Maria Auxiliadora Vieira do Carmo

Oral Mucosal Conditions in Chronic Hepatitis C Brazilian Patients: A Cross‐Sectional Study

OBJECTIVE Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. METHODS A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. RESULTS The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant (P = 0.002). The most frequent variations of normality included Fordyces spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). CONCLUSION The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.

Oral lichen planus and chronic hepatitis C: a controversial association.

Our aim was to study the possible association between oral lichen planus and chronic hepatitis C in patients from the state of Minas Gerais, Brazil. Two groups of patients were studied: group 1, 50 patients with oral lichen planus evaluated for the presence of chronic hepatitis C; and group 2, 215 patients with chronic hepatitis C examined for evidence of oral lichen planus. Diagnosis of oral lichen planus in both groups was based on clinical and histologic findings. One case of chronic hepatitis C was diagnosed in group 1 (2.0%), which was not considered statistically significant (P = .464). In group 2, the prevalence of oral lichen planus was 2.3% (5 cases), which showed statistical significance (P = .002). Although our results suggest oral lichen planus as an extrahepatic manifestation of chronic hepatitis C in the studied population, the association between these two entities should be further investigated.

Exacerbation of oral lichen planus lesions during treatment of chronic hepatitis C with pegylated interferon and ribavirin

It is estimated that 170-200 million people in the world are chronically infected with the hepatitis C virus. This fact indicates that the prevention and treatment of hepatitis C virus infection are a priority in public health care. To date, the best treatment consists of the combination of pegylated interferon (IFN) and ribavirin. IFN is costly and associated with low tolerance and severe side effects. Ribavirin is also problematic because it causes secondary anemia in most patients. It has been described that oral lichen planus (OLP) can appear or be exacerbated during the treatment of chronic hepatitis C. The improvement of the lesions of OLP after the discontinuation of therapy suggests that IFN may induce or worsen these lesions in some patients. This study examines three cases of exacerbation of OLP during the treatment of chronic hepatitis C with pegylated IFN and ribavirin.

Xerostomia, hyposalivation and sialadenitis in patients with chronic hepatitis C are not associated with the detection of HCV RNA in saliva or salivary glands

Objective Salivary gland disorders in patients with chronic hepatitis C (CHC) have been considered oral extrahepatic manifestations, reinforcing the hepatitis C virus (HCV) as a sialotropic virus. Hence, the authors investigated the prevalence of HCV RNA in saliva and salivary glands and its possible association with xerostomia, hyposalivation and sialadenitis in patients with CHC. Patients and methods In 65 patients with confirmed CHC, the HCV RNA was investigated by nested RT-PCR in saliva samples and minor salivary glands. Xerostomia, hyposalivation, clinical and histopathological evidence of sialadenitis were also evaluated. Univariate and multivariate analyses were employed to verify associations. Results HCV RNA was detected in the saliva of 26/65 (40.0%) patients and in 12/65 (18.5%) salivary glands. Xerostomia was reported by 23/65 (35.4%) patients, and hyposalivation was diagnosed in 13/65 (20.0%) patients. Sialadenitis was confirmed by histopathological features in 31/65 (47.7%) patients. Twelve (38.7%) of the 31 patients with sialadenitis presented HCV RNA in saliva and 2/31 (6.5%) in salivary glands. No associations were found between xerostomia, hyposalivation or sialadenitis and the detection of HCV RNA in saliva or in salivary glands. Conclusions Although xerostomia, hyposalivation and sialadenitis are frequent findings in CHC patients, our study did not confirm the association between the detection of HCV RNA in saliva or salivary glands with these salivary gland disorders. However, an indirect role of HCV by immune-mediated virus mechanisms in the pathogenesis of salivary gland disorders in this group of patients cannot be ruled out.

Oral leukoplakias with different degrees of dysplasia: comparative study of hMLH1, p53, and AgNOR.

BACKGROUND hMLH1 is one of the major proteins of the mammalian mismatch repair system. It has been suggested that the mismatch repair machinery could be linked to p53, a tumor suppressor protein. The AgNOR technique is used to assess cell proliferation. The aim was to compare the immunoexpression of hMLH1 and p53, and AgNOR number in oral leukoplakias with different degrees of dysplasia. METHODS Sixty-two samples were evaluated by immunohistochemistry for hMLH1 and p53, and AgNOR technique, being 17 without dysplasia, 19 with mild dysplasia, 16 with moderate dysplasia, and 10 with severe dysplasia. RESULTS hMLH1 immunoexpression showed decreasing indexes, while p53 and AgNOR showed increasing indexes from lesions with lower degrees of dysplasia to lesions with more severe dysplasia. An inverse correlation between hMLH1 and both p53 and AgNOR, and a direct correlation between p53 and AgNOR were observed. CONCLUSIONS Alterations in the immunoexpression pattern of hMLH1 and p53 seemed to be early events in oral carcinogenesis. During acquisition of a more dysplastic phenotype, keratinocytes may show diminished capacity of DNA repair and tumor suppression, as well as higher cellular proliferation, and these pathways can be somehow interconnected.

hMLH1 immunoexpression is related to the degree of epithelial dysplasia in oral leukoplakia.

BACKGROUND hMLH1 is a protein of the mammalian mismatch repair system responsible for genomic stability during repeated duplication. Relation between its altered expression linked to microsatellite instability has also been observed in oral leukoplakias (OL) and squamous cell carcinomas pointing to a possible role of hMLH1 in oral carcinogenesis. To our knowledge, this is the first study evaluating the immunoexpression of hMLH1 in OLs regarding their different degrees of epithelial dysplasia. METHODS Sixty-two specimens of OL were classified in four groups: 17 without dysplasia, 19 with mild dysplasia, 16 with moderate dysplasia, and 10 with severe dysplasia. Immunohistochemistry for hMLH1 was performed, and percentage of positive cells was assessed. In the statistical analysis, P values <0.005 were considered significant. RESULTS hMLH1 immunoexpression showed decreasing indexes from lesions with lower degrees of dysplasia to lesions with more severe dysplasia. Statistical difference was found mainly between suprabasal layers and total indexes. CONCLUSIONS hMLH1 immunoexpression was inversely related to the OL degree of dysplasia. The total epithelial hMLH1 index seems to be of more clinical relevance than the evaluation stratified by layers. Our findings also suggest a role of such alterations in this pathway of DNA repair as an early event in oral carcinogenesis.

Intraoral sebaceous carcinoma

Intraoral sebaceous carcinoma (SC) is a rare tumour in the oral cavity thought to arise from malignant transformation of oral sebaceous glands. To our knowledge, only six cases of intraoral SC have been reported in the English language literature. The purpose of the present article is to report an additional case and review the literature.

Correlation between salivary anti‐HCV antibodies and HCV RNA in saliva and salivary glands of patients with chronic hepatitis C

BACKGROUND To investigate the correlation between anti-hepatitis C virus (HCV) antibodies in saliva and detection of HCV RNA in saliva and salivary glands of patients with chronic hepatitis C. METHODS A total of 180 samples of saliva (131 non-stimulated and 49 stimulated) from 133 patients with chronic hepatitis C were tested by ELISA for presence of anti-HCV antibodies. Results were compared with the detection of HCV RNA in saliva and salivary glands samples. Pearsons chi-squared and Fishers exact tests were performed for statistical analysis. RESULTS Anti-HCV antibodies could be detected in 47/180 (26.1%) saliva samples. In 11/47 (23.5%) of these, HCV RNA was also detected. From the 133/180 (73.9%) saliva samples with undetectable anti-HCV antibodies, 49/133 (36.8%) were positive for HCV RNA at least in one saliva sample. From the 64 patients from whom salivary gland samples were available, 17/64 (26.6%) had detectable anti-HCV antibodies in saliva, from which 2/17 (11.8%) also had HCV RNA in the salivary gland. From the 47/64 (73.4%) cases negative for anti-HCV antibodies in saliva, 10/47 (21.3%) were positive for HCV RNA in salivary gland. CONCLUSIONS Taken together, our results suggest that there is no correlation between the presence of anti-HCV antibodies in saliva and the detection of HCV RNA in saliva and salivary glands in patients with chronic hepatitis C. Nevertheless, as there was a statistically significant difference between detection of anti-HCV antibodies and HCV RNA in stimulated saliva, our study points toward the need for new research on mechanisms of HCV shedding in saliva.

Detection of HCV RNA in saliva does not correlate with salivary flow or xerostomia in patients with chronic hepatitis C

OBJECTIVE The objective of this study was to investigate the prevalence of hepatitis C virus (HCV) RNA in saliva and its possible association with xerostomia and hyposalivation in patients with chronic hepatitis C. STUDY DESIGN One hundred and thirty-six patients with confirmed diagnosis of chronic hepatitis C were prospectively analyzed before HCV treatment. The prevalence of xerostomia and hyposalivation was clinically evaluated. HCV RNA was investigated in saliva samples by qualitative PCR test. Univariate and multivariate analyses were used to verify associations. RESULTS Xerostomia was reported by 48 (35.3%) patients, whereas hyposalivation was observed in 26 (19.1%). HCV RNA was positive in the saliva of 53 (39.0%) patients. An association among HCV RNA-positive saliva with xerostomia or hyposalivation was not observed. CONCLUSION Our results demonstrate that the detection of HCV in saliva does not correlate with salivary flow or xerostomia in patients with chronic hepatitis C.

Tumor of the hard palate

At the Oral Diagnosis Clinic at the Dentistry School of Universidade Federal of Minas Gerais, a 29-year-old white woman was admitted with a slow-growing, painless oral lesion that had been present for 1 year. The patient was in her eighth month of pregnancy and was receiving medical treatment for slight iron-deficiency anemia related to the pregnancy. Extraoral examination revealed no other abnormalities. One lobulated, nonulcerated lesion was evident on the right posterior hard palate. It was mainly pink with darkened, reddish and whitish areas. The lesion was well circumscribed and partially sessile with a fibrous consistency; it measured approximately 35 20 mm. Superficial vascularity was evident in some areas (Figure 1, A). Radiographic examination did not reveal evidence of bone involvement (Figure 1, B). Neither the dental caries on the maxillary right first molar nor the periapical lesion on the maxillary left lateral incisor appeared to be associated with the lesion.