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PubMed2005

Evaluation of oral manifestations and masticatory force in patients with polymyositis and dermatomyositis.

BACKGROUND: The polymyositis (PM) and dermatomyositis (DM) complex encompasses a heterogeneous group of acquired autoimmune skeletal muscle diseases called idiopathic inflammatory myopathies (IIM). Despite their histological and immunopathological differences, the end result of the affected muscles in all of these entities is the triad of chronic inflammation, fibrosis and the loss of muscle fibres. The aim of this study was to perform a complete analysis of the orofacial abnormalities in 34 patients with PM and DM. METHODS: Evaluation of subjective oral symptoms, measurement of whole resting saliva flow rate (WS) with the 'spitting method', a visual investigation of the oral soft tissue alterations, light- and electron microscopic analysis of the symptoms of capillary abnormalities or signs of focal infiltration in labial biopsy specimens were carried out. The number of decayed, missing and filled teeth (DMF-T) according to the WHO recommendations (1997), the periodontal probing depth (PPD), the plaque index (PI; Silness-Löe) and the gingival index (GI; Löe-Silness) were determined. For comparison with healthy controls the masticatory force (MF) and the force of the upper extremities' flexors were measured with a specially developed device. The SPSS version 11.0 for Windows software program, two-tailed Student's t-test and Mann-Whitney test were used to statistically analyse all data. Values were considered to be significant if P level was < or = 0.05. RESULTS: Nine patients complained of subjective xerostomia, 11 showed the signs of salivary hypofunction (WS < or = 0.1 ml/min). The most prominent symptom of the oral mucosa and perioral tissues was the presence of telangiectasia, detected in seven cases. Fibrosis of the minor salivary glands was found in 12 patients, interstitial-perivascular infiltration was detected in eight cases, periductal infiltration in one case. The findings on dental and periodontal conditions indicate, that the patients with IIM diseases had significantly higher DMF-T scores (24.06 +/- 7.04 vs. 19.54 +/- 8.93, respectively; P = 0.002), they had less remaining teeth in average (15 vs. 20; P = 0.002), compared with the control group. Their oral hygiene was significantly worse (PI was 1.46 +/- 0.75 and 0.73 +/- 0.54, P = 0.001). GI was significantly higher in the patients (1.27 +/- 0.60 and 0.66 +/- 0.56, respectively, P = 0.0003), although we could not demonstrate any difference in the severity of the periodontal destruction between patients and controls. Masticatory force was significantly weaker in the first molar region on both sides in the patient group (309 +/- 213 N and 113 +/- 146 N, P = 0.0016 for the right side; 315 +/- 239 N and 123 +/- 76 N, P = 0.009 for the left side), but only the left hands showed to be weaker in the patient group (77 +/- 27 N and 59 +/- 20 N, P = 0.04). CONCLUSION: In conclusion, the present study showed that, patients with IIM diseases have hyposalivation and mucosal alterations, mainly in the form of telangiectasia. They have increased prevalence of dental caries, which may be secondary to the hyposalivation. The masticatory and the upper extremity flexor forces indicate that the weakness of the masticatory muscles can manifest earlier than that of the arms.

Adult↗
PubMed2002

Pemphigus vulgaris: update on etiopathogenesis, oral manifestations, and management.

Pemphigus is a group of potentially life-threatening diseases characterized by cutaneous and mucosal blistering. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles. Certain ethnic groups, such as Ashkenazi Jews and those of Mediterranean origin, are especially liable to pemphigus. Pemphigus vulgaris (PV), the most common and important variant, is an autoimmune blistering disease characterized by circulating pathogenic IgG antibodies against desmoglein 3 (Dsg3), about half the patients also having Dsg1 autoantibodies. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examinations, is essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected by both normal human skin and monkey esophagus or by enzyme-linked immunosorbent assay (ELISA). Before the introduction of corticosteroids, pemphigus vulgaris was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids, with azathioprine, dapsone, methotrexate, cyclophosphamide, and gold as adjuvants or alternatives, but mycophenolate mofetil and intravenous immunoglobulins also appear promising.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Oral manifestations in a group of blind students.

The blind population observed in this study exhibited a relatively low caries rate while the amount of plaque per subject was considered high. Although comparisons within the group were made, no significant differences were revealed when both PHP-M and DMF rates were tested against age and degree of blindness. The percentage of anterior fractures was consistent with recent estimates for the sighted population. Estimates of occlusion also showed close correlation with the general population. Maintenance of oral hygiene remains the most outstanding challenge in the care of blind patients. The problem of motivation as encountered in the sighted patient is magnified here. Disclosing agents for staining plaque are not effective for patient education. Other senses, particularly that of touch, must be utilized when instructing the blind patient in oral hygiene methods.

Adolescent↗
PubMed1999

Oral manifestation of tertiary syphilis: case report.

This paper describes a case of benign tertiary syphilis represented by a solitary hypertrophic lesion on the dorsum surface of the tongue. The diagnosis was confirmed by serologic tests (VDRL and FTA-ABS). Histopathological analysis of biopsy specimens revealed, in the lamina propria, the presence of well-developed granulomas associated with necrotic areas (gummatous lesion). Currently, tertiary syphilis is rarely seen; however, this case emphasizes that it still exists and must be considered in the differential diagnosis of inflammatory oral lesions.

Adult↗
PubMed1988

Oral manifestations of oxalosis secondary to ileojejunal intestinal bypass.

Oxalosis is a rare condition that may be either hereditary or acquired. It may be secondary to a number of primary causes, which include renal failure, oxalate poisoning, malabsorption syndromes, and in this case, ileojejunal bypass surgery. Systemic oxalate overload following such bypass surgery results from a defect in the enterohepatic circulation and from the loss of calcium and bile salts in the feces. The oxalate is then absorbed into the circulation, and the supersaturated solution precipitates in the systemic tissues. Reported cases of oral involvement are rare. This article presents a 2 1/2-year follow-up of such a patient and the resultant progressive and unrelenting nature of the disorder. As a result of our experience, we suggest early aggressive oral surgical management of the widespread oral lesions.

Alveolar Process↗
PubMed2005

Adult T-cell leukemia/lymphoma with predominant bone involvement, initially diagnosed by its oral manifestation: a case report.

Adult T-cell leukemia/lymphoma (ATL/L) is a rare malignant neoplasm linked to human T-cell lymphotropic virus type 1 (HTLV-1). This virus has been identified in Japan, the Caribbean, and, more recently, Brazil. We report a case of ATL/L (lymphoma-type) affecting a 30-year-old Brazilian woman. She presented a painful and ulcerated lesion on her hard palate mucosa. Conventional radiographs and computed tomography revealed the involvement of several bones plus the lung and axillary lymph nodes. Histopathological and immunohistochemical analyses of oral biopsy confirmed a T-cell non-Hodgkin's lymphoma. Final diagnosis of ATL/L was made based on HTLV-1 positivity. She underwent multiple cycles of chemotherapy, which produced some improvement, but she died as a consequence of pulmonary and hepatic complications 4 months after the initial diagnosis. Besides the process of diagnosing and typing a malignant lymphoma, this article outlines the value of computed tomography and the necessity of performing HTVL-1 investigation in patients with a diagnosis of lymphoma of T-cell lineage.

Adult↗
PubMed2005

Sjögren's syndrome: the diagnostic potential of early oral manifestations preceding hyposalivation/xerostomia.

Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional 'untouchable' association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.

Early Diagnosis↗
PubMedDate not supplied

Oral manifestations of drug therapy.

Increasingly, patients with complicated medical problems are coming to dental offices for treatment. These patients report using a variety of medications to control one or more chronic conditions. Many of these medications produce changes in the mouth because of toxic overdoses, side effects, allergic reactions, or as a consequence of the primary action of the drug. These effects include: xerostomia, gingival hyperplasia, candidiasis, mucositis, stomatopyrosis, gingival bleeding, petechia, salivary gland problems, intrinsic stain, cheilitis, erythema multiforme, lichen planus, ulcerations, taste changes, tardive dyskinesias, and soft tissue pigmentation. This article discusses presentations and causes of oral changes secondary to systemic drug use.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1991

Oral manifestations of viral infections in immunocompromised patients.

Viral infections are a significant cause of morbidity and mortality in immunosuppressed patients. It is clear that diseases or medical treatments that have cytostatic or cytotoxic effects on lymphocytes and disrupt cytokine production or activity increase the risk of viral infections. While the rate of viral infection varies with the nature and degree of immunosuppression, it is clear that reactivation of latent virus is the most important determinant of the types of viral infections most frequently noted in immunosuppressed patients result from the reactivation of latent virus. Herpesviruses account for the majority of oral viral infections. Herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus infections nearly always result from reactivation of latent virus, while cytomegalovirus infections, besides presenting as reactivated disease, are almost as likely to present as a primary infection in susceptible hosts. Other viral pathogens potentially of concern in immunocompromised patients are enteric viruses (adenoviruses and coxsackieviruses), human papillomaviruses, and possibly the recently identified human herpesvirus type 6. Ninety-eight percent of herpes simplex virus lesions are caused by reactivated disease and tend to be characterized by large, very painful ulcerative lesions throughout the mouth. Varicella-zoster virus is also rarely seen as primary infection, and the herpes zoster lesions involving cranial nerves can cause significant morbidity, including postherpetic neuralgia, corneal scarring, cranial nerve palsies, and deafness. Distinct oral ulcerative lesions caused by Epstein-Barr virus and cytomegalovirus have only recently been described in detail and are usually associated with disseminated disease. Oral human papillomavirus lesions are noted as warts and condylomas. The contribution of enteric viruses and human herpesvirus type 6 to oral disease in immunosuppressed patients is yet to be determined.

Cytomegalovirus↗
PubMed1980

Oral manifestations of the congenital insensitivity-to-pain syndrome.

The congenital insensitivity-to-pain syndrome is a sensory syndrome in which pain is impaired. It has been variably classified under a variety of terms, on occasion leading to some confusion. The condition is present at birth. The patient is usually, but not always, normal with respect to intelligence, development, and psychological adjustments. Other sensory perceptions are normal. Traumatic lesions as a result of self-mutilative acts are not uncommon, especially at an early age. The condition may not be apparent clinically until the time of initial tooth eruption. As the primary teeth erupt, the patient acquires the necessary apparatus for self-infliction of wounds to oral structures, skin, and fingernails. A case of congenital indifference to pain is presented, with clinical documentation of tooth-related problems occurring over a 2-year period and of the steps taken to correct or minimize the traumatic effects of chewing.

Humans↗
PubMed1977

Oral manifestations of herpes simplex virus infections.

Most individuals are infected with Herpes Simplex in childhood usually suffering a mild febrile illness of no consequence. Later some individuals suffer recurrent infections which appear as cold sores on the lip while others intermittently shed virus in the oro-pharygeal secretions. Adults uninfected in childhood may be exposed to viruses for example by kissing and develop an acute primary herpes with fever and gingivo-stomatitis occasionally requiring hospital admission. Awareness of this condition is required for diagnosis after which the majority of patients seen in otolaryngological practice need only supportive therapy, explanation and reassurance. Recurrent cold sores are no more that a nuisance in most patients, but occasionally they are severe and in others the cold sore may precipitate oral erythema multiforme. Unfortunately the treatments available for recurrent cold sores are rather unsatisfactory.

Erythema Multiforme↗
PubMed1977

Oral manifestations of pachyonychia congenita. Report of a case.

Few cases of pachyonychia congenita are reported in the dental and medical literature because of the rarity of the disease. This article presents a review of the literature and adds a new case history. Examination of a 4-year-old boy revealed the presence of the disease, which was also present in the mother and a newborn sibling.

Child, Preschool↗
PubMed1988

Oral manifestations of AIDS: a study of 84 patients.

Early diagnosis of AIDS is vital in providing appropriate referral for medical care and counseling. Subtle intraoral signs and symptoms identified by the dental practitioner can aid in the diagnosis of the disease. Because the role of the practitioner in detection and treatment of AIDS patients is becoming greater, signs found in 84 patients are described.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Oral manifestations during chemotherapy for acute lymphoblastic leukemia: a case report.

A 14-year-old, male patient was referred for the treatment of mucositis, idiopathic facial asymmetry, and candidiasis. The patient had been undergoing chemotherapy for 5 years for acute lymphoblastic leukemia. He presented with a swollen face, fever, and generalized symptomatology in the mouth with burning. On physical examination, general signs of poor health, paleness, malnutrition, and jaundice were observed. The extraoral clinical examination showed edema on the right side of the face and cutaneous erythema. On intraoral clinical examination, generalized ulcers with extensive necrosis on the hard palate mucosa were observed, extending to the posterior region. Both free and attached gingivae were ulcerated and edematous with exudation and spontaneous bleeding, mainly in the superior and inferior anterior teeth region. The tongue had no papillae and was coated, due to poor oral hygiene. The patient also presented with carious white lesions and enamel hypoplasia, mouth opening limitation, and foul odor. After exfoliative cytology of the affected areas, the diagnosis was mixed infection by Candida albicans and bacteria. Recommended treatment was antibiotics and antifungal administration, periodontal prophylaxis, topical application of fluor 1.23%, and orientation on and control of proper oral hygiene and diet during the remission phase of the disease.

Adolescent↗
PubMedDate not supplied

Oral manifestations of a child with chronic vomiting.

Perimolysis is a type of intrinsic erosion--an irreversible dental demineralization linked to chronic regurgitation--which causes teeth to be more susceptible to dental caries. The purpose of this case report was to study a 35-month-old chronic vomiting child who visited the Department of Pediatric Dentistry in Yonsei Dental Hospital, Seoul, South Korea, for an evaluation of and treatment for the loss of tooth structure of his primary teeth. To prevent further destruction of the teeth and maintain occlusal height, all the posterior teeth were restored with stainless steel crowns and all the anterior teeth were restored with resin veneer crowns after pulpal treatment under general anesthesia. Therefore, when a child suffering from chronic vomiting visits a pediatric dental clinic, it is prudent to: (1) perform all possible dental treatment to control vomiting's adverse influences on the oral structures; and (2) refer the patient to a pediatrician to determine the cause of vomiting.

Child, Preschool↗
PubMed1989

[Oral manifestations in patients infected with human immunodeficiency virus].

This study describes the stomatological findings reported on 20 Peruvian patients infected by the human AIDS virus. Lesions occurring most frequently were: xerostoma (80%), pseudomembranous candidiasis (70%), commissural cheilitis (55%), atrophy of filiform papillae (40%), ulcerative lesions (30%), vellous leucoplasia (25%) and erithematose or atrophic candidiasis (25%). Prevalence of the diverse lesions detected was correlated with the clinical stage of the disease in order to identify those manifestations that could be considered as early signs or precursors of the Acquired Immuno-Deficiency Syndrome (AIDS). The present article includes a review of the literature related to those clinical, epidemiological and preventive aspects that the dental surgeon must understand if he is to perform diagnosis and treatment on this type of patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Mucocutaneous pigmented spots and oral myxomas: the oral manifestations of the complex of myxomas, spotty pigmentation, and endocrine overactivity.

The complex of myxomas, spotty pigmentation, and endocrine overactivity is a recently recognized syndrome, transmitted as an autosomal dominant trait. The most serious component of the disorder is cardiac myxoma, which has caused the death of one fourth of the affected patients and serious disability in an equal number. It is, therefore, important to recognize patients at risk from the syndrome and, in particular, to test them for cardiac myxoma. Fortunately, in many patients the myxoma complex has a clearly visible marker: mucocutaneous pigmentation. Among 58 patients with the syndrome, spotty facial pigmentation was present in 36 (62%), and 29 (50%) of these also had pigmented spots on their lips. This type and distribution of pigmentation should be a clue to the possible presence of the complex of myxomas, spotty pigmentation, and endocrine overactivity, and patients thus affected should be referred for further investigation. Oral cavity myxoma(s) occurred in four patients with the syndrome.

Adult↗