Impact of Anxiety on Health-Related Quality of Life and Symptoms of Burnout in Multi-Professional Residents in Brazil During the COVID-19 Pandemic

We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

Peripheral dentinogenic ghost cell tumor-report of two cases and review of the literature

Peripheral dentinogenic ghost cell tumor (DGCT) is a rare and non-aggressive benign odontogenic tumor. They usually affect the elderly and are predominantly located in the anterior region of the jaws. Their differential diagnosis includes reactive/inflammatory gingival lesions. We report here two cases of peripheral DGCT in a 73-year-old female and a 48-year-old male patient and review the cases published in the literature. Both lesions presented as a nodular lesion in the mandible, and panoramic radiography showed no abnormalities. Microscopically, it was observed to be an ameloblastomatous epithelial proliferation associated with clusters of ghost cells and dysplastic dentin. Immunohistochemistry revealed positivity for cytokeratin 19 and a low Ki-67 proliferative index. Based on histopathological features and the absence of radiographic findings, a diagnosis of peripheral DGCT was rendered. The low number of cases published of peripheral DGCT makes case reports important in providing information that helps in their diagnoses and management.

Evaluation of the Association of Early Implant Failure With Local, Environmental, and Systemic Factors: A Retrospective Study

PURPOSE

This study aimed to assess the association of early implant failure (EIF) with demographic, local, environmental, and systemic factors.

METHODS

Clinical charts of 594 individuals with 2,537 dental implants were assessed. EIF was characterized by implant loss before and up to the abutment connection. Logistic regression analysis was used to verify the association between EIF and local, environmental, and systemic factors at the individual and implant levels. The chosen level of significance was 5%.

RESULTS

EIF occurred in 144 implants (5.68%) and in 97 individuals (16.3%). At the individual level, smoking habits (odds ratio [OR] = 2.54; 95% confidence interval [CI] = 1.00 to 6.47; P = .05), absence of postoperative antibiotic therapy (OR = 2.73; CI = 1.22 to 6.13; P = .02), and bone augmentation (OR = 1.83; CI = 1.17 to 2.85; P = .01) were significantly associated with EIF. At the implant level, smoking habits (OR = 2.90; CI = 1.60 to 5.26, P < .001), absence of postoperative antibiotic therapy (OR = 2.77; CI = 1.36 to 5.63, P = .005), postoperative complications (OR = 28.35; CI = 6.79 to 118.45, P < .001), implant length ≤8.5 mm (OR = 1.79; CI = 1.07 to 2.99; P = .03), and diameter <3.75 mm (OR = 1.65; CI = 1.08 to 2.52, P = .02) were associated with EIF. Age, sex, alcohol abuse, diabetes, hypertension, and long-term medication use were not associated with EIF at both individual and implant levels (P ≥ .12).

CONCLUSIONS

Smoking habits, absence of antibiotic therapy, bone augmentation, postoperative complications, implant diameter <3.75 mm, and implant length ≤8.5 mm were associated with EIF. Clinicians should be aware of these associations that should be controlled for when feasible. Future cohort studies are required to confirm the risk factors.

Central giant cell granuloma: A clinicopathological and immunohistochemical study of macrophages, blood vessels, lymphatic vessels and regulatory proteins

OBJECTIVE

This study seeks to investigate immunohistochemical parameters that could distinguish non-aggressive Central giant cell granuloma (CGCG) from aggressive CGCG, two groups of lesions which differ in their clinical and radiographic features and prognosis.

MATERIAL AND METHODS

12 cases of non-aggressive CGCG and 11 cases of aggressive CGCG were investigated and associated the immunohistochemical expression of macrophages (CD68 and CD163), blood vessels (CD34 and CD105), lymphatic vessels (D2-40) and regulator proteins (p63 and Ki-67). Clinical and radiographic features were also studied.

RESULTS

Associations between all proteins in non-aggressive and aggressive CGCG were not significant (p > 0.05). With respect to non-aggressive CGCG, there were no significant correlations, while in aggressive CGCG there was a significant positive correlation between CD68 and CD163 (p = 0.031), between CD34 and D2-40 proteins (p = 0.04), whereas a significant negative correlation was observed between CD105 and CD68 (p = 0.040). However, regardless of aggressiveness of CGCG, there was a significant positive correlation between CD68 and CD163 (p = 0,04). Among the clinical and immunohistochemical aspects, only the symptomatology was a significant risk factor for the occurrence of aggressive CGCG (OR = 12.00/p = 0.016).

CONCLUSION

Macrophages and angiogenesis contribute to their maintenance and development of CGCG. In addition, immunohistochemistry used here was not able to differentiate their aggressiveness. However, symptomatology was proved to be a risk factor for the occurrence of aggressive CGCG. It is possible that clinical features, particularly symptomatology, represent the most appropriate parameter to attempt to distinguish GCCG.

Systemic risk indicators for peri-implant diseases in individuals with implant-supported fixed prostheses: A cross-sectional study

PURPOSE

The present study aimed to identify the systemic risk indicators associated with peri-implant mucositis and peri-implantitis in individuals with implant-supported fixed prostheses.

MATERIALS AND METHODS

In this cross-sectional study, clinical evaluations of periodontal and peri-implant conditions were performed by a single examiner in a sample of 71 volunteers with 360 implants. Peri-implant mucositis was defined as the occurrence of bleeding on probing in association with redness and swelling or suppuration, without bone loss. Peri-implantitis was defined based on a radiograph of bone loss ≥ 3 mm and/or a probing depth ≥ 6 mm with bleeding and/or suppuration on probing. The systemic factors evaluated were obesity, hormone replacement therapy, osteopaenia and osteoporosis, high blood pressure and hypercholesterolaemia. Logistic models were applied to assess the associations between peri-implant diseases and systemic factors.

RESULTS

Mucositis and peri-implantitis were found in 83.1% and 16.9% of the individuals, respectively. The regression analysis showed that obesity (prevalence ratio = 5.23; 95% confidence interval, 1.91 to 96.83; P = 0.01) and high systolic blood pressure (prevalence ratio = 4.23; 95% confidence interval, 1.66 to 12.87; P = 0.03) were associated with peri-implantitis at the individual and implant levels, respectively. No systemic factor was associated with peri-implant mucositis (P ≥ 0.06).

CONCLUSION

Obesity and high systolic blood pressure were associated with peri-implantitis, whereas no systemic factor was associated with peri-implant mucositis. Future prospective studies are required to confirm these as true risk factors. Patients with obesity and/or high systolic blood pressure could be informed of the likely association with peri-implantitis, preferably before implant placement.

Ameloblastoma with adenoid features: A series of eight cases

BACKGROUND

Ameloblastoma with adenoid features are characterized by the presence of duct-like structures formed from the parenchyma of the tumor. This study was conducted to report a series of eight ameloblastomas with adenoid features, highlighting their clinicopathological and immunohistochemical aspects.

MATERIAL AND METHODS

Out of 71 cases of ameloblastomas, this study classified 8 cases as ameloblastomas with adenoid features. Clinicopathological data and immunohistochemistry for CK7, CK14, CK19, IMP3, p53 and Ki-67 were evaluated.

RESULTS

From those cases of ameloblastoma exhibiting adenoid features, there were 4 women and 4 men, with mean age of 39 years. Most cases affected the mandible and all presented radiographically as a radiolucency. The predominant histopathological features were pseudoducts, squamous metaplasia, nuclear hyperchromatism, clear cells, whorled aspect of epithelial structures, cribriform growth pattern, proliferation of spindle cells and extracellular eosinophilic material. Immunohistochemical analysis showed high expression for CK14 (n = 6) and CK19 (n = 3) and all cases (n = 8) were negative for p53, IMP3 and CK7. In addition, all samples (n = 8) showed low expression for Ki-67.

CONCLUSIONS

The similarities between the histopathological and immunohistochemical features of eight cases described in the present study and those described in previous studies support the possibility that these lesions are adenoid ameloblastomas. In addition, the immunohistochemical results of CK14, CK19, p53 and Ki-67 did not differ from those of conventional ameloblastomas.

Total bilateral TMJ reconstruction for pain and dysfunction: Case report

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The use of TMJ protheses was configured as a good therapeutic alternative for severe conditions that do not respond to conservative treatments.

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A correct diagnosis of the pathology and the correct indication for reconstruction are fundamental for the success of the technique.

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The stock prostheses is a good alternative when there is no need for mandibular advancement and the branches are still preserved.

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Further studies are needed to demonstrate whether these results are long term.

Introduction

Temporomandibular disorders encompass a set of clinical conditions that affect the temporomandibular joint, the masticatory muscles and the associated tissues. Many therapeutic alternatives can be considered, being divided into non-invasive, minimally invasive and invasive interventions. This work aims to report a case of inflammatory joint pain and dysfunction treated with bilateral TMJ full reconstruction with alloplastic prosthesis stock.

Case report

Patient D.J.S.S., female, 41 years old, hypertensive, for six years had constant pain in TMJ bilaterally, with limitation of mouth opening, with a clinical signs of joint disc displacement without reduction. Initially treated only by conservative approaches. Without improvement, arthrocentesis of the TMJ was performed. The symptoms do not regress, leading the patient to bilateral discopexy procedure. We opted for the alloplastic substitution of the temporomandibular joint with prostheses of stock in both joints through an established protocol.

Discussion

The main objective of the reconstruction of the temporomandibular joint in cases of joint bone degeneration is the restoration of form and function, considering the reduction of pain as a secondary result. Alloplastic replacement of TMJ can be considered as an alternative therapy to improve the quality of life of a small group of patients showing signs and symptoms of TMD as a reduction of maximum mouth opening, pain, etc.

Conclusion

The use of total joint prostheses has been configured as a good therapeutic alternative for severe conditions of TMJ that do not respond to conservative treatments. However, further studies are needed to demonstrate whether these results are long term.

Appositional bone graft tunneled: Technical note

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The tunnel technique for onlay bone grafting is a simple and easy to perform technique.

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We had no implant loss with the tunnel technique in the onlay bone graft.

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The fact that the periosteum is kept intact, is a crucial element for the survival and viability of the graft block.

Introduction

A satisfactory positioning of the dental implants is very important in the cosmetic and functional outcome in this treatment for edentulous. Insertion of an endosseous implant in the correct positioning requires sufficient bone volume. Therefore, bone-grafting procedures are becoming increasingly common, especially for the augmentation of horizontally deficient ridges. PRESENTATION OF CASE: Many patients have been treated with this technique of appositional Bone Graft Tunneled at our clinic since 2005. The method will be completed through the technical note of a surgical procedure involving a dental implant used for edentulous space rehabilitation in the jaws and the tunnel technique with an appositional bone graft, using the mandibular arch as the donor area.

Discussion

The substitution of screws to stabilize the bone graft for the tunnel technique allowed the surgery to be performed in a shorter time. The advantages were as follows: the absence of complications associated with conventional titanium screws, the preservation of the integrity of the periosteum, and the fact that there was no need to remove the screws through relaxing incisions in the gingival mucosa before placing the implant.

Conclusion

The tunnel technique for onlay bone grafting is a simple and easy to perform technique, which is completed with less surgical time and at a lower cost and has presented highly predictable results and high success rates.

Transcriptional profiles of SHH pathway genes in keratocystic odontogenic tumor and ameloblastoma

BACKGROUND

Sonic hedgehog (SHH) pathway activation has been identified as a key factor in the development of many types of tumors, including odontogenic tumors. Our study examined the expression of genes in the SHH pathway to characterize their roles in the pathogenesis of keratocystic odontogenic tumors (KOT) and ameloblastomas (AB).

METHODS

We quantified the expression of SHH, SMO, PTCH1, SUFU, GLI1, CCND1, and BCL2 genes by qPCR in a total of 23 KOT, 11 AB, and three non-neoplastic oral mucosa (NNM). We also measured the expression of proteins related to this pathway (CCND1 and BCL2) by immunohistochemistry.

RESULTS

We observed overexpression of SMO, PTCH1, GLI1, and CCND1 genes in both KOT (23/23) and AB (11/11). However, we did not detect expression of the SHH gene in 21/23 KOT and 10/11 AB tumors. Low levels of the SUFU gene were expressed in KOT (P = 0.0199) and AB (P = 0.0127) relative to the NNM. Recurrent KOT exhibited high levels of SMO (P = 0.035), PTCH1 (P = 0.048), CCND1 (P = 0.048), and BCL2 (P = 0.045) transcripts. Using immunolabeling of CCND1, we observed no statistical difference between primary and recurrent KOT (P = 0.8815), sporadic and NBCCS-KOT (P = 0.7688), and unicystic and solid AB (P = 0.7521).

CONCLUSIONS

Overexpression of upstream (PTCH1 and SMO) and downstream (GLI1, CCND1 and BCL2) genes in the SHH pathway leads to the constitutive activation of this pathway in KOT and AB and may suggest a mechanism for the development of these types of tumors.

Oral findings in patients with mucolipidosis type III

Mucolipidosis type III is a rare, autosomal recessive disorder, which is part of a group of storage diseases as a result of inborn error of lysosomal enzyme metabolism. It is characterized by the gradual onset of signs and symptoms affecting the physical and mental development as well as visual changes, heart, skeletal and joint. Although oral findings associated with mucolipidosis type II have been extensively reported, there is a shortage of information on mucolipidosis type III. This paper presents radiological and histological findings of multiple radiolucent lesions associated with impacted teeth in the jaw of a 16 year-old youngster with mucolipidosis type III.

Gingival cyst of the adult: a case report and immunohistochemical investigation

A 42-year-old woman had a sessile swelling that involved the maxillary gingiva corresponding to the right canine and premolar area. Clinical examination showed a painless small nodule (10 mm in diameter) located between the right maxillary canine and premolar. The lesion was vesicular, sessile, and slightly compressible on palpation. Microscopic examination of the lesion (following an excisional biopsy) showed cystic spaces covered by an epithelium lining that consisted of cuboidal and squamoid cells intermingled with clear cells. These morphologic findings were consistent with gingival cyst of the adult. Immunohistochemical technique against cytokeratins revealed that the epithelial cells were positive for cytokeratins No. 7, 8, 13, 14, and 19. Two years after removal, no recurrence was reported.