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Sepulveda Inostroza EA, Bressane A, Schwarzmeier LÂT, Lacerda EB, Anjos KRD, Santos TSPD, Cavalcanti DR, Nascimento FD, Almeida JD, Oliveira Alves MG. Evaluation of micronuclei, cytomorphometric and cytologic changes of the oral mucosa in hookah and cigarette smokers. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:640-650. [PMID: 38692958 DOI: 10.1016/j.oooo.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/05/2023] [Accepted: 03/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To analyze the effect of hookah and cigarettes on the oral mucosa of smokers through the use of exfoliative cytology. STUDY DESIGN Smear samples were collected by exfoliative cytology from the tongue of 33 hookah smokers, 22 cigarette smokers, and 30 non-smokers. The selected analyses include micronuclei (MN), metanuclear anomalies, epithelial maturation, and cytomorphology (nuclear area [NA], cytoplasmic area [CA], and NA/CA ratio). RESULTS The largest differences observed for MN and metanuclear anomalies were between cigarette smokers and the control group (notably 1 MN P = .04; total cells with MN P = .039; total MN P = .042; karyorrhexis and binucleation, P = .0001). The hookah group, compared with the control group, showed the greatest differences for karyolysis (P = .0023), binucleation (P = .0003), and broken egg (P = .008). Significant differences were found between the smokers and the control groups regarding changes in the superficial cell without nucleus, perinuclear halo, vacuolization, color change, mucus, and keratohyalin granules. There was a significant increase in the NA and NA/CA ratio in the smoker groups. CONCLUSION This study showed that a combined analysis of exfoliative cytology associated with other diagnostic methods is a useful tool for studying oral carcinogenesis. Hookah and cigarettes showed similar effects in terms of displaying substantial cytogenetic and cytotoxic damage.
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Affiliation(s)
- Elvira Antonieta Sepulveda Inostroza
- Technology Research Center (NPT), Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil; School of Dentistry, Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil
| | - Adriano Bressane
- Department of Environmental Engineering, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | | | | | - Karine Rodrigues Dos Anjos
- Research Center for Lasers and Applications - Nuclear and Energy Research Institute (IPEN)/University of São Paulo (USP), São Paulo, Brazil
| | | | | | - Fábio Dupart Nascimento
- Department of Biochemistry, Molecular Biology Division, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Janete Dias Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Mônica Ghislaine Oliveira Alves
- Technology Research Center (NPT), Universidade Mogi das Cruzes, Mogi das Cruzes, Brazil; Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil.
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Thomas P, Mathew D, Anisha K, Ramasubramanian A, Ramalingam K, Ramani P, Sekar D. A Retrospective Analysis of the Clinicopathological Profile of Oral Squamous Cell Carcinoma in Tobacco and Non-tobacco Users: Highlighting the Significance of Chronic Mechanical Irritation. Cureus 2024; 16:e59953. [PMID: 38854267 PMCID: PMC11161867 DOI: 10.7759/cureus.59953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND AND AIM Oral squamous cell carcinoma (OSCC) is among the leading top three cancers in India. However, recent literature has shown an increase in the rise of oral cancer in younger individuals without any history of tobacco-related habits. Chronic mucosal irritation (CMI) has been noted to have a substantial impact on the development and etiology of OSCC. With the shift in the trend, it is imperative to observe and monitor alterations associated with its etiological factors. The study aims to evaluate the prevalence and clinical characteristics of OSCC patients and the association of these parameters in cases with and without tobacco usage. METHODOLOGY A retrospective study spanning a period of 10 years was done on histopathologically diagnosed cases of OSCC. Various clinicopathological characteristics were collected from patient records, including demographic features, tobacco-related habits, including tobacco chewing and smoking, clinical presentation, anatomic sites, and histopathological grading based on the inclusion and exclusion criteria. The data were tabulated to Microsoft Excel (Microsoft Corporation, Redmond, WA), and descriptive statistics analysis and chi-square test of significance were applied to the data using IBM SPSS Statistics (version 29.0.2; IBM Corp., Armonk, NY). The study correlated the epidemiologic behavior of OSCC with age, gender, site, and tobacco-related habits. RESULTS This study included a sample size of 204 (72 females & 132 males). Tobacco-related habit-associated cases were 98 (48.5%) and without tobacco habits were 61 cases (29.6%). Etiology associated with CMI emerged to be a significant tooth-related factor. Out of 72 females, 32 (44.4%) of the females were without habit. OSCC caused by trauma from CMI was analyzed in 40 cases (19.6%) and 22 (55%) were females. The majority of lesions (76 (37.4%) cases) presented on the lateral border of the tongue. Among the OSCC patients with a history of chronic mechanical irritation, 37 (48.7%) cases were observed to be specifically on the lateral border of the tongue. CONCLUSION These 10-year data will generate awareness about the disease pattern occurring within a community and provide an overview of the prerequisite of considering CMI as an etiological factor for the development of OSCC without the association of tobacco-related habits.
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Affiliation(s)
- Priya Thomas
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
- Oral and Maxillofacial Pathology and Oral Microbiology, Annoor Dental College & Hospital, Ernakulam, IND
| | - Deepu Mathew
- Oral and Maxillofacial Pathology and Oral Microbiology, Annoor Dental College & Hospital, Ernakulam, IND
| | - Kutty Anisha
- Oral and Maxillofacial Pathology and Oral Microbiology, Annoor Dental College & Hospital, Ernakulam, IND
| | - Abilasha Ramasubramanian
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Durairaj Sekar
- RNA Biology Lab, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Rodrigues RR, Freitas VS, Alves PM, Almeida Freitas RD, Souza LBD, Andrade Santos PPD. Evaluation of the presence of Th1 response through T-bet and IFN-gamma immunohistochemical expression in lower lip and oral tongue squamous cell carcinomas. Pathol Res Pract 2024; 253:155010. [PMID: 38101155 DOI: 10.1016/j.prp.2023.155010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Evaluate the immunohistochemical expression of T-bet and IFN-γ in lower lip (LLSCC) and oral tongue squamous cell carcinoma (OTSCC), verifying the presence of Th1 responses in lesions with different clinical conditions. METHODS AND MATERIALS Thirty OTSCC and 30 LLSCC were analyzed by immunohistochemistry. T-bet was quantitatively assessed by parenchyma cell and stroma quantification, and IFN-γ was semi-quantitatively analyzed: 1:0-25%; 2:26-50%; 3:51-75%; 4:> 75% immunopositive cells. Histological differentiation degrees were categorized as well differentiated (WD), moderately differentiated (MD), or poorly differentiated (PD). RESULTS OTSCC presented the highest number of T-bet+, parenchyma (p: 0.006), stroma (p: 0.156), parenchyma/stroma (p: 0.015), with no relationship to histological malignancy grade. IFN-γ higher concentrations in LLSCC were detected in parenchyma, stroma and in parenchyma/stroma (p: 0.000), as well as greater immunoreactivity in WD and MD (p: 0.001). In OTSCC, a positive and statistically significant correlation was observed between T-bet+ in parenchyma and IFN-γ in stroma(r: 0.388; p: 0.034), in addition to a statistically significant positive correlation between T-bet in parenchyma compared to stroma(r: 0.411; p: 0.024) and for IFN-γ in both parenchyma and stroma(r: 0.775; p: 0.000) in LLSCC. Higher T-bet+ was observed in OTSCCs, although higher IFN-γ was detected in LLSCCs. CONCLUSION Thus, we suggest that, even though LLSCC presented lower T-bet+, the favorable microenvironment in these lesions led to an expressive activation of IFN-γ by T-bet+, considerably acting on Th1 differentiation and in antitumor activity, which, admittedly, present less aggressive behavior, reinforcing once again the important role of this cytokine and its use in strategy to fight cancer.
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Affiliation(s)
| | - Valéria Souza Freitas
- Department of Dentistry, State University of Feira de Santana (UEFS), Feira de Santana, BA, Brazil
| | - Pollianna Muniz Alves
- Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, PB, Brazil
| | | | - Lélia Batista de Souza
- Department of Oral Pathology, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
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Louredo BVR, Curado MP, Penafort PVM, de Arruda JAA, Abreu LG, Mesquita RA, Pinto-Júnior DDS, Abrahão AC, Andrade BABD, Agostini M, Moraes RM, Anbinder AL, Dourado PHS, Santos TCRBD, Pires FR, Bordignon NCT, Gondak RO, DE Oliveira MG, Carrard VC, Martins MD, Sousa-Neto SS, Arantes DAC, Mendonça EF, Cieslak-Sanches SR, Antunes DM, Amaral-Silva GKD, Manieri PR, Ramalho LMP, Dos Santos JN, Leonel ACLDS, Perez DEDC, Verheul HCCRS, Barroso KMA, Rodrigues FLS, Gonzaga AKG, Fernandes RR, DE Souza LB, Souza LLD, Pontes FSC, Pontes HAR, Silva CA, Câmara J, Libório-Kimura TN, Santos-Silva AR, Lopes MA, Almeida OPD, Romañach MJ, Vargas PA. Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil. Braz Oral Res 2023; 37:e126. [PMID: 38126470 DOI: 10.1590/1807-3107bor-2023.vol37.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/06/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.
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Affiliation(s)
| | - Maria Paula Curado
- A. C. Camargo Cancer Center, International Research Center, Group of Epidemiology and Statistics on Cancer, São Paulo, SP, Brazil
| | - Paulo Victor Mendes Penafort
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - José Alcides Almeida de Arruda
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte, MG, Brazil
| | - Ricardo Alves Mesquita
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | | | - Aline Corrêa Abrahão
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Oral Diagnosis and Pathology, Rio de Janeiro, RJ, Brazil
| | | | - Michelle Agostini
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Oral Diagnosis and Pathology, Rio de Janeiro, RJ, Brazil
| | - Renata Mendonça Moraes
- Universidade Estadual Paulista - Unesp, Institute of Science and Technology, Department of Bioscience and Oral Diagnosis, São José dos Campos, SP, Brazil
| | - Ana Lia Anbinder
- Universidade Estadual Paulista - Unesp, Institute of Science and Technology, Department of Bioscience and Oral Diagnosis, São José dos Campos, SP, Brazil
| | - Pedro Henrique Silva Dourado
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Oral Pathology, Rio de Janeiro, RJ, Brazil
| | | | - Fábio Ramoa Pires
- Universidade do Estado do Rio de Janeiro - UERJ, School of Dentistry, Department of Oral Pathology, Rio de Janeiro, RJ, Brazil
| | | | - Rogério Oliveira Gondak
- Universidade Federal de Santa Catarina - UFSC, Department of Pathology, Florianópolis, SC, Brazil
| | - Marcia Gaiger DE Oliveira
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Vinicius Coelho Carrard
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | | | - Diego Antônio Costa Arantes
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Sciences, Goiânia, GO, Brazil
| | - Elismauro Francisco Mendonça
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Sciences, Goiânia, GO, Brazil
| | | | - Daniella Moraes Antunes
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculty of Dentistry, Campo Grande, MS, Brazil
| | | | - Patricia Rubia Manieri
- Universidade Federal da Bahia - UFBA, School of Dentistry, Laboratory of Oral and Maxillofacial Pathology, Salvador, BA, Brazil
| | - Luciana Maria Pedreira Ramalho
- Universidade Federal da Bahia - UFBA, School of Dentistry, Laboratory of Oral and Maxillofacial Pathology, Salvador, BA, Brazil
| | - Jean Nunes Dos Santos
- Universidade Federal da Bahia - UFBA, School of Dentistry, Laboratory of Oral and Maxillofacial Pathology, Salvador, BA, Brazil
| | | | - Danyel Elias da Cruz Perez
- Universidade Federal de Pernambuco - UFPE, Department of Clinic and Preventive Dentistry, Oral Pathology Unit, Recife, PE, Brazil
| | | | | | - Flávia Luiza Santos Rodrigues
- Universidade Federal do Rio Grande do Norte - UFRN, School of Dentistry, Department of Oral Pathology, Natal, RN, Brazil
| | - Amanda Katarinny Goes Gonzaga
- Universidade Federal do Rio Grande do Norte - UFRN, School of Dentistry, Department of Oral Pathology, Natal, RN, Brazil
| | - Romana Renery Fernandes
- Universidade Federal do Rio Grande do Norte - UFRN, School of Dentistry, Department of Oral Pathology, Natal, RN, Brazil
| | - Lélia Batista DE Souza
- Universidade Federal do Rio Grande do Norte - UFRN, School of Dentistry, Department of Oral Pathology, Natal, RN, Brazil
| | - Lucas Lacerda de Souza
- Universidade Federal do Pará - UFPA, João de Barros Barreto University Hospital, Service of Oral Pathology, Belém, PA, Brazil
| | - Flávia Sirotheau Corrêa Pontes
- Universidade Federal do Pará - UFPA, João de Barros Barreto University Hospital, Service of Oral Pathology, Belém, PA, Brazil
| | - Hélder Antônio Rebelo Pontes
- Universidade Federal do Pará - UFPA, João de Barros Barreto University Hospital, Service of Oral Pathology, Belém, PA, Brazil
| | - Caroline Alfaia Silva
- Universidade Federal do Amazonas - UFAM, School of Medicine, Department of Pathology and Legal Medicine, Manaus, AM, Brazil
| | - Jeconias Câmara
- Universidade Federal do Amazonas - UFAM, School of Medicine, Department of Pathology and Legal Medicine, Manaus, AM, Brazil
| | - Tatiana Nayara Libório-Kimura
- Universidade Federal do Amazonas - UFAM, School of Medicine, Department of Pathology and Legal Medicine, Manaus, AM, Brazil
| | - Alan Roger Santos-Silva
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Márcio Ajudarte Lopes
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Oslei Paes de Almeida
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Mário José Romañach
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Oral Diagnosis and Pathology, Rio de Janeiro, RJ, Brazil
| | - Pablo Agustin Vargas
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
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Alshami ML, Al‐Maliky MA, Alsagban AA, Alshaeli AJ. Epidemiology and incidence of oral squamous cell carcinoma in the Iraqi population over 5 years (2014-2018). Health Sci Rep 2023; 6:e1205. [PMID: 37064317 PMCID: PMC10090270 DOI: 10.1002/hsr2.1205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
Background Oral squamous cell carcinoma is one of the most common and life-threatening neoplasms worldwide, and is responsible for approximately 90% of all oral malignancies. Aim This study was aimed at providing updated information on oral squamous cell carcinoma in all Iraqi governorates for the 5-year period from 2014 to 2018, including the annual incidence and demographic variables. Materials and Methods The total number of oral squamous cell carcinoma cases in Iraq, along with associated demographic information (age, sex, and site), for the 5-year period from 2014 to 2018 was obtained. The statistical analysis consisted of descriptive analysis, including frequency, percentage, and mean ± standard deviation. A χ 2 test was performed to compare frequencies between male and female patients, among age groups, and among different OSCC sites. The χ 2 test was also used to assess the association of each OSCC site with age and sex. The significance threshold was set at p < 0.05, and the confidence interval was set at 95%. The incidence rate of oral squamous cell carcinoma for each year was calculated by dividing the number of OSCC cases per year by the population of Iraq, then multiplying the result by 100,000. Results A total of 722 cases were recorded. Statistically, oral squamous cell carcinoma was found to be more prevalent in males and individuals over 40 years of age. The tongue was the most common site of occurrence. Lip squamous cell carcinoma cases were high in males. The incidence rate of oral squamous cell carcinoma was estimated to be 0.4 per 100,000 people. Conclusion Males and older people are at relatively higher risk of developing oral cancer. The tongue is the most affected site, but any site in the oral cavity may be involved. Further exploration of the causes of oral malignancy in Iraq is necessary to improve prevention strategies.
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Jain V, Mahajan R, Rathi S, Biyani V, Ninama K, Marfatia Y. Oral mucosal lesions - A study of 369 cases. Indian Dermatol Online J 2023; 14:213-220. [PMID: 37089853 PMCID: PMC10115344 DOI: 10.4103/idoj.idoj_203_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 03/12/2023] Open
Abstract
Background Diagnosing and treating oral cavity lesions is a challenging task for most of the clinicians due to similar symptoms and clinical appearances. Frequently, histopathology and immunohistochemistry aid in making the diagnosis. Objectives The objectives were to describe the clinical features, and histopathological features and systemic association in patients with oral mucosal lesions (OML). Materials and Methods A cross-sectional descriptive study was undertaken at a tertiary care centre in patients with OML. A total of 369 cases with OML were included in the study. Results Males constituted 61.78% of the cases. History of habits such as tobacco, gutka chewing, smoking, and alcohol was given by 32.25%, 29.81%, 26.56%, and 11.38% of cases, respectively. Common symptoms were soreness, burning sensation, oral pain and ulcers. Both oral and cutaneous involvement was seen in 17.89% of cases. Oral lichen planus (oral LP) constituted largest group of patients (21.96%) wherein reticulate type was the most frequent type and buccal mucosa was the commonest site. Oral carcinomas constituted 20.33% of cases followed by infective etiology (11.92%), vesiculobullous group of diseases (10.30%), aphthous stomatitis (8.94%), premalignant lesions (7.05%) such as leukoplakia (3.80%) and submucous fibrosis (2.44%). Histopathology was done in 209 cases. Clinico-histopathological correlation was seen in oral LP (90.27%), oral pemphigus (82.35%), and malignancies (98.66%). Conclusion Oral LP formed the largest group of cases followed by Oral squamous cell carcinoma (SCC). Several rare conditions, such as Melkersson-Rosenthal syndrome and blue rubber bleb nevus syndrome were also a part of the study. Thorough clinical and histopathological examination in this diverse group of diseases clinches the diagnosis.
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Rahadiani N, Habiburrahman M, Handjari D, Stephanie M, Krisnuhoni E. Clinicopathological characteristics predicting advanced stage and surgical margin invasion of oral squamous cell carcinoma: A single‑center study on 10 years of cancer registry data. Oncol Lett 2022; 24:364. [PMID: 36238853 PMCID: PMC9494421 DOI: 10.3892/ol.2022.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
The incidence profile of oral squamous cell carcinoma (OSCC) has not previously been comprehensively reported in Indonesia. The present study aimed to identify clinicopathological characteristics of patients with OSCC according to sex and age, to analyze histological differentiation patterns specific to tumor subsites, to highlight the role of lymphovascular invasion (LVI) in metastasis, and to develop a model to predict advanced stage and margin invasion. A retrospective cross-sectional study was performed using 581 medical records and pathological specimens from cancer registry data in the Dr Cipto Mangunkusumo Hospital (Jakarta, Indonesia), between January 2011 and December 2020. Clinicopathological characteristics were analyzed using parametric and non-parametric tests. Multivariate logistic regression analyses were performed for eligible parameters, identified using bivariate analysis, to predict advanced stage and margin invasion. Calibration of the prediction model was evaluated using the Hosmer-Lemeshow test, its discrimination value assessed using the receiver operating characteristic and area under the receiver operating characteristic curve (AUC). Sex-specific patterns in tumor subsites and differences in clinical staging according to age were demonstrated in the patients with OSCC. The proportion of well-differentiated cases was significantly higher in most tumor subsites, except in the buccal mucosa (more moderately differentiated cases) and floor of the mouth (well and moderately differentiated cases being equal). LVI was significantly associated with nodal metastasis but not distant metastasis. Multivariate analysis demonstrated that age ≤45 years [odds ratio (OR), 2.26] and LVI (OR, 8.42) predicted patients having advanced-stage OSCC among general populations (AUC, 0.773); however, LVI (OR, 8.28) was the sole predictor of advanced stage amongst young patients (AUC, 0.737). Margin invasion was predicted solely by tumor subsite, including mouth not otherwise specified (OR, 3.04) and palate (OR, 6.13), in the general population (AUC, 0.711). Furthermore, margin invasion was predicted by the palate subsite (OR, 38.77) and LVI (OR, 11.61) in young patients (AUC, 0.762). Investigating young patients thoroughly when finding SCC in the mouth and palate, and assessing LVI, especially among young patients, is critical to prevent advanced staging and margin invasion.
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Affiliation(s)
- Nur Rahadiani
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Muhammad Habiburrahman
- Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Diah Handjari
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Ening Krisnuhoni
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
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Kovalski LNS, Zanella VG, Jardim LC, Só BB, Girardi FM, Kroef RG, Barra MB, Carrard VC, Martins MD, Martins MAT. Prognostic factors from squamous cell carcinoma of the hard palate, gingiva and upper alveolar ridge. Braz Oral Res 2022; 36:e058. [PMID: 36507745 DOI: 10.1590/1807-3107bor-2022.vol36.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to evaluate the clinicodemographic characteristics and treatment protocol as prognostic factors in patients with oral squamous cell carcinoma (OSCC) of the hard palate, upper gingiva, and alveolar ridge (HPUGAR). This retrospective cohort study collected data of patients treated in two head and neck surgery departments in southern Brazil between 1999 and 2021. Information on clinicodemographic data, habits, site, size, clinical aspect, clinical staging, cervical metastasis, treatment, and survival was collected. Associations between independent variables and outcomes were assessed using Pearson's chi-square test and binary regression. Kaplan-Meier test was employed to compare the survival between the neck approaches. Forty-one patients were included; most were male (61%), with a mean age of 68.8 (± 13.9) years. The consumption of tobacco (p = 0.003) and alcohol (p = 0.02) was significantly higher in male than in female patients. The main clinical features observed in the study sample were lesions larger than 2 cm (48.7%), no cervical (90.2%), or distant metastasis (90.2%). Surgery alone was the main treatment approach (48.8%). The watch-and-wait strategy was adopted in 34 cases (83.0%), while elective neck dissection was applied in five (12.2%). Only two patients with cN0 disease (4.9%) presented with cervical metastasis at follow-up. Eight patients (12.2%) died of the disease. Clinicodemographic variables, habits, surgical margins, and histological subtype were not significantly associated with cervical metastasis or survival. Cervical metastasis (p = 0.004) was associated with poor survival. No difference was detected in survival between different neck approaches (p = 0.28). Cervical metastasis and local recurrence are negative prognostic factors for HPUGAR OSCC.
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Affiliation(s)
- Luan Nathiel Santana Kovalski
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Virgilio Gonzalez Zanella
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Department of Head and Neck Surgery, Porto Alegre, RS, Brazil
| | - Luisa Comerlato Jardim
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Bruna Barcelos Só
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Fabio Muradás Girardi
- Hospital Ana Nery, Department of Head and Neck Surgery, Santa Cruz do Sul, RS, Brazil
| | - Ricardo Gallicchio Kroef
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Department of Head and Neck Surgery, Porto Alegre, RS, Brazil
| | - Marinez Bizarro Barra
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Deparment of Pathology, Porto Alegre, RS, Brazil
| | - Vinicius Coelho Carrard
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre, Department of Oral Medicine, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology and Oral Medicine, Porto Alegre, RS, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre, Department of Oral Medicine, Porto Alegre, RS, Brazil
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9
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Bezerra HKF, Passos KKM, Leonel ACLDS, Carvalho EJDA, Nascimento EHLD, Ramos-Perez FMDM, Perez DEDC. Identifying misconceptions about oral radiology and medicine among dental students. J Dent Educ 2021; 86:144-153. [PMID: 34542910 DOI: 10.1002/jdd.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/21/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE/OBJECTIVES Misconceptions are learning deficiencies that can lead to inappropriate clinical decision-making in dental practice. Although misconceptions are common among students, they are rarely analyzed in dental education. Thus, this study aimed to identify and analyze students' misconceptions about oral radiology and medicine at a Brazilian dental school. METHODS Between October 2019 and March 2020, a self-administered anonymous questionnaire was distributed to dental students at the Federal University of Pernambuco, Brazil, which comprised multiple-choice questions about oral radiology and medicine. The questions were divided into two groups: 10 knowledge-based questions (less demand for reasoning) and five scenario-based questions (higher demand for reasoning). The students' responses were assessed for correctness (correct or incorrect) and confidence (sure or unsure), while misconceptions were identified when a student was sure of an incorrect response. Pearson's chi-square test was used to analyze the variables (α = 0.05). RESULTS A total of 1380 responses were collected. Misconceptions represented 24.3% (n = 336) of the total responses and 56.8% of the incorrect responses. The mean misconceptions per student were 3.7 (range, 0-8). Students who chose incorrect answers tended to have higher confidence levels (p < 0.001). Moreover, misconceptions were more frequent for scenario-based questions (25.7%) than for knowledge-based questions (23.7%) (p = 0.000). CONCLUSION A large number of misconceptions existed among participants. Our findings will aid educators and students in identifying misconceptions and planning measures to prevent and correct them.
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Affiliation(s)
| | | | | | - Elaine Judite de Amorim Carvalho
- School of Dentistry, Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Danyel Elias da Cruz Perez
- School of Dentistry, Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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10
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Law ZJ, Khoo XH, Lim PT, Goh BH, Ming LC, Lee WL, Goh HP. Extracellular Vesicle-Mediated Chemoresistance in Oral Squamous Cell Carcinoma. Front Mol Biosci 2021; 8:629888. [PMID: 33768115 PMCID: PMC7985159 DOI: 10.3389/fmolb.2021.629888] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022] Open
Abstract
Oral Squamous Cell Carcinoma (OSCC) remains a cancer with poor prognosis and high recurrence rate. Even with multimodal treatment options available for OSCC, tumor drug resistance is still a persistent problem, leading to increased tumor invasiveness among OSCC patients. An emerging trend of thought proposes that extracellular vesicles (EVs) play a role in facilitating tumor progression and chemoresistance via signaling between tumor cells. In particular, exosomes and microvesicles are heavily implicated in this process by various studies. Where primary studies into a particular EV-mediated chemoresistance mechanism in OSCC are limited, similar studies on other cancer cell types will be used in the discussion below to provide ideas for a new line of investigation into OSCC chemoresistance. By understanding how EVs are or may be involved in OSCC chemoresistance, novel targeted therapies such as EV inhibition may be an effective alternative to current treatment options in the near future. In this review, the current understandings on OSCC drug mechanisms under the novel context of exosomes and microvesicles were reviewed, including shuttling of miRNA content, drug efflux, alteration of vesicular pH, anti-apoptotic signaling, modulation of DNA damage repair, immunomodulation, epithelial-to-mesenchymal transition and maintenance of tumor by cancer stem cells.
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Affiliation(s)
- Zhu-Jun Law
- School of Science, Monash University Malaysia, Selangor, Malaysia
| | - Xin Hui Khoo
- School of Science, Monash University Malaysia, Selangor, Malaysia
| | - Pei Tee Lim
- School of Science, Monash University Malaysia, Selangor, Malaysia
| | - Bey Hing Goh
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Wai-Leng Lee
- School of Science, Monash University Malaysia, Selangor, Malaysia
| | - Hui Poh Goh
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
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11
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Leonel ACLDS, Martelli-Junior H, Bonan PRF, Kowalski LP, da Cruz Perez DE. COVID-19, head and neck cancer, and the need of training of health students and practitioners regarding to tobacco control and patient counseling. Oral Oncol 2020; 106:104739. [PMID: 32354693 PMCID: PMC7180372 DOI: 10.1016/j.oraloncology.2020.104739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | - Hercílio Martelli-Junior
- Oral Diagnosis, Dental School, State University of Montes Claros, UNIMONTES, Montes Claros, Minas Gerais, Brazil; Center for Rehabilitation of Craniofacial Anomalies, Dental School, University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Luiz Paulo Kowalski
- A.C. Camargo Cancer Center, Department of Head and Neck Surgery and Otorhinolaryngology, São Paulo, São Paulo, Brazil; Department of Head and Neck Surgery, University of Sao Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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12
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Sharma P, Narwal A, Kamboj M. Detection of Apoptosis in Leukoplakia and Oral Squamous Cell Carcinoma using Methyl Green Pyronin and Hematoxylin and Eosin. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:189-196. [PMID: 32754214 PMCID: PMC7354069 DOI: 10.30699/ijp.2020.107263.2115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Background & Objective: Cell population and turnover are controlled by a balance between cell proliferation and apoptosis. Detection of apoptosis in oral cancer contributes to its better prognosis and improved management. This study aimed to quantify apoptotic cells in leukoplakia and oral squamous cell carcinoma (OSCC) using methyl green-pyronin (MGP) and hematoxylin and eosin (H & E) staining. Methods: The sample included a total of 130 subjects (comprising 108 males and 22 females). Formalin fixed and paraffin embedded tissues were used and categorized into three groups of normal oral mucosa (n=10), leukoplakia with dysplasia (n=60), and OSCC (n=60). The number of apoptotic cells and apoptotic index (AI) were calculated after staining with MGP and routine H & E stained slides. Results: MGP stained the condensed chromatin of apoptotic cells. Statistically significant difference (P≤0.001) was observed among various study groups in terms of numbers of AI and apoptotic cells. Also, AI increased with increasing grades of dysplasia, and it was the highest in well differentiated OSCC. Results were statistically significant in both H & E and MGP stained sections (P≤0.001). A good correlation was found between MGP and H & E staining results. Conclusion: MGP is more specific and can lead to intense staining for chromatin in apoptotic cells. Accordingly, it can provide a good alternative to H&E in identifying apoptotic cells.
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Affiliation(s)
- Pooja Sharma
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Anjali Narwal
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Mala Kamboj
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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13
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Tshering P, Dorjee S, Dendup T, Dorji T, Wangmo D. Epidemiological and histopathological characteristics of head and neck cancers in Bhutan from 2011 to 2017: a retrospective descriptive study. Ecancermedicalscience 2020; 14:1024. [PMID: 32346390 PMCID: PMC7176063 DOI: 10.3332/ecancer.2020.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Head and neck cancers are among the commonest cancers in the developing world. Personal habits, such as the use of tobacco, betel nut and alcohol are strongly associated with the development of head and neck cancers at certain sites. Therefore, they are among the preventable cancers. In Bhutan, there has not yet been a study conducted on head and neck cancers. OBJECTIVE To describe baseline epidemiological and histopathological characteristics of head and neck cancers in Bhutan. METHODS This is a 7-year descriptive study of all cases of head and neck cancers presented at the Jigme Dorji Wangchuk National Referral Hospital from 2011 to 2017. The data were collected from the hospital's medical records section, histopathology records, patient referral unit and some treatment centres in India. Prior approval was sought from the Research and Ethics Board for Health, the Ministry of Health and the hospital management. RESULTS There were a total of 515 cases of head and neck cancers from 2011 to 2017. The crude incidence rate was 10 per 100,000 and the overall age adjusted rate was 12.3 (95% CI 9.5-15.1) per 100,000 population. The prevalence during this 7-year period was 69.1 per 100,000 population. The commonest cancers are thyroid, oral cavity, hypopharyngeal, laryngeal and nasopharyngeal cancer in decreasing order. Head and neck cancers are more common in males than females in the majority of sites except thyroid, salivary gland and sinonasal malignancies. Thyroid cancers and nasopharyngeal cancers are found to affect younger age groups. Tashigang (48) followed by Paro (43) recorded the highest number of cases. Squamous cell carcinoma is the commonest histopathology type in almost all the cases, while papillary carcinoma is the commonest among thyroid cancers. Personal habits, such as smoking, chewing tobacco, betel nut and alcohol consumption, were found to be more common among patients suffering from oral cavity, laryngeal, hypopharyngeal and oropharyngeal cancers. CONCLUSION Head and neck cancers are the third most common cancer in Bhutan after stomach cancer and cervical cancer. Thyroid, oral cavity and hypopharynx are the top three anatomical sites for head and neck cancers in Bhutan. The current epidemiological and histopathological profile of head and neck cancers will form a baseline of information and basis for further research on head and neck cancers in Bhutan.
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Affiliation(s)
- Phub Tshering
- Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Sithar Dorjee
- Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan
| | | | | | - Dechen Wangmo
- Minister of Health, Royal Government of Bhutan, Thimphu, Bhutan
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14
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Prado NS, Bonan RF, Leonel AC, Castro UF, Carvalho EJ, Silveira FM, Perez DE. Awareness on oral cancer among patients attending dental school clinics in Brazil. Med Oral Patol Oral Cir Bucal 2020; 25:e89-e95. [PMID: 31880286 PMCID: PMC6982986 DOI: 10.4317/medoral.23207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022] Open
Abstract
Background Oral cancer is considered a public health problem worldwide. Dental schools may play an important role in educating patients about oral cancer. This study aimed at evaluating the knowledge of patients attending clinics at two dental schools in Brazil.
Material and Methods From March 2017 to April 2017, 251 patients who were attending clinics at two dental schools in Recife, Brazil, were included in the study. Patients were contacted in the waiting rooms of the clinic. Each participant completed a self-administered questionnaire, which consists of 21 questions, including socio-demographic and specific information on the disease. Data were analyzed using descriptive statistics, and a chi-square test (with a 5% significance level) was used to assess the correlation between the variables, education and family income and other variables.
Results Most participants were women (64.9%) with a mean age of 42.72 years. Most participants were knowledgeable about oral cancer and identified tobacco use (48.6%), alcohol consumption (25.1%), and solar radiation (12%) as the primary risk factors for the disease. Only 36.7% of the participants reported having received counselling on oral cancer, of which 18.3% received the information from a dentist. All patients with an income higher than six minimum wages were aware about oral cancer (p = 0.001).
Conclusions These findings emphasize the importance of educational programs in dental schools as well providing integrated services for patients seeking care at school clinics, including population’s awareness on oral cancer. Key words:Dental school, knowledge, oral cancer, oral health education, patient education.
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Affiliation(s)
- N-S Prado
- Universidade Federal de Pernambuco, School of Dentistry Department of Clinical and Preventive Dentistry, Oral Pathology Section 4ª Travessa Professor Artur de Sá, s/n Cidade Universitária. 50740-521. Recife, Pernambuco, Brazil
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Purwanto DJ, Soedarsono N, Reuwpassa JO, Adisasmita AC, Ramli M, Djuwita R. The prevalence of oral high‐risk HPV infection in Indonesian oral squamous cell carcinoma patients. Oral Dis 2019; 26:72-80. [DOI: 10.1111/odi.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Denni J. Purwanto
- Department of Surgical Oncology Dharmais National Cancer Hospital Jakarta Indonesia
| | - Nurtami Soedarsono
- Department of Oral Biology Faculty of Dentistry Universitas Indonesia Jakarta Indonesia
| | - Jauhari O. Reuwpassa
- Department of Surgical Oncology Dharmais National Cancer Hospital Jakarta Indonesia
| | - Asri C. Adisasmita
- Department of Epidemiology Faculty of Public Health Universitas Indonesia Depok Indonesia
| | - Muchlis Ramli
- Department of Surgical Oncology Cipto Mangunkusumo National Hospital‐Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Ratna Djuwita
- Department of Epidemiology Faculty of Public Health Universitas Indonesia Depok Indonesia
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Passos KKM, Leonel ACLDS, Bonan PRF, Castro JFL, Pontual ADA, Ramos‐Perez FMDM, da Cruz Perez DE. Information on oral cancer available on the internet: Is it reliable? Oral Dis 2019; 25:1832-1833. [DOI: 10.1111/odi.13150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Kamilla Karla Maurício Passos
- Department of Clinical and Preventive Dentistry, School of Dentistry Universidade Federal de Pernambuco Recife Brazil
| | | | | | - Jurema Freire Lisboa Castro
- Department of Clinical and Preventive Dentistry, School of Dentistry Universidade Federal de Pernambuco Recife Brazil
| | - Andrea dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, School of Dentistry Universidade Federal de Pernambuco Recife Brazil
| | | | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry Universidade Federal de Pernambuco Recife Brazil
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