Extractions in kidney transplant recipients: A prospective observational pilot study.

BACKGROUND: The authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction. METHODS: The authors selected patients who underwent kidney transplants more than 6 months ago (study group) and patients who had not (control group) older than 18 years who needed to undergo extraction of erupted teeth. The same oral surgeon performed all tooth extractions while the patients were under local anesthesia. Another blind researcher examined the patients 3, 7, and 21 days after tooth extraction. The first end point was occurrence of complications (local acute infection, alveolitis, increased bleeding), and the second end point was socket reepithelialization on day 21. RESULTS: Forty-five tooth extractions were performed on 38 study group participants and 61 on 57 control group participants. There was no statistical difference between the groups regarding the incidence of any complication or delayed socket epithelialization. CONCLUSIONS: The results of this pilot study suggest that there is no difference in postoperative healing after tooth extractions between stable kidney transplant patients and control patients. PRACTICAL IMPLICATIONS: This is the first prospective study assessing the frequency of postoperative complications after tooth extraction in kidney transplant recipients. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT02547753.

Complications related to dental extractions in patients with chronic kidney failure undergoing hemodialysis: a pilot study.

OBJECTIVE: To clinically assess socket healing after tooth extraction and the occurrence of intra- and postoperative complications in patients with chronic kidney failure (CKF) receiving hemodialysis (HD) by comparing them with a control group. STUDY DESIGN: This prospective study involved 48 patients with CKF receiving HD (study group [SG]) and 29 participants without CKF (control group [CG]) undergoing tooth extractions. No prophylactic antibiotic was administered to the participants. One calibrated dentist evaluated all individuals at 3, 7, 21, and 60 days after the tooth extractions and assessed hemostasis time, occurrence of local or distant infection, epithelialization, and deposition of alveolar bone. RESULTS: In the SG, 87 teeth were extracted through 65 interventions, and in the CG, 76 teeth were extracted through 36 interventions. Bleeding beyond 30 minutes was observed in 12 interventions (18.5%) in SG participants and was controlled with local hemostatic agents. Neither group had individuals presenting with postoperative infectious complications at the surgical site or at a distance. After 21 days, we observed delayed epithelialization in 29.9% (26 of 87) of the individuals in the SG compared with 3.9% (3 of 37) of those in the CG (P < .001). After 60 days, all the sockets were epithelialized and showing radiographic signs of alveolar bone neoformation. CONCLUSIONS: Individuals with CKF receiving hemodialysis tend to heal well after dental extractions. They did not have an increased risk of infectious complications after simple tooth extractions, but they showed prolonged bleeding events more often than control subjects. Additional research studies using larger sample sizes of patients with CKF receiving hemodialysis are needed to confirm our findings.

Poor oral health status and short-term outcome of kidney transplantation.

AIMS: This study aims to know whether poor oral health increases the risk of acute rejection and hospitalization in kidney allograft recipients. METHODS AND RESULTS: This is a prospective cohort study. The same dentist followed participants for 2 months after renal transplant for monitoring oral health (clinical evaluation, DTMF index, and CPITN index), signs of graft rejection, infection, and hospitalization. We compiled rates and reasons for hospital readmission or extended hospital stay. The CPITN had a mean score of 0.38 ± 0.71, increasing to 0.90 ± 0.84, 60 days after transplant (P < .001). No one rejected the graft in the period of study. Patients with older age (P = .009; OR: 1.07; CI 95% 1.01-1.12) were at higher risk of hospitalization at each year of age and patients presenting pretransplant dental focus (P = .001; OR: 7.23; CI 95% 2.13-24.56) had 7.23 times more chance to be hospitalized in the first 2 months after the transplant. One participant was hospitalized due to acute foci of dental infection. CONCLUSION: There was an association between dental focus and hospital readmission/stay. However, our methods do not provide conclusive proof of causality. Hospitalization due to acute dental infection was rare.

Salivary shedding of herpesviruses in renal transplant recipients.

AIM: The aim of the present study was to describe the salivary shedding of human herpesviruses (HHV) in renal transplant recipients and to observe the oral manifestations in this group. METHODS: A prospective case-control study was conducted with a study group of 20 renal transplant recipients and a control group of 20 non-transplanted, immunocompetent individuals. Clinical examination evaluated the presence of drug-induced gingival overgrowth (DIGO), salivary flow, and caries. Stimulated saliva was collected from both groups, with HHV being detected by using real-time polymerase chain reaction. RESULTS: The mean age of the study group was 45.90 ± 9.89 years, with 55% (11/20) being female, 60% (12/20) being Caucasian, 65% (13/20) having a deceased donor, and 70% (14/20) having used tacrolimus as the main immunosuppressive drug. Renal transplant recipients had shedding of more herpesviruses compared to the control group, with the exception of HHV-7. Statistical significance was found for herpes simplex virus-1 (HSV-1) (P = 0.017) and cytomegalovirus (P = 0.035). DIGO was observed in seven patients (35%), with 35% (7/20) presenting with decreased salivary flow and four (20%) reporting xerostomia. CONCLUSION: Renal transplant recipients excreted herpesviruses more often than control individuals, especially HSV-1. Decreased salivary flow and xerostomia were more frequent in patients who used tacrolimus, whereas those who used cyclosporine had more cases of DIGO.

Prevalence of and Factors Associated with Actinic Cheilitis in Extractive Mining Workers.

The objective of the present study was to determine the prevalence of actinic cheilitis among extractive mining workers and factors associated with the condition, especially the relationship between clinical appearance and the length of occupational exposure to sunlight. A cross-sectional study was performed in Dona Inês, Paraíba, Brazil between 2014 and 2015. A clinical examination, clinical photography and a questionnaire were applied to 201 extractive mining workers. The T-student's, ANOVA one-way, Fisher's exact and Pearson chi-squared tests were performed and the significance level was set at 5%. A high prevalence of actinic cheilitis was observed (38.8%). Length of occupational exposure to sunlight in months (169.63±112.68, p=0.002) was associated with actinic cheilitis. Most workers were Caucasian (p<0.001) and aged 37.41±12.15 years (p=0.004). The time of occupational exposure to sunlight was significant in relation to the following clinical features: atrophy (225.75±97.31; p=0.024); blurred demarcation between the vermilion border of the lip and the skin (186.68±113.15; p=0.032); vertical fissures (210.09±123.07; p=0.046); white and red spotting (199.51±91.80; p=0.004); hard consistency of the lip (225.81±122.34; p=0.012). A high prevalence of actinic cheilitis was found. Age and ethnicity were associated with the presence of AC. Severe clinical presentations of actinic cheilitis were found among participants who had worked for at least 185 months (approximately 15 years) exposed to the sun.

Clinical outcome of dental procedures among renal transplant recipients.

AIMS: To compare outcomes of dental procedures among a group of renal transplant recipients who had received antibiotic prophylaxis (AP) before the procedure and another group that had not received AP. METHODS AND RESULTS: The records of all renal transplant patients treated at the Special Care Dentistry Center (SCDC) were assessed. Dental procedures documented in the records were classified as invasive or noninvasive. All dental procedures performed were compiled, and the prescription or nonprescription of prophylactic antibiotics, and the incidence and description of postoperative complications after invasive procedures were recorded. Eighty-seven records were evaluated. Out of 190 invasive procedures all were simple dental extractions, 107 (56.3%) were preceded by AP; out of 242 noninvasive procedures, 14 (5.7%) were preceded by AP. A lack of uniformity on the type and dose of the antibiotic prescribed was observed. Four postoperative complications after invasive procedures (dental extraction) were noted and in 2 cases the procedures were preceded by AP. CONCLUSION: This retrospective study showed no difference in postextraction outcomes between renal transplant recipients who received and who did not receive AP before dental extractions.

Prevalence of and factors associated with actinic cheilitis in extractive mining workers

Abstract The objective of the present study was to determine the prevalence of actinic cheilitis among extractive mining workers and factors associated with the condition, especially the relationship between clinical appearance and the length of occupational exposure to sunlight. A cross-sectional study was performed in Dona Inês, Paraíba, Brazil between 2014 and 2015. A clinical examination, clinical photography and a questionnaire were applied to 201 extractive mining workers. The T-student's, ANOVA one-way, Fisher's exact and Pearson chi-squared tests were performed and the significance level was set at 5%. A high prevalence of actinic cheilitis was observed (38.8%). Length of occupational exposure to sunlight in months (169.63±112.68, p=0.002) was associated with actinic cheilitis. Most workers were Caucasian (p<0.001) and aged 37.41±12.15 years (p=0.004). The time of occupational exposure to sunlight was significant in relation to the following clinical features: atrophy (225.75±97.31; p=0.024); blurred demarcation between the vermilion border of the lip and the skin (186.68±113.15; p=0.032); vertical fissures (210.09±123.07; p=0.046); white and red spotting (199.51±91.80; p=0.004); hard consistency of the lip (225.81±122.34; p=0.012). A high prevalence of actinic cheilitis was found. Age and ethnicity were associated with the presence of AC. Severe clinical presentations of actinic cheilitis were found among participants who had worked for at least 185 months (approximately 15 years) exposed to the sun.

Resumo O objetivo foi determinar a prevalência de queilite actínica entre os trabalhadores extrativistas minerais e os fatores associados a esta lesão, principalmente a relação da aparência clínica da lesão com o tempo de exposição ocupacional à luz solar. Foi realizado um estudo transversal, entre 2014 e 2015, em Dona Inês / PB, localizado no Nordeste do Brasil. Foram aplicados um exame clínico, registro fotográfico e um questionário a 201 trabalhadores extrativistas minerais. Realizaram-se os testes "t" student, ANOVA, Exato de Fisher e Qui-quadrado de Pearson, o nível de significância foi de 5%. Observou-se alta prevalência de queilite actínica (38,8%). A duração da exposição ocupacional à luz solar, em meses, (169,63 ± 112,68, p = 0,002) foi associada à presença de queilite actínica. Estes trabalhadores eram, em sua maioria, brancos (p<0.001) com idade média de 37.41±12.15 anos (p=0.004). O tempo de exposição ocupacional à luz solar foi significativo em relação às seguintes características clínicas: atrofia (225,75 ± 97,31; p = 0,024); perda da demarcação entre o vermelhão do lábio e a borda da pele (186,68 ± 113,15; p = 0,032); Fissuras verticais (210,09 ± 123,07; p = 0,046); Manchas brancas e vermelhas (199,51 ± 91,80; p = 0,004); Consistência dura do lábio (225,81 ± 122,34; p = 0,012). Conclui-se que a prevalência de queilite actínica foi alta. A idade e a etnia foram fatores associados a presença de queilite actinica. Os participantes que haviam trabalhado pelo menos 185 meses (aproximadamente 15 anos) sob exposição ao sol, apresentaram manifestações clínicas graves da queilite actínica.

Oral shedding of HSV-1 and EBV and oral manifestations in paediatric chronic kidney disease patients and renal transplant recipients.

OBJECTIVE: Previous research demonstrated that salivary shedding of HSV-1 and EBV occurs often in adult renal transplant recipients, but there is a lack of studies on the presence of them in the saliva of paediatric population. Therefore, the objective of this study is to describe oral characteristics and to compare the shedding profile of HSV-1 and EBV in the saliva of children with renal transplant to that of chronic kidney disease patients and controls. METHODS: This is a cross-sectional study involving 100 children, being 25 renal transplant recipients, 25 chronic kidney disease patients and 50 healthy children. Demographic and oral clinical characteristics were assessed. Saliva samples were collected and submitted to screening for EBV and HSV-1 by using nested polymerase chain reaction technique. Fisher's exact, Pearson's chi-square and Kruskal-Wallis tests were used for statistical analysis at a significance level of 5%. RESULTS: Oral shedding of HSV-1 (28%) and EBV (60%) were significantly higher in renal transplant recipients compared to the other groups. Single vesicles in the oral mucosa were statistically associated with the presence of HSV-1 (p = .035). In children with chronic kidney disease, there was a higher prevalence of pale oral mucosa (32%) and enamel hypoplasia (40%) compared to paediatric renal transplant recipients and controls. Dental calculus (36%), candidiasis (8%), drug-induced gingival overgrowth (16%), mouth blisters (8%), xerostomia (12%) and salivary gland enlargement (20%) were more common in paediatric renal transplant recipients. CONCLUSIONS: Therefore, it can be concluded that salivary shedding of HSV-1 and EBV in paediatric patients was more often found in renal transplant recipients than in the renal failure and control children. Transplanted recipients showed more oral manifestations than renal failure and control children did.

Oral shedding of human herpesviruses in renal transplant recipients.

OBJECTIVE: To describe the shedding profile of human herpesviruses in the saliva of renal transplant recipients. METHODS: This is a prospective case-control study of 50 renal transplant recipients and control group of 50 individuals (non-transplanted and immunocompetent). Mouthwash samples were collected via oral rinse and then submitted to screening for the presence of eight types of herpesviruses by using multiplex PCR. Fisher's exact, chi-square, and Student t tests were used for statistical analysis, and the significance level was set at 5%. RESULTS: The mean age of the study group was 49.42 ± 12.94 years, 28/50 (56%) were female, and the time elapsed after transplantation was 68.20 ± 67.19 months. Herpes simplex virus 1 (HSV-1) (P = 0.025) and Epstein-Barr virus (EBV) (P = 0.024) were, statistically, more excreted in the saliva of renal transplant recipients compared to control group. Gender (P = 1.00) and age (P = 0.563) did not influence the salivary shedding of herpesviruses in renal transplant recipients. Individuals who excreted varicella-zoster virus in saliva had a shorter mean time of transplantation (22:00 + 2.82 months) (P < 0.001). CONCLUSION: Renal transplant recipients excreted herpesviruses more often than controls, especially HSV-1 and EBV, with salivary shedding of herpesviruses being more frequent in patients with recent kidney transplantation. CLINICAL RELEVANCE: The present findings support other longitudinal studies evaluating the relationship between oral shedding of human herpesviruses and clinical presence of active infection and renal transplant failure.

Reparação alveolar pós-exodôntica em indivíduos transplantados renais / Post-extraction socket healing among renal transplant recipients

A literatura apresenta vários artigos que estudam o tipo e a frequência de alterações bucais em pessoas transplantadas renais, mas é escassa em pesquisas que proporcionem evidências científicas sobre o risco de tratamento odontológico invasivo induzir infecção local ou à distância em receptores de transplante. A escassez de estudos que abordam manejo clínico em procedimentos odontológicos invasivos em pacientes transplantados reflete o empirismo e a falta de homogeneidade nas recomendações das equipes transplantadoras em relação ao manejo odontológico ideal do indivíduo receptor de transplante renal. Este volume apresenta um compilado de três trabalhos científicos que abordaram manejo do indivíduo transplantado renal e a avaliação do desfecho clínico após procedimentos odontológicos invasivos. As pesquisas foram executadas no Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da USP. Todas tiveram aprovação do comitê de ética em pesquisa. A primeira pesquisa buscou conhecer, por meio de questionário, as condutas dos cirurgiões dentistas frente ao tratamento odontológico de pacientes transplantados renais. O segundo estudo avaliou retrospectivamente a incidência de complicações após exodontias em pacientes transplantados renais, realizadas no CAPE, por diferentes dentistas, que foram precedidas ou não por antibioticoterapia profilática. O terceiro estudo teve por objetivo avaliar a reparação alveolar após extrações de dentes erupcionados de forma prospectiva, em pacientes transplantados e controles, sem receberem antibioticoterapia profilática. Os resultados mostraram que a maioria dos dentistas entrevistados se sentem inseguros em realizar tratamento odontológico em pacientes transplantados renais e prescrevem antibiótico profilático excessivamente, e com posologia empírica. Foi constatado por meio do estudo retrospectivo que o uso ou não de antibiótico profilático antes de exodontias em indivíduos transplantados renais não afeta o desfecho pós-operatório. Por fim, os resultados do terceiro estudo evidenciaram que não há diferença na epitelização e no reparo alveolar pós-exodôntico entre indivíduos transplantados renais e não transplantados, quando submetidos à exodontias simples, sem o uso de antibiótico profilático.

Magnetic resonance imaging appearance of foreign-body granulomatous reactions to dermal cosmetic fillers.

Foreign body granulomas can develop after the injection of various cosmetic filling materials into the facial area to flatten wrinkles. Clinically, reactive lesions are easily mistaken for soft-tissue neoplasms or cysts. This report presents a case of foreign body granuloma in a 52-year-old female patient complaining of a painless swelling in the nasolabial region. Both clinical and histological features are described, underscoring the diagnostic role of magnetic resonance imaging findings.

Tratamento de hemangioma por escleroterapia em aplicação única / Hemangioma treatment by sclerotherapy in a single application

Hemangioma é um tumor benigno oriundo de uma proliferação de tecido vascular em desenvolvimento e requer um diagnóstico apropriado para que a obtenção de um tratamento satisfatório seja alcançada. O tratamento depende do tamanho e da localização da lesão e pode ser feito com esclerose química, crioterapia, laserterapia, ligadura e excisão, ulceração artificial, embolia arterial, eletrocautério, termocautério ou radioterapia. Apresentamos um caso de uma paciente do gênero feminino, 63 anos, compareceu ao serviço de cirurgia e traumatologia bucomaxilofaciais apresentando lesão em mucosa jugal direita notada após um trauma oclusal acidental. Ao exame, notou-se edentulismo parcial superior e inferior e um tumor arroxeado em mucosa jugal direita, medindo aproximadamente 2 x 2,5 centímetros. O caso foi tratado com aplicação única de solução esclerosante (Ethamolin®),havendo resolução do quadro em 70 dias.. O tratamento de escolha foi a escleroterapia química, por se tratar de uma opção de fácil aplicação e baixo custo... (AU)

Hemangioma is a benign tumor originating of tissue proliferation of the vascular tissue in development and requires proper diagnosis for obtaining a satisfactory treatment is achieved. The treatment depends on the size and location of the lesion and can be done by chemical sclerosis, cryotherapy, laser therapy, ligation and excision, artificial ulceration, arterial embolism, electrocautery,thermocautery or radiation. Female patient, 63 years old, attended the oral and maxillofacialservice presenting lesion on the right buccal mucosa noted after an accidental occlusal trauma. Upon examination, it was noticed upper and lower partial edentulism and a purple tumor on the right buccal mucosa, measuring approximately 2 x 2.5 cm. The patient was treated with one application of sclerosing solution (ethamolin ®), that was resoluted in 70 days. The treatment was the chemical sclerotherapy, because it is an option for easy application and has a low cost... (AU)

Cisto dentígero: modalidades de tratamento / Dentigerous cyst: modalities of treatment

Introdução: O cisto dentígero é o segundo cisto odontogênico mais frequente nos maxilares. É uma lesão benigna, derivada do epitélio odontogênico da coroa de um dente não erupcionado, porém de etiopatogenia incerta. São geralmente radiotransparentes e, mais comumente, uniloculares. Estas lesões são observadas em exames de rotina ou quando não ocorre o irrompimento de um dente permanente. Os terceiros molares inferiores e os caninos superiores são os dentes mais acometidos, sendo também alta a ocorrência desta lesão em dentes supranumerários e associados a odontomas. O cisto dentígero ocorre principalmente nas três primeiras décadas de vida, tendo um crescimento lento e assintomático; pode atingir dimensões consideráveis, causando deformidade facial, impactação e deslocamento de dentes e/ou estruturas adjacentes. Objetivo: Definição das técnicas de marsupialização e enucleação, bem como consideração de critérios objetivos importantes para o plano de tratamento, como tamanho do cisto, idade, proximidade com estruturas anatômicas e importância clínica do dente envolvido. Apesar das peculiaridades clínicas de cada caso e do método de tratamento escolhido, o prognóstico destas lesões é favorável, quando se emprega apropriada terapêutica. Material e Método: O presente estudo apresentará um relato de caso tratado através da manobra de descompressão seguida de enucleação, bem como uma discussão acerca das modalidades de tratamento. Resultado: O paciente encontra-se em pós-operatório de dois anos sem sinais de recidiva da lesão e ausência de parestesias em face. Conclusão: A técnica empregada preservou a função neurossensorial e mostrou-se eficiente para a cura da lesão.

Introduction: The dentigerous cyst is the second most common odontogenic cyst in the jaws. It is a benign lesion of odontogenic epithelium derived from the crown of a tooth that has not erupted, but of uncertain etiology. They are generally radiolucent and usually unilocular. These lesions are observed in routine examinations or when the eruption of a permanent tooth is delayed. The third molars and maxillary canines are the most affected teeth, and also the high occurrence of this lesion is associated with supernumerary teeth and odontomas. The dentigerous cyst occurs mainly in the first three decades of life, It's growth is slow, asymptomatic and can reach considerable size causing facial deformity, displacement and impaction of teeth and/or surrounding structures. Objective: Definition of marsupialization and enucleation techniques as well as consideration of important objective criteria for the treatment plan like cyst size, age, proximity to anatomical structures and clinical importance of the involved tooth. Despite the clinical peculiarities of each case and the chosen treatment method, the prognosis of these lesions are favorable when appropriate therapy is used. Material and Method: This study will present a case report treated by maneuver of decompression followed by enucleation and discussion of treatment modalities. Result: The patient is on two years of postoperative without signs of relapse and absence of paresthesias in the face. Conclusion: The technique preserved the neurosensory function and was effective for the extinction of the lesion.

Celulite facial de origem odontogênica. Apresentação de 5 casos / Odontogenic facial cellulitis: a presentation of five cases

A maioria das infecções de origem odontogênica se originam a partir de necrose pulpar com invasão bacteriana no tecido periapical e periodontal, que pode levar à formação de abscesso, quando a infecção prevalece sobre as resistências do hospedeiro. Em situações nas quais a coleção purulenta não é capaz de drenar através de superfície cutânea ou mucosa bucal, o abscesso pode se estender através dos planos fasciais dos tecidos moles, patologia que se denomina celulite. Complicações graves, decorrentes dos quadros de celulite facial podem ocorrer, se o tratamento instituído não for adequado, podendo evoluir para trombose do seio cavernoso, abscesso cerebral, mediastinite, ou ainda, morte do paciente. Portanto, o tratamento de escolha dessa condição deve ser a drenagem rápida e agressiva da coleção purulenta em associação com antimicrobianos de amplo espectro e com características bactericidas. O objetivo deste trabalho é apresentar uma série de casos de celulite facial de origem odontogênica, acometendo pacientes de diferentes idades, sendo o tratamento proposto a associação da terapia medicamentosa, drenagem imediata da coleção purulenta e extração dos elementos dentários responsáveis pela infecção.

Most odontogenic infections arise from pulpar necrosis with bacterial invasion in the periapical and periodontal tissue, which may lead to abscess formation when the infection prevails over the resistance of the host. In situations where the pus cannot drain through the oral mucosa or the skin surface, the abscess may extend through the fascial planes of the soft tissues, a condition known as cellulitis. Severe complications from fascial cellulitis can occur if the treatment instituted is not appropriate, with possible progression to cavernous sinus thrombosis, brain abscess, mediastinitis or even death. The treatment of choice should therefore be rapid and aggressive pus drainage in association with broad-spectrum antimicrobial and antibacterial drugs. The aim of this paper is to present a series of cases of facial cellulitis of odontogenic origin affecting patients of different ages, the proposed treatment being a combination of drug therapy, immediate drainage of pus and extraction of the infected teeth.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis.

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A blastomicose sul americana, paracoccidiodomicose (Pb micose) ou doença de Lutz é uma infecção fúngica endêmica na América Latina. É causada pelo fungo dimórfico Paracoccidiodes brasiliensis, e pode causar lesões na mucosa oral. Nós avaliamos a incidência de lesões orais de Pb micose nos pacientes atendidos em um Centro Especializado em Diagnóstico Oral com foco principal nas diferentes formas clinicas das lesões, suas localidades, ocupação dos pacientes, hábitos deletérios e diagnóstico e metodologia, e foram detectados 31 casos (18 pacientes). Os resultados mostraram que 88,8% dos pacientes eram do sexo masculino com idade média de 50 anos de idade, e 39% trabalham, ou trabalhavam, com atividades relacionadas à agricultura. Observou-se que 88,9% eram fumantes e 72,2% ingeriam álcool. Citologia esfoliativa foi feita em 66,6%. Mucosa jugal foi acometida em 30%, gengiva, e lábios 16% (cada um) foram os locais mais comuns de lesões orais da Pb micose. Comparando o diagnóstico inicial com o definitivo feito pelos profissionais, a acurácia foi de 33%; o diagnóstico dos estudantes foi mais preciso demonstrando 72,5% do diagnóstico inicial correto com diferença estatística significante (p=0,25) através do teste ANOVA do SPSS WIN com nível de significância de 5%. Biópsia incisonal e citologia esfoliativa são eficientes para um diagnóstico precoce desta doença na boca; o treinamento dos estudantes em diagnóstico para reconhecer as patologias orais é urgente para melhorar a saúde pública.