Pleomorphic adenoma (PA) is the most common benign neoplasm of the salivary glands, occurring in both major and minor glands, with a predilection for the intraoral palate. Its presentation in the upper lip is rare and, when large, may result in facial deformity, alveolar bone resorption, and tooth displacement, especially in long-standing lesions. Clinically, PA presents as a solid, painless, slow-growing, and well-circumscribed mass, which may cause functional morbidity depending on its size and location. The differential diagnosis includes canalicular adenoma, other benign minor salivary gland neoplasms, mesenchymal tumors (lipoma, fibroma, neurofibroma, schwannoma, and hemangioma), and cystic lesions (mucocele, dermoid cyst, and epidermoid cyst). Distinguishing among these entities requires a detailed clinical evaluation, imaging studies, and histopathological confirmation, often complemented by immunohistochemistry. Complete excisional biopsy with adequate margins remains the treatment of choice, providing an excellent prognosis and reducing the risk of recurrence or malignant transformation. This report describes an uncommon case of large PA of the upper lip, associated with alveolar bone loss and tooth displacement, highlighting the importance of early diagnosis and appropriate surgical management.

To report a multifocal case of paracoccidioidomycosis (PCM) with oral, pulmonary, and adrenal involvement, highlighting diagnostic challenges and the role of dental professionals in early detection. A 50-year-old Brazilian man, smoker, and alcohol user presented with oral ulcers, weight loss, and respiratory symptoms. Clinical, histopathological, and imaging analyses confirmed PCM by Paracoccidioides brasiliensis with pulmonary and adrenal dissemination. Treatment included liposomal amphotericin B, hydrocortisone replacement, and photodynamic therapy (PDT) for oral lesions, followed by sulfamethoxazole-trimethoprim maintenance. Combined therapy led to resolution of oral and cutaneous lesions, respiratory improvement, and adrenal stabilization. After 10 months, the patient showed weight gain and no recurrence. Despite Brazil’s high PCM prevalence, delayed diagnosis remains common due to non-mandatory reporting and limited professional awareness. Oral manifestations preceded systemic symptoms, emphasizing the dentist’s role in early diagnosis. PCM is an underdiagnosed systemic mycosis with potentially severe outcomes. Recognition of oral lesions as early indicators enables timely intervention and prevents systemic complications. Strengthening awareness among dental and medical professionals, along with improved epidemiological surveillance, is essential to enhance prognosis and reduce morbidity.

Rendu-Osler-Weber syndrome, also known as hereditary hemorrhagic telangiectasia (HHT), is an autosomal dominant disorder affecting approximately 2 individuals per 100,000 inhabitants. The diagnosis of HHT is frequently delayed due to asymptomatic presentation and a lack of awareness among healthcare professionals. The case described herein involves a 41-year-old male patient who sought attention to elucidate multiple purple lesions on his oral cavity. Despite previous consultations with various healthcare providers, a definitive diagnosis remained elusive. The patient reported frequent nosebleeds, episodes of anemia, and symptoms of depression. Notably, his mother had succumbed to a vascular accident, exhibiting a similar oral clinical presentation. Upon clinical examination, multiple erythematous punctate macules were observed on the lips and tongue, which blanched under pressure. Similar lesions were also noted on the fingertips. The diagnosis was established based on clinical findings, and the patient was advised to seek ongoing medical care for appropriate follow-up and management.

Oral rhabdomyomas are rare benign neoplasms that primarily affect male adults over the age of 50. A 53-year-old male presented with a 2-year asymptomatic mouth floor swelling, recently causing food ingestion and speech difficulties. Intraoral examination revealed a fibrous swelling, slightly larger on the left, smooth with no color change or tenderness. No triggering factors were reported, and the patient had no history of smoking, alcohol use, or systemic health issues. Dermoid or epidermoid cysts were ruled out via aspiration puncture. An incisional biopsy was performed with a differential diagnosis of salivary gland neoplasm versus leiomyoma. The microscopical study confirmed rhabdomyoma diagnosis, showing polygonal neoplastic cells with vacuolated and granular cytoplasm. The neoplastic cells tested positive for PAS and showed strong positivity for HHF35 and desmin, while they were negative for S100 and smooth muscle actin. Surgical removal was performed, and the patient is living well with no recurrence.

AIMS:The aim of this study is to characterize the clinical and microscopic features of recurrent oral/labial HSV-1 infection with unusual clinical presentations. METHODS:A literature review and retrospective case series of patients with recurrent oral/labial HSV-1 with unusual presentations were conducted. Data were collected from medical records, and all cases were confirmed by histopathology and immunohistochemistry. RESULTS:Eight patients (five males, 62.5%; three females, 37.5%) with a mean age of 61.8 years presented with unusual HSV-1 manifestations, including solitary lesions, white plaque-like appearance, non-keratinized site involvement, or prolonged duration. Lesions involved the tongue border (n = 4, 50%), anterior ventral tongue, hard palate, posterior ridge crest, and lower lip (n = 1, 12.5% each). Presented as well-demarcated solitary ulcers (n = 6, 75%), solitary papule (n = 1, 12.5%), and whitish plaque-like lesions (n = 1, 12.5%). Only two patients were immunosuppressed. All cases responded successfully to management, including pharmacotherapy, surgical excision, or photobiomodulation. Unusual clinical presentations of oral/labial HSV-1 infection are scarcely reported in the literature. CONCLUSION:Unusual HSV-1 manifestations can occur in immunocompetent individuals; however, exclusion of undiagnosed immunosuppression remains necessary. A definitive diagnosis relies on careful histopathological evaluation of ulcer edges, which is crucial for guiding appropriate treatment. Further documentation of similar cases is essential to reinforce that these unusual presentations can indeed affect immunocompetent patients.

Odontogenic cysts are defined as those cysts that arise from odontogenic epithelium and occur in the jaws. The most common treatments for this pathology are cystectomy and bone resection or with assistant techniques that are called marsupialization or decompression. The aim of decompression is to reduce the size of the cysts with a device that keeps open the cysts to reduce the osmotic pressure inside the cyst and promote a safer second surgery. Here we described a case of decompression of a large radicular cyst in maxilla using a customized device printed in a 3D printer, with the aim to increase comfortable for the patient during the period of decompression of Odontogenic Cysts. The period of this decompression was 6 months. This case illustrates a new technique with an alternative device for decompression of Odontogenic Cysts.

Mucocele is the most common minor salivary gland benign disorder in the oral cavity. Different techniques to treat mucoceles have been presented and the conventional surgical approaches, such as excision and marsupialization, may present challenges related to bleeding and surgery duration. This paper reports highlighting its advantages in soft tissue stabilization and hemostasis. Three patients with oral mucoceles in the lower lip underwent excision using the chalazion clamp. This tool facilitated the tissue stabilization, effective hemostasis and reduced the surgical time. None of the patients reported postoperative paresthesia, and no lesion recurrences were observed during the follow-up periods, which ranged from one to five years. The chalazion clamp, commonly used in ophthalmology, provides compression and stabilization, minimizing intraoperative bleeding and improving the surgical precision because it clearly defines the area of the surgery. Its use in mucocele excision allowed selective removal of the minor salivary glands while eliminating the need for an additional assistant. The clamp also enhanced surgical visibility and control, leading to improved outcomes. The application of clamp in mucocele surgery presents a promising, cost-effective alternative which enhances procedural efficiency and patient safety.

OBJECTIVE:To evaluate the efficacy of topical tacrolimus offered on a custom tray to treat desquamative gingivitis (DG).STUDY DESIGN:Eighteen patients with symptomatic DG related to oral lichen planus (OLP) or mucous membrane pemphigoid (MMP) were selected, of which 13 completed the study. Periodontal treatment was followed by the fabrication of a custom silicone tray to apply a tacrolimus gel formulation (0.1%). Clinical evaluation (complaint of pain and burning - visual analog scale from 0 to 10; and the presence of erythema, desquamation, vesicle/blister, erosion, ulcer, and bleeding) was performed by the same examiner on day 1, and every 15 days for 90 days.RESULTS:Total remission was found in 4 patients (30.76%). Partial remission was found in 69.24% of the patients, classified with an excellent (30.76%), good (30.76%), and regular (7.69%) recovery, respectively. There was a reduction of about 60% in pain and 65% in burning sensation complaints. Wilcoxon test revealed significant differences between pre- and post-treatment pain and burning sensation symptoms (P < .01).CONCLUSION:Topical application of 0.1% tacrolimus gel was effective in the treatment of DG in controlling pain and burning sensation, leading to the clinical remission of gingival lesions in patients with OLP and MMP.

Paracoccidioidomycosis is a systemic fungal infection first described in Brazil by Adolf Lutz in 1908. In this report, we present a case involving a 50-year-old male patient who had ulcerated oral cavity lesions persisting for five years. Additionally, he exhibited crusty lesions in the perioral and glabella regions, local lymphadenopathy, trismus, dry cough, and a recent weight loss of 13kg. An incisional biopsy revealed a chronic granulomatous inflammatory process with multinucleated giant cells and numerous fungal yeast. The patient was subsequently referred to a hospital, where he was diagnosed with multifocal paracoccidioidomycosis affecting the oral mucosa, skin, lungs, and adrenal glands. Treatment consisted of liposomal amphotericin B and hydrocortisone for 20 days. Following his hospital discharge, he continued treatment with hydrocortisone and Bactrim, resulting in a regression of the lesions and a weight gain of more than 14kg over the past ten months. He is currently under ongoing monitoring. This case underscores the essential role of dentists in diagnosing systemic diseases, which can aid in avoiding delays in receiving timely treatment.

Histoplasma capsulatum, the causative agent of histoplasmosis, is an uncommon systemic fungal illness that represents significant health risks to people living with HIV/AIDS (PLHV), especially those who are residents in endemic regions like Brazil. While oral histoplasmosis is rare, this observation can serve as a significant indicator of compromised immunological state, particularly in those with low numbers of TCD4+ cells. This study intends to examine recent literature on oral histoplasmosis and to provide a case of oral manifestations as the first indication of disseminated histoplasmosis in a young woman recently diagnosed with HIV.

PURPOSE:This systematic review aimed to determine the effects of maternal exposure to bisphosphonates (BPs) during pregnancy on neonatal outcomes. It aimed to disclosfe the impact of BPs on neonates and identify aspects that require further investigation. METHODS:A comprehensive search of PubMed, Science Direct, LILACS, EMBASE, and Web of Science was conducted until August 2022, with no time restrictions. The selection criteria included studies published in English that evaluated pregnant women who were exposed to BPs. RESULTS:From an initial pool of 2169 studies, 13 met the inclusion criteria for this systematic review. These studies collectively included 106 women (108 pregnancies) who were exposed to BPs either before orduring pregnancy. A summary of the key characteristics of the selected studies and the risk of bias assessment are provided. Exposure to BPs occurs at various stages of pregnancy, with different indications for BP treatment. The most frequently reported neonatal outcomes were spontaneous abortion, congenital malformations, hypocalcemia, preterm birth, and low birth weight. CONCLUSION:Although previous reports have linked BPs before or during pregnancy with adverse neonatal outcomes, these associations should be interpreted with caution. Given the complexity of these findings, further research is necessary to provide more definitive insights to guide clinical decisions regarding the use of BPs in pregnant women.

A 65-year-old male patient with dark skin visited the Oral Diagnosis Clinic, complaining of a maxillary lesion that had persisted for 13 years. The intraoral examination revealed a slight 3-cm vestibular swelling on the right maxilla, covered by normal oral mucosa. Cone-beam tomography unveiled a multilocular radiolucent lesion affecting the maxilla bilaterally. An incisional biopsy was performed with the initial suspicion of odontogenic myxoma, and the histological examination revealed vascular spaces of varying diameters associated with hemorrhagic areas in dense connective tissue, leading to the diagnosis of intraosseous hemangioma. The patient was referred for oral rehabilitation and is currently under regular follow-up. Intraosseous hemangiomas within the jaw bones are uncommon and typically tend to be diagnosed in the posterior mandible of young women. In this case, the biopsy was crucial in establishing the diagnosis due to the rarity of this lesion, particularly considering its location, the patient's age, and gender.

We report a case of 51 year-old Brazilian woman who initially presented with complaints of ill fitting dentures and oral lesions. Clinical examination revealed white striae, erythematous, atrophic and hyperkeratotic areas as well as erosions and ulceration on the buccal mucosa bilaterally which raised suspicions of Systemic Lupus Erythematosus. Laboratory hematological and immunological examinations, including an incisional biopsy were ordered to confirm the diagnosis. Treatment with topical 0.1% clobetasol propionate was initiated resulting in improvement of her symptoms. Further investigations revealed the presence of malar erythema, oral ulcers, blood diseases and positivity for ANF. The patient was referred to a rheumatologist for appropriate treatment. This case highlights the importance of a multidisciplinary approach to management of systemic diseases, with dentists playing a crucial role through their expertise in the early detection of oral manifestations. This approach can lead to improved treatment strategies and a better quality of life for patients.

Odontogenic cysts are bony lesions in the jaws that can reach large sizes. Decompression, a technique that helps in their surgical treatment, aims to reduce their size. We aimed to conduct a systematic review of the main types of device used for the decompression of odontogenic cysts and to analyse the indications, types, advantages, and disadvantages of the devices used. We searched PubMed, Science Direct, LILACS, EMBASE, and Web of Science until February 2023, with no time restriction. We considered studies with a minimum of 10 patients published only in English, those that reported cases and case series, randomised clinical trials of the decompression of odontogenic cysts, and the types of devices used during the decompression period. All reported odontogenic cysts had to have been confirmed by biopsy in their respective publications. We found 713 articles in the selected databases. After removing duplicates, 499 remained. After reading the titles and abstracts, we excluded 461 articles so 38 remained. Nine studies were selected for the review, totalling 244 patients. A total of 206 lesions were identified and confirmed by anatomopathological examination: 123 keratocysts, 40 dentigerous cysts, 34 radicular cysts, one cyst of epithelial origin but without specification, and eight unicystic ameloblastomas. Although we did not find out which device is best for the decompression of odontogenic cysts, our findings show that those that are most effective should be as comfortable as possible and should remain in place. They should have stability in the oral cavity and be easy for the patient to clean.

•ITAC represents a diagnostic challenge because of its morphology and rarity.•Careful clinicopathological correlation and whole-body examination is essential.•The present case shows an immunoprofile compatible with a salivary gland origin.

Background: Foreign bodies adherent to the hard palate often mimic oral lesions. Case report: A 10-month-old female infant presented with the sudden development of a hard palate lesion. With photography and visualization, the “lesion” was a false nail, which belonged to the child’s caregiver. Discussion/conclusion: The differential diagnosis of palatal lesions in infants should include foreign bodies, and if identified as such, evaluation under anesthesia may be avoided.

Purpose This systematic review aimed to determine whether the pentoxifylline and tocopherol (PENTO) protocol effectively reduce the risk of osteoradionecrosis (ORN) in patients undergoing tooth extraction after head and neck radiotherapy. Methods We searched PubMed, SCOPUS, LILACS, EMBASE, Web of Science, and Cochrane databases up to August 2022. We considered only studies that included patients diagnosed with head and neck cancer undergoing tooth extraction with PENTO prophylaxis after radiotherapy. Results Of the 642 studies identified, 4 were included. Across the included studies, 387 patients had 1871 teeth extracted while on PENTO prophylaxis. The interval of the PENTO protocol differed among the studies included. Overall, a total of 12 (3.1%) patients had ORN, whereas at the individual tooth level analysis the ORN rate was 0.9%. Conclusions Insufficient evidence exists to promote using the PENTO protocol before dental extractions to prevent ORN.

OBJECTIVE: To report a case of pleomorphic adenoma that was surgically removed and to describe the surgical technique available to remove this lesion. CASE REPORT: A male patient, caucasian, 46 years old, with a 4-year history of pleomorphic adenoma. He mentioned that he went to other services for treatment, but without success. He came at our service for treatment with tumoral excision. Local anesthesia was performed with mepivacaine with a vasoconstrictor and tumoral excision was performed with the overlying mucosa and the periosteal region to avoid recurrence. The patient has been under postoperative follow-up for two years without recurrence. CONCLUSION: Pleomorphic adenoma is a benign tumor and presents as a submucosal mass of slow growth. The ideal treatment for the Pleomorphic Adenoma tumor is the total excision of the lesion with the removal of the mucosa covering the region to avoid recurrence.

Purpose: The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. Methods: In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient's medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. Results: Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. Conclusions: Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable.