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Introdução: Recentemente, novas formas de consumo do tabaco têm se tornado cada vez mais populares, principalmente entre os jovens, como os cigarros eletrônicos, narguilé e hábito de mascar o tabaco, sendo vistas como meras diversões inofensivas. Objetivo: Realizar uma revisão de literatura sobre as formas alternativas de consumo de tabaco e sua relação com saúde bucal. Materiais e métodos: Foi realizado um levantamento bibliográfico, nas bases de dados PubMed, Periódicos CAPES e Scielo, por meio dos termos em “cigarro eletrônico (E-cigarette); narguilé (Waterpipe smoking); fumo de mascar (Chewing tobacco)”, selecionando artigos que evidenciavam as características dessas formas alternativas de consumo de tabaco e suas repercussões orais. Resultados: A popularização das formas alternativas de fumo entre os jovens deve-se principalmente a introdução de aromas e sabores ao tabaco, assim como estratégias de marketing e a concepção errada no que diz respeito a não ser prejudicial. Vários estudos têm demonstrado os efeitos deletérios à saúde, e alguns outros relatam a possível associação com alterações na cavidade bucal. Conclusão: Os cigarros eletrônicos, narguilé e hábito de mascar o tabaco, são formas alternativas de fumo com risco subestimado pelos seus usuários, apresentando diversas repercussões orais precoces, incluindo lesões potencialmente e malignas. Tal tema, deve ser considerado um problema de saúde pública, e estratégias de prevenção dirigidas aos jovens devem ser implementadas, assim como a conscientização por parte dos dentistas aos seus pacientes, a fim de reduzir o aumento dessa nova geração de fumantes.

Editorial Caros(as) leitores(as) O Congresso Odontológico Londrinese (COL) é um evento científico realizado pelos graduandos do 5º ano do curso de Odontologia da Universidade Estadual de Londrina (UEL), que tem como objetivo contribuir cientificamente para a formação dos acadêmicos e profissionais da área. Na sua 9ª edição, a comissão organizadora contou com participação do professor Dr. Hedelson Odenir Iecher Borges como presidente e professores de todas as áreas da Odontologia da UEL, a fim de consolidar uma interação de toda a comunidade acadêmica. O 3º COL e 9º COUEL foi realizado no período de 19 a 22 de maio de 2021 em um formato 100% online. A grade cientifíca foi composta por palestras ministradas por professores e profissionais de reconhecida importância nacional e internacional, além de apresentações de trabalhos. Comissão Organizadora 3º Congresso Odontológico Londrinense – 9º COUEL/Edição Online - UEL – Universidade Estadual de Londrina - 2021

Syphilis is a sexually transmitted infection, caused by the anaerobic spirochete Treponema pallidum. It is characterized by a variety of clinical manifestations including the oral mucosa, mimicking several diseases, thereby making diagnosis a challenge for clinicians. Therefore, the objective of this work is to report three cases of syphilis that were diagnosed based on oral lesions of different clinical aspects. In this series of cases, the lesions were found on the tongue and hard palate and presented as white plaques, ulcers or erythematous spots associated with ulcers. In the two cases, incisional biopsy was performed, and the histopathological aspects were suggestive of syphilis. Treponemic and non-treponemic tests were positive for all the patients, confirming syphilis. Therapy with benzathine-penicillin, administered intramuscularly led to complete remission of oral lesions in all the patients. The syphilis reemergence in the last years demands its inclusion in the differential diagnosis of several oral lesions. Diagnosing syphilis by oral lesions can be difficult once it can mimic other conditions. Therefore, dentists should know the clinical aspects of this infection, since many cases may exhibit only oral manifestations, to help in the diagnosis and control of the infection spread. Keywords: Syphilis. Treponemal Infections. Oral Manifestations. ResumoA sífilis é uma infecção sexualmente transmissível, causada pela espiroqueta anaeróbia Treponema pallidum. É caracterizada por uma variedade de manifestações clínicas, incluindo a mucosa oral, podendo mimetizar várias doenças, tornando o diagnóstico um desafio. Portanto, o objetivo deste trabalho é relatar três casos de sífilis diagnosticados a partir de lesões orais de diferentes aspectos clínicos. Nesta série de casos, as lesões foram encontradas na língua e palato duro e apresentadas como placas brancas, úlceras ou manchas eritematosas associadas a úlceras. Em dois casos, foi realizada biópsia incisional e os aspectos histopatológicos foram sugestivos de sífilis. Os testes treponêmicos e não treponêmicos foram positivos para todos os pacientes, confirmando a sífilis. A terapia com penicilina benzatina, administrada por via intramuscular, levou à remissão completa das lesões orais em todos os pacientes. O ressurgimento da sífilis nos últimos anos exige sua inclusão no diagnóstico diferencial de várias lesões bucais. O diagnóstico da sífilis por lesões orais pode ser difícil, pois pode mimetizar outras condições. Portanto, o dentista deve conhecer os aspectos clínicos dessa infecção, pois muitos casos podem apresentar apenas manifestações orais, para auxiliar no diagnóstico e controle da disseminação da infecção. Palavras-chave: Sífilis. Infecção Treponêmica. Manifestações Orais.

Introdução: A AIDS é causada pela infecção do HIV, que progressivamente causa degradação do sistema imunológico do hospedeiro e, consequentemente, o surgimento de diferentes patologias, inclusive na região orofacial. Seu tratamento atua no impedimento da replicação viral, e é chamado de terapia antirretroviral altamente ativa (HAART). Este método terapêutico pode estar associado a alguns efeitos colaterais orofaciais e sistêmicos. Objetivo: Analisar a presença das lesões orofaciais e dos efeitos colaterais associados ao uso da HAART em pacientes HIV+. Material e métodos: Uso de um questionário semiestruturado com informações demográficas, sociais, clínicas e terapêutica, exame físico extra e intraoral, exames laboratoriais e teste de sialometria. Resultados: A amostra foi composta de 43 indivíduos, sendo 53,5% do sexo feminino com cor de pele branca e idade entre 27 e 58 anos. A maioria refere ter se infectado por meio de atividade sexual (58,1%) com diagnóstico feito nos últimos 10 anos (68,1%). A maioria teve carga viral quantificada abaixo do limite mínimo (74,4%) e contagem de linfócitos T CD4+ acima de 500 células por mm³ de sangue (56,8%). Algumas lesões orofaciais, infecções oportunistas e efeitos colaterais ao uso da HAART foram identificados, mas somente a presença de lesões orais foram diretamente relacionadas a baixa quantidade de linfócitos T CD4+ (p=0,05). Conclusão: Todo cirurgião-dentista deve estar atento a presença de lesões orofaciais de pacientes HIV+ porque isso pode indicar uma baixa contagem de linfócitos T CD4+ e, consequentemente, de baixa adesão ou falha na HAART.

OBJECTIVE This cross-sectional study aimed to evaluate the prevalence and factors potentially associated with the development of actinic cheilitis (AC) in Brazilian rural workers. SUBJECTS AND METHODS A professional performed all physical examinations and evaluations using semi-structured questionnaires in 240 rural workers. RESULTS Eighty-three participants were diagnosed with AC (34.6%). It was more prevalent among workers older than 45 years (3.29-10.96 95% IC; OR = 3.30; p = .0018), Caucasians (phototypes I and II) (4.78-16.12 95% IC; OR = 10.81; p

Objective This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and methods Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results At oral physical examination, the most frequent findings were tooth loss (568–85.67%), coated tongue (422–63.65%) and oral bleeding (192–28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03–2.51) and OR = 1.69 (1.08–2.66), respectively). Conclusions The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.

To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC ≤40 years old.

Background To evaluate the frequency of maxillary dentures-related lesions and the possible associated risk factors. Material and Methods Ninety-seven participants were selected, and a complete anamnesis, physical examination and tests of occlusion vertical dimension (OVD), retention and stability of the denture, biofilm quantification, cytopathology, sialometry, pH analysis and buffer capacity of the saliva were performed. Statistical analyses were performed with the Pearson’s chi-square, Mann-Whitney tests, and Pearson’s coefficient (p

Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

Burkitt lymphoma (BL) is a rare and aggressive malignant neoplasm frequently involving the jawbones in children. The main purpose of this article is to report the case of a nine-year-old boy with widespread BL diagnosed through oral findings. The patient was referred after complaining of dental mobility for two weeks. The physical examination revealed premature eruption of permanent teeth. The periapical radiographic examination showed a diffuse bone rarefaction in the involved area. An incisional biopsy was performed, leading to the diagnosis of BL. The patient was then treated with chemotherapy and is free of disease after an 18-month follow-up. The main signs and symptoms of an oral BL could mimic a dental problem, thus it is extremely important to be knowledgeable about this disease, which can be fatal without early diagnosis and treatment.

AIM To evaluate the association between the presence of selected bacterial species/groups in the apical root canal and expression of mediators of soft and bone tissue destruction in apical periodontitis lesions. Relationships between bacteria and some other features of apical periodontitis were also investigated. METHODOLOGY Seventeen freshly extracted teeth with pulp necrosis and apical periodontitis were included. The apical root segment was sectioned and cryopulverized; DNA was extracted and evaluated for the presence of 9 bacterial species/groups using real-time polymerase chain reaction. Lesions were processed for histopathological and immunohistochemical analyses, which targeted matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9), receptor activator of NFκB (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG). Associations of the target bacteria with expression of these mediators, presence of symptoms, lesion size and histopathological diagnosis were evaluated. Data were analysed using the chi-square, Fisher's exact, Mann-Whitney and Pearson tests. P values lower than 0.05 were considered significant. RESULTS All pulverized apical root samples were positive for bacteria. The most prevalent taxa were Actinobacteria (53%), Streptococcus species (35%), Fusobacterium species and Parvimonas micra (18%). The target mediators exhibited a high mean expression in the lesions (MMP-2: 82%; MMP-9: 73%; RANK: 78%; RANKL; 81%; OPG; 83%). Mean RANKL:OPG ratio was significantly higher in granulomas than cysts (P

Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.

Pessoas transgênero são aquelas cuja identidade de gênero não se enquadra nas normas impostas pela sociedade quanto ao gênero designado ao nascer, com base na genitália. Obviamente, as características sexuais secundárias dependem dos esteroides sexuais. A redesignação hormonal tem dois objetivos: reduzir as características sexuais secundárias induzidas por hormônios do sexo original e induzir as características sexuais secundárias do novo sexo. O uso desses hormônios esteroides sexuais pode favorecer o desenvolvimento de lesões da mucosa oral, como o granuloma piogênico, que é uma lesão vascularizada não neoplásica, comum na cavidade oral, causada por trauma, irritantes locais ou fatores hormonais. A etiologia atualmente não é clara, mas trauma e aumento do nível de estrogênio e progesterona têm sido sugeridos como potenciais fatores contribuintes. Portanto, o objetivo principal deste artigo é relatar um granuloma piogênico em desenvolvimento em uma mulher transgênero que pode estar associado à terapia hormonal e destacar os efeitos da terapia hormonal nos tecidos orais.

The fibrous histiocytoma is a soft tissue neoplasm that affects the dermis and the subcutaneous tissue, rarely is found in the oral cavity and perioral regions, and is originated from the proliferation of fibroblasts and histiocytes. The objective of this paper is to report a case of Benign Fibrous Histiocytoma in a 30-year-old male patient, complaining of a painless nodule in the tongue for about six months. With the clinical diagnostic hypotheses of Fibrous Hyperplasia or Traumatic Neuroma an excisional biopsy was performed. The histopathological examination revealed a non-encapsulated proliferation of spindle cells with some giant multinucleated cells in the periphery of the lesion. Immunohistochemical reactions were performed, staining only for vimentin in the spindle cells and for CD68 in the multinucleated giant cells. According to these characteristics, the final diagnosis was Benign Fibrous Histiocytoma. The correct diagnosis of spindle shaped cell neoplasia must be performed with the aid of histopathological analysis and immunohistochemistry, mainly because the morphological similarities with other benign and malignant lesions.

Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.

O Líquen Plano Oral (LPO) é uma doença crônica imunologicamente mediada com potencial de malignização incerto. O objetivo desse artigo é relatar um caso de Carcinoma de Células Escamosas (CCE) diagnosticado em paciente com diagnóstico prévio de LPO. Paciente do sexo feminino, 69 anos, foi atendida durante uma campanha de diagnóstico precoce de câncer de boca realizada na cidade de Londrina/PR, sendo detectada uma lesão eritroplásica em língua e encaminhada para uma melhor avaliação. Na anamnese a paciente relatou que há 2 anos atrás foi diagnosticada com LPO através de biópsia em língua, não sendo proposto nenhum tratamento. Ao exame físico, observamos uma mancha eritematosa em borda lateral de língua do lado esquerdo, não apresentando nenhuma outra lesão na cavidade oral. Com a hipótese diagnóstica de eritroplasia, foi requisitada a lâmina da biópsia anterior para análise, que revelou características microscópicas incompatíveis com o diagnóstico de LPO. Optamos então por realizar uma nova biópsia e a análise histopatológica revelou ilhas de células epiteliais malignas invadindo o tecido conjuntivo, estabelecendo o diagnóstico de CCE. A paciente foi encaminhada para tratamento, sendo realizada glossectomia parcial. Em acompanhamento de 6 meses a paciente encontra-se bem e sem sinais de recidiva. A transformação maligna do LPO ainda é discutida na literatura e muitos casos relatados podem se tratar de erro no diagnóstico inicial, como no caso apresentado. O erro de diagnóstico pode levar a morbidades importantes e comprometer o prognóstico do caso.Descritores: Diagnóstico; Líquen Plano; Carcinoma de Células Escamosas.ReferênciasGiuliani M, Troiano G, Cordaro M, Corsalini M, Gioco G, Lo Muzio L et al. Rate of malignant transformation of Oral Lichen Planus: a systematic review. Oral Dis. 2019; 25(3):693-709.Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: a 12-years retrospective study. Acta Odontologica Scandinavica 2013;71(3/4):834-40.Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002;46(2):207-14.Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010;28(1):100-8.Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral lichen planus – a review. J Oral Pathol Med. 2010;39(10):729-34.van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003;32(9):507-12.Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. 1978;46(4):518-39.Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS et al. Malignant transformation of oral lichen planus and oral lichenoid lesions: a meta-analysis of 20095 patient data. Oral Oncology. 2017;68:92-102.Eisenberg E. Oral lichen planus:a benign lesion. J Oral Maxillofac Surg. 2000;58(11):1278-85. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res. 2016;308(8):539-51.Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.Sousa FACG, Paradella TC, Brandão AAH, Rosa LEB. Líquen plano bucal versus displasia epitelial: dificuldades diagnósticas. Braz J Otorhinolaryngol. 2009;75(5):716-20.Rode M, Kogoj-Rode M. Malignant potential of the reticular form of oral lichen planus over a 25-year observation period in 55 patients from Slovenia. J Oral Sci. 2002;44(2):109-11.Van der Meij EH, Mast H, Van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year followup study of 192 patients. Oral Oncol. 2007;43(8):742-48.Oliveira Alves MG, Almeida JD, Balducci I, Guimarães Cabral LA. Oral lichen planus: a retrospective study of 110 Brazilian patients. BMC Res Notes. 2010;3:157.Radochová V, Drˇízhal I, Slezák R. A retrospective study of 171 patients with oral lichen planus in the East Bohemia-Czech Republic–single center experience. J Clin Exp Dent. 2014;6(5):e556-61.Fitzpatrick S, Hirsch S, Gordon S. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. 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EditorialCaros(as) Leitores(as)O Congresso Odontológico da Universidade Estadual de Londrina (COUEL) é um evento científico realizado pelos graduandos do 5ºano do curso de Odontologia da UEL, que tem como objetivo contribuir cientificamente para a formação dos acadêmicos e profissionais da área.Na sua 7ª edição, a comissão organizadora contou com participação do professor Dr. Ademar Takahama Junior como presidente e professores de todas as áreas da Odontologia da UEL, a fim de consolidar uma interação de toda a comunidade acadêmica.O 7º COUEL foi realizado no período de 13 a 15 de setembro de 2018 na cidade de Londrina/PR no Teatro Mãe de Deus. A grade cientifíca foi composta por palestras ministradas por professores e profissionais de reconhecida importância nacional e internacional, além de apresentações de trabalhos.Comissão Organizadora

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is characterized by cutaneous and/or mucosal ulcers in patients receiving immunosuppressive medication or with age-related immunosenescence. Its microscopic appearance often leads to a diagnostic challenge, sometimes mimicking an overt lymphoma. A 47-year-old woman, with a previous diagnosis of systemic lupus erythematosus, was referred for evaluation of a gingival ulcer, present for about 2 months and located in the maxillary peri-implant mucosa around implants, resembling peri-implantitis. An incisional biopsy was performed, and the microscopic evaluation showed a polymorphic infiltrate with some Reed-Sternberg-like cells. Immunohistochemistry showed positive findings for CD20, CD30, CD45, PAX-5, MUM-1, LMP-1 and EBER1/2, establishing the diagnosis of EBVMCU. After 2 months, total regression of the lesion was noted without any intervention. We discuss the possible association between the EBVMCU and systemic lupus erythematosus; to our knowledge, this is the first report of an EBVMCU simulating peri-implantitis.

Objective: The aim of this study was to determine the range of oral histopathological diagnoses in a Brazilian survey obtained from a surgical pathology hospital laboratory. Material and Methods: A retrospective cross-sectional study was performed, and all histological slides from the oral and maxillofacial region during a 14-year period were reviewed. The materials were grouped into five major diagnostic categories, and age and sex were specified. Results: A total of 769 samples were collected and submitted for histopathological analysis. There were 245 oral cases, which were divided into 48 different diagnoses. There was no sex predilection, and the mean age was about 44 years old. Proliferative non-neoplastic lesions (43.2%) and malignant neoplasms (26.5%) comprised the main two groups of diagnoses. Conclusion: The malignant prevalence observed in this Brazilian sample may be due to the nature of the population or, most probably, to the nature of the source, a referral hospital center in the city.

Fabry disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme α-galactosidase A. We report a case of a 55-year-old woman, with previous diagnosis of Fabry disease that was referred complaining of pain in the gingiva for about 1 year. The physical examination revealed short fingers, angiokeratomas in the neck, fissured tongue and desquamative gingivitis. An incisional biopsy was performed in the gingival lesions and the histopathologic analysis revealed a subepithelial blister, compatible with the diagnosis of mucous membrane pemphigoid. A topical corticosteroid therapy was instituted associated with conventional periodontal treatment. After 3 weeks, all areas of erythema or ulceration were healed, and the symptoms had disappeared. Fabry disease is a rare disorder with a few cases of oral abnormalities described. A high incidence of autoantibodies has been reported in patients with Fabry disease, which may explain the development of the desquamative gingivitis condition.

Akutna mijeloična leukemija agresivna je maligna neoplazma koja se uglavnom pojavljuje kod starijih osoba u dobi od 65 godina. Oralne manifestacije i najčešće spontano krvarenje uobičajeni su nalazi u slučaju te bolest i mogu upućivati na početnu fazu. U ovom izvještaju opisan je slučaj 47-godišnjeg muškarca s jednomjesečnim spontanim oralnim krvarenjem. Pacijent je već prije zatražio mišljenje dvaju profesionalaca, ali bez ikakva rezultata. Fizikalni pregled pokazao je bljedoću, vrućicu, krvarenje iz nosa (epistaxis) i ekhimoze u oralnoj sluznici. Kompletna krvna slika upućivala je na anemiju, tešku trombocitopeniju i leukocitozu sa skretanjem KS-a ulijevo, pojačavajući tako dijagnozu hipoteze akutne leukemije. Pacijent je odmah prevezen u bolnicu i unatoč tomu što mu je pružena hitna pomoć, umro je tri dana poslije zbog difuznoga plućnog alveolarnog krvarenja. Na uzorku periferne krvi bila je obavljena imunofenotipizacija i dobivena je dijagnoza hipogranularne inačice akutne promijeloične leukemije. Kašnjenje u postavljanju dijagnoze moglo je utjecati na nepovoljan ishod. Rana dijagnoza i liječenje prijeko su potrebni za preživljavanje pacijenata s leukemijom pa su i doktori dentalne medicine odgovorni za rano otkrivanje oralnih manifestacija leukemije i za brzo upućivanje pacijenta odgovarajućem stručnjaku., Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.

Actinic cheilitis is a potentially malignant disorder of the lips. Its first cause is believed to be UV sun radiation. The lesion is highly heterogeneous, making the choice of area to be biopsied difficult. This study exploits the capabilities of time-resolved fluorescence spectroscopy for the identification of the most representative area to be biopsied. A preliminary study was performed on fourteen patients. A classification algorithm was used on data acquired on nine different biopsies. The algorithm discriminated between absent, mild, and moderate dysplasia with a sensitivity of 92.9%, 90.0%, and 80.0%, respectively. The false positive rate for healthy tissue (specificity) was 88.8%.

Objective: to report a case of adenomatoid odontogenic tumor (AOT), highlighting its features and differential diagnosis. Case report: a 16-year-old male with a unilocular radiolucent lesion involving the unerupted 24th tooth. Considering AOT, dentigerous cyst, calcifying cystic odontogenic tumor, and unicystic ameloblastoma as the clinical diagnoses, an excisional biopsy was performed. Microscopic analysis revealed a parenchyma containing tubular structures and roset-like areas, establishing a diagnosis of AOT. Conclusion: the acknowledgement of clinical, radiographic, and microscopic features of AOT is essential to guide a definitive diagnosis and, as a consequence, to enable a suitable treatment of the patient. Objetivo: relatar um caso clínico de tumor odontogênico adenomatoide (TOA) enfatizando suas características clínicas, radiográficas e histopatológicas, de forma a contribuir na definição dos seus diagnósticos diferenciais. Relato do caso: a lesão acometeu um paciente do sexo masculino, de 16 anos,como uma lesão radiolúcida, unilocular, associada ao dente 24 incluso. A partir das hipóteses diagnósticas de TOA, cisto dentígero, tumor odontogênico cístico calcificante e ameloblastoma unicístico, foi realizada a biópsia excisional. Na microscopia, observou-se a presença de cavidade cística revestida por epitélio escamoso estratificado não-queratinizado, estruturas tubulares, áreas semelhantes a roseta, áreas cribriformes e de calcificação, permitindo o estabelecimento do diagnóstico de TOA. Conclusão: radiograficamente o TOA pode ser confundido com outras lesões intraósseas, como o cisto dentígero e o ameloblastoma unicístico,que também acometem pacientes jovens e podem envolver dentes inclusos em maxila anterior, além disso, histopatologicamente, apesar de possuir um padrão característico, áreas de outros cistos ou tumores odontogênicos podem estar presentes. Sendo assim, o reconhecimento das características tanto clínicas, radiográficas e histopatológicas do TOA são muito importantes, especialmente no que diz respeito ao tratamento adequado do paciente.

Actinic cheilitis is a potentially malignant disorder of the lips. Its first cause is believed to be UV sun radiation. The lesion is highly heterogeneous, making the choice of area to be biopsied difficult. This study exploits the capabilities of time-resolved fluorescence spectroscopy for the identification of the most representative area to be biopsied. A preliminary study was performed on fourteen patients. A classification algorithm was used on data acquired on nine different biopsies. The algorithm discriminated between absent, mild, and moderate dysplasia with a sensitivity of 92.9%, 90.0%, and 80.0%, respectively. The false positive rate for healthy tissue (specificity) was 88.8%.

Actinic cheilitis is a potentially malignant disorder that mostly affects the vermilion border of the lower lip and can lead to squamous cell carcinoma. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. Late diagnosis is a limiting factor of therapeutic possibilities available to treat oral cancer. The diagnosis of actinic cheilitis is mainly based on clinical and histopathological analysis and it is a time consuming procedure to get the results. Information about the organization and chemical composition of the tissues can be obtained using fluorescence lifetime spectroscopy techniques without the need for biopsy. The main targeted fluorophores are NADH (nicotinamide adenine dinucleotide) and FAD (flavin adenine dinucleotide), which have free and bound states, each one with different average lifetimes. The average lifetimes for free and bound NADH and FAD change according to tissue metabolic alterations and allow a quick and non-invasive clinical investigation of injuries and to help clinicians with the early diagnosis of actinic cheilitis. This study aims to evaluate the fluorescence lifetime parameters at the discrimination of three degrees of epithelial dysplasia, the most important predictor of malignant development, described in up to 100% of actinic cheilitis cases.

Head and neck chondrosarcomas are rare and potentially lethal tumours, which are even more uncommon in the head and neck region. The diagnosis of chondrosarcoma is based on the histopathological pattern of malignant chondroid tissue proliferation. The grade of malignancy and the histological surgical margins are some of the most important prognostic factors for this group of tumour. In the present report we described two cases of chondrosarcoma affecting the maxilla, which presented different behaviours. The first patient, with a high-grade tumour, died of local recurrence and the second patient, with a low-grade tumour, is alive and free of disease 60 months after the treatment. These two cases emphasize the importance of histological tumour grade and appropriate treatment for the prognosis.

Objective: the aim of this paper is to report a case of palatal Mucoepidermoid carcinoma (MEC) mimicking a mucocele, to highlight the main differential diagnoses, and to point out the need of a biopsy to establish the diagnosis even in a suspicion of benign reactive lesions. Case report: a female was referred to a stomatologist for evaluation of a palate swelling noticed about two months earlier. Physical exam revealed a painless translucent submucosal nodule, with an erythematous halo, in the right soft palate. Considering the clinical appearance, diagnostic hypothesis included mucocele and pleomorphic adenoma. An incisional biopsy was performed. Histological analysis of the specimen showed definitive diagnosis of low grade MEC. The case was managed through a complete surgical excision. Currently, she has been followed up without any signs of recurrence. Conclusion: early diagnosis of MEC may guide an adequate therapeutic management and, consequently, promote a favorable prognosis. Resumo Objetivo: O objetivo deste trabalho é relatar um caso de carcinoma mucoepidermoide palatino (CME) mimetizando uma mucocele, ressaltar os principais diagnósticos diferenciais e apontar a necessidade de uma biópsia para estabelecer o diagnóstico mesmo na suspeita de benigno. lesões reativas. Relato de caso: uma fêmea foi encaminhada a um estomatologista para avaliação de um inchaço no palato notado cerca de dois meses antes. O exame físico revelou nódulo submucoso translúcido, indolor, com halo eritematoso no palato mole direito. Considerando a aparência clínica, a hipótese diagnóstica incluiu mucocele e adenoma pleomórfico. Uma biópsia incisional foi realizada. A análise histológica do espécime mostrou diagnóstico definitivo de CME de baixo grau. O caso foi gerenciado através de uma incisão cirúrgica completa. Atualmente, ela tem sido acompanhada sem sinais de recorrência. Conclusão: o diagnóstico precoce da CME pode orientar um manejo terapêutico adequado e, consequentemente, promover um prognóstico favorável.

Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. AIM: The purpose of this study was to retrospectively analyze all cases of parotid tumors treated at our institution from 1953 to 2003. METHODS: All patients with primary parotid tumors were selected; clinical and histopathological data were analyzed and described. RESULTS: 600 cases of parotid tumors were selected; 369 were benign and 231 were malignant. Pleomorphic adenoma was the most frequent benign tumor. The most common malignant tumor was the mucoepidermoid carcinoma. Therapy in most cases consisted of parotidectomy. Adjuvant therapy - mainly radiotherapy - was used in some cases with malignant tumors. The incidences of local, regional and distant recurrences of malignant tumors were 10%, 8% and 9%. CONCLUSION: Patients with parotid tumors treated at our institution were mainly adults, with marginally more female patients. Benign tumors were mostly the pleomorphic adenoma, which were more frequent than malignancies. Most of the patients were treated by partial or total parotidectomy. Adjuvant therapy, mainly radiotherapy, was used in selected malignant cases.Os tumores de glândula salivar são raros e acometem principalmente a parótida, sendo a maioria de natureza benigna. OBJETIVOS: Avaliar todos os casos de tumor de parótida atendidos na nossa instituição, durante o período de 1953 a 2003. Estudo Retrospectivo. CASUÍSTICA E MÉTODOS: Todos os pacientes com tumores primários de parótida foram selecionados e os dados clínicos e histopatológicos foram analisados e descritos. RESULTADOS: Foram selecionados 600 casos, sendo 369 benignos e 231 malignos. Dentre os tumores benignos, o adenoma pleomorfo foi o mais comum, e dentre os malignos, o carcinoma mucoepidermoide. A principal modalidade de tratamento foi a parotidectomia e em alguns casos malignos, terapias adjuvantes, principalmente a radioterapia, foram aplicadas. Os índices de recorrência local, regional e à distância dos tumores malignos foram de 10%, 8% e 9%, respectivamente. CONCLUSÕES: O perfil dos pacientes com tumor de parótida foi formado predominantemente por adultos e discreta predileção pelo gênero feminino. Os tumores benignos foram os mais frequentes. A maioria dos pacientes foram tratados por parotidectomia parcial ou total. O uso de terapias adjuvantes, principalmente a radioterapia, foi reservada para casos específicos de tumores malignos.

Salivary gland tumors are uncommon and most of them are of epithelial origin. Mesenchymal tumors affecting the parotid are extremely rare, and we present a series of 19 cases. All parotid tumors (600 cases) treated at the Department of Head and Neck Surgery from A.C. Camargo Hospital, Brazil from 1953 to 2003 were reviewed and 19 cases of nonlymphoid mesenchymal origin were selected. The histological characteristics were reviewed and clinical features were obtained from the medical charts. 15 out of 19 were benign tumors, including 5 lymphangiomas, 5 neurofibromas, and one case each of schwannoma, lipoma, solitary fibrous tumor, meningioma and giant cell tumor. Four malignant tumors were classified as rhabdomyosarcoma, fibrosarcoma, Langerhans cell histiocytosis and endodermal sinus tumor. From the malignant cases, only the patient with fibrosarcoma died due the tumor, the other three are alive with no signs of recurrence. In our series of 600 cases of parotid gland tumors, nonlymphoid mesenchymal tumors corresponded to 3.16% (19 cases; 15 benign and 4 malignant). All cases were treated by surgery with no recurrences, except one case of fibrosarcoma whose patient died of distant metastasis.

Osteosarcoma (OS) is a rare and aggressive malignant bone tumor, which occurs more frequently in long bones of young people. About 10% of the cases affect the head and neck region presenting peculiar features. The main sites of this tumor in head and neck are the mandible followed by the maxilla, and it seems to have a similar distribution between the genders. The most common clinical feature is the local swelling. Pain and paresthesia may be present in some cases. The early signs of this tumor in the jaw bones can be a dental mobility or widening of the periodontal ligament space. The diagnosis of OS is established with histological examination, which shows malignant mesenchymal cells producing osteoid or bone. The main modality treatment for head and neck OS is surgical resection with wide margins. The benefits of adjuvant therapies like chemotherapy and radiotherapy are still not clear. The major complication is local recurrence, with metastasis occurring as a solitary or a late stage event.

Made available in DSpace on 2018-12-11T16:41:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 The purpose of this study was to evaluate the expression of the enzymes involved in the biotransformation of tobacco and alcohol. A study group of 41 young patients (≤40 years old) with oral squamous cell carcinoma (OSCC) was compared to 59 control subjects (≥50 years old) with tumours of similar clinical stages and topographies. The immunohistochemical expression of CYP1A1, CYP1B1, ALDH1A1, and ALDH2 was evaluated using the tissue microarray technique. There was a predominance of males, smokers, and alcohol drinkers in both groups. Most tumours were located in the tongue (43.9% vs. 50.8%), were well-differentiated (63.4% vs. 56.6%), and were in clinical stages III or IV (80.5% vs. 78.0%). No difference was observed in the expression of CYP1A1, ALDH1A1, or ALDH2 between the two groups. CYP1A1 and ALDH2 protein expression had no influence on the prognosis. The immunoexpression of CYP1B1 was significantly higher in the control group than in the young group (P < 0.001). The 5-year relapse-free survival was better in patients with CYP1B1 overexpression vs. protein underexpression (64% vs. 25%; P < 0.05), regardless of age. ALDH1A1 expression improved relapse-free survival in young patients. These results suggest a lower risk of recurrence with increased metabolism of carcinogens by CYP1B1. Further studies involving other genes and proteins are necessary to complement the results of this research. Department of Bioscience and Oral Diagnosis Institute of Science and Technology Universidade Estadual Paulista Julio de Mesquita Filho - UNESP, Avenida Francisco José Engenheiro Longo 777 Biopathology Program Institute of Science and Technology Universidade Estadual Paulista Julio de Mesquita Filho - UNESP International Research Centre A.C. Camargo Cancer Centre Department of Pathology A.C. Camargo Cancer Centre Department of Specific Formation Universidade Federal Fluminense Department of Head and Neck Surgery and Otorhinolaryngology A.C. Camargo Cancer Centre Department of Bioscience and Oral Diagnosis Institute of Science and Technology Universidade Estadual Paulista Julio de Mesquita Filho - UNESP, Avenida Francisco José Engenheiro Longo 777 Biopathology Program Institute of Science and Technology Universidade Estadual Paulista Julio de Mesquita Filho - UNESP

Introduction The aim of this study was to evaluate the possible associations among the histopathological diagnosis, the inflammatory infiltrate profile, the presence of pain, and the immunoexpression of matrix metalloproteinases MMP-2 and MMP-9 in periapical lesions from primary endodontic infection. Methods Fifty-one primary periapical lesions obtained from extracted teeth were selected for this study. Patients were previously evaluated for the presence of pain and sinus tract related to the tooth to be extracted. Tissues were processed for microscopic examination and MMP-2 and MMP-9 immunoexpression. Microscopically, samples were classified as periapical granulomas or periapical cysts and the inflammatory infiltrate as chronic or mixed. The percentage of immunopositive cells for MMP-2 and MMP-9 of each case was performed based on 10 consecutive microscopic fields. The Student t or chi-square tests were used in the statistical analysis. Results Of the total, 28 cases were classified as periapical granulomas (54.90%) and 23 cases as periapical cysts (45.10%). Seventeen patients (33.33%) reported pain associated with the extracted tooth, with 12 cases of periapical granulomas (70.58%) and 5 cases of periapical cysts (29.42%). All cases showed immunopositivity for MMP-2 and MMP-9 in a high percentage of cells, mainly in the cytoplasm of the leukocytes. MMP-2 was expressed more in periapical granulomas than periapical cysts ( P P Conclusions According to the results, we may conclude that MMP-2 and MMP-9 are highly expressed in periapical lesions from a primary endodontic infection. Moreover, we may suggest MMP-2 is expressed more in periapical granuloma and in cases associated with pain.

Oral squamous cell carcinoma (SCC) is considered a primarily localized disease, and distant metastasis is not common. An increasing number of case reports involving unusual sites for distant metastasis from oral carcinoma have been reported in the literature. This is likely due to the improved control of cancer at the primary site, increasing the chance of developing a delayed metastasis. This article presents a case of a 58-year-old woman who refused surgical treatment for a very aggressive SCC on the mandibular alveolar ridge. The tumor did not respond to chemotherapy or radiotherapy, and the patient developed metastasis in the skull bone approximately 1 year after the initial diagnosis. The site of the primary tumor (next to the bone) as well as the patient's refusal of the proposed treatment, may have led to the hematological spread of the malignant cells, resulting in the distant metastasis.

Actinic cheilitis (AC) is considered a potentially malignant disorder that mainly affects the lower lip, and it is caused by prolonged sun exposure. Clinical diagnosis relies on visual inspection by a trained clinician, when suspected of dysplasia changes, a biopsy is required. The heteregenous characteristics of the AC, makes the choice of the biopsy site a difficult task. Fluorescence detection has been presented as a useful tool to to detect biochemical and morphological tissue features related to cancer diagnosis, but still its effectiveness to discriminate premalignant lesion is not completely defined. In this clinical study, 57 AC patients were investigated using widefield fluorescence imaging (WFI) to evaluate the efficacy of this technique as an auxiliary tool to biopsy site location. A handheld fluorescence system based on 400-450 nm LED illumination Distinct trained clinicians evaluate the patient either with the conventional examination or the WFI, and were blinded to the other evaluation. A biopsy site was chosen based on the clinical examination, and another site was chosen using the fluorescence visualization. A total of 114 punch biopsies were performed, and 93% of the tissue samples presented epithelial dysplasia. The majority of the sites that presented moderate or severe dysplasia were sites chosen by WFI, showing its efficiency to improve the diagnosis of AC.

Objetivo: relatar um caso clínico de tumor odontogênico adenomatoide (TOA) enfatizando suas características clínicas, radiográficas e histopatológicas, de forma a contribuir na definição dos seus diagnósticos diferenciais. Relato do caso: a lesão acometeu um paciente do sexo masculino, de 16 anos,como uma lesão radiolúcida, unilocular, associada ao dente 24 incluso. A partir das hipóteses diagnósticas de TOA, cisto dentígero, tumor odontogênico cístico calcificante e ameloblastoma unicístico, foi realizada a biópsia excisional. Na microscopia, observou-se a presença de cavidade cística revestida por epitélio escamoso estratificado não-queratinizado, estruturas tubulares, áreas semelhantes a roseta, áreas cribriformes e de calcificação, permitindo o estabelecimento do diagnóstico de TOA. Conclusão: radiograficamente o TOA pode ser confundido com outras lesões intraósseas, como o cisto dentígero e o ameloblastoma unicístico,que também acometem pacientes jovens e podem envolver dentes inclusos em maxila anterior, além disso, histopatologicamente, apesar de possuir um padrão característico, áreas de outros cistos ou tumores odontogênicos podem estar presentes. Sendo assim, o reconhecimento das características tanto clínicas, radiográficas e histopatológicas do TOA são muito importantes, especialmente no que diz respeito ao tratamento adequado do paciente.

Actinic cheilitis (AC) is a disease caused by prolonged and cumulative sun exposure that mostly affects the lower lip, which can progress to a lip squamous cell carcinoma. Routine diagnosis relies on clinician experience and training. We investigated the diagnostic efficacy of wide-field fluorescence imaging coupled to an automated algorithm for AC recognition. Fluorescence images were acquired from 57 patients with confirmed AC and 46 normal volunteers. Three different algorithms were employed: two based on the emission characteristics of local heterogeneity, entropy and intensity range, and one based on the number of objects after K-mean clustering. A classification model was obtained using a fivefold cross correlation algorithm. Sensitivity and specificity rates were 86% and 89.1%, respectively.

Traumatic neuromas are characterized by the presence of pain, burning, or paresthesia, associated with a history of trauma, normally surgery, in the same site. In the oral cavity, the most commonly affected sites are the lip, tongue, and mental nerve area. Pressure on the suspected area usually provokes pain. They microscopically consist of a proliferation of nerve fascicles embedded in a background of collagen. We present a case of a 42-year-old Latin American female patient complaining of a painful solitary nodule erupting on the lingual surface of the mandibular body. Histopathological analysis showed a traumatic neuroma associated with mature ganglion cells, which is an extremely unusual finding. After complete removal of the lesion the symptoms disappeared. To the best of our knowledge, this is the first case of a unique lesion with unusual clinical and histopathological features reported in the English language literature.