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A clear cell variant of calcifying epithelial odontogenic tumor is a rare benign odontogenic neoplasm, accounting for 33 cases described in the literature. In this article, we report a challenging example of clear cell variant of calcifying epithelial odontogenic tumor of the posterior maxilla in a 45-year-old female patient showing locally aggressive growth and recurrence. Microscopically, islands of polyhedral cells containing abundant cytoplasm, well-developed intercellular bridges blended with clear cells were observed. The nuclei were frequently pleomorphic and permeated by hyaline calcified material. Immunohistochemistry revealed positivity for pan-cytokeratin (AE1/AE3), cytokeratins (CK-14 and CK-19), Bcl-2, p53, and p63. The Ki-67 proliferative index was ~10%. As odontogenic tumors are rare, when a significant clear cell component is observed, the differential diagnosis with other lesions of the jaws with similar morphology, including other odontogenic tumors with prominent clear cell component, clear cell odontogenic carcinomas, and metastatic tumors, is difficult.

Adenoid ameloblastoma is a rare benign odontogenic tumor that favors a slight predilection for male patients, fourth and fifth decades of life, and posterior regions of the jaws. To date, less than 40 cases have been reported in the English language literature. The radiographic aspects of adenoid ameloblastoma vary from unilocular and well-defined lesions to diffuse and multilocular lesions. Most of the lesions exhibit a radiolucent image and are usually large, with a mean size of 3.5 cm. Microscopically, pseudoductal structures composed of columnar cells in a palisaded arrangement formed from the parenchyma of the tumor were observed. We describe a case of adenoid ameloblastoma in a 54-year-old woman, who presented with no symptoms. Panoramic radiography showed a well-circumscribed, unilocular radiolucency in the left posterior maxilla. As odontogenic tumors are rare, some entities are infrequently encountered, making the diagnosis more difficult. Clinicians, oral and maxillofacial surgeons and oral pathologists should be familiar with the adenoid ameloblastoma and its differential diagnosis for accurate diagnosis and management.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Maxillofacial prosthetic rehabilitation is almost always indicated after surgical treatment of affected individuals with oral cavity and pharynx cancers. Few articles have described in detail the technical sequence of maxillofacial prosthesis fabrication. The first case is a 56-year-old woman who was rehabilitated with pharyngeal obturator prosthesis after a partial maxillectomy, including soft palate, tonsil, oropharynx, and retromolar space regions. The second case is an 83-year-old man who was rehabilitated with hard palatal obturator prosthesis after a maxillectomy, including hard palate and nasal floor. In both cases, the patients complained of oronasal regurgitation and difficulty in chewing, swallowing, and speaking. A multi-professional approach including oral rehabilitation should be part of the treatment plan for individuals with oral and pharyngeal cancer after tumor resection.

Maxillofacial prostheses are among the modalities of prosthetic rehabilitation but the disinfectant solutions for their cleaning have been barely explored. The purpose of the present study was to evaluate the antibacterial effects of a Brazilian green propolis glycolic (PGL) solution on the removal of biofilm from the surface of two maxillofacial elastomers (room temperature vulcanization [RTV] and high consistency silicone rubber [HCR]). A total of 42 specimens (3×10 mm) were made with these two elastomers and Staphylococcus aureus was allowed to grow for 24 hours on the surface of the biomaterials. Specimens (n=3) were randomly allocated to the following treatment groups by immersion for 15 minutes: 0.9% saline solution; 2% chlorhexidine gluconate (CHX); 11%, 16% and 20% PGL; and Daro Brand® antimicrobial liquid agent and antibacterial gel soap. Quantitative assessment was performed by counting the number of colony-forming units (CFU). Two-way ANOVA was employed for data analysis. Specimens of both maxillofacial elastomers treated with PGL solutions at concentrations of 11%, 16% and 20%, as well as 2% CHX, did not reveal CFU/mL of the S. aureus strain, indicating the broad spectrum of antibiofilm action of these disinfectant solutions. In addition, the Daro Brand® antimicrobial liquid agent showed lower CFU/mL in both maxillofacial elastomers compared to the Daro Brand® gel soap and 0.9% saline solution. Therefore, disinfection with PGL solutions is effective and might be considered to be a promising alternative in eliminating the S. aureus biofilm from specimens of maxillofacial elastomers by immersion for 15 minutes. Las prótesis maxilofaciales se encuentran entre las modalidades de rehabilitación protésica, pero las soluciones desinfectantes para su limpieza son poco investigadas. El objetivo del presente estudio fue evaluar el efecto antibacteriano de una solución Brasileña de propóleo verde glicólico (PVG) para remoción de biopelícula de la superficie de dos elastómeros maxilofaciales (vulcanización a temperatura ambiente [VTA] y caucho de silicona de alta consistencia [CSAC]). Se realizaron un total de 42 muestras (3×10 mm) con estos dos elastómeros y dejados en contacto con Staphylococcus aureus durante 24 horas sobre su superficie. Las muestras (n=3) fueron colocadas aleatoriamente en los siguientes grupos de tratamiento de inmersión durante 15 minutos: solución salina al 0,9%; gluconato de clorhexidina al 2% (CHX); 11%, 16% y 20% PVG; y agente líquido antimicrobiano y jabón en gel antibacterial Daro Brand®. La evaluación cuantitativa se realizó contando el número de unidades formadoras de colonias (UFC). Para el análisis de datos se utilizó ANOVA de dos vías. Las muestras de ambos elastómeros maxilofaciales tratados con soluciones de PVG a concentraciones de 11 %, 16 % y 20 %, así como con CHX al 2%, no revelaron UFC/mL de la cepa de S. aureus, lo que indica el amplio espectro de actividad antibiopelícula de estas soluciones. Además, el agente antimicrobiano líquido Daro Brand® mostró menores UFC/mL en ambos elastómeros maxilofaciales en comparación con el jabón en gel Daro Brand® y la solución salina al 0,9 %. Por lo tanto, la desinfección con soluciones de PVG es eficaz y puede considerarse una alternativa prometedora en la eliminación del biopelícula de S. aureus en las muestras de elastómeros en inmersión durante 15 minutos. As próteses maxilofaciais estão entre as modalidades de reabilitação protética, mas as soluções desinfetantes para sua limpeza são pouco exploradas. O objetivo do presente estudo foi avaliar os efeitos antibacterianos de uma solução brasileira de própolis verde glicólica (PVG) na remoção de biofilme da superfície de dois elastômeros maxilofaciais (vulcanização a temperatura ambiente [VTA] e borracha de silicone de alta consistência [BSAC]). Um total de 42 espécimes (3×10 mm) foram confeccionados com esses dois elastômeros e Staphylococcus aureus foi deixado em contato por 24 horas na superfície dos biomateriais. As amostras (n=3) foram alocadas aleatoriamente nos seguintes grupos de tratamento por imersão por 15 minutos: solução salina a 0,9%; gluconato de clorexidina a 2% (CHX); 11%, 16% e 20% de PVG; e agente líquido antimicrobiano Daro Brand® e sabonete em gel antibacteriano. A avaliação quantitativa foi realizada pela contagem do número de unidades formadoras de colônia (UFC). ANOVA de duas vias foi empregada para análise de dados. Espécimes de ambos os elastômeros maxilofaciais tratados com soluções de PVG nas concentrações de 11%, 16% e 20%, bem como 2% CHX, não revelaram UFC/mL da cepa S. aureus, indicando o amplo espectro de ação antibiofilme dessas soluções desinfetantes. Além disso, o agente líquido antimicrobiano Daro Brand® apresentou menor UFC/mL em ambos os elastômeros maxilofaciais em comparação ao sabonete em gel Daro Brand® e solução salina 0,9%. Portanto, a desinfecção com soluções de PVG é eficaz e pode ser considerada uma alternativa promissora na eliminação do biofilme de S. aureus de espécimes de elastômeros maxilofaciais por imersão por 15 minutos.

The impact of rheumatoid arthritis (RA) on the shaping of the oral and gut microbiome raises the question of whether and how RA treatment modifies microbial communities. We examined changes in the oral and gut microbiota in a mouse model of antigen-induced arthritis (AIA) treated or not with methotrexate (MTX).Maxillae and stools were evaluated by the MiSeq platform of the V4 region of the 16S rRNA gene. Alveolar bone parameters were analysed by micro-computed tomography. Moreover, arthritis-induced changes in hyperalgesia and oedema were assessed, along with the impact on periodontal bone health.Microbial communities in MTX-treated AIA mice revealed distinct clusters compared to the control and AIA groups. Overall, MTX impacted the richness and variability of microorganisms in the oral-gut axis microbiome at the phylum level. Regarding the oral microbiome, while in the control group the most dominant phylum was Firmicutes, in the AIA group there was a shift towards the predominance of Campilobacteriota and Bacteroidetes associated with the disease. MTX treatment led to greater dominance of the health-associated phylum Proteobacteria. In the gut microbiome, AIA induction resulted in increased abundance of the Verrucomicrobiota phylum, and MTX treatment restored its levels compared to control. Importantly, the MTX-treated AIA animals had significantly less periodontal bone loss, as well as decreased hyperalgesia and joint oedema compared to the AIA animals.Data suggest the benefit of MTX treatment in protecting alveolar bone, in addition to providing new insights on the drug-microbiome interaction in the course of RA.

In recent decades, understanding tumorigenesis and the complex interaction between the host and the immune system has been the pillar for significant advances in anticancer therapy. Conventional anticancer therapy (e.g., cut, burn, and cytotoxic drugs) involves multiple targeting of tumor cells. However, the tumor tissue microenvironment can present a dysregulated, stimulating, or subverted immune response which, in turn, reveals pro-tumor activities favoring tumor expansion and progression. Recently, new potential targets have been identified based on immunomodulatory therapies, which are crafted to re-establish the host anti-tumoral immune response. Clinicians should fully understand the intricate interactions between carcinogens, the tumor milieu, the immune system, and traditional anticancer therapies in order to progress and to overcome the refractory/recurrent challenges and morbidity of the disease. Thus, in this article, we highlight the complex milieu of the oral cancer immune response, pointing out potential therapeutic immunotargets for oral squamous cell carcinomas. The impact of traditional anticancer therapy on the immune system is also outlined.

Chediak-Higashi syndrome (CHS) is an autosomal recessive disorder characterized by leukocytes with giant secretory granules and a myriad of clinical features. However, it is unknown whether oral lesions are part of the syndrome or are refractory to systemic treatment. Herein, we integrated the available data published in the literature on the oral manifestations of individuals with CHS. Searches on PubMed, Web of Science, Embase, Scopus, and LILACS were conducted to identify studies published up to March/2022. The Joanna Briggs Institute tool was used for the critical appraisal of studies. Fourteen articles (21 cases) were detected. The mean age of individuals was 15.9±8.8 years. There was a slight predominance of males (52.4%). The major manifestation was periodontal disease (81%), although ulceration of the oral mucosa (14.3%), gingival/labial abscess (4.8%), and periodontal abscess (4.8%) were also reported. Oral rehabilitation including dental implants (9.5%) was performed after tooth losses due to the poor prognosis of periodontal therapy. CHS is usually diagnosed in an early stage due to its systemic manifestations such as classic oculocutaneous albinism, recurrent infections, and a propensity for bleeding. Oral health providers should be aware of the manifestations of individuals with CHS. Special care, including oral prophylaxis, is indispensable.

Objective: This living systematic review aims to integrate the morphological and tissue-based molecular caracterization of oral lesions occurring in individuals infected by COVID-19 (OLICs). Materials and Design: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Scopus, Ovid, Embase, and LILACS were searched to identify reports on OLICs with morphological and/or tissue-based molecular data. Results: Four studies reporting five cases were included. Three patients were male, and the mean age of the individuals was 47.6 years. The most reported anatomical location was the palate (n = 4), whereas ulcers were the most frequent clinical presentation (n = 3). Histopathologically, all cases revealed cell vacuolization and exocytosis in the epithelial layer. In the mesenchymal layer, inflammatory cell infiltrate and thrombi/microvascular thrombosis were observed in three cases. Immunohistochemical reactions were performed in two cases. Both cases were negative for HHV-1, HHV-2, and CMV. One case revealed positivity for SARS-CoV-2 spike protein. No other molecular tests were found for the characterization of OLIC. Conclusions: The pathological characteristics of OLICs are still unspecific. However, with the ongoing COVID-19 pandemic and well-documented new cases, whether OLICs are due to coinfections or has a primary origin can be determined.

We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Oral mucositis secondary to head and neck chemoradiation displays a complex molecular pathogenesis involving epithelial and microvascular injury, release of pro-inflammatory cytokines, and host-microbiome communications. These processes lead to oxidative stress and the release of reactive oxygen species that stifle the structural integrity of the oral mucosa, with emergence of erosions and ulcers. The consequences are malnutrition, psychological/psychiatric symptoms, poor quality of life, and occurrence of opportunistic infections. The latter pose a major challenge due to the risk of interruption of anti-neoplastic therapy, tumour recurrence and, ultimately, death. This article aims to present the clinical characteristics, molecular pathogenesis, and an overview of the predisposing factors and current management of oral mucositis. It is anticipated that the future direction of the management of oral mucositis will focus on evidence-based prehabilitation and pre- and per-chemoradiation therapy monitoring.

The correct diagnosis of vertical root fractures (VRF) in the presence of artifacts is a challenge for clinicians and endodontists. Moreover, there is controversy about which imaging technique is best for this purpose. In an in vitro model, we evaluated the diagnosis of VRF in teeth treated endodontically with and without intraradicular metal posts, using the Clark technique and cone beam computed tomography (CBCT), as well as the interference of artifacts with the diagnosis. Twenty-two first or second maxillary or mandibular premolars were included. Teeth were randomly allocated to three groups: G1 (two teeth without fracture with endodontic treatment and one with an intraradicular metal post); G2 (10 fractured teeth with endodontic treatment); and G3 (10 fractured teeth with endodontic treatment plus a metal post). The examiners recorded the presence or absence of fracture and its location and classified its type. There was no statistically significant difference between image acquisition systems. When differentiating the teeth (first vs. second premolars), there was a statistically significant difference among the examiners (p=0.020). However, when comparing the values obtained by the examiners regarding the visualization of the fracture site as well as the presence of fracture correlated with the presence of a metal post and angulation, there were no statistically significant differences (p>0.05). Digital radiographs and CBCT were similar for the diagnosis of VRF. High sensitivity was observed by CBCT image reconstructions. Therefore, the presence of metal posts generated artifacts, resulting in low sensitivity, specificity and accuracy. El correcto diagnóstico de fracturas radiculares verticales (FRV) con presencia de artefactos es un desafio para endodoncistas y dentistas generales. Además de ello, existe controversia sobre qué técnica de imagen es mejor para este propósito. El objetivo del presente trabajo fue evaluar el diagnóstico de FRV en dientes tratados endodónticamente con y sin postes metálicos intrarradiculares, utilizando la técnica de Clark y tomografía computarizada de haz cónico (TCHC), así como la interferencia de artefactos en el diagnóstico, in vitro. Se utilizaron veintidós primeros o segundos premolares maxilares o mandibulares. Los dientes fueron distribuidos aleatoriamente en tres grupos: G1 (dos dientes sin fractura con tratamiento endodóntico y uno con poste intrarradicular metálico); G2 (10 dientes fracturados con tratamiento endodóntico); y G3 (10 dientes fracturados con tratamiento endodóntico más un poste metálico). Los examinadores registraron la presencia o ausencia de fractura, el tipo y su ubicación. Los resultados mostraron que no hubo diferencia estadísticamente significativa entre los sistemas de adquisición de imágenes. En relación al tipo de diente utilizado (primeros y segundos premolares), hubo una diferencia estadísticamente significativa entre los examinadores (p=0,020). Sin embargo, al comparar los valores obtenidos por los examinadores con respecto a la visualización del sitio de la fractura, así como la presencia de fractura correlacionada con la presencia de poste metálico y angulación, no hubo diferencias estadísticamente significativas (p>0,05). Las radiografías digitales y TCHC fueron similares para el diagnóstico de FRV. Se observó una alta sensibilidad mediante reconstrucciones de imágenes TCHC. Por lo tanto, la presencia de postes metálicos genera artefactos resultando en la baja sensibilidad, especificidad y precisión. O diagnóstico correto de fraturas radiculares verticais (FRV) na presença de artefatos é um desafio para clínicos e endodontistas. Além disso, há controvérsias sobre qual técnica de imagem é a melhor para esse fim. Em modelo in vitro, avaliamos o diagnóstico de FRV em dentes tratados endodonticamente com e sem pinos metálicos intrarradiculares, pela técnica de Clark e tomografia computadorizada de feixe cônico (TCFC), bem como a interferência dos artefatos no diagnóstico. Vinte e dois primeiros ou segundos pré-molares superiores ou inferiores foram incluídos. Os dentes foram alocados aleatoriamente em três grupos: G1 (dois dentes sem fratura com tratamento endodôntico e um com pino intrarradicular metálico); G2 (10 dentes fraturados com tratamento endodôntico); e G3 (10 dentes fraturados com tratamento endodôntico mais um pino metálico). Os examinadores registraram a presença ou ausência de fratura e sua localização e classificaram o tipo. Não houve diferença estatisticamente significativa entre os sistemas de aquisição de imagens. Na diferenciação dos dentes (primeiros vs. segundos pré-molares), houve diferença estatisticamente significativa entre os examinadores (p=0,020). Porém, ao comparar os valores obtidos pelos examinadores quanto à visualização do local da fratura, bem como a presença de fratura correlacionada com a presença de pino metálico e angulação, não houve diferenças estatisticamente significantes (p>0,05). As radiografias digitais e a TCFC foram semelhantes para o diagnóstico de FRV. Alta sensibilidade foi observada por reconstruções de imagem TCFC. Portanto, a presença de pinos metálicos gerou artefatos, resultando em baixa sensibilidade, especificidade e precisão.

To integrate the available data published on malignant peripheral nerve sheath tumours (MPNST) of the oral and maxillofacial region. Searches in Embase, PubMed, Web of Science and Scopus were conducted for the identification of case reports/case series in English language. The risk of bias was assessed using the Joanna Briggs Institute tool. Outcomes were evaluated by Cox regression and Kaplan-Meier methods. A total of 306 articles were retrieved, 50 of which reporting 57 MPNST were included. The lesion showed a predilection for the mandible (n = 18/31.57%) of middle-aged adults (~40.5 years) with a male/female ratio of 1.1:1. The individuals were mostly symptomatic with a mean evolution time of 9.6 months. Surgical removal plus adjuvant therapy (especially radiotherapy) was the main approach (51.86%). Recurrence was reported in 39.62% of cases. Nodal and distant metastases were identified in 28.26% and 26.66% of cases, respectively. The 2-year cumulative survival rate was 55%. Independent predictors of poor survival were the presence of neurofibromatosis type 1 (p = 0.04) and distant metastases (p = 0.004). The diagnosis of MPNST is challenging due to the variety of its clinical and histopathological presentations. Local aggressiveness and the potential for metastases are common outcomes of this neoplasm.

Cisplatin plays a central role in cancer chemotherapy, but resistance to this drug remains a major obstacle in treatment. Drawbacks related to cisplatin failure may be associated with cell energy metabolism. This study investigated whether photobiomodulation (PBM) can potentiate the effects of cisplatin on keratinocytes (HaCat) and cancer cells (SCC25 and HN12). Cells were treated with laser (GaAlAs; 660 nm; 60 mW; 0.33 J; 2.14 W cm-2 ; 11.7 J cm-2 and 6 s) and cisplatin (7.8 μg mL-1 ) to evaluate cell viability, Ki-67, VEGF, TGF-β1, EGF expression and ROS production. Observations were validated in the SCC25 cell lineage, where the type of cell death (necrosis/apoptosis) and the amount of ATP were assessed. Cell lineages showed increased sensitivity to cisplatin associated with PBM (Cis-PBM). Ki-67 was augmented in all cell lineages treated with Cis-PBM when compared to cisplatin alone (Cis). Cis or Cis-PBM significantly decreased VEGF expression in cancer cells, while no changes were seen in the expression of TGF-β1 or EGF compared to control. ROS levels were similar in the Cis and Cis-PBM groups. Cells treated with Cis-PBM died by apoptosis, leading to greater consumption of ATP. These observations suggest that PBM may potentiate the effects of cisplatin, leading to increased drug cytotoxicity and enhanced cell death.

The aim of this study was to describe a series with 66 cases of infected cemento-osseous dysplasia (COD) and to discuss the demographic distribution, clinicoradiographic features and treatment of this condition. A study looking back on the diagnoses made at a single Brazilian centre within a 28-year timeframe was performed. A literature review with searches across five databases was also conducted to identify reports on osteomyelitis/infected COD. Descriptive and statistical analyses were performed. The case series study showed a female/male ratio of 21:1. Affected individuals’ mean age was 57.4 years. Mandible was the most affected site (95.5%) and florid subtype was the most frequent infected COD (62.1%). Tooth extraction was the main factor associated with the development of infection associated within a COD lesion. The literature review retrieved 30 studies reporting 46 cases of this condition. Asian women in their 40 s and 50 s were more affected. Surgery for removal/curettage of necrotic bone was acknowledged as an appropriate approach to the treatment of this infection. The clinicodemographic data of the study were similar to data collected across the literature. Clinicians, maxillofacial surgeons and oral rehabilitation providers should be alert to the diagnosis of COD, since infection is a frequent complication whose management is challenging.

Objectives The objective of the present study was to investigate the expression of immune checkpoints (PD-L1, PD-L2, PD-1 and CTLA-4), immune inhibitory molecule HLA-G, markers of tumor-infiltrating lymphocytes (TIL) and dendritic cells (DC), as well as its association with clinicopathological features of adenoid cystic carcinomas (ACC) of the salivary glands. Materials and methods Thirty-six samples from patients with ACC were analyzed immunohistochemically for the expression of PD-L1, PD-L2, PD-1, CTLA-4, HLA-G, CD8, GrB, CD1a and CD83. Positivity of HLA-G, PD-L1 and PD-L2 expression was defined by cut-offs values. CD8+ TIL was measured semiquantitatively and also using cut-off values obtained by the ROC curve considering recurrence of the lesion. Results ACC showed low CD8+, GrB+ TIL, CD1a and CD83 populations, as well as scarce positivity for CTLA-4 and PD-1. In contrast, PD-L2 and HLA-G expression was increased, while no PD-L1 expression was detected. Interestingly, cases with lower CD8+ TIL density presented greater recurrence rates. Conclusion Our findings suggest that the ACC microenvironment exhibits low immunogenicity, represented by low TIL and DC density. Moreover, there seems to be activation of the immune inhibitory proteins/PD-L2 and HLA-G, a scenario that may favor tumor escape from the immune system and partially explain the poor prognosis of ACC.

Background The diagnosis of oral and maxillofacial mature T/NK-cell neoplasms is challenging because of their rarity, morphological heterogeneity and complex immunophenotype, with scarce available data describing their clinical and microscopic aspects. Therefore, in this study we investigated a series of mature T/NK-cell neoplasms affecting this anatomical region and provided an updated literature review. Methods Cases diagnosed as mature T/NK cell lymphomas affecting the oral and maxillofacial region were retrospectively retrieved from six pathology files and their diagnoses were confirmed using haematoxylin and eosin-stained slides, immunohistochemical reactions and in situ hybridization for Epstein-Barr virus (EBV) detection. Patients' clinical data were collected from their pathology forms. Results A total of 22 cases were included in this study. Eleven (50%) consisted of extranodal NK/T-cell lymphomas, nasal type; eight (36.4%) were peripheral T-cell lymphomas, NOS; two (9.1%) were adult T-cell leukaemia/lymphomas, and one (4.5%) was an ALK-positive anaplastic large cell lymphoma. Overall, males predominated, with a mean age of 55.7 years. The palate was the most affected site (50%), and tumours usually presented as destructive and painful ulcers. EBV was present in all cases of extranodal NK/T cell lymphoma nasal type, but was absent in the other subtypes. Conclusion Among mature T/NK-cell lymphomas of the oral and maxillofacial region, extranodal NK/T cell lymphoma, nasal type and peripheral T-cell lymphoma, NOS predominated. Older men were the most affected patients, and this heterogenous group of neoplasms has a very aggressive clinical behaviour.

The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Objectives Neutrophil extracellular traps (NETs) play a role in the pathogenesis of periodontitis and rheumatoid arthritis (RA). However, it remains poorly understood whether NETs participate in the cross-talk between periodontitis and RA. Herein, we investigated the production of NETs in individuals with periodontitis and RA and its association with clinical parameters. The impact of periodontal therapy on RA and NET release was also assessed. Methods The concentration of NETs and cytokines was determined in the saliva and plasma of individuals with early RA (n = 24), established RA (n = 64) and individuals without RA (n = 76). The influence of periodontitis on the production of NETs and cytokines was also evaluated. Results Individuals with early RA had a higher concentration of NETs in saliva and plasma than individuals with established RA or without RA. Periodontitis resulted in an increase in the concentration of NETs of groups of individuals without RA and with early RA. The proportion of individuals with high concentrations of IL-6, IL-10 and GM-CSF was higher among individuals with periodontitis than among individuals without periodontitis. The concentrations of TNF-α, IL-6, IL-17/IL-25 and IL-28A were particularly high in individuals with early RA. Worse periodontal clinical parameters, RA onset and RA activity were significantly associated with circulating NETs. Periodontal therapy was associated with a reduction in the concentration of NETs and inflammatory cytokines and amelioration in periodontitis and RA. Conclusion This study reveals that NETs are a possible link between periodontitis and RA, with periodontal therapy resulting in a dramatic switch in circulating NET levels.

Tobacco smoking involves a high risk of human malignancies, including oral cancer, because it contains multiple carcinogens that cause genetic instability. Thus, a worse prognosis would be expected for cancer patients who are smokers. The aim of this study was to assess the DNA damage response through the expression of checkpoint kinase 2 (CHK2), H2A histone family member X (H2AX), and P53 among smokers and non-smokers with oral squamous cell carcinoma (OSCC). Associations between immunoexpression of proteins and clinicopathological data and histopathological grading were also analyzed. A total of 35 individuals (18 non-smokers and 17 smokers) with OSCC of the tongue and/or floor of the mouth were included. Immunohistochemistry for H2AX was conducted for the identification of double-strand breaks, CHK2, and P53 to evaluate the expression of this protein in cell cycle regulation. The sample consisted of 22 males and 13 females, with a mean age of 63.9±11.8 years. OSCC of non-smokers were well-differentiated tumors in 50% of the cases, and those of smokers were equally distributed into moderately differentiated and poorly differentiated tumors (35.3% each). Overall, 31 (88.6%) cases were CHK2-positive, 27 (77.1%) were H2AX-positive, and 23 (65.7%) were P53-positive, with no difference between smokers and non-smokers (p > 0.05). No association was found between proteins and clinicopathologic data (p > 0.05). Similarities in CHK2, H2AX, and P53 immunohistochemical staining patterns were observed between smokers and non-smokers, and immunoexpression was not associated with clinicopathological parameters. However, the findings indicated consistent expression of these proteins in OSCC.

Background Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding. Case report We report here a challenging case of aggressive CGCG in a 15-year-old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H-score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow-up for 11 years without evidence of recurrence. Conclusion Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries

Background Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. Objective To characterize the diversity of cutaneous manifestations of COVID-19, and facilitate understanding of underlying pathophysiology. Methods Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. Results The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, while retiform purpura presented exclusively in ill, hospitalized patients. Limitations We cannot estimate incidence or prevalence. Confirmation bias is possible. Conclusion This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were non-specific, while others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology., Capsule Summary

Medical as well as non-medical practitioners specialized in oral health are at high risk of infection with the Coronavirus-19 (Covid-19) because of the proximity with potentially infected biological fluids. This risk is permanent, especially during examination, care and transfer of patients. Regarding the pandemic progression of Covid-19, efficient protocols of prevention are urgently needed. Based on our experience and on the recently reported guidelines from the French National Agency for Public Health (ARS, March 5, 2020), the French Society of Hospital Hygiene (SFHH, March 4, 2020) and the Department of Infectious Risk Prevention of the Hospitals of Paris-Public Assistance (APHP, March 6, 2020), we provide several recommendations for practitioners specialized in oral health, to protect themselves from nosocomial infections, especially Covid-19.

Liposarcomas of the oral cavity are rare. Those originating in the buccal mucosa cause challenging diagnostic and therapeutic issues since less than 40 cases of liposarcomas of the buccal mucosa and cheek have been reported in the worldwide literature. Herein, we present a case of atypical lipomatous tumor/well-differentiated liposarcoma affecting a 45-year-old female patient. Ultrasonography and magnetic resonance imaging confirmed a well-defined mass located in the right buccal mucosa, extending to the submucosal layers of the cheek. Histopathologically, a well-differentiated fatty neoplasm with presence of prominent stromal inflammatory cells was observed. Multifocally scattered bizarre hyperchromatic stromal cells, some of which multinucleated, were also observed. An immunohistochemical panel comprising vimentin, S-100, CD10, CD34, CD20, CD3, CD68, CD138, MDM2, Ki-67, and P53 was employed to better characterize the lesion. A local recurrence event occurred during a 10-year follow-up period. Surgical resection was performed during both episodes. We also provided an overview of demographic and clinicopathological characteristics, immunohistochemical features, imaging findings, and the differential diagnosis of liposarcoma of the oral cavity. Knowledge of the etiopathological and clinical aspects of this rare neoplasm is fundamental in order to rule out other conditions, including lipomatous lesions that affect the buccal mucosa.

Among the ways to approach cases of ectopic teeth, the surgical approach is a valid option and should be considered, since it is considered simple and it permits direct visualization and a rapid recovery. The aim of this article is to report a rare case of ectopic tooth in the lateral wall of the nasal cavity caused by trauma in the maxillofacial region in childhood, and to describe its clinical and imaging characteristics as well as ways of treatment and surgical aspects. A 25-year-old woman was seen at the clinic of Maxillofacial Surgery and Traumatology due to the presence of a foreign body in the nose. A treatment plan was elaborated based on physical and radiographic examination. The tooth was removed by a surgical approach and the patient underwent esthetic rehabilitation. Surgical treatment of ectopic teeth provides a good and satisfactory postoperative result, is simple and mostly without complications. Ectopic teeth are rare, and the professional should be able to perform the diagnosis, indication and planning of treatment, as well as its execution. Surgical treatment is an option that produced an effective result in the present case.Descriptors: Mouth; Tooth, Impacted; Ambulatory Surgical Procedures.ReferencesVerma RK, Bakshi J, Panda NK. Ectopic intranasal tooth: an unusual cause of epistaxis in a child. Ear Nose Throat J. 2012;91(6):242-44.Gupta YK, Shah N. Intranasal tooth as a complication of cleft lip and alveolus in a four years old child: case report and literature review. Int J Paediatr Dent. 2001;11(3):221-24.Thor AL. Delayed removal of a fully intruded primary incisor through the nasal cavity: a case report. Dental Traumatol. 2002;18(4):227-30.Koçak HE, Özdamar K, Bilgi B, Aipayam H. Case report a rare cause of intranasal mass: bilateral ectopic nasal teeth. Iran J Otorhinolaryngol. 2017;29(94):287-89.Van Essen TA, Van Rijswijk JB. Intranasal toothache case report. J Laryngol Otol. 2013;127(3):321-22.Kim DH, Kim JM, Chae SW, Hwang SJ, Lee SH, Lee HM. Endoscopic removal of an intranasal ectopic tooth. Int J Pediatr Otorhinolaryngol. 2003;67(1):79-81.Ray B, Singh LK, Das CJ, Roy TS. Ectopic supernumerary tooth on the inferior nasal concha. Clin Anat. 2006;19(1):68-74.Zalagh M, Akhaddar A, Benariba F. Chronic rhinorrhea revealing an actinomycotic rhinolithiasis with ectopic tooth. Int J Oral Maxillofac Surg. 2012;41(3):297-99.Moreano EH, Zich DK, Goree JC, Graham, SM. Nasal tooth. Am J Otolaryngol. 1998;19(2):124-26.Sammatino G, Trosino O, Perillo L, Cioff A, Marenzi G, Mortellaro C. Alternative transoral approach for intranasal tooth extraction. J Craniofac Surg. 2011;22(5):1944-46.Lee FP. Endoscopic extraction of an intranasal tooth: a review of 13 cases. Laryngoscope. 2001;111(6):1027-31.

Myiasis is an infection caused by the deposition of fly larvae in tissues, and its involvement in the human oral cavity is uncommon. Herein, we have performed a data analysis of published cases of oral myiasis. A search was performed in PubMed, Ovid, Web of Science, Scopus, and LILACS. Geographic distribution, demographic data, associated factors, clinical features, fly types, treatment, and presence of sequelae were analyzed. A total of 122 articles reported the cases of 157 infected individuals. The most affected countries were India (41%) and Brazil (29.5%). Male predominance (67.5%) and a mean of 41.9 years of age were observed. The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%). There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing. The establishment of a standard treatment protocol, enabling comparison in future studies and providing uniformity in treatment strategies offered by health services is strongly recommended.

The coronectomy technique is an alternative to conventional impacted tooth removal which aims to reduce the risk of damage to the inferior alveolar nerve (IAN). The technique is usually performed by senior oral surgeons or residents in training. Herein, patients were treated in a single service, in which coronectomy was performed by an undergraduate dental student on partially erupted lower third molars. A prospective analysis was performed on 21 individuals submitted to a total of 35 coronectomies. Clinical and radiographic follow-up was performed for at least 12 months. Overall, healing was within normal limits, without major complications and without permanent IAN injury. However, one case showed temporary IAN paraesthesia resolved within a month and two required repetitions of coronectomy due to the remaining enamel, but with a good final result. Root migration was observed in all cases, but no other surgery was required. Coronectomy may be an important option for treating partially erupted teeth in close nerve relationships, which could also be performed by trained undergraduate dental students. This series is interesting because it can encourage oral and maxillofacial surgeons to train undergraduate students and to stimulate their attraction and passion for surgery.

Introduction Anticoagulants are widely used in orthopedic surgery to decrease the risk of deep vein thrombosis. While significant bone impairment is induced by long-term heparin therapy, little is known about the effects of direct oral anticoagulants (DOACs). Herein, we investigated the effects of dabigatran etexilate (Pradaxa®), a DOAC inhibitor of thrombin, on bone cells using in vitro and ex vivo cell culture models. Materials and methods Osteoblasts and osteoclasts exposed to different concentrations of dabigatran etexilate and untreated cells were assayed for cell differentiation and activity. Favorable osteogenic conditions for osteoblasts were tested using titanium with nanotopography (Ti-Nano). In addition, mice treated with a dabigatran etexilate solution had bone marrow cells analyzed for the ability to generate osteoclasts. Results Dabigatran etexilate at concentrations of 1 μg/mL and 2 μg/mL did not impact osteoclast or osteoblast viability. The drug inhibited osteoclast differentiation and activity as observed by the reduction of TRAP+ cells, resorption pits and gene and protein expression of cathepsin K. Consistently, osteoclasts from mice treated with dabigatran showed decreased area, resorptive activity, as well as gene and protein expression of cathepsin K. In osteoblast cultures, grown both on polystyrene and Ti-Nano, dabigatran etexilate reduced alkaline phosphatase (ALP) activity, matrix mineralization, gene expression of ALP and osteocalcin. Conclusions Dabigatran etexilate inhibited osteoclast differentiation in ex vivo and in vitro models in a dose-dependent manner. Moreover, the drug reduced osteoblast activity even under optimal osteogenic conditions. This study provides new evidence regarding the negative overall impact of DOACs on bone cells.

Background The aim of the present study was to investigate pain perception and anxiety within the context of surgery for the placement of mandibular block bone and to evaluate the causality effect between theses variables. Material and methods A total of 13 patients were recruited for the study and were submitted to mandibular autogenous block bone surgery. Demographic data were collected and the anxiety level was determined using the State-Trait Anxiety Inventory (STAI). The STAI was administered on the day of surgery and on the 14th postoperative day. Pain was determined using the visual analogue scale (VAS) and limitation of daily activities and postoperative symptoms were also reported. Data were analyzed using parametric tests (α=0.05) and cross-lagged analysis was performed to verify a causality effect. Results Few patients reported interference with daily activities or the presence of postoperative symptoms. A significant association of bad breath/taste with STAI-State was detected on the 14th postoperative day. No evidence of causality between STAI and VAS was detected. Conclusions The patient's self-evaluation indicates that the pain and anxiety level felt during treatment was not directly associated with the clinical aspects of the surgical procedure or with postoperative activities/symptoms limitations. Key words:Anxiety pain, questionnaires, autogenous bone block, treatment, outcomes.

Complete removal of hypertrophied inferior nasal turbinates may favour the occurrence of the empty nose syndrome (ENS). Some surgeons recommend partial turbinectomy in order to minimize the occurrence of ENS. However, little is known about whether total removal of the inferior nasal turbinate is associated with ENS. The aim of the present study was to evaluate the effects of total turbinectomy and septoplasty on the breathing of individuals undergoing orthognathic surgery with maxillary impaction. A total of 20 individuals participated in this cross-sectional study, in which the relationship between exposure (maxillary orthognathic surgery) and outcome (nasal respiratory function) was investigated. The Empty Nose Syndrome 6-Item questionnaire and Nasal Obstruction Symptom evaluation scale were applied to investigate the ENS. A three-dimensional assessment of the piriform opening was performed pre- and postoperatively by computed tomography in order to measure the volume of the nasal cavities using the Dolphin Imaging software. ENS was detected in 35% of patients, while 13 reported improved breathing. Symptoms of ENS such as dryness, suffocation, nose feels too open and nasal crusting were mentioned. The mean nasal cavity volume was 7477.15 mm³ greater in the initial evaluation (p

Introduction: Postoperative management of patients undergoing tonsillectomy is challenging. Photobiomodulation therapy (PBMT) has emerged as a new tool providing therapeutic benefits. However, the contribution of PBMT to the postoperative outcomes of tonsillectomy is still undefined. This systematic review and meta-analysis evaluated the published literature addressing the effects of PBMT on post-tonsillectomy. Methods: Searches in Scopus, PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and grey literature were carried out for the identification of randomised controlled trials reported up to August/2021. The risk of bias with the Cochrane Collaboration tool and meta-analysis was performed. Outcomes were assessed with the Kaplan-Meier method and the log-rank test. Results: A total of 1183 articles were retrieved, of which only two were included for qualitative and quantitative analysis. The wavelengths were 685 nm and 980 nm with energy density set at 4 J/cm². The mandibular angle and the surgical wound were the sites of laser irradiation. Individuals who had not undergone PBMT after tonsillectomy were more likely to report pain and odynophagia in the first 24 hours after surgery than individuals who had undergone PBMT after tonsillectomy (P0.05). However, both studies found a significant association of PBMT with reduced analgesic consumption. Conclusion: Although PBMT seems promising for the management of individuals undergoing tonsillectomy, a limited number of studies are available in the literature.

Undifferentiated cells play pivotal roles in sustaining tissue homeostasis during physiological turnovers and after tissue impairment. Nestin and Neuron-glial antigen 2 (NG2) are markers frequently deployed to distinguish progenitor populations. In the salivary gland scenario, these markers remain largely unknown. Particularly for a double-labeled group of progenitor cells (NG2The major salivary glands tissues of Nestin-GFP/NG2-DsRed mice were analyzed under a fluorescence microscope. The cells marked by GFP and DsRed were counted in the merged image component of random representative images obtained for each gland sample at × 20 magnification.In the parotid, submandibular, and sublingual glands, the population of cells exclusively expressing Nestin was more abundant. There was a predominance of Nestin, NG2, and double-labeled cells in the submandibular gland compared to the parotid gland, mainly near the ductal system. Of note, the sublingual and parotid glands had similar populations of NestinCollectively, our study revealed differential expression patterns of Nestin and NG2, alone or in combination, in the salivary gland subset during homeostasis.

To evaluate the efficacy of photobiomodulation for bone repair of critical surgical wounds with implants of bone morphogenetic proteins (BMPs) and bovine biological membranes, using histological and histomorphometric analysis.Tissue engineering has been developing rapidly through the use of various biomaterials for the treatment of bone defects, such as mechanical barriers consisting of biological membranes and implants of biomaterials for bone supply.Thirty-two male rats were divided into four groups (n = 8): group I-C: control; group II-PT: photobiomodulation therapy; group III-PM: Gen-ProHistological analysis confirmed the histomorphometric results, with the experimental groups showing bone neoformation of significantly higher quality and quantity at the end of 30 days compared with the control group.Photobiomodulation therapy was effective for bone repair mainly when associated with BMPs and a biological membrane. The results of this study are promising and stimulate further scientific and clinical research.

Objectives To analyse the occurrence of calcifying epithelial odontogenic tumours (CEOT) based on biopsy records from different Brazilian geographic regions and to contrast the data with a review of the literature. Materials and methods A 2-step study was conducted. Step 1 consisted of a collaborative study of biopsies obtained from 1953 to 2017 at six Brazilian oral and maxillofacial pathology centres. Evaluation of 86,268 biopsy records was performed. Demographic and histopathological diagnosis data were assessed. In Step 2, a review of the literature of case reports and cases series of CEOT identified across five electronic databases was conducted. Results In the collaborative study, 32 cases of CEOT were evaluated. This figure represented 0.03% of the oral and maxillofacial lesions and 1.7% of all odontogenic tumours across the centres. Women in the fourth decade of life were more affected. CEOT occurred more in the mandible than in the maxilla (ratio 1.9:1). The review of the literature showed that Asian individuals were more affected by this neoplasm. Conclusions Useful knowledge on the epidemiology, treatment and follow-up of CEOT has been provided. Demographic data and clinical features of the cases presented in this collaborative study were quite similar to those of studies reported worldwide.

This article describes a simple method for painting an artificial iris for the manufacturing of an ocular prosthesis with dark and light tones, both with excellent esthetic results. The challenge of choosing colors around the pupil and medium zone during painting is aided by the application of Newton's color wheel theory. This technique provides a safer choice of color during the painting procedure by using a mixture of ceramic pigments.

Objective The aim of this study was to investigate the frequency and some characteristics of odontogenic tumours, odontogenic cysts and non-odontogenic cysts in an elderly population (≥60 years). Background Few studies describe the distribution of oral lesions in older people. Materials and methods A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of four Brazilian referral centres between 2000 and 2016. Data such as gender, age, anatomical location, symptomatology and histopathological diagnosis were collected and categorised. Statistical analyses were performed adopting a P-value of ≤.05 and a 95% confidence interval. Results A total of 7259 biopsy records of elderly participants were analysed; 642 cases were cystic lesions and odontogenic tumours, 491 of which being classified as odontogenic cysts (76.5%), 75 as odontogenic tumours (11.7%) and 76 as non-odontogenic cysts (11.8%). The most frequent lesions in each group were radicular cyst (n = 268), ameloblastoma (n = 51) and salivary duct cyst (n = 21), respectively. Overall, women were more affected (n = 351, mean age: 68 years). Intraosseous lesions were more common in the mandible (n = 342), and soft tissue cysts occurred more in the lip (n = 13). Conclusion Odontogenic cysts were relatively common, whereas odontogenic tumours and non-odontogenic cysts were rarer among the older people studied in the present investigation.

Background The aim of this study was to integrate the available data published on calcifying odontogenic cyst (COC), dentinogenic ghost cell tumor (DGCT), and ghost cell odontogenic carcinomas (GCOCs) into a comprehensive analysis of their clinicoradiological features, treatment, and recurrence. Materials and methods An electronic search with no publication date restriction was undertaken in October 2017 in the following databases: PubMed, Medline Ovid, Web of Science, and Scopus. Eligibility criteria included publications containing enough clinical, radiological, and histopathological information to confirm a definite diagnosis of these lesions. Data were evaluated descriptively. Results The literature review indicated a total of 234 publications reporting 367 COCs, 55 DGCTs and 44 GCOCs. These lesions have a predilection for Asian males. COCs mainly affect the mandible and patients in the second decade of life, DGCTs mostly affect the mandible and patients in the fourth decade of life, and GCOCs mostly affect the maxilla and patients in the fifth decade of life. Conclusion Conservative surgery was the most common therapy for COCs and DGCTs, while radical surgery was most common for GCOCs. This study provides important and interesting data that could help clinicians and surgeons as well as oral and maxillofacial pathologists with the diagnosis and management of these lesions.

COVID-19 continues to be at the cusp of its transmission with bouts of second and third waves and the pandemic is yet far from over Data on medical aerosols in the literature are more robust unlike the limited data reported on the absolute risk of COVID-19 amongst dentist providers It is precarious to assume that dental care using protective shields involves limited exposure to the virus 1 A previous study2 on the mortality risk of 278 physicians revealed that 6% were dentists;thus, the burden imposed by COVID-19 on health workers is overwhelming, undeniable and should not be underestimated

Objectives To investigate the frequency of malignant oral and maxillofacial lesions among children and adolescents from representative geographic regions of Brazil. Materials and Methods A retrospective study was conducted on biopsies obtained from 1990 to 2016 at six Brazilian oral and maxillofacial pathology referral centers. A total of 85,105 biopsy specimens from children and adolescents were analyzed. Gender, age, anatomical location, symptomatology and histopathological diagnosis were evaluated. Data were analyzed using descriptive statistical methods. Results Fifty-eight (0.06%) malignant oral and maxillofacial lesions were diagnosed in children (19%) and adolescents (81%). The lesions were more frequent among females (60.3%) and adolescents. The most prevalent lesions were mucoepidermoid carcinomas (22.4%), osteosarcomas (13.8%), squamous cell carcinomas (12.1%), and Burkitt’s lymphomas (12.1%). The most commonly affected sites were the palate (19%), mandible (13.8%), and maxilla (13.8%). Almost half the patients were asymptomatic. Conclusion Pediatric oral and maxillofacial malignant lesions were infrequent and showed wide diversity, with a prevalence of mucoepidermoid carcinomas. Analysis of malignant lesions in children and adolescents helps pediatric dentists and oncologists to obtain a better understanding of such lesions and to reduce the time for diagnosis, with a consequent improvement of prognosis.

Background Odontogenic myxoma (OM) is an uncommon neoplasm of the jaws. Considering the importance of defining the relative incidence and demographic profile of these lesions in South America, the aim of this study was to analyze the clinical and imagiological features of OM from three South American oral pathology services and to discuss these findings in light of the literature. Methods Data regarding age, gender, anatomic site and imagiological features from 85 cases of OM were collected. Additionally, we did a review of OM studies published in three electronic databases. Results Among 63,450 oral biopsies, 1,178 (1.85%) were odontogenic tumors (World Health Organization - 2017), of which 85 (7.21%) met the criteria of OM. The mean age was 30.7 years (range: 10-61 years; SD: 12.22). Forty-five (52.9%) cases occurred in females and 40 (47.1%) in males (ratio: 1:1.12). Maxilla was affected in 44 cases (53%) and mandible in 39 (47%). Of the 41 informed cases (48.2%), all of them were radiolucent lesions. The literature review indicated a majority of mean ages in third decade and a predilection for females, mandible and multilocular radiolucent lesions. Conclusions The features of OM samples have strong similarity to that reported in studies from other continents. It is possible to infer that geographic variation does not help to explain some differences observed in the clinical features of OM. This article is protected by copyright. All rights reserved.