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Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions.To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region.Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies.A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%.This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

Objectives To assess the association between oral mucosa hyperpigmentation in patients with leukemia and imatinib mesylate use. Additionally, we compared our data to those obtained from a systematic review. Materials and methods A cross-sectional study was conducted with 74 patients undergoing treatment with imatinib mesylate. Sociodemographic characteristics, oral mucosa alterations, and medical history were evaluated. Oral hyperpigmentation was scored. The use of imatinib mesylate and hydroxyurea was evaluated. Association between oral hyperpigmentation and imatinib mesylate was assessed. A systematic review was also conducted to retrieve case reports or case series of patients with oral hyperpigmentation associated with imatinib mesylate. Results Among the 74 participants, 41 were male (55.4%) and 33 were female (44.6%). Participants’ mean age was 49.3 years. Sixty-six (89.2%) patients developed hyperpigmented lesions in the hard palate mucosa. In multivariate analysis, patients who had used imatinib mesylate for > 72 months had a hyperpigmentation score 1.62 times higher than those who had used this medication during a shorter period. Patients who had used hydroxyurea for > 30 days had a hyperpigmentation score 1.43 times higher than those who had used this medication during a shorter period. The systematic review retrieved 20 clinical cases of patients undergoing imatinib mesylate treatment and exhibiting oral hyperpigmentation. Conclusions The development of oral hyperpigmentation is associated with imatinib mesylate use. Hydroxyurea seems to increment such an association. Clinical relevance To assist providers in the differential diagnosis of hyperpigmented lesions associated with imatinib mesylate, as well as in the clinical management of such lesions. Objetivos Avaliar a associação entre hiperpigmentação da mucosa oral em pacientes com leucemia e mesilato de imatinibe usar. Além disso, comparamos nossos dados com os obtidos em uma revisão sistemática. Materiais e métodos Foi realizado um estudo transversal com 74 pacientes em tratamento com mesilato de imatinibe. Foram avaliadas características sociodemográficas, alterações da mucosa oral e histórico médico. A hiperpigmentação oral foi marcou. Foi avaliado o uso de mesilato de imatinibe e hidroxiureia. Associação entre hiperpigmentação oral e imatinibe mesilato foi avaliado. Uma revisão sistemática também foi realizada para recuperar relatos de casos ou séries de casos de pacientes com hiperpigmentação associada ao mesilato de imatinibe. Resultados Entre os 74 participantes, 41 eram do sexo masculino (55,4%) e 33 do sexo feminino (44,6%). A média de idade dos participantes foi de 49,3 anos. Sessenta e seis (89,2%) pacientes desenvolveram lesões hiperpigmentadas na mucosa do palato duro. Na análise multivariada, os pacientes que usaram mesilato de imatinibe por > 72 meses tiveram um escore de hiperpigmentação 1,62 vezes maior do que aqueles que usaram este medicação durante um período mais curto. Pacientes que usaram hidroxiureia por > 30 dias apresentaram escore de hiperpigmentação 1,43 vezes maior do que aqueles que usaram esse medicamento por um período menor. A revisão sistemática recuperou 20 casos clínicos de pacientes submetidos a tratamento com mesilato de imatinibe e exibindo hiperpigmentação oral. Conclusões O desenvolvimento de hiperpigmentação oral está associado ao uso de mesilato de imatinibe. A hidroxiureia parece incrementar tal associação. Relevância clínica Para auxiliar os profissionais no diagnóstico diferencial de lesões hiperpigmentadas associadas ao mesilato de imatinibe, bem como no manejo clínico dessas lesões.

Background Quantitative assessment of bleeding in dental extractions is rarely reported in the literature. The assessment of bleeding might provide additional evidence to predict and minimize postoperative outcomes. The aim of this study was to evaluate the pattern of bleeding in individuals taking direct oral anticoagulants (DOACs) submitted to dental extractions. Methods Intraoperative bleeding was evaluated by using total collected bleeding corrected by absorbance reading (dental bleeding score). To monitoring bleeding episodes from the day of surgery, this cohort was followed up until the seventh postoperative day. Results Forty-five procedures were performed in three comparative groups, patients under DOACs, individuals taking vitamin K antagonists (VKAs) and without anticoagulant therapy. No bleeding events were observed in procedures carried out in individuals of the DOAC group. Additional hemostatic measures were required in two procedures in the VKA group and one in the non-anticoagulated group. The dental bleeding scores obtained for the DOAC and VKA groups were similar. Conclusions Our data suggest that the DOAC therapy did not result in increased bleeding outcomes in this sample.

Granulocytic sarcoma (GS) is an extramedullary tumor associated with myelodysplas tic syndromes or myeloproliferative diseases. Intraoral manifestations are considered uncommon, with a reasonable number of cases, and are mostly related to leukemia. The association of oral GS and myelofibrosis is very rare and only three cases have been published. In this paper, we report the fourth case of oral lesion in a patient with a diagnosis of myelofibrosis. The aim of this study was to present a review of the literature, discussing the current and previous cases of oral GS associated with myelofibrosis or other hematological disorders and the importance of accurate diag nosis through clinical, microscopic, and immunohistochemical features. O sarcoma granulocítico (SG) é um tumor extramedular associado a síndromes mielodisplásicas ou doenças mieloproliferativas. As manifestações intraorais são consideradas incomuns, com número razoável de casos, e estão principalmente relacionadas à leucemia. A associação de SG oral e mielofibrose é muito rara e apenas três casos foi publicado. Neste trabalho, relatamos o quarto caso de lesão oral em paciente com diagnóstico de mielofibrose. O objetivo deste estudo foi apresentar uma reviso de na literatura, discutindo os casos atuais e anteriores de SG oral associada a mielofibrose ou outros distúrbios hematológicos e a importância do diagnóstico preciso por meio de características clínicas, microscópicas e imuno-histoquímicas.

To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures. A total of eight cases of perioperative and 12 episodes of postoperative bleeding were documented. The complications were generally managed with local measures and did not require hospitalization. We found significant association of postoperative hemorrhage with increased perioperative bleeding (P = 0.043) and combination of anticoagulant and antiplatelet therapy (P < 0.001). The chance of postoperative hemorrhage for procedures with increased perioperative bleeding is 8.8 times bigger than procedures without perioperative bleeding. Dental surgery in patients under antithrombotic therapy might be carried out without altering the regimen because of low risk of perioperative and postoperative bleeding. However, patients with increased perioperative bleeding should be closely followed up because of postoperative complications risk.

This study sought to review current guidelines and the most optimal dental management for patients undergoing cardiac valve 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.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Os objetivos deste trabalho foram 1) avaliar o impacto da terapia anticoagulante oral no sangramento associado à exodontias durante os períodos intraoperatório e pósoperatório; 2) investigar os efeitos do etexilato de dabigatrana, um inibidor direto da trombina, sobre as células ósseas. Para atender o objetivo 1, foram recrutados indivíduos em uso de anticoagulantes orais do tipo antagonista de vitamina K (AVK) e alvo-específico (DOAC, do inglês direct oral anticoagulant) e indivíduos sem terapia anticoagulante com indicação de exodontia. As exodontias foram realizadas sem a suspensão da terapia anticoagulante e parâmetros associados a desfechos hemorrágicos foram avaliados. A avaliação quantitativa do sangramento intraoperatório foi realizada por meio da mensuração do volume e análise dos fluidos aspirados durante o procedimento e normalizada por um escore. Obtivemos como resultados que as complicações hemorrágicas pós-operatórias bem como o escore de sangramento intraoperatório foi similar entre os grupos, sendo que nenhum evento hemorrágico foi observado no grupo DOAC. A história prévia de complicações hemorrágicas em procedimentos odontológicos (p=0,001) e uso de medidas hemostáticas locais (p=0,017) foram estatisticamente maiores no grupo AVK. Para atender o objetivo 2, experimentos foram conduzidos a partir de modelo in vitro, no qual o efeito da terapia anticoagulante foi avaliado diretamente sobre as células ósseas e em modelo animal ex-vivo. Neste modelo ex-vivo, células de animais previamente tratados com etexilato de dabigatrana foram diferenciadas em osteoclastos. Culturas primárias de células-tronco de camundongos e ratos foram diferenciadas em osteoclastos e osteoblastos e tratadas com o fármaco disponível comercialmente, etexilato de dabigatrana (Pradaxa® 1-6 μg/mL) bem como seu princípio ativo, dabigatrana (0,1, 0,3, 3 e 6 μg/mL). Células não expostas aos medicamentos foram utilizadas como controle. A diferenciação de osteoclastos foi inibida pelo tratamento em ambos os modelos, in vitro e ex-vivo. Paralelamente, observou-se a redução da expressão gênica e proteica do marcador Catepsina K e da atividade reabsortiva destas células. Nas culturas de osteoblastos, o tratamento inibiu a expressão gênica dos marcadores fosfatase alcalina (ALP) e osteocalcina, reduziu a atividade in situ de ALP e a deposição de matriz extracelular, indicando um efeito negativo na diferenciação dos osteoblastos. Concluiu-se que o uso de anticoagulantes orais não aumentou a ocorrência de desfechos hemorrágicos na população estudada, o que reforça a manutenção da terapia para a realização de exodontias. O tratamento sobre culturas celulares utilizando etexilato de dabigatrana impactou negativamente a diferenciação e atividade de osteoclastos e osteoblastos The objectives of this study were 1) to evaluate the impact of oral anticoagulant therapy on the pattern of intraoperative and postoperative bleeding in dental surgery; 2) to investigate the effects of dabigatran etexilate, a direct thrombin inhibitor, on bone cells. To fulfill objective 1, individuals undergoing oral anticoagulant therapy with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) and individuals without anticoagulant therapy, who had indication of dental extraction were included. Dental surgery procedures were performed without interruption of anticoagulant therapy and parameters associated with hemorrhagic outcomes were evaluated. Intraoperative bleeding was evaluated by means of the measurement of the total amount of blood collected during the procedure corrected by absorbance reading and normalized by score. The results showed that the occurrence of bleeding events and the intraoperative blood loss were similar among groups and hemorrhagic episodes were not observed amongst the individuals taking DOACs. The previous history of complications in dental procedures (p=0.001) and the use of additional hemostatic measures (p=0.017) were significantly higher in the VKA group. To fulfill objective 2, experiments were conducted by means of an in vitro model in which the direct effect of anticoagulant therapy on bone cells was evaluated. An ex-vivo animal model in which cells of animals previously treated with dabigatran etexilate were differentiated was also carried out into osteoclasts. Primary cultures of mice and rats cells were differentiated into osteoclasts and osteoblasts and treated with dabigatran etexilate solution (Pradaxa® 1-6 μg/mL) and its active principle dabigatran (0.1, 0.3, 3 and 6 μg/mL). Untreated cells were used as controls and the effects of the treatment on cell viability and differentiation were evaluated. Both dabigatran etexilate and its active principle, dabigatran inhibited osteoclast differentiation and activity in vitro and in the ex-vivo model, as demonstrated by the reduction of resorption pits and cathepsin K gene and protein expression. In osteoblast cultures, dabigatran etexilate reduced the in situ alkaline phosphatase (ALP) activity, matrix mineralization and gene expression of ALP and osteocalcin. These findings indicated osteoblast inhibition. In conclusion, oral anticoagulant therapy did not result in increased bleeding outcomes in this sample, which strengthen the advocacy of the maintenance of the therapy during dental surgery. Dabigatran etexilate treatment impaired the activity and differentiation of osteoclasts and osteoblasts.

Background: Infective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE. Objective: To analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE. Methods: We performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371). Results: Of the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p

Objective The aim of the study was to investigate factors associated with bleeding outcomes in liver disease individuals. Study Design A retrospective study of the information of liver disease individuals who had undergone dental surgery at a hospital-based dental service between 2010 and 2016 was conducted. Sociodemographic and clinical data, including perioperative and postoperative bleeding episodes were surveyed. The association between the outcome variable (bleeding) and the independent variables was evaluated by means of bivariate analyses and Poisson regression analysis. Level of significance was set at .05. Results A total of 71 procedures were carried out in 47 individuals. Seventeen cases (24%) of bleeding complications were recorded. Individuals who had already been submitted to blood transfusion (P = .014) and those who had reported previous hemorrhage (P = .006) presented higher occurrence of bleeding complications. Poisson regression revealed that previous blood transfusion (P = .044) and the indication of liver transplantation (P = .025) significantly increased the occurrence of perioperative and postoperative bleeding. Conclusions Bleeding outcomes in liver disease patients were associated with those procedures that required previous blood transfusion usually with basal platelet count

Drug-induced reactions are complications associated with high mortality and significant morbidity. Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9-year-old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. A drug-induced hypersensitivity reaction to antibiotics was suspected, and a diagnosis of TEN was made. The patient was managed with withdrawal of the suspected causative agent, and the oral lesions were treated with low-level laser therapy (LLLT) and oral hygiene. This case highlights that TEN requires interdisciplinary intervention with dental assistance and follow-up to improve symptoms, nutrition, systemic condition, and quality of life.

Some prospective studies have been designed specifically to investigate perioperative bleeding in dental surgery. The quantitative assessment of intraoperative blood loss can be useful for indicating the real risk of bleeding complications, especially in medically compromised individuals. The aim of this study was to evaluate the pattern of bleeding in individuals under vitamin K antagonist (VKA) therapy and non-anticoagulated individuals submitted to dental extractions. Perioperative bleeding was evaluated by using a total collected bleeding corrected by absorbance reading (dental bleeding score). 138 procedures were performed. When the perioperative dental bleeding score was correlated with the number of extracted teeth, the quantity of bleeding was found to be directly proportional to the procedure. Extractions of two or more teeth presented higher scores than single extractions (p = 0.003). In a comparative analysis between the VKA and non-anticoagulated groups, no significant difference in the scores was found. The previous history of complications in dental procedures (p = 0.001) and the use of additional hemostatic measures were higher in the VKA group (p = 0.017). VKA therapy did not impact significantly the volume of blood lost during dental extractions. Perioperative bleeding assessment might be a useful parameter for evaluating patients under antithrombotic treatment.

Metastatic calcinosis (MC) is a pathologic process that results from the deposition of calcified product in normal tissues as result of hyperphosphatemia with or without concomitant hypercalcemia. A 52-year-old man with history of renal transplant was evaluated for an asymptomatic nodule on the dorsal surface of the tongue. On intraoral examination, an undefined, firm, sessile, irregular, and yellowish surface nodule, measuring 10 × 8 × 4 mm was observed. Panoramic radiograph showed radiopaque areas adjacent to the hyoid bone and paired linear areas of calcification next to the mandibular angle. The medical history revealed a previous diagnosis of chronic renal disease with slightly increased levels of serum phosphorus (5.5 mg/dL). An excisional biopsy was performed. Histopathologic and scanning electron microscopy analysis revealed the presence of amorphous material and basophilic irregularly shaped acellular deposits with a lamellar-like aspect. A final diagnosis of MC was made and the patient was referred for medical evaluation. Financial support: FAPEMIG.

Objective To assess the characteristics of individuals undergoing treatment for leukemia with imatinib mesylate (IM) and to evaluate the factors associated with oral hyperpigmentation in those individuals. Our data have also been compared with those obtained from a systematic review. Study Design A cross-sectional study was conducted with 74 leukemic individuals undergoing IM treatment. Sociodemographic characteristics, oral alterations, and medical history were evaluated. Participants underwent clinical examination for the evaluation of oral hyperpigmentation. Additionally, a systematic review of previous case reports or case series published in electronic databases was carried out. Results Sixty-six (89.3%) individuals developed hyperpigmentation on the hard palate. Individuals who had used IM for more than 72 months presented an oral hyperpigmentation score 1.62 times higher than those who had used IM for less than 72 months. Individuals who had used hydroxyurea for a period longer than 30 days presented an oral hyperpigmentation score 1.43 higher than those who had used hydroxyurea for a period shorter than 30 days. The systematic review retrieved 16 articles reporting cases of individuals undergoing IM treatment and presenting oral hyperpigmentation. Conclusion The development of hyperpigmentation in oral mucosa is associated with the use of IM and hydroxyurea. Support: FAPEMIG.

Objective To review 112 literature cases of patients who received maxillectomies and were rehabilitated with an immediate surgical obturator (ISO) and to discuss details such as sociodemographic data, histopathology, type of maxillary resection, type of prosthetic treatment, and follow-up period. Two illustrative cases of ISO installed after maxillectomy are also presented. Study Design The study was carried out in 2 steps. In the first, an electronic search of ISO for patients who received maxillectomies was performed on MEDLINE/PubMed. In the second, 2 cases diagnosed in children with maxillary neoplasms were reported. Results The review involved 71 (63%) male patients and 41 (37%) female patients with a mean age of 52.8 years. The predominant diagnosis reported was squamous cell carcinoma (67.4%). All patients were treated with conventional methods or by computer-aided design and computer-aided manufacturing method ISO with follow-up periods ranging from 3 weeks to 96 months. Pain and discomfort were reported by few patients. The illustrative cases were an odontogenic myxoma and a fibrous histiocytoma, both in the maxillary region. ISO was installed immediately after maxillectomy. Conclusions ISO was fundamental for the support and protection of the surgical dressing, maintaining facial contour, and enhancing speaking, swallowing, and chewing functions with a rapid return to normal function. Support: FAPEMIG and FMP-FO/UFMG.

Objetivo: Avaliar a participação da Odontologia, em equipe multiprofissional, no contexto hospitalar, a partir da demanda por avaliação odontológica em um hospital de Belo Horizonte. Materiais e Métodos: Foram analisadas 137 solicitações de avaliação odontológica, encaminhadas entre fevereiro/2010 e fevereiro/2012. Foram avaliadas todas as solicitações descritas em interconsultas, agrupadas em: condições patológicas, solicitação de avaliação, sintomas, higiene bucal e outras observações. Os dados foram registrados emplanilhas do programa Excel for Windows e apresentados em valores absolutos e percentuais. Resultados: A maioria dos pacientes era do sexo masculino (70%) com idade média de 54 anos (±19,88). As descrições das solicitações de interconsulta totalizaram: condições patológicas (n=98), solicitação de avaliação (n=19), sintomas (n=-20), higiene bucal (n=10) e outras observações (n=21). As cinco expressões mais recorrentes nos pedidos foram “condição dentária precária” seguida pela “avaliação odontológica”, “dor de dente”, “lesõesde mucosa” e “dentes com mobilidade”. As cinco expressões mais recorrentes nos pedidos foram “condição dentária precária” seguida pela “avaliação odontológica”, “dor de dente”, “lesões de mucosa” e “dentes com mobilidade”. Conclusão: Conclui-se que, no período de dois anos houve crescimento das solicitações por avaliações odontológicas apesar de muito pequeno, frente ao total de internações ocorridas no mesmo período. O crescimento da procura pelo cirurgião-dentista pode representar o reconhecimento da necessidade de sua integração na equipe hospitalar, mesmo sem estar clara a noção de equipe multiprofissional.Descritores: Saúde bucal. Unidade hospitalar de Odontologia. Assistência odontológica.

Intravenous immunoglobulin (IVIG) is used in the treatment of neuropathy. This case report presents, for the first time, a patient with severe periodontal destruction after chronic therapy with IVIG. The patient reported having extracted his maxillary anterior teeth himself due to high mobility. Clinical examination and radiographic images show a generalized and severe periodontitis. No significant alterations in genetic or microbiological features were observed. The present case suggests that periodontal disease aggravation could be considered a new adverse effect of IVIG therapy. Postulated mechanisms are immune complexes formation, complement activation, and a direct effect in osteoclasts. In conclusion, it is important that patients that will receive IVIG treatment underwent dental evaluation.