Resumo A síndrome de Sjögren (SS) é uma doença autoimune crônica sistêmica que afeta as glândulas lacrimal e salivar. A SS pode se manifestar como SS primária (SSp) ou SS secundária (SSs), a última ocorrendo em conjunto com outra desordem autoimune. Em ambos os casos, os olhos secos e a boca seca afetam a qualidade de vida do paciente. As complicações tardias podem incluir cegueira, destruição dos tecidos dentários, candidíase oral e linfoma. Este artigo relata dois casos de SS, cada um apresentando lesão nodular oral incomum diagnosticada como linfoma MALT reincidente e mucocele. A importância do diagnóstico, tratamento e manejo das lesões orais por um cirurgião-dentista durante o atendimento de pacientes com SS é enfatizada, pois as manifestações orais da SS podem comprometer a qualidade de vida do paciente.

Abstract Sjögren’s syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient’s quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient’s quality of life.

ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS: Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

OBJECTIVE: To evaluate the effects of the levels of glycemic control on the frequency of clinical complications following invasive dental treatments in type 2 diabetic patients and suggest appropriate levels of fasting blood glucose and glycated hemoglobin considered to be safe to avoid these complications. METHOD: Type 2 diabetic patients and non-diabetic patients were selected and divided into three groups. Group I consisted of 13 type 2 diabetic patients with adequate glycemic control (fasting blood glucose levels <140 mg/dl and glycated hemoglobin (HbA1c) levels <7%). Group II consisted of 15 type 2 diabetic patients with inadequate glycemic control (fasting blood glucose levels >140 mg/dl and HbA1c levels >7%). Group III consisted of 18 non-diabetic patients (no symptoms and fasting blood glucose levels <100 mg/dl). The levels of fasting blood glucose, glycated HbA1c, and fingerstick capillary glycemia were evaluated in diabetic patients prior to performing dental procedures. Seven days after the dental procedure, the frequency of clinical complications (surgery site infections and systemic infections) was examined and compared between the three study groups. In addition, correlations between the occurrence of these outcomes and the glycemic control of diabetes mellitus were evaluated. RESULTS: The frequency of clinical outcomes was low (4/43; 8.6%), and no significant differences between the outcome frequencies of the various study groups were observed (p>0.05). However, a significant association was observed between clinical complications and dental extractions (p = 0.02). CONCLUSIONS: Because of the low frequency of clinical outcomes, it was not possible to determine whether fasting blood glucose or glycated HbA1c levels are important for these clinical outcomes.

INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.

Green tea, a product from Camellia sinensis, consists of over 200 componentes. The most known are the catechins, ou polyphenolic compounds, or flavonoids, but it contains also polysacharide conjugates, amino acids, caffeine and vitamins. Studies have suggested that the regular consumption of green tea reduces the risk of cancer, protecting agains initial events and progression of the disease, may act as antioxidant, has bactericidal properties, and that green tea consumption may be an adjuvant in the treatment of diabetes mellitus, hypertension and hypercholesterolemia. Our experimental study was carried out with male Wistar rats, separated in two groups, experimental and control. The animals in control group were given water ad libitum, and the animals in the experimental group received green tea instead of water. After 2 weeks of experimental period, all the animals, suffered surgical wounds on the dorsum. The animals were sacrificed on 1, 3 and 7 days after surgery. Skin samples were used for light microscopy evaluation. Our results allowed us to observe that the experimental group (green tea drinking) presented accelerated epithelial neformation on day 3 after surgery, when epithelial neoformation is in the initial phases. The surgical areas presented 48.20% X 27.32% epithelial neoformation for green tea group and their controls respectivelly at this time. The results of the present study, along with other information about green tea in the literature, strongly suggests that regular use of green tea may be beneficial in surgery situations, when fast epithelial neoformation is desirable.

El té verde, producto de la planta Camellia sinensis, consiste en más de 200 componentes. Los más conocidos son las catequinas o compuestos polifenólicos o flavonoides, pero contiene también polisacáridos conjugados, aminoácidos, cafeína y vitaminas. Diversos estudios han sugerido que el consumo regular de té verde reduce el riesgo de cáncer, protege contra los eventos iniciales y su progresión, puede actuar como antioxidante, tiene propiedades bactericidas, y su consumo puede ser un co-adyuvante en el tratamiento de la diabetes mellitus, hipertensión e hipercolesterolemia. Nuestro estudio experimental fue realizado con ratas Wistar machos, separadas en dos grupos, experimental y control. Los animales del grupo control recibieron agua ad libitum y los animales del grupo experimental recibieron té verde. Después de 2 semanas de experimentación, en todos los animales fueron realizadas heridas quirúrgicas en el dorso. Los animales fueron sacrificados 1, 3 y 7 días después de la cirugía. Muestras de piel fueron usadas para evaluación microscópica. Nuestros resultados permitieron observar que el grupo experimental (tratado con té verde) presentó una aceleración en la neoformación epitelial en el 3er día posquirúrgico, cuando la neoformación está en la fase inicial. En este período, las áreas quirúrgicas presentaron 48,20% de neoformación epitelial en el grupo tratado contra 27,32% en el grupo control. Los resultados del presente estudio, junto con otras informaciones existentes en la literatura sobre el té verde, sugieren fuertemente que el uso regular de este producto puede ser benéfico en situaciones quirúrgicas, cuando se desea una rápida neoformación epitelial.

O objetivo deste estudo foi avaliar a eficácia do propionato de clobetasol a 0,05% administrada com moldeiras em 22 pacientes com gengivite descamativa por meio de estudo duplo-cego, cruzado, placebo-controlado. Pacientes receberam bisnaga número 1 e foram instruídos a aplicar a pomada 3 vezes ao dia por um período de 2 semanas, e reduzir a aplicação para 1 vez ao dia na terceira semana. Os pacientes foram instruídos a suspender o tratamento por 2 semanas, e então receberam a bisnaga 2, usando-a da mesma maneira que o container 1. Com relação aos sinais, 17 pacientes apresentaram alguma melhora, enquanto 5 apresentaram piora com o propionato de clobetasol. Com o uso do placebo, 14 pacientes apresentaram alguma melhora, e 8 pacientes apresentaram piora do seu quadro clínico. Com relação aos sintomas, houve completa melhora em 2 pacientes, melhora parcial em 12, ausência de resposta em 7, e piora em 1 pacientes durante o uso do propionato de clobetasol. Com o uso do placebo, houve melhora parcial em 8 pacientes, ausência de resposta em 12 e piora dos sintomas em 2 pacientes. Não foi verificada diferença estatisticamente significante em nenhum dos parâmetros entre o uso do clobetasol e placebo; p>0,05. Baseado no protocolo utilizado neste grupo de pacientes, o propionato de clobetasol não demonstrou efetividade significante quando comparado ao placebo.

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

O tratamento das lesões gengivais de doenças vesicobolhosas auto-imunes constitui grande desafio na estomatologia, principalmente pela natureza crônica das lesões. O tratamento sistêmico é necessário no controle das apresentações mais graves; entretanto, quando possível, o tratamento tópico é preferível. Este artigo descreve uma técnica oclusiva para aplicação de corticosteróide tópico que tem demonstrado ser eficaz no controle dessas lesões, sobretudo em pacientes com manifestações exclusivamente gengivais.

Management of gingival lesions of vesicobullous autoimmune diseases is one the main challenges to oral medicine, primarily because of their chronic nature. Systemic therapy is required in most severe lesions, however, whenever feasible, topic corticosteroid therapy is preferred. This article describes a technique to provide topical occlusive corticotherapy that has shown to be effective in controlling these lesions, especially in patients exclusively with gingival lesions.

Undernutrition in early life is associated with a number of acute and chronic sequelae, and recovering is a controversial issue. Even if undernutrition in Brazil is declining, studies have shown that about 31% of brazilian children still present severe or moderate malnutrition. The present study goal was to induce early malnutrition in rats and observe short- (undernourished) and long-term (after recovered) effects on defense cells involved in wound healing. Undernutrition was produced by separating the pups from the mother for 10 hours/day during the suckling period (21 days after birth). As controls were used rats at same age not submitted to suckling restriction. Undernutrition and recovering states were assessed by body weight. Skin wounds were made on the shaved backs of all, undernourished, recovered and their controls, under tribromoethanol anesthesia. Aninals were sacrificed 1, 3, 7 and 14 days after surgery and the tissues were properly prepared and observed under light microscopy. Our results showed that: 1) neutrophils, lymphocytes and macrophages couting in healing area were lower in undernourished and in recovered animals as compared with their controls; 2) there were a basal deficiency in lymphocytes and macrophages numbers in recovered animals but not in those acutelly undernourished. These results allow us to conclude that post-nattally undernourished animals submitted to a nutritional rescue time showed a complete recovery in physical weight, but in spite of the physical recovery, the wound healing showed less defense cell density in healing areas suggesting long-term sequelae of early undernutrition

La desnutrición postnatal está asociada a un conjunto de secuelas agudas y crónicas, y su recuperación es aún asunto controvertido. En Brasil, a pesar de estar disminuyendo la desnutrición, algunos estudios han demostrado que alrededor del 31% de los niños presentan malnutrición moderada o severa. El objetivo del presente estudio fue inducir una desnutrición precoz en ratas y observar los efectos inmediatos (desnutrición) y permanentes (depués de la recuperación) sobre las células de defensa involucradas en la cicatrización. La desnutrición fue provocada separando las crías de sus madres, por 10 horas diarias, durante el periodo de lactancia (21 días de nacidos). Como contoles fueron usadas ratas de la misma edad no sometidas a restrición láctea. Los estados de desnutrición y de recuperación fueron evaluados por el peso corporal. Las heridas fueron realizadas en la piel rasurada del dorso de los animales desnutridos, recuperados y controles, bajo anestesia con tribromoetanol. Los animales fueron sacrificados 1, 3, 7 y 14 días después de la cirugía y los tejidos de la región cicatricial fueron procesados histológicamente y examinados al microscopio óptico. Los resultados mostraron que: 1) el número de neutrófilos, linfocitos y macrófagos en la área de cicatrización, fue menor en los animales desnutridos y en recuperación que en los controles; 2) enlos animales recuperados hubo una deficiencia basal en el número de linfocitos y macrófagos, lo que no ocurrió en los animales con desnutrición aguda. Estos resultados permitieron concluir que los animales sometidos a desnutrición postnatal mostraron una recuperación completa en el peso físico después del periodo de recuperación nutricional, pero que la región de cicatrización mostró menor densidad de células de defensa, sugiriendo secuelas permanentes de la desnutrición postnatal

Cádmio (Cd) é um metal pesado que exerce uma variedade de efeitos tóxicos, crônicos e agudos, em organismos expostos. O objetivo deste estudo foi investigar o potencial carcinogênico do Cd no epitélio do palato e da gengiva de ratos Wistar. Dois grupos de animais foram estudados: grupo 1 que consistiu de 5 ratos expostos a cloreto de cádmio (CdCl2) em água de bebedouro (300 mg/L) por um período de 6 meses; grupo 2 que também consistiu de 5 ratos submetidos às mesmas condições dos animais do grupo 1, mas permaneceu livre de Cd por um período adicional de 6 meses. Dois outros grupos (C1 and C2) com o mesmo número de animais, entretanto não expostos ao CdCl2, foram usados como controle para o grupo 1 e 2, respectivamente. Todos os animais foram pesados antes e após o período experimental. Após terem sido sacrificados, os tecidos de interesse para o estudo foram fixados em formalina a 10%, processados por meio de técnica histopatológica padrão, corados em HE, e analisados sob microscopia de luz, utilizando parâmetros cariométricos e estereológicos. Perda de peso, atrofia do epitélio da gengiva e do palato mole foram os principais achados deste estudo, e verificados apenas no grupo 1 (p < 0.05). Em conclusão, Cd não produziu efeito carcinogênico nos tecidos orais, nas condições experimentais empregadas neste estudo.

Cadmium (Cd) is a heavy metal that exerts a variety of toxic effects, chronic and acute, in exposed organisms. The aim of this study was to investigate the carcinogenic potential of Cd in the palatal and gingival epithelium of Wistar rats. Two groups of animals were studied: group 1 consisted of 5 rats exposed to cadmium chloride (CdCl2) in drinking water (300 mg/L) for 6 months; group 2 also consisted of 5 rats placed in the same conditions as those of group 1, but kept free of Cd for 6 additional months. Two other groups (C1 and C2) with the same number of animals, but not exposed to CdCl2, were used as a control for groups 1 and 2, respectively. All animals were weighed before and after the experimental period. After animals being killed, tissues of interest were fixed in solution of 10% formalin, processed by standard histologic techniques, stained with HE, and analyzed under light microscopy using karyometric and stereologic parameters. Loss of body weight, atrophy of the gingiva and soft-palate epithelium were the principal findings of this study, and verified only in the group 1 (p < 0.05). In conclusion, at the concentration tested, Cd presented no carcinogenic effect on the oral tissues within the experimental time period.

Skin serves as interface between inner aand outer environment, and acts a a mechanical barrier. Changes in its characteristics may lead to a higher pathogenicity, less defense capacity, or both. Diabetes mellitus is a heterogeneous group of chronic hyperglycemic disorders, considered a syndrome rather than a simple disease. Complications by diabetes are mostly associated with the chronicity of the disease and very little information exists about its early pathological processes. Animal models are considered very useful for the study of early diabetes. Wistar rats with lloxan induccced diabetes were used in a way to study the progresive effects of diabetes mellitus on the skin epithelium. Five animals were sacrificed at 7 days (Phase I) and five others at 26 days (Phase II) after the comprovation of hyperglycemic state. Animals not inyected with alloxan were used as control. Histometric and stereologic methods were used for the tissue analysis. Our results allow us to observe that nevertheless progressive thickness decrease is observed with the progress of the disease, epithelial thickness is observed decreased very early in the course of the diabetes. Our results suggest that, although diabetes is a chronic disease, and many of its complications are related to the chronicity, it is reasonable to think about ddeficiency in the capacity of acting as a barier for the skin epithelium even in early phases of the disease. Professionals must be aware about patients with high risk for diabetes development

La piel sirve como una interface entre los medios interno y externo de nuesto cuerpo. Una de sus funciones es actuar como una barrera mecánica. Cambios en sus características pueden conducir a una mayor patogenicidad y/o, a una menor capacidad de defensa. La diabetes mellitus se caracteriza por un grupo heterogéneo de alteraciones hiperglicémicas crónicas, siendo considerada un síndrome más que una simple enfermedad. Las complicaciones de la diabetes están asociadas, principalmente, con la cronicidad de la enfermedad, existiendo escasa información sobre los procesos patológicos desencadenantes. Los modelos animales son considerados muy útiles para el estudio de la diabetes inicial. Las ratas Wistar con diabetes inducida con aloxana, fueron utilizadas como modelo para estudiar los efectos progresivos de la diabetes mellitus sobre el epitelio de la piel. Cinco animales fueron sacrificados a los 7 días (Fase I) y otros cinco a los 26 días (Fase II) luego de comprobarse el estado hiperglicémico. Animales no inyectados con aloxana fueron usados como controles. Fueron usados métodos histométricos y estereológicos para el análisis de los tejidos. Nuestros resultados permitieron observar que no obstante la alteración progresiva del grosor del epitelio durante la evolución de la enfermedad, la alteración del mismo ocurre muy precozmente en el curso de la diabetes. Nuestros resultados sugieren que, a pesar de ser la diabetes una enfermedad crónica, y de que muchas de sus complicaciones están relacionadas con su cronicidad, es razonable pensar en una deficiencia en la capacidad de la piel en su acción de barrera, aún en las etapas iniciales de la enfermedad. Los profesionales debería considerar estas características en relación a aquellos pacientes con alto riesgo de desencadeanar una diabetes mellitus