Cassius Carvalho Torres-Pereira

Email for distance diagnosis of oral diseases: a preliminary study of teledentistry

We examined the feasibility of distance diagnosis of oral diseases, using transmission of digital images by email. Twenty-five cases of oral lesions were documented during a 12-month study in a primary care public health clinic in Paraná in Southern Brazil. Clinical electronic charts and images were produced and sent by email to two oral medicine specialists with a median of 10 years experience in the field. The consultants provided a maximum of two clinical hypotheses for each case. In 15 of the 25 cases (60%) both consultants made a correct diagnosis; in seven cases (28%) only one consultant made a correct diagnosis; and in three cases (12%) neither consultant made a correct diagnosis. Thus in 88% of cases, at least one consultant was able to provide the correct diagnosis. The results suggest that distant diagnosis can be an effective alternative in the diagnosis of oral lesions and that the using two distant consultants improves diagnostic accuracy. Primary care public health clinics may benefit from the use of email and digital cameras for telehealth in remote areas where oral medicine specialists are not available.

Abordagem do câncer da boca : uma estratégia para os níveis primário e secundário de atenção em saúde

Progress in cancer management by health systems involves improvements in surveillance, organization of healthcare services, specific programs focused on primary and secondary prevention, and scientific and technical advances in diagnosis and treatment. Despite well-known progress in the management of malignant neoplasms in all the above areas, oral cancer displays persistently high morbidity and mortality rates, apparently failing to reflect the accumulated scientific knowledge on the disease. The current article discusses the reasons for this mismatch, the need for redefining priorities in oral cancer management, and the implementation of such priorities as a public health policy.

Teledentistry: Distant Diagnosis of Oral Disease Using E-Mails

OBJECTIVE The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail. SUBJECTS AND METHODS The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard. RESULTS In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574). CONCLUSIONS The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Oral cancer public policies: is there any evidence of impact?

Investigation in oral cancer comprises many different fields such as epidemiology, risk factors, biological markers, diagnostic testing, screening, treatment and prognosis. Although many researchers have dealt with the oral cancer problem, it is unknown if any public policy is capable of reducing its incidence around the world under the scrutiny of the scientific method. This paper aims to briefly review and discuss the literature regarding oral cancer public policies and to screen the evidence of controlled implementations of oral health policies that have been able to diminish oral cancer incidence around the globe.

Squamous cell carcinoma of the tongue after bone marrow transplantation in a patient with Fanconi anemia

Fanconi anemia (FA) is an autosomal recessive disorder that might cause a variety of congenital and developmental abnormalities. The most important features of FA are progressive bone marrow failure and development of malignancies, particularly acute myeloid leukemia and solid tumors. This paper reports the case of a 12-year-old patient with FA assisted at the Stomatology and Bucomaxillofacial Cancer Prevention Service of São Lucas Hospital, Brazil, who had been submitted to bone marrow transplantation (BMT) at the age of 5 and exhibited oral lesions characteristic of chronic graft versus host disease (GVHD). The patient was treated and followed-up for the oral lesions. Eleven years after the BMT, he developed squamous cell carcinoma of the tongue with an aggressive behavior, which was considered an untreatable condition. The patient died few months later from asphyxia at the age of 16. The reasons for development of these malignant conditions are unknown. However, chromosomal instability typically observed in FA cases, BMT factors and GVHD have been considered. Systematic follow-up of these patients allows early and less invasive therapeutic approaches.

Micro-marsupialization as an alternative treatment for mucocele in pediatric dentistry.

BACKGROUND Mucocele is a common oral lesion in children and adolescents. Different techniques have been described for the treatment; however, all of them are invasive. AIM This work studied the efficacy of micro-marsupialization for the treatment for mucoceles in paediatric patients. DESIGN A retrospective review was performed using the clinical records of patients aged between 0 and 18 years with a clinical diagnosis of mucocele. The following data were obtained: age, gender, location and size of the lesion, duration of mucocele development, and type of treatment and its results. RESULTS The mean age of the patients was 11.1 ± 3.95 years. Mucoceles were found in the lower lip (83.7%), buccal mucosa (11.6%), and tongue (4.7%). From the overall cohort of 86 cases, 33 were treated by micro-marsupialization, of which five developed a recurrence that required surgical excision. The other 53 cases were treated by surgical excision, and three of these had recurrent disease. No statistically significant difference was found between the treatment methods. CONCLUSIONS Micro-marsupialization can be used to treat mucoceles in paediatric dentistry. It is simpler to perform, minimally invasive, requires no local infiltration of anaesthesia, has a lower postoperative complications rate, and is well-tolerated by patients.

Mouth self-examination as a screening tool for oral cancer in a high-risk group of patients with Fanconi anemia

OBJECTIVE Oral cancer usually occurs at accessible sites, enabling early detection by visual inspection. Fanconi anemia (FA) is a recessive disorder associated with a high risk of developing head and neck solid tumors. The aim of this study was to assess the ability to perform mouth self-examination (MSE) in these patients. STUDY DESIGN A total of 44 patients with FA, aged ≥ 18 years, were given a self-reported questionnaire to collect sociodemographic data and information about health-related behaviors and oral cancer awareness. They were asked to perform MSE, which was evaluated using criteria for mucosal visualization and retracting ability. Subsequently, an oral medicine specialist clinically examined all participants, and these findings were considered to be the gold standard. RESULTS The sensitivity and specificity values of MSE were 43% and 44%, respectively. The MSE accuracy was 43%. Most patients (73%) reported that MSE was easy or very easy, although 75% showed insufficient performance. CONCLUSIONS The accuracy of MSE alone is not sufficient to indicate whether MSE should be recommended as a strategy to prevent oral cancer in patients with FA. Nevertheless, the present results indicate that this inexpensive technique could be used as a tool for early detection of cancer in these patients.

[Minor salivary gland tumours: a 10-year study].

Salivary gland tumours represent between 2 % and 6.5 %, approximately, of all head and neck tumours. The aim of this paper was to identify the frequency of minor salivary gland tumours among patients in the Oral Medicine Clinic of the Federal University of Paraná during the period from 1997 to 2007. A retrospective study was conducted on 1,923 histopathological analyses of oral lesions. Fourteen cases of salivary gland tumours were found, of which 7 were benign and 7 malignant. The lesions were localized mainly in the palate (71.5 %). By histological type, 50 % of the lesions were characterized as pleomorphic adenoma, 28.6 % mucoepidermoid carcinoma, 14.3 % cystic adenoid carcinoma and 7.1 % as polymorphous adenocarcinoma. These findings suggest that salivary gland tumours have a low incidence in the population and that the pleomorphic adenoma is the most common type of tumour, followed by mucoepidermoid carcinoma.

Oral leukoplakia in patients with Fanconi anaemia without hematopoietic stem cell transplantation

Fanconi anaemia is a genetic disease characterized by congenital abnormalities, progressive bone marrow failure, and a higher predisposition of oral squamous cell carcinoma. The purpose of this study was to evaluate the prevalence of oral mucosa lesions in patients with Fanconi anaemia without hematopoietic stem cell transplantation (HSCT).

Salivary detection of periodontopathic bacteria in Fanconi's anemia patients.

Fanconis anemia (FA) is characterized by bone marrow failure and can lead to infections such as periodontal disease. The aim of this study was to compare the prevalence of four periodontopathic bacteria including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum and Treponema denticola in saliva samples from children with and without FA. Paraffin-stimulated saliva samples were collected from 71 children and adolescents, aged 6-18 years old. The samples were divided in three groups: FA without HSCT (n = 25), FA with HSCT (n = 23) and Non-FA (n = 24). The test bacteria were identified using a 16S rRNA-based PCR analysis. P. gingivalis was the most frequent species in all groups and T. denticola the less frequent. P. gingivalis was also common species in combinations in all groups. No statistically difference was observed between the groups for single bacteria, pair or triple combination. The combination of the four species was detected in one saliva sample of the FA without HSCT group and in five samples of the Non-FA group, with statistical difference between them (p < 0.05, Fisher exact test). Systemic alterations found in FA subjects did not affect the salivary distribution of the four bacteria analyzed.