Nicorandil-induced severe oral ulceration

Nicorandil has been shown to precipitate persistent ulcerative stomatitis in a small percentage of patients. To date over 50 cases have been reported, initially in France and, more recently, in the United Kingdom and Portugal, but this is the first report of nicorandil-induced ulceration in Irish medical or dental literature. It has been suggested that a previous history of aphthous ulceration may predispose the development of nicorandil-induced ulcers, although onlyone of these patients reported a history of recurrent oral ulceration (ROU).     

Riga-Fedes syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report

A case of natal teeth associated with traumatic ulceration to the ventral surface of the tongue (Riga-Fedes syndrome) in a four week old boy is presented. On radiographic examination, two teeth, present at birth, were found to be early erupted deciduous lower central incisors. A family history of natal teeth, all involving both lower deciduous central incisors associated with trauma to the tongue during suckling, was elicited. The ulceration healed over a period of four weeks using an innovative conservative treatment regime, involving the use of Stomahesive Wafer. Four months later the only sign of any previous pathosis was a fibrous scar on the ventral surface of the tongue.     

Nicorandil-induced oral ulceration: report of 3 cases and review of the Japanese literature

Nicorandil-induced oral ulceration in 3 Japanese patients is reported. The patients were men aged 86, 81, and 91 years. Ulcers of 15, 10, and 12 mm in diameter, respectively, were observed at the border of all of the patients' tongues. These were painful and persistent but not indurated. Irritation by the teeth or dentures was not evident. They had been administered nicorandil at a dose of 15 mg for 22, 54, and 90 months, respectively; therefore, ulceration induced by nicorandil was suspected. In consultation with the doctor, nicorandil was withdrawn. The ulcers disappeared 5, 8, and 9 weeks, respectively, after the cessation of nicorandil. No relapse of the ulcer was noted. The findings suggest that these were the examples of nicorandil-induced oral ulceration.     

Extensive sublingual ulceration leads to tongue deformity in a child with delayed development

An extensive sublingual ulceration in a two year old girl with delayed development was reported. The severe lesion resulted from repetitive trauma caused by the lower central incisors in combination with uncontrolled movement of the orofacial muscles. Treatment successfully healed the lesion, however an deformity of the tongue remained afterwards. Given this risk, health care providers should be aware of the danger posed by sublingual ulcerations in children with neurologic conditions when the child's lower primary incisors erupt. Early diagnosis and referral to a pediatric dentist can prevent progression of the lesion as well as deformity of the tongue.     

Gingival ulceration in HIV infection

Abstract. All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-ycar period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.     

HIV感染者伴口腔念珠菌及其它真菌感染

目的：通过分析83例艾滋病合并真菌感染的临床病例,提高对HIV/AIDS早期诊断能力,减少临床误诊.方法：收集HIV感染者83例,均经湖北省疾病控制中心HIV确认试验确诊.分析患者的临床症状、体征及实验室检查,重点观察真菌感染的种类及部位,并进行相应真菌培养及药敏试验.结果：主要全身症状有长期发热、慢性腹泻、咳嗽及进行性消瘦、恶液质等.实验室检查提示所有患者CD4＋细胞计数均＜200 cell/μL,最低者仅为8 cell/μL.83例中伴有消化道念珠菌感染4例,呼吸道念珠菌感染2例,另有隐球菌脑膜炎4例,卡氏肺孢子虫肺炎4例,肺组织胞浆菌病2例,马尔尼菲青霉菌感染2例.真菌培养及耐药性显示念珠菌对氟康唑类药物已产生一定耐药性.结论：HIV感染者伴口腔念珠菌病的发生表明其已进入AIDS病期,口腔念珠菌病的出现可作为早期发现AIDS的重要临床指症,常伴发于口腔念珠菌感染的其他部位的真菌感染亦为全身免疫功能下降的局部表现.     

Treatment with or without cooperation

The first condition required for carrying out a successful orthodontic treatment involves patient cooperation. Yet, for a long time, orthodontic research has minimized the importance of nontechnical factors: until a recent period practitioners had to content themselves with mere impressions, feelings and other beliefs, rather than a qualitative control of knowledge and behaviors. Thanks to data processing, testing one's choices, decisions and therapeutic strategies has been made possible to obtain a better cooperation. At the beginning of this third millennium, this new concept of the orthodontist's role is moreover in keeping with a general trend in medical and dental therapeutics: any biotechnological innovation is nowadays presented with a concern for the patient's information, education and relation, taking into account his/her social and cultural background.     

Recurrent aphthous ulceration: a possible clinical manifestation of reactivation of varicella zoster or cytomegalovirus infection

The etiology of the most common intraoral mucosal disease, recurrent aphthous ulceration (Rau), Remains Obscure. Here, attempts were made to diagnose reactivation of varicella zoster (CMV), Rpstcin-Barr (EBV) And Human herpes virus 6 (HHV-6) infections from paired sera in association with Rau Recurrences. The first sample was obtained within 3 days after a new recurrence (I) and the second 10–14 days later (2). The study initially comprised IS otherwise healthy Rau Patients (GRA) and 17 sex- and age-matched healthy non-Rau Individuals. Values of specific antibody subclasses (IgM. IgG. IgA) were determined by Elisa (VZV, CMV. EBV) and Ifa (Hhv-6). Patients and controls exhibited differences in parameters on specific VZV IGM And C'M V IgM. In order to substantiate these findings, specific VZV IGM and CMV IGM Were subsequently also evaluated in 17 other Rau Patients (GR B). Ten patients in GR A and II in Gr B were IgM seropositive for either Vzv And/or CMV in at least one of the serum samples, whereas in the controls only one was VZV IGM Positive and none CMV IGM Positive. Evaluated as groups, optometric density (OD) antibody levels of VZV IGM Were significantly higher in the patients (gr A (I, 2) vs controls: p<0.0001; gr B (1,2) Vs Controls: P相似文献   

Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy

Tongue strength is reduced in patients treated with chemoradiotherapy for oral/oropharyngeal cancer. Tongue strengthening protocols have resulted in improved lingual strength and swallowing in healthy individuals, as well as in patients following a neurological event. However, no studies have examined the efficacy of tongue strengthening exercises on tongue strength, swallowing, and quality of life (QOL; Head and Neck Cancer Inventory) in patients treated with chemoradiotherapy. A randomized clinical trial examined the effects of a tongue strengthening programme paired with traditional exercises vs. traditional exercises alone. Dependent variables included tongue strength, swallowing, and QOL in a group of patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Differences with regard to tongue strength and oropharyngeal swallow efficiency (OPSE) were not observed within or between groups. QOL in the eating and speech domains improved following treatment in both groups. However, the experimental group demonstrated greater impairment in QOL in the social disruption domain following treatment, whereas the control group demonstrated a slight improvement in functioning. Tongue strengthening did not yield a statistically significant improvement in either tongue strength or swallowing measures in this patient cohort. Patient compliance and treatment timing may be factors underlying these outcomes.     

Severe oral ulceration in patients with HIV infection: A case series

OBJECTIVE: Oral ulceration occurs in an estimated 2–4% of patients with HIV infection. This retrospective observational study describes the aetiology and characteristics of 94 HIV-positive patients with either severe and/or recurrent oral ulceration presenting at a dedicated HIV dental unit over a 4-year period. METHODS: Case records were reviewed for diagnosis investigations, CD4 count, CDC stage and treatment modality. RESULTS: Of the 94 patients 50% had an AIDS diagnosis. In patients with asymptomatic HIV disease minor recurrent oral ulceration was the commonest diagnosis whilst large non-specific neutropenic ulcers were more frequently seen in patients with symptomatic disease with low CD4 counts. A variety of treatment modalities were used including thalidomide. An algorithm is presented for the management of patients with severe oral ulceration.     

Ameloblastoma with ulceration

Conclusion We have discussed a case of ameloblastoma of the left lower jaw in a 29-year-old male. This tumor is believed to be of the central type and was connected with the gingival epithelium after invasion of the soft tissue outside of the jawbone where it formed a spontaneous ulcer on the gingiva.     

Candidal infection of the tongue with nonspecific inflammation of the palate

A retrospective study of ten patients with median rhomboid glossitis (MRG) revealed the presence of a nonspecific inflammatory reaction of varying degrees of severity in the overlying palatal mucosa. Clinical records and photographs indicated that the palatal reactions physically approximated the underlying glossal lesions, suggesting a relationship between these entities. The nature of the relationship is uncertain, but it may involve a localized infection of the palatal mucosa by Candida species, from the MRG. Alternatively, irritation by soluble, possibly Candida-related factors from the MRG that are applied repeatedly to the palatal mucosa during swallowing may be responsible.     

Oral ulceration in HIV infection: Investigation and pathogenesis

Oral ulcerations associated with HIV infection include recurrent aphthous ulcers (RAU). Whereas RAU prevalence is not increased, lesion severity is: among a group of HIV⁺ patients, 66% had the more severe herpetiform or major RAU. This increased severity suggests that HIV disease-related changes in the immune system may exacerbate RAU. In the peripheral blood of healthy subjects with RAU, CD4:CD8 cell ratios may be reversed and the proportion of T cell receptor-γδ⁺ cells increased. HIV disease-related immune system changes are characterized by reversed CD4:CD8, lowered CD4 cell counts and an inverse correlation between CD4 cell counts and per cent activated γδ lymphocytes. Adhesion molecules and cytokines involved in lymphocyte homing may be important in RAU pathogenesis: ICAM-I and ELAM are strongly expressed, and TNFα production is increased in peripheral blood lymphocytes of healthy patients with RAU. In patients with active HIV disease/AIDS, serum TNFα levels are increased. Thalidomide, which inhibits TNFα production, is effective treatment for RAU. Some RAU patients have vitamin B12 or folate deficiencies, levels of which are commonly low in HIV⁺/AIDS patients. However, in a case control study of HIV⁺ patients, vitamin B12- or folate-deficiencies were not found to be significant risk factors for RAU.     

Oral ulceration and iatrogenic disease in HIV infection.

Ulcerative lesions of oropharyngeal mucous membranes are less commonly seen than other lesions in HIV infection and may be associated with mycotic, bacterial, and viral infection, as well as neoplasia. Differential diagnosis may be difficult because of the clinical similarity of ulcerations that can represent various causes. The term "atypical ulceration" has been suggested because it may be impossible to differentiate some of the oral ulcerations from each other. Iatrogenic ulceration is seen occasionally, as the consequence of chemotherapy or irradiation.