Oral lymphoma in HIV infection.

OBJECTIVE: This study reports the main clinical and histological features, and the treatment and outcomes of six HIV-associated oral lymphomas. SUBJECTS: During the period 1991-1995, six cases of lymphoma presenting in the oral cavity were diagnosed in this clinic. All six patients were men ranging in age from 36 to 62 years with CD4 counts below 100 cells mm-3. RESULTS: In five patients, oral lymphoma was the first AIDS defining disease. Four lesions occurred on the gingiva, one on the palate and one on the tongue. The duration of symptoms prior to presentation ranged from 2 weeks to 14 months. In all but one patient, the lesions presented as red, exophytic masses and were diagnosed clinically as Kaposi's sarcoma. None of the five lesions presenting on the palate or gingiva showed radiographic evidence of bone destruction. Metastatic work-up failed to diagnose lymphoma elsewhere in the five cases where this was performed. Histological diagnoses included two small, non-cleaved (Burkitt's type) lymphomas, two immunoblastic lymphomas, one large cell lymphoma and one small, non-cleaved (non-Burkitt's) lymphoma. CONCLUSION: These findings highlight the uncommon clinical presentation of this disease and despite its relative rarity, demonstrate the need to maintain a high degree of suspicion in any unusual oral lesion in this group of patients.

Topical steroid therapy in oral lichen planus: review of a novel delivery method in 24 patients.

Lichen planus is a chronic mucocutaneous disorder of unknown etiology. The natural progression of oral lichen planus (OLP) is long and can extend over a number of years. Although many patients with OLP remain asymptomatic, some experience periods of marked inflammation with breakdown of the lesions, and require treatment. Corticosteroids are the mainstay of treatment for oral lesions, but delivery to affected mucosal sites can be problematic. The purpose of this study was to retrospectively review the results of topical steroid therapy in a group of patients with OLP, using a novel delivery method. The records of 33 patients with biopsy-proven OLP were reviewed and the relevant clinical features were noted at minimum review intervals of one, six and 12 months. Of this group, 24 patients had been treated using a standardized treatment protocol consisting of a corticosteroid ointment applied topically to mucosal lesions using cloth strips. Gingival lesions were treated using a steroid preparation in an adhesive paste. Nine patients remained asymptomatic and were not treated. In the treated group, 14/24 (58 per cent) of patients showed an improvement in symptoms by one month. The remainder showed no change or a worsening of their symptoms. Repetition of the treatment protocol resulted in improvement in all the non-responders, and by one year 23 of 24 (96 per cent) of the patients had experienced improvement or control of their symptoms. Long-term failure to control the symptoms in the single non-responding case was related to poor patient compliance. Results from this study show that a novel delivery method and treatment protocol for the application of topical steroids onto lesional mucosa is useful for the symptomatic control of oral lichen planus.

Cancer of the tongue.

Squamous cell carcinoma of the tongue is the most common intraoral malignancy. It may be preceded by visible precursor lesions showing hyperkeratosis, erythroplakia or a combination of these conditions. The clinical appearance is highly variable, and ranges from asymptomatic white patches to large fungating, infiltrating lesions. Earlier detection of squamous cell carcinoma of the tongue should improve survival rates for this malignancy, which have not appreciably increased over the past several decades. The oral cavity is an accessible site and the dentist has an important role to play in early detection.

Actinic cheilitis and carcinoma of the lip.

During dental examinations, the lips are readily overlooked. Dentists should routinely examine the lips visually and by palpation. Actinic cheilitis is a common condition caused by damage to the lips through exposure to sunlight, and is readily diagnosed clinically. Its progress can be minimized by the use of an appropriate sun screen when outdoors. Actinic cheilitis can undergo malignant transformation into squamous cell carcinoma. The clinical features and management of these conditions are described.

Facial neuralgias: a clinical review of 34 cases.

This paper reviewed the clinical features of the facial neuralgias, and described the demographic data for 24 cases of atypical facial neuralgia, seven cases of trigeminal neuralgia, two cases of cluster headache and one of glossopharyngeal neuralgia, which were all referred for investigation and treatment over a three-month period to a teaching hospital dental department.

Oral pathology in Canada: a survey.

The Canadian Academy of Oral Pathology conducted a survey of its active members to obtain information on their demographics, professional activities and university affiliations, and to assess Canada's present and future oral pathology needs. Data were also collected on Canadian oral pathology diagnostic biopsy services. This paper reports the salient findings of the survey, and discusses their implications for the specialty of oral pathology as well as for the Canadian dental community.

Hypertrophic lichen planus of the oral mucosa.

Hypertrophic lichen planus is a variant of the condition not previously recognised as occurring in the mouth. Four cases are described that have been followed clinically for 18, 9, 6 and 3 years. The histopathology is described.

The oral manifestations of HIV infection.

The spectrum of oral lesions found in the HIV-infected population forms a diverse group of opportunistic conditions, all of which may be seen in non-HIV infected patients. With the continuing increase in HIV-positive individuals, it is important that practising dentists become familiar with the clinical features of HIV-associated oral diseases to facilitate early diagnosis and appropriate therapy.

Two cases of oral pigmentation associated with quinidine therapy.

Melanin pigmentation of the hard palate is described in two patients receiving long-term quinidine therapy for cardiac arrhythmia. The importance of quinidine-induced oral pigmentation in the differential diagnosis of oral pigmentary disturbances is discussed.

Oral tumours.

The authors of this article review briefly the anatomy of the oral soft tissues and describe the more common benign and malignant tumours of the mouth, giving emphasis to their clinical features.

Benign lymphoid hyperplasia of the palate.

Seven patients with benign lymphoid hyperplasia of the palate are reported. Clinically, these lesions presented as painless non-ulcerated masses that were unilateral in 6 of the cases and bilateral in one. Microscopically, the lesions were characterized by a mixed lymphoid infiltrate, germinal centres and vascular channels with hyperplasia of endothelial cells. The patients were followed for 3-10 years subsequent to diagnosis. One patient had 2 sequential lesions on opposite sides of the palate. Another patient with lesions of both submandibular salivary glands in addition to the palate developed rheumatoid arthritis, xerophthalmia and serologic changes consistent with systemic autoimmune disease. To date, none of the patients developed signs and symptoms of lymphoma or leukemia. The etiology of these lesions is unknown. Their distinction from lymphoma of the palate, as well as their possible relationship to the benign lymphoepithelial lesion of palatal mucous glands, is discussed.

Multiple myeloma with initial presentation in the jaw: a clinical-pathologic discussion.

A 39-year-old white female presented with jaw pain initially interpreted as a manifestation of an odontogenic infection. Mandibular radiographs revealed lytic lesions suggesting a diagnosis of myeloma, which was subsequently confirmed by abnormalities in serum and urinary proteins and in bone marrow. Chemotherapy produced a transient response, but eventual relapse with extramedullary plasmacytomas and plasma cell leukemia led to death. The clinicopathologic implications of this case are presented and discussed.

The effect of DMBA on hamster cheek pouch mucosa in vitro: constant exposure.

Repeated topical application of DMBA to hamster cheek pouch mucosa in vivo has been shown to cause dysplastic changes and ultimately the development of squamous cell carcinomas in the epithelium. A technique has already been reported whereby neonatal hamster pouch mucosa can be maintained in vitro and dysplastic changes have been described in the epithelium after a single exposure to DMBA. By 35 days in organ culture, these changes disappeared and the epithelium regained its normal organotypic morphology. In this study, the tissue was maintained in vitro in medium containing various concentrations of DMBA for up to 49 days. Dysplastic changes were seen in the epithelium of the explants with some histological evidence of malignant behaviour. These changes were observed throughout the experimental period.