Tatuagens por amálgama são lesões pigmentadas, exógenas, de frequente ocorrência na mucosa bucal, que resultam da introdução acidental de partículas de amálgama nos tecidos moles. O diagnóstico da tatuagem por amálgama é simples, geralmente, baseado em achados clínicos, complementado pela história recente ou pregressa de remoção de restauração por amálgama. Radiografias intraorais podem ser úteis na detecção de radiopacidade, associadas à partícula de amálgama. Nos casos em que as tatuagens por amálgama não permitem diferenciação de outras lesões melanocíticas, o exame histopatológico deve ser realizado. Os autores relatam à ocorrência de lesão extensa por tatuagem de amálgama com confirmação histopatológica.

Amalgam tattoos are common exogenous pigmented lesions of the oral mucosa occurring mainly by inadvertent placement of amalgam particles into soft tissues. The diagnosis of amalgam tattoo is simple, usually based on clinical findings associated with presence or history of amalgam fillings removal. Intraoral X-rays may be helpful in detecting amalgam-related radiopacity. In cases where amalgam tattoo cannot be differentiated from other causes of oral pigmentation, a biopsy should be performed. This article deals with an extensive amalgam tattoo lesion which required a biopsy for a definitive diagnosis.

As reações liquenoides por drogas são mais comuns na pele, mas também podem ocorrer na mucosa bucal. Estas lesões são de difícil diagnóstico por causa de sua semelhança clínica com às do líquen plano oral idiopático. O presente artigo relata um caso de reação liquenoide em mucosa bucal, associado ao uso de carbamazepina, no qual o processo de diagnóstico é enfatizado

Lichenoid drug reactions are more commom in skin, but they may also occur in the oral mucosa. It is difficult to diagnose these lesions due to their clinical similarity to the idiopathic oral lichen planus lesions. The present article reports a case of lichenoid reaction in oral mucosa associated to the use of carbamazepine, emphasizing the diagnostic process

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS: The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5%). Dapsone was prescribed for a total of nine patients, of whom eight (89%) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90%), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60%), of whom one patient showed complete remission. CONCLUSION: The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

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.

Este estudo teve por objetivo avaliar a qualidade de vida em pacientes submetidos a tratamento cirúrgico para neoplasias de glândulas salivares menores (NGSM). Doze pacientes (10 mulheres e 2 homens, idade média de 49,4 anos) com diagnóstico histopatológico de adenoma pleomórfico (AP, 3 casos), adenocarcinoma polimorfo de baixo grau de malignidade (APBG, 2 casos), carcinoma adenóide cístico (CAC, 4 casos), e carcinoma muco-epidermóide (CME, 3 casos) foram avaliados. Todos os pacientes foram tratados por excisão cirúrgica; pacientes com CAC receberam radioterapia complementar. A qualidade de vida dos pacientes foi avaliada através de um questionário de auto-avaliação referente ao bem-estar físico, estado emocional, atividades normais diárias, e relações familiares. Os resultados mostraram que os pacientes com CME - os mais jovens entre todos os pacientes - relataram uma piora significativamente maior em seu bem-estar físico e estado emocional após o tratamento quando comparados com pacientes tratados de AP (P < 0,05), e também em suas atividades funcionais quando comparada com indivíduos tratados de AP e APBG (P < 0,05). Em conclusão, a idade de desenvolvimento da neoplasia e o tipo de doença produzem maior impacto na qualidade de vida do paciente do que faz o grau de agressão do tratamento.

This study was aimed at assessing the quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms (MSGN). Twelve patients (10 women and 2 men, mean age: 49.4 years) with histopathologic diagnosis of pleomorphic adenoma (PA, 3 cases), polymorphous low-grade adenocarcinoma (PLGA, 2 cases), cystic adenoid carcinoma (CAC, 4 cases), and muco-epidermoid carcinoma (MEC, 3 cases) were evaluated. All of them were treated by surgical excision; patients with CAC received radiotherapy as well. The patients’ quality of life was evaluated through a self-administered questionnaire concerning their physical well-being, emotional status, normal daily activities, and family relationships. The results showed that patients with MEC - the youngest among all patients - reported a significantly greater worsening of their physical well-being and emotional status after treatment as compared with patients treated for PA (P < 0.05), and also of their functional activities as compared with those treated for PA and PLGA (P < 0.05). In conclusion, age of development of the neoplasm and type of disease produce more impact on patients’ quality of life than does the therapy’s degree of aggression.

A Síndrome de ardência bucal (SAB) é uma doença complexa, de etiologia desconhecida. Caracteriza-se por uma sensação de queimação na mucosa bucal, não obstante seu aspecto clínico normal, sendo bastante freqüente em mulheres após a menopausa. O propósito deste estudo foi o de investigar a SAB em bases clínicas e, em adição, analisar sua possível relação com a freqüência de espécies do gênero Candida isoladas da cavidade bucal desses indivíduos. Foram estudados trinta e um pacientes, 28 mulheres e 3 homens, 13 caucasianos e 18 não caucasianos, média de idade 61,3 (faixa dos 30 - 85 anos). A maioria deles (80,6%) estava sob medicação por longo período. Anti-hipertensivos, ansioliticos e antidepressivos foram as drogas mais utilizadas. A ardência bucal estava associada a outras queixas secundárias em 83,8% dos pacientes. A língua foi o sítio mais afetado (70,9%), seguida pelo vermelhão do lábio inferior (38,7%) e palato duro (32,2%). A associação de sensação de ardência com câncer bucal (cancerofobia) foi referida por 67,7% dos pacientes. Exames hematológicos (hematócrito, hemoglobina e glicemia em jejum) revelaram dois casos cada, de anemia e diabetes tipo 2. Fatores locais, exodontias, e uso de próteses estavam associados com o conjunto de sintomas em 35,5% dos casos. Foram referidas alterações importantes nas atividades cotidianas, em conseqüência da SAB, em 29% dos pacientes. Leveduras do gênero Candida foram isoladas da cavidade bucal de 45,16% dos indivíduos com SAB e igualmente do grupo-controle, não constituindo dado qualitativamente importante. Dentre as espécies do Gênero Candida, C. albicans foi a mais freqüente (9 - 29,03% e 12 - 38,70%), seguida de C. parapsilosis (2 - 6,45% e 0 - 0%), C. tropicalis (1 - 3,22% e 2 - 6,45%), C. krusei e C. kefyr (1 - 3,22% e 0 - 0%). Em conclusão, nossos resultados mostraram a importância de uma possível relação da SAB com o uso crônico de medicamentos, depressão, menopausa e cancerofobia. Não foi observada associação entre SAB e prevalência de leveduras do gênero Candida.

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.

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.

O carcinoma epidermóide constitui a neoplasia maligna mais comum da boca, afetando principalmente indivíduos com mais de 50 anos. Sua ocorrência em jovens, com idade inferior a 40 anos, é rara (1 a 6% dos casos). Descreve-se um caso de carcinoma epidermóide acometendo dorso e borda da língua, classificado como T2N1M0 (estádio III), em paciente do sexo feminino, leucoderma, 25 anos, não-fumante e não-etilista. A apresentação inicial do caso era de ulceração profunda com dor intensa. Fatores predisponentes locais e gerais, diagnóstico diferencial e prognóstico são discutidos, bem como a revisão da literatura referente a diversos aspectos do carcinoma epidermóide em jovens.

Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity, usually affecting individuals over 50 years of age. It rarely occurs in patients who are less than 40 years old (1 to 6%). This report describes a case of squamous cell carcinoma, staged T2N1M0 (stage III), involving the lateral border and dorsal surface of the tongue of a 25-year-old white female patient, with no smoking or drinking habits. Initial tumor presentation was of deep ulceration and intense pain. This report focuses on the etiological factors, differential diagnosis and prognosis related to the case. Additionally, a brief literature review regarding squamous cell carcinoma in young patients is also included.

Objective: To compare specimen adequacy and diagnostic agreement between liquid-based preparations and conventional smears in oral lesions, and to test the viability of immunocytochemical assay in liquid-based preparations from oral carcinoma lesions. Material and Methods: Samples were collected from 44 patients. Conventional smears were prepared first, using a cytobrush device. Then the brush, containing the residual material, was immersed in a preservative fluid. The sample in the preservative fluid was processed according to the manufacturer directions (AutoCyte, Inc. Elon College, North Carolina, USA). Slides of both techniques were stained by Papanicolaou method. For immunocytochemical assay, a cytokeratin pool AE1/AE3 (Dako, CA, USA) was applied in liquid-based preparations from oral carcinoma lesions following the Streptavidin-biotin-peroxidase method. Fisher’s exact test was used; significance was set for p ≤0.05. Results: Both techniques agreed on cytologic diagnosis in every case they yielded an adequate specimen; in 3 cases conventional smear resulted in hypocellularity and therefore inadequate for analysis. On specimen analysis, the liquid-based cytology demonstrated a statistically significant, 41% overall improvement in smear thickness and 66% in cell distribution (p ≤0.05), and a reduction in cell overlapping and presence of blood (p ≤0.05). The cell morphology was better visualized in the liquid-based preparations. The immunocytochemical assay reactions were positive in all malignant cases, the visualization of the immunostained cells being especially clear. Conclusion: Both, the liquid-based preparation and conventional smear, are diagnostically reliable; the liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility.

Objetivo: Comparar la efectividad de la muestra y la coincidencia de diagnóstico entre preparaciones de base líquida y frotis convencionales en lesiones orales, y probar la viabilidad de la prueba inmuno-citoquímica en preparaciones de base líquida de lesiones de carcinoma oral. Material y Métodos: Se obtuvieron muestras de 44 pacientes. Primeramente se prepararon frotis convencionales, usando un dispositivo cytobrush. A continuación se sumergió el cepillo que contenía el material residual en un líquido conservante. La muestra en el mismo fue procesada de acuerdo con las indicaciones del fabricante (AutoCyte, Inc. Elon College, North Carolina, USA). Se tiñeron preparaciones de ambas técnicas de acuerdo con el método de Papanicolaou. Para la prueba inmuno-citoquímica se usaron conjuntamente AE1/AE3 (Dako, CA, USA) para las lesiones de carcinoma oral, de acuerdo con el método de la Estreptovidina-biotina-peroxidasa. Se usó la prueba exacta de Fisher; fijándose la probabilidad significativa en p ≤0.05. Resultados: Ambas técnicas coincidieron en el diagnóstico citológico en todos los casos donde se usó una muestra adecuada; en 3 casos el frotis convencional mostró hipocelularidad y, por lo tanto, resultó inadecuado para el análisis. En el análisis de muestras, la citología de base líquida mostró una mejora general estadísticamente significativa), de un 41% en espesura de frotis y de un 66% en la distribución de células (p ≤ 0.05), además de una reducción en la superposición de células y la presencia de sangre (p ≤ 0.05). La morfología celular se observó mejor en las preparaciones de base líquida. Las reacciones de la prueba inmuno-citoquímica fueron positivas en todos los casos de malignidad, siendo especialmente clara la observación de células inmuno-marcadas. Conclusión: Tanto las preparaciones de base líquida como los frotis convencionales son dignos de confianza desde el punto de vista del diagnóstico; el método de base líquida mostró una mejora general en la preservación de muestras, adecuación de ejemplares, observación de morfología celular y reproducibilidad.

This paper discusses the difficulties in making a definitive diagnosis of oral psoriasis based upon clinical and histological evidence only. A young black male presented with multiple lesions showing erosions, fissures, and yellowish scales on the vermilion borders of both lips. He also had erythematous-erosive areas on the gingivae, a fissured tongue showing greyish areas on its ventral surface, whitish lesions and longitudinal sulci in the hard palate with lacelike lesions on the soft palate. Biopsies from the lower lip, gingiva and soft palate showed hyperkera-tosis, spongiosis, acanthosis, and elongation of rete ridges. In addition, collections intraepithelial micro-abscesses of Munro were observed. These findings are consistent with oral psoriasis. Typical cutaneous lesions and a family history of psoriasis were absent.

Este artículo comenta las dificultades de hacer un diagnóstico definitivo de psoriasis oral basado en la evidencia clínica e histológica. Se presenta un joven varón negro con múltiples lesiones que muestran erosiones, fisuras y escaras amarillentas en el borde bermellón de ambos labios. También tenía áreas eritematosas-erosivas en la encía, una lengua fisurada que mostraba áreas grisáceas en su superficie ventral, lesiones blanquecinas y lesiones longitudinales en el paladar duro junto lesiones entrelazadas en el paladar blando. Las biopsias del labio inferior , la encía y el paladar blando mostraron hiperqueratosis, espongiosis, acantosis, y elongación de las crestas epiteliales. Además, se observaron micro-abscesos intraepiteliales de Munro. Estos resultados son coincidentes con psoriasis oral. No tenía las lesiones cutáneas típicas ni una historia familiar de psoriasis.

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.

Três casos da forma juvenil da paracoccidioidomicose são relatados. Especial ênfase foi dada com relação às manifestações bucais, particularmente no que diz respeito ao envolvimento periodontal. Os principais achados periodontais foram: destruição progressiva e generalizada do osso alveolar causando acentuada retração gengival e exposição das raízes dentárias. Mobilidade dentária e perda espontânea de alguns dentes constituíram também sinais clínicos importantes. A mucosa gengival apresentava-se lisa, eritematosa e superficialmente edemaciada. Pequenas áreas de ulceração com finas granulações foram observadas na gengiva de um dos pacientes. Estes aspectos, embora raros, podem representar os primeiros sinais da paracoccidioidomicose juvenil e, às vezes, sua única manifestação.

Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erithematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestation.