Estudio de la transformación maligna y factores de riesgo en pacientes con leucoplasia oral

La leucoplasia es la lesión potencialmente maligna más frecuente y también la que presenta mayor índice de transformación maligna. Llevamos a cabo una descripción exhaustiva de las características clínicas y hábitos de 90 pacientes de leucoplasia oral que acuden a la Unidad Docente de Medicina oral de la Facultad de Odontología de Santiago, diagnosticados mediante biopsia desde el año 1995 al 2010, y cuyo seguimiento mínimo es de un año. El grupo está compuesto por 51,1% de hombres y 48,3% de mujeres. La edad media del grupo en general fue de 58,86 años. El 55,6% fumadores. Encontramos diferencias significativas en cuanto al sexo y el consumo de tabaco y entre sexo y consumo de alcohol, los hombres fuman y beben más que las mujeres. Del grupo de 90 pacientes el 58,9% presentaban lesiones no homogéneas. El 45,6% presentaban en el momento del diagnóstico una lesión de menos de 2 centímetros. El 57,8% de los pacientes presentaban afectación en más de una localización

Applications of OralCDx ® methodology in the diagnosis of oral leukoplakia

Objective: We aim to evaluate the effectiveness of the brush biopsy technique using OralCDx ® (OralScan Laboratories Inc., Suffern, NY) as a new method for early diagnosis and control of a 'potentially malignant disorder' such as oral leukoplakia. Design of the study: We performed a study in which samples were taken using OralCDx ® on 24 patients who visited the Master of Oral Medicine, Oral Surgery and Implantology of the University of Santiago de Compostela between February 2009 and May 2010. These patients presented clinical and histological lesions that were consistent with oral leukoplakia. We evaluated the relationship between the keratinization degree of the lesions and cell representation; the diagnosis obtained through OralCDx ® and biopsies; and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: 50% of patients were men and 50% women with an average age of 62.38 years. The Kappa coefficient relating keratinization of lesions and cell representation was 0.33, the OralCDx ® - biopsy diagnostic rate reached a Kappa value of 0.66, recording 72.7%, sensitivity and 92.3% specificity, PPV was 88.8%, while NPV reached 80%. Conclusions: cytology sampling with OralCDx ® showed high sensitivity and specificity values, which make it a good tool for monitoring oral leukoplakia, but nowadays the most reliable method that allows us to confirm the exact diagnosis of the lesions and their anatomical and pathological characteristics still is conventional biopsy using a surgical scalpel. © Medicina Oral S. L

Distracción osteogénica del reborde alveolar: revisión de la literatura

Uno de los principales problemas para la colocación de implantes dentales es la presencia de hueso insuficiente que impide que sean de una longitud y/o de un diámetro adecuados. Dentro de los métodos que se usan para el aumento del reborde alveolar se incluye tan solo desde hace una década la aplicación de los principios de distracción osteogénica (DO). Esta técnica se basa en la separación gradual de dos fragmentos de hueso perfectamente vascularizados, entre los que se forma un callo de distracción que progresivamente se transforma en hueso maduro. Un científico clave en el desarrollo de esta técnica fue el traumatólogo ruso Ilizarov. Esta revisión bibliográfica evalúa la metodología, el funcionamiento y las posibles aplicaciones de DO en el tratamiento de los defectos del reborde alveolar. Por sus cualidades demostradas, la DO podría sustituir el uso de injertos y regeneración ósea guiada para favorecer las relaciones esqueléticas de los rebordes alveolares.One of the principal problems in dental implantation is the lack of sufficient bone height or width. In the case of the alveolar ridge, a very effective technique for resolving this problem is distraction osteogenesis, introduced in this context about a decade ago. This technique is based on the gradual separation of a mobile but fully vascularized bone segment from the basal bone, leading to the formation of an intervening soft callus which gradually transforms to mature bone. A key researcher in the development of this technique was the Russian traumatologist Ilizarov. The present article reviews alveolar ridge distraction procedures and their clinical application. Alveolar ridge distraction may often be preferable to bone grafting or guided bone regeneration for increasing ridge height and width prior to implantation

Correlation between clinical and pathologic diagnosis in oral leukoplakia in 54 patients

The main aim of this study was to establish a correlation between the clinical and pathologic diagnosis of oral leukoplakia with a particular focus on epithelial dysplasia. We reviewed the medical records of 54 patients with a clinical and histologic diagnosis of oral leukoplakia who were seen at our center between 2002 and 2008. We found that the disease was more common in men (59.3%) than in women and we also detected a significantly greater prevalence of alcohol and tobacco consumption in men. The mean age of the patients was 62.57 years. Three patients had been histologically diagnosed with invasive cancer and 4 with carcinoma in situ. The most common lesion site for leukoplakias with severe dysplasia and invasive carcinoma was the lateral aspect of the tongue, the floor of the mouth, and the gums. It is therefore essential to include these sites in the clinical examination to aid early diagnosis. A higher degree of dysplasia should be suspected in non-homogeneous leukoplakias. While dysplasia is associated with a greater risk of malignant transformation, it is also important to monitor leukoplakias without dysplastic features as they can occasionally be the site of carcinoma

Histopathological findings in oral lichen planus and their correlation with the clinical manifestations

Objectives: To highlight the most characteristic histopathological findings of oral lichen planus and their correlation with the clinical manifestations and forms. Study design: We performed a retrospective study of 50 biopsied and diagnosed cases of oral lichen planus obtained over a period of 11 years, spanning from May 1998 to April 2009. We analyzed the age and sex of the patient, type of lichen planus, location and different histopathological findings, comparing them with the clinical lesions. Results: Seventy eight percent of the patients are female and 22% are male, with an average age of 56.06 years for both sexes. The most frequent clinical form is reticular, present in 78% of the cases, and the most common location is the buccal mucosa, present in 70% of the patients. Hydropic degeneration of the basal layer and lymphocytic infiltration in the subepithelial layer are observed in the entire sample. Signs of atypia were identified in 4% of the cases, but without dysplasic features. Other common histological findings were the presence of necrotic keratinocytes (92%), hyperplasia (54%), hyperkeratosis (66%), acanthosis (48%), and less frequently, serrated ridges (30%) and the presence plasma cells (26%) Conclusions: Oral lichen planus is a disease that is more common in women, usually appearing in the fifth and sixth decades of life. The most common clinical form is reticular, manifesting mainly in the buccal mucosa. Histological findings characteristic of oral lichen planus include hydropic degeneration of the basal layer, lymphocytic infiltration in the subepithelial layer and the absence of epithelial dysplasia; however, it is also frequent to observe hyperplasia phenomena at the epithelial level, hyperkeratosis, acanthosis and the presence of necrotic keratinocytes. © Medicina Oral

Glositis romboidal: localización atípica: caso clínico y diagnóstico diferencial

La glositis romboidal media (GRM) es una alteración benigna, poco frecuente, que afecta ligeramente más a los varones. Suele localizarse en la línea media del dorso de la lengua por delante de la 'V' lingual, en forma de área rojiza, romboidal, plana como una mácula o a veces exofítica, mamelonada, que puede sobresalir de 2 a 5 mm, en la que no se observan papilas filiformes. Se presenta el caso clínico de un varón de 61 años de edad que consulta por presentar una lesión exofítica asintomática en dorso de lengua, situada a nivel paramedial izquierdo. El estudio histopatológico es compatible con glositis romboidal. Se debe realizar el diagnóstico diferencial con otras lesiones exofíticas frecuentes en esta localización como: hemangioma o lesión vascular, granuloma piogénico, amiloidosis, tumor de células granulares y carcinoma de células escamosas, analizando tanto los aspectos clínicos como histopatológicos de cada una de ellas. A través de este caso clínico comprobamos que la GRM puede tener una localización paramedial, que denominamos atípica.Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual 'V', appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by 2 - 5 mm. This paper reports a case of rhomboid glossitis in a 61- year-old man who consulted for a painless raised lesion on the dorsum of the tongue, in left paramedial (not medial) location. Histopathological findings were compatible with rhomboid glossitis. Other diagnoses considered but ruled out on the basis of the clinical and histopathological findings were haemangioma, pyogenic granuloma, amyloidosis, granular cell tumour, and squamous cell carcinoma. This case confirms that rhomboid glossitis may occur in paramedial locations

A new morphologic classification of the alveolar ridge after distraction osteogenesis in human patients. A 17 years retrospective case series study

To perform a morphologic classification based on the results of bone augmentation after a distraction osteogenesis. Thirty-four (34) patients (24 women and 10 men; mean age, 47.1 years (SD=9.5); age range, 23 to 62 years) underwent a total of 42 alveolar ridge distractions before the placement of a total of 89 dental implants. Ridge bone morphology was evaluated as the main ordinal variable. Chi-squared, Kruskal-Wallis and ANOVA one-way test were used. Category I (30.95%): consisted of wide alveolar rim and no bone defects Category II (28.57%): wide alveolar rim, lateral bone surface concavity. Category III (23.81%): narrow alveolar rim, lateral bone surface concavity. Category IV (2.38 %): distraction transport segment forming a bridge, without bone formed beneath and requiring guided bone regeneration. Category V (9.52%): return of the transport segment to its initial position due to the reverse rotation of the distractor screw. Category VI (4.76 %): distraction transport segment completely lost. Subcategory D (28.57%), consisted of lingual deviation of the distraction axis, occurring in any of the categories I to IV. More men (76.9 %) presented with category I (p<0.001). The use of the chisel resulted mainly in categories I and II (69.4 %) (p<0.001). GBR was only required in 23.1 % of the cases in Category I (p=0.011). The bone height achieved decreases as the category increases, due to the accompanying osteogenic limitations (p<0.001). The implants placed in category I were longer 11.5 ± 0.9 mm (CI95% 10.9-11.9 mm) compared to those placed in category III with a length of 10.4 ± 1.5 mm (CI95% 9.5-11.4 mm) (p=0.035). The alveolar ridge after distraction osteogenesis could be divided into six morphologic categories which provide a useful basis for decision-making regarding implant placement

Therapeutic alternatives in the management of osteoradionecrosis of the jaws. Systematic review

to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined. The review was organized according to the PRISMA protocol with regards to the following PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention); between all therapies (C=Comparison); healing of lesions (O=outcome). Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclusively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effective option, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p=0.002). Only 1 case (0.9%) corresponded to low level laser therapy. It seems clear that early intervention with conservative surgical combined with pharmacological methods improves the prognosis of ORN

Lichenoid areas may arise in early stages of proliferative verrucous leukoplakia: a long-term study of 34 patients

Background: Proliferative verrucous leukoplakia is considered an uncommon oral potentially malignant disorder with a high malignant transformation rate. The objective of this paper was to define its cancer incidence and related risk factors.: Method: A retrospective audit of 34 patients diagnosed with proliferative verrucous leukoplakia from a university-based unit, during the period from 1995 to 2019 was performed. The mean number of visits was 23 ± 18.6. The follow-up was divided into four-time intervals to evaluate the clinical presentation, number of lesions, dysplasia grade, and malignant transformation rate. Results: The majority of patients were females 29 (85.3%), with verrucous component (77.8%), with a gingival presentation (31.8%), and with a preceding lichenoid area (44.1%). Eleven patients (32.4%) were affected by oral cancer during the follow-up, developing a total of 15 carcinomas. The mean age of malignant transformation was 67.2 ± 12.9 years, particularly 8 ± 8.5 from the onset of the lesions. Warty forms presented a higher mean estimate for malignant transformation (15.2 years, 95% confidence interval 4.4–26 years) than nodular forms (1.9 years, 95% confidence interval 1.9–1.9) (p = 0.019). Patients with an initial proliferative verrucous leukoplakia diagnosis suffered a higher risk of malignancy, particularly 15.55 times (95% confidence interval 1.69–143.17; p = 0.015) than those who did present a preceding area with lichenoid morphology. Conclusion: Proliferative verrucous leukoplakia presented a high malignant transformation rate and sometimes displayed preceding oral lichenoid areas in early stages. Further studies are needed to understand the impact of these lichenoid areas in proliferative verrucous leukoplakia progressionS

Counselling toward reducing alcohol use, knowledge about its morbidity and personal consumption among students of medical and dental courses in north-western Spain

Alcohol use disorder (AUD) is directly linked to high-risk consumption. Healthcare students have a crucial role to play in its prevention and management. The aim of this study is to analyse alcohol consumption, as well as to consider the knowledge and attitudes regarding morbidity, and the stage of change when providing assistance to quit AUD. A cross-sectional study was conducted among Dentistry and Medical students using specific and validated questionnaires in an anonymous and voluntary way. Initially, 925 students were invited to participate, of them 500 were reached. Among them 85.9% suffered from AUD of whom 75% were women (p<0.001), and it was considered that the female gender constituted an independent risk factor (OR=2.63, CI 95% 1.55-4.45, p<0.001). The majority of the participants did not achieve the pass mark, nonetheless, the results showed improved levels of knowledge among participants in the latter years of their studies (p<0.001). Dental students demonstrated greater shortcomings in terms of their knowledge of general pathology, whereas the medical students? knowledge of oral pathologies proved worse (p<0.001). Most of students believed that identifying cases of AUD-affected patients falls within their competence, nonetheless, they believed that they do not have the necessary competencies. Among participants 58.2% were in a stage of change regarding AUD attitudes. The majority of respondents presented AUD. In general, the participants? knowledge about alcohol was low. Reviewing the syllabuses and evaluating the implementation of gender-differentiated training programmes in both degrees would be considered necessary