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Xeroderma pigmentosum (XP) is a rare autosomal disorder characterized by extreme sensitivity to ultraviolet radiation. DNA repair mechanisms are impaired, and minimal sun exposure can lead to the development of cutaneous neoplasms in very young patients. Intraoral carcinomas are uncommon and, when present, are located mainly at the tongue tip. We report an unprecedented case of squamous cell carcinoma (SCC) in the floor of mouth of a 23-year-old woman with XP. The patient was referred to the oncologist, and 2 months after surgical resection, she underwent a single session of chemotherapy plus radiotherapy. However, she died 73 hours after undergoing her first chemotherapy session. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments (especially cisplatin-based chemotherapy) in patients with XP and reviewed the main characteristics of the disease, especially cases with oral manifestations reported in the literature.

Aim: To evaluate the efficacy of photodynamic inactivation (PDI) mediated by hypericin encapsulated in P-123 copolymeric micelles (P123-Hyp) alone and in combination with fluconazole (FLU) against planktonic cells and biofilm formation of Candida species Materials & methods: PDI was performed using P123-Hyp and an LED device with irradiance of 3.0 mW/cm2 . Results: Most of isolates (70%) were completely inhibited with concentrations up to 2.0 μmol/l of HYP and light fluence of 16.2 J/cm2. FLU-resistant strains had synergic effect with P123-HYP-PDI and FLU. The biofilm formation was inhibited in all species, in additional the changes in Candida morphology observed by scanning electron microscopy. Conclusion: P123-Hyp-PDI is a promising option to treat fungal infections and medical devices to prevent biofilm formation and fungal spread.

The aim of this study is to report the results obtained with a protocol of topical application of capsaicin gel 0.025 % in the management of burning mouth syndrome (BMS) to evaluate the influence of the disease and treatment on their quality of life (QOL) using the OHIP-14 questionnaire (Oral Health Impact Profile). After clinical examination and diagnosis of BMS, 10 patients reported the intensity of the burning by means of a subjective score ranging from 0 to 10 and also answered the OHIP-14. Then, a topical application protocol of capsaicin gel 0.025 % was initiated, with weaning from medication and complete withdrawal within 180 days. At each reassessment consultation (30, 60, 90 and 180 days), the patients answered the OHIP-14 and subjective burning scores were collected again. Overall, the capsaicin gel showed gradual reduction or elimination of symptoms of BMS, as well as an improvement in the QOL of patients throughout treatment. At 180 days, after medication withdrawal, 6 patients (60 %) reported total absence of burning and in four patients (40 %) the score remained or decreased. In one patient (10 %) the score increased, although it remained below the initial score. The results showed an improvement in the QOL of all patients who completed the protocol and the impact of BMS on the QOL decreased in relation to the initial score in all patients. The topical use of 0.025 % capsaicin gel was effective in reducing or remitting symptoms of BMS. The OHIP-14 questionnaire showed the negative impact of BMS on patients' QOL and the role of treatment in its improvement.

The aim of this work was to report biosecurity measures in the Oral and Maxillofacial Radiology (OMR) clinic in the current context of COVID-19, based on a literature review. An electronic search for scientific papers was perform ed using PubMed, Embase, Web of Science, and Scopus database. Although the literature related to care in the OMR clinic regarding COVID-19 is still scarce, this unprecedented scenario created by the pandemic generated an urgent need for measures to prevent the transmission of the virus. Dentists are at maximum risk of contagion and, although the practice of OMR generally does not produce aerosols, radiologists and technicians are continually in contact with body fluids, such as saliva. In additio n, imaging exams are often indispensable for emergency or elective dental diagnosis and treatment. Training in infection control practices during major outbreaks of infectious diseases should be quickly reinforced and dental settings have unique characteristics that warrant specific infection control considerations. Some recommendations have been proposed and were discussed, which cover patient flow, equipment handling and environment, radiographic technique and processing, personal protective equipment and preparation and issuance of radiological reports and access to exam results. Due to the COVID-19 pandemic, biosecurity measures in the routine of the OMR clinic are indispensable to enable emergency dental care and the perspectives of returning to elective treatment. Biosecurity measures and staff training at the OMR clinic should be instituted immediately, since imaging exams are an important and often indispensable part of dental diagnosis and treatment.

Leukoedema is a change that affects the jugal mucosa bilaterally, presenting as a whitish or grayish-white plaque. It has uncertain etiology, but is believed to be derived from a developmental change, while leukoplakia is a clinical term for the definition of a non-shaved white plaque that can affect the jugal mucosa and other oral sites. Its etiology may be linked to the use of tobacco, alcohol and ultraviolet radiation, being considered a potentially malignant lesion and treatment will depend on the degree of cellular dysplasia and extent of the lesion. The aim of this article is to present a clinical case of a patient diagnosed with two white lesions in the jugal mucosa. A 57-year-old female brown patient sought dental care complaining of white spots on her cheeks. She reported being a smoker for 35 years, having the habit of consuming a pack and a half a day. After clinical examination, the diagnostic hypotheses of leukoedema and leukoplakia were raised. Incisional biopsy, followed by histopathological analysis, confirmed the diagnosis of leukoedema with overlapping leukoplakia. Leukoedema does not require treatment as it is a variation of normality. However, it may be clinically associated with disorders that require intervention, as in the case presented, generating masking of characteristics and, consequently, diagnostic confusion.

Osteoradionecrosis (ORN) is one of the most severe oral complications after the head and neck cancer treatment. Tooth extraction, through its traumatic stimulation, is identified as an important predisposing factor. Indications and preventive methods for carrying out these procedures in irradiated patients are questioned, thus, establishing appropriate protocols is essential. This article reports a case of multiple tooth extractions in a cancer patient whose preventive measures were taken without the occurrence of complications. Based on a literature review, this paper accounts the appropriate indications of this procedure, the risk of developing osteoradionecrosis, and the prevention possibilities for this sequela. In addition, this report addresses a viable oral rehabilitation alternative after this kind of surgery by using overdenture on the lower jaw teeth.

BackgroundTraditionally known as a common contaminant, Rhodotorula mucilaginosa is among the leading causes of invasive fungal infections by non-candida yeasts. They affect mainly immunocompromised individuals, often mimicking the cryptococcosis infection, despite invasive infections by Rhodotorula are still not well explained. Thus, here we aimed to characterize microbiologically clinical isolates of R. mucilaginosa isolated from colonization of a patient with chronic renal disease (CKD), as well as to evaluate their phylogeny, antifungal susceptibility, virulence, and pathogenicity in order to infer the potential to become a possible infection.Methodology/Principal FindingsFor this study, two isolates of R. mucilaginosa from oral colonization of a CKD patient were isolated, identified and characterized by classical (genotypic and phenotypic) methods. Susceptibility to conventional antifungals was evaluated, followed by biofilm production, measured by different techniques (total biomass, metabolic activity, colony forming units and extracellular matrix quantification). Finally, the pathogenicity of yeast was evaluated by infection of Tenebrio molitor larvae.All isolates were resistant to azole and sensitive to polyenes and they were able to adhere and form biofilm on the abiotic surface of polystyrene. In general, similar profiles among isolates were observed over the observed periods (2, 24, 48 and 72 hours). Regarding extracellular matrix components of biofilms at different maturation ages, R. mucilaginosa was able to produce eDNA, eRNA, proteins, and polysaccharides that varied according to time and the strain. The death curve in vivo model showed a large reduction in the survival percentage of the larvae was observed in the first 24 hours, with only 40% survival at the end of the evaluation.Conclusions/SignificanceWe infer that colonization of chronic renal patients by R. mucilaginosa offers a high risk of serious infection. And also emphasize that the correct identification of yeast is the main means for an efficient treatment.Author SummaryThe genus Rhodotorula is known to be a common contaminant, however, it has been increasing in the last years, reports of different forms infections by this yeast, reaching mainly individuals with secondary diseases or with low immunity. However, very little is known about the mechanism that triggers the disease. Thus, this study aims to characterize microbiologically clinical isolates of R. mucilaginosa isolated from a patient with chronic renal disease, as well as to evaluate their phylogeny, antifungal susceptibility, virulence, and pathogenicity in order to infer the potential to become a possible infection. It was possible to characterize in general the clinical isolates, to determine that they are resistant to an important class of the antifungal agents which are the azoles. In addition, they are able to adhere and to form biofilm on abiotic surfaces, this skill represents an important factor of virulence, which would guarantee their presence in medical devices, such as catheters, surfaces. These biofilm works as true reservoirs of these fungi disseminate and cause serious infections. This pathogenic potential was reinforced by a great reduction of survival in the larvae infected with this yeast. Therefore our results infer a high risk of infection to patients who are colonized by R. mucilaginosa.

The objective of this study was to investigate tongue coating (TC) frequency and its colonization by yeasts in a group of chronic kidney disease (CKD) patients. Clinical examination of the oral mucosa of 33 CKD patients was performed to investigate oral and tongue lesions. TC was diagnosed according to its clinical characteristics. Stimulated saliva and TC samples were collected to verify the salivary flow, and determine yeast frequency, species and counts. TC was found in 18/33 of the patients (54.55 %) and was the most frequent oral lesion found. Of 18 patients with TC, 13 (72.22 %) presented positive cultures for yeasts on the tongue dorsum, and one (5.55 %) in the saliva only. Yeasts were significantly more frequent in the tongue dorsum when compared to the saliva (p = 0.0106). The most frequent yeast species found was C. albicans (55.55 %), while C. parapsilosis comprised 50 % of non-albicans Candida species. This study demonstrated high amounts of yeasts on the cultures from TC samples of CKD patients, strongly suggesting that TC is a clinical representation of a polymicrobial biofilm, which could serve as a gateway for disseminated infection in immunosuppressed patients undergoing frequent hospitalization.

Malignant oral neoplasms have great relevance because they represent one of the main causes of death in the world. Squamous cell carcinoma is its most frequent form, but reports in the retromolar region are rare when compared to other oral sites. The objective of this work is to demonstrate the diagnosis and conduct in the case of a patient participating in the Oral Injury extension project (LeBu) at the State University of Maringá - PR/BR. Male patient, 67 years old, a heavy smoker for about 50 years, alcoholic, attended the university with an ulcer in the right lower retromolar region of brownish-white color, with approximately 3 to 4 mm, irregular shape, and rough surface. A biopsy was performed in the lesion region, collecting a fragment of approximately 2 mm, which was referred for histopathological examination, resulting in a diagnosis of moderately differentiated, invasive squamous cell carcinoma. The patient was referred for medical oncological, surgical, and chemotherapy treatment, remaining under dental monitoring throughout the treatment and later with scheduled returns. After 4 years of follow-up, the patient is in good general physical condition, with no signs of recurrence, orally rehabilitated, even quitting the smoking habit. Thus, it is concluded that the diagnosis and treatment of head and neck neoplasms lacks a multidisciplinary view, being the dental surgeon of great importance both for the diagnosis of these injuries, as well as in the prevention and treatment of injuries that may arise from or after the treatment. Las neoplasias bucales malignas tienen una gran relevancia porque representan una de las principales causas de muerte en el mundo. El carcinoma de células escamosas es su forma más frecuente, pero los informes en la región retromolar son raros en comparación con otros sitios orales. El objetivo de este trabajo es demostrar el diagnóstico y conducta en el caso de un paciente que participa en el proyecto de extensión de Lesión Oral (LeBu) de la Universidad Estatal de Maringá - PR/BR. Paciente de sexo masculino, 67 años, fumador empedernido hace 50 años, alcohólico, que acudió a la universidad por presentar una úlcera en región retromolar inferior derecha de color blanco pardusco, de aproximadamente 3 a 4 mm, de forma irregular y superficie rugosa. Se realizó biopsia en la región de la lesión, recogiéndose un fragmento de aproximadamente 2 mm, que se derivó para examen histopatológico, resultando en diagnóstico de carcinoma escamoso invasivo moderadamente diferenciado. El paciente fue derivado para tratamiento médico oncológico, quirúrgico y quimioterápico, permaneciendo bajo seguimiento odontológico durante todo el tratamiento y posteriormente con retornos programados. Tras 4 años de seguimiento, el paciente se encuentra en buen estado físico general, sin signos de recidiva, rehabilitado oralmente, incluso abandonando el hábito tabáquico. Así, se concluye que el diagnóstico y tratamiento de las neoplasias bucales carecen de una visión multidisciplinar, siendo el cirujano dentista de gran importancia tanto para el diagnóstico de estas lesiones, como en la prevención y tratamiento de las lesiones que puedan derivarse de o el tratamento. As neoplasias bucais malignas possuem grande relevância por representarem uma das principais causas de morte no mundo. O carcinoma espinocelular é sua forma mais frequente, porém raros são os relatos em região retromolar, quando comparado a outros sítios bucais. O objetivo deste trabalho é demonstrar o diagnóstico e conduta no caso de um paciente participante do projeto de extensão de Lesões Bucais (LeBu) da Universidade Estadual de Maringá - PR/BR. Paciente do sexo masculino, 67 anos de idade, fumante assíduo há cerca de 50 anos, etilista, compareceu à universidade apresentando uma úlcera em região retromolar inferior direita de coloração branca acastanhada, com aproximadamente 3 a 4mm, forma irregular e superfície rugosa. Realizou-se a biópsia na região da lesão, coletando um fragmento de aproximadamente 2 mm, o qual foi encaminhado para o exame histopatológico, resultando em diagnóstico de carcinoma espinocelular, moderadamente diferenciado, invasivo. O paciente foi encaminhado para tratamento médico oncológico, cirúrgico e quimioterápico, permanecendo sob acompanhamento odontológico durante todo o tratamento e posteriormente com retornos programados. Após 4 anos de acompanhamento, o paciente se encontra em bom estado físico geral, sem sinais de recidiva, reabilitado oralmente, cessando inclusive o hábito tabagista. Desta forma, conclui-se que o diagnóstico e tratamento de neoplasias de cabeça e pescoço carece de uma visão multidisciplinar, sendo o cirurgião dentista de grande importância tanto para o diagnóstico destas lesões, como na prevenção e tratamento de lesões que possam surgir decorrentes ou após o tratamento.

We report a case of a 23-year-old woman with xeroderma pigmentosum (XP) and a painless endophytic ulcer on the mouth floor, measuring approximately 2 cm, with 8 months of evolution. She had a family history of a brother with XP who underwent lower lip resection and denied neurologic disturbances or prior surgical procedures. Weak photophobia and numerous hyperpigmented ephelides throughout the body were observed. Histopathologic examination of the incisional biopsy confirmed the diagnosis of squamous cell carcinoma. It is known that intra-oral carcinomas are uncommon in XP individuals and, when present, are located mainly at the tongue tip. The patient was referred to the oncologist and 2 months after surgical resection underwent a single chemotherapy and radiotherapy session. However, she died in less than 72 hours after this procedure. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments in XP patients.

A displasia cemento-óssea florida (DCOF) consiste em uma lesão fibro-óssea benigna dos maxilares, onde o osso é substituído por um tecido fibroso semelhante ao cemento. A etiologia desta desordem é desconhecida e apresenta-se totalmente assintomática e, em muitos casos, as lesões são detectadas em uma radiografia tomada para outros fins. Possui maior expressão no gênero feminino, em pacientes melanodermas e de meia idade. Nos exames de imagem, possuem um amplo espectro de apresentações, onde as lesões variam de totalmente radiolúcidas (fase osteolítica), mistas a radiopacas (fase de mineralização). A DCOF pode se assemelhar a lesões como a displasia periapical, cementoma gigantiforme, osteomielite crônica esclerosante difusa e a doença óssea de Paget. O diagnóstico da DCOF é baseado principalmente nos achados clínicos associados aos exames imaginológicos, não havendo a necessidade, na maioria dos casos, de biópsia para o diagnóstico dessa entidade. Na medida do possível procedimentos cirúrgicos devem ser evitados, devido a susceptibilidade do osso a infecções. O objetivo do presente trabalho é relatar dois casos clínicos de pacientes com displasia cemento-óssea florida em diferentes fases, com características distintas no exame de tomografia computadorizada de feixe cônico.

Objectives To determine the frequency of yeast in the oral cavity of patients with chronic renal failure, undergoing hemodialysis (PCRFH); identification and antifungal susceptibility profile of yeast and demographic profile of patients. Methods We performed mouthwash in 146 PCRFH; the rinse fluid was collected and cultured, yeasts grown were identified by phenotypic and molecular methods. The antifungal susceptibility profile was determined against nystatin, amphotericin B, fluconazole, voriconazole, and caspofungin based in Clinical and Laboratory Standards Institute (document M27-A3). Results Positive culture was observed in 39% of patients, of whom 53% were women; the median of dialysis time was 2.9 years. The age of the colonized patients varied between 26 and 84 years, with a median of 52.5 years. PCRFH over 45 years were significantly more colonized (P = 0.0108) as well as denture wearers (84.0%). We isolated 81 yeasts, predominantly Candida albicans (63%) followed by Candida glabrata. In general, yeasts were sensitive to the evaluated antifungal agents, but there was significant variation in the minimum inhibitory concentration, especially among non-C. albicans Candida (NCAC) compared to fluconazole, caspofungin, and amphotericin B. NCAC required significantly higher concentrations of fluconazole (P

Background Patients with chronic kidney disease, stage 5, undergoing hemodialysis treatment are frequently colonized by yeasts, with high chance of developing fungal infections. The objective of this study was to assess the presence of yeasts in the oral cavity of these individuals, associating findings with the presence of oral lesions and the use of dental prostheses. Methods Clinical examinations of the oral mucosa were performed in 52 patients, when the use of removable dental prostheses and the presence of oral lesions were observed and recorded. Saliva samples were collected to identify yeast specimens and colony-forming units. Results Colonization by yeasts was found in 42.31% of the patients, 100% of which belonging to the genus Candida, with the predominance of C. albicans (69.23%). Half of the patients (26) presented some type of oral lesion, the majority (63.33%) suggestive of candidiasis, which was confirmed in 57.89% of cases. The chance that these patients carried yeast colonies in the presence of dental prostheses and oral lesions was 6.33 and 2.62 times higher, respectively. Conclusions Patients investigated in this study presented a high incidence of yeasts in the oral cavity, with those with oral lesions and dental prostheses being more likely to carry yeasts. When oral lesions are detected in patients undergoing hemodialysis treatment, particularly in those who are prosthesis users, early diagnosis and treatment of this type of lesion, in association with systemic investigations, should be performed to mitigate possible unfavorable prognoses.

Objetivo: divulgar o Projeto e seus serviços aos municípiosda 15ª Regional de Saúde, alertar o telespectador a respeito do auto-exame, mostrar ao profissional da Odontologia a importância da iniciativa em se realizar biópsias e exames histopatológicos quando necessário (diante de determinados diagnósticos presuntivos), salientar o valor da interdisciplinaridade na Odontologia, reiterar a importância e grandiosidade dos resultados obtidos quando diferentes esferas (Universidade e Regional de Saúde) trabalhamem busca de um bem comum: a qualidade de vida do paciente. Metodologia: para a confecção do vídeo, foram gravadas imagens de palestras, do acolhimento dos pacientes na clínica odontológica, das consultas, dos exames pré-operatórios e dos procedimentos cirúrgicos, bem como dos trabalhos realizados pelos profissionais da assistência social, psicologia, fonoaudiologia, pedagogia e nutrição. Imagens com o trabalho junto à comunidade externa e com a explicação audiovisual do auto-exame foram editadas. Resultados: o trabalho resultou em um vídeo que explorou de forma educativa e dinâmica um trabalho que vem sendo realizado há 15 anos pelo Projeto LEBU, em parceria com a 15ª Regional de Saúde. Didaticamente conseguiu explicar a importância em se fazer o auto-exame bucal em busca de estruturas que não estejam em seu padrão normal. Conclusão: colaborou fortemente para a contemplação de um dos compromissos do LEBU, que é entrelaçar de forma prática e real a Universidade (Departamento de Odontologia) com as necessidades da sociedade (15ª Regional de Saúde do Paraná) de forma sensível a seus problemas, colaborando na reflexão, construção e difusão dos valores da cidadania.

A leishmaniose e provocada por parasitas do genereo Leishmania. e os sintomas mais comuns sao lesoes cutâneas, febre e mal-estar. O diagnostico e feito pela observacao laboratorial dos parasitas presentes nas lesoes, ou atraves de testes como a dermorreacao de Montenegro, ELISA e imunofluorescencia indireta. Este trabalho relata o caso de uma paciente, leucoderma, 15 anos, que queixava-se de uma lesao na gengiva, com dor e sangramento.No exame clinico, observou-se uma lesao ulcerativa, na regiao de incisivos centrais superiores, de 1,5cm. Na anamnese relatou que teve leishmaniose ha cinco anos, mas fora tratada. Foi realizada biopsia no local da lesao. Os exames radiograficos panorâmico e periapical, nao apresentaram alteracoes. Foram solicitados exames laboratoriais, dermorreacao de Montenegro e imunofluorescencia indireta. Na Reacao de Montenegro o resultado foi positivo, assim como a imunofluorescencia indireta e a biopsia. O teste micologico direto e cultura para fungos foram negativos. Comprovou-se que a lesao era resultado de recidiva de leishmaniose e a paciente foi encaminhada para um medico. Concluimos que, em casos de ulceras bucais em pacientes com historia previa de leishmaniose, deve ser considerada sua recidiva. Exames laboratoriais devem ser realizados com complemento do exame clinico e radiografico. Palavras-chave: Leishmaniose; Biopsia; Leishmaniose Mucocutânea.