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This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors. Resumo Lipomas são as neoplasias mesenquimais benignas mais comuns, no entanto sua etiopatogenia ainda permanece desconhecida. Dessa forma, essa pesquisa teve como objetivo detectar, quantificar e comparar a expressão imunoistoquímica do EGFR, VEGF e contagem microvascular (MVC) dos lipomas orais, relacionando-os com as características clínicas e morfológicas dos casos estudados. A amostra foi composta por 54 lipomas orais (33 clássicos e 21 não clássicos) e 23 casos de tecido adiposo normal. A análise da expressão imunoistoquímica de EGFR e VEGF foi fundamentada na marcação citoplasmática e/ou nuclear. O índice angiogênico foi avaliado por meio da MVC. A contagem de células foi realizada utilizando software IMAGE J®. Os dados obtidos foram analisados no software Statistical Package for Social Science. O nível se significância de 5% foi adotado para os testes estatístico. A análise da imunoexpressão das proteínas revelou para o EGFR diferença estatisticamente significativa (p=0,041) entre o lipoma clássico e o tecido adiposo normal. Houve diferença significativa na MVC entre lipomas não clássicos e tecido adiposo normal (p=0,022). Nos lipomas não clássicos, apenas a imunoexpressão de VEGF apresentou correlação do tipo moderada, positiva e significativa (r=0,607; p=0,010) em relação a MVC. Ademais, nos lipomas clássicos foi percebido que os adipócitos imunomarcados para EGFR estiveram diretamente proporcionais a imunoexpressão de VEGF, apresentando correlação do tipo moderada, positiva e estatisticamente significativa (r=0,566; p = 0,005). Com base nos resultados, pode-se sugerir que o EGFR, VEGFR e MCV participam do desenvolvimento nos lipomas orais, contudo, não estão primariamente envolvidos no crescimento tumoral dessas neoplasias.

Odontomas are the most common tumor-like (hamartoma) odontogenic lesions in the gnathic bones. There are two main types: complex odontoma which is composed mainly of amorphous calcification, and compound odontoma which is characterized by irregular tooth-like structures. Odontomas are generally asymptomatic and in most cases involve only one quadrant of the maxilla or mandible. The treatment of choice is surgical removal. The aim of the present study is to report a rare case of multiple complex odontomas affecting the mandible and to review the literature on the clinical and pathological features of these tumors.

The present study investigated the expression of COX-2, EMMPRIN, HIF-1α, and GLUT-1 in the gingival tissue to verify if there is a correlation between the immunoexpression of these proteins and the changes caused by the inflamed infiltrate present in the gingival tissues.A morphological analysis of epithelial changes (hyperplasia, exocytosis, spongiosis, and hydropic degeneration) was performed, as well as a semiquantitative analysis of the immunoexpression of COX-2, EMMPRIN, HIF-1α, and GLUT-1 in the epithelium and connective tissue of 60 specimens of gingival tissue.Epithelial immunoexpression to COX-2 was observed in three cases, while EMMPRIN, HIF-1α, and GLUT-1 were strongly expressed in the basal layer of the epithelium and gradually decreased until the upper layers. In the connective tissue, COX-2 immunoexpression showed a statistically significant association (p 0.001) with the gingival inflammatory infiltrate. In connective tissue, EMMPRIN and HIF-1α exhibited intense immunopositivity, while GLUT-1 was negative in most cases.COX-2 expression may constitute a biological marker of gingival tissues since its epithelial immunoexpression may indicate a greater propensity for the establishment of periodontal disease.

Este trabalho relata o caso clínico de uma paciente do sexo feminino, 33 anos, com queixa principal de múltiplas ulcerações em mucosa bucal, a qual havia sido previamente diagnosticada com pênfigo vulgar, porém devido aos efeitos adversos da terapia medicamentosa abandonou o tratamento. Foi objetivada a retomada da adesão da paciente ao tratamento, com auxílio multiprofissional, tornando-a corresponsável pela sua melhora clínica e a terapêutica envolveu o uso tópico de pomada de Propionato de Clobetasol 0,05% e a administração sistêmica de Prednisona, atingindo resultados satisfatórios pela ótima evolução clínica.

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating complication associated with antiresorptive agents, in which treatment can be quite challenging. This study aimed to report two cases of cancer patients with MRONJ treated in a complementary manner by antimicrobial photodynamic therapy (aPDT). Both patients were male, 84 and 82 years old, respectively, and had a diagnosis of prostate adenocarcinoma and bone metastasis, treated with intravenous injections of bisphosphonates. The dental history for both was toothache, followed by extraction of dental elements that culminated with the appearance of necrotic bone in the mandibular region, which was confirmed with imaging exams and histopathological reports. The treatment protocol for both cases consisted of performing the aPDT once a week, associated with the use of 10 volumes hydrogen peroxide and 0.12% chlorhexidine digluconate for continuous use after oral brushing and amoxicillin with clavulanate three times a day for 7 days. The patient in case 1 performed 27 sessions, responded well to treatment, however, due to complications of the underlying neoplasm, he died without complete resolution of the osteonecrosis. In case 2, 32 sessions were carried out, with a good evolution of the symptoms. The patient is being followed up for 14 months, with no need for surgical intervention to date. Based on the reported cases and the literature survey, it can be concluded that aPDT can be an effective alternative in cases of MRONJ. The patients in the study in question showed success and control of the clinical picture.

As dermatoses bolhosas autoimunes constituem um grupo de doenças clinicamente caracterizadas pela formação de bolhas como resultado da ação específica de autoanticorpos. Quando os anticorpos apresentam especificidade para componentes das junções intercelulares dos queratinócitos as bolhas se formam dentro do epitélio, como ocorre no Pênfigo. Se os autoanticorpos são direcionados contra componentes das junções epitélio-conjuntivo, formam-se bolhas subepiteliais, característica do grupo de doenças penfigóides. O objetivo desse trabalho foi a realização de uma revisão de literatura do tipo narrativa para análise das características que envolvem a etiopatogenia, apresentação clínica e histopatológica do pênfigo e do grupo de doenças penfigoides. Este estudo contribui para fornecer bases teóricas que suportam a compreensão das características inerentes a essas patologias.

The aim of the present study was to evaluate the 5-year recurrence-free survival and prognostic factors of odontogenic keratocyst (OKC) from a single-center retrospective cohort in the northeastern region of Brazil. Forty cases of OKC comprised the study population. In the cohort analyzed, 18 (45%) cases were recurrent OKCs and 22 (55%) were non-recurrent OKCs. Recurrence-free survival was defined as the period from the release of the histopathological report to the occurrence of relapse or last visit to the service. Comparison of the clinicopathological variables between primary and recurrent OKC lesions revealed no differences in the frequency of epithelial thickness, presence of satellite cysts and cystic spaces, presence of an inflammatory infiltrate, locularity, and lesion borders. The frequency of symptoms was practically the same even after recurrence. Satellite cysts were more frequent in the group of recurrent lesions (n = 9, p = 0.002) and the presence of an inflammatory infiltrate was also significantly associated with recurrent lesions (n = 15, p = 0.006). Previous decompression or marsupialization was associated with recurrence of the lesion (p = 0.010). In conclusion, the most significant prognostic factors were previous decompression or marsupialization, as well as, morphological parameters associated with the recurrence cases were the presence of an inflammatory infiltrate and satellites cysts. The risk of recurrence is low but continues due to the particularities of epithelial proliferation in OKC.

A trajetória das políticas públicas de saúde bucal no Brasil foi historicamente caracterizada como um longo processo de rupturas e continuidades. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os modelos assistenciais e políticas públicas de saúde bucal no Brasil desenvolvidas ao longo do período de 1950 a 2019. Desenvolveu-se mediante o método qualitativo, consistindo em uma revisão integrativa da literatura. O tema abordado baseou-se em evidências bibliográficas e documentos públicos produzidos por setores estratégicos do governo. Os primeiros modelos assistenciais em saúde bucal implementados no Brasil se configuravam como excludentes, elitistas, mutiladores e pouco resolutivos. Apenas em 1994 o Ministério da Saúde criou o Programa Saúde da Família (PSF), incluindo, em 2001, as Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família (ESF). Diante da falta de uma política nacional efetiva para a saúde bucal, a Política Nacional de Saúde Bucal (PNSB), conhecida como Brasil Sorridente, foi criada em 2004, e em 2011, a Política Nacional de Atenção Básica (PNAB) foi aprovada. Ao ser revisada em 2017, a equipe de saúde bucal foi excluída da equipe multiprofissional mínima. O cenário histórico da saúde bucal no Brasil é caraterizado por dois momentos distintos, em que inicialmente houve evolução dos modelos assistenciais em saúde bucal, seguido pela exclusão da saúde bucal no contexto de saúde da família.

Odontogenic cysts are a heterogeneous group of lesions with varied clinical behavior.To analyze the expression of the epidermal growth factor receptor (EGFR), Cyclin D1, and transcription factor SOX2 in the odontogenic epithelium evaluating the cell cycle control and cystic expansion.This was a cross-sectional study including 40 cases, 20 odontogenic keratocysts (OKC), 10 botryoid odontogenic cysts (BOC), and 10 glandular odontogenic cysts (GOC).All cases of OKC, BOC, and GOC were positive for EGFR in all layers of the cyst lining. The highest expression of nuclear Cyclin D1 was observed in the suprabasal layer of OKCs and in the basal and suprabasal layers of GOC and BOC (p0.001). In addition, SOX2 was only expressed in the suprabasal layer of OKCs.The high expression of EGFR in the cyst membrane suggests that EGF stimulates epithelial proliferation in BOCs, and the high expression of SOX2 in OKCs may be related to the presence of stem cells in the lesion. Cyclin D1 is related to cell cycle disruption in G1-S contributing to stimulates epithelial proliferation of OKCs and GOCs and BOCs.

Oropharyngeal cancer is characterized by high morbidity and mortality. Prognostic factors for this cancer are therefore useful to predict overall survival and may provide additional therapeutic targets.To evaluate the 5-year overall survival and prognostic factors for oropharyngeal squamous cell carcinoma.Retrospective cohort (2008-2018) of a cancer referral center. The population of the study was a hospital-based cohort consisting of patients diagnosed with oropharyngeal cancer who underwent surgery and/or adjuvant therapy (radio- and/or chemotherapy).A total of 253 patients with oropharyngeal squamous cell carcinoma were analyzed. The mean age was 59.8 ± 11.9 years and there was a male predominance (81.8%). Smoking and alcohol consumption were found in 88.0% and 84.2% of the sample, respectively. The combination of radiotherapy and chemotherapy was the treatment modality in 42.7% of the sample, followed by surgery combined with radio- and chemotherapy in 15.8%. There were 143 deaths (events), the mean survival was 11.55 ± 9.69 months, and the 5-year overall survival rate was 1.1%. Overall survival was lower for clinical stage III/IV (p 0.001), HPV p16-negative status (p = 0.019), and an interval 4 weeks between diagnosis and the beginning of treatment (p 0.007).Among the prognostic factors analyzed in this cohort, p16-negative status as a poor prognostic indicator and tumor stage III/IV and an interval longer than 4 weeks between diagnosis and the beginning of treatment were significantly associated with lower overall survival.

Salivary gland cystadenoma is a rare benign neoplasm, representing 1.4% of all benign salivary gland tumors. It presents a predilection for the major salivary gland and middle-aged or elderly adults. The present study reports a rare case of cystadenoma in the floor of the mouth a 5-year-old male patient, who was referred to an oral diagnosis center for evaluation of the lesion. After performing an incisional biopsy, microscopic analysis revealed a cystadenoma. The patient’s treatment was excision of the lesion and he has been under follow-up for one year with no signs of recurrence.

Objective To aim of this systematic review was to explore the relationship between Human papillomavirus (HPV) and epithelial-mesenchymal transition (EMT) related to the prognosis of oropharyngeal squamous cell carcinoma (OPSCC). Design For this systematic review, searches were performed in PubMed, Web of Science, Scopus, Science Direct, and Cochrane, and a random-effects model was used for meta-analysis. The presence of EMT was confirmed by the loss of E-cadherin immunoexpression and overexpression of vimentin. Results In summary, EMT-related proteins were expressed regardless of HPV status; however, overall survival was better in HPV-positive OPSCC cases, with a 5.88 times lower death risk compared to HPV-negative patients (OR = 0.17; 95%CI = 0.10–0.30). Likewise, the maintenance of E-cadherin in OPSCC was associated with an 11.11 times lower risk of death due to the disease (OR = 0.09; 95%CI = 0.01–0.88). Conclusions More advanced clinical stages (III/IV) and the presence of lymph node metastases (N1–3) were common in OPSCC but were not significantly associated with HPV status.

Fibromyxoma is an unusual collagenized variant from odontogenic myxoma neoplasm, presenting a recurrence index of 9.52%. The case report aims to describe an uncommon lesion which presents diagnostic challenges due its similarity to other lesions such as intraosseous neurofibroma and central odontogenic fibroma. An 18-year-old female patient presented a radiolucent lesion discovered on the routine panoramic radiography, which was well circumscribed and had unilocular aspect. Clinically, the patient did not report any symptoms. Then excisional biopsy was performed for histologic evaluation of the lesion, which was observed cells with fusiform or rounded pattern in an abundant fibrous dense stroma and sometimes myxoid. Immunohistochemical analysis were request and the results were S-100(-), CK19(-), SMA(-), and vimentin (+); consequently the diagnosis of odontogenic fibromyxoma was confirmed by morphologic and immunohistochemical findings. Finally, the treatment of choice was enucleation associated with curettage due to good prognosis and she is under follow-up.

The lymphoid tissue from the body plays an important role in the recognition and processing of antigens. In response to antigen-antibody reaction, lymphoid cells proliferate, increasing in number to combat the aggressor agent more effectively, resulting in hyperplasia of this tissue. A 61-year-old female patient attended a referral service in oral diagnosis because of a lesion on right jugal mucosa, fibrous consistency, smooth, painless, 1 cm in size, and lasting for 3 months. An excisional biopsy was performed, and clinical hypotheses were cyst of the salivary duct or mucocele. Histopathologic analysis revealed a well-circumscribed and encapsulated lymphoid aggregate fragment characterized by well-differentiated small lymphocyte layers and collections of reactive lymphoblasts. Macrophages were also identified by presence of phagocytic material in their cytoplasm, thus establishing the diagnosis of lymphoid hyperplasia. Currently, the patient is well undergoing preservation after 6 months.

Objective: This study aims to determine the frequency and features of odontogenic keratocyst (OKC) in children aged 0 to 14 years in an oral pathology service in Brazil. Study design: A retrospective study was performed to review cases of OKC in children diagnosed between 1986 and 2017. Clinical data were evaluated from medical records (sex, race, age, anatomic location, treatment, radiographic findings, and recurrence). Results: Ninety-seven cases of OKC were diagnosed in a 31-year period in all age groups and 10 were found in children (10.3%). Ages ranged from 2 to14 years (mean age ± standard deviation [SD], 10.5 ± 3.5), with 8 males and 2 females. The most frequent location was the anterior region of the mandible (n = 4). Patients were predominantly asymptomatic. Moreover, in 2 children, clinical findings of Gorlin-Goltz syndrome were observed. The most commonly used treatment was enucleation followed by curettage, and 2 cases recurred. Conclusion: Although uncommon in pediatric patients, OKC should be considered a differential diagnosis in cases of osteolytic lesions in gnathic bones. Thus, the periodic assessment of children by dentists and pediatricians is essential to get a correct diagnosis and early treatment to avoid greater disfigurement these patients.

A 61-year-old female patient presented a nodular lesion located in the right buccal mucosa with a 3-month evolution. Clinical hypotheses of salivary duct cyst and mucocele were proposed, and the patient underwent excisional biopsy. Microscopically, a well-circumscribed and encapsulated lymphoid aggregate fragment was observed, characterized by layers of well-differentiated small lymphocytes and collections of reactive lymphoblasts. These findings, associated with immunohistochemistry, established the diagnosis of follicular lymphoid hyperplasia. Currently, the patient is well, under follow-up after six months.

Introdução: No final do ano de 2019, ocorreu o surto de um novo coronavirus em Wuhan. Esse novo coronavirus, SARS-CoV-2, é o agente etiológico da COVID-19, uma doença inflamatória multissistêmica, que pode levar a sérios danos pulmonares. Devido a rápida disseminação da doença, a pandemia foi declarada oficialmente em março de 2020 e as principais medidas preventivas são o uso de máscara, higiene frequente das mãos, distanciamento físico e etiqueta de tosse. Objetivo: O objetivo desse trabalho é apresentar um relato de experiência do componente curricular “Biossegurança na prática odontológica”, ofertado durante o período letivo suplementar excepcional. Metodologia: Trata-se de um estudo de abordagem descritiva, do tipo relato de experiência. Resultados: Tal componente, foi ofertado entre junho e julho de 2020 na Universidade Federal do Rio Grande do Norte, campus Natal-RN, durante 5 semanas, de forma síncrona, com carga horária de 45 h, para uma turma de 40 alunos. Os recursos metodológicos e didáticos desenvolvidos foram aula expositiva dialogada, tempestade de idéias, quiz, games, exposição de material áudio visual, seminários, leituras e discussão de textos didáticos e artigos científicos, através de plataformas como Sigaa/UFRN, Google meet, Kahoot, Mentimeter e Wondershare Filmora. Além da atuação docente houve participação de um estagiário à docência (Pós graduação em Ciências odontológicas da UFRN) e duas alunas monitoras (Graduação em Odontologia da UFRN). Conclusão: O formato remoto, ofereceu um ecossistema educacional que forneceu acesso temporário, e, que é uma modalidade de ensino planejada com proposta pedagógica, materiais, ambiente e formato próprios.

This study aimed to identify the level of knowledge, attitudes and practices related to biosafety measures, prevention and control by dental surgeons (DCs) during the pandemic. An online questionnaire consisting of 42 questions was disseminated to the DCs operating in Brazil through social networks and also to the 27 Regional Councils of Dentistry in the country via e-mail. The collection period was from June 26 to July 2, 2020. A total of 751 DCs answered the questionnaire, of these, 54.9% undertook training in preventing and controlling the spread of the virus and the scientific article was the main means of information (44.5%). Regarding biosafety in dental care, 95.9% reported having knowledge of ANVISA's rules on the subject, however, regarding attitudes and practices, there was a failure to comply with the recommendations. Link between professional performance and training or not, were factors associated with greater knowledge and correct biosafety attitudes and practices. Although the Brazilian DCs have good levels of knowledge about biosafety measures for the prevention of COVID-19, they still fail to comply with basic attitudes and recommended practices.

Self-induced lesions or factitious ulcer of the mouth can be manifestation of unusual or aggressive oral habits or an emotional disorder. Here, we report 2 rare cases of difficult management of factitious ulcer. The first was an 18-year-old male patient who was a former alcohol, tobacco, marijuana, and cocaine user referred to the stomatology service because of lateral tongue lesion because the lesion itched and burned. The second occurred in a 10-year-old male patient who was taken to service because of a lip injury. The patients had the lesions treated but presented recurrence; biopsy specimen revealed a chronic inflammatory process. Systemic and local alterations that justified the ulcerations were investigated but were not found. Low-level laser therapy was performed for the 2 patients. The clinical follow-up, clinical history, and histopathologic aspects for the lesions were of great importance, and diagnosis was chronic wound by self-inflicted thermal injury.

Introduction in the region, population declines and the local extinction of birds are highly probable AIdo Leopold wrote that habitat conservation (Levey and Stiles, 1994). The local extinction requires that we save 'every cog and wheel' of anyone of these species might significantly (Leopold, 1949). The basis for his statement is alter recruitment patterns of these plants and, that species interact in ways both positive and over the long term, influence plant community negative, direct and indirect. When interacstructure. Here, we investigate how extinction tions are strong, loss of one species may affect offo~r avian frugivores might affect four shrub abunda~ce of other species in the community specIes. whose fruits are commonly eaten by (e.g. Paine, 1966; Terborgh, 1986). Diffuse these birds. We evaluate the potential impacts interactions, although much less strong, may of frugivore loss by comparing seed shadows a!so affect species' abundances and distribup~oduced by the existing frugivore community tJons. Seed dispersal by animals is an example ~th seed shadows that we predict would result of a diffuse interaction, because many animals if one or more bird species were extinct. We typic.ally disperse the seeds of a given plant ~hen modi~ predicted seed shadows by impo~ specIes (e.g. McDiarmid et aL, 1977; Lambert, mg four different seed-survival models. If the 1989). It is also an important mutualism, especurrent frugivore community creates a significially in tropical wet forests (Gentry, 1982). In cantly different spatial distribution of di~ this chapter we explore the potential consepersed seeds from that created by a community quences to plants of losing one or more seedthat lacks one or more frugivores, then extincdispersers from the community in a system tion of those frugivores may result in qualitative characterized by diffuse interactions between and quantitative changes to plant recruitment fleshy-fruited plants and fruit-eating birds. patterns. Thus, this study provides a glimpse In tropical wet forests of Costa Rica, a of how plant populations might be altered relatively small set of avian frugivores remove following extinction of one or more species and disperse most seeds of some understorey of frugivorous birds. shrubs (Loiselle and Blake, 1990, 1999). Given We start by providing a brief review of the large-scale disturbances that have occurred factors that influence how much plant