Biomedical subjects
Publications and source records attributed to S R Porter.
Primary immunodeficiencies are increasingly recognized yet there is little data concerning the oral manifestations of such disorders. This article reviews the current literature and details the oral aspects of well-characterized primary immunodeficiencies.
A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44% of dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease.
There are many causes of recurrent oral mucosal ulceration, particularly gastrointestinal, mucocutaneous, and hematologic disease. The present report details the features of a patient with recurrent oral ulceration caused by autoimmune neutropenia.
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External beam radiotherapy treatment of malignant conditions in the head and neck can give rise to several adverse oral effects if the oral or salivary tissues are within the field of beam. We report on a patient with widespread oral melanotic hyperpigmentation that developed after a course of radiotherapy for metastatic carcinoma in the cervical lymph nodes. As no other local or systemic cause was evident it is possible this abnormal hyperpigmentation was a result of the radiotherapy. The development of oral melanotic macules as a consequence of radiotherapy has not been previously described.
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The oral features of three members of a family with familial benign neutropenia (a mother and two children) are detailed. Prepubertal periodontitis, oral ulceration, and angular stomatitis were the principal features.
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The oral features of a patient with notable maxillary and mandibular gingival enlargement secondary to leukaemic infiltration in chronic lymphocyte leukaemia are presented.
New patterns of oral mucosal disease and indeed new disorders have been emerging over the past decade. Although infection with human immunodeficiency viruses (HIV) is having the most profound impact, there are also major changes in oral health and the standard of health care required, because of other new disorders and medical care. The increase in tissue transplantation, with the concomitant use of immunosuppression is resulting in a range of oral problems. Other iatrogenic oral diseases likely to increase include ulcers associated with cytotoxic chemotherapy; lichenoid eruptions related to drugs and restorative materials; and a multiplicity of other complications. Dilemmas are presented by some new disorders such as orofacial granulomatosis. No less are the difficulties presented by the now obvious heterogeneous nature of oral subepithelial vesiculobullous disorders. Finally, there are, even in these days of social medicine and antimicrobial availability, new infectious diseases emerging. Continued increases in population mobility; continued sexual promiscuity; and the development of new drugs are all likely to act to increase the spectrum of oral disorders seen.
Over 19,000 patients treated by 57 HIV-infected health care workers (HCWs) have been tested for HIV. Apart from the notorious Florida dental case, no patient has been shown to be infected by treatment given by an HIV-infected HCW. Cases of 10 HIV-infected HCWs have been examined in some depth. The evidence indicates that HIV transmission from HCWs to patient is exceedingly improbable, and almost impossible where recommended infection control procedures are adhered to.
The knowledge and attitudes of dental patients in the UK and Hong Kong towards aspects of cross-infection control have been surveyed. Almost all patients expected dentists to wear protective gloves but only 73% and 40% expected dental staff to wear protective face masks and spectacles respectively. Most patients were aware that such measures were for the benefit of both dental staff and patients. Just over 50% of patients believed that they could contact HIV from an HIV-infected dentist. UK and Cantonese patients had generally similar attitudes to cross-infection protection, but the latter were positively influenced by the routine use of masks and spectacles and were more concerned about HIV transmission than UK patients.
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The responses of clinicians to results of hematologic and serologic investigation of 79 patients with recurrent aphthous stomatitis have been reviewed. Twenty percent of patients with abnormal results were not adequately managed by attending clinicians.
Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.
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There has been considerable controversy as to whether oral lichen planus (LP) has a premalignant potential. This study retrospectively examined the records of 241 British patients with histologically confirmed LP seen during the 10-year period 1982-92. Nine patients (3.7%) were known to have developed well-differentiated invasive carcinoma or carcinoma in situ in an area of LP. Most carcinomas at presentation were in areas of atrophic and/or erosive LP, 6 were in patients older than 65 years, and 6 were on the tongue. The results support a small but clinically important premalignant potential for LP.