Prevalence of Candida spp., xerostomia, and hyposalivation in oral lichen planus--a controlled study.

OBJECTIVE: To determine the frequency of Candida spp., xerostomia, and salivary flow rate (SFR) in three different groups: patients with OLP (OLP group), patients with oral mucosal lesions other than OLP (non-OLP group), and subjects without oral mucosal lesions (control group). MATERIAL AND METHODS: Xerostomia as well as SFR was investigated in the three groups. Samples for isolation of Candida spp. were collected from OLP lesions (38 patients), non-OLP lesions (28 patients), and healthy subjects (32 subjects). RESULTS: There was no statistically significant difference regarding the frequency of xerostomia and hyposalivation among the three groups (P > 0.05). A higher prevalence for colonization by Candida spp. was found in the healthy subject as compared to that of patients with OLP (P = 0.03) and non-OLP (P = 0.02) groups. Low SFR was not a factor for colonization by Candida spp. CONCLUSIONS: Xerostomia and hyposalivation occur with similar frequency in subjects with and without oral lesions; also, the presence of oral lesions does not increase the susceptibility to colonization by Candida spp. It seems that any study implicating Candida spp. in the malignant transformation of oral lesions should be carried out mostly on a biochemical basis, that is, by testing the capability of Candida spp. to produce carcinogenic enzyme.

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion.

Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.

Oral colonization by Candida species in AIDS pediatric patients.

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.

Orofacial granulomatosis of the lip: a report of 2 cases with histological and immunohistochemical analyses and intralesional corticotherapy.

Orofacial granulomatosis is a generic term applied to manifestations of several diseases including sarcoidosis, Crohn's disease, Melkersson-Rosenthal syndrome, cheilitis granulomatosa of Miescher, tuberculosis and foreign-body reactions. What bonds these diseases together is the presence of noncaseating granulomas. A typical clinical manifestation of orofacial granulomatosis is recurrent labial swellings that eventually persist. This article describes 2 cases of OG diagnosed with the aid of immunohistochemical analysis and successfully treated with intralesional steroids.

The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia.

AIM: This study evaluated the effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia. METHODS: Twelve patients with severe xerostomia were treated with acupuncture after radiation therapy. The baseline data were obtained preceding acupuncture treatment, and used as reference values. Acupuncture was performed in 12 sessions, 20 min each, twice a week, during a 6-week period. Clinical response was evaluated objectively by saliva collection measuring resting and stimulated whole salivary flow rates, and subjectively by a visual analogue scale patients' self-evaluation questionnaire. Statistical analyses were performed with a repeated-measures analysis of variance by using a mixed-effect modeling procedure. RESULTS: The results showed a statistically significant improvement for salivary flow rates on both objective and subjective evaluations (P<0.05). On objective evaluation there was an increase for resting salivary flow of 142.2% (mean=0.04 mL/min to 0.12 mL/min) and of 73.5% (mean=0.09 mL/min to 0.21 mL/min) for stimulated salivary flow. On subjective evaluation, visual analogue scale raised 36 points (mean=18.4 to 53.8) for sensation of more saliva production. CONCLUSION: According to the results of the present study, acupuncture showed a significant effect on saliva production, suggesting this therapy as a useful treatment for patients suffering from radiation-induced xerostomia.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients.

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients.

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

Hard palate perforation: an unusual finding in paracoccidioidomycosis.

A 36-year-old black man presented to his dermatologist in May 1996 complaining of mucosal lesions in the mouth, as well as perforation of the hard palate. The lesions had started approximately 7 months before and had worsened gradually. Other complaints included odynophagia, dysphagia, mild dyspnea, and dry cough. The patient was in good general health, but reported a 3 kg weight loss over the previous semester. The hard and soft palate presented erythematous ulcers with a finely granulated base and irregular, but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate was seen in the center of the ulcerated region (Fig. 1). Direct examination of 10% KOH cleared specimens showed typical double-walled, multiple budding yeast structures. Paracoccidioidomycosis (PCM) serologic reactions tested positive for double immunodiffusion (DI), complement fixation (CF) 1 : 256 and counterimmunoelectrophoresis (CIE) 1 : 128. Hematoxylin and eosin-stained sections of oral lesions showed an ulcer covered by a fibrous leukocytic crust, with a lymphoplasmacytic infiltrate, as well as multinuclear giant cells containing round bodies with a double membrane. Gomori-Grocott staining showed budding and blastoconidia suggestive of PCM. Lung computed tomography (CT) exhibited findings consistent with pulmonary PCM. Diagnosis of the chronic multifocal form of PCM with oral and pulmonary manifestations was established. Drug therapy was initiated with ketoconazole (KCZ) 200 mg twice daily, which led to clinical cure in approximately 2 months. Serum antibody values rose 30 days after institution of therapy (CIE 1 : 256; CF 1 : 512), peaking at day 60 (CIE 1 : 1024; CF 1 : 1024). Three months later the daily dose was reduced to 200 mg and titers declined slowly. The diameter of the perforation remained unchanged (Fig. 2). The hard palate perforation was corrected with a palatoplasty 27 months after initiation of drug therapy (Fig. 3). KCZ was discontinued when serologic cure was achieved after 34 months of treatment (DI weakly positive; CIE 1 : 8; CF not measurable). The patient was discharged 46 months after the first visit.

Traumatic bone cyst: report of two cases and review of the literature.

Traumatic bone cysts usually are found in young individuals and most frequently have the radiographic appearance of well-circumscribed radiolucent lesions with a tendency to scallop between the roots of the teeth. Two well-documented cases of traumatic bone cysts are presented in which some differences related to their radiographic features were observed. The possible explanations for these differences are discussed and a brief review of the literature regarding the main characteristics of traumatic bone cyst lesions also is provided.

Periodontal aspects of the juvenile form of paracoccidioidomycosis.

Three cases of the juvenile form of paracoccidioidomycosis are reported. Emphasis has been given to the oral manifestations, particularly the periodontal involvement. The main periodontal findings were: generalized and progressive alveolar bone destruction leading to gingival recession with exposure of the tooth roots, and spontaneous tooth losses. The gingival mucosa was predominantly smooth, erythematous and slightly swollen. These aspects, although rare, may be the earliest signs of the disease and sometimes its only manifestations.