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Florid cemento-osseous dysplasia (FCOD) is a benign slowly growing fibro-osseous disorder, usually diagnosed accidentally through routine radiographic examination. The lesions are generally asymptomatic, but, in the most severe cases, focal enlargement and pain may occur due to infection. Here, we report the rare case of a Caucasian middle-aged woman showing, at orthopantomography performed during routine dental check-up, the presence of multiple symmetrical, dense and lobulated radiopaque bone lesions in several areas of the jaws, surrounded by a radiolucent border. The lesions were asymptomatic. Histologically, the replacement of healthy bone by metaplastic bone and fibrous tissue, typical of FCOD, was observed. The lesion remained painless, clinically and radiologically stable over two years follow-up. In asymptomatic cases, no treatment is required, but active clinical and radiographic follow-up are recommended at long-term, to reduce the risk of dental infections and oral surgery involving the area of the lesion. The avascular nature of FCOD contributes to susceptibility to severe infection, bone sequestration and osteomyelitis, limiting the in-site penetration of the antibiotics. Therefore, a careful clinical and radiographic monitoring of the lesions is recommended together with periodical dental check-up.
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BACKGROUND: Human immunodeficiency virus (HIV) infection can be associated with oral mucosal diseases, including oral candidiasis and HPV infection, which are putative indicators of the immune status. AIM AND METHODS: This retrospective cross-sectional study was aimed at assessing the prevalence of HIV-related oral mucosal lesions in a cohort of Italian HIV+ patients regularly attending the Clinics of Infectious Diseases. RESULTS: One hundred seventy-seven (n = 177) patients were enrolled and 30 (16.9%) of them showed HIV-related diseases of the oral mucosa. They were mainly found in male patients over 35 years old, undergoing Combination Antiretroviral Therapy (cART), and with CD4+ count < 500/µL. Oral candidiasis was the most common HIV-related oral lesion. No significant correlations could be detected between the prevalence of HPV infection and other clinical parameters (lymphocyte count, cART treatment and viral load). CONCLUSIONS: HIV-related oral mucosal diseases can correlate with immunosuppression. Early diagnosis and management of oral lesions in HIV+ patients should be part of the regular follow-up, from a multidisciplinary perspective of collaboration between oral medicine and infectious disease specialists, in an attempt to reduce morbidity due to oral lesions and modulate antiretroviral therapy according to the patient's immune status.
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Osteoradionecrosis (ORN) is a serious long-term complication of head and neck radiotherapy (RT), which is often triggered by dental extractions. It results from avascular aseptic necrosis due to irradiated bone damage. ORN is challenging to treat and can lead to severe complications. Furthermore, ORN causes pain and distress, significantly reducing the patient's quality of life. There is currently no established preventive strategy. This narrative review aims to provide an update for the clinicians on the risk of ORN associated with oral surgery in head and neck RT patients, with a focus on the timing suitable for the oral surgery and possible ORN preventive treatments. An electronic search of articles was performed by consulting the PubMed database. Intervention and observational studies were included. A multidisciplinary approach to the patient is highly recommended to mitigate the risk of RT complications. A dental visit before commencing RT is highly advised to minimize the need for future dental extractions after irradiation, and thus the risk of ORN. Post-RT preventive strategies, in case of dento-alveolar surgery, have been proposed and include antibiotics, hyperbaric oxygen (HBO), and the combined use of pentoxifylline and tocopherol ("PENTO protocol"), but currently there is a lack of established standards of care. Some limitations in the use of HBO involve the low availability of HBO facilities, its high costs, and specific clinical contraindications; the PENTO protocol, on the other hand, although promising, lacks clinical trials to support its efficacy. Due to the enduring risk of ORN, removable prostheses are preferable to dental implants in these patients, as there is no consensus on the appropriate timing for their safe placement. Overall, established standards of care and high-quality evidence are lacking concerning both preventive strategies for ORN as well as the timing of the dental surgery. There is an urgent need to improve research for more efficacious clinical decision making.
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Post-operative management of patients receiving oral biopsy includes the control of edema, pain, infection, and re-epithelization at the surgical site. This clinical study investigates the topical use of a bioadhesive gel, containing essential oils, to promote wound healing and prevent post-operative pain and infection, avoiding the need for surgical suture and chlorhexidine applications. Ten patients, who needed to receive oral biopsies (≤6 mm in diameter) for the diagnosis of mucosal oral lesions, were enrolled. The bioadhesive gel successfully controlled the post-surgical pain; at 1-week follow-up visit, no signs of infection nor side effects were reported and the surgical sites were completely healed. The bioadhesive gel resulted in a very promising agent for the post-operative management of oral biopsy site, without the need for surgical suture and chlorhexidine applications.
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Anti-Inflamatórios/administração & dosagem , Mucosa Bucal/efeitos dos fármacos , Óleos Voláteis/administração & dosagem , Cicatrização/efeitos dos fármacos , Adulto , Anti-Inflamatórios/química , Biópsia/efeitos adversos , Clorexidina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/lesões , Mucosa Bucal/patologia , Cuidados Pós-OperatóriosRESUMO
OBJECTIVE: Unstimulated whole saliva (UWS) sialometry uses the spitting method to assess occurrence of hyposalivation. This study compares the UWS flow rates in volunteers sitting in a laboratory or in a clinical setting, in order to evaluate the influence of environment on salivary secretion. DESIGN: 25 healthy volunteers were recruited and divided into two groups to perform UWS sialometry under the two different settings (T1). Eleven weeks later, the participants repeated the same test (T2). At a unique time point and under the clinical setting, 18 patients complaining of xerostomia also performed the UWS sialometry; these values were used as control to corroborate findings. RESULTS: Different scenarios - laboratory one vs. clinical one - did not affect measurements of mean UWS flow rates. Both intra- and inter-individual variabilities, reported as standard error of the mean (SEM) and within-subject variance (WSV), resulted below the threshold of 0.1g/min. A significant difference was found between UWS flow rates from healthy volunteers and those from patients with xerostomia (p<0.05). Test/retest reliability showed a moderate correlation of datasets collected at the two time points from healthy volunteers (T1 vs. T2, 11 weeks later): under laboratory and clinical settings, Pearson's coefficients of correlation were r=0.62 and r=0.32, respectively. CONCLUSIONS: Type of environment did not influence UWS sialometry via spitting method, which appeared reliable for intra-day analysis of the salivary flow rate, although prone to physiological variations over time.
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Saliva/metabolismo , Adolescente , Adulto , Meio Ambiente , Feminino , Humanos , Masculino , Saliva/fisiologia , Salivação/fisiologia , Taxa Secretória/fisiologia , Xerostomia/diagnóstico , Xerostomia/fisiopatologia , Adulto JovemRESUMO
Pseudoxanthoma elasticum (PXE), which is a genetic, multi-target disorder characterized by progressive calcification and fragmentation of elastic fibers, affects several organs, including the eyes, skin, and cardiovascular system. Diagnosis of PXE is currently based on cutaneous and ocular signs, histopathologic findings, and a patient's family history. PXE-related oral mucosal lesions are rarely reported, possibly due to the potential for misdiagnosis as Fordyce spots; however, when such lesions are reported, they are primarily localized to the vestibular mucosa of the lower lip. Here, we report the case of a female with an intraoral presentation of PXE at the labial and palatal sites. PXE was previously suspected in this patient because of the presence of cardiovascular, ocular, and cutaneous signs; however, a cutaneous biopsy showed findings not consistent with PXE. Incisional biopsy of the palatal lesion confirmed the PXE diagnosis, leading to proper management of the disorder to prevent ophthalmologic and cardiovascular complications.
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Palato , Pseudoxantoma Elástico/diagnóstico , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment.