Oral vascular manifestations of Klippel-Trénaunay syndrome.
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Adolescent↗
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Oral and maxillofacial manifestations of hereditary sensory neuropathy.
Hereditary sensory neuropathies are a rare group of neurological disorders manifested from early childhood by diminished or absent sensibility to pain, touch and temperature. A Kashmiri family with four members affected by congenital sensory neuropathy and its oral manifestations is described. Pain and temperature sensation was lost in various parts of the body including the orofacial region resulting in mutilating acropathy, particularly of the limbs and face. Orofacial motor function was normal. Three of the four members had corneal opacification due to scarring from keratitis. To prevent any further mutilation, any corrective surgery is best delayed until the patient is old enough. A discussion of the oral manifestations of this condition with a review of the literature is presented.
Adult↗
Oral candidiasis: clinical manifestations, diagnosis, and treatment.
Oral candidiasis (candidosis) is an infection with multiple manifestations. To prevent prolongation of undiagnosed cases, it is essential that the dental clinicians have an understanding of the etiology, pathogenesis, and treatment of this disease. The learning objective of this article is the identification of the various clinical features of candidiasis. The underlying causes of oral candidiasis include antibiotic therapy, poor denture hygiene, xerostomia, immune deficiencies, diabetes, and some less common conditions. Candidal infection may be superimposed on other mucosal diseases and may disguise the underlying disease. The diagnosis is established using clinical appearance and patient history, and it may require diagnostic tests. A significant segment of the population carries intraoral Candida, without any symptoms of infection, complicating the use of diagnostic tests.
Adult↗
Recurrent aphthous ulcers in Fanconi's anaemia: a case report.
Fanconi's anaemia (FA) is an autosomal recessive disorder that is clinically characterized by aplastic anaemia, congenital malformations of the renal, cardiac, skeletal and skin structures, and an increased predisposition to malignancies. Patients with FA often present with bleeding and infection, which are symptoms related to thrombocytopenia and neutropenia. There are few reports of the oral manifestations of FA. We describe oral aphthous ulcerations in two siblings with FA. There was a rapid improvement and healing of ulcers after blood transfusions and increased haemoglobin levels. This may support the role of severe anaemia in oral ulcerations.
Adolescent↗
Severe gingival bleeding in a myelodysplastic patient: management and outcome.
BACKGROUND: The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. Oral manifestations of the disease and oral complications of medical management may result in significant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection. METHODS: This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gingival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia. RESULTS: The patient did not present any episode of gingival hemorrhage after the periodontal treatment. CONCLUSION: The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyperplasia, and gingival bleeding, with the intent of preventing further hemorrhagic episodes and possible systemic infection.
Adult↗
Gingival hyperplasia complicating acute myelomonocytic leukemia.
Many systemic illnesses manifest clinical signs in the oral cavity. A remarkable case of gingival hyperplasia heralding the presence of acute myelomonocytic leukemia (AML FAB-M4) is described. The oral manifestations of acute leukemia are reviewed.
Adult↗
The spectrum of plasma cell neoplasia in oral pathology.
Plasma cell tumors are lymphoid neoplastic proliferations of B cells that may be classified as multiple myeloma (MM), solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (PEM). These types of neoplasia are typically found in adults and may occur as disseminated tumors of the bone marrow or in some cases as solitary bone or extramedullary tumors. Most SBP eventually develop into MM, whereas only 30% of the PEM do so. Oral manifestations in the form of oral and maxillofacial lesions are often the first sign of the disease. Treatment of these neoplastic tumors varies depending on the type of proliferation and may involve surgery, radiotherapy and chemotherapy, alone or combined. This paper reviews the main clinical and pathological aspects of these tumors and their relationship to the oral and maxillofacial area.
Humans↗
Periodontal manifestation of Langerhans' cell histiocytosis in a young man: case report with a 24-month follow-up.
A 25-year-old male patient with skin lesions of Langerhans' cell histiocytosis (LCH) was referred for periodontal treatment because of bilateral severely inflamed ulcerative periodontal lesions at the mandibular second premolar and first molar. On the left side, significant bone loss was revealed. Anti-infectious and surgical periodontal therapy resulted in significant probing pocket depth reduction and clinical attachment gains that were maintained for up to 24 months after surgery. Biopsies were taken during periodontal surgery. Immunohistochemical staining revealed that the periodontal lesions were uncommon periodontal manifestations of LCH. Reports of oral manifestation of LCH and treatment methods are reviewed.
Adult↗
[AIDS and the oral cavity].
The oral cavity is the site for a number of diseases associated with an infection of the human immunodeficiency virus. Often the oral lesions may appear before the establishment of an AIDS diagnosis; and occasionally, the diagnosis may depend solely on the oral manifestations. The most commonly reported oral infections are those caused by Candida albicans and the herpes simplex virus. Hairy leukoplakia, a newly described lesion, may also be of viral origin. Kaposi's sarcoma is the most frequently reported oral malignancy in patients with AIDS. Oral squamous cell carcinoma and non-Hodgkin's lymphomas have also been reported.
Acquired Immunodeficiency Syndrome↗
Pemphigus vulgaris. A presentation of 14 cases and review of the literature.
Pemphigus vulgaris (PV) is a chronic vesicular-ampullar mucocutaneous disease that almost always produces oral manifestations. The fact that blisters on the oral mucosa are sometimes the first manifestation of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of PV to ensure early diagnosis and treatment. We present a series of 14 patients with clinically and histologically diagnosed PV seen in the Teaching Unit of Oral Medicine of the University of Murcia (Spain) between 1981 and 2001. A thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, and the signs and symptoms of the disease. Complementary studies were also carried out, with the evaluation of hematological parameters (including blood chemistry), the histology and immunohistochemical characteristics (direct immunofluorescence in 2 cases). Treatment comprised topical corticoids, in 12 cases combined with systemic corticoids, and associated to intralesional corticotherapy in one patient. A good response to treatment was observed in all cases.
Administration, Oral↗
Orofacial lesions in 126 newly diagnosed HIV/AIDS patients seen at the University College Hospital, Ibadan.
Human immune deficiency virus (HIV) infection is one of the most devastating infection in modern times. Oral manifestations of HIV infection occur in approximately 30-80% of patients infected with this virus and the factors, which predispose to these lesions include: CD4 count less than 200 cells/mm, viral load, xerostomia, poor oral hygiene and smoking. These manifestations have subsequently become important entry criteria for: clinical trials of various therapeutic regimes, prophylaxis of HIV related opportunistic infections, anti-retroviral trials and vaccine studies. Over a six month period, all newly diagnosed HIV/AIDS patients attending the Special Treatment Clinic at the Haematology Department of the University College Hospital, Ibadan, Nigeria were recruited into this study before anti-retroviral therapy was commenced. As part of the general physical examination of these patients, a thorough orofacial evaluation was also carried out and the findings were documented. The most prevalent orofacial lesions were candidiasis, xerostomia, melanotic hyperpigmentation and herpetic ulcer among others. The aim of this study was to evaluate the pattern of oral lesions found in patients who were newly diagnosed as having HIV infection prior to commencement of anti-retroviral drugs and relate these lesions to the age, sex and occupation of the patients. These findings may suggest the likelihood that there is a pattern of oral manifestation of HIV infection.
AIDS-Related Opportunistic Infections↗
Erythema multiforme, potential complicating factor in dental therapy.
Erythema Multiforme, (E.M.) is an interesting dermatologic disease which has oral manifestations. It presents a diagnostic dilemma because the oral cavity has the ability to produce varied manifestations. The range of possible etiologies fo oral disease is immense. Therefore, the dentist must have a differential diagnosis for all oral lesions. The following case report represents a differential diagnosis problem which hampered routine dental therapy. The oral soft tissue lesions needed to be managed before the endodontic therapy could be completed.
Adult↗
Oral lesions among HIV-infected hemophiliacs. A study of 54 patients.
BACKGROUND: HIV-infected individuals develop a large variety of oral manifestations. This study was designed to assess the prevalence and types of oral lesions among HIV-positive hemophiliacs. MATERIALS AND METHODS: A study population of 54 hemophiliacs was evaluated from February, 1987 to March, 1992 in order to analyze types, prevalence and relationships to clinical stages of HIV-related oral lesions. Thirty-six (67%) of the group of patients were HIV seropositive. The remaining 18 tested negative to HIV during the observation period. RESULTS: The majority of patients suffered from hemophilia A. One patient was also bisexual and two were also intravenous drug abusers. Analysis of patient stage revealed that half had a CD4+ T-lymphocyte count over 0.5 x 10(9)/L cells, 10 between 0.2 and 0.499 x 10(9)/L and 8 showed a count lower than 200 x 10(9)/L. Oral lesions were recorded in 18 (50%) HIV-seropositive hemophiliacs. No oral lesions were observed among the HIV-seronegative hemophiliacs. Advanced stage of immunosuppression and presence of oral lesions were significantly associated (p = 0.040). Candidiasis was the most common disturbance, followed by hairy leukoplakia. Oral herpes simplex infection, necrotizing gingivitis and facial herpes zoster were found in a small number of patients. Those with oral lesions showed a lower median CD4+ T lymphocyte count (0.209 x 10(9)/L cells; range 0.008 to 0.615) when compared to the ones without oral lesions (median CD4+ count was 0.539 x 10(9)/L cells; range 0.042 to 1.180; p = 0.002). CONCLUSIONS: HIV-seropositive hemophiliacs may develop oral lesions during the course of their disease. Candidiasis and hairy leukoplakia are among the most common manifestations. A careful oral examination should be included in the clinical evaluation of all HIV-infected hemophiliacs.
HIV Seropositivity↗
Oral presentation of polyarteritis nodosa.
A case of polyarteritis nodosa in a woman with oral manifestations and digital gangrene is presented. Oral lesions in this connective tissue disorder are rare, and few cases have previously been reported.
Female↗
In situ detection of hepatitis C virus RNA in salivary glands.
Chronic hepatitis C virus (HCV) infection has been associated with several extrahepatic manifestations, among these, to diseases with oral manifestations such as Sjögren's syndrome or sialadenitis. HCV-RNA has been detected in saliva and in salivary glands from patients with sialadenitis by polymerase chain reaction. However, morphological evidence of HCV replication in salivary gland cells is needed to support a role for HCV in causing sialadenitis or Sjögren's syndrome. We have used in situ hybridization and immunohistochemistry to analyze the presence of HCV-RNA of sense and antisense polarity and HCV core antigen, respectively, in salivary gland biopsies from 19 patients with chronic sialadenitis or Sjögren's syndrome (eight anti-HCV-positive; 11 anti-HCV-negative). HCV-RNA of both positive and negative polarity as well as HCV core antigen were detected in the epithelial cells of the salivary gland biopsies from all of the anti-HCV-positive patients but in none of the anti-HCV-negative cases. The percentage of HCV-infected cells ranged from 25 to 48.8% in the patients studied. In conclusion, we have shown that HCV infects and replicates in the epithelial cells from salivary glands of patients with Sjögren's syndrome or chronic sialadenitis. However, its implication in the pathogenesis of these diseases deserves future research.
Adult↗
Oral candidiasis in children with immune suppression: clinical appearance and therapeutic considerations.
Children and adolescents with immune compromise and suppression are particularly susceptible to the development of oral candidiasis. In fact, oral candidiasis is the most common oral manifestation in HIV-infected children. Oral candidiasis has been linked to a depressed immune system, more rapid progression to AIDS, more advanced stage of disease in AIDS, and decreased survival. Several different forms of candidiasis may be recognized clinically. These forms are 1) pseudomembraneous candidiasis; 2) erythematous (atrophic) candidiasis; 3) papillary hyperplasia; 4) chronic hyperplastic candidiasis; 5) angular cheilitis; and 6) median rhomboid glossitis. Diagnosis of candidiasis is primarily based upon clinical appearance; in some cases, however, exfoliative cytology and/or biopsy of the lesion may be necessary. It is also possible to culture the lesion to determine the specific subtype of candidia and to evaluate the susceptibility of the fungus to specific antifungal agents. Both topical and systemic treatment by antifungal medications are readily available.
Antifungal Agents↗
Psoriasis of the dorsal surface of the tongue.
Psoriasis is primarily an inherited inflammatory skin disease, it is characterized by erythemato-squamous lesions that usually involve elbows, knees and the scalp. Oral manifestations are rare in psoriasis, infact, oral psoriasis involves 2% of psoriatic patients and usually it is observed with the onset of cutaneous lesions and progresses with them. Differential diagnosis should be done for Reiter's syndrome, leukoplakia and geographic tongue. The authors describe a case of tongue psoriasis without cutaneous lesions.
Adult↗
Group II and III lesions in HIV positive Nigerians attending the General Hospital Lagos, Nigeria.
OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV infected adult Nigerian patients attending the HIV Clinic of the General Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD: Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN et al, for oral manifestation of HIV. WHO classification of oral lesions based on the degree of association with HIV infection was also used. Oral lesions were treated using established treatment protocols. RESULTS: Seventy patients had oral lesions of HIV, of these fourteen (20%) patients had Group II and III oral lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU), 4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented with oral symptoms severe enough to require use of appropriate medication. Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group II and III lesions are less prevalent than group I lesions in HIV infected adult Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral lesions of HIV are associated with a lot of pain, morbidity and may also compromise aesthetics. By compromising adequate nutrition and practice of good oral hygiene, they may lead to further deterioration of the health of the patient and can accelerate the course of the disease. Early recognition and diagnosis of these lesions by the oral clinician and/or trained dental practitioner affords the patient the opportunity of receiving prompt and appropriate medical treatment as well as counseling.
Adolescent↗