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A 17-year-old male sought countryside hospital with throat pain and afebrile for 8 days, being prescribed cephalexin. Due to worsening of clinical condition with lingual protrusion and progressive loss of voice, he returned other times to the service, when he was referred for health center. He was transferred to emergency care unit and conducted to capital hospital for drainage of retropharyngeal abscess. Patient presented dyspnea, initiating treatment with dexamethasone, with clinical improvement of the tumor, but when suspended, the tumor grew up. He was transferred to intensive care unit and submitted to a computed tomography of skull, tracheostomy, gastrostomy, and excisional biopsy of the lesion that occupied all the oropharynx. He presented cardiorespiratory arrest, seizures, and respiratory infection. Results of biopsy and immunohistochemistry diagnosed Burkitt’s lymphoma. Patient was submitted to chemotherapy with regression of the lesion and return the tongue to the normal conditions.

Objective: To analyze the determinant clinical and histologic aspects in the establishment of the diagnosis of the glandular odontogenic cyst (GOC).Study Design: A cross-sectional study was performed in 2 oral pathology services. All slides of GOCs were reviewed and clinical data were obtained from the patient records. The determination of the diagnosis followed predetermined microscopic parameters according to the World Health Organization. Statistical analysis was performed in order to identify the predictive parameters for the diagnosis of GOC. Results: From the 9 patient cases of GOCs, 55.5% were male, with a mean age of 50.6 years, and 66.6% were located in the mandible. All cases presented with intraepithelial microcysts or duct-like spaces, clear or vacuolated cells, variable thickness of the cyst lining, and papillary projections into the lumen. Multiple compartments, surface eosinophilic cuboidal cells, and epithelial spheres or plaque-like thickenings were observed in 8 (88%) cases. Apocrine snouting of hobnail cells were present in 6 (66%), mucous goblet cells in 3 (33.3%), and cilia in only 1 (11%). Conclusion: The association between the predictive clinical and histopathological aspects for the diagnosis of this rare lesion is fundamental, since GOC has the potential to mimic other potentially more aggressive lesions.

Objective: To evaluate and compare the efficacy of photodynamic therapy and photobiomodulation in the control of chemotherapy-induced oral mucositis in pediatric patients. Study Design: A superiority, randomized, open, controlled, and triple-blind clinical trial consisting of 54 patients aged 10 months to 18 years and totaling 91 cases of oral mucositis were drawn for allocation into 2 groups. Group A (experimental) was subjected to photodynamic therapy (0.01% methylene blue, laser of 660 nm, 100 mW, 0.028 cm2, 3 J) and group B (control) to photobiomodulation (660 nm, 100 mW, 0.028 cm2, 1 J). For evaluating oral mucositis, the World Health Organization and Children's International Mucositis Evaluation Scale (ChIMES) scales were used, and the patients were followed up daily until clinical cure of the lesions. The χ2test, Fisher exact test, Student t test and Mann-Whitney U test, in addition to the mixed linear regression and Poisson models, were used for comparison, with the maximum error admitted of 5%. Results: There was no difference between the groups in regard to the number of sessions necessary for clinical cure of the oral lesions (P = .058), reduction in pain, and difficulty with swallowing or chewing (P> .05). Within each group, however, the reductions were significant (P

Objective: To determine the demographic profile of all histologically diagnosed odontogenic cysts (OC) and nonodontogenic cysts (nOC) over a 30-year period in a Brazilian population. Study Design: A descriptive cross-sectional study was performed with OC and nOC to obtain information about epidemiologic data. The diagnosis followed the World Health Organization (2017) parameters of a descriptive statistical analysis. Results: A total of 6235 lesions were diagnosed. Of these, 544 (8.72%) corresponded to OCs and nOCs. Radicular cyst was the most frequently inflammatory OC (81.76%). Among the development of OCs and nOCs, the dentigerous cyst was the most frequent (56.78%), followed by odontogenic keratocyst (34.67%) and glandular odontogenic cyst (3.01%). The inflammatory OCs were most common in female (53.4%) patients, with a mean age of 34.4 years, and the maxilla (56.6%) was the most affected anatomic site. In addition, the OCs and nOCs were more frequent in female (62.8%) patients, with a mean age of 29.2 years, located in the mandible (66.8%). Conclusion: Knowledge of the epidemiologic profile, clinical aspects, and pathologic aspects of OC and nOC provides more accurate data about diagnosis and appropriate treatment.

Patient N.J.E., a 69-year-old black male liver recipient, complained of pain in the oral cavity. Clinical examination revealed ulcerated lesions on the dorsal surface of the tongue, right buccal mucosa, and lower right vestibule. In view of clinical findings and medical history, the diagnostic hypothesis suggested an oral infection. The culture was carried out with the purpose of microbiologic analysis (swab) along with incisional biopsy of tongue lesion, leading to a diagnosis of Actinomyces infection. The patient was treated with specific antimicrobials, oral topical solutions, and, as an adjuvant, antimicrobial photodynamic therapy (aPDT). aPDT consisted of daily application of the photosensitizer on the lesions, and after 5 minutes, the low-level light laser was applied in the visible red spectrum (660 nm) with fixed power of 100 mW and energy density of 6 J/cm². After 15 days, good clinical tissue recovery was observed; however, because of other systemic complications, the patient died.

Patient J.C., 37 years old and male, was diagnosed as having a poorly differentiated metastatic squamous cell carcinoma of the rhinopharynx treated with radiotherapy and chemotherapy in 2008 with complete remission and has been in medical follow-up since then. In 2017, he attended a dentistry service, reporting the need of dental extraction. The clinical examination revealed remaining teeth in a poor state of preservation and also showed a bone exposure area, corresponding to the edentulous region of the right lower third molar, of elliptical shape and approximately 2 cm. Panoramic radiograph showed bone rarefaction in the reported region. J.C. stated that a dental surgical procedure had been performed on this area 1 month earlier. The diagnostic hypothesis was suggestive of osteoradionecrosis. Oral care protocol was prescribed, using mouthwashes with sodium bicarbonate, 0.12% chlorhexidine digluconate, and 10-volume hydrogen peroxide. The patient was followed up biweekly, and after 4 months, the complete clinical repair was observed without painful symptomatology.

A 41-year-old male patient, a white farmer, was referred to the stomatology clinic diagnosed as having actinic cheilitis. Clinically, atrophic and leukoplastic areas were observed throughout the lower lip, and loss of the border between the red lip skin and the cutaneous portion. An incisional biopsy was performed in the leukoplastic area, and histopathologic examination showed atrophic and atypical stratified orthokeratinized pavement epithelium with severe oral epithelial dysplasia. The therapeutic approach was the removal of all leukoplastic areas using the high-intensity diode laser for re-epithelialization of the affected mucosa. Proper follow-up is being performed every 3 months, and after 9 months, no signs of relapse were observed. Because of the potential for malignancy of actinic cheilitis and the presence of dysplastic epithelial alterations, an early approach is justified. The vaporization of the labial tissues with high-intensity diode laser was effective in superficial removal of affected tissues.

Objective To evaluate the effect of antimicrobial photodynamic therapy (PDTa) on the treatment of chemotherapy-induced mucositis in pediatric patients. Study Design It was a pilot study of an open, controlled, and blind randomized clinical trial conducted with 29 patients, with ages ranging from 10 months to 18 years, who were divided into 2 groups. Group A was submitted to PDTa with 0.01% methylene blue and red laser with 3 J energy per point; group B was submitted to photobiomodulation with wavelength of 660 nm and 1 J energy per point. The chi-square, Fisher exact, Student's t, and Mann-Whitney tests and the mixed linear regression model were used for comparison between the groups, with the maximum error admitted of 5%. Results There was no difference between the groups regarding the number of sessions necessary for clinical cure of the oral lesions (P = .95) or reduction in pain (P = .26; P = .49). Within each group, however, there was significant reduction in pain (P = .03; P = .003). Conclusion PDTa could be used for control of oral mucositis in children/young patients. It was well tolerated and presented satisfactory results, the same as photobiomodulation in reducing pain associated with the mucositis.

The aim of this article is to report the case of a 23-year-old female patient that sought dental service for examination of an asymptomatic slow-growing large lump in the mandibular gingiva causing displacement of the right first molar. Excisional biopsy, histopathological analysis, Alcian blue/periodic acid-Schiff (PAS) staining and immunohistochemistry analysis for S-100 were performed. The diagnosis established was oral focal mucinosis. After three years, the patient is still under follow-up, without any recurrences. Although cases of oral focal mucinosis of this particular size are rare, this entity should be considered in the differential diagnosis of oral lesions located in the gingiva.

The aim of the present study was to clinically, morphologically, and immunohistochemically correlate the expression of cytokeratins (CKs) 7, 10, 13, 14, 16, and 19 in 30 cases of tongue squamous cell carcinoma (SCC) with disease outcome, metastases, clinical stage (tumor, node, metastasis [TNM]), and histological grade of malignancy proposed by Bryne. Statistical analysis (χ2 test) showed that only histological grading was not significantly correlated with the clinical variables. CK expression varied in the samples analyzed. CK 10 expression was significantly correlated with the presence of metastases, and the expression of CK 16 was related to disease outcome and also to TNM stages III and IV. These results indicate that metastases and TNM are effective prognostic indicators. The histological grading proposed by Bryne did not reflect the biological behavior of the tongue SCC cases studied. Analysis of some intermediate CK filaments can reflect the biological behavior and aggressiveness of some tongue SCCs.

Resumen Antecedentes y metodos El papel de la respuesta inmune en la citopatogenia de la enfermedad periodontal constituye tema de estudio de diversos investigadores. El objetivo de este trabajo fue investigar a traves de inmunohistoquimica la densidad y el patron de distribucion de la celulas inflamatorias mononucleadas (linfocitos T helper e linfocitos B), utilizando los anticuerpos anti CD4 y anti CD20 en 17 casos de gingivitis cronica y 25 casos de periodontitis cronica. Resultados Fue observada inmunopositividad para las celulas CD4 en un patron difuso por todo tejido conectivo de todos los casos de gingivitis cronica. De los 25 casos de periodontitis cronica, 22 (88%) presentaron un patron de distribucion en pequenos focos aislados. Con relacion a las celulas CD20, 16 casos de gingivitis cronica exhibieron positividad en un patron focal de distribucion tanto en posicion yuxtaepitelial como en areas distantes del epitelio (10 casos, 62,5%). En los casos de periodontitis cronica fue observada marcacion positiva para el anticuerpo anti CD20 en 22 casos (88%), predominando el patron focal en posicion yuxtaepitelial y distante del epitelio (17 casos, 77,3%). El analisis estadistico no mostro diferencia significativa en la densidad de celulas CD4 y CD20 positivas entre los casos de gingivitis y periodontitis cronica. Conclusion Fue concluido que a pesar de no ser constatada tal diferencia estadistica, hubo una mayor densidad de linfocitos B en ambos grupos, sugiriendo una mayor participacion de la respuesta inmune humoral el los diferentes estadios de la enfermedad periodontal.

The oral squamous cell carcinoma (OSCC) very often affects subjects above the sixth decade of life. However an increasing incidence has been observed in younger individuals, below 40 years. We conducted a systematized review of the current clinical, histopathological and therapeutic aspects of OSCC in young patients. Our work included studies that addressed OSCC involving young patients in the period 2007 2012, and which were indexed in PubMed. Initially, 499 articles were obtained; after refinement, 340 articles had their titles and abstracts evaluated, with 17 included in the sample. The majority of studies reported male predominance (87.5%), association with tobacco and/ or alcohol use (66.6%), advanced clinical stages at diagnosis (77.7%) and, at histopathology, moderately differentiated tumors (72.7%). Based on the results, we believe there are differences in the factors associated with pathogenesis, biological behavior and prognosis in young patients, since most studies show more rapid and aggressive tumor progression in this age group. We suggest the conduction of research focusing on the pathogenesis and carcinogenesis of OSCC in young patients, thereby searching for better scientific evidence. O carcinoma de células escamosas oral (CCEO) acomete mais frequentemente indivíduos em uma faixa etária acima da sexta década de vida. No entanto, tem-se observado uma crescente incidência em indivíduos mais jovens, abaixo dos 40 anos de idade. Realizou-se uma revisão sistematizada dos aspectos clínicos, histopatológicos e terapêuticos atuais do CCEO em pacientes jovens. Foram incluídos os estudos que abordavam o CCEO envolvendo indivíduos jovens no período de 2007-2012 e indexados na base de dados PubMed. Dos 499 artigos obtidos inicialmente, 340 tiveram os títulos e resumos avaliados, com 17 sendo incluídos na amostra. A maioria dos estudos relatou predominância do sexo masculino (87,5%), associação com uso de tabaco e/ou álcool (66,6%), estágios clínicos mais avançados da doença (III e IV) ao diagnóstico (77,7%) e, histopatologicamente, tumores moderadamente diferenciados (72,7%). Com base nos resultados encontrados, acredita-se que possa haver diferenças quanto aos fatores associados à etiopatogenia, ao comportamento biológico e ao prognóstico em pacientes jovens, uma vez que grande parte dos estudos mostra uma progressão tumoral mais rápida e agressiva nessa faixa etária. Sugere-se o desenvolvimento de pesquisas com foco na etiopatogenia e na carcinogênese do CCEO em pacientes jovens, buscando, assim, melhores evidências científicas.