Photodynamic Detection (PDD) is a diagnostic technique involving administration of a photosensitizer to the targeted cells that can be stimulated by short wavelength light which then leads to emission of light at a different wavelength (lower energy). The light emitted by the cells can be detected and analysed (by a spectroscope). All cells have the innate ability (due to endogenous fluorophores) to fluoresce, termed autofluorescence. Any cellular, metabolic or structural changes can alter the fluorescence intensity peaks. In this study 5-aminolevulinic acid (5-ALA) photosensitizer prodrug was used, which is metabolised in highly active cells to protoporphyrin IX (PpIX). Excitation of a cell at 405nm wavelength (light) leads to emission of autofluorescence at 500nm and PpIX at 635nm. The purpose of this investigation was to evaluate the use of compact spectroscopy together with the photosensitizer prodrug 5-ALA, in assessing clinically suspicious oral lesions. To that end the followings were assessed: • The fluorescence intensity ratio (FIR) or Red/Green ratio at 635/500nm measurements of normal anatomical sites at ten oral anatomical sites to map and create baseline readings for normal oral mucosal site fluorescence. • The effect of participants’ characteristics on the normal oral mucosal site FIR measurements. • The use the fluorescence intensity ratio (FIR) measurements to determine any differences between the lesion and the normal oral readings and whether the FIR from clinically suspicious oral lesions is associated with the histopathology grade. In addition to the sensitivity and specificity of the technique in assessing clinically suspicious (premalignant) oral lesions for potential malignant change.Prior to the trial commencing, approval were obtained from the Research Ethics Committee (REC), local NHS Research and Development (R&D), and Medicine Healthcare product Regulatory Agency (MHRA) and the University of Dundee Research Innovation Services (RIS). A total of thirty five participants with clinically suspicious oral lesions were recruited in Dundee (Dundee Dental Hospital) and Glasgow (Southern General Hospital). A Photodynamic Detection method using compact fluorescence spectroscopy and 5-ALA mouth rinse was applied. FIR measurements from ten normal anatomical sites were obtained in every patient to study the variation at different normal oral sites and the effect of the participant’s characteristics on these readings. In addition, two FIR measurements were obtained from each lesion and a further one taken from normal looking mucosa well beyond the lesion boundary (i.e. more than 5mm away) prior to biopsy. The readings were compared to study the reliability, reproducibility and efficacy of the photodynamic method in detecting mucosal abnormality. A total of 292 spectral readings obtained from normal mucosa were used to study the FIR measurements at normal oral anatomical sites. The results showed that the oral regions could be grouped into two broad categories with similar readings, the palatal and tongue readings in one group and buccal, ventral tongue, floor of the mouth, gingiva and lip mucosa on the other (essentially keratinized and non keratinized groups). The same set of readings were further analysed to study the effect of individual characteristics (age, gender, presence of oral prosthesis, metabolic diseases, smoking and alcohol consumptions) on the FIR measurements. There was no significant difference between FIR measurements within each of the groups studied, although at times sample sizes were very small.A total of 134 spectral readings obtained from 47 lesions that were biopsied from 35 patients recruited to the trial were used for the next part of the study. There were 91 spectra obtained from the lesions and 43 spectra obtained from the normal sites (more than 5mm away from the borders of the lesion) for comparison. There was a significant difference between the lesion and normal site readings. The FIR readings for the dysplastic lesions were significantly different when compared with the normal and benign hyperkeratoses. However there was no significant difference between dysplastic and inflammatory lesions (lichen planus, lichenoid lesions and candidal leukoplakia) on the one hand and inflammatory lesions and hyperkeratotic lesion on the other. Further analysis showed the sensitivity in detecting all the clinically suspicious oral lesions from the normal sites was 59.5% and specificity was 73.8%. The sensitivity in detecting dysplasia from normal sites was 100% and specificity 100%.Photodynamic Detection was able to detect a difference between the oral lesions from normal mucosa (but so is the naked eye!). However there was variation in the sensitivity and specificity in detecting a range of different pathological conditions. The technique was highly sensitive in detecting dysplasia from normal mucosa but unfortunately the technique is not able to discriminate reliably between dysplasia and inflammatory lesions whose clinical appearance can be very similar. In conclusion, the photodynamic detection method used in this study would not appear to offer a reliable screening tool for the early detection of oral dysplasia/cancer. The need to consider adjunctive tests that discriminate inflammation from dysplasia is required. Photodynamic Detection (PDD) is a diagnostic technique involving administration of a photosensitizer to the targeted cells that can be stimulated by short wavelength light which then leads to emission of light at a different wavelength (lower energy). The light emitted by the cells can be detected and analysed (by a spectroscope). All cells have the innate ability (due to endogenous fluorophores) to fluoresce, termed autofluorescence. Any cellular, metabolic or structural changes can alter the fluorescence intensity peaks. In this study 5-aminolevulinic acid (5-ALA) photosensitizer prodrug was used, which is metabolised in highly active cells to protoporphyrin IX (PpIX). Excitation of a cell at 405nm wavelength (light) leads to emission of autofluorescence at 500nm and PpIX at 635nm. The purpose of this investigation was to evaluate the use of compact fluorescence spectroscopy together with the photosensitizer prodrug 5-ALA, in assessing clinically suspicious oral lesions. To that end the followings were assessed: • The fluorescence intensity ratio (FIR) or Red/Green ratio at 635/500nm measurements of normal anatomical sites at ten oral anatomical sites to map and create baseline readings for normal oral mucosal site fluorescence. • The effect of participants’ characteristics on the normal oral mucosal site FIR measurements. • The use the fluorescence intensity ratio (FIR) measurements to determine any differences between the lesion and the normal oral readings and whether the FIR from clinically suspicious oral lesions is associated with the histopathology grade. In addition to the sensitivity and specificity of the technique in assessing clinically suspicious (premalignant) oral lesions for potential malignant change. Prior to the trial commencing, approval were obtained from the Research Ethics Committee (REC), local NHS Research and Development (R&D), and Medicine Healthcare product Regulatory Agency (MHRA) and the University of Dundee Research Innovation Services (RIS). A total of thirty five participants with clinically suspicious oral lesions were recruited in Dundee (Dundee Dental Hospital) and Glasgow (Southern General Hospital). A Photodynamic Detection method using compact fluorescence spectroscopy and 5-ALA mouth rinse was applied. FIR measurements from ten normal anatomical sites were obtained in every patient to study the variation at different normal oral sites and the effect of the participant’s characteristics on these readings.

Magister Chirurgiae Dentium (MChD) / Introduction:Hereditary Epidermolysis bullosa (EB) is a group of rare mechanobullous dermatological disorders in which blisters develop following gene mutations. These genes encode structural proteins that anchor the epidermis to the underlying dermis.There are four main types of Epidermolysis bullosa, with more than 20 subtypes. The medical, physical and psychosocial aspects of Epidermolysis bullosa are well documented (Lucky et al, 2005; Mellerio et al, 2005). Many studies have documented case reports of associated oral lesions (Silva et al, 2004; Pacheco and de Sousa Araugio 2008; Siqueira et al, 2008). However, no assessment of the impact of these oral lesions on the affected person's everyday life has been made. The morbidity of the oral lesions associated with EB is expected to have an impact on the quality of life of these patients.Aim:To assess the prevalence and impact of oral lesions on daily activities in persons with Epidermolysis bullosa in Cape Town, South Africa, utilizing the Oral Impact on Daily Performance (OIDP) measure. Research Design and Methodology A case-controlled, descriptive analysis of the way in which oral lesions impact on quality of life in persons with Epidermolysis bullosa was carried out using semi-structured interviews. Fourteen persons with a confirmed diagnosis of hereditary Epidermolysis bullosa who attended the dermatology clinics at the Red Cross and Groote Schuur hospitals participated in the study. The control group comprised eighteen persons closely matched for gender, age, and dental status. Three persons with EB were unavailable for inclusion in the study.Results and Discussion Fourteen persons with Epidermolysis bullosa and eighteen controls were included in the study. Epidermolysis bullosa Simplex comprised the largest sub-group (n=9). Two persons had Junctional Epidermolysis bullosa, two had recessive Dystrophic Epidermolysis bullosa and one person had Kindler syndrome. The oral manifestations observed were consistent with those reported in the literature(Chimenos et al, 2003; Silva et al, 2004; Pekinar et al, 2005). No significant oral lesions (other than tooth decay) were seen in persons in the Epidermolysis bullosa Simplex group. Oral ulcers, atrophy of the dorsal surface of the tongue and gingival erythema were seen in persons with Junctional Epidermolysis Bullosa. The two individuals with Dystrophic Epidermolysis bullosa had a maximal oral opening of 15mm and 24mm. Ankyloglossia, depapillation of the dorsal tongue, absence of palatal rugae and poor oral hygiene was seen in these two persons. The patient with Kindler syndrome presented with erythematous and inflamed gingiva and cratering in the maxillary anterior interdental area. The gingiva appeared desquamative, fragile and bled with even the slightest provocation. Healing peri-oral blisters and angular cheilitis was also seen. His mouth opening was restricted to a maximal oral aperture of 13mm and his tongue extrusion was limited to only the tip of the tongue passing over the lower anterior incisor teeth.Defects in the tooth enamel was recorded in both participants with Junctional Epidermolysis bullosa and one person with dystrophic Epidermolysis bullosa, as well as excessive occlussal tooth wear (attrition), which may have been secondary to enamel hypoplasia. The dental caries status of the Epidermolysis bullosa and control groups varied according to age. The dmf for persons with Epidermolysis bullosa (all of whom had Epidermolysis bullosa Simplex), was lower than in the control group. The DMF in EB persons (15.3) was higher than in the control group (10.1).Toothache and tooth decay were the most common perceived complaints in both the Epidermolysis bullosa and control participants, accounting for the high overall OIDP score in both groups (87.5%). No statistically significant difference was found between the two groups (85.7% and 88.9% for Epidermolysis bullosa and control group persons respectively).Conclusion:The results of the study show that oral lesions (particularly tooth decay and toothache) in persons with Epidermolysis bullosa do affect their daily activities and the impact thereof is high. Other oral manifestations, irrespective of the subtype, had little impact on the OIDP score. This may be because the EB persons become tolerant of and “learn to cope” with them.Recommendations:Epidermolysis bullosa is a rare condition and not all persons with EB will present with lesions. However, all health personnel (including oral health profession) must be cognizant of this condition, in order to manage these persons safely, without incurring harm inadvertently. Thus, the overall management of persons with Epidermolysis bullosa must encompass ways to minimize and prevent trauma; provide an optimum wound healing environment; provide pain management and judicious checks for the development of premalignant lesions. This necessitates a multidisciplinary and holistic approach, with emphasis on patient involvement. To this end, an oral health care programme should form an integral part of their management because of the risk of dental disease. Periodic recall visits will enable the monitoring of home care and minimize the need for advanced restorative procedures. In this way, one may reduce the impact any oral problems may have, so that they do not further influence the patients well being.

Abstract The utilization of oral lesions as a screening tool for HIV is not well documented. Attendees at two primary health care facilities (Khutsong and Heidelberg) were assessed to determine the predictive value of group I oral lesions for HIV infection. The objectives were to investigate the: 1) HIV prevalence amongst attendees at PHC facilities, 2) Prevalence of HIV-related oral lesions and 3) Correlation between the oral lesions and the HIV status using the Likelihood Ratio test. Methods: All patients over 12 months of age presenting at the two facilities for a curative care consultation over a one-week period (in April 2005) were included. Consent was obtained by trained counselors who also conducted a brief interview and offered pre-test counseling to patients wishing to know their HIV status. Two calibrated dentists conducted a head, neck and oral examination and administered a rapid saliva HIV test (OraQuick HIV-1/2-Rapid HIV-1/2 Antibody Test). Results: A total of 654 attendees were surveyed in the 2 facilities. There was a 100% response. The mean age of the participants was 34 years (range: 1-94), and the majority (73%) were female. HIV prevalence rates were 34% at Khutsong and 36% at Heidelberg. The HIV prevalence peaked at 46% in the 16-45 age groups. Of the 228 who tested positive for HIV, 121 (53%) patients were diagnosed with 1 or more Group I oral lesion. Oral candidiasis (46%) and oral hairy leukoplakia (19%) were the two most common oral lesions diagnosed in the HIV positive cohort. The positive predictive values and specificity values for multiple lesions ranged between 96% and 100%. Most of the likelihood ratios for multiple lesions were greater than 10 which implied that the patients who presented with these lesions were extremely likely to test positive for HIV. The sensitivity values (1% to 37%) and negative predictive values (66% to 70%) remained relatively low. Conclusion: The HIV prevalence of patients attending PHC facilities was high (34%). Oral lesions are useful markers of HIV-infection and should alert clinicians to the presence of HIV infection. Multiple group I lesions were more predictive of HIV infection compared to single lesions.

Magister Chirurgiae Dentium - MChD / Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) present with oral manifestations of HIV as the first sign of the disease. While Lesotho has a population of fewer than 2 million people, it is faced with the harsh reality of a dire shortage of health care workers including oral health care workers (OHCWs). The high prevalence of HIV is of major concern to oral health workers who regularly encounter patients presenting with oral lesions associated with HIV disease. Oral health care workers need to have adequate knowledge of these conditions for effective management thereof. To determine the knowledge, attitudes and practises of oral health care workers (OHCWs) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCWs in 26 public and private care facilities in all ten districts of Lesotho. A self–administered questionnaire was used to gather information on demographic characteristics of OHCWs and their knowledge, attitudes and practices regarding the management of oral lesions associated with HIV. A visual aid depicting seven colour images of lesions strongly associated with HIV was used to assess knowledge. Data was analysed using Microsoft Excel® and the R statistical package. The outcome of the study was then presented using tables and charts as appropriate. Frequencies, means and 2x2 contingency tables were generated and Fisher‟s exact tests were used for associations. A significance level of (p<0.05) was used.

Magister Scientiae Dentium - MSc(Dent) / Introduction: South Africa has an estimated HIV prevalence rate of 29.5%, in Gauteng province, the prevalence rate in women attending ante-natal clinic is 28.7% and in the Johannesburg Metro District, the prevalence rate is 41%. The early identification of HIV in the HIV positive well patient or HIV positive unwell patient can lead to the commencement of early intervention and treatment, thus resulting in a higher quality of life for the patient and lower treatment costs for the State. Aim: To determine the oral health knowledge, practices and treatment patterns of nurses at ARV clinics in Johannesburg Metro District. Materials and Methods: The study design was a convenient cross-sectional survey conducted between May 2014 and January 2015 in the Johannesburg Metro District. The study population comprised of nursing staff at ARV clinics in the Johannesburg Metro District. 147 questionnaires were distributed among the nurses that were in contact with the patients. Only 100 (n=147) questionnaires came back completed. The data collected was entered into Microsoft Excel and imported to STATA 13.1 to determine statistical significance using chi-squared test. A p-value was regarded significant if <0.05. Results: The results of the study depicted poor knowledge on oral manifestations of HIV/AIDS from the nursing staff at the ARV clinics in the district. Although 85% could describe the oral lesions found in the oral cavity and 66% perceived that they could identify Oral Candidiasis (OC), only 47% could correctly identify the lesion. 57% perceived knowing the condition associated with OC and only 46% correctly named the condition (p- value=0.001). Only two thirds of 43% of nurses could manage OC using drugs from the protocol accessible at the clinics, 25% referred and 32% did not know how to manage the OC (p-value=0.001). Only 40% (n=100) of the nurses referred patients for oral health promotion. Almost all the nurses (81%) indicated repeatedly that they need more training on oral health and oral health promotion. Conclusions: There is a need to include the oral manifestations of HIV in the nursing curriculum. Continued professional development should include Oral Health Promotion. Further research is needed to explore means of incorporating an oral health and disease module in the nursing curriculum.

Os portadores do vírus HIV, no curso da doença podem ser acometidos por manifestações oportunistas e/ou apresentar aumento do índice CPOD (dentes cariados, perdidos e obturados). O objetivo principal desse estudo transversal foi determinar o índice CPOD e a prevalência de lesões da mucosa bucal (Candidose, Eritema linear gengival, Leucoplasia pilosa oral, Herpes simples, Úlceras bucais, Sarcoma de Kaposi e Linfoma) em uma amostra de conveniência composta por 140 indivíduos infectados pelo HIV atendidos no Serviço Ambulatorial Especializado (SAE) de Porto Velho-RO. E, avaliar a associação entre os parâmetros bucais com a contagem de linfócitos TCD4, a quantificação de carga viral (CV) e o uso de terapia antiretroviral (TARV). Para tanto, foram realizados exames clínicos bucais para o levantamento de lesões de mucosa bucal e índice CPOD, bem como coleta de dados (gênero, idade, hábito de fumar, contagens CD4 e CV, uso de TARV) mediante entrevistas e análise de prontuários. Nos resultados, foram observados: idade média de 39 anos (10,7), contagem de TCD4 média de 380 cels/mm3, 53% dos indivíduos com CV indetectável, 24,2% dos indivíduos apresentaram lesões bucais e o índice CPOD médio foi 16,9, com alta proporção de dentes perdidos. A lesão mais comumente observada foi a candidose que mostrou relação com a contagem de TCD4 e a presença de leucoplasia pilosa foi associada com o aumento da CV. O uso regular da TARV mostrou relação com a baixa prevalência de lesões bucais, proporcionando melhor qualidade de vida aos indivíduos portadores de Aids. Foi possível concluir na amostra avaliada: baixa prevalência de lesões bucais; índice CPOD elevado. No que se refere à avaliação das associações: índice CPOD não relacionado com CV nem com TCD4; uso da TARV mostrou relação positiva com a redução das lesões bucais; indivíduos com maiores contagens TCD4 e menor CV tendem a apresentar menos lesões bucais. / The HIV bearers, in the course of the disease can be affected by opportunistic infections and/or present increase in the DMFT index (decayed, missing and filled teeth). The main objective of this study was to determine DMFT index and the prevalence of lesions of the oral mucosa (Candidosis, Erythema linear gengival, Oral hairy leukoplakia, Herpes simplex, Mouth ulcers, Kaposis sarcoma and lymphoma) in a convenience sample of 140 people infected with HIV attended the Ambulatory Specialized Service Serviço Ambulatorial Especializado (SAE) from Porto Velho- RO. And, to evaluate the association between oral parameters with the counting of lymphocytes TCD4, the quantification of viral load (VL) and the use of antiretroviral therapy (ARVT). Oral clinical examinations were conducted for the lifting of oral lesions of the oral mucosa and DMFT index, and collecting data (gender, age, smoking, TCD4 and VL counts, use of ARVT) through interviews and analysis of medical records. Were observed: average age of 39 years ( 10.7), TCD4 count average of 380 cels/mm3, 53% of individuals with undetectable VL, 24.2% of individuals had oral lesions and DMFT index average was 16,9, with a high proportion of missing teeth. The lesion most commonly seen was the candodosis and the hairy leukoplakia presence was associated with increasing VL. The regular use of ARVT showed relationship with the low prevalence of oral lesions, providing better quality of life for people with AIDS. Could be concluded in the sample assessed: low prevalence of oral lesions; DMFT index high. Regarding the assessment of the associations: DMFT index not linked to VL or with TCD4; use of ARVT showed positive relationship with the reduction of oral lesions; people with TCD4 more counts and VL minor to present oral fewer injuries.

p. 1-122 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T18:00:49Z No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T16:51:40Z (GMT) No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) / Made available in DSpace on 2013-05-04T16:51:40Z (GMT). No. of bitstreams: 1 9999999999999.pdf: 5819061 bytes, checksum: ef3a93df9666817aa3437a80b1999934 (MD5) Previous issue date: 2008 / Esta tese apresenta o resultado da investigação sobre manifestações clínicas orais em indivíduos infectados pelo HIV, analisando suas implicações na condição de saúde em crianças e adultos. Também investigou o papel da candidíase oral pseudomembranosa como possível preditora da progressão para a Aids. Foram desenvolvidos três estudos: o primeiro de corte transversal realizado por meio de uma revisão de prontuários clínicos dos indivíduos com 13 anos de idade ou mais assistidos pelo serviço de odontologia do Centro de Referência Estadual de Aids (CREAIDS), em Salvador-Bahia. O segundo, também de corte transversal semelhante ao primeiro, porém com indivíduos menores de 13 anos de idade atendidos no CREAIDS. O terceiro estudo desenhado como coorte histórica foi desenvolvida com dados sócio-demográficos, clínicos, terapêuticos e imunológicos de menores de 13 anos de idade acompanhados pelo serviço de pediatria médica deste Centro de Referência. Os resultados estão apresentados na forma de 03 (três) artigos e demonstram redução na freqüência das manifestações orais associadas com a infecção pelo HIV ao longo do período estudado (2003 a 2005), tanto em adultos quanto em crianças, principalmente nos grupos que utilizavam terapia anti-retroviral (TARV). Estas manifestações foram mais freqüentes em indivíduos que apresentaram alteração imunológica, caracterizada por elevados níveis da carga viral plasmática e redução da contagem dos linfócitos T CD4 +. As manifestações orais foram mais freqüentes em adultos com baixa escolaridade Além disso, foram observadas altas taxas de cárie dentária nestas populações. No entanto, entre as crianças, a cárie dentária mostrou-se associada à ocorrência de lesões orais. Foi observado ainda que a forma “persistente” da candidíase oral pseudomembranosa está associada com alteração imunológica severa e apresentou uma menor mediana de tempo até o diagnóstico de Aids em relação a candidíase episódica ou não candidíase. Esta pesquisa confirma a tendência observada na maioria dos estudos de menor proporção de manifestações orais em indivíduos infectados pelo HIV que utilizam a TARV. No entanto, estes indivíduos apresentam importantes necessidades de cuidados à saúde bucal / Salvador

Infection with Human Papillomavirus (HPV) is the sexually transmitted viral disease most prevalent in world. The infections can range from asymptomatic establishment to induction of squamous cell carcinomas. It has been discussed the correlation of HPV infection and the development and/or aggravation of lesions in the oral mucosa. The aim of this study was to evaluate the occurrence of HPV and its genotypes in patients with oral lesions and in healthy oral mucosa of users and non-users of drugs in the state of Sergipe, Brazil. Thirty-nine patients aged 2 to 83 years with clinically detectable lesions in the oral mucosa and 106 patients with healthy oral mucosa between 11 and 79 years were evaluated. Samples were collected by exfoliating the oral mucosa. For quality control of DNA extraction beta-globin PCR was performed. HPV DNA was detected using primers MY09/MY11 and GP5+/GP6+. Genotyping was performed by multiplex-PCR with specific primers for HPV types 6, 16 and 18. Our study detected the virus in all types of lesions evaluated. The occurrence of HPV was 76.92% (30/39) in patients with oral lesions. The most common virus type was HPV-6 in 56.67% (17/30), followed by HPV-18 in 26.67% (8/30) and HPV-16 in 6.67% (2/30). Positive results were found in 83.02% (88/106) of patients with healthy oral mucosa. The most common virus type was HPV-6 in 45.45% (40/88), followed by HPV-18 in 35.23% (31/88) and HPV-16 in 4.54% (4/88). Between multiple drug users 86.67% (52/60) were positive and multiple HPV infections were identified in 23.08% (12/52). At |non-users| the occurrence was 78.26% (36/46). A high occurrence of HPV was found in the study, both in oral lesions and in healthy mucosa. Rates of HPV detection in the oral cavity vary markedly in the world and make the relationship between HPV and oral carcinogenesis still controversial. Additional studies to evaluate the role of human papillomavirus in the development of lesions in the oral mucosa are necessary. There are few data available on the frequency of oral HPV infection in Brazilian population and especially among drug users. Other studies on HPV prevalence among drug users are needed for a better understanding of their exposure to the virus and for the development of prevention strategies. / A infecção pelo Papilomavírus Humano (HPV) é a doença viral sexualmente transmissível mais prevalente no mundo. Suas infecções podem variar de assintomáticas à indução de Carcinomas de Células Escamosas. Entre os agentes infecciosos associados ao câncer oral, tem-se discutido a correlação da infecção por HPV em mucosa oral e o desenvolvimento e/ou agravamento das lesões. O objetivo deste estudo foi avaliar a ocorrência do HPV e seus genótipos em pacientes com lesão oral e em mucosa oral saudável de usuários e não-usuários de drogas no estado de Sergipe, Brasil. Foram avaliados 39 pacientes com idade entre 2 e 83 anos, com lesões clinicamente detectáveis na mucosa oral e 106 pacientes com mucosa oral saudável entre 11 e 79 anos. As amostras foram coletadas por esfoliação da mucosa oral. Para o controle de qualidade da extração de DNA foi utilizado PCR para beta-globina. DNA-HPV foi detectado utilizando primers MY09/MY11 e GP5+/GP6+. A genotipagem foi realizada através de multiplex-PCR com primers específicos para os tipos virais 6, 16 e 18. Nosso estudo detectou DNA-HPV em todos os tipos de lesões avaliadas. A prevalência do HPV foi de 76,92% (30/39) nos pacientes com lesões orais. O tipo viral mais frequente foi o HPV-6, presente em 56,67% (17/30), seguido do HPV-18 em 26,67% (8/30) e do HPV-16 em 6,67% (2/30). DNA-HPV foi encontrado em 83,02% (88/106) dos pacientes com mucosa oral sadia. O tipo viral mais frequente foi o HPV-6, presente em 45,45% (40/88), seguido do HPV-18 em 35,23% (31/88) e do HPV-16 em 4,54% (4/88). Entre usuários de múltiplas drogas 86,67% (52/60) foram positivos e infecções múltiplas por mais de um tipo viral foram identificadas em 23,08% (12/52) dos indivíduos. Entre os "não usuários" a taxa de infecção pelo HPV foi de 78,26% (36/46). Desta forma, foi verificada uma alta ocorrência do HPV em nosso estudo, tanto em lesões orais quanto em mucosas saudáveis. As taxas de detecção do vírus em cavidade oral variam acentuadamente no mundo e tornam a relação do HPV com o processo de carcinogênese oral ainda controversa. Isso faz necessária a realização de estudos adicionais que avaliem o papel do Papilomavírus Humano no desenvolvimento de lesões na mucosa oral. Há poucos dados disponíveis sobre a frequência de infecção oral por HPV na população brasileira e especialmente entre usuários de drogas. Novos estudos sobre a prevalência do HPV entre usuários de drogas são necessários para melhor compreensão da sua exposição ao vírus e o desenvolvimento de estratégias de prevenção.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-08-04T17:50:33Z No. of bitstreams: 2 Dissertação- Hidecazio de Oliveira Souza - 2016.pdf: 2011905 bytes, checksum: 80960a24ceef92045a0a71ba9a6cff7d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-05T13:37:40Z (GMT) No. of bitstreams: 2 Dissertação- Hidecazio de Oliveira Souza - 2016.pdf: 2011905 bytes, checksum: 80960a24ceef92045a0a71ba9a6cff7d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-05T13:37:40Z (GMT). No. of bitstreams: 2 Dissertação- Hidecazio de Oliveira Souza - 2016.pdf: 2011905 bytes, checksum: 80960a24ceef92045a0a71ba9a6cff7d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-04 / The population growth has been observed due to a reduction in mortality and better quality of life throughout the world, with aging the most frequent consequence of this process. The falling birth rate is also another reality observed, im some countries as Brazil. Two population groups are directly related to these changes: children and elderly. These individuals presented different oral pathologies caused by various etiological factors. Although knowledge of the occurrence of the reality of these changes be important, few clinicopathological studies of the frequency of these lesions have been reported in the literature involving children and elderly. In Brazil, some studies were performed, but in small quantities. This study aimed to establish the occurrence profile of oral pathologies alterations in a population of Brazilian children and elderly, from diagnosis based on histopathological aspects of biopsies. Clinicopathological data of the lesions were retrieved and reviewed in a Brazilian population and collected information about gender, age, location and histopathological diagnoses of the lesions occurred in children (0-14 years) and elderly (≥ 60 years). Children were grouped according to the dentition, 0-5, 6-10 and 11-14 years, and the elderly were grouped 60-69, 70-79, 80-89 and ≥90 years. The lesions were categorized in non-neoplastic lesions, benign neoplasms, malignant neoplasms and potentially malignant lesions. The non-neoplastic lesions were subcategorized in: inflammatory/reactive, cysts, autoimmune conditions, bone lesions, pigmented oral lesions and others. Benign and malignant neoplasms were subcategorized according to tissue origin in: epithelial, mesenchymal, salivary gland, odontogenic tumors (benign) and other (malignant). Regarding the location, the lesions were distributed in: maxilla, mandible, buccal mucosa, lips, tongue, oral floor and not specified. A total of 10.340 biopsies were retrieved, being included in the study 8.081biopsies, 10.93% being seen in children. The female represented 54.13% of the cases (p=0.8903). Ages ranged from 0 to 14 years with an average of 9.94 years, and the group of 11-14 years, the most common (p=0.0657). Regarding location, the mandible was the most affected, with 30.02%, followed by the maxilla (25.92%) and lips (25.82%) (p=0.0133). Non-neoplastic lesions was the most common category with 80.40%, followed by benign neoplasms (18.46%) and malignant neoplasms (1.14%) (p≤0.0001). Potentially malignant lesions among children weren’t found. Among the non-neoplastic lesions, inflammatory/reactive lesions were the most common (68.61%), followed by cysts (23.52%). Among the benign neoplasms, odontogenic tumors were most common (53.37%) followed by epithelial (22.70%). Among the malingnant neoplasms were most observed mesenchymal lesions (80.00%) and salivary gland lesions (20.00%). The most common oral pathologies alterations in children were mucocele, inflammatory fibrous hyperplasia and dentigerous with 24.24%, 11.10% and 10.08%, respectively. From 8081 biopsies, 15.72% were in elderly. Female was most affected with 62.91% of the cases (p≤0.0001). The age ranged from 60 to 95 years with an average of 67.9 years, with a group of elderly with aged 60-69 the most common (p≤0.0001). Regarding the location, maxilla was the most affected, with 28.50%, followed by the mandible (24.49%) and buccal mucosa (17.64%) (p≤0.0001). Non-neoplastic lesions was the most category observed with 72.13%, followed by benign neoplasms (10.31%), malignant neoplasms (9.13%) and potentially malignant lesions (8.43%) (p≤0.0001). Among the non-neoplastic lesions, inflammatory/reactive lesions were the most common (82.86%), followed by cysts (8.30%). Among the benign neoplasms, mesenchymal tumors (38.17%) followed by epithelial tumors (32.06%) were more observed. Among the malignant tumors, epithelial lesions (88.80%) and salivary gland (6.90%) were most common. The most common oral pathologies alterations in the elderly were the inflammatory fibrous hyperplasia, oral squamous cell carcinoma, and hyperkeratosis with dysplasia with 44.17%, 6.93% and 6.77%, respectively. The study found a higher incidence of oral lesions in female children, aged 11-14 years, with non-neoplastic lesions the most common category, mainly inflammatory/reactive lesions and cysts. The most frequent lesions were mucocele, inflammatory fibrous hyperplasia and dentigerous cyst, as observed by other studies in the literature. In elderly, the study found a higher incidence of oral lesions in female, with individuals in the age group 60-69 years the most affected. Non-neoplastic lesions represented the most common category, and inflammatory/reactive the subcategory most frequent. The second subcategory most observed were malignant neoplasms of epithelial origin. The most frequent lesions were inflammatory fibrous hyperplasia, oral squamous cell carcinoma and hypekeratosis. / O crescimento populacional tem sido observado devido à redução da mortalidade e melhor qualidade de vida em todo o mundo, sendo o envelhecimento a consequência mais frequente deste processo. A redução da natalidade também é outra realidade observada, em algumas regiões como o Brasil. Dois grupos populacionais estão diretamente relacionados a essas mudanças: crianças e idosos. Esses indivíduos apresentam diferentes alterações patológicas bucais resultantes de variados fatores etiológicos. Embora o conhecimento da realidade de ocorrência dessas alterações seja importante, poucos estudos clínicopatológicos sobre a frequência dessas lesões têm sido publicados na literatura envolvendo crianças e idosos. No Brasil, alguns trabalhos foram realizados, porém em quantidade reduzida. Este estudo teve como objetivo estabelecer o perfil de ocorrência das alterações patológicas bucais em parte de uma população de crianças e idosos brasileiros, a partir do diagnóstico baseado nos aspectos histopatológicos de biópsias. Dados clínicopatológicos das lesões foram recuperados e revisados em uma população brasileira e coletadas informações sobre gênero, idade, localização e diagnósticos histopatológicos de lesões ocorridas em crianças (0-14 anos) e idosos (≥ 60 anos). As crianças foram agrupadas de acordo com dentição em 0-5, 6-10 e 11-14 anos, e os idosos foram agrupados de 60-69, 70-79, 80-89 e ≥90 anos. As lesões foram categorizadas em: lesões não-neoplásicas, neoplasias benignas, neoplasias malignas e lesões potencialmente malignas. As lesões não-neoplásicas foram subcategorizadas em: inflamatórias/reativas, cistos, condições autoimunes, lesões ósseas, lesões pigmentadas e outras. As neoplasias benignas e malignas foram subcategorizadas de acordo com a origem tecidual em: epiteliais, mesenquimais, glândula salivar, tumores odontogêncios (benignas) e outras (malignas). Em relação à localização, as lesões foram distribuídas em: maxila, mandíbula, mucosa jugal, lábios, língua, assoalho bucal e não especificados. Um total de 10.340 biópsias foi recuperado, sendo incluídas no estudo 8081 biópias, 10,93% sendo observadas em crianças. O gênero feminino representou 54,13% dos casos (p=0,8903). A idade variou de 0 a 14 anos com uma média de 9,94 anos, sendo o grupo de 11-14 anos o mais comum (p= 0,0657). Quanto à localização, a mandíbula foi a mais afetada, com 30,02%, seguido pela maxila (25,92%) e lábios (25,82%) (p=0,0133). Lesões não-neoplásicas foi a categoria mais comum com 80,40%, seguido por neoplasias benignas (18,46%) e neoplasias malignas (1,14%) (p≤0,0001). Não foram encontradas lesões potencialmente malignas entre crianças. Entre as lesões não-neoplasicas, as lesões inflamatórias/reativas foram as mais comuns (68.61%), seguidas por cistos (23,52%). Entre as neoplasias benignas, os tumores odontogênicos foram mais comuns (53,37%) seguidos pelas epiteliais (22,70%). Dentre as neoplasias malignas foram mais observadas lesões mesenquimais (80,00%) e de glândula salivar (20,00%). As alterações patológicas bucais mais freqüentes em crianças foram a mucocele, a hiperplasia fibrosa inflamatória e o cisto dentígero com 24,24%, 11,10% e 10,08%, respectivamente. Dentre 8081 biópsias, 15,72% foram em idosos. O gênero feminino foi mais prevalente com 62,91% dos casos (p≤0,0001). A idade variou de 60 a 95 anos com uma média de 67,9 anos, com o grupo de idosos entre 60-69 anos o mais comum (p≤0,0001). Em relação à localização, maxila foi a mais afetada, com 28,50%, seguido pela mandíbula (24,49%) e mucosa jugal (17,64%) (p≤0,0001). Lesões não-neoplásicas foi a categoria mais observada com 72,13%, seguido por neoplasias benignas (10,31%), neoplasias malignas (9,13%) e lesões potencialmente malignas (8,43%) (p≤0,0001). Entre as lesões não-neoplásicas, as lesões inflamatórias/reativas foram as mais comuns (82,86%), seguidas por cistos (8,30%). Entre as neoplasias benignas, os tumores mesenquimais (38,17%) seguidos pelas epiteliais (32,06%) foram os mais observados. Dentre as neoplasias malignas, as lesões epiteliais (88,80%) e de glândula salivar (6,90%) foram mais comuns. As alterações patológicas bucais mais frequentes em idosos foram a hiperplasia fibrosa inflamatória, o carcinoma espinocelular, e a hiperqueratose com displasia com 44,17%, 6,93% e 6,77%, respectivamente. O estudo observou maior ocorrência de lesões bucais em crianças do gênero feminino, na faixa etária de 11-14 anos, com as lesões não neoplásicas a categoria mais comum, principalmente as lesões inflamatórias/reativas e cistos. As lesões mais encontradas foram a mucocele, a hiperplasia fibrosa inflamatória e o cisto dentígero, assim como observado por outros estudos da literatura. Em idosos, o estudo observou maior ocorrência de lesões bucais em mulheres, com indivíduos na faixa de idade entre 60-69 anos os mais acometidos. As lesões não neoplásicas representaram a categoria mais comum, com maior frequência de lesões inflamatórias/reativas. A segunda subcategoria mais observada foram as neoplasias malignas de origem epitelial. As lesões mais frequentes foram a hiperplasia fibrosa inflamatória, o carcinoma espinocelular e a hiperqueratose.