Pilot study on recurrent aphthous stomatitis (RAS): a randomized placebo-controlled trial for the comparative therapeutic effects of systemic prednisone and systemic montelukast in subjects unresponsive to topical therapy.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is characterized by recurrent painful oral ulcers whose etiology remains largely unknown. Numerous therapeutic protocols have been tried so far, but effectiveness remains an issue. OBJECTIVE: To test a new drug for patients with recurrent oral aphthae nonresponsive to local corticosteroid therapy, we compared the therapeutic effectiveness and adverse effects of systemic prednisone and systemic montelukast in a placebo-controlled trial. STUDY DESIGN: Sixty patients suffering from minor RAS for > or =6 months were studied and randomly assigned to 3 groups of 20 each in a double-blind study. Patients of group A took 25 mg prednisone orally daily for 15 days, 12.5 mg daily for 15 days, 6.25 mg daily for 15 days, then 6.25 mg on alternate days for 15 days. Patients of group B took 10 mg montelukast orally every evening and then on alternate days for the second month. Patients of group C took 100 mg cellulose (placebo) by mouth daily for the first month and on alternate days for the second month. Outcomes assessed were days til pain cessation, days to ulcer healing, and number of aphthae occurring during the follow-up period. RESULTS: Both prednisone and montelukast were effective in reducing the number of lesions and improving pain relief and ulcer healing when compared with placebo. Prednisone was more effective than montelukast in pain cessation (P < .0001) and in accelerating ulcer healing (P < .0001). However, adverse drug reactions recorded during the entire trial were more common in the prednisone group compared with montelukast (10%) and placebo (10%). CONCLUSIONS: These data suggest that the effectiveness of systemic montelukast is similar to that of systemic prednisone in patients with RAS. The lack of serious side effects makes montelukast a candidate drug to use in cases of RAS where pharmacologic therapy for long periods is needed.

[Microbial environmental monitoring in the dental surgery room]. / Monitoraggio microbiologico ambientale nello studio odontoiatrico.

The aim of our study is to analyse the contamination level of air, water and hard surfaces before and after works activities in a dental clinic. Four different methods are detected for the sampling of the hard surfaces: contact plates, nitrocellulose membranes, swab and mask system, bioluminometer. Our results are overall satisfactory, but few critical situations related to some practice, were observed. In comparing the four methods of sampling the hard surfaces, the use of bioluminometer although referring to indirect indices, appears to give results comparable to those obtained with the contact plates and nitrocellulose membranes, which determine the microbiologic count. Contact plates and nitrocellulose membranes appear to be of more friendly use and show same results.

Pemphigus vulgaris with oral involvement: evaluation of two different systemic corticosteroid therapeutic protocols.

BACKGROUND: Pemphigus vulgaris is a potentially life-threatening disease characterized by cutaneous and mucosal blistering. Systemic corticosteroids remain the mainstay of therapy, transforming an invariably fatal disease into one with a mortality that is now less than 10%. Nevertheless, oral lesions are often recalcitrant and corticosteroid therapy can provoke adverse effects. OBJECTIVE: To determine whether two different regimens of systemic corticosteroid therapy based on prednisone gave different benefits. METHOD: We examined two different regimens of systemic corticosteroid therapy based on prednisone in an open study. Ten patients (group A) were treated with systemic corticosteroids, in a therapeutic protocol made up of orally administered prednisone. Ten matched patients (group B) were treated with systemic corticosteroids alternating a pulse of intravenous betamethasone with orally administered prednisone. RESULTS AND CONCLUSIONS: The pulse protocol appeared to have some advantages both in a shorter time to resolution of symptoms and oral lesions, and in terms of minor adverse effects.

Idiopathic dysgeusia; an open trial of alpha lipoic acid (ALA) therapy.

We selected two homogenous groups, each of 22 patients with idiopathic dysgeusia, an altered perception of taste, matched for age and sex, for an open trial of alpha lipoic acid compared with placebo. The 22 patients in the study group were treated with alpha lipoic acid for 2 months. The 22 patients in the control group were treated for 2 months with carboxymethylcellulose. The latter group was then treated with alpha lipoic acid for 2 months. The results showed significant symptomatic improvements compared with placebo, in both groups of patients with dysgeusia treated with alpha lipoic acid, suggesting that idiopathic dysgeusia may be a neuropathy comparable to the burning mouth syndrome.

Oral leukoplakia: open trial of topical therapy with calcipotriol compared with tretinoin.

The aim of the current study was to evaluate, in an open trial, the clinical efficacy of topical calcipotriol compared with tretinoin in the therapy of hyperkeratotic oral lesions (leukoplakia). The study group consisted of 40 patients with histologically proven oral leukoplakias, 20 treated with calcipotriol, the other 20 with tretinoin. The treatment was for 5 weeks and follow-up at 4 months, with clinical assessments at 2, 4 and 5 weeks and regular laboratory assessments. The results showed a significant reduction in lesions (80%), in both calcipotriol and tretinoin groups, with no documented topical or systemic adverse reactions, results maintained at 4 months. Tretinoin however, potentially can induce erythema, angular cheilitis and xerostomia. The study suggests that topical calcipotriol is as effective in the therapy of oral leukoplakia as is topical tretinoin.

Oral proliferative verrucous leukoplakia (PVL); open trial of surgery compared with combined therapy using surgery and methisoprinol in papillomavirus-related PVL.

Proliferative verrucous leukoplakia (PVL) is a unique oral white lesion in which human papillomavirus (HPV) may play a role. PVL behaves far more aggressively than other forms of leukoplakia with a high rate of recurrence after surgical excision, and relentless progression to verrucous hyperplasia and to verrucous or squamous cell carcinomas. The treatment of PVL is usually by surgery, but there is often early recurrence. This study was an open trial of surgery in 25 patients with oral HPV-positive PVL, compared with combined therapy using surgery and methisoprinol in another group of 25 patients with oral PVL. Six months postoperatively there was a significant difference, with 18 recurrences in the patients treated by surgery alone compared to only two recurrences in the patients treated also with methisoprinol (isoprinosine or inosine pranobex), a synthetic agent with immunomodulatory properties and some antiviral activity against HPV. Eighteen months postoperatively there were no further recurrences in the patients treated by surgery alone but another two recurrences in the patients treated with methisoprinol. Overall, by 18 months follow-up, there were 18 recurrences in the group treated by surgery alone, compared with four in those also receiving methisoprinol. The use of this antiviral agent appeared to offer a significant enhancement to the surgical management of PVL.

Acitretin and treatment of the oral leucoplakias. A model to have an active molecules release.

AIMS: The aim of this study was to investigate the effectiveness of acitretin in a new topical formulation (mucoadhesive two-layer tablets) for the treatment of oral leucoplakias. METHODS: Twenty-one volunteers, 16 men, five women, with oral leucoplakia (histologically diagnosed), were included in this double-blind placebo-controlled study. Patients were randomized in three groups (A, B, C) of seven patients each. Groups A and B received tablets with different in vitro release profiles, and group C subjects (controls) received tablets without acitretin. The acitretin dose was 20 mg/day (two 10 mg tablets daily). Serum aspartate aminotransferase, alanine aminotransferase, cholesterol and triglycerides were evaluated before and after treatment. At the end of therapy the concentrations of acitretin in plasma, saliva and tissue were measured by high-performance liquid chromatography. RESULTS: At the end of the study 71% (groups A and B) of patients showed clinical remission or marked improvement. No improvement was noted in the control subjects (group C). These results were further confirmed by histological findings. There were no significant changes in laboratory values in the three groups. The acitretin concentration in plasma and tissue ranged from 0 to 50 mg with no difference between groups A and B, and it was very high in saliva (ranging from 4.9 to 43 mg) with higher concentrations in group A than in group B (due to a longer adhesion time in group A). Patients' compliance was excellent. The results show that mucoadhesive tablets of topical acitretin are efficacious in the treatment of oral leucoplakia without systemic side-effects.

[The quantitative assessment of DNA in potentially cancerous cases of oral lichen]. / La valutazione quantitativa del DNA nei casi di lichen del cavo orale potenzialmente cancerosi.

The increased prevalence of all variants of oral lichen, both as a result of increasing frequency and improved knowledge of the pathologist, coupled with its greater trend to malignant transformation has focused the attention of researchers on the development of new technology that could help in the early detection of the precancerous lesion. DNA cytometric detection can be useful to detect the precancerous lesion when clinical and histological findings of the transformation are still absent. The early diagnosis of such lesions entitles to use a more aggressive treatment, both medical and surgical.

[The importance of direct immunofluorescence in the diagnosis of oral lichen planus. A clinical study and proposal of new diagnostic criteria]. / L'importanza dell'immunofluorescenza diretta nella diagnosi del Lichen planus orale. Studio clinico e proposta di nuovi criteri diagnostici.

A series of 40 lesions of various kinds as lichen planus are examined using samples stained with trichromic test. HLA-DR expression with immunoperoxidase technique and direct immunofluorescence using the standard techniques. The aim of the study was to discover the usefulness for diagnosis of direct immunofluorescence, above all in histologically uncertain cases. The results suggest the view that direct immunofluorescence is essential for diagnosis of lichen planus, in all clinical aspects. The author concludes with description of clinical proceeding for differential diagnosis between white and erosive lesions of mouth.

[The importance of direct immunofluorescence in the diagnosis of oral lichen planus. A clinical study and proposal of new diagnostic criteria]. / L'importanza dell'immunofluorescenza diretta nella diagnosi del Lichen planus orale. Studio clinico e proposta di nuovi criteri diagnostici.

A series of 40 lesions of various kinds as lichen planus are examined using samples stained with trichromic test. HLA-DR expression with immunoperoxidase technique and direct immunofluorescence using the standard techniques. The aim of the study was to discover the usefulness for diagnosis of direct immunofluorescence, above all in histologically uncertain cases. The results suggest the view that direct immunofluorescence is essential for diagnosis of Lichen planus, in all clinical aspects. The author concludes with description of clinical proceeding for differential diagnosis between withe and erosive lesions of mouth.

[A proposal of a new histological method for the dynamic diagnosis of the disease stage in oral lichen planus]. / Proposta di un nuovo metodo istologico per la diagnosi dinamica dello stadio di malattia nel lichen planus orale.

The paper describes a histological fixing and staining technique capable of identifying the stage of disease in oral lichen planus. This is based on staining the nuclei on the basal stratum blue instead of red-orange as normally occurs using Mallory's technique. Under particular conditions of increased cellular protein synthesis these become a typical blue colour.

[The pathogenesis of lichen planus. Experimental research on the significance of HLA-DR antigenic expression by keratinocytes]. / La patogenesi del lichen planus. Ricerca sperimentale circa il significato dell'espressione dell'antigene HLA-DR da parte dei cheratinociti.

The incidence and distribution of keratinocytes expressing the major histocompatibility complex antigen HLA-DR were determined in lesions of oral lichen planus. The authors examine the condition, but its functional significance remains unknown.

[Goldenhar syndrome]. / La sindrome di Goldenhar.

The AA. outline the principals features about the etiology, pathogenesis, clinic and therapy of the oculo-auriculo vertebral dysplasia or Goldenhar's syndrome, with the best attention about the most interesting hypotheses on the pathogenesis, like focal necrosis for hemorrhage in development of face.

[Orofaciodigital syndrome]. / Le sindromi orofaciodigitali (OFD).

The AA. behaving the orofaciodigital syndromes, describe the main peculiarity of the etiology, anatomo-pathology, clinical features, diagnosis to the light of the late acquisitions about these.