Birt-Hogg-Dubé syndrome: a review and presentation of the first case with oral lesions.

Birt-Hogg-Dubé syndrome manifests as small, skin-colored, dome-shaped, or pedunculated cutaneous lesions. Three histopathologic patterns have been described: fibrofolliculomas, trichodiscomas, and acrochordons. The patient described in this article also had small, elevated, intraoral papules involving the mucosal surfaces of the lips, buccal mucosa, and gingivae, which represents a finding that had not been described in the literature previously.

Kaposi's sarcoma in patients with AIDS.

All health care providers must become increasingly aware of the early signs and symptoms of AIDS as KS frequently appears in the head, neck, and oral regions. Dentists are responsible for recognizing these lesions, especially the early lesions, providing dental treatment as appropriate, and for referring patients with AIDS for counseling and treatment that cannot be provided in their office. Early detection of KS is particularly important for patients receiving dental treatment. The dentist must be careful not to further compromise the patient's health by extensive or stressful dental treatment and to prevent intraoperative or postoperative complications. Early supportive and palliative care will improve the patient's prognosis. Dental care will help HIV-infected patients and those with AIDS to avoid caries and periodontal disease. In addition, regular dental care will enable the dentist in the early diagnosis of the disease's oral manifestations, such as candidiasis, hairy leukoplakia, KS, or other oral opportunistic infection. Treatment of these conditions can significantly improve the patients' quality of life and their chances for survival. When universal precautions are used for infection control in the dental office there is no reason that comprehensive dental care cannot be provided for HIV infected patients--both for those that we know are infected and for those that are infected and we don't know about.

Bilateral white corrugated lesions on the lateral tongue surface.

A patient with bilateral hairy leukoplakia and candidiasis of the tongue was diagnosed and described. Lesions of the tongue that should be considered in the differential diagnosis include: idiopathic clinical leukoplakia, tobacco-induced leukoplakia, frictional keratosis, edema, lichen planus, galvanic lesions, geographic tongue, maceration, and chronic hyperplastic candidiasis. Hairy leukoplakia occurs predominantly on the tongue as in the patient described. The typical presentation is easily diagnosed but atypical cases may be diagnosed by their lack of response to antifungal treatment and histological exclusion of other lesions. The natural history of hairy leukoplakia needs further study. Hairy leukoplakia has not been reported in patients not infected by HIV; therefore, patients with hairy leukoplakia should be considered highly suspect for subsequent development of AIDS.

Bilateral mixed density lesions in the body of the mandible.

A patient with actinomycosis involving the right and left body of the mandible is reported. Such a diagnosis, although not common, should be considered when formulating a differential diagnosis of such mixed radiopaque-radiolucent lesions. Proper collection of a specimen, transplant, and culture under anaerobic conditions is imperative if a laboratory diagnosis is to be made. A biopsy, yielding the characteristic histopathological features of actinomycosis infection, is frequently adequate for diagnosis and treatment.

A solitary, exophytic, crateriform lesion on the mandibular retromolar gingiva.

A solitary, intraoral keratoacanthoma discovered on the mandibular left retromolar mucosa in a 64-year-old black male is reported. This is the eighth lesion of this type reported to date. The patient had stopped smoking 5 years earlier and gave no history of an occupation involving pitch or tar. The lesion had the typical clinical and microscopic features of a keratoacanthoma. A 6-month recall examination showed no evidence of recurrence of the lesion.

White, exophytic lesion of the left lateral surface of the tongue.

Verrucous carcinoma is an unusual variant of squamous cell carcinoma; it comprises approximately 5% of all oral malignancies. The buccal mucosa, gingiva, and tongue are the most commonly involved areas within the oral cavity. Histologically, verrucous carcinoma can present a diagnostic dilemma. The basement membrane is often intact, which may cause the pathologist to misinterpret these carcinomas as hyperkeratosis and severe dysplasia. The preferred treatment for this lesion is wide local excision. Regional lymph node dissection is usually not necessary and radiation therapy appears to be contraindicated. Close follow-up is recommended.

Painful, mixed density mass of the right maxilla.

An additional case of rare, benign osteoblastoma occurring in the right maxilla of a 27-year-old female is reported. The differential diagnosis is discussed and the important distinction between osteoblastoma and low-grade osteosarcoma is stressed.

Well-defined radiolucent area involving the anterior maxilla.

An example of a large and symptomatic nasopalatine duct cyst is presented. This cyst is the most common type of developmental or fissural cyst occurring in the maxilla. Treatment for most patients is conservative surgical excision. The excised tissue should be submitted for histopathologic examination to establish a definitive diagnosis and to rule out the possibility of a more serious lesion.

Acute, life-threatening disease first appearing as odontogenic pain.

Rapidly spreading rhinocerebral infection by Phycomycetes (mucormycosis) in a diabetic patient with ketoacidosis is described. The dentist and dental specialists should be alert to the early signs and symptoms of this disease as they evaluate and follow patients who are debilitated and who have odontogenic pain. It cannot be overemphasized that a successful outcome is critically dependent on early recognition and prompt therapy, especially in a person with diabetic acidosis as death may occur within 2-5 days after the first symptoms appear.

Desquamative gingivitis and extragingival collapsed bulla.

Mucous membrane pemphigoid is a relatively rare, chronic scarring vesiculobullous disease that frequently affects the oral and ocular mucosa. Other mucous membranes and skin are less frequently affected. Characteristic oral lesions include desquamative gingivitis, and extragingival ulcers and collapsed vesicles and bullae. Ocular involvement may lead to blindness. Local and systemic corticoid hormones, dapsone, and periodontal therapy have all been used with variable success to treat the disease.

A well-defined coronal radiolucent area involving an impacted third molar.

The dentigerous cyst is the most common developmental odontogenic cyst and appears as an asymptomatic, well-defined radiolucent area surrounding the crown of an impacted tooth. Because of potential serious complications, lesions that are consistent radiographically with a dentigerous cyst should be totally removed and examined microscopically to establish a definitive diagnosis.

Smooth-surfaced, nonpainful swelling in the buccal mucosa.

A typical example of irritation fibrosis arising in the buccal mucosa has been presented. Clinicians are cautioned that although this common oral lesion generally appears clinically in a fairly characteristic manner, to rule out a more serious, similar appearing disease, these lesions should be surgically excised and examined microscopically.

Firm swelling on the anterior maxillary gingiva of an infant.

A female infant with a congenital granular cell epulis on the maxillary gingiva has been described. This is consistent with the most common clinical presentation of this lesion. The similarities and differences of this lesion are compared with granular cell tumor.

Nonpainful, erythematous, circinate lesions of a protean nature on a fissured tongue.

We have presented a case of BMG with concomitant fissured tongue, a not uncommon association for two rather common oral diseases. BMG is relatively simple to recognize, and the diagnosis most commonly is based on clinical appearance and history of the presence of the lesions. Clinicians should be aware, however, of the similarity, clinically and histologically, of lesions of BMG with other, more serious diseases such as psoriasis and Reiter's syndrome. Patients with characteristic lesions of BMG should be evaluated closely for signs and symptoms of these other diseases.

Draining fistulas associated with an endodontically treated tooth.

A case of periapical actinomycosis is presented. Although apparently uncommon, actinomycosis should be considered when a chronic periapical lesion, often in the maxilla, is associated with an endodontically treated tooth or a previous history of trauma. Histologic examination of the tissue or the presence of "sulfur granules" in the exudate will usually establish the diagnosis. Treatment consists of local curettage and antibiotic therapy.

Two fluid-filled gingival lesions in the mandibular canine-first premolar area.

The appearance of two gingival cysts in the area of the mandibular right canine and first premolar is reported in a 46-year-old black man (Fig 1) along with a single cyst in the same location in another patient (Fig 2, 3). Gingival cysts are compared with lateral periodontal cysts. The similarities in location, clinical behavior, morphologic appearance, and age of occurrence would indicate a strong relationship. The gingival cyst probably represents the extraosseous counterpart of the intraosseous lateral periodontal cyst. A distinction based on strict clinical, radiographic, and surgical criteria should be made between these cysts.