Maria Carmen Fontoura Nogueira da Cruz

Avaliação clínica das lesões orais associadas a doenças dermatológicas

FUNDAMENTOS: As doencas dermatologicas nao estao representadas apenas pelas lesoes que afetam a pele, mas, tambem, por manifestacoes que podem envolver as mucosas, inclusive a mucosa oral. OBJETIVOS: Avaliar a frequencia das manifestacoes orais em pacientes com doencas dermatologicas, considerando-se a localizacao e as caracteristicas clinicas das lesoes encontradas, o sexo, a idade e a raca dos acometidos. METODOS: Estudo observacional, do tipo transversal, com pacientes que procuraram atendimento no Servico de Dermatologia do Hospital Universitario Presidente Dutra (HUPD) da Universidade Federal do Maranhao (UFMA) entre outubro de 2007 e outubro de 2008 (n=88). RESULTADOS: A idade variou entre cinco e 88 anos, e o sexo feminino foi o mais atingido (2:1). Dos casos examinados, 35% eram de liquen plano, 33% de lupus eritematoso, 24% de eritema multiforme, 7% de penfigo vulgar e 1% do grupo penfigoide. As lesoes orais foram mais frequentes nos portadores de liquen plano (51%) e lupus eritematoso (20%). O liquen plano reticular foi a forma clinica mais comum e a mucosa jugal, o sitio mais acometido. CONCLUSOES: O conhecimento dessas patologias pelo cirurgiao-dentista e de fundamental importância, cabendo-lhe uma parcela de responsabilidade pelo diagnostico precoce e orientacao para o tratamento adequado. Alem disso, o exame intraoral deve ser incorporado como pratica de rotina durante o atendimento dermatologico.

Changes in immunoexpression of E-cadherin and β-catenin in oral squamous cell carcinoma with and without nodal metastasis

The aim of this study is to analyze the immunohistochemical expression of E-cadherin and beta-catenin in oral squamous cell carcinoma to better understand the biological behavior of this lesion. The sample consisted of 15 cases of the tongue and 15 of the lower lip. The pattern and intensity of the labeling and the analysis of the percentage of tumor cells immunopositive in membrane for E-cadherin and beta-catenin were related to the anatomic location of the lesion, the presence or absence of nodal metastasis, and the histological gradation of malignancy in the tumor invasion front. The presence or absence of cytoplasmic and nuclear labeling was also recorded. The membrane expression for E-cadherin and beta-catenin predominately displayed a heterogeneous pattern in the carcinomas studied. No significant difference was observed between the expression pattern and the quantity of cells immunopositive for E-cadherin and beta-catenin and the anatomic location of the lesion or the presence or absence of nodal metastasis. However, a statistically significant difference was found between the reduced expressio\n of these proteins and the high malignancy score. The reduced immunoexpression of these proteins in the membrane may be related to the high degree of cell indifferentiation in cases of oral squamous cell carcinoma with high scores.

Immunohistochemical expression of E-cadherin and CD44v6 in squamous cell carcinomas of the lower lip and tongue

This study analyzed the immunohistochemical expression of E-cadherin and CD44v6 in 15 squamous cell carcinomas (SCCs) of lower lip and 15 SCCs of tongue in order to verify a possible association between these proteins and the anatomic location of the lesion, nodal metastasis and histological grading of malignancy. The pattern of expression and number of immunopositive cells were evaluated. The results were analyzed with the Fishers exact test, Mann-Whitney test and Spearmans Correlation Coefficient (r). using the SPSS software 10.0 for Windows. Statistical significance was set at 5% determined for a p-value<0.05 for all tests. There was no significant difference (p>0.05) in the pattern of expression and number of immunopositive cells for E-cadherin and CD44v6, regarding the anatomical location and nodal metastasis. For the histological grading, low score SCCs showed higher immunopositivity for E-cadherin and CD44v6, both for the pattern of expression and number of immunopositive cells (p<0.05). There was a negative correlation between the total score of malignancy and the pattern of expression and number of immunopositive cells for E-cadherin and CD44v6 (p<0.05). In conclusion, SCCs of the lower lip and tongue did not reveal significant differences in the expression of E-cadherin and CD44v6. The expression of these adhesion molecules revealed association only with tumor histological grading of malignancy. Therefore, these results suggest that E-cadherin and CD44v6 may not help elucidating the differences between the biological behavior of SCCs of the lower lip and tongue.

Oral microbiome, periodontitis and risk of head and neck cancer

A wide range of studies has been successfully exploring the association between the human microenvironment, sustained inflammation, and cancer. Growing evidence has then emerged in this field over the past few years. Nevertheless, reliable data addressing the impact of the oral microbiome and periodontitis on the pathogenesis and risk of head and neck malignancies remain scarce. Hence, this communication focuses on briefly discuss the relationship between the oral microbiome, periodontitis and head and neck cancer based on the current understanding of such a disease-associated scenario.

Longitudinal assessment of immunological and oral clinical conditions in patients undergoing anticancer treatment for leukemia

OBJECTIVE The aim of this study was to evaluate the evolution of the immunological and oral clinical conditions of children and adolescents undergoing anticancer treatment for leukemia (ATL). METHODS Twenty patients aged 3-15 years undergoing chemotherapy seen at a referral center for cancer treatment in the State of Maranhão, Brazil, from 2008 to 2009, were evaluated at baseline (1st). Twenty-two controls were selected in public schools. Oral lesions, caries experience (deft and DMFT), plaque index (PI), gingival index (GI) and salivary IgA were analyzed. Patients and controls were evaluated after 6 months (2nd). The Shapiro Wilk, Mann-Whitney, Wilkoxon and Spearman correlation tests were carried out (alpha=5%). RESULTS Gingivitis and mucositis were the most frequent manifestations in oral mucosae during the two phases. The mean DMFT index increased from 3.9 ± 4.2 (1st) to 4.4 ± 4.3 (2nd) (p = 0.04). The mean deft index was the same in the 1st (1.9 ± 2.7) and 2nd (1.9 ± 2.7) evaluation (p = 0.86). The GI also did not vary between assessments: 1st (1.3 ± 0.4) and 2nd (1.3 ± 0.3) - (p = 0.12), except on the lingual and distal surfaces, where increased from the 1st to 2nd evaluation (p < 0.01). The PI varied from 0.9 to 1.1, but this difference was not significant (p = 0.48), except for the lingual surface, where increased from 0.6 to 1.0 (p = 0.04). There was a reduction in salivary IgA levels from 2.9 to 1.9 μg/mL (p = 0.04), and mean IgA was significantly higher in the control group (5.4 μg/mL) if compared to cases (p < 0.01). CONCLUSION The clinical and immunological oral conditions of children and adolescents undergoing ATL presented an unfavorable evolution. This study highlights the need for monitoring oral conditions during the ATL and draws attention to the additional responsibility of the otolaryngologist in referring ATL patients to the dentist, especially in the presence of clinical evidence of oral problems. We suggest that the planning of ATL take into account the oral health, in a multidisciplinary oncology team.

Oral manifestations as important symptoms for juvenile dermatomyositis early diagnosis: a case report

BACKGROUND Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy of childhood and adolescence, characterized by symmetrical weakness of proximal muscles and classical cutaneous features. Literature reports rarely describe or focus on oral lesions that are associated with this disease. CASE REPORT This case describes a 4-year-old girl in whom the oral lesions were the initial manifestations of JDM. Physical examination revealed characteristic skin manifestations, proximal muscle weakness, extensive calcinosis, necrotic ulceration, complicated erysipelas, and diffuse alopecia. The diagnosis was established based on the clinical, histological, electroneuromyography, and biochemical findings. CONCLUSION Recognition of gingival telangiectases as an important diagnostic marker of JDM leads us to suggest that identifying oral manifestations, which may be carried out by a paediatric dentist, contributes in establishing an early diagnosis and an immediate treatment of this condition.

Immunohistochemical analysis of mismatch proteins in carcinogenesis of the lower lip

This study investigated the immunohistochemical expression of hMLH1 and hMSH2 proteins in lower lip squamous cell carcinoma (SCC) and actinic cheilitis (AC), to contribute to the understanding of the development of lower lip cancer.

Systemic alterations and their oral manifestations in pregnant women

The aims of this literature review are: to depict the main oral diseases that are related to pregnancy; to clarify some of the possible systemic mechanisms that are associated with these changes; and to address issues about oral care during pregnancy. A womans organs undergo various physiological, neurological, and hormonal changes during pregnancy. Such changes occur gradually and are essential for the development of the fetus, providing what is needed for tissue formation and establishment of reserves for uterine and fetal life. In turn, the oral cavity shows some events during this period. Among the changes most frequently cited in the literature are pyogenic granuloma, gingivitis, and periodontitis. The inflammation of the periodontal tissues due to the formation of the biofilm increases dramatically in size and severity during the course of a normal pregnancy, even without changes in the amount of biofilm present. In addition, a decrease in salivary pH is observed in pregnant women and may lead to an increased incidence of dental caries in this period.

Oral and maxillofacial biopsied lesions in Brazilian pediatric patients: A 16-year retrospective study

PURPOSE: To survey oral and maxillofacial lesions biopsied in a Brazilian pediatric hospital. METHODS: Biopsy records over a 16-year period (1992-2008) were retrieved from the files of the Anatomy and Pathology Service, Hospital Presidente Dutra, Federal University of Maranhao, Brazil. Pediatric cases patients aged 16 years old or younger were selected. Oral and maxillofacial diagnoses were grouped into 10 categories, and lesions were evaluated for age, gender, anatomic location and pathological diagnosis. Data were analyzed using descriptive statistics. RESULTS: Of a total of 3,550 pediatric biopsies, 88 cases (2.48%) were located in oral or maxillofacial sites. Similar incidence rates were observed between the genders and the prevalence of lesions was highest in the permanent dentition period (>12-16 years old). Maxilla was the most commonly affected anatomic location. As regards the diagnostic categories, the highest number of lesions was in the hyperplastic/reactive category. The most frequently encountered lesions were inflammatory fibrous hyperplasia and mucocele. Malignant lesions were rarely described. CONCLUSION: This study shows a similar trend to that reported in previous studies on the most frequent oral and maxillofacial lesions found in the pediatric population. The majority of lesions detected were benign, and malignant lesions were diagnosed in a very low number of patients.

Perfil epidemiológico das neoplasias de glândulas salivares diagnosticadas em São Luís-MA

INTRODUCAO E OBJETIVO: As neoplasias de glândulas salivares constituem um grupo de lesoes, clinica e morfologicamente diverso, capaz de determinar importantes desafios diagnosticos e terapeuticos. O escopo do trabalho e determinar a frequencia relativa e a distribuicao das neoplasias de glândulas salivares diagnosticadas no Instituto Maranhense de Oncologia Aldenora Bello (IMOAB). MATERIAL E METODOS: Realizou-se estudo retrospectivo dos casos de neoplasia de glândula salivar diagnosticados no IMOAB, no periodo de janeiro de 1997 a dezembro de 2007. Dados sobre sexo, idade e localizacao anatomica foram obtidos em prontuarios medicos. Cortes histologicos foram avaliados sob microscopia de luz e os casos foram categorizados segundo a classificacao da Organizacao Mundial da Saude (OMS)(4). Os dados coletados foram analisados por meio de estatistica descritiva. RESULTADOS: Foram identificados 232 casos, dos quais 178 eram neoplasias benignas (76,7%) e 54 (23,3%), malignas. Os tres tipos histologicos mais frequentes foram: adenoma pleomorfico (59,5%), tumor de Warthin (13,8%) e carcinoma adenoide cistico (6,9%). A maioria dos casos foi diagnosticada em pacientes do sexo feminino, com proporcao homem:mulher de 1:1,3. As neoplasias benignas e malignas apresentaram picos de incidencia na quarta e setima decadas de vida, respectivamente. Com relacao a localizacao anatomica, 154 casos (66,4%) afetaram a parotida, 43 (18,5%) acometeram a glândula submandibular e 35 (15,1%) envolveram glândulas salivares menores. CONCLUSAO: Em conjunto com outros estudos, os resultados da presente pesquisa sugerem discretas variacoes na frequencia relativa e distribuicao das neoplasias de glândulas salivares entre as populacoes do Brasil e de outras regioes do mundo.