Alcohol sclerotherapy to treat vascular malformations in the oral cavity.

OBJECTIVE: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. MATERIAL AND METHODS: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. RESULTS: The vascular malformations treated ranged from 7mm to 60mm (median: 24.5mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. CONCLUSIONS: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity.

Drug-induced disorders of teeth.

It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.

Diphenylhydantoin-induced gingival overgrowth in man: a clinico-pathological study.

In a cross-sectional, epidemiological study of diphenylhydantoin-induced gingival overgrowth (DGO) in 60 epileptic patients, gingival lesion severity was statistically compared with other clinical, laboratory, and histopathological findings. Evident DGO was observed in 50% of patients, and positive correlations were detected between overgrowth severity and oral debris, calculus accumulation, plaque score, gingival inflammation, and probing depth. However, no valid correlation was observed between lesion and patient age, mouth breathing, daily drug dose, plasma diphenylhydantoin level, or duration of drug intake. Also, there were no significant correlations between connective fiber richness and the intensity of epithelial hyperplasia and severity of gingival overgrowth.

Comparison of a new test for the measurement of resting whole saliva with the draining and the swab techniques.

A quantification method for measuring whole saliva is described. This whole saliva test (WST) consists of a Whatman paper strip, is easily carried out, innocuous, low-cost and single use. Due to its characteristics, it could be considered as the oral equivalent of Schirmer's tear test. A sample of 159 healthy subjects (81 males and 78 females; mean age 31.62 years) participated in this comparative study of this new procedure and two other tests, the draining and the swab test. Correlation was statistically positive among the three types of tests.

[Prevalence of oral lichen planus and oral leukoplakia in 112 patients with oral squamous cell carcinoma]. / Prevalencia de liquen plano oral y leucoplasia oral en 112 pacientes con carcinoma oral de células escamosas.

OBJECTIVE: To study the association existing between precancerous conditions, like oral lichen planus and oral leukoplakia into 112 patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We applied a protocol to 112 patients with OSCC in the "Servicio de Estomatología del Hospital General Universitario de Valencia". We made two groups: 1. patients with precancerous lesions and oral carcinoma, 2. patients with OSCC and no precancerous lesions. RESULTS: The average age was 61.4 years, 85 of them being men and 27 women. The tongue and floor of the mouth were the most common locations. 33.6% of the tumours presented stage TNM I, most of them being histologically well differentiated and the 55.8% were ulcerated. We found differences between two groups of the patients regarding alcohol and tobacco habits, location, size and clinical stage and histological differentiation of the malignant lesions.

[Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case]. / Aspergilosis sinusal a partir de un tratamiento odontológico. Presentación de un caso clínico.

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.

[Oral lichen planus plaques and homogeneous leukoplasia: comparative results of treatment with CO2 laser]. / Liquen plano oral en placas y leucoplasia oral homogénea: resultados comparativos tras el tratamiento de estas lesiones con láser CO2.

OBJECTIVE: To determine the efficacy of CO2 laser therapy in plaque-like oral lichen planus and homogeneous oral leukoplakia. MATERIAL AND METHODS: We studied two groups of patients; one comprised 29 cases of plaque-like oral lichen planus (group 1) and the other one included 34 cases of homogeneous oral leukoplasia (group 2). After histological study, all the lesions were treated by CO2 laser evaporation at 10 W. We analyzed the results following one month, three months and one year after the treatment. RESULTS: In group 1, 19 lesions (65.5%) were revoluted enterally in one month. Patients reported a slight to moderate pain in 16 cases (55.2%), while 4 (13.8%) showed recurrences after three months and 12 (41.4%) at the end of the following time (one year). In group 2 we found a complete healing after one month in 28 cases (82.4%), with a slight to moderate pain in 22 cases (64.7%). Three months after the treatment we found 7 recurrences (20.6%) and 8 (25.8%) one year after. CONCLUSIONS: We found lower rate of recurrences in homogeneous oral leukoplakias than in plaque-like oral lichen planus after treatment with carbon dioxide laser therapy.

[Oral histiocytosis X with severe upper maxillary destruction]. / Histiocitosis X oral con severa destrucción del maxilar superior.

Histiocytosis X is a group of disorders of the reticuloendothelial system that have different clinical features and common histological characteristics, including abnormal proliferation of Langerhans cells. Eosinophilic granuloma is a localized form of histiocytosis affecting one or more bones. A case report is made of a patient diagnosed as histiocytosis X whose first manifestation was the appearance of an orosinusal communication. The lesions were located in the maxillary bones and produced large osteolytic lesions. No other bones were affected. In spite of surgery and radiotherapy, the disease recurred at 12 months.

[Pathology of the oral mucosa in patients with type I diabetes mellitus: study of 44 cases]. / Patología de la mucosa oral en el paciente diabético tipo I: Estudio de 44 casos.

We study the pathology of the oral mucosa in a group of type I diabetics. The most common disease was oral candidiasis (9.09%), whereas the other pathologies encountered showed no significant differences with the controls.

[Melkersson-Rosenthal syndrome. Oligosymptomatic form developed during medical treatment of a phobic depressive process]. / Síndrome de Melkersson-Rosenthal. Forma oligosintomática desencadenada durante el tratamiento médico de un proceso depresivo fóbico.

An oligosymptomatic form of Melkersson-Rosenthal syndrome which developed following psychiatric treatment for depressive phobic disease is presented. Morphological characteristics found in gingival mucosa biopsy are commented on, as well as the evolutive course and therapeutic procedures carried out on the patient.

[Oral leukoplakia: clinical, histopathologic, and molecular features and therapeutic approach]. / La leucoplasia oral: definición de parámetros clínicos, histopatológicos y moleculares y actitud terapéutica.

Dermatology departments are currently seeing an increase in the number of cases of oral diseases. Of note among the range of lesions covered by this broad area of knowledge is oral leukoplakia-the most common precancerous lesion and the most problematic in terms of both diagnosis and therapeutic management. In addition to defining leukoplakia, this review also establishes a differential diagnosis with the other most important oral diseases and analyzes the different clinical, histologic, and molecular features that can provide an indication of the risk of malignant transformation. Finally, a therapeutic algorithm is presented to help us optimize clinical management of the disease.

Number V Oral lichen planus: clinical features and management.

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

Alendronate-related oral mucosa ulcerations.

Alendronate is widely used in the treatment of osteoporosis and other bone diseases. Although it is considered a well-tolerated drug, there are numerous reports of adverse effects on the mucosa in the upper aerodigestive tract, with oesophagitis as the most common complication. The strict regulations for the proper administration of the drug indicate that these side effects might well be the result of a direct, irritant mechanism on the upper aerodigestive tract. We present two clinical cases of patients who developed extensive palatal ulcers as a result of taking alendronate. We discuss possible mechanisms implicated in the production of the ulcers and some clinical factors of interest.

[Epidemiological study of inflammatory periapical cysts]. / Estudio epidemiológico de los quistes inflamatorios periapicales.

We have realized an epidemiologic study of 467 inflammatory periapical cysts. We have valued: age, sex, radiographic size, localization, clinic, evolution time and morphologic aspects. Ware not agree with some authors about some morphologic description.

[Sjögren's syndrome]. / El sindrome de Sjögren.

We carry out an updated review of Sjögren's syndrome on occasion of the presentation of three new clinical cases whose oral manifestations led the patients to first seek help. Each patient was subjected to clinical exploration, together with complementary evaluations, aimed at establishing an early and precise diagnosis of the syndrome. We consider it important to adopt a series of standardized diagnostic criteria and revise treatment to maintain the orodental conditions as favorable as possible.

[Sialoadenosis of the parotid glands: diagnostic considerations]. / Sialoadenosis de las glándulas parótidas: consideraciones diagnósticas.

We present 3 cases of Sialoadenosis of the parotid glands, one male and two females, who presented associated systemic pathology (liver cirrhosis and diabetes mellitus), detected following clinically suspect syaloadenosis (the patients were unaware of their systemic disease). In all three cases definitive diagnosis was established by needle aspiration of the gland. Which revealed great acinar dilatation. Finally, differential diagnosis was established between sialoadenosis and those conditions with clinical presentations similar to those described for sialoadenosis.

[Paget's disease of the bone. Review, clinical case and stomatologic considerations]. / Enfermedad ósea de Paget. Revisión, caso clínico y consideraciones estomatológicas.

Updating information regarding the concept, etiopathogenesis, histopathology, clinical picture, and treatment of Paget's disease of bone (osteitis deformans) is presented. A symptoms is described, and the therapeutic approach for patients with disabling disturbances of the oral cavity dueto Paget's disease is recommended.

[Buccal manifestations of type I diabetes mellitus. Study of its oral symptomatology and dental involvement]. / Manifestations buccales du diabète sucré type I. Etude de sa symptomatologie orale et incidence dentaire.

We are hereby presenting a survey conducted on 44 diabetic patients of the I type and 44 health individuals used as a reference group. In the light of the results of the survey in question a poorer oral hygiene for the I type insulin-dependent diabetic patients than for those in the control group has been detected (E.G. whereas 40.91% of the diabetic patients exhibited a very poor hygiene, the rate detected for the control group amounted to 22.72% only). Nevertheless, this poorer hygiene did not seem to influence caries level direct since no meaningful difference in the two groups CAO indexes was detected at all. Cellulitis was very frequent in the diabetic group whereas post-extraction alveolitis and mouth dryness were found at comparable levels in the two groups.

Orofacial manifestations of mixed connective tissue disease with an uncommon serologic evolution.

Mixed connective tissue disease is a multisystemic disorder with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis, and is differentiated from them by a high titer of antibody to ribonucleoprotein. Orofacial manifestations of mixed connective tissue disease include trigeminal neuralgia-like pain, neuropathy, features suggestive of Sjögren's syndrome, and lymphadenopathy. Our recent experience with one patient with trigeminal neuropathy, facial paralysis, Sjögren's syndrome, and aseptic meningitis as early manifestations of the disease, together with an uncommon serologic evolution, is described.