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PubMed1995

An overview of the oral manifestations of AIDS-related Kaposi's sarcoma.

Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (AIDS-KS) is the most common malignancy in human immunodeficiency virus infection and is seen most often in homosexual men. The oral cavity is frequently involved by AIDS-KS and may represent the initial site of this malignancy in up to 60% of patients. A number of treatment modalities, including systemic and localized chemotherapy and radiotherapy, are available for AIDS-KS. The initial diagnosis of AIDS-KS requires microscopic evaluation of biopsy material because this disease can mimic a number of intraoral lesions, including atrophic candidiasis, erythroplakia, pyogenic granuloma, bacillary angiomatosis, median rhomboid glossitis, hemangioma, and lymphoma. Overall, treatment of AIDS-KS does not significantly affect the prognosis or survival of AIDS patients, however, treatment can alleviate aerodigestive and/or respiratory dysfunction, allow for adequate nutritional intake, and improve the quality of life for these patients.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Fungal infections of the oral cavity.

Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or pastille forms. Clotrimazole is used as a topical agent in lozenge form; it is highly effective but can cause liver enzyme changes. Ketoconazole, which is usually prescribed systemically, is highly effective but also capable of causing adverse liver changes. Chlorhexidine can be used as an oral rinse or as a disinfectant for dentures.

Female↗

PubMed1993

A case of kwashiorkor.

Kwashiorkor is part of the spectrum of protein-energy malnutrition. The condition results from a lack of nutritional protein coupled with carbohydrate excess. Protein malnutrition is much more common in the Third World; however, it is also the most common form of nutritional deficiency among hospitalized patients in the United States. Cutaneous clues to the diagnosis of protein deficiency include the "flag sign," hypochromotrichia, alopecia, "crazy pavement" dermatosis, pallor, and glossitis. Systemic manifestations include peripheral edema, liver disease, neurologic changes, diarrhea, weight loss, and hypoalbuminemia. We report here a case of profound kwashiorkor in a nonhospitalized patient who presented with multiple cutaneous and systemic findings indicative of protein malnutrition.

Adult↗

PubMed1996

Prevalence of oral lesions in inflammatory bowel disease.

OBJECTIVE: To obtain precise data on the prevalence of oral lesions in inflammatory bowel disease (IBD). METHODS: Oral lesions were carefully sought in a consecutive series of 198 Italian IBD outpatients, 77 with Crohn's disease (CD) and 121 with ulcerative colitis (UC); 89 subjects with functional intestinal motility disorders served as controls. RESULTS: The oral lesions detected were angular cheilitis (in 7.8% of CD patients, 5% of UC patients, and 0% of controls (p < 0.05, patients vs controls), lichen (6.5, 5.8, and 3.3%, respectively, p = not significant), aphthous ulcers (5.2, 5.8, and 5.6%, respectively, p = not significant), candidiasis (5.2, 0.8, and 0%, respectively, p < 0.05, CD patients vs controls), benign tumors (5.2, 0, and 7.8%, respectively, p < 0.05, patients vs controls), leukoplakia (5.2, 11, and 3.3%, respectively, p = not significant), and, less frequently, glossitis and herpes labialis. No specific CD oral lesions were observed in this series. No correlation was found between clinical disease activity and frequency of oral lesions. CONCLUSIONS: Aphthous ulcers are not common in IBD patients. Oral candidiasis is more frequent in CD than UC patients and controls.

Adolescent↗

PubMed1996

Common oral conditions.

Although some oral lesions, such as torus palatinus, are normal variants, and others, such as benign migratory glossitis, are self-limited, several common oral conditions require prompt diagnosis and treatment to reduce the potential for serious complications. Treatment of dental and periodontal abscesses may include incision and drainage, antibiotic therapy, pain control and dental extraction. Treatment of sialolithiasis (blockage of the salivary gland ducts) may require application of moist heat, antibiotics and surgical removal of impacted stones. Hyperkeratosis, a white patch on the oral mucosa that does not rub off or bleed (as does the white patch of candidiasis) commonly occurs in persons who use smokeless tobacco products. The lesion may require biopsy if it still persists two to four weeks after discontinuation of the tobacco product. Squamous cell carcinoma, which accounts for 95 percent of all oral cancers and is most commonly associated with alcohol and tobacco use, is usually asymptomatic until the late stage of the disease. Suspicious lesions should be biopasied to confirm the diagnosis.

Diagnosis, Differential↗

PubMed1996

[Alcohol and smoking. The risk factors for the oral cavity].

A higher risk for the development of oral cancer was associated with heavy smoking and heavy drinking, but alcohol drinking and tobacco smoking are also correlated with other oral cavity disease. Tobacco is the most important factor of leukoplakia, but other diseases like ANUG, periodontitis, median rhomboid glossitis, chronic hyperplastic candidiasis and others are also correlated to cigarette smoking. It was observed that smokers have more plaque than non-smokers, even if no difference in the bacteria composition was found between smokers and non-smokers samples, and the vascular reaction associated with plaque induced gingivitis is suppressed in smokers. Periodontitis are generally considered to be a consequence of an unfavourable host-parasite interaction, but personal factors that diminish the efficiency of the host defence, like tobacco smoking and alcohol drinking, can play an important role in the development of periodontal diseases. Cigarette smoking may be considered a major risk factor for periodontitis and it can also increase its severity; therefore, alveolar bone loss increases with tobacco smoking. Recent investigations show that smokers respond less favourably than no smokers to the different modalities of periodontal therapy, as surgical and non surgical, or guided tissue regeneration. Moving from these observations the authors critically analyze the literature concerning these important risk factors which appear to be strongly correlated with periodontal diseases.

Alcohol Drinking↗

PubMed1998

Gongylonema macrogubernaculum in captive African squirrels (Funisciurus substriatus and Xerus erythropus) and lion-tailed macaques (Macaca silenus).

Necropsies performed between 1989 and 1995 on 15 African rope squirrels (Funisciurus substriatus) and 20 African ground squirrels (Xerus erythropus) from the Baltimore Zoo revealed 13 cases of gongylonemiasis. Nematodes were embedded in the epithelium of the esophagus, pharynx, buccal mucosa, and tongue, resulting in varying degrees of esophagitis, pharyngitis, stomatitis, and glossitis, respectively. Routine fecal examinations were negative, and the nematodes appeared to be unaffected by repeated treatments with ivermectin. Most of the affected animals had shown clinical signs of dyspnea and/or inanition and emaciation. Suppurative rhinitis was also a frequent finding at necropsy and was associated with the presence of the nematodes in eight animals. Dissection of whole nematodes from formalin-fixed specimens revealed morphologic features consistent with Gongylonema macrogubernaculum, a species previously only reported in nonhuman primates. The squirrels were housed in the same building with numerous primate species, and a review of pathology records revealed esophageal gongylonemiasis in three lion-tailed macaques (Macaca silenus), lingual gongylonemiasis in a spotnose monkey (Cercopithecus buettikoferi), and buccal gongylonemiasis in a brown-headed tamarin (Saguinus fuscicollis). Examination of whole nematodes dissected from one of the lion-tailed macaques also demonstrated the unique morphology of G. macrogubernaculum. Nematodes belonging to the species Gongylonema are acquired by ingestion of the intermediate host, the cockroach. This is the first report of G. macrogubernaculum in a nonprimate species and suggests that captive African squirrels can serve as reservoir hosts for this parasite in a zoo environment.

Animals↗

PubMedDate not supplied

The p53 and nm23-H1 genes are not deleted in oral benign epithelial lesions.

In an effort to identify genetic changes that may be the early hallmarks of epithelial cell overproliferation, we searched for p53 and nm23-H1 allelic deletions in oral benign epithelial lesions. In the study group were 25 benign epithelial lesions (lichen planus--17; leukoplakia--8; recurrent aphthous ulcers--2; one specimen diagnosed as benign migratory glossitis). Among 21 samples analysed for exon 4 (p53 gene) LOH, only 6 were informative, with no loss of either allele. OF 23 samples tested for LOH at intron 6 of p53 gene, 8 were informative, again with no presence of LOH. For nm23-H1 gene, the analysis was performed on a total of 24 cases. Of them, 16 were informative, however, none exhibited LOH at this locus. In conclusion, whereas the presence of gross gene alterations (LOH) would have been definitive evidence for the involvement of p53 and/or nm23 in the hyperproliferation process, the absence of LOH does not exclude the presence of either smaller mutations, altered regulation of normal gene, or dysfunction at the level of wild type protein. Alternatively, p53 and nm23-H1 may have no relation to oral lesion formation, and cannot presently be considered as an early step in benign, tissue transformation.

Adult↗

PubMed1964