Fabio Abreu Alves

Objective: To propose a clinical classification system for oral squamous cell carcinoma (OSCC) based on lesion characteristics, aiming to enhance early recognition and initial clinical diagnostic hypothesis rate in clinical practice. Methods: A retrospective analysis of 422 OSCC cases was conducted from 2005 to 2023. Lesions were clinically categorized through clinical photographs as either “conventional” (including non‐ulcerated plaques; red, white, or mixed and ulcerated infiltrative lesions with raised indurated margins) or “atypical” (different from the one described above) based on their presentation. Atypical cases were further subclassified into morphological types. Results: Of the 422 OSCC cases, 316 (74.9%) were classified as conventional and 106 (25.1%) as atypical. Conventional cases were predominantly ulcerative or leukoplakic, while atypical cases exhibited fissure‐like and exophytic patterns. Tongue border was most commonly affected in conventional OSCC, while floor of the mouth and buccal mucosa predominated in atypical forms. Conclusion: Approximately one‐quarter of OSCC cases present with atypical clinical features. The proposed classification provides a practical tool for clinicians to recognize these variants. However, further prospective validation is warranted to determine whether its application improves clinical recognition and diagnostic accuracy.

Aim: To develop the pediatric version of the Oral Mucositis Impact Scale in Oncology Patients (EIMOPO-Infantil), based on a quality of life instrument originally designed for adults. Methods: The researchers adapted the instrument for children and created a preliminary version of the EIMOPO-Infantil. Two rounds of analysis were conducted with a multidisciplinary expert panel using the Delphi Technique to achieve consensus (over 80% agreement) on the instrument’s content. An initial version was created for pretest through a cross-sectional study to qualitatively assess the comprehension of the questions by the target pediatric population. The instrument was self-administered to a convenience sample of 10 outpatient participants, aged 7–12 years, with cancer diagnosis and history of oral mucositis. Results: The pretest phase showed excellent comprehension by participants, with 100% reporting full understanding of the questions. Conclusion: The EIMOPO-Infantil was successfully developed in Brazilian pediatric oncology patients and is now ready for a large-scale validation.

Aims: Osteoradionecrosis (ORN) is a severe late complication of head and neck radiotherapy, often refractory to conventional treatment. Photobiomodulation therapy (PBMT) and photodynamic therapy (PDT) have shown regenerative, analgesic, and antimicrobial effects. This report aims to describe the non‐invasive management of extensive mandibular ORN with intra‐ and extraoral fistulas using a combined PBMT–PDT protocol. Case Report: A 72‐year‐old man previously treated with chemoradiation for laryngeal carcinoma developed chronic mandibular ORN after third molar extraction, complicated by a pathologic fracture, persistent suppuration, and failure of surgery, hyperbaric oxygen, antibiotics, and curettage. Clinical evaluation revealed intra‐ and extraoral suppurative fistulas and radiographic bone sequestration. A conservative regimen was initiated, consisting of weekly PBMT and PDT sessions following chlorhexidine irrigation. Over approximately one year (50 sessions), the patient reported progressive pain relief and reduced analgesic use. Complete closure of both fistulas was achieved, with recovery of soft‐tissue sensitivity and radiographic resolution of sequestration. No adverse effects occurred, and the planned surgical debridement was canceled. Conclusion: Combined PBMT and PDT promoted complete resolution of extensive, refractory mandibular ORN using a fully non‐invasive approach. This case highlights the synergistic potential of dual phototherapy as a safe and effective alternative when surgery is contraindicated or declined. Further studies are warranted to clarify underlying mechanisms and optimize treatment parameters.

Background: Talquetamab (TAL), a first-in-class bispecific antibody targeting GPRC5D and CD3, has demonstrated high efficacy in heavily pretreated relapsed and refractory multiple myeloma (RRMM), achieving response rates of approximately 70%. However, TAL is frequently associated with on-target, off-tumor oral toxicities. Objective: This study aimed to review the features of oral toxicities related to TAL. Methods: A comprehensive review of the recent literature on TAL-associated oral toxicities was conducted. Extracted data included time to onset, incidence, severity grading, and reported management strategies for these adverse events. Results: Oral effects are hypothesized to arise from immune activation against epithelial cells expressing GPRC5D in the tongue, salivary glands, and hard keratinized tissues. Clinical studies, including the MonumenTAL-1 trial, have reported dysgeusia in up to 72% of patients, dry mouth in 39%, and dysphagia in 24% of patients. Such toxicities typically arise within a few weeks of initiating TAL therapy and tend to persist. They can significantly impair nutrition and quality of life, often leading to weight loss exceeding 6% of baseline body weight. Current management is largely supportive, including corticosteroid mouthwashes, saliva stimulants, nutritional counseling, and TAL dose adjustments, with limited efficacy. The ongoing TALISMAN trial is evaluating prophylactic interventions such as dexamethasone mouthwash and pregabalin. Conclusion: Oral toxicities often emerge early and may persist throughout the therapy. Consequently, early recognition, preventive care, and multidisciplinary management are essential to mitigate oral complications and preserve quality of life in patients receiving TAL.

OBJECTIVE: To evaluate access to treatment for cervical (CVC), colorectal (CRC), thyroid (CT), and central nervous system (CCNS) cancers that differ in incidence, prognosis, early detection program, and in their requirements for high-complexity and technologically advanced treatments METHODS: Data from IntegradorRHC INCA (2013–2022) were extracted. Sociodemographic and clinic characteristics and time diagnosis-to-treatment were analyzed using multinomial logistic regression and cumulative incidence function. RESULTS: 395,225 cases of cancers were identified, CC = 168,951, CVC = 141,189, CT = 57,755 and CCNS = 27,330. Patients with CNS and CRC had higher cumulative probability (CPob) of treatment initiation within 60 days compared to CVC/CT. The North region was less likely to receive treatment within 30 days for all cancers (odds ratio — OR: CNS = 0.34; CVC = 0.30; CT = 0.17; CRC = 0.49). Radiotherapy showed a lower chance of earlier treatment for all cancers (94% lower CNS; CVC = 48%; CRC = 81%). There was a greater chance of treatment initiation within 30 days for patients with higher education for CVC (OR = 1.42); CT (OR = 2.09). White individuals demonstrated a consistently higher CPob of treatment initiation at 60 days for all cancers compared to Black (CNS: 60 versus 49%; CVC: 37 versus 29%; CT: 32 versus 21%; CRC: 52 versus 45%). For CT, males had a higher CPob of treatment 37% in males compared to 30% in females at 60 days). For CRC, CPob of treatment initiation at 60 days was higher among individuals at younger (60% compared to 46% for those aged > 69 years) and clinical stage IV (56% compared to stage 1 — 45%). CONCLUSION: In Brazil, patients requiring multimodal treatments or therapies demanding technology, such as radiotherapy or chemotherapy, faced longer delays. Regional and sociodemographic disparities persist, with timely access to cancer treatment limited in socioeconomically disadvantaged regions, such as the North and Northeast, among Black patients and individuals with lower education.

Extracellular vesicles (EVs), particularly small EVs (sEVs), are nanoscale particles secreted by cells that mediate intercellular communication and hold promise in tissue regeneration. Dental mesenchymal stem cells (D-MSCs) are an attractive source of sEVs due to their non-invasive collection, ease of expansion, and low immunogenicity. This scoping review aimed to evaluate current evidence on the regenerative potential of sEVs derived from D-MSCs (D-MSC-sEVs) and the methods used for their isolation and application. A search was performed using PubMed/MEDLINE, Scopus, Web of Science, and EMBASE. The inclusion criteria were studies investigating D-MSC-sEVs in all languages ​​and data. Studies not using human MSCs or in vitro models were excluded. The search resulted in 2,285 records and 44 studies were included. D-MSC-sEVs were obtained from the dental pulp of permanent and deciduous teeth, periodontal ligament, apical papilla, dental follicle, and gingiva. The most robust evidence of D-MSC-sEVs has been from craniofacial tissues, with particular emphasis on increasing bone volume and the number of trabeculae in defects, with improved angiogenesis and neurogenesis. They have also been investigated for skin, nervous tissues, joints, tendons, angiogenesis, and inflammation. These results demonstrate the potential of using D-MSC-sEVs for immunomodulation and regeneration for different diseases as an alternative to cellular therapies. Graphical abstract

Objectives This systematic review aimed to investigate the frequency, characteristics, and clinical outcomes of complications arising from endodontic and periodontal infections in patients undergoing hematopoietic stem cell transplantation (HSCT) and to evaluate their potential impact on transplant prognosis. Materials and methods A comprehensive search was initially conducted in PubMed/MEDLINE, Scopus, Embase, and ProQuest databases up to and including July 2025, and subsequently updated to include studies published up to and including October 2025. The eligibility criteria included clinical studies addressing endodontic or periodontal complications in the context of HSCT. Case reports and conference abstracts were excluded. Two independent reviewers performed data extraction and assessed the risk of bias using the Newcastle–Ottawa Scale. Results Of 1,385 studies initially identified, six met the inclusion criteria, comprising 1,730 participants and 53 individuals presenting with endodontic or periodontal complications. Endodontic complications, including acute and chronic apical abscesses, were reported across all HSCT phases: pre-conditioning, hospitalization, and beyond day + 100. Several cases required intravenous antibiotics or extraction, underscoring the risk of infection progression under immunosuppression. Periodontal complications such as gingivitis, periodontitis, abscesses, and swelling were also described. Conclusions Evidence indicates that endodontic and periodontal infectious complications may arise during HSCT, requiring interventions such as dental extraction or intravenous antibiotic therapy. These events underscore the importance of preventive oral care and interdisciplinary collaboration among dental, hematology, and infectious disease teams. Comprehensive pre-transplant screening and management should be standardized to identify and treat odontogenic infections before conditioning, ensuring safer and more predictable transplant outcomes. Clinical relevance Endodontic and periodontal infections are clinically relevant yet preventable complications in HSCT. Comprehensive and personalized dental care, including early diagnosis, appropriate treatment of odontogenic infections, and continuous monitoring tailored to each patient’s transplant phase, is essential to minimize systemic complications and ensure transplant safety. Incorporating structured and individualized dental management as a mandatory component of multidisciplinary HSCT care can reduce morbidity, shorten hospitalization, and improve long-term outcomes.