Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2021. Vol. 26, no. 6

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    The impact of COVID-19 on access to dental care for people with disabilities:a global survey during the COVID-19 first wave lockdown
    (2021) Mac Giolla Phadraig, Caoimhin; van Harten, Maria T; Diniz Freitas, Márcio; Limeres Posse, Jacobo; Faulks, Denise; Dougall, Alison; Diz Dios, Pedro; Daly, Blánaid
    It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide. Aim: To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020). Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar?s test to compare reported practice before to during lockdown, and before to after lockdown. Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed. During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.
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    Clinical characterization of gingival type of burning mouth syndrome:a cross-sectional study
    (2021) Coppola, Noemi; Blasi, Andrea; Amato, Massimo; Ferrigno, Roberto; Mignogna, Michele D.; Leuci, Stefania
    The aim of this study is to investigate the prevalence of localized intraoral neuropathic pain in a cluster of patients who reported the involvement of gingival site as only clinical manifestation of dysesthesia, analysing type and distribution of symptoms. Burning mouth syndrome (BMS) patients were enrolled in the study. Patients were screened through laboratory test and a conventional oral examination with periodontal chart. A questionnaire to collect data on symptoms, oral site involved, quality of sleep, anxiety was submitted to all the patients. A total of 236 patients were recruited. Seventy-six patients (32.2%) presented generalized type, whereas 160 (67.8%) had localized type. In the localized BMS group, the gingiva was involved in 70 patients and in 33 of these it was the only site involved. In the gingival subgroup, 35 patients reported burning, 29 pain and 24 xerostomia. To best our knowledge, this study is the first that analyses gingival involvement as the only site in BMS and it could encourage further investigations to understand the etiopathogenesis of gingival BMS.
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    High prevalence of oral potentially malignant disorders and risk factors in a semi-urban brazilian city:a population-based cross-sectional study
    (2021) Martins-de-Barros, Allan Vinícius; Barros, Ana Maria Ipólito; Silva, Caio César Gonçalves; Ramos, Letícia Francine Silva; Ferreira, Stefânia Jerônimo; Araújo, Fábio Andrey da Costa; Silva, Emanuel Dias de Oliveira; Carvalho, Marianne-de Vasconcelos
    Oral Potentially Malignant Disorders (OPMDs) are defined as lesions with a greater likelihood of progressing to cancer. Population-based studies that evaluate the prevalence of OPMDs are scarce in Brazil. The aim of the present study was to determine the prevalence of OPMDs and associated risk factors in a semi-urban Brazilian population. This is a cross-sectional study, whose universe included individuals aged 40 years or older residing in a medium-sized city of northeastern Brazil. Data collection was divided into two steps: interview and oral examination. The outcome variable was the presence of OPMDs. The predictor variables were sociodemographic characteristics and risk habits. The bivariate analysis was performed through chi-square test. The crude prevalence ratios (PR) and its respective 95% confidence intervals (CI) were calculated. Poisson regression analysis with robust variance was used to calculate adjusted PRs and 95% CI. Three hundred fourteen individuals were included in the study. When asked about risk habits, 58.9% reported being current smokers or ex-smokers and 62.2% reported being current drinkers or ex-drinkers. The prevalence of OPMDs was 7.6% and was significantly higher among individuals with black skin color (p < 0.001), alcohol users (p = 0.017), and individuals with both tobacco and alcohol habits (p = 0.012). Therefore, the population in the present study had a high frequency of risk habits associated with PMDs of the oral cavity.
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    Effect of antibiotic prophylaxis for preventing infectious complications following impacted mandibular third molar surgery. A randomized controlled trial
    (2021) Yanine, Nicolás; Sabelle, Nicole; Vergara-Gárate, Valentina; Salazar, Josefina; Araya, Ignacio; Carrasco-Labra, Alonso; Martín, Conchita; Villanueva, Julio
    The objective of this study was to determine the effect of antibiotic prophylaxis in preventing postoperative infections after extraction of impacted mandibular third molars. A Parallel-group, randomized, blind, placebo-controlled trial was performed. 154 patients were randomly allocated to 2 groups; experimental (n=77) receiving 2g amoxicillin 1 hour prior to surgery and control (n=77) receiving placebo. Primary outcome was postoperative infections and secondary outcome was the need for rescue analgesia. 4.5% of patients developed postoperative infections, five patients of the control group (4 alveolar osteitis, 1 surgical site infection) and two of the experimental group (1 alveolar osteitis, 1 surgical site infection). Difference between groups was not statistically significant, RR=0.4 (95%CI 0.08-1.99, ?=0.41) NNTB=26. Rescue analgesia intake was significantly higher in the control group (41 vs 18 patients of experimental group) RR=0.49 (95%CI 0.32-0.75, ?<0.05) NNTB=3. The use of 2g amoxicillin 1 hour before surgery was not effective in significantly reducing the risk of postoperative infections from impacted mandibular third molars extraction, when compared to placebo. Nevertheless, antibiotic prophylaxis was associated with a reduced need for rescue analgesia.
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    Can buccal infiltration of articaine replace traditional inferior alveolar nerve block for the treatment of mandibular molars in pediatric patients?:a systematic review and meta-analysis
    (2021) Yu, Jianfeng; Liu, Siyan; Zhang, Xiao
    It is unclear if buccal articaine infiltration can be used as an alternative to standard inferior alveolar nerve block (IANB) for treating mandibular molars in pediatric patients. Therefore, this study aimed to pool evidence to compare the efficacy of buccal infiltration of articaine vs IANB with lignocaine for pediatric dental procedures. We searched the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for randomized controlled trials (RCTs) comparing the two techniques in pediatric patients and reporting the success of anesthesia and/or pain during treatment. PRISMA guidelines were followed. Seven RCTs were included. Pooled analysis of five studies indicated no statistically significant difference in the success rates of the two anesthetic techniques (OR: 1.02; 95% CI: 0.13, 7.96; I2=69%, p=0.98). Meta-analysis of data from the four studies demonstrated no statistically significant difference in pain during the procedure with buccal infiltration of articaine or IANB with lignocaine (SMD: 0.62; 95% CI: -1.37, 0.12; I2=88%, p=0.10). Evidence suggests that buccal infiltration of articaine is a viable alternative to IANB with lignocaine in pediatric patients for treating mandibular molars. Based on the confidence intervals, there may be a tendency of higher success rates with buccal infiltration of articaine.
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    Delay in diagnosis of oral cancer:a systematic review
    (2021) Lima, Andrea Márcia da Cunha; Meira, Ingrid-Andrade; Marques Soares, Maria Sueli; Bonan, Paulo Rogério Ferreti; Mélo, Cláudia Batista; Piagge, Carmem Silvia Laureano Dalle
    Oral cancer represents a worldwide public health problem, being among the most prevalent, associated with high morbidity and mortality rates. This systematic review aimed to review the causes of the delayed diagnosis of oral cancer mainly in the elderly, in developed and developing countries. Search strategy was developed for MEDLINE databases (via PubMed), EMBASE, Web of Science, SCOPUS, and LILACS and for grey literature (Google Scholar, ProQuest and OpenGrey), without language or period restrictions. The risk of bias was assessed using instruments from the Joanna Briggs Institute and the quality of evidence according to the GRADE system. The search resulted in 14,473 records, of which only 13 met the eligibility criteria. The total sample was 1,705 participants, with a predominance of males. All studies included reported causes of delayed diagnosis of oral cancer related to the patient and five also reported causes related to health professionals. The scarce knowledge of the population was pointed out as the main cause of delayed diagnosis of this cancer. Regarding the risk of bias, ten studies were classified as low risk and three, as moderate risk. The quality of the evidence was very low for the outcome related to delayed diagnosis of oral cancer. Wide dissemination of information on oral cancer is needed, especially for the elderly, such as its initial signs and symptoms, in developed and developing countries. Further studies should be conducted to better understand the causes of delayed diagnosis of oral cancer in countries with different socioeconomic statuses.
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    The genotypes and virulence attributes of C. albicans isolates from oral leukoplakia
    (2021) Weerasekera, Manjula Manoji; Wijesinghe, Gayan Kanchana; Sampath, Asanga; Dilhari, Ayomi; Madhumal, Thilina; Dilrukshi, Rasika; Willaddara, Rajitha; Karunathilaka, Sunil; Gunasekara, Chinthika; Fernando, Neluka; Samaranayake, Lakshman P.
    There is a debate as to whether some types of oral leucoplakias (OL) are caused by Candida species, and whether they contribute to the malignant transformation, associated with a minority of such lesions. As no detailed population analysis of yeast isolates from OL is available, we evaluated the virulence attributes, and genotypes of 35 C. albicans from OL, and compared their genotypes with 18 oral isolates from healthy individuals. The virulence traits evaluated were esterase, phospholipase, proteinase, haemolysin and coagulase production, and phenotypic switching activity, and yeast adherence and biofilm formation. DNA from OL and control yeasts were evaluated for A, B or C genotype status. Phospholipase, proteinase, and coagulase activity and biofilm formation was observed in 80%, 66%, 97 % and 77 % of the isolates, respectively. Phenotypic switching was detected in 8.6%, while heamolytic, and esterase activity and adherence were noted in all isolates. The genotype A was predominant amongst both the OL and control groups. Due to the small sample size of our study a larger investigation to define the role of candidal virulent attributes in the pathogenicity of OL is warranted, and the current data should serve as a basis until then.
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    Association between xerostomia, oral and general health, and obesity in adults. A cross-sectional pilot study
    (2021) Pérez-González, Alba; Suárez Quintanilla, Juan; Otero Rey, Eva; Blanco Carrión, Andrés; Gómez García, Francisco José; Gándara Vila, Pilar; Martín Biedma, Benjamín; Pérez-Sayáns, Mario
    The objective of this study was to analyse the association between oral and general health variables and obesity indicators with the sensation of dry mouth or xerostomia as evaluated on the Xerostomia Inventory (XI). A total of 354 randomly selected subjects participated in this cross-sectional pilot study and completed an anonymous questionnaire. Anthropometric, clinical, and xerostomic variables were evaluated. Kruskal-Wallis, ANOVA and Bonferroni test were used for multiple comparisons. ROC curves and multinomial logistic regression were used to determine the (OR) risk of xerostomia. A total of 30.7 % of respondents reported xerostomia based on XI. The dry mouth question, the XI taken as a ?gold standard?, showed a diagnostic sensitivity of 70.37 %, and a specificity of 83.27 % (AUC=0.768, p<0.001). Logistical regression showed the highest xerostomia OR was associated to patients with bad self-perceived health, 6.31 (CI 95% 2.89-13.80, p<0.001). In the model adjusted for tooth mobility, bone or respiratory diseases, and the consumption of anxiolytics and antidepressants, the OR was 3.46 (CI 95% 1.47-8.18, p=0.005). a high prevalence of xerostomia was found in this cross-sectional pilot study, which was significantly more frequent in women, and increased with age. Xerostomia was associated to several systemic diseases, psychological conditions, and oral functional disorders such as tooth mobility. These preliminary results can serve as the basis for developing guidelines for the application of innovative measures designed to improve the quality of life of individuals with xerostomia.
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    Online audio-visual information on oral cancer for Spanish-speaking laypersons. A cross-sectional study
    (2021) Ulloa-Morales, Yaima; Negreira-Martínez, Francisco; Blanco-Hortas, Andrés; Patiño Castiñeira, Berta; San-Román-Rodríguez, Elena; Varela Centelles, Pablo Ignacio; Seoane Romero, Juan M.
    Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay. Online resources are often used by patients to obtain health/medical information. However, there are no reports on the quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were to disclose the type of information about oral cancer available, and whether it may be useful to shorten the patients? oral cancer appraisal time-interval. Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. Keywords: ?Cáncer oral?; ?cáncer de boca?. The first 100 results in each viewing list were retrieved by three reviewers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulness were calculated for each video. The presence of non-scientifically supported information was also assessed. A descriptive analysis was undertaken, and relationships between variables were explored using the Spearman correlation test. A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) and their length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video (10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The most useful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643; p<0.001) could be observed between usefulness and comprehensiveness of the videos, together with negative correlations between the visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensiveness (-0.183; p<0.05). Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, and often includes non-scientifically supported information. Most of these resources are produced by mass media and healthcare professionals, with minor contributions from educational and healthcare institutions. Visualization rates negatively correlated with the usefulness and comprehensiveness of the contents in these digital objects.
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    Optimal application of compressive palatal stents following mesiodens removal in pediatric patients:a Randomized Controlled Trial
    (2021) Jang, Hyo-Jin; Choi, Youn-Kyung; Kwon, Eun-Young; Choi, Na-Rae; Jang, Yoon-Sun; Song, Jae-Min; Shin, Sang-Hun
    There is no scientific evidence supporting the choice of a palatal stent in patients who underwent removal of an impacted supernumerary tooth. We aimed to investigate the effects of palatal stents in patients who underwent supernumerary tooth removal through a palatal approach and to suggest the optimal stent thickness and material. We recruited 144 patients who underwent extraction of a supernumerary tooth between the maxillary anterior teeth. Subjects were assigned to a control group (CG) or one of four compressive palatal stent groups (CPSGs) classified by the thickness and material of the thermoplastic acrylic stent used. Palatal gingival swelling and objective indices (healing, oral hygiene, gingival, and plaque) were evaluated before surgery and on postoperative days (PODs) 3, 7, and 14; pain/discomfort and the Child Oral Health Impact Profile (COHIP) were assessed as subjective indices of the effects of the stent. The CPSGs showed faster healing than did the CG on PODs 7 (P<0.001) and 14 (P=0.043); swelling was measured by 1.64±0.88 mm and 4.52±0.39 mm, respectively. Although swelling was least in the 4-mm hard group (0.92±0.33 mm), the difference compared with that in the 2-mm hard group (1.01±0.18 mm) was not significant (P=0.077). The CPSGs showed better COHIP (P<0.001-0.036) and pain scores (P<0.001) than did the CG on PODs 1-3. Compressive palatal stents reduce discomfort by decreasing pain and alleviating swelling. Although a stent is effective regardless of its thickness and material, 2-mm hard stents maximized such positive effects with minimal discomfort.
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    Microtomographic reconstruction of mandibular defects treated with xenografts and collagen-based membranes:a pre-clinical minipig model
    (2021) Gómez, Juliana; Bergamo, Edmara Tp; Tovar, Nick; Talib, Huzefa S; Pippenger, Benjamin E.; Herdia, Valeria; Cox, Madison; Coelho, Paulo G.; Witek, Lukasz
    The goal of this study was to evaluate hard tissue response following guided bone regeneration using commercially available bovine bone grafts and collagen membranes; bilayer collagen membrane and porcine pericardium-based membrane, by means of a non-destructive three-dimensional (3D) computerized volumetric analysis following microtomography reconstruction. Bone regenerative properties of various bovine bone graft materials were evaluated in the Göttingen minipig model. Two standardized intraosseous defects (15mm x 8mm x 8mm) were created bilaterally of the mandible of eighteen animals (n=72 defects). Groups were nested within the same subject and randomly distributed among the sites: (i) negative control (no graft and membrane), (ii) bovine bone graft/bilayer collagen membrane (BOB) (iii) Bio-Oss® bone graft/porcine pericardium-based membrane (BOJ) and (iv) cerabone® bone graft/porcine pericardium-based membrane (CJ). Samples were harvested at 4, 8, and 12-week time points (n=6 animal/time point). Segments were scanned using computerized microtomography (?CT) and three dimensionally reconstructed utilizing volumetric reconstruction software. Statistical analyses were performed using IBM SPSS with a significance level of 5%. From a temporal perspective, tridimensional evaluation revealed gradual bone ingrowth with the presence of particulate bone grafts bridging the defect walls, and mandibular architecture preservation over time. Volumetric analysis demonstrated no significant difference between all groups at 4 weeks (p>0.127). At 8 and 12 weeks there was a higher percentage of new bone formation for control and CJ groups when compared to BOB and BOJ groups (p<0.039). The natural bovine bone graft group showed more potential for graft resorption over time relative to bovine bone graft, significantly different between 4 and 8 weeks (p<0.003). Volumetric analysis yielded a favorable mandible shape with respect to time through the beneficial balance between graft resorption/bone regenerative capacity for the natural bovine bone graft.
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    Expression profile of components of the ?-catenin destruction complex in oral dysplasia and oral cancer
    (2021) Goñi, Francisca J; Peña-Oyarzún, Daniel; Torres, Vicente A; Reyes Rojas, Montserrat
    Oral cancer represents the sixth most common cancer in the world and is associated with 40-50% survival at 5 years. Within oral malignancies, oral squamous cell carcinoma (OSCC) is commonly preceded by potentially malignant lesions, which, according to histopathological criteria, are referred to as oral dysplasia and their diagnosis are associated with higher rates of malignant transformation towards cancer. We recently reported that aberrant activation of the Wnt/??catenin pathway is due to overexpression of Wnt ligands in oral dysplasia. However, the expression of other regulators of this pathway, namely components of the ?-catenin destruction complex has not been explored in oral dysplasia. Using immunohistochemical analyses, we evaluated nuclear expression of ??catenin and its association with Wnt3a and Wnt5a. Likewise, components of the ?-catenin destruction complex, including Adenomatous Polyposis Coli (APC), Axin and Glycogen Synthase Kinase 3 beta (GSK-3?) were also evaluated in oral dysplasia and OSCC biopsies. We found that moderate and severe dysplasia samples, which harbored increased expression of nuclear ??catenin, depicted augmented cytoplasmic expression of GSK?3?, Axin and APC, in comparison with OSCC samples. Also, GSK-3? was found nuclear in mild dysplasia and OSCC samples, when compared with other study samples. Cytoplasmic levels of components of the ?-catenin destruction complex are increased in oral dysplasia and might be responsible of augmented nuclear ??catenin.
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    Medication related osteonecrosis of the jaws (MRONJ):factors related to recurrence after treatment with surgery and platelet rich plasma (PRP) placement
    (2021) Sánchez Gallego-Albertos, Celia; Castillo Pardo de Vera, José Luis del; Viejo Llorente, Aurora; Cebrián Carretero, José Luis
    Medication-related osteonecrosis of the jaws (MRONJ) is a well-known complication associated with antiresorptive and antiangiogenic therapies. The purpose of this study was to analyse if there is any predictive factor of recurrence after local debridement plus platelet rich plasma (PRP) placement in MRONJ patients. Seventy MRONJ patients treated at the department of Oral and Maxillofacial Surgery in La Paz Hospital (Madrid, Spain) were included in this retrospective study. All of them were treated surgically by local debridement and PRP placement. The observation period was between January 2012 and January 2019. Information regarding use, type, administration, and duration of therapy with BP/denosumab was recorded. The follow-up period ranged from 2-52 months. A descriptive analysis, a bivariate and a multivariate study were performed. Most of the patients were women (82.9%) between 50-70 years old (64.3%), with a stage II disease (74.3%). The therapy lasted more than 12 months in 54.8% of them. Zoledronic acid was the main antiresorptive used (44.3%), followed by oral administered BPs (29 patients, 41.4%) and denosumab (10 patients, 14.3%). Osteoporosis (48.6%), breast cancer (30%) and multiple myeloma (11.4%) were the main diseases because the patients were taking antirresorptives. 13 patients (18.6%) experienced recurrence. We found that breast cancer patients (p>0.0001), smokers (p>0.016), and administration of zoledronic acid (p>0.0001) were related to recurrence. After performing the multivariate model, we found that the only factor related to recurrence was smoking habit (Wald 3.837, p=0.05, OR 6.12). recurrence after local debridement plus PRP placement in our MRONJ series affected to 18.6% of patients. It seems to be more frequent in breast cancer patients, smokers, and after zoledronic acid administration. Smoking habit was the only independent factor related to recurrence in our series.
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    Expression of spindle assembly checkpoint proteins BubR1 and Mad2 expression as potential biomarkers of malignant transformation of oral leukoplakia:an observational cohort study
    (2021) Monteiro, Luís Silva; Silva, Patrícia; Delgado, Maria Leonor; Amaral, José Barbas do; Garces, Fernanda; Salazar, Filomena; Pacheco, José Júlio; Simao, Joao Carlos Lopes; Bousbaa, Hassan; Warnakulasuriya, Saman
    The Spindle Assembly Checkpoint (SAC) is a surveillance mechanism essential to ensure the accuracy of chromosome segregation during mitosis. Our aim was to evaluate the expression of SAC proteins in oral carcinogenesis, and to assess their potential in predicting malignant transformation of oral leukoplakia. We analysed the immunoexpression of BubR1, Mad2, Bub3, and Spindly proteins in 64 oral biopsies from 52 oral leukoplakias and 12 normal tissues. Univariate and multivariate analysis were performed to evaluate predictive factors for malignant transformation (MT). We observed that BubR1 and Mad2 were more highly expressed in high dysplasia grade lesions than in low grade or normal tissues (P<0.05). High expression of Spindly was significantly correlated with a high Ki-67 score (P=0.004). Six (11.5%) oral leukoplakias underwent malignant transformation. In univariate analysis, the binary dysplasia grade (high grade) (P<0.001) was associated with a higher risk of malignant transformation as well as high BubR1 (P<0.001) and high Mad2 (P=0.013) expression. In multivariate analysis, high expression of BubR1 and Mad2 when combined showed an increased risk for malignant transformation (P=0.013; HR of 4.6, 95% CI of 1.4-15.1). Our findings reveal that BubR1 and Mad2 were associated with an increased risk for malignant transformation independently of histological grade and could be potential and useful predictive risk markers of malignant transformation in oral leukoplakias.
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    What is the frequency of floor of the mouth lesions? A descritive study of 4,016 cases
    (2021) Costa, Anderson Mauricio Paiva e; Corrêa Pontes, Flávia Sirotheau; de Souza, Lucas-Lacerda; Lopes, Márcio Ajudarte; Santos Silva, Alan Roger; Vargas, Pablo Agustín; Andrade, Bruno Augusto Benevenuto de; Bezerra, Kelly Tambasco; Romañach, Mário José; Gomez, Ricardo Santiago; Costa, Rafael Ferreira e; Júnior, Décio-dos-Santos-Pinto; Perez, Danyel Elias da Cruz; Castro, Jurema Freire Lisboa de
    The aim of this study was to investigate the frequency of oral lesions in the floor of the mouth from representative oral pathology centres in Latin America. This study was conducted on biopsies obtained from January of 1978 to December of 2018 at nine Latin America oral and maxillofacial pathology centres. Gender, age and histopathological diagnosis were evaluated. Data were analysed using descriptive methods. Chi-square test was used for pairwise comparisons. From 114,893 samples, 4,016 lesions (3.49%) occurred in the floor of the mouth. Brazil showed 3,777 cases (94%), Mexico 182 cases (4.5%) and Argentina 57 cases (1.4%). Benign lesions represented 65.1% (2,617 cases), followed by 34.9% (1,404 cases) of malignant disorders. Lesions of epithelial origin were more frequent (1,964 cases; 48.9%), followed by salivary glands (1,245 cases; 31%) and soft tissue lesions (475 cases; 11.7%). The most common histological subtypes were oral squamous cell carcinoma (1,347 cases; 33.5%), ranula (724 cases; 18%), oral leukoplakia (476 cases; 11.8%) and inflammatory fibrous hyperplasia (239 cases; 5.9%). The lesion affected males in 2,129 cases and females in 1,897 cases. In the current study, lesions in the floor of the mouth represented 3.49% of biopsies submitted to oral pathology services and oral squamous cell carcinoma, ranula and leukoplakia were the most common lesions.
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    Oral Kaposi sarcoma development is associated with HIV viral load, CD4+ count and CD4+/CD8+ ratio
    (2021) de Sousa, Rosa Hiolanda Abreu; de Souza, Lucas-Lacerda; Guedes, Pablyanne Tereza Louzada; Ribeiro, Ana-Carolina-Prado; Rodrigues-Oliveira, Leticia; Brandao, Thais-Bianca; Alves, Barbara Waleria Gonçalves; Lopes, Márcio Ajudarte; Santos Silva, Alan Roger; Monteiro, Julius Caesar Mendes Soares; Gonçalves, Thaís Tapajós; Almeida, Oslei Paes de; Corrêa Pontes, Flávia Sirotheau; Rebelo-Pontes, Hélder-Antônio
    Kaposi?s sarcoma (KS) is an uncommon, multifocal and angioproliferative lesion, which demonstrates a poor prognosis. The aim of the present research was to explore the association of HIV viral load, CD4+ and CD8+ counts and the CD4+/CD8+ ratio on the risk of oral Kaposi?s sarcoma (KS) development. A total of 62 patients were retrieved from March 2008 to October 2020 from the files of two oral pathology centres. Clinical, laboratory and follow-up data were retrieved from their medical files. Poisson regression was used to explore the role of history of immunosuppression and its association with oral KS development. A P-value <0.05 was considered significant. Sixty-two patients were included in the present study (32 with oral KS and 30 with no presentation of lesions anywhere on the body). Patients with oral KS presented a mean age of 32.6 years, and male patients were more affected. The hard palate (15 cases; 46.8%) was the main anatomical site affected. The lesions were mostly presented as swellings (13 cases; 40.6%) and nodules (12 cases; 37.5%). Systemic manifestations were also observed, including candidiasis (4 cases; 12.5%), bacterial infection (3 cases; 9.3%), tuberculosis (3 cases; 9.3%), herpes simplex (3 cases; 9.3%) and pneumonia (3 cases; 9.3%). A significant correlation was observed between HIV viral load, CD4+ count and the CD4+/CD8+ ratio with oral KS development. HIV viral load, CD4+ count and the CD4+/CD8+ ratio are associated with oral KS development.
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    Clinical management of alveolar osteitis. A systematic review
    (2021) Garola, Federico; Guilligan, Gerardo; Panico, René Luis; Leonardi, Nicolás; Piemonte, Eduardo
    Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several therapeutic interventions have been described for the treatment of AO, however, there are no treatment standardized protocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the different treatments for AO. The feasibility of the application of these interventions is also discussed. A structured electronic and hand search strategy was applied to PubMed, Scopus, Cochrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies according to PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients? percentages. Those treatments that reach VAS ? 4 on day 2 or before; or ? 85% of patients with absence of pain symptoms at day 7 or before were considered accepTable for their recommendation. The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AO treatments. 53,8% of the treatments fulfill the proposed parameters for pain control. Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management of AO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCept Patch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected according to their availability and advantages or disadvantages.
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    Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study
    (2021) Ramis-Alario, Amparo; Tarazona Álvarez, Beatriz; Peñarrocha Diago, Miguel; Soto Penaloza, David; Peñarrocha Diago, María; Peñarrocha Oltra, David
    Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosis after endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of different radiographic techniques in obtaining area and volume measurements of periapical lesions. Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (index test) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodontic microsurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radiographic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer. The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preoperatively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiography detected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical radiography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2D methods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purposes. The measurements were found to be significantly different in both the preoperative and the follow-up images.  Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively and at follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by the periapical and panoramic radiographs.