Oral potentially malignant disorders: clinical-pathological study of 684 cases diagnosed in a Brazilian population.

BACKGROUND: The frequency and distribution of oral potentially malignant disorders (OPMD) may vary among different populations. The aim of the present study was to evaluate the clinical-pathological characteristics of OPMD diagnosed in a Brazilian oral pathology laboratory over a period of 11 years. MATERIAL AND METHODS: All cases diagnosed as leukoplakia, speckled leukoplakia, erythroplakia, and actinic cheilitis from 2005 to 2015 were analyzed. Clinical information was obtained from laboratory forms and histological information was obtained from histological slides stained with hematoxylin and eosin. RESULTS: the final sample was comprised of 684 cases, of which 292 were males and 392 were females. The mean age was 58 years. The anatomical site most often involved was the lateral border of the tongue (23%), followed by the lower lip (20%), and by the buccal mucosa/vestibule (18%). Leukoplakia accounted for 82% of the sample (564 cases). The mean size of the leukoplakia and speckled leukoplakia lesions was 13 mm (ranging from 1 to 100 mm) and 15 mm (ranging from 5 to 30 mm), respectively (p=0.460). Males reported smoking and drinking alcohol more frequently than females (p=0.001 and p<0.0001, respectively). In half of the cases, dysplasia was not histologically detected, while slight dysplasia was detected in 28% of the cases. The lesions from patients aged from 41 to 80 years presented moderate and severe dysplasia more often than lesions from patients in other age groups. CONCLUSIONS: OPMD were more common in females in their sixties. Females were more frequently affected in all anatomical sites, except for the lips. Leukoplakia lesions were the most common OPMD, followed by actinic cheilitis. The lateral border of the tongue was the most affected anatomical site. OPMD located in the floor of the mouth/sublingual mucosa and lesions from older patients presented severe epithelial dysplasia with greater frequency.

Prevalence of pulmonary hypertension in systemic sclerosis.

OBJECTIVE: To assess the prevalence of pulmonary arterial hypertension (PAH) in patients with the diagnosis of systemic sclerosis (SSc) followed at a tertiary university service. MATERIAL AND METHODS: Fifty-seven patients with SSc were studied by clinical assessment directed at the cardiopulmonary system, pulmonary function tests and Doppler echocardiography (ECHO). The following criteria were considered for the diagnosis of PAH: pulmonary artery systolic pressure (PASP) > or = 40 mmHg and/or the presence of other direct and indirect signs of PAH detected upon ECHO. RESULTS: Sixteen patients (28%) were diagnosed with PAH upon ECHO, 13 based on PASP > or = 40 mmHg and 3 based on direct and indirect signs of PAH; 8 patients had isolated PAH and 8 had PAH secondary to pulmonary fibrosis. Nine patients showed signs suggestive of cor pulmonale upon ECHO; among these patients, 6 had pressure recordings > or = 40 mmHg and 3 had a PSAP between 35 and 40 mmHg; one patient was asymptomatic and 8 showed signs suggestive of PAH upon clinical examination. Among the clinical and laboratory variables studied, a correlation was only observed between PAH and an elevated erythrocyte sedimentation rate (p = 0.004). CONCLUSIONS: The prevalence of PAH associated with SSc observed in this study was similar to those reported in the literature. However, the cut-off of PSAP measured by ECHO and used for the diagnosis of PAH associated with SSc needs to be revised.

Population-based analysis of 10,766 hospitalizations for mandibular fractures in California, 1991 to 1993.

BACKGROUND: This study describes mandibular fracture incidence, causes, and consequences in a large population. METHODS: California hospital discharge data from 1991 to 1993 were examined to describe causes, lengths of stay, and hospital charges for patients hospitalized for mandibular fractures. Rates were calculated per 100,000 population. RESULTS: There were 10,766 discharges with mandibular fracture as principal diagnosis or as diagnoses two through five on the discharge record (rate=11.5). Of these, 2,694 had mandibular fracture as the only diagnosis (principal diagnosis). For all 10,766 cases, assaults were responsible for more than half (54.0%) of all admissions for mandibular fracture. The highest rates were found among males (18.7), blacks (43.0), and adults aged 16 to 20 (26.5). Charges for the initial hospitalization (excluding physician's fees) for the 2,694 cases with only a diagnosis of mandibular fracture were used to estimate mean charges ($8,740). The total extrapolated 1993 inflation-adjusted hospital charges for mandibular fractures were $34 million per year. Most patients' bills were submitted to government payers, such as Medicaid. CONCLUSION: Treatment of mandibular fractures represents a considerable cost to public-supported programs as well as to patients.

Adult dental visits in California: successes and challenges.

OBJECTIVES: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. METHODS: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. RESULTS: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18-34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). CONCLUSION: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.