Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection

Oral manifestations of sporotrichosis : a neglected disease

Sporotrichosis is an uncommon subacute or chronic infection caused by Sporothrix spp. In some urban areas of Latin America, sporotrichosis has been considered an emergent cosmopolitan disease of zoonotic transmission by domestic cats. There are four diff

Periradicular lesions in HIV-infected patients attending the faculty of dentistry:Clinical findings, sociodemographics status, habits and laboratory data - Seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection

O efeito da terapia anti-retroviral na prevalência das manifestações bucais associadas à infecção pelo HIV/AIDS

As lesões bucais são fortemente associadas à aids, como candidíase, leucoplasia pilosa e sarcoma de Kaposi. Após a introdução da terapia anti-retroviral combinada, algumas lesões mostraram comportamentos diferenciados: sarcoma de Kaposi e candidíase têm sido associados à imunossupressão, enquanto lesões de glândula salivar associadas ao HIV e lesões papilomatosas foram relacionadas à lenta progressão para aids. Dessa forma, este estudo propõe-se analisar o efeito da terapia anti-retroviral na prevalência das manifestações bucais associadas à infecção pelo HIV em dois centros de referência no Rio de Janeiro. Foi realizado estudo epidemiológico retrospectivo dos prontuários dos pacientes HIV positivos atendidos no Hospital Universitário Clementino Fraga Filho e na Clínica de Estomatologia da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro de 1988 a 2004. Foram coletados dados relativos ao tipo e local de lesões bucais associadas ao HIV; bem como sexo; idade; escolaridade; renda familiar mensal; nível socioeconômico; via de transmissão; histórico de infecções oportunistas associadas à aids; contagem de linfócitos T CD4; carga viral; tipo de terapia anti-retroviral; tabagismo; etilismo e uso de drogas. Para cada paciente, foram consideradas como entradas no banco de dados a data do primeiro exame clínico bucal, bem como quando observada nova lesão bucal ou em caso de alteração na terapia anti-retroviral. Para análise estatística, foram utilizados os testes estatísticos Qui-Quadrado e Qui-quadrado para tendência quando necessário (p<0,05). Foram analisados 1012 prontuários, resultando em 1230 entradas no banco de dados: 920 do sexo masculino e 310 do sexo feminino. Foram diagnosticadas lesões bucais em 45% dos casos, principalmente candidíase pseudomembranosa, candidíase eritematosa e leucoplasia pilosa. A terapia antiretroviral combinada foi associada a menor prevalência de lesões bucais, em especial candidíase pseudomembranosa, queilite angular, eritema linear gengival, úlceras inespecíficas e sarcoma de Kaposi. Pacientes com menores contagens de linfócitos T CD4 apresentaram maior prevalência de lesões bucais, principalmente candidíase pseudomembranosa, candidíase eritematosa, queilite angular, eritema linear gengival e úlceras inespecíficas. Em contrapartida, indivíduos com maiores contagens de linfócitos T CD4 tiveram maior prevalência de lesões papilomatosas. Ao longo do estudo, observou-se aumento na prevalência de mulheres, bem como de indivíduos com mais de 40 anos, menos de 8 anos de escolaridade e com menor nível socioeconômico. Houve redução na prevalência total de lesões bucais no decorrer dos períodos analisados, principalmente candidíase pseudomembranosa, queilite angular e sarcoma de Kaposi. Por outro lado, houve aumento na prevalência de lesões papilomatosas e doença de glândula salivar associada ao HIV. Nossos resultados refletem os fenômenos sociais associados à infecção pelo HIV na era da terapia anti-retroviral combinada: feminização, pauperização e envelhecimento dos pacientes. A introdução da terapia anti-retroviral combinada levou à redução na prevalência de lesões bucais, principalmente aquelas associadas à imunossupressão. Os aumentos nas prevalências de lesões papilomatosas e doença de glândula salivar associada ao HIV podem ser observados na população brasileira. A alta prevalência de lesões bucais e a facilidade de realização do exame bucal sugerem ser viável utilizar esse exame como forma auxiliar e de baixo custo no monitoramento do paciente HIV positivoOral lesions are strongly associated to aids, like candidiasis, oral hairy leukoplakia and Kaposi’s sarcoma. Following the introduction of highly active antiretroviral therapy (HAART), some oral lesions showed various behaviours: Kaposi’s sarcoma and candidiasis were related to immunessupression, while HIV-associated salivary gland disease and oral warts were associated with slower progression to aids. Therefore, this study intent is to evaluate the effect of antiretroviral therapy on the oral manifestations of HIV infection in two referral centers at Rio de Janeiro. A retrospective epidemiological study was performed of the medical record of HIV-positive patients who attended Clementino Fraga Filho University Hospital and Stomatology Clinic of the Dental School of Rio de Janeiro Federal University from 1988 to 2004. Type and site of oral lesions were assessed, as well as sex; age; level of education; monthly family income; socioeconomic status; mode of transmission; defining opportunistic infections of aids ; CD4 counts; viral load; type of anti-retroviral therapy; tobacco use; alcohol and drug abuse. Noted from each medical record was the date of the first medical examination, changes in antiretroviral medications, as well as the presence of any new oral lesion. For statistical analysis, chi-square and trend chi-square tests were used whenever necessary (p<0,05). One thousand and two medical records were studied, resulting in 1230 entries in the study’s database: 920 men and 310 women. Oral lesions were diagnosed in 45% of the cases, especially pseudomembranous candidiasis, erythematous candidiasis and oral hairy leukoplakia. HAART were associated to a lower prevalence of oral lesions, especially pseudomembranous candidiasis, angular cheilitis, linear gingival erythema, NOS ulcers and Kaposi’s sarcoma. Patients with lower CD4 counts had a higher prevalence of oral lesions, mainly pseudomembranous candidiasis, erythematous candidiasis, angular cheilitis, linear gingival erythema and not otherwise specified ulcers. On the other hand, individuals with higher CD4 counts had a higher prevalence of oral warts. Throughout the study, increase in the prevalence of women was observed, as well as of individuals with more than 40 years-old, less than 8 years of education and lower socioeconomic status. A reduction in the prevalence of oral lesions was observed through the studied periods, especially pseudomembranous candidiasis, angular cheilitis and Kaposi’s sarcoma. On the other hand, there was an increase in the prevalence of oral warts and HIV-associated salivary gland disease. Our results reflect the social trend of HIV infection in the era of HAART: feminization, pauperization and elderly involvement. The introduction of HAART led to a reduction in the prevalence of oral lesions, especially those associated with immunossupression. The increases in the prevalence of oral warts and HIV-associated salivary gland diseases can be observed in a Brazilian population. The high prevalence of oral lesions and the relative simplicity of the bucal exam suggest the feasibility of using the latter as an auxiliary and low-cost form of monitoring the HIV positive patient138f

Avaliação da Relação entre Tamanho do Tumor e Características Sociais em Pacientes com Carcinoma de Células Escamosas Bucal

O carcinoma de células escamosas (CEC) acomete principalmente homens com mais de 50 anos, tabagistas e etilistas. Muitos pacientes com CEC em mucosa bucal já apresentam lesões avançadas, reduzindo seu prognóstico. O objetivo deste estudo foi analisar as características sociais dos pacientes com CEC bucal, correlacionando-as com o tamanho do tumor. Foi realizado levantamento dos casos de CEC bucal, a partir das informações cadastradas de 2000 a 2003, no Hospital do Câncer I (HC I) do Instituto Nacional de Câncer (INCA). Foram coletados dados referentes a sexo, idade, grau de escolaridade, tabagismo, etilismo, distância entre o bairro de residência e o local de assistência médica e local anatômico e tamanho do tumor no momento da admissão do paciente no INCA. Foram analisados 1.308 prontuários, sendo 1.029 homens (78,7%) e 279 (21,3%) mulheres. Tumores de tamanhos maiores foram relacionados a um menor grau de escolaridade (p=0,011). Por outro lado, a distância entre o bairro de residência e o local de assistência não se mostrou estatisticamente significante em relação ao tamanho do tumor (p=0,134). O baixo grau de escolaridade conferiu-se como risco para o tamanho do tumor, mas tal relação não foi observada em relação à distância entre o bairro de residência e o local de assistência. Novos estudos são necessários para minimizar as falhas referentes às variáveis sociais selecionadas neste estudo de modo a permitir uma avaliação mais precisa em relação à associação avaliada

The frequency of oral conditions detected in hematology inpatients

Background: Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. Objective: To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. Methods: Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. Results: Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. Conclusion: This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases. Keywords: Stem cell transplantation, Hematologic diseases, Oral manifestation

Early and late oral features of chronic graft-versus-host disease

Background:Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites.Objective:The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation.Methods:This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year).Results:Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation.Conclusion:Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation

Early and late oral features of chronic graft-versus-host disease

Background: Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic cell transplantation, and the mouth is one of the affected sites. Objective: The aim of this study was to evaluate the oral features of this disease after hematopoietic cell transplantation. Methods: This was a cross-sectional multicenter study that enrolled patients submitted to transplantation. Oral evaluations used the National Institutes of Health criteria, salivary flow rates, and the range of mouth opening. Pain and xerostomia were evaluated through a visual analogue scale. Patients were divided into two groups based on the transplantation time (up to one year and more than one year). Results: Of the 57 evaluated recipients, 44 had chronic graft-versus-host disease: ten (22.72%) in the group with less than one year after transplantation, and 34 (77.27%) in the group with more than one year after transplantation. Lichenoid/hyperkeratotic plaques, erythematous lesions, xerostomia, and hyposalivation were the most commonly reported oral features. Lichenoid/hyperkeratotic plaques were significantly more common in patients within the first year after the transplant. The labial mucosa was affected more in the first year. No significant changes occurred in the frequency of xerostomia, hyposalivation, and reduced mouth opening regarding time after transplantation. Conclusion: Oral chronic graft-versus-host disease lesions were identified early in the course of the disease. The changes observed in salivary gland function and in the range of mouth opening were not correlated with the time after transplantation3614349CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO CARLOS CHAGAS FILHO DE AMPARO À PESQUISA DO ESTADO DO RIO DE JANEIRO - FAPERJ472817/2007-8E-26/170.794/200