Elen de Souza Tolentino

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Saliva and tongue coating pH before and after use of mouthwashes and relationship with parameters of halitosis

Objectives The aim of this work was to evaluate saliva and tongue coating pH in oral healthy patients with morning bad breath before and after use of different oral mouthrinses. Material and Methods aliva and tongue coating pH of 50 patients allocated in 5 groups were measured respectively by a digital pHmeter and color pH indicators, before, immediately after and 30 min after rinsing 5 different mouthrinses: cetilpiridine chloride associated with sodium chloride, triclosan, enzymatic solution, essential oil and distilled water. Results Only triclosan and essential oil increased salivary pH immediately after rising. The enzymatic solution decreased salivary and tongue coating pH immediately after rinsing. Conclusion Salivary pH tended to be acidic while tongue coating pH tended to be alkaline, even after rising. Triclosan and essential oil mouthrinses increased salivary pH immediately after rinsing. Enzymatic solution decreased saliva and tongue coating pH immediately after rising.

Ameloblastic Fibro-Odontoma: A Diagnostic Challenge

An 11-year-old girl presented to our department to have a second opinion regarding a lesion involving her left mandible. She had previously undergone several radiographic exams including panoramic, helical, and cone-beam computed tomography. Radiographic examinations revealed a well-defined radiolucent region, which contained an irregular radiopaque mass of 3 cm in diameter, localized to the left angle of the mandible. Our presumptive diagnosis was complex odontoma. Excisional biopsy was performed, and microscopic features showed strands and islands of odontogenic epithelium showing peripheral palisading and loosely arranged central cells, identical to stellate reticulum, embedded in a myxoid cell-rich stroma resembling the dental papilla. Dentin and enamel were also presented. The diagnosis was ameloblastic fibro-odontoma, which is a rare mixed odontogenic tumor, derived from epithelial and ectomesenchymal elements that form the dental tissues.

Atypical Lesion on Soft Palate: A Curious Case

El objetivo de este trabajo es presentar un caso de un hombre de 39 anos de edad, con un tejido de 2 cm pediculado color purpura en el paladar blando, junto al area retromolar superior derecha, asintomatico, con un dia de evolucion y de aspecto vascular. No habia historia de trauma o enfermedades sistemicas. Con base en los hallazgos clinicos nuestro diagnostico previo fue granuloma traumatico, hemangioma o la formacion de coagulos sanguineos, despues de un traumatismo local. Luego de una semana, el examen intraoral revelo ausencia de la lesion, la que desaparecio por completo. Este caso ilustra que la ausencia de historia de trauma y las caracteristicas clinicas atipicas, puede ser un desafio diagnostico en la rutina clinica.

Phenotype and cell proliferation activity of duct-like structures in human sublingual glands: a histological and immunohistochemical study

There are several age-related microscopic changes in the salivary glands, including the increase in the number of duct-like structures (DLS). However, the true origin and the phenotype of the DLS are not known. Objective To evaluate the phenotype and the cell proliferation index of the DLS of human sublingual glands. Material and Methods Sixty sublingual glands obtained from human cadavers were divided into two groups - 0-30 and 61-90 years old. The phenotype was estimated by immunostaining for cytokeratin 19 (CK 19) and the S-100 protein as well as by the presence of mucin and glycogen. The cell proliferation index was determined by the Ki-67 antibody. The histochemical techniques used periodic acid-Schiff (PAS) and Alcian Blue. In each captured microscopic field, the DLS were counted to establish a percentage for the staining profile. The statistical analysis was accomplished using Student’s t-test, the Mann-Whitney test and Pearson’s correlation coefficient (p<0.05). Results Comparing both groups, only CK 19 showed a statistically significant difference (p=0.033), with the strongest expression in the elderly group. There was no significant difference between PAS and Alcian Blue (p=0.270). In both groups, the immunostaining for CK 19 was stronger than that for S-100 (p=0.004;p<0.001), but there was no correlation between the two immunomarkers (ρ=-0.163; p=0.315). There was no immunostaining for Ki-67. Conclusions DLS demonstrate a ductal phenotypic profile and do not present cell proliferation activity. DLS may represent a regressive process arising from acini or represent the result of metaplasia.

Von Recklinghausen's Disease -Diagnosis from Oral Lesion: Neurofibromatosis I

A 35 years-old male patient was referred to your Institution due to a nodule on the palate with more than 15 years of evolution. In general physical examination noticed the presence of papules and cafe au lait (coffee with milk) pigmentation in many parts of the body. Intra oral examination found a swelling in the hard palate and resilient on palpation, asymptomatic with three centimeters of diameter. Incisional biopsy was performed and the diagnosis was neurofibroma. Complete resection of the lesion was performed confirming the initial diagnosis. The general clinical findings and the presence of neurofibroma confirmed the diagnosis of Von Recklinghausens disease. This paper emphasizes the important role of the dentist in diagnostic and follow-up of the Von Recklinghausens disease.

Continuity resection of the mandible after ameloblastoma – feasibility of oral rehabilitation with rhBMP-2 associated to bovine xenograft followed by implant installation

Recombinant human morphogenetic protein (rhBMP) is a graft alternative for extensive mandibular reconstruction after tumor resections. However, the feasibility of rhBMP-2 to receive osseointegrated implants and prosthetic rehabilitation has been rarely reported. This study reports on a case of an extensive solid ameloblastoma along the mandibular body. The treatment consisted of resection followed by off-label use of rhBMP type 2 associated with bovine bone xenograft. Eleven months postoperatively, the patient was prosthetically rehabilitated with dental implants, without evidence of resorption or complications. The literature on mandibular reconstructions using rhBMP and their feasibility for future osseointegrated implant placement was also reviewed. Based on the presented case, the association between rhBMP-2 and a bovine bone xenograft could be considered a feasible option for the reconstruction and rehabilitation of large mandibular defects after tumor resection. According to the literature, the use of rhBMP as a graft material is encouraging, with good clinical outcome. However, there are no long-term studies demonstrating success and survival rates of implants placed in these grafts. Future investigations will be required to ascertain the long-term survival of implants in areas grafted with rhBMP. Also, there is a lack of information regarding the prosthetic rehabilitation of these patients.

Potencial de Transformación Maligna del Liquen Plano Oral: Estudio Retrospectivo

El liquen plano oral (LPO) es una enfermedad mucocutanea inflamatoria mas comun en las mujeres. Su etiologia aun no es bien definida y esta condicion puede estar relacionada, por ejemplo, a la ansiedad, estres, diabetes, las enfermedades autoinmunes, infecciones y predisposicion genetica. El LPO se manifiesta en dos formas principales: reticular y erosivo. El objetivo de esta investigacion es, a traves de un estudio retrospectivo, analizar el posible potencial maligno del LPO. Se analizaron los registros de los pacientes atendidos en dos proyectos de lesiones bucales de dos diferentes instituciones en el periodo de 1995 a 2014. Se recogieron datos como genero, edad, presencia de enfermedad sistemica, presencia de lesiones en la piel, tabaquismo, duracion de la lesion, localizacion, sintomas, tratamiento, proservacion y transformacion maligna. Los resultados mostraron que, de los 3488 analizados, 85 (2,4%) tuvieron un diagnostico confirmado de LPO, que afecta fundamentalmente a pacientes de sexo femenino (85%) siendo el LP reticular mas comun. En relacion a la transformacion maligna del LPO, 1 paciente (0,85%) tenia carcinoma de celulas escamosas 4 anos despues del diagnostico inicial de LPO. Ademas, 3 pacientes mostraron atipia celular moderada en el diagnostico. Los resultados refuerzan el potencial de transformacion maligna del LPO. Aunque esta asociacion es especulativa, la posibilidad debe ser considerada por los profesionales, que deben presentar estos pacientes a largos periodos de preservacion.

Manifestações bucais da paracoccidioidomicose: considerações gerais e relato de caso

Paracoccidioidomycosis is a systemic disorder that primarily involves the lungs and then disseminates to other organs and systems. The aim of this work was to present a literature review about this disease, focusing clinical aspects, epidemiology, methods of diagnosis and treatment, and relate a case diagnosed after clinical evaluation, exfoliative cytology and incisional biopsy. Secondary lesions appear frequently in the mucous membranes, lymph nodes and skin. Both clinical presentation of the mycosis and the course of the disease vary from patient to patient. Subclinical infections have been documented in healthy residents of areas where the disease is endemic. These areas are confined solely to certain countries in Latin America. Paracoccidioidomycosis is frequently diagnosed in Brazil, Venezuela, Colombia, Ecuador, and Argentina; in Brazil, it constitutes an important public health problem. The etiologic agent is a dimorphic fungus, Paracoccidioides brasiliensis. It is important to pay attention to chronic ulcerated lesions of oral mucosa, considering the possible diagnosis of paracoccidioidomycosis. Key words: Paracoccidioidomycosis. Exfoliative cythology. Antifungal agents. Oral manifestations.

Avaliação do pH da saliva e da saburra lingual antes e após a utilização de soluções enxaguantes orais

The aim of this work was to evaluate saliva and tongue coat pH in oral healthy patients with morning breath through an analog pHmeter and color pH indicators, before and immediately after use of different mouthwashes and 30 minutes after rinsing, relating the possible pH alterations to parameters of halitosis. 50 patients were allocated in 5 groups, with 5 different solutions rinses – Cetilpiridine chloride associated with sodium chloride, Triclosan, enzymatic solution, essential oil and distilled water. Triclosan and essential oil increased saliva pH immediately after rinsing and enzymatic solution reduced saliva and tongue coat pH.