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Biomedical subjects

Crispian Scully

Publications and source records attributed to Crispian Scully.

At least 73 records · Page 4Linked to original sources
PubMed2003

Paracoccidioidomycosis of the mouth: an emerging deep mycosis.

Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.

Adult↗
PubMed2003

Paracoccidioidomycosis of the mouth: an emerging deep mycosis.

Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.

Communicable Diseases, Emerging↗
PubMed2003

Halitosis.

Halitosis (oral malodour or breath odour) is a fairly common complaint. Halitosis is most often a consequence of oral bacterial activity, typically from anaerobes. Occasional causes include systemic disease, and some patients have a psychogenic background to the complaint. The management is outlined in this paper.

Bacteria, Anaerobic↗
PubMed2003

Dentistry for those requiring special care.

Individuals with special needs, namely those whose dental care is complicated by a physical, mental or social disability, often have a higher level of unmet dental need and poorer oral hygiene than the general population, and offer unique challenges to the dental practitioner. This paper outlines the dental management of the three most common groups of individuals with special needs.

Coronary Disease↗
PubMed2003

The diagnosis and management of recurrent aphthous stomatitis: a consensus approach.

BACKGROUND: Recurrent aphthous stomatitis, or RAS, is a common oral disorder of uncertain etiopathogenesis for which symptomatic therapy only is available. This article reviews the current data on the etiopathogenesis, diagnosis and management of RAS in a primary care setting. METHODS: The authors reviewed publications on Medline from 1995 through 2000, the period since the last major reviews were published. RESULTS: RAS may have an immunogenetic background owing to cross-reactivity with Streptococcus sanguis or heat shock protein. Predisposing factors seen in a minority include haematinic (iron, folate or vitamin B12) deficiency, stress, food allergies and HIV infection. While topical corticosteroids remain the mainstay for therapy, a number of other immunomodulatory modalities now are available. CONCLUSIONS: There is still no conclusive evidence relevant to the etiopathogenesis of RAS, and therefore therapy can attempt only to suppress symptoms rather than to address the basic issues of susceptibility and prevention. CLINICAL IMPLICATIONS: In the majority of patients, symptomatic relief of RAS can be achieved with topical corticosteroids alone, with other immunomodulatory topical agents or by combination therapy.

Adjuvants, Immunologic↗
PubMed2002

Oral squamous cell carcinoma; from an hypothesis about a virus, to concern about possible sexual transmission.

Nearly two decades ago, we produced the first evidence for the presence of viral nucleic acids in oral squamous cell carcinoma (OSCC) tissues, hypothesising that there may be a viral involvement in at least some OSCC. Subsequently, human papillomaviruses (HPV) in particular have been implicated in OSCC. Antibody responses to HPV are seen and HPV-DNA detected in tumors by us and many others, the virus being mainly HPV-16, the genotype associated with ano-genital cancer. HPV are seen by in situ hybridisation only in tumour and premalignant tissue but not in surrounding normal mucosa suggesting HPV has a causal relationship. HPV may also be integrated in the host genome, further suggesting a causal role. Studies of patients with OSCC have suggested possible sexual transmission of HPV. Recent studies have indicated that HPV may be aetiologically important particularly in some types of oropharyngeal cancer, at least in tonsillar carcinogenesis, and may represent an alternative pathway in carcinogenesis to the established factors of tobacco and alcohol. We have come a very long way in the two decades since our first suggestion of a viral aetiopathogenesis was greeted with incredulity, and data from on-going studies by the International Agency for Research on Cancer, Johns Hopkins Oncology Center and others are eagerly awaited.

Adolescent↗
PubMed2002

Synergism between HIV and other viruses in the mouth.

The HIV family replicate in and are shed from the mouth. Oral sexual practices potentially contribute to the overall extent of HIV transmission, particularly if high-risk practices are not restricted. Herpesviruses and papillomaviruses that appear in the oral cavity can determine oral HIV replication. The mechanisms probably include heterologous transactivation, enhanced expression of HIV receptors and co-receptors in target cells, release of cytokines and chemokines, and production of superantigens. Oral diseases peculiar to, or more common in, the HIV-infected patient further predispose to heightened oral HIV replication and trafficking. Defining the mechanisms by which oral viruses interact with HIV in the co-infected host should permit intervention measures against oral HIV transmission to be more precisely targeted.

Epstein-Barr Virus Infections↗
PubMed2002

An update on the controversies in bacterial endocarditis of oral origin.

OBJECTIVES: The aim of this review was to evaluate the evidence implicating dental procedures in bacterial endocarditis (BE) development and the basis for antimicrobial prophylaxis (AP). STUDY DESIGN: In this article, the literature is reviewed and meaningful findings about epidemiology, pathogenesis, and AP guidelines for BE of oral origin are highlighted. Available results are used to formulate clinical recommendations for the dental practitioner. RESULTS: The nature of dental procedures that cause bacteremia, patients at risk for BE, and the effectiveness of AP guidelines, continue to be points of controversy. There appears to be further evidence to support the important role of oral health status in the prevention of BE of dental origin. CONCLUSIONS: One objective of the dental practitioner in caring for patients at risk for BE should be to promote oral health care. There are no hard data on which to scientifically base the need for AP in patients at risk for BE. However, it would appear prudent, at least from the medicolegal perspective, to provide AP, at least to persons with previous BE or prosthetic heart valves and to those undergoing oral surgery, periodontal treatment, or implant placement.

Antibiotic Prophylaxis↗
PubMed2002

Oral surgery in patients on anticoagulant therapy.

OBJECTIVE: Surgery is the main oral healthcare hazard to the patient with a bleeding tendency, which is mostly caused by the use of anticoagulants. The traditional management entails the interruption of anticoagulant therapy for dental surgery to prevent hemorrhage. However, this practice may increase the risk of a potentially life-threatening thromboembolism. Because this issue is still controversial, it is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients on the 3 main types of anticoagulants: coumarins, heparins, and aspirin. MATERIALS REVIEWED: The pertinent literature and clinical protocols of hospital dentistry departments have been extensively reviewed and discussed. RESULTS: Several evolving clinical practices in the last years have been detected: anticoagulant use is generally not discontinued; oral surgery is performed despite laboratory values showing significant bleeding tendency; new effective local methods are used to prevent bleeding; and patients at risk are referred to hospital-based clinics. CONCLUSION: The management of oral surgery procedures on patients treated with anticoagulants should be influenced by several factors: extent and urgency of surgery, laboratory values, treating physician's recommendation, available facilities, dentist expertise, and patient's oral, medical, and general condition.

Analgesics↗
PubMed2002

Pemphigus vulgaris: update on etiopathogenesis, oral manifestations, and management.

Pemphigus is a group of potentially life-threatening diseases characterized by cutaneous and mucosal blistering. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles. Certain ethnic groups, such as Ashkenazi Jews and those of Mediterranean origin, are especially liable to pemphigus. Pemphigus vulgaris (PV), the most common and important variant, is an autoimmune blistering disease characterized by circulating pathogenic IgG antibodies against desmoglein 3 (Dsg3), about half the patients also having Dsg1 autoantibodies. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examinations, is essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected by both normal human skin and monkey esophagus or by enzyme-linked immunosorbent assay (ELISA). Before the introduction of corticosteroids, pemphigus vulgaris was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids, with azathioprine, dapsone, methotrexate, cyclophosphamide, and gold as adjuvants or alternatives, but mycophenolate mofetil and intravenous immunoglobulins also appear promising.

Adrenal Cortex Hormones↗
PubMed2002

Fragile X (Martin Bell) syndrome.

Fragile X syndrome is a neurodevelopmental disorder that results from a single gene mutation on the X chromosome. It is the most common genetic cause of learning disability, though many patients remain unrecognized. Fragile X syndrome is characterized phenotypically mainly by a long coarse face, prominent ears and macro-orchidism. Affected individuals are also mentally challenged and may have mitral valve prolapse, and seizures. A case of Fragile X syndrome is reported, with oral findings and potential management difficulties in oral care.

Adult↗
PubMed2002

Adverse effects of antiretroviral therapy: focus on orofacial effects.

The optimum anti-HIV drug has yet to be found. This paper will summarise some of the oral adverse effects associated with antiretroviral agents against HIV. The development of antiretroviral drugs for the treatment of HIV infection has been aimed at the inactivation of two HIV enzymes: reverse transcriptase and proteases. Erythema multiforme, ulcers and xerostomia are the main oral side effects associated with reverse transcriptase inhibitors. Parotid lipomatosis, taste disturbance, xerostomia and perioral paraesthesia are oral adverse effects, which are mainly related to protease inhibitor therapy. The search for new antiretrovirals with different active mechanisms and patterns of resistance constitutes a key question in HIV treatment. The use of new drugs and drug combinations will lead to the appearance of oral lesions, which will be difficult to identify and treat and which cannot be ignored by the practitioner.

Anti-HIV Agents↗
PubMed2002

Severe periodontitis in Marfan's syndrome: a case report.

BACKGROUND: Connective tissue disorders, such as some forms of Ehlers-Danlos syndrome, have been associated with severe periodontitis. METHODS: This report describes a case of Marfan's syndrome, an inherited disorder of connective tissue caused by mutations in the fibrillin-1 gene, in which the patient presented with severe periodontitis. RESULTS: At examination, an average full-mouth clinical attachment level loss of 5.6+/-2.1 mm, furcation involvement, and severe alveolar bone loss were observed in a 41-year-old Caucasian male. Tooth hypermobility was also present. CONCLUSIONS: This case appears to be the first documentation of severe periodontitis in a patient with Marfan's syndrome. It supports the hypothesis that a variety of connective tissue disorders may confer increased susceptibility to periodontal tissue breakdown.

Adult↗
PubMedDate not supplied

Infectious hepatitis C, hepatitis G, and TT virus: review and implications for dentists.

In the past 10 years, hepatitis C and G viruses have been identified, and in the last two years a further parenterally transmitted agent, termed TT virus (TTV), has been discovered. These viruses have a worldwide distribution and frequently cause chronic infection. The purpose of this article was to promote an understanding of these viral agents and their relevance in dental practice. Infected patients may develop a chronic carrier state without clinical disease or may develop liver disease, and may have related oral conditions. Dental providers will see a growing number of patients with HCV/HGV and possibly TTV infection. All of these patients require appropriate infection control measures during dental treatment.

Blood-Borne Pathogens↗
PubMedDate not supplied

The role of the dental team in preventing and diagnosing cancer: 3. oral cancer diagnosis and screening.

UNLABELLED: Oral cancer is among the ten most common cancers world-wide, and is especially seen in disadvantaged elderly males. Members of the dental profession have a duty to detect both potentially malignant and malignant oral lesions. Early detection and prompt treatment offer the best hope to the patient with oral cancer, providing the best chance of a cure. As patient awareness regarding the danger of oral cancer increases, the demand for oral cancer 'screening' is also expected to increase significantly. The signs and symptoms of cancer often resemble less serious conditions more commonly found in the mouth and similarly presenting as a lump, red or white patch or ulcer. If any such lesion does not heal normally within 3 weeks, a malignancy or some other serious disorder must be excluded. A biopsy is indicated. Prompt referral to an appropriate specialist usually allows for the best management but, if this is not feasible, the dental practitioner should take the biopsy which should be sent to a specialist oral pathologist for histological evaluation. CLINICAL RELEVANCE: Early detection and prompt treatment offer the best hope to the patient with oral cancer, providing the best chance of a cure. As patient awareness regarding the danger of oral cancer increases, the demand for oral cancer'screening' is expected to increase significantly as well.

Biopsy↗