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A case of linear IgA disease with prominent oral lesions is presented. Oral manifestations in linear IgA disease have been reported as minor clinical presentations. In our patient the oral manifestations predominated and were the only clinical manifestations for 5 years before the skin lesions appeared. Linear IgA disease should be included in the differential diagnosis of bullous dermatoses with oral lesions.
UNLABELLED: The aim of the study was to evaluate cutaneous and oral manifestations in infected HIV patients. MATERIALS AND METHODS: We retrospectively analyzed 169 cases admitted in Infectiouse Disease Department of Iaşi in 2001-2002 period. RESULTS: Cutaneous and oral manifestations were: candidiasis (99 cases), herpes virus infectious (36 cases), scabies and straphylococcal/streptococcal skin disease (26 cases), prurigo nodularis, psoriasis and verruca vulgaris (9 cases). Children of 0-13 year old group was 75.73 percent. Classification of HIV infection was related with CD4 count for 166 cases. Twelve cases with oral pharyngitis candidiasis, scabies and streptococcal skin diseases was 2-3 recurrent episodes of manifestations. Etiotrop treatment was associated with HAART therapy. CONCLUSIONS: Cutaneous and oral manifestations are occurred frequently in HIV infected patients, with a various etiology, but the severity, persistence and its evolution did not evaluate.
OBJECTIVES: Examine variations in oral manifestations of HIV by gender, race, risk behaviors, substance use and immune status in a previously unstudied population in the southeast region of the USA. DESIGN: Cross-sectional analytic study. SETTING: Academic medical center, North Carolina, USA. SUBJECTS: First 238 HIV-infected adults (76% male; 59% Black) enrolled in an ongoing longitudinal study. METHODS: Oral examination, medical chart review, sociodemographic and behavioral interview. Descriptive, bivariate, and multivariable analyses. OUTCOMES: Presence of oral manifestations of HIV. RESULTS: 50% had recent CD4 counts < 200 cells microliters-1, 48% had one or more oral lesion. Specific lesion prevalence: hairy leukoplakia (OHL) 26.5%; candidiasis (OC) 20%; HIV-associated periodontal diseases (HIV-PD) 8.8%; aphthae 4.2%; papillomas 2.5%; herpes simplex 2.1%; HIV salivary gland disease 2.1%; Kaposi's sarcoma (KS) 1.7%; other 1.3%. In bivariate analyses, OHL was associated with being male, White, having a CD4 < 200, and men who have sex with men (MSM); OC was associated with CD4 < 200 and current smoking; HIV-PD was associated with consumption of more than seven alcohol-containing drinks per week; KS was associated with being male and MSM. Significant variables in multivariable analysis for presence of any oral lesion were White, CD4 < 200, and more than seven drinks/week; for OHL were male and CD4 < 200; and for OC were White, CD4 < 200, current smoking, and not MSM. CONCLUSIONS: MSM were at increased risk for KS and OHL, not OC, while smokers were at increased risk of OC. OC, OHL, and any oral lesion were associated with immune suppression. OHL was more likely in males independent of CD4 count.
This paper presents a preliminary approach to the study of the oral manifestations of HIV infections in the region of the Americans. A general description of the lesions encountered is provided together with a review of the prevalence of the different manifestations in some countries of the Americas. Oral candidiasis was the most common oral lesion identified. Among oral candidiasis lesions differences were noted in relation to the frequency of the clinical forms seen. Hairy leukoplakia was the second most frequent lesion in almost all studies, with the exception the Peruvian study, where the most prevalent oral condition was xerostomia. The numbers of cases of HIV-gingivitis and HIV-periodontitis found in the countries of the Americas were lower than the cases in USA. Other oral manifestations of HIV infections seen were: Kaposi's sarcoma, oral erythema, labial herpetic infection. It is concluded that still more studies are needed, oral health professionals need additional training in the detection and treatment of lesions, and information needs to be systematized and standardized such that it is possible to make accurate comparisons among regions and countries. Recommendations are included to improve this situation.
This article describes the baseline findings from a study designed to compare the oral manifestations of HIV infection in homosexual men and intravenous drug users. Both seropositive and seronegative persons were studied. A standard examination instrument was developed to record indexes of oral disease as well as to record the presence of oral lesions. The two groups differed in terms of education, race, socioeconomic status, employment status, housing, and smoking experience. The prevalence and type of oral lesions differed in the two seropositive groups. In seropositive homosexual men, white lesions on the tongue (28.4%) predominated; whereas for the seropositive intravenous drug users, oral candidiasis (43.0%) and gingival marginal erythema (33.3%) were most often detected. We also observed that seronegative intravenous drug users displayed a greater number of oral lesions than seronegative homosexual men. For seropositive homosexual men, lesion presence was significantly associated with decreased levels of CD4; positive associations were seen with current smoking, antiviral drug use, and antibiotic use, and a negative association was observed with current employment. In contrast, only exposure to antiviral drugs was significantly correlated with lesion presence for seropositive intravenous drug users. This baseline analysis from our longitudinal study suggests clear differences in oral manifestations of HIV infection between seropositive homosexual men and intravenous drug users and between seronegative homosexual men and intravenous drug users. Among other parameters, it is apparent that lifestyle, access to health care, and the condition of the oral cavity before infection influence the development of oral lesions in persons with HIV infection.
Thirty children with AIDS, aging 2 to 6 years, of both genders, treated as outpatients at the hospital Santa Casa de Misericórdia, São Paulo, were evaluated for oral manifestations and compared to a control group of age- and sex-matched healthy subjects. The correlation between oral lesions and the degree of immunosuppression was analyzed. The most prevalent oral manifestations--lymphadenopathy, followed by gingival alterations--were observed in the children with the highest levels of immunosuppression. Other manifestations observed in the AIDS group were: pseudomembranous and erythematous candidosis, enlargement of the parotids and ulcers. The results did not indicate a higher frequency of lesions. However, the observed oral manifestations had an early occurrence, which indicates that the early diagnosis is an important component in the management of those patients.
Sickle cell anemia (SCA) is a well known hemoglobinopathy which results from a substitution of amino acids in the polypeptidic chain. SCA was considered endemic in certain areas of the world. It has been recognized now that it may have a wide geographic distribution. Few studies have dealt with dental manifestations or complications of SCA (Cox and Soni, 1984). Nevertheless none of them have showed epidemiological data for a large series of oral manifestations. To date, no epidemiological data of our country is available in the literature. The aim of this study was to determine the oral manifestations of SCA in a Venezuelan population. Seventeen patients affected were examined at the University Hospital and the Dental Clinic. Age ranged between 1 1/2-48 years. Each patient was haematologically diagnosed by hemoglobin electrophoresis and only homozygous individuals were selected. Each patient was analyzed according to general clinical history, as well as, dental history; clinical and radiological examination using periapical, panorex and bite-wings radiographs. Our results showed that the most affected group was between 20 to 30 years (41.18%). According to sex, females were more affected than males (64.71%). The most common phenotype was mestizo (47.31%). The most frequent type of hemoglobinopathy was Hg-SS and Hg SS-F. The most common soft tissue oral manifestation was buccal mucosa pallor in 77.05%. In addition, the hard tissue findings involved enlarged medullary spaces (70.58%). Cicatritial infarcts were present in 77.05% of cases and the step-ladder effect was demonstrated in 82.35% of cases. Our observations could be due to genetic, environmental, nutritional and geographical factors.
Oral research concerning diabetes mellitus has revealed a number of clinical implications. These include, among others, the need for more intense management of the diabetic patient with periodontal disease because tissue destruction may be accelerated, the need for rapid control of oral infection in these patients in order to prevent exacerbation of the existing metabolic imbalance, and the desirability of performing a screening for diabetes mellitus on all patients exhibiting asymptomatic parotid enlargement. Despite the explosion of knowledge concerning diabetes mellitus that has occurred since the discovery of insulin, its definitive etiology continues to elude the scientific community and its treatment remains in the realm of clinical management rather than in that of prevention and cure. In the past, research on diabetes has focused on the role of insulin in seeking the fundamental etiology of diabetes and its complications. With the progression of research, it has become apparent that the initiation and progression of the disease probably involve the interplay of a multiplicity of factors. Hereditary and immunologic factors, as suggested earlier, appear to be operated on by environmental factors, subsequently altering the body's metabolic milieu with widespread primary and secondary effects. Fertile areas for future oral research in diabetes mellitus will include, therefore, genetics, immunology, enzymology, and basement membrane pathology. On the cellular and molecular levels, particularly, the oral cavity and associated structures comprise a somewhat under-investigated area in diabetes mellitus research and, thus, hold great promise for increasing our knowledge of this complex disease.
The acquired immunodeficiency syndrome (AIDS) pandemic continues to increase in magnitude and to plague the world. Dental professionals knowingly or unknowingly are involved in this pandemic because of the need to provide dental care without discrimination. Additionally, oral manifestations of human immunodeficiency virus (HIV) infection are common and often are major patient complaints as well as sometimes the first sign or symptom of HIV infection. Oral manifestations of HIV immunosuppression include opportunistic infections, autoimmune diseases, and malignancies. Therefore, the dental clinician has the opportunity to recognize and diagnose oral manifestations of HIV infection and to participate in patient management and counseling.
Oral manifestations of herpes zoster are very less common than cutaneous. Only a few cases of oral herpes zoster in children had been already described. Authors report a case of maxillary superior nerve's herpes zoster. Oral lesions are encountered in case of viral disease of the second and third branch of trigeminal nerve (VII, VIII). Dental pain is usually the first sign and can induce misdiagnosis. The diagnosis is based on the specific ulcerative lesions, strictly unilateral, developed in the field of sensitive innervation of the maxillary nerves. The use of antiviral drugs seems to be actually the best treatment.
The objectives of this study were to assess the prevalence of oral manifestations of HIV infection, the periodontal health status and the oral health behaviour of a group of 51 HIV infected adults. The design was a cross-sectional descriptive study which took place in a community dental clinic in south London dedicated to treatment of this group of patients. Data were collected through a self-administrated questionnaire, interview and clinical examination and results showed that 76.5 per cent had one or more oral manifestations of HIV infection. Intra-oral herpes, papilloma and non-Hodgkin's lymphoma were not identified. A very positive attitude towards oral hygiene was identified. Plaque levels were low. All individuals studied had some evidence of bleeding gums.
BACKGROUND: The HIV/AIDS epidemic in Cambodia has become a major problem in the last 7-8 years, mainly because in this formerly war-stricken country the socioeconomic situation is only slowly improving. Since only very few studies have been published to date on the oral health status of Cambodian HIV/AIDS patients, it was the purpose of the present investigation to study oral manifestations in Cambodian patients with HIV disease. METHODS: One hundred one Cambodian patients with HIV infection or AIDS were examined for the presence of oral manifestations in one medical center in Phomh Penh, Cambodia. RESULTS: Sixty-three men and 38 women with a median age of 32 years were examined (age range 7.5-63.5 years). Of these patients, 42.6% were smokers, 46.5% of men were heavy drinkers and 90.5% of men were promiscuous compared with 5.3% of women. The most frequent AIDS-defining diseases were wasting syndrome (54.5%), Pneumocystis carinii pneumonia (PcP) (19.8%) and tuberculosis (18.8%). Puritic papular eruption, a common cutaneous manifestation in HIV-infected patients, was seen in 17.8% of patients. Candida-associated infections of the oral cavity were most common. Among the patients, 52.5% revealed pseudomembranous candidiasis and 35.6% had bilateral hairy leukoplakia. Only 10% of patients had no oral lesions. Also common were necrotising ulcerative gingivo-periodontal diseases (27.7%). CONCLUSION: The general health status of 101 Cambodian patients with HIV infection and AIDS was poor, and they demonstrated a large number of oral manifestations. Antiretroviral therapy is presently not available and only a fraction of patients receives antimycotic treatment (25.7%). HIV infection and the AIDS epidemic in Cambodia have become a serious problem and patients urgently need adequate diagnosis and antiretroviral therapies.
There exists a multitude of systemic diseases which exhibit consequential oral manifestations. Dermatologic disorders frequently involve intraoral and perioral tissues which dental practitioners should be familiar with. A compilation of disorders including; bullous diseases (such as Pemphigus Vulgaris, Erythema Multiforme, Pemphigoid, Dermatitis Herpetiformis, Epidermolysis Bullosa, and Darier's disease), as well as non bullous diseases (such as Lichen Planus, Psoriasis, Lupus erythematosus, Scleroderma, and Perioral Dermatitis); and their oral manifestations are presented in order to facilitate their early diagnosis and subsequent treatment.
HIV-related oral conditions occur in a large proportion of patients, and frequently are misdiagnosed or inadequately treated. Dental expertise is necessary for appropriate management of oral manifestations of HIV infection or AIDS, but many patients do not receive adequate dental care. Common or notable HIV-related oral conditions include xerostomia, candidiasis, oral hairy leukoplakia, periodontal diseases such as linear gingival erythema and necrotizing ulcerative periodontitis, Kaposi's sarcoma, human papilloma virus-associated warts, and ulcerative conditions including herpes simplex virus lesions, recurrent aphthous ulcers, and neutropenic ulcers.
Ellis-van Creveld syndrome, or chondroectodermal dysplasia, is an autosomal recessive disorder with characteristic clinical manifestations. Its incidence in the general population is low. The oral manifestations of Ellis-van Creveld are found in soft tissues and teeth, but the dental literature on the subject is scarce. In the last 20 years, 5 cases of Ellis-van Creveld syndrome have been followed at the Pediatric Dentistry Service of the Hospital Sant Joan de Déu, Barcelona. The present study describes the constant and variable oral findings in these patients, which play an important role in the diagnosis criteria for the syndrome. The presence of a great variety of oral manifestations such as fusion of the upper lip to the gingival margin, presence of multiple frenula, abnormally shaped and microdontic teeth, and congenitally missing teeth requires multidisciplinary dental treatment, with consideration for the high incidence of cardiac defects in these patients.
Selective immunoglobulin A (IgA) deficiency is the most common of the primary immunodeficiencies with a frequency of 1/300-1/3000, depending on the screened population. As secretory IgA (SIgA) has a protective role in mucosal surfaces from invasion of microorganisms, it is thought that IgA-deficient subjects are susceptible to periodontal diseases and oral manifestations. Previous studies show contradictory results, concerning the involvement of the individuals' periodontium with IgA deficiency. The aim of this study was to investigate and compare the oral manifestations in IgA-deficient subjects with controls. Eleven selective IgA-deficient subjects aged 3-18 years with serum IgA levels <10 mg dl(-1) and 11 age-sex-matched healthy children as the controls entered the study. Oral mucosal investigation, dental caries, plaque accumulation and periodontal status were assessed. Serum immunoglobulin levels were measured by single radial immunodiffusion (SRID) method. Saliva immunoglobulins and secretory component levels were measured by enzyme linked immunosorbent assay (ELISA) methods. IgA-deficient patients had serum and saliva IgA levels less than 10 mg dl(-1) and 10 microg ml(-1), respectively, but other serum immunoglobulin levels were normal and saliva immunoglobulin M (IgM) levels were increased, compared with controls. There were no significant differences in oral manifestations between IgA-deficient subjects and controls, which may be a result of compensatory increase of saliva IgM or other non-immunological defence factors in saliva. Thus, it is not necessary to evaluate IgA and SIgA in all the patients with oral and dental lesions and it is thought that it is better to investigate other factors.
The vast majority of children with HIV infection present oral manifestations among the first signs of illness. These lesions are not produced directly by the virus, but are manifestations associated with HIV infection, and are not pathognomic of the infection itself. Some of these oral lesions have a prognostic value with regard to progression of the infection and the appearance of AIDS; independently of other, more commonly used markers. The essential risk factors that influence the development of such oral manifestations are the low number of CD4+ lymphocytes, xerostomia, and the lack of anti-retroviral therapy. Opportunist infections, such as mycoses -- including pseudomembranous oral candidiasis, are found with higher frequency; followed by the herpetic viral infections. The oral lesions that appear in infected children differ in prevalence from those found in seropositive adults, some, such as parotid hypertrophy, present more exclusively in children, others, such as periodontal bacterial infections and Kaposi's Sarcoma, are lesions that predominate in the adult HIV-infected population. Given the current impact of the pandemic caused by HIV, it is the responsibility of dental professionals to prevent, detect, treat and control the oral lesions in those patients infected with HIV. All of which will be reflected in a reduction in transmission, lower mortality and greater long-term survival for infected children.
Numerous bacterial diseases, both viral and fungal in nature, can affect the oral cavity, either directly or secondarily as a result of a systemic problem. Their oral manifestations can vary, but are sometimes very typical, and early detection significantly reduces the risk of transmitting pathogenic agents to the dental team and to patients. The principal oral manifestations are reviewed and special emphasis is placed on sexually transmitted diseases and HIV infection.