Demographic analysis of oral lichen planus presentations to Auckland Oral Medicine Clinic from 1999 to 2006.

AIM: The objective of this study was to describe the demographic characteristics of a case series of patients with a clinical and histopathological diagnosis of oral lichen planus who presented to the Oral Health Unit (Auckland District Health Board) between the years 1999 and 2006 (an 8-year period). METHOD: The records of patients who had a clinical and histopathological diagnosis of oral lichen planus were audited. Demographic (age, gender, ethnicity), clinical and histopathological data were collated. Patients whose ethnicity was not recorded were noted but not included in this part of the analysis. RESULTS: Between 1999 and 2006, 267 patients (82 males, 185 females; age range 21 to 93 years) had a clinical and histopathological diagnosis of oral lichen planus. Ethnicity data were available for 207 of those, of whom 108 (52.2%) were European; 65 (31.4%) of Indian subcontinent origin (India, Pakistan, Sri Lanka); 20 (9.7%) were Asian; 14 (6.8%) were Pacific Islanders; 50 (24.2%) were 'Other'; and 10 (4.8%) were 'Unknown'. None was Maori. CONCLUSION: The age and gender distribution in this case series were similar to that observed in a comparable UK study. The major findings were in the ethnic distribution of oral lichen planus in the sample, with patients of Indian subcontinent origin being over-represented, and Maori being under-represented.

Is electrogustometry useful for screening abnormalities of taste?

BACKGROUND: Electrogustometry is an accurate and increasingly popular method used to examine taste. However, its usefulness as a screening test is unknown. METHODS: We asked 114 subjects, some healthy but most with medical conditions possibly affecting taste, to rate their overall taste ability, on a scale of zero to 10. Those who had current symptoms related to taste- and who rated their taste as five or worse - were defined as 'aberrant tasters'. We recorded automated electrogustometry thresholds, and visual analogue scale intensity ratings, for solutions of the four basic tastes (sweet, sour, salty and bitter). A visual analogue scale score of 50 was used as a cut-off point to identify 'poor tasters'. RESULTS: The sensitivity and specificity of electrogustometry in identifying abnormal taste function were low. CONCLUSIONS: We conclude that automated electrogustometry is not a useful clinical screening method for taste disturbance in a population such as ours.

Electrogustometry: strengths, weaknesses, and clinical evidence of stimulus boundaries.

Electrogustometry is well established as a clinical tool for the estimation of taste detection thresholds. Nevertheless, the user is sometimes unaware of the impact of superficially minor procedural and psychophysical factors upon the reliability and comparability of threshold estimates. The inherent strengths and limitations of the procedure are outlined, and aspects of the control and specification of the stimulus that moderate threshold measures are discussed. In addition, threshold estimates from two individuals with severe unilateral taste loss are used to illustrate the level at which anodal dc current may elicit common, rather than taste, sensation. Where chorda tympani section is complete and historical (older than 7-14 days), very high stimulus levels, conservatively over 5 micro A/mm2 (100 micro A linear current with a 5-mm diameter electrode), are required to activate trigeminal responses.

The efficacy of casein phosphoprotein-calcium phosphate complex (DC-CP) [Dentacal] as a mouth moistener in patients with severe xerostomia.

OBJECTIVES: The purpose of this study was to evaluate casein derivatives coupled with calcium phosphate (CD-CP) (Dentacal, NSI Pty Ltd, Hornsby, Australia) as a mouth moistener in a group of dentate patients with severe xerostomia. DESIGN: The study was a subjective, patient self-evaluation questionnaire on the use of Dentacal compared with the moistening strategies that they usually used. SETTING: The study was hospital and community based. SUBJECTS/MATERIALS, AND METHODS: Thirty eight patients with severe xerostomia were recruited from the larger group of 124 who had taken part in a clinical trial of the anti-caries efficacy of casein derivatives complexed with calcium phosphate (Hay and Thomson, 2002). Each patient used Dentacal for 14 days and the responses to it were compared with the responses to their other mouth moistening strategies. RESULTS: The outcome indicated that Dentacal, when used as an atomised spray in the mouth, provided good moistening and lubrication. CONCLUSIONS: The material could provide benefits in both oral moistening and dental caries prevention in dentate people with xerostomia.

Quality of life and nutritional studies in Sjogren's syndrome patients with xerostomia.

People with xerostomia can experience significant difficulties eating some foods which, before the onset of the dry mouth, would have been easily consumed. The few studies in the literature indicate that such people become deficient in a variety of nutrients. In this study, supporting evidence was sought to confirm whether a New Zealand population of people with Sjogren's Syndrome and xerostomia was malnourished. Quality of life issues were measured in the same patients. There was no evidence of nutritional deficiency in the study group, nor did xerostomia seem to be important as a determinant of psychological distress or overall quality of life. As measured by the GHQ-12 score, xerostomic people without their natural teeth were, however, more psychologically distressed than those with a natural dentition. The importance of maintaining the natural dentition in xerostomia is emphasised by this latter result.

Prevention of infective endocarditis associated with dental treatment and other medical interventions. National Heart Foundation.

The prevention of infective endocarditis is extremely important for people with valvular heart disease and other high-risk cardiac conditions. The following is the National Heart Foundation's updated recommendations for the prophylaxis of infective endocarditis. The recommended antibiotic regimens have changed considerably from the previous guidelines. In response to these guidelines, Pharmac has instituted a number of changes to the Schedule to reduce the barriers to prescribing the recommended drugs for this indication. Pharmac expects that the last of these drugs to be listed on the Schedule (cefuroxime axetil) will be in place by 1 October 1999. Prescriptions will need to be endorsed "prophylaxis for endocarditis". Therefore, any prescriber (doctor or dentist) will be able to prescribe the recommended drugs on an endorsed prescription but, until 1 October 1999, some of the drugs may not be fully subsidised. Pharmac will be informing prescribers of the details of these changes in the near future. The Ministry of Health has recently alerted practitioners to the possible risk of heart valve damage following the long-term use of weight-loss drugs fenfluramine (Ponderax) and dexfenfluramine (Adifax). All patients who have taken these drugs for longer than 3 months should have a clinical check and, if any abnormality is detected, should be referred to a cardiologist. If mild or greater aortic or mitral regurgitation is present, antibiotic prophylaxis against endocarditis is recommended.--Boyd A Swinburn, Medical Director, National Heart Foundation.

Oral manifestations and dental management of immunocompromised patients.

Successful management of dental problems in immunocompromised patients requires an understanding of the diverse causes of immunodeficiency so that patients may be protected from potential hazards. Consultation with the patient's physician, oncologist, or haematologist is mandatory before any invasive dental procedure if there is concern about the disease process itself or doubt about adequate levels of leukocytes or platelets. Particular attention must be paid to maintain the intact mucosal barriers in the provision of dental care.

Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea.

Snoring and obstructive sleep apnoea (OSA) both seem at least to be associated with narrowing of the upper airway and sleep-induced loss of muscle-tone. Mandibular advancement splints (MAS) have been proposed as a relatively simple method to increase oro- and hypo-pharyngeal dimensions thereby increasing the size of the airway. However, data on their effectiveness are conflicting and there are no clear indications as to which design is most effective or when they should be used. The effects of two designs of splint (types A and B) have been evaluated in 14 and nine subjects, respectively, using the Epworth Sleepiness Score (ESS) and domiciliary sleep monitoring on separate nights. Both splints reduced the median ESS (type A from 12 to 4.5; P = 0.003, type B from 7 to 4; P = 0.005). The apnoea-hypopnoea index was not affected by type A, but was reduced from 7.1 to 0.8; P = 0.005 by type B splints. There was evidence of a small improvement in overnight oxygen saturation for type B splints (P = 0.02). The splints were well tolerated and continued to be used nightly by 18 subjects. Mandibular advancement splints may offer a simple and effective alternative for the treatment of snoring and mild OSA in selected patients. Splint design may have considerable bearing on efficacy.

A simple percutaneous inserter for radiopaque gold seeds used in radiotherapy treatment planning.

Percutaneous insertion of a radiopaque marker is an important technique used in radiotherapy planning for both external-beam and brachytherapy. It is of particular importance in the oral cavity. We describe the construction and use of a simple inserter for 'cold' gold seeds manufactured from a commercially available Becton Dickinson Brand 5-mL disposable syringe and a Becton Dickinson Brand 18 G 1 1/2 TW (1.25 x 38 mm) hypodermic needle.

Temporomandibular disorders.

1. Temporomandibular disorders represent predominantly a group of psycho-physiological problems. 2. The temporomandibular joint is no different from other joints, and the role of the dentition in the induction of TMDs is relatively unimportant. 3. The majority of patients get better with time. Only a small proportion require surgical intervention. 4. A therapeutic history is an important part of the overall management, and must exclude other pathology. 5. Treatment protocols should be conservative, non-invasive, and reversible.

An evaluation of the diagnosis, treatment, and outcome of patients with chronic orofacial pain.

A review of the records and follow-up of 106 patients who had been referred to pain management clinics in Auckland between January 1990 and October 1992 because of chronic, protracted, orofacial pain, showed that more than half gained lasting benefit. This is consistent with the experience of other interdisciplinary pain clinics dealing with various chronic pain disorders, where previous and often multiple treatments have proved unsuccessful. The patients who made good progress tended to be those motivated to take charge of, and responsibility for, their own rehabilitation. Those patients still seeking a "cure", or who felt it was not up to them to take an active part in the management of their pain problem, tended to make poor or no progress. Of concern was the number of instances of misdiagnosis seen, resulting in inappropriate and, on occasion, harmful treatments. On average, the patients had consulted three general or specialist dental or medical practitioners before referral. Chronic pain problems usually require considerable time and a multidisciplinary environment for accurate diagnoses, and a carefully planned management programme. Often, neither are readily available to the busy general practitioner, whose training and experience is directed toward the treatment of acute pain. As a result, patients with chronic pain often end up treated with methods more appropriate for acute pain, which may entrench and compound the pain problem and lead to permanent disability. Recognition and referral of the patient with chronic pain at an early stage can improve the chances of successful management, and avoid frustration and disillusionment of both the practitioner and the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Propolis allergy: a cause of oral mucositis with ulceration.

Propolis has been used since ancient times in folk medicine for its alleged beneficial effects. It is a potent sensitizer and is well recognized as a cause of occupational allergic eczematous contact dermatitis in apiarists. Recently, there has been an increase in allergic eczematous contact dermatitis because of nonoccupational exposure to propolis in "natural products" and biocosmetics. This report describes a patient who had acute oral mucositis with ulceration as a result of using propolis-containing lozenges.

Photogrammetry used to assess post-operative facial swelling in a drug trial.

A trial was designed to test the efficacy of ibuprofen in controlling post-operative pain and swelling following the surgical removal of lower third molar teeth. Because of the rigid criteria imposed on the trial it was not satisfactorily completed but the method of measuring the volume of the swelling by stereometric photogrammetry, which is reproducible, versatile and non-invasive, was considered to be worth reporting in context.

Allopurinol-amplified lichenoid reactions of the oral mucosa.

Three cases of oral lichenoid reaction linked with the administration of allopurinol are presented. Withdrawal of the drug resulted in considerable clinical improvement in one case and complete resolution of the ulcerative lesions in the other two cases. The consideration of drug-induced reactions in the differential diagnosis of oral mucosal diseases has been emphasized.

The use of an elimination diet in the treatment of recurrent aphthous ulceration of the oral cavity.

The involvement of components of food in the causation of recurrent aphthous ulceration of the oral mucosa is controversial. To test the proposition, seventeen patients with RAU which had been resistant to other forms of treatment were studied with the aid of a strict elimination diet. Five patients abandoned the difficult diet, and of the remaining twelve there were five patients who had remission of RAU while on the diet. In four of these five patients a particular food was identified which, when eliminated from the normal diet, led to either marked improvement or resolution. The results of this study clearly indicate the participation of food components in the etiology of some cases of RAU .