Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson’s chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Metastatic lesions to the mandible may be originated from primary tumors elsewhere in the body. However, metastatic colonic carcinomas to this bone have been described infrequently. We report the case of a 71-year-old man with an adenocarcinoma in the sigmoid colon with liver metastasis. The patient underwent chemotherapy with indication of sigmoidectomy and retroperitoneal lymphadenectomy. One year and four months after the first metastatic diagnosis, the patient presented a tumor mass in the body and branch of the right mandible. Histopathological and immunohistochemical analysis with monoclonal antibodies specific for CEA, CK20, CDX-2, and vilin were compatible with the diagnosis of moderately differentiated metastatic adenocarcinoma with colonic origin. However, due to the wide spread of the disease, the patient died four months later. Tumor markers have been applied in clinical practice to assist in the diagnosis and to help guide prognosis, staging and treatment of cancer. The management of metastatic lesions remains a controversial issue and the development of new and more specific markers of gastrointestinal differentiation that may promote early diagnosis, are of continuous interest.

AIM: To evaluate the oral conditions of patients with chronic kidney disease undergoing dialysis and to determine the influence of dialysis duration and bone metabolism on the prevalence and severity of the alterations found. METHODS: The simplified oral hygiene index (OHI-S), prevalence of dental caries (decayed, missing filled teeth index, DMFT), and the periodontal screening and recording (PSR) index were evaluated in 154 patients. Parathyroid hormone (PTH), calcium, phosphorus and urea measurements, as well as panoramic radiographs, were obtained from all patients. To evaluate the effect of duration of dialysis treatment on oral health, the patients were divided into two groups: (1) <5 years and (2) > 5 years. Regarding blood levels of PTH, patients were divided into three groups: (1) 0-149 pg/mL, (2) 150-584 pg/mL, and (3) >585 pg/mL. The OHI-S identified the accumulation of biofilm and calculus around the teeth. RESULTS: Gingival inflammation was found in 100% of dentate patients, with 2 being the predominant PSR score (72.3%). The DMFT index was high (17.52). Dental calculus was the most common radiographic finding (70.8%). No significant correlation was observed between dialysis duration, biochemical alterations, and oral health. CONCLUSIONS: Most patients undergoing dialysis presented precarious oral hygiene, periodontal inflammation, and bone alterations. However, these manifestations were not influenced by the duration of dialysis or bone metabolism.

The aim of the study was to determine the immunohistochemical expression of the PCNA, p53 and bcl-2 proteins in pleomorphic adenomas.onineteen specimens of pleomorphic adenomas were selected for analysis by the streptavidin-biotin-peroxidase method with antibodies againstp53, PCNA and bcl-2 proteins. It was observedweak labeling for p53 in 12 cases (63.1%) andforPCNA in 8 (42.1%). With respect to the bcl-2 labeling index,ono expression of this protein was detected in 12 cases, corresponding to 63.1% of the sample. Based on these findings, it was concluded that p53 and PCNA can favor the proliferative activity of pleomorphic adenomas, whereas bcl-2 probably doesonot effectively particípate in the pathogenesis of this tumor.

El objetivo del estudio fue determinar la expresión inmmunohistoquímica de las proteínas PCNA, p53 y bcl-2 en adenomas pleomórficos. Fueron seleccionados 19 especímenes de adenomas pleomórficos para análisis a través del método de la estreptavidina-biotina-peroxidasa con anticuerpos contra las proteínas p53, PCNA y bcl-2. Fue observada leve marcación para p53 en 12 casos (63,1%) y para PCNA en 8 (42,1%). Con relación al índice de marcación para bcl-2,ono fue detectada en 12 casos (63,1%) expresión de esta proteína. En base a los resultados, se concluyó que las proteínas p53 y PCNA pueden favorecer la actividad proliferativa de adenomas pleomórficos, y por otro lado, la bcl-2 probablementeono participaría efectivamente de la patogenia de este tumor.

The oral cancer development can be from apparently normal mucosa, or from precursory lesions, that can represent different step of oral epithelial carcinogenesis process. This study aimed to analyze morphologically trough the hematoxilina/eosine technique normal oral mucosa, oral fibroepithelial inflammatory hyperplasia and oral epithelial dy splasia (OED) to get more informations about the epithelial alterations that can to precede the installation and evolution of oral cancer. Its was observed that some of the morphologic alterations in the oral fibroepitelial hyperplasia were provably associated to the inflammatory process, where exist the action of chemical mediators with capacity to promote cellular morphologic modifications and alterations of the tissue architecture but not to common alterations of lesions potentially malignant. Correlating the clinical aspect of the lesions with the histopato logic diagnosis of oral epithelial dysplasia its was not observed expressive difference, however the majority of the OED specimens had clinical diagnosis of leucoplasia. Its was concluded that the simple observation of the morphologic characteristics of epithelial alterations in the oral mucosa can to improve the diagnostic of the lesions suffered by this mucosa, however, its not offers much informations about which would be the events that would lead to the establishment of a determined lesion.

El desarrollo del cáncer oral puede darse a partir de una mucosa aparentemente normal o a partir de una lesión precursora inicial, las cuales pueden representar pasos diferentes del proceso de carcinogénesis epitelial oral. El objetivo de este estudio fue analizar morfológicamente, a través de la técnica de la hematoxilina / eosina, la mucosa oral normal, hiperplasia fibroepitelial oral y displasia epitelial oral, con el propósito de obtener mayor información sobre las alteraciones epiteliales que pueden preceder al establecimiento y evolución de una neoplasia propiamente tal. Fue constatado que muchas de las alteraciones morfológicas observadas en las hiperplasias fibroepiteliales orales probablemente eran asociadas al proceso inflamatorio, donde es conocida la acción de mediadores químicos con capacidad de promover modificaciones morfológicas celulares y en la estructura tisular y no necesariamente representan alteraciones comunes de lesiones potencialmente malignas. Correlacionando el aspecto clínico de las lesiones con el diagnóstico histopatológico de displasia epitelial oral, no fue observada diferencia expresiva; sin embargo, la mayoría de los especímenes tuvo diagnostico clínico de leucoplasia. Se concluyó que la simple observación de las características morfológicas de las alteraciones de la mucosa oral puede ayudar el establecimiento del diagnóstico de las lesiones sufridas por la mucosa; sin embargo, no ofrecen mucha información sobre cuáles serían los eventos que llevarían al establecimiento de una determinada lesión.

Objetivo: Realizar una evaluación epidemiológica de los quistes odontogénicos en pacientes de 0 a 14 años de edad, verificando cuales son las lesiones de mayor incidencia entre estas edades. Métodos: Fueron evaluadas 100 fichas histopatológicas de lesiones diagnosticadas como quistes de naturaleza odontogénica, enfatizando las características clínicas (género, edad, tipo de lesión quística, localización anatómica y tamaño de la lesión) y radiográficas. Resultados: Fue observado que el género masculino, con edad media de 9,78 años, así como las regiones posterior de mandíbula y anterior de la maxila fueron más comprometidos. El quiste dentígero fue la lesión más común, seguida del quiste radicular. Se observó además, que en la muestra evaluada el aspecto radiográfico unilocular y las lesiones asintomáticas fueron las más frecuentes. Conclusiones: Se concluyó que es muy importante realizar éste tipo de estudios, una vez que, a través de ellos podemos conocer la frecuencia e incidencia de diversas lesiones, principalmente en pacientes pediátricos, en los cuales poco se conoce sobre la prevalencia de las lesiones quísticas de los maxilares.

Objective: To realize an epidemiologic survey of odontogenic cysts in patients from 0 to 14 years old in order to find out the most prevalent lesions of each age period. Methods: 100 histopathologic files of lesions diagnosed as cysts of odontogenic origin were retrieved emphasing their clinic (cystic lesion pattern, gender, age, anatomical site and lesion lenght) and radiographic features, which the surgical specimens were forwarded for the Oral Pathology Service of UFRN. Results: It could be identified that either the male gender, with an age average of 9,78 years, or the mandible posterior and the anterior maxilla region were more involved. Dentigerous cyst was the most prevalent lesions, followed by the radicular cyst. Moreover, a unilocular radiolucence and asymptomatic lesions were more common in the sample. Conclusions: To sum up, it can be infered the outstanding relevance of studies like the present since that it is through than that it can be reached the knownlodge of the frequence and incidence of several lesions, especially in paediatric patients inasmuch as the few knownlodge of the cystic lesion prevalence in their jaws.

Objetivo: Realizar uma avaliação epidemiológica dos cistos odontogênicos em pacientes de 0 a 14 años de edad, verificando quais são as lesões de mayor incidência entre estas idades. Métodos: Foram avaliadas 100 fichas histopatológicas de lesões diagnosticadas como cistos de natureza odontogênica, enfatizando as características clínicas (gênero, idade, tipo de lesão cística, localização anatômica e tamanho da lesão) e radiográficas. Resultados: Foi observado que o gênero masculino, com idade média de 9,78 anos, assim como as regiões posterior de mandíbula e anterior da maxila foram mais comprometidos. O cisto dentígero foi a lesão mais comum, seguida d cisto radicular. Observou-se, além disso, que na amostra avaliada o aspecto radiográfico unilocular e as lesões assintomáticas foram as mais freqüentes. Conclusões: Foi concluído que é muito importante realizar este tipo de estudos, uma vez que, através deles podemos conhecer a freqüência e incidência de diversas lesões, principalmente em pacientes pediátricos, nos quais pouco se conhece sobre a prevalência das lesões císticas dos maxilares.

El papel de la respuesta inmunológica en la patogénesis de la enfermedad periodontal constituye tema constante de investigación por diversos autores. En el presente trabajo se propuso realizar un análisis inmunohistoquímico de la densidad y del patrón de distribución de la población celular macrofágica utilizando el anticuerpo anti-CD68 en 17 casos de gingivitis crónica y 25 de periodontitis crónica. Las células CD68+ se distribuyeron difusamente por todo el tejido conectivo. El análisis estadístico reveló diferencia significativa entre los especimenes estudiados (p < 0,05), siendo la densidad de las células macrofágicas mayor en la gingivitis crónica. Los resultados observados sugieren una mayor participación de esas células en la patogénesis de la gingivitis.

The important function of immunological reaction in periodontal disease has been studied by several reports. In order to achieve contributive information to the knowledge of the pathogeny of this disease, an immunohistochemical analysis of the density and distribution of macrophagic cells was realized using anti-CD68 antibody  in 17 cases of chronic gingivitis and 25 cases of chronic periodontitis. The CD68+ cells exhibited diffuse distribution in the connective tissue. The statistical analysis shown differences in relation to the density of this cells between the groups (p < 0,05), where the density of macrophacgic cells was higher in the chronic gingivitis. Its results can infer that the macrophagic cells has greated role in the pathogenesis of gingivitis.

Abstract Several studies have demonstrated the association of thrombocytopenia with the occurrence of bleeding in patients with malignant neoplasia, immunosuppressive states or the use of anticoagulant medicine. In this paper we evaluated the occurrence of spontaneous bleeding in 40 children with malignant neoplasia and its relation between this disease verifying its relation to this oral complication, the type of neoplasm, treatment and platelet counts. Two children with acute lymphoblastic leukemia and 4 with acute myelogenous leukemia developed 10 episodes of spontaneous oral bleeding, mainly in gingival areas, coinciding most of them with thrombocytopenic states. The Fisher's exact test does not show significant difference in the occurrence of spontaneous oral bleeding between children with systemic neoplasm and solid tumours (p = 0.067); nevertheless, statistically, children with systemic neoplasm and thrombocytopenia had a higher risk of presenting this complication (OR = 10.93 y OR = 8.077 respectively). The bleeding coincided with the use of methotrexate and cytarabine. It was concluded that the risk of spontaneous oral bleeding in children with malignant neoplasm is higher, mainly in children with systemic neoplasm. On the other hand, the occurrence of spontaneous oral bleeding can be considered as an early sign of thrombocytopenia in these patients.

Resumen Diversos estudios han demostrado la asociación de trombocitopenia con la ocurrencia de sangrado en pacientes con neoplasias malignas, estados de inmunosupresion o el uso de medicamentos. En el presente estudio se evaluó la ocurrencia de sangrado oral espontáneo en 40 niños con neoplasias malignas y si existía relación entre esta complicación estomatológica con el tipo de neoplasia, tratamiento y el conteo plaquetario. Dos niños con leucemia linfoblástica aguda y 4 con leucemia mieloblástica aguda desarrollaron conjuntamente 10 episodios de sangrado oral espontáneo, principalmente en la gingiva, coincidiendo la mayoría de éstos con periodos de trombocitopenia. El test exacto de Fisher no mostró diferencia estadísticamente significativa en la ocurrencia de sangrado oral espontáneo entre los niños con neoplasias sistémicas y aquéllos con tumores sólidos (p = 0.067); sin embargo, estadísticamente, los niños con neoplasias sistémicas y con trombocitopenia tuvieron mayor riesgo de presentar esa complicación (OR = 10.93 y OR = 8.077 respectivamente). El sangrado coincidió con el uso acentuado metotrexato y la citarabina. Concluimos que el riesgo de sangrado oral espontáneo en niños con neoplasias malignas es alto, sobre todo en aquéllos acometidos por neoplasias sistémicas. Por otro lado, la presencia de sangrado oral espontáneo puede ser considerada como un indicio precoz de trombocitopenia severa en esos pacientes.

El Queratoquiste Odontogénico, constituye un tipo histológico de los quistes odontogénicos de desarrollo cuya mayor incidencia ocurre entre la segunda y tercera década de la vida, pudiendo tener un segundo pico de aparición hacia la quinta década. La zona del tercer molar inferior, ángulo mandibular desde donde progresan hacia la rama y el cuerpo constituyen la ubicación más frecuente de la lesión. Entre los otros quistes odontogénicos éste presenta mayor importancia debido a la alta tasa de recurrencia ubicada entre el 25 y 60% y porque presenta características histopatológicas que lo diferencian de otras lesiones quísticas. Se reporta un caso en un paciente de sexo masculino de 16 años de edad que en un examen radiográfico con finalidad ortodoncica presentó una lesión radiolucida unilocular circunscrita comprometiendo área del seno maxilar derecho extendiéndose hasta el piso de la órbita del mismo lado y desplazando el diente 18. Después de los exámenes clínico, radiográfico e histopatológico se diagnosticó: Queratoquiste Odontogénico. Se realizó tratamiento quirúrgico con resultados satisfactorios y sin señales clínicas ni radiográficas de recidiva hasta el momento