Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e558-e562.

Angiogenesis of Oral Lichen Planus: A possible pathogenetic mechanism.

Scardina GA, Ruggieri A, Messina P, Maresi E.

University of Palermo Department of Oral Sciences "G. Messina" Via Del Vespro, 129, 90127 Palermo, ITALY, scardina@odonto.unipa.it.

Objective: Oral Lichen Planus (OLP) is a chronic inflammatory disease with an autoimmune inflammatory pathogenesis. The aim of the research is to compare the vascular endothelial growth factor (VEGF) and adhesion of molecules in the biopsy samples of patients affected by OLP, in order to research the presence of the angiogenetic phenomenon and to understand its pathogenetic mechanism. Materials and Methods: Thirty OLP patients and thirty healthy subjects were enrolled in a study. The immunohistochemical analysis of the VEGF and vascular-endothelial adhesion molecules was carried out by means of primary antibodies and anti-CD34, anti-VEGF, anti-CD106 antigen (VCAM-1) and anti-CD54 antigen (ICAM-1). The statistical significance of the differences was checked with the Mann-Whitney test (MW test). The level of significance was set to P<0.001. Data analysis was carried out with StatView 5.0.1 (SAS Institute Inc., Cary, NC). Results: The results reveal the presence of a significant angiogenesis in OLP patients for the VEGF, CD34, CD106 and CD54 (P < 0.001).. The number of vessels in the biopsies of the patients with OLP (mean +/-SD: 21.27+/-4.85), compared with the healthy subjects (mean +/-SD: 4.74+/-0.97) was significantly more (Mann-Whitney test, P < 0.001). The positive expression rate of VEGF, CD34, VCAM-1 and ICAM-1 in oral lichen samples was 64.2%, 54.3%, 32.5% and 29.7%, respectively. Isolated endothelial cells and newly-formed micro-vessels and endothelial cells with high-immune-positivity to the antibodies anti-ICAM-1 and anti-VCAM-1 were observed. Conclusions: The results of our immunohistochemical research show that a significant neoangiogenesis occurs in oral lichen planus.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e563-e567.

Comparative Analysis of Cell Proliferation Ratio in Oral Lichen Planus, Epithelial Dysplasia and Oral Squamous Cell Carcinoma.

Sousa FA, Paradella TC, Carvalho YR, Rosa LE.

Rua Irmã Maria Demétria Kfuri, 196 - Jardim Esplanada II - CEP: 12.242-500 - São José dos Campos, São Paulo - Brazil, facgs@uol.com.br.

Background: Although oral lichen planus has been classified by the World Health Organization (WHO) as a potentially malignant disorder, such classification is still the target of much controversy. Aim: To evaluate the cell proliferation rate in oral lichen planus, comparing it to the rate observed in epithelial dysplasia and oral squamous cell carcinoma, aiming at indications which might indicate the potential for malignant transformation . Material and Methods: Twenty-four cases of each lesion were submitted to the streptoavidin-biotin and AgNOR technique to evaluate the immunohistochemical expression of PCNA and the mean NORs/nucleus, respectively. Results: Positivity for PCNA was observed in 58.33% of oral lichen planus cases, 83.33% of epithelial dysplasia cases and 91.67% of oral squamous cell carcinoma cases. Chi-squared test showed that the number of positive cases for PCNA was significantly lower in oral lichen planus than in oral squamous cell carcinoma (p<0.05). No significant statistical difference between oral lichen planus and epithelial dysplasia (p>0.05) and between the epithelial dysplasia and oral squamous cell carcinoma (p>0.05) was observed. The mean NORs/nucleus in oral lichen planus, epithelial dysplasia and oral squamous cell carcinoma were 1.74+/-0.32, 2.42+/-0.62 e 2.41+/-0.61, respectively. Variance analysis (ANOVA) revealed significant statistical difference between oral lichen planus and the other studied lesions (p<0.05). Conclusion: Oral lichen planus cell proliferation rate was less than in oral epithelial dysplasia and oral squamous cell carcinoma which might explain the lower malignant transformation rate .

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e568-e572.

Oral Allergy Syndrome (OAS). General and stomatological aspects.

Ausukua M, Dublin I, Echebarria MA, Aguirre JM.

Medicina Bucal. Departamento de Estomatología Facultad de Medicina y Odontología Universidad del País Vasco / EHU Barrio Sarriena s/n Leioa 48940. Vizcaya. Spain, josemanuel.aguirre@ehu.es.

Oral Allergy Syndrome (OAS) is a special contact allergy conditioned by specific amino acids in food allergens, usually fruits, as well as some proteins from different pollens. It is usually manifested in the mouth, however relatively little is known about the syndrome in Odontology. OAS is a fairly common adverse reaction that occurs after ingesting certain foods, such as peaches or apples, produced in atopic individuals who usually suffer from rhinitis, bronchial asthma or both. This syndrome mainly affects the oral cavity and oropharynx, provoking minor local alterations, although there may be serious systematic reactions, making it important to distinguish it from other oral processes when making the diagnosis. One of the more severe forms of OAS is anaphylaxis, which is food-induced. In this study, we will analyze the key etiopathogenic, clinical and therapeutic aspects of this syndrome, focusing specifically on the stomatological aspects.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e573-e578.

Correlation between oral health-related quality of life (OHQoL) and oral disorders in a Turkish patient population.

Caglayan F, Altun O, Miloglu O, Kaya MD, Yilmaz AB.

Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Ataturk University, 25240 Erzurum / TURKEY, facagla@gmail.com.

Objectives: The purpose of the present study is to determine the nature of the complaints that bring patients to our clinic and to what degree these complaints affect their quality of life (QoL). We also aimed to determine any associations between gender, education or harmful habits and each patient's oral health-related quality of life (OHQoL). Methods: A total of 1090 patients, consisting of 651 females (59.7 %) and 439 males (40.3 %), were included in this study. Of these patients, 220 constituted healthy controls. Two patient-centered outcome measures, the 14 item OHIP-14 and the 16 item OHQoL-UK measures were used. Results: Most of the patients presented with toothache and caries (50.1 %), 11.2 % had suffered tooth loss and had denture needs, 9.2 % had periodontal problems, 1.8 % had temporomandibular joint (TMJ) disorders, 3.8 % had buried third molars, 2.4 % had orthodontic and aesthetic disorders, 1.3 % had suffered injury due to trauma, and 20.2 % came only for control checkups. OHQoL was best in the control group and the worst in patients who had suffered trauma. In addition, we noted correlations between gender, education and harmful habits, and that of the patient's oral health-related quality of life. Conclusion: According to our results, OHQoL is associated with the oral complaints of patients. Furthermore, OHQoL may not only be associated with the oral health status of patients, but factors such as gender, education and harmful habits may also play a role.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e579-e582.

The Relationship of Amelogenesis Imperfecta and Nephrocalcinosis Syndrome.

Kirzioglu Z, Ulu KG, Sezer MT, Yüksel S.

Research Assistant in Süleyman Demirel University, Faculty of Dentistry, Department of Paediatric Dentistry, Isparta/Türkiye, gorkemulu@yahoo.com.

Aim: To analyze the prevalence and associated oral findings of nephrocalcinosis in a group of patients affected with amelogenesis imperfecta (AI). The relationship between types of AI and nephrocalcinosis were also evaluated. Design: This study examines patients who were referred to Pediatric Dentistry Department of SDU between the years of 2002-2007 and who, upon clinical and radiological examination, were diagnosed with AI and treated. Patients were offered information about the possibility of nephrocalcinosis syndrome. Patients who agreed to have tests carried out on their renal system were advised to visit the department of nephrology at the clinic. Results: Suspicious radiopacity was observed during renal ultrasonography of a controlled number of patients with hypoplastic type AI. Laboratory results revealed low Ca values (100-300 mg/days) and normal P values (0.4-1.3 g/days). Delayed eruption, gingival hyperplasia, pulp stones and orthodontic problems were also observed in the same patient groups. Conclusion: Although renal findings were observed in a few patients, pediatric dentists are the doctors who are the first to have early contact with this patient group. Because of the potential risk of nephrocalcinosis, early diagnosis may offer good prognosis.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e583-e587.

Problem-based learning versus lectures: Comparison of academic results and time devoted by teachers in a course on Dentistry in Special Patients.

Moreno-López LA, Somacarrera-Pérez ML, Díaz-Rodríguez MM, Campo-Trapero J, Cano-Sánchez J.

Departamento de Medicina y Cirugía Bucofacial, Universidad Complutense de Madrid, Pza Ramón y Cajal s/n 28034 Madrid, Spain, medicinaoral@gmail.com.

Objectives: Problem-Based Learning (PBL) is a teaching-learning technique centred on the complete development of the student. It has been successfully implemented in several universities, notably in the health sciences. The process of creating the European Higher Education Area, initiated in Bologna, encourages European universities to use new methodologies in the teaching-learning process, including PBL. Our objectives were to analyze the results obtained by using PBL with fifth-year Dentistry students. Study design: Comparison of academic results between students receiving lectures and PBL participants, and assessment of differences between them in the time devoted to tasks by students and teachers. Results: PBL participants obtained higher grades compared to those receiving lectures only(p<0.05). The two student groups devoted the same amount of time to this subject but the time distribution of tasks was very different, with PBL students spending more time on group work and analysis of the literature. The teachers devoted much more time to the PBL group. Conclusions: PBL is a teaching-learning methodology that improves student academic results. PBL diverts student time to more complex tasks but requires a greater commitment from the teachers.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e588-e592.

Dental extractions in patients on antiplatelet therapy. A study conducted by the Oral Health Department of the Navarre Health Service (Spain).

Cardona-Tortajada F, Sainz-Gómez E, Figuerido-Garmendia J, Lirón de Robles-Adsuar A, Morte-Casabó A, Giner-Muñoz F, Artázcoz-Osés J, Vidán-Lizari J.

Plaza de la Paz, s/n, 1 planta 31002-Pamplona, Spain, fcardont@cfnavarra.es.

Objectives: Antiplatelet drugs are used to treat and prevent a wide range of cardiovascular pathologies and/or cerebrovascular accidents. Although the use of anticoagulants in dental extractions is highly protocolized, a clear control method has not yet been established for antiplatelet drugs. This study is directed at evaluating the clinical consequences of extractions in patients on antiplatelet therapy. Study design: The Oral Health Department of the Navarre Health Service-Osasunbidea conducted a trial on 155 patients who underwent dental extractions and were receiving antiplatelet therapy. The patients were not requested to interrupt the medication and local measures were taken to control potential haemorrhage. Results: No major haemorrhages were reported. One patient had a moderate haemorrhage that required emergency care. In the remaining patients the bleeding was controlled with local measures. With regard to subsequent bleeding, no differences were observed between the various antiplatelet drugs used. The only statistically significant relationship found was between bleeding and the number of teeth extracted. Conclusions: It can be concluded that no more than 3 teeth should be removed at any one time, and for multiple extractions, the teeth should be adjacent to each other.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e593-e596.

Treatment of chronic mandibular dislocations by eminectomy: Follow-up of 10 cases and literature review.

Vasconcelos BC, Porto GG, Neto JP, Vasconcelos CF.

Faculdade de Odontologia de Pernambuco Departamento de Cirurgia e Traumatologia BMF Av. General Newton Cavalcanti, 1650 Camaragibe - PE 54753-220 Brazil, belmiro@pesquisador.cnpq.br.

INTRODUCTION: Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in that position. OBJECTIVES: To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the results of these surgeries and make a critical review of the literature. METHODS: The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, University of Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomy between 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. RESULTS: The mean maximal mouth opening in the preoperative period was 48.4 +/- 8.5 mm and in the postoperative period it was 41.3 +/- 5.0 mm. No facial nerve paralysis or recurrence was observed. CONCLUSION: The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationship to the postoperative maximal mouth opening, recurrence and articular function.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e597-e600.

Papillary cystoadenoma lymphomatosum (Warthin-like) of minor salivary glands.

Párraga-Linares L, Aguirre-Urízar JM, Berini-Aytés L, Gay-Escoda C.

Centro Médico Teknon, Instituto de investigación, UB-IDIBELL, C/Vilana, 12, 08022. Barcelona, Spain, cgay@ub.edu.

Papillary cystadenoma lymphomatosum is a benign salivary gland tumor most frequently located in the parotid gland (Warthin's tumor). Its presentation in other major, or in minor, salivary glands is rare. Clinically, it manifests as a slow growing tumor, fluctuant on palpation due to its cystic morphology. The treatment of choice is complete excision with wide tumor-free margins. We present a 73-year-old female patient with an asymptomatic tumor of 8 years evolution in the right posterior area of the hard palate. We performed surgical excision and a biopsy, which was reported as papillary cystadenoma lymphomatosum. During the post-operative examination carried out after 3 weeks, it was observed that the lesion had recurred. The lesion was re-operated, performing the excision with CO2 laser and including the periosteum to ensure complete resection of the tumor. At 10 months follow-up, there was no recurrence of the lesion. This article includes a review of this condition and discusses its most important clinical and pathologic features and therapeutic approaches.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e601-e604.

Metastasis of renal clear-cell carcinoma to the oral mucosa, an atypical location.

Maestre-Rodríguez O, González-García R, Mateo-Arias J, Moreno-García C, Serrano-Gil H, Villanueva-Alcojol L, Campos de Orellana A, Monje-Gil F.

Servicio de Cirugía Oral y Maxilofacial Hospital Universitario Infanta Cristina. Avenida de Elvas s/n. 06080. Badajoz, Spain, oscar@clinicamaestre.com.

The majority of cases of metastatic tumors involve the mandible and some the maxilla but they are considerably less common in intraoral soft tissues. In addition, the primary tumor is known in the majority of cases; although in one-third of such cases, metastasis is the first clinical manifestation. The most common primary tumors metastasizing to the mouth are lung carcinoma in men and breast carcinoma in women. An oral metastasis implies a serious prognosis, as in the majority of patients there is multiple organ involvement at the time of diagnosis. We present the case of a 52-year old patient with renal pathology who came to the emergency room due to a rapidly increasing gingival tumor. With the provisional clinical diagnosis of a pyogenic granuloma,the tumor was excised. Subsequent anatomopathological analysis revealed a tumor metastasis compatible with clear-cell carcinoma, and its renal origin was confirmed by means of immunohistochemical techniques.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e605-e611.

Results of a major ambulatory oral surgery program using general inhalational anesthesia on disabled patients.

Cortiñas-Saenz M, Martínez-Gómez L, Roncero-Goig M, Saez-Cuesta U, Ibarra-Martin M.

C/ La Marina n 2, Bloque 5, 1-A. 04007 Almería, Spain, stl967523977@wanadoo.es.

Objectives: To assess the demographic characteristics and comorbidities of the group to be studied, as well as various quality indicators of a Major Ambulatory Surgery (MAS) program. Quantification of the surgical-anesthetic incidents. Study design: We aimed to perform a retrospective and descriptive analysis of disabled patients who had received oral ambulatory surgery under general anesthesia. Data obtained from the clinical history and telephone interview included the demographic characteristics, socioeconomic status, previous dental history, cause of the mental disability, degree of mental retardation, comorbidity measured according to the scale of the American Society of Anesthesiologists (ASA), anesthesia or preoperative surgical treatments, level of analgesia, length of stay, incidents in the Resuscitation Ward, the rate of substitution, suspensions, patients admitted, complications and the degree of patient satisfaction. Results: We included 112 oral surgery procedures performed on disabled patients who were treated under general inhalational anesthesia as part of MAS during the years 2006-2007. During this period, 577 restorations, 413 extractions, 179 sealants, 102 pulpectomies, 22 root canal treatments, 17 gingivectomies and 3 frenectomies were performed. A total of 75% (78 cases) of the patients had coexisting medical pathology. The average surgery time per patient was 72.69 +/- 29.78 minutes. The rate of replacement was 100%. The rate of suspension was 1.92%. The percentage of patients readmitted was 1.92%,due to significant bleeding in the mouth, which did not require treatment and the patients were discharged from hospital 24 hours after being admitted. The rate of patients who required re-hospitalization was 3.84%. Conclusions: The MAS performed in this group, despite being on patients with high comorbidity resulted in only a low number of medical incidents reported.

Med Oral Patol Oral Cir Bucal. 2009 Nov 1;14(11):e612-e615.

Peripheral developing odontoma in newborn. Report of two cases and literature review.

Silva AR, Carlos-Bregni R, Vargas PA, Almeida OP, Lopes MA.

Faculdade de Odontologia de Piracicaba - UNICAMP. Departamento de Diagnóstico Oral (Area de Semiologia). Avenida Limeira, 901, Caixa Postal 52, Piracicaba - SP, Brasil, malopes@fop.unicamp.br.

Extra-osseous odontogenic tumors are rarely observed. However, it is widely accepted that the remains of odontogenic epithelium entrapped in the oral soft tissues may be a possible source for peripheral odontogenic tumors differentiation. Peripheral developing odontoma is considered exceptionally rare, since few similar cases are described in the English-related literature under diverse nomenclature, such as irregular eruption, ectopic tooth, ectopic soft-tissue mesiodens, ectopic odontoma and extra-osseous tooth germ. Previously reported cases invariably affected children and surgical exploration revealed tooth germs exclusively embedded in the soft tissue without bone involvement. Microscopically, all these cases exhibited developing tooth germs composed of ameloblasts, enamel matrix, odontoblastic layer, dentin and dental papilla and the morphological findings seem to depend on the developmental stage of each tooth germ at discovery. Thus, we believe that it is relevant to report two additional cases that were recently diagnosed in Brazil and Guatemala, focusing on their nomenclature, correct diagnosis and further treatment.