Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience.

BACKGROUND: Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS: A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS: A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION: Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.

Expression of Interleukin-1ß and Interleukin-8 in Oral Potentially Malignant Disorders and Carcinomas.

Objective: To evaluate interleukin-1ß (IL-1ß) and interleukin-8 (IL-8) epithelial expressions in potentially malignant disorders of the oral mucosa as malignant predictive markers. Study design: About 55 tissues embedded in paraffin, comprising 15 oral lichen planus (OLP) lesions, 15 leukoplakias, 15 oral squamous cell carcinomas (OSCC), and 10 samples of normal oral mucosa were included in the study. IL-1ß and 8 expressions were assessed by immunohistochemistry using antibodies antihuman IL-1ß human (sc-7884, Santa Cruz® H-153) and antihuman IL-8 (ab7747, abcam®). The number of positive cells was compared using Student's t-test. Any p-value < 0.05 was considered statistically significant. Results: Nuclear and cytoplasmatic keratinocyte staining were positive for both cytokines in all study groups. However, a statistically significant decrease was observed within all cases compared to normal mucosa, both staining for IL-1ß and 8. Moreover, IL-8 showed significant differences between OLP and leukoplakia, and when compared to OSCC. Conclusions: Oral epithelial expression of IL-1ß and 8 seems to decrease when the malignant transformation of the oral mucosa increases.

Oral manifestations associated with antimalarial therapy in patients with systemic lupus erythematosus.

INTRODUCTION: Lupus erythematosus (LE) is an autoimmune disease often treated with antimalarial drugs. The prolonged use of chloroquine and hydroxychloroquine can cause hyperpigmentation in the skin, oral mucosa and retinal pigment epithelium, which in turn can trigger toxicity in this epithelium, which in some cases causes vision loss. The objective of the present work was to establish the association between the presence of oral pigmented macules by antimalarial and secondary retinal toxicity. METHODS: A total of 105 patients diagnosed with LE being treated with chloroquine/hydroxychloroquine were evaluated. All patients were ophthalmologically evaluated for retinopathy screening. When the patient showed oral hyperpigmented maculae, an incisional biopsy was performed with the corresponding histopathological study with informed consent. The variables were compared using the chi-square test for quantitative variables and the non-parametric Mann-Whitney U-test for categorical variables. The confidence level was established at 95%, and p-values of ≤0.005 were considered statistically significant. RESULTS: Only 9.5% of the patients showed oral brown spots. Histopathologically, 100% of the oral macules showed characteristics of oral pigmentation by drug and 100% ophthalmological parameters of normality. Two patients presented with a diagnosis of pre-retinopathy, but none showed oral lesions. CONCLUSION: Hyperpigmented macules in the buccal mucosa in lupus patients receiving antimalarial treatment are not frequent and do not represent a predictive finding of toxicity of the drug.

Urine Cortisol Levels in Children Before Dentistry Consultation to Measure the Presence of Anxiety: A Cross Sectional Study

Objective: To assess and compare cortisol levels in urine before dentistry consultation in children with signs of anxiety and without it. Material and Methods: Participation of 36 children (18 boys and 18 girls) aged 3 - 10 years. They were divided into two groups: patients with anxiety and patients previously adapted to the visit according to the Hamilton Anxiety Scale. A urine sample was taken from each patient 10 minutes before the dentistry consultation. The samples were preserved in cold and were then analyzed by chemiluminescence to determine cortisol serum levels. The data were analyzed by using Mann-Whitney U test, with SPSS software. A 5% confidence level was used, taking p<0.05 values as statistically significant. Results: 18 patients (50%) were classified as anxious patients and 18 (50%) as no anxious. Urine mean cortisol levels in anxious patients were 16.55 ± 8.47 mcg/dL and 3.88 ± 2.08 mcg/dL, in children without stress signs. Statistical significance was observed when both groups were compared (p≤0.0001). Cortisol levels were higher in girls with signs of anxiety (19.74 ± 9.16 mcg/dL) versus boys under the same condition (13.37 ± 6.75 mcg/dL). With regard to the levels of cortisol according to the age group, the results were 13.28 ± 5.24 mcg/dl in the first group (3 to 5 years old), 14.67 ± 7.23 mcg/dl in the second (6 to 8 years old) and 30.13 ± 5.78 mcg/dl in the third (9 and 10 years old) in anxious patients. Conclusion: High serum cortisol levels are directly related with anxiety and stress signs in children before dentistry consultation.

Fibroma traumático: dos presentaciones clínicas una misma entidad / Traumatic fibroma: two clinical presentations same entity

El Fibroma Traumático (FT) se considera la patología reactiva de tejido conjuntivo más frecuente de la cavidad bucal, cuya etiología es el trauma crónico. Es más frecuente en la segunda década de la vida, se presenta sin predilección por grupo étnico o género y aparece en áreas frecuentemente traumatizadas como carrillos, bordes laterales de lengua y labio inferior. Se presentan dos casos, ambos pacientes presentados en este trabajo fueron de sexo femenino, la primera de ellas de 59 años de edad y portadora de prótesis total superior, que mostró al examen clínico una lesión particular donde la presión mecánica de la prótesis ocasionó un crecimiento tumoral de 1cm de diámetro, color rosa pálido, lisa y brillante que se desprende del paladar duro a través de un pedículo. Esta lesión al examen clínico podría pasar desapercibida por la forma como se apoya sobre la mucosa del paladar. La otra paciente mostraba la lesión típica que caracteriza al FT, patología tumoral, sésil, en labio superior lado izquierdo, antre la comisura y la línea media del paciente, aproximadamente 6mm de diámetro, color rojizo y erosionada en la superficie, asociada a fricción crónica posterior a un trauma. La conducta a seguir para ambos casos fue extirpación quirúrgica y estudio histopatológico, obteniéndose como diagnóstico definitivo FT. La importancia de estos casos se basa en que ambas patologías aunque tienen el mismo diagnóstico histopatológico poseen presentaciones clínicas completamente distintas y una de ellas inusual, esto probablemente originado por el agente causal

Traumatic fibrosis (TF) is considered the reactive connective tissue disease more common in the oral cavity, the etiology is chronic trauma. It is more common in the second decade of life, is presented without preference for gender or ethnic group and appears frequently traumatized areas such as cheeks, lateral edges of tongue and lower lip. Both cases was in female patients, the first is 59 years old and superior total prosthesis, clinical examination showed a particular injury where the mechanical pressure of the prosthesis caused a tumor growth completely flattened 1cm in diameter, pale pink, smooth and bright that it appears the hard palate through a pedicle. This injury to the clinical examination may go unnoticed by the way is based on the mucosa of the palate. The other patient showed the typical lesion characteristic of the FT, tumor pathology, sessile on the upper lip, approximately 6mm of diameter, reddish and eroded on the surface friction associated with chronic post-trauma. The conduct to be followed in both cases was surgical excision and histopathology, obtained as a definitive diagnosis: TF. The importance of these cases is based on both disorders but have the same histopathological diagnosis have completely different clinical presentations and one of them is unusual, this probably originated by the causal agent

Manejo odontológico del paciente con lupus eritematoso / Dental management of patients with lupus erythematosus

El Lupus Eritematoso es una enfermedad crónica autoinmune que afecta el tejido conectivo y tiene predilección por mujeres en edad reproductiva. Se caracteriza por afectar diversos sistemas como el nervioso central, cardiovascular, músculoesquelético, renal y mucocutáneo entre otros. El compromiso sistémico en estos pacientes los transforma en individuos de alto riesgo para el tratamiento odontológico, por lo que se deben tener consideraciones clínicas y preventivas especiales para atenderlos y el odontólogo debe estar preparado para tratar adecuadamente sus necesidades y también debe estar en la capacidad de reconocer las expresiones clínicas en los tejidos blandos ya que pueden representar una de las primeras manifestaciones de la enfermedad y aquí desempeñaría un rol importante en su diagnóstico precoz

Lupus Erythematosus is a chronic autoimmune disease which involves connective tissue. It has predilection for female patients during the reproductive stage. It affects different systems such as nervous, cardiovascular, musculoskeletal, renal and mucocutaneal system. The systemic changes patients present, turns them into high risk individuals for dental treatment. Therefore, special clinical and preventive measures must be considered with these patients. Dentists should be prepared in order to treat patient's needs properly and should be in the capacity of identifying different clinical expressions on soft tissues that could lead to early diagnose of this disease

Estudio epidemiológico del fibroma traumático en una muestra de la población venezolana durante el período 1991-2001

El Fibroma Traumático (FT) es una patología reactiva frecuente de la cavidad bucal causada por estímulos traumáticos. Predomina en adultos entre cuarta y quinta década sin predilección por género. Es una lesión elevada, redondeada, de superficie lisa, base de implantación sésil o pediculada y de coloración rosada. A pesar de su elevada frecuencia no existen estudios epidemiológicos que la caractericen en nuestra población por lo que se plantea como objetivos, determinar la prevalencia del FT y estudiar las características epidemiológicas y clínicas de un grupo de pacientes venezolanos con FT. El estudio es de tipo retrospectivo (período 1991-2001), fueron evaluadas 4.908 historias del archivo central de histopatología bucal de la Facultad de Odontología de la UCV. Se tomaron datos epidemiológicos y clínicos de los casos de FT, se organizaron mediante instrumentos de recolección de datos y fueron analizados estadísticamente. La prevalencia fue del 11,16% (n=548). La distribución por edad osciló entre meses de vida y 96 años, con una media de 47,10 ± 0,75 años. El 94% tenía como diagnóstico presuntivo FT, 528 casos fueron asintomáticos, el 29,7%, se localizó en carrillos seguido por labio inferior (20,4%), el 85,8% mostró una coloración igual a la de la mucosa adyacente, el 62,9% no excedió los 5mm de tamaño y el 59% fueron sésiles. Por los resultados obtenidos se puede concluir que el FT es una lesión reactiva frecuente en Venezuela, puede presentarse a cualquier edad y cursa con características de benignidad que todo odontólogo general debe conocer para su diagnóstico y manejo.

Traumatic fibroma (TF) is a common reactive entity of the oral cavity caused by trauma. TF is frequent in adults around 4th and 5th decade of life with no gender predilection. It is a smooth-surfaced pink lesion with sessil o pedunculated base of implantation. Although, it is a frequent lesion there is a lack of epidemiological studies in Venezuela, for that reason the aim of this study was to determine the prevalence, epidemiological and clinical characteristics of a Venezuelan group. A retrospective study was designed between 1991 and 2001, 4.908 histories were evaluated from the archives of the Central Histopatological Laboratory of the Dental School, UCV. Epidemiological and clinical data regarding TF was collected and statically analysed. TF prevalence was 11, 16% (n=548). Age distribution oscillated between months of birth and 96 years old (mean 47,10 ± 0,75 years). Clinical diagnosis of TF was made in 94% of the histories, 528 cases were asymptomatic, and 29, 7%, were located in the oral mucosa follow by lower lip (20,4%). Colour was similar to the surrounded mucosa in 85,8% of cases, 62,9% were less than 5mm in size and 59% of cases were sessil. Results of this study concluded that TF is a common reactive lesion in Venezuela, occurs at any age, and shows a benign clinical behaviour. General dentist must be able to recognise and manage it.

Oral manifestations of systemic and cutaneous lupus erythematosus in a Venezuelan population.

BACKGROUND: The aim of this study was to characterize oral lesions in patients with systemic and cutaneous lupus erythematosus (LE) in a Venezuelan group. METHODS: Ninety patients with LE were studied. Oral biopsies were taken from patients who showed oral mucosal involvement. Tissue samples were investigated with histology and direct immunofluorescence techniques for the presence of immunoglobulins G, M, A and complement factor C3. RESULTS: In 90 patients with LE, 10 patients showed oral lesions related to the disease. Sixteen lesions were investigated. Oral ulcerations accompanied by white irradiating striae occurred in five patients, erythema was observed in five patients and a white homogeneous plaque in one patient. Fifteen lesions demonstrated vacuolar basal degeneration and 12 thickening of the basement membrane histologically. Direct immunofluorescence was negative in three samples. CONCLUSIONS: These findings corroborated that ulcers are not the only manifestation of LE in the oral mucosa. Clinical and histological examinations are significant as immunoproteins are not always found on the oral sample.

Estudio del apéndice del frenillo vestibular: ¿Alteración del desarrollo o lesión neoplásica? / Tissue tag of the labial frenum: Development anomaly or neoplastic lesion?

El apéndice del frenillo vestibular (AFV) es un fragmento de tejido mucoso que se desprende desde el frenillo labial del maxilar superior. Aunque su formación y función aún son desconocidas  se reconoce como una alteración del desarrollo. Sin embargo, muchos odontólogos y médicos confunden a menudo esta entidad  con  hiperplasias fibrosas producto de trauma. El objetivo de la siguiente investigación fue determinar la frecuencia de AFV en una población y su posible asociación con factores traumáticos locales. Se realizó un examen estomatológico completo a 185 individuos luego de llenar una historia clínica y consentimiento informado. Cerca del 20% de la población estudiada presentaron AFV (36 individuos), sin embargo el uso de prótesis o aparatología ortodóncica/ortopédica no pudo asociarse estadísticamente. El AFV es una anomalía del desarrollo que se presenta con relativa frecuencia y no se relaciona con factores traumáticos, por lo cual no representa una lesión reactiva y mucho menos neoplásica.

Tissue tag of the labial frenum (TTLF) is a fragment of oral mucosa that arises from the labial superior frenum. Its cause and function are still unknown, however, it is considered an alteration of the normal oral anatomy. Although its nature, many dentists and medics confuse this entity with fibrous hyperplasias produced by trauma. The aims of this study were to determine the frequency of TTLF and the association to traumatic local factors. 185 people were examined after filling an oral medicine history and signed an informed consent. About 20% of the study population showed TTLF (36 people), however, the use of prostheses or orthodontic treatment could not be statistically associated. TTLF is a relatively frequent development anomaly that it is not cause by trauma, and it does not represent a reactional lesion or a neoplasia.

O apêndice do frenillo a vestibular (AFV) é um fragmento do tecido mucoso que seja vindo fora de maxilar superior labial do frenillo. Embora suas formação e função não sejam sabidas ainda sejam reconhecidas como uma alteração do desenvolvimento. Não obstante, muitos dentistas e doutores confundem frequentemente esta organização com o produto do trauma das hiperplasias fibrosas. O objetivo da seguinte investigação era determinar a freqüência de AFV em uma população e de sua associação possível com fatores traumáticos locais. Uma examinação completa estomatologica a 185 indivíduos após o enchimento a uma historia clínica e a um consentimento informado foi feita. Perto de 20% da população estudada eles pressentem AFV (36 indivíduos), não obstante o uso do prótesis ou do aparatología ortodôntica o ortopédica não podia ser associado estatísticamente. O AFV é uma anomalia do desenvolvimento que aparece com freqüência relativa e não se relaciona aos fatores traumáticos, assim não representa uma lesão reativa e muito menos neoplásica.