Management of iatrogenic chloroform mucosal burn in the palate: a case report.

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient's quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.

Strong antimicrobial activity of Hypericum perforatum L. against oral isolates of Lactobacillus spp.

Lactobacillus spp. are one of the first microorganisms involved in the development of dental caries in the first years of life of the child. The purpose of this study was to investigate the antibacterial effect of alcoholic extract of hypericin against strains of Lactobacillus spp. and determine its related MIC (minimum inhibitory concentration); and cytotoxic effect against gingival fibroblasts. Antimicrobial activity and MIC were evaluated using micro broth dilution method based on CLSI (clinical and laboratory standards institute) protocols. Determination of cytotoxicity was done by using MTT assay protocol on gingival fibroblast cells at 24, 48 and 72 hours after adding different concentrations of alcoholic extract of hypericin. Hypericin extract had an antimicrobial effect on lactobacillus spp., and its MIC was determined to be 0.625µg/ml . The IC50 value after 24, 48 and 72 hours was obtained as 0.89µg/ml, 0.7µg/ml and 0.604µg/ml, respectively. Hypericin extract MIC for L.acidophilus spp. was 0.625µg/ml and given that, MIC was less than IC50. This concentration does not have toxic effects on gingival fibroblast cells. The results of this study indicate that hypericin extract was able to eliminate acid producing strains in the mouth and can be evaluated as a suitable and safe substitute for mouthwashes and oral disinfectants.

The Relationship between Anger Expression and Its Indices and Oral Lichen Planus.

Oral lichen planus (OLP) is a common inflammatory disease with unknown etiology. Depression, stress and anxiety are psychological factors that their influence on the expression of lichen planus by affecting the immune system's function has been confirmed. There is a probable relationship between anger and OLP expression. Therefore, the present study aimed to evaluate the association of "anger" and OLP. In this descriptive study 95 subjects were included in 3 groups. A: patients with oral lichen planus, B: positive control, C: negative control. Anger and its indices were assessed by the State-Trait Anger Expression Inventory-2 (STAXI-2) questionnaire, and pain was measured via the Visual Analogue Scale (VAS). The collected data were analyzed statistically using SPSS 18 software. The lichen planus and positive control groups bore higher total anger index (AX index) values compared with the negative control. Comparing anger expression-in (AXI) among the lichen planus and negative control groups revealed higher grades in lichen planus group. Evaluating the pain severity index (VAS) data and anger indices in lichen planus group, Spearman's Rank Correlation Test revealed a significant correlation between TAngR (reactional anger traits) and pain severity. The findings of this study indicated that there was a significant correlation between anger control and suppression of lichen planus development. On the other hand, the patients with more severe pain mostly expressed their anger physically. Based on the findings, we can make the claim that anger suppression and its control-in (gathering tension) may play a role in the development of lichen planus as a known psychosomatic disorders.

A Case of Tuberous Sclerosis Without Multiorgan Involvement.

Tuberous sclerosis or Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant and progressive neurocutaneous disorder involves multiple organs mainly brain, heart, kidney, lung, liver, skin and eye. The diagnosis is typically made clinically. Here, we are reporting a case of TSC presented mainly with dermatologic findings and only neurologic manifestations on MRI. A 15-year-old female with intellectual disability is followed up at neurology clinic for history of seizure. Intelligence evaluation showed that she has intellectual disability. She had wart like lesions distributed in form of butterfly over the face especially involving nose. She did not have any sign and symptom of heart, kidney, lung, bone and eye involvement. Also, her laboratory tests were normal. Despite the physical examination showed absolutely intact neurologic examination, but brain MRI and CT scan revealed several cortical and subcortical tubers, and subependymal glial nodules; no evidence of giant cell astrocytomas and aneurysm. Hypesignal foci are seen at subcortical white matter on long TR images. Fibers are involved. In this case, there is no evidence of giant cell astrocytomas and aneurysm. It seems that TSC could be the prevalent disorder and referring intellectual disability patients in birth with normal organs could be diagnosed as TSC. Therefore, there is necessary need to design genetic natal and post natal tests for diagnosis of TSC cases. Also, there is pivotal that similar cases must be reported; perhaps TSC is more prevalent than to be considered.

Evaluation of the Relationship between Serum Lipid Profile andOral Lichen Planus.

Background and aims. Oral lichen planus (OLP) is an immunologic disorder. A large number of studies have reported that lipid rafts have a key role in receptor signaling of lymphocytes. Here, we explore the potential of lipid rafts as targets for the development of a new class of agents to down-modulate immune responses and treat autoimmune diseases. Materials and methods. The present cross-sectional study evaluated 88 patients referring to the Department of Oral Medicine in 3 groups (Group 1: erosive OLP; Group 2: non-erosive OLP; Group 3: healthy). A total of 3 mL of blood sample was taken from each subject and the serum levels of cholesterol, triglycerides, HDL and LDL were determined. The mean outcomes of each group were compared with each other and analyzed two by two. Results. The results of statistical analyses showed no significant differences in mean HDL and LDL serum levels between the three groups. The results of post hoc LSD test showed that mean serum levels of subjects with erosive and non-erosive lichen planus were higher than those in healthy subjects. In relation to triglyceride serum levels, the mean serum levels of triglycerides were higher in erosive and non-erosive OLP patients compared to healthy subjects. Conclusion. Triglyceride and cholesterol can be considered to have a critical role in the incidence of lichen planus and in its manifestations as predisposing factors.

Schwannoma in the midline of hard palate: a case report and review of literature.

Schwannoma is a benign encapsulated slow-growing tumor that originates from Schwann cells of the peripheral nerve sheath. It usually occurs in the head and neck; however, it is rare in the oral cavity. The tongue is the most common site of intraoral schwannomas, followed by the floor of the mouth, palate, gingiva, vestibular mucosa, lips and mental nerve area. We report a rare case of schwannoma in the midline of hard palate with ulcerated surface in a 21-year-old male with a two-month history of a painless swelling on his palate. Clinical, radiographic and histopathological features along with differential diagnosis and treatment are also discussed.

Evaluation of the Effect of Two Systemic Doses of HESA-A on Prevention of Induced Tongue Neoplasm in Rats.

Background and aims. The aim of the present study was to compare the inhibitory effects of two systemic doses of HESA-A on prevention of 4-NQO-induced tongue neoplasms in rats. This study evaluated weight and histopathological changes. Materials and methods. Forty-eight male Sprague Dawley rats were divided into four groups of A, B, C and D of each 12 rats. The rats in groups B to D received 30 ppm of 4-Nitroquinoline-1-oxide (4-NQO) in drinking water for 12 weeks.  When feeding with 4-NQO was initiated, the rats in groups B and C received HESA-A at doses of 250 and 500 mg/kg, respectively, 3 times a week. Body weights were measured three times a week. At the end, the rats were euthanized and the tongue was removed. Histological evaluations for carcinogenesis were carried out under a light microscope. Results. The mean body weights of rats in groups B, C and D were significantly lower than that in group A (P < 0.05). There were no significant differences in weight changes between groups B, C and D. In the present study, after 12 weeks of treatment, Tongue specimens in groups B and C did not exhibit severe dysplastic changes; however, concurrent hyperplasia, without atypia and mild-to-moderate dysplastic changes were detected. These changes were significantly less than those in group D, with significant differences between group D and groups A, B and C (P<0.001, P<0.01 and P<0.05, respectively). Conclusion. HESA-A has dose-dependent inhibitory effects on the development of neoplasms of the tongue.

Squamous cell carcinoma arising from an oral lichenoid lesion: a case report.

Lichenoid reactions represent a family of lesions with different etiologic factors and a common clinical and histologic ap-pearance. Lichen planus is included with lichenoid reactions and is a relatively common chronic mucocutaneous disorder. The most important complication of lichenoid reactions is the possibility of malignant transformation. That is why it has been considered a precancerous condition. Although the malignant transformation rate varies widely in the literature, from 0.4 to 6.5 percent, in most studies it does not exceed 1%. The aim of this paper is to report a rare case of squamous cell car-cinoma (SCC) arising within an oral lichenoid lesion in a 17-year-old woman, where SCC is very uncommon. The patient did not have any risk factors and was healthy. The lesion was located on the border of the tongue. In view of thecommon occurrence of OLP (oral lichen planus) and the unresolved issues regarding its premalignant potential, this case report illus-trates the need for histologic confirmation and a close follow-up of clinical lesions with lichenoid features.

Pemphigus Vulgaris Associated with Rheumatoid Arthritis in a Patient not Taking Penicillamine.

D-penicillamine is one of the disease-modifying anti-rheumatic drugs (DMARDs). Drug-induced pemphigus is not fre-quently associated with D-penicillamine, and to date, the number of reported cases is about a hundred. Most reports of D-penicillamine-induced pemphigus vulgaris are in patients with rheumatoid arthritis. It has rarely been reported in patients not taking D-penicillamine. We report a case of pemphigus vulgaris in a 48-year-old female patient with rheumatoid arthri-tis, not taking penicillamine.

Evaluation of Serum TNF-α and TGF-ß in Patients with Oral Lichen Planus.

BACKGROUND AND AIMS: The role of cytokines in the immunopathogenesis of oral lichen planus (OLP) has received much attention. The aim of this study was to evaluate the serum levels of TNF-α and TGF-ß in patients with OLP in an Iranian population. MATERIALS AND METHODS: Thirty-two patients with OLP and 32 age-matched healthy volunteers as a control group were included in this study. Serum tests including TNF-α and TGF-ß was performed in both groups. Data analysis was performed using descriptive statistics and Mann-Whitney U test using SPSS software version 16.0. RESULTS: The mean of TNF-α in study and control groups were 157 ± 115 pg/ml and 14 ± 10 pg/ml, respectively. The difference between the two means was statistically significant (P < 0.001). Moreover, the mean of TGF-ß in study and control groups were 155 ± 26 pg/ml and 175 ± 57 pg/ml, respectively. The difference between the two means was statistically significant (P = 0.03). CONCLUSION: According to the results of the present study, there was a significant decrease in the serum levels of TGF-ß and a significant increase in the serum levels of TNF-α in patients with oral lichen planus. The increase in TNF-α serum levels in patients with OLP explains the inflammatory process in the course of the disease.

Oral lichen planus: clinical features, etiology, treatment and management; a review of literature.

Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for two forms of OLP; therefore, follow-up should be considered. There are many un-established etiological factors for OLP and some different treatment modalities are based on etiology. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. We have used review papers, case reports, cohort studies, and case-and-control studies published from 1985 to 2010 to prepare this review of literature.

Evaluation of Relationship between Lichen Planus and HCV Antibody.

BACKGROUND AND AIMS: Lichen planus is a relatively common chronic mucocutaneaous disease with an unknown cause, and is considered a manifestation of cell-mediated immune response. Hepatitis C virus (HCV) and its subgroups have been associated with lichen planus in different geographic locations. The present study was undertaken to evaluate the prevalence of HCV antibody in patients with lichen planus in northwest Iran. MATERIALS AND METHODS: This descriptive analytical study included 30 patients with cutaneous lichen planus, 30 pa-tients with oral lichen planus, and 30 healthy individuals as controls. Anti-HCV test was run for all the subjects. Descriptive statistics as well as chi-square test, to compare means in the three study groups, were applied to the data using SPSS 14.0 computer software. RESULTS: Age and sex differences between the groups were not significant. No statistically significant differences were ob-served in anti-HCV test results between the groups (P = 0.50). CONCLUSION: No statistically significant relationships were observed between lichen planus and HCV antibody in the studied samples.

Prevalence of Candida species in erosive oral lichen planus.

BACKGROUND AND AIMS: The clinical management of oral lichen planus poses considerable difficulties to the clinician. In recent years, researchers have focused on the presence of pathogenic microorganisms such as Candida albicans in the patients with refractory lichen planus. The aim of the present study was to investigate the prevalence of candida species in the erosive oral lichen planus lesions. MATERIALS AND METHODS: Twenty-one patients with erosive oral lichen planus and twenty-one healthy individuals aged 18-60 were randomly selected; samples were taken from the tongue, saliva and buccal mucosa with swab friction. Theses samples were sent to the laboratory for determining the presence of candida species in cultures and direct examination method. RESULTS: No significant difference was found between healthy individuals and patients with erosive lichen planus regard-ing presence of candida species. The type of candida in the evaluated samples was Candida albicans in both healthy and patient groups. CONCLUSION: According to the results, candida was not confirmed as an etiologic factor for erosive lichen planus lesions.

Relationship between Lichen Planus and Helicobacter pylori Infection.

BACKGROUND AND AIMS: Lichen planus (LP) is a relatively common, chronic dermato-mucosal disease that often affects the oral mucosa. Among bacterial infections affecting LP, Helicobacter pylori has recently been proposed as an important etiologic factor. The present study was designed to evaluate the association of LP and H. pylori infection. MATERIALS AND METHODS: This study included 30 patients with skin LP, 30 patients with oral LP and 30 healthy individuals without LP as control group. Patients and control group were selected from those referred to a dental and a dermatology clinic. Urea breathing test (UBT) was performed for all subjects. Descriptive statistic (frequency and percentage) were applied and chi-square test was employed to compare mean differences, using SPSS 13.0 computer software. RESULTS: UBT test were positive in 24 patients (80%) in oral LP group, 22 patients (73.3%) in skin LP group, and 20 individuals (66.7%) in the control group. No significant differences were found in the positive test results between the three groups (P = 0.50). CONCLUSION: In this study, no significant association was found between LP and H. Pylori infection.

Comparison of the effect of combination of triamcinolone acetonide and vitamin a mouthwash with triamcinolone mouthwash alone on oral lichen planus.

BACKGROUND AND AIMS: Lichen planus is a relatively common mucocutaneous disease, with an unknown etiology. There is no complete cure for oral lichen planus (OLP), but some drugs, including corticosteroids, retinoids, cyclosporine and antibiotics are commonly used for treatment of OLP. The aim of the present study was to compare the effect of combi-nation of triamcinolone and vitamin A mouthwash with triamcinolone mouthwash alone on OLP. MATERIALS AND METHODS: Twenty OLP patients were randomly divided into two groups of 10. The experimental group was treated with combination of triamcinolone and vitamin A mouthwash and the control group was treated with triamcinolone-containing mouthwash alone. The patients were examined once every two weeks and the lesion size, pain and burning sensation were recorded based on visual analogue scale during a two-month period. Data were analyzed by Mann-Whitney U test using SPSS software. RESULTS: The use of combination of triamcinolone-vitamin A mouthwash was effective in decreasing the pain and burning sensation of OLP (P = 0.012). Decrease in pain and burning sensation were similar in both groups (P = 0.73). The use of combination of triamcinolone-vitamin A mouthwash led to a decrease in the size of keratotic, atrophic and erosive OLP lesions (P = 0). Decrease in the size of the lesions was significantly greater in the study group compared to the control group (P = 0.029). CONCLUSION: The use of combination of triamcinolone-vitamin A mouthwash is effective in decreasing the size of keratotic, atrophic or erosive lesions.

Comparison of the Effect of Mouthwashes with and without Zinc and Fluocinolone on the Healing Process of Erosive Oral Lichen Planus.

BACKGROUND AND AIMS: Lichen planus is a chronic inflammatory disorder with unspecified etiology, appearing as a result of stress, genetic predisposition and immunologic factors. Erosive type of the disease is more important because of its clinical symptoms of pain, irritation and malignancy risk. Despite various medications used, a definite cure for lichen planus is un-known. Regarding the effect of zinc on healing of ulcers, the aim of this study was to compare the effect of a mouthwash with and without zinc and fluocinolone on healing of erosive oral lichen planus. MATERIALS AND METHODS: Twenty randomly-selected patients with erosive oral lichen planus were divided into two groups of 10. One group received zinc mouthwash with fluocinolone ointment and the other group received placebo with ointment. The largest dimension of the ulcers was measured by digital calipers and the intensity of pain was determined by visual ana-logue scale. Data was analyzed with Mann-Whitney U test. RESULTS: Pain, irritation and lesion surface area decreased in both groups. Decrease in pain severity was identical in both groups (P = 0.11). However, decrease in surface area with zinc mouthwash plus fluocinolone was more than that with only fluocinolone (P = 0.037). CONCLUSION: 0.2% zinc mouthwash plus fluocinolone and only fluocinolone were both effective in decreasing pain, irrita-tion, and surface area of OLP. However, decrease in surface area with zinc mouthwash plus fluocinolone was more than that with fluocinolone alone.

Treatment of desquamative gingivitis with free gingival graft: a case report.

Recalcitrant gingival erythematous lichen planus lesions comprise a considerable therapeutic problem. This case of chronic desquamative gingivitis in a 25-year-old woman with erosive oral lichen planus was treated with topical and systemic corti-costeroid administration, followed by placement of a free gingival graft on right upper quadrant. Although recurrence of the lesions was observed following both treatment modalities, free gingival graft despite being an aggressive therapy, proved more effective and with fewer side effects compared with topical or systemic steroid therapy, and seems to be a promising treatment modality with the benefit of more stable results, among others.

The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection.

BACKGROUND AND AIMS: Dentists administer thousands of local anesthetic injections every day. Injection to a highly vascular area such as pterygomandibular space during an inferior alveolar nerve block has a high risk of intravascular needle entrance. Accidental intravascular injection of local anesthetic agent with vasoconstrictor may result in cardiovascular and central nervous system toxicity, as well as tachycardia and hypertension. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections. MATERIALS AND METHODS: Three experienced oral and maxillofacial surgeons performed 359 inferior alveolar nerve block injections using direct or indirect techniques, and reported the results of aspiration. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases. Data were analyzed using t-test. RESULTS: 15.3% of inferior alveolar nerve block injections were aspiration positive. Intravascular needle entrance was seen in 14.2% of cases using direct and 23.3% of cases using indirect block injection techniques. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between direct or indirect block injection techniques (P = 0.127) and between right and left injection sites (P = 0.778). CONCLUSION: According to our findings, the incidence of intravascular needle entrance during inferior alveolar nerve block injection was relatively high. It seems that technique and maneuver of injection have no considerable effect in incidence of intravascular needle entrance.

Evaluation of Glove Damage during Dental Procedures among Dental Specialists in Tabriz.

BACKGROUND AND AIMS: Dental practitioners are prone to occupational risk of infection. This can be prevented in part by wearing gloves. However, for this to be effective, gloves should be intact during the entire course of dental procedure. Leaky surgical latex gloves have been seen in 0.9% of cases before use. As much as 1.9% of latex gloves have been reported to be damaged during dental procedures. In this study, we decided to assess glove damage during dental procedures among dental specialists in Tabriz. MATERIALS AND METHODS: Thirty-six dental specialists were selected for this study. Each practitioner received 40 pairs of intact powdered latex gloves. Upon the completion of dental procedures, the gloves were retrieved and any tears were evaluated separately for right and left hands. Data was analyzed using chi-square test. RESULTS: 159 punctures were detected in 144 gloves (5%) out of 2880 unpaired gloves used by practitioners. They noticed the tear(s) in 60 cases (2%), however, 99 cases (3%) of tear(s) were not noted during the procedure. The highest rate of glove damage was observed in the prosthodontists' group (12.3%), which was statistically significant comparing to other groups (p=0.048). The lowest rate of the damage was observed in the oral surgeons' group (2%) which showed no significant difference (p=0.134). The highest rate of punctures in the gloves was observed in the first and second fingers of the non-dominant hand. CONCLUSION: The damage to 5% of the gloves is highly significant, with a potential role in occupational hazards. The higher rate of leaks in the prosthodontists' group compared to other groups demands for greater prudence in this field. The high rate of leaks in the first and second fingers of the non-dominant hand requires more attention to this area during daily practice.

Knowledge and Attitude of Dental Practitioners in Ta-briz Regarding Infection Control Procedures.

BACKGROUND AND AIMS: Blood-borne infections such as hepatitis B, hepatitis C and HIV might be transmitted from one individual to another during dental procedures. Therefore, sterilization and personal protection procedures are of utmost significance in dental offices. The importance of awareness of cross-infection and antiseptic principles lies in the fact that in most cases it is not possible to identify patients with hepatitis or AIDS. The aim of the present study was to evaluate awareness of infection control procedures among dental practitioners in Tabriz. MATERIALS AND METHODS: In this descriptive study, 150 dental practitioners working in clinics and pri-vate offices of Tabriz were randomly selected. Data was collected by means of a self-administered questionnaire, which included respondents' personal profile and questions on infection control and sterilization methods. RESULTS: There were no statistically significant differences in the level of knowledge between male and female dental practitioners regarding infection control; however, there was a decline in awareness as age increased. CONCLUSION: The results of the present study suggest that in some cases dental practitioners neglect the principles for personal protection and cross-infection control. Therefore, our society is subject to widespread infection in dental offices and clinics. This potential risk necessitates careful monitoring along with government support of treatment procedures, the inclusion of infection control costs into treatment expenses and an emphasis on continuing education about infection control procedures through seminars and congresses.