and histopathological information to confirm a definite diagnosis of the neoplasm. Data were evaluated descriptively and statistically using the MedCalc software. The Kaplan-Meier method was used for survival analysis. The systematic review detected nine articles from eight countries. Six cases with no age predilection occurred in male individuals complaining of painful swelling in the posterior mandible. Radiographically, the lesions were large, with expansive radiolucency and with ill-defined borders and seven cases were associated with preexisting odontogenic lesions. Radical surgery was the treatment of choice in the majority of cases. Recurrences (n = 6), metastasis (n = 4) and death (n = 4) were frequently observed in many cases. Odontogenic carcinosarcoma is a very aggressive neoplasm with a poor prognosis. This study provides knowledge that could help surgeons, oncologists, otorhinolaryngologists and oral maxillofacial pathologists with the diagnosis and management of these lesions.

A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review.

OBJECTIVES: To investigate the frequency of oral paracoccidioidomycosis from representative geographical regions of Brazil and to compare the data with a literature review. MATERIALS AND METHODS: A retrospective study was conducted on 108,304 biopsies obtained from 1953 to 2016 at six Brazilian oral and maxillofacial pathology services. Demographic data and clinical and histopathological diagnosis of oral paracoccidioidomycosis were evaluated. A literature review of oral paracoccidioidomycosis studies published in three electronic databases was carried out. Data were analysed descriptively. RESULTS: A total of 320 cases of oral paracoccidioidomycosis were surveyed (0.3% of the oral lesions at the centres studied). The lesions were more frequent among male patients. The gingiva/alveolar ridge was the most affected site. Mean age of affected individuals was 51.3 years (±11.7). The literature review showed a higher incidence of oral paracoccidioidomycosis in the south-east and south regions of Brazil. Male individuals and individuals between 50 and 59 years were most affected. CONCLUSIONS: Oral paracoccidioidomycosis is an uncommon lesion observed in oral biopsy samples. The differences in the relative frequency of oral paracoccidioidomycosis are related to geographical variations. Men between 50 and 59 years are more affected. This study provides helpful information for clinicians in the diagnosis of oral paracoccidioidomycosis.

Calcifying odontogenic cyst: A 26-year retrospective clinicopathological analysis and immunohistochemical study.

BACKGROUND: To identify the prevalence and clinicopathological profile of calcifying odontogenic cysts (COC) stored at an oral pathology service, and to analyze the immunoexpression of cyclooxygenase 2 (COX-2) and cyclin D1 (CD1) in these cysts. MATERIAL AND METHODS: After a retrospective analysis (1990-2016) carried out to identify cases of COC, a sample of 12 cases was selected for immunohistochemical analysis of COX-2 and CD1 by the immunoperoxidase technique. Protein expression was evaluated semiquantitatively by attributing a score of 0 to 3 (0 = no staining; 1 = 1-25%; 2 = 26-50%, and 3 = >51% immunopositive cells). RESULTS: Twenty cases of COC were diagnosed over the study period. These cysts were more common in the posterior mandible and in men (male-to-female ratio of 1.2:1), with a mean age of 29.9 years. Among the 12 cases analyzed, immunoexpression of COX-2 was observed only in the inflammatory infiltrate in 50% of the cysts (n = 6). Protein CD1 was detected (score 1) in 66.6% of cases (n = 8), and COX-2 was negative in 50% (n = 6). CONCLUSIONS: The prevalence of COC among all odontogenic cysts was 3.5%, representing an uncommon lesion. Immunohistochemical analysis suggested that COX-2 does not participate in lesion progression. The cell proliferation index of COC was low, as demonstrated by the expression of CD1, suggesting a proliferative profile compatible with more indolent lesions. Key words:Odontogenic cysts, odontogenic tumors, epidemiology, immunohistochemistry, cell proliferation.

A retrospective multicentre study of cystic lesions and odontogenic tumours in older people.

OBJECTIVE: The aim of this study was to investigate the frequency and some characteristics of odontogenic tumours, odontogenic cysts and non-odontogenic cysts in an elderly population (≥60 years). BACKGROUND: Few studies describe the distribution of oral lesions in older people. MATERIALS AND METHODS: A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of four Brazilian referral centres between 2000 and 2016. Data such as gender, age, anatomical location, symptomatology and histopathological diagnosis were collected and categorised. Statistical analyses were performed adopting a P-value of ≤.05 and a 95% confidence interval. RESULTS: A total of 7259 biopsy records of elderly participants were analysed; 642 cases were cystic lesions and odontogenic tumours, 491 of which being classified as odontogenic cysts (76.5%), 75 as odontogenic tumours (11.7%) and 76 as non-odontogenic cysts (11.8%). The most frequent lesions in each group were radicular cyst (n = 268), ameloblastoma (n = 51) and salivary duct cyst (n = 21), respectively. Overall, women were more affected (n = 351, mean age: 68 years). Intraosseous lesions were more common in the mandible (n = 342), and soft tissue cysts occurred more in the lip (n = 13). CONCLUSION: Odontogenic cysts were relatively common, whereas odontogenic tumours and non-odontogenic cysts were rarer among the older people studied in the present investigation.