The reappearance of a forgotten disease in the oral cavity: Syphilis

Syphilis is a sexually transmitted disease (STD) produced by Treponema pallidum, which mainly affects humansand is able to invade practically any organ in the body. Its infection facilitates the transmission of other STDs.Since the end of the last decade, successive outbreaks of syphilis have been reported in most western Europeancountries. Like other STDs, syphilis is a notifiable disease in the European Union. In Spain, epidemiological informationis obtained nationwide via the country’s system for recording notifiable diseases (Spanish acronym EDO)and the national microbiological information system (Spanish acronym SIM), which compiles information froma network of 46 sentinel laboratories in twelve Spanish regions. The STDs that are epidemiologically controlledare gonococcal infection, syphilis, and congenital syphilis. The incidence of each of these diseases is recordedweekly. The information compiled indicates an increase in the cases of syphilis and gonococcal infection in Spainin recent years. According to the EDO, in 1999, the number of cases of syphilis per 100,000 inhabitants was recordedto be 1.69, which has risen to 4.38 in 2007. In this article, we review the reappearance and the evolution ofthis infectious disease in eight European countries, and alert dentists to the importance of a) diagnosing sexuallytransmitteddiseases and b) notifying the centres that control them (AU)

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The reappearance of a forgotten disease in the oral cavity: syphilis.

Syphilis is a sexually transmitted disease (STD) produced by Treponema pallidum, which mainly affects humans and is able to invade practically any organ in the body. Its infection facilitates the transmission of other STDs. Since the end of the last decade, successive outbreaks of syphilis have been reported in most western European countries. Like other STDs, syphilis is a notifiable disease in the European Union. In Spain, epidemiological information is obtained nationwide via the country's system for recording notifiable diseases (Spanish acronym EDO) and the national microbiological information system (Spanish acronym SIM), which compiles information from a network of 46 sentinel laboratories in twelve Spanish regions. The STDs that are epidemiologically controlled are gonococcal infection, syphilis, and congenital syphilis. The incidence of each of these diseases is recorded weekly. The information compiled indicates an increase in the cases of syphilis and gonococcal infection in Spain in recent years. According to the EDO, in 1999, the number of cases of syphilis per 100,000 inhabitants was recorded to be 1.69, which has risen to 4.38 in 2007. In this article, we review the reappearance and the evolution of this infectious disease in eight European countries, and alert dentists to the importance of a) diagnosing sexually-transmitted diseases and b) notifying the centres that control them.

Lepromatous leprosy: a review and case report.

Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen s bacillus). It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the multibacillary lepromatous leprosy and the paucibacillary tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularly for less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence.

Lepromatous leprosy: a review and case report

Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen’s bacillus).It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the “multibacillary” lepromatous leprosy and the “paucibacillary” tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularlyfor less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence

La lepra es una enfermedad granulomatosa sistémica crónica y contagiosa, producida por Mycobacterium leprae (bacilo de Hansen). Se transmite de persona a persona y tiene un largo período de incubación (entre 2 y 6 años). Existen dos formas clínicas polares: lepra lepromatosa (multibacilar) y lepra tuberculoide (paucibacilar), con otras formas intermedias de características híbridas. Las manifestaciones orales suelen aparecer en la lepra lepromatosa y se producen en el 20 al 60% de los casos. Pueden tratarse de nódulos múltiples (lepromas), que progresan a necrosis y ulceración. Las úlceras curan con lentitud; forman cicatrices atróficas o pueden causar la destrucción del tejido. Las lesiones suelen localizarse en el paladar duro y blando, en la úvula, en el dorso de la lengua, en los labios y en las encías. También puede producirse destrucción de la parte frontal del maxilar y pérdida de dientes. El diagnóstico, basado en la presunción clínica, se completa con el examen bacteriológico e histopatológico, así como mediante la prueba de la lepromina (intradermorreacción que suele ser negativa en la forma lepromatosa y positiva en la tuberculoide). El diagnóstico diferencial incluye lupus eritematoso sistémico, sarcoidosis, leishmaniasis cutánea y otras enfermedades de la piel, sífilis terciaria, linfomas, micosis sistémicas, lesiones traumáticas y neoplasias malignas, entre otras. El tratamiento es difícil, ya que ha de prolongarse durante mucho tiempo, requiere varios fármacos con efectos adversos y resulta muy caro, sobre todo para los países menos desarrollados. Los de empleo más frecuente son la dapsona, la rifampicina y la clofazimina. También son eficaces las quinolonas, como ofloxacino y pefloxacino, así como algunos macrólidos, como la claritromicina y la minociclina. En el presente trabajo se expone el caso clínico de un paciente afecto de lepra lepromatosa, adquirida en un ambiente familiar de contagio durante la infancia y adolescencia

Appearance and culture: oral pathology associated with certain "fashions" (tattoos, piercings, etc.).

Humans are characterized by a compulsive tendency to distinguish themselves from the rest: differences in clothes, hairstyle or "decorative" details are used to this effect, based on highly diverse criteria. Such differentiating practices may be aimed at identification with a certain ideological group, for example, or with a concrete "fashion", and involve the use of jewelry, clothes, unusual attire, hairstyles, mutilations, etc. In this context, the present review addresses certain aspects of mutilation practices from both the general and specifically dental perspectives. Mutations imply permanent or lasting sectioning or lesions of a part of the body, and comprise skeletal deforming, dental mutilations, circumcision, ablation of the clitoris, scarification, tattoos, and perforations (particularly of the soft tissues). In this sense, tattoos and perforations or piercings are popular -- particularly among adolescents. This trend may be interpreted as a form of communication, identity expression, or as a type of body cult (i.e., so-called "body art"). Such mutilating practices reflect different motivations including fashion, rebelliousness, differentiation, sexual motives, the remembering of events, physical sensations, and ethnic or tribal influences. However, these practices can cause complications such as infections, laceration and soft and hard tissue damage, hypersensitivity reactions and other alterations of variable severity. Under these premises, questions are raised concerning the competence of those who perform these mutilations, the preventive measures adopted, and the legal conditions under which tattoos and piercings are made in our society.