Analysis of oral manifestations of leukemia: a retrospective study

OBJECTIVE: To evaluate in detail the oral complications of leukemia at initial presentation. Associations between oral manifestations and laboratory data were also investigated.
STUDY DESIGN: A retrospective study of 230 cases was conducted to investigate the nature and incidence of oral manifestations at initial presentation. The following data were determined for each patient: age, sex, haemogram at diagnosis (which included haemoglobin, red blood cell counts, differential white blood cell counts, platelet counts), classification of the type of leukemia's systemic symptoms and oral manifestations at the initial physical examination including the dental consultation.
RESULTS: It was revealed that the type of leukemia diagnosed, except with CML, is related to the age prediliction of patients. The incidence of leukemia is higher in males than in females. The most common manifestations of leukemia are lymphadenopathy (71.4% in ALL; 45% in AML), laryngeal pain (52.7% in ALL; 37.3% in AML), gingival bleeding (43.2% in AML; 28.6% in ALL), oral ulceration, and gingival enlargement. Fever (92.2%) was the most common symptom in patients with all types of leukemia. Platelet counts from 25000 mm^-3 to 60000 mm^-3 are at sufficiently low levels to result in spontaneous bleeding. Most of the patients had WBC counts of greater than 10000 mm^-3.Only 12.6% of patients had normal WBC counts.
CONCLUSIONS: It was concluded that the age predilic-tion and prevalence of oral manifestations are closely related to the type of leukemia.     

梅毒在口腔黏膜表现的临床分析——附8例报告

目的:分析梅毒在口腔黏膜的临床表现。方法:总结8例以口腔梅黏膜病损为首发症状的梅毒患者的临床特征,并结合相关文献进行临床分析。结果:8例梅毒患者中7例表现为梅毒黏膜斑,好发部位为下唇;3例表现为梅毒性黏膜炎。1例在一期梅毒时期被误诊为复发性口疮。1例儿童因父母双方均为梅毒患者而间接感染结论:梅毒在口腔的首发症状以梅毒黏膜斑最为常见。口腔医生应掌握梅毒的口腔病损,并及时对患者家属进行梅毒筛查,以免误诊,漏诊。     

Florid oral manifestations in an atypical familial adenomatous polyposis family with late presentation of colorectal polyps

Early identification and prophylactic surgery are essential in preventing development of malignancy in colorectal polyps in familial adenomatous polyposis (FAP). Previous studies indicate a 100% cumulative risk of developing colonic polyps in individuals with FAP by the age of 34 yr. However, we have previously reported late-onset and non-penetrance of polyposis in four families. We describe here in detail one of these families with florid oral manifestations detectable on panoramic radiography of the jaws, which were instrumental in the diagnosis of FAP in the index patient and for ascertainment of her family for screening. The pathological adenomatous polyposis coli (APC) gene mutation in this family was shown to segregate with dento-osseous changes. Panoramic jaw radiography is a common examination carried out prior to dental or oral surgical procedures. This case illustrates the importance of appropriate investigations, including family history and colonoscopy, even in relatively older patients with radiological findings such as those described here and in members of their families at risk of FAP.     

Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients

The aim of the study was to compare dental caries status and the number and type of oral mucosal lesions in HIV positive children from a hospital outpatient department and an institutionalized setting. Oral examinations were performed using presumptive diagnostic criteria. The Fisher's Exact and the Mann-Whitney tests were used for statistical comparison of the two study groups. A total of 169 children were examined of whom 42% were institutionalized and 58% hospital outpatients. One institutionalized child presented with Noma. Twenty-one percent of the institutionalized population presented with molluscum contagiosum, while none of the hospital outpatients presented with this condition. Significantly more intraoral mucosal lesions were observed in the hospital compared with the institutionalized group. The most frequently encountered oral lesion was candidiasis. Pseudomembranous candidiasis was the most common type. Twice as many intraoral ulcers were recorded in the institutionalized group. Thirty-nine percent of the hospitalized patients had multiple lesions compared with 28% in the institutionalized group. Almost three quarters of both populations were caries-free. The mean DMFT was considerably higher in the hospital population. For both the permanent and primary teeth, the decayed component (D/d) made up the major part of the DMFT/dmft, followed by the missing (M/m) component. No fillings were recorded in either the primary or permanent teeth for both groups. Oral lesions are common in HIV populations and were seen in both the hospital and institutionalized groups, at high prevalence levels (63 and 45%). HIV infected children should be considered high risk for caries because of the use of chronic medications, and to receive appropriate care in terms of both treatment and services.     

The oral manifestations of chronic graft-versus-host disease (cGVHD) in paediatric allogeneic bone marrow transplant recipients

The oral manifestations of chronic graft-versus-host disease (cGVHD) in eight allogeneic bone marrow transplant (BMT) paediatric recipients were studied clinically, and lip biopsies were performed in seven of them. A prominent lichenoid reaction was observed in four patients, two with accompanying ulceration. Superficial mucoceles were present in three children. Clinically obvious xerostomia was seen in seven patients. Lip biopsies were positive and correlated with the clinical manifestations. Both clinical and histological findings confirmed the diagnosis of cGVHD. In three additional children, with systemic manifestations indicating cGVHD, the oral mucosa was clinically and histologically normal, and the systemic manifestations were, thus, attributed to drug reactions. The above findings indicate the high value of oral examination in diagnosing or confirming paediatric cGVHD. Superficial mucoceles, reported for the first time in paediatric recipients, seem to be important in the early diagnosis of cGVHD.     

Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US clinic

Background: Introduction of highly active antiretroviral therapy (HAART) has resulted in a significant decrease of oral manifestations (OMs). The profile and risk factors for OM in those individuals initiating HAART remain understudied in the Southeast of the United States, region of increasing HIV prevalence. Objective: To determine clinical, socio‐demographic, and laboratory characteristics associated with the presence of OM among patients initiating HAART. Methods: Retrospective review of electronically captured data from patients initiating HAART at a Southeastern US clinic. Prevalence was determined, and risk factors for overall OM, oropharyngeal candidiasis (OPC), and all other OM were evaluated using logistic regression. Results: In our sample (n = 744), majority of individuals were males (75 percent), African‐American (50 percent), mean age of 39 years, 42 percent of which reported sex with men (MSM). Two hundred sixty‐six had some type of OM. Compared with those without any OM, patients with OM had a lower mean baseline CD4+ T cells count (CD4 count) (331 ± 260 versus 179 ± 244 CD4 cells/mm³) and higher mean baseline HIV‐1 RNA viral load (4.0 ± 1.34 log₁₀ versus 4.6 ± 1.30 log₁₀) (P < 0.01). In the logistic regression models seeking to determine factors associated with an increased risk of OM and OPC, the only characteristic associated with the outcome was baseline CD4 value. Being male, African‐American, and heterosexual showed a protective role for OM other than OPC. Conclusion: OM continues to be common despite HAART. General OM and OPC were closely associated with a low baseline CD4 count. Knowledge of risk factors for OM can potentially help clinicians target oral evaluation of HIV‐positive individuals.     

Oral manifestations in HIV-positive adults from Northern Thailand

Eighty-seven HIV-infected patients in a provincial hospital in Northern Thailand were examined for oral manifestations of HIV disease and AIDS. The median age was 31.3 years. Seventy-four of the patients were women, 13 were men. 96.6% had a history of heterosexual transmission. Sixty-one patients were CDC-category A, 20 were category B and 6 were category C (AIDS). Thirty-eight percent of the patients revealed oral lesions; 23% had one oral lesion and 13.8% had two oral lesions. Common lesions were oral candidiasis (10.3% pseudomembranous candidiasis, 6.9% erythematous candidiasis and 3.4% both forms), oral hairy leukoplakia (11.5%) and exfoliative cheilitis (6.9%). Gingival linear erythema was seen in 8% of the patients; periodontal lesions and necrotising ulcerative gingivitis were not observed. Men were more commonly affected by oral manifestations than women (P < 0.004). The spectrum of oral lesions is comparable to other studies from the region, although most of these reported more men than women. Also, the degree of immunosuppression was more marked (AIDS).     

Oral manifestations of eating disorders: a critical review

Background:  Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications.
As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED.
Methods:  Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed.
Results:  Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances.
Conclusion:  Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.     

The spectrum of orofacial manifestations in systemic sclerosis: a challenging management

Systemic sclerosis (SSc) is a rare multisystem connective tissue disorder characterized by the triad fibrosis, vasculopathy and immune dysregulation. This chronic disease has a significant impact on the orofacial region that is involved in more than two‐thirds of the cases. SSc patients can show a wide array of oral manifestations, which are usually associated with a severe impairment of the quality of life. They often present a decreased the salivary flow and a reduced mouth opening that contribute substantially to the worsening of the oral health status. Therefore, SSc patients require specific and multidisciplinary interventions that should be initiated as early as possible. The identification of specific radiological and clinical signs at the early stage will improve the management of such patients. This study reviews the wide spectrum of orofacial manifestations associated with SSc and suggests clues for the oral management that remains challenging.     

Acute leukaemia presenting as oral ulceration to a dental emergency service

Leukaemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukaemias, which can be rapidly fatal if left untreated. This report describes the case of a 22-year-old female who presented to a dental emergency department with oral manifestations of acute leukaemia. It outlines the role of oral lesions in the diagnosis of acute leukaemias and emphasizes the importance of immediate referral by general dental practitioners.     

Oral manifestations in patients with gastro-oesophageal reflux disease: a single-center case–control study

Objective:  To assess the occurrence of oral pathological changes and symptoms in patients affected by gastro-oesophageal reflux disease (GERD).
Patients and methods:  200 patients with GERD and 100 matched healthy controls were studied. Thorough visual examination of the dental and oral mucosal tissues was performed and medical history relevant to oral symptoms was collected. The primary outcome was defined as a statistically significant difference, between the study group and controls, in the presence of the following indicators: soft/hard palate and uvula erythema, tooth wear, xerostomia, oral acid/burning sensation, subjective halitosis and dental sensitivity. Statistical analysis included chi-squared test, and crude odds ratio with 95% CI.
Results:  Univariate analysis showed that xerostomia, oral acid/burning sensation, subjective halitosis, and soft and hard palate mucosa and uvula erythema were more common in patients with GERD than matched controls ( P  < 0.05).
Conclusions:  This study failed to find any significant association between GERD and dental erosions, whereas some symptoms and other objective oral mucosal changes were found to be significantly associated with GERD.     

Fanconi's anemia: clinical and radiographic oral manifestations

BACKGROUND: Fanconi's anemia (FA) is a rare autosomal recessive disorder characterized by progressive bone marrow failure, congenital abnormalities, and predisposition to malignancies. There are 11 genetic subtypes characterized by complementation groups - FA- A, B, C, D1, D2, E, F, G, I, J, and L. OBJECTIVE: To evaluate and describe clinical, oral and radiographic manifestations of patients with FA. METHODS: A quantitative analysis of clinical manifestations, oral lesions and panoramic radiographs was performed in 33 patients. RESULTS: Clinical manifestations included melanin skin pigmentation, skin vascular and ocular anomalies. Melanin pigmentation on oral mucosa, traumatic lesions, gingival bleeding, dental biofilm and gingival alterations were the main oral manifestations that were found. Oral and clinical manifestations were not dependent on patient's sex. No significant statistical difference between females and males was detected. Dental anomalies were not remarkable either at clinical or at radiographic examinations. Although several dental anomalies were observed in patients with FA, the correlation between this disease was not established from this study. Panoramic radiographs showed agenesis, taurodontism, radicular anomalies such as dilaceration, tapering, and foreshortening. CONCLUSION: This study suggests that gingival alterations are associated with defective oral hygiene but not with hematologic conditions. It also helps elucidate oral manifestations of FA. These patients are living longer and need special dental care.     

Oral manifestations in HIV/AIDS infected patients from India

OBJECTIVES: To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication. SUBJECTS AND METHODS: One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records. RESULTS: Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females. CONCLUSIONS: Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.     

Human immunodeficiency virus infection: A review of the mode of infection, pathogenesis, disease course, and the general and clinical manifestations

Acquired immunodeficiency syndrome (AIDS) was first recognized in 1981 and in 1983 the virus responsible for this syndrome, the human immunodeficiency virus, was first isolated. There has been an increasing understanding of the many aspects related to infection with this virus and this review discusses the historical as well as the more recent findings related to infection with this virus. In particular, the pathogenesis, mode and course of infection are discussed followed by an overview of the general and oral manifestations of infection with this virus.     

Urban legends series: oral manifestations of HIV infection

Human immunodeficiency virus‐related oral lesions (HIV‐OLs), such as oral candidiasis (OC) and oral hairy leukoplakia (OHL), have been recognized as indicators of immune suppression since the beginning of the global HIV epidemic. The diagnosis and management of HIV disease and spectrum of opportunistic infection has changed over the past 30 years as our understanding of the infection has evolved. We investigated the following controversial topics: (i) Are oral manifestations of HIV still relevant after the introduction of highly active antiretroviral therapy (HAART)? (ii) Can we nowadays still diagnose HIV infection through oral lesions? (iii) Is the actual classification of oral manifestations of HIV adequate or does it need to be reviewed and updated? (iv) Is there any novelty in the treatment of oral manifestations of HIV infection? Results from extensive literature review suggested the following: (i) While HAART has resulted in significant reductions in HIV‐OLs, many are still seen in patients with HIV infection, with OC remaining the most common lesion. While the relationship between oral warts and the immune reconstitution inflammatory syndrome is less clear, the malignant potential of oral human papillomavirus infection is gaining increasing attention. (ii) Effective antiretroviral therapy has transformed HIV from a fatal illness to a chronic manageable condition and as a result expanded screening policies for HIV are being advocated both in developed and in developing countries. Affordable, reliable, and easy‐to‐use diagnostic techniques have been recently introduced likely restricting the importance of HIV‐OLs in diagnosis. (iii) The 1993 EC‐Clearinghouse classification of HIV‐OLs is still globally used despite controversy on the relevance of periodontal diseases today. HIV‐OL case definitions were updated in 2009 to facilitate the accuracy of HIV‐OL diagnoses by non‐dental healthcare workers in large‐scale epidemiologic studies and clinical trials. (iv) Research over the last 6 years on novel modalities for the treatment of HIV‐OLs has been reported for OC and OHL.     

Oral lichen planus: a condition with more persistence and extra‐oral involvement than suspected?

Background: Lichen planus is a relatively common and often studied chronic mucocutaneous condition. Reports detailing certain aspects relevant to patients affected have been lacking or inconsistent. Methods: A questionnaire‐based survey was employed to assess the duration of oral lesions and the prevalence of self‐reported potential extra‐oral manifestations associated with oral lichen planus in 87 patients. All patients had recognized clinical features of oral lichen planus, and most had had histopathological confirmation following oral biopsy. Results: We report the findings of a preliminary survey which assessed the duration of oral lesions and the prevalence of extra‐oral lesions consistent with lichen planus in patients presenting with oral lesions. The study confirmed the chronic nature of oral lichen planus and the rarity of spontaneous resolution. Most subjects had experienced symptoms for one to ten years (66 patients; 75.8%). Approximately 40% (36 patients) of the sample reported clinical features suggestive of extra‐oral manifestations of lichen planus by the time that their oral lesions were apparent. The most commonly reported extra‐oral manifestations involved the nails (27.6%, 24 patients). 25.3% (22 patients) reported a persistently sore throat suggestive of oesophageal or pharyngeal involvement. Skin (17.2%, 11 patients), and genital (10.3%, 9 patients) involvement was relatively infrequently reported. Most patients reported extra‐oral lesions at only one site. Conclusions: The survey results suggest that in patients with oral lichen planus oral lesions persist for a prolonged period, and that extra‐oral lesions may be more common than suspected. However, further studies involving specialists to examine extra‐oral sites are required.