Oral and Maxillofacial Lesions Diagnosed in Older People of a Brazilian Population: A Multicentric Study

A retrospective multicenter study of oral and maxillofacial lesions in older people

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Treatment of facial myiasis in an elderly patient with oral squamous cell carcinoma: Case report

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Myiasis may develop secondary to malignant neoplasms.

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Surgical treatment associated with administration of Ivermectin is effective in curing myiasis.

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The establishment of a multiprofessional team is fundamental in the treatment of myiasis.

Myiasis is caused by the infestation of fly larvae in human tissues and it presents immunodeficiency, poor hygiene, or malignant neoplasias as predisposing chronic diseases.

Objective

To describe a clinical case of myiasis associated with oral squamous cell carcinoma (OSCC) in an elderly patient.

Case presentation

A 60-year-old male, black, smoker, and alcoholic patient with OSCC, who refused initial cancer treatment and sought hospital care with an extensive facial lesion and approximately 150 larvae in the extraoral region. The treatment was given through the administration of 6 mg of Ivermectin associated with the surgical removal of the larvae. Subsequently, palliative chemotherapy began.

Discussion

Myiasis can sometimes be associated with OSCC and it commonly occurs in individuals who live in unhealthy locations and present poor hygiene and low immunity. In addition to medication, the surgical removal of the larvae is important in the treatment of myiasis.

Conclusion

Patient adherence to cancer treatment is essential to avoid the negative evolution of the tumor. The social component linked to the development of myiasis makes it an important public health topic, as it is related directly to the lack of primary care. Surgical and drug treatments are required to cure myiasis.

Diode laser surgery versus electrocautery in the treatment of inflammatory fibrous hyperplasia: a randomized double-blind clinical trial

OBJECTIVES

To compare the efficacy and safety of diode laser and electrocautery techniques for inflammatory fibrous hyperplasia (IFH) removal.

MATERIALS AND METHODS

In this randomized double-blind clinical trial, 40 individuals were randomly allocated to two groups: group 1 (G1) consisted of 20 individuals assigned to treatment with diode laser and group 2 (G2) consisted of 20 individuals assigned to treatment with electrocautery. The following transoperative parameters were evaluated: bleeding, temperature, and surgical technique parameters (energy deposited on tissue, flow rate, and time of incision). The postoperative parameters evaluated were as follows: pain, functional alterations (chewing, speaking), analgesic medication intake, swelling, healing of the wound area, and patient satisfaction.

RESULTS

Among the 40 individuals included in the study, four (two in G1 and two in G2) did not complete the entire follow-up. Therefore, 36 individuals (18 in G1 and 18 in G2) participated. Participants in G1 and in G2 had similar demographic characteristics. No difference regarding the trans- or postoperative parameters evaluated was observed between G1 and G2 (p > 0.05). Also, no difference regarding the time for healing was observed between groups.

CONCLUSIONS

Diode laser seems to be as effective and safe as electrocautery when applied under similar conditions for IFH removal.

CLINICAL RELEVANCE

IFH corresponds to 65% of the lesions observed in denture wearers. This study shows that under similar conditions diode laser is as effective and safe as electrocautery for removal of IFH.

Oral and maxillofacial lesions in older individuals and associated factors: A retrospective analysis of cases retrieved in two different services

BACKGROUND

Studies on the oral and maxillofacial lesions (OMLs) in older people usually assess data of laboratory services and data from oral medicine clinic have been poorly described. The aim of this study was to describe and to compare OMLs in older individuals considering two data sources, besides to assess associated factors with the three most frequent lesions.

MATERIAL AND METHODS

A retrospective study was conducted with individuals aged 60 years or older. Data of individuals and lesions reported in both services were collected. Univariate analysis was used to test the association between the occurrence of the lesion and the independent variables. The level of significance was set at 5%.

RESULTS

A total of 1,695 (37.3%) records were from the Oral Medicine clinic and 2,848 (62.7%) from the Laboratory service. Inflammatory/reactive lesion group was the most frequent in both services (40.4% in Oral Medicine Clinic and in 44.2% Laboratory). The second and third groups of lesions in the Oral Medicine clinic were infectious diseases (18.5%), and variations of normality (10.8%), while in the laboratorial service were the malignant neoplasms (17.6%) and potentially malignant disorders (13.3%). Differences between services regarding the frequency of lesion groups occurred (p<0.05), except for pigmented (p=0.054) and infectious (p=0.054) groups. Females (OR: 2.08; CI: 1.81-2.39) and individuals who wore a removable prosthesis (OR: 3.99; CI: 2.83-5.62) were also likely to have inflammatory fibrous hyperplasia. Old-old individuals (OR: 1.70; CI: 1.30-2.21), male (OR: 3.63; CI: 3.00-4.39), smoking (OR: 6.05; CI: 4.84-7.56) or alcohol use (OR: 3.95; CI: 3.12-5.01) were likely to have squamous cell carcinoma.

CONCLUSIONS

The results showed different frequencies of OMLs in older individuals according to the data sources and age group. The findings are important to direct public policies for this age group. Key words:Oral medicine, laboratory service, older adult, oral diagnosis, oral and maxillofacial pathology.

Stomatological disorders in older people: An epidemiological study in the Brazil southern

BACKGROUND

The aim of this retrospective, cross-sectional and observational study was to perform a survey of the stomatological conditions of elderly patients seen in a period of 40 years at a Stomatology Service in Southern Brazil.

MATERIAL AND METHODS

A total of 24,347 medical records were reviewed, of which 5,063 belonged to elderly patients aged 60 to 97 years. The stomatological conditions, systemic conditions, and smoking and alcohol drinking habits as well were recorded.

RESULTS

The mean age of the patients was 69.29 years, 67.1% were female and 32.9% were male. Variations of normality accounted for 44.5% of the cases. The most prevalent disorders were fungal infections (26.1%), reactive inflammatory lesions (24.6%), burning mouth syndrome (14.9%), benign neoplasms (12.4%), autoimmune disorders (12.3%), premalignant lesions (10.2%) and malignant epithelial neoplasms (7.2%). Regarding biopsied lesions, squamous cell carcinoma was the most prevalent at 30.2%, followed by hyperplasic lesions (28.2%).

CONCLUSIONS

Knowledge of these physiological and pathological conditions in the oral cavity of the older people is essential for early diagnosis and preventive and therapeutic measures when necessary.