Effect of cannabis usage on the oral environment: a review.

AIM: To evaluate oral environmental changes in cannabis users. MATERIAL AND METHODS: The MEDLINE and Cochrane Central register of controlled trails (CENTRAL) were searched up to April 2007 to identify appropriate studies. RESULTS: Independent screening of 982 titles and abstracts (MEDLINE-Pubmed) and (Cochrane) papers resulted in seven eligible publications. CONCLUSION: Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects, such as xerostemia, leukoedema and an increased prevalence and density of Candida albicans.

Betel quid-associated oral lesions and oral Candida species in a female Cambodian cohort.

BACKGROUND: Betel quid chewing (BQC) is still prevalent among elderly Cambodian women and is associated with a wide variety of oral mucosal lesions. BQC has also been associated with a reduced rate of dental caries and changes in the oral microbiological flora. METHODS: Since no studies were available on the impact of BQC on the oral carriage of Candida species, in this study oral swabs (Fungiquick, Hain Diagnostika, Germany) were taken from the tongue and palate of 48 Cambodian women with BQC habit (study group) and 13 control subjects without BQC habit (control group) to determine the spectrum of Candida species in these two groups. In addition, we investigated lesions of the oral mucosa likely to be associated with BQC habit in both study and control groups. RESULTS: The median duration of BQC was 10 years (range 10 months-30 years). The following oral lesions were found in the study group: betel chewer's mucosa (85.4%), oral leukoplakia (8.3%), leukoedema (37.5%) and oral lichen planus (4.2%). Oral candidiasis was seen neither in BQ-chewers nor in controls. Candida spp. were found in 70.8% of the cases (controls 69.2%). Whilst C. albicans was isolated from 27.1% of the study cohort, C. tropicalis was the second most common isolate. One control case was colonised by C. dubliniensis--the first report of this organism from a Cambodian population. There was no significant difference in the candidal carriage rate or the Candida species isolated between the study and the control group. CONCLUSIONS: Mycological findings from the present study do not indicate that BQC has a significant effect on oral colonisation by Candida species.

Leucoedema frente a nevo blanco esponjoso. A propósito de un caso / Leukoedema versus white sponge nevus. A case report

El leucoedema es una patología oral supuestamente muy frecuente, mientras que el nevo blanco esponjoso es una rareza. Sin embargo, ambas entidades son muy parecidas en cuanto a clínica, histopatología, microscopia electrónica, evolución y tratamiento. Se presenta el caso de un varón de 46 años con lesiones blanquecinas en la mucosa oral. Se realiza un exhaustivo diagnóstico diferencial entre leucoedema y nevo blanco esponjoso, llegándose a la conclusión de que son entidades relacionadas (AU)

Leucoedema: una revisión de la literatura / Leukoedema: a review of the literature

El leucoedema es una entidad de naturaleza benigna, que clínicamente se describe como un blanqueamiento difuso y opalino de la mucosa oral que le confiere un aspecto aterciopelado, generalmente bilateral, simétrico y de carácter crónico. Es más frecuente en negros americanos, aunque la prevalencia descrita en cada estudio es controvertida, al igual que su patogenia. Histológicamente se caracteriza por una hiperparaqueratosis, una acantosis con hiperplasia epitelial, espongiosis, edema intracelular y papilomatosis; no se observan alteraciones malignas o premalignas ni en el epitelio ni en el tejido conectivo. Deberemos diferenciar esta entidad del resto de lesiones blancas orales. No se recomienda tratamiento alguno, excepto el evitar aquellos irritantes locales que puedan favorecer su aparición. (AU)

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The influence of cigarette consumption and smoking machine yields of tar and nicotine on the nicotine uptake and oral mucosal lesions in smokers.

The purpose of this investigation, which has been performed as two studies, was to evaluate the association between the daily exposure to nicotine (measured as cigarette smoking machine yields) and the actual uptake of nicotine by cigarette smokers, as well as the association between oral mucosal changes and the exposure to cigarette smoke. In Study 1, consumption data, soft tissue changes and nicotine intake were measured in 47 habitual smokers using cigarettes with tar and nicotine yields within the ranges 9.3-12.2 and 0.72-1.16 mg per cigarette, respectively. The subjects were divided into three groups based on daily cigarette consumption; group averages (standard deviation) were 10.8 (2.2), 17.9 (1.9) and 28.4 (6.1) cigarettes per day. The group averages of tar deliveries from their usual brands of cigarettes were 11.1, 11.0 and 10.5 mg per cigarette, and group averages of nicotine deliveries were 1.05, 1.05 and 1.06 mg per cigarette, respectively. In Study 2, the same data were measured in a group of 77 habitual smokers with an average individual consumption of 11-21 cigarettes per day. The participants in Study 2 were divided into three groups according to tar delivery from their usual brands to cigarettes, with group averages of tar being 6.4 (1.2), 11.0 (1.2) and 16.0 (1.1) mg per cigarette, and of nicotine being 0.70 (0.12), 1.05 (0.12) and 1.34 (0.08) mg per cigarette, respectively. The average consumption of all three groups was within the range 17.1 to 17.9 cigarettes per day. The daily exposures to nicotine and tar were measured as the smoking machine yields multiplied by the number of cigarettes smoked per day. Nicotine uptake was determined by monitoring nicotine and its seven main metabolites in 24-h urine samples. In Study 1 there were significant differences between the three groups in the total amount of nicotine and metabolites excreted in the 24-h urine. The average nicotine uptake was 14.9, 24.4 and 35.4 mg per day, respectively. In Study 2, the 24-h excretion of nicotine and metabolites was about the same in all three groups and averaged 24.5 mg per day. The nicotine uptake was significantly correlated to the number of cigarettes smoked per day but not to the smoking machine yields of tar and nicotine per cigarette. The average prevalences for each of the different oral mucosal lesions (leukoedema, smoker's palate and hairy tongue) were found to increase with increasing consumption and nicotine uptake (Study 1); they were also independent of tar and nicotine yields from the cigarettes smoked (Study 2). These results indicate that the actual uptake of nicotine by smokers could not be estimated from the smoking machine yields. Reduction in exposure to smoke components may best be accomplished if smokers are encouraged to smoke fewer lower-yield cigarettes and to avoid smoking more of each cigarette.

Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-yr follow-up study of 12,212 users.

OBJECTIVE: To study the effect of cessation of tobacco use on the incidence of lichen planus, leukoplakia and other oral mucosal lesions. DESIGN: A 10-yr cohort study in a rural population of Ernakulam district, Kerala, India. MATERIAL AND METHODS: Some 12,212 tobacco users were interviewed and examined in a baseline survey and re-examined annually for 10 years. At each examination they were exposed to health educational programs to encourage them to quit their tobacco use. The incidence rates were calculated using person-years method among those who stopped their tobacco use and all others. RESULTS: A total of 77,681 person-years of observation accrued among men and 32,544 among women. Among men 6.5% of these and among women 14.4% were in the stopped category. The incidence of oral lichen planus did not show any consistent association with cessation of tobacco habits (incidence ratio 1.35) but for leukoplakia there was a substantial drop in the incidence after cessation (incidence ratio 0.31). Several other tobacco-associated oral mucosal lesions such as oral lichen planus-like lesion, smoker's palate, preleukoplakia, central papillary atrophy of the tongue and leukoedema showed either zero, or very small incidence, after cessation. CONCLUSION: The reported association between tobacco use and lichen planus appears to be indirect but for all other lesions it is direct. The cessation of tobacco use led to a substantial fall in the incidence of leukoplakia and other lesions implying a reduced risk for oral cancer after cessation of tobacco use.

Effects of cannabis smoking on oral soft tissues.

The oral effects of cigarette smoking have been well documented but the effects of cannabis smoke on the oral environment have been poorly documented. Three-hundred cannabis/tobacco/methaqualone smokers were examined. Two control groups consisting of 152 tobacco- and 189 non-smokers respectively were examined similarly. Health of the oral tissues and oral dryness was recorded. Lesions present included leukoedema, leukoplakia and numerous others. The only significant differences between lesions and conditions noted in cannabis users and controls occurred with respect to leukoedema, dry mouth and traumatic ulcer.

Leukoedema: a review of the literature.

Leukoedema, a grayish-white lesion of the oral mucosa in humans, was once thought to be a probable precursor to leukoplakia. Clinical examination differentiates leukoedema from leukoplakia, lichen planus, white sponge nevus, and pathomimia morsicatio buccarum. Prevalence rates vary greatly in different countries and in different ethnic groups. For many years, leukoedema was alleged to occur only in adult populations until Martin and Crump found this lesion in children and youth. There is a definite predilection for this lesion in black Americans. Although the etiology is unknown, it has been suggested that leukoedema develops in areas of local irritation. This article reviews the literature related to the prevalence of leukoedema and correlates the independent findings, which might pertain to its etiology.

Giant centrifugal miliaria profunda.

A 4-month-old developed rapidly enlarging, white plaques up to several centimeters in diameter in areas where occlusive tape had been applied, almost all on the sites of venous or arterial punctures. Microscopy demonstrated the features of miliaria profunda, with sweat duct occlusion and evidence of extravasation of sweat into the dermis. This clinical entity has not been described previously, and we suggest the name giant centrifugal miliaria profunda.

An investigation into the association between leukoedema and smoking.

One thousand, nine-hundred and ninety-six Cape Coloured high school pupils (655 females and 1,341 males, 14-18 years old) were examined to determine the prevalence of leukoedema and to investigate its relationship with smoking. Results were contradictory. Only in some subgroups was it found that the proportion of smokers with leukoedema was significantly larger than non-smokers with leukoedema; that those with leukoedema consumed significantly more tobacco than those without leukoedema, and that there was a corresponding increase in smoking and leukoedema with age. An analysis of the relationship between smoking, the sex, and leukoedema showed a relationship between sex and leukoedema, but that leukoedema was independent of smoking. Also the prevalence of the condition in smokers and ex-smokers was not significantly different. No correlation existed with the type of smoking and between the severity of the lesion and the amount of tobacco consumed. It is concluded that smoking does not cause the lesion but may aggravate it and that its etiology must be multifactorial.

Leukoedema - an epidemiologic study with special reference to the influence of tobacco habits.

Among 20,333 individuals aged 15 years and above, examined in urban, suburban and rural regions in the middle of Sweden, leukoedema was found in 48.9%. The sex difference, males 61.9% and females 35.9%, was highly significant (P less than 0.001). The condition was most prevalent in the age groups 25-34 and 15-24 years being 60.6 an 53.7%, respectively. Leukoedema was significantly more prevalent among individuals with some daily tobacco habit (60.0%) than among those without (36.3%) (P less than 0.001), being most prevalent among smokers. The lesion seemed to be related to the amount of smoking since it was most prevalent among heavy smokers and also the most clearly established lesions were found in this group.

Clinical signs for the early recognition of cancer of the oral cavity.

The dentist bears a particularly great responsibility with regard to the early detection of cancer of the oral cavity, since only early detection provides the greatest prospect of a cure. A description is therefore given of the features of the oral mucous membrane on which the differential diagnosis of 'carcinoma of the oral cavity' must in particular be made. The author then sets out an examination procedure which every dentist should follow before any treatment is given; this will also make it possible to detect those carcinomas of which the patient himself is not yet aware.