Morphological analysis and chemical content of radiation caries : a polarized light microscopy and scanning electron microscopy study

Orientador: Marcio Ajudarte LopesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Dentre as seqüelas oriundas da radioterapia para o tratamento do câncer de cabeça e pescoço, a cárie de radiação está entre as mais significativas, podendo gerar destruição dentária generalizada. Considerando os escassos trabalhos que avaliaram a morfologia e a progressão microscópica da cárie de radiação, este estudo teve por objetivo principal analisar a morfologia e o conteúdo mineral da cárie de radiação utilizando trinta e seis dentes extraídos de onze pacientes que receberam radioterapia na região de cabeça e pescoço. As características deste material foram descritas considerando os aspectos macroscópicos, radiográficos, histológicos por meio da microscopia de luz polarizada (MLP) e ultra-estruturais por meio da microscopia eletrônica de varredura (MEV). De modo complementar, o conteúdo mineral destes dentes foi quantificado com auxílio da microanálise, baseada na espectroscopia de dispersão de energia (EDS). A cárie de radiação desta amostra apresentou o mesmo perfil histológico, ultra-estrutural e o mesmo padrão de desmineralização que os descritos na literatura para cáries convencionais, com presença de dentina desmineralizada, esclerose dentinária, zona translúcida, tratos mortos dentinários, dentina reacional e deposição de dentina intra-tubular. Diminuição do conteúdo de Cálcio (Ca) e Fósforo (P) na dentina desmineralizada e razão Ca/P semelhante aos valores esperados para dentina desmineralizada convencional, dentina e esmalte sadios não irradiados também foram encontrados. Por fim, constatamos que a cárie de radiação se desenvolve seguindo os mesmos padrões morfológicos e de desmineralização das cáries convencionais e que a dentina dos dentes irradiados preserva a habilidade reparadora em resposta à progressão da cárieAbstract: Among sequelae of radiation therapy for the treatment of the head and neck cancer, radiation caries is the one of the most significant, being able to cause generalized dental destruction. Considering the lack of works that had evaluated the morphology and the microscopical progression of the radiation caries, the main objective of this study was to analyze the morphology and the mineral content of the radiation caries using thirty and six extracted teeth of eleven patients who had undergone radiation in the head and neck region. The characteristics of this material were described considering the macroscopic, radiographic, histologic by polarized light microscopy (PLM) and ultrastructural by scanning electron microscopy (SEM). In complementary way, the mineral content of these teeth was quantified with aid of the microanalysis based on the energy dispersive x-ray (EDS). The radiation caries of this sample presented the same histological and ultrastructural profile and the same demineralization standard that the ones described in literature for conventional caries, with presence of demineralized dentin, sclerotic dentins, translucent zone, dentin dead tracts, reactional dentin and intratubular dentin deposition. Reduction of the content of Calcium (Ca) and Phosphor (P) in the demineralized dentin of radiation caries and Ca/P reason similar to the expected values for non-irradiated demineralized dentin, dentine and enamel was also found. Finally, it was also observed evidence that the radiation caries develops following the same morphological and demineralization standard of the conventional caries and that the dentin of irradiated teeth preserves the ability of repairman in reply to the progression of the cariesMestradoEstomatologiaMestre em Estomatopatologi

Linear verrucous epidermal nevus with oral manifestations: report of two cases

Linear verrucous epidermal nevi (LVEN) are characterized by verrucous papules often coalescing into well-demarcated skin-colored or brown plaques following the lines of Blaschko. We present two new cases of LVEN with oral mucosa involvement and briefly discuss this very rare finding. In both cases, oral biopsies showed hyperkeratosis, acanthosis, and papillomatosis. Although several treatment modalities have been reported for the cutaneous lesions, there is no consensus for the management of oral lesions so far

Proliferative verrucous leukoplakia may initially mimic lichenoid reactions

Proliferative verrucous leukoplakia is an intriguing disease, which occurs particularly in women aged greater than 60 years, is not associated with tobacco and alcohol, and has a high risk of recurrence and malignant transformation. Although it is well known that the typical presentation is characterized by multifocal and verrucous white lesions, there is no description that its initial clinical presentation may simulate a lichenoid reaction.Proliferative verrucous leukoplakia is an intriguing disease, which occurs particularly in women aged greater than 60 years, is not associated with tobacco and alcohol, and has a high risk of recurrence and malignant transformation. Although it is well known that the typical presentation is characterized by multifocal and verrucous white lesions, there is no description that its initial clinical presentation may simulate a lichenoid reaction31086186

Stafne?s bone defect in a metastatic prostate cancer patient : a diagnostic conundrum

Stafne?s bone defect (SBD) is an uncommon bone alteration that affects the mandible and usually presents as an asymptomatic radiolucency located in the posterior region of body or angle of the mandible, below the alveolar canal. Although clinical and radiographic features are more often sufficient for the diagnosis, other lesions and bone alterations have been described in the differential diagnosis and may lead to a misinterpretation and an incorrect diagnosis. Herein, we report a case of an 89-yearold man with metastatic prostate cancer to multiple bones, presenting an asymptomatic solitary well-defined radiolucent image on the right side of the posterior body of the mandible, in close contact with its inferior border. A bone depression was confirmed by computed tomography scans of the mandible and a metastatic inclusion was ruled out by bone scintigraphy with a final diagnosis of SBD. The aim of this report was to highlight the importance of differentiating SBD from metastases in cancer patients and to reinforce the usefulness of multiple imaging modalities in the differential diagnosis of SBD

Non-ulcerated necrotizing sialometaplasia may mimic a salivary gland tumor

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory entity that mainly affects the minor salivary glands located in the hard palate. Classically, NS is characterized as a nodule that evolves to a central ulcer. The most widely recognized triggering factor is an ischemic event. The diagnosis becomes a challenge in non-ulcerated NS cases which is essential to rule out the possibility of salivary gland tumors, especially the malignant ones. Here, we presented a case of a 32-year-old male patient with a 1-month complaint of a painful, slightly elevated erythematous area on the hard palate. Incisional biopsy was performed, and NS was diagnosed based on histopathological and immunohistochemical analyses. Clinicians should be aware of and consider NS as a differential diagnosis of minor salivary gland tumors, particularly when it presents as a non-ulcerated clinical aspect

Oral carcinoma development after 23 years of renal transplantation

Renal transplant patients are treated with immunosuppressive drugs that decrease the effectiveness of the immune system, making them more prone to developing cancer. Skin and lip carcinomas are common malignancies encountered after transplantation, whereas oral carcinomas are rare. We report the case of a 51-year-old female Caucasian patient, with no history of smoking, who presented white lesions on the tongue and an ulcerated lesion on the lower lip beginning 4 months prior. Diagnosis of squamous cell carcinoma for both lesions was made following incisional biopsies. Interestingly, the patient reported a renal transplantation 23 years prior, and was maintained on a combination of cyclosporine, mycophenolate sodium and prednisone. The patient also presented a history of several basal and squamous cell carcinomas on sun-exposed areas of the skin. Both lesions were surgically excised. No sign of recurrence or new lesions in the oral cavity have been observed; however, new skin lesions are frequently diagnosed. This case report highlights that oral cancers may occur in transplant patients in the absence of classical risk factors. Thus, clinicians must be aware of the importance of thorough oral examination in transplant patients in routine follow-up

Benign oral vascular lesions treated by sclerotherapy with ethanolamine oleate : a retrospective study of 43 patients

Although sclerotherapy is a common treatment for benign oral vascular lesions, there is no well-standardized protocol for this purpose. The aim of the present study was to describe the clinical characteristics of patients treated by sclerotherapy with ethanolamine oleate (EO), in order to contribute to a better understanding of this technique. Medical records and images of 90 patients treated by the same sclerotherapy protocol were retrieved and analysed. Thus, 43 cases with complete information were selected and described. The most affected age group was 41?70 years, with a female predominance and 86% of patients being Caucasian. Lips were the most affect site (70%) followed by the tongue (16%). Regarding clinical appearance, approximately 90% of lesions were classified as nodules, and 90% of patients reported no pain. Approximately 40% of lesions were 0.5?1.0 cm in size. In 58% of the patients, only one application of ethanolamine oleate was necessary. The application doses varied according to the lesion size and number of applications. Complete clinical regression occurred in 91% of cases, whereas 9% showed partial regression. Sclerotherapy with EO is an acceptable, effective and affordable treatment for benign oral vascular lesions

Radiation-related superficial oral mucoceles : an under-recognized acute toxicity in head and neck cancer patients

Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy

In situ analysis of gelatinolytic activity in human dentin

Matrix metalloproteinases (MMPs) such as gelatinases are differentially expressed in human tissues. These enzymes cleave specific substrates involved in cell signaling, tissue development and remodeling and tissue breakdown. Recent evidences show that gelatinases are crucial for normal dentin development and their activity is maintained throughout the entire tooth function in the oral cavity. Due to the lack of information about the exact location and activity of gelatinases in mature human dentin, the present study was designed to examine gelatinolytic levels In sound dentin. In situ zymography using confocal microscopy was performed on both mineralized and demineralized dentin samples. Sites presenting gelatinase activity were identified throughout the entire biological tissue pursuing different gelatinolytic levels for distinct areas: predentin and dentinal tubule regions presented higher gelatinolytic activity compared to intertubular dentin. Dentin regions with higher gelatinolytic activity immunohistochemically were partially correlated with MMP-2 expression. The maintenance of gelatinolytic activity in mature dentin may have biological implications related to biomineralization of predentin and tubular/peritubular dentinal regions, as well as regulation of defensive mechanisms of the dentin-pulp complex.Peer reviewe