RESUMEN

Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are mucocutaneous autoimmune diseases characterized by blistering lesions of mucous membranes and skin, with very similar clinical manifestations. This study aimed to systematically review the literature on the clinical and demographic profile, diagnostic methods, and treatment of patients with pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP). Studies describing cases of PV and MMP diagnosed by direct immunofluorescence that exhibited intraoral manifestations were included. Thirty-two articles were included, with 18 studies on PV and 15 on MMP, corresponding to 50 and 123 cases diagnosed as PV and MMP, respectively. Most patients with PV (64 %) and MMP (81.3 %) were women in the fifth and sixth decade of life, respectively. The mouth was the primary site of involvement both in PV (71.4 %) and in MMP (91 %). The cheek mucosa and gingiva were the most frequently affected intraoral sites in PV (30 %) and MMP (64.2 %), respectively. Direct immunofluorescence was positive for IgG in all cases of the two conditions. The treatment of choice was systemic corticosteroid therapy for patients with PV (50 %) and topical treatment for patients with MMP (53.7 %). Differences in intraoral site predilection, extraoral involvement, and the results of diagnostic tests allow us to trace the clinical, demographic, and diagnostic profile of PV and MMP that contributes to differential diagnosis and therapeutic management.

RESUMEN

Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic/myofibroblastic origin with intermediate biological behavior. We report here two cases of SFT affecting an unusual anatomical site in 58-year-old and 40-year-old female patients and discuss the differential diagnosis of this lesion. In case 01, the lesion showed the clinical appearance of an asymptomatic "blister" with normal color, rubbery consistency, measuring 0.3 cm, and affected the lower lip; while in case 02, a symptomatic red nodular lesion with a soft consistency and measuring 0.5 cm affected the floor of the mouth. Excisional biopsies were performed. Microscopically, two well-delimited benign neoplasms were observed, exhibiting the proliferation of ovoid to spindle-shaped mesenchymal cells, vascular spaces with staghorn arrangement, and the absence of mitosis figures. Immunohistochemistry was performed in case 01 to assist in the diagnosis. Weak and diffuse immunostaining was observed for α-SMA and intense and diffuse immunopositivity for Bcl-2 and CD34. Based on histopathological and immunohistochemical features, a diagnosis of SFT was rendered in both cases. The low occurrence and nonspecific clinical features of oral SFT may make its clinical diagnosis difficult. Also, morphological and immunohistochemical are essential for differential diagnosis with other mesenchymal neoplasms.(AU)

O tumor fibroso solitário (TFS) é uma neoplasia de origem fibroblástica/miofibroblastica com comportamento biológico intermediário. Nesse artigo relatamos dois casos de TFS afetando sítios anatômicos incomuns em pacientes do sexo feminino de 58 anos e 40 anos e discutir os seus diagnósticos. No caso 01 clinicamente a lesão apresentou um aspecto de "bolha" assintomática, coloração normal da mucosa, consistência borrachoide medindo 0,3 cm, em região de lábio inferior, enquanto que no caso 02, como uma lesão sintomática, vermelha, nodular com consistência mole e medindo 0,5 cm afetando o assoalho bucal. As biópsias excecionais foram realizadas. Microscopicamente, observamos duas lesões neoplásicas bem delimitadas exibindo uma proliferação de células mesenquimais variando de ovoides a fusiformes, vasos sanguíneos em formato de "chifre de veado", com ausência de figuras de mitoses. No caso 01 foi realizado análise imuno-histoquímica para auxiliar no diagnóstico. Foi observado uma marcação fraca e difusa de α-SMA e uma intensa e difusa imunopositividade para o Bcl-2 e CD34.Baseado nos achados histopatológicos e imuno-histoquímicos o diagnóstico de TFS foi estabelecido em ambos os casos. A baixa ocorrência e os achados clínicos inespecíficos do TFS oral podem dificultar o diagnóstico clínico. Além disso, as análises morfológicas e imuno-histoquimicas são essenciais para realização do diagnóstico diferencial com outras neoplasias mesenquimais.(AU)_

Asunto(s)

RESUMEN

INTRODUCTION: Myiasis is a disease caused by the infestation of fly larvae in the skin, which complete part of their life cycle by feeding on host tissues. OBJECTIVE: To report a rare case of tongue myiasis in a patient admitted to a psychiatric ward, focusing on clinical management. CASE REPORT: A dependent care and mentally challenged 55 years old male patient was hospitalized in a psychiatric ward. After 42 days, during the intraoral examination, it was noted numerous larvae peeking from inside of a wound on the dorsum of the tongue. The clinical diagnosis of myiasis was rendered. For the treatment, manual removal was performed initially and ivermectin (15 mg), metamizole sodium (500 mg/ml), and chlorhexidine digluconate (0.12%) were prescribed. After one week, larvae were no longer observed, and the wound was completely healed. CONCLUSION: Myiasis occurrence is uncommon in the mouth, however, its correct diagnosis and treatment are necessary to avoid further damage to patients, especially those who are hospitalized.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the levels of oxidative stress markers in the saliva of patients with oral lichen planus (OLP). METHODS: A cross-sectional study was conducted with 22 patients diagnosed both clinically and histologically with OLP (reticular or erosive) and 12 individuals without OLP. Non-stimulated sialometry was performed and oxidative stress (myeloperoxidase - MPO and malondialdehyde - MDA) and antioxidant (superoxide dismutase - SOD and glutathione - GSH) markers were determined in the saliva. RESULTS: Among the patients with OLP, most were women (n = 19; 86.4%) and reported to have experienced menopause (63.2%). Patients with OLP were mostly in the active stage of the disease (n = 17; 77.3%) and the reticular form was predominant (n = 15; 68.2%). No statistically significant differences were observed when comparing SOD, GSH, MPO and MDA values between individuals with and without OLP, as well as between erosive and reticular forms of OLP (p > 0.05). Patients with inactive OLP presented higher SOD when compared to those with active disease (p = 0.031). CONCLUSION: Oxidative stress markers in the saliva of patients with OLP were similar to those found in people without OLP, which can be related to the high exposure of the oral cavity environment to several physical, chemical and microbiological stimuli, important generators of the oxidative stress.

Asunto(s)

RESUMEN

Inflammatory fibrous hyperplasia (IFH) is a common reactive lesion in dental prostheses users that may be associated with chondroid metaplasia (CM). Metaplasia is an adaptive cellular process that may be caused by trauma. We reported here five cases of IFH associated with CM and analyzed morphologically the deposition of collagen in these lesions. Patients had a mean age of 58.8 years-old and were ill-fitting dental prostheses users. They presented nodular lesions located in the anterior maxilla. Microscopically, it was observed hyperplastic fibrous connective tissue with chronic inflammatory infiltrate and hyaline cartilage. No morphological differences were observed in collagen deposition under light microscopy, but quantitative analysis revealed a significantly higher collagen deposition at the connective tissue near CM (p = 0.015). IFH associated with CM affects ill-fitting dental prostheses users. The presence of CM is not significant to the lesion prognosis. However, its formation and the higher collagen deposition near it reinforces the IFH reactive origin.

La hiperplasia fibrosa inflamatoria (HFI) es una lesión reactiva común en los usuarios de prótesis dentales que puede estar asociada con la metaplasia cartilaginosa (MC). La metaplasia es un proceso celular adaptativo que puede ser causado por un trauma. El presente informe analizó cinco casos de HFI asociados a MC y se analizaron morfológicamente la deposición de colágeno en estas lesiones. Los pacientes tenían una edad media de 58,8 años y eran usuarios de prótesis dentales mal adaptadas. Se observaron lesiones nodulares localizadas en el la parte anterior del maxilar Microscópicamente se observó tejido conectivo fibroso hiperplásico con infiltrado inflamatorio crónico y cartílago hialino. No se observaron diferencias morfológicas en la deposición de colágeno bajo microscopía óptica, pero el análisis cuantitativo reveló una deposición de colágeno significativamente mayor en el tejido conectivo cerca de MC (p = 0,015). La HFI asociada con la MC afecta a los usuarios de prótesis dentales mal adaptadas. La presencia de MC no es significativa para el pronóstico de la lesión. Sin embargo, su formación y la mayor deposición de colágeno cerca de MC refuerza el origen reactivo de HFI.

RESUMEN

Necrotizing sialometaplasia (NS) affects salivary glands, and despite being a benign condition, its clinical and histopathological features sometimes mimic other malignant pathologies of epithelial origin. This article presents two cases of NS and discusses clinicopathological features and the differential diagnosis of this condition. The first case, a 76-year-old woman with a 6-month history of painful oral thrush. Intraoral examination showed an ulcerative lesion located on the hard palate. The clinical hypothesis was squamous cell carcinoma. Second, a 26-year-old man with a 40-days ulcerative lesion on the soft palate. Intraoral examination revealed a reddish ulcer measuring 0.5 cm. Clinical hypothesis was traumatic ulcer. In both cases, a biopsy was performed, and a histopathological diagnosis of NS was established. NS cause is poorly understood, and its clinical features resemble other oral lesions with ulcerative aspects. Thus, dentists must be aware of the clinical features of oral ulcers with more than a 2-week duration without defined etiology.

Asunto(s)

RESUMEN

INTRODUCTION: Pycnodysostosis is a rare autosomal recessive syndrome that provides the abnormal bone metabolism that increases the susceptibility of patients to develop osteomyelitis. OBJECTIVE: This systematic review was conducted to analyze the risk factors associated with the development of complications in the jaws (fractures and osteomyelitis), as well as their clinical-pathological characteristics and therapeutic approaches in patients with pycnodysostosis. METHODS: Searches were performed in the PubMed, Web of Science, Scopus, Lilacs, and Cochrane databases. Case reports or case series that met the eligibility criteria according to the PRISMA statement were included. The full texts of 31 articles were retrieved. Twenty of these articles published between 1969 and 2018 were selected, which described 26 cases of osteomyelitis in patients with pycnodysostosis. RESULTS: The mean age of the patients was 37.84 years; the male-to-female was 1.36:1. The mandible was the most affected site (76.9%). Tooth extraction was the main risk factor for osteomyelitis (61.5%), followed by infection (26.8%) and mandibular fracture (23.0%). Antibiotic therapy alone or combined with some surgical procedure was the treatment used in most cases (80.7%). CONCLUSION: The findings of this review showed that patients with pycnodysostosis are more likely to develop osteomyelitis of the jaws after surgical procedures, especially tooth extraction which remains the main risk factor for its establishment. In addition, prophylactic antibiotic-therapy in the pre- and postoperative periods may prevent the development of osteomyelitis in pycnodysostosis.

Asunto(s)

RESUMEN

Objetivos: Analisar parâmetros sialométricos (fluxo salivar, pH e capacidade tampão) e presença de alterações orais em portadores de IRC em hemodiálise. Metodologia:A pesquisa caracteriza-se por ser estudo transversal e observacional, constituída por dados clínicos e demográficos de pacientes portadores de IRC (n=50), comparados com pacientes sistemicamente saudáveis (n=20). Utilizou-se o teste qui-quadrado e exato de Fisher para verificar a associação entre as variáveis categóricas. O Mann-Whitney foi aplicado para se obter a comparação das variáveis quantitativas entre os grupos analisados. Para todos os testes, o nível de significância adotado foi 95%. Resultados:No grupo de pacientes portadores de IRC,a maioria dos pacientes (56%) apresentou halitose, grande parte (69,5%) tinha cálculo dentário visível e 26%, alguma lesão em mucosa oral. Foi constatado CPO-D médio de 13,9. Foi encontrada uma diferença estatisticamente significativa entre os valores de fluxo salivar (p=0,001) e do pH (p=0,037) com o grupo controle, mas não houve diferença significativa nos valores da capacidade tampão da saliva, nem desses valores com a idade, o sexo, o tempo de hemodiálise, a quantidade de líquido ingerido diariamente, medicamentos em uso ou comorbidades. Conclusão:A saúde bucal dos pacientes com IRC foi considerada precária, o que pode comprometer a realização do transplante. Assim, salienta-se a importância da inserção do cirurgião dentista na equipe de assistência ao paciente com IRC. (AU)

Objective: To characterize the oral health of Chronic kidney disease (CKD) patients by evaluating salivary flow, pH and salivary buffering capacity, oral lesions, gingival bleeding, calculus and index of decayed, missing and filled teeth. Methodology: The present cross sectional, observational, analytical study, was composed of the clinical and demographic data of patients with CKD (n = 50) and compared with those systemically healthy patients (n = 20). The chi-square and Fisher's exact test were used for association between categorical variables. The Mann-Whitney test was applied to compare the quantitative variables between the groups. Level of significance of 5% was used for all the tests. Results:In the group of patients with CKD, 56% presented halitosis, 69.5% had visible dental calculus and 26% had some kinf of lesion in the oral mucosa. There was a statistically significant difference between salivary flow and pH in the group with CKD and the control group, but there was not significant difference in buffering capacity. Conclusion: The participant's oral health was considered precarious, which must be minimized, because those patients are potential transplant candidates. Therefore, it is important to point out the significance of a dentist in the assistance team of patients with CKD. (AU)

Asunto(s)

RESUMEN

INTRODUÇÃO: A candidose eritematosa oral é uma infecção fúngica comum em usuários de prótese. Em algumas situações os pacientes exibem resistência ao tratamento convencional. Novas terapias vêm surgindo como alternativas para o seu tratamento, como a terapia fotodinâmica antimicrobiana (TFDa). OBJETIVO: Analisar a eficácia da TDFa no tratamento da candidose eritematosa oral em comparação com o tratamento convencional a base de nistatina. METODOLOGIA: O presente estudo consiste em um ensaio clínico, controlado e randomizado, realizado por meio de um estudo clínico e análise microbiológica em pacientes diagnosticados com candidose eritematosa oral, os quais foram divididos entre grupo controle, tratados com suspensão oral de nistatina e grupo caso, tratados com sessões de TFDa. Os pacientes foram avaliados quanto a eficácia do tratamento, através da aplicação de um índice clínico, além de serem realizadas análises microbiológicas, em períodos préestabelecidos (7,14,21 e 30 dias). RESULTADOS: Dos 41 pacientes analisados, sendo 18 deles do grupo controle e 23 do grupo caso, 32 (78%) obtiveram sucesso dos tratamentos utilizados. Quanto ao grau clínico, as severas exibiram mais dificuldade em apresentar remissão, enquanto todas as lesões leves e moderadas regrediram. O grupo caso, exibiu resultados semelhantes ao do grupo controle, no entanto, não houve diferenças estatisticamente significativa entre os grupos, tanto quanto ao sucesso do tratamento, nas análises microbiológicas, no qual foi contatado o predomínio da Candida albicans,entre as espécies de Candida ssp. e de Staphylococcus ssp. nas próteses dentarias. CONCLUSÕES: A TFDa é uma alternativa de tratamento promissora, por apresentar resultados satisfatórios, não causar alterações aos tecidos orais e seu uso não levar ao desenvolvimento de resistência ao tratamento (AU).

INTRODUCTION: Oral erythematous candidiasis is a common fungal infection in users of complete dentures. patients often exhibit resistance to conventional treatment. New therapies are emerging as alternatives for its treatment, such as antimicrobial photodynamic therapy(aPDT). AIM:Analysis in patients diagnosed with oral erythematous candidiasis, who were divided into a control group, treated with oral nystatin suspension, and an intervention group, treated with aPDT sections. METHODS: The present study consists of a clinical, controlled and randomized trial conducted by means of a clinical and microbiological analysis in patients diagnosed with oral erythematous candidiasis, who were divided into a control group, treated with oral nystatin suspension, and an intervention group, treated with aPDT sections. Patients were reassessed as to the effectiveness of treatment through the application of a clinical index, in addition to microbiological analysis,in pre-established periods (7,14,21 and 30 days).RESULTS:Of 41 patients analyzed in our research, 32 (78%) were successful in their treatment,4 (9,8%) were unsuccessful, and 5 (12,2%) gave up treatment. Patients were also analyzed for the degree of the lesion, and it was observed that those of the severe type had more difficulty in presenting remission, while the lesions mild and moderate, all showed regression. The case group exhibited similar results to the control group, however, there were no statistically significant differences between the groups, as far as treatment success was concerned, in microbiological analyzes, in which the predominance of Candida albicans, among the species of Candida ssp. and Staphylococcus ssp. in dental prostheses. CONCLUSIONS: aPDT is a promising treatment alternative, as it presents satisfactory results, does not cause changes to oral tissues and its use does not lead to the development of resistance to treatment, so further studies with larger samples are needed to verify its effectiveness (AU).

Asunto(s)

RESUMEN

Objetivo: Esta pesquisa avaliou o nível de satisfação dos usuários sobre o Núcleo de Apoio à Saúde da Família(NASF) e sua atuação em relação à contribuição nas Unidades de Saúde da Família da Secretaria Municipal deSaúde de Macaíba. Metodologia: Os dados foram coletados na rede pública de saúde de Macaíba-RN, a partirde questionário semiestruturado e observação sistemática não participante, tendo como sujeitos 200 usuáriosrepresentantes das 20 unidades pesquisadas. Para análise da questão aberta foi utilizado o processo decategorização. Sobre o método observacional, baseou-se na organização do espaço, nas características dos sujeitos participantes e o conjunto específico das atividades realizadas pelas equipes do Núcleo de Apoio à Saúde da Família segundo um roteiro de observação. Resultados: Para os usuários, o NASF trouxe garantia de melhor acesso aos serviços com atendimento especializado, resolutivo e acolhedor. Conclusão: A existência demelhorias trazidas pelo NASF à comunidade foi percebida por todos os participantes desse estudo, o que justifica a manutenção, continuidade e ampliação destas equipes no município de Macaíba trazendo resolutividade eampliação da cobertura na atenção especializada à população assistida

Objective: This study aimed to assess the level of satisfaction of users on the Support Center for Family Health(NASF) and its performance in relation to the contribution in the Family Health Units of the Municipal HealthMacaíba. Methodology: Data were collected in public health Macaíba-RN in 2012, for semi-structuredquestionnaire and nonparticipating systematic observation, as having interviewed 200 representatives of 20surveyed units. To analyze the open question the categorization process was used. About obser vational methodwas based on the organization of space, the characteristics of the participating subjects and the specific set ofactivities performed by teams of NASF according to a script of observation. Results: For users, the NASF broughtensuring better access to specialized services, resolving and welcoming service. Conclusion: The existence ofimprovements brought by NASF community was perceived by all participants of this study, which justifies the maintenance, continuity and expansion of these teams in the county Macaíba bringing resolution and expanding coverage in specialized care to assisted population

Asunto(s)