Stomatology Service Research Articles

Dental care for children in a Tertiary Hospital

Aim: To evaluate the profile of pediatric onco-hematological patients and the outpatient dental care provided to these individuals from January 2016 to December 2019 by the Pediatric Dentistry division of the Dentistry and Stomatology Service of a tertiary hospital. Methods: Data were collected from the medical records of 179 pediatric patients undergoing treatment for onco-hematological diseases, aged between 0 and 19 years, regarding their profile and the outpatient dental care provided by the Pediatric Dentistry Service of the Dentistry and Stomatology Service of a tertiary hospital. Data were tabulated and subjected to descriptive statistical analysis. Results: The majority of the patients were male, with a mean age of 12. Anemia and leukemia were the most prevalent diseases in this study. During the evaluation period, 1548 dental appointments were performed, 696 of which were clinical evaluations. The remaining appointments involved various dental procedures. The most common procedures included the topical application of fluoride and dental prophylaxis, followed by extractions, laser therapy, tooth decay removal, and restorations/sealants. Conclusion: Assessing patient profiles and the dental care provided are important tools for improving dental care protocols and enhancing the quality of life for pediatric onco-hematological patients.

Demographic and stomatological profiles of pacientes at the Instituto de Saúde de Nova Friburgo

Epidemiological studies are essential, since through them it is possible to formulate a clinical profile, to determine the prevalence and incidence of lesions, as well as characterizing particularities specific to the environment where such tasks are performed. Objective: To perform an epidemiological survey of the main oral lesions diagnosed at the Stomatology Outpatient Clinic of the Instituto de Saúde de Nova Friburgo ISNF/UFF, drawing a demographic and clinical profile. Material and methods: A retrospective and observational study, conducted with data collection in the medical records of patients treated at the stomatology service in 2018. The information collected were gender, skin color, age, locality, occupation, income, schooling, and oral injury. Results: Data were collected from 150 patients, 93 (62%) women, 79 (53%) white, aged between 2 and 94 years, mean age of 53 years, 124 (83%) from the downtown of Nova Friburgo, 32 (21%) retired, 30 (22%) received a minimum wage and 42 (28%) incomplete middle school. Regarding oral lesions, 38 (25%) patients had actinic cheilitis, 18 (12%) prosthetic stomatitis and 5 (3%) oral cancer. Conclusion: Middle-aged women sought the outpatient clinic more frequently, and some lesions, if diagnosed early, especially actinic cheilitis, may prevent oral cancer.

Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study.

There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics. A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained. A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%). Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations.

Congenital granular cell tumor: an unusual case report

Congenital granular cell tumor is an uncommon benign oral lesion of uncertain histogenesis that affects the alveolar ridge region of newborns. The present study aims to report an unusual congenital granular cell tumor case, emphasizing clinical, morphological, and immunohistochemical aspects. A 10-day-old newborn patient attended the stomatology service with a nodular pedunculated lesion of normal color located in the anterior region of the superior alveolar ridge. Thus, the diagnostic hypothesis was congenital epulis, and an excisional biopsy was performed. Histopathological analysis revealed features consistent with the diagnosis of congenital granular cell tumor. In addition, we performed immunohistochemical staining for vimentin, Ki-67, and S100. The patient has been under follow-up with no clinical signs of recurrence. Due to its rarity, the analysis of congenital granular cell tumor’s clinicopathological characteristics enables an adequate diagnosis and treatment.

ORAL MANIFESTATIONS OF SYPHILIS: AN EPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL

<h3>Objectives</h3> This study is an epidemiologic survey of cases of syphilis diagnosed from oral manifestations. <h3>Study Design</h3> The medical records of patients with oral lesions of syphilis treated at a stomatology service in southern Brazil were reviewed. <h3>Results</h3> A total of 109 cases were selected in which there was laboratory confirmation. The mean age of the patients was 34.4 years and, of these, 51% were men. In 105 cases, the disease was diagnosed in the secondary stage; in 3 cases, the disease was in the primary stage and, in 1 case, in the tertiary stage. The 3 cases of primary syphilis presented as single and ulcerated nodules and the case of tertiary syphilis as a necrotic lesion in the palate. In 86% of cases of secondary syphilis there were multicentric oral lesions, with the labial mucosa and the tongue being most affected. In most cases these lesions presented as grayish-white plaques (85%), associated or not with erosive and/or ulcerated lesions (33%). In 91.7% of cases painful symptoms were reported. <h3>Conclusions</h3> Considering the significant increase of syphilis incidence, dentists should recognize its oral manifestations because early diagnosis can minimize the risks of complications and transmission.

SUBMANDIBULAR SALIVARY GLAND SIALOLOGY: CASE REPORT

The objective of this study is to report the case of a 63-year-old dark-skinned male patient who attended the stomatology service reporting,:I feel something under my tongue." On extraoral examination, there was nothing worthy of noting. Intraoral examination showed a nodular lesion, located on the floor of the mouth on the right side, extending from canine area up to the second premolar, with a normal color and hard consistency, measuring 2.3 × 1.8 × 0.5 cm, without painful symptoms. The clinical hypothesis was sialolithiasis. A complementary imaging exam, occlusal x-ray, was requested, and a radiopacity compatible with a calcified mass was observed. After surgical removal by means of an excisional biopsy, histopathologic sections revealed fragments of amorphous eosinophilic material showing lines of concentric calcifications, confirming the clinical and imaging diagnosis of sialolithiasis. This case reinforces the importance of the stomatologist in elucidating the correct diagnosis of pathologies of salivary glands to guide conservative treatment.

PLEOMORPHIC ADENOMA IN PALATE: CASE REPORT

The objective of this work is to report the case of a 45-year-old dark-skinned female patient with the presence of an injury for 10 years and without treatment who attended the stomatology service with the main complaint of a "lump in the mouth." On intraoral examination, a nodular lesion on the hard palate was noted, with a normal color and with reddish spots in the center, a smooth, oval surface with a sessile base, sharp edges, and firm consistency, measuring 0.8 × 0.8 × 0.5 cm. The clinical hypothesis was pleomorphic adenoma (AP). An incisional biopsy was performed, and histopathologic sections revealed a benign neoplasm derived from the salivary gland. The patient was submitted to complete removal of the lesion after confirmation of the anatomopathologic diagnosis of AP. This case reinforces the importance of the stomatologist in elucidating the diagnosis of neoplasms in salivary glands as well as directing the conservative treatment.

ORAL MELANOTIC MACULA: CASE REPORT

The oral melanotic macula is a color change of the mucosa by the focal increase in melanin and melanocytes. The objective of this work is to report the case of a 46-year-old female patient, with an 8-month evolution of a black lesion in the labial region. The patient presented to the stomatology service complaining about "a stain on her lip." On extraoral examination, a single brown macula, uniformly pigmented in the vermillion of the lower lip, noninfiltrating, smooth surface, and measuring 1.4 × 0.9 cm, was observed. On intraoral examination, there was nothing worth noting. The clinical diagnosis was a labial melanotic macula. An excisional biopsy was performed and the histologic sections stained in hematoxylin and eosin revealed areas of pigmentary incontinence of probable inflammatory cause, confirming the oral melanotic macula diagnosis. It is important that pigmented lesions are biopsied to eliminate the possibility of malignant lesion.

MANDIBULAR OSTEORADIONECROSIS IN A PATIENT SUBJECTED TO ONCOLOGICAL TREATMENT: CASE REPORT

This case report is about a 61-year-old brown-skinned male patient who underwent cancer treatment 7 years ago and attended the stomatology service reporting "a yellowish mass in the jaw." On intraoral examination, in the region of the alveolar ridge on the right side the presence of a single, yellowish mass was observed, exposed through the loss of integrity of the alveolar mucosa compatible with bone sequestration. The clinical hypothesis was osteoradionecrosis. The patient was referred for hyperbaric oxygenation and, shortly after the configuration of this step, he was reassessed and directed to the buccomaxillofacial surgeon. An excisional biopsy was performed, which resulted in fragments of compact bone tissue with areas of necrosis and bacterial colonies. The patient is undergoing clinical follow-up and imaging examination. This case reinforces the importance of the stomatologist in elucidating the diagnosis and directing treatment, maintaining quality of life for the patient.

A 3CM PYOGENIC GRANULOMA ON THE LINGUAL DORSUM OF A YOUNG PATIENT: A CASE REPORT

An 11-year-old female patient arrived at the stomatology service of an educational institution reporting that, initially, “a small protuberance like a wart appeared in the tip of her tongue” and that a dentist prescribed metronidazole. The lesion shrank, but around 1 week later it began to grow rapidly again, reaching great proportions. The patient reported being healthy with no allergies, no use of medication, and no morbid personal and family history. Extraoral examination revealed no facial or lymph node elevations. Intraoral physical examination found a lesion on the anterior dorsum of the tongue, measuring approximately 3.0 cm × 2.0 cm, single, nodular, lobulated, pedicular, pink with white dots, softened and with spontaneous bleeding. The diagnostic hypothesis was pyogenic granuloma with indication for excisional biopsy, which was performed the following week and the histopathologic report confirmed the diagnostic. The patient was followed for 4 months without recurrence. An 11-year-old female patient arrived at the stomatology service of an educational institution reporting that, initially, “a small protuberance like a wart appeared in the tip of her tongue” and that a dentist prescribed metronidazole. The lesion shrank, but around 1 week later it began to grow rapidly again, reaching great proportions. The patient reported being healthy with no allergies, no use of medication, and no morbid personal and family history. Extraoral examination revealed no facial or lymph node elevations. Intraoral physical examination found a lesion on the anterior dorsum of the tongue, measuring approximately 3.0 cm × 2.0 cm, single, nodular, lobulated, pedicular, pink with white dots, softened and with spontaneous bleeding. The diagnostic hypothesis was pyogenic granuloma with indication for excisional biopsy, which was performed the following week and the histopathologic report confirmed the diagnostic. The patient was followed for 4 months without recurrence.

VERRUCOUS CARCINOMA IN DORSAL REGION OF THE TONGUE: CASE REPORT

Verrucous carcinoma (VC) is a clinical-histopathologic variant of squamous cell carcinoma. The objective of this work is to report a clinical case of a 39-year-old brown-skinned male patient with an injury 10 years ago who sought the stomatology service complaining of "white spot on the tongue." During the anamnesis, the patient reported being a smoker for 20 years. On intraoral examination, a white plaque was noted on the dorsal region of the tongue, with a white color, sharp edges, firm consistency, and warty surface, measuring 3.0 × 2.0 cm. The clinical hypothesis was verrucous leukoplakia. An incisional biopsy was performed, and histopathologic sections revealed areas of epithelial neoplasia with keratin formation that invaded the lamina propria with minimally invasive VC compatibility. The patient was referred to the oncologist. This case reinforces the importance of the stomatologist in the elucidation of cases with potential for malignancy and in the direction of treatment.

DENTIGEROUS CYST: CASE REPORT

The dentigerous cyst is common among odontogenic cysts. The objective is to report the case of a dentigerous cyst submitted to marsupialization to minimize damage to adjacent structures after total enucleation. A 14-year-old male patient arrived at the stomatology service reporting a nodule in the region of tooth 12 3 months ago. On intraoral examination, a nodule was noted, infiltrative, normochromic and violet, unique, with sharp limits, spherical shape, smooth surface, soft consistency, fixed, and tender, measuring 2 × 3 × 1.5 cm. Computed tomography revealed a well-defined, hypodense lesion with a hyperdense halo surrounding tooth 12. Incisional biopsy was performed with marsupialization of the lesion. Histopathology revealed a lesion of the cystic cavity, covered by a stratified squamous epithelium, which was not keratinized. After 3 months the lesion decreased and the patient was referred for enucleation of the lesion. The dentigerous cyst is common among odontogenic cysts. The objective is to report the case of a dentigerous cyst submitted to marsupialization to minimize damage to adjacent structures after total enucleation. A 14-year-old male patient arrived at the stomatology service reporting a nodule in the region of tooth 12 3 months ago. On intraoral examination, a nodule was noted, infiltrative, normochromic and violet, unique, with sharp limits, spherical shape, smooth surface, soft consistency, fixed, and tender, measuring 2 × 3 × 1.5 cm. Computed tomography revealed a well-defined, hypodense lesion with a hyperdense halo surrounding tooth 12. Incisional biopsy was performed with marsupialization of the lesion. Histopathology revealed a lesion of the cystic cavity, covered by a stratified squamous epithelium, which was not keratinized. After 3 months the lesion decreased and the patient was referred for enucleation of the lesion.

EPIDERMOID CARCINOMA—CLEAR CELL VARIANT: CASE REPORT

The aim of this study is to report the case of a 75-year-old dark-skinned male patient symptomatic lesion in the region of the alveolar ridge with extension to the oral floor with a 4-month evolution who attended the stomatology service reporting "to see the wound." On extraoral examination, palpable lymph nodes in the submandibular region were noted. On intraoral examination, a tumor lesion, reddish, in the lower anterior alveolar ridge with infiltration to the oral floor, an ulcerated surface, firm consistency, and diffuse limits was noted. The clinical diagnosis was squamous cell carcinoma. An incisional biopsy was performed, and histopathologic analysis of the specimens showed the absence of tumor emboli in lymphatic vessels and of perineural invasion. Periodic acid-Schiff stains showed diastasis-resistant positivity and immunohistochemical reactions were positive for AE1/AE3 and p63 but negative for a-smooth muscle actin, confirming squamous cell carcinoma clear cell variant. The patient was referred to the oncologist.

ORAL PLASMABLASTIC LYMPHOMA DIAGNOSIS AND TREATMENT FOLLOW-UP: CASE REPORT

Plasmablastic lymphoma (PBL) is a rare variant of large diffuse B-cell non–Hodgkin lymphoma with predilection for extranodal localization in the oral cavity. A 43-year-old HIV-positive female patient attended a stomatology service for evaluation of a painful oral mass with 6 months of duration. At the extraoral examination, swelling in the left hemiface and facial increased lymph nodes were present. Intraorally, a purplish red exophytic sessile nodule presenting indefinite borders and an ulcerated surface was found. Areas of necrosis were observed at the upper alveolar ridge, palate, and left buccal mucosa, and adjacent teeth were mobile. The clinical impression was a malignant neoplasm, and the patient was submitted to an incisional biopsy. The histopathologic and immunohistochemistry were consistent with a PBL. The patient was referred to the hematologic service and submitted to DA-EPOCH chemotherapy. After 3 months of follow-up consultations, partial remission of the lesion without considerable systemic or oral intercurrences was observed.

SQUAMOUS CELL CARCINOMA OF THE MAXILLARY SINUS: CASE REPORT

A 66-year-old, dark-skinned female patient attended the stomatology service due to the presence of a tumoral lesion in the sinuses on the right side with a 4-month evolution. She had painful symptoms, nasal congestion, and discharge. The patient was neither a smoker nor an alcoholic. Clinically, the extraoral examination revealed an expressive facial asymmetry, firm palpation, and the presence of yellowish discharge draining. Intraorally, there was an increase in volume in the vestibule mucosa, with its erasure and firm consistency. A cone beam computed tomography was requested and showed aggressive, irregular growth with resorption of the cortical cortex of the maxillary sinus and invasion maxillary sinus. Therefore, an incisional biopsy was performed. The anatomopathologic examination revealed a squamous cell carcinoma. The patient was referred to the oncology service and was being treated with radiotherapy due to the impossibility of surgical resection, but 9 months after the diagnosis, the patient died.

AMPUTATION NEUROMA IN THE REGION OF THE LOWER LIP MUCOSA: CASE REPORT

Amputation neuroma (NA) represents a reactive proliferation of neural tissue in an attempt to repair a nervous bundle traumatized by an accident or during surgical maneuvers. We report the case of a 65-year-old Black female patient with an injury that arose after a car accident 20 years ago. The patient attended the stomatology service reporting a "puff on the lip." Upon intraoral examination, 2 nodular lesions in the region of the lower lip mucosa were noted, measuring 0.3 × 0.3 × 0.3 cm and 0.5 × 0.5 × 0.5 cm, with normal sharp limits, normal, fixed consistency, smooth and painless surface. The clinical hypothesis was hyperplasia caused by trauma. Excisional biopsy was performed and histopathologic sections revealed stratified keratinized squamous epithelium and the lamina propria, presenting a discrete chronic inflammatory infiltrate with hyperplastic vessels and neural bundles, confirming NA. This case reinforces the importance of the stomatologist in elucidating the diagnosis of lesions in the oral cavity caused by accidents.

BENIGN SMALL TUMOR OF THE MINOR SALIVARY GLAND—PLEOMORPHIC ADENOMA: CASE REPORT

The aim of this study is to report the case of a 55-year-old dark-skinned male patient, with a 20-year history of drinking, who attended the stomatology service with the main complaint of a "mass in the roof of the mouth" with an evolution of 1 month. On extraoral examination, no changes were observed. On intraoral examination, a single nodular lesion with red coloration, smooth surface with an angiogenesis aspect was observed, without sensitivity, located on the soft palate, measuring 1.5 cm × 1.5 cm × 0.5 cm. The suggestive clinical diagnoses were pleomorphic adenoma (AP) and adenocarcinoma. An incisional biopsy was performed, and histologic sections stained in hematoxylin and eosin revealed benign salivary gland neoplasia, confirming the hypothesis of AP. The patient was referred to the maxillofacial surgeon for treatment. This case reinforces the importance of the stomatologist in elucidating cases of neoplasms in salivary glands with clinical presentation suggestive of malignancy as well as in directing the treatment.

GRANULAR CELL TUMOR: CASE REPORT

The granular cell tumor is a benign soft tissue neoplasm, considered an unusual pathology. The aim of this study is to report the case of a 43-year-old brown-skinned female patient who attended the stomatology service reporting “a lump on her tongue.” In the history of the current disease, the patient reported a 6-month-old lesion with swelling and painlessness. On intraoral examination, a submucosal nodule on the dorsum of tongue, with a smooth surface, yellowish color, sharp boundaries, oval and firm consistency, unique and measuring 0.5 × 0.5 × 0.2 cm, was observed. An excisional biopsy was performed with clinical suspicion of granular cell tumor, a neoplasm of mesenchymal origin composed of granular cells, histologically confirmed by hematoxylin and eosin,. The patient is being followed up and has no sign of recurrence. This case reinforces the importance of the stomatologist in elucidating the diagnosis of submucosal lesions in the oral cavity, which should be biopsied to eliminate the possibility of malignant nature. The granular cell tumor is a benign soft tissue neoplasm, considered an unusual pathology. The aim of this study is to report the case of a 43-year-old brown-skinned female patient who attended the stomatology service reporting “a lump on her tongue.” In the history of the current disease, the patient reported a 6-month-old lesion with swelling and painlessness. On intraoral examination, a submucosal nodule on the dorsum of tongue, with a smooth surface, yellowish color, sharp boundaries, oval and firm consistency, unique and measuring 0.5 × 0.5 × 0.2 cm, was observed. An excisional biopsy was performed with clinical suspicion of granular cell tumor, a neoplasm of mesenchymal origin composed of granular cells, histologically confirmed by hematoxylin and eosin,. The patient is being followed up and has no sign of recurrence. This case reinforces the importance of the stomatologist in elucidating the diagnosis of submucosal lesions in the oral cavity, which should be biopsied to eliminate the possibility of malignant nature.

SEBACEOUS CARCINOMA IN RETROMOLAR REGION: CASE REPORT

Sebaceous carcinoma is a rare malignant tumor derived from the adnexal epithelium of the sebaceous glands. A 58-year-old White male patient attended the stomatology service complaining about a "lump near the third molar." In the history of the current disease, the patient reported a lesion that appeared approximately 6 months ago and with painful symptoms. Intraoral examination showed a single erythematous tumor in the retromolar region with a smooth surface and ulcerated areas, diffuse borders, irregular, firm, fixed with an infiltrative characteristic, tender, and measuring 2.5 × 2.0 × 1.0 cm. An incisional biopsy was performed with clinical suspicion of squamous cell carcinoma. The histologic sections stained in hematoxylin-eosin and the immunohistochemical reaction showed positivity for epithelial membrane antigen, highlighting the vesicular pattern of the tumor cell cytoplasm. The final result was compatible with sebaceous carcinoma. The patient was referred to the oncology sector and is waiting for cancer treatment.

UNUSUAL ORAL MANIFESTATION OF PARACOCCIDIOIDOMYCOSIS MIMICKING ORAL SYPHILIS

A 38-year-old White man, rural dweller, presented to the stomatology service reporting a painful nodule with ulcerated areas in the buccal mucosa on the right side extending to the upper and lower lips about 1 year ago. He reported mouth opening limitation and difficulty eating. Facial asymmetry was also noticed in the extraoral examination. Some oral infectious diseases were considered as diagnostic hypotheses. Laboratory exams and partial biopsy were conducted. Serological tests were compatible with syphilis and microscopic features were inconclusive. Treatment with penicillin G benzathine intramuscular and dipyrone was prescribed. The patient returned 3 months later for follow-up examination without regression of signs and symptoms. A new biopsy was performed, and microscopic features confirmed oral paracoccidioidomycosis. The patient was referred to an infectologist and pneumologist. Treatment with itraconazole 100 mg was performed. Partial remission of oral lesions was observed after 2 months.