Maiara de Moraes

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.

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.

Sialolipoma in Minor Salivary Gland: Case Report and Review of the Literature

Sialolipoma is a rare benign neoplasm characterized by a well-circumscribed mass composed of neoplastic mature adipose tissue and non-neoplastic salivary gland elements. A 72-year-old woman presented with a painless swelling located in the hard palate, which had been identified 15 days earlier. Microscopically, the tumor was well-circumscribed consisting of lobular proliferation of the lipomatous tissue with thin fibrous tissue septa containing clustered salivary gland elements. Both the glandular and adipose components were found in almost equal proportion. No atypia in the adipose tissue was observed. The definitive diagnosis was sialolipoma. The patient showed no signs of recurrence 8 months after surgical excision. Including the present case, 35 cases of sialolipoma have been reported in the English literature. Of these 35 cases, 16 cases were located in minor salivary glands. Gender was identified in 14 of these cases with 4 males (28.5%) and 10 females (71.5%). The age distribution was from 27 to 84 years (mean, 61.6 years) and the tumor size ranged from 0.9 to 4 cm (mean, 1.7 cm). The most frequently reported clinical presentation was of a painless swelling (56.3%).

Central odontogenic fibroma

Odontogenic fibroma (OF) is a benign odontogenic tumor characterized by various amounts of odontogenic epithelium in a mature fibrous stroma. Two variants can be distinguished: an intraosseous or central OF (COF) and an extraosseous or peripheral. The intraosseous variant is an extremely rare tumor that presents clinical, radiographic, and histopathologic variable findings. A thorough review of the English literature revealed 78 cases of COF so far. Thus, we report an additional case of COF occurring in the maxilla of a 36-year-old woman. In addition, we performed a brief description and discussion of the cases reported in the maxilla and mandible.

Immunoexpression of RANK, RANKL, OPG, VEGF, and vWF in radicular and dentigerous cysts.

BACKGROUND Radicular (RC) and dentigerous cysts (DC) can show a range from little to quite extensive primary/secondary inflammation and it is possible that the variation seen in the fibrous capsule of these cysts might reflect differences in the osteolytic activity. Moreover, the presence of hemorrhagic areas in the fibrous capsule of DC could also contribute to the increase in osteolytic activity. The aim of this study was to compare immunohistochemical expression of nuclear factor κappaB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG), vascular endothelial growth factor (VEGF) and angiogenic index in RC and DC. METHODS These proteins were evaluated in 20 RC and DC by immunohistochemistry. Angiogenic index was determined by microvessel count (MVC) using anti-von Willebrand factor antibody. RESULTS RANK and RANKL were higher in DC than RC in fibrous capsule. RC showed higher expression of VEGF in the epithelium and capsule. DC exhibited higher MVC than RC. CONCLUSIONS Ours results suggest that RANK and RANKL play an important role in bone resorption in DC and the hemorrhagic areas in the capsule of DC could be explained by increased vessels number. The higher VEGF expression in RC might be related to nature of these lesions, where the inflammatory process contributes significantly to these findings.

Immunoexpression of TNF‐α and TGF‐β in central and peripheral giant cell lesions of the jaws

BACKGROUND Peripheral giant cell lesion (PGCL) is a reactive process associated with a local irritating factor that shows low recurrence after treatment, especially if the irritating factor is eliminated. On the other hand, central giant cell lesion (CGCL) presents a variable clinical behavior ranging from slow and asymptomatic growth without recurrence to rapid, painful and recurrent growth. Our aim was to compare the immunoexpression of tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) in CGCL and PGCL. METHODS Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of TNF-α and TGF-β in multinucleated giant cells (MGC) and mononucleated cells (MC). RESULTS The PGCL showed lightly higher expression of TNF-α than CGCL. In comparison with PGCL, the CGCL showed higher expression of TGF-β in MC and MGC (P < 0.05) and in total cells (P < 0.05). Significant positive correlation was found between expressions of TGF-β and TNF-α in CGCL (P < 0.05). CONCLUSIONS Our results suggest that, in CGCL, coordinated interactions between TGF-β and TNF-α may be important for osteoclastogenesis and bone resorption. PGCL occasionally cause bone resorption but to a lower extent, a fact that might be explained by the lower expression of TGF-β in these lesions.

Desmoplastic fibroblastoma (collagenous fibroma) of the tongue

To the Editor, Desmoplastic fibroblastoma (DF), also known as collagenous fibroma, is a benign, relatively paucicellular, soft tissue tumor characterized by spindleto stellate-shaped fibroblasts and myofibroblasts embedded in a prominent collagenous background.1 Since the characterization of this tumor by Evans,2 fewer than 100 cases have been reported in the English literature. Clinically, DF manifests as a painless, slow-growing mass of more than six-months duration.3 Most cases are diagnosed in adult males.3 The tumor usually involves the subcutis or skeletal muscle and has a wide anatomic distribution.3,4 Most patients have been treated by conservative surgical excision, and neither local recurrence5 nor metastasis has been reported.2 Only four cases of DF affecting the oral cavity have been reported.5– 8 We report herein a case of DF located in the tongue, a previously unreported site. An 87-year-old woman presented for evaluation of a painless swelling located in the tongue, which had been identified three years earlier. Her medical history was noncontributory. Intraoral examination revealed a yellowish, smooth, sessile, firm nodule located in the left margin of the tongue (Fig. 1). The patient reported no traumatic episode. An excisional biopsy was performed based on the initial clinical diagnosis of lipoma. Gross examination revealed a well-circumscribed, oval-shaped, fibroelastic mass, measuring 0.7 cm × 0.7 cm × 0.5 cm. Histopathologic examination revealed a nonencapsulated, but well-delineated, submucosal tumor covered with non-ulcerated mucosa in the absence of marked epithelial atrophy (Fig. 2A). The tumor was relatively paucicellular, with a prominent collagenous background. The tumor cells had a spindle to stellate shape and contained relatively large round nuclei with delicate chromatin (Fig. 2B), and occasionally, small nucleoli. A slight increase in cellularity was observed at the periphery of the tumor. Blood vessels were inconspicuous and most of them had thin walls. Small foci of calcification were identified in central areas of the tumor (Fig. 2C). Focal entrapment of skeletal muscle was noted at the periphery. Some areas of the specimen presented thick collagen bundles arranged in a whorled or storiform pattern and separated by prominent clefts (Fig. 2D), resembling sclerotic fibroma. No mitosis, necrosis, cystic degeneration, or infiltration of adipose tissue was observed. Despite scarce stromal mast cells, inflammatory cells such as lymphocytes, plasma cells or histiocytes were absent. Spindleto stellate-shaped cells were diffusely positive for vimentin (Fig. 3A). Most tumor cells were also positive for α-SMA (Fig. 3B). There was no immunoreactivity to S-100 protein or CD34 (Fig. 3C). Histochemical analysis with Masson’s trichrome stain confirmed the collagenous nature of the stroma (Fig. 3D). The definitive diagnosis was DF. The patient showed no clinical signs of recurrence nine months after surgical excision. DF is a rare tumor of the oral cavity and, to date, lesions have been observed only in the palate5– 7 and alveolar ridge.8 Thus, the present case is the first report of DF arising in the tongue. The pathogenesis of DF is still unclear and whether DF represents a peculiar reactive process or a neoplasm has not been completely established in the literature.1,3 Cytogenetic studies suggested a translocation t(2;11)(q31;q12) to constitute a recurrent and nonrandom event in DF,4 providing further evidence for a neoplastic disorder. Microscopically, despite apparent circumscription, DF may infiltrate both adipose tissue and skeletal muscle,2 and entrap nerves.3 In the present case, histologic examination revealed only small infiltration of skeletal muscle at the periphery of the specimen. Although DF is a relatively paucicellular tumor,1,7 some increase in cellularity is frequently observed at the periphery of the lesion.3 The tumor cells are stellateor spindle-shaped and present a round or elongated nucleus with delicate chromatin and small nucleoli3,5 findings also observed in this case. Binucleated cells and few multinucleated

Immunoexpression of Transforming Growth Factor Beta and Interferon Gamma in Radicular and Dentigerous Cysts

INTRODUCTION The aim of this study was to evaluate and compare the immunohistochemical expression of transforming growing factor beta (TGF-β) and interferon gamma (IFN-γ) between radicular cysts (RCs) and dentigerous cysts (DCs). METHODS Twenty RCs and DCs were selected for analysis of the immunoexpression of TGF-β and IFN-γ in the epithelium and capsule. RESULTS The cell reactivity of TGF-β and IFN-γ in the lining epithelium and capsule of RCs showed no significant differences when compared with DCs (P > .05). There was a tendency of a higher expression of TGF-β in the capsule of DCs. CONCLUSIONS Our results showed the presence of TGF-β and IFN-γ in RCs and DCs, supporting the hypothesis that both participate in the development of these lesions, where IFN-γ usually plays a role in bone resorption, which is counterbalanced by the osteoprotective activity performed by TGF-β.

Photodynamic therapy using chloro-aluminum phthalocyanine decreases inflammatory response in an experimental rat periodontal disease model

BACKGROUND AND OBJECTIVE Emerging evidence suggests that photodynamic therapy (PDT) can exhibit immunomodulatory activity. The purpose of the present study was to analyse cytokine profiles after application of PDT in gingival tissues of rats with ligature-induced periodontal disease (PD). STUDY DESIGN/MATERIAL AND METHODS Periodontal disease was induced through the introduction of a cotton thread around the first left mandibular molar, while the right side molars did not receive ligatures. After 7days of PD evolution, ligatures were removed from the left side, and the animals were randomically divided into the following treatment groups: I, rats without treatment; II, rats received chloro-aluminum phthalocyanine (AlClPc); III, rats received low-level laser alone; and IV, rats received AlClPc associated with low-level laser (PDT). The animals were killed 7days after the treatments, and the mandibles were histologically processed to assess morphological and immunohistochemical profile, while gingival tissues were removed for quantification of tumor necrosis factor (TNF)-α, interleukin (IL-)1β and IL-10 expression (by ELISA). RESULTS Histomorphological analysis of periodontal tissues demonstrated that PDT-treated animals show tissue necrosis, as well as lower TNF- α expression, compared to ligatured animals treated with AlClPc alone. CONCLUSIONS It was concluded that PDT using AlClPc entrapped in a lipid nanoemulsion may be useful in therapies, because of immunomodulatory effects that decreased the inflammatory response and cause tissue destruction.

Effects of photodynamic therapy mediated by nanoemulsion containing chloro-aluminum phthalocyanine: a histologic and immunohistochemical study in human gingiva

BACKGROUND Photodynamic therapy (PDT) uses photosensitizing agents, which are delivered in target cells, followed by local application of visible light in specific wavelengths. This reaction produce reactive oxygen species able to induce cell death by apoptosis or necrosis, injured to the local vasculature, and exert important effects on the immune system. OBJECTIVE The present work evaluated the clinical findings, histomorphological alterations and immunodetection of VEGF after PDT using chloro-aluminum phthalocyanine (AlClPc) entrapped in a lipid nanoemulsion in a split-mouth clinical trial. MATERIAL AND METHODS Eight healthy volunteers with clinical indication for extraction were included in the study. Seven days before the extraction 40 ul of nanoemulsion AlClPc 5μM was injected into gingival tissue followed by irradiation with diode laser, the contralateral side was used as control. Tissue specimens were removed seven days after the PDT and divided into two groups (test and control groups) for histological and immunohistochemical analysis. Patients were monitored at days, 0, 7, 14 and 30 to assess adverse effects of the therapy. RESULTS The therapy was well tolerated by all patients. Adverse effects were short-time and completely reversible. Areas of edema, vascular congestion, and intense vascularization were viewed in gingival samples that received PDT. Additionally, dystrophic calcification was observed in subepithelial region. VEGF showed moderate to strong immunostaining in specimens subjected to PDT. CONCLUSIONS Taken together, the results showed that the protocol used in this study mediated by nanoemulsion containing AlClPc is safe for clinical application in gingival tissue and suggests that VEGF is increased after PDT.