Antonio de Lisboa Lopes Costa

Randomized trials for the treatment of burning mouth syndrome: an evidence-based review of the literature.

Burning mouth syndrome (BMS) is defined as a chronic pain condition, characterized symptomatically by a generalized or localized burning sensation in the oral cavity. Various drugs have been used in attempting to treat BMS, but there is insufficient evidence to show the effect of any effective treatment. The aim of this review was to assess the effectiveness of therapies for BMS. Randomized controlled trials (RCTs) enrolling patients with a diagnosis of BMS were identified by searching Pubmed and Scoppus databases. The methodological quality of included studies was assessed on the basis of the method of allocation concealment, blindness of the study, loss of participants, size sample, and outcome concealment. A total of 12 relevant articles were analyzed. Therapies that used capsaicin, alpha-lipoic acid (ALA), and clonazepam were those that showed more reduction in symptoms of BMS. However, many studies of therapeutic interventions in BMS lack consistency in their results, because they use in their methodology, sample and a relatively short time of therapy and often do not provide a follow-up of patients treated. Thus, future studies are required to establish the treatment for patients suffering from this chronic and painful syndrome.

Proliferating Cell Nuclear Antigen (PCNA) and p53 Protein Expression in Ameloblastoma and Adenomatoid Odontogenic Tumor

In this study, proliferating cell nuclear antigen (PCNA) and p53 protein expressions were analyzed in 16 cases of ameloblastoma and 8 cases of adenomatoid odontogenic tumor (AOT). The cases of ameloblastoma consisted of solid type tumors and histologic arrangements of different subtypes were observed. In some specimens, more than one histologic subtype was identified in the same lesion, and each tumor was categorized according to the predominant cell pattern. The odontogenic tumors were grouped as follows: follicular ameloblastoma (n=7), plexiform ameloblastoma (n=4), acanthomatous + follicular ameloblastoma (n=3), basal cell ameloblastoma (n=2), adenomatoid odontogenic tumor (n=8). PCNA immunohistochemical expression revealed stronger quantitative labeling index for the follicular ameloblastoma, while for p53 protein the strongest quantitative labeling index was detected in the plexiform type. Nevertheless, statistical analysis using ANOVA and Tukeys test did not detect significant differences (p>0.05) among the histologic subtypes of ameloblastoma. The findings of this study suggest that the different histologic patterns of ameloblastoma did not show a direct correlation with their clinical behavior and consequently with the prognosis of the cases. The results also indicated that the ameloblastoma has greater proliferative potential than the AOT, which can contribute to explain its more aggressive and invasive characteristics.

Correlação entre a classificação clínica TNM e as características histológicas de malignidade do carcinoma epidermóide oral

Histological staging of deep invasive margin of oral squamous cell carcinoma has a significant influence on survival of patients since the tumor cells are more poorly differentiated in this area and have high prognostic value. AIM: the purpose of the present study is to correlate TNM clinical classification with histopathologic characteristics (degree of keratinization, nuclear pleomorphism, invasion pattern and lymphoplasmocytic infiltrate) and histologic malignancy scores in 38 cases of oral epidermoid carcinoma in the lesions deepest areas. STUDY FORM: Retrospective clinical study. MATERIAL AND METHOD: This is a retrospective study based on histological review of 38 cases of oral squamous cell carcinoma selected from the medical files of Hospital Dr. Luis Antonio, Natal - Rio Grande do Norte, Brazil. TNM clinical classification data were obtained from the analysis of the medical records. Two pathologists performed histological malignancy staging on routine 3 µm-thick sections of invasive tumor areas stained with hematoxylin and eosin. For statistical analysis, parametric (ANOVA) and non-parametric tests (Tukey; Pearson; Chi2) were employed. RESULTS: We found significant correlation between TNM clinical staging and malignancy mean score (p= 0.001) and histopathologic parameters, such as nuclear pleomorphism (p= 0.016) and degree of keratinization (p= 0.025). Furthermore, there were also statistically significant correlations between lymphocytic infiltration (p= 0.016) and nuclear pleomorphism (p= 0.004) with TNM classification when grouped in two series: TNM I/II and III/IV. CONCLUSION: TNM classification, as well as malignancy mean score, had statistically significant correlation with degree of keratinization, nuclear pleomorphism and lymphocytic infiltration. These highly significant results indicated that histologically invasive areas may be primarily responsible for the clinical behavior of the tumor, and this may be important for the therapy of choice for oral squamous cell carcinoma.

Comparative immunohistochemical expression of RANK, RANKL and OPG in radicular and dentigerous cysts

OBJECTIVE Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) are members of the superfamily of ligands and receptors of tumour necrosis factor family involved in bone metabolism. The formation, differentiation and activity of osteoclasts are regulated by these proteins. To clarify the roles of osteoclast regulatory factors in cystic expansion of odontogenic cysts, expression of these proteins were analysed in radicular and dentigerous cysts. DESIGN The immunohistochemistry expression of these biomarkers were evaluated and measured in lining epithelium and fibrous capsule of the radicular (n=20) and dentigerous cysts (n=20). RESULTS A similar expression in lining epithelium was observed in the lesions. The fibrous capsule of dentigerous cyst showed a higher content of RANK-positive and RANKL-positive cells than fibrous capsule of radicular cyst. In the lining epithelium the RANKL/OPG ratio showed higher numbers of OPG-positive than RANKL-positive cells, whereas fibrous capsule of the cysts had a tendency to present a similar expression (OPG=RANKL). CONCLUSION Ours findings indicate the presence of RANK, RANKL and OPG in cysts. Moreover, increased expression of OPG compared to RANKL in the lining epithelium could contribute to the differential bone resorption activity in theses lesions.

Correlation between TNM classification and malignancy histological feature of oral squamous cell carcinoma

UNLABELLED Histological staging of deep invasive margin of oral squamous cell carcinoma has a significant influence on survival of patients since the tumor cells are more poorly differentiated in this area and have high prognostic value. AIM The purpose of the present study is to correlate TNM clinical classification with histopathologic characteristics (degree of keratinization, nuclear pleomorphism, invasion pattern and lymphoplasmocytic infiltrate) and histologic malignancy scores in 38 cases of oral epidermoid carcinoma in the lesions deepest areas. STUDY FORM: Retrospective clinical study. MATERIAL AND METHOD This is a retrospective study based on histological review of 38 cases of oral squamous cell carcinoma selected from the medical files of Hospital Dr. Luis Antonio, Natal--Rio Grande do Norte, Brazil. TNM clinical classification data were obtained from the analysis of the medical records. Two pathologists performed histological malignancy staging on routine 3 microm-thick sections of invasive tumor areas stained with hematoxylin and eosin. For statistical analysis, parametric (ANOVA) and non-parametric tests (Tukey; Pearson; Chi2) were employed. RESULTS We found significant correlation between TNM clinical staging and malignancy mean score (p= 0.001) and histopathologic parameters, such as nuclear pleomorphism (p= 0.016) and degree of keratinization (p= 0.025). Furthermore, there were also statistically significant correlations between lymphocytic infiltration (p= 0.016) and nuclear pleomorphism (p= 0.004) with TNM classification when grouped in two series: TNM I/II and III/IV. CONCLUSION TNM classification, as well as malignancy mean score, had statistically significant correlation with degree of keratinization, nuclear pleomorphism and lymphocytic infiltration. These highly significant results indicated that histologically invasive areas may be primarily responsible for the clinical behavior of the tumor, and this may be important for the therapy of choice for oral squamous cell carcinoma.

High-risk human papillomavirus (HPV) is not associated with p53 and bcl-2 expression in oral squamous cell carcinomas.

OBJECTIVE To determine the frequency and type of human papillomavirus (HPV) in oral squamous cell carcinomas (OSCC), as well as to identify a possible association between HPV infection and the expression pattern of p53 and bcl-2, and identify whether the oral HPV infection is a characteristic finding in our sample. METHODS We performed polymerase chain reaction and dot blot hybridization for the detection of HPV DNA in paraffin sections as well as immunohistochemical analysis of p53 and bcl-2 in our sample. RESULTS Twenty-six cases (29.5%) were positive for the virus by PCR. Dot blot hybridization identified HPV 18 in 21 (80.8%) cases, HPV 16 in one (3.8%) case and a combination of the two types in the four (15.4%) remaining cases. No other type of HPV was detected in the sample. Immunohistochemistry showed p53 in 26 (60.4%) cases and bcl-2 in 17 (39.5%) ones. No significant association was observed between the presence of HPV and the expression of the proteins studied (p=0.988 and p=0.748, respectively). CONCLUSIONS Although this investigation have detected only 29.5% of HR-HPV DNA in OSCC, it is possible that this virus contribute to the development of some case of this tumor. Furthermore, it seems that the immunohistochemical expression of p53 and bcl-2 and the presence of HPV DNA are independent events in OSCC.

Immunoexpression of HIF-1α and VEGF in Periodontal Disease and Healthy Gingival Tissues

Hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) are proteins that stimulate the proliferation and migration of endothelial cells. These proteins have been described in many pathologic and inflammatory conditions, but their involvement in the development of periodontitis has not been thoroughly investigated. This study compared the immunohistochemical expression of these proteins, involved in angiogenesis and hypoxia, by immunostained inflammatory and endothelial cells in periodontal disease and healthy gingival tissues. Gingival tissue samples were divided as follows: 30 samples with chronic periodontitis, 30 with chronic gingivitis, and 30 of healthy gingiva. Results were analyzed statistically by the Kruskal-Wallis, Mann-Whitney and Spearman correlation tests (p=0.01). Inflammatory and endothelial cells were found to express these proteins. Periodontitis showed median percentage of HIF-1α-positive cells of 39.6%, 22.0% in cases of gingivitis and 0.9% in the healthy gingiva group (p=0.001). For VEGF, median percentage of immunopositive cells was 68.7% for periodontitis, 66.1% in cases for gingivitis, and 19.2% for healthy gingival specimens (p<0.001). Significant correlation between VEGF and HIF-1α was also observed in healthy gingiva (p<0.001).The increased expression of HIF-1α and VEGF in periodontitis, compared to gingivitis and healthy gingiva, suggests possible activation of the HIF-1α pathway in advanced periodontal disease. The correlation between HIF-1α and VEGF expression in healthy gingiva suggests a physiological function for these proteins in conditions of homeostasis. In periodontal disease, HIF-1α and VEGF expression may be regulated by other factors, in addition to hypoxia, such as bacterial endotoxins and inflammatory cytokines.

Leucoplasias bucais: relação clínico-histopatológica

A relacao entre o aspecto clinico e as caracteristicas histologicas das leucoplasias bucais foi avaliada em 28 pacientes adultos, que apresentaram lesoes leucoplasicas na mucosa bucal. As lesoes foram divididas quanto ao aspecto clinico em homogeneas e nao-homogeneas, e classificadas segundo suas caracteristicas histopatologicas em seis grupos: hiperceratose com ausencia de displasia epitelial; displasia epitelial leve; displasia epitelial moderada; displasia epitelial severa, carcinoma in situ e carcinoma invasivo. Os resultados clinicos mostraram maior ocorrencia de leucoplasias homogeneas (78,6%) do que nao-homogeneas (21,4%). Os achados histopatologicos demonstraram que 32,2% dos casos apresentaram hiperceratose com ausencia de displasia epitelial, 53,5% evidenciaram displasia epitelial (39,3% leve, 7,1% moderada e 7,1% severa) e 14,3% diagnosticados como carcinoma invasivo. As leucoplasias homogeneas apresentaram alteracoes celulares discretas, enquanto as nao-homogeneas evidenciaram displasia epitelial severa e carcinoma invasivo. Os resultados sugerem um maior cuidado no diagnostico e controle de leucoplasias dada a possibilidade de transformacao maligna.

Clinical study of the oral manifestations and related factors in type 2 diabetics patients

UNLABELLED Diabetes Mellitus (DM) is reported with and associated to oral alterations, with conflicting results. The aim of this study was to identify the prevalence of oral soft tissue alterations in type 2 diabetes mellitus patients. MATERIAL AND METHODS Socioeconomic variables, gender, heredity, capillary glucose control and local factors (prosthesis, dry mouth sensation) were analyzed in 196 diabetic and non-diabetic patients enrolled in HIPERDIA, at 41 Health units of Natal, Brazil. STUDY DESIGN A case study. RESULTS The last blood glucose mean was 177.0 mg/dl for diabetics and 89.46 mg/dl for non-diabetics. Mean capillary blood glucose was elevated in diabetics (215.95 mg/dl); it was 102.31 mg/dl in non-diabetics. The family history confirmed the heredity nature of the disease in 68.8% of diabetic patients (n = 66) (p < 0.001); salivary flow was 49% (n = 47) in diabetics, and 34% (n = 34) in non-diabetics. Candidiasis was present in 30.5% of diabetic patients (n=29) and 36% of non-diabetics (n=36). Both groups had lesions in the palate - 81.4% (n = 35) in diabetics, and 71.1% in non-diabetics (n = 27) (p = 0.68). CONCLUSION The alterations are not related to diabetes and are present independently of having or not type 2 Diabetes Mellitus.

Óbito em caso de leishmaniose cutâneomucosa após o uso de antimonial pentavalente

The authors report a case of mucocutaneous leishmaniasis in a 45-year-old patient who was unsuccessfully treated with pentavalent antimonial for 30 days. After 10 days from the initial treatment and before starting a new therapeutic regimen with the same drug the patient died due to sudden cardiac arrest.