Medicina Oral, Patología Oral y Cirugía Bucal (Internet)

Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil

Objective: One of the most important objectives of a public health service is early diagnosis of disease, which provides a better prognosis and reduction in treatment cost. We investigated the delay for diagnosis and treatment of oral cancer in a public hospital. Material and methods: One hundred eighty records of patients who attended for their first consultation in the department of head and neck surgery in a public hospital from Belo Horizonte-Brazil, between the period from 1 January 1999 to 31 December 2001 were analysed. The following variables were analyzed: gender, age, evolution time (ET), time elapsed from referral to hospital and first appointment (RT), time elapsed from first appointment and treatment (TT), total time elapsed from first noticing the lesion and starting treatment (TTE), sites and staging. Results: Results for males and females were, respectively: mean age = 57.9 and 60.8 years; ET= 169.4 and 215.4 days; RT = 27.9 and 40.6 days; TT = 40.9 and 44.9days; TTE = 207.9 and 263.8 days. No correlation was observed between age and TTE for either gender. Women presented the highest mean values for ET and TTE (p<0.01). Conclusion: It was concluded that public health policy should be developed to address the excessively long time lapsed between diagnosis and treatment as well as improve public health education programs to promote early oral cancer identification.

A histological and clinical study on oral cancer: Descriptive analyses of 365 cases

Cancer is the second cause of death in Portugal right after cardio vascular diseases. In Portugal the incidence of oral and pharynx cancer (OPC) is higher than uterus and larynx cancers, and in US its frequency is higher than melanoma or uterus cancer, diseases that concern more population than oral cancer. Aims. The aim of this paper is to identify preferable anatomic location for oral cancer, mean age of patients, the use of tobacco and alcohol, histological characteristics, staging, type of therapeutics, presence of metastases and 1 and 5 year follow up. Matherials and Methods. Data was collected from clinical charts of 365 cases from the Centro de Lisboa do Instituto Português de Oncologia with histological confirmation of malign tumor of the mouth. These cases are the total of oral malign tumors in the years of 1997, 1998 and 1999 in that institution. Results. We observe that despite modern diagnostic and treatment techniques 37,9% of all patients died after first year with evidence of tumor. From all patients just 23,7% were free of disease after 5 years of treatment. Tongue was the principal region affected and the average age was 62, 25 years. It was concluded that 57, 8% of patient were smokers and 43,8% were alcohol drinkers. A high number of patients were submitted to radiotherapy either alone or with other treatment options.

Lymphoid lesions of salivary glands: Malignant and Benign

Lesions of salivary glands with a prominent lymphoid component are a heterogeneous group of diseases that include benign reactive lesions and malignant neoplasms. Occasionally, these pathologic entities present difficulties in the clinical and pathological diagnosis and prognosis. Lymphoepithelial sialadenitis, HIV-associated salivary gland disease, chronic sclerosing sialadenitis, Warthin tumor, and extranodal marginal zone B-cell lymphoma are examples of this pathology that are sometimes problematic to differentiate from one another. In this paper the author reviewed the main clinical, pathological and prognostic features of these lesions.

Oral non-squamous malignant tumors: diagnosis and treatment

Some 90% of oral cancers consist of squamous cell carcinomas that arise from the oral mucosa. The remaining 10% of malignancies consist of malignant melanomas, carcinomas of the intraoral salivary glands, sarcomas of the soft tissues and the bones, malignant odontogenic tumors, non-Hodgkins lymphomas and metastases from primary tumors located elsewhere in the body. These malignancies will be briefly reviewed and discussed. The emphasis is on diagnosis and management.

Results of a dental care protocol for mentally handicapped patients set in a primary health care area in Spain

Objective: Disabled people have the same right as other people to receive the health care they need, but they sometimes have difficulties to achieve it. In Castilla y Leon it has come into effect a law to guarantee Primary and Secondary Care coordination to provide dental treatment under sedation or anaesthesia to mentally disabled people who need it. Our aim is to evaluate the results of the implementation of such a law through a specific protocol in our health setting. Study design: Descriptive, made in a Health Area over a year, on mentally disabled people who were sent to hospital for treatment under anaesthesia after Primary Dental Care Units assessment. It has been studied the age, gender, mental disease, dental diagnosis and treatment undergone. Results: 108 patients attended the program (51% male), with a mean age of 31 years. 67% presented profound learning disability, 19% mental illness with disability, 11% presented cerebral palsy and another 3% had autism. Most frequent dental pathologies were caries (86%) and dental plaque (71%). Most common dental procedures were tooth extraction (78%), professional tooth cleaning (75%) and fillings (67%). Conclusions: We achieved to provide necessary dental treatment to a large number of disabled people, who would not have received it otherwise. It was a challenge to plan and implement the protocol coordinating Health Care Levels and workers. It still has to be done an economic and efficiency analysis of procedures and a patient satisfaction study.

Objetivos: Las personas con discapacidad tienen el mismo derecho que el resto de la población a recibir las prestaciones sanitarias que requieran, pero en ocasiones tienen dificultades para ello. En Castilla y León se ha publicado un Decreto que garantiza la coordinación entre Atención Primaria y Especializada, para que las personas con discapacidad psíquica que precisen tratamientos odontológicos bajo sedación o anestesia, lo reciban correctamente. Nuestro objetivo es evaluar en nuestra Área los resultados de la aplicación de dicho Decreto a través de un protocolo específico. Diseño del estudio: Descriptivo, realizado durante un año en un Área de Salud, sobre los pacientes discapacitados psíquicos que, tras ser atendidos en las unidades de salud bucodental de Atención Primaria, son derivados al hospital de referencia por precisar anestesia general para su tratamiento. Se estudió su edad, sexo, discapacidad psíquica padecida, diagnósticos odontológicos e intervenciones a las que se sometieron. Resultados: Accedieron al programa 108 pacientes (51% varones), con 31 años de edad media. El 67% presentaban retraso mental profundo, el 19% enfermedad mental con discapacidad, el 11% parálisis cerebral y el 3% autismo. Las patologías bucodentales más frecuentes eran la caries(86%) y la placa dental (71%). Las intervenciones más habituales fueron exodoncias (78%), tartrectomías (75%) y obturaciones (67%). Conclusiones: Se consiguió que un número importante de discapacitados accedieran a intervenciones necesarias que, de otro modo, no hubieran recibido. La organización e implantación del protocolo supuso un reto de coordinación de gerencias y profesionales. Queda por hacer un análisis de los costes y efectividad de las intervenciones y de la satisfacción de los usuarios.

Criteria for selecting children with special needs for dental treatment under general anaesthesia

Objective: To study criteria for helping to select children with special needs for dental treatment under general anaesthesia. Materials and methods: Group of 30 children (aged under 18) examined on the Course at the Universidad Complutense de Madrid (UCM) (Specialisation on holistic dental treatment of children with special needs) and subsequently referred to the Disabled Childrens Oral Health Unit (DCOHU) within Primary Health Care Area 2 of the Madrid Health Service (SERMAS) where dental treatment under general anaesthesia was given during 2005. Relevant data were taken from their case histories with regard to their general health, oral health and behaviour. Results: In most of the children (22 children), it was possible to carry out a complete dental diagnosis. With regard to medical diagnoses, the most frequent pathology was cerebral palsy (8 children), but it was not possible to establish a link between the pathology and the use of general anaesthesia. With regard to oral health, most of the children received restorative treatment in all 4 quadrants (26 children). On the basis of scales for behavioural evaluation and movement, most of the children (17 children) showed clearly negative behaviour, with movements that interrupted or hindered examination. Conclusions: With the exception of certain specific medical problems, the reasons for using general anaesthesia for dental treatment in children with special needs are extensive treatment needs and bad behaviour, both of which can be judged objectively.

Objetivo: estudiar criterios que ayuden a la selección de aquellos niños con necesidades especiales candidatos a recibir tratamiento odontológico con anestesia general. Material y métodos: grupo de estudio constituido por 30 niños (menores de 18 años), estudiados en el Título Propio de la Universidad Complutense de Madrid (UCM) Especialista en atención odontológica integral en el niño con necesidades especiales y posteriormente remitidos a la Unidad para la Salud Bucodental de Niños Discapacitados (USBD-D) dependiente del Área 2 de Atención Primaria del Servicio Madrileño de Salud (SERMAS) donde se llevó a cabo el tratamiento dental con anestesia general durante el año 2005. De sus historias clínicas se han obtenido los datos mas relevantes en relación con su salud general, salud oral y comportamiento. Resultados: en la mayor parte de los niños (22 niños) pudo realizarse un diagnóstico odontológico completo. En relación con los diagnósticos médicos, la parálisis cerebral fue la patología mas frecuente (8 niños), sin que podamos establecer una asociación entre patología sistémica y uso de anestesia general. Respecto a la salud oral, la mayoría de los niños recibieron tratamiento restaurador en los 4 cuadrantes (26 niños). En base a las escalas de evaluación comportamental y del movimiento, la mayoría de niños (17 niños) mostraron comportamientos claramente negativos, con movimientos que ya interrumpieron o dificultaron la exploración. Conclusiones: con excepción de algún problema médico puntual, son las necesidades extensas de tratamiento y el mal comportamiento, parámetros ambos objetivables, las características que justificarán el empleo de la anestesia general para el tratamiento dental de niños con necesidades especiales.

Oral biopsy in dental practice

The conclusions drawn from the study of an oral biopsy are considered essential for the definitive diagnosis of diseases of the oral mucosa, and for the subsequent planning of appropriate treatment. Although the obtainment of biopsies is widely used in all medical fields, the practice is not so widespread in dental practice - fundamentally because of a lack of awareness of the procedure among dental professionals. In this context, it must be taken into account that the early diagnosis of invasive oral malignancy may be critical for improving the patient prognosis. However, in some cases the results are adversely affected by incorrect manipulation of the biopsy material. The present study provides an update on the different biopsy sampling techniques and their application. Such familiarization in turn will contribute to knowledge of the material and instruments required for correct biopsy performance in dentistry, as well as of the material required for correct sample storage and transport.

La utilización de la biopsia oral se considera una prueba irrefutable para el diagnóstico definitivo de enfermedades de la mucosa bucal y la subsiguiente planificación de un enfoque terapéutico adecuado. Aunque esta técnica está ampliamente extendida en todas las especialidades médicas, en el ámbito de la odontología no está muy divulgada, fundamentalmente por el desconocimiento de la misma por parte del odontólogo general; y cabe tener en consideración que un diagnóstico temprano de un cáncer oral invasivo pueda mejorar de forma radical el pronóstico del paciente. Sin embargo, en ocasiones el resultado se ve malogrado por un inadecuado manejo del material a analizar. El objetivo de este trabajo es actualizar las diversas técnicas para obtener la muestra y su aplicación. Nos facilitará, en gran medida, conocer el material e instrumental que precisemos para su toma en odontología y el material más apropiado para la conservación y el transporte de la muestra.

Salivary gland application of botulinum toxin for the treatment of sialorrhea

Sialorrhea or excessive salivation, and drooling, are common and disabling manifestations in different neurological disorders. A review is made of the literature, based on a PubMed search, selecting those articles describing clinical trials involving the injection of botulinum toxin A in the salivary glands of patients with different diseases characterized by sialorrhea. The most frequently treated diseases were infant cerebral palsy (30%), Parkinsons disease (20%) and amyotrophic lateral sclerosis (15%). Over half of the authors injected the product into the parotid glands, 9.5% into the submaxillary glands, and 38% into both. The total doses of toxin injected varied from 10-100 units of Botox® or 30-450 units of Dysport® according to the different authors. A reduction was observed in the production of saliva following these injections, and the duration of the therapeutic effect was 1.5-6 months. Six articles (30%) described the presence of adverse effects such as dysphagia, xerostomia and chewing difficulties. Most of the clinical studies involved small patient samples, with no blinding or randomization, and no control group. Moreover, no data are available on the efficacy and adverse effects of treatment in the context of long-term prospective studies. The effective therapeutic dose and ideal form of application remain to be established, and require the conduction of further controlled clinical trials involving large sample sizes.

La sialorrea o salivación excesiva es un síntoma incapacitante común en diversas enfermedades neurológicas. Se realizó un análisis de la literatura sobre la base de datos PubMed y se seleccionaron los artículos que describen ensayos clínicos basados en la inyección de toxina botulínica A en las glándulas salivales de pacientes con diversas enfermedades que cursaban con sialorrea. Las patologías mayoritariamente tratadas fueron la parálisis cerebral infantil (30%), la enfermedad de Parkinson (20%) y la esclerosis lateral amiotrófica (15%). Más de la mitad de los autores inyectaron el producto en las glándulas parótidas, el 9.5% en las glándulas submaxilares y el 38% en ambas. Las dosis totales de toxina inyectadas variaron entre 10 a 100 unidades de Botox® o 30 a 450 de Dysport® según los diferentes autores. Se demostró la reducción de la producción de saliva tras dichas inyecciones si bien la duración del efecto terapéutico fue de 1,5 a 6 meses. En 6 artículos (30%) se describen la presencia de efectos adversos como disfagia, xerostomía y dificultad a la masticación. La mayoría de estudios clínicos constan de una muestra pequeña, no hay estudios a doble ciego ni aleatorización y carecen de grupo control. Además no se dispone de datos sobre la eficacia y los efectos adversos con estudios prospectivos a largo plazo. Aún queda por determinar la dosis terapéutica eficaz y el modo de aplicación ideal para lo cual son necesarios más estudios clínicos controlados y con un tamaño mayor de la muestra.

Factors related to survival from oral cancer in an Andalusian population sample (Spain)

Introduction: Approximately 3% of malignant tumors originate in the oral cavity. The majority are squamous cell carcinomas, and a small percentage, malignant tumors of the salivary glands, lymphoreticular diseases, bone tumors, melanomas, sarcomas, malignant odontogenic tumors and metastases of tumors from other locations. The prognosis of these pathologies depends on the size, infiltration, and site of the lesion, the presence or absence of metastatic spread, and to a certain degree the differentiation of the tumor. The prognosis of an oral cancer remains generally negative, with 5-year survival figures below 50%, producing high rates of mortality and morbidity. Objectives: To evaluate the influence of different variables on survival in an oral cancer population. Patients and methods: Two-hundred and sixteen patients with oral squamous cell carcinoma were studied over a period of five years, evaluating 42 variables grouped into five data sections: personal, lesion, site, stage, and risk factors. Results and conclusions: Average survival was 2088 days, with a standard deviation of 98 days. The factors most associated with mortality were: location in the gingiva (p=0.0590), in the trigone (p=0.0104), size (T3-T4) (p=0.0004) and lymph node involvement (N2a-N2b) (p=0.0035). Tobacco and alcohol, nowadays considered to be highly significant in carcinogenesis, had no considerable influence on survival.

Introducción: aproximadamente un 3% de los tumores malignos se origina en la cavidad oral. La mayoría corresponden a carcinomas de células escamosas, y un pequeño porcentaje a tumores malignos de glándulas salivares, enfermedades linforeticulares, tumores óseos, melanomas, sarcomas, tumores malignos odontogénicos y metástasis de tumores de otras localizaciones. El pronóstico de estas patologías depende del tamaño, infiltración y localización de la lesión, presencia o ausencia de extensión metastática y en cierto grado de la diferenciación del tumor1. La patología neoplásica oral aún mantiene un pronóstico general negativo, con unas cifras globales de supervivencia a los 5 años menores del 50%, produciendo altas tasa de mortalidad y morbilidad2,3. Objetivo: evaluar la carga de distintas variables sobre el tiempo de supervivencia en una población con cáncer oral. Pacientes y metodo: sobre 216 paciente realizamos un estudio de casos de cáncer de oral de células escamosas a 5 años, evaluando 42 variables, agrupadas en cinco apartados: datos personales, de la lesión, localización, estadiaje y factores de riesgo. Resultados y conclusiones: el tiempo medio de supervivencia fue 2088 días, con un error estándar de 98 días. Los factores asociados a mayor mortalidad fueron: localización en la encía (p= 0.0590), en trígono (p= 0.0104), el tamaño (T3-T4) (p= 0.0004) y afectación ganglionar (N2a-N2b) (p= 0.0035). El tabaco y el alcohol, considerados hoy de gran importancia en la génesis del cáncer, no influyeron considerablemente en el tiempo de supervivencia.

Effectiveness of low flow vascular lesions sclerosis with monoetanolamine: Report of six cases

Vascular malformations or even hemangiomas need therapeutic intervention if they start to cause clinical symptoms or personal discomfort. Different therapeutic modalities, including cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgery, and/or embolization, can be performed successfully. Sclerotherapy with monoethanolamine is a relatively simple and effective method to treat low flow vascular lesions. We presented a report of six cases of vascular malformations treated with monoethanolamine. There were 3 male and 3 female patients, with an age range of 20 to 68 years. The patients were submitted to applications according to clinical response and/or tolerability. In all cases, low-flow vascular lesions were recorded and submitted to infiltration with 2.5% monoethanolamine, directly into the lesions. The volume applied was approximately the middle of affected area. Vascular lesions were characterized as low-flow due to absence of arterial pulsation and flat consistence. The sclerosis with 2.5% monoethanolamine resulted in complete or partial involution, without severe complications.

Distraction osteogenesis in Goldenhar Syndrome: Case report and 8-year follow-up

Goldenhar syndrome is a well-known condition featuring the following triad of anomalies: ocular abnormalities, microtia and vertebral anomalies. This syndrome involves structures arising from the first and second branchial arches. Craniofacial anomalies, including mandibular, zygomatic and/or maxillary hypoplasias are found in 50% of patients with Goldenhar syndrome. Patients with this syndrome may present unilateral or bilateral underdevelopment of the mandible. Several treatments for the correction of the dento-facial deformity have been described, among them distraction osteogenesis is one that shows promising results. Distraction osteogenesis is the process of bone formation that occurs during slow separation of the segments of bone after an osteotomy and it has been used to alleviate facial asymmetry. Mandibular distraction osteogenesis has been applied for many years, but long-term reports present controversial results. The purpose of the case report is to describe the immediate and long-term effects of distraction osteogenesis used to treat mandible asymmetry in a 5-year-old boy with Goldenhar syndrome.

Maxillary sinus lift with intraoral autologous bone and B - Tricalcium Phosphate: Histological and histomorphometric clinical study

Introduction: Rehabilitation with implants in the upper maxilla often implies a challenge due to the shortage and quality of the remaining bone. Different kinds of grafts have been described in an endeavour to solve these problems. Aim: The purpose of this study was to assess the osteoconduction potential of an autogenous bone and B-Tricalcium Phosphate mixture, in the treatment of atrophic upper maxillae. Materials and Methods: 22 patients were treated using the "sinus lift" technique. All patients had residual bone equal to or greater than 5 mm, the sinus was lifted, bone grafted and implants installed during the same surgical procedure (autologous bone and B- Tricalcium Phospahate). During the implant exposure after the osseointegration period, samples of regenerated bone were taken using a trephine from 5 patients. Paraffin-embedded sections were analysed the structure and tissues percentages. Data were estimated statistically. Results: Clinical results showed integration of the 42 fixtures installed. Histological analysis showed good integration of the -Tricalcium Phosphate in the newly formed bone likewise absence of inflammation. Histomorphometric analysis showed a mean bone proportion of 30.7% (range 22.8% - 50.6%). Conclusions: Results suggest the osteoconductive material B-Tricalcium Phosphate associated with autologous bone obtained through filtration is an appropriate graft for implant treatment of atrophic maxillae, in combination with the sinus lift procedure.

Intoducción: La rehabilitación con implantes en el maxilar superior supone en muchas ocasiones un reto debido a la escasez y pobre calidad del hueso remanente. Se han descrito diferentes tipos de injertos para tratar de solucionar estos problemas. Objetivo: Valorar el potencial osteoconductivo de una mezcla de hueso autólogo y B-Fosfato Tricálcico, en el tratamiento mediante implantes de maxilares superiores atróficos. Diseño: Se trataron 22 pacientes mediante la técnica de "elevación de seno". Todos los pacientes presentaron un hueso residual igual o mayor a 5 mm., y se realizó la elevación de seno y la instalación del injerto (hueso autólogo y B-Fosfato Tricálcico) y los implantes en un mismo tiempo quirúrgico. Durante la exposición de los implantes, tras la osteointegración, se tomaron muestras del hueso, mediante una trefina, en 5 pacientes. Se procesaron para su inclusión en parafina y se analizó su estructura y los porcentajes titulares presentes. Con los datos obtenidos se realizo un análisis estadístico descriptivo. Resultados: Se demostró la integración de las 42 fijaciones instaladas. El análisis histológico demostró una buena integración del B-Fosfato Tricálcico en el hueso neoformado así como la ausencia de inflamación. El análisis morfométrico demostró una proporción media de hueso del 30,7% (rango 22,8 - 50,6). Conclusiones: Los resultados sugieren que el material osteoconductivo B-Fosfato Tricálcico asociado con hueso autólogo obtenido mediante filtración, es un injerto adecuado para el tratamiento con implantes de maxilares atróficos, cuando se combina con el procedimiento de elevación de seno.

Sinus elevation by in situ utilization of bone scrapers: technique and results

Objectives: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement. Material and methods: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed. Results: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm², mean bone volume obtained was 0.56 cm³ and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of the implants were osseointegrated at 6 months after prosthesis placement. Conclusion: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane.

The influence of soft acidic drinks in exposing dentinal tubules after non-surgical periodontal treatment: A SEM investigation on the protective effects of oxalate-containing phytocomplex

Objective: The aim of this study was to investigate the different smear layer morphologies produced by instrumentation with a hand curette and a periodontal sonic scaler for potential removal by soft acidic solution. The effect of a new oxalate-containing phytocomplex spray in preventing tubules exposure after citric acid solution application was also evaluated. Methods: Thirty recently extracted human teeth were used to obtain root dentinal fragments and divided in two groups: Curette treatment (CRT) root planed applying 30 working strokes to each surface using a Graceys curette 5-6 and Ultrasonic scaler (USC) treated using a periodontal scaler mounted on an ultrasonic hand-piece for 30 seconds. Each principal group was further divided in three sub-groups (Control, Acid challenge and Acid/Phyto-oxalate). The control group samples were immersed in distilled water buffered to pH 7.4 using NH4OH solution. The samples of the acid challenge group were immersed in a solution of citric acid 0,02M; [pH 2.5] for 3 minutes. The samples of the Acid/Phyto-oxalate group were sprayed for 15 sec with a 1.5% phytocomplex spray prior to immersion. Samples were examined using SEM. Results: Ultrasonic instrumentation created a very thin smear layer whereas curettes produced a multilayered smear layer. The acidic solution was able to remove the smear layer from root surfaces treated with ultrasonic instrumentation exposing the dentinal tubules. The smear layer on the root surfaces treated with hand instruments was not completely removed. The phytocomplex solution was able to prevent dentinal tubule exposure. Conclusions: Acidic soft drinks are able to remove the smear layer created on root surfaces during different non-surgical periodontally treatments. The smear plugs created by hand instrumentation appeared to be more resistant to acid attack. The tested phytocomplex solution protected the dentine from demineralization and it might prevent post-treatment dentinal hypersensitivity induced by acidic soft drinks.