Luiz Alcino Monteiro Gueiros

Oral manifestations of syphilis

The past decade has shown a significant rise in the prevalence of infective syphilis in the developed world, and striking increases in its frequency have occurred in Eastern Europe, particularly the UK, and in the US. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Significant oral lesions such as gumma-associated bony destruction and a possible predisposition to oral squamous cell carcinoma are associated with tertiary disease. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. The aim of this report is to review syphilis-related oral lesions, as well as to summarize the relations between human immunodeficiency virus (HIV) and syphilis.

Impact of ageing and drug consumption on oral health

The impact of ageing on oral health and salivary flow is usually over-estimated possibly because of the high frequency of polypharmacy observed in this subset of patients. Understanding the physiological changes and treatment-related oral complications of older patients is essential to promote accurate management of symptoms and improve their quality of life. The current paper reviews age-related physiological chances in salivary glands and the effect of polypharmacy on oral health, focusing on xerostomia and hyposalivation.

Cleidocranial dysplasia: oral features and genetic analysis of 11 patients

BACKGROUND Cleidocranial dysplasia (CCD) is a dominantly inherited autosomal disease characterized by typical bone defects including short stature, persistently open or delayed closure of the cranial sutures, and hypoplastic or aplastic clavicles. Oral features are frequent and include supernumerary teeth, delayed eruption or impaction of the permanent teeth, and malocclusion. Heterozygous mutations in RUNX2 gene, which encodes a transcription factor essential for osteoblast differentiation, were identified as the etiological cause of CCD. OBJECTIVE AND METHODS Herein, we performed physical and radiographic examination and screening for RUNX2 mutations in 11 patients from five families with CCD. RESULTS All patients demonstrated the classical phenotypes related to CCD. Families whose affected members had several dental alterations such as multiple impacted and supernumerary teeth demonstrated heterozygous missense mutations (R190Q and R225Q) that impair the runt domain of RUNX2. On the other hand, CCD patients from families with low frequency of dental abnormalities showed no mutation in RUNX2 or mutation outside of the runt domain (Q292fs→X299). CONCLUSION The current findings suggest a correlation between dental alterations and mutations in the runt domain of RUNX2 in CCD patients. Further clinical and genetic studies are needed to clarify the relationship between phenotypes and genotypes in CCD and to identify other factors that might influence the clinical features of this uncommon disease.

Clinicopathological features and proliferation markers in tongue squamous cell carcinomas

The aim of this study was to evaluate the clinicopathological features and immunohistochemical expression of proliferation markers in oral tongue squamous cell carcinomas (OTSCC). Sixty-three patients without previous treatment or distant metastases were selected. Clinical information was retrieved from medical charts, histopathological analysis was performed and expression of proliferation markers (Ki-67, Mcm-2 and geminin) was evaluated. Most patients were men (81%) (male:female ratio 4.25:1). The age range was 31-92 years (mean 57.6 ± 11.81 years). A high Anneroth score was associated with tumour size (p=0.05), tumoural embolization of the blood vessels (p=0.003), nodal metastasis (p=0.05), nodal capsule rupture (p=0.016) and distant metastasis (p=0.002). Elevated Bryne scores were significantly associated with nodal capsule rupture (p=0.02), distant metastasis (p=0.002), shorter overall survival (OS) (p=0.03) and disease-free survival (DFS) (p=0.05) compared with patients with lower score. Elevated Ki-67+ cells (p=0.05) and Mcm-2+ cells (p=0.008) were associated with nodal metastasis and tumours with a high geminin score demonstrated a significant tendency for neural invasion (p=0.05). Anneroth and Bryne score in association with biomarkers of proliferation can be useful for evaluating the biological behaviour of OTSCC.

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-

Optical Coherence Tomography as an Auxiliary Tool for the Screening of Radiation-Related Caries

OBJECTIVE The aim of this study was to evaluate the morphological alterations of radiation-related caries using optical coherence tomography. METHODS Thirty-six extracted teeth from 11 patients who had undergone radiotherapy were sectioned in the sagittal axis in the center of the carious lesion, and 100 μm thick sections were obtained from each specimen. One sample from each tooth was investigated by an optical coherence tomography (OCT) system, and the results were compared with histological images from polarized light microscopy. RESULTS In OCT dentin caries images, the demineralized area appeared as a white region, whereas the translucent zone appeared as a dark area, a similar pattern also seen in coronal caries. In noncavitated enamel lesions clinically observed as brown discoloration, the area of high porosity, and also the dark color, absorbs part of the light, resulting in a dark pattern. Finally, the involvement of dentin-enamel junction (DEJ) or cement-enamel junction (CEJ) could be clearly observed, when present and marked alterations along the CEJ could be noted, as junction continuity loss, gap formation, and mineral loss tissue. CONCLUSIONS The OCT technique was able to characterize radiation-related caries, from a morphological point of view. Also demonstrated was its potential benefit for use in the clinical monitoring of radiation-related carious process.

Increased number of Langerhans cells in oral lichen planus and oral lichenoid lesions.

OBJECTIVE The aim of this study was to quantify the presence of Langerhans cells (LC) in oral lichen planus (OLP) and oral lichenoid lesions (OLL), comparing them with normal epithelium. STUDY DESIGN Thirty-six patients with biopsy-proven OLP or OLL were selected for the study, as well as 23 control subjects free of inflammatory conditions. Immunohistochemical reactions were performed using the streptavidin-biotin peroxidase complex method with CD1a and CD83 primary antibodies. Densities were compared between groups and correlated with microscopic findings. RESULTS Patients with lichenoid conditions (OLP + OLL) presented higher densities of CD1a(+) cells than the control subjects (P = .03). Higher densities of CD1a were associated with a thinner layer of inflammatory cells (P = .02). CONCLUSIONS This study indicates that OLP and OLL are characterized by the recruitment of LC, which may play a significant role on its pathogenesis.

Solitary peripheral osteomas of the jaws

Osteoma is a benign osteogenic tumor composed of cancellous or compact bone, classified as peripheral, central, or extraskeletal. Peripheral osteomas are uncommon. Excluding the maxillary sinuses, the maxilla is a rare site for osteomas. The purpose of this report was to describe clinicopathological and radiological features of two peripheral osteomas occurring in the jaws, one located in the mandible and another in the edentulous maxillary alveolar ridge. The tumors were asymptomatic and were fully excised without any complications or recurrence. The lesions were submitted to histopathological analysis and diagnosed as peripheral osteoma, compact type.

Giant sialocele following facial trauma

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

Oral squamous cell carcinoma in a 7-year-old Brazilian boy.

Squamous cell carcinomas (SCCs) are amongst the commonest malignancies in adults but in paediatric patients are exceptionally rare, particularly those involving the oral mucosa. The aim of the present report is to describe the features of a gingival well-differentiated SCC in a 7-year-old Brazilian boy. Immunostaining for p53, Ki-67 and Mcm2 showed increased cellular proliferation compared with normal epithelium. In situ hybridization failed to identify human papilloma virus infection. Correct diagnosis of well-differentiated squamous carcinoma can be difficult in children and differentiation from pseudoepitheliomatous hyperplasia is essential to establish proper treatment.