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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.

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.

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.