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Considering the chemical and structural properties of dentin, this study was aimed at evaluating the effect of dentin matrix alone or combined with mesenchymal stromal cells (MSC) on postextraction alveolar bone regeneration.Wistar rats were subjected to tooth extraction with osteotomy and allocated into groups according to the graft inserted: (1) Gelita-SponThe Bio-Oss group showed less bone than Gelita-Spon and Dentin/MSC; no other significant differences were seen in HE analysis. The Bio-Oss group showed higher expression of collagen type I compared to the Dentin and Dentin/MSC groups and also higher osteocalcin expression than the Dentin/MSC group. There was a tendency of higher expression of osteopontin in the MSC, Dentin, and Dentin/MSC groups and higher VEGF in the MSC group. On micro-CT analysis, the Bio-Oss and the Dentin/MSC groups exhibited greater bone volume than the Control. Serum calcium and phosphorus levels did not significantly differ between the groups. SEM analysis depicted particles of Bio-Oss and dentin in the respective groups, as well as significant cellularity in the MSC group.Autogenous nondemineralized dentin is an alternative for alveolar bone grafting, which can be improved by combination with MSC.This work provides support for the clinical applicability of dentin graft alone or combined with MSC.

We aimed to evaluate the effects of the deoxycholic acid (DCA) in the submental and subplantar regions of rats, and to histologically analyze the changes caused in the submandibular glands, soft tissues of the paw, and inguinal adipose tissue.Sixty male Wistar rats were divided into DCA and control (CG) groups. DCA was injected in the submental, inguinal, and subplantar regions, and saline was injected in the CG. The animals were euthanized after 24 h and at 7 and 21 days.The DCA group showed edema in the submental region in 24 h and in the paw in all experimental times. In the paw there were also erythema and ulceration in 7 days, and alopecia after 21 days. At 21 days, a few animals also showed erythema and ulceration in paw; however, there was no significant difference from CG. Histological analysis of the paw showed an intense inflammatory process, with a predominance of neutrophils, lymphocytes, and plasma cells in 24 h and 7 days. In the adipose tissue, we observed loss of architecture and inflammatory infiltrate, followed with a lower number of adipose cells, and at 21 days, fibroplasia. In the submandibular glands we observed inflammatory infiltration, loss of tissue architecture, and fibrosis.DCA produces a significant inflammatory process in the structures. It can cause skin ulcerations and, in salivary glands, it causes loss of tissue architecture and fibrosis.There has been growing increase in the use of DCA for aesthetic purposes by health care providers. Due to the presence of important anatomical structures in the submental region, constant vigilance is required to report new adverse effects.

BACKGROUND Both zoledronic acid, a potent bisphosphonate, and the antiangiogenic drug sunitinib are included in anticancer protocols and have also been associated with jaw osteonecrosis. Our aim was to compare the effect of these drugs on tissue repair at tooth extraction sites. METHODS Wistar rats were allocated into four groups: (1) sunitinib; (2) sunitinib/zoledronic acid; (3) zoledronic acid; (4) control group. The animals underwent tooth extractions and maxillae were macro- and microscopically analyzed. RESULTS On macroscopic evaluation, the zoledronic acid group showed a significantly higher frequency of oral mucosal lesion; lesions in the sunitinib/zoledronic acid group were larger, albeit not significantly so. The sunitinib/zoledronic acid group had significantly less epithelium than the zoledronic acid and control group, but showed no significant difference compared to the sunitinib group. The sunitinib/zoledronic acid and zoledronic acid groups did not differ from each other, but had significantly less connective tissue and more non-vital bone and microbial colonies than sunitinib and control groups, whereas these latter two groups did not significantly differ from each other. Vital bone and inflammatory infiltrate did not significantly differ between groups. CONCLUSION Sunitinib alone is not associated with non-vital bone, whereas the sunitinib/zoledronic acid combination and zoledronic acid alone are.

El tumor odontogénico de células granulares central (TOCGC) es una neoplasia odontogénica rara con predilección por la mandíbula de las mujeres de edad mediana. La lesión muestra un crecimiento lento y una característica radiográfica de una lesión radiolúcida unilocuclar con bordes escleróticos. El objetivo del presente estudio es reportar un nuevo caso de TOCGC con envolvimiento atípico del maxilar anterior. El examen clínico mostró aumento de volumen del paladar duro y el área vestibular del canino izquierdo y premolar del maxilar superior. La tomografía computarizada de haz cónico mostró una lesión unilocular hipodensa bien delimitada que se extendía del incisivo central izquierdo a la región premolar izquierda. El análisis histopatológico mostró células eosinofílicas granulares e islas de epitelio odontogénico e inmunotinción positiva para CK14, vimentina, CD68, Ki67 y S-100, lo que estableció el diagnóstico de TOCGC. El paciente está en seguimiento sin recidiva durante dieciséis meses.

Medication-related osteonecrosis of the jaws (MRONJ) is a rare and serious adverse effect of anti-resorptive and/or antiangiogenic therapy that can cause necrotic bone exposure in the oral cavity, which affects patients’ quality of life. The present study aimed to review literature regarding MRONJ with special focus on diagnostic and treatment. The databases PubMed, Scielo and Google Scholar were searched for reports regarding diagnostic and treatment of MRONJ. Even though this disorder shows poor response to treatment, there is an increase in cure rates when early diagnosed and treated. In this way, systematic dental follow-up of patients under anti-resorptive and/or antiangiogenic therapy is essential for the identification of signs and symptoms suggestive of MRONJ like pain, swelling or dental mobility. Radiographic and tomographic features like increase of bone density, bone sclerosis or osteolysis, persisting alveolar socket, periosteal neoformation, lamina dura widening and mandibular canal widening may indicate bone necrosis. Since there is no universally accepted treatment to cure MRONJ, the management involves symptom palliation and control of associated infection, and surgical excision of necrotic bone is recommended for more severe cases. Each case must be individually evaluated by a multidisciplinary team, allowing dental and medical discussion. The prevention of MRONJ by patients education, elimination of risk factors and oral health maintenance is still the most important measure in the management of these patients. A osteonecrose maxilar relacionada a medicamentos (MRONJ) é um raro e grave efeito adverso de terapia antirreabsortiva e/ou antiangiogênica que pode causar exposição de osso necrótico em cavidade bucal, o que implica na qualidade de vida dos pacientes. O presente trabalho teve por objetivo revisar a literatura sobre MRONJ enfatizando os critérios de diagnóstico e tratamento. As bases de dados PubMed, Scielo e Google scholar foram consultadas em busca de artigos que abordassem o tema. Embora apresente baixa resposta ao tratamento, o diagnóstico e tratamento precoce aumentam a chance de cura. Dessa forma, o acompanhamento odontológico sistemático de pacientes que estejam em terapia antirreabsortiva e/ou antiangiogênica é fundamental para a identificação de sinais ou sintomas sugestivos de MRONJ como dor, tumefação ou mobilidade dentária. Alterações radiográficas ou tomográficas como aumento da densidade óssea, esclerose óssea ou osteólise, persistência de alvéolo dentário, neoformação periosteal, espessamento da lâmina dura e estreitamento do canal mandibular podem ser indicativos da presença de necrose óssea. Como ainda não existe um tratamento universalmente aceito capaz de curar a MRONJ, a abordagem envolve paliação de sintomas e controle da infecção associada, reservando-se a remoção cirúrgica da área necrótica para casos mais graves. Salienta-se que cada caso deve ser avaliado individualmente por uma equipe multidisciplinar que permita a discussão entre a equipe de saúde bucal e equipe médica. A prevenção da MRONJ por meio da educação dos pacientes, eliminação dos fatores de risco e manutenção da saúde bucal constitui ainda a medida mais importante no manejo desses indivíduos.

The aim of this study was to evaluate morphological and immunohistochemical features of tooth extraction sites in rats subjected to different antiresorptive drugs. Wistar rats were allocated into 4 groups according to the treatment: (1) alendronate, (2) raloxifene, (3) strontium ranelate, and (4) control. The animals underwent tooth extraction (60th day of treatment) and afterwards were euthanized (90th day of treatment). Tooth extraction sites were analyzed by means of scanning electron microscopy (SEM), hematoxylin-eosin staining (H&E), and immunohistochemical staining (RANKL and OPG). On H&E analysis, the alendronate group showed greater amounts of non-vital bone, biofilm, inflammatory infiltrate and root fragment, and smaller amount of vital bone. The strontium ranelate group showed great amount of non-vital bone. This group also had lower levels of OPG, while the alendronate group showed lower OPG and RANKL than the other groups. On SEM analysis, the alendronate group showed a considerable number of microcracks on the alveolar bone surface and few Howship lacunae and lack of bone cells as well. The raloxifene, strontium ranelate, and control groups showed a large number of bone cells and Howship lacunae on the bone surface and few microcracks. Alendronate therapy is associated with macro- and microscopic features of medication-related osteonecrosis of the jaw at tooth extraction sites, whereas raloxifene therapy is not, and strontium ranelate therapy is associated with non-vital bone. Osteonecrosis of the jaws is a serious side effect of alendronate therapy, where tooth extraction is a major risk factor. Considering the significant number of patients undergoing antiresorptive therapies worldwide, the present study investigated whether raloxifene and strontium ranelate interfere with bone repair after tooth extraction in a similar way to bisphosphonates.

La actinomicosis es una enfermedad infecciosa muy infrecuente de tipo crónico y supurativo que afecta al área cervicofacial e el tracto gastrointestinal. El presente trabajo tuvo como objetivo, revisar informaciones importantes en cuanto etiopatogenia, presentación clínica y tratamiento de la actinomicosis cervicofacial. Se puede clasificar de tres maneras a depender del sitio anatómico: cervicofacial (50%), torácica (30%) y abdominal (20%). Presentamos una revisión de la literatura con foco en aspectos importantes de la actinomicosis cervicofacial. Aunque micosis, la enfermedad es causada por bacterias grampositivas del género Actinomyces, siendo que A. israelli es el agente etiológico más frecuente, cuales son microorganismos comensales de la boca. Sin embargo, si la integridad de la mucosa es violada, ellos se tornan patogénicos. La actinomicosis es lentamente progresiva y frecuentemente imita otras condiciones clínicas como malignidades. El tratamiento consiste en terapia antibiótica y puede durar 12 meses en casos más graves. El conocimiento de los profesionales de salud acerca de esa enfermedad es fundamental para promover su prevención, diagnóstico precoz y tratamiento correcto.

This study evaluated the effect of laser photobiomodulation (PBM) on oral leukoplakia and squamous cell carcinomas (OSCC) in a model of oral carcinogenesis.Forty-one C57Bl/6 female mice were distributed in control group, 4-NQO group, Laser group 1.5 J and Laser group 9 J. Oral cancer was induced on the tongue by nitroquinoline oxide (4-NQO), diluted in the water for 16 weeks. In the 18th and 19th weeks, PBM with a diode laser, 0.028 cmAll animals exposed to carcinogen developed clinical and histological alterations such as leukoplakia and OSCC on the tongue. There was no significant difference among Laser groups 1.5 and 9 J and 4-NQO group (not irradiated) regarding the area of leukoplakia and carcinomas (P 0.05) or thickness of epithelial tissue and keratin (P 0.05). There were also no association between PBM and histologic classification of the lesions (P = 0.87), frequency of OSCC (P = 0.57), grade of tumor differentiation (P = 0.88) or depth of invasion (P = 0.45).Laser PBM, in both parameters used, does not influence on clinical and histological characteristics of oral leukoplakia and OSCC.Results suggest that PBM may be a safe treatment for adverse effects of antineoplastic therapies in patients with leukoplakia and OSCC.

Background Syphilis is an infectious, sexually transmitted disease with varied oral manifestations, that can mimic other lesions. This study aimed to conduct an epidemiological survey of cases of syphilis, diagnosed from oral manifestations, establishing the sociodemographic profile of patients and clinical characteristics of oral lesions. Methods The medical records of patients with oral lesions of syphilis acquired were reviewed, and 109 cases were selected. Results The mean age of the patients was 34.4 years and, of these, 51% were male. In 105 cases, the disease was diagnosed in the secondary stage; in three cases, in the primary stage; and, in one case, in the tertiary stage. The cases of primary syphilis presented as single and ulcerated nodules, and the case of tertiary syphilis, as a necrotic lesion in the palate. In 86% of cases of secondary syphilis, there were multicentric lesions, presenting as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%), mostly affecting the labial mucosa and tongue. In 91.7% of cases painful symptoms were reported. Conclusion Considering the increase in syphilis, it is extremely important that dentists recognize its oral manifestations, because early diagnosis and treatment can minimize the risks of complications and transmission.

Introdução: Os tumores que afetam as glândulas salivares apresentam vasta diversidade morfológica. Objetivo: Identificar a prevalência de neoplasias de glândulas salivares em pacientes atendidos no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (HSL-PUCRS), em Porto Alegre (RS), no período de 2007 a 2016. Método: Estudo retrospectivo por meio da análise de 201 arquivos do Departamento de Patologia do HSL-PUCRS. Resultados: Foram encontrados 73 casos de neoplasias de glândulas salivares e os prontuários eletrônicos e físicos dos casos selecionados foram analisados. Dos 73 casos, 56 (76,7%) eram de neoplasias benignas e 17 (23,3%) de neoplasias malignas. A faixa etária com maior número de casos foi entre 41 e 60 anos e o sexo feminino apresentou a maior prevalência com 54,8%. A glândula parótida apresentou maior prevalência, perfazendo 72,6% dos casos. O tipo neoplásico mais prevalente foi o adenoma pleomórfico, com 53,4%. O padrão de distribuição das neoplasias de glândulas salivares foi semelhante ao encontrado em outras Regiões do Brasil. Conclusão: As glândulas salivares maiores foram as mais afetadas pelos processos neoplásicos. Adenoma pleomórfico e carcinoma adenoide cístico foram os tumores benignos e malignos mais frequentes, respectivamente, e a glândula parótida foi o local mais acometido. Com base na literatura prévia, esses resultados permitem inferir que algumas características demográficas (por exemplo, sexo e idade) variam entre as diferentes Regiões geográficas.

Gardner syndrome is a hereditary disease in which patients develop gastrointestinal polyps, osteomas, desmoid tumors, epidermoid cysts, fibromas, lipomas, and retinal lesions. Dental abnormalities such as supernumerary or impacted teeth, odontomas and dentigerous cysts are also reported. The most serious concern in this syndrome is the extremely high risk of gastrointestinal polyps undergoing malignant transformation. Since the maxillofacial findings usually precede gastrointestinal polyps, the dentist plays a crucial role in the diagnosis of Gardner syndrome, and panoramic radiography is an important tool in the diagnosis of the disease. We report here a case of Gardner syndrome in a patient showing mandibular osteomas and impacted teeth. Also, cases of Gardner syndrome with maxillofacial manifestations reported in the literature were reviewed and compared with ours. According to the findings, osteomas are important manifestations of this syndrome, and regardless of the absence of family history of intestinal polyposis, their occurrence should prompt diagnostic evaluation for this disease.

Multiple myeloma is a multifocal plasma cell proliferation in the bone marrow. Its occurrence in the jaws is frequent; however, oral lesions rarely appear as a primary manifestation of the disease. A 66-year-old man complained of a painful swelling in his mouth, which had evolved over 4 months. At the examination, an extensive lesion in the left mandibular region was observed. The computed tomography demonstrated an osteolytic lesion measuring 4 × 2.5 cm, associated with a pathologic fracture of the mandible body. A biopsy revealed a malignant neoplasia with proliferation of lymphoid and plasmacytoid cells. Immunohistochemical examination was positive for antibodies CD138, CD56, Ki-67, and lambda light chains. Confirmation of the diagnosis of multiple myeloma occurred with the observation of osteolytic areas in multiple regions of the skull. The patient was referred to the oncology department; however, he died before starting the treatment.

A 70-year-old Caucasian female presented with multiple small, firm, yellowish nodules in the mucosa of the lower and upper lips, buccal mucosa, and dorsal and ventral surfaces of the tongue. Medical history of the patient included carpal tunnel syndrome surgery, systemic arterial hypertension, osteoarthritis, osteoporosis, and hypercholesterolemia. Laboratory tests showed serum levels of thyroid-stimulating hormone (TSH) at 6.56 UI/µmL, leukocyte count of 3,400/mm³, and erythrocyte sedimentation rate of 36 mm/1 h. A biopsy of the oral lesions was performed, and the histopathologic examination revealed connective tissue with deposits compatible with amyloid material, which was also observed in the Congo red examination. Concurrently, chest radiograph, serum protein electrophoresis, C-reactive protein, urea and creatinine, and urinalysis were performed and did not reveal any alterations. The patient was referred to the rheumatologist and is now undergoing follow-up.

Uremic stomatitis represents an unusual condition associated with uremia in patients with renal failure. A 29-year-old man with chronic renal failure on hemodialysis was referred by nephrology service because of complaint of multiple painful oral lesions. The patient had been hospitalized for fever associated with severe pancytopenia and elevated levels of creatinine and urea (16.10 mg/dL and 251 mg/dL, respectively). On physical examination, the patient presented with whitish plaques interspersed by reddish areas of atrophy and epithelial erosion and few ulcerated areas dispersed in the upper and lower labial mucosa, bilateral buccal mucosa, bilateral tongue border, ventral surface of tongue, floor of the mouth, labial commissures, soft palate, and lower lip vermillion. Chlorhexidine 0.12% mouthwash was prescribed to assist in oral antisepsis. Laser therapy was performed periodically for local analgesia. The oral lesions regressed spontaneously as the serum levels of urea decreased with hemodialysis.

A 54-year-old black female patient undergoing dexamethasone and bortezomib therapy for multiple myeloma presented with asymptomatic papules and nodules on the border of the tongue. The lesions were firm in consistency, with light yellowish color and ranging in size from 0.2 to 0.6 cm. A biopsy was performed, and the histopathologic examination with hematoxylin and eosin showed an extracellular deposition of eosinophilic material within the connective tissue. Congo red stain confirmed the diagnosis of amyloidosis. Amyloid deposition associated with multiple myeloma is progressive and can involve any organ. Currently, there is no treatment for this condition. Therefore, the patient has been kept under clinical follow-up showing involvement of the tongue, floor of the mouth, and lower and upper lip, which present with reduced tissue elasticity.

Objective This study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine, and 50% erythromycin on the optimization of healing process of traumatic ulcers made on tongue of rats. Study Design Forty-eight Wistar rats were divided into 4 groups: control, chlorhexidine (Chx), povidone-iodine (PvI), and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 hours, a microbiologic sample was taken and daily application of the substances started. Six animals from each group were euthanized at 4 days and the others at 8 days postoperative. Before euthanasia, a new microbiologic collection was performed. Results The experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after 3 days of treatment. Er exhibited the lowest inflammation scores after 7 days of treatment. PvI showed reduction of microorganisms at both times and under aerobic and microaerophilic conditions. Er significantly reduced the count of microorganisms in aerobic condition compared with control group. Conclusions All drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.

Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant-cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand-wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.

To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy.A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX).Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups.BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.

The present work aimed to review the literature focusing on the diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ) and its implications regarding the management of the disease. Since the report of the first cases, BRONJ concepts, diagnostic criteria and guidelines have been changed. The presence of bone exposure in the oral cavity was at first a sine qua non condition for diagnosis. However, it seems that the great concern now is the possibility of occurrence of BRONJ without this feature. Some authors warn that the bone exposure criterion leads to late diagnosis and poor response to treatment. Meanwhile, some radiographic features, such as bone sclerosis, have been postulated as early signs of the disease. Criticisms have also been raised about the clinical staging system of BRONJ. While there is no consensus on the subject, common sense recommends treating symptomatic patients taking bisphosphonate as having BRONJ despite the absence of bone exposure; and asymptomatic patients must be kept under dental follow-up, since all of them are at risk for BRONJ.