Oral And Maxillofacial Pathology Neville 4th Edition Pdf 11 [PORTABLE]
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Children and adolescents are individuals with peculiar characteristics. They have different lifestyles and engage in different risky behaviors when compared to adults or older. Thus, they may be affected by specific diseases and illnesses (5). Knowledge about oral and maxillofacial lesions that affect these individuals is important for oral health practitioners as well as physicians in general practice and in Pediatrics (6), who will be able to provide an assertive diagnosis and timely referral to treatment, mitigating distress to the affected individual and his/her parent/caregiver (7). Moreover, awareness of the most frequent oral and maxillofacial lesions among young individuals may guide decisions during the development of oral health policies and allocation of resources in health facilities, where oral health services are provided to children and adolescents (8).
Epidemiological studies with representative samples about the frequency of oral and maxillofacial lesions in children and adolescents are yet to be fully explored in the literature. Usually, the outcomes evaluated in young individuals are dental caries, malocclusion, and traumatic tooth injuries (2,4,9,10). Moreover, previous studies through which the frequency of oral and maxillofacial disorders among pediatric individuals has been investigated are based only on the analysis of data from laboratory services (2,4,7,9,11,12). Data on oral and maxillofacial lesions that do not require biopsy and laboratory analysis for diagnosis have been poorly reported thus far. This may lead to the missing notification of diseases whose diagnosis is predominantly clinical.
Records of individuals attending the Oral Medicine clinic service and records from the laboratory service in Oral and Maxillofacial Pathology of the Dental School of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, were retrieved and evaluated. The Oral Medicine clinic service is a referral center in Oral Medicine in the state of Minas Gerais, where services with respect to the diagnosis and treatment of oral and maxillofacial lesions to individuals from various regions of this state are provided. The laboratory provides services on histopathological and cytological analysis to the Oral Medicine clinic service of the university and to other public and private services in Brazil.
The diagnosis of oral and maxillofacial lesions was based on two criteria. Benign and malignant neoplasms were classified according to the 2017 World Health Organization (WHO) classification (15). The other conditions were classified according to the descriptions of the Oral and Maxillofacial Pathology textbook by Neville et al. (16). Then, the oral and maxillofacial lesions were assigned to ten different lesion groups, following a similar grouping method previously used by Fonseca et al. (17).
Data from the Oral Medicine clinic service, from the laboratory service and from the Oral Medicine clinic service and the laboratory service together were analyzed. For this last data pool, cases of individuals with records of the same oral and maxillofacial lesion (diagnosed on the same date) in both services, only the record of the Oral Medicine clinic service was computed. Records from the Oral Medicine clinic service are indicative of the final diagnosis of the oral and maxillofacial lesion after the accomplishment of a clinical exam and complementary exams, avoiding unreliable diagnoses in this dataset.
Data were analyzed using the Social Package for Social Sciences (SPSS) program (SPSS, Inc., version 20.0, Armonk, NY, USA). Descriptive statistics and the chi-square test were performed. A comparison between the records of the Oral Medicine clinic service and the laboratory service regarding age, sex and skin color of children and adolescents was performed. Analyses of frequency for lesion groups in the Oral Medicine clinic service and in the laboratory service as well as among children and among adolescents were performed. Analyses of frequency of the ten most common oral and maxillofacial lesions in the Oral Medicine clinic service and in the laboratory service as well as among children and adolescents were performed. Analysis of the previous occurrence of trauma in individuals affected by mucocele and inflammatory fibrous hyperplasia in the Oral Medicine clinic service and in the laboratory service were performed. Analyses of frequency with respect to the anatomical locations that were most affected by oral and maxillofacial lesions in the clinical service, in the laboratory service, and in both services were also performed. Finally, analyses of frequency of the three most common oral and maxillofacial lesions in each of the lesion groups in the Oral Medicine clinic service, in the laboratory service and in both services as well as in children and adolescents were performed.
Table 4 shows the anatomical locations of oral and maxillofacial lesions. In the Oral Medicine clinic service, lips (28.9%), gingiva (11.2%) and bones (9.9%) were the most affected locations, while in the laboratory service, bones (34.7%), lips (28.1%) and tongue (7.6%) were the most affected locations. When data from both services were analyzed together, bones (29.3%), lips (27.3%) and tongue (7.7%) were the most affected anatomical locations by the lesions evaluated in this study.
The three most common oral and maxillofacial lesions in each of the lesion groups in the Oral Medicine clinic service, the laboratory service and in both services evaluated together are displayed in (Supplement 7) ( _58231_s07.pdf)., (Supplement 8) ( _58231_s08.pdf). and (Supplement 9) ( _58231_s09.pdf). The three most common oral and maxillofacial lesions in each of the lesion groups in children and in adolescents are showed in (Supplement 10) ( _58231_s010.pdf). and (Supplement 11) ( _58231_s011.pdf).
Table 5, Table 5 cont. shows the characteristics and results of the studies included in the literature review. Mucocele was the most frequent lesion in seven included studies. Most frequent oral and maxillofacial lesion groups were reactive/inflammatory lesions (2,7,12,24), salivary gland pathology/disease (11,20,23) and cystic, odontogenic cysts, and cystic and tumoral odontogenic lesions (18,19,22). Regarding the most affected anatomical locations, the lips were the most affected: four included studies. Regarding the origin of the data, 10 studies had data retrieved in laboratory services and one from Oral Medicine clinic and laboratory services.
Inflammatory/reactive lesions was the most frequent group of oral and maxillofacial lesions in the present study. It is important to highlight that there is no standardized classification of oral and maxillofacial lesions. However, our findings are in line with the results of most studies in the literature (2,4,7,12). In two Brazilian studies (11,25), the group of salivary gland diseases was the most frequent. In fact, this finding took place due to the occurrence of mucocele, the most frequent lesion in the evaluated studies. In these studies, mucocele was classified as a salivary gland outcome, while in our study and in other studies (2,7,9,12), mucocele was assigned to the group of inflammatory/reactive lesions. In a study conducted in Australia (26), the most common group of oral and maxillofacial lesions among pediatric individuals was pathology associated to the teeth. If this lesion group existed in our study, this would likely be one of the most frequent lesion groups, considering that the pericoronal follicle was the second most common lesion in our study (7.5%), when data of the Oral Medicine clinic service and of the laboratory service were analyzed together.
The second most frequent lesion group in the Oral Medicine clinic service and in the laboratory service was odontogenic/non-odontogenic cysts. Similar findings were reported elsewhere (2,7,26). Potentially malignant disorders and malignant neoplasms among children and adolescents were rare, corroborating the results of other authors (2,4,11,12). Three cases of actinic cheilitis were observed in the Oral Medicine clinic service, while in the laboratory service, ten cases of this group of oral and maxillofacial lesions were reported (nine cases of epithelial dysplasia and one of actinic cheilitis). Kwok et al. (12) stated that potentially malignant disorders and malignant lesions are significantly more frequent in adults than in children and adolescents. Etiological factors, such as nutritional deficiency, human papillomavirus (HPV) infection, sporadic mutations, and passive smoking may be associated with the occurrence of malignant neoplasms among the individuals of our sample (27,28).
In the Oral Medicine clinic service (25.9%) and in the laboratory service (25.6%), the most common oral and maxillofacial lesion was mucocele. This finding is in line with several other studies in the literature 11,12). In the study of AtaĆde et al. (11), the frequency was 36.3%. The Figure in the study of Kwok et al. (12) was 27.91%. The etiology of this lesion is directly related to mechanical trauma, which is relatively common in pediatric patients (11). Although the scarce information on trauma detected in our study, this type of report was more common in the Oral Medicine clinic, suggesting that in this service, the amount of available information is more complete. Torabi-Parizi et al. (4) and Abdullah et al. (9) concluded that the most frequent lesion among children and adolescents was pyogenic granuloma. In our study, this lesion was the fifth most frequent among young individuals in the Oral Medicine clinic service and in the laboratory service.
Unlike other studies conducted in Brazil (3,25), in our study, ranula was more frequent in children (6.1%) than in adolescents (2.7%). Vale et al. (3) concluded that ranula affected more individuals in the second decade of life than in the first, while Cavalcante et al. (25) stated that the mean age of the individuals affected by ranula was 11.5 years. Recurrent aphthous stomatitis was the seventh most frequent oral and maxillofacial lesion in the Oral Medicine clinic service. However, such lesion was not among the most common lesions in the laboratory service. This difference occurs because, normally, the biopsy procedure to confirm the diagnosis is unnecessary. 2b1af7f3a8