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Background The authors undertook a prospective study to determine whether kidney transplant recipients had an increased risk of developing complications, such as local acute infection, alveolitis, increased bleeding, pain, and delayed healing, after tooth extraction. Methods The authors selected patients who underwent kidney transplants more than 6 months ago (study group) and patients who had not (control group) older than 18 years who needed to undergo extraction of erupted teeth. The same oral surgeon performed all tooth extractions while the patients were under local anesthesia. Another blind researcher examined the patients 3, 7, and 21 days after tooth extraction. The first end point was occurrence of complications (local acute infection, alveolitis, increased bleeding), and the second end point was socket reepithelialization on day 21. Results Forty-five tooth extractions were performed on 38 study group participants and 61 on 57 control group participants. There was no statistical difference between the groups regarding the incidence of any complication or delayed socket epithelialization. Conclusions The results of this pilot study suggest that there is no difference in postoperative healing after tooth extractions between stable kidney transplant patients and control patients. Practical Implications This is the first prospective study assessing the frequency of postoperative complications after tooth extraction in kidney transplant recipients. This clinical trial was registered at ClinicalTrials.gov . The registration number is NCT02547753.

Objective To clinically assess the socket healing after tooth extraction and the occurrence of intra- and postoperative complications in chronic kidney failure (CKF) patients on hemodialysis (HD) by comparing them to a control group. Study desing This is a prospective study involving 48 patients with CKF on HD (study group – SG) and 29 participants without CKF (control group – CG) undergoing tooth extractions. No prophylactic antibiotic was given to the participants. One calibrated dentist evaluated all individuals at 3, 7, 21, and 60 days after the tooth extractions and assessed hemostasis time, occurrence of local or distant infection, epithelization, and deposition of alveolar bone. Results In the SG, 87 teeth were extracted through 65 interventions, and in the CG, 76 teeth were extracted through 36 interventions. Bleeding beyond 30 minutes was observed in 12 interventions (18.5%) on SG participants and was controlled with local hemostatic agents. None of the groups had individuals presenting postoperative infectious complications at the surgical site or a distance. After 21 days, we observed delayed epithelialization in 29.9% (26/87) of the individuals of SG compared to 3.9% (3/37) of those of CG (P Conclusions Individuals with CKF on hemodialysis tend to heal up well following dental extractions. They did not have an increased risk of infectious complications after simple tooth extractions, but they showed prolonged bleeding events more often than controls. Additional research studies using larger sample sizes of patients with CKF on hemodialysis are needed to confirm our findings. Clinical relevance This pilot study contributes to dentists ability to provide better dental management for people with chronic kidney failure undergoing hemodialysis through understanding the course of healing following dental extractions.

Aims To compare outcomes of dental procedures among a group of renal transplant recipients who had received antibiotic prophylaxis (AP) before the procedure and another group that had not received AP. Methods and results The records of all renal transplant patients treated at the Special Care Dentistry Center (SCDC) were assessed. Dental procedures documented in the records were classified as invasive or noninvasive. All dental procedures performed were compiled, and the prescription or nonprescription of prophylactic antibiotics, and the incidence and description of postoperative complications after invasive procedures were recorded. Eighty-seven records were evaluated. Out of 190 invasive procedures all were simple dental extractions, 107 (56.3%) were preceded by AP; out of 242 noninvasive procedures, 14 (5.7%) were preceded by AP. A lack of uniformity on the type and dose of the antibiotic prescribed was observed. Four postoperative complications after invasive procedures (dental extraction) were noted and in 2 cases the procedures were preceded by AP. Conclusion This retrospective study showed no difference in postextraction outcomes between renal transplant recipients who received and who did not receive AP before dental extractions.

Purpose The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. Materials and Methods A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. Results Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. Conclusion Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Despite its effectiveness, radiochemotherapy treatment in the head and neck region is accompanied by acute oral complications such as oral mucositis, dysphagia, xerostomia, and dysgeusia. The aim of this study was to analyze and prospectively assess the frequency and evolution of acute oral complications during radiochemotherapy in patients diagnosed with squamous cell carcinoma in the head and neck region. We have analyzed oral complications of 20 patients during 6 weeks of radiochemotherapy treatment for squamous cell carcinoma. Oral mucositis was evaluated according to the World Health Organization criteria, dysphagia, and dysgeusia according to the National Cancer Institute Common Toxicity Criteria, and xerostomia according to parameters set by the Seminars in Radiation Oncology. Mucositis was first observed in the second week and all patients presented some degree of mucositis in the fourth week of radiotherapy. Xerostomia and dysphagia were initially reported already in the first week of radiotherapy. All patients presented xerostomia in the fourth week; however, dysphagia was observed in all patients, only in the sixth week. Dysgeusia was first observed in the second week, becoming more severe in the third week. Acute oral complications can be observed throughout the treatment, but the third week of radiotherapy seems to represent a critical week, regardless of the grade of the complication. The sixth week presents the worst grades of these complications. Knowledge about the natural course of oral complications during radiotherapy is important to develop better strategies for treatment and improve the patients’ quality of life.

The objective of this study was to identify the epidemiological profile of facial fractures and to associate with clinical-epidemiological variables. An epidemiological survey was conducted in which data retrieved from the records of patients with facial fractures were analyzed. Pearson χ(2) test, Student t-test, one-way analysis of variance, Bonferroni post-hoc test, and logistic regression were used for statistical analysis, adopting a level of significance of 5%. The sample consisted of 718 patients ranging in age from 21 to 30 years (56.4%), including 480 (66.9%) men. Traffic accidents were the main etiological agent (62.7%) and the nasal bones were the most affected (41.8%). An association was observed between age and etiology (P < 0.001), fractured bone (P < 0.001), type of treatment (P < 0.001), hospital length of stay (P < 0.001), and complications (P = 0.001). Patients with traffic accident [odds ratio (OR) = 3.08, P < 0.001] and fall (OR = 2.50, P = 0.049) as etiology had more risk of complications. The type of fractured bone was associated with etiology (P < 0.001), type of treatment (P < 0.001), hospital length of stay (P < 0.001), and complications (maxilla--OR = 1.90, P = 0.004). In conclusion, facial fractures predominantly affect men aged 21 to 30 years. Traffic accidents are the main etiology and the nasal bone is the site most affected. It was observed that the older the patient, the greater the susceptibility to falls, surgical treatment, hospital stay, and complications. Patients with maxillary or mandibular fractures remain hospitalized for longer periods of time. Fractures by traffic accident and fall had more risk of complications. The risk of complications was also higher in patients with maxilla fracture.

Objective: To evaluate clinically the postextraction socket healing in patients with chronic kidney failure (CKF) undergoing hemodialysis (HD) and in a control group of individuals. Study Design: This was a prospective observational study that included 48 individuals with CKF in HD to compose the study group (SG) and 29 patients in the control group (CG) without CKF. A questionnaire on medical history, clinical examination, and laboratory tests were applied. All participants were subjected to extractions of erupted teeth, without antibiotic prophylaxis. Postoperative evaluations were performed 3, 7, 21, and 60 days after the extractions. Results: In the SG, we performed 87 extractions in 65 surgeries, and, in the CG, 76 extractions were performed in 36 surgeries. In the SG, there was a significant delay in surgical wound epithelization (29.9% vs 3.9%, P

Objective: The objective of this study is to assess the prevalence of oral lesions in a cohort of renal transplant recipients before and just after transplantation. Study design: This is a cohort study involving 80 renal transplant recipients. The same researcher/dentist evaluated orofacial characteristics at the 3 different time points: immediately before transplantation, 15 to 20 days after transplantation, and 45 to 60 days after renal transplantation. Oral lesions were photographed and a presumptive diagnosis was established. Results: Immediately before transplantation, 3 of the 80 participants (3.7%) showed some oral soft tissue lesions. In the second and third time periods, 23.7% (18 out of 76) and 25.7% (19 out of 74) of the participants showed oral soft tissue lesions, respectively. Ulcers and candidiasis were the most frequent lesions associated with the use of everolimus (P = .023) and azathioprine (P = .034), respectively. Fewer patients reported xerostomia after transplantation than before (P

Objectives To investigate the radiographic findings of mucopolysaccharidoses (MPS) on panoramic radiographs in a series of 16 patients. Study Design This retrospective cross-sectional study included panoramic radiographs of 16 patients with cytogenetically diagnosed MPS. Two blinded, previously calibrated observers evaluate the presence or absence of the following features: type of dentition; stage of dental age in comparison with chronologic age; delayed exfoliation of deciduous teeth; supernumerary teeth; teeth impaction; enlarged, cyst-like dental crypt; hypercementosis; taurodontism; generalized enamel hypoplasia; enlargement of the bone marrow spaces; thinning of cortical bone; unusual morphology of condyles; and flattening of the condylar head. Results The final sample was composed of 8 MPS IV, 7 MPS VI, and 1 MPS I cases. All patients presented unusual morphology of condyles. Cyst-like dental crypt (75%), taurodontism, and teeth impaction (68.75% each) were also overall common findings. Generalized enamel hypoplasia was exclusively identified in patients with MPS IV (75% of those patients). Conclusions Radiographic features of oral and maxillofacial manifestations in patients with MPS frequently encountered by dentists may help recognize the disorder. However, because of sample size limitations, it was not possible to infer any statistical relationship between the radiographic features and the types of MPS.

Objective The aim of this study was to perform a survey of diagnosed lesions at a Stomatology Clinic at a University for 1 year. Study Design Retrospective study with analysis of 58 patients’ records. Poorly completed records or uncertain diagnoses were excluded. Results Through the analysis of the records, a male prevalence (51.7%) aged above 41 years (58.6%) was observed, with lower levels of education (elementary school) and lower salary. The majority of the diagnosed lesions were single, localized in the lip, especially the lower lip. Actinic cheilitis was the most prevalent diagnosis, followed by vascular injuries, and lower prevalence of leukoplakia and carcinoma. Biopsy was the complementary exam most performed, followed by imaging examinations. Laser therapy was the most used treatment not only to surgery, but also for biomodulation. Conclusions Actinic cheilitis had a great prevalence in the patients. Male patients older than 41 years and considered at risk for oral cancer were the most seen by the Health Service. Ease of access for people, particularly those with low salaries, to a referral service of Oral Diagnosis located in the interior, can help to overcome the deficiencies or shortcomings of the Public Service. Support: PIBIC.

Objective The aim of this study was to verify the prevalence of oral cancer in patients admitted to a referral oncology hospital. Study Design Cross-sectional and descriptive study, in which 166 patients diagnosed with cancer were examined. Results Of the admitted patients, there was a prevalence of males (64.5%) with an average age of 51.7 years and nonwhite color (59%). Among the various types of cancer, acute leukemia (34.9%) was the most prevalent, followed by lymphomas (16.9%), pharynx and larynx (7.8%), mouth (6%), lung (6%), and head and neck cancer (6%). Chemotherapy was the most prescribed (58.4%) therapeutic approach, followed by its association with radiotherapy (18.7%), and only radiotherapy (9.6%). Radiotherapy was the most used treatment for oral cancer. Conclusions In the evaluated sample, oral cancer was the fourth most prevalent type, predominating for the sixth decade of life, in a ratio of 4 males to 1 female. Radiotherapy was the most-used treatment. Financial support: PIBIC.

Objective The aim of this study was to determine the prevalence of oral acute complications related to antineoplastic treatment. Study Design The sample consisted of 166 patients in a reference hospital in which clinical examination was carried out. Results There was male prevalence (64.5%) aged between 31 and 60 years (51.2%) and nonwhite skin color (59%). Acute leukemia (34.9%) and lymphomas (16.9%) were the most frequent neoplasms found. Chemotherapy was the widely prescribed antineoplastic treatment (87.3%), usually associated to other therapeutic approach (33.1%). The most prevalent complaint was burning mouth (25%), followed by toothache (21.4%), dysphagia (16.6%), xerostomia (15.5%), and oral ulceration (14.3%). Oral mucositis was the most prevalent toxicity (18.7%), followed by xerostomia (15.7%) and candidosis (8.4%). Conclusions The dentist must be aware of the oral acute complications in patients under chemotherapy antineoplastic treatment because they have high morbidity, mainly mucositis stage I, present in this study in all ages and sexes. Support: PIBIC

A 70-year-old female patient was referred to the stomatology clinic for evaluation of an injury on her tongue. On medical history, it was found she was a patient with type 2 diabetes mellitus and hypertension, using antihypertensive, hypoglycemic, and antihistamine agents along with insulin, eye drops, and sedatives. She was also being seen by an endocrinologist. She is allergic to many medications (acetylsalicylic acid and its derivatives, dipyrone, and nonsteroidal anti-inflammatory drugs). On oral examination, the patient had a dry oral mucosa with little lubrication and mild candidosis of the tongue, treated by ketoconazole. The clinical diagnosis was Sjogren syndrome. Anti-SSA and anti-SSB were found to be positive. A rheumatoid factor (RF) test was within the normal limits, as was the hemogram. The patient has not yet consented to lip biopsy due to decompensated diabetes (glycated hemoglobin 7.6% and fasting glycemia 115 mg/dL). The patient was referred to the doctor for diabetes control and is under proper follow-up care.

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.

Purpose Studies addressing the changes in craniofacial morphology of patients with mucopolysaccharidosis (MPS) are important for a better understanding of the progression of this disease. The present objective was to identify major cephalometric abnormalities in these patients. Materials and Methods This was a cross-sectional case-and-control study. The sample was composed of 2 types of study subjects (patients with MPS and normal subjects). The outcome variables were numerous cephalometric elements that measure facial height, dental positioning, facial growth pattern, and mandibular and maxillary positioning. The Student t test was used to compare the mean angular and linear measurements of the case and control groups and the level of significance was set at a P value less than .05. The Bonferroni method was used for adjustment of the P value ( P Results The control group consisted of randomly selected subjects matched to the patients with MPS for the demographic variables of gender and age. Seventeen patients with MPS were evaluated (64.7% female). The mean age of the sample was 13.29 years. One patient had MPS I, 8 had MPS IV, and 8 had MPS VI. The results showed important differences between groups in angular measurements (angle formed by the line between the sella and nasion [SN] and the plane of the gonion and gnathion, angle formed by the intersection of the gnathion point and the SN line, angle formed by the intersection of the long axis of the lower incisor with the line between the nasion and the B point, angle formed by the intersection of the long axes of the upper and lower incisors, and angle formed by the Frankfort horizontal plane with the mandibular plane) and linear measurements (condyle to A point, condyle to gnathion, pro-nasal ( Pn) point to the line between the pogonion and upper incisor, and the nearest point of the anterior half of the soft palate to the posterior pharyngeal wall). The angle formed by the SN line with the plane between the gonion and the gnathion and the distance from the condyle to the A point showed meaningful differences after Bonferroni adjustment. Conclusion Patients with MPS present a tendency toward vertical growth that results in a dolichocephalic facial pattern. In addition, a smaller nasopharyngeal space was observed, a factor that might be responsible for the mouth breathing observed in these patients.

Background Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. FCOD is usually asymptomatic. In severe cases, focal expansion may occur due to infection. Management of the symptomatic patient is more difficult due to the avascular nature of the lesion which contributes to susceptibility severe infection, bone sequestration, and osteomyelitis when surgery is performed. Case report This paper presents a rare case of severe FCOD; the black woman patient was diagnosed based on clinical and radiographic findings and treated conservatively. The examination of panoramic radiographs revealed a multiple sclerotic masses with radiolucent borders, found in the mandible and maxilla which were symmetrical at presentation. The patient continuous with the follow-up. Discussion This report confirms that a diagnosis can be made with accurate clinical and radiographic assessment. The correct selection of treatment for FCOD depends on this information.

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood. The masses develop from remnants of thyroglossal ducts and typically appear as midline neck masses. Double thyroglossal cysts and the complete failure of the obliterative process of thyroglossal duct are very rare in the literature. This manuscript describes a rare case of double thyroglossal duct, localized above the geniohyoid muscles affecting the floor of the mouth region and sublingual gland. The diagnostic criteria of the tumor and surgical procedure are discussed. To our knowledge, only 3 similar cases were reported in the literature.

Esthesioneuroblastoma, or olfactory neuroblastoma (ONB), is a rare malignant tumor of the olfactory neuroepithelium, which is normally confined to the superior one third of the nasal septum, cribriform plate, and superior turbinates but may extend to the base of the skull and intracranial space. ONB accounts for only 3% of all intranasal tumors, and its etiology remains unclear. The tumor can affect both children and adults, with a bimodal peak incidence between 11 and 20 years and between 51 and 60 years.1 Controversy exists regarding the origin, diagnosis, and management of ONB, mainly because of its rarity and the fact that most institutions treat only a small number of patients with this diagnosis.2; 3 ; 4 Many cases go unrecognized because of difficulties in the diagnosis of this tumor as a result of nonspecific initial symptoms (nasal obstruction, recurrent epistaxis). There are rare reports of ONB arising in the nasopharynx, ethmoid sinus, and maxillary sinus. We report a rare case of a very large ONB in a pediatric patient. The clinical appearance of the tumor and diagnostic procedure are discussed, and cases published in the literature are reviewed.

1 Master’s degree student of oral pathology, UFRN.2 Master’s degree student of dentistry, UEPB.3 Doctoral student of materials science and engineering. Full professor, UEPB.4 Doctoral student of materials science and engineering. Full professor, UEPB.5 Doctorate in oral pathology, UFRN. Full professor of oral pathology, UEPB.Send correspondence to: Dmitry Jose de Santana Sarmento - Rua Jose Jesuino de Brito 415 Quarenta Campina Grande PB 58.416-270.Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on December 13, 2009; and accepted on March 23, 2010. cod. 6838