Camila De Barros Gallo

Psychological Stress and Recurrent Aphthous Stomatitis

INTRODUCTION AND OBJECTIVES: Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS. METHOD: Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist. RESULTS: There was a higher level of psychological stress among RAS group patients when compared to the control group (P < 0.05). CONCLUSION: Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.

Differential expression of toll‐like receptor mRNAs in recurrent aphthous ulceration

BACKGROUND Toll-like receptors (TLR) are membrane proteins that recognize conserved molecules derived from bacterial, viral, fungal or host tissues. They are responsible for promoting the production of cytokines and chemokines, increasing the expression of costimulatory molecules and influencing the T Helper response (Th) toward either a Th1 or Th2 profile, thereby modulating the regulatory T cell response and controlling the integrity of the epithelial barrier. The key factors responsible for increased susceptibility to recurrent aphthous ulceration (RAU) are unclear, and because TLRs are involved in both immune regulation and control of the epithelial barrier, a deficiency in TLR activity is likely to cause increased susceptibility. METHODS We investigated the gene expression of TLRs one through 10 in tissue samples and peripheral blood mononuclear cells (PBMC) of RAU patients in comparison to healthy controls using real-time quantitative reverse transcription PCR. RESULTS The analysis of mRNA expression levels in oral lesion showed significant (P < 0.01) overexpression of the TLR2 (~6-fold) gene and decreased expression of the TLR3 (~5-fold) and TLR5 (~6-fold) genes in comparison with healthy oral mucosa. The analysis of mRNA expression in PBMC indicated a down-regulation of TLR5 gene expression in the cells from RAU patients (P < 0.05; ~2-fold). CONCLUSION Our results support the hypothesis that a subset of RAU patients has fewer TLR expression that have been tentatively implicated in anti-inflammatory effects. This derangement of TLR gene expression may cause an overlay exuberant inflammation reaction in situations where normal individuals are resistant.

Drug‐induced pigmentation of hard palate and skin due to chronic chloroquine therapy: report of two cases

Pigmentation of the oral mucosa is usually associated with physiological melanin deposition and is usually seen in dark-skinned people. In white patients, oral pigmentation calls for careful examination. Isolated and wellcircumscribed pigmented lesions are usually diagnosed as melanocytic naevus, melanotic macule or amalgam tattoo, or more uncommonly as an initial sign of melanoma, whereas diffuse or multifocal pigmented lesions are more likely to be a sign of underlying systemic disorder, such as Addison s disease, Peutz–Jeghers syndrome, melanoplakia or human immunodeficiency virus (HIV) infection, or a side-effect of drug therapy. The drugs more commonly implicated in hyperpigmentation of the skin and oral mucosa tissues are the antimalarials, tetracycline, zidovudine, and nonsteroidal anti-inflammatory drugs. We report two patients who presented with oral pigmentation. Patient 1 was a 65-year-old white woman who presented with a 90-day history of a diffuse blue-grey pigmentation on the hard-palate mucosa (Fig. 1a). On examination, she was also found to have blue-grey

Low Intensity laser therapy in patients with burning mouth syndrome: a randomized, placebo-controlled study

The aim of this study was to assess the effectiveness of low intensity laser therapy in patients with Burning Mouth Syndrome (BMS). Thirty BMS subjects were randomized into two groups - Laser (LG) and Placebo (CG). Seven patients dropped out, leaving 13 patients in LG and 10 patients in CG. Each patient received 4 irradiations (laser or placebo) twice a week, for two consecutive weeks (blinded to the type of irradiation received). Infrared laser (AsGaAI) irradiations were applied to the affected mucosa in scanning mode, wavelength of 790 nm, output power of 20 mW and fluence of 6 J/cm2. A visual analogue scale (VAS) was used to assess the therapeutic effect before and after each irradiation, and at all the control time periods: 7, 14, 30, 60 and 90 days after the last irradiation. One researcher delivered irradiation and another recorded the results. Both researchers were blinded, the first to the results, and the second to the type of radiation applied. The results were categorized according to the percentage of symptom level variation, and showed a statistically better response in LG in only two categories of the control checkpoints (p=0.02; Fishers Exact Test). According to the protocol used in this study, low intensity laser therapy is as beneficial to patients with BMS as placebo treatment, indicating a great emotional component of involvement in BMS symptomatology. Nevertheless, there were positive results in some statistical analyses, thus encouraging further research in BMS laser therapy with other irradiation parameters.

CC chemokine ligand 3 and receptors 1 and 5 gene expression in recurrent aphthous stomatitis

OBJECTIVE The aim of this study was to investigate the local and systemic expression of CC-chemokine ligand 3 (CCL3) and its receptors (CCR1 and CCR5) in tissue samples and peripheral blood mononuclear cells of recurrent aphthous stomatitis (RAS) patients. STUDY DESIGN This case-control study enrolled 29 patients presenting severe RAS manifestations and 20 non-RAS patients proportionally matched by sex and age. Total RNA was extracted from biopsy specimens and peripheral blood mononuclear cells for quatitative reverse-transcription polymerase chain reaction. The data obtained by relative quantification were evaluated by the 2(-ΔΔCt) method, normalized by the expression of an endogenous control, and analyzed by Student t test. RESULTS The results demonstrated overexpression in RAS tissue samples of all of the chemokines evaluated compared with healthy oral mucosa, whereas the blood samples showed only CCR1 overexpression in RAS patients. CONCLUSIONS These findings suggest that the increased expression of CCL3, CCR1, and CCR5 may influence the immune response in RAS by T(H)1 cytokine polarization.

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion

Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.

Efficacy of photobiomodulation on oral lichen planus: a protocol study for a double-blind, randomised controlled clinical trial

Introduction Oral lichen planus (OLP) is an idiopathic chronic mucocutaneous disease with a wide range of clinical manifestations, including white reticular patches, erosive/ulcerative and atrophic lesions, both associated with intense symptomatology. Topical corticosteroids are commonly used as standard therapy. However, patients frequently present relapses after the discontinuation of treatment as well as developing resistance to corticosteroid therapy. Photobiomodulation (PBM) has been shown to be a potential therapeutic tool to treat inflammatory disorders, including OLP. The aim of this study was to compare the efficacy of PBM (660 nm) with corticosteroid therapy with clobetasol propionate 0.05% for the treatment of OLP. Methods and analysis Forty-four patients with symptomatic and histopathological diagnosis of OLP will be randomised into two experimental groups in a double-blind manner: control group (n=22): clobetasol propionate 0.05%+placebo PBM, and experimental group (n=22): PBM (λ=660 nm, power 100 mW, radiant exposure: 177 J/cm2 and 0.5J per point)+placebo gel. Laser will be applied 2×/week for 1 month and clobetasol propionate three times a day for 30 days and the same for placebo treatments. The primary variable (pain) and the secondary variables (clinical score, evaluation of functional scores, clinical resolution, OLP recurrence, quality of life and anxiety and depression) will be evaluated at the baseline, once a week during treatment (depending on the variables) and after 30 days and 60 days of follow-up. Pain will be evaluated using visual analogue scale and clinical characteristics will be scored using the Thongprasom Index. The quality of life and anxiety and depression will be evaluated by Oral Health Impact Profile-14 questionnaire and by Hospital Anxiety and Depression Scale for anxiety scale, respectively. The serum and salivary levels of interleukin (IL)-6, IL-10, IL-1β, INF-γ and tumour necrosis factor-α will be evaluated by ELISA at baseline and at the end of treatment. Ethics and dissemination This protocol was approved (#2.375.410) by the Nove de Julho University (UNINOVE) Research Ethics Committee. The data gathered using this protocol will be published in a peer-reviewed journal. Trial registration number NCT03320460.

Gingival complex odontoma: a rare case report with a review of the literature

Odontomas are odontogenic tumors composed of a mixture of dental tissues. They are very common hamartomas of the jaws. However, their peripheral or gingival counterparts are extremely uncommon. The objective of this article is to report a rare case of gingival complex odontoma in an 11-year-old patient, and also to review all published cases of this type of lesion.

Odontogenic Myxoma in a Child treated with enucleation and curettage

Odontogenic myxoma is an aggressive benign odontogenic tumor, accounting for 3-6% of all the odontogenic tumors in adults. The incidence among children is lower. Due to its clinical behavior, there is no consensus on the best treatment. In this paper, the authors report the case of a 9-year-old girl with the diagnosis of odontogenic myxoma. The panoramic X-ray showed an extensive radiolucent lesion involving the left mandibular body causing teeth displacement. The treatment consisted of tumor enucleation followed by vigorous curettage of the bone walls. Both the base of the mandible and the inferior alveolar nerve were preserved. The patient is asymptomatic after 6 months of surgery. The age of the patient and the radiographic features were taken into account when deciding in favor of the conservative treatment.

Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

Introducao A Sindrome de Ardencia Bucal (SAB) e uma condicao caracterizada pelo sintoma de ardencia na mucosa oral na ausencia de qualquer sinal clinico. Sua etiologia ainda e desconhecida e, ate o momento, nao dispoe de tratamento efetivo. Objetivo Avaliar o perfil do paciente portador de SAB, as terapias instituidas e seus resultados em estudo retrospectivo. Material e metodo Foram coletados os dados clinicos e terapeuticos dos prontuarios de pacientes diagnosticados com SAB, no periodo de janeiro de 2013 a abril de 2015, no Ambulatorio da Disciplina de Estomatologia Clinica da Faculdade de Odontologia da Universidade de Sao Paulo. Os criterios para o diagnostico utilizados se basearam nos estabelecidos pela International Headache Society em 2013 e foram observadas as terapeuticas empregadas e seus resultados. Resultado Doze pacientes foram diagnosticadas com SAB neste periodo, todas do sexo feminino, media de idade 61,18 anos, e a principal regiao acometida pelo sintoma de ardor foi o apice de lingua. O tempo de duracao deste sintoma variou de 6 meses a 25 anos. As terapias utilizadas para o controle de sintomas da SAB foram capsaicina, clonazepan topico, laserterapia e homeopatia. Dentre as terapias instituidas, a capsaicina apresentou efeito imediato na reducao dos sintomas. Conclusao O presente estudo demonstrou que os desafios que circundam a obtencao de um tratamento efetivo para a SAB sao diversos e estao principalmente relacionados ao desconhecimento da etiopatogenia da doenca. O perfil demografico dos pacientes aqui estudados foi semelhante ao descrito na literatura disponivel, entretanto, as variaveis representadas por sintomas secundarios (historia medica, niveis de ansiedade e depressao) podem constituir fatores modificadores da resposta terapeutica e da propria etiopatogenia da doenca.