Pyostomatitis vegetans: A review of the literature

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn’s disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and ⁄ or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease (AU)

Pyostomatitis vegetans: a review of the literature.

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn's disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and / or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease.

Burning mouth disorder (BMD) and taste: a hypothesis.

BACKGROUND: Burning mouth disorder (BMD) is a burning or stinging sensation affecting the oral mucosa, lips, and/or tongue, in the absence of clinically visible mucosal lesions. There is a strong female predilection, with the age of onset being approximately 50 years. The causes of BMD are multifactorial and remain poorly understood. Often BMD patients report, in association, change in taste. In this regards, it is relevant that in central nervous system connections exist between taste and oral pain and that taste normally inhibits oral pain. AIM: The working hypothesis of this study considers a possible relationship between burning mouth disorders and alterations of taste. Several conditions or pathologies can be responsible of taste disturbances that might be the cause of oral pain in BMD patients. SUBJECTS AND METHODS: We have analyzed, retrospectively, 142 cases of BMD with associated taste disturbance. Possible causes that could be responsible for alterations of taste were investigated. RESULTS AND CONCLUSIONS: Sixty-one subjects revealed the habitual use of drugs having a documented interference with taste perception. Thirty-five subjects, among the 81 patients who had no associated pathology or habitual use of drugs, noticed in their clinical history conditions, pathologies or use of drugs that are known to affect the gustatory system. Therefore, we propose that BMD may represent an oral phantom pain induced in susceptible individuals by alteration of taste.

Burning mouth disorder (bmd) and taste: A hypothesis

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Background: Burning mouth disorder (BMD) is a burning or stinging sensation affecting the oral mucosa, lips, and/or tongue, in the absence of clinically visible mucosal lesions. There is a strong female predilection, with the age of onset being approximately 50 years.The causes of BMD are multifactorial and remain poorly understood.Often BMD patients report, in association, change in taste.In this regards, it is relevant that in central nervous system connections exist between taste and oral pain and that taste normally inhibits oral pain.Aim: The working hypothesis of this study considers a possible relationship between burning mouth disorders andalterations of taste. Several conditions or pathologies can be responsible of taste disturbances that might be the cause of oral pain in BMD patients.Subjects and methods: We have analyzed, retrospectively, 142 cases of BMD with associated taste disturbance. Possible causes that could be responsible for alterations of taste were investigated.Results and conclusions: Sixty-one subjects revealed the habitual use of drugs having a documented interference with taste perception. Thirty-five subjects, among the 81 patients who had no associated pathology or habitual use of drugs, noticed in their clinical history conditions, pathologies or use of drugs that are known to affect the gustatory system. Therefore, we propose that BMD may represent an oral phantom pain induced in susceptible individuals by alteration of taste

Oral malignant melanoma: a review of the literature.

Primary oral melanoma (POM) is an uncommon malignant tumor that originates from the proliferation of melanocytes. Such tumors can be present at any location in the oral cavity; however, it affects more frequently the hard palate and the maxillary alveolar mucosa. POM is usually asymptomatic in the early stages and it presents normally as a pigmented patch or as a mass with a rapid growth rate. In the advanced stages, it can show ulceration, swelling, bleeding, rapid enlargement and loosening of teeth. Melanoma of the mouth is rare, most commonly occurring in the upper jaw of patients more than 65 years. Because of a frequent delay in diagnosis, the tumors are often diagnosed when they are deeper than the average cutaneous melanoma. The prognosis is extremely poor, especially in advanced stages. Therefore, pigmented lesions of undetermined origin should be routinely subjected to a biopsy examination. In this study, we aimed to present a review on primary malignancy.

Oral aphthous-like lesions, PFAPA syndrome: a review.

Aphthous ulcers are the most common oral mucosal lesions in the general population. Several precipitating factors for aphthous ulcers are suggested to operate on subjects with genetic predisposition. Sometimes aphthous ulcers can be the sign of systemic diseases. Therefore, it is essential to establish a correct diagnosis to determine suitable therapy. There are several diseases potentially responsible for oral ulcers. Sometimes appearance of periodic oral ulcers coincides with periodic fever and other symptoms leading to the diagnosis of a rare childhood disease: PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenopathy) syndrome. PFAPA or Marshall's syndrome is characterized by abrupt onset of periodic episodes of high fever accompanied by aphthous stomatitis, pharyngitis and cervical adenitis, often associated with headache and / or abdominal or joint pain. Owing to the periodic onset of oral symptoms, often an oral physician or pediatric dentist may be the first healthcare worker to evaluate a child with clinical signs compatible with PFAPA syndrome. Children diagnosed with this condition require systematic oral follow-up to monitor for signs of ulceration.

Burning mouth syndrome and burning mouth in hypothyroidism: proposal for a diagnostic and therapeutic protocol.

BACKGROUND: Burning mouth syndrome (BMS) is a common disorder frequently affecting women past the 5th decade of age. It is characterized by oral burning, mainly involving the tongue, lip, and anterior palate, but without oral lesions or alteration showing in blood tests and/or instrumental findings. OBJECTIVE: We proposed to exclude alterations due to thyroid function and echographic abnormality in formulating BMS diagnosis. The aim of this study was to propose a blood and instrumental protocol including thyroid function and echography to obtain a correct BMS diagnosis. In the absence of such an assessment, a number of patients with oral burning and hypothyroidism may erroneously be considered BMS patients. STUDY DESIGN: For this study, a group of 123 patients initially diagnosed with BMS was selected, following use of the current preliminary diagnostic protocol for BMS (study group). A further 123 patients with dental problems and without oral burning were selected as a control group. All patients were submitted to further protocol based on a study of their thyroid function and echography. RESULTS: Thirteen control patients showed some thyroid alteration compared with 85 patients of the study group. In relation to these further examinations, a therapeutic protocol based on use of thyroxine, lipoic acid, or clonazepam was applied for patients belonging to the study group. Fifty-eight patients (47%) showed hypothyroidism and were treated with thyroxine, and 37 (64%) of these showed a positive response (VAS 1 and 0). Twenty-seven patients (22%) evinced euthyroidism with an inhomogeneous parenchyma thyroid echographic pattern. These were treated with lipoic acid, and 23 (85%) of them responded positively (VAS 1 and 0). Thirty-eight patients (31%) showed euthyroidism and no echographic alteration. Only these were considered to be true BMS patients and were treated with lipoic acid. Only 10 (26%) of these patients responded positively (VAS 1 and 0). CONCLUSIONS: This study reveals that subjects with thyroid alterations are often considered to be BMS patients and that hypothyroidism could be responsible for oral burning and/or dysgeusia in some supertaster subjects. For these reasons, we propose that the study of thyroid function be inserted in the diagnostic process for BMS patients.

Guidelines for diagnosis and management of aphthous stomatitis.

Aphthous ulcers are the most common oral mucosal lesions in the general population. These often are recurrent and periodic lesions that cause clinically significant morbidity. Many suggestions have been proposed but the etiology of recurrent aphthous stomatitis (RAS) is unknown. Several precipitating factors for aphthous ulcers appear to operate in subjects with genetic predisposition. An autoimmune or hypersensitivity mechanism is widely considered possible. Sometimes aphthous ulcers can be the sign of systemic diseases, so it is essential to establish a correct diagnosis to determine suitable therapy. Before initiating medications for aphthous lesions, clinicians should determine whether well-recognized causes are contributing to the disease and these factors should be corrected. Various treatment modalities are used, but no therapy is definitive. Topical medications, such as antimicrobial mouth-washes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol), can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective.

In vitro biological response to a light-cured composite when used for cementation of composite inlays.

OBJECTIVE: To define the cytotoxicity of a photo-cured composite when used as a bonding system under a composite inlay. METHODS: Composite specimens were photo-cured with or without a 2 mm composite inlay interposed between them and the light source. Samples were extracted in complete cell culture medium and the obtained eluates applied to primary cultures of human pulp and gingival fibroblasts. After 72 h of incubation, cell viability was evaluated by MTT assay. Survival rates were calculated with respect to negative controls. RESULTS: Both shielded and unshielded composite samples were cytotoxic to pulp and gingival cells. The inlay shielded composite samples reached a significantly higher level of cytotoxicity compared to the unshielded ones. SIGNIFICANCE: The results suggested that the cytotoxicity of a light-cured composite resin used as a bonding system for indirect composite restorations may be significantly increased as a result of an inlay light-shielding effect.