Oral Mucosal Conditions in Chronic Hepatitis C Brazilian Patients: A Cross-Sectional Study

Objective: Our purpose was to carry out an epidemiological study to assess the prevalence of oral mucosal conditions in Brazilian patients with chronic hepatitis C. Methods: A cross-sectional survey was carried out on 215 patients with chronic hepatitis C who were examined for oral mucosal conditions, including oral mucosal lesions and variations of normality. Results: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent (207 patients). Oral mucosal lesions were present in 147 patients (68.4 percent), whereas variations of normality were observed in 173 patients (80.5 percent). The most common lesions included cheek biting in 42 cases (19.5 percent), candidiasis in 39 cases (18.1 percent), and leukoplakia in 28 cases (13.0 percent). The association of oral lichen planus with hepatitis C virus (HCV) infection proved to be statistically significant ( P =  0.002). The most frequent variations of normality included Fordyce's spots in 96 cases (44.7 percent), lingual varicosities in 67 cases (31.2 percent), and fissured tongue in 60 cases (27.9 percent). Conclusion: The prevalence of patients with chronic hepatitis C presenting oral mucosal conditions was 96.3 percent. Despite this high prevalence, only the association between oral lichen planus and hepatitis C showed statistical significance. Considering that HCV infection may be associated with extrahepatic disorders, such as oral manifestations, efforts should be made to clarify the possible relation between oral conditions and HCV infection. This may be helpful in the earlier diagnosis of the infection mainly in asymptomatic patients.     

光动力治疗口腔黏膜癌及癌前病变的临床进展

口腔癌是发生在口腔的恶性肿瘤之总称,严重影响人类生命和生活,发病率高,致残率和病死率高。许多口腔癌由癌前病变发展而来,最常见的是口腔黏膜白斑、扁平苔藓等。目前针对口腔癌一线治疗方案分为:手术切除、放射线治疗、化学治疗以及联合治疗。特别是高龄口腔癌症患者,传统治疗尚有一定的局限性和毒副作用。针对癌前病变常用药物和手术治疗,复发率较高,患者精神压力大。光动力疗法(Photodynamic th erapy,PDT)是通过光动力学反应选择性破坏病变组织的微创治疗手段,主要应用于体表和空腔脏器表面肿瘤的非手术治疗。它具有抗瘤谱广、靶向特异性高、对正常细胞器官损伤小、全身毒副作用低、可以重复治疗等特点。在癌症复发或高龄癌症患者不能耐受手术和放化疗的治疗中取得了一定疗效。PDT为口腔黏膜病变(特别浅表病变和早期病变)提供了手术或放疗之外的另一种选择。本文将从PDT治疗口腔黏膜肿瘤、口腔黏膜癌前病变等疾病的治疗方面进行综述和展望。     

Oral manifestations of systemic and cutaneous lupus erythematosus in a Venezuelan population

BACKGROUND: The aim of this study was to characterize oral lesions in patients with systemic and cutaneous lupus erythematosus (LE) in a Venezuelan group. METHODS: Ninety patients with LE were studied. Oral biopsies were taken from patients who showed oral mucosal involvement. Tissue samples were investigated with histology and direct immunofluorescence techniques for the presence of immunoglobulins G, M, A and complement factor C3. RESULTS: In 90 patients with LE, 10 patients showed oral lesions related to the disease. Sixteen lesions were investigated. Oral ulcerations accompanied by white irradiating striae occurred in five patients, erythema was observed in five patients and a white homogeneous plaque in one patient. Fifteen lesions demonstrated vacuolar basal degeneration and 12 thickening of the basement membrane histologically. Direct immunofluorescence was negative in three samples. CONCLUSIONS: These findings corroborated that ulcers are not the only manifestation of LE in the oral mucosa. Clinical and histological examinations are significant as immunoproteins are not always found on the oral sample.     

Oral profile of eating disorders patients: Case series

Oral alterations in patients diagnosed with eating disorders (ED) are reported in the literature, but few articles demonstrate these changes in a specific population. This study aims to summarize the findings of 26 patients with ED in a Brazilian dental clinic, through analyzing the body mass index and oral conditions (decayed, missing and filled teeth—DMFT, dental wear, salivary flux, xerostomia, oral hygiene—OHI‐S, oral lesions, and the prevalence of candidiasis), in order to facilitate recognition and enable accurate diagnosis for the general dentist. Probably, the premature diagnosis of ED resulted in lower DMFT and oral lesions.     

口腔黏膜病患者牙周健康状况调查分析

目的通过流行病学调查方法了解口腔黏膜病患者牙周健康状况,为口腔黏膜病患者牙周病的预防与治疗提供依据。方法对中国医科大学附属盛京医院口腔科门诊的黏膜病患者766人进行牙周专科检查,填写调查问卷,检查结果采用SPSS 13.0软件进行统计学分析。结果口腔黏膜病患者牙周健康者只有10.70%。不同性别、年龄、学历、口腔护理情况显著影响口腔卫生及口腔健康情况;口腔黏膜病中,患者就诊率最高的是口腔溃疡(34.20%),其次为扁平苔癣(32.64%);口腔溃疡及扁平苔藓的牙周炎患病率均较高,分别是95.42%和92.80%。结论口腔黏膜病的发病与发展与牙周健康水平有着密切的相关性,应从多角度分析口腔黏膜病患者牙周健康不良原因,及牙周健康不良是否会影响口腔黏膜病变,并采取积极预防及治疗措施。     

Scandinavian Fellowship for Oral Pathology and Oral Medicine: guidelines for oral pathology and oral medicine in the dental curriculum

In Scandinavia, as in many European countries, most patients consult their general dentist once a year or more. This gives the dentist a unique opportunity and an obligation to make an early diagnosis of oral diseases, which is beneficial for both the patient and the society. Thus, the dentist must have knowledge of clinical symptoms, local and systemic signs and clinical differential diagnoses to make an accurate diagnosis. The dentist must be competent in selecting appropriate diagnostic tests, for example, tissue biopsy and microbiological samples, and conducting them correctly, as well as in interpreting test results and taking appropriate action accordingly. Furthermore, the dentist must be aware of diseases demanding multidisciplinary cooperation and be able to recognise his/her professional limitation, and to refer to other specialists when required. The dental curriculum changes over time as new approaches, treatments and diagnostic possibilities develop. Likewise, the role of the dentist in the community changes and may vary in different countries. As members of the Scandinavian Fellowship for Oral Pathology and Oral Medicine and subject representatives of oral pathology and oral medicine, we feel obliged to contribute to the discussion of how the guidelines of the dental curriculum support the highest possible standards of dental education. This article is meant to delineate a reasonable standard of oral pathology and oral medicine in the European dental curriculum and to guide subject representatives in curriculum development and planning. We have created an advisory topic list in oral pathology and oral medicine.     

Oral lichen planus: a retrospective study of 690 British patients

OBJECTIVE: This is the largest UK patient group with oral lichen planus (OLP) to be studied in terms of the demographic and clinical characteristics. MATERIALS AND METHODS: Data were taken from the medical records of 690 consecutive patients referred to Oral Medicine subsequently found to have clinical, and usually histopathological confirmatory features of OLP. Over two-thirds (68.7%) of the patients were Caucasians. RESULTS: Eighty-two per cent of the patients had been referred to a specialist Oral Medicine service by general dental practitioners, 62% of the patients being referred as a consequence of oral mucosal and/or gingival pain. Reticular OLP was the most common intra-oral presentation, but 60% of such lesions were accompanied by other clinical types of OLP. 95% of lesions were bilateral. About 13% of patients reported symptoms or signs, or had a known history of lichen planus or possible lichen planus affecting non-oral epithelia. In only 13% of patients did all signs and symptoms of OLP resolve within 12-246 months (median 35 months). A malignant transformation rate of 1.9% was observed in the present group. CONCLUSIONS: Oral lichen planus in UK persons almost always gives rise to bilateral reticular OLP, rarely resolves spontaneously, and has a low rate of malignant transformation.     

Prevalence of oral mucosal lesions in elderly people in Santiago, Chile

BACKGROUND: Oral prevalence studies are important to know the state of health and the needs of treatment. Our aim was to determine the prevalence of oral mucosal lesions and associated factors among aging Chileans. METHODS: A random sample by age, gender, and socioeconomic status was obtained, comprising 889 individuals older than 65 years. Individuals were interviewed and examined in Santiago, the capital of Chile, according to the World Health Organization guidelines. RESULTS: The prevalence of one or more oral mucosal lesions in the sample was 53%. Logistic regression model revealed that denture use increased the probability of one or more oral mucosal lesions by threefold, while age, gender, smoking, medication use, xerostomia, and social or cultural factors had no effect. The most common lesion was denture stomatitis (22.3%), followed by irritative hyperplasia (9.4%), oral mucosal varicosities (9%), solitary pigmented lesions (4%), traumatic ulcer (3.5%), angular cheilitis (2.9%), multiple pigmented lesions (2.8%), hemangioma (2.3%), lichen planus (2.1%), leukoplakia (1.7%), recurrent aphthous stomatitis (1.4%), nicotine stomatitis (1.3%), median rhomboid glossitis (0.9%), actinic cheilitis (0.9%), pyogenic granuloma (0.7%), oral squamous papiloma (0.6%), and mucocele (0.2%). One case of oral cancer was observed. Different factors increased the probability of specific oral mucosal pathologies. CONCLUSIONS: We can conclude that oral mucosal lesions are common in elderly people in Santiago, suggesting the necessity for improved standards of prevention, and diagnostic and opportune treatment of these lesions.     

The importance of multidisciplinary healthcare for paraneoplastic pemphigus

Paraneoplastic pemphigus (PNP) is a mucocutaneous disease that occurs in association with an underlying neoplasm. Oral mucosal lesions may be the only manifestation of this condition, or they may be observed in association with cutaneous lesions. The prognosis of PNP is generally poor, and the disease is often fatal. This article highlights an aggressive case of PNP that initially presented with oral mucosal lesions and emphasizes the importance of a multidisciplinary approach for evaluation and management of this condition.     

Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.     

Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey

OBJECTIVE: The aim of this study was to determine the prevalence of oral lesions in 13- to 16-year-old students. METHODS: A cross-sectional survey was carried out on students in Duzce, a province in the western Black Sea region of Turkey. A total of 993 children aged between 13 and 16 from eight secondary schools were examined. Oral lesions with recurrent behavior, if observed, were recorded at the time of examination. Venous blood samples were obtained for detecting hemoglobin levels. RESULTS: Two hundred sixty adolescents (26.2%) were diagnosed with at least one oral mucosal lesion at the time of the examination. Thirteen different mucosal alterations were diagnosed, and the most common lesions were angular cheilitis (9%), linea alba (5.3%), and aphthous ulceration (3.6%). The correlation between occurrence of mucosal lesions and sex was not statistically significant (P > 0.05). Statistical evaluation of the data revealed a significant relationship only between the presence of angular cheilitis and anemia (P < 0.05). CONCLUSION: This study is the first epidemiologic study of oral mucosal lesions in adolescents in Turkey. Angular cheilitis was the only oral mucosal lesion that had a significant correlation with anemia.     

Is workplace screening for potentially malignant oral disorders feasible in India?

J Oral Pathol Med (2010) 39 : 672–676 Background: Because of delays in diagnosis, oral cancer usually presents for therapy at a late stage. Patients are unaware of having lesions as they are mostly asymptomatic and physicians generally do not examine the mouth sufficiently. People in rural areas or are underserved may not frequently visit the dentist who can easily pick up these lesions early. Screening programs are useful in that regard. Such programs in general are conducted by either inviting people to come to a screening center or by health care workers visiting the individual households. However, those who work during the day may not visit screening centers or be at home during the day of the screening by a visiting health care worker. Workplace screening overcomes these challenges. Methods: To assess the feasibility of a screening program to detect potentially pre‐malignant oral disorders in a workplace in India, clinically visible mucosal lesions were compared with the clinical photographs of the same lesions assessed by an expert. Role of smoking, alcohol, and chewing betel quid and tobacco in the etiology of those lesions were assessed. Results: Sixty‐nine percent of the eligible subjects participated in the screening (n = 1613). Prevalence of leukoplakia was 5%. Bidi (OR = 35.6), and cigarette smoking (OR = 22.8), alcohol (OR = 17.6), and tobacco and areca nut chewing (OR = 7.5), were significantly associated with leukoplakia and erythroplakia (all P < 0.05). Conclusions: Conduction of a screening program by valid visual inspection to detect potentially malignant oral disorders within a workplace is not only feasible but also effective.     

Oral mucosal involvement in Langerhans' cell histiocytosis: long-term follow-up of a rare case

Langerhans' cell histiocytosis (LCH) is a rare disease where different organs and systems may be affected. Oral involvement generally consists of mucosal ulceration associated with lesions of the underlying bone. Many reports exist about the misdiagnosis of this disease. Various symptoms may lead the clinician to an incorrect diagnosis, especially with multiple organ involvement. Oral manifestations are common, and dentists should be aware of this disease and evaluate intraoral findings accordingly. This study presents an LCH case characterized by oral mucosal ulcerations with no involvement of the underlying bone. A definitive diagnosis was made by open biopsy from the oral mucosa.     

Periodontal health and oral mucosal lesions as related to occupational exposure to acid mists

OBJECTIVES: The association between exposure to acid mists and periodontal changes and oral mucosal lesions was measured using data from an Oral Health Promotion Program in a large metal plant. The role of sociodemographic factors, lifestyle, and oral health behavior in relation to these outcomes was also examined. METHODS: This is a cross-sectional study of 665 active male workers who volunteered to participate in the oral health program. A job exposure matrix was constructed with industrial hygienist scores and job titles to estimate years of exposure to acid mists. Oral health outcomes were identified during standardized dental examinations. Unconditional logistic regression models were utilized in the analysis. RESULTS: Duration of exposure to acid mists exposure was positively associated with oral mucosal lesions among workers without lip sealing. Only age, low salaries and oral hygiene-related variables were associated with periodontal changes, and estimates varied according to lip sealing. CONCLUSIONS: Results suggest that long-term occupational exposure to acid mists is associated with oral mucosal lesions, and that absence of lip sealing may increase the intensity of exposure.     

克罗恩病患者口腔黏膜损害研究

目的：探讨口腔黏膜病变在克罗恩病（CD）患者中的临床特征。方法：将诊断为CD的59例患者由消化内科医师分为口腔型及非口腔型,再经口腔科医师对全部CD患者的口腔黏膜情况进行专科检查,分析CD患者中的口腔黏膜病变特征,并对两组之间的肠道病变部位进行分析研究。结果：59例CD患者中口腔型CD（23／32）比非口腔型CD（7／27）有更多的病例表现为口腔方面症状,在32例口腔型CD患者中,最常见的口腔黏膜损害为卡他性牙龈炎（n＝19）,其次为复发性阿弗他溃疡（n＝8）,肉芽肿性病变（n＝4）,鹅卵石样改变（n＝3）,唇炎（n＝3）,增殖性化脓性口腔炎（n＝1）。口腔型CD患者合并有肛周疾病者占53％（17／32）,多于非口腔型CD患者的22％（6／27）。结论：口腔症状在CD患者的临床表现中占有较大比例,其中最为常见的口腔表现为卡他性牙龈炎,有口腔症状的CD患者更有可能合并有肛周病变。     

Oral lesions in patients participating in an oral examination screening week at an urban dental school

BACKGROUND: Dental education must emphasize early diagnosis and management of oral mucosal disease, including early detection of oral premalignant lesions and cancer. The authors evaluated clinical findings of oral screening examinations of dental patients during a one-week period in an urban dental school clinic. METHODS: Third- and fourth-year dental students conducted clinical screening examinations for all dental patients of record seen during the Yul Brynner Foundation's Oral, Head and Neck Cancer Awareness Week in April 2006. RESULTS: Of 262 patients, 100 (38.2 percent) reported that they had used tobacco for a mean of 8.1 years. Most patients reported having denture or tooth and gingival problems. The dental students reported abnormal findings in 55 patients (21 percent). Two patients had suspected premalignant lesions that were diagnosed as lichen planus and traumatic keratosis. CONCLUSIONS AND CLINICAL IMPLICATIONS: The one-week screening provided an educational opportunity for the dental students, and the results demonstrate the value of having a focused week to reinforce the importance of head and neck and oral soft-tissue examination. The finding of mucosal lesions in 21 percent of patients of record reflects the fact that lesions were present but undetected. In addition, there are important implications for teaching and patient care. The screening week provided an opportunity for students to be active in a national campaign for cancer detection, and it represents an opportunity for visible community participation in the recognition of oral mucosal diseases in dental training programs and broadly for the profession.     

Oral findings in three different groups of immunocompromised patients

The objective of this study was to determine the frequency of oral, dental and periodontal findings in three different groups of immunocompromised patients and in a healthy control group, to evaluate whether there is a correlation between manifestations of disease and immunologic parameters. The survey included 46 patients with a diagnosis of systemic lupus erythematosus, 48 heart transplant recipients, and 53 adult patients suffering from acute leukemias. Fifty matched healthy subjects were used as a control group. Each patient had to answer questions on medical and dental health and underwent a thorough oral, dental and serological investigation. Oral mucosal lesions were found in nearly half of all immunocompromised patients (49.6%), but in only 26% of control patients. No significant associations were found between different types of oral lesions and the underlying cause of immunosuppression. Leukemia patients showed age-unrelated higher scores in periodontal indices (P<0.05). Laboratory parameters failed to be significant in the assessment of oral health.     

Validity and reliability of a newly developed quality of life questionnaire for patients with chronic oral mucosal diseases

J Oral Pathol Med (2011) 40 : 604–609 Introduction: The aims of this study were to test the validity and reliability of a newly developed discipline‐specific questionnaire, the Chronic Oral Mucosal Diseases Questionnaire (COMDQ), to measure quality of life in patients with chronic oral mucosal conditions. Materials and methods: Two patient samples were recruited for the purposes of this study. First, a random sample of 160 patients attending the Oral Medicine Unit of Cork University Dental School and Hospital with the following chronic oral mucosal conditions, recurrent aphthous stomatitis, oral lichen planus, the more common vesiculobullous conditions (mucous membrane pemphigoid and pemphigus vulgaris) and orofacial granulomatosis. Second, the COMDQ was randomly distributed to a sample of 100 patients without a chronic oral mucosal condition. Convergent and discriminative validity and internal consistency of the newly developed questionnaire were assessed. Results: This study has demonstrated that the newly developed questionnaire has good convergent validity with Pearson correlation coefficient of 0.819 with Oral Health Impact Profile‐14 and 0.883 with Visual Analogue Scale for pain scores. The discriminative validity was also good with statistically significant differences between patients with chronic oral mucosal conditions and without chronic oral mucosal conditions. The new instrument has also demonstrated excellent reliability with Cronbach’s alpha of 0.929. Conclusions: In conclusion, this study has demonstrated that the COMDQ is a valid and reliable measure to assess quality of life in patients with chronic oral mucosal diseases and therefore will be a valuable instrument in the management of these conditions.