RESUMO
Importance: Dry mouth, oral candidiasis, and recurrent aphthous ulcers are 3 of the most common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. Observations: In a meta-analysis of 26 population-based cohort and cross-sectional studies, the global prevalence of dry mouth symptoms was 23% (95% CI, 18% to 28%), placing individuals at risk of oral candidiasis, dental caries, dysgeusia, masticatory/speech impairment, and oropharyngeal dysphagia. Dry mouth is associated with using more than 3 oral medications per day (odds ratio [OR], 2.9 [95% CI, 1.4 to 6.2]), head and neck radiation, and Sjögren disease. Symptoms may include difficulty swallowing and speaking, thirst, and halitosis. Dry mouth is associated with an 11.5% (95% CI, 3.6% to 27%) higher risk of oral candidiasis, based on a meta-analysis of 6 observational cohorts. Management of dry mouth includes mechanical salivary stimulants, oral moisturizers, and/or systemic sialagogues. Oral candidiasis is an opportunistic fungal infection caused by overgrowth of the Candida genus with C albicans, which accounts for 76.8% of infections. The prevalence of oral candidiasis is higher in patients who are immunosuppressed, for example, those with HIV (35% [95% CI, 28% to 42%]) and those with salivary gland hypofunction (OR, 3.02 [95% CI, 1.73 to 5.28]). Common risk factors associated with oral candidiasis include use of antibiotics (P = .04) and oral mucosal disorders such as lichen planus. Oral burning and dysgeusia are common symptoms of oral candidiasis. Treatment includes addressing risk factors and use of topical and/or systemic antifungal medications. Recurrent aphthous stomatitis is characterized by symptomatic round or oval oral ulcers, which are covered by a gray-white fibrin layer and encircled by an erythematous ring. A meta-analysis of 10 case-controlled studies revealed an increased risk of recurrent aphthous stomatitis associated with polymorphism of IL-1ß (+3954C/T) (OR, 1.52 [95% CI, 1.07 to 2.17]) and IL-1ß (-511C/T) (OR, 1.35 [95% CI, 1.09 to 1.67]). Another meta-analysis of 9 case-control studies reported that patients with recurrent aphthous stomatitis had a higher frequency of nutritional deficiencies, including vitamin B12 (OR, 3.75 [95% CI, 2.38 to 5.94]), folic acid (OR, 7.55 [95% CI, 3.91 to 14.60]), and ferritin (OR, 2.62 [95% CI, 1.69 to 4.06]). Recurrent aphthous stomatitis can be associated with systemic diseases. A meta-analysis of 21 case-control studies revealed that celiac disease is associated with a higher incidence of recurrent aphthous stomatitis (25% vs 11%; OR, 3.79 [95% CI, 2.67 to 5.39]; P <.001). Topical corticosteroids are first-line agents to manage recurrent aphthous stomatitis; however, systemic medications may be necessary in more severe cases. Conclusions and Relevance: Dry mouth, oral candidiasis, and recurrent aphthous ulcers are common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. First-line treatment includes over-the-counter sialagogues for dry mouth, topical antifungals for oral candidiasis, and topical corticosteroids for aphthous ulcers. Oral conditions that do not improve with first-line treatment may require treatment with systemic medications.
Assuntos
Doenças Estomatognáticas , Humanos , Candidíase Bucal/tratamento farmacológico , Estudos Transversais , Cárie Dentária/etiologia , Disgeusia/etiologia , Qualidade de Vida , Estomatite Aftosa/etiologia , Xerostomia/epidemiologia , Xerostomia/etiologia , Glucocorticoides/uso terapêutico , Doenças Estomatognáticas/epidemiologia , Doenças Estomatognáticas/etiologia , Doenças Estomatognáticas/terapiaRESUMO
BACKGROUND: Oral lichen planus (OLP) is considered an oral potentially malignant disorder. While OLP has been associated with the development of oral squamous cell carcinoma (OSCC), little is known about the role of topical corticosteroids therapy (TCT) in the promotion of carcinogenesis. The study aimed to determine if TCT influences the time of malignant transformation of OLP to OSCC. The study also investigates this correlation in the presence or absence of Candida overgrowth, and in the context of conventional OSCC risk factors such as smoking, alcohol use, and male gender. METHODS: A retrospective analysis of electronic health records at a tertiary care academic medical center was performed. Patients with OLP and OSCC were considered for inclusion. The diagnosis of OLP required both clinical and histological documentation. RESULTS: Eighty-two patients met inclusion criteria, consisting of 48 women (58.25%) and 34 men (41.5%) and the mean patient age was 65.9 years (SD = 13.25). Forty-five patients (54.9%) received TCT for OLP before they developed OSCC. The time between the OLP and OSCC diagnoses increased by four years in patients who received topical steroid therapy for OLP (p < 0.001) and decreased by three years (p = 0.010) in those with Candida overgrowth. Gender, smoking, and alcohol use did not have a statistically significant influence on the time between OLP and OSCC. CONCLUSION: The management of OLP using TCT potentially delayed cancer development in our study. Conversely, it appears that Candida may play a role in the field cancerization of OLP patients.
Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Líquen Plano Bucal , Neoplasias Bucais , Corticosteroides/efeitos adversos , Idoso , Carcinoma de Células Escamosas/tratamento farmacológico , Transformação Celular Neoplásica , Feminino , Humanos , Líquen Plano Bucal/tratamento farmacológico , Masculino , Neoplasias Bucais/tratamento farmacológico , Estudos RetrospectivosRESUMO
In this article, we discuss several common abnormal signs and symptoms that may be present in the oral cavity initially with or without any systemic symptoms at a typical dental practice. The purpose of this discussion is to increase clinical awareness for establishing differential diagnoses so that patients may obtain appropriate referrals for appropriate medical treatment.
Assuntos
Anemia/complicações , Complicações do Diabetes/complicações , Infecções por HIV/complicações , Doenças da Boca/etiologia , Humanos , Doenças da Boca/patologiaAssuntos
Gengivite Ulcerativa Necrosante/diagnóstico , Gengivite Ulcerativa Necrosante/etiologia , Pênfigo/complicações , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Nistatina/uso terapêuticoRESUMO
Oral and perioral herpes simplex virus (HSV) infections in healthy individuals often present with signs and symptoms that are clearly recognized by oral health care providers (OHCPs). Management of these infections is dependent upon a variety of factors and several agents may be used for treatment to accelerate healing and decrease symptoms associated with lesions. This article will review the pertinent aspects of topical and systemic therapies of HSV infections for the OHCP.
Assuntos
Antivirais/uso terapêutico , Estomatite Herpética/tratamento farmacológico , 2-Aminopurina/administração & dosagem , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapêutico , Aciclovir/administração & dosagem , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Administração Oral , Administração Tópica , Antivirais/administração & dosagem , Famciclovir , Humanos , Cuidados Paliativos , Valaciclovir , Valina/administração & dosagem , Valina/análogos & derivados , Valina/uso terapêuticoRESUMO
Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a multisystem disorder of small blood vessels subdivided into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Oral manifestations (OMs) have been reported to include mucosal ulceration, gingival enlargement, alveolar bone necrosis, tooth loss, oro-antral communication, palatal perforation, parotitis, and candidal infection mainly in GPA. They may appear during the course of the disease, as a disease flare-up, or as the presenting sign. These OMs are often nonspecific and can mimic an array of conditions, therefore formulating a differential diagnosis can be challenging. This review updates the OMs of GPA, and, for the first, time includes OMs of other AAVs. It provides recommendations for the overall assessment and the diagnosis and management of all AAV OMs with considerations for treatment coordination. The role of oral health care providers in multidisciplinary care is highlighted.
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Manifestações Bucais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Poliangiite Microscópica/diagnóstico , Síndrome de Churg-Strauss/diagnóstico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/terapiaRESUMO
Mycosis fungoides (MF) is a rare cutaneous T-cell lymphoma (CTCL) with significant morbidity and mortality rates. Involvement of MF in the oral cavity is uncommon, often follows cutaneous involvement, and is usually associated with a poor prognosis. Herein, we describe a case of a 72-year-old White male with biopsy-proven oral T-cell lymphoma (TCL) in the setting of MF with systemic disease progression. Mycosis fungoides with oral involvement can often prove challenging to diagnose and manage. Thorough medical history intake and clinical examination supported by histopathologic and immunohistochemical analysis are imperative because delay in the diagnosis can lead to disease progression.
Assuntos
Linfoma Cutâneo de Células T , Micose Fungoide , Neoplasias Cutâneas , Masculino , Humanos , Idoso , Neoplasias Cutâneas/patologia , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/patologia , Micose Fungoide/diagnóstico , Micose Fungoide/patologia , Biópsia , Progressão da DoençaRESUMO
OBJECTIVE: The aim of this study was to evaluate and compare quality of life (QoL) parameters in patients with oral potential malignant disorders (OPMDs), namely, oral lichen planus (OLP) and oral epithelial dysplasia (OED). STUDY DESIGN: A cross-sectional study was completed at the oral maxillofacial surgery/oral medicine practices at University of Pennsylvania. Patients with clinical and histopathologic confirmation of OLP or OED from January to June 2021 were included in the study. The primary predictor variable was the OPMD type. The primary outcome variable was the score of 3 separate surveys: the Chronic Oral Mucosal Disease Questionnaire-26 (COMDQ-26), Oral Potential Malignant Disorder QoL Questionnaire (OPMDQoL), and Hospital Anxiety and Depression Scale. Multiple linear regression was used to determine independent predictors of increased/decreased questionnaire scores. RESULTS: The final study sample consisted of 100 patients:53 patients had OLP (53.0%), 39 patients had OED (39.0%), and 8 patients had OLP with OED (8.0%). Relative to OED, OLP added 15.7 points to the COMDQ-26 survey score (P < .001). Relative to OED, OLP added 8.9 points to the OPMDQoL survey score (P = .003). CONCLUSIONS: Oral lichen planus shows significantly poorer QoL specifically within the COMD-26 and OPMDQoL questionnaires, compared with OED. Additionally, patients with OPMDs aged 40 to 64 years were independently associated with higher COMD-26 scores compared with older patients (>65 years).
Assuntos
Líquen Plano Bucal , Doenças da Boca , Lesões Pré-Cancerosas , Humanos , Líquen Plano Bucal/patologia , Qualidade de Vida , Estudos Transversais , HiperplasiaRESUMO
Gastroesophageal reflux disease (GERD) is a clinical condition in which stomach contents leak backward into the esophagus. It affects millions of people worldwide and has a detrimental effect on quality of life. Heartburn and acid regurgitation are typical GERD symptoms, while atypical manifestations include noncardiac chest pain, cough and laryngitis. The oral and maxillofacial manifestations of GERD may include dental erosion, xerostomia, mucositis, aphthous like ulcerations, sour taste, burning mouth, hyperesthesia, bruxism, and/or temporomandibular disorder (TMD). This narrative review provides oral health care professionals with an update to medical aspects of GERD, recognition and management of oral and maxillofacial manifestations of the condition and provision of appropriate dental care for this patient population.
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Refluxo Gastroesofágico , Laringite , Humanos , Saúde Bucal , Qualidade de Vida , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , TosseRESUMO
This article presents a case of a 39-year-old woman with spontaneous lip swelling with gingival erythema. The case report discusses orofacial granulomatosis, a condition that often poses diagnostic and management challenges. Additionally, the article emphasizes the importance of establishing a definitive diagnosis of this disease, which has similar clinical and histological features to other oral and systemic conditions. Finally, a successful management approach is discussed that uses combination therapy consisting of intralesional steroid injections and oral hydroxychloroquine.
Assuntos
Granulomatose Orofacial , Hidroxicloroquina , Adulto , Feminino , Granulomatose Orofacial/tratamento farmacológico , Humanos , Hidroxicloroquina/uso terapêutico , Injeções Intralesionais , Esteroides/uso terapêuticoRESUMO
INTRODUCTION: Kohlschutter-Tonz syndrome (KTS) is a rare, genetic condition, which typically manifests as a triad of symptoms: 1) amelogenesis imperfecta, 2) infantile onset epilepsy, and 3) intellectual disability. The condition poses dental treatment challenges given the manifestation of amelogenesis imperfecta. Additional considerations are needed to medically manage these patients who present with epilepsy and intellectual disability. CASE REPORT: Our patient presented with multiple restorative needs, was treated under general anesthesia, and maintained good oral outcomes with close follow-up. DISCUSSION: To the best of our knowledge, this is the first case report which documents comprehensive dental management of a pediatric patient with KTS.
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Amelogênese Imperfeita , Epilepsia , Deficiência Intelectual , Amelogênese Imperfeita/terapia , Criança , Demência , Assistência Odontológica , HumanosRESUMO
Lymphoproliferative disorders (LPDs) are a group of conditions characterized by excessive production of lymphocytes manifested in various patterns including lymphadenopathy, tumor-like lesions, and lymphomas. LPD may be stimulated by Epstein-Barr virus (EBV) infection that most commonly appears in the setting of immunocompromised status such as long-term use of immunosuppressive medications and in individuals with primary immunodeficiency disorders. EBV mucocutaneous ulcer is a benign LPD reaction that mostly regresses spontaneously but sometimes requires medical or surgical intervention. This article presents a case of oral EBV mucocutaneous ulceration that affected an individual with a history of complex primary immunodeficiency disorders consisted of common variable immunodeficiency disease associated with T-cell dysfunction. This case is unique because the oral lesions led to the diagnosis of concurrent widespread EBV-negative follicular lymphomas, seemingly unrelated to her EBV-positive LPD oral disease. Yet, both occurred in the setting of severe immunosuppression from the primary immunodeficiency disorders.