Tuberculosis of the tongue: A rare case

Introduction: Tuberculosis mostly affects the lungs, but may also affect the central nervous system, lymphatic system, circulatory system, genitourinary system, bones, joints, and skin. Extrapulmonary involvement in tuberculosis is rare, accounting for just 10 to 15% of cases. The lymph nodes are the second most common site of tuberculosis infection. Oral tuberculosis has long been thought to be an unusual phenomenon. Oral manifestations are thought to occur in just 0.05 to 5% of all tuberculosis cases. Surface ulcers, patches, papillomatous lesions, and indurated soft tissue lesions are the most common oral manifestations. Case Presentation: A 69-year-old man presented to the Department of Ear, Nose, Throat at MGM Hospital in Aurangabad, India, with a painful ulcer and tiny nodules on the tongue’s tip and lateral surface. The ulcer appeared 3–4 weeks ago without any obvious trigger with a prickling feeling and increased soreness over the area., Onintraoral inspection multiple small nodules is measuring about 0.1 cm and multiple circular ulcer measuring about 0.2 x 0.1 cm in diameter at the tip and lateral border of the tongue. A granulomatous center and a whitish, well-defined border with mild elevation characterized the ulcer. Conclusion: Despite the rarity of tuberculosis evidence in the oral cavity, oral tuberculosis should be included in the differential diagnosis of chronic oral lesions. To prevent ineffective oral therapy, accurate diagnosis is crucial for successful care by concentrating on the pathological source.

Estomatitis por metotrexate: Breve revisión del tema / Methotrexate stomatitis: A brief review

El empleo de metotrexate como inmunoimodulador y antimetabolito, ha ido en aumento debido a su efectividad terapéutica, bajo costo y su esquema sencillo de dosis única semanal. Sin embargo, recientemente se han reportado efectos adversos graves relacionados con su administración, entre ellos la estomatitis. Las úlceras bucales son el efecto adverso oral más frecuente y se relacionan con la falta de administración complementaria de ácido fólico, iatrogenias ocasionadas por errores en la ingestión o interacciones farmacológicas.

The use of methotrexate as immunomodulator and antimetabolite has been increasing because of its therapeutic effectiveness, low cost, and simple scheme single dose weekly. However, have recently been reported serious adverse effects related to administration, including stomatitis. Mouth ulcers are the most frequent oral adverse effect and relate to the lack of supplemental folic acid, iatrogenic errors caused by ingestion or drug interactions.

Periodontal Treatment Needs and Oral Ulceration in Children and Adolescents with Celiac Disease.

Aim: To determine periodontal treatment needs and the incidence of oral ulceration among children and adolescents with celiac disease and to compare their findings with a healthy age and gender-matched control group. Methods: A prospective study was conducted at King Hussein Medical Center on a total of 86 patients: 43 patients with celiac disease as the study group (comma removed) and 43 healthy age and gender-matched participants as the control group. Both groups were questioned for a history of recurrent mouth ulcers (comma removed) and the frequency of tooth brushing. The dental examination for each patient in both groups included the following: plaque index, gingival index (comma removed) and Community Periodontal Index of Treatment Needs (CPITN). The oral mucosa was examined clinically for any lesion consistent with aphthous ulceration. Results: There were 26 females and 17 males in each group, with a mean age of 13.2 and 13.3 years respectively. Plaque scores were significantly higher among the study group (p<0.05) while the difference in the gingival scores was not statistically significant (p>0.05). Recurrent aphthous ulceration (RAS) was positive among 13 (30.23%) celiac patients compared to 9 (20.9%) among the control group. However, the result was not statistically significant (p>0.05). CPITN revealed no significant difference between the two groups although the mean index was higher among the celiac group. No one in either group scored 0, while the highest percentage in both groups scored 2. Shallow and deep pockets (scores of 3 and 4) were greater in celiac patients. Overall, the variation between the two groups was not statistically significant. Conclusion: Oral hygiene status seems worse in celiac patients, which indicates that oral health education programs may be beneficial for these children. Although the need for periodontal treatment and the frequency of RAS are higher in celiac patients, the statistical difference was not significant (p NS).

Doença de Behçet e a visão do otorrinolaringologista / Behçet’s disease as viewed by the otorhinolaryngologist

A doença de Behçet é um distúrbio inflamatório autoimune, que acomete pequenos vasos sanguíneos. O diagnóstico da síndrome é clínico e necessita a presença de úlceras orais recorrentes, úlceras genitais e desordens oculares. No entanto, diversos sistemas podem ser afetados. Na avaliação otorrinolaringológica, as lesões orais são os sintomas mais frequentes da doença. O paciente do caso desenvolveu odinofagia no pósoperatório de cirurgia para correção de aneurisma. Ao exame, foram identificadas úlceras orais e lesão ulcerada na base peniana. Foi aventada hipótese diagnóstica de doença de Behçet e iniciado terapia com corticoide e colchicina. Embora a doença de Behçet não seja frequente na prática diária, os profissionais médicos devem estar atentos a sua apresentação

Behçet’s disease is an inflammatory autoimmune disorder that affects small blood vessels. The diagnosis of the syndrome is clinical and requires the presence of recurrent oral ulcers, genital ulcers, and ocular disorders. However, several systems may be affected. On otorhinolaryngological evaluation oral lesions are the most frequent symptoms of the disease. The patient described here developed postoperative odynophagia after surgery for aneurysm. On examination oral ulcers and ulcerated lesion on the penile base were found. A diagnosis of Behcet’s disease was hypothesized and therapy with corticosteroids and colchicine was initiated. Although Behcet’s disease is rare in everyday practice, medical professionals should be aware of its presentation

Oral ulceration with bonesequestration: case report / Ulceração bucal com sequestro ósseo: relato de caso

This report describes the case of a 38-year-old male patient that presented bilateral ulcerations with bone necrosis in the mandibular lingual area at the level of the mylohyoid ridge for 30 days. The patient reported discrete pain and eventually bleeding. Occlusal radiograph showed bilateral bone exostoses in the lingual mandibular cortical bone. Oral ulceration with bone sequestration diagnosis was based on clinical examinationand on oclusal radiograph. The patient was treated with antibiotics, 0.12% chlorhexidine mouth washes and removal of bone sequestrations. At clinical follow-up at 60 days, it was observed that the region was completely healed. The patient had bruxism, which was diagnosed based on the examination of wear on the surfaces of anterior incisors and on family reports. For this reason, he was referred to a clinical dentist for treatment with an occlusal splint. This is a rare lesion and the recognition of its characteristics is important for an accurate diagnosis and adequate clinical management.

Este estudo relata o caso de um paciente do gênero masculino, 38 anos de idade, que apresentava úlceras bilaterais com necrose óssea na região lingual da mandíbula no nível da linha miloioidea há trinta dias. O paciente relatava dor discreta e sangramento eventual.A radiografia oclusal mostrava exostoses ósseas bilaterais na cortical óssea lingual da mandíbula. O diagnóstico de úlcera com sequestro ósseo baseou-se no exameclínico e na radiografia oclusal. O paciente foi tratado com antiobióticos, bochechos com clorexidina a 0,12%e remoção dos sequestros ósseos. Após sessenta dias, na consulta de proservação, observou-se que a região estava completamente cicatrizada. O paciente apresentava bruxismo, o qual foi diagnosticado pela observação de facetas de desgaste nos incisivos inferiores e por meio de entrevista com os familiares. Em razão disso,o paciente foi encaminhado para um clínico geral para que fosse realizado um tratamento com placa miorrelaxante. Essa lesão é rara e o reconhecimento de suas características é importante a fim de que se realize o diagnóstico preciso e o tratamento apropriado.

Ulcerative lesions of the mouth: an update for the general medical practitioner: [review]

Oral ulceration is a common complaint of patients attending out-patient clinics. Because of the diversity in causes of oral ulceration, patients presenting with oral mucosal disease can be challenging to diagnose and manage. Patients with signs or symptoms of oral ulcers are sometimes referred to gastroenterology clinics; however, in most instances the ulcers do not result from gastrointestinal disease. The aim of the present article is to review aspects of the etiology, diagnosis and management of common ulcerative disorders of the oral mucosa. A search in the National Library of Medicine computerized bibliographic database MEDLINE was performed. Selection of publications, extraction of data, and validity assessment were then performed by the authors. Based upon the searched literature, it is concluded that there are several systemic disorders that can present with similar clinical signs and symptoms, and knowledge of each disease is necessary for the clinician to provide proper management.

A ulceração oral é uma queixa comum dos pacientes que são atendidos em ambulatórios. Com freqüência é difícil estabelecer um diagnóstico preciso e atingir o controle dos sinais e sintomas dos pacientes que apresentam ulceração oral. Os pacientes acometidos por ulceração oral são eventualmente encaminhados para os ambulatórios de gastroenterologia, entretanto, a maioria das úlceras não reflete doença gastrointestinal, e sim desordens sistêmicas que podem se apresentar com sinais e sintomas clínicos similares. O objetivo do presente artigo foi revisar aspectos da etiologia, diagnóstico e tratamento das desordens ulcerativas mais comuns da mucosa oral. Foi realizada uma busca no banco de dados MEDLINE da National Library of Medicine. A seleção dos artigos, coleta de dados e julgamento em termos da pertinência de inclusão foram realizadas pelos autores. Baseado na literatura pesquisada, foi concluído que existem várias doenças sistêmicas que podem apresentar sinais e sintomas clínicos semelhantes e o conhecimento de cada doença poderá guiar o clínico para uma intervenção apropriada.

Diagnostic criteria of Behcet's disease: problems and suggestions

There are no specific diagnostic laboratory tests for Behcet's disease. Diagnosis relies on proper history-taking and typical clinical manifestations. To provide more objectivity to the diagnosis, several diagnostic criteria have been introduced including one major set of guidelines by the International Study Group for Behcet's Disease (ISGBD) in 1990 which has made a significant contribution, although some disagreements exist in interpretation. Based on this criteria, recurrent oral ulceration is an obligatory manifestation for the diagnosis of Behcet's disease; however, some data indicates it is not a requirement for the diagnosis. In this article the author critically reviews different accepted diagnostic criteria or classifications of Behcet's disease and gives recommendations for a more thorough diagnosis.