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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2022. Vol. 27, no. 3
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- Informed consent in dentistry and medicine in Spain:practical considerations and legality(2022) Otero, María; Oishi, Natsuki ; Martínez, Fernando; Ballester, Maria Teresa; Basterra Alegría, JorgeThe healthcare practice of dentistry, as well as medicine, is framed within a legal environment. Patients have the right to know all the information related to any action performed on them and dental or medical doctors are obliged to obtain their patient?s prior written informed consent (IC) before undertaking any healthcare procedures. Here we reviewed the legality and jurisprudence in Spain regarding IC. We also used INFLESZ text readability analysis software to analyse a sample of official Spanish informed consent documents (ICDs) from different surgical and interventional procedures related to dentistry and oral cavity interventions. It is a mistake to confound IC with ICDs. This error prevents physicians from considering the former as a care process in which the patient?s authorisation signature is the last link in a chain formed, almost in its entirety, by the informative process and deliberation alongside the patient. Multiple factors can influence communication between practitioners and their patients. Importantly, treatment adherence is greater when patients feel involved and autonomous in shared decision-making and when the circumstances of their lives are adequately considered. We concluded that although the ICDs we analysed conformed to the requirements set out in international law, they were somewhat difficult to read according to the reading habits of the general Spanish population. Knowledge about the legality of IC helps professionals to understand the problems that may arise from their non-compliance. This is because the omission or defective fulfilment of IC obligations is the origin of legal responsibility for medical practitioners. In this sense, to date, there have been more convictions for defective ICs than for malpractice. The information provided in ICs should include the risks, benefits, and treatment alternatives and must be tailored to the needs and capabilities of the patient to enable autonomous decision-making.
- Medication related to pigmentation of oral mucosa(2022) Mallagray-Montero, María del Carmen; Moreno López, Luis Alberto; Cerero Lapiedra, Rocío; Castro-Janeiro, María; Madrigal Martínez-Pereda, CristinaThe diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn?t reflected in the Summary of Product Characteristics. Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.
- Oral microbiome and systemic antineoplastics in cancer treatment:a systematic review(2022) Rodríguez-Fuentes, Manuel Eros; Pérez-Sayáns, Mario; Chauca Bajaña, Luis; Barbeito Castiñeiras, Gema; Pérez del Molino Bernal, María Luisa; López López, RafaelOral mucositis is one of the most common side effects in cancer patients receiving systemic antineoplastics. However, the underlying biological mechanisms leading to this condition are still unclear. For this reason, it has been hypothesised that systemic antineoplastics may cause an imbalance on the oral microbiota that subsequently triggers oral mucosa damage. A systematic review was performed following the PRISMA protocol and the PICO question established was: patients diagnosed with cancer, who are candidates for receiving systemic antineoplastics (P=Patients), that undergo oral microbiome determinations (I=Intervention), before and after systemic antineoplastics administration (C=Comparison), to analyse changes in the oral microbiome composition (O=Outcome). The bibliographic search was carried out in PubMed and other scientific repositories. Out of 166 obtained articles, only 5 met eligibility criteria. Acute myeloid leukaemia (AML) was the most frequent type of cancer (40 %) among the participants. Only one of the studies included a control group of healthy subjects. Heterogeneity in the protocols and approaches of the included studies hindered a detailed comparison of the outcomes. However, it was stated that a decrease in bacteria ? diversity is often associated with oral mucositis. On the other hand, fungal diversity was not associated with oral mucositis although ? diversity was lower at baseline on patients developing oral candidiasis. There is insufficient scientific evidence of oral microbiological changes in patients undergoing systemic antineoplastics. Further investigations ought to be carried out to identify microorganisms that might play a key role in the pathogenesis of oral mucosa damage in patients undergoing systemic antineoplastics.
- Is immunohistochemistry more sensitive than hematoxylin-eosin staining for identifying perineural or lymphovascular invasion in oral squamous cell carcinoma? A systematic review and meta-analysis(2022) Negreiros Nunes Alves, Ana Paula; de Paula, Dayrine Silveira; Lima, Lia Vila Real; Sousa-Dantas, Thinali; Lima Mota, Mário Rogério; Sousa, Fabrício Bitu; Silva, Paulo-Goberlânio-de BarrosThis study aimed to analyze whether immunohistochemistry (IHC) is more sensitive than hematoxylin-eosin (H&E) staining for identifying perineural invasion (PNI) or lymphovascular invasion (LVI) in oral squamous cell carcinoma (OSCC). In this systematic review and meta-analysis (Prospective Register of Systematic Reviews ? CRD 42021256515), data were obtained from six databases (PubMed, Scopus, LILACS, Web of Science, EBSCO, LIVIVO, Embase) and the grey literature. Cross-sectional observational studies of the diagnostic sensitivity of IHC for PNI and LVI were included. Studies were selected in two phases: first collection and reference retrieval. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed study quality, while the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach assessed evidence quality. The meta-analysis (random effects model) was performed using MedCalc 18.2.1 software (MedCalc®) (p<0.05). Four studies (560 patients with 295 biopsies) were analyzed. The combined sensitivity was 76% (95% confidence interval [CI], 44.30?97.19%) and specificity was 42% (95% CI, 23.40?62.02%). The positive predictive value (PPV) and negative predictive value (NPV) were 61% (95% CI, 49.78?71.53%) and 70% (95% CI, 37.63?94.43%). The overall accuracy was 58% (95% CI, 45.17?70.65%). The risk of bias was low, and GRADE analysis showed a very low certainty of evidence. Our data suggest that IHC staining to highlight PNI/LVI may be useful in cases in which H&E analysis results in a negative decrease in the prevalence of false-negative cases and underestimated treatment.
- Complications associated with submental liposuction:a scoping review(2022) Diniz, Demóstenes Alves; Gonçalves, Kalyne Kelly Negromonte; Silva, Caio César Gonçalves; de Araújo, Emerllyn Shayane Martins; Carneiro, Suzana-Célia-de-Aguiar Soares; do Lago, Carlos Augusto Pereira; Cavalcanti do Egito Vasconcelos, BelmiroLiposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disFiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction. At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described. Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae. Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications.
- Impact of the coronavirus pandemic on maxillofacial trauma:a retrospective study in southern Spain(2022) Infante-Cossío, Pedro; Fernandez-Mayoralas-Gomez, Macarena; González Pérez, Luis Miguel; Martínez de Fuentes, Rafael; Rollón Mayordomo, Angel; Torres Carranza, E.The coronavirus pandemic has impacted health systems worldwide, with Spain being one of the most affected countries. However, little is known about the extent to which the effects of staying home, social distancing, and quarantine measures have influenced the epidemiology of patients with maxillofacial trauma. The aim of this study was to analyze the impact of the coronavirus pandemic on the incidence, demographic patterns, and characteristics of maxillofacial fractures in the largest hospital in southern Spain. Data from patients who underwent surgery for maxillofacial fractures during the first year of the pandemic between 16 March 2020 and 14 March 2021 (pandemic group) were retrospectively compared with a control group during the equivalent period of the previous year (pre-pandemic group). The incidence was compared by weeks and by lockdown periods of the population. Demographic information, aetioloy, fracture characteristics, treatment performed, and days of preoperative stay were evaluated. Descriptive and bivariate statistics were calculated (p<0.05). During the first year of the pandemic, there was a 35.2% reduction in maxillofacial fractures (n=59) compared to the pre-pandemic year (n=91, p=0.040). A significant drop was detected during the total home lockdown period of the population (p=0.028). In the pandemic group, there was a reduction in fractures due to interpersonal aggressions, an increase in panfacial fractures, a significant increase in other non-facial injuries associated with polytrauma (p=0.037), a higher number of open reduction procedures with internal fixation, and a significantly longer mean preoperative stay (p=0.016). The first pandemic year was associated with a decline in the frequency of maxillofacial trauma and a change in the pattern and characteristics of fractures. Inter-annual epidemiological knowledge of maxillofacial fractures may be useful for more efficient planning of resource allocation and surgical practice strategy during future coronavirus outbreaks and population lockdowns.
- Odontogenic tumors:a retrospective study in Egyptian population using WHO 2017 classification(2022) Al-aroomy, Leena; Wali, Mona; Alwadeai, Mohamed; Desouky, Eman El; Amer, HatemOdontogenic tumors (OTs) are considered important among oral lesions because of their clinicopathological heterogeneity and variable biological behavior. The purpose of this retrospective cross-sectional study was to evaluate the frequency and distribution of different types of odontogenic tumors based on the current 2017 WHO Classification of Head and Neck Tumors over a period of 5 years. This was achieved by reviewing the records of Cairo's educational hospitals and institutions and comparing the results with findings in the literature. The records of patients diagnosed with odontogenic tumors were obtained from six educational hospitals and a single institute in Cairo which included: Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University; General Pathology Department, Faculty of Medicine, Cairo University; Oral Pathology Department, Faculty of Dentistry, Ain Shams University; Eldemerdash Hospital, Ain Shams University; El-Sayed Galal Hospital, Al-Azhar University; Ahmed Maher Teaching Hospital and National Cancer Institute. These records were reviewed over a 5-year (2014-2018) period and the odontogenic tumors were investigated for frequency, age, gender and site. The data were recorded, then analyzed using SPSS software. Intraosseous (central) odontogenic tumors constituted 2.56% of all 8974 registered oral and maxillofacial biopsies. A total of 230 cases of OTs were collected and reviewed. Of these, 97.8% were benign and 2.17% were malignant. The mandible was the most commonly affected anatomic location. Ameloblastoma, with a predilection for the posterior mandible, was the most frequent odontogenic tumor (55.65%), followed by cemento-ossifying fibroma (14.78%) and odontoma (9.13%). Females were more commonly affected than males. Most of the patients were in the third and fourth decades of life. There were no peripheral odontogenic tumors diagnosed in this period. Some similarities and differences between our findings and those of previous studies of various populations were witnessed. OTs may greatly diverge according to the version of the classification used and by the sample size of the study. Retrospective analysis of the relative frequency of OTs in different countries will be helpful in enhancing the understanding of OTs, which is important for both oral maxillofacial surgeons and pathologists.
- Epidemiology and survival outcomes of lip, oral cavity, and oropharyngeal squamous cell carcinoma in a southeast Brazilian population(2022) Louredo, Brendo Vinícius Rodrigues; Vargas, Pablo Agustín; Pérez-de-Oliveira, Maria Eduarda; Lopes, Márcio Ajudarte; Kowalski, Luiz Paulo; Curado, María PaulaLip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) represent a major health problem in the global scenario. In South America, the highest incidence rates are seen in Brazil. Therefore, the epidemiological and clinical profile and survival outcomes of lip, oral cavity, and oropharyngeal SCC was studied in São Paulo State, Brazil. The clinicopathological data of 12,099 patients with lip, oral cavity, and oropharyngeal SCC were obtained from hospital cancer registries of the Fundação Oncocentro de São Paulo, Brazil (2010?2015). Survival rates and other analyses were performed using SPSS software. A clear male predominance was observed, particularly for patients with oropharyngeal SCC (88.3%). The average age of patients was higher for lip cases (65 ± 13.5 years) compared to other sites. The schooling level was low for most patients, especially in lip cases (87.9%). Most of the patients with oral cavity (71.8%) and oropharyngeal (86.3%) SCC had advanced-stage (III?IV) disease. However, the majority of lip cases (83.3%) were at an early stage (I?II). Surgical excision was the main treatment for lip (72%) and oral cavity SCC (23.5%), and chemoradiotherapy was the main treatment for oropharyngeal SCC (40.2%). The 5-year overall survival (OS) for patients with lip, oral cavity, and oropharyngeal SCC were 66.3, 30.9, and 22.6%, respectively. Multivariate analysis revealed that the determinants of OS were different for lip, oral cavity, and oropharyngeal SCC, except for those at the clinical stage, which was an independent predictor for all sites. OS-independent determinants varied according to the affected site. Oral cavity and oropharyngeal SCC presented worse survival rates than those for lip SCC.
- Clinical effect of vitamin C supplementation on bone healing:a systematic review(2022) Barrios-Garay, Kevin; Toledano-Serrabona, Jorge; Gay-Escoda, Cosme; Sánchez-Garcés, María ÁngelesThe aim of the present systematic review was to evaluate the clinical effect of vitamin C on bone healing after bone fracture or bone reconstruction procedures. In October 2020, Cochrane Library, Scopus and PubMed-Medline databases were searched without restrictions to identify animal and human studies that fulfilled the eligibility criteria. Outcome measures were bone healing time, bone gain (mm), bone density and adverse events. The risk of bias assessment of the selected studies was evaluated by means of Cochrane Collaboration?s Tool for randomized clinical trials, while randomized clinical animal trials were assessed according to SYRCLE?s tool. Additionally, quality of reporting animal studies were assessed according to ARRIVE guidelines. Out of the 248 articles that yielded the initial search, 11 papers about the effect of ascorbic acid on bone healing were selected. In most of the animal studies, vitamin C seemed to accelerate bone formation owing to an enhanced osteoblastic proliferation and differentiation and its antioxidant function when pro-oxidant substances were added. It was not possible to observe this phenomenon in human studies. Although additional well-performed animal and human studies are required, vitamin C seems to accelerate bone regeneration without adverse events. However, it is not possible to recommend a specific dose or route of administration of vitamin C to improve the bone healing process in humans as there was great heterogeneity among the included studies.
- Clinical manifestations of head and neck cancer in pediatric patients, an analysis of 253 cases in a single Brazilian center(2022) Arboleda, Lady Paola Aristizábal; Pérez-de-Oliveira, Maria Eduarda; Hoffmann, Iva Loureiro; Cardinalli, Izilda Aparecida; Gallagher, Karen Patricia Dominguez; Santos Silva, Alan Roger; de Mendonça, Regina Maria HolandaPediatric head and neck cancer (PHNC) is rare and its nonspecific clinical manifestations may often lead to delayed diagnosis. We aimed to describe the signs, symptoms, and clinicopathological characteristics of PHNC. Medical records were retrospectively reviewed for all PHNC cases diagnosed from 1986 to 2016 affecting patients aged 19-years and younger from a tertiary referral center in Brazil. Demographic variables, anatomical site of primary tumors, histopathological diagnoses, signs and symptoms, and patterns of misdiagnosis were collected and interpreted by statistical and descriptive analysis. A total of 253 PHNC cases were included. The mean age was 9.3 years and male patients were more frequently affected (60.9%). Burkitt lymphoma (23.7%), nasopharyngeal carcinoma (15.8%), and rhabdomyosarcoma (15.4%) were the most common cancer types. The nasopharynx (28.9%), cervical/lymph node region (25.3%), and craniofacial bones (8.3%) were the predominant anatomical sites. Tumor/swelling (68.4%), was the clinical finding often presented. The univariable analysis showed association between tumor histology and clinical variables such as sex (p=0.022), age (p<0.0001), anatomical location (p<0.0001) tumor/swelling (p=0.034), pain (p=0.031), systemic/general manifestations (p=0.004), nasal/breathing alterations (p=0.012), orbital/ocular alterations (p<0.0001). Misdiagnosis such as tonsillitis, otitis, and abscess were frequent. Although the clinical findings of PHNC are often unspecific, this study provided signs and symptoms with significant correlations between tumor histology. The suspicion of malignancy should be considered when the main signs and symptoms reported here appear and persist, in order to conduct a timely diagnosis.
- Histopathological analysis of soft tissue changes in gingival biopsied specimen from patients with underlying corona virus disease associated mucormycosis (CAM)(2022) Pandiar, Deepak; Ramani, Pratibha; Krishnan, Reshma Poothakulath; Y, DineshCorona Virus Disease-2019 (COVID-19) is perhaps the disastrous medical emergencies that has ever hit globally with multiple strains. Amongst various sequelae, mucormycosis may be considered as the most debilitating one. Post COVID-19 mucormycosis is formally regarded as corona virus disease associated mucormycosis (CAM). The aim of the current paper is to present twelve cases of CAM with unique clinical presentation with a detailed histopathological correlation of the gingival biopsied material. Twelve cases of CAM were included in the study who presented initially with non-purulent swelling of the gingiva. The clinic-demographic data pertaining to age, gender, location, laterality and presence of co-morbidities was collected along with histopathological examination of biopsied specimen. The patients ranged from 31-65 years (mean age 47.33 years). There was a male predominance. Clearly, maxillary right gingiva was mostly affected and all cases presented with non purulent, non tender swelling of the gingiva. The incisional biopsy from the gingiva consistently showed pseudoepitheliomatous hyperplasia of the surface epithelium along with vacuolar degeneration, extensive stromal edema, massive mixed inflammatory reaction, congested blood vessels, hemorrhage and abundant multinucleated giant cells. Potassium hydroxide (10% KOH) mount served no additional diagnostic advantage. After two initial biopsies any suspected case of CAM with these features was treated with appropriate antifungal therapy and conservative excision. Gingival swelling with aforementioned histopathological features resembling post COVID-19 histological alterations could be alarming early signs of CAM and are candidate of prompt antifungal therapy rather than repeat biopsy for confirmation.
- Oral conditions and salivary analysis in HIV-uninfected subjects using preexposure prophylaxis(2022) Macedo, Nayara; Baggio, Gabriela; Henn, Indiara; Santos, Juliane; Corrêa, Gefter Thiago Batista; Ignácio, Sérgio-Aparecido; Souza, Paulo; Azevedo-Alanis, Luciana ReisNew prevention strategies have been advocated to control the progression of HIV/AIDS, such as preexposure prophylaxis (PrEP). The aim of this study is to evaluate the potential changes in the oral and salivary conditions of HIV-uninfected subjects using PrEP. Subjects were evaluated before beginning the medication (T0), at the first follow-up (T1), and at the second follow-up (T2). Xerostomia, presence of untreated cavitated caries, oral hygiene habits, taste, gingival and plaque index, stimulated salivary flow rate (SSFR), and salivary concentrations of calcium, glucose, urea, and total proteins were evaluated. Data obtained were analyzed using statistical tests (p<0.05). Forty-seven participants (41 men; 6 women) were evaluated at T0. Thirty (28 men; 2 women) and 17 men were reassessed at T1 and T2, respectively. There was no difference between the SSFR and oral and salivary conditions between T0, T1, and T2 (p>0.05), except for the salivary calcium concentration, that increased at T2 compared to T1 (p=0.02). There was significant difference between taste and xerostomia at T1 (p=0.017), and the need to drink to swallow at T2 (p=0.015). There was significant correlation between the reported amount of saliva and taste (p=0.039, r=-0.378) at T1. The prolonged use of PrEP seems to be associated with reports of dry mouth and worsening of taste, possibly associated with increased salivary calcium concentration.
