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The aim of this multicentric study was to assess the diagnostic accuracy of a telediagnosis service for oral mucosal disorders.This study included 100 patients seen at the oral medicine outpatient clinic of 3 Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catrina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform.The sensitivity and specificity of telediagnosis were compared with those of the face-to-face approach and found to be 100% and 97.4%, respectively. The concordance between the examiners was 95%, and case management was relatively simple in approximately 60% of cases.Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.

Objetivo: Proponer el uso del láser de baja potencia extraoral para el tratamiento de la odinofagia asociada a mucositis hipofaríngea radio inducida. La odinofagia se caracteriza por dolor al tragar, que a menudo requiere cambios en la dieta, lo que impacta directamente en la calidad de vida del paciente. Material y métodos: La investigación fue un estudio observacional descriptivo con reporte de series de casos clínicos. Se realizó aplicación de fotobiomodulación extraoral para tres pacientes con odinofagia asociada a mucositis oral e hipofaríngea. Se utilizó la terapia con láser de baja potencia (Therapy XT DMC®), con λ808nm, 100 mW de potencia y 4J de energía, 40 segundos por punto. Se recopilaron, transcribieron y revisaron cualitativamente los informes de tres pacientes que se sometieron a tratamiento. Los puntos de aplicación del láser se propusieron a partir de un estudio anatómico previo en cadáveres, que buscó identificar la mejor zona de aplicación del láser extraoral en la región cervical para llegar a la hipofaringe. Resultados: Los pacientes informaron una reducción de la odinofagia y una mayor comodidad con el uso de este tratamiento en el trígono carotídeo. Conclusión: El trígono carotídeo resultó ser la mejor región extraoral para la aplicación de láser para llegar a la región hipofaríngea. El uso de láser de baja potencia aplicado en esta región redujo la odinofagia de los pacientes. Se necesitan más estudios para evaluar la capacidad analgésica de este tratamiento.

Introduction: Oral and hypopharyngeal mucositis are considered acute effects of great importance of radiotherapy. Patients present painful ulcers, dysphagia, odynophagia and difficulties in speaking, which can lead to malnutrition and treatment discontinuation. Currently, photobiomodulation therapy, using low-level laser therapy is the treatment of choice for oral mucositis. Objective: To propose the use of extraoral laser therapy to treat odynophagia associated with radioinduced hypopharyngeal mucositis. Methods: Pilot study divided into two stages: (1) Anatomical study in cadavers, to select the best area of application of the extraoral laser in the cervical region to reach the hypopharynx. In this stage, we opted for the use of low-level light therapy (XXXXX®), continuous mode, λ660nm, 100mW power, 0.028cm2 spot. (2) Application of extraoral photobiomodulation for patients with odynophagia associated with oral and hypopharyngeal mucositis. The same low-level laser therapy (XXXXX®,) was used, but with λ808nm, 100mW power and 4J energy, 40 pulses per point. Reports of three patients who underwent treatment were collected, transcribed and reviewed qualitatively. Results: (1) The anatomical region that allowed better access of extraoral laser therapy to the hypopharynx was the carotid triangle. (2) Patients reported reduced odynophagia and greater comfort with the use of this treatment. Conclusion: The carotid trigone was the best extraoral region for laser application to reach the hypopharyngeal region. The laser therapy protocol applied in this region brought comfort to the patients assessed. Further studies are needed to assess the analgesic capacity of this treatment.

Aims: To report two cases of onco-hematologic diseases diagnosed by oral biopsy and subsequent flow cytometry immunophenotyping. Presentation of Case: Case 1: A 36-year-old woman, HIV +, referred to the Hospital Dentistry Center presenting an extensive, ulcerated and painless lesion in the left maxilla involving teeth #24, #25, #26 and #27. A fine needle aspiration and incisional biopsy were performed and one sample was sent to anatomopathological analysis and other to immunophenotyping. Immunophenotyping revealed 31.2% of aberrant plasma cells with phenotype suggestive of plasmablastic lymphoma. Case 2: 62-year-old male patient attended Hospital Emergency presenting extra and intraoral swelling on the left side of maxilla. Fine needle aspiration and incisional biopsy were performed, followed by pathological analysis and immunophenotyping. Immunophenotyping revealed 40.7% of large mature B cells with phenotype suggestive of diffuse large B-cell lymphoma. Both patients presented histopathological and immunophenotyping results leading to the same diagnosis. After definitive diagnosis, both patients underwent antineoplastic treatment through cycle of chemotherapy. Conclusion: Immunophenotyping is a well-established method for the diagnosis of onco-hematologic diseases and has been shown to be effective for the rapid diagnosis of oral tumors.

BACKGROUND The cell-block technique is a cytological diagnostic method that decreases cellular dispersion; however, its usefulness regarding intraosseous lesions is underexplored. Therefore, this study aimed to assess the diagnostic usefulness of cell-block for cystic and cyst-like jaw lesions. METHODS Individuals with cystic or cyst-like jaw lesions who underwent aspiration biopsy were considered eligible. Aspiration of luminal content was prepared and processed by the cell-block technique. Cytological evaluations were blindly performed by two trained PhD students (in a single evaluation) and one oral and maxillofacial pathologist (OMP). Cohen's kappa statistic was used to measure inter-rater agreement. RESULTS The sample was composed of 52 lesions, represented by 25 radicular cysts (RC), 17 odontogenic keratocysts (OKC), 5 idiopathic bone cavities (IBC), and 5 unicystic ameloblastomas (UA). The kappa coefficient of cell-block compared to histopathological diagnosis was 0.390 (95% confidence interval [95%CI], 0.195-0.585) for PhD students and 0.612 (95%CI, 0.433-0.791) for the OMP. The highest concordance rates between cell-block and histopathological diagnosis were observed for RC (PhD = 76.0%; OMP = 80.0%) and OKC (PhD = 58.8%; OMP = 76.5%). Conflicting results were found regarding IBC (PhD = 40.0%; OMP = 80.0%) and UA, that presented the overall lowest concordance rates (PhD = 20.0%; OMP = 40.0%). CONCLUSION The cell-block technique presented a high diagnostic usefulness for detecting RC and OKC and, if associated with clinical and radiographic characteristics, might be sufficient for final diagnosis of these diseases. Regarding IBC and UA, an analysis with a higher number of cases is recommended to determine the true usefulness of the cell-block as ancillary tool for the diagnosis of these lesions.

RESUMO As próteses bucomaxilofaciais (PBMF) têm como objetivo a reabilitação oral de pacientes com mutilações decorrentes de cirurgias de câncer de boca. Como parte dessa reabilitação oral, a terapia fonoaudiológica associada ao biofeedback ultrassonográfico da língua possibilita melhor precisão da produção de fala. O presente estudo teve por objetivo caracterizar a produção de fala de um indivíduo com histórico de múltiplas cirurgias oncológicas que levaram à glossectomia total, com auxílio de um dispositivo individualizado de acrílico, idealizado a partir da parceria Odonto-Fonoaudiologia da instituição e confeccionado por especialista em PBMF e terapia fonoaudiológica, utilizando o biofeedback visual com ultrassonografia. O indivíduo era homem, 45 anos, professor aposentado com histórico de carcinoma epidermóide de língua com episódios de recidiva. Como tratamento oncológico, foram realizadas diversas cirurgias associadas à radioterapia, ao longo de sete anos. O tratamento oncológico culminou com a glossectomia total e instalação de osteorradionecrose de mandíbula. O tratamento desta sequela da radioterapia também exigiu múltiplas abordagens cirúrgicas, com perda de grande parte da mandíbula, levando ao severo comprometimento das funções de deglutição e fala. Durante o atendimento multiprofissional da equipe Odonto-Fonoaudiologia de um hospital universitário, foi idealizada a confecção de um dispositivo individualizado de acrílico, objetivando melhorar a inteligibilidade da fala do paciente. Tal dispositivo foi confeccionado por dentista especialista em PBMF e ajustado em conjunto com a equipe de Fonoaudiologia. Com o dispositivo de acrílico adaptado, o indivíduo iniciou a terapia fonoaudiológica associada ao biofeedback, por meio da ultrassonografia de língua, com o objetivo de promover o refinamento da produção de fala dos fones fricativos [s] e [∫]. Ao comparar a avaliação pré-terapia e pós-terapia, foi possível identificar, após a análise das falas por juízes, melhora quanto à Porcentagem de Consoantes Corretas, de moderadamente severa para levemente moderada, bem como a inteligibilidade de fala, de insuficiente para regular. O dispositivo individualizado com a terapia fonoaudiológica associada ao biofeedback produziram resultados de fala satisfatórios, considerando-se a gravidade do caso e o elevado grau de mutilação do paciente.

OBJECTIVE To verify whether there are differences between populations of CD8 + and FoxP3 + T cells in lesions of oral lichen planus associated with hepatitis C virus chronic infection (OLP-HCV) and lesions of idiopathic oral lichen planus (OLP-I). MATERIALS AND METHODS A case-control study was performed using a convenience sample of 11 paraffin-embedded tissue blocks of OLP-HCV and 19 of OLP-I. Histological sections stained with haematoxylin and eosin were used to classify the intensity of inflammatory infiltrate. Immunohistochemistry was used to identify CD8 + and FoxP3 + T cells. The count of positive cells was compared between the two groups and correlated to clinical and demographic data (p

Introdução: No câncer de cabeça e pescoço (CCP), as sequelas relacionadas aos tratamentos e à própria localização do tumor podem trazer alterações físicas e funcionais, com impacto na qualidade de vida (QV) destes pacientes. Objetivo: mensurar o impacto do câncer de boca sobre a qualidade de vida relacionada à deglutição e saúde bucal em pacientes com câncer de cabeça e pescoço, após tratamento médico com radioterapia e/ou cirurgia. Métodos: participaram do estudo dez pacientes em pós-tratamento médico para o CCP e que foram submetidos aos questionários de qualidade de vida M.D. Anderson Dysphagia Inventory (MDAD), Oral Health Impact Profile (OHIP-14) e Questionário de Qualidade de Vida da Universidade de Washington (UW-QOL). Resultados: Os resultados dos domínios emocional e funcional do protocolo MDADI demonstraram médias positivas, enquanto o domínio físico apresentou médias que demonstraram baixo funcionamento do dia-a-dia e qualidade de vida. A partir do questionário OHIP-14, verificou-se que 40% dos participantes foram classificados com alto índice de impacto na saúde bucal. As dimensões ‘’desconforto psicológico’’ e ‘’deficiência’’ impactam negativamente na QV dos pacientes. “Atividade’’ e “saliva” foram os problemas mais relatados, mostrando que, ‘’saliva’’, ‘’humor’’ e ‘’mastigação’’ foram os três domínios mais importantes na visão dos pacientes, verificado a partir do protocolo UW-QOL. Conclusão: Apesar do número reduzido de pacientes e da heterogeneidade de localização dos tumores, os resultados demonstram que o CCP e as sequelas de seu tratamento podem impactar de maneira significativa a QV dos pacientes em diversos domínios.

RESUMO Este estudo teve como objetivo correlacionar o grau de comprometimento da deglutição e da fala de pacientes submetidos à glossectomia devido ao câncer de língua. Trata-se de um estudo de casos, de caráter transversal observacional, realizado em sete pacientes, com idade acima de 18 anos, que realizaram glossectomia como tratamento do câncer de língua. Foram excluídos da pesquisa pacientes que possuíam doenças neurológicas, ou que realizaram outras cirurgias de cabeça e pescoço, não relacionadas ao câncer de língua. Foi realizada avaliação clínica da deglutição, por meio do protocolo Avaliação de Segurança da Deglutição (ASED) e classificação da ingestão oral, conforme a Escala Funcional de Ingestão por Via Oral (Functional Oral Intake Scale - FOIS) A avaliação da fala se deu por meio do protocolo MBGR (Marchesan, Berrentin-Felix, Genaro, Rehder). Observou-se que as maiores alterações na deglutição ocorreram em fase oral da deglutição, havendo necessidade de modificações na alimentação, impactando o nível de ingestão oral. As alterações de fala mais encontradas foram distorção nos fonemas linguoalveolares /ɾ/ e /l/ e linguopalatais /s/, /z/, /ʃ/, /ʒ/ e imprecisão articulatória. Houve correlação entre as alterações de deglutição e o nível de ingestão oral e as alterações de fala, demonstrando que, quanto maiores as modificações presentes na alimentação, maiores as alterações de fala encontradas nos indivíduos do presente trabalho.

Introduction Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions. Objective To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients. Methods Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteonecrosis of the jaws as main objective, were selected and analyzed. Results Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients. Conclusion Selecting an appropriate therapy for osteonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan. Resumo Introdução A osteonecrose da mandíbula pode resultar da radiação usada na radioterapia para tratamento de tumores malignos ou de medicamentos usados para remodelação óssea e antiangiogênese, como os bifosfonatos. Essas condições podem ser associadas a fatores desencadeantes, como infecção, trauma e diminuição da vascularização. O tratamento de pacientes com osteonecrose da mandíbula requer cautela, pois não existe um tratamento específico que atue de maneira isolada e decisiva. No entanto, diferentes modalidades de tratamento podem ser empregadas de forma associada para controlar e estabilizar lesões. Objetivo Revisar os conhecimentos atuais sobre a etiologia e o tratamento da osteonecrose da mandíbula, tanto induzidos por radiação quanto relacionados à medicação, para melhorar o conhecimento dos profissionais que busquem a qualidade de vida de seus pacientes. Método Revisão de literatura na base de dados PubMed, bem como pesquisa manual de publicações relevantes na lista de referência de artigos selecionados. Foram selecionados e analisados artigos em inglês publicados de 1983 a 2017, que avaliaram osteonecrose da mandíbula como seu principal objetivo. Resultados Infecções, traumas e diminuição da vascularização são fatores desencadeantes da osteonecrose da mandíbula. Medidas profiláticas e/ou estabilizadoras podem ser usadas em associação com modalidades terapêuticas para o tratamento adequado de pacientes com osteonecrose da mandíbula. Conclusão Selecionar uma terapia apropriada para o tratamento de osteonecrose da mandíbula com base na literatura atual é uma decisão racional que pode ajudar a estabelecer a um plano de tratamento adequado.

Background and objective: radioiodine treatment (I131) used to treat thyroid carcinomas produces side effects (sialadenitis, xerostomia, dysphagia and caries susceptibility) reflecting in a poor pa...

The idiopathic bone cavity (IBC) is an intraosseous pseudocyst devoid of epithelial lining. Clinically, IBCs of the jaw are asymptomatic and normally found in routine radiographic exams. Although the literature regarding the content of IBCs is controversial, the final diagnosis is usually aided by the discovery of an empty cavity upon surgical exploration. The aim of this study was to perform cytological and histological analysis of IBC contents. Cytological analysis of nine cases of IBC was performed after puncture and processed by the cell block technique. Histological analysis was performed in six cases in which it was possible to collect enough material by curettage of bone walls. Remarkably, cell block analysis revealed the presence of fibrin, often arranged as a net; erythrocytes; and inflammatory cells, with a predominance of lymphocytes as well as some macrophages and neutrophils. Histological analysis showed the presence of scant connective tissue, bone trabeculae, hemorrhagic foci, and hemosiderin. Only two cases presented scattered multinucleated giant cells. Cytological evaluation of IBC content by the cell block technique might represent a useful diagnostic tool, especially in cases in which there is no available material for curettage in the cavity.

This report is about a 45-year-old man with acute myeloid leukemia (AML), treated with chemotherapy and allogeneic bone marrow transplant (allo-BMT) in 2010. After allo-BMT the patient developed chronic graft-versus-host disease (cGvHD) and was treated with a corticosteroid and immunosuppressants. In 2018, he presented with a whitish lesion with a central ulcer in the left anterior portion of the tongue. An incisional biopsy revealed the histopathologic diagnosis of invasive squamous cell carcinoma (SCC), poorly differentiated. Partial glossectomy was performed with free surgical margins. Two months later, the SCC recurred as an ulcero-infiltrative lesion. The new planning includes glossectomy, cervical dissection, and graft followed by radiotherapy. This case suggests the susceptibility to develop oral malignancies after allo-BMT. Additionally, these tumors could have an aggressive behavior with a tendency to recur, indicating a poor prognosis. Periodic assessments are necessary for all patients who undergo allo-BMT and develop cGvHD.

Introduction: Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions. Objective: The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined. Methods: A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients’ files. Results: A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5–2 cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%). Conclusion: Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis. Resumo: Introdução: As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive a hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes. Objetivo: A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados. Método: Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes. Resultados: Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2 cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%). Conclusão: As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo. Keywords: Giant cell granuloma, Hyperplasia, Oral cavity, Pyogenic granuloma, Reactive hyperplastic lesions, Palavras-chave: Granuloma de células gigantes, Hiperplasia, Cavidade oral, Granuloma piogênico, Lesões hiperplásicas reativas

A 38-year-old man, user of illicit drugs, cannabis smoker, and alcoholic, presented an evolution of cutaneous, oral, and ophthalmologic lesions a few hours after the use of 5 to 8 tablets of amphetamine and alcohol. In 2011, a similar condition was reported after ingestion of cephalexin. Erythematous macules and papules were observed in the lower and/or upper limbs, dorsum, trunk, and genitalia, with areas of central necrosis ("bulls-eye" aspects). In the oral examination, multiple shallow ulcers were observed, covered by exudate in multiple sites of the oral mucosa. The diagnosis was erythema multiforme. The patient was treated at the hospital with corticoids, analgesic, and antibiotics. Dental team applied laser therapy (λ660 nm, 100 mW, 1 J, 10 s/point, 0.0028 cm² spot) every day and prescribed mouthwashes (0.05% clobetasol propionate, 2 times/d) until hospital discharge. Drug use may trigger severe manifestations of erythema, with a risk of progression to Stevens-Johnson syndrome. The multiprofessional approach was crucial in this case.

Xanthomatous cells have lipid droplets in their cytoplasm. They may be associated with xanthomas that are cutaneous lesions of variable morphology, due to deposition of lipids in the skin. These deposits are inside histiocytes, which acquire a frothy appearance. They can be associated with disturbance of lipid metabolism, especially hyperlipemia and hypercholesterolemia. A female patient, white, 59 years old, presented with a submucosal lesion in the lower lip, approximately 2 cm, with purplish coloration of yellowish background, with no precise limits and with 2 years of evolution. The lesion was removed, and the patient was referred for histopathologic analysis in which sheets of foamy-looking histiocytes (xanthomatous cells) present in connective tissue and permeating muscle fibers and adipose tissue were observed. Immunohistochemistry was performed, with positivity for CD68 antigen and negativity for CD1a and protein S100. The patient is under medical investigation of metabolic syndrome that may be associated with the presence of these cells.

Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplastic proliferation with variable clinical behavior; the male:female ratio is 1.6:1.0. The pathogenesis of LCH is imperfectly understood. A newborn boy, 1 month old, had a small focal lesion with a papillomatous surface, was cured, and the tissue removed was granulomatous, friable, and bleeding. The microscopic examination revealed histiocytes with abundant eosinophilic cytoplasm and lobulated or coffee bean-like nucleus admixed with a variable number of eosinophils, lymphocytes, and neutrophils. In a immunohistochemical study, cells were positive for CD1A, S100, CD68, and fascin. The patient was referred to the onco-hematology service of a pediatric hospital and had his body fully examined, without other lesions being identified. After a 2-year follow-up, there was no recurrence. At the site where the lesion was cured, an ulcer remained, through which the early eruption of the tooth 84 occurred. This tooth is currently present.

Intra-oral sebaceous adenoma (SA) is a rare benign tumor accounting for 0.1% of all salivary gland neoplasms consisting of sebaceous epithelium in a fibrous stroma. A 50-year-old female was referred by her dentist for treatment of an oral lesion in the right buccal mucosa and retromolar trigone. Clinically, a nodule asymptomatic was observed, 1.5 cm, sessile base, rose-colored with the central region yellowish and areas of telangiectasia, with 6 months’ of evolution. The patient also presented Fordyce granules on buccal mucosa, bilaterally. Clinical diagnosis of lipoma was made. After excisional biopsy, the histologic sections revealed a tumor composed of sebaceous cell nests and dilated salivary ducts with areas of squamous differentiation and minimal atypia, enclosed in a fibrous stroma. Minor salivary glands with usual aspects were observed deeply. Final diagnosis was SA, and the patient follow-up is being conducted.

Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.

Maxillofacial prostheses (MFP) are used to rehabilitate patients who had oral cancer or benign tumors of large proportions that were treated with mutilating surgery and in the rehabilitation of the ones mutilated by firearms, accidents, or bone destruction by drug abuse. This study aimed to report the importance of MFP in the rehabilitation of 32 patients treated in a university hospital in southern Brazil over the past 7 years as well as to discuss their impact on the quality of life of its users. It was a mixed method approach. Quantitative data was collected through the Oral Health Impact Profile 14-item questionnaire. Also, patients provided qualitative information through face-to-face interviews, recorded and analyzed by the content analysis method. Results indicated MFP brought functional, aesthetic, and psychoemotional benefits to its users. It seems to play a key part in the rehabilitation of patients who underwent mutilating surgical treatments.

A boa comunicação escrita é uma habilidade essencial para a troca de informações entre profissionais da saúde. No contexto do SUS, essa troca ocorre por meio de documentos de referência e contrarreferência. Considerando as lesões bucais que necessitam de avaliação na atenção secundária, documentos de referência permitem avaliar a necessidade clínica e a urgência de cada caso, com impactos na priorização do acesso. A falta de detalhamento e concisão dos documentos de referência impacta na agilidade do fluxo do paciente entre os níveis de atenção à saúde e, consequentemente, na qualidade do cuidado a ele oferecido. Visando aprimorar o detalhamento dos documentos de referência em Estomatologia na região da Grande Florianópolis, Santa Catarina, foi desenvolvido o OralDESC - um roteiro de apoio à descrição de lesões bucais. O roteiro também vem sendo utilizado pelas disciplinas relacionadas ao Diagnóstico Bucal na Universidade Federal de Santa Catarina. Além de apresentar o roteiro, este trabalho procura ampliar a análise da questão, apresentando alguns desafios para a implantação dos complexos regulatórios no Brasil, bem como as dificuldades relatadas no país e em outras parte do mundo no que se refere à qualidade dos documentos de referência. Adicionalmente, apresenta a visão de alguns autores sobre o potencial educativo dos processos de referência e contrar-referência e a importância da formação para a comunicação escrita. São partilhadas, ainda, reflexões sobre a necessidade de inclusão, nos currículos acadêmicos, de atividades que permitam o desenvolvimento de habilidades de comunicação por estudantes de Odon-tologia, de forma a capacitá-los à atuação em redes de atenção que privilegiam a interação multiprofissional, interdisciplinar e trans-disciplinar.

This study aimed to understand how patients perceive their oral health and the resulting oral manifestations of antineoplastic chemotherapy, as well as to analyze the impact of these alterations on oral health-related quality of life. A total of 80 patients undergoing treatment participated in this study. A questionnaire was applied using the Oral Health Impact Profile (OHIP-14) index and open interviews. Items with the highest impact prevalence included "worsened taste of food sensation" (35.00%), "discomfort in eating food" (20.00%), and "feeling stressed" (17.50%). The outpatients showed the highest prevalence scores, whereas the inpatients presented higher quality of life impact severity. The ways in which the patients perceived how their oral alteration affected their quality of life were distinct and subjective. It is important that dentists act together with a multiprofessional team developing strategies to alleviate the impact of the disease and chemotherapy on oral cavity and patients' quality of life.

Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa. Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years. Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa. Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.

Background To investigate the skeletal development of HIV infected children through a morphological analysis of the cervical vertebrae (CV) in lateral cephalometric radiographs. Material and Methods The sample consisted of 86 lateral cephalometric radiographs of male and female children aged between 6 and 14 years old. The radiographs were equally distributed in groups 1 (HIV infected children) and 2 (non-infected children, paired by sex and age). Two examiners analyzed the CV according to the method of Hassel and Farman (1995). Spearman correlation coefficient was used to associate age and skeletal development within groups, while Mann-Whitney test compared the skeletal development between groups. Results The correlation of age and skeletal development in group 1 reached 0.17, 0.27 and 0.27 (p >0.05) for C2, C3 and C4, respectively, while in group 2 it reached 0.65, 0.54 and 0.60, respectively (p 0.05). Conclusions HIV infected and non-infected children showed a similar development of the CV. However, the weak correlation between age and CV development in HIV infected children highlights the need for careful decisions prior to therapeutic approaches – especially those founded on the prediction of skeletal development, such as maxillofacial surgeries, and orthopedic and orthodontic procedures. Key words:Cervical vertebrae, growth and development, HIV, radiology.

radioiodine treatment (IThirty-seven patients undergoing Isignificant difference in calcium/phosphate concentration was shown between M1 and M2, with evident decrease at M2. Flow rate reduced right after treatment with 41% of patients returning to previous rate at M3 (no statistical difference). A higher number of patients related xerostomia and difficulty in swallowing food at M2. The results showed that xerostomia/hyposalivation, dysphagia and calcium/phosphate concentration decrease may be considered early radioiodine side effects.

This study proposes a simple standardized method for the production of analog X-ray images of dolphin teeth, and to explore its potential use as a complementary technique in the evaluation of dental pathology in small cetaceans. We investigated exposure times that produced the best results, and whether radiographs helped in the diagnosis of macroscopic abnormalities. Teeth of six species of dolphins (Delphinidae: Tursiops truncatus, Steno bredanensis, Sotalia guianensis, Delphinus sp., Stenella coeruleoalba, and Stenella frontalis) were X-rayed in an analog dental X-ray machine operating at 70 kVp and 7 mA. Intraoral size 2 standard films were used, and the focus-film distance was standardised at 35 cm. Those species with smaller teeth (total length 12-20 mm) had the best results when exposed for 0.3 seconds, while species with larger teeth (30-45 mm) had to be exposed for 0.4 seconds for their best result. Three independent examiners analysed all the images taken. The average pairwise percent agreement was 73% (Fleiss' Kappa = 0.229), suggesting fair agreement between examiners. Analog X-ray images produced were useful in complementing the diagnosis of dental pathology and abnormalities in dolphins, in addition to allowing the observation of internal details and lesion depths, which would not be possible with conventional macroscopic methods. The use of analog X-ray imaging is easily applicable to the study of dolphin teeth, with low operating costs and simple logistics compared to other non-destructive analytical approaches such as Micro-CT.