COVID-19 hospitalized patients and oral changes: a case-control study.

OBJECTIVES: To investigate the association between hospitalization for COVID-19 and oral changes, and to evaluate whether oral changes can indicate a higher risk of disease progression to death. MATERIALS AND METHODS: This case-control study analyzed patients hospitalized (university hospital), including those in intensive care unit and clinical wards. The study group comprised 69 COVID-19 positive patients (PCR-test), while the control group included 43 COVID-19 negative patients. A dentist performed oral evaluations, and salivary samples were collected for calcium, phosphatase, and pH analysis. Sociodemographic data, hospitalization information, and hematological test results were collected from electronic-medical records. The presence of oral changes was assessed using chi-square tests, and the predicted risk of death was analyzed using binary logistic regression. RESULTS: COVID-19 positive patients had a significantly higher prevalence of oral changes compared to COVID-19 negative patients. The presence of any oral changes in COVID-19 positive patients indicated a 13-fold higher risk of mortality. "Bleeding ulcers," "pressure ulcers," and "angular cheilitis" were significantly associated with hospitalization for COVID-19. CONCLUSION: There may be an association between hospitalization for COVID-19 and the development of oral changes, including bleeding ulcers, pressure ulcers. and angular cheilitis. These oral changes may serve as potential indicator for disease progression an increased risk of death. CLINICAL RELEVANCE: COVID-19 hospitalized patients have a higher prevalence of oral changes, which indicate an increased risk of mortality. Oral medicine staff should be included in multidisciplinary teams to detect and treat these oral changes promptly.

Trichoscopic, oral, and periungual fold findings as activity and damage markers in dermatomyositis patients and their correlation with myositis antibodies.

There is little clarity about the clinical manifestations of dermatomyositis (DM) in the periungual folds, scalp, and oral cavity and their association with disease activity and damage. The objective of this study was to compare the prevalence of trichoscopic, oral, and periungual changes between DM and healthy patients and assess their possible association with disease activity and damage. We conducted an observational, transversal, and analytical study between 2020 and 2021. Forty DM patients were matched by sex and age with 40 healthy individuals. On the same day, all patients had a clinical evaluation of the hands, periungual folds, scalp, and oral cavity. Photographs of these areas and peripheral venous blood tests, including myositis-associated (MAAs) and myositis-specific antibodies (MSAs), were taken. Two dermatologists blinded to their diagnosis, damage, and activity levels registered the lesions. The disease activity and damage were evaluated using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). The presence of mechanic's hands, Gottron's sign, and Gottron's papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; thick tortuous capillaries in scalp; gingival telangiectasias in the oral cavity; and positive MSAs associated with severe cutaneous involvement in DM patients (Anti-TIF1g, Anti-MDA5, Anti-SAE1/2) were associated with a higher CDASI activity score. The presence of MSAs associated with intense muscle involvement in DM patients (Anti-Mi2a, Anti-Mi2b, Anti-NPX2, and Anti-SAE1/2) was related to a lower CDASI activity score. Gottron's sign and Gottron's papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; basal erythema in scalp; and gingival telangiectasias in the oral cavity were associated with a higher CDASI damage score. There are trichoscopic, oral and periungual fold findings and some myositis-specific antibodies that correlate with disease activity and damage in DM patients.

Oral manifestations of anti-neutrophil cytoplasmic antibody-associated vasculitis: an update and narrative review of the literature.

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a multisystem disorder of small blood vessels subdivided into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Oral manifestations (OMs) have been reported to include mucosal ulceration, gingival enlargement, alveolar bone necrosis, tooth loss, oro-antral communication, palatal perforation, parotitis, and candidal infection mainly in GPA. They may appear during the course of the disease, as a disease flare-up, or as the presenting sign. These OMs are often nonspecific and can mimic an array of conditions, therefore formulating a differential diagnosis can be challenging. This review updates the OMs of GPA, and, for the first, time includes OMs of other AAVs. It provides recommendations for the overall assessment and the diagnosis and management of all AAV OMs with considerations for treatment coordination. The role of oral health care providers in multidisciplinary care is highlighted.

Geneva reports have implications for dental providers.

AIDS: At the Geneva World AIDS Conference there were several presentations which were of particular interest to dentists. One presentation discussed how saliva proteins and saliva pH are altered by HIV infection. In another presentation, it was explained that CD4 counts may predict the development of oral candidiasis. Occupational exposures were also addressed.^ieng

Preventing measles deaths.

PIP: Each year, measles kills more than 1 million children in developing countries, especially malnourished children and children with complications. Prompt hospital admission is required to prevent measles-associated deaths if children with measles exhibit a general danger sign (lethargy or unconsciousness, convulsions, inability to eat or drink, or vomiting), signs of xerophthalmia, deep or extensive mouth ulcers, severe pneumonia, severe dehydration, or severe malnutrition. No drug can treat this viral infection; measles management consists of treating complications. Health workers must insert a nasogastric tube to administer liquid foods and fluids in children with severe measles who cannot eat. They should clean both eyes with a clean cloth and water 3 times a day. They should apply tetracycline eye ointment 3 times a day for 7 days. They should give a child with signs of xerophthalmia a treatment dose of vitamin A and another dose 3 weeks later. Health workers need to clean the mouth with clean water and a pinch of salt at least 4 times a day and put 1% gentian violet on mouth sores after cleaning. They should treat an anaerobic mouth infection, indicated by a foul smelling discharge, with metronidazole. Measles patients with an acute ear infection should receive paracetamol for pain and fever and an antibiotic for the infection. In the case of ear discharge, the health worker must clean the ears at least twice a day with cotton wool or a clean cloth. They should encourage mothers of measles patients with diarrhea to continue breast feeding. Health workers must administer more fluids than usual. They need to monitor hospitalized children to detect any additional complications. They need to look for danger signs; record the child's temperature, pulse, and respiratory rate twice a day; and weigh the child daily. Children with measles must be isolated for 4 days after onset of the rash. Any child in contact with the ill child should receive a dose of measles vaccine if he/she has not already been vaccinated or had measles. A vaccine coverage rate of at least 90% is the best way to prevent measles and measles-associated deaths.^ieng

Making good use of nature's contraceptive.

PIP: Some new recommendation on how to use breast feeding scientifically and a contraceptive method are suggested. We know that breastfeeding is the most important determinant of fertility in societies that do not have modern contraception. Breast milk has other benefits, such as immune protection against gastrointestinal diseases, reduced incidence of necrotizing enterocolitis, food allergies and diabetes, and possibly increasing the child's IQ. Breastfeeding can contribute to birth spacing, which can double the child's chance of survival relative to children born less than 2 years apart. Lactation can be up to 98% effective as a contraceptive during the 1st 6 months postpartum. It is suggested that the mother use her infant's development as a cue for beginning artificial contraception. When the child's teeth start erupting, it is time to start supplementing with other foods, and to start contraception. If she begins menstruating, the woman should, of course, begin contracepting at once. Another recommendation is to supplement the woman's diet with milk biscuits, throughout pregnancy and lactation rather than give cow's milk to infants in formula. Later on the biscuits could be given to babies for teething.^ieng

[Clinical manifestations of primary Sjogren's syndrome]. / Kliniske manifestasjoner ved primaert Sjögrens syndrom.

The article reviews the symptoms and signs of primary Sjögren's syndrome. It describes the clinical and laboratory investigations of such patients, and briefly discusses the occurrence of malignancy in Sjögren's syndrome.

Uganda: paediatric AIDS.

PIP: The occurrence of reported cases of AIDS in children in Uganda, and the most common symptoms are discussed. By May 1988, 359 cases of AIDS in children has been reported. All but 12 were in babies less than 2 years of age, suggesting that maternal transmission, rather than casual contact, had caused the infection. Information was available on HIV status of 224 mothers. 42% of these had AIDS or ARC (AIDS related complex). 85 of 87 mothers whose sera had been tested were positive for HIV. Blood testing is not accurate in children until about 15 months of age, since maternal antibodies persist after birth. The most common symptoms seen in childhood AIDS in Uganda are weight loss, failure to thrive, chronic diarrhea, and repeated, chronic oral thrush (candidiasis). Other indicators are otitis media, generalized dermatitis, tuberculosis, septicemia and meningitis. Less common signs are shingles, Kaposi's sarcoma and Cryptospor meningitis. Some of these clinical findings are common in this area, so it is important to define a working clinical case definition of pediatric AIDS.^ieng

[Acquired immunodeficiency syndrome and odontostomatology in Africa]. / Syndrome immunodeficitaire acquis et odonto-stomatologie en Afrique.

PIP: AIDS represents a grave threat to both the general population and the medical personnel of Central Africa. The literature suggest use of rubber gloves for physicians, midwives, and laboratory personnel but is silent on their usefulness for dentists. Dentists are in constant contact with saliva and blood, and their risk of infection during their working hours is probably proportional to the number of patients they treat each day and the number of years they have practiced. Prophylaxis seems to be a more complex problem in Africa than in the US. There are few well defined risk groups in Africa, the disease has probably been present longer, and the prevalence of HIV infection is probably higher. Each patient must therefore be considered a possible carrier. Dentists should use a different pair of gloves for each patient, a difficult goal in Africa where supplies of all kinds are scarce. The majority of instruments and materials used in odontostomatology are designed for use with uncovered hands. To avoid infection of 1 patient by another, only disposable needles and syringes should be used. All nondisposable equipment must be completely sterilized before use. Given the limited success of previous health campaigns to control sexually transmitted diseases in Africa, the prospects for success of AIDS prevention programs are modest. Until a successful vaccine and simple diagnostic test are found, measures to prevent AIDS should be modelled on those to prevent the far more contagious hepatitis B.^ieng

Primary Sjogren syndrome: clinical and immunopathologic features.

Primary Sjogren syndrome is an autoimmune condition in which dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) result from lymphocytic infiltration of lacrimal and salivary glands. Clinical and laboratory features of 60 primary Sjogren syndrome patients seen at our clinic during the past three years are presented. These patients illustrate the wide spectrum of extraglandular features that may occur as a result of lymphoid infiltration of lung, kidney, skin, stomach, liver, and muscle. They further emphasize the difficulty in classifying a patient as primary or secondary Sjogren syndrome (ie, sicca symptoms associated with systemic lupus erythematosus, rheumatoid arthritis, or scleroderma), particularly early in the disease course. As an initial step in understanding the pathogenesis, the lymphocytes that infiltrate the salivary glands and lymph nodes were characterized by using monoclonal antibodies that recognize distinct lymphocyte subsets and by using in vitro functional assays. These studies have demonstrated that affected tissues have infiltrates of T cells with helper/inducer activity and with a high frequency of "activation antigens." The immunohistologic techniques are useful in differentiating "benign" and "pseudolymphoma" lesions (both due predominantly to T cells) from non-Hodgkin lymphoma (usually due to B-cell infiltrates). Although there is no "cure" for primary Sjogren syndrome patient's symptoms may be significantly improved by measures aimed at prevention of ocular and dental complications and by the recognition of extraglandular features that may be amenable to specific treatment.

Gastrointestinal manifestations of multiple endocrine neoplasia, type IIB.

Multiple endocrine neoplasia, type IIB (MEN 2b), is comprised of medullary carcinoma of the thyroid, pheochromocytoma, diffuse ganglioneuromatosis of the gastrointestinal tract, and skeletal abnormalities. Alimentary tract manifestations, especially enlargement of the lips and tongue by proliferative neural tissue, are often the earliest clues to the presence of the syndrome. A patient is presented here who illustrates the chronicity and diversity of symptoms characteristic of MEN 2b. It is important to recognize the typical oral manifestations of this syndrome so that the thyroid gland can be evaluated before the development of disseminated medullary carcinoma.

Halitosis.

Bad breath, halitosis, is an unpleasant problem most people try to avoid. Physicians seem particularly adept at avoiding halitosis by referring patients with this problem to a dentist. However, halitosis may be a symptom of a serious disease. Even if a serious disorder is not present, the cause of bad breath can usually be determined and appropriate therapy given. In this article the causes of halitosis and suggestions for treatment are outlined.