Oral Manifestations of Neurofibromatosis: A Rare Case Report.

Neurofibroma (NF) is a rare benign non-odontogenic tumor of the oral cavity. NF may present either as solitary lesions or as part of the generalized syndrome of NF or von Recklinghausen’s disease of the skin. The heterogeneous nature of NF was established by Riccardi et al. and he recognized at least seven types of NF. Among these proposed classifications of the disease, two distinct forms are generally accepted namely, a peripheral form known as NF Type I (NF-I), and a central form known as NF-II. NF-I represents the classic form of this disease, described by Recklinghawsen in 1882. Clinically, oral NF usually appears as slow growing, painless, pedunculated or sessile nodules. For illustration, a case of a NF with oral findings is been presented.

Effect of highly active antiretroviral therapy use on oral manifestations in pediatric patients infected with HIV.

Aims: The aim was to assess the prevalence of oral lesions in HIV‑infected children undergoing highly active anti‑retroviral therapy (HAART), and the association between the duration of HAART usage and oral lesions. Subjects and Methods: Totally, 111 medical and dental records of HIV‑infected children, aged from 2 to 16 years old were reviewed for medical data, presence of oral lesions, and caries prevalence. According to the type of medication, the children were grouped as follows: 51 were under HAART (G1), 46 were using anti‑retroviral medication (G2), and 14 were using no medication (G3). Results: The majority of the HIV children had AIDS (65.8%), of which 86.3% were in G1, 63% in G2, and 0% in G3. The mean length of therapy was 34.4 months, with no difference between groups (Kruskal–Wallis; P = 0.917). The prevalence of the oral lesions was 23.4%, namely, G1 was 27.5%, G2 was 21.7%, and G3 was 14.3% (P > 0.05). Gingivitis was the most common oral manifestation (15.3%) seen in the three groups, followed by gingival linear erythema and pseudomembranous candidiasis in G1 and G2. The mean values regarding deft and DMFT indexes were, respectively, 3.2 and 1.9 (G1), 2.8 and 1.6 (G2), and 3.8 and 3.0 (G3). For the patients without AIDS (n = 38), oral manifestations were seen in 29.4% of G2 compared to G1, with 0% (Chi‑square; P > 0.05). In terms of therapy duration, 47.65% of the patients who had been under HAART for 18 months or less had oral manifestations, compared to 13.3% of those who had been treated for a longer time (Chi‑square; P = 0.007). Conclusions: Although the prevalence of oral lesions was similar between the groups, it was less in patients without AIDS and those under HAART. The duration of HAART usage had a significant influence on the prevalence of these lesions.

Mouth - A Diagnostic Mirror of Various Diseases.

The mouth is a unique site, due to the presence of hard and soft tissues in close approximation. It serves in various purposes of speech, mastication and digestion. It is an important entry point for many pathogens in the body. Many systemic diseases manifest in the oral cavity and mouth can show early signs or the only signs of a disease process at a site elsewhere. As the mouth is an easily accessible site, the indicators it shows of various diseases should not be overlooked. A dentist thus can frequently be exposed to such conditions and play a key role in the diagnostic procedure of various systemic diseases. Appropriate knowledge of these oral manifestations is essential for early diagnosis, treatment and referral of cases.

Conventional systemic treatments associated with therapeutic sites of local lesions of secondary syphilis in the oral cavity in patients with AIDS.

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions.

Patología bucal en 161 pacientes VIH-positivos asintomáticos y sintomáticos / Oral pathology in 161 asymptomatic and symptomatic HIV infected patients

Estudio prospectivo, cuyo objetivo fue establecer la prevalencia de manifestaciones bucales en individuos infectados por el virus de inmunodeficiencia humana y su relación con el estudio clínico de la infección. Se examinaron 161 pacientes VIH-positivos, de los cuales 64 (40 por ciento) se encontraban en los estadios CDC-II y III y 97 (60 por ciento) en el estadio CDC-IV. El examen clínico se llevó a cabo en la consulta externa de la Clínica de SIDA del Instituto Nacional de la Nutrición Salvador Zubirán, de septiembre de 1989 a junio de 1990. Los examinadores previamente calibrados realizaron el diagnóstico de las alteraciones bucales, basados en criterios clínicos prestablecidos. Ciento veinticinco pacientes (78 por ciento) presentaron una o varias manifestaciones bucales. El porcentaje de pacientes con lesiones bucales se incrementó significativamente en relación al estadio clínico (p < 0.05). La leucoplasia vellosa (40 por ciento) y la candidosis eritematosa (31 por ciento) fueron las lesiones con mayor prevalencia. La frecuencia observada para las diferentes manifestaciones bucales no presentó diferencias estadísticas al comparar los valores encontrados en estadios tempranos (CDC-II y III) con el tardío (CDC-IV), con excepción de la candidosis pseudomembranosa y la queilitis descamativa las cuales mostraron valores significativamente más altos en pacientes en la etapa de SIDA que en asintomáticos (p < 0.001 y p < 0.05 respectivamente). No se encontró asociación entre tabaquismo y xerostomía con la prevalencia encontrada para candidosis bucal. Los hallazgos del presente estudio mostraron que la prevalencia y características clínicas de las manifestaciones bucales encontradas son similares a lo reportado en otros países, con excepción de la gingivitis úlceronecrosante