Alessandra De Albuquerque Tavares Carvalho

Oral complications of HIV disease

Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

Atividade antimicrobiana e antiaderente in vitro do extrato de Rosmarinus officinalis Linn. sobre bactérias orais planctônicas

In this study was investigated the antimicrobial activity and in vitro adherence inhibition of a hydro alcoholic Rosmarinus officinalis Linn. (alecrim) on standard strains of Streptococcus mitis ATCC 98811, Streptococcus sanguinis ATCC 10556, Streptococcus mutans ATCC 25175, Streptococcus sobrinus ATCC 27609 and Lactobacillus casei ATCC 7469 extract. The test was carried out by inundation tecniques in Petri dishes to determine the Minimum Inhibitory Concentration (MIC) and inclined tubes techniques the Minimum Inhibitory Concentration of Adherence to glass (MICA) at the presence of 5% sucrose. Tests with gluconate of chlorexidine 0.12% were performed as controls. MICs of the Rosmarinus officinalis extract dilutions (mg/mL) against S. sanguinis ATCC 10556, S. mutans ATCC 25175, S. sobrinus ATCC 27609 and L. casei ATCC 7469 were 1:1, 1:4, 1:1 e 1:4, respectively. The extract from alecrim inhibited all the standard strains growth tested, except for S. mitis ATCC 98811. MICAs of the Rosmarinus officinalis extract dilutions (mg/mL) against S. mitis ATCC 98811, S. mutans ATCC 25175 e S. sobrinus ATCC were 1:8, 1:16 e 1:8, respectively. The results suggest that there is a possibility of the alecrim use as an oral antimicrobial. Nevertheless, study models which could reproduce situations similar to those seen in bucal caries are necessary for the antimicrobial agents evaluation in the treatment and biofilm dependant oral infections prevention.

Effect of Low-Level Laser Therapy in the Treatment of Burning Mouth Syndrome: A Case Series

OBJECTIVE The aim of this study was evaluate the effect of low-level laser therapy (LLLT) in the treatment of burning mouth syndrome (BMS) patients. BACKGROUND DATA BMS is a clinical condition characterized by a burning sensation in a morphologically normal oral mucosa, without association with systemic disorders. METHODS Ten patients with oral burning sensation were included in the study. After careful evaluation of medical history and oral examination, the diagnosis of BMS was established. All patients were submitted to one weekly session of LLLT for 10 weeks. A continuous wavelength of 660 nm, power 40 mW, 20 J/cm(2), 0.8 J/point, with each point irradiated for 10 sec. In all sessions the burning intensity was evaluated with a 10-cm visual analogue scale (VAS), with 0 indicating no symptoms and 10 indicating the worst burning possible. The burning intensity evaluation by VAS was performed immediately before (VAS baseline) and immediately after each LLLT session. The nonparametric Wilcoxon test was used for statistical analysis, considering significance of 5%. RESULTS All patients reported improvement in all sessions, with reduction in VAS scores by up to 58% in the tenth session. When only the VAS baseline of the first session was compared with the other sessions, there was a statistically significant reduction in VAS scores in the fourth (p=0.03), fifth (p=0.03), sixth (p=0.009), seventh (p=0.003), eighth, ninth, and tenth (all p=0.002) sessions. CONCLUSIONS LLLT may be an alternative treatment for the relief of oral burning in patients with BMS.

Atividade antimicrobiana in vitro do extrato de Anacardium occidentale L. sobre espécies de Streptococcus

The antimicrobial activity of the extract of the stem bark of Anacardium occidentale L., was evaluated in three cultures of bacteria of the dental plate. The antimicrobial activity was assayed in Petri dishes using the diffusion method for determination of the minimal inhibitory concentration (MIC) and minimal inhibitory concentration of adherence (MICA). Aureolar inhibition (MIC) was observed with concentrations of 12.5 mg/mL in S. mutans and 6.25 mg/mL in S. mitis and S. sanguis. The results suggest that the extract has effect in the MICA in concentrations of 0.31 mg/mL in S. mutans and S. mitis and of 0.15 mg/mL in S. sanguis and therapeuticly can be used in the dentistry as an antibacterial agent.

Principles and applications of polymerase chain reaction in medical diagnostic fields: a review

Recent developments in molecular methods have revolutionized the detection and characterization of microorganisms in a broad range of medical diagnostic fields, including virology, mycology, parasitology, microbiology and dentistry. Among these methods, Polymerase Chain Reaction (PCR) has generated great benefits and allowed scientific advancements. PCR is an excellent technique for the rapid detection of pathogens, including those difficult to culture. Along with conventional PCR techniques, Real-Time PCR has emerged as a technological innovation and is playing an ever-increasing role in clinical diagnostics and research laboratories. Due to its capacity to generate both qualitative and quantitative results, Real-Time PCR is considered a fast and accurate platform. The aim of the present literature review is to explore the clinical usefulness and potential of both conventional PCR and Real-Time PCR assays in diverse medical fields, addressing its main uses and advances.

Uremic stomatitis in chronic renal failure

The clinical fea-tures of uremic stomatitis are poorly defined and are rarelydetailed in relevant textbooks. The present report detailsthe clinical and histopathological features of probableuremic stomatitis in a patient with longstanding chronic re-nal failure and reviews current knowledge of this unusualoral mucosal disorder.A 46-year-old man was referred by the Nephrology De-partment of Hospital das Clinicas to the Oral Medicine unitof Universidade Federal de Pernambuco, Recife, Brazilcomplaining of a burning sensation of the oral mucosa anddysgeusia. The burning sensation affected all oral mucosalsurfaces, had been present for the previous 3 months, wascontinuous, and had no notable initiating or precipitatingfeatures. In addition, the patient had had adherent white le-sions of the oral mucosa for the previous 3 months that hadnot resolved with topical nystatin suspension used for 30days.The patient was a taxi driver, married, with 2 healthychildren. He had previously drunk up to 20 units of alco-hol per week and smoked 40 cigarettes per day, but he hadstopped both habits at 22 years of age. He had developedchronic renal disease due to nonspecific nephritis associ-ated with severe hypertension in 1991, at which time thepatient commenced hemodialysis. In the same year the pa-tient underwent renal transplantation, but the renal allograftwas rejected 4 years later. The patient subsequently devel-oped hepatitis B infection as a consequence ofhemodialysis and was treated with interferon for approxi-mately 3 months. He continued hemodialysis 3 timesweekly for 10 years until he underwent a further renal trans-plant in 2001. At the time of his referral to Oral Medicine(late 2003), the patient was on a combination of pred-nisolone (10 mg daily) and azathioprine (150 mg daily);his renal disease was considered stable aside from some el-evation of plasma urea and creatinine. A renal biopsy in2003 revealed no histopathological features of rejection.Extra-oral examination revealed no obvious signs of re-nal disease other than a uremic oral malodor. There was nocervical lymphadenopathy, and the cranial nerves weregrossly intact.Intra-oral examination revealed adherent white plaquesof the floor of the mouth, buccal mucosae, lateral bordersof the tongue, and gingivae (Figs. 1-3). There were no othermucosal lesions likely to explain the oral mucosal soreness.In view of the extensive nature of the oral lesions, uremicstomatitis was judged to be the working diagnosis; how-ever, the differential diagnosis included oral lichen planusand chronic hyperplastic candidosis. In addition, since thepatient had been on immunosuppressive treatment that in-cluded azathioprine and prednisolone, oral hairy leucopla-kia (OHL) could also account for the clinical signs ob-

Serologic profile and clinical markers of Sjögren syndrome in patients with rheumatoid arthritis

OBJECTIVE The aim of this study was to evaluate the clinical relevance of rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) in patients with Sjögren syndrome (SS) secondary to rheumatoid arthritis (RA). METHODS The study included 118 individuals, and the subjects were divided into three groups: rheumatoid arthritis (RA; n = 46), RA with secondary Sjögren syndrome (RA/SS; n = 20) and healthy controls (C; n = 52). Clinical and laboratory characteristics, including ocular, oral, and serum markers, anti-CCP, and rheumatoid factor (RF), were compared in addition to biopsy of labial minor salivary glands. RESULTS The RA group exhibited unstimulated salivary flow rate, and Schirmer test results were similar to those for C and higher than those for RA/SS (P < .05). Furthermore, the frequency of xerophthalmia and xerostomia was similar among the RA and C groups, and much higher in the RA/SS group (P < .05). Anti-CCP positivity and serum levels were similar in both RA groups, irrespective of SS diagnosis (RA × RA/SS; P > .05). RF presented a similar frequency and serum level between the RA and RA/SS groups (P > .05). CONCLUSIONS Secondary SS seems to be a cluster of oral and ocular symptoms among patients with RA. Anti-CCP and RF are not relevant to evaluate the presence of SS among these patients.

Th1 and Th2 polymorphisms in Sjögren's syndrome and rheumatoid arthritis

BACKGROUND Sjogrens syndrome is characterized by T-cell infiltration of exocrine glands leading to parenchymal destruction and impaired glandular function. This process is orchestrated by cytokines, whose secretion can be regulated by genetic polymorphisms. MATERIALS AND METHODS The aim of this study was to investigate the influence of interleukin-6 -174G/C, interleukin-10 -1082G/A, tumor necrosis factor-α -308G/A, interferon-γ +874A/T gene polymorphisms in (RA) and secondary Sjögrens syndrome (sSS). A study sample that comprised of 138 Brazilian patients was divided into three groups: RA (n = 66), sSS (n = 20), and healthy controls - C (n = 52). Patients were subjected to Schirmers test, unstimulated salivary flow rate, biopsy of minor salivary glands, and serological tests for diagnosing SS. Genomic DNA was obtained from saliva samples and submitted to genotyping. The association between genotypes/alelle frequency and SS susceptibility was tested, as well as their association with clinical features of SS. RESULTS Tumor necrosis factorα (TNFα)-308GA polymorphisms differed significantly between AR, SS, and C patients (P = 0.008). IL-6 overall G carriers and TNFα A carriers had a higher risk of presenting SS (P = 0.021). IL-6 polymorphism distribution was also distinctive regarding lymphocytic infiltration at the minor salivary glands (P = 0.026) and Schirmers test (P = 0.035). CONCLUSION These results suggest that IL-6 -174GC and TNFα-308GA gene polymorphisms are associated with susceptibility to SS. Additionally, IL-6 polymorphism could influence lymphocytic infiltration of salivary glands and diminish lachrymal gland function.

Mannose-binding lectin gene (MBL-2) polymorphism in oral lichen planus

TNF-α may be associated with the etiopathogenesis of oral lichen planus (OLP), and it has been suggested that polymorphism of mannose-binding lectin (MBL) increases the in vitro production of TNF- α. The aim of the present study was to assess the relevance of genetic diversity of MBL in OLP. The study sample comprised 90 individuals, 45 OLP patients and 45 healthy volunteers. MBL-2 gene was amplified using real-time PCR. Frequency of A/A genotype was 55.6% in OLP and 53.3% in healthy volunteers. Likewise, A/0 heterozygote genotype was found in 42.2% and 35.6%; 2.2% and 11.1%, had the recessive 0/0 genotype respectively. Frequencies of the “A” and “0” alleles were 77% and 23% in the OLP group and 71.2% in control group. There were no statistically significant differences regarding genotype frequency (p = 0.546) or allele frequency (p = 0.497). In conclusion, no significant association was found between polymorphism of MBL-2 gene and OLP.

Pigmented Oral Squamous Cell Carcinoma: A Case Report and Brief Review of the Literature

Melanin impregnation in squamous cell carcinoma (SCC) is an uncommon histological finding. Rare nonmelanocytic entities were previously described as having melanocyte colonization. A 57-year-old Brazilian woman was referred with a pigmented lesion in the lower lip and alveolar ridge with a prior clinical diagnosis of melanoma. The incisional biopsy of the tumor revealed an SCC with strong colonization of melanocytes in the stroma. The authors report a case of an unusual SCC variant and a brief review of the literature.