Salomão Israel Monteiro Lourenço Queiroz

Clinical and histopathological evaluation and habits associated with the onset of oral leukoplakia and erythroplakia

Objective:This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer.Material and method:A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearsons chi-squared test and Fishers exact test (p ≤ 0.05) were used.Results:Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years.Conclusion:Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment.

An evaluation of the efficacy of local hemostatic measures in dental patients taking oral anticoagulants: a critical review of the literature over the past two decades.

The increased risk of bleeding observed in patients on oral anticoagulant therapy (OAT) undergoing outpatient oral surgical procedures has been reported in the literature and remains a major concern in the care of these patients. This is still of great concern to dental surgeons that discontinuing OAT medication increases the risk of thromboembolism, while maintaining the therapeutic dose increases the risk of hemorrhage. Several local hemostatic measures have been used to control bleeding in patients on OAT. However, the effectiveness of these measures has not been thoroughly investigated. The aim of this study is to evaluate the efficacy of local hemostatic measures in patients taking oral anticoagulants. Various databases were searched using the key terms. Selection criteria included publications in English, Spanish, or Portuguese within the last 20 years. The titles and abstracts of papers were initially screened, and reports of 18 clinical trials were selected for a critical review and scored according to CONSORT 2010 guidelines. The data extracted from these trials represented 1821 patients receiving OAT, 4116 tooth extractions, and 144 cases of postoperative bleeding. In most studies, there were no differences in the effectiveness of various local hemostatic measures, and only tranexamic acid was proven effective as compared with a placebo group. The reported INR values varied widely among studies; the lowest INR value was 0.9 and the highest was 5.0. All local hemostatic methods showed low rates of bleeding; and when bleeding occurred, the use of these methods was essential for controlling postoperative bleeding. While local hemostatic measures appear to be effective in controlling postoperative bleeding, additional controlled randomized clinical trials are needed to assess the true effectiveness of these measures in patients taking OAT.

Expression of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of the oral tongue

Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) act in the proteolysis of basement membrane and extracellular matrix structures, facilitating tumor invasion. The purpose of this study was to evaluate the relationship between these proteins and clinicopathological parameters in squamous cell carcinoma of the oral tongue (SCCOT). Sixty cases of SCCOT were submitted to immunohistochemistry and analyzed semiquantitatively at the invasion front and in the tumor core. The results were associated with lymph node metastasis, clinical stage, locoregional recurrence, clinical outcome and histological grade of malignancy. A higher expression of uPA was observed in cases of tumors of high-grade versus low-grade malignancy (p = 0.010). Moreover, the cases with the worst pattern of invasion presented an overexpression of uPA (p = 0.011). The presence of locoregional recurrence was associated with uPAR (p = 0.039), and the expression of both biomarkers was much higher at the invasion front than in the tumor core (p < 0.001). The results suggest uPA and uPAR are involved in the progression and aggressiveness of SCCOT, mainly at the tumor-host interface.

Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis

BACKGROUND Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice. OBJECTIVE To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology. METHODS This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05). RESULTS A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%). STUDY LIMITATIONS Retrospective study with data from medical records. CONCLUSION Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.BACKGROUND Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice. OBJECTIVE To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology. METHODS This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05). RESULTS A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%). STUDY LIMITATIONS Retrospective study with data from medical records. CONCLUSION Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.

Expressão imunoistoquímica da endoglina (CD105) e do fator de von Willebrand em carcinoma epidermoide oral e sua relação com parâmetros clinicopatológicos

Background Angiogenesis has been linked with progression of malignant neoplasms and although studies have been conducted investigating angiogenic markers in oral squamous cell carcinoma (OSCC), contradictory results are reported in the literature. Objectives To evaluate immunohistochemical expression of CD105 and von Willebrand factor (vWF) in OSCC and their relationships with clinical parameters of the tumors. Methods Immunoexpression of these biomarkers was analyzed in 30 cases of OSCC and correlated with clinical parameters of the tumors (age and sex of patients, anatomic site and Tumor, Node and Metastasis clinical staging [TNM]). Results In OSCC specimens, immunostaining was more effective using the anti-vWF antibody than using the anti-CD105 antibody. Angiogenic indices, determined by microvascular count (MVC) technique, were different for the floor of the mouth and the retromolar region, with statistical significance (p = 0.004). There were no statistically significant relationships between results for the two biomarkers and TNM clinical staging or angiogenic indices. Conclusions The findings of this study suggest that vascular remodeling is involved in oral carcinogenesis, although there was no evidence of a significant association with clinical stage of lesions.