Diagnosis of systemic sarcoidosis prompted by orofacial manifestations: a review of the literature

BACKGROUND: Sarcoidosis is a multifactorial systemic inflammatory disorder of unknown origin characterized by many potential signs and symptoms, as well as by the presence of noncaseating granulomas in the organs involved. Sarcoidosis also may manifest in the oral and maxillofacial region. CASE DESCRIPTION: The authors describe a patient with xerostomia, dysgeusia, oral burning, xerophthalmia and bilateral parotid enlargement. She was diagnosed as having systemic sarcoidosis on the basis of the histologic findings of a biopsy of the labial minor salivary gland, as well as subsequent diagnostic evalutons. CONCLUSION AND CLINICAL IMPLICATIONS: Enlargement of major salivary glands may be the first sign of sarcoidosis in a patient with few other symptoms or clinical findings suggestive of the disease. This case emphasizes the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling associated with xerostomia. It also highlights the dentist's potential role in the diagnosis and dental treatment of patients with systemic sarcoidosis.     

Sarcoidosis

Sarcoidosis is a chronic generalized benign granulomatous disorder of perhaps an autoimmune character which can afflict many organs. The insidious form prevails, a (sub)acute onset covers about one third of cases. In most patients the lungs are involved; tissue damage by granulomas and inflammatory cells causes a reduction of respiratory capacity, with dyspnoea as a result. Other often-affected organs are larger joints, skin and eyes. The diagnosis is based on the symptoms, thoracic x-ray and histology. In most cases prednisone is the drug of first choice. It is tantalizing to have to decide whether to treat or not. The decision is based on the severity of the process in vital organs.     

Oral sarcoidosis: a review of literature

Sarcoidosis is a common systemic granulomatous disease affecting multiple organs. Oral involvement is relatively rare and, to our knowledge, there have been only 64 cases reported in the English literature. Most cases of oral sarcoidosis present with mobility of the teeth due to rapid alveolar bone loss. Other oral manifestations include asymptomatic swelling of the involved mucosa, gingivitis and ulcers. Diagnosis of sarcoidosis is by exclusion as no specific test is available. Radiographic, biochemical and histological findings are non-specific, but helpful. All cases of sarcoidosis do not require treatment. Corticosteroids are the treatment of choice in patients requiring treatment. Other drugs such as chloroquine, methotrexate, infliximab and thalidomide are also used in the treatment of sarcoidosis. In most of the oral cases reported, systemic steroids and surgery were the preferred treatment.     

Das Heerfordt-Syndrom — eine seltene Erstmanifestation der Sarkoidose

Sarcoidosis is a chronic, multisystem disorder of unknown cause characterized by noncaseating epithelioid granulomas. Infectious agents and genetic components have been discussed. Heerfordt’s syndrome with uveitis, enlargement of the parotid glands and optional paralysis of the Nn. facialis is a form of sarcoidosis. The diagnosis is confirmed by histology. Further analyses are fiberoptic bronchoscopy with bronchoalveolar lavage or the gallium-67 scan in combination with blood findings. The therapy of choice is glucocorticoids. We present a case report of Heerfordt’s syndrome and a review of the literature covering different aspects of sarcoidosis.     

Novel Mouth‐Exercising Device for Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a chronic inflammatory disease resulting in progressive juxtaepithelial fibrosis of the oral soft tissues and can cause increasing difficulty in mastication, swallowing, speaking, and mouth opening. The treatment of severe trismus requires a combination of surgical release and physiotherapy. Often physiotherapy alone can modify tissue remodeling in OSMF to increase oral opening. This article describes the fabrication and use of a new mouth‐exercising device that helps the patient to squeeze/stretch the cheek mucosa to increase elasticity. The device can be used as a sole treatment modality or can be used in association with pharmacological and surgical treatment modalities for OSMF. Improvement in mouth opening was observed in four OSMF patients treated with a mouth‐exercising device for 6 months as a sole treatment modality.     

腮腺淋巴结结节病一例报告并文献复习

目的：提高对腮腺淋巴结结节病的认识。方法：对1例病理确诊为腮腺淋巴结结节病患者的临床资料进行分析，并结合相关文献进行讨论。结果：结节病是一种原因不明的多系统疾病，以非干酪样坏死性肉芽肿炎症为主要病理特征。临床上大约90％的患者有肺部病变，单发于腮腺淋巴结罕见。该患者术前诊断为多形性腺瘤，手术切除后随访10年未复发。结论：腮腺淋巴结结节病患者易被误诊为肿瘤，病理活检对于结节病的确诊至关重要，手术切除是最有效的治疗方法。     

腮腺淋巴结结节病一例报告并文献复习

目的：提高对腮腺淋巴结结节病的认识。方法：对1例病理确诊为腮腺淋巴结结节病患者的临床资料进行分析,并结合相关文献进行讨论。结果：结节病是一种原因不明的多系统疾病,以非干酪样坏死性肉芽肿炎症为主要病理特征。临床上大约90％的患者有肺部病变,单发于腮腺淋巴结罕见。该患者术前诊断为多形性腺瘤,手术切除后随访10年未复发。结论：腮腺淋巴结结节病患者易被误诊为肿瘤,病理活检对于结节病的确诊至关重要,手术切除是最有效的治疗方法。     

Oral sarcoidosis: a case report and review of the literature

Sarcoidosis is a chronic multi‐system immuno‐inflammatory disorder characterized by non‐caseating granulomatous infiltration of affected tissues that may result in fibrosis and organ dysfunction. It generally affects genetically predisposed young adults who develop a local dysregulated cell‐mediated immune response towards an undefined ‘sarcoidal antigen’. From recent data, it has become evident that Propionibacterium acnes and Mycobacterium tuberculosis are the probable antigenic agents which initiate sarcoidosis. Oral sarcoidosis is rare with only about 70 cases having been reported in the literature. The purpose of this report is to present a case of oral and cutaneous sarcoidosis in a black female that was probably triggered by mycobacteria.     

Orofacial presentations of sarcoidosis--a case series and review of the literature

Sarcoidosis is a multi-system disease of unknown aetiology characterised by the presence of non-caseating granulomas, the lungs and lymph nodes being the most affected sites. Orofacial manifestations of the condition are increasingly recognised, with several recent case reports where the initial presentation of the disease is in the region. Here, we report six cases of orofacial sarcoidosis which help to illustrate the wide spectrum of the condition.     

Sarcoidosis presenting as gingival erosion in a patient under long-term clinical control

BACKGROUND: Sarcoidosis is an inflammatory granulomatous systemic disease that rarely affects the oral cavity. Gingival involvement has been reported in only a very limited number of cases, occasionally as the first manifestation of the disease. This article reports a case of sarcoidosis affecting the gingiva and alveolar mucosa in a patient previously treated for the systemic disease and considered under long-term clinical control. METHODS: A 57-year-old white female presented with a chief complaint of gingival pain in the maxillary right area lasting 3 years. Clinical examination revealed an erythematous, ill-defined erosive macule on the buccal aspect of the maxillary right gingiva extending from the canine to the third molar. The medical history included a diagnosis of sarcoidosis 16 years prior to presentation, which was considered to be under clinical control for the last 11 years. An incisional biopsy was obtained. RESULTS: Histopathology indicated the presence of an intense chronic inflammatory infiltrate and focal areas with non-caseating granulomas. Periodic acid-Schiff and Grocott's stains were negative for microorganisms, and the diagnosis was compatible with sarcoidosis. Systemic evaluation showed no involvement of other areas and organs, and the patient was managed with topical steroid therapy using silicone trays in conjunction with conventional periodontal therapy and oral hygiene instructions. Complete response was achieved after 6 months, and the patient remains in clinical follow-up. CONCLUSION: Although sarcoidosis is a systemic disease that rarely affects the gingiva, the possibility of gingival involvement as the sole manifestation of the disease should be considered in the differential diagnosis of gingival lesions.     

Are oral and dental diseases linked to cancer?

Oral Diseases (2011) 17 , 779–784 Objective: Infection and inflammation play a role in carcinogenesis, and highly prevalent oral and dental diseases have been significantly linked to some types of cancer. This article reviews current literature in this area. Materials and Methods: Open literature review using the PubMed database and focused on publications from 2000 to 2010. Results: Numerous potential mechanisms are implicated in the oral disease/carcinogenesis paradigm, including infection‐ and inflammation‐associated cell pathology and microbial carcinogen metabolism. Poor oral hygiene is associated with oral cancer, but there is also evidence of a possible link between oral or dental infections and malignancies in general. Conclusion: Oral infections may trigger malignant transformation in tissues of the mouth and other organs. However, scientific evidence to date remains weak and further well‐conducted studies are warranted before cancer can be properly added to the list of oral infection‐related systemic diseases.     

Breast metastasis around dental implants: a case report

Background Metastases to the oral cavity and to the jaws are rare; hence, the clinical manifestations of the oral metastasis lesion could frequently be simulating general pathologic entities, making the diagnosis a challenging process to the dental team. Local factors, such as trauma, have been observed to facilitate the growth of blood‐borne tumors. To this end, surgical procedures such as fixture placement might cause cancer cells to spread. Purpose Careful clinical examination is a valuable help in diagnosing oral lesions, which can improve the quality of life of patients and reduce the risks of oral complications. Materials and Methods A female patient was referred to the clinic with symptoms of irritation, swelling, and pain associated with implants in the mandible and the maxilla. Results Clinical examination, x‐ray, and histopathology revealed that the patients suffered from a metastatic lesion, primary tumor being an adenocarcinoma of the breast diagnosed at the same time. Conclusion Optimal clinical examination in conjunction with radiography and histopathology is a necessity in order to discover malignant lesions in time. Routine dental check‐ups must comprise more thorough soft‐tissue examination.     

Changes in the oral cavity might reflect psychological disorders in some patients

Aim: The treatment of oral dysesthesias, such as burning mouth syndrome, can be challenging. Patient acceptance of the role of psychological etiological factors might be improved if there are clinical signs that patients could confirm themselves, which could be used as reinforcement of clinical discussions. Published associations between psychological disorder and various oral signs and symptoms are not suited to this purpose, as they are ambiguous in origin and implication. Others, used clinically in this situation, are not supported by published literature. Therefore, the purpose of this study was to determine if a demonstrable relationship could be established between psychological profile and the appearance and function of the oral cavity. Methods: Seventy‐nine participants underwent an oral examination and completed a Depression Anxiety Stress Scale‐21 questionnaire. Correlations were calculated between clinical variables and the raw Depression Anxiety Stress Scale scores. Univariate analyses determined variables with significant differences between a high‐risk and normal group, and multiple logistic regression models were calculated for these. Results: Various oral signs and symptoms were found to correlate with depression, anxiety, and/or stress, with some predictive of psychological disturbance. Conclusions: These signs and symptoms might be used to reinforce the psychological aspects of an oral dysesthesia.     

Oral health care patterns and the history of miscarriage

Objective: Oral infections can trigger the production of pro‐inflammatory mediators that may be risk factors for miscarriage. We investigated whether oral health care patterns that may promote or alleviate oral inflammation were associated with the history of miscarriage in 328 all‐Caucasian women. Materials and methods: Of 328 women in this cross‐sectional cohort, 74 had history of miscarriage (HMC). Medical, dental and sociodemographic data were collected through clinical examinations, medical record searches and structured questionnaires. Results: The multivariate regression analyses indicated that urgency‐based dental treatment demonstrated a significant association [odds ratio (OR) = 2.54; 95% confidence interval (CI): 1.21–5.37; P = 0.01] and preventive dental treatment demonstrated a marginally significant inverse association (OR = 0.53; CI: 0.26–1.06; P = 0.07) with HMC. Self‐rated poor oral health had a non‐significant positive association with HMC (OR 1.60; CI: 0.88–2.90). Conclusion: Our results provide sufficient evidence for hypothesis generation to test whether other precise measures of oral inflammation are associated with adverse birth outcomes.     

Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus

Background: Oral lichen planus (OLP) is considered to be an autoimmune disease of unknown aetiology that affects the mucosae, especially the oral cavity. Objective: We compared tacrolimus 0.1% ointment and clobetasol 0.05% ointment for the treatment of OLP. Patients and Methods: A total of 32 patients (20 females and 12 males; all white, Italian origin, mean age of 43.6±18.4 years; 16 patients per treatment group) were treated with tacrolimus or clobetasol ointment for 4 weeks in a randomized, double‐blind, clinical trial. Pain severity, burning sensation, and mucosal lesion extension were assessed using a four‐point scale. Results: At the end of the treatment period, symptom scores were significantly lower in the tacrolimus group than in the clobetasol group. Conclusion: The results of this study suggest that tacrolimus 0.1% ointment is more effective than clobetasol propionate 0.05% ointment in the treatment of OLP. However, other studies are needed to confirm the effectiveness of this treatment before it can be recommended for use in clinical practice.     

局限性口腔创伤性感染的诊治与预防

口腔创伤性感染是指口腔软硬组织遭受创伤后继发的感染.口腔软硬组织创伤后经及时、正确处理,发生感染的概率较低;若未得到及时、有效治疗,可引起局限性感染,继续发展可引起骨髓炎、间隙感染甚至累及全身重要器官危及患者生命.文章通过对局限性口腔创伤性感染的病因、临床表现、诊断、治疗和预防等进行阐述,以期为口腔全科医生及时、正确地...     

Human papillomavirus and oral disease – emerging evidence: a review

Human papillomavirus (HPV) infections have received considerable attention in recent years. Of the 120 or so known types of the virus, some cause a variety of benign wart‐like lesions of the skin and genital and oral mucosae, whilst others are aetiologically associated with cervical and anogenital cancers. Recent epidemiologic evidence suggests that HPV may also be an independent risk factor for oropharyngeal cancer. In this context it has been suggested that HPV virus may modulate the process of carcinogenesis in some tobacco and alcohol induced oropharyngeal cancers and act as the primary oncogenic agent for inducing carcinogenesis among non‐smokers. Dental practitioners have a major role in detecting all lesions of the oral mucosa caused, or possibly caused, by HPV. This paper briefly reviews the current state of knowledge of molecular and clinical aspects of HPV infections of the oral mucosa.     

Oral leukoplakia—to treat or not to treat

Various treatment modalities have been described for reducing or eliminating malignant development of oral leukoplakia, but no treatment has gained universal approval due to lack of randomized clinical studies. At present, it is uncertain whether we can do harm to the patients by treating or by not treating them. An essential aspect is the observation of cancer development even after surgical removal of the clinical lesions. Inadequate resection of the lesions or field cancerization may account for this phenomenon. Another challenge is whether surgical removal of the lesions in fact is associated with a cancer promotional effect resulting in increased risk of cancer. Moreover, unidentified existing cancer in non‐suspicious oral leukoplakias may for diagnostic purposes imply that surgical removal is recommendable as well as serial section of all excised tissue. Intensive follow‐up programmes for leukoplakias are important, independent of surgical intervention.     

Oral adverse reactions due to cinnamon‐flavoured chewing gums consumption

Cinnamon‐flavoured products (toothpaste, chewing gum, food, candy and mouthwash) can cause oral adverse reactions; among these, the most common is contact stomatitis (cinnamon contact stomatitis, CCS). Signs and symptoms of contact allergic reactions affecting the oral mucosa can mimic other common oral disorders, making diagnosis difficult. As CCS may be more prevalent than believed and its clinical features can frequently determine misdiagnosis, we reviewed case reports and case series of oral adverse reactions due to cinnamon‐containing chewing gums, emphasizing clinical aspects, diagnostic and management procedures. We also proposed an algorithm to perform a diagnosis of CCS as in the previous published literature the diagnostic approach was not based on a harmonized and shared evidence‐based procedure. Moreover, as patients can refer to different specialists as dentists, dermatologists and allergists, a multidisciplinary approach is suggested.     

Expression of receptor activator of NF‐κB ligand and osteoprotegerin in peripheral giant cell granulomas of the jaws

J Oral Pathol Med (2010) 39 : 687–689 Background: Peripheral giant cell granuloma is a tumor of the jaw characterized by the presence of multinucleated giant cells and mononuclear cells within a fibrous stroma. These lesions are considered to be of a reactive nature rather than neoplastic. Although peripheral giant cell granulomas is a well‐described clinical entity, little is known on its pathogenesis. The aim of this study was to investigate the receptor activator of NF‐κB ligand (RANKL) and osteoprotegerin (OPG) expression and immunolocalization in giant cell granulomas. Methods: RANKL and OPG protein expression was evaluated in 22 peripheral giant cell granulomas samples, by means of immunohistochemistry. Staining was evaluated semi‐quantitatively, according to the extent and intensity of the stain. Results: RANKL was expressed in all cases with a cytoplasmic staining pattern, whereas OPG expression was detected in 21 of the 22 cases examined. Active multinucleated giant cells exhibited intense immunoreactivity for both proteins. Conclusion: RANKL and OPG are expressed in peripheral giant cell granulomas of the jaw in a manner supporting the osteoclastic nature of giant cells whereas the possible osteoclastic lineage of stromal monocytes remains ambiguous.