Cancer bucal: diseño y evaluación de un índice de riesgo multifactorial

Objetivo: Categorizar el riesgo de cáncer bucal a través de un índice multifactorial. Pacientes y métodos: 53 pacientes con cáncer bucal y 100 controles fueron examinados por profesionales calibrados en la Facultad de Odontología, Universidad Nacional de Córdoba entre 2009-2013. Edad, género, índice de masa corporal, tabaco, tabaquismo pasivo, alcohol, bebidas calientes, trauma crónico de la mucosa oral, desórdenes potencialmente malignos, candidiasis bucal, virus del papiloma humano, pérdida dentaria, prótesis desadaptadas, dieta, carcinógeno ambientales, arsénico en agua de consumo e historia familiar de cáncer fueron las variables registradas. El Modelo 1 fue construido asignando un punto por cada variable. El Modelo 2 fue construido con las variables estadísticamente significativas del análisis univariado y el Modelo 3 fue construido con las variables estadísticamente significativas del análisis univariado que no requieren inspección clínica para su registro. El Modelo 4 fue construido con las variables estadísticamente significativas del análisis multivariado por regresión logística. Para cada variable significativa el OR fue redondeado al número entero más cercano. Para cada paciente se obtuvo un puntaje total sumando los valores de las variables presentes en el mismo. Todos los pacientes fueron ordenados según su puntaje total y divididos en dos grupos según la mediana. La diferencia del riesgo de cáncer bucal entre los grupos de mayor y menor puntaje fue analizada mediante X 2 . Fue evaluada la sensibilidad y especificidad de cada modelo. Los resultados fueron validados mediante validación cruzada leave-one-out. Resultados: En los cuatro modelos tener mayor puntaje estuvo estadísticamente asociado con riesgo de cáncer bucal: Modelo 1 OR 7.9 IC 95% 3.7-16.9, p<0.0001; Modelo 2 OR 50, IC 95% 14.3-174.5, p< 0.0001; Modelo 3 OR 3.17, IC 95% 1.57-6.41, p 0.001; Modelo 4 OR 28.16, IC 95% 11.25-70.50, p<0,0001. Los valores de sensibilidad, especificidad, razón de verosimilitud positiva, razón de verosimilitud negativa y proporción de riesgo atribuible fueron para Modelo 1: 0.86, 0.49, 0.9, 0.14 y 73%; Modelo 2: 0.94, 0.75, 2, 0.04 y 94%; Modelo 3: 0.68, 0.6, 0.9, 0.28 y 53%; Modelo 4: 0.73, 0.91, 4.33, 0.15 y 76%; respectivamente. El Modelo 2, mostró una validación cruzada mediante leave-one-out con un error menor a 4%. Conclusiones: La acumulación de factores carcinogénicos está relacionada a mayor riesgo de cáncer bucal. El índice de riesgo multifactorial obtenido mediante análisis univariado resulta adecuado para programas de monitoreo y prevención de cáncer bucal, y debe ser ejecutado por odontólogos adecuadamente entrenados en medicina bucal

Delays in the diagnosis of oral cancer due to the quarantine of COVID-19 in Córdoba, Argentina

Coronavirus disease (COVID) 2019 has become a health challenge for the entire world. The first case of COVID in Argentina was reported on March 3rd, 2020.1 In this scenario, local authorities declared a quarantine, which effectively began on March 20th and is still ongoing. Although in recent months there have been some flexibilities, Argentinian lockdown is one of the longest isolation measures worldwide. The restrictive measures halted private and public dental care services, similar to the situation in Italy.2 The government restricted transportation between cities, only allowed in critical cases. However, people are also frightened by the increased risk of COVID infection when visiting health centers. The Oral Medicine Department (Universidad Nacional de Córdoba) remains closed since the second week of March 2020. Thus, our activities are hindered, including follow-up of oral potentially malignant disorders (OPMD) and oral cancer (OC). Due to the reduced clinical work, new visits for oral conditions were also disrupted putting those patients at risk.3 The rational use of telemedicine helped us to manage referrals.4 However, nowadays we are treating individuals that we have not seen in a long time as the result of this long-standing quarantine. We would like to report four cases showcasing the impact of lockdown in the follow-up of OPMD and early diagnosis of OC.publishedVersionFil: Gilligan, Gerardo Marcelo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Lazos, Jerónimo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Piemonte, Eduardo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Criado, Esteban. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Panico, René. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina

Clinical management of alveolar osteitis. A systematic review

Alveolar Osteitis (AO) is one of the most common complications of tooth extraction. Several therapeutic interventions have been described for the treatment of AO, however, there are no treatment standardized protocols. The aim of this study was to conduct a systematic review on the efficacy in pain control of the different treatments for AO. The feasibility of the application of these interventions is also discussed. A structured electronic and hand search strategy was applied to PubMed, Scopus, Cochrane Library, OpenGrey, and Google Scholar between January 2010 and July 2020 to identify studies according to PRISMA guidelines. The inclusion criteria were original English and Spanish clinical trials that analyzed pain-control parameters according to visual analog scale (VAS, 0-10 scale), or pain relief patients? percentages. Those treatments that reach VAS ? 4 on day 2 or before; or ? 85% of patients with absence of pain symptoms at day 7 or before were considered accepTable for their recommendation. The final review included 17 clinical trials. Among them, there were analyzed a total of 39 different AO treatments. 53,8% of the treatments fulfill the proposed parameters for pain control. Treatment alternatives are multiple, heterogeneous, and difficult to compare. The management of AO is summarized in basic (intra-alveolar irrigation) and specific procedures (Alveogyl®, Neocones®, SaliCept Patch®, Low-Level Laser, Platelet-Rich Fibrin) that reach pain control success. They could be selected according to their availability and advantages or disadvantages

In reply to the letter to the editor "Tele(oral)medicine: A new approach during the COVID-19 crisis"

We report a case reflecting a suitable use of telemedicine in Oral Medicine. A general dental practitioner, working in a small Patagonian village (more than 1,000 km away from our institution), referred us a case using Instagram and WhatsApp. It was a 7-year-old female with chief complaint of spontaneous gingival bleeding, with no previous medical conditions.publishedVersionFil: Gilligan, Gerardo Marcelo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Piemonte, Eduardo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Lazos, Jerónimo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Panico, René. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina

Oral cancer associated with chronic mechanical irritation of the oral mucosa

Most of the studies dealing with Chronic Mechanical Irritation (CMI) and Oral Cancer (OC) only considered prosthetic and dental variables separately, and CMI functional factors are not registered. Thus, the aim of this study was to assess OC risk in individuals with dental, prosthetic and functional CMI. Also, we examined CMI presence in relation to tumor size. A case-control study was carried out from 2009 to 2013. Study group were squamous cell carcinoma cases; control group was patients seeking dental treatment in the same institution. 153 patients were studied (Study group n=53, Control group n=100). CMI reproducibility displayed a correlation coefficient of 1 (p<0.0001). Bivariate analysis showed statistically significant associations for all variables (age, gender, tobacco and alcohol consumption and CMI). Multivariate analysis exhibited statistical significance for age, alcohol, and CMI, but not for gender or tobacco. Relationship of CMI with tumor size showed no statistically significant differences. CMI could be regarded as a risk factor for oral cancer. In individuals with other OC risk factors, proper treatment of the mechanical injuring factors (dental, prosthetic and functional) could be an important measure to reduce the risk of oral cancer

Osteonecrosis por bifosfonatos

Fil: Bachmeier, Evelin. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Talavera, Angel Daniel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Brusa, Martín Eduardo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Los primeros reportes de osteonecrosis maxilar asociada a bifosfonatos datan del año 2003, cuando se reportaron casos de dicha entidad asociados al uso de ácido zoledrónico en pacientes oncológicos. Sin embargo, desde el año 2005 ha ido aumentando el número de casos de osteonecrosis asociado al uso de bifosfonatos orales.www.smicba.orgFil: Bachmeier, Evelin. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Talavera, Angel Daniel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Brusa, Martín Eduardo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Odontología, Medicina y Cirugía Ora

Criterios Odontológicos en pacientes con medicación antirresortiva y/o antiangiogénica: revisión narrativa

Fil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.Fil: Gilligan, Gerardo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.Fil: Panico, René Luis. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.La osteonecrosis mandibular es un efecto adverso atribuible a la administración de drogas antirresortivasy antiangiogénicas, eventualmente severa, caracterizada por la ne-crosis y exposición posterior del hueso en la región maxilofacial, apesar de la falta de antecedentes de tratamiento de radiación en ca-beza o cuello. Disparada generalmente por un procedimiento odon-tológico invasivo, una infección dental preexistente o un traumatismode la mucosa por prótesis desadaptadas, y puede generar gravessecuelas bucales. Por ello, el odontólogo es responsable de la pre-vención y tratamiento de la osteonecrosis de los maxilares asociadosa medicamentos. Esta enfermedad está condicionada por factoressistémicos y locales, y el odontólogo debe reconocerlos para estimarel riesgo del paciente. Los criterios para la indicación y realizaciónde los procedimientos odontológicos deben ser adaptados deacuerdo con el riesgo del paciente. El objetivo de esta revisión na-rrativa es aclarar algunos de los interrogantes más frecuentes sobre medicamentos, a la luz de las investigaciones más recientes.Medication-related osteonecrosis of the jaws is an adverse effect attributable to the administration of antiresorptive and antiangiogenic drugs, eventually severe, characterized by necrosis and subsequent exposure of the bone in the maxillofacial region, despite the lack of a history of radiation treatment on head or neck. It is generally triggered by an invasive dental procedure, a pre-existing dental infection or mucosal trauma due to ill-fitting dentures, and it can produce serious oral sequelae. Therefore, the dentist is responsible for the prevention and treatment of medication-related osteonecrosis of the jaws. This disease is conditioned by systemic and local factors, and the dentist should recognize them to assess the patient’s risk. The criteria for the indication and performance of dental procedures should be adapted according to the patient’s risk. The aim of this narrative review is to clarify some of the most frequent questions about the role of the dentist in medication-related osteonecrosis of the jaws in light of the most recent research.info:eu-repo/semantics/publishedVersionFil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.Fil: Gilligan, Gerardo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.Fil: Panico, René Luis. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología “A”; Argentina.Odontología, Medicina y Cirugía Ora

Clinical and Immunohistochemical epithelial profile of non-healing chronic traumatic ulcers

Background: Chronic wounds were previously related to cancer. Chronic Traumatic Ulcers (CTU) are lesions caused by chronic mechanical irritation (CMI) frequently diagnosed in Oral Medicine. Although these conditions may re-flect a benign nature, some authors have proposed its relationship with malignant transformation. Currently, there are scarce investigations that evaluate biomarkers within CTU. The aim of this study was to evaluate cell differentiation and proliferation biomarkers patterns of CTU and OSCC through recognized markers such as cytokeratin 19 and Ki67 and correlate it with clinical features of both groups of patients. Material and Methods: A Cross-sectional study of adult patients (n=79), both sexes, attended at Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba. The patients were classified into two groups: CTU (n=41), and OSCC (n=38). A subset of specimens were immunolabeled with Ki67 and Ck19. Results: The population consisted of 51.9% male and 48.1% female, with an average of 57.0 ± 13.9. years (OSCC group) and 60.9 ± 14.9 years (CTU group). OSCC group presented higher scores for both biomarkers (Ki67 and Ck19), but only there were differences statistically significant for Ki67 (p=0.032). 25% of non-healing CTU were positive with medium scores of Ck19 and showed an immunohistochemical profile similar to OSCC. The lateral tongue was the most frequent site in both groups. Conclusion: The altered immunohistochemical pattern found in many specimens of CTU was also observed in OSCC. The tongue border presents physiological conditions that could offer a suitable environment for the development of neoplastic events associated with CMI. Further studies are needed to understand the underlying mechanisms that could link oral non-healing ulcers with early malignant changes.publishedVersionFil: Gilligan, Gerardo Marcelo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Panico, René. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Di Tada, Cecilia. Fundación para el Progreso de la Medicina. Laboratorio de Inmunohistoquímica; ArgentinaFil: Piemonte, Eduardo. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Medicina Oral; Argentina.Fil: Brunotto, Mabel Noemí. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal; Argentina

Oral carcinogenesis biomarkers in Oral Chronic Mechanical Irritation-associated lesions

Previous works of our team had shown clinical data which suggest that Chronic Mechanical Irritation (CMI) could be a risk factor for Oral Cancer (OC). However, there are no known patterns of biomarkers in CMI indicative of cellular malignancy. The aim of this study was to identify a biomarker pattern of differentiation (Ck19) and cell proliferation (Ki67) in CMI-associated lesions, similar to those observed in OC. Methods: a Cross-sectional study of adult patients (n = 61), both sexes, with lesions associated with CMI according to the Piemonte et al criteria. CK19 and Ki67 Immunohistochemistry were carried out in biopsies of both types of lesions and the patterns were described according to previous publications of Safadi and Argyris. The present study was approved by Ethics Committee of the College of Dentistry, Universidad Nacional de Cordoba. Results: Ki67 overexpression and a CK19 focal pattern with strong intensity in basal and parabasal cells were observed in CMI lesions, similar to that observed in OC. Conclusion: there is no scientific literature on biomarker patterns of Oral CMI. Therefore, the described pattern, particularly Ck19, is novel and could be indicative of the relationship between the presence of CMI and oral carcinogenesis.Fil: Gilligan, Gerardo Marcelo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Panico, René Luis. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Di Tada, Cecilia E. Fundación para el progreso de la Medicina; Argentina.Fil: Di Tada, Cecilia E.. Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones en Química Biológica; Argentina.Fil: Brunotto, Mabel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra Biología Celular A; Argentina.Otras Ciencias de la Salu

Multifactorial risk index for oral cancer

Groups of 53 patients with oral cancer and 100 controls who were attended at the Dentistry College (Córdoba, Argentina) between 2009 and 2013 were examined by trained professionals. Age, gender, body mass index, smoking, involuntary smoking, alcohol consumption, hot beverages, chronic mechanical irritation of the oral mucosa, oral potentially malignant disorders, oral candidiasis, human papillomavirus, tooth loss, illfitting dentures, diet, environmental carcinogens, arsenic in drinking water, and cancer family history were recorded. Model 1 (M1) was built with statistically significant variables, Model 2 (M2) was built with statistically significant variables not acquired through clinical examination; both were analyzed with a c2 test. Model 3 (M3) was built with statistically significant variables through multivariate logistic regression analysis. For each variable a value of a whole number corresponding to the OR was assigned. Also, for each individual a total value was obtained by the sum of registered variables. The sample was split into 2 groups according to the median of total value, which were analyzed with a c2 test.http://www.sciencedirect.com/science/article/pii/S2212440314001527Fil: Piemonte, Eduardo David. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Castillo, Graciela del Valle. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra Química Biológica B; Argentina.Fil: Belardinelli, Paola Alejandra. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología B; Argentina.Fil: Brunotto, Mabel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra Biología Celular A; Argentina.Fil: Lazos, Jerónimo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Secchi, Dante Gustavo. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Talavera, Angel Daniel. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Estomatología A; Argentina.Fil: Lanfranchi Tizeira, Héctor Eduardo. Universidad de Buenos Aires. Facultad de Odontología; Argentina.Otras Ciencias de la Salu