Medicina Oral, Patología Oral y Cirugía Bucal (Internet)

Oral Candidiasis in children and adolescents with cancer: **Identification of Candida spp**

Oral candidiasis represents a serious problem for children with cancer. The mortality rate of this infection has increased due to fungal septicemia, associated with a primary buccal infection. Objective: Identify the Candida spp. in buccal lesions of patients with cancer, establish the predominant species and correlate them to age and sex of the patient, clinical presentation, type of neoplasic disease and cytostatic therapy received. Study design: 62 patients, between 0-16 years, were investigated in a cross sectional study. Sample inclusion criteria: Patients with malignant neoplasic disease that were receiving cytostatic treatment and had suspicious lesions of oral candidiasis. Patients with antifungal therapy, active caries, calculus or intraoral appliances were excluded. A clinical evaluation was carried out. The lesion sample was taken and studied by direct exam and culture in CHROMagar-Candida and Sabouraud-Dextrose Agar with chloramphenicol. The identification of the isolated yeast was done by the filamentation test, carbohydrate fermentation and assimilation. Results: Most of the cases (69.35%) were positive to oral candidiasis, C. albicans was the most frequent species found, followed by C. parapsilosis (14.89%), C. tropicalis (12.77%), C. krusei (4.26%), C. glabrata (2.13%) and C. lusitaniae (2.13 %). In some cases more than one specie were isolated (9.30%). The most frequent location of the lesion was in the tongue (72.70%). The pseudomembranous candidiasis was the most frequent clinical presentation found (78.71%). There were not significant statistically differences with regard to sex and age of the patient, type of neoplasic disease and cytostatic agent received. Conclusion: The results suggest that oral candidiasis is a frequent complication in the pediatric oncological population, being C. albicans the main etiological agent, however, there is an important participation of other Candida species.

Prostatic adenocarcinoma with mandibular metastatic lesion: Case report

Metastatic lesions of primary tumors, which originate in different parts of the body, comprise almost 1 % of different types of oral cancers. These lesions can affect either bones or soft tissues in the maxillofacial region. Whenever the maxillofacial area is affected, the most common location is in the molar region of the mandible. The clinical presentation of mandibular metastasis follows a clinical pattern characterized by irradiated dental pain in the third molar region. The most frequent sign is parethesia of the area innervated by the mandibular alveolar dental nerve. Differential diagnosis and treatment of these patients can be extremely difficult because there a number of pathologic conditions with similar symptoms and because diagnostic examination can be highly confusing. The aim of this article is to present a case of prostatic adenocarcinoma where the only metastasis was found in the jaw. A literature review will be presented, hoping to contribute to the scarce information regarding this lesion, due to its low frequency and atypical expression of this type of metastasis in terms of etiology, biological behavior and treatment.

Alrededor del 1% de todos los tipos de cáncer oral son metástasis de tumor primario originado en cualquier parte del organismo, pueden afectar tanto los tejidos blandos como los huesos maxilares. Las metástasis, desarrolladas en la mandíbula son poco frecuentes, sin embargo en el territorio máxilofacial, la zona más común de localización es en la mandíbula, y se ubica más frecuentemente en el área molar. La presentación clínica de la metástasis mandibular tiende a seguir algunas condiciones comunes como es el dolor de tipo dentario irradiado a la zona del tercer molar. El signo más frecuente de una metástasis mandibular es la parestesia en la zona de distribución del nervio dentario inferior. No obstante el diagnóstico y su terapéutica en estos pacientes puede ser difícil, debido a que los exámenes de diagnóstico pueden dar resultados confusos. El objetivo de este artículo es realizar una revisión de la literatura a propósito de un caso de metástasis única mandibular de adenocarcinoma de próstata, considerando la expresión atípica de este tipo de metástasis, la poca información al respecto y la bajísima incidencia de esta lesión, poniendo énfasis en su etiología, comportamiento biológico y tratamiento.

Congenital granular cell tumor (congenital epulis): A lesion of multidisciplinary interest

Congenital granular cell tumor (CGCT), or congenital epulis, is an uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates and may cause respiratory and feeding problems. We report a case of a 3-day-old female newborn, who presented an intraoral tumor mass which was protruding from her mouth, compromising feeding. Under general anesthesia, the lesion was completely removed and the patient had an uneventful postoperative course. Clinical features and treatment approaches are presented and discussed, emphasizing the necessity of a multidisciplinary approach in such cases.

Secretor status and ABH antigens expression in patients with oral lesions

Objectives: The aim of this work was to investigate the secretor status of patients with oral pre-cancerous and cancerous lesions and ABH antigens expression in fixed tissue sections of these patients. Study design: To reveal A, B and H antigens in tissue sections of patients with precancerous and cancerous oral lesions (n= 54) we used a modified specific red cell adherence technique (SRCA-test). Normal endothelial cells expressed ABH antigens, the presence of indicator erythrocytes at the lumen of the blood vessels served as a built in positive control. The test results were graded from negative adherence to very strongly positive adherence. Negative adherence was defined as a complete absence of adhered indicator erythrocytes. A strongly positive reaction was defined as a sheet of indicator erythrocytes adhered to the epithelia cells. Results: In 31 of the 54 samples analyzed the test showed slightly positive results on atypical areas, and there was a complete antigen deletion in areas histologically affected by neoplasia. Sixteen samples showed a total absence of ABH antigens in both histologically normal and pathological areas. As a working hypothesis, we propose that areas of SRCA-test negative epithelium are closely related to invasive carcinomas and may be their precursor lesions. Further it is suggested that areas of blood group isoantigen negative epithelium showing atypia, or in some instances near normal histology, may give rise to relatively low grade carcinomas. Conclusions: Considering these results we suggest the use of this method to monitor probable preneoplastic lesions in risk population, specially in those with no secretor status.

pH and salivary sodium bicarbonate during the administration protocol for methotrexate in children with leukemia

Objective: To analyze the behavior of pH and sodium bicarbonate (NAHCO3) in the saliva of patients with leukemia during the administration protocol for Methotrexate (Mtx). Materials and Methods: A controlled clinical essay was carried out on 23 patients between 4 and 18 years of age with high-risk Acute Lymphoblastic Leukemia. Sampling was carried out at To: basal condition; T1: 12 hours after intravenous administration of sodium bicarbonate, before administering Mtx and T2: 3 hours after administering Mtx, the time of maximum concentration. Chiron-Diagnostic 378® equipment was used to determine pH and sodium bicarbonate. The data was interpreted using Analysis of Variance at the 5% significance level. Results: The highest values of sodium bicarbonate were observed at T2, with salivary pH levels remaining within neutrality ranges, diminishing slightly in T1. Conclusion. In this study, the dose of sodium bicarbonate considered in the administration protocol of 3 g /m² Mtx, kept sodium bicarbonate levels in saliva at normal levels and pH neutral.

Cinnamon products as a possible etiologic factor in orofacial granulomatosis

Objectives: It has been reported that clinical changes due to hypersensitivity reactions to various foods, preservatives, and oral hygiene products may be consistent with the characteristic signs of orofacial granulomatosis (OFG). The objective of this study was to examine 37 well-documented cases of cinnamon-induced contact stomatitis for clinical and histological features consistent with a diagnosis of OFG. Study design: We reviewed the records of the 37 cases to screen them for the clinical and histopathologic features of OFG. Results: Twelve patients showed clinical characteristics of OFG. The most commonly affected site was the gingiva. Focal non-caseating, epitheloid granulomas were observed in four histologic specimens. Multinucleated giant cells were observed in an additional four cases. Conclusions: Although OFG may have multiple etiologies, it is clear that, in some instances, a hypersensitivity reaction to cinnamon products can elicit lesions consistent with OFG.

Cornelia de Lange syndrome: A case report

Cornelia de Lange is a genetic syndrome which affects between 1/10.000 and 1/60.000 neonates, but its genetic bases are still not clear. Its principal clinical characteristics are the delay in growth and development, hirsute, structural anomalies in the limbs and distinctive facial characteristic. Dental problems are frequent and include: ogival palate, micrognathia, dental malalignment, delayed teething, microdontic teeth, periodontal disease and dental erosion produced by gastric reflux. Discussed is the case of a 29 year old patient affected by the syndrome in question, which presents the principal clinical characteristics. The patients general state of health is acceptable, without cardiac or respiratory alterations. The intraoral exploration shows policaries, periodontal disease, persistence of the temporal teeth and ectopic molars. After completing the necessary pre-operatory preparations, the entire odontological treatment was carried out under general aesthesia, due to the patients total lack of collaboration.

El síndrome de Cornelia de Lange es un síndrome genético que afecta entre 1/10.000 y 1/60.000 neonatos, y cuyas bases genéticas todavía no están claras. Sus características clínicas principales son el retraso en el crecimiento y en el desarrollo, hirsutismo, anomalías estructurales en miembros y unas características faciales distintivas. Los problemas dentales son frecuentes e incluyen: Paladar ojival, micrognátia, malposición dental, retraso en la erupción, microdoncia, enfermedad periodontal y erosión dental producida por el reflujo gástrico. Se describe el caso de una paciente de 29 años de edad afecta por el síndrome en cuestión, que presenta las principales características clínicas. El estado general de la paciente es aceptable, sin alteraciones cardíacas ni respiratorias. La exploración intraoral muestra policaries, enfermedad peridontal, pesistencia de dientes temporales y cordales ectópicos. Después de realizar las pruebas preoperatorios necesarias, se realiza el tratamiento odontológico completo bajo anestesia general, debido a la nula colaboración de la paciente.

Dental treatment for disabled children in the Spanish Public Health System

The Spanish Public Health System is stepping up its efforts to meet all the medical needs of the population. Oral health is of increasing interest for society, especially for parents who are keen for their children to have healthy teeth. Disabled children with both physical and mental disabilities do not always receive the dental care they need. The purpose of this bibliographical review is to evaluate the services provided by the Spanish Public Health System to such children. We have noted marked differences in the types of dental treatment given to these patients in the different Autonomous Communities of Spain. Some, such as Asturias, Navarra and Extremadura, offer specific care for disabled children. Others, such as Ceuta and Melilla, provide more general care.

Cada vez son más los esfuerzos del Sistema Sanitario Público Español por cubrir todas las necesidades médicas que pueda tener la población. La salud bucodental es un aspecto que cada día interesa más a la sociedad, fundamentalmente a los padres que desean que sus hijos tengan una adecuada condición oral. Los niños discapacitados, tanto físicos como psíquicos, constituyen un colectivo que no siempre recibe las atenciones odontológicas que precisan. El objetivo de esta revisión bibliográfica es valorar los servicios que presta la Sanidad Pública Española a estos niños. Hemos observado que existe una importante discrepancia en cuanto a los diferentes tipos de tratamientos bucodentales que se realizan a estos pacientes según sea la Comunidad Autónoma a la que pertenezcan. Así, en ciertas Comunidades Autónomas, como Asturias, Navarra y Extremadura, incluso se lleva a cabo una atención específica de los pacientes discapacitados infantiles. En otras como, Ceuta, Melilla, la atención, por parte de la Sanidad Pública, es más generalizada.

High resolution image in bone biology I: Review of the literature

Bone microstructure has usually been assessed by obtaining samples invasively and analyzing them with conventional histomorphometric methods. Improvements in high-resolution image acquisition systems have enabled non-invasive assessment of bone morphology and a more precise 3-D evaluation by means of "virtual biopsies", permitting bone assessment in regeneration or remodeling processes. This review describes the characteristics and limitations of bone assessment using different high-resolution image systems (synchrotron-radiation computed tomography, micro-computed tomography, acoustic scanning microscope; micro-magnetic resonance imaging). Morphometric variables that can be obtained from these images are reported and compared with conventional histomorphometric variables.

La valoración de la microestructura ósea se ha realizado habitualmente mediante la obtención invasiva de muestras y el procesado y evaluación de las mismas con métodos convencionales histomorfometricos. La mejora de los sistemas de obtención de imágenes con alta resolución permite la valoración no invasiva de la morfología ósea con evaluaciones tridimensionales más precisas, con las denominadas "biopsias virtuales" que permiten realizar la valoración del hueso en procesos de regeneración o remodelación. Este trabajo de revisión describe las características y limitaciones de la evaluación ósea de diferentes sistemas de imagen de alta resolución (Tomografia computerizada mediante radiación sincrotrón; Micro tomografía computerizada; Microscopio de escaneado acústico; Micro imagen por resonancia). También se describen diversas variables morfométricas que pueden ser obtenidas a partir de las imágenes obtenidas y que pueden ser comparadas con las variables histomorfométricas convencionales.

Retention of three fissure sealants and a dentin bonding system used as fissure sealant in caries prevention: 12-month follow-up results

Background. Bonding agents could be used as fissure sealants. This study compares the retention three fissure sealants (Delton®, Delton Plus® and Concise®) and a filled dentin bonding system (Optibond Solo®). Methods. Fifty-six children aged 7-8 years received fissure sealants either in the four permanent first molars, in the four deciduous second molars, or in all eight of these teeth. Every child received a different sealing material in each quadrant on a random basis. Clinical evaluation at 12 months was performed by a single blind examiner, and the retention was classified as either a success (total retention) or a failure (partial retention or not present). Results. There were no statistically significant differences among the four materials in permanent maxillary molars or deciduous molars. In permanent mandibular molars, Optibond Solo® showed a lower percentage of retention (40.9%), significantly different (p=0.002) to that of Delton® (89.5%), Delton Plus® (87.5%) and Concise® (76.5%). Conclusion. One bottle dentin bonding system used as a sealant does not improve the retention of conventional fissure sealants. Clinical Implication: Because of the scarcity of studies on the use of dental adhesives as sealants, further studies are warranted for the final support of that conclusion.

Effect of post space preparation on apical seal: Influence of time interval and sealer

Objective: To assess the efficacy of two sealants to preserve the apical seal after root canal preparation and cementation of posts at 24 h or 72 h after endodontic treatment. Study design: Sixty human single-root teeth were instrumented and obturated using lateral compaction technique with EndoFill® [30] or AH-Plus® [30] and were prepared in one of three ways, leaving a 3 mm gutta percha remnant in all cases: without cast post preparation, with preparation after 24 h or after 72 h. After cementing the posts, the specimens were thermal cycled at 5 and 55˚C in water baths, submerged in 2% methylene blue dye for 72 h, embedded in acrylic resin and cut transversally into three 1-mm apical sections. Dye leakage was quantitatively assessed as the percentage leaked area. Results and conclusion: Comparison of the apical sections showed significant differences in leakage with both sealers among the three preparation groups (p<0.001). No significant differences between sealers were found in any preparation group or in the same sections.