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There is no debate that oral health and general well-being are inextricably bound. Many commonly prescribed medications have associated dental and oral manifestations that often are nonspecific and can vary in significance. This article reviews many common oral manifestations of systemic drugs, including the clinical manifestations, diagnosis, and treatment of these conditions.
First clinical manifestations of HIV-infection may occur in the oral region. The stomatologist plays an important role in early detection and diagnosis. Therefore he should have good knowledge of all possible oral manifestations of this disease.
Wegener's granulomatosis is a disease involving renal, lung and vascular tissue, but patients also present to the general dental practitioner with intra-oral manifestations. This case study describes the early onset, progression and treatment of the presenting intra-oral manifestations and the periodontal and endodontic implications of Wegener's granulomatosis.
OBJECTIVE: To determine whether there are any differences in the oral manifestations of sub-groups of persons with HIV. These data could provide information for planning of oral health promotion and prevention programmes. DESIGN: A comparative inter-group cross-sectional investigation of the oral manifestations of HIV. Ethnic, gender and sexual orientation differences were taken into consideration. SETTING: Three large general hospitals that offer comprehensive medical investigations and care to persons with HIV. SUBJECTS AND METHODS: A total of 485 HIV-positive adults participated. Clinical examination and, where necessary, swabs or smears of lesions for microbiology, biopsies for histology. MAIN OUTCOME MEASURES: Presence of lesions, associated signs, incidence and type of micro-organisms. RESULTS: A total of 485 HIV-positive persons were examined over a period of 3 years consisting of 225 Blacks, 191 Coloureds (persons of 'mixed' descent) and 69 Whites. Data were analysed using, where relevant, the chi 2 test or Fisher's exact test. Heterosexual males revealed a higher prevalence of all oral lesions combined when compared with heterosexual females. A similar finding was evident when HIV-associated periodontal diseases was compared in these two groups. Homosexual males had a higher prevalence of candidal infections than heterosexual males. Coloured heterosexuals had a higher prevalence of oral lesions combined than black heterosexuals. All these results showed statistical significance. CONCLUSIONS: The study tends to show that different patterns of prevalence emerge when inter-group comparisons are made of oral soft tissue diseases evident in HIV-infected South Africans.
INTRODUCTION: The advent of new antiretroviral drugs such as protease inhibitors (PI) has generated sensible changes in oral manifestation patterns in human immunodeficiency virus (HIV) infected adult patients. OBJECTIVES: The purpose of the present study was to assess whether the use of highly active antiretroviral therapy (HAART) has brought changes to pattern and prevalence of oral lesions related to HIV in the HIV-infected pediatric population. CASUISTIC AND METHOD: We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection and followed up by the Ambulatory of AIDS, Clinical Otorhinolaryngology, Hospital das Clinicas, Medical School, Sao Paulo University, from January 1990 to December 2004. Four hundred and fifty-nine children were divided into two groups, according to age range: X (0-5 years and 11 months) and Y (6-12 years and 11 months). These groups were subdivided into four subgroups, according to use of ART (antiretroviral therapy without PI) or HAART. We recorded data related to type of oral lesion presented, as well as serum CD4+ lymphocyte count. The groups were compared concerning prevalence and presentation pattern of oral manifestations. RESULTS: Out of 459 children, 144 (31.4%) had oral lesions. We observed that in children aged 6-12 years and 11 months who were taking HAART, there was lower prevalence of oral lesions (p=0.005), specially hairy leukoplakia (p<0.02), without any affection to the common presentation pattern of these lesions. The same subgroup also had higher serum CD4+ lymphocyte counts (p<0.001). CONCLUSION: We concluded that use of HAART could lead to reduction in prevalence of oral lesions in HIV-infected children.
Rett syndrome is a recently discovered, progressive neurological disorder that occurs exclusively in females early in life. Females with this rare and often misdiagnosed clinical entity have unusual but distinctive oral/digital habits. Dentists aware of Rett syndrome and its distinct manifestations will be able to aid in early diagnosis and treatment of those afflicted. A case report of a 4-year, 3-month-old white female with Rett syndrome and review of pertinent literature are presented. The previously reported oral/digital habits and oral manifestations of Rett syndrome are listed along with other unreported oral findings. Many of these oral manifestations are not unique to Rett syndrome. There is a likelihood that they may be related to trauma secondary to the excessive oral/digital habits, poor gait, and seizure activity.
The myelodysplastic syndromes are a heterogenous group of hematologic disorders of myeloid progenitor cells. Oral manifestations may be among the first signs and often reflect degrees of neutropenia or neutrophil dysfunction. A patient with persistent herpes labialis and severe oral mucosal ulceration in myelodysplastic syndrome is reported. The features of myelodysplasia are reviewed and their oral manifestations and significance to dental management outlined.
Scleroderma is characterized by fibrotic changes of the skin and organ systems. The disease presents in a variety of forms, ranging from the most aggressive progressive systemic sclerosis (PSS), to the three less aggressive, CREST syndrome, morphea, and the more localized form, linear scleroderma. The oral manifestations of the disease result from deposits of collagen in the tissues or as a result of collagen deposition around nerves and vessels. All oral tissues are affected. In scleroderma patients, the oral manifestation most commonly recognized is wide periodontal ligament spaces. Limited function, impaired healing, and neurologic symptoms all may be present to varying degrees, depending on the form and progression of the disease.
Two cases of plasmacytoma in the oral cavity are described. The first case was a plasmacytoma of the palate in a 64-year-old man, which be an oral manifestation of multiple myeloma, with fatal course 17 months after the first examination. The second was a plasmacytoma in a 43-year-old man, manifesting first in the mandible. A review of the recent Japanese dental literature was made: 14 cases were found in the literature exhibiting evidence of plasmacytoma in the oral region. Eight of these patients had oral manifestations of multiple myeloma (IgG myeloma, 3; IgA myeloma, 1; IgD myeloma, 1; B-J myeloma, 1; undetermined, 2). The other six cases were single lesions of plasmacytoma. The ratio of males to females was 1:1. The mandible was more frequently involved than the other oral structures. The site of predilection was the posterior portion of swelling and, less frequently, pain. Surgical treatment was favored in single lesions of plasmacytoma, while in myeloma chemotherapy and a combination of radiotherapy-chemotherapy constituted 75% of treatment.
Fifty patients with insulin-dependent diabetes mellitus (IDDM) in the age group of 5-20 years were assessed for oral candidal carriage state and other related oral manifestations. The control group showed 16% Candida carrier state, whereas the IDDM group showed 92% candida carrier state. The candidal count was significantly higher in the IDDM group. Other associated oral manifestations like dry mouth, burning sensation, and painful fissures were also observed in the IDDM subjects.
Two cases of the Klippel-Trenaunay-Weber syndrome are presented. In one of the cases postsurgical complications arose in association with the vascular component of the syndrome complex. Oral surgeons and dentists must remain aware of the potentially serious complications of dental and/or surgical procedures in such cases. Other stigmata of the syndrome are discussed and related to similar conditions.
The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.
The introduction of HIV protease inhibitors was accompanied by reduction in HIV-associated opportunistic infections. Therefore, we performed a retrospective study of HIV-infected patients to evaluate the effects of therapy with an HIV protease inhibitor (PI) on oral candidosis. This was of special interest, because an important virulence factor of Candida albicans is the secreted aspartic protease (SAP), which is assigned to the same class of aspartic proteases as HIV protease. Sixty-two patients were examined five times over a period of 2 years. There was a hint at a difference in the frequencies of C. albicans carrier state and manifest oral candidosis in favour of treatment with a PI. In addition, loss of Candida colonization and manifest oral candidosis was observed only in patients with elevation of CD4 cells upon PI. This might explain the effect, which also might go back to a direct inhibition of yeast SAP.
Oral manifestations of Crohn's disease (CD) are not uncommon, but they can be difficult to diagnose and treat. We describe a patient with long-standing CD and a lingual ulcer, which we attributed to CD. The oral lesions were unresponsive to conventional therapy such as steroids, mesalamine, and other topical agents. There was an excellent response to infliximab, a chimeric monoclonal antibody to tumor necrosis factor (TNF-alpha). In the context of this case we discuss the various differential diagnoses. Furthermore, we report on different therapeutic options and their effectiveness. Oral manifestations of CD, which are refractory to systemic steroids and mesalamine, show an excellent response to infliximab.
Clofazimine (Lamprene) is an antimycobacterial drug that has antiinflammatory activity in a number of chronic autoimmune skin disorders. We report 22 patients treated with clofazimine for chronic graft-versus-host disease (cGVHD). The initial dose was 300 mg orally in a single daily dose for 90 days. After 90 days, the dose was lowered to 100 mg orally each day and the medication continued indefinitely as tolerated. Treatment courses lasted 7 to 835 days and were generally well tolerated. Gastrointestinal side effects occurred in eight of 22 patients (36%) and hyperpigmentation was noted in 12 of 22 patients (55%), which resolved upon decrease or discontinuation of the drug. Over 50% of patients with skin involvement, flexion contractures, or oral manifestations achieved complete or partial responses. Seven of 22 patients (32%) were able to reduce other immunosuppressive medications. Thus, clofazimine is safe and has encouraging efficacy in cGVHD, particularly if sclerodermatous skin, joint contractures, or oral manifestations are present. The mechanism by which clofazimine induces a response is unknown, but might be secondary to suppression of alloreactive T-cell function in cGVHD target organs. Clofazimine deserves further study for the treatment of cGVHD.
In this case-report we describe a patient who was first seen with a painless lesion of the chin. Despite treatment with antibiotics and steroids it didn't heal. Later on, painful ulcerations of the mouth, perianal itching lesions and a central skotoma appeared. In the hospital--course a syphilitic infection with multiple oral ulcerations and occular infestation was diagnosed. The lesion on the chin was interpreted as the primary chancre as a time--correlation of its appearance and the time of exposition could be documented. The epidemiology, the diagnostic measures are described. We outline the manifestations of syphilis and their change in our time and discuss therapeutic regimes.
To study the prevalence of oral manifestations, we examined 217 patients infected with the human immunodeficiency virus (HIV). Most of our patients were intravenous drug abusers (IVDAs) (65%). Other risk categories were represented by IVDAs who were also male homosexuals or bisexuals (11%), male homosexuals and bisexuals (16%), sexual partners of HIV-infected patients (5%), and hemophilic persons and recipients of blood transfusions (3%). Forty-six patients were women and 171 were men, with a median age of 27 years (range, 11 to 65 years). At the time of first examination, 38% of patients had asymptomatic HIV infection, 36% had lymphadenopathy syndrome, 17% had AIDS-related complex, and 9% had AIDS. Oral manifestations were observed in 89 (41%) patients. Of these, 15 had asymptomatic infection, 23 had lymphadenopathy syndrome, 27 had AIDS-related complex, and 24 had AIDS. Increasing severity of disease was significantly associated with higher prevalence of oral lesions (p less than or equal to 0.0001). Candidiasis was the most common oral lesion, followed by hairy leukoplakia. Kaposi's sarcoma, melanotic macules, herpes labialis, condyloma acuminatum, perioral molluscum contagiosum, and bacterial glossitis due to Escherichia coli infection were found in a small number of patients. Results of culture for fungi, available for 203 patients, revealed that 51% of patients with positive Candida cultures had clinical evidence of candidiasis. Our study demonstrates that oral lesions are also important signs of HIV infection among IVDAs. Early diagnosis of these manifestations is becoming increasingly significant in the practice of dentistry.
An immunologic response to the quinine used to "cut" heroin caused oral manifestations of thrombocytopenic purpura. The patient had an admission platelet count of 2,000 per cubic millimeter. Treatment with corticosteroids and withholding of the offending resulted in a platelet count of 265,000 per cubic millimeter 13 days after admission. Oral manifestations of purpura disappeared on the fourth day of treatment.