Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E57-E61.

Histopathological findings of pleomorphic adenomas of the salivary glands.

Ito FA, Jorge J, Vargas PA, Lopes MA.

Dr. Márcio Ajudarte Lopes, Semiologia - Faculdade de Odontologia de Piracicaba, UNICAMP. Av. Limeira, 901, Caixa Postal: 52, CEP: 13414-903, Piracicaba - SP - Brazil, malopes@fop.unicamp.br.

Objectives: To describe the histopathological features of pleomorphic adenoma (PA) with special reference to the epithelial and mesenchymal components. Study design: 189 PA were selected and classified as myxoid or stroma-rich, cellular or cell-rich and classic (balanced amount of epithelial and stromal components). The epithelial component was analyzed according to the presence of plasmacytoid, spindle, clear, squamous, basaloid, cubic, oncocytoid and mucous cells and the morphological pattern (trabecular, ductal, cystic and solid). The stromal component was analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue. Results: Plasmacytoid cells were the most commonly found cellular type followed by fusiform and cuboidal cells. Trabeculae and duct-like structures were the most frequent patterns formed by the epithelial cells. Myxoid and chondroid stroma were the most frequently found mesenchymal-like tissue usually forming the so called myxochondroid stroma. Conclusion: The knowledge of the immense variety of cells, architectures and morphological characteristics present in PA of the salivary gland is essential for a correct diagnosis.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E62-E68.

Association between oral HSV-1 and survival in allogeneic hematopoietic stem cell transplanted patients.

Guimaraes AL, Gomes CC, Marques-Silva L, Correia-Silva JF, Victoria JM, Gomez RS, Bittencourt H.

Prof. André Luiz Sena Guimarães, Universidade Estadual de Montes Claros, Hospital Universitário Clemente Faria, Av Cula Mangabeira, 562, Bairro Santo Expedito, Montes Claros, MG, Brazil, cep 39401-001, andreluizguimaraes@gmail.com.

Introduction: This study was designed to investigate the effect of oral HSV-1 shedding on the survival of allogeneic hematopoietic stem cell transplanted (allo-HSCT) patients. Methods: One hundred nineteen allo-HSCT patients were included in the study and divided in three groups: before transplant, 100 days after transplant and 1 year of allo-HSCT. Healthy volunteers matched by age and gender were also selected. Oral swabs were performed and the nested PCR was used to detect HSV-1 presence in the oral mucosa. In statistical analysis, chi-square test was used to test the distribution of HSV1 shedding among the three groups. Time to death after allo-HSCT was displayed by means of the Kaplan-Meier method and the results were compared by the log-rank test. Cox proportional hazards multivariate model was used to evaluate the survival. Results: We observed that HSV-1 shedding was similar at different points after allo-HSCT. However, HSV-1 shedding before allo-HSCT was associated with worst survival rates after allo-HSCT in multivariate analysis. Conclusion: Our data demonstrates that HSV-1 shedding in oral mucosa before transplant is associated with worst survival rate of allo-HSCT patients.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E69-E72.

Multiple dens invaginatus, mulberry molar and conical teeth. Case report and genetic considerations.

Sedano HO, Ocampo-Acosta F, Naranjo-Corona RI, Torres-Arellano ME.

Dr. Heddie O. Sedano, Associated Clinical Specialties Oral Pathology and Craniofacial Clinic, School of Dentistry, UCLA, CA, hsedano@dentistry.ucla.edu.

Dens in dente, also known as dens invaginatus and dilated compound odontoma, is a malformation that can occur on primary, permanent, or supernumerary teeth that is characterized by a deep invagination of the surface of a crown or root covered with enamel. This abnormality in tooth morphology generally affect the maxillary lateral incisors but several cases of multiple dens invaginatus have been reported in the literature. A 15 year-old female patient is reported here presenting five dens invaginatus: four in the permanent mandibular incisors and one in the permanent, maxillary left central incisor, additionally the following dental findings were observed: a permanent mandibular left mulberry molar, molarization of some premolars, several microdontic conoid teeth, retention of five primary teeth, absence of several permanent teeth germs, a macrodontic molar with abnormal roots and several periapical radiolucencies associated to the dens invaginatus. There was no family history of similar dental findings to those observed in the patient. There are several genes that participate in the development of teeth, of those, the following five genes could be implicated as responsible or co-participators for some of the dental anomalies present in this patient: MSX1 (Muscle segment homeobox 1), DLX1 & DLX2 (Distal-less homeobox 1 & 2 genes), PAX9 (Paired box gene) and PITX2 (Pituitary homeobox transciption factor 2).

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E73-E75.

Pleomorphic adenoma of the palate in a child: A case report.

Dhanuthai K, Sappayatosok K, Kongin K.

Dr. Kittipong Dhanuthai, Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Henri Dunant Rd. Pathumwan District, Bangkok 10330, Thailand, fibroma123@yahoo.com.

Salivary gland tumors are rare in children and the incidence differs from the adult counterpart. When salivary gland tumors do arise in children, they preferentially affect major salivary glands, but minor salivary gland tumors have also been reported. We reported the first case of palatal pleomorphic adenoma in a 13 year-old child from Thailand. She came to Sawanpracharak hospital with the chief complaint of a swelling at the left side of the palate. The oral mucosa covering the lesion was intact. Occlusal radiograph revealed no bony destruction. Incisional biopsy was performed on this patient. The biopsy showed several ducts which were lined by cuboidal cells. These ducts were surrounded by myoepithelial cells, some of which had the plasmacytoid appearance The patient was treated by wide local excision and no recurrence was observed 8 years after the surgery. Differential diagnoses of a palatal swelling in children and treatment of pleomorphic adenoma at the palate were also discussed.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E76-E80.

Biotechnological advances in neuro-electro-stimulation for the treatment of hyposalivation and xerostomia.

Lafaurie G, Fedele S, Martín-Granizo-López R, Wolff A, Strietzel F, Porter SR, Konttinen YT.

Dr. Andy Wolff, Harutzim 60917, Israel, awolff@zahav.net.il.

Treatment of xerostomia is a common clinical challenge in the oral medicine practice. Although some treatments have been used to improve the symptoms of xerostomia, none is completely satisfactory for the patients who suffer of this alteration. In the last years non-pharmacological treatments based on electro-stimulation for the treatment of xerostomia have been developed. This review is aimed at presenting new developments for the treatment of xerostomia, applying neuro-electro-stimulation by miniaturized intra-oral electro-stimulators. These devices increase salivary secretion and improve symptoms of oral dryness. Their effect is obtained by means of stimulation of the lingual nerve, in whose proximity the electrodes of the apparatus are placed. The objective of this mechanism is both to directly stimulate the salivary glands controlled by that nerve and to enhance the salivary reflex. Clinical studies have been carried out that have demonstrated the wetting effect of the method described in this article.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E81-E89.

Pharmacological interactions of anti-inflammatory-analgesics in odontology.

Gómez-Moreno G, Guardia J, Cutando A, Calvo-Guirado JL.

Dr. Gerardo Gómez-Moreno, Facultad de Odontología, Universidad de Granada, Colegio Máximo s/n, Campus de Cartuja, E-18071, Granada (Spain) , ggomez@ugr.es.

In this second article we describe the more interesting pharmacological interactions in dental practice based on the prescription of analgesic narcotics, paracetamol and non-selective non-steroid anti-inflammatory drugs (NSAI) (which inhibit cyclooxigenase 1 -COX 1- and cyclooxigenase 2 -COX 2-) and selective NSAIs (COX 2 inhibitors). The importance of preventing the appearance of these pharmacological interactions is because these are medicaments prescribed daily in odontology for moderate pain treatment and inflammation in the oral cavity. Paracetamol can interact with warfarin and therefore care should be taken with chronic alcoholic patients. All NSAIs reduce renal blood flow and consequently are capable of reducing the efficacy of medicaments used for treating arterial hypertension, which act via a renal mechanism. Especial attention should be taken considering the risk of interaction between the antagonists of AT1 receptors of angiostensin II (ARAII) and the NSAIs.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E90-E92.

Synchronous unilateral parotid neoplasms. A case report.

Herce-López J, Salazar-Fernández CI, Mayorga-Jiménez F, Gallana-Álvarez S, Pérez-Sánchez JM.

Dr. Javier Herce López, Calle Alcalde Manuel Camino Míguez N 4, Gines 41960 (Sevilla), Spain, javiherce@yahoo.es.

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite often the recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multiple tumours in the parotid glands is rare and the majority of these are multifocal Warthin's tumors (papillary cystadenoma lymphomatosum). The simultaneous development of tumours with different histological types is unusual and when it occurs, the most common combination is a pleomorphic adenoma and a Warthin's tumor. There are many articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronous benings tumors, being pleomorphic adenoma and Warthin's these tumors. The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin's tumor within the superficial lobe of her left parotid gland.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E93-E97.

In vitro evaluation of the influence of the cortical bone on the primary stability of two implant systems.

Andrés-García R, García-Vives N, Herrero-Climent F, Fernández-Palacín A, Ríos-Santos V, Herrero-Climent M, Bullón P.

Dr. Rodrigo Andrés García, C/ Pablo Gargallo, 35, C.P. 28035. Madrid, randresgarcia@gmail.com.

Aims: Immediate loading has become a predictable option for treatment, while one of the main requirements for its implementation is obtaining appropriate primary stability in implants. With that aim, conical implants are commercially available, since, according to specialized literature, they provide greater stability. One of the methods to measure implant stability which has evolved to further stages is resonance frequency analysis (RFA). In the present paper we attempt to evaluate the influence of the cortical bone on the primary stability of two implants of similar diameter and length. Study design: 15 fresh cow ribs were selected and six different implant beds were prepared in each. These preparations corresponded to two different implant systems: A Swiss Plus from Zimmer Dental(R) and an Mk IV from Nobel Biocare(R). Two drilling protocols were used for soft bone, hard bone and bone without cortical. After preparing the beds, the implants were placed and implant primary stability was measured with the Osstell(R) mentor. Results: Higher ISQ (Implant Stability Quotient) values were observed for both implant systems when the cortical bone is maintained than when it is eliminated, the difference being statistically significant in the case of Mk IV implants. Conclusions: The results from this study show the importance of preserving cortical bone during drilling in order to obtain greater primary stability.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E98-E102.

Central giant cell lesion of mandible managed by intralesional triamcinolone injections. A report of two cases and literature review.

Mohanty S, Jhamb A.

Dr. Aakarsh Jhamb, SFS 111, Rajouri Aptts., Rajouri Garden, New Delhi 110064, India, draakarsh@yahoo.co.in.

Central giant cell lesion (CGCL) is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. We describe our experience in managing this lesion by intralesional triamcinolone. The mainstay of treatment of CGCL in our centre until now has been surgical curettage or resection. We chose two patients for this pilot endeavour at our hands. Case I is a 10 year old girl having CGCL of left side mandible. Case II is a 20 yr old man with CGCL affecting the left side posterior mandible. Both patients responded well to intralesional administration of triamcinolone acetonide (Kenacort-10(R)) with no obvious recurrences to date. Successful application of this conservative drug therapy for managing CGCL can not only save the patient from a mutilating procedure but also has significant financial implications. The amount of triamcinolone injected ranged from 85mg to 180mg by 5-6 injections at weekly intervals.

Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14(2):E103-E107.

Dental fluorosis: Exposure, prevention and management.

Alvarez JA, Rezende KM, Marocho SM, Alves FB, Celiberti P, Ciamponi AL.

Dr. Jenny Abanto Alvarez, Faculdade de Odontologia de São Paulo, Departamento de Odontopediatria - Avenida Professor Lineu Prestes, 2227, Cidade Universitária, CEP: 05508-000. São Paulo, SP, Brazil, jennyaa@usp.br.

Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors and bone growth. The risk period for esthetic changes in permanent teeth is between 20 and 30 months of age. The recommended level for daily fluoride intake is 0.05 - 0.07 mg F/Kg/day, which is considered of great help in preventing dental caries, acting in remineralization. A daily intake above this safe level leads to an increased risk of dental fluorosis. Currently recommended procedures for diagnosis of fluorosis should discriminate between symmetrical and asymmetrical and/or discrete patterns of opaque defects. Fluorosis can be prevented by having an adequate knowledge of the fluoride sources, knowing how to manage this issue and therefore, avoid overexposure.