Intraoral herpes simplex virus infection in a patient with common variable immunodeficiency.

We report a challenging case of an atypical presentation of recrudescent herpes simplex virus infection in a patient with common variable immunodeficiency. Oral infections in immunosuppressed patients may present with unusual clinical features that can mimic non-infectious diseases. This report discusses the diagnostic steps necessary for definitive diagnosis and to guide appropriate and effective management.

Management of the oral sequelae of cancer therapy.

Oral cancer and the oral sequelae of treatment for oral and other malignancies can significantly affect a patient's oral and systemic health, as well as have a profound impact on quality of life. Compromised oral health prior to, during, and following cancer therapy can affect treatment outcomes. Increasingly, dental professionals in the community are being called upon to provide care for these individuals. Radiation therapy is routinely used for tumors of the head and neck, delivering a concentrated radiation dose to the tumor, but also to the immediately surrounding tissue. Oral complications are related to the site radiated and the total radiation dose. Cancer chemotherapy is provided as a primary treatment for some cancers and as an adjunctive modality for other cancers. The goal is to eradicate the rapidly growing cells of the tumor, but chemotherapy is often toxic to other cells that rapidly divide normally including the oral mucosa. The use of combined chemotherapy and radiation is now considered standard for most locally advanced tumors of the head and neck. The toxicities of this combined therapy are essentially the same as with radiation alone, but develop more rapidly and are typically more severe when they reach maximum level. The most common oral sequelae of cancer treatment are: xerostomia, the sensation of a dry mouth as a result of damage to the salivary glands and/or medication; mucositis, the inflammation and ulceration of the oral mucosa; and infection as a result of the loss of mucosal integrity. Management of oral health during cancer therapy includes identifying at-risk patients, patient education, appropriate pretreatment interventions, and timely management of complications. Appropriate preventive and therapeutic measures will help minimize the risk of oral and associated systemic complications, improve treatment outcomes, and improve the patient's quality of life.

Oral manifestations in patients with hypogammaglobulinemia.

OBJECTIVE: The overall objective of this study was to assess the oral manifestations and their association with immunologic status and health history, of individuals with hypogammaglobulinemia. STUDY DESIGN: A case-controlled study of 100 subjects with hypogammaglobulinemia and 93 control individuals was performed. All participants were examined for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Decayed, missing, filled teeth and community periodontal index were recorded. Complete blood count, serum immunoglobulins, and lymphocyte immunophenotyping were measured on the same day of the oral health assessment. RESULTS: Individuals with hypogammaglobulinemia showed higher prevalence of enamel hypoplasia and complaints of dry mouth, and lower prevalence of dental caries and periodontal disease. CONCLUSIONS: The systemic conditions associated with hypogammaglobulinemia were not associated with enhanced susceptibility to caries, gingivitis, or periodontitis; however, individuals with hypogammaglobulinemia were more likely to report more episodes of recurrent aphthous ulcers compared with control individuals.

Comparison of oral manifestations with CD4 count in HIV-infected patients.

AIM AND OBJECTIVE: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. MATERIALS AND METHODS: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student's " t" test, was applied and objective conclusions were drawn. RESULT: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count <200 (group A), 10 patients were in group, B (CD4 count 200-500 cell/mm 3 ) and 2 patients in group C(CD4 >500 cell/mm 3 ). Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. CONCLUSION: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.

Periodonto: consideraciones en pacientes oncológicos que requieren quimioterapia / Periodontium: some considerations in oncologic patients requiring chemotherapy

El cáncer es una enfermedad sistémica en la cual el organismo produce células malignas en exceso, que tienen un desenfrenado crecimiento y división. El cáncer causa el 13 por ciento de las muertes por enfermedad en el planeta, convirtiéndose en la segunda enfermedad responsable de muertes, detrás de las enfermedades cardíacas. Se estima que a lo largo del siglo XXI ha de convertirse en la principal enfermedad que afecte a personas en países desarrollados. Aún así, se ha producido un aumento en la supervivencia de los pacientes oncológicos. El tratamiento del cáncer es multidisciplinario y en él la cooperación de los distintos profesionales que intervienen es de gran importancia para su correcta planificación. Se basa en tres pilares: la cirugía, la radioterapia y la quimioterapia. También existe un cuarto pilar, la terapia biológica, que incluye hormonoterapia, inmunoterapia y técnicas no citotóxicas.

Primary herpetic gingivostomatitis in an adult patient using an orthodontic appliance / Gingivoestomatitis herpética primaria en un paciente adulto utilizando un aparato ortodóntico

The present article describes a clinical case of an adult patient using an orthodontic appliance, who returned to the dental office after the placement of orthodontic mini-implants, complaining of aphthas. By means of clinical and case history evaluation the diagnosis of primary herpetic gingivostomatitis was reached. The treatment was prescription of an antiviral agent associated with a chlorhexidine-based oral mouthwash. One week after their onset, there was complete regression of the lesions.

El presente artículo describe un caso clínico de un paciente adulto utilizando un aparato de ortodoncia, que regresó a la consulta dental después de la colocación de mini-implantes ortodónticos, quejándose de aftas. Por medio de la evaluación clínica y de historia del caso, el diagnóstico de gingivoestomatitis herpética primaria fue realizado. El tratamiento fue la prescripción de un agente antiviral asociados con un enjuague bucal con clorhexidina. Una semana después de su inicio, se produjo regresión completa de las lesiones.

[Molecular analysis of two cases of severe congenital neutropenia].

Severe congenital neutropenia is a rare hematological disease characterized by a selective decrease in circulating neutrophils, maturation arrest of granulocytic precursors at the promyelocyte stage, and recurrence of infections. A 2-month-old male infant (patient A) and a 14-month-old female child (patient B) were referred to our hospital due to severe neutropenia. Sequencing analysis of ELA2 and HAX1 genes was performed. Two single nucleotide polymorphisms of HAX1 gene were found. They were 5,104T-->G point mutation of exon 1 and 5,474A-->G point mutation of intron 1 in HAX1 gene. The mutation of ELA2 gene was not found. The patient A showed a good response to granulocyte colony-stimulating factor (G-CSF) treatment and the absolute neutrophil count recovered to 1,195/microL. But the patient B showed a partial response to G-CSF treatment and experienced several episodes of herpetic gingivostomatitis, oral ulcer, acute pharyngotonsillitis and otitis media during follow-up.

The prevalence of oral mucosal lesions in adults from the Turin area.

AIM: To assess the prevalence of oral mucosal lesions (OML) and evaluate its association with tobacco and alcohol consumption and the wearing of removable dentures in an adult population from the Turin area, Italy. MATERIALS AND METHODS: A retrospective study, based on an invitational self-selected screening, was performed on 4098 subjects. It included clinical examination plus biopsies when necessary. Patient history included age, sex, denture wearing and risk habits. Internationally accepted criteria were adopted to classify the OMLs. RESULTS: Males were observed to have more OMLs (557/2040; 27.3%vs 471/2058; 22.89%). Overall OML prevalence was linked to risk habits and age. Tobacco was linked to leukoplakia, melanin pigmentation, smoker's palate, frictional lesions and papilloma. It was negatively related to recurrent aphthous stomatitis and oral lichen planus. Alcohol was linked to leukoplakia, frictional lesions and median rhomboid glossitis. The tobacco-alcohol association was linked to frictional lesions, leukoplakia, melanin pigmentation and smoker's palate. Denture wearers had an overall higher prevalence of OMLs, in particular candidiasis, traumatic and frictional lesions. CONCLUSIONS: The prevalence of OMLs in Turin seems to be comparable to those in other European studies and emphasize that risk habits and denture wearing have some relationship with the presence of OMLs.

Condições bucais relacionadas com o estresse: uma revisão dos achados atuais / Buccal conditions related with the stress: a revision of the current discoveries

O desequilíbrio da harmonia entre o corpo e a mente é o que origina o desenvolvimento de doenças relacionadas ao estresse. Muitas patologias hoje estudadas têm íntima relação com o estresse, e estabelecer a relação estresse/doença é fundamental para conhecer e tratar algumas dessas patologias. Considerando-se a importância do tema para os alunos e profissionais da Odontologia, justifica-se a realização deste trabalho, com vista ao melhor entendimento acerca do tema abordado e ao aprimoramento do diagnóstico das mesmas. Podemos sugerir que os aspectos psicossociais, em especial o estresse, têm sua participação na etiologia de algumas condições na cavidade bucal, atuando de forma conjunta com outros fatores, entretanto o papel do estresse nessas condições estudadas não está perfeitamente esclarecido. É necessário enfatizar que estas condições devem merecer atenção especial do cirurgião dentista, que, por sua vez, faz parte de uma equipe multidisciplinar no atendimento do paciente, sendo necessário o encaminhamento do paciente portador de uma dessas condições associadas ao estresse a profissionais especializados, para uma terapia adjunta, podendo melhorar sobremaneira o resultado do tratamento odontológico.

The unbalance between body and mind is what originates the development of diseases related to stress. A number of pathologies today studied has intimate relationship with stress. To establish the relationship between stress and disease is fundamental to know and to treat some of those pathologies. Considering the importance of the issue for dental students and professionals, it is justified the accomplishment of this work, with view to the best understanding about the approached theme and to the establishment of the its diagnosis. We can suggest that the psico-social aspects, especially stress, have their participation in the aetiology of some conditions in the oral cavity, acting in varied ways with other factors. However, the role of stress in those studied conditions is not perfectly understood. It is necessary to emphasize that these conditions should have the dentist’s special attention and are part of a multidisciplinary team in the patient’s attendance, being necessary the direction of the patient bearer of one of those conditions associated to stress to specialized professionals for an attached therapy.

Frequency of postoperative complications after balloon compression for idiopathic trigeminal neuralgia: prospective study.

BACKGROUND: Idiopathic trigeminal neuralgia (ITN) is often treated with balloon compression, considered in the literature to be a safer and more efficient procedure than other surgeries, with a high success rate. METHODS: This study evaluated 105 patients with idiopathic trigeminal neuralgia who underwent balloon compression of the trigeminal ganglion, with a follow-up of 210 days, and clinical questionnaires and a systematic physical evaluation used as instruments. RESULTS: There was a significant decrease in the shock-like complaint (P < .001), although 66.3% still experienced pain after 7 days of surgery from other causes; 50.5% presented limitation during jaw activities. Other complaints were hearing, taste and/or smelling loss, and visual difficulties. One patient had a TMJ ankylosis and needed surgical TMJ treatment. CONCLUSIONS: Although neurosurgery in the treatment of severe ITN pain is known to provide relief and its importance is recognized, there may also be severe complications that could compromise habitual tasks to various degrees. Therefore, the patient needs to be alerted about all complaints that he or she might present after the procedure. The professional has a duty to correctly inform and alert every patient under his or her care.

Oral health in renal transplant recipients administered cyclosporin A or tacrolimus.

OBJECTIVE: The aim of this study was to determine the oral status of renal transplant recipients receiving cyclosporin A (CsA) or tacrolimus (FK-506) as immunosuppressant. SUBJECTS AND METHODS: A total of 88 renal transplant recipients receiving CsA (63 men and 25 women, mean age 51.4 years) and 67 receiving FK-506 (57 men and 10 women, mean age 33.5 years) were included in the study. Donor type, histocompatibility, cold ischemia time and prior delayed graft function were similar between the two groups. Demographics and pharmacological data were recorded for all subjects. RESULTS: The results demonstrated that CsA caused a greater number of oral diseases. A greater number of gingival overgrowth was present in patients treated with CsA. However, the combined use with calcium channel blockers increased the gingival overgrowth number. The occurrence of candida in saliva was observed in 80 renal recipients treated with CsA and 20 treated with FK-506. The presence of squamous oral carcinoma (n = 3) and herpes simplex (n = 10) was observed in patients treated with CsA. These alterations were not observed in renal recipients treated with FK-506. CONCLUSIONS: Renal recipients constitute a high-risk group for oral diseases, as they are immunocompromised. However, the FK-506 regime appears to ameliorate this effect, compared with CsA. Adequate pre- and post-transplant oral health care is recommended for these subjects, irrespective of the time interval for which the drug is administered.

Oral ulcers in children under chemotherapy: clinical characteristics and their relation with Herpes Simplex Virus type 1 and Candida albicans.

OBJECTIVE: The objective of this study was to determine the clinical characteristics of oral ulcers in pediatric oncology patients undergoing chemotherapy and their relation with the presence of Herpes Simplex Virus (HSV) type 1 and Candida albicans. STUDY DESIGN: The sample consisted of 20 ulcerative lesions from 15 children treated with chemotherapy in the Pediatric Service of the Regional Hospital of Concepción, Chile. Two calibrated clinicians performed clinical diagnosis of the ulcers and registered general data from the patients (age, general diagnosis, absolute neutrophil count, and number of days after chemotherapy) and clinical characteristic of the ulcers: number, size, location, presence or absence of pain and inflammatory halo, edge characteristics, and exudate type. Additional to clinical diagnosis, culture for Candida albicans (C) and polymerase chain reaction (PCR) for Herpes Simplex Virus type 1 was performed. RESULTS: Ten ulcers occurred in patients with acute lymphoblastic leukemia, five in patients with acute myeloblastic leukemia and five in patients with other neoplastic diseases. Eight ulcers were HSV (+) / C (-), 6 HSV (-) / C (-), 4 HSV (+) / C (+) and 2 HSV (-) / C (+). Preferential location was the hard palate. Most lesions were multiple, painful, with inflammatory halo, irregular edges and fibrinous exudate. The average size was 6,5 millimeters, and the mean number of days after chemotherapy was 7.5 days. CONCLUSIONS: Oral ulcers in children with oncological diseases did not present a specific clinical pattern. They were strongly associated with HSV.

Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic.

Oral ulceration is a common complaint of patients attending out-patient clinics. The aim of this review is to provide the gastroenterologist with a differential diagnosis of oral ulceration, and a practical guide for the management of recurrent aphthous stomatitis, including topical and systemic therapy. The association of recurrent aphthous stomatitis with Behçet's disease and other systemic disorders, including coeliac disease, is discussed. Recent evidence concerning the immunopathogenesis of Behçet's disease is reviewed, including renewed interest in the role of Streptococcus sanguis and possible infectious triggering of an inappropriate immunoinflammatory response, resulting in tissue damage. The efficacy and limitations of conventional treatment for this mutisystem disorder are outlined together with the potential role of novel biological agents, such as anti-tumour necrosis factor-alpha therapy. Oral ulceration, as a manifestation of inflammatory bowel disease and a complication of drug therapy, is described. Guidance is given concerning indications for referral of patients with oral ulceration to an oral physician/surgeon for further investigations, including biopsy if appropriate.

[Cutaneous and oral manifestations in HIV-infected children and adults--169 cases]. / Manifestari cutaneo-mucoase în infectia HIV/SIDA. Consideratii pe 169 de cazuri.

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 Iasi 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.