Erythromycin: an alternative for the management of oral mucositis?

BACKGROUND: Oral mucositis (OM) is an important acute adverse effect of anticancer therapy. This condition presents high morbidity and may lead to the suspension of anticancer therapy. MATERIAL AND METHODS: We reviewed the literature on the pathobiology of OM and the properties of erythromycin (EM), to consider the possibility of its use for the prevention and treatment of OM. We searched the PubMed, Scopus and Web of Science databases and selected complete articles published in English or Spanish that met the inclusion criteria. The search terms "erythromycin", "inflammation", "immunomodulation" and "oral mucositis" were used. RESULTS: The control of free radicals, transcription factors and pro-inflammatory cytokines has been considered as the key to the management of OM. EM has the ability to modulate oxidative stress, acts on the transcriptional system and inhibits the production of several cytokines that have been directly implicated in OM pathobiology. CONCLUSIONS: The present review suggests that EM could be effective in the treatment of OM. Experimental studies investigating the use of EM in OM should be encouraged.

Oral manifestations of syphilis: an epidemiological study in southern Brazil.

BACKGROUND: Syphilis is an infectious, sexually transmitted disease with varied oral manifestations, that can mimic other lesions. This study aimed to conduct an epidemiological survey of cases of syphilis, diagnosed from oral manifestations, establishing the sociodemographic profile of patients and clinical characteristics of oral lesions. METHODS: The medical records of patients with oral lesions of syphilis acquired were reviewed, and 109 cases were selected. RESULTS: The mean age of the patients was 34.4 years and, of these, 51% were male. In 105 cases, the disease was diagnosed in the secondary stage; in three cases, in the primary stage; and, in one case, in the tertiary stage. The cases of primary syphilis presented as single and ulcerated nodules, and the case of tertiary syphilis, as a necrotic lesion in the palate. In 86% of cases of secondary syphilis, there were multicentric lesions, presenting as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%), mostly affecting the labial mucosa and tongue. In 91.7% of cases painful symptoms were reported. CONCLUSION: Considering the increase in syphilis, it is extremely important that dentists recognize its oral manifestations, because early diagnosis and treatment can minimize the risks of complications and transmission.

Stomatological disorders in older people: An epidemiological study in the Brazil southern.

BACKGROUND: The aim of this retrospective, cross-sectional and observational study was to perform a survey of the stomatological conditions of elderly patients seen in a period of 40 years at a Stomatology Service in Southern Brazil. MATERIAL AND METHODS: A total of 24,347 medical records were reviewed, of which 5,063 belonged to elderly patients aged 60 to 97 years. The stomatological conditions, systemic conditions, and smoking and alcohol drinking habits as well were recorded. RESULTS: The mean age of the patients was 69.29 years, 67.1% were female and 32.9% were male. Variations of normality accounted for 44.5% of the cases. The most prevalent disorders were fungal infections (26.1%), reactive inflammatory lesions (24.6%), burning mouth syndrome (14.9%), benign neoplasms (12.4%), autoimmune disorders (12.3%), premalignant lesions (10.2%) and malignant epithelial neoplasms (7.2%). Regarding biopsied lesions, squamous cell carcinoma was the most prevalent at 30.2%, followed by hyperplasic lesions (28.2%). CONCLUSIONS: Knowledge of these physiological and pathological conditions in the oral cavity of the older people is essential for early diagnosis and preventive and therapeutic measures when necessary.

Cannabidiol: an alternative therapeutic agent for oral mucositis?

WHAT IS KNOWN AND OBJECTIVE: Chemo- and radiotherapy are therapeutic modalities often used in patients with malignant neoplasms. They kill tumour cells but act on healthy tissues as well, resulting in adverse effects. Oral mucositis is especially of concern, due to the morbidity that it causes. We reviewed the literature on the etiopathogenesis of oral mucositis and the activity of cannabidiol, to consider the possibility of its use for the prevention and treatment of oral mucositis. METHODS: We searched the PubMed database and selected complete articles published in English that met the inclusion criteria for the period 1998-2016. The search terms 'cannabinoids', 'cannabidiol', 'oxidative stress', 'antioxidants' and 'oral mucositis' were used. RESULTS AND DISCUSSION: The control of oxidative stress may prevent and alleviate oral mucositis. Studies have demonstrated that cannabidiol is safe to use and possesses antioxidant, anti-inflammatory and analgesic properties. WHAT IS NEW AND CONCLUSIONS: The literature on the use of cannabidiol in dentistry is still scarce. Studies investigating the use of cannabidiol in oral mucositis and other oxidative stress-mediated side effects of chemotherapy and radiotherapy on the oral mucosa should be encouraged.

Polymethylmethacrylate dermal fillers: evaluation of the systemic toxicity in rats.

This study evaluated local and systemic reactions after an intravascular injection of polymethylmethacrylate (PMMA) at two concentrations in a murine model. Thirty rats were divided equally into three groups: 2% PMMA, 30% PMMA, and a control group (normal saline only injection). The filler was injected into the ranine vein. The rats were sedated at 7 and 90 days and a clinical evaluation performed. After euthanasia, the right lung, liver, and right kidney were removed, weighed, and microscopically analyzed. The submandibular lymph nodes and tongue were removed and examined microscopically. Serum was subjected to liver and kidney function tests. No groups showed clinical alterations. Microspheres were not observed at any distant organ. Two samples from the 2% PMMA group showed a local inflammatory response at day 7 and another two samples from the 30% PMMA group at day 90. The group injected with 30% PMMA presented higher levels of alanine aminotransferase (P = 0.047) after 90 days when compared with the other groups. The data obtained in this study demonstrate that intravascular injections of PMMA fillers show potential health risks such as chronic inflammation at the implantation site.

Clinical and pathological characteristics of polymethylmethacrylate and hyaluronic acid in the rat tongue.

Adverse effects on the oral mucosa after the use of dermal fillers have been increasingly reported due to their increased use for facial aesthetics. The objective of this study was to evaluate the clinical and histologic effects of two types of product, 10% polymethylmethacrylate and 20mg/ml hyaluronic acid, locally and at long distance, examining initial and late reactions. Each substance was randomly and separately injected in rats' tongues (polymethylmethacrylate, n = 16; hyaluronic acid, n = 18). They were compared with the control group (n = 16) at 3 observation times (7, 60 and 90 days) for clinical analysis, intensity of local inflammatory response (haematoxylin and eosin staining), amount of newly formed blood vessels and macrophages (immunohistochemical assays), density of collagen fibres (picrosirius staining) and systemic migration of the product to the liver and kidney (haematoxylin and eosin staining). The results showed inflammation triggered by the injection of the material, suggesting that both substances cause responses in local tissue, although there was biocompatibility with hyaluronic acid. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice.

Mucoepidermoid carcinoma: a retrospective study.

AIM: The aim of this study was to review the cases of mucoepidermoid carcinoma diagnosed at the Stomatology Service of São Lucas Hospital (PUCRS). METHODS: Medical charts were reviewed focusing on the sex and age of the patients, clinical aspect, anatomic site, signs and symptoms, size and histological grade of the lesion. RESULTS AND CONCLUSION: Of the 19383 patients who were seen between 1978 and 2009, 675 (3.48%) had a histopathological diagnosis of malignant neoplasm of the oral maxillofacial region including 12 (1.78%) cases of mucoepidermoid carcinoma. The mean age of patients with mucoepidermoid carcinoma was 43.8 years, and there was a predilection for males (58.7%). All cases occurred in the minor salivary glands, and the palate was the site most frequently affected (41.7%). Pain and local irritation were present in 50% of cases, and the size of lesions ranged from 0.3 cm to 5.0 cm. The histological classification of low- and intermediate-grade occurred at the same frequency (36.4%), and symptoms (pain, local irritation) occurred indiscriminately in different grades of tumor.

Cartilaginous choristoma of the tongue.

Choristomas are lesions composed of normal cells or tissues occurring in an abnormal location. Cartilaginous choristomas of the oral mucosa are rare and occur preferentially on the tongue and less often in sites such as the soft palate and gingiva. Oral lesions are generally covered by integral mucosa and can occur at any age. The present study describes a case of a 73-year-old female presenting with an asymptomatic cartilaginous choristoma on the ventral surface of the tongue which had developed over a period of 3 years. The clinical presentation and management of the case are discussed and the literature is reviewed. This is the 28th reported case of a cartilaginous choristoma of the tongue and the third with a ventral localisation.

Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases.

AIM: The present study examined retrospectively the clinical and radiographic characteristics of pyogenic granuloma (PG), peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF), located in the gingiva and alveolar ridge. METHODS: Biopsy records of the Stomatology Service of São Lucas Hospital-PUCRS were reviewed between 1980 and 2006. The medical charts of patients with histopathologic diagnosis of PG, PGCG and POF were selected. The data obtained were evaluated by means of descriptive statistics, analysis of variance (ANOVA), and the chi-squared test (chi-squared), considering the 5% level of significance. RESULTS: Of the 138 cases analyzed, 57.2% corresponded to PG, 22.5% to PGCG and 20.3% to POF. PG and POF exhibited a predilection for females and PGCG for males. PG occurred in younger individuals and showed a greater tendency for bleeding (P=0.018). PG showed a greater frequency of reddish color (P<0.001), PGCG purplish (P<0.001) and POF pinkish (P<0.001). In the radiographic examination, the presence of radiopaque foci was greater in POF (P<0.001), and resorption of the subjacent alveolar bone was found more often in PGCG (P<0.001). POF exhibited a longer evolution. There was no difference in lesions with respect to local irritating factors, ulceration, size, site and recurrence. Pregnancy was a factor linked to PG. CONCLUSION: Despite the lesions investigated exhibit similar clinical characteristics, the present study demonstrated that aspects such as age of the patient and evolution, color, bleeding and radiographic characteristics can help in the differential diagnosis of these lesions.

Necrotizing sialometaplasia of the palate in a cocaine-using patient. A case report.

Cocaine abuse and the consequent prevalence of the damage associated with it have increased in the global population. The damage depends on the route of administration, where an important sequel of snorting is perforation of the nasal septum and palate. Necrosis of the palate, meanwhile, is also the manifestation of other diseases such as tertiary syphilis, necrotizing sialometaplasia and malignant neoplasms. The differential diagnosis of such lesions is important for determining appropriate treatment. A case of an ulcerated lesion in the palate of a cocaine-using patient whose diagnosis was necrotizing sialometaplasia is reported.

Effect of 10% formalin on radiographic optical density of bone specimens.

OBJECTIVES: The aim of this work was to determine whether the fixation process with 10% formalin modifies the radiographic optical density of bone. METHODS: Eight rabbit tibiae were placed in separate containers with one of the following fixative solutions: 10% formalin (n = 3), 10% phosphate-buffered formalin (n = 3) or 10% calcium carbonate-buffered formalin (n = 2). Radiographs were obtained at 5 different times: before fixation (time zero), then 1 day, 15 days, 30 days and 90 days following immersion in the fixative solution. Radiographs were scanned and optical density was determined using ImageTool software. RESULTS: There was no significant difference in radiographic optical density among the specimens fixed in 10% formalin (146.60+/-32.44), 10% phosphate-buffered formalin (149.84+/-32.43) and 10% calcium carbonate-buffered formalin (146.61+/-35.92). Regardless of buffering, optical density at time zero was significantly higher than that at 15 days, 30 days and 90 days. However, while optical density at 1 day was significantly higher than that at 30 days and 90 days, it did not differ from that at 15 days. There was also no significant difference in density between 30 days and 90 days (ANOVA, Tukey, at 5% level of significance). CONCLUSION: The radiographic optical density of specimens stored in 10% formalin diminishes with time, irrespective of buffering, which suggests the occurrence of bone demineralization.

White sponge nevus. A case report.

White sponge nevus is a rare autosomal dominant hereditary disorder manifesting upon physical examination as white symmetric, diffuse, thickened, corrugated or velvety plaques on the oral, esophageal or genital mucosa. They are also found to be bilateral and asymptomatic. The tissue changes can be present at birth or manifest during childhood or adolescence, and this disorder occurs in females more than in males. It is a benign condition since cases of malignancy have not been reported, and it does not require treatment. Therefore, it is important to establish a differential diagnosis to rule out other white lesions that occur on the oral mucosa, mainly those in which there is a risk of malignancy. A case of white sponge nevus is reported along with a discussion on the differential diagnosis and clinical management.

The effect of head-fractioned teletherapy on pulp tissue.

AIM: To evaluate the early and delayed effects of fractioned teletherapy (radiotherapy) on the dental pulps of rats using Co(60). METHODOLOGY: In group 1 - rats (n = 15) were subjected to fractioned teletherapy by 30 daily sessions fractioned in doses of 200 cGy day(-1), totaling 60 Gy and the rats were killed immediately after the final dose of irradiation; group 2 - same protocol but killed 30 days following the final irradiation dose; groups 3 (n = 7) and 4 (n = 8) - formed controls without irradiation. Following perfusion, the left mandible of each rat was dissected and processed for histopathology. Serial sections (5 microm) were obtained and stained with HE or picrosirius. Observations were recorded for the coronal pulp tissue. A blinded observer evaluated HE sections using pre-defined indices of inflammation, nuclear alterations and extracellular matrix (ECM) hyalinization. Images of sections stained with picrosirius were converted to black and white for analysis by image-pro plus; areas in black (collagen) were measured as percentage area. The pulps of mandibular incisors of the specimens prepared for transmission electron microscopy (TEM) were subjected to descriptive analysis. Magnifications of 6300 and 10000 x were used to observe 10 pulp fibroblasts from each group. RESULTS: No inflammatory reactions or modification of the ECM status were found (P = 0.428) in any specimens. The collagen content also displayed no significant changes (P = 0.067) as a result of treatment. Groups 1 and 2 displayed significantly more nuclear alterations than the control groups (P < 0.05). The bubble-like aspect was more pronounced in group 1, and the bubbles looked smaller in group 2. The ECM showed no differences in the hyalinization status and there were no differences in the collagen area within the pulps. Under TEM, the pulp fibroblasts in group 1 displayed nuclear alterations that resembled circular, oval or elongated perforations; perforations also appeared in the cytoplasm. CONCLUSION: Fractioned teletherapy is capable of producing nuclear alterations in the dental pulp tissue of rats.

Aspectos de interesse clínico sobre a síndrome PFAPA (febre periódica, estomatite aftosa faringite a adenite / Clinical aspects of PFAPA syndrome (periodic fever, aphthous somatitis, pharyngitis and adenitis

O objetivo do a artigo é apresentar uma revisão da literatura sobre síndrome PFAPA, enfocando suas características clínicas, métodos e diagnósticos e tratamento. Foram consultados artigos indexados no Medline, publicados no período de 1984 a 2003. A síndrome PFAPA é uma enfermidade benigna, que se caracteriza por episódios recorrentes de febre alta, estomatite aftosa, faringite e adenite cervical em crianças de faixa etária inferior a cinco anos. As crianças apresenta-se saudáveis entre episódios febris, cujo o interval é, classicamente, de 28 dias. A prednisona aborta os sinais e sintomas atenuam-se espontaneamente com o avanço da idade não são descritas sequelas a longo prazo. Após a análise da literatura, fica clara a importância do correto diagnóstico diferencial com a síndrome de Bechet, síndrome da imonuglobulinemiaD, febre familiar do mediterrâneo e neutropenia cíclica. Uma vez confirmado o diagnóstico, o profissional deve tranquilizar e orientar os familiares, esclarecendo-ossobre a diminuição da recorrência dos quadros com o avanço da idade ou mesmo completa remissão com a chegada da puberdade.

Association between Helicobacter pylori and recurrent aphthous stomatitis in children and adolescents.

BACKGROUND: The recurrent aphthous stomatitis (RAS) is a common disease with unknown etiology. Helicobacter pylori has been shown to be the causative factor in peptic ulcers. Considering the similarities of histologic features between gastric and oral ulceration, we studied the possible involvement of H. pylori in the development of RAS. METHODS: A total of 105 children and adolescents were investigated--53 patients with RAS (case group) and 52 patients without lesions (control group). Specimens obtained by swabbing RAS lesions, intact oral mucosa, and dental plaque were submitted to a polymerase chain reaction (PCR)-based assay. RESULTS: Helicobacter pylori was present in six patients of the case group (11.3%) and in three of the control group (5.8%). When the site of infection was studied, 9.4% of the RAS lesions were PCR positives. In the case group and control group, 5.7 and 1.9% of the specimens from dental plaque, respectively, and 5.7 and 3.8% of the specimens from the intact oral mucosa, respectively, were PCR positives. CONCLUSION: There was no association between RAS lesions and infection of the oral cavity by H. pylori in children and adolescents (P = 0.254).