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PubMedDate not supplied

Secondary syphilis in an HIV positive patient.

The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso of skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.

Adult↗
PubMed1983

Gastrointestinal manifestations of multiple endocrine neoplasia, type IIB.

Multiple endocrine neoplasia, type IIB (MEN 2b), is comprised of medullary carcinoma of the thyroid, pheochromocytoma, diffuse ganglioneuromatosis of the gastrointestinal tract, and skeletal abnormalities. Alimentary tract manifestations, especially enlargement of the lips and tongue by proliferative neural tissue, are often the earliest clues to the presence of the syndrome. A patient is presented here who illustrates the chronicity and diversity of symptoms characteristic of MEN 2b. It is important to recognize the typical oral manifestations of this syndrome so that the thyroid gland can be evaluated before the development of disseminated medullary carcinoma.

Adult↗
PubMed2006

The management of Sjögren's syndrome.

Sjögren's syndrome is a chronic autoimmune disorder, characterized by lymphocytic infiltration and malfunction of the exocrine glands, resulting in dry mouth and eyes. The syndrome can present either alone (primary Sjögren's syndrome) or in the context of an underlying connective tissue disease (secondary Sjögren's syndrome). Systemic features, resulting from cutaneous, respiratory, renal, hepatic, neurologic, and vascular involvement, often occur. Two types of primary Sjögren's syndrome are currently recognized: a benign disease that affects quality of life, and a systemic syndrome associated with increased morbidity and mortality owing to a high risk of malignant transformation, and that requires close follow-up. Ocular involvement, manifested as keratoconjunctivitis sicca, is managed with local and systemic stimulators of tear secretion and supportive surgical procedures. Treatment of oral manifestations includes intense oral hygiene, prevention and treatment of oral infections, use of saliva substitutes, and local and systematic stimulation of salivary secretion. Cholinergic agents, such as pilocarpine and cevimeline, are helpful in patients with residual salivary function, and ciclosporin ocular drops seem to be of some benefit. Systemic immunosuppressives are reserved for treatment of severe extraglandular manifestations of Sjögren's syndrome. Anti-B-cell therapy is a new potential therapy for the glandular and extraglandular manifestations, such as glomerulonephritis or vasculitis, in addition to the management of lymphoma associated with Sjögren's syndrome. Induction of oral tolerance and gene-transfer modalities were recently attempted in animal models, with promising results.

Adjuvants, Immunologic↗
PubMed1998

Graft-versus-host disease. Case report and discussion.

The graft-versus-host disease reaction is an immunologic consequence resulting from the grafting of immunocompetent cells from one individual to an immunocompromised host. The oral manifestations of this disease process include severe oral pain, xerostemia, ulcerative lesions, and mucositis. With appropriate history and diagnostic testing, these lesions can be differentiated from other oral diseases having similar clinical appearance.

Adult↗
PubMed2006

Characterization of oral pemphigus vulgaris in Thai patients.

Pemphigus vulgaris (PV) is a serious mucocutaneous disease that be fatal if left untreated. The oral mucosa is often the first site to be affected by the disease. It is thus important that the dentist is able to recognize oral manifestations of PV and refer appropriately. Although oral PV is a well-characterized condition, the disease characteristics of patients in Thailand have not been previously reported. Here, we describe patient and lesion characteristics of 18 cases of oral PV. For these 18 cases, the mean age was 38 years, and the male:female ratio was 1:2. The most commonly affected sites were the gingiva and buccal mucosa, and the duration of disease was approximately one year. Medications previously used included corticosteroids and interferon, and nine patients reported systemic disease. Histopathologic examination with/without direct immunofluorescence was the method of diagnosis in all cases.

Adolescent↗
PubMed2002

Eating disorders.

Eating disorders are a serious concern in clients health and a challenge to oral health professionals. These illnesses, including anorexia nervosa, bulimia, binge eating, and pica, are characterized by serious disturbances in eating and effects on psychological health. Physiologic changes associated with eating disorders may be devastating and can lead to mortality. Despite the serious consequences of eating disorders on physical and psychological health and well being, these disorders are often difficult to diagnose. Even when detected, ill clients may be averse to accepting treatment. Thus, oral health professionals must be aware of the signs of eating disorders, and be prepared to collaborate with other health care providers to treat them. The purpose of this course is to review the medical and dental literature concerning eating disorders types, risk factors, systemic health consequences, oral manifestations, and treatment considerations. The role of oral health professionals as part of an interdisciplinary health team focused on addressing the needs of clients with eating disorders will be addressed.

Dental Care for Chronically Ill↗
PubMed2005

[Histopathological features of oral pemphigus vegetans].

OBJECTIVE: To investigate the clinicopathological features of oral pemphigus vegetans. METHODS: Seven cases of pemphigus vegetans involving oral mucosa were included in this study. The paraffin sections were analyzed by routine light microscope. RESULTS: There were 5 females and 2 males in this group, with an average age of 52.7 years. The course of diseases was from 3 months to 10 years. Oral manifestations included verrucous or papilliform hyperplasia of oral mucosa, with extensive edema and exudation. Similar skin lesions were found in 5 patients. Under the microscope, pemphigus vegetans showed epithelial thickening with prolonged rete pegs, intraepithelial clefts in suprabasal cells. Eosinophilic microabscesses was often seen within the epithelium. Other microscopic changes were intraepithelial edema and eosinophils infiltration, chronic inflammatory cells infiltration in the lamina propria. CONCLUSION: The microscopic features pemphigus vegetans described in this study are of valuable for pathological diagnosis of oral pemphigus vegetans.

Adult↗
PubMed1996

Women as dental patients: are there any gender differences?

There is an increasing awareness that gender differences affect both health and disease. This review looks at gender differences as they pertain to the mouth. Not only does pregnancy, the menstrual cycle and the menopause affect the oral tissues but there are also gender differences in regard to patterns of dental disease as women access dental care differently and react to health promotion in a more positive manner. Women live longer and are therefore more likely to be on drugs which complicate treatment. Care must also be taken in prescribing drugs during pregnancy and lactation and attention must be paid to the interaction of drugs with oral contraceptives. Certain systemic diseases such as Sjögrens syndrome, rheumatoid arthritis and anorexia nervosa which have specific oral manifestations are especially common in women. Although oral cancer is mainly a problem among men the rise in smoking among young women poses a problem for the future. HIV/AIDS can be diagnosed on the basis of oral lesions and this may be of great importance in the event of a pregnancy. Although facial pain and facial arthromyalgia (temporomandibular joint dysfunction) pain are common in the population, women come forward for treatment much more frequently. Burning syndrome is especially common among post menopausal women and urgently needs more research.

Burning Mouth Syndrome↗
PubMed1996

Dental considerations for the patient with renal disease receiving hemodialysis.

An increasing number of Americans are living with end-stage renal disease. This disease has many implications for dentistry, in terms of oral manifestations and management of afflicted patients. The authors present pertinent information to help dentists treat patients who exhibit the oral and systemic manifestations of renal disease, from the onset of renal impairment through hemodialysis.

Antibiotic Prophylaxis↗
PubMed2005

Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists.

Despite the crucial role oral health care providers can have in the early identification of eating disorders and the referral and case management of patients with these disorders, little is known concerning their knowledge of oral complications of these disorders. The purpose of this study was to determine the knowledge among dentists and dental hygienists concerning the oral and physical manifestations of eating disorders. Employing a randomized cross-sectional study, data were collected from 576 dentists and dental hygienists randomly selected from the American Dental Association and the American Dental Hygienists' Association. Results indicated low scores concerning knowledge of oral cues, physical cues of anorexia, and physical cues of bulimia among study participants. More dental hygienists than dentists correctly identified oral manifestations of eating disorders (p=.001) and physical cues of anorexia (p=.010) and bulimia (p=.002). As the first health professional to identify oral symptoms of eating disorders, the most important task of the dental care provider when identifying oro-dental signs of eating disorders is to ensure that the patient receives treatment. Implications for education include the addition of conceptual, procedural, and skill-based curricula objectives addressing etiologic assessment and patient communication--thus increasing behavioral capacity for delivery of restorative care and patient referral.

Anorexia Nervosa↗
PubMedDate not supplied

General and oral characteristics in Rett syndrome.

Rett syndrome (RS) is a neurodegenerative disorder characterized by developmental arrest of parts of the brain. It is an X chromosome-linked condition which affects females almost exclusively. Recent reports have been generated concerning the multidisciplinary management of individuals exhibiting Rett syndrome. The aim of the present report was to provide an update on the oral manifestations of the disorder. We evaluated the general and oral characteristics of RS in 13 female patients. The most frequent manifestations were stereotyped hand movements and bruxism. The treatment we carried out included the use of biteplanes and acupuncture.

Acupuncture Therapy↗
PubMedDate not supplied

Mucocutaneous candidiasis as first manifestation of autoimmune polyglandular syndrome type I.

Autoimmune polyglandular syndrome type 1 exhibits very specific oral manifestations in the form of enamel hypoplasia and oral candidiasis. The authors present the case of a 10-year-old girl with autoimmune polyglandular syndrome characterized by chronic mucocutaneous candidiasis infections, hypoparathyroidism, and enamel hypoplasia. The importance of this entity is stressed, with special attention to the observed oral anomalies.

Candidiasis, Chronic Mucocutaneous↗
PubMedDate not supplied

Quantitative assessment of the efficacy of oral ketoconazole for oral candidosis in HIV-infected patients.

Fifteen male patients with manifest oral candidosis due to Candida albicans, suffering from AIDS-related complex (ARC) or full-blown AIDS, were investigated both clinically and microbiologically before and about 1 and 4 weeks after 7 to 10 days of treatment with 200 mg ketoconazole p.o. per day. Candida albicans was quantitated in mouthwash fluid. The antimicrobial susceptibility of the Candida albicans isolates was assessed using the IC30 test. In the short term, clinical cure was obtained in 87%, mycological cure in 53%. In the long term, the corresponding figures were 56 and 9%, respectively. Eradication of Candida albicans was not possible if IC30 values exceeded 256 micrograms ml-1. While pretreatment counts of Candida albicans in those patients also taking zidovudine did not differ from those in the rest of the study population, both the clinical and the mycological efficacy of ketoconazole seem to be higher both in the short and the long term when administered together with zidovudine. In consideration of the high relapse rate after about 4 weeks, an interval treatment protocol with oral ketoconazole is proposed.

AIDS-Related Opportunistic Infections↗
PubMed1986

Acquired immune deficiency syndrome (AIDS) in the United States in 1986: etiology, epidemiology, clinical manifestations, and dental implications.

The acquired immune deficiency syndrome (AIDS) results from a lymphotropic retrovirus (HTLV-III) infection and is characterized by specific opportunistic infections and malignancies. The virus is transmitted primarily by semen and blood. Infection is limited principally to defined risk groups, i.e., homosexual men and intravenous drug users. Head and neck manifestations include cervical lymphadenopathy and Kaposi's sarcoma. Oral manifestations include Kaposi's sarcoma, candidiasis, hairy leukoplakia, precocious periodontal disease, xerostomia, herpes simplex, recurrent aphthae, erythema multiforme, and venereal warts. Although HTLV-III is present in saliva, there are no reported cases of transmission secondary to dental procedures. Appropriate precautions and techniques are recommended in treating patients at risk for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Oral aphthous ulcers and dental enamel defects in children with coeliac disease.

AIM: Coeliac disease is characterized by oral manifestations, such as dental enamel defects and recurrent oral aphthae. In this study we compared the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) between patients diagnosed with coeliac disease and healthy controls. METHODS: A total of 72 patients with coeliac disease were studied together with 162 normal healthy subjects as controls to individualize the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) in this disease. RESULTS: Dental enamel defects were found in 14/70 (20%) coeliac patients and in 9/159 (5.6%) controls. In particular, 13/53 (24.5%) coeliac patients with mixed or permanent dentition and 1/17 (5.8%) coeliac children with deciduous dentition had enamel defects. Altogether, 9/145 (6.2%) control subjects with mixed or permanent dentition had dental enamel defects. None of the controls with deciduous dentition had enamel defects. Thus, the enamel defects occurred more frequently in coeliac patients (p < 0.001). Regarding RAS, 24/72 (33.3%) coeliac patients and 38/162 (23.4%) control subjects had aphthous ulcers. Statistically significant differences were not observed between the two groups (p > 0.05). One in three coeliac subjects suffering from RAS received benefit from a gluten-free diet. CONCLUSION: In the present study, the prevalence of enamel defects was found to be greater in coeliac patients than healthy controls. Even though the prevalence of RAS in coeliac subjects varied from healthy controls, the difference was not statistically significant. However, more than 1/3 coeliac subjects suffering from RAS benefited from a gluten-free diet.

Adolescent↗
PubMed1997

Is erythematous candidiasis associated with advanced HIV disease?

OBJECTIVES: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito-urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease. SUBJECTS AND METHODS: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm-3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%. RESULTS: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use. CONCLUSIONS: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.

AIDS-Related Opportunistic Infections↗
PubMed2006

Aspects of HIV disease relevant to dentistry in the 21st century.

UNLABELLED: HIV disease remains a significant health concern in Europe and the rest of the world. The present article details the epidemiological shifts, changes in therapy and oral manifestations of HIV disease of relevance to all oral healthcare professionals. CLINICAL RELEVANCE: Knowledge regarding the oral and dental aspects of HIV infection remain of importance to all dental healthcare professionals.

AIDS-Related Opportunistic Infections↗