Patrícia Meira Bento

Prevalence of oral mucosal lesions among patients with diabetes mellitus types 1 and 2

BACKGROUND Patients with diabetes mellitus have been associated with a number of changes in the oral cavity, such as gingivitis, periodontitis, mucosal diseases, salivary dysfunction, altered taste, and burning mouth. OBJECTIVES To determine the prevalence of oral mucosal lesions in patients with diabetes mellitus. METHODS A cross-sectional observational study between August and October 2012 with a convenience sampling was performed for 51 patients with diabetes mellitus (type 1 and type 2). The study consisted of two phases: 1) a questionnaire application; 2) intraoral clinical examination. For the analysis of data, we used descriptive statistics, Fishers exact test in bivariate analysis (significance level of 0.05), and Poisson Regression. RESULTS The prevalence of oral lesions was 78.4%. Traumatic ulcers (16.4%) and actinic cheilitis (12.7%) were the most prevalent lesions. The lips (35.3%) and tongue (23.5%) were the most common location. The bivariate analysis showed an association with the type of diabetes, and two variables (age and comorbidity) were quite close to the significance level. In the Poisson Regression analysis, only diabetes type 2 remained significant after adjusting the model. CONCLUSIONS The results of this study show a high prevalence of oral mucosal lesions in diabetic patients. The oral mucosal lesions are mostly associated with diabetes type 2.

Correlation between temporomandibular joint morphology and disc displacement by MRI

OBJECTIVES The aim was to evaluate the morphology of the temporomandibular joints (TMJs) disc and condyle as well as its correlation with disc displacement, using MRI. METHODS 190 TMJs were retrospectively analysed. The condyle morphology of each TMJ was evaluated by two observers using both axial and coronal views, as were their disc morphology and displacement, using sagittal view. Condyle morphology was classified as flat, convex, angled or rounded in the coronal sections and as anterior side flat/posterior side convex, biconvex, anterior side concave/posterior side convex, flat or biconcave in the axial view. Disc morphology was determined as biconcave, biplanar, biconvex, hemiconvex or folded. χ2, Fisher exact and Bonferroni correction tests were used to evaluate the data. ANOVA followed by post hoc Tukeys test was used to evaluate the interaction between age and disc displacement. RESULTS Anterior disc displacement with reduction; convex condyle morphology in the coronal view; anterior side concave/posterior side convex morphology in the axial view; and biconcave discs were found to be the most prevalent findings. An association was observed between disc morphology and disc displacement (p<0.001). No correlation between condyle morphology and TMJ disc displacement was found (p=0.291 for axial and p=0.14 for coronal views). CONCLUSIONS The results of this study suggest that TMJ disc morphology is associated with disc displacement.

Mucopolysaccharidosis: radiographic findings in a series of 16 cases.

OBJECTIVES To investigate the radiographic findings of mucopolysaccharidoses (MPS) on panoramic radiographs in a series of 16 patients. STUDY DESIGN This retrospective cross-sectional study included panoramic radiographs of 16 patients with cytogenetically diagnosed MPS. Two blinded, previously calibrated observers evaluate the presence or absence of the following features: type of dentition; stage of dental age in comparison with chronologic age; delayed exfoliation of deciduous teeth; supernumerary teeth; teeth impaction; enlarged, cyst-like dental crypt; hypercementosis; taurodontism; generalized enamel hypoplasia; enlargement of the bone marrow spaces; thinning of cortical bone; unusual morphology of condyles; and flattening of the condylar head. RESULTS The final sample was composed of 8 MPS IV, 7 MPS VI, and 1 MPS I cases. All patients presented unusual morphology of condyles. Cyst-like dental crypt (75%), taurodontism, and teeth impaction (68.75% each) were also overall common findings. Generalized enamel hypoplasia was exclusively identified in patients with MPS IV (75% of those patients). CONCLUSIONS Radiographic features of oral and maxillofacial manifestations in patients with MPS frequently encountered by dentists may help recognize the disorder. However, because of sample size limitations, it was not possible to infer any statistical relationship between the radiographic features and the types of MPS.

Facial trauma as physical violence markers against elderly Brazilians: A comparative analysis between genders

The aim of this study was to characterize the profile of elderly Brazilians with injuries resulting from physical violence and identify victimization differences. A descriptive and exploratory study was conducted involving the analysis of medico-legal and social records of 259 elderly victims of physical violence treated at an Institute of Forensic Medicine and Dentistry over four years (from January 2008 to December 2011). The forensic service database was evaluated by researchers properly trained and calibrated to perform this function between January and March 2013. Socio-demographic variables of victims, aggression characteristics, aggressors profile and types of lesions were evaluated. Descriptive and multivariate statistics using Multiple Correspondence Analysis (MCA) were performed. The prevalence of facial trauma was 42.9%. Based on the MCA results, two groups with different victimization profiles were identified: married men aged 70-79 years, victims of community violence at night, suffering facial injuries; and single, widowed or separated women aged 60-69 years, victims of domestic violence during the day, suffering trauma in other areas of the body. The results suggest that there is a high prevalence of facial injuries among elderly Brazilians victims of physical violence and there are important differences related to victimization characteristics according to gender.

Tenascin and fibronectin in pleomorphic adenoma of the salivary gland

Objectives: To analyze the expression and distribution pattern of extracellular matrix components in pleomorphic adenomas of the major and minor salivary glands and to compare the morphological findings of these tumors with the immunohistochemical expression, considering the different types of stroma predominating in each case. Methods and Results: The expression of tenascin (TN) and fibronectin (FN) was analyzed in 23 cases of pleomorphic adenomas, 11 major and 12 minor salivary gland tumors, by the streptavidin-biotin method using anti-tenascin and anti-fibronectin antibodies. In addition, the immunohistochemical results were correlated with the morphological findings of the lesions. All cases analyzed were immunoreactive for the antibodies used. Fibronectin showed strong labeling in fibrous and chondroid stroma, while labeling was weak in hyaline and myxoid stroma. Tenascin expression was more intense in fibrous and chondroid stroma and moderate in hyaline and myxoid stroma. Conclusions: No difference in the expression of these proteins was observed between major and minor salivary gland tumors.

THE INFLUENCE OF DISPLAY MODALITIES ON PROXIMAL CARIES DETECTION AND TREATMENT DECISION

The aim of this study was to investigate the influence of digital radiographic display on caries detection and choice of treatment among undergraduate students. Forty images of extracted human teeth were acquired using a PSP digital system. The proximal surfaces were evaluated for the presence of proximal caries and choice of treatment by 36 undergraduate students, divided into three groups according to the semester they were taking. The images were evaluated in two forms of image display: laptop, and printed on acetate viewed on a lightbox. The accuracy of the different forms of image display on caries detection was evaluated by means of ROC curve analysis and its effect by mixed linear regression. Residue analysis was used to verify the adequacy of the treatment of choice for the chosen diagnosis. There was no significant effect either for the display modalities (p=0.058) or for the different undergraduate student groups (p=0.991). The Az was 0.539 for printed images and 0.516 for laptop. The decisions based on treatment of choice were consistent with the scores achieved for caries detection. Accuracy of caries detection using a laptop was comparable to accuracy using printed images. Treatment decision was not affected by image display modality. The semester of the dentistry course that undergraduate students were taking did not significantly increase the accuracy of their proximal caries detection.

Head and neck cancer, quality of life, and determinant factors: a novel approach using decision tree analysis

OBJECTIVE The goal of the present study was to investigate health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) in patients under treatment for head and neck cancer and to identify the associated factors. STUDY DESIGN A cross-sectional study was conducted with 102 patients undergoing treatment for head and neck cancer at 2 medical centers. Participants answered a sociodemographic questionnaire and the Brazilian versions of the Medical Outcomes Study 36 (SF-36) and the Oral Health Impact Profile (OHIP-14) questionnaires to assess HRQoL and OHRQoL, respectively. Clinical aspects, cancer staging, and treatment approach were also investigated. Descriptive and multivariate analyses were performed by using decision tree analysis with the Chi-square Automatic Interaction Detector (CHAID) algorithm. RESULTS The decision tree revealed that reduced quality of life is associated with the clinical staging (adjusted P value = .035), patients gender (adjusted P value = .028), and treatment approach (adjusted P value = .032). Female patients who are diagnosed with advanced head and neck cancer and undergo radiotherapy or chemotherapy are more likely to exhibit lower rates of quality of life. CONCLUSIONS The results suggested that sociodemographic characteristics, clinical staging, and treatment approach can exert a significant influence on the quality of life of patients with head and neck cancer.

Decrease in Mandibular Cortical in Patients With Type 1 Diabetes Mellitus Combined with Poor Glycemic Control

In this study we analyzed the mandibular cortical bone of patients with type 1 diabetes mellitus (T1DM) and non-diabetic. Fifty patients with T1DM and 100 non-diabetic ones paired by age and gender were analyzed. Two double-blinded observers evaluated 150 digital panoramic images of both groups. The mandibular cortical bone was analyzed using the Mandibular Cortical Index (MCI), Mental Index (MI), Gonial Index (GI), Antegonial Index (AI) and Upper and Lower Panoramic Mandibular Indexes (UPMI and LPMI), with the aid of RADIOIMP® software. Influence of T1DM in the morphology of the mandibular cortical bone was studied based on obtaining data related to T1DM diagnosis time, blood glucose level, T1DM control and the presence of chronic complications. Collected data were submitted to descriptive (mean and standard deviation) and inferential analyzes (Pearsons chi-squared test and Fishers exact test) (p≤0.05). According to the MCI, individuals with T1DM had higher frequencies of mandibular cortical alterations, in both sexes and all age groups (p<0.01). For quantitative indexes, MI, GI, AI, UPMI and LPMI, female patients showed statistically significant differences for GI and AI, while male patients had statistically significant differences for all indexes (p<0.05), presenting the individuals with TDM1 inferior measures. Individuals with poor T1DM control showed significantly higher frequency of mandibular cortical alteration (92.3%), with lower means for MI, GI, AI and LPMI (p≤0.05). In conclusion, patients with T1DM showed decrease in the mandibular cortical bone when compared to non-diabetic ones, indicating that poor disease control is associated with these alterations.

Mucoepidermoid carcinoma of the retromolar region: report of a clinical case

Although the number of reported cases is low, mucoepidermoid carcinoma is the most common malignant salivary gland neoplasm in the oral cavity. Its etiology is unknown. Clinically, it is described as a painful or painless swelling most often seen in the palate. Due to its great biological diversity, treatment and prognosis depend on the histological grade, location, and tumor stage. The objective of the present study was to describe a clinical case of mucoepidermoid carcinoma in a Brown female patient aged 45 years. Intraoral physical examination revealed a 1.0 cm diameter, bluish bubble with clear boundaries in the left retromolar region. The bubble had been there for roughly four months. An excisional biopsy was performed to confirm the clinical diagnosis of mucocele. Yellowish mucous leaked during the excision. The anatomical-pathological result was mucoepidermoid carcinoma, after which the patient was referred to a head and neck surgeon. Hence, we emphasize the importance of early diagnosis and proper management of this disease. Even when its clinical appearance is not suggestive of malignancy, mucoepidermoid carcinoma diagnosis should be considered in cases of proliferative oral lesions.

Radiographic evaluation of the dental condition of elderly people treated at a Brazilian public university

Aim: To assess the dental status of elderly patients examined in the clinical dentistry course of a Brazilian public university. Methods: An observational and descriptive study based on the analysis of panoramic radiographs. The sample consisted of 60 elderly patients who met the inclusion criteria. Two observers who had been trained in appropriate conditions performed the radiographic analysis. Data were stored in a specific form, recorded in a database and analyzed using descriptive statistics (measures of central tendency and variability) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis test, Chi-square analysis and calculation of the Cramer’s V coefficient). Results: Most patients had at least one tooth in the oral cavity (71.7%), while 28.3% were totally edentulous, an average of 10.5 teeth per individual. The average number of teeth was 11.36 in males and 9.89 in females. The number of healthy teeth was 328 (5.47 per patient). In this study, 88.3% of the subjects had periodontal bone loss, with prevalence of moderate (35.0%) and severe (28.3%) bone loss. Conclusions: Given the high incidence of edentulous individuals, the high number of restored teeth and poor periodontal conditions, it is concluded that the overall oral health status of the evaluated elderly subjects is poor.