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Haematological malignancies like acute and chronic leukemias, malignant lymphoma and plasma cell disorders may exhibit oral manifestation during their course. In this article the oral manifestation of a number of haematological malignancies presented in the oral cavity as well as the complications of the treatment are described.
Oral manifestations in HIV infected individuals are common and may occur as mycotic, bacterial or viral infections neoplasms or manifestations of unknown etiology. Some of the oral manifestations may be of importance in early diagnosis of HIV infection. In particular, oral candidiasis occurring as pseudomembranous, erythematous and hyperplastic types should be considered. Oral hairy leukoplakia, pathognomonic for an HIV infection, has been considered to represent a probable diagnostic marker for the development of AIDS. HIV gingivitis and periodontitis are of particular significance. Early and correct diagnosis of HIV-associated manifestations are of importance to the patient as well as to the dentist who should take adequate protection measures.
OBJECTIVES: The goals of this literature review were to (1) update a prior review [Shiboski CH (1997) The epidemiology of HIV-related oral manifestations in women: a review. Oral Dis 3: S18-S27] of studies on the epidemiology of HIV-related oral manifestations in women prior to the availability of highly active antiretroviral therapy (HAART); (2) explore the effect of HAART on HIV-related oral disease among women; and (3) explore future research directions with respect to HIV-related oral disease epidemiology among African women. METHODS: A computer-assisted search was conducted to identify studies on the prevalence of oral conditions in HIV-infected women in relation to immunological markers and HAART [excluding studies reviewed in Shiboski CH (1997) The epidemiology of HIV-related oral manifestations in women: a review. Oral Dis 3: S18-S27]. Results were summarized and discussed for (1) studies conducted in the developed world prior to and during the era of HAART; and (2) studies conducted in sub-Saharan Africa. RESULTS: Candidiasis (OC) is the most common oral lesion among HIV-infected women, and has been found to be associated with a low CD4 count and a high plasma viral load. Preliminary findings suggest that HAART is associated with a decreasing OC incidence. The few studies identified on HIV-related oral disease in African women suggest that OC is also a common condition in this setting. CONCLUSION: Future oral epidemiology research efforts in Africa should focus on the potential role of OC as sentinel marker of HIV infection and disease progression, to improve detection and prevention of selected opportunistic illnesses.
Maple syrup urine disease is a rare inborn error of metabolism that manifests mainly by neurologic deterioration, coma, and death in early childhood. Oral manifestations described in this article were mostly gingival enlargement and rampant caries, while histopathologic findings revealed a picture compatible osteomyelitis.
Most infants with congenital HIV infection appear normal at birth. Clinical difficulties usually begin as the first year proceeds, and in about half of the children oral manifestations are the first signs. Oral manifestations are commonly found in HIV-positive asymptomatic and pediatric AIDS patients, they are the earliest clinical signs of HIV infection and disease progression in children, and may be used as diagnostic markers, especially in developing countries. Studies have established an accurate association between oral manifestations and progression of HIV disease in children. Since the mouth is easily accessed for clinical examination, the important oral signs should be utilized in the diagnosis and early intervention of AIDS in these vulnerable populations.
It has been speculated that impaired salivary flow is common in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). The aim of this study is to investigate the relation between oral manifestations and salivary function in patients with ESRD undergoing HD. Salivary function was measured by quantitative salivary scintigraphy in 60 patients with ESRD undergoing HD, as well as in 36 age- and sex-matched healthy controls for comparison. The 60 patients with ESRD undergoing HD were separated into two subgroups: group 1, 30 patients with oral manifestations, and group 2, 30 patients without oral manifestations. After an intravenous injection of 5 mCi of technetium 99m pertechnetate, sequential images at 1 minute per frame were acquired for 30 minutes. The 1- and 15-minute uptake ratios were calculated as the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one 200-mg tablet of ascorbic acid administered orally 15 minutes post-tracer injection, then the maximal excretion ratios of the four major salivary glands were calculated. Our results show significantly poorer salivary function in patients with ESRD with oral manifestations compared with patients with ESRD without oral manifestations and healthy controls by means of objective and quantitative salivary scintigraphy.
It is strange that the existence of oral psoriasis seems so rare. Other papulosquamous disorders, such as lichen planus, are frequently associated with oral manifestations, yet oral psoriasis is rare given the prevalence of cutaneous disease. One explanation is that oral lesions are asymptomatic and do not come to the clinician's attention. Other explanations, however, are necessary. Epithelial turnover time is significantly increased in psoriatic plaques and may be as rapid as 3 to 7 days, whereas normal epithelial turnover is 28 days. Some have suggested that this abnormally increased turnover time in psoriasis approximates that of the normal regenerative time of the oral epithelium, and this possibility may account for the apparent lack of changes in the oral mucosa of patients with psoriasis [1]. It is also possible that oral lesions of psoriasis are altered both clinically and histologically by other factors within the oral microenvironment and are not recogized. Although controversy has appeared in the literature about whether lesions of oral psoriasis exist, there is sufficient evidence that a subset of patients have oral lesions in association with skin disease. This occurrence is more common in patients with the severe forms of psoriasis, such as generalized pustular psoriasis. The diagnosis of oral psoriasis should be based on good clinical and histologic evidence, and, in general, the clinical course of the oral lesions should parallel that of the skin disease. Exclusion of other causes is important, particularly if cutaneous lesions are absent and a diagnosis of isolated oral psoriasis is entertained. Because neither the clinical nor the histologic changes are absolutely specific for psoriasis, the patient requires holistic evaluation. That being said, in day-to-day practice it is most likely not practical to obtain a biopsy of asymptomatic oral lesions for definitive histologic or immunofluorescence studies. The clinician, however, must have a high degree of awareness and pay close attention to the oral mucosa in patients with psoriasis. A thorough examination is imperative, because asymptomatic oral lesions may be found more frequently in patients with psoriasis if clinicians habitually check mucous membranes during the generalized skin examination. Conversely, in patients with troublesome oral lesions, a cutaneous examination that reveals subtle changes suggestive of psoriasis may provide clues to the oral diagnosis. A detailed history remains the cornerstone of diagnosis, because a family history of psoriasis or a history of psoriasis now in remission may guide physicians when they note oral lesions.
In 1954, Papillon-Leage and Psaume were the first to describe the clinical characteristics of oral-facial-digital syndrome (OFDS). On the basis of their clinical features and the inheritance pattern, 2 variants were initially distinguished, namely OFDS type I (Papillon-Leage and Psaume) and OFDS type II, or Mohr syndrome. At present, 11 types of OFDS have been discovered. OFDS represents a heterogeneous group of disorders characterized by oral manifestations including oral frenula, cleft or lobulated tongue, high arched palate, cleft lip and/or palate, facial anomalies, and digital abnormalities such as syndactyly, polydactyly, brachydactyly, and clinodactyly. Depending on the type of OFDS, abnormalities may be present in other organs, such as the brain and heart. We report a patient with OFDS in whom multiple recurrent and de novo keratocysts were found. Although multiple keratocysts are commonly found in Gorlin-Goltz nevoid basal cell carcinoma syndrome, a relationship between OFDS and multiple keratocysts has not been described.
Systemic health is often closely linked to the state of the oral cavity: many systemic diseases and conditions have oral manifestations. Likewise, oral microbiological infections may also affect one's general health status. Indeed, animal and population-based studies now suggest that periodontal diseases may be linked with systemic diseases and conditions including cardiovascular diseases, diabetes, respiratory diseases, adverse pregnancy outcomes, and osteoporosis. Better understanding of this correlation will help both dental and medical professionals to determine the best approach to patient care. This review will focus on the current knowledge linking periodontal infections to a set of systemic diseases. While a number of interactions have been identified, additional research will be required to determine whether these associations are causal or coincidental, and to evaluate disease pathogenesis and potential therapeutic interventions. These findings place oral health in the perspective of systemic health, and they suggest that the dental and medical professions should develop even closer ties in the future.
Lichen planus is the most common dermatologic disease with oral manifestations, and oral lichen planus (OLP) is one of the more common mucosal conditions a clinician is likely to encounter in his or her practice. It is an immunologically based, chronic, inflammatory, mucocutaneous disorder of undetermined etiology. While research over the past decade has dramatically improved the overall understanding of the underlying pathogenesis of OLP, specific details of its pathogenesis and a clear understanding of why certain patients are afflicted while others are not, remains elusive. The care and management of patients with OLP continues to challenge even the most experienced clinician, and strongly suspected associations with chronic liver disease and oral squamous cell carcinoma further complicate matters. To provide prudent and competent care, oral health care providers must have a basic understanding of the impact the disease and/or its treatment may have on their patients.
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Lesions of the oral mucosa are frequently described in association with psoriasis, particularly in the pustular type. Controversy surrounds the question whether mucosal lesions can be considered as oral manifestation of psoriasis. Two patients presented with concurrent pustular psoriasis and mucosal lesions with the characteristic picture of geographic tongue. Histopathology of the mucosa showed typical features of psoriasis such as marked acanthosis, clubbing of the rete ridges, focal parakeratosis and neutrophilic infiltrates. There was parallel improvement of the skin and the mucosal lesions with systemic retinoid treatment. On the basis of the histopathological features and the clinical course we favour the hypothesis that geographic tongue is an oral manifestation of pustular psoriasis.
The first case of HIV infection was reported in Nigeria in 1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women (P = 0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.
AIM: To determine the prevalence of dental and oral lesions, as well as treatment need, in a group of HIV sero-positive Brazilians. In addition, to test the association between oral manifestation of HIV infection and age, sex, mode of transmission and drug therapy. METHOD: All HIV seropositive patients attending a dedicated dental clinic in Recife were invited to participate in the study. They were all examined by one trained and calibrated examiner and interviewed by one trained interviewer. RESULTS: 161 of 204 patients (78.9%) agreed to participate in this study. Most of the participants were male (76%), had acquired HIV sexually (74.5%), and were taking some form of antiretroviral therapy (70.8%). 33.5% had one or more oral manifestation of HIV. Candidiasis was the most common (28.6%), followed by hairy leukoplakia (9.3%), Kaposi sarcoma (2.5%), ulceration (2.5%), herpes simplex (1.2%), papiloma (0.6%), and 4.4% had periodontal disease. Only 1.2% reported xerostomia. There were no differences in the prevalence of oral manifestations of HIV infection between age groups, sexes, modes of transmission and types of drug therapy (P>0.05). The mean DMF-T score was 19 (SD 8) and 78.9% needed some form of dental treatment. CONCLUSIONS: While the prevalence of oral manifestations of HIV/AIDS was low in this sample of HIV seropositive Brazilians, dental status was poor and need for dental treatment was high.
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Oral complications of chronic graft-versus-host disease are well known and may be present in up to 80% of persons with the condition. A case involving a 29-year-old woman with chronic graft-versus-host disease after allogeneic bone marrow transplantation is presented to illustrate how oral mucosal lesions may be adversely affected by severe caries. A variety of extensive mucosal lesions were continually irritated by the sharp edges of the carious teeth. Full-mouth extractions facilitated the complete resolution of the oral lesions. The patient has had no recurrence of oral lesions 4 years after the extractions and has shown no adverse mucosal changes 3 1/2 years after rehabilitation with complete dentures.
The practice of dentistry requires an understanding of medical illnesses and the implications of treatment on the oral environment. Periodic review enables the practitioner to anticipate patient needs and to interact competently with other medical care providers. Presented in this review are recent advances in understanding the relationship between medical and oral diseases. Where appropriate, therapeutic regimens for the treatment of oral manifestations are suggested. Diabetes remains equivocally associated with periodontal disease. The dynamic nature of the immune system and the exhaustive list of oral microbial flora have led to immense and promising research in understanding the pathogenesis of periodontal diseases. It is anticipated that this would lead to methodologies that could modulate the mechanisms of host response and thereby regulate, for example, bone resorption in inflammatory periodontal diseases. HIV-associated periodontal and other oral manifestations have provoked challenging goals in efficient treatment of these patients. The survival time of cancer patients continues to lengthen, resulting in significant numbers of affected individuals. Treatment modalities, chiefly radiation and chemotherapy, produce marked effects on the oral tissues. The detrimental oral consequences of oncologic therapy can be reduced with proper patient education and attention to prophylactic measures. Neoplasia occurs within the oral environment often mimicking inflammatory disease. Systemic diseases may manifest orally and may be subtle in presentation. The dentist is compelled to evaluate all lesions of the oral tissues with the expectation that they may be a lesser sign of a more severe condition.