Potential oral manifestations of cardiovascular drugs

Oral Diseases (2010) 16 , 769–773 Objective: The aim of this work was to determine the frequency and nature of oral manifestations secondary to use of cardiovascular drugs. Methods: Five hundred and thirty one patients attending an adult cardiology clinic in Saudi Arabia were questioned about the occurrence of oral dryness, dysgeusia, or burning sensation and were clinically evaluated for the presence of oral mucosal or gingival disease. Data were statistically analyzed with chi‐squared tests, odds ratios and Student’s t‐test. Results: Oral symptoms and/or signs were recorded in 75 (14.1%) patients with xerostomia being the most common (7.5%), followed by lichenoid (lichen planus‐like) lesions (3.6%) and dysgeusia (1.9%). Xerostomia was significantly more frequent in patients with a history of diabetes mellitus and in female patients (P < 0.05). There were no statistically significant differences (P > 0.05) between patients with or without oral manifestations when age, gender, cardiovascular risk factor, cardiac disease, type of cardiac drug used or the number of medications were assessed. There was a trend for xerostomia to be less frequent in patients receiving therapy with angiotensin converting enzyme inhibitors and a slight trend of xerostomia to be more likely with increased number of non‐cardiac and total number of agents per subject. The number of non‐cardiac and total medications taken by patients with potential oral manifestations tended to be greater than that of patients without oral manifestations. Conclusions: The frequency of potential oral manifestations in patients receiving cardiovascular agents was 14.1%. The occurrence and character of the oral manifestations had no significant relation with individual cardiac drugs, although there was a trend for oral manifestations to be likely with increasing number of drugs.     

Clinical and immunological effects of azithromycin in Behçet''s disease

Background: The aim of this study was to evaluate the effects of azithromycin on mucocutaneous manifestations, oral health and immune response in Behçet's disease (BD). Methods: Eight BD patients with active mucocutaneous symptoms were treated with azithromycin for 4 weeks. Oral health, clinical manifestations and in vitro interleukin (IL)‐12, interferon (IFN)‐γ, IL‐10 and monocyte chemotactic protein (MCP)‐1 responses were evaluated before and after treatment. Results: The number of folliculitic lesions, healing time of oral ulcers and scores of plaque indexes (PLIs) were lower after azithromycin treatment (P < 0.05). Scores of PLIs correlated positively with the healing time of oral ulcers (P = 0.02). Although a trend towards increased stimulated IL‐10 responses with azithromycin was observed, no statistically significant difference was found. Stimulated and unstimulated MCP‐1, IFN‐γ and IL‐12 responses were similar before and after treatment (P > 0.05). Conclusion: Azithromycin was observed to be effective in decreasing folliculitic lesions and fastening the healing time of oral ulcers in BD.     

US1HIV – changing patterns in HAART era,patients’ quality of life and occupational risks

Oral manifestations are early and important indicators of HIV‐infection. Several lesions with strong association to HIV infection have been described: oral candidiasis (OC), oral hairy leukoplakia (OHL), Kaposi's sarcoma (KS), Non‐Hodgkin‐Lymphoma (NHL), necrotising ulcerative gingivitis and periodontitis. These lesions may be present in up to 50% of patients with HIV‐infection and up to 80% of those with AIDS. Changing patterns in HAART era: With the advent of highly active antiretroviral therapy (HAART) the prevalence of OC, OHL and HIV – associated periodontal disease has decreased in adults. The prevalence of KS has not changed. However, there has been an increase in HPV‐associated oral lesions (papillomas, condylomas and focal epithelial hyperplasia) and HIV‐related salivary gland disease. In children receiving HAART no change in the prevalence of HIV‐related oral lesions has been found. Quality of life: The presence of oral lesions has a marked impact on health related quality of life. HIV‐associated orofacial lesions may lead to facial disfigurement (KS, NHL) or may impair speech and swallowing. Consequently, weight loss and pain may be result. Studies have shown that patients with OC, angular cheilitis and OHL have a high score of decayed teeth (DMFT). Xerostomia and taste disturbances may also be factors with impact on quality of life. Occupational risks: Occupational exposure to HIV has resulted in 57 documented cases of HIV sero‐conversion among healthcare workers in the US (December 2001). Exposure to HBV and HCV carries a much higher risk of occupational infection than that for HIV‐exposure.     

Low reproducibility between oral radiologists and general dentists with regards to radiographic diagnosis of caries

Aim: Early clinical and radiological diagnosis of dental caries is one of the fundamental objectives of clinical dentistry because of the high frequency of the disease and severe complications if caries remains untreated, especially among the elderly and patients with immunodeficiency. Dental panoramic tomography (DPT) is a common radiographic method for evaluating dentition when indicated, especially in an adult population. The aim of this study was to assess the reproducibility of diagnosis between specialists in oral radiology and general dentists with regards to caries lesions based on DPTs of adults.

Material and methods: One-hundred DPTs taken from adult patients (average age 35) and then analyzed and reported on by 42 general dentists were then analyzed independently by two specialists in oral radiology with respect to caries lesions in the premolar and molar areas using radiographic criteria established for caries diagnosis. The general dentists versus oral radiologists were not calibrated before. Level of agreement between specialists and general dentists was measured using Cohen’s kappa.

Results: Comparison between observations of general dentists and specialists in oral radiology showed that 61% of the caries lesions on proximal surfaces of premolars and molars observed by specialists went unobserved by general dentists. Cohen’s kappa value for specialists was 0.85 (p?<?.001) and for each specialist and general dentists 0.48 (p?<?.001) and 0.44 (p?<?.001).

Conclusions: The reproducibility between specialists in oral radiology and general dentists for detecting caries in DPTs was low.     

Oral manifestations of HIV infection in patients receiving highly active antiretroviral therapy (HAART) in Bahia, Brazil

Objectives: We investigated the oral manifestations of HIV‐infected patients in Salvador, Brazil, and their relationship to immunologic, sociodemographic, and therapeutic factors. Methods: This was a cross‐sectional study that used data from adult patients' medical records in the dentistry service of the AIDS Reference Center in Salvador, Brazil. We reviewed the patients' records to collect information concerning oral health status and data on socioeconomic status, immunologic status, and treatment. Results: A total of 993 patients were included in the study, of whom 473 (47.6 percent) were male. Approximately 5.5 percent of the patients presented with any oral lesions. Oral lesions were the most common in the patients with fewer than 350 CD4+T lymphocytes (8.4 percent) and with viral loads greater than 10,000 copies (8.3 percent). Conclusions: Our study shows that lesions are more common in patients with advanced immune suppression and low level of schooling. Oral candidiasis and angular chelitis were the most common lesions seen.     

Bacteria and Candida yeasts in inflammations of the oral mucosa in children with secondary immunodeficiency

J Oral Pathol Med (2012) 41 : 568–576 Background: Oral microbial flora and a damaged oral mucosa may increase the risk of bacteriemia, fungemia and complications in immunocompromised patients. Aim of the Study: Assessment of presence: bacteria and Candida spp. in different oral lesions, and the incidence of bacteremia in the case of a damaged mucosa in transplant recipients and patients receiving anti‐tumour chemotherapy. Material and Method: Forty‐five patients – 18 months to 18 years of life, were included (20 – organ recipients, 14– anti‐tumour chemotherapy, 11 – control group). Clinical, oral mucosa examination focused on the type, severity and site of lesions, and microbiology assessed the presence of bacteria and fungi in the material from lesions. Blood cultures were performed in ten immunocompromised patients with manifestations of systemic infection. The control material consisted of blood cultures made prior to the onset of oral lesions and after 4–6 weeks following their remission in a diagnosed bacteremia. The statistical analysis was performed. Results: In the subjects with secondary immunodeficiency, among other coagulase‐negative Staphylococcus (CoNS), Candidia spp. were more frequent. In cancer patients, mucositis was associated with Candida spp., Streptococcus spp. Organ recipients with stomatitis exhibited the presence of CoNS, Streptococcus viridians and other. Oral lesions in the control group contained Haemophilus parainfluenzae, Neisseria spp. and Staphylococcus aureus. In 30% of immunocompromised patients, oral lesions were accompanied by bacteremia. Conclusions: A correlation has been found between oral lesions and the presence of S. aureus in patients without secondary immunodeficiency, and of CoNS, Enterococcus spp., Candida spp. in immunocompromised patients.     

Warty dyskeratoma/focal acantholytic dyskeratosis--an update on a rare oral lesion

J Oral Pathol Med (2012) 41 : 261–267 Background: Warty dyskeratoma (WD) is an uncommon lesion of the skin that is considered to be associated with the pilosebaceous apparatus. Histologically similar lesions have been described in the oral region mainly by case reports and under the terms ‘WD’ or ‘focal acantholytic dyskeratosis (FAD)’. Owing to the paucity of reports, many aspects of the oral lesions remain unclear. The purpose of this study is to report a new case in an extremely rare location, the buccal mucosa, and to present a comprehensive updated review and analysis of the literature. Methods: We reviewed all cases of oral lesions that were diagnosed as WD and FAD and analyzed them according to their clinical and pathologic features. Results: The search yielded only 41 cases. The lesions usually appeared as asymptomatic, solitary, white nodules, papules, or patches on bone‐bound mucosa. They occasionally had a rough surface and depressed center. The lesions were most common in the fifth to seventh decades. Use of tobacco appeared to be the most prevalent predisposing factor. The histopathological differential diagnosis of the lesion included acantholytic squamous cell carcinoma, keratoacanthoma, and Darier’s disease. Conclusion: Warty dyskeratoma/FAD are uncommon oral lesions which are not encountered in the daily practice of oral pathologists. The absence of an association of oral lesions with the pilosebaceous apparatus suggests that they are probably distinctly different from cutaneous ones. As such, we suggest the histologic term isolated FAD for oral lesions, rather than WD.     

Oral radiographic and clinico-pathologic presentation of Erdheim-Chester disease: a case report

A 69-year-old woman with unexplained fever and weakness was referred for evaluation of a solitary mandibular swelling adjacent to a severely resorbed edentulous mandibular ridge. The patient had coexisting craniofacial-skeletal lesions and diabetes insipidus. Histological and immunohistochemical staining of sections from mandibular lesions confirmed the rare diagnosis of Erdheim-Chester disease. The absence of cardiac, pulmonary, renal, and major neurological manifestations was suggestive of a diagnosis at an early stage of the disease. Early diagnosis has been rare with less than 100 reported cases. A review of the literature revealed only 2 cases that report detailed maxillomandibular radiographic findings. A seemingly benign clinical presentation of a potentially grave disease that presents with an osteolytic-sclerotic oral radiographic picture is reported.     

The efficacy of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice: an update

To cite this article:
Int J Dent Hygiene 9 , 2011; 97–100
DOI: 10.1111/j.1601‐5037.2010.00446.x
López‐Jornet P, De la Mano‐Espinosa T. The efficacy of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice. Abstract: Objective: The aim of this communication is to revise papers published on autofluorescence imaging, a non‐invasive technique that is used to identify neoplastic oral cavity lesions. Methods: A literature search was performed, using the PubMed database and the key words ‘autofluorescence’ and ‘Velscope’, limiting the search to papers in English or Spanish published from 2002 to June 2009. Results: The Velscope^® system has a sensitivity of 98–100% and specificity of 94–100%. Autofluoresence is a supplementary tool used in the diagnosis of oral cancer, although other more reliable and robust studies are needed for confirmation. Conclusions: There is insufficient evidence to demonstrate that its use as an adjunct to conventional oral screening provides additional benefit to conventional oral cancer screening alone.     

Cleidocranial dysplasia: report of six clinical cases

Cleidocranial dysplasia (CCD) is an autosomal‐dominant disorder that occurs due to mutations in the Cbfa 1 gene, also called Runx 2, located on the short arm of chromosome 6, affecting osteoblast skeletal‐specific bones that have intramembranous ossification. This condition is characterized by hypoplastic clavicles, short stature, and great clinical significance in the stomatognathic complex, with involvement of facial bones, changes in the eruption patterns, including multiple supernumerary and retained teeth. This study reports six subjects of the same family with CCD identified in the Dentistry Clinic of Oral Diagnosis Department, Universidade Paulista, Campus Sorocaba, Sao Paulo State, Brazil. All cases had clinical and radiographic aspects of this important condition, such as short stature, hypertelorism, severe mobility of the shoulders, and supernumerary and retained teeth. Due to the rare incidence and phenotypic manifestations, CCD can be easily misdiagnosed. The oral commitments are one of the main (functional and aesthetic) causes of complaints in these subjects; and a dentist must establish the diagnosis as early as possible, followed by behaviors and practices that can minimize harmful manifestations of the syndrome and improve health associated with oral and multidisciplinary integration offering improvements in quality of life of these subjects.     

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.     

Prevalence of oral disease among adults with primary HIV infection

Objective: To explore the type and prevalence of oral mucosal lesions among adults with primary HIV infection (PHI) compared with HIV‐negative adults at high risk for HIV disease, and in relation to HIV viral load. Methods: We conducted standardized oral examinations to identify specific oral mucosal lesions among adults with PHI, both pre‐seroconversion and post‐ seroconversion‐recently infected, compared with HIV‐negative adults. We compared the group with oral lesions to those without oral lesions with respect to HIV‐RNA load and CD4 + T‐cell count. Results: Among 115 adults (predominantly men), pseudomembranous candidiasis was the most common oral lesion among those with PHI, and was found in 4% of the 23 participants in pre‐seroconversion and in 9% of 69 participants with post‐seroconversion recent infection, compared with none found among 23 HIV negatives. Among those with PHI, the median viral load was higher and the median CD4 + T‐cell count lower among the 15 participants with an oral lesion of any type than among the 77 participants without oral lesions (P = 0.02 and 0.04, respectively). Conclusion: This finding suggests that individuals with PHI who have oral lesions may be more likely to transmit HIV because of their higher viral load.     

Prevalence of oral mucosal lesions in adults undergoing highly active antiretroviral therapy in Hong Kong

Aim:  Highly active antiretroviral therapy (HAART) has altered the prevalence and incidence of oral mucosal lesions of HIV infection. Recent reports show a variation in the prevalence of oral mucosal lesions in different population groups. Understanding the prevalence of these lesions is of paramount importance in the efficient delivery of dental care to such cohorts. The aim of the present study was to investigate the prevalence of oral mucosal lesions and salivary parameters during HAART in an ethnic Chinese cohort in Hong Kong. Methods: A cross‐sectional estimation of the prevalence of oral mucosal lesions was carried out in 101 HIV‐infected ethnic Chinese in Hong Kong using the European Community–Clearinghouse classification. Results: The prevalence of oral mucosal lesions was more common in patients who were classified at baseline as Centers for Disease Control (CDC) C3 category than CDC A2, A3, B2, and B3 (P < 0.05). An overall prevalence of 1.98% was observed for oral Kaposi’s sarcoma. Additionally, the HIV group on HAART (0.37 ± 0.23 mL/min) had significantly lower salivary flow rates (P < 0.01) compared with the healthy group (0.49 ± 0.15 mL/min). Conclusions: Although HAART appears to markedly reduce the prevalence of oral mucosal lesions during the course of HIV disease, regular systematic oral screening is still warranted for such populations for the early diagnosis and management of pathologies, such as Kaposi’s sarcoma.     

Management of the oral manifestations of senile purpura in an edentulous patient: a case report

Senile purpura occurs because of a weakness of the vascular supporting tissues mainly caused by aging and is most often seen on the dorsal surface of the hands and the extensor surfaces of the forearms, and has also been observed in the oral mucosa of elderly patients. These red lesions present as sharply margined subcutaneous hemorrhagic spots and are due to trauma, such as damage to the endothelium of small blood vessels, or a coagulation defect. They can also be due to reduced perivascular support, or capillary fragility and permeability, or a combination of all of these factors. Oral manifestation of senile purpura can also be induced by long periods of medication use leading to fragile areas of the mucosa. The presence of senile purpura requires continuous follow‐up since drug‐induced purpura may cause plaque function alterations. An accurate diagnosis in elderly complete denture wearers can minimize bleeding and prevent possible development of ulcerations under the dentures, especially during the adaptation period to the prosthesis. This case report, presents the care and 3‐year follow‐up of a 66‐year‐old woman with complete dentures who presented with the oral manifestations of senile purpura caused by the continued use of several medications.     

Disseminated histoplasmosis with oral manifestation

Histoplasmosis is a fungal disease that affects humans and is caused by Histoplasma capsulatum. The presentation of the infection may be acute, chronic, or disseminated. The disseminated form has extrapulmonary manifestations which may include oral manifestation a. A patient with AIDS sought treatment and he had disseminated histoplasmosis with oral manifestations. The purpose of this case report and literature review is to emphasize the role the dental team has in the diagnosis of disseminated disease when a patient presents with oral manifestations associated with the disease. This case report is clinically relevant because it is not uncommon for oral manifestations to be one of the first signs of systemic disease.     

Oral manifestations as an early clinical sign of acute myeloid leukaemia: a case report

Leukaemia is the most common malignancy in children and one of the most common malignancies in young adults. Acute myeloid leukaemia is often associated with early oral manifestations. The purpose of this study is to report the case of a 49‐year‐old male with spontaneous gingival bleeding for over two years with undiagnosed leukaemia. Haematological investigation was instigated and on referral to the Haematology Department at Dunedin Public Hospital, the diagnosis of an acute myeloid leukaemia was confirmed. Since oral lesions can be one of the early events of acute myeloid leukaemia, they may be considered as an important diagnostic indicator for oral health practitioners, and their roles in diagnosing and treating such patients.     

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 chronic graft‐versus‐host disease: current pathogenesis,therapy, and research

Optimal management of complex autoimmune diseases requires a multidisciplinary medical team including dentists to care for lesions of the oral cavity. In this review, we discuss the presentation, prevalence, diagnosis, and treatment of oral manifestations in chronic graft‐versus‐host disease (cGVHD), which is a major late complication in patients treated by allogeneic hematopoietic stem cell transplantation. We assess current general knowledge of systemic and oral cGVHD and present general treatment recommendations based on literature review and our clinical experience. Additionally, we review areas where the understanding of oral cGVHD could be improved by further research and address tools with which to accomplish the long‐term goal of providing better health and quality of life to patients with cGVHD.     

Oral manifestations of secondary syphilis in the elderly – a timely reminder for dentists

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79‐year‐old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non‐specific ulceration of the oral mucosa. After 20 days, the patient was re‐evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients.     

Cowden syndrome—a case report emphasizing the role of the dental surgeon in diagnosis

Cowden syndrome or multiple hamartoma syndrome, is a rare genetic condition inherited in an autosomal dominant pattern characterized by cutaneous manifestations, polyps, thyroid gland neoplasias, and macrocephaly. This report presents the case of a 36‐year‐old patient who looked for dental treatment for a gingival nodule. Current and past medical history and oral and facial manifestations led to the diagnosis of Cowden syndrome. This case report emphasizes the role of the dental surgeon in the diagnosis of this systemic disease, based on the analysis of medical history and manifestations in the oral cavity.