Is there difference in the comparative and quantitative salivary proteome between stimulated and unstimulated saliva in head and neck cancer patients treated by radiotherapy?

Stimulation of saliva production is an alternative to improve the quality of life of patients treated by radiotherapy. However, there is no information about changes in the salivary proteome of stimulated and unstimulated saliva in these patients. OBJECTIVES: Thus, we evaluated the difference in the proteomic profile of stimulated and unstimulated saliva in patients with head and neck cancer (HNC) treated by radiotherapy. METHODS: Stimulated and unstimulated saliva were collected from 9 patients with HNC before (BRT), during (DRT; 2-5 weeks) and after (ART; 3-4 months) treatment. Healthy patients paired by age and gender also had their saliva collected (C; control group). The stimulated and unstimulated salivary flow were evaluated (p < 0.05). Salivary proteins were extracted and processed for shotgun proteomic analysis. RESULTS: Significant differences were observed between stimulated and unstimulated salivary flows for C and BRT (p greater than 0.001), but not for DRT and ART. Proteins involved with apoptosis, antibacterial and acid-resistance were decreased in stimulated saliva in comparison to unstimulated saliva DRT and ART. Isoforms of keratins were not identified in control and BRT. CONCLUSION: there is a marked difference in the protein profile of stimulated and unstimulated salivary flows in HNC patients treated by radiotherapy. In addition, saliva stimulation in patients with HNC decreases important proteins involved with dental protection. The unstimulated salivary flow seems to be the best alternative to search for biomarkers. Our results contribute in an unprecedented way to understand the changes in the salivary proteome of different flows in HNC patients undergoing radiotherapy treatment.

An unusual clinical manifestation of oral melanocytic nevus.

Melanocytic nevi are acquired or congenital benign neoplasms, often found in skin but rarely in the oral mucosa. This article reports an atypical case of oral hypopigmented melanocytic nevus in a 39-year-old woman referred for evaluation of a well-circumscribed papule with discrete brownish spots in the buccal mucosa. An excisional biopsy was performed, the results of which led to a clinical diagnosis of inflammatory fibrous hyperplasia. The histopathologic analysis resulted in a diagnosis of hypopigmented intramucosal melanocytic nevus. This unusual clinical manifestation of melanocytic nevus reinforces the importance of including nonpigmented or hypopigmented melanocytic nevi in the differential diagnosis of papules arising in the oral mucosa. A biopsy and subsequent histologic examination of the specimen are recommended to establish an accurate diagnosis.

Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up.

INTRODUCTION: Hereditary gingival fibromatosis (HGF) is a rare disease characterized by gingival enlargement, normal color with benign and firm consistency. This growth may be exacerbated by use of drugs and plaque build-up. The treatment for this clinical condition is surgical excision of the enlarged gingival tissue or the extraction of all teeth. CASE REPORT: A 20-year-old Brazilian female handicapped patient with a chief complaint of exaggerated gingival enlargement who had been prescribed Carbamazepine and Gardenal was referred to our center. According to the clinical presentation and family history, the final diagnosis of gingival enlargement was HGF. Full dental treatment was performed, including basic periodontal treatment, restorations, sealants, and gingivoplasty with internal bevel. Special care was taken to ensure that there was no change in patient's anticonvulsant medication. The patient has been monitored for seven years without signs of recurrence of gingival hyperplasia due to constant professional and home control of plaque.

Viability of dental implants in head and neck irradiated patients: A systematic review.

BACKGROUND: The purpose of this systematic review was to evaluate the safety of dental implants placed in irradiated bone and to discuss their viability when placed post-radiotherapy (RT). METHODS: A systematic review was performed to answer the questions: "Are dental implants in irradiated bone viable?" and "What are the main factors that influence the loss of implants in irradiated patients?" RESULTS: The search strategy resulted in 8 publications. A total of 331 patients received 1237 implants, with an overall failure rate of 9.53%. The osseointegration success rates ranged between 62.5% and 100%. The optimal time interval between irradiation and dental implantation varied from 6 to 15 months. CONCLUSION: The interval time between RT and implant placement and the radiation doses are not associated with significant implant failure rates. The placement of implants in irradiated bone is viable, and head and neck RT should not be considered as a contraindication for dental rehabilitation with implants. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2229-E2240, 2016.

Panorâmica versus TCFC para interpretação de ateromas calcificados da carótida / Panoramic versus CBCT exams to suggest carotid artery calcifications

Objetivo: o objetivo deste estudo foi avaliar a prevalência das calcificações na artéria carótida – CACs – em imagens digitais panorâmicas (PD) e de tomografia computadorizada de feixe cônico (TCFC) dos mesmos pacientes. A CAC é uma doença vascular que acomete os pacientes acima dos 50 anos, coincidindo com uma grande maioria de pacientes que procura reabilitação por implantes. Assim sendo, é importante que o implantodontista esteja atento à interpretação da CAC, uma vez que detectada requer encaminhamento do paciente a um cardiologista para confirmação do diagnóstico. Material e métodos: foram avaliadas 100 imagens (200 lados) de panorâmicas digitais (idade média de 48 anos) e a imagem TCFC dos mesmos pacientes. O re-exame das imagens panorâmicas foi realizado com o objetivo de identificar os CACs falso-positivos e falso-negativos em relação à TCFC. Resultados: considerando 200 lados analisadas, 3,5% (n=7/200) foram interpretadas como CACs em radiografias panorâmicas, e 2,5% (n=5/200) em imagens de TCFC. Dos sete casos CACs positivos em radiografias panorâmicas, três foram falso-positivos quando comparados à correspondente TCFC. Quanto aos cinco casos CACs positivos em TCFC, um era falso-negativo, comparado à imagem panorâmica respectiva. Conclusão: calcificações artéria carótida – CACs – podem ser vistas nas imagens panorâmicas e/ou TCFC, no entanto, a panorâmica tendeu a mostrar casos falso-positivos da CAC. A CAC surge como um achado incidental nos exames de panorâmica e de TCFC, mas ainda assim o dentista tem como obrigação encaminhar o paciente para um cardiologista para a confirmação do diagnóstico, uma vez detectada a sua suposta presença.

Central giant cell granuloma: treatment with calcitonin, triamcinolone acetonide, and a cystic finding 3 years and 6 months after the primary treatment.

BACKGROUND: Central giant cell granuloma is a benign condition of the jaws which may present an aggressive behavior. CASE REPORT: A 9-year-old boy was complaining of swelling in the floor of the mouth. A solid swelling was observed in the area of the lower incisors. From the radiographic exam, we observed a radiolucent image in the mandibular bone with well-defined limits extending from the apical region of tooth 33 to the apical region of tooth 42. DISCUSSION: Due to the diagnosis and the age of the patient, we chose a conservative treatment, administering subcutaneous injections of calcitonin. During this treatment, no reduction to the lesion was observed. Therefore, we chose to treat the lesion with triamcinolone acetonide. Monthly follow-ups demonstrated good lesion reduction and the absence of any clinical symptoms during the first 2 years. After a 3-year follow-up, the patient returned, presenting mobility of the lower incisors. A significant increase in the size of the lesion was observed. After a biopsy, with the removal of tissue which had the appearance of a cyst capsule, microscopic analyses were found to be compatible with a secondarily infected cyst. Two months following this procedure, the patient did not present tooth mobility anymore and the oral mucosa presented a normal aspect. Following a radiographic exam, full lesion repair was observed. These conservative treatments should be the first option in cases of central giant cell granuloma and the patient must be observed for a long period of time, until no further clinical or radiographic signs of lesions are observed.