Medication related to pigmentation of oral mucosa

Background: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. Material and Methods: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. Results: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn’t reflected in the Summary of Product Characteristics. Conclusions: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.(AU)

Central sensitization in burning mouth syndrome: a practical approach using questionnaires.

OBJECTIVES: Some experts have suggested that burning mouth syndrome (BMS) should be included in the family of central sensitivity syndromes, a group of similar medical disorders linked by the central sensitization (CS) mechanism. Our objective is to assess the presence of CS in patients with BMS by performing a clinical examination and administering questionnaires to measure the generalized extent of pain, the presence of associated symptoms, and the number of other concurrent chronic pain conditions. STUDY DESIGN: We conducted a case-control study in 82 subjects (40 patients with BMS and 42 controls). Patients with BMS were diagnosed using The International Classification of Headache Disorders 3rd edition, beta version (ICHD-IIIß) criteria. The Widespread Pain Index (WPI) and Symptom Severity (SS) Score questionnaires were used to determine the degree of central sensitivity. The number of other concurrent chronic pain conditions was determined with the Neblett inventory. RESULTS: Data indicative of CS show a statistically significant association with BMS. Both SS Score and Widespread Pain Index scores higher in patients with BMS. Additionally, patients with BMS reported a significantly higher number of other central sensitivity syndromes. CONCLUSIONS: Patients with BMS could present a CS component as well as other chronic pain conditions. The use of questionnaires may be useful to determine the degree of central sensitivity in patients with BMS.

Oral and dental health status in patients with eating disorders in Madrid, Spain

Background: The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the fol-lowing oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH. Material and Methods: This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disor-der Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p<0.05 (confidence level > 95%).Results: The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001) No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene prac-tices. Conclusions: On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter

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Tumor de células granulares (tumor de Abrikossoff) en la lengua. A propósito de un caso y revisión de la literatura / Granular cell tumor (Abrikossoff´s tumor) of the tongue. A case report and literature review

Introducción: El tumor de células granulares o tumor de Abrikossoff es una neoplasia de los tejidos blandos que suele afectar a mujeres entre la cuarta y la sexta década de la vida. Puede desarrollarse en cualquier parte del organismo, pero es en la región intraoral y especialmente en la lengua donde se localiza con mayor frecuencia como un nódulo asintomático de crecimiento lento. Se analizan los hallazgos clínicos e histopatológicos, el diagnóstico diferencial y la actitud terapéutica ante esta patología junto con una revisión de la literatura. Caso clínico: una mujer de 21 años de edad acude al Departamento de Medicina y Cirugía Bucofacial de la facultad de Odontología de la universidad Complutense de Madrid por presentar una lesión asintomática en la lengua de un año de evolución. El diagnóstico definitivo tras la biopsia escisional fue de tumor de células granulares. Discusión: Descrito por primera vez en 1926 como ‘mioblastoma de células granulares’, ha recibido distintas denominaciones ‘neurofibroma de células granulares’ o ‘schwannoma de células granulares’ lo que evidencia su controvertida histogénesis. Actualmente se defiende la teoría de un origen neural de las células granulares basado principalmente en estudios inmunohistoquímicos. Su comportamiento generalmente benigno y su baja tasa de recidiva tras la exéresis quirúrgica establecen un pronóstico favorable. Conclusiones: Dadas las posibilidades diagnósticas que se pueden establecer clínicamente, la realización de una biopsia escisional y su posterior análisis histopatológico, resulta indispensable para el correcto diagnóstico y tratamiento de la lesión (AU)

Introduction: Granular cell tumor is a soft tissue neoplasm that usually affects females in the fourth to sixth decades of life. It can affect any area of the body, with preponderance to the oral cavity, specifically in the tongue, as an asymptomatic nodule of slow growth. histological findings, differential diagnosis and therapeutic implications are discussed together with a review of the literature. Case report: A 21 year old female comes to the Oral Surgery and Medicine Department of the Complutense university of Madrid because of an asymptomatic lesion in the tongue of a year of evolution. The final diagnosis after exisional biopsy was granular cell tumor. Discussion: Firstly described as ‘granular cell myoblastoma’, different terms have been applied to this entity such as ‘granular cell neurofibroma’ or ‘granular cell schwannoma’. The theory of a neural origin of the granular cells based on inmunohistochemical studies is now accepted. Its usual benign behavior and its low recurrence rate after surgical excision set a favorable prognosis. Conclusion: A surgical excisional biopsy of the tumor and histological examination are necessary for the correct diagnosis and treatment due to differential diagnosis including benign soft tissue tumors (AU)

The pattern of lip cancer occurrence over the 1990-2011 period in public hospitals in Madrid, Spain.

BACKGROUND: Some regions of Spain along with Canada and Australia have the highest rates of lip cancer in the world. The objective of this study was to examine the trends in the pattern of occurrence of lip cancer in Madrid, Spain. METHODS: Data were extracted from the Central Tumour Registry of Madrid, between 1990 and 2011. Variables examined were age, sex, topographic and morphological location and tumour histology. Two consecutive periods, 1990-2001 and 2002-2011, were studied by descriptive and analytical methods, and the data from the two periods were statistically compared. RESULTS: A total of 881 cases were registered during the period 1990-2011. Comparing data between the two periods (1990-2001 and 2002-2011), subtle variations in age, histology and location were noted. Gender ratios remained constant. The mean age increased from 66.3 to 69.7 years (P < 0.05). In the second period, the histological distribution showed an increase in frequency of basal cell carcinoma, from 2.1% to 4.7%, while the frequency of squamous cell carcinomas remained constant. Basal cell carcinoma no longer predominantly occurred in women, decreasing from 80% to 21.1% (P < 0.001). The distribution by gender of squamous cell carcinoma had become more equal due an increase in its frequency in women (P < 0.001). Frequency of tumours on lip mucosa and commissure had increased between the two periods (P < 0.004). CONCLUSIONS: The pattern of lip cancer reported to Public Hospitals of Madrid is changing: declining rates are noted since 2001-02. However, it is necessary to monitor these data to confirm the observed trends in future years.

Ability of Dental Students in Spain to Identify Potentially Malignant Disorders and Oral Cancer.

The aim of this study was to assess the ability of students at the School of Dentistry, Complutense University of Madrid, Spain, to diagnose oral cancer and other potentially malignant disorders, as well as to compare their ability at different stages of the learning process and evaluate their knowledge retention. Students were surveyed after they had studied oral medicine and oral pathology at two time points: midway through and near the end of their studies. The survey consisted of questions about 40 photographs of benign oral lesions, malignant oral lesions, and potentially malignant disorders. The response rate for all groups was greater than 70%. The results showed that these students' overall success rate in differentiating benign from malignant lesions averaged 73.9%. When the distinction for potentially malignant disorders was included, their average overall success rate decreased to 42.8% (p<0.001). Furthermore, the students' average success rate was at its lowest at the end of the dental program (p<0.001). Results from this study suggest that, given these students' difficulties in identifying potentially malignant disorders, an increased emphasis on cancer education in the dental curriculum may be needed for future practitioners to master this ability.

Alpha lipoic acid efficacy in burning mouth syndrome. A controlled clinical trial.

BACKGROUND: A double-blind placebo-controlled trial was conducted in order to evaluate the efficacy of alpha lipoic acid (ALA) and determine the statistical significance of the outcome variables. Burning mouth syndrome (BMS) is defined as an oral burning sensation in the absence of clinical signs which could justify the syndrome. Recent studies suggest the existence of neurological factors as a possible cause of the disease. MATERIAL AND METHODS: 60 patients with BMS, in two groups: case group with 600 mg/day and placebo as control group; with follow up of 2 months. RESULTS: 64% of ALA patients reported some level of improvement, with a level of maintenance of 68.75% one month after treatment. 27.6% of the placebo group also demonstrated some reduction in BMS symptoms. CONCLUSIONS: Long-term evolution and the intensity of symptoms are variables that reduce the probability of improvement with ALA treatment.

Descriptive study of the patients treated at the clinic 'Integrated Dentistry for patients with Special Needs' at Complutense University of Madrid (2003-2012)

OBJECTIVES: To study clinical and epidemiological characteristics of the patients treated at the clinic 'Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)' at Complutense University of Madrid (UCM),as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. Study DESIGN: Medical records review of all the patients referred to the clinic of 'Integrated Dentistry for Patients with Special Needs', performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). RESULTS: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%)and intellectual disability (8,85%). 70'18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%

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Descriptive study of the patients treated at the clinic "integrated dentistry for patients with special needs" at Complutense University of Madrid (2003-2012).

OBJECTIVES: To study clinical and epidemiological characteristics of the patients treated at the clinic "Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)" at Complutense University of Madrid (UCM), as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. STUDY DESIGN: Medical records review of all the patients referred to the clinic of "Integrated dentistry for patients with special needs", performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). RESULTS: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%) and intellectual disability (8,85%). 70'18% of the patients were treated, with with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%. CONCLUSIONS: Given the high number of patients with some kind of pathology and the amount of medicines that they use, it seems necessary for dentistry students to have a specific training regarding how to handle and treat these patients, so they will be able to provide them the best possible care.

Cuidados orales en el paciente oncológico / Oral care in the oncological patient

El odontólogo tiene un papel muy importante no solo en la detección precoz del cáncer oral, sino en el cuidado del paciente oncológico. Los tratamientos de quimioterapia y radioterapia producen efectos adversos en la cavidad oral, y el mantenimiento de la salud a ese nivel es esencial para prevenir y minimizar dichos efectos. Las complicaciones orales más comunes en pacientes con tratamiento oncológico son la mucositis, la hiposialia, las alteraciones del gusto, la osteonecrosis, el sangrado de la mucosa oral y las infecciones por inmunodepresión. El manejo de estas complicaciones comprende la identificación de la población de riesgo, el inicio de las intervenciones antes del tratamiento oncológico y el manejo oportuno de las lesiones provocadas por el mismo. Es imprescindible llevar a cabo una evaluación de la cavidad oral antes del tratamiento oncológico, realizando los tratamientos odontológicos que estén indicadas para así reducir las complicaciones durante y después del tratamiento antineo-plásico (AU)

The dentist has a very important role not only in the early detection of oral cancer, but also in the care of the oncological patient. Chemotherapy and radiotherapy treatments produce adverse effects in the oral cavity, and the maintenance of health at this level is essential to prevent and minimise these effects. The most common oral complications in patients with oncological treatment are mucositis, hyposalivation, taste alterations, osteonecrosis, bleeding of the oral mucosa and infections due to immuno-suppression. The management of these complications includes the identification of the population at risk, the commencement of interventions before the oncological treatment and the timely management of the lesions caused by it. It is essential to carry out an evaluation of the oral cavity before the oncological treatment, performing dental treatments that are indicated in order to reduce the complications during and after the antineoplastic treatment (AU)

Diagnostic criteria in proliferative verrucous leukoplakia: Evaluation

OBJECTIVES: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. Study DESIGN: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. RESULTS: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. CONCLUSIONS: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease

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Síndrome de Sjögren. Revisión e implicaciones en el ámbito de la salud oral / Sjögren Syndrome. Review and impact on the area of oral health

El síndrome de Sjögren (SS) es una enfermedad crónica, sistémica, inflamatoria y autoinmune que afecta a las glándulas exocrinas salivales y lagrimales, produciendo boca seca (xerostomía) y ojos secos. El SS es la principal causa no y atrogénica de laxerostomía. Esta sensación subjetiva de sequedad orales la causante de que los pacientes consideren su salud oral deficiente. Suelen presentar dificultades para hablar, masticar y tragar, alteraciones del gusto, sensación de boca ardiente así como dolor en las glándulas salivales al comer. Actualmente no hay ninguna cura para el SS, así como ningún tratamiento que minimiceo restaure el daño hecho a las glándulas. El objetivo del tratamiento será aliviar el disconfort oral y mantener la bocahidratada

The Sjögren Syndrome (SS) is a chronic, systemic, inflammatory and autoimmune disease that affects the salivary and lacrima lexocrine glands, producing dry mouth(xerostomia) and dry eyes. SS is the principal non-iatrogenic cause of xerostomia. This subjective sensation of oral dryness is the cause of patients considering their oral health deficient. Difficulties are usually presented in speaking, chewing and swallowing, taste alterations and burning mouth sensation aswell as pain in the salivary glands wheneating. Currently there is no cure for SS, nor is the retreatment that minimises or restores the damage to the glands. The objective of the treatment shall be to alleviate the oral discomfort and maintain the mouth hydrated

Diagnostic criteria in proliferative verrucous leukoplakia: evaluation.

OBJECTIVES: to evaluate the ability of the diagnostic criteria proposed by Cerero et al in 2010 to perform an early diagnose in patients with proliferative verrucous leukoplakia. STUDY DESIGN: retrospective study with patients diagnosed with leukoplakia at Oral Medicine Service at Oral Medicine and Surgery Department at Dentistry Faculty at Universidad Complutense of Madrid. RESULTS: the criteria were applied in 116 patients, turning positive in 40 cases. Out of these, 24 (60%) had been previously diagnosed with PVL. Most frequent criteria were major criteria A and E, concerning lesion's site and histopathology, and minor criteria b and c, concerning sex and smoking habit. CONCLUSIONS: diagnostic criteria developed by Cerero et al can be a useful tool for an early diagnose of PVL, as in 60% of the cases, the criteria would have allowed to make an early diagnose of the disease.

Simulation for training in oral cancer biopsy: A surgical model and feedback from GDPs

Objectives: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees’ perception. Study design: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific checklists and by means of a self-applied questionnaire. Results: The workshop was perceived as “very interesting” even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). Conclusions: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills (AU)

Simulation for training in oral cancer biopsy: a surgical model and feedback from GDPs.

OBJECTIVES: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees' perception. STUDY DESIGN: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific check-lists and by means of a self-applied questionnaire. RESULTS: The workshop was perceived as "very interesting" even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). CONCLUSIONS: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills.

Pacientes con xerostomía: un retoterapéutico para el odontoestomatólogo / Patients with xerostomia: a therapeutic challenge for the dentist

La xerostomía, como manifestación clínica de la hiposialia, es cada vez más frecuente en la práctica diaria debido a su etiología multifactorial: polimedicación, tratamiento oncológico, estrés, edad avanzada, etc. Los pacientes ven afectada en gran medida su calidad de vida, ya que padecerán alteraciones funcionales y orgánicas, siendo estas motivo de consulta. Debido a la inexistencia de un protocolo estandarizado de tratamiento para la xerostomía, se plantea el objetivo de analizarlos productos existentes con sus características e indicaciones, ya que el profesional debe conocerlos métodos terapéuticos. Siempre que sea posible, se tratarán las causas etiológicas que ocasionan xerostomía haciendo hincapié en las medidas preventivas. Deberá acompañarse de un tratamiento sintomático y de estimulación de la producción salival, para mejorar la calidad de vida. Para los casos más graves, se recurrirá a fármacos sistémicos. El tratamiento de la xerostomía es largo y complejo, con resultados muy variables. Se requiere seguir investigando en nuevas alternativas, comprobando y mejorando la eficacia de los métodos ya existentes (AU)

Xerostomia, as a clinical manifestation of hyposialia, is increasingly more frequent indaily practice due to its multifactor etiology: polymedication, oncological treatment, stress, advanced age, etc. The patients’ quality of life is affected to a great extent, since they will suffer functional and organic alterations, without these being a reason for consultation. Due to the non-existence of a standardized protocol of treatment for xerostomia, the objective was posed of analyzing the existing products with their characteristics and indications, since the professional must know the therapeutic methods. Whenever possible, it will deal with the etiological causes that bring about xerostomia, stressing the preventive measures. It must be accompanied by a symptomatic treatment and stimulation of the saliva production, in order to improve the quality of life. For the most serious cases, systemic medicines will be turned to. The treatment of xerostomia is long and complex, with quite variable results. Continued research in new alterations and verifying and improving the effectiveness of the existing methods are required (AU)

Case report of necrotizing sialometaplasia

Introduction: Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involveminor and major salivary glands. Gland tissue ischaemia has been proposed as the aetiology.Case Report: A 21-year-old woman was referred with a 1-week history of bilateral painful swelling of the palate,with the development of two deep ulcers after the first 3 days. Ulcer edges were elevated but not indurated, andthe bases had a necrotic appearance. An incisional biopsy of the margin of one ulcer confirmed the diagnosis ofnecrotizing sialometaplasia. The ulcers spontaneously healed within 8 weeks without treatment.Discussion: The clinical and histological similarity between this entity and a malignant lesion implies a risk ofunnecessary or inadequate treatment. This case illustrates the need for an incisional biopsy to be analyzed by anexperienced pathologist to establish a correct diagnosis (AU)

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Síndrome de boca ardiente: puesta al día / Burning mouth syndrome: update

El Síndrome de Boca Ardiente (SBA) es una entidad conocida desde hace tiempo que se caracteriza por una sensación de ardor de la mucos oral en ausencia de signos clínicos y que suele aparecer en mujeres de edad media o avanzada La etiología de esta patología no es conocida, pero se han descrito factores locales, sistémicos y psicológicos relacionados con los síntomas, y las últimas investigaciones sugieren que es posible que exista una base neurológica. Debido al escaso conocimiento sobre la etiología, a día de hoy, no existe un tratamiento eficaz para todos los pacientes. El presente artículo realiza una revisión sobre la etiología, manejo y tratamiento del SBA (AU)

Burning Mouth Syndrome (BMS) is an entity which has been known for a long time. It consists on a burning sensation of the oral mucos a without anyclinical sign. It is usually found in women in the middle age or even in the elderly.The ethiology is unknown but many factors has been described to be related to the symptoms: local, systemic or psycological factors. Last researches suggests that a neurological factor could be involved in the development of the disease. Because of the lack of knowledge about the etiology, nowadays, there is not an effective treatment for most of the patients. This paper reviews the ethiology of BMS, the management of the patients and the treatment (AU)

The use of toluidine blue in the detection of pre-malignant and malignant oral lesions.

INTRODUCTION: The purpose of this study was to evaluate the efficacy of the toluidine blue (TB) test as a diagnostic tool in the detection of malignant and dysplastic lesions of the oral cavity. This study was carried out because of a lack of consensus among different authors on the utility of TB, as well as to determine useful adjuncts to detect oral pre-cancer and cancer. MATERIALS AND METHODS: The study included 160 patients with oral mucosal disorders that included suspicious or malignant lesions detected at clinical visual examination, confirmed by histopathological evaluation. All lesions were submitted to TB staining. RESULTS: The sensitivity and specificity for the detection of malignant or dysplastic lesions by this test were 65.5% and 73.3%, respectively. Overall, the detection rate with TB (sensitivity) was slightly lower compared with those reported by other authors but the specificity was comparable to several reports. Positive predictive value (35.2%) was also lower than previous studies, whereas negative predictive value (90.6%) was similar. CONCLUSIONS: The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.

Case report of necrotizing sialometaplasia.

INTRODUCTION: Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involve minor and major salivary glands. Gland tissue ischaemia has been proposed as the aetiology. CASE REPORT: A 21-year-old woman was referred with a 1-week history of bilateral painful swelling of the palate, with the development of two deep ulcers after the first 3 days. Ulcer edges were elevated but not indurated, and the bases had a necrotic appearance. An incisional biopsy of the margin of one ulcer confirmed the diagnosis of necrotizing sialometaplasia. The ulcers spontaneously healed within 8 weeks without treatment. DISCUSSION: The clinical and histological similarity between this entity and a malignant lesion implies a risk of unnecessary or inadequate treatment. This case illustrates the need for an incisional biopsy to be analyzed by an experienced pathologist to establish a correct diagnosis.