The effect of pimecrolimus cream 1% compared with triamcinolone acetonide paste in treatment of atrophic-erosive oral lichen planus.

INTRODUCTION: Oral lichen planus (OLP) is a common chronic mucocutaneous disease. Patients with atrophic and erosive types of OLP often have symptoms of soreness, and require proper treatment. The main treatment for OLP has been the administration of topical or systemic corticosteroids. The objective of this study was to compare the efficacy of adcortyl cream (triamcinolone acetonide in orabase) with topical pimecrolimus cream for the treatment of erosive OLP. MATERIALS AND METHODS: Twenty-eight patients with OLP were enrolled in a single blind clinical trial and assigned to either a pimecrolimus 1% cream group or an adcortyl 0.1% cream group. The medication was applied every day for 2 months and patients were assessed every 2 weeks. RESULTS: The mean lesion size and mean pain and burning sensation scores did not differ between the pimecrolimus and adcortyl cream groups. The pimecrolimus cream was well tolerated. No clinical drug-related adverse events were observed. CONCLUSION: Topical pimecrolimus cream may be recommended as a safe and effective alternative therapy in the treatment of OLP. Pimecrolimus cream is as effective as adcortyl cream in managing the signs and symptoms of OLP.

Oral verrucous carcinoma and ameloblastoma: a rare coincidence.

INTRODUCTION: Oral verrucous carcinoma (OVC) is a rare malignancy of the oral cavity that was first described by Ackerman. This tumor is a well-differentiated low-grade, slow growing cancer that is locally invasive without metastasis. Ameloblastoma is one of the most common odontogenic tumors, which originates from the odontogenic epithelium. Verrucous carcinoma along with central ambloblastoma is a rare phenomenon. CASE REPORT: A case of verrucous carcinoma along with central ambloblastoma in a 49-year-old man, which was referred with a painless exophytic lesion with a verrucous and granular surface, is reported. Panoramic radiography revealed a well-defined radiolucency with sclerotic borders. To the best available knowledge, this phenomenon has not yet been reported. CONCLUSION: Verrucous carcinoma could occur in the wall of odontogenic cysts and tumors and should be considered during the differential diagnosis of a radiolucency, which is observed in the jaws with rapid growth or which presents some changes from its previous appearance.

Oral manifestations of human immunodeficiency virus-infected patients.

INTRODUCTION: Oral lesions are among the earliest clinical manifestations of human immunodeficiency (HIV) infection and are important in early diagnosis and for monitoring the progression to acquired immunodeficiency syndrome (AIDS). The purpose of this study was to determine the prevalence of oral lesions and their relationship with a number of factors in HIV/AIDS patients attending an HIV center. MATERIALS AND METHODS: A total of 110 HIV-positive patients were examined to investigate the prevalence of oral lesions according to the criteria established by the European Community Clearing House on Oral Problems Related to HIV Infection. An independent T-test was used for correlation of oral lesions with CD4+ count and a χ2 test was used for analysis of the relationship of co-infection with hepatitis B virus (HBV), sexual contact, route of transmission, history of drug abuse, and history of incarceration. RESULTS: Most of the cases were male patients (82.7%). The mean age across all participants was 36.2±8.1 years. Rampant carries, severe periodontitis and oral candidiasis were the most notable oral lesions. Oral lesions were more prevalent in patients between 26-35 years of age. There was a significant difference between patients with and without pseudomembranous candidiasis and angular cheilitis according to mean level of CD4+. CONCLUSION: The most common oral presentations were severe periodontitis, pseudomembranous candidiasis and xerostomia.

A comparative study of toluidine blue-mediated photodynamic therapy versus topical corticosteroids in the treatment of erosive-atrophic oral lichen planus: a randomized clinical controlled trial.

Recently, photodynamic therapy (PDT) has been suggested as a new treatment option that is free from side effects for erosive-atrophic oral lichen planus (OLP). The purpose of this study was to compare the effect of toluidine blue-mediated photodynamic therapy (TB-PDT) with local corticosteroids on treatment of erosive-atrophic OLP. In this randomized clinical trial, 25 patients with keratotic-atrophic-erosive oral lichen planus were allocated randomly into two groups. Group 1 (experimental): topical application of toluidine blue with micropipette was applied, and after 10 min, the patients were treated with a 630-nm GaAlAs laser (power density: 10 mW/cm(2)) during two visits. Group 2 (control) used mouthwash diluted with dexamethasone (tab 0/5 in 5 ml water) for 5 min, and then, it was spat out, and after 30 min, the mouth was rinsed with 30 drops of nystatin 100,000 units for 5 min and again spat out. Demographic data, type, and severity of the lesions and pain were recorded before and after treatment and then at the 1-month follow-up visit. Response rate was defined based on changes in intensity of the lesions and pain. In the experimental and control groups, sign scores of changes significantly reduced after treatment respectively (p = 0.021) and (p = 0.002), but between the two groups, no significant difference was observed (p = 0.72). In the experimental (p = 0.005) and control groups (p = 0.001), the intensity of lesions significantly reduced after treatment and there was a significant difference between the two groups (p = 0.001). The mean amount of improvement in pain was significantly greater in the control group compared with the experimental group (p < 0.001) (α = 0.05). Our study showed that TB-PDT with laser was effective in the management of OLP.

Removal of refractory erosive-atrophic lichen planus by the CO2 laser.

UNLABELLED: AIM, STUDY AND BACKGROUND: The erosive-atrophic form of Oral lichen Planus (OLP) is often associated with severe pain and burning sensation. This study investigated the efficacy of CO2 laser surgery for management of refractory erosive-atrophic OLP. METHODS: Ten patients with thirteen erosive-atrophic OLP resistant to standard therapy participated in this study. The size and clinical scores of the lesions and the level of pain/discomfort were recorded before treatment. The lesions were then removed with a CO2 laser device (10600 nm, continuous wave, 5 W, slightly defocused). The subjects were evaluated 1 month and 3 months later and the response rate was assessed according to the decrease in pain, sign scores and size of the lesions. RESULTS: There was a significant reduction in pain and lesion size at 1 and 3 months following laser treatment (p<0.05). The sign scores of the lesions were also significantly improved at follow-up periods compared to the pretreatment state (p<0.05). At the end of the follow-up period, 54% of the lesions showed 3 or 4 degrees of improvement in the clinical score and 23% improved 1 or 2 degrees, whereas 23% remained unchanged post-operatively compared to the pretreatment evaluation. CONCLUSION: The present results indicate that the CO2 laser surgery is an effective modality for management of erosive-atrophic OLP and can be considered as a suitable alternative to standard treatment.

The Effect of Low-level Laser Therapy on Trigeminal Neuralgia: A Review of Literature.

The effect of low intensity laser radiation in the treatment of acute and chronic pain is now established in many studies. Tri-geminal neuralgia is a pain passes through nerve's branches and its trigger is located in skin or mucosa that could lead to pain with a trigger stimulus. The pain involved branches of trigeminal nerve that sometimes has patients to seek the treatment for several years. Nowadays different treatments are used for relief of pain that most of them cause tolerance and various side effects. This paper reviews and summarizes scientific papers available in English literature publishedin PubMed, Scopus, Science Direct, Inter science, and Iran Medex from 1986 until July 2011 about the effect of these types of lasers on trigeminal neuralgia which is one of the most painful afflictions known. In different studies, the effect of laser therapy has been compared with placebo irradiation or medicinal and surgical treatment modalities. Low-level laser therapy (LLLT) is a treatment strategy which uses a single wavelength light source. Laser radiation and monochromatic light may alter cell and tissue function. However, in most studies laser therapy was associated with significant reduction in the intensity and frequency of pain compared with other treatment strategies, a few studies revealed that between laser and placebo group there was not any significant difference according to the analgesic effect. Low-level laser therapy could be considered in treatment of trigeminal neuralgia without any side effects.

Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran.

OBJECTIVE: The aim of this study was to determine the prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, northeast of Iran. BACKGROUND: This study was conducted to assess the prevalence of oral lesions in the institutionalized elderly. METHODS: In this survey, we studied all of the nursing homes in Mashhad; a total of five encompassing 237 residents. The subjects were examined and lesions recorded in a designed checklist. T-test, chi-square and Fisher's exact tests were used for the analysis. RESULTS: The mean age of the patients was 79.59 ± 8.88. Ninety-eight per cent of cases had at least one oral mucosal lesion. The most common lesions were fissured tongue (66.5%), atrophic glossitis (48.8%), sublingual varicosity (42%) and xerostomia (38%). There was no significant difference in the prevalence of denture-related lesions (DRLs) between men and women (p > 0.05). Xerostomia was more prevalent in 70-79-year-old than in 60-69-year-old subjects. No case of oral malignant lesion was detected. DISCUSSION: These findings revealed a higher prevalence of oral mucosal lesions in Mashhad city compared with other studies conducted in other major cities in Iran and abroad. The results emphasise the necessity of national programmes towards oral health promotion.

Pyostomatitis vegetans: report of a rare case.

Pyostomatitis vegetans is a rare chronic disorder of the oral mucosa. It is a highly specific marker for inflammatory bowel disease. Although immunological and microbial factors have been suggested as predisposing factors, the exact aetiology is unknown. Here, a case of pyostomatitis vegetans in a 30-year-old woman is reported. No bowel involvement was observed. Report of such cases emphasizes the importance of early diagnosis of oral findings in control and management of disease.

A comparative pilot study of low intensity laser versus topical corticosteroids in the treatment of erosive-atrophic oral lichen planus.

BACKGROUND AND OBJECTIVE: Treatment of oral lichen planus (OLP) remains a great challenge for clinicians. The aim of our study was to compare the effect of low intensity laser therapy (LILT) with topical corticosteroids in the treatment of oral erosive and atrophic lichen planus. MATERIALS AND METHODS: Thirty patients with erosive-atrophic OLP were randomly allocated into two groups. The experimental group consisted of patients treated with the 630 nm diode laser. The control group consisted of patients who used Dexamethason mouth wash. Response rate was defined based on changes in the appearance score and pain score (Visual Analogue Scale) of the lesions before and after each treatment. RESULTS: Appearance score, pain score, and lesion severity was reduced in both groups. No significant differences were found between the treatment groups regarding the response rate and relapse. CONCLUSION: Our study demonstrated that LILT was as effective as topical corticosteroid therapy without any adverse effects and it may be considered as an alternative treatment for erosive-atrophic OLP in the future.

Clinical and histopathological analysis of oral squamous cell carcinoma of young patients in Mashhad, Iran: a retrospective study and review of literature.

OBJECTIVES: Oral Squamous cell carcinoma (OSCC) is primarily a disease that mainly occurs in males in their sixth and seventh decades of life and is rare in young adults. STUDY DESIGN: In this retrospective study, records of patients under the age of 40, with the diagnosis of OSCC in the Oral Medicine Department of Mashhad Dental Faculty during the past 13 years were analyzed. Their socioeconomic data, demographic, clinical and histopathological characteristics, risk factors, familial history were assessed and applicable studies and case reports in the literatures were reviewed. PCR (Polymerase chain reaction) analysis was also done for detection of human papilloma virus (HPV). RESULTS: From 158 cases of OSCC diagnosed in our centre, 21 patients were younger than 40 years. Most of them were young men (12 cases). There was no significant risk factor in this group. The most common site of involvement was the tongue. The most common clinical presentation was exophytic lesion with ulcer. No HPV DNA was detected in these patients. CONCLUSION: Characteristics of OSCC in young patients are different from older age group. Major risk factors (smoking and alcohol consumption and HPV) were not etiologic factors for OSCC in young patients in our province.

Oral cancer knowledge among patients referred to Mashhad Dental School, Iran.

BACKGROUND: Early intervention improves treatment results in oral cancer. The purpose of present study was to assess the level of awareness and knowledge about oral cancer among patients referred to Mashhad Dental School. METHODS: Three hundred and twenty individuals completed a 15 item written questionnaire that focused on oral cancer risk factors, signs and symptoms, epidemiology, and treatment. Statistical analyses were performed with the Kruskal-Wallis and Friedman tests (level of significance, P=0.05). RESULTS: A total of 89.4% of patients who completed the questionnaire had a poor understanding of oral cancer, particularly with regard to etiology. Additionally, 83.8% were unaware of oral cancer risk factors. Only 8.8% knew the most likely sites for oral cancer. No relation was identified between knowledge and sex (P=0.01), or age (P=0.052) of the subjects. There was a significant correlation between the level of education and knowledge score (P<0.001). Medical students and health professionals had the highest knowledge scores (P<0.001). CONCLUSION: According to the results of this study, information regarding oral cancer knowledge is quite low. Therefore, it seems necessary to increase the level of public awareness with the use of various educational programs in order to reduce morbidity and mortality.

Multifocal epithelial hyperplasia, a rare oral infection in Asia: report of twelve cases in Iran.

OBJECTIVES: Multifocal epithelial hyperplasia (MEH) is benign, asymptomatic oral disease with viral etiology. The frequency of this disease varies widely from one geographic region to another, and can vary, from 0.002 to 35% depending on the population studied. STUDY DESIGN: Here we report the clinicopathological features of twelve cases of MEH referred to Oral Medicine Department of Mashhad Dental School for the first time in Iran. Records of patients with the diagnosis of MEH in our department during 7 years were analyzed and data were extracted. RESULTS: Most of the patients were younger than 20-year-old (66%), and females were predominantly affected (7:12). The mean age of onset was 12.72+/-10.14 years and the mean duration was 52.54 +/- 78.51 months. Patients had multiple, well circumscribed, soft, non tender, flattened papules, with a color similar to the adjacent mucosa, in different areas of the oral cavity but the most affected site was buccal mucosa. Familial history of such lesions was negative in all patients. Only three cases showed spontaneous regression. CONCLUSION: In spite of rare nature of this disease in Asia, it seems that it is not the case in Khorasan Province, southeast Iran.

Oral Squamous cell carcinoma with an unusual clinical manifestation: a case report.

INTRODUCTION: Squamous cell carcinoma is the most common malignant tumor of the oral cavity and one of the 10th most common causes of death. It arises from dysplastic oral squamous epithelium. By considering the pathogenesis of squamous cell carcinoma, the smooth and intact surface for this lesion is not usual. CASE PRESENTATION: A painful nodular lesion with smooth surface on the left buccal mucosa of a 75-year-old female patient was observed. She noticed it 2 weeks ago. Histopathological examination revealed oral squamous cell carcinoma. CONCLUSION: In this paper, we report an unusual clinical presentation of oral squamous cell carcinoma in buccal mucosa which is very rare.

Squamous cell carcinoma arising from an odontogenic keratocyst: a case report.

Squamous cell carcinoma (SCC) derived from keratocystic odontogenic tumor is an extremely rare tumor that is limited to the jaws. Most intraosseous carcinomas originate from the epithelial lining of odontogenic cysts, so they are called odontogenic carcinomas. They occur more frequently in men and the mean age of patients is 57 years. The following report describes an extremely rare case of an odontogenic carcinoma derived from a keratocystic odontogenic tumor in a 20-year-old man. The patient presented with an exophytic lesion in the retromolar region of the mandible which was first noticed by the patient 25 days earlier. In panoramic radiograph a well-defined radiolucency around the impacted 3rd molar was observed. Clinical and radiographic diagnosis was odontogenic SCC. Surgical resection was performed and histhopathologic examination of the lesion confirmed the diagnosis of SCC in the wall of a keratocystic odontogenic tumor.

Oral Lichen Planus: a retrospective study of 420 Iranian patients.

OBJECTIVE: In terms of the demographic and clinical characteristics, this is the one of the largest studies on Iranian patients with Oral Lichen Planus (OLP). STUDY DESIGN: Data was taken from the medical records of 420 consecutive patients referred to the Oral Medicine Department, and who were subsequently found to have clinical and usual histopathology consistent with features of OLP. RESULTS: Seventy percent of the patients had been referred to the Oral Medicine Department by general dental practitioners. 52.6% were referred due to oral mucosal and/or gingival pain or burning sensation. Reticular OLP was the most common presentation (76.9%); about 18% of patients reported symptoms or signs, or had a known history of OLP, or possible Lichen Planus affecting non-oral epithelia. A malignant transformation rate of 0.07% was observed.

Extragingival pyogenic granuloma: a case report.

The pyogenic granuloma is thought to represent an exuberant tissue response to local irritation or trauma.Clinically these lesions usually present as single nodule or sessile papule with smooth or lobulated surface. These may be seen in any size from a few millimeters to several centimeters. Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly (75% of all cases). Rarely it may present extragingivally. Here, we report a case of Pyogenic granuloma in the palate of a 16 years old man which is very rare location for this lesion.

Oral Squamous Cell Car-cinoma with an Unusual Clinical Manifestation: A Case Report.

Squamous cell carcinoma (SCC) is the most com-mon malignant tumor of the oral cavity and one of the ten most common causes of death. It arises from dysplastic oral squamous epithelium. Considering the pathogenesis of SCC, a smooth and intact surface in this lesion is not a usual finding. In this paper, we report an extremely rare case of oral SCC in buccal mucosa presenting as an exo-phytic lesion with smooth and intact surface, very unusual for oral SCC.