Levamisole and low-dose prednisolone in the treatment of reccurent aphthous stomatitis.

CONTEXT: Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease. However, the available therapies for RAS only relieve symptoms and do not provide a cure. AIMS: This study assessed the response to treatment with levamisole and low-dose prednisolone drug combination in patients with RAS. METHODS AND MATERIAL: Fifty RAS subjects were enrolled in the single-blind randomized placebo-controlled trial. Study medications were administered thrice daily for 3 consecutive days/week for 3 consecutive weeks. Patients in Group 1 received placebo, Group 2 received levamisole (50 mg) and Group 3 received levamisole (50 mg) and low-dose prednisolone (5 mg). Patients were followed up for 60 days after treatment. Response to treatment was assessed using the following clinical parameters: pain due to ulcers, number of ulcers/episode, size of ulcers, duration of ulcers, and frequency of ulcers (episodes/month). STATISTICAL ANALYSIS USED: Mann­Whitney U-test. RESULTS: A statistically significant improvement was noted in all parameters except for the size of ulcers in patients treated with levamisole alone and with combination of levamisole and low-dose prednisolone. There was no statistically significant improvement in the placebo group. Both active groups had significantly better improvement when compared to placebo group, while there was no significant difference between the two active groups. CONCLUSIONS: Levamisole alone and combination of levamisole and low-dose prednisolone are effective modes of therapy for RAS.

Pachyonychia congenita tarda: A rare case report.

Pachyonychia congenita is a rare, but well-characterized autosomal dominant disorder of keratinization. It usually begins within the first few months of life. Here, we are presenting a rare case, which started at the age of 10 years of life and is known as pachyonychia congenita tarda. The case is being reported for its rarer occurrence as the patient had oral leukokeratosis and angular cheilosis present in the same type of the syndrome (Jadassohn-Lewandowsky syndrome), which is still uncommon.

Surgical Management of a Rare Case of Congenital DoubleUpper Lip.

Congenital double lip is a rare developmental anomaly which usually involves the upper lip. It may occur in isolation or as a part of Ascher's syndrome. The occurrence of double lip may result in facial deformity especially when patient attempts to talk, smile, or even try to show the teeth. It affects esthetics and also interferes with speech and mastication. Although surgery may be undertaken to facilitate speech and mastication, majority of cases are operated for cosmetic reasons. A case of congenital double upper lip which was surgically treated for cosmetic reason is reported.

Analgesic efficacy of diazepam and placebo in patients with temporomandibular disorders: a double blind randomized clinical trial.

AIM: The aim of the study was to evaluate and compare the analgesic efficacy of placebo and diazepam in patients with temporomandibular disorder. MATERIALS AND METHODS: Thirty-five patients were recruited with a diagnosis of temporomandibular disorder based on standard clinical diagnostic criteria for temporomandibular disorder. The patients were put in to one of the two groups: placebo or diazepam at random. The average pain intensity was recorded with visual analog scale (VAS) at pretreatment, at weekly interval till the completion of a three-week trial and at post-treatment visit on the eighth week from baseline. The secondary outcome measures were changes in masticatory muscle tenderness, viz. massater muscle, lateral pterygoid muscle, medial pterygoid muscle and temporalis muscle and changes in mouth opening. STATISTICAL ANALYSIS: Intra-group comparison for analgesic efficacy and mouth opening was carried out by Wilcoxon's signed ranked test. Inter-group comparison for analgesic efficacy was also carried out using Mann-Whitney's test. RESULTS: A statistically significant (P<0.01) decrease in temporomandibular disorder pain in the placebo group (65%) and statistically highly significant (P<0.001) decrease in the diazepam group (72%) were observed on VAS after three weeks of treatment. The inter-group comparison demonstrated no statistically significant difference between the groups. CONCLUSION: This study suggests that the placebo can give near similar results as diazepam can. So the role of placebo should also be considered as one of the important management strategies. In the short term, reduction in the masticatory muscle tenderness and significant improvement in the mouth opening in both the groups were observed.

Oral manifestations and radiographic changes in the jaw-bones of patients with end-stage renal disease onmaintenance hemodialysis: a descriptive study / Estudo descritivo das manifestações bucais e alterações radiográficas em maxilares de pacientes com doençarenal terminal e sob hemodiálise

Objectives: The purpose of the present study was to assess the oral manifestations and radiographic changes in the jawbones of patients undergoing hemodialysis, diagnosed with end-stage renal disease (ESRD). Methods: Forty patients on maintenance hemodialysis were clinically examined for oral manifestations and evaluated for radiographic changes in the jaws with panoramic and intra-oral periapical radiographs. Results were expressed as Percentage. Results: Out of 40 patients, 37 patients (92.5%) showed at least one or more oral manifestations. The most common oral manifestations were mucosal pallor (70%), xerostomia (57.5%), petechiae and ecchymoses (37.5%), and less common were taste alterations (15%), uremic odor (7.5%), coated tongue (10%) and mucosal pain (2.5%). Radiographic changes seen were loss of lamina dura (22.2%), altered trabecular pattern (5.5%), multiple radiolucent lesions (5%), and pulp calcification (2.7%). Conclusions: Most of the patients presented with oral signs and symptoms. However it was observed that patients demonstrating radiographic changes were mostly those who were on dialysis for a relatively long duration.

Objetivos: O objetivo do presente estudo foi avaliar as manifestações orais e alterações radiográficas nos maxilares de pacientes submetidos à hemodiálise e com diagnóstico de doença renal em estágio terminal (DRET). Métodos: 40 pacientes em hemodiálise de manutenção foram examinados clinicamente e avaliados radiograficamente por meio de radiografias panorâmicas e periapicais em busca de manifestações orais nas mandíbulas. Resultados: Dos 40 pacientes, 37 pacientes (92,5%) apresentaram pelo menos uma ou mais manifestações orais. As manifestações orais mais comuns foram: palidez da mucosa (70%), xerostomia (57,5%), petéquias e equimoses (37,5%); e menos comuns: alterações do paladar (15%), odor urêmico (7,5%), língua saburrosa (10%) e mucosa dolorida (2,5%). As alterações radiográficas observadas foram a perda da lâmina dura (22,2%), padrão trabecular alterado (5,5%), lesões radiolúcidas múltiplas (5%) e calcificação pulpar (2,7%). Conclusões: A maioria dos pacientes apresentava sinais e sintomas orais. Entretanto, foi observado que os pacientes demonstrando alterações radiográficas foram principalmente aqueles que estavam em diálise por um período relativamente longo.

Lycopene in the management of oral lichen planus: a placebo-controlled study.

CONTEXT: Oxidative stress has been implicated in the pathogenesis of lichen planus, and a lower level of lycopene has been reported in erosive and atrophic oral lichen planus (OLP) patients. However, its efficacy in the management of OLP has not been reported. AIM: This study was designed to assess the efficacy of systemic lycopene in the management of OLP. SETTINGS AND DESIGN: This prospective, randomized, double-blind, placebo-controlled study was done in the Oral Medicine Department of a postgraduate teaching dental hospital in India. MATERIALS AND METHODS: Thirty symptomatic OLP patients, randomly divided into two groups of 15 each, were administered lycopene 8 mg/day and an identical placebo, respectively, for 8 consecutive weeks. Burning sensation using visual analogue scale and overall treatment response using Tel Aviv-San Francisco scale were recorded at every visit. The data obtained were analyzed statistically using Wilcoxon Rank test, Mann-Whitney and Fischer's Exact test. RESULTS: A higher (84%) reduction in burning sensation was seen in lycopene than in the placebo group (67%). All 15 (100%) patients in the lycopene group showed 50% or more benefit and 11 (73.3%) patients showed 70-100% benefit, while this number was only 10 and 4 (26.7%), respectively, in the placebo group. CONCLUSION: Lycopene was very effective in the management of OLP, and oxidative stress may have a role in disease pathogenesis.

Probiotics--do they have a role in medicine and dentistry?

Probiotics are dietary supplements containing potentially beneficial bacteria or yeasts. They are administered in different quantities that allow for colon colonization. These products help in stimulating health promoting flora and also suppressing the pathologic colonization and disease spread. The use of probiotic plays an important aspect in dentistry too ever since the oral infections occupied the prime space among the other infections effecting the humans. This concept of microbial ecologic change both for medical and dental changes has accumulated a lot of evidence in recent times. But to date, no substantial literature and use has been postulated. There are claims that probiotics strengthen the immune system to combat allergies, stress, exposure to toxic substances and other diseases. There are reports of their beneficial use in HIV infection and cancers, mostly, the colo-rectal carcinomas. Their use in pre malignant and malignant oral disorders is yet to be probed. Strains of genera lactobacillus and bifidobacterium are the most widely used probiotic bacteria. This review is an attempt to discuss briefly the role of probiotics in medicine and dentistry.

Pathogenesis of oral lichen planus--a review.

Oral lichen planus (OLP) is a T-cell-mediated chronic inflammatory oral mucosal disease of unknown etiology. OLP presents as white striations, white papules, white plaques, erythema, erosions, or blisters affecting predominantly the buccal mucosa, tongue and gingiva. Both antigen-specific and non-specific mechanisms are hypothesized to be involved in the pathogenesis of oral lichen planus (OLP). Antigen-specific mechanisms in OLP include antigen presentation by basal keratinocytes and antigen-specific keratinocyte killing by CD8(+) cytotoxic T cells. Non-specific mechanisms include mast cell degranulation and matrix metalloproteinase activation in OLP lesions. These mechanisms may combine to cause T cell accumulation in the superficial lamina propria, basement membrane disruption, intra-epithelial T cell migration and keratinocyte apoptosis in OLP. The various hypotheses proposed for pathogenesis of oral lichen planus are discussed in this review.

Garre's sclerosing osteomyelitis.

Garre's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre's osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

Desmoplastic ameloblastoma in the maxilla: a case report and review of literature.

Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma (AM). The location of this lesion, its histology and radiological features differ from those of conventional AM. We report a case of DA in the canine / premolar region of the left maxilla of a 32-year-old woman and present a brief review of the literature. Radiographically, it had a mixed radiolucent / radiopaque appearance with ill-defined margins. Histologically, the tumor was characterized by extensive stromal desmoplasia and small tumor islands of odontogenic epithelium in the stroma, along with a few areas of reactive bone formation. The tumor was treated by partial maxillectomy and the patient was disease free after 1 year.

Malignant peripheral nerve sheath tumor of the maxilla.

The term malignant peripheral nerve sheath tumor (MPNST) refers to most spindle cell sarcomas arising from nerve or neurofibroma or showing nerve sheath differentiation and has been recently adopted by WHO. Malignant tumors of the peripheral nerve sheath are most commonly seen in association with the neurofibroma or at the site of irradiation and may also occur de novo. Its diagnosis has been called "one of the most difficult and elusive diagnosis in soft tissues diseases". We present a rare case of MPNST in a 12-year-old girl, who presented with a swelling of left cheek region of 2 months duration. Intraorally, the swelling extended buccally and palatally from premolar to tuberosity region. Swelling was fixed and firm to hard in consistency. A clinical diagnosis of odontogenic sarcoma was made. It was surgically excised and the histological features were suggestive of malignant peripheral nerve sheath tumor of the maxilla.

Study of serum fucose and serum sialic acid levels in oral squamous cell carcinomia.

Serum fucose and sialic acid levels were determined in 50 oral cancer patients and 25 healthy controls. A statistically significant increase was noted in the study group. The increase in serum fucose level correlated well with the clinical staging in the study group whereas sialic acid did not. These values were independent of age, sex and histopathological grading. The result suggest that the serum fucose level is a better biochemical tumor marker than sialic acid level. However its usefulness may be limited if used judiciously to assess the prognosis of the disease.