Non-invasive therapies for management of temporomandibular disorders: A systematic review

Introduction: As a multifactorial disease, temporomandibular disorders (TMD) require a complex therapeutic approach, being noninvasive therapies the first option for most patients. The aim of this study was to perform a systematic review to analyze the most common non-invasive therapies used for TMD management.Methods: The review was done by searching electronic databases to identify controlled clinical trials related to pharmacologic and non-invasive treatments. Of all potential articles found, 35 were included in this review.Results: Low-level laser therapy (LLLT), occlusal splints (OS) and oral exercises/behavior education (OE/BE) were the most common therapies used. LLLT showed significant results in pain and movement improvement in most studies. OS was usually combined to other therapies and resulted in improvement of pain. OE/BE showed significant results when combined with ultrasound, LLLT, and manual therapy.Conclusions: Non-invasive treatments can provide pain relief and should be prescribed before surgical procedures. LLLT was the therapy with the higher number of studies showing positive results. Based in heterogeneity of treatment protocols, diagnostic and outcomes criteria used, new well-designed randomized controlled trials (RCT) are necessary.Keywords: Temporomandibular disorder; temporomandibular joint; myofascial pain; treatment; temporomandibular dysfunction; pharmacologic

Keratoacanthoma associated to cutaneous horn manifestation: case report and difficulty of diagnosis

Background: Cutaneous horn (CH) is a conical hyperkatotic projection of skin with keratotic material. A broad variety of lesions may be found with clinical aspect of cutaneous horn, including malignant tumors.  Case report: We report a case of patient with 77- year-old male, presenting an asymptomatic lesion with clinical aspect of CH in lower lip. The clinical diagnosis hypothesis was squamous cell carcinoma (SCC) and an incisional biopsy was performed. The histopathological analysis revealed a keratoacantoma (KA) and the lesion was completely removed. The one year follow-up revealed no recurrence. Discussion: CH rarely is accompanied by KA. However, KA shows a greater degree of nuclear atypia than SCC making the differentiation of two diseases very difficult. This case highligh the importance of histopathological examination to rule out malignancy.Introdução: O corno cutâneo (CC) é uma projeção hiperceratótica cônica da pele. Uma ampla variedade de lesões podem ser encontrados com aspecto clínico de corno cutâneo, incluindo tumores malignos. Relato de caso: Relatamos um caso de paciente do sexo masculino, 77 anos de idade, apresentando uma lesão assintomática, com aspecto clínico da CC no lábio inferior. A hipótese de diagnóstico clínico foi de carcinoma espinocelular (CEC) e uma biópsia incisional foi realizada. A análise histopatológica revelou um ceratoacantoma e a lesão foi completamente removida. Em um ano de acompanhamento nenhuma recidiva foi observada. Discussão: CC raramente é acompanhada por ceratoacantoma. No entanto, ceratoacantoma mostra um maior grau de atipia nuclear do que CEC tornando a diferenciação de duas doenças muito difícil. Neste caso ressaltamos a importância do exame histopatológico para descartar malignidade

Effects of osteoporosis on alveolar bone repair after tooth extraction: A systematic review of preclinical studies

This systematic review aimed to address whether the alveolar socket repair after a tooth extraction is impacted by an osteoporotic phenotype and propose methodological observations. Design: A search strategy in MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases was performed. Quality assessment was carried out through the SYRCLE Risk of Bias tool. Results: Out of the 1147 potentially relevant records, 25 met the inclusion criteria. Most of the studies were performed in rats, and ovariectomy (OVX) was the most frequent osteoporosis induction method. Histomorphometry, micro-computed tomography (microCT), and Immunohistochemistry were the main bone repair evaluation methods. Most of the included studies (88 %) presented negative impacts of osteoporosis on the alveolar socket repair. Only three studies (12 %) showed no statistical differences among groups. Overall, most of the quality assessment categories presented a high percentage of unclear risk of bias due to insufficient information in the studies. Conclusions: The results indicated that an osteoporotic phenotype seems to impair alveolar socket repair after tooth extraction. However, there is still a lack of information and standardization. Therefore, further studies should consider the proposed methodological aspects regarding animal characteristics, OVX associated with a low calcium diet, waiting 8 weeks to osteoporosis induction, maxillary molars as the best option for tooth extraction, confirming and reporting OVX and osteoporosis success, and an appropriate method of repair analysi

Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study

This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients’ profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment

Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions

The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability

BMI-1 expression increases in oral leukoplakias and correlates with cell proliferation

Oral leukoplakia (OL) is a white lesion of an indeterminate risk not related to any excluded (other) known diseases or disorders that carry no increased risk for cancer. Many biological markers have been used in an attempt to predict malignant transformation; however, no reliable markers have been established so far. Objective: To evaluate cell proliferation and immortalization in OL, comparing non-dysplastic (Non-dys OL) and dysplastic OL (Dys OL). Methodology: This is a cross-sectional observational study. Paraffin-embedded tissue blocks of 28 specimens of Non-dys OL, 33 of Dys OL, 9 of normal oral mucosa (NOM), 17 of inflammatory hyperplasia (IH), and 19 of oral squamous cell carcinomas (OSCC) were stained for Ki-67 and BMI-1 using immunohistochemistry. Results: A gradual increase in BMI-1 and K-i67 expression was found in oral carcinogenesis. The immunolabeling for those markers was higher in OSCC when compared with the other groups (Kruskal-Wallis, p<0.05). Ki-67 expression percentage was higher in OL and in IH when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). Increased expression of BMI-1 was also observed in OL when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). No differences were observed in expression of both markers when non-dysplastic and dysplastic leukoplakias were compared. A significant positive correlation between Ki-67 and BMI-1 was found (Spearman correlation coefficient, R=0.26, p=0.01). High-grade epithelial dysplasia was associated with malignant transformation (Chi-squared, p=0.03). Conclusions: These findings indicate that BMI-1 expression increases in early oral carcinogenesis and is possibly associated with the occurrence of dysplastic changes. Furthermore, our findings indicate that both Ki-67 and BMI-1 are directly correlated and play a role in initiation and progression of OSCC

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country’s health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country's health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population

An analysis of the completeness of referral forms and cases evaluated by an oral medicine specialized service

Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases.Objective: The primary aim of this study was to assess the completeness of referral forms of the patients referred from the primary care to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist.Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral’s completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant’s information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients’ diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment.Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. In regards to the need of referral, 40,6% of the cases (n=50) could be settle at the primary care. Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services