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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.

SUMMARY OBJECTIVE: This study aimed to characterize the clinical (disease activity and exocrine gland function), laboratory, interleukin 6 (IL-6) serum levels, and IL-6-174G/C (rs1800795) genetic polymorphisms among rheumatoid arthritis (RA), RA plus Sjögren’s syndrome (RA+SS), and control subjects. METHODS: A case-control study enrolling 137 women (52±11 years old) were divided into three groups as follows: RA (n=70), RA+SS (n=29), and healthy control (C, n=38). Individuals underwent clinical evaluation composed of Schirmer’s test, unstimulated salivary flow rate, and evaluation of disease activity and functional capacity (Disease Activity Score [DAS28] and Health Assessment Questionnaire [HAQ]). IL-6 serum levels and IL-6-174G/C polymorphisms were assessed. RESULTS: RA and RA+SS presented higher serum levels of IL-6 than controls (p

This study aimed to assess the frequency of temporomandibular disorders (TMDs) in patients with axial spondyloarthritis (axSpA) compared to healthy individuals.We systematically searched PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar database from their inception until 2022, without language restriction. We used a standardized dataset to extract data from observational studies. Patients were required to have axial spondyloarthritis and clinical and/or radiographic evidence of temporomandibular joint dysfunction. Meta-analysis was done with a random effects model. Systematic review was registered under number CRD42020206283.We identified seven relevant trials, which provided data for 745 patients and 216 temporomandibular disorders events. The combined odds ratio (OR) showed that the risk of temporomandibular disorders in individuals with axial spondyloarthritis was higher than the control group (pooled OR = 5.26, 95% CI 2.50-11, 06; p0.02; IThe results of this systematic review and meta-analysis suggest that patients with axial spondyloarthritis have an increased frequency of temporomandibular disorders. TMDs seems to be secondary to postural alterations rather than direct involvement of the temporomandibular joints (TMJs).

Biologic agents are rapidly emerging as an effective therapy to treat autoimmune and other chronic diseases. The use of these agents is poorly characterized, resulting in a lack of guidance for dental practitioners. Case reports of oral adverse events have begun to emerge. However, their scope and frequency have not been summarized and analysed to date. The objective of this review was to characterize the literature on oral adverse effects associated with biological therapy when used for autoimmune and inflammatory disorders.This review was developed in accordance with scoping review recommendations. Search strategies were developed and employed for six databases. Studies were selected using a systematic search process but with broad inclusion of study types given the paucity of information available. Reports of oral adverse events were analysed descriptively according to agent, mechanism of action, underlying disease, and oral adverse effect observed.Our search returned 2080 articles and 51 met our inclusion criteria, of which most were case reports. The most frequent adverse effects included angioedema, oral lichenoid lesions, osteonecrosis of the jaw, and oral infections. There were also cases of oral malignancies associated with use of biologic agents. Less common effects such as pigmentation were also described.Oral adverse events have been reported in patients on biologic therapy, albeit in small numbers to date. This limits the generalizability of these results, which should not be used to generate a clinical guideline as they are based primarily on case reports. However, this study presents the first review characterizing the adverse effects observed. Large multi-center studies will be necessary to further define the oral and dental complications caused by biologic agents.

Personal history of autoimmune rheumatic diseases has been implicated in the development of malignant neoplasms. Our aim was to assess the risk of head and neck cancers in patients with autoimmune rheumatic diseases.The articles search included PubMed, EMBASE, LILACS, The Cochrane Library, CINAHL, Scopus, Web of Science, and Google Scholar with no language restrictions for studies published from inception of the databases to August 20, 2022, assessing the risk of head and neck cancer in patients with autoimmune rheumatic diseases. Studies were included if they reported the standardized incidence ratio (SIR) with corresponding 95% confidence intervals (CIs). The primary outcome was risk of head and neck cancers in patients with autoimmune rheumatic diseases compared with the general population. Pooled summary estimates were calculated using a random-effects model, and subgroup analyses were done to establish whether risk of head and neck cancers varied according to study site.Our search identified 5378 records, of which 32 cohort studies were eligible for systematic review and 24 for meta-analysis (including 273,613 patients). A significant association was found between head and neck cancer and autoimmune rheumatic diseases (SIR=2.35; 95% CI: 1.57 - 3.50; p0.01, IOur study suggests that patients with autoimmune rheumatic diseases had a significantly increased risk of head and neck cancer compared with the general population, including thyroid, oral and nasopharyngeal cancers. These findings have implications for the individualized screening of these patients and the planning of specialist cancer services. The protocol is registered with PROSPERO, number CRD42020197827.

Purpose: To characterize oral and oropharyngeal squamous cell carcinoma (OOPSCC) patients with dental needs before cancer treatment and to correlate their baseline characteristics with cancer treatment-related toxicities. Methods: A prospective cohort study that recruited OOPSCC patients referred to the Dental Oncology Service at the Instituto do Câncer do Estado de São Paulo, Brazil, for dental treatment between November/2019 and December/2020. Comorbidities, sociodemographic data, medication in use, treatment-related toxicities and altered laboratory tests results were correlated. Results: 110 patients were included. The most common comorbidities reported and altered laboratory results were respectively hypertension, dyslipidemia, diabetes and C-reactive protein, hemoglobin, and hematocrit. Toxicities were progressive over time. There was no correlation between the comorbidities and cancer treatment-related toxicities. There was a positive correlation between medications in use and oral mucositis (OM) and a negative correlation between medications and dysgeusia. OM was associated with altered laboratory findings, including thyroxine (T4) and free thyroxine (FT4) starting at D15; calcium at D5/10/30; urea at D25/30/33-35; creatinine at D15/30; alkaline phosphatase at D20/25; syphilis at D15/30. Family income and housing were OM predictors. Oral candidiasis (OC) was associated with syphilis and HIV at D20. Conclusion: Laboratory findings including altered T4, FT4, urea, calcium, alkaline phosphatase, creatinine, and syphilis may be useful clinical predictors of OM. Syphilis and HIV may also be considered reliable predictors of OC secondary to OOPSCC treatment. Despite the high frequency of comorbidities and abnormal laboratory results, dental treatment before cancer treatment resulted in no adverse events in our sample.

Objective. To assess the evidence for treatment of oral involvement of pemphigus and pemphigoid with biologics.Study Design. This systematic review used a comprehensive search strategy to identify literature describing oral involvement of pemphigus or pemphigoid treated with a biologic agent. The primary outcome measures were efficacy and safety of biologic therapy.Results. Inclusion criteria was met by 154 studies including over 1200 patients. Treatment of pemphigus with a total of 11 unique biologic agents and 3 unique combinations of agents is reported. Five randomized controlled trials (RCT) were included in the final analysis that investigated infliximab, IVIg, rituximab and autologous platelet-rich plasma therapy for pemphigus vulgaris. Three non-RCT studies reported on successful rituximab or IVIg therapy for mucous membrane pemphigoid. Studies demonstrated considerable heterogeneity in agent, methods, and quality.Conclusions. Evidence clearly describing oral tissue response to biologic therapy is sparse. Two RCTs support use of rituximab, one supports use of IVIg, and one pilot study suggests intralesional injection of autologous platelet-rich plasma aids healing of oral PV lesions. As oral lesions of pemphigus and pemphigoid can be refractory to systemic therapy, drug trials including biologic therapies should document details regarding response of the oral lesions to therapy.

Objectives The study aimed to perform a systematic review and meta-analysis of the complications following major and minor salivary gland biopsy. Materials and methods Observational studies assessing postoperative complications of minor salivary gland biopsy and indexed at Medline/PubMed, EMBASE, Cinahl, LILACS, or Scopus were selected. This review was registered under the protocol number: CRD42020211169. The level of significance considered was 0.05, and the R software (The R Foundation, Vienna, Austria) was used for the metanalysis. Results Twenty-seven studies reporting 3208 patients were included in this review. The combined prevalence of postsurgical complications was 11% (95% CI, 8 to 13%, p=0,01). The percentage of the combined prevalence of neurological complications was 3% (95% CI, 1-6%, p= 0,01). The surgical technique did not influence the frequency of overall and neurological complications. Conclusion Minor salivary gland biopsies are a safe and predictable procedure that should be performed on the lower lip. Postoperative complications are more common than previously reported, but permanent complaints are uncommon.

Schwannomas are uncommon benign tumors arising in the nerve-supporting Schwann cells. Intraoral lesions usually present in the tongue or floor of the mouth as a submucosal nodule, while the palate is rarely affected. A 26-year-old white man presented with an asymptomatic submucosal fibroelastic nodule in the hard palate. The 2 × 2-cm lesion was covered by normal-appearing mucosa. Under the working diagnosis of minor salivary gland tumor, an incisional biopsy was performed, and analysis revealed an encapsulated tumor with a well-defined biphasic pattern: hypercellular areas with spindled cells arranged in palisades and less cellular areas formed by irregular arranged masses of elongated cells and fibers. The diagnosis of schwannoma was rendered, and the lesion was excised together with periosteum. No recurrence was observed after 30 months of follow-up. Palatal nodules usually present as minor salivary gland tumors; rarer lesions, such as schwannomas, represent a clinical diagnostic challenge. Clinicians should consider schwannoma in the differential diagnosis for palatal nodules and manage them with incisional biopsy and prompt treatment.

Oral mucoceles are common lesions characterized by accumulation of mucus following rupture of a minor salivary gland duct. However, congenital mucoceles are a rare and distinctive oral condition observed in newborns. This case report details the features of a congenital labial nodule diagnosed as congenital mucocele. These lesions are rare in the oral cavity and should be diagnosed in the delivery room, but many cases are referred for further evaluation. Management is simple, and recurrence is not expected.

O objetivo deste artigo é relatar um caso de mixoma odontogênico no lado direito da maxila com envolvimento do seio maxilar e fazer uma revisão de literatura envolvendo aspectos clínicos, radiográficos, histológicos e de tratamento desta patologia. O mixoma odontogênico dos maxilares é uma lesão benigna, sem preferência por sexo, raça ou localização, com características clínicas e radiográficas extremamente variadas, o que amplia demasiadamente o número de patologias tumorais do sistema estomatognático com as quais pode ser feito o diagnóstico diferencial.The aim of this paper is to report a case of odontogenic myxoma that affected the right maxilla and maxillary sinus. We have also reviewed the literature in regards of the clinical, radiographic, histological and treatment aspects of this pathology. Odontogenic myxomas of the maxillofacial region are benign lesions, without preference for gender, race or location, with extremely varied clinical and radiographic characteristics, thus increasing the number oral and maxillofacial region tumors with which we can make the differential diagnosis.

Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery.

A lymphoepithelial cyst (LC) is a rare occurrence in the oral cavity, lined by a keratinized stratified squamous epithelium that is surrounded by diffuse lymphoid tissue, that often contains lymphoid follicles. The clinical aspect of oral LC includes an asymptomatic yellowish nodule (less than 10 mm) with regular surface and soft consistency. It usually affects the floor of the mouth and the ventral and posterolateral surfaces of the tongue in adult male patients. To date, approximately 280 cases of LC in the oral cavity have been reported in the literature; however, none of them appear bilaterally. This article presents the histopathological and immunohistochemical findings of a unique bilateral LC in the posterolateral region of the tongue.

Juvenile Sjögren's syndrome is a rare condition that affects children and adolescents with distinctive clinical features. Parotid swelling usually precedes regular oral and ocular symptoms, while typical serological findings may be absent. Hence, diagnosing juvenile Sjögren's syndrome may be challenging to the attending pediatric dentist, and long-term management without proper diagnosis may be jeopardized. The purpose of this report was to detail the features of an adolescent with primary Sjögren's syndrome diagnosed 12 years after the onset of the disease. An updated literature review highlighted the unusual aspects of the pediatric form of the disease.

The impact of ageing on oral health and salivary flow is usually over-estimated possibly because of the high frequency of polypharmacy observed in this subset of patients. Understanding the physiological changes and treatment-related oral complications of older patients is essential to promote accurate management of symptoms and improve their quality of life. The current paper reviews age-related physiological chances in salivary glands and the effect of polypharmacy on oral health, focusing on xerostomia and hyposalivation.