Synovial Chondromatosis of the Temporomandibular Joint Successfully Treated by Surgery.

Synovial chondromatosis (SC) is a chronic process, defined as a reactive cartilaginous proliferation, characterized by formation of cartilaginous nodules, usually loose in the joint space of the synovial membrane. It mainly affects large joints such as knee, hip, shoulder, and elbow, commonly in male patients. However, its manifestation in the Temporomandibular joint (TMJ), is a rare finding, occurring predominantly in females. This paper reports a case of a woman who presented to the service of Stomatology complaining of mouth opening limitations and pain in her left pre-auricular region. After clinical and radiographic analyses, the condition was diagnosed as SC of the TMJ. The loose bodies within the TMJ were removed under general anesthesia. Histological and follow-up features of this lesion are also discussed. To our knowledge, this is the second report of SC of the TMJ in Brazil.

Inflammatory cells in minor salivary glands of patients with chronic hepatitis C: immunophenotype, pattern of distribution, and comparison with liver samples.

OBJECTIVES: To characterize the immunophenotype and the distribution of the inflammatory infiltrate (INF) in salivary glands (SG) of patients with chronic hepatitis C, comparing with laboratorial data (genotype, viral load, METAVIR, and HCV RNA in SG), and liver. METHODS: INF was classified as diffuse or focal. Immunohistochemistry for CD3, CD20, CD8, CD4, CD57, CD68, and S100 was performed in 61 SG and 59 livers. RESULTS: Diffuse INF was more common in SG than in liver. CD3(+), CD20(+), and CD8(+) were the most frequent cells in both tissues, with few CD57(+), CD68(+), and S100(+) cells. CD4(+) cells were common in liver, but rare in SG. Liver presented higher indexes for all markers, except S100(+) (p<0.05). Higher CD3(+), CD20(+), and CD8(+) (p<0.05) were observed in SG with focal infiltrate than with diffuse infiltrate. In liver, CD20(+) and CD3(+) were higher in focal infiltrate, and CD68(+) in diffuse infiltrate (p<0.05). Comparisons with laboratorial data did not show statistical significance. CONCLUSIONS: The INF in SG was mainly composed by T and B lymphocytes, mostly cytotoxic T cells. The glandular INF can present differences in composition according to its distribution. A more intense inflammation was observed in liver, but similar cell types were identified in SG, except for CD4(+).

Clinical and demographic overlaps among immunologically mediated oral diseases: a challenge for clinicians.

This study sought to assess and compare retrospective demographic and clinical data of oral lesions of lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid from the records of the Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Brazil, covering a period of 55 years. Out of 25,435 specimens, these immunologically-mediated diseases accounted for 301 (1.18%) cases, of which 250 (0.98%) were lichen planus, 27 (0.11%) were pemphigus vulgaris, and 24 (0.09%) were mucous membrane pemphigoid. Lichen planus presented mainly as white asymptomatic plaques on buccal mucosa. Pemphigus vulgaris was usually characterized by multiple symptomatic erithematous ulcers on the buccal mucosa. Painful ulcers and/or blisters on the gingiva were the most common presentation for mucous membrane pemphigoid. Desquamative gingivitis was noted for all 3 diseases, but mainly for mucous membrane pemphigoid. Overall, lesions were more frequent in white women >50 years. Oral manifestations of immunologically-mediated diseases are relatively rare, and the correct diagnosis can be a challenge for dentists as the lesions often share similar clinical and demographic features.

660 AsGaAl laser to alleviate pain caused by cryosurgical treatment of oral leukoplakia: a preliminary study.

OBJECTIVE: To investigate the ability of low-level laser therapy (LLLT) to alleviate pain caused by the cryosurgical treatment of oral leukoplakia (OL). METHODS: Ten patients with OL were submitted to cryosurgical treatment (Non-LLLT group) and eight were submitted to cryosurgical treatment associated with LLLT (LLLT group). Laser irradiation of patients within the LLLT group was performed using a 50 mW 660 nm continuous wave Gallium Aluminum Arsenide (GaAlAs) laser with a spot size at the tissue surface of 0.0286 cm(2) (irradiance = 1.75 W/cm(2)). Three points within an area of 1 cm(2) around the cryosurgical site were irradiated in contact mode for 28 s per point (1.4 J at 49 J/cm(2) per point). Irradiation was carried out immediately following cryosurgical treatment and at 48 and 72 h post-cryosurgical treatment. A numerical rating scale was used to assess the pain. The relationship between the treated groups and pain was assessed using the Mann-Whitney test. RESULTS: Treated OL sites appeared to be clinically normal and with no evidence of recurrence during the average 9-month follow-up period. It could be observed that the LLLT group reported less pain than did the non-LLLT group. CONCLUSION: LLLT is an important strategy used to reduce post-surgical pain caused by cryosurgical treatment of OL.

Oral leukoplakias with different degrees of dysplasia: comparative study of hMLH1, p53, and AgNOR.

BACKGROUND: hMLH1 is one of the major proteins of the mammalian mismatch repair system. It has been suggested that the mismatch repair machinery could be linked to p53, a tumor suppressor protein. The AgNOR technique is used to assess cell proliferation. The aim was to compare the immunoexpression of hMLH1 and p53, and AgNOR number in oral leukoplakias with different degrees of dysplasia. METHODS: Sixty-two samples were evaluated by immunohistochemistry for hMLH1 and p53, and AgNOR technique, being 17 without dysplasia, 19 with mild dysplasia, 16 with moderate dysplasia, and 10 with severe dysplasia. RESULTS: hMLH1 immunoexpression showed decreasing indexes, while p53 and AgNOR showed increasing indexes from lesions with lower degrees of dysplasia to lesions with more severe dysplasia. An inverse correlation between hMLH1 and both p53 and AgNOR, and a direct correlation between p53 and AgNOR were observed. CONCLUSIONS: Alterations in the immunoexpression pattern of hMLH1 and p53 seemed to be early events in oral carcinogenesis. During acquisition of a more dysplastic phenotype, keratinocytes may show diminished capacity of DNA repair and tumor suppression, as well as higher cellular proliferation, and these pathways can be somehow interconnected.

hMLH1 immunoexpression is related to the degree of epithelial dysplasia in oral leukoplakia.

BACKGROUND: hMLH1 is a protein of the mammalian mismatch repair system responsible for genomic stability during repeated duplication. Relation between its altered expression linked to microsatellite instability has also been observed in oral leukoplakias (OL) and squamous cell carcinomas pointing to a possible role of hMLH1 in oral carcinogenesis. To our knowledge, this is the first study evaluating the immunoexpression of hMLH1 in OLs regarding their different degrees of epithelial dysplasia. METHODS: Sixty-two specimens of OL were classified in four groups: 17 without dysplasia, 19 with mild dysplasia, 16 with moderate dysplasia, and 10 with severe dysplasia. Immunohistochemistry for hMLH1 was performed, and percentage of positive cells was assessed. In the statistical analysis, P values <0.005 were considered significant. RESULTS: hMLH1 immunoexpression showed decreasing indexes from lesions with lower degrees of dysplasia to lesions with more severe dysplasia. Statistical difference was found mainly between suprabasal layers and total indexes. CONCLUSIONS: hMLH1 immunoexpression was inversely related to the OL degree of dysplasia. The total epithelial hMLH1 index seems to be of more clinical relevance than the evaluation stratified by layers. Our findings also suggest a role of such alterations in this pathway of DNA repair as an early event in oral carcinogenesis.

Risk factors in burning mouth syndrome: a case-control study based on patient records.

Burning mouth syndrome (BMS) is a multifactorial condition which is still poorly understood. The aim of this study was to evaluate a group of patients with BMS, as compared to a control group, and to describe related local and systemic factors. Records of patients referred to the Oral Pathology Service at the School of Dentistry over a period of 7 years were considered for the study, within which 32 patients with a diagnosis of BMS were found. A randomized group matched for age and gender was also evaluated for the study. Data were analyzed statistically using the SPSS 12.0 for Windows. Prevalence of BMS was 0.99% (32 BMS patients/3,243 records), considering that females were more commonly affected than were males and that the majority of the individuals were in their sixties. The univariate analysis performed comparing the two groups revealed statistical differences concerning the presence of gastrointestinal diseases (p = 0.003) and urogenital diseases (p = 0.012). The intake of H-2 receptor antagonist and proton pump inhibitor drugs (p = 0.015) also proved to be significant. Logistic regression analysis confirmed that gastrointestinal and urogenital problems were indeed risk factors that were solely associated with BMS. Although a diversity of related factors could be identified, gastrointestinal problems were the most prevalent, suggesting that the management of BMS patients requires attention and an appropriate approach to such disorders.

Detection of HCV RNA in saliva does not correlate with salivary flow or xerostomia in patients with chronic hepatitis C.

OBJECTIVE: The objective of this study was to investigate the prevalence of hepatitis C virus (HCV) RNA in saliva and its possible association with xerostomia and hyposalivation in patients with chronic hepatitis C. STUDY DESIGN: One hundred and thirty-six patients with confirmed diagnosis of chronic hepatitis C were prospectively analyzed before HCV treatment. The prevalence of xerostomia and hyposalivation was clinically evaluated. HCV RNA was investigated in saliva samples by qualitative PCR test. Univariate and multivariate analyses were used to verify associations. RESULTS: Xerostomia was reported by 48 (35.3%) patients, whereas hyposalivation was observed in 26 (19.1%). HCV RNA was positive in the saliva of 53 (39.0%) patients. An association among HCV RNA-positive saliva with xerostomia or hyposalivation was not observed. CONCLUSION: Our results demonstrate that the detection of HCV in saliva does not correlate with salivary flow or xerostomia in patients with chronic hepatitis C.

Oral mucosal conditions in chronic hepatitis C Brazilian patients: a cross-sectional study.

OBJECTIVE: Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. METHODS: A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. RESULTS: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant (P = 0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). CONCLUSION: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.

Exacerbation of oral lichen planus lesions during treatment of chronic hepatitis C with pegylated interferon and ribavirin.

It is estimated that 170-200 million people in the world are chronically infected with the hepatitis C virus. This fact indicates that the prevention and treatment of hepatitis C virus infection are a priority in public health care. To date, the best treatment consists of the combination of pegylated interferon (IFN) and ribavirin. IFN is costly and associated with low tolerance and severe side effects. Ribavirin is also problematic because it causes secondary anemia in most patients. It has been described that oral lichen planus (OLP) can appear or be exacerbated during the treatment of chronic hepatitis C. The improvement of the lesions of OLP after the discontinuation of therapy suggests that IFN may induce or worsen these lesions in some patients. This study examines three cases of exacerbation of OLP during the treatment of chronic hepatitis C with pegylated IFN and ribavirin.

Oral lichen planus and chronic hepatitis C: a controversial association.

Our aim was to study the possible association between oral lichen planus and chronic hepatitis C in patients from the state of Minas Gerais, Brazil. Two groups of patients were studied: group 1, 50 patients with oral lichen planus evaluated for the presence of chronic hepatitis C; and group 2, 215 patients with chronic hepatitis C examined for evidence of oral lichen planus. Diagnosis of oral lichen planus in both groups was based on clinical and histologic findings. One case of chronic hepatitis C was diagnosed in group 1 (2.0%), which was not considered statistically significant (P = .464). In group 2, the prevalence of oral lichen planus was 2.3% (5 cases), which showed statistical significance (P = .002). Although our results suggest oral lichen planus as an extrahepatic manifestation of chronic hepatitis C in the studied population, the association between these two entities should be further investigated.

Intraoral sebaceous carcinoma.

Intraoral sebaceous carcinoma (SC) is a rare tumour in the oral cavity thought to arise from malignant transformation of oral sebaceous glands. To our knowledge, only six cases of intraoral SC have been reported in the English language literature. The purpose of the present article is to report an additional case and review the literature.

Mucosal varicosities: case report treated with monoethanolamine oleate.

We reported a case of varicosities in the buccal mucosa treated with sclerotherapy. The sclerosant agent used was the monoethanolamine oleate. After three sessions the lesions disappeared and the patient is follow-up.

Submandibular osseous choristoma.

PURPOSE: Osseous choristoma is a rare, benign lesion of the oral cavity and is usually found in the tongue. It presents as a tumour-like mass of normal bony structure with mature cells in an abnormal position. The object of this paper is to report one case of osseous choristoma. PATIENT: A 32-year-old male presented with a lesion in the submandibular region, which was treated by excision. After 28 months of follow-up there was no recurrence. CONCLUSION: Upon reviewing the English literature, no previous case of an osseous choristoma located in the submandibular region has been found. Extended clinical and radiographic follow-up is necessary after surgical excision of an osseous choristoma, despite its benign nature.

Sclerotherapy of benign oral vascular lesion with ethanolamine oleate: an open clinical trial with 30 lesions.

OBJECTIVE: The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with ethanolamine oleate. STUDY DESIGN: Twenty-seven patients with 30 examples of oral vascular malformation, hemangioma, or varix were treated with intralesional injections of 1.25% or 2.5% ethanolamine oleate at an interval of 15 days between each application. The lesions were divided into 2 categories: (1) lesions of 20 mm or less and (2) those greater than 20 mm. Subsequently, the Mann-Whitney test was used a means of statistical analysis. RESULTS: Although the number of injections varied from patient to patient, all lesions responded to the treatment, showing total clinical regression. Lesions of 20 mm or less needed a lesser number of applications than those greater than 20 mm (P < .05). CONCLUSIONS: Ethanolamine oleate is a 100% effective sclerosant agent for treatment of benign oral vascular lesions. In this study, no difference was found between the 2 concentrations applied.

Primary syphilis of oral mucosa: case report of an unusual manifestation.

Dental clinicians and other health care providers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. Many infectious diseases, including human immunodeficiency virus, hepatitis, tuberculosis, and syphilis are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. Oral disease as a consequence of primary syphilis is rare. This article details a patient presenting with a labial nodule as her only clinical manifestation of undiagnosed primary syphilis.