HIGHLIGHTS Hospitalized COVID-19 patients often exhibit poor oral hygiene, which may contribute to higher mortality. Integrating oral health care into hospital protocols could improve overall patient health outcomes.

Actinic prurigo (AP) is a rare, chronic photodermatoses with a challenging diagnosis, particularly when labial involvement represents the sole clinical manifestation of the disease. This study reports a case of a 66-year-old patient presenting with an ulcerated and crusted lesion on the lower lip with a 20-year history, initially clinically diagnosed as actinic cheilitis. A biopsy was performed, and histopathological analysis revealed stratified squamous epithelium with acanthosis and spongiosis, underlying connective tissue with a dense chronic inflammatory infiltrate, and well-organized lymphoid follicles, establishing the diagnosis of cheilitis associated with actinic prurigo. Management consisted of strict photoprotection associated with adjunctive topical corticosteroid therapy (dexamethasone). Six-month postoperative follow-up demonstrated complete remission of local clinical signs and symptoms. This report highlights the relevance of clinicopathological correlation and supports the effectiveness of localized therapeutic approaches in predominantly labial manifestations of actinic prurigo.

The OHI demonstrated moderate internal consistency and consistent associations with oral health-related quality of life and cardiovascular risk indicators. Objective: The primary objective was to propose and internally assess an Oral Health Index (OHI) which integrates multiple clinically assessed oral health variables. The secondary objective was to investigate its association with oral health-related quality of life (OHRQoL) and common clinical cardiovascular risk (CVR) factors. Material and Methods: This observational study included 191 participants. Seven parameters (tooth loss, periodontal disease, endodontic involvement, residual roots, extractions due to periodontitis, inflammatory oral mucosal diseases, and dental maintenance and rehabilitation status) were combined using Z-scores to compute the OHI, with higher scores indicating poorer oral health. CVR factors included age/sex thresholds, education level, BMI, smoking status, diabetes, hypertension, pulse pressure, and lung function. OHRQoL was assessed using the Oral Health Impact Profile. Results: Higher OHI scores were associated with poor oral health-related quality of life. Participants with cardiovascular risk factors had significantly higher OHI scores. The analysis demonstrated that the OHI was directly associated with worse oral health-related quality of life and a greater cardiovascular risk burden, independent of age, sex, and comorbidities. Conclusions: This study proposed and internally assessed the Oral Health Index, designed to integrate multiple clinical parameters into a single standardized measure of oral health. The OHI demonstrated moderate internal consistency and showed consistent associations with poorer oral health conditions, reduced oral health-related quality of life, and a greater cardiovascular risk burden.

This case report presents a rare instance of a Calcifying Epithelial Odontogenic Tumor (CEOT) in the maxilla of a 52-year-old male, characterized by a painless, growing mass and facial asymmetry. Imaging revealed extensive involvement of the maxillary sinus, nasal cavity, pterygoid plate, and infraorbital margin. Histopathological analysis confirmed the diagnosis, showing polyhedral odontogenic epithelium with amyloid-like material. The patient underwent conservative surgical excision, preserving function and aesthetics, with no recurrence observed at 16 months postoperatively. This case underscores the importance of a multidisciplinary approach in managing CEOT, particularly in complex anatomical regions, to achieve favorable outcomes. Long-term follow-up remains essential. Key words:Calcifying Epithelial Odontogenic; Pindborg tumor; CEOT; maxilla; odontogenic tumors.

This study aimed to evaluate the efficacy of a single preoperative 15 mg sublingual dose of melatonin in reducing surgical discomfort, pain, edema, and trismus following mandibular third molar extraction. A randomized, double-blind, placebo-controlled trial was conducted with 46 patients allocated to receive melatonin (n = 22) or placebo (n = 24) 45 min before surgery. The primary outcomes were intraoperative pain and discomfort and postoperative pain. Secondary outcomes included patient-perceived edema (VAS-Edema, days 1–5), trismus (5-point scale, days 1–5; interincisal measurement, day 7), and rescue medication consumption. No statistically significant differences were observed between the melatonin and placebo groups for any outcome. Intraoperative discomfort (QCirDental total score, p = 0.54) and pain (VAS, p = 0.67) were comparable. Similarly, postoperative pain levels across all time points (p = 0.67), edema over five days (p = 0.26), and trismus based on self-assessment (all days p > 0.50) and clinical measurement (p = 0.79) did not differ. Within the limitations of this clinical trial, a single 15 mg preoperative dose of sublingual melatonin was not superior to placebo in alleviating surgical discomfort, pain, edema, or trismus after third molar extraction. Clinically, these findings suggest that melatonin may have limited effectiveness in managing common complications in oral surgery.

Central Giant Cell Granuloma (CGCG) is a benign lesion of unknown etiology with aggressive behavior and rapid evolution, affecting approximately 7% of tumors in the maxillomandibular region. Clinical treatment is not very effective, whereas surgical treatment is comprised of radical surgical resection with clear margins. This paper reports the trajectory of a 21-year-old male patient with a delayed diagnosis due to failure of radiographic interpretation, where the dentist opted for endodontic treatment, 20 months after the first panoramic radiograph. The patient was referred for specialized treatment, where tomographic imaging and an incisional biopsy were performed with a diagnosis of CGCG, which led to partial resection of the mandible and subsequent rehabilitation with microvascularized flap and osseointegrated implants.

Aim: The aim of this study is to observe the perioperative discomfort resulting from oral surgeries, while also advancing the validation process of the Self-Perception Questionnaire of Dentoalveolar Oral Surgery (QCirDental). Methods: The study was characterized as observational and cross-sectional. The sample was composed by 432 patients submitted to dental extractions. Where performed test-retest reliability, split-half reliability and exploratory factor analysis. Results: The study demonstrated the reliability of the QCirDental questionnaire through test-retest (Cα .93) and split-half reliability analyses (First: r .92 p< .001; Second: r .92 p< .001). Three domains, namely Physical Feelings (PF), General Perceptions (GP), and Feeling of Loss (FL), were identified through exploratory factor analysis. The PF domain exhibited the strongest correlation (rs.95, p< .001) with the overall questionnaire score implying that it could be reduced to a set of 11 questions. Surgical time showed association with PF and GP; surgical complexity with PF and GP and; volume of local anesthesia with PF and GP. Conclusions: This study provides insights into the factors influencing patient discomfort during oral surgeries. This research also advanced the validation process of QCirDental, confirming its reliability.

Calcifying epithelial odontogenic tumor (CEOT) is a locally aggressive benign tumor prevalent in the posterior mandible, accounting for less than 1% of all odontogenic tumors. A 51-year-old male patient reported a complaint of swelling on the right side for the past 6 months with clinical diagnosis of dental abscess. On intraoral examination, a swelling in the edentulous premolar-molar region in the maxilla was noticed. The radiologic exam revealed an ill-defined, mixed, multilocular, and expansile lesion involving the right maxilla. On microscopic examination was observed extensive areas of acellular, eosinophilic amyloid-like deposits intermixed with polyhedral odontogenic epithelial cells. In some areas, the amyloid-like material exhibited calcifications resembling Liesegang rings. Congo-red staining revealed red-orange staining of the amyloid-like deposits, and the odontogenic epithelial cells were immunopositivity for AE1/AE3 and CK19. The lesion was diagnosed as CEOT, and the patient underwent surgical removal with no signs of disease until last follow-up.

Scleroderma is a rare connective tissue disease involving vascular injury and autoimmunity. It is characterized by the thickening, hardening, and tightening of connective tissues, leading to multifaceted complications. Scleroderma is classified into 2 forms, localized scleroderma and systemic sclerosis (SSc). The systemic form is further subdivided into limited SSc (formerly known as CREST syndrome) or diffuse SSc. This report describes the case of a 41-year-old woman with gingival pain, temporomandibular joint pain, frequent fevers, night sweats, excessive thirst, hunger, frequent urination, and weight gain. Her medical history included Sjögren syndrome and Raynaud phenomenon. Physical examinations revealed petechiae on the palms, lips, tongue, and soft palate; hypochromia of the lips; fibrosis; dry mouth; and active periodontal disease. Serologic test results were positive for anticentromere and antinuclear antibodies and negative for anti-topoisomerase I antibody, confirming the diagnosis of limited SSc. The oral manifestations were critical to the early diagnosis of limited SSc. Telangiectasia, labial fibrosis, and xerostomia were key indicators. Interdisciplinary collaboration between oral healthcare professionals and rheumatologists is essential for optimal patient management. Further research is needed to understand the underlying mechanisms of SSc and refine the diagnostic criteria.

Syphilis is a highly contagious infectious disease primarily transmitted through sexual contact, caused by Treponema pallidum, an anaerobic gram-negative bacterium. Oral manifestations are significant, with the oral cavity often being the first site to exhibit symptoms. This study aims to present the clinical manifestations of oral syphilis through a six cases diagnosed in a dental setting. The results reveal that oral syphilis lesions predominantly affect areas such as the tongue, gingiva, and palates, presenting as mucous plaques, ulcerations, and erythematous regions. Painful oral sores and cervical lymphadenopathy were common, with symptoms varying in duration from 3 weeks to 3 months. All cases were classified as secondary syphilis and were confirmed through serological tests. Key words:Syphilis, Treponema pallidum, Oral Cavity, Oral manifestation.

Background:This study investigated the association among preoperative dental anxiety, intraoperative discomfort, and postoperative pain perception across various types of dental extractions, ranging from simple to complex procedures. Methods:A prospective observational clinical trial was conducted in 573 patients who underwent dental extractions. Preoperative anxiety was assessed by using a self-reported verbal scale. Intraoperative discomfort was measured using the Self-Perception Questionnaire for Dentoalveolar Oral Surgery. Postoperative pain was assessed on the seventh day using a verbal categorical rating scale. Results:Preoperative anxiety levels were significantly higher in patients who underwent mandibular third molar extraction. Intraoperative discomfort was significantly influenced by surgical technical complexity, surgical duration, and preoperative anxiety. Mediation analysis revealed that anxiety indirectly influenced postoperative pain through intraoperative discomfort with no direct effect. The analysis confirmed the interplay between anxiety, surgical factors, intraoperative discomfort, and patient demographics in shaping the surgical experience. Conclusions:The findings indicate that Anxiety did not directly predict postoperative pain in most surgical groups; however, it appeared to contribute to increased intraoperative discomfort, which subsequently elevated postoperative pain levels.

Abstract Objective The aim of this study was to evaluate juxta-apical radiolucency (JAR) prevalence and its relationship with adjacent structures using cone-beam computed tomography (CBCT). Material and method CBCT scans were analyzed from a database from 2017 to 2021 of adult patients with mandibular third molars to visualize the presence of JAR. Third molars associated with JAR were classified according to impaction depth, angulation, and root development. JAR was also classified according to its relationship with the mandibular canal and its cortical area, size, and location. The chi-square test and the Mann-Whitney Test were performed to compare the age of patients and gender regarding the presence or absence of JAR. Result 1097 CBCT scans were collected from the database during the evaluation period, and after the application of the eligibility criteria, 155 scans were included in the analysis. Thirty-one third molars showed the presence of JAR with a 20% prevalence. Most cases were observed to be unilateral (84%), located mesially (53%), and medium-sized (53%), in contact with the mandibular canal with cortical presence (50%), visualized in third molars mostly mesioangular (36%), partially intraosseous (86%), and with complete root development (92%). No significant differences were detected between gender and age concerning the presence of JAR. Conclusion High JAR prevalence was observed, which was frequently in contact with the mandibular canal, being considered a potential risk for nerve damage.

Aim: This study aimed to investigate the presence of oral ulcers and associated factors in hospitalized patients with COVID-19. Study design A comparative study was conducted on hospitalized patients who tested positive (n=69) and negative (n=43) using RT-PCR. Oral evaluations were performed by a dentist, and hospitalization and laboratory data were collected. Chi-square tests were used to assess the presence of oral ulcers and associated factors, and t-tests were used for laboratory test analysis. Results The presence of oral ulcers was significantly associated with COVID-19 hospitalization (p<0.001). Traumatic and hemorrhagic ulcers were found to be associated with hospitalization by COVID-19 (p=0.047 and p<0.001, respectively). Among COVID-19-positive patients, traumatic ulcers were associated with the use of mechanical ventilation and pronation (p=0.004 and p<0.001, respectively), while hemorrhagic ulcers were associated with pronation and patient death (p=0.002 and p<0.001, respectively). Traumatic ulcers were also associated with decreased red blood cells, hemoglobin, and hematocrit, while hemorrhagic ulcers were associated with leukocytosis, neutrophilia, uremia, and increased creatinine levels. Conclusion Oral ulcers are significantly associated with COVID-19 hospitalization and systemic conditions. Dentists should remain vigilant in identifying and considering these oral changes, especially in critically ill patients. Support by: CAPES.

A 40-year-old woman presented with a painless ulcerated nodule on her upper lip that had been present for 3 months. The patient initially described the lesion as a "darkened spot," which had previously been treated by another clinician as herpes but showed no improvement. Upon examination, a dentist considered the possibility of an infectious process and conducted an incisional biopsy. Under microscopic examination, the biopsy revealed a proliferation of large lymphoid cells with significant pleomorphism, mitotic figures, eosinophils, and areas of necrosis. These neoplastic cells were observed to infiltrate muscle bundles, and some displayed kidney-shaped nuclei. Immunohistochemical analysis demonstrated positivity for LCA, CD30, CD4, CD8, CD68, Granzyme B, and a Ki-67 index of approximately 50%. Conversely, CD20, CD79a, MUM1, ALK, and CD56 were all found to be negative. Furthermore, in situ hybridization for EBV yielded a negative result. Remarkably, three weeks after the surgical procedure, the patient returned with complete regression of the lesion. Based on the clinical, histopathological, and immunohistochemical findings, the diagnosis of primary mucosal CD30-positive T-cell lymphoproliferative disorder was established.

This study presents a case of bisphosphonate-associated osteonecrosis of the jaw (ONJ) in an oncology patient. The case involves a patient who was diagnosed with breast cancer in 2007 and underwent radiotherapy and chemotherapy. In 2020, the patient developed metastasis in the lungs and bones and received chemotherapy treatment combined with Zoledronate. During an intraoral examination, an area of exposed bone was observed in the region where tooth 17 had been extracted for dental implant placement. The patient reported local pain, and radiographically (through panoramic and computed tomography), areas of bone sequestration were evident. The proposed treatment plan included decontamination using 0.12% chlorhexidine, Photodynamic Therapy (with methylene blue), oral hygiene instruction, and the PENTO protocol (involving pentoxifylline, tocopherol, and amoxicillin). After five weeks, the patient experienced improvements in symptoms, along with a reduction in bone exposure. This case underscores the significance of palliative care in alleviating pain and enhancing the patient's overall quality of life.

Objective: This study aimed to investigate the feasibility and effectiveness of using smartphone-derived heart rate variability (HRV) as a diagnostic tool for assessing both general and oral health conditions. Methods: An exploratory and cross-sectional study was conducted. HRV was recorded through smartphone photoplethysmography (PPG). Were searched associations between HRV and the American Society of Anesthesiologists (ASA) risk classification in dentistry, tooth loss (TL), dental maintenance and rehabilitation status (DMRS), and periodontal disease (PD). To confirm the reliability of signal acquisition pattern by PPG method via smartphone, heart rate (HR) was compared using four additional devices. Results: The HR derived from the smartphone demonstrated reliability comparable to traditional monitoring devices. Significant associations were found between higher HRV scores with better oral health outcomes. Smartphone-derived HRV was able to detect comorbidity with 68.3% of sensitivity and 61.5% of specificity. Conclusion: This study underscores the potential of smartphone-derived HRV as a complementary diagnostic tool for evaluating both general and oral health conditions. The findings reveal discernible associations between HRV and the ASA classification for risk in dentistry and with the studied oral health parameters. HR derived from smartphone is reliable when compared with traditional cardiac monitoring devices.

OBJECTIVES:To assess the potential impact of dentin hypersensitivity on the quality of life in people with chronic systemic diseases. METHODS:We included 252 volunteers, 18 years or older, with ≥ 6 teeth, and under outpatient medical follow-up for systemic chronic diseases. Short Form Health Survey 36 (SF-36) was used to assess quality of life (QoL); Oral Health Impact Profile-14 (OHIP-14) and Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) were used for oral health-related quality of life (OHRQoL). Dentin hypersensitivity pain was assessed using an evaporative and tactile test, and pain assessment was performed using a numerical rating scale and a verbal rating scale. Medical information was obtained from anamnesis forms and the hospital digital medical records. RESULTS:Of 252 participants, 60% had dentin hypersensitivity. There was a negative impact on the QoL/OHRQoL of individuals with dentin hypersensitivity regarding the vitality, mental health, physical functioning, and bodily pain dimensions of SF-36, and the functional limitation, physical pain, physical disability, and psychological disability dimensions of OHIP-14. Dentin hypersensitivity appeared to exert an indirect influence on QoL. CONCLUSION:Dentin hypersensitivity negatively impacts the quality of life in patients with chronic systemic diseases.

Background: Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of DS and identify its associated predictive and mediating variables. Material and Methods: This study is classified as prospective observational, cross-sectional, and multicenter. Patients were consecutively selected in accordance with established criteria for tooth extraction. Data on patient demographics, surgical procedures and postoperative outcomes were collected. Nominal variables were analyzed using the Chi -Square Test, while associations involving ordinal values or considering counts or layers were examined using the Kendall's Tau -B Test or Mantel-Haenszel Test for trend. The GLM Mediation Model was employed to investigate potential mediation or indirect effects or potential underlying mechanisms of predictive variables on the development of DS. Two -tailed significance level of p <= 0.05 was considered statistically significant. Results: A total of 1,357 patients undergoing routine dental extractions were included. DS was observed in 13 patients (prevalence of 1%). DS was associated with younger patients (under 50 years old), longer procedures, and the presence of surgical accidents, but only when mediated by surgical complexity. Smoking, particularly in com bination with complex surgeries and surgical accidents, was associated with DS. Postoperative pain for more than two days and reported at moderate to high levels, emerged as a potential warning sign for DS. The use of antibiotics was found to significantly reduce the risk of DS (RR reduction of 36% and absolute risk reduction of 0.63%). Conclusions: Routine dental extractions revealed a 1% prevalence of dry socket. The obtained results suggests that DS is a multifactorial condition influenced by various factors, including gender, age, smoking, antibiotic prescription and surgical factors such as length, technique and accidents, nevertheless, those associations were observed mainly considering the influence of one variable on another.

Background:Osseointegration depends on primary stability, and further, implant surface modifications may improve secondary stability. This randomized clinical trial evaluates whether adding a fluoride solution enhances the implant stability. Materials and Methods:Stability of dental implants with two different types of surface treatments was compared utilizing resonance frequency analysis (RFA). Twelve patients were recruited: eight females and four males with an average age of 58.3 years and they received either double acid etched implants (control: Porus Implant, Sistema Conexão) and double acid etched implants containing fluoride on their surfaces (test: Porus Nano Implant, Sistema Conexão). Each patient received one implant from the test category and another implant from the control category, resulting in 24 implants in this study. RFA, utilizing Osstell was used to assess the implant stability, immediately after the placement of implant and 15, 30 and 45 days post-implant placement. Results:At the initial time, there was no difference between the test and control groups regarding the ISQ. However, after 15, 30, and 45 days, ISQ values for the test group were significantly higher than the control group. When using implants without fluoride addition, it was observed that after 15 days, the ISQ values were lower than those found at the initial time, but after 30 days, values matched the initial. Concerning the test group results, the ISQ values from T0 (immediately after implant placement) to T3 (45 days after implant placement) always increased from every period of evaluation. Conclusions:It was concluded that double acid etched implants with surfaces containing fluoride solution increases the implant stability quotient, compared to implants with fluoride-free double acid etched surfaces.

BACKGROUND:Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment. OBJECTIVES:The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery. MATERIAL AND METHODS:This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure. RESULTS:General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain. CONCLUSIONS:Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.