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ABSTRACT Objective: In the Brazilian public health system, referral letters, issued by general dentists and physicians who perform initial clinical assessments, is the main source of information in arriving at a final diagnosis. However, the consistency and completeness of the referral letters remain poorly explored. Therefore, we assessed the quality of referral letters received by an oral medicine service at a dental specialty center over a 2-year period (2023–2024) and characterized the diagnostic profile of referred cases. Methods: This census-based retrospective cross-sectional study analyzed 430 referral letters using 8 predefined criteria (0–8 points) on lesion characteristics, clinical history, and diagnostic hypothesis. The referral letters were classified as poor (0–1), regular (2–3), good (4–6), or excellent (7–8). Results: All referrals were from public services; 47.0% were issued in 2023 and 53.0% in 2024. Referrals to dentists accounted for 97.2% of the referrals. Most letters were rated as regular (60.5%) or good (23.0%), while 15.6% were classified as poor and only 0.9% as excellent. Frequently reported descriptors included lesion location (84.2%) and primary morphology (76.5%). Clinically relevant details such as symptomatology (22.8%), time of evolution (16.0%), lesion size (3.5%), and limits (2.3%) were mostly absent. Diagnoses included benign lesions (71.9%), potentially malignant disorders (10.7%), normality variations (6.3%), and malignant lesions (3.7%); 7.4% of the referrals had no diagnosis. Referral quality scores differed significantly across diagnostic categories (p=0.0076), with lower scores observed in cases without a final diagnosis. Conclusions: Despite the predominance of benign lesions, more than one in every seven referrals, which were often incompletely documented, involved potentially malignant disorders or malignant lesions. Strengthening referral documentation through targeted training and standardized electronic templates may improve screening accuracy, support the earlier detection of oral lesions, and reduce diagnostic delays within the Brazilian unified health system.

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ABSTRACT Objectives: This study aimed to compare quality of life and caregiver burden between caregivers and guardians of children with autism spectrum disorder and those of neurotypical children. Methods: A total of 124 caregivers participated and were assigned to two groups: autism spectrum disorder (ASD; n=62) and neurotypical (NT; n=62). Participants were recruited from a specialized multiprofessional dental care institution. Data were collected using a sociodemographic questionnaire, the WHOQOL-BREF, and the Zarit Burden Interview. Data were tabulated and analyzed using a 5% significance level. Results: The mean age of the children was 9.45 years in the ASD Group and 8.29 years in the NT Group. The proportion of boys was higher in the ASD Group than in the NT Group (p<0.001). Regarding functional independence, 69.4% of children with ASD depended on caregivers for activities of daily living, whereas 67.7% of neurotypical children were independent (p<0.001). For oral hygiene, 64.4% of children with ASD required caregiver assistance, whereas 82.3% of neurotypical children performed oral hygiene independently (p<0.001). Overall quality of life did not differ significantly between groups. However, specific items in the physical and psychological domains differed significantly between groups (Q3: p=0.021; Q4: p=0.001; Q26: p=0.003). By contrast, caregiver burden was significantly higher among caregivers of children with autism spectrum disorder than among caregivers of NT children, as reflected by higher total and domain scores (p<0.001). Conclusion: Although caregivers in both groups reported moderate quality of life, those caring for children with autism spectrum disorder experienced substantially greater caregiver burden. These findings support the need for targeted strategies to reduce caregiver stress and improve well-being in families of children with autism spectrum disorder. Brazilian Registry of Clinical Trials: RBR-4cvz58n and U1111-1299-9942.

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ABSTRACT Objective: To investigate oral manifestations and the presence of T. pallidum DNA in children exposed to maternal syphilis by integrating epidemiological, clinical, and molecular data. Methods: This two-phase observational study analyzed health, perinatal, and dental records of children born to mothers diagnosed with syphilis during pregnancy. In Phase 1, demographic characteristics, maternal treatment adequacy, birth conditions, and oral clinical findings were assessed. In Phase 2, a subset of children underwent comprehensive oral examinations, including evaluation for enamel defects associated with congenital syphilis. Oral samples were collected and processed by DNA extraction followed by nested PCR targeting T. pallidum-specific genes. Results: Although no statistically significant differences were observed between maternal treatment groups for some outcomes, children exposed to maternal syphilis showed enamel hypoplasia, Hutchinson-like incisors, and molar defects. PCR amplification identified T. pallidum DNA in oral samples from a subset of participants, suggesting possible persistence of treponemal DNA or residual genetic material after maternal treatment. Conclusion: Children exposed to maternal syphilis may present with distinctive oral alterations, and molecular detection of T. pallidum DNA in the oral cavity supports the need for long-term dental follow-up and integration of oral examinations into postnatal care programs.

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ABSTRACT Objective: In this study, we aimed to evaluate the primary health care attribute of first-contact access from the perspective of users of family and oral health teams in São Paulo, Brazil. Methods: A cross-sectional study was conducted at 12 basic health units between January and November 2021. The adult versions of the Primary Care Assessment Tool (PCATool-Brazil) and PCATool-Oral Health were used to assess first-contact access through its two components of utilization and accessibility. Results: In total, 537 individuals participated, including 129 users of oral health teams and 408 users of family health teams. In both groups, utilization scores were higher than accessibility scores. Among users of oral health teams, the mean scores were 8.08 for utilization and 4.37 for accessibility; among users of family health teams, the corresponding scores were 8.43 and 3.80. For oral and family health teams, high performance for utilization was observed in 85.37% and 87.53% of users, whereas low performance for accessibility was observed in 95.08% and 97.70% of users, respectively. Few differences in participant characteristics were observed among users of oral health teams, with higher utilization scores noted among those without private health insurance. Regarding users of family health teams, higher utilization scores were observed among older adults, retirees, or pensioners; beneficiaries of social programs; those without private health insurance; and those with hypertension and or diabetes. For accessibility, higher scores were observed among men, older adults, and retirees or pensioners. Conclusion: Overall, utilization was satisfactory and accessibility was unsatisfactory in both family and oral health teams. Primary health care services were recognized as a usual source of care, but organizational barriers to timely access remain, especially in oral health care. These findings highlight the need to strengthen accessibility in primary health care, particularly through organizational strategies aimed at improving timely access to care.

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ABSTRACT Objective: To investigate the prevalence, co-occurrence, and temporal dynamics of Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, and Pseudomonas aeruginosa in oral and tracheal samples from critically ill patients receiving mechanical ventilation. Methods: This observational analytical study included 21 adult patients receiving mechanical ventilation who were admitted to an intensive care unit. Oral and tracheal samples were collected within the first 24 h after intubation (Day 0) and again after 48 h (Day 2). Bacterial genomic deoxyribonucleic acid was extracted and analyzed using quantitative realtime polymerase chain reaction. Microbial detection was evaluated qualitatively based on the presence or absence of each microorganism and quantitatively using relative bacterial load analysis. Statistical analyses assessed correlations between oral and tracheal colonization patterns and temporal changes in bacterial load. Results: More than 43% of oral and tracheal samples tested positive for at least one investigated pathogen at both collection time points, indicating persistent microbial colonization during mechanical ventilation. Significant positive correlations for Staphylococcus aureus detection were observed between oral and tracheal samples on Day 0 (p=0.0028) and Day 2 (p=0.0021), suggesting a possible association between oral colonization and lower airway microbial presence. Streptococcus pneumoniae detected in initial oral samples showed a significant correlation with tracheal detection after 48 h (p=0.03). Quantitative analyses demonstrated no significant changes in bacterial load over time for most microorganisms. However, Klebsiella pneumoniae showed a significant increase in tracheal bacterial load between Day 0 and Day 2 (p=0.04), with higher tracheal loads than oral samples on Day 2 (p=0.01). Conclusion: The oral cavity may serve as an important reservoir of respiratory pathogens in patients receiving mechanical ventilation. The observed correlations between oral and tracheal colonization and pathogen-specific colonization patterns reinforce the relevance of oral health management in critical care settings. In particular, the increase in tracheal Klebsiella pneumoniae load suggests that lower airway proliferation may occur during mechanical ventilation independently of simultaneous increases in oral bacterial load.

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ABSTRACT Objective To analyze changes in dental service production in Brazilian Primary Health Care from 2015 to 2025 and characterize pandemic-associated disruption and post-pandemic recovery by procedure type and Federative Unit. Methods This ecological interrupted time-series study used secondary data on primary health care dental procedures recorded in the Brazilian Unified Health System. Six indicators were evaluated: scheduled consultations, health promotion and prevention activities, and surgical, endodontic, periodontal, and restorative procedures. Annual rates per 100,000 inhabitants were calculated. Three periods were defined: pre-pandemic (2015-2019), pandemic (2020-2021), and recovery (2022-2025). National percentage changes were calculated using selected annual rates, whereas the proportion of the pandemic-related decline recovered was calculated using period means. Interrupted time-series analyses were performed using segmented regression with Newey-West standard errors. Results Dental service production declined during the pandemic across all indicators, and mean recovery-period levels remained below pre-pandemic means. The largest reductions between 2019 and 2021 occurred in health promotion and prevention activities (-79.6%), periodontal procedures (-62.5%), scheduled consultations (-58.8%), and surgical procedures (-53.8%). Recovery remained incomplete across all indicators, ranging from 7.6% for scheduled consultations to 68.8% for restorative procedures. Total procedure rates showed a significant pre-pandemic annual decline of 21.4% (95%CI=-24.9% to -17.7%), an immediate reduction of 56.1% in 2020 (95%CI=-71.4% to -32.6%), and a positive post-2020 annual change of 14.8% (95%CI=1.2% to 30.2%). Marked territorial heterogeneity was observed in both the magnitude of decline and the pattern of recovery. Conclusion Dental service production in Brazilian Primary Health Care declined substantially during the COVID-19 pandemic and recovered only partially during 2022-2025, with persistent territorial disparities in recorded service production.

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ABSTRACT Objective: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive, and antiangiogenic therapies commonly used to treat osteoporosis, malignant bone tumors, and metastatic diseases. This review provides a comprehensive overview of the pathophysiology, clinical presentation, diagnosis, prevention, and management of MRONJ. Methods: This narrative review examined the prevalence of MRONJ and its clinical and radiological features, particularly those relevant to disease staging, and outlined current preventive and treatment strategies, aiming to improve patient outcomes and quality of life. Results: Patients with cancer receiving high-dose intravenous antiresorptive medications exhibited a higher incidence of MRONJ than that observed in patients treated for osteoporosis. Clinical staging systems, especially those developed by the American Association of Oral and Maxillofacial Surgeons, facilitate disease classification based on clinical and imaging findings, thereby guiding treatment selection and prognosis assessment. Preventive approaches, conservative management, surgical procedures, and adjunct therapies have been proposed to promote healing of both hard and soft tissues. Conclusion: Although emerging therapeutic options are promising, prevention and personalized treatment remain major challenges.

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ABSTRACT Porphyromonas gingivalis (P. gingivalis) is a Gram-negative anaerobic bacterium recognized as a keystone pathogen in periodontitis. Beyond its established role in periodontal tissue destruction, accumulating evidence links P. gingivalis to several systemic conditions, including cardiovascular disease, Alzheimer's disease, rheumatoid arthritis, diabetes mellitus, and adverse pregnancy outcomes. This review synthesizes current evidence on how P. gingivalis may contribute to systemic disease beyond the oral cavity, with particular emphasis on its virulence factors, including gingipains and lipopolysaccharide, and the pathways linking periodontal infection to pathological processes in distant organs. We discuss how hematogenous dissemination, immune-evasion mechanisms, and chronic inflammatory responses may mediate these systemic effects. A clearer understanding of these associations may inform integrated approaches to periodontal care and systemic disease management.

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ABSTRACT Objective This systematic review evaluated the effectiveness of photobiomodulation for preventing recurrent herpes labialis. Methods Eligibility criteria were defined using the PICOS framework, and only randomized clinical trials were included. We searched PubMed, Embase, Scopus, the Cochrane Library, the Virtual Health Library, and gray-literature sources. Of the records identified, nine reports underwent full-text assessment, and three studies met the eligibility criteria. Results Two trials reported lower recurrence frequencies after photobiomodulation compared to control interventions, while one trial found no difference. Findings regarding recurrence severity and duration were inconsistent across studies. No adverse events were reported in the studies that provided safety data. Conclusion The available evidence suggests that photobiomodulation may reduce the recurrence frequency, severity, and duration of herpes labialis. However, the certainty of the evidence was rated as low due to small sample sizes, incomplete blinding, and variations in laser parameters and comparators. These limitations restrict generalizability and preclude definitive clinical recommendations. Well-designed randomized controlled trials with standardized protocols and consistent outcome measures are needed to establish the clinical utility of photobiomodulation for recurrent herpes labialis.

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ABSTRACT This review synthesizes current evidence on host immune responses to bacteria, their roles in the development and progression of periodontitis, and emerging immunomodulatory therapeutic strategies designed to restore periodontal homeostasis. Periodontitis develops through interactions between a dysbiotic bacterial community that disrupts host–microbe homeostasis and a chronic, maladaptive interaction with the host immune system. Key immune subversion microorganisms such as Porphyromonas gingivalis trigger inflammation while subverting immune surveillance by evading complement-mediated clearance and impairing neutrophil function. This dual behavior creates a biological paradox: bacteria induce inflammation to obtain nutrients while simultaneously suppressing effective antimicrobial activity, thereby perpetuating chronic, tissue-destructive immune activation. The osteoimmune response, particularly the Th17/IL-17 axis, is a central pathway linking microbial dysbiosis to persistent inflammation and alveolar bone resorption. These findings suggest that successful periodontal therapy must extend beyond mechanical biofilm removal by addressing underlying immune dysregulation. Potential adjunctive strategies for modulating this response include specialized pro-resolving mediators, complement inhibitors such as Cp40, and selected probiotics with immunoregulatory properties. Collectively, these approaches are intended to restore immune balance, enhance resolution of inflammation, and promote periodontal tissue repair. Current evidence demonstrates that periodontitis is not solely a microbial infection but also involves dysregulated host immunity. Clarifying how bacteria manipulate immune pathways may facilitate the development of therapies that complement bacterial control by targeting the inflammatory mechanisms underlying tissue destruction. Immunomodulatory interventions therefore represent promising candidates for promoting sustained periodontal stability and inflammatory resolution.

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ABSTRACT This case report describes a male patient diagnosed with multiple myeloma who experienced significant bleeding from both the maxillary and mandibular dental sockets following dental extraction, lasting several days. Laboratory tests revealed prolonged prothrombin time and thrombin time, accompanied by reduced factor VII levels. Initial management with intravenous vitamin K and fresh frozen plasma failed to achieve hemostasis. Despite the risk of thrombosis, low-dose tranexamic acid was initiated, resulting in effective hemorrhage control and improved healing of the alveolar sockets. This case illustrates the complex hemostatic imbalance between pro- and anticoagulant factors in a patient with multiple myeloma. It also underscores the diagnostic and therapeutic challenges associated with managing bleeding in patients with a high risk of thrombosis.

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ABSTRACT This case documents the clinical pattern of a fibrinopurulent ulcer with a hyperplastic lesion that developed after the initiation of two classes of targeted therapies acting on different components of the mitogen-activated protein kinase signaling pathway (BRAF inhibitors [BRAFi] and MEK inhibitors [MEKi]). A 66-year-old woman was diagnosed with choroidal melanoma in the right eye in 2012 and successfully treated by choroidal melanoma resection. Tumor recurrence was diagnosed 8 years later. Nivolumab and ipilimumab were prescribed, but this combination was replaced with dabrafenib-trametinib due to disease progression. A second orbital exenteration and adjuvant radiotherapy to the orbital cavity (total dose of 4,000 cGy) were performed during dabrafenib-trametinib therapy. A few months after initiating this combination, the patient reported oral discomfort and an ulcer on the dorsum of the tongue. An incisional biopsy showed only signs of inflammation. A second biopsy demonstrated the same histological pattern. Based on clinical and histopathological findings, the final diagnosis was stomatitis associated with BRAFi-MEKi therapy. An intralesional injection of triamcinolone solution combined with 2% mepivacaine was performed. One month later, 0.05% topical corticosteroid was prescribed, and the lesion completely healed after an additional month. This report describes a previously unreported clinical presentation of an oral adverse event associated with combined BRAFi-MEKi therapy. It highlights the importance of recognizing unusual oral toxicities related to targeted therapies, as well as the role of appropriate local management in controlling symptoms and allowing the continuation of oncologic treatment.